“You’d better come back to the unit. Your daughter’s getting worse. I think we’re going to have to intubate her.”
“I’ll be right there.”
I hung up the phone and cried.
She looked ghastly. Her respiratory rate was well over 70, and her chest and abdomen heaved with each breath. Despite maximal supplemental oxygen her blood oxygen saturations (sats) were only in the low 80s. Dr. Inman explained that although it still wasn’t clear whether the problem was transient tachypnea of the newborn, respiratory distress syndrome or meconium aspiration, if she wasn’t put on a ventilator soon she’d tire out and stop breathing. I gave my consent for the procedure and left the room. I wanted to stay with her, but I couldn’t bear to witness my own child being intubated.
When I returned the tube was in place and a respiratory therapist was bagging her. Her oxygen sats had climbed to 90 percent and her colour was better.
“The procedure went well,” Dr. Inman said. “Right now she’s heavily sedated. You’d better go get some sleep. You have a long day ahead of you tomorrow – we’ll be flying her down to the neonatal ICU at McMaster first thing in the morning.”
The Medevac jet arrived at 10:00 a.m. The transfer team consisted of two NICU nurses. Like everyone else who had treated our daughter (now named Alanna) thus far, they were real pros – meticulous, skillful, and caring. They reviewed the entire case, examined her thoroughly, started two more IVs and switched her over to their own infusion pumps. After communicating with their base neonatologist they adjusted some of her medications. They then detached her from the hospital ventilator, put her in their specialized transfer isolette and reconnected her to a portable ventilator. Once all that was finished they pulled out a Polaroid camera, snapped a picture of her and handed it to me. I thanked them and put it in my knapsack. I later found out that in cases where critically ill infants die shortly after Medevac, oftentimes the pre-transfer snapshot is the only photograph the parents have of their baby taken while the child was alive. I asked the team how I’d find McMaster Children’s Hospital when I got to Hamilton. They said as long as there were no other patients requiring air ambulance evacuation they’d make room for me on the jet. I could hardly express my gratitude. An hour later we were in the air.
A ground ambulance met us at the airport in Hamilton and drove us to the hospital. Alanna had held her own during the transfer. It was beginning to look like she might survive this ordeal. As we navigated the hospital corridors on our way to the NICU, thoughts I had been keeping tightly caged broke free: Did she go too long without oxygen? Was she brain-damaged? Would she develop cerebral palsy or be profoundly handicapped? The uncertainty was maddening.
The NICU was a brightly lit sea of chaos. Each isolette was like a life raft bobbing in the turbulence. Some of the infants within the isolettes weren’t much bigger than the palm of my hand. It was hard not to stare. I tried to stay out of the way as the transfer team got Alanna settled in. Once the changeover was complete I had a brief meeting with the attending neonatologist. He said he planned to keep Alanna on her existing ventilator settings for the rest of the day. If she remained stable, they would start trying to wean her off in the morning. He asked me where I’d be staying in Hamilton. I had no clue. He gave me the phone number and address of a nearby Ronald McDonald house. I called them and secured a room. I then pulled up a seat and spent the rest of the day watching my daughter’s fragile little chest rise and fall in synch with the mechanical bellows.
To everyone’s surprise, Alanna tolerated weaning exceptionally well. After two days of respiratory support she graduated to breathing on her own. Shortly after she was liberated from the ventilator her nurse wrapped her in a warm blanket and let her sit with me in a rocking chair. It was wonderful. I wanted to cradle her in my arms forever.
That afternoon I asked the neonatologist if he had any idea how she was doing cognitively. He said it was difficult to predict such things this early in the recovery phase, but that NICU infants who were able to breastfeed successfully had a significantly higher likelihood of being neurologically intact. He recommended Jan be brought to Hamilton to bond with Alanna and initiate breastfeeding. I spoke to Miles about it. He worked some phone magic, and two days later Jan was admitted to one of McMaster’s postpartum wards.
The ink hadn’t yet dried on my wife’s admission papers before we were on our way to the NICU. Alanna’s nurses knew Jan was coming and that she’d be trying to breastfeed, so there was hint of excitement in our little corner of the room. Jan and I were both nervous. The words of the neonatologist weighed heavily on our minds: NICU infants who were able to breastfeed successfully had a significantly higher likelihood of being neurologically intact. Jan picked up Alanna and hugged her for several minutes. It was their first encounter.
When we felt we were ready, a nurse led us to an adjacent room and closed the door so we could have some privacy. Jan sat in a chair, slid part of her hospital gown to the side and undid one of the flaps of her nursing bra. She then put our daughter to her breast.
Alanna rooted around aimlessly for what seemed like an awfully long time. Our hearts sank. We put her mouth closer to its target. She fussed and fidgeted a while longer, then suddenly latched on and began gulping milk down at a furious pace. When the breast was completely drained she fell asleep, content. Jan and I were delirious with joy. Our baby was going to be fine.
Alanna hit all her milestones early. She’s a crackling ball of energy who enjoys gymnastics, trampoline, volleyball, piano, art and reading. She has never exhibited any ill effects related to her traumatic birth. We consider ourselves to be extremely lucky.
Snip, Snip
When I was single I always said I wanted to have eight kids. Eight kids! Can you imagine? I got a serious reality check when our first child was born. Ellen was a wonderful baby, but caring for her was a lot more work than I had anticipated. Feeding, burping, bathing, changing, rocking, walking, entertaining – it was a full-time job.
Kristen arrived 15 months after Ellen. She was equally marvellous, but following her birth our workload seemed to triple rather than double.
Alanna made her dramatic debut 13 months later. Suddenly we were up to our eyeballs in dirty diapers. Jan started using the word “vasectomy” a lot. Naturally, I pretended not to hear her.
One frisky night about two months after Alanna’s birth, Jan and I forgot to take appropriate precautions. The next morning I went to my office and returned with the morning-after pill. The first dose left her feeling queasy, so that evening when it was time for the final set of pills Jan considered not taking them. She telephoned her mother in Manitoba for her opinion on the matter. My usually demure mother-in-law mulled it over for about one-tenth of a second before hollering: “For God’s sake, Janet, take the pills!”
Jan took them. The next day I visited Miles and requested a vasectomy.
When you’re an MD in a small hospital it sometimes feels weird shedding your lab coat and morphing from doctor into patient, but what’s the sense of driving hundreds of kilometres to undergo procedures that can very capably be performed by your own colleagues? On V-Day I arrived at the hospital bright and early. After registering at the front desk I went to the patients’ locker room and changed into one of those ridiculous Barbie-sized gowns that always leave half your backside exposed. Who designs those things, anyway? As I walked to the operating room, a trio of ER nurses I work with passed me in the hallway.