Thursday, April 11, 2013

Day Eleven



Having children changes you forever. On the list of things you don’t need to be told, this fact slips neatly between stapling your finger really hurts and grown men who wear backwards baseball caps are assholes. But the funny thing is, in my case, it wasn’t really true. At least, not at first. 

I do remember welling up when they placed my blood-and-vernix-covered daughter on my wife’s chest. I do remember being dumbly happy for several days after we got home from the hospital. I do remember staring at my newborn for longer than I normally stare at things that aren’t doing anything. But I don’t remember feeling like I had changed. Not meaningfully.

There were practical differences. Our grocery bill had inexplicably doubled. We now owned eight quarts of Purell. And my house smelled like a dairy on a hot day. But I didn’t really feel any different. At my core, I was the same person the day before my daughter was born as I was the day after.

Until the eleventh day.

“It’s probably not a big deal,” I told the advice nurse on the phone. “But my daughter has blood in her stool.”

The nurse asked a series of questions, clearly prompted by a script on a computer. Does she seem lethargic? Does she have a fever? Is she nursing? And so on. Then she placed me on hold.

I looked at my wife holding our lethargic, feverish, non-nursing newborn. We stood in the kitchen. Somehow, neither of us was terribly concerned. We’d done everything right. Natural childbirth. Cloth diapers. Breastfeeding. We were models of modern, progressive parenting; obnoxiously over-informed. We weren’t paranoid about germs, diaper rash, or taking the baby outside. As first time parents go, we had our shit together.

“Sir?” the nurse said, returning to the line. “We’d like you to bring her in.”

“To the pediatrician’s office?”

“To the emergency room.”


An ER waiting room is a bleak place. No one is happy to be there. We sat under blue florescent lights in chairs bolted to the linoleum floor. I wanted to leave. I was uncomfortable, but not nervous. I thought we were wasting our time. We’d been waiting for an hour already. If she was in any danger, I thought, they’d have seen her right away. This was CYA bullshit.

A mother sat between her two children in a row of seats near the tinted windows. Her pre-teen daughter had a large homemade-looking bandage on the side of her head. Blood showed through the gauze. Her eyes were red from tears, but she now appeared to be quietly managing her considerable pain. Her younger brother looked sickly, too. Their mother was exhausted. She was alone with a seriously injured child. Her hair was stringy and matted. Her eyes, fixed blankly in the middle distance, puffed out like a drug user’s. Her misfortune had begun long before this day. She had a sufferer’s countenance; the visage of someone whose life had not worked out at all like she planned.

She slowly became aware of me looking at her. I was careful not to show pity.  Her eyes fell on my wife, holding our limp child in her arms. Awareness returned to the woman. A sudden expression of intense concern came across her face, as though she’d just seen someone climb onto the window ledge of a tall building. Her concern then turned to the pity that I’d been so careful to spare her. Her mouth opened as if to say something to us. When words failed, she put her arms around her two children.

I got up and went to the reception desk.

“Excuse me. We’ve been here for an hour. I know other people have been here longer, but we’ve got an eleven day-old child with a fever of 103. Do the doctors know we’re waiting out here?”

“Sir, I assure you the doctors are aware and we’re going to get you in as soon as we can.”

“Okay,” I said, aware of my impotence.

I returned to my seat. My wife had seen the woman’s look, too. It had frightened her. She began to cry.

“Do you think she’s going to be okay?”

“Of course, she is,” I said, knowing that neither one of us believed I had any idea what I was talking about.

The large doors to the ER opened and a nurse appeared.

“Elizabeth Hairston?”

The mother and her children got to their feet. They walked past us. The mother paused near us as her daughter met the nurse.

“How’s the baby doing?” she asked my wife.

“We don’t know.”

 “Try not to worry. It’s a good hospital.”

“Thanks,” said my wife.

“What’s wrong with her?”

“She’s got a fever and some blood in her stool.”

“How old?”

“Eleven days.”

The woman sighed weakly.

“I’ll say a prayer for her.”

She followed her children through the doors. For the first time in my life, I was comforted by the thought of someone praying on my behalf.

We waited another two hours.


Inside the ER, we were sent to a large private room with a proper door instead of a curtain. I’d been to the ER many times and never knew such rooms existed. We were joined by a doctor who evinced the preternaturally calm yet clinical demeanor of someone who lives in a world of perpetual crisis.

“I’m Doctor Sequeira. I’m the pediatric attending” she said. She was an attractive white woman with a soft voice who looked to be about my age, none of which pleased me. On the whole, I prefer my doctors to look and sound like Jack Klugman. She had the lanky, muscular body of someone who competes in triathlons. The skin around her nose was inflamed, indicating a persistent cold. “So, tell me what’s been going on?” she continued casually, though with obvious medical interest.

We told her about the stomach discomfort. The spitting up. The trouble sleeping. None of which had alarmed us. But when we found streaks of blood in the diaper and her fever spiked, we decided we should call someone.

