In the early evening, I stand in the grocery store checkout line. A young mother in front of me presses a pig-tailed toddler against her hip as she rummages for her credit card, and a man with silvered hair and a monogrammed shirt shifts impatiently behind me. As I watch the toddler, I’m hit with a twinge of nostalgia. I think of how I used to pull my daughter’s hair into uneven pigtails, of how they framed her two-toothed grin. I’d give anything to go back, for just one day, to when she was that age—to feel her small body wriggle against me and hear her emphatic voice.
Suddenly, the toddler lunges for the card reader and drops her mother’s car keys. I see it then, on the toe of my shoe. Two burgundy spots against the light tan. Drops of blood from the delivery.
I think back to the afternoon. I sit inside a hospital office overlooking a red brick building with peeling window frames and tap words into the electronic medical record. Halfway through a sentence, the cell phone on the desk alarms, Code Neonate Room 216. I send the rolling chair spinning and run in stiff-soled shoes through the neonatal intensive care unit, down the concrete stairwell, and through the halls of labor and delivery before plowing through the wooden door.
“Shoulder dystocia, one minute,” a nurse wearing a pink headband says as she fumbles for the Ambu bag. Across the room, I can see the mother’s face sheened in sweat; her hair is matted to her forehead. The obstetrician, washed of color in the spotlight, sits on a stool between the mother’s thighs and passes stitches through a perineal tear as threads of thin red fluid drip onto a drape below. A man with an open-collared shirt stands towards the head of the bed, rooted in place on the linoleum as he holds the tension of his wife’s hand, and on the warmer lies the baby: straight obsidian black hair, thick eyelashes covering the closed meniscus of her eyelids, fat cobalt blue cheeks, and parted ashen lips.
“Is there a heartbeat?” I ask.
The nurse shakes her head and hands me the stethoscope. There is nothing but a still hollowness.
Over the next eight minutes, we place a breathing tube, give compressions, insert an umbilical venous catheter, and administer two doses of epinephrine. At nine minutes, there is still no heartbeat. For a moment, my mind slips, and I picture myself sitting on a stool at the bedside, telling the parents their baby is dead, the mother wailing before the rock-hard words can even leave my mouth. But we give another dose of epinephrine, and a minute later, there is the sound of her heartbeat as it thrums beneath her sternum, the sound of valves opening and closing, the whoosh of expelled blood. The sound of life.
I lift her slack body into the transport incubator while the respiratory therapist feeds the ventilator tubing through the side ports, and we wheel her over to her mother. When she reaches out to touch her daughter’s chest, her hand trembles, and her eyes water with emotion.
“What’s her name?” I ask.
“Isabelle.”
When we get upstairs, the nurse lays out the cooling mattress. The afternoon sun streams in through the west window, and the baby makes stuttering gasps against the ventilator. By three hours of age, her right forearm contracts rhythmically while her legs bicycle against the air until we drip an antiepileptic into her bloodstream. Then there is just the tick of the infusion pumps counting out the milliliters of dextrose fluid and the hiss and pop of the ventilator delivering an even breath every two seconds.
Over the first two days, the electrical readout from the sensors on her scalp is sluggish, her pupils barely respond to light, and she has no gag reflex. She barely reacts to touch and rides the ventilator. But by the third day, her breathing becomes steady, and we slip out the breathing tube, already coated with adherent secretions. After 72 hours of therapeutic hypothermia, her body temperature gradually returns to normal.
By the fourth day, we start drips of her mother’s breast milk through a feeding tube, and her eyes flutter open in response to touch. Every day she makes strides. She moves her pudgy arms and legs, sucks a pacifier, and gazes up into her mother’s eyes. On day seven, she is transported down to radiology for an MRI to evaluate brain injury while her parents sit at her vacant bedside and barely breathe. By early afternoon the radiology read comes back: no signs of injury. I feel something heavy slip away.
Over the next week, she starts to feed by mouth, increasing her volumes each day until she no longer needs the feeding tube. By week three, she is ready to go home, and her parents carry her in her car seat through the front doors of the NICU, into the elevator, through the hospital lobby, and out into the diffuse spring sunlight.
The weekend after Isabelle’s discharge, I take my shoes outside onto the driveway. The sky is a brilliant blue, and green tinges of leaves poke through shells of buds; the wind slips through my fleece. I scrub the spots of blood with an antibacterial wipe, and tan shoe polish comes off instead, leaving the burgundy spots haloed and dark. Next, I smear shoe polish into the leather and brush away the brown curds of polish with a horsehair brush. The drops of blood remain.
All these years later, those spots are still there, and I think of Isabelle every time I wear those tan shoes. And like those marks on my shoes, memories of babies and families remain etched in my mind—stories of failures, tragedies, successes, and joys. Our patients become an inextricable part of our lives. We carry their stories with us.
Benjamin Rattray is a neonatologist.
Image credit: Shutterstock.com