As we spoke, she gently examined our naked nine pound baby who seemed much smaller on the full-sized exam table. She cried weakly, sounding like a starving kit in an abandoned den.

The doctor looked at us.

“So,” she began, pausing pregnantly as though this was a full sentence. “You probably know that fever is a sign of infection.”

We nodded, though my nod was meant as an acceptance of her premise, rather than an agreement that it applied to my child.

“And when most of us get a fever, we have an immune system that kicks into gear and starts fighting that infection,” the doctor continued delicately. “The problem in that at—” She looked at a chart. “At eleven days, your baby doesn’t have an immune system yet.” She looked at us to make sure we understood. “So we have to give her one.”

“What does that mean?” my wife asked, making me aware, for the first time, the something was going to happen. “We did natural childbirth. No drugs. No nothing. We’re going to spread out our vaccines. I don’t want to pump her full of antibiotics at eleven days old.” My wife’s voice quavered in a way I’d never heard before.

“Yeah,” I added by way of support. “We’d really rather not put her on antibiotics. Are you sure we can’t give it a little time and see if she improves before we—“

“The problem is, at this age, we don’t have a little time,” the doctor cut me off. “If she has an infection – and we have to assume she does because of the fever – she…we…” she hesitated, choosing her words carefully. “It has to be treated very aggressively.”

“But wait,” my wife objected. “How do you even know what she has?”

“We don’t. We can rule out some things right away. And we will. But even if we rule them out, we won’t know what we’re dealing with until we get some other tests back. The cultures need time to grow.”

“Can we wait until we get the first tests back?” I asked.

Our daughter was crying more loudly now. The doctor handed her to my wife who lifted her shirt and bra and offered her a breast. She fussed and did not take it.

“We need to start her on broad spectrum antibiotics as soon as possible. That way, we’re addressing as many causes as possible right away. If the first test comes back positive and we know what we’re dealing with, we can be more targeted in our treatment. But for now, we have to treat her for everything.”

I looked at our baby. Through her fine corn silk hair I saw the faint freckles on the back of her neck; angle’s kisses, the nurse had called them in the delivery room.  They were the first thing I noticed about her. Perfectly normal, they’d said. Next I’d noticed her tiny nose. It looked like a ski jump. Where did that cartoon nose come from? And her eyes. Bluer than a public pool. The left one didn’t open as much as the right. She may grow out of it, they’d told me. Nothing to be concerned about.

Before she arrived, I thought often about what our relationship would be like. It’s all about the mother for the first 18 months, everyone said. I knew that would probably be the case, but I wondered anyway. What wordless conversations would we share? Would she recognize the timber in my chest when I read to her? How would we communicate for that first year and a half?

In only eleven days, I’d begun to interpret her cries. Hungry, wet, tired. I knew I was deluding myself, but I liked the idea that I was learning to understand her. She could tell me things. I could listen and respond. In a way, I thought, this will be the basis of our entire relationship. She will tell me what she needs and I’ll do my best to get it for her.

“The problem with babies,” the doctor began again, “is that they can’t tell us what’s wrong. When they hurt, they can’t tell us where. They can’t describe their pain. They can’t tell us their symptoms. So unfortunately, we have to treat them for everything.”

It was the most obvious thing I’d ever heard, yet somehow it had never occurred to me. Being a doctor for a baby is nothing like being a doctor for an adult. It’s closer to being a vet. Not because babies’ illnesses are different or their bodies are smaller, but because the patient can never tell you what’s wrong.

My wife looked at me hopefully, as if I might offer an alternative or a firm rebuke of the doctor’s prescription. My eyes drifted from hers to the baby in her arms. She seemed hardly human; born but not yet whole. Her tiny face was anchored by full yet delicate lips that held the last of her waning color. Her arms were short and weak. The tiny hands at the ends were good for nothing more than reflexively clutching fingers. Her helplessness became mine.

“Doctor, can you give us a minute to talk?” I asked.

“Of course.”

The doctor left the room and I looked at my wife.

“I don’t want to give an eleven day-old baby antibiotics,” she said fiercely. “It’s crazy.”

“I agree. Maybe we should get a second opinion.” I reminded her that my father had a friend who was a pediatrician. I could call him at home.

“Okay.”

I asked the doctor to come back in. I told her we wanted to get a second opinion. She, of course, knew the doctor I intended to call. Then she motioned me into the hall as my wife lay down next to the baby on the exam table, trying vainly to feed her on her side.

“I think calling Dr. Saffa is a good idea. I’m confident he’s going to tell you the same thing I am. But I need you to understand than we don’t have a lot of time.”

“What do you mean?”

“The longer we let the infection go, the harder it’s going to be to fight.”

“As in, it will take longer for her to recover?” I asked, sensing that she wasn’t saying what she meant.

“As in, at this age, we have about three days.”

“Until what?”

“Until we may not be able to fight the infection anymore.”


The doctor was right, my family friend told me. Infections in newborns were not to be trifled with. My wife sat on the exam table, holding our tiny child, grimly accepting the reality of interventive Western medicine. I asked the doctor to come in. I told her we were ready.

“The first thing we need to do is rule out meningitis,” she told us. “And unfortunately that means we’re going to need to do a lumbar puncture.”

“What!” my wife fairly yelled.

“A spinal tap. We need to extract some of her spinal fluid.”

I began to feel very cold. Sweat formed on my brow. The doctor looked at me.

“Are you okay?” she asked kindly.

“I’m not feeling very well all of a sudden. I think I should probably sit down.”

I took a seat and fought the nausea.

“I know it sounds awful, but it’s the only way to rule out meningitis, which can be fatal.”

I felt the color leaking from my face. My wife began to cry. I wanted to go to her and hold the two of them, but I felt certain that if I stood up I would collapse.

“I’m going to do the tap myself,” the doctor assured us. “We’re also going to need a urine sample, and unfortunately at this age the only way to get one is with a catheter. We’ll give her a little break after the tap. Then I’ll have the nurses come in and get the urine sample. The sooner we start running tests, the sooner we’ll know what we’re dealing with.”

“Okay,” murmured my wife, consenting with the same enthusiasm with which one agrees to an amputation.

The doctor went to a cabinet and removed a kit.

“We’re going to need her to be very still. Do you feel like you want to hold her down?”

My wife and I looked at each other.

“Some parents feel strongly that they want to be in the room, but if you don’t want to be, that’s okay. I can have the nurses come in.”

“I want her to know we’re here,” my wife said to me.

I got shakily to my feet and moved closer to the table. Our daughter had fallen asleep.

“Are you sure you can do this?” the doctor asked me, sensing my cowardice.

“Yes,” I lied.

“Okay. Then let’s roll her onto her side.”

My wife gently placed our daughter on the paper-covered table, exposing the pallid skin of her back. The pinkness that marked her Irish heritage was long since absent. She stirred and began to fuss.

“It’s okay, sweet girl. Momma’s here,” my wife whispered cinematically.

I petted her wispy hair. She was so damn small.

The doctor began to swab her back with Betadine, the ochre liquid staining her fuzz-covered skin. The cool liquid woke her and she began to cry. I placed a shaky hand on her legs, helping to curve her body into the fetal position that must have once seemed safe. The doctor spread a sterile blue square over her back. Then she took a syringe with an impossibly long needle and slowly inserted it into my daughter’s spine.

Newborns do not scream. That is not what it was. It was a wail of pure agony and betrayal. A baby does not know fear. When fear is stripped from the sound of crying, all that is left is pain. And it is much worse.

“Please hurry,” my wife pleaded while looking into her daughter’s twisted eyes.

The syringe slowly filled with clear, viscous fluid.

“Almost done,” the doctor said calmly.

She carefully extracted the needle.

“Done.”

She swabbed the spot on the baby’s back where the needle had been and covered it with gauze.

“Why don’t you just hold her for a while?” the doctor told my wife. She labeled the sample and handed it to someone who’d entered the room without my noticing. Then she returned to my wife and daughter. She petted the baby’s hair kindly.

“I’m so sorry I had to put you through that,” she whispered. “I hope you won’t hold it against me.”

I looked at her with admiration. Her skill was matched by humanity.

She turned to me.

“And I’m so sorry I had to put you through that.”

The three of us let out a laugh of relief.

“I may or may not hold it against you,” I said smiling.


The next three days were a blur. The catheterization was, if possible, worse than the spinal tap. The two nurses charged with doing it were criminally incompetent and possibly visually impaired. After watching them repeatedly stab our infant daughter’s urethra, my wife transformed into a she-bear, chasing them out of the room and demanding that Doctor Sequeira return. We were later told that the nurses had struggled because they weren’t used to performing the procedure on a newborn, which was like being told that captain only hit the iceberg because he normally takes the southern route.

We were admitted to the hospital. They took blood samples and stool samples to go along with the urine and spinal fluid. Our daughter had an IV taped to her splinted wrist, making her arm look like a baby seal flipper. She received a steady cocktail of antibiotics and fluids while we waited for cultures to grow. I lived on a diet of popsicles, stolen from the freezer of the pediatrics ward. My wife never left the hospital. I left only to retrieve clothes from home or to pick-up the occasional takeout meal on Fillmore Street.

It wasn’t meningitis.

We were turned over to the chief of pediatric medicine, who brought in the chief of infectious diseases. The tests kept coming back negative. She wasn’t getting any better. But she wasn’t getting any worse. Different antibiotics were recommended. Finally, on the third day, a diagnosis.

Salmonella.

We were practically ashamed. The doctors assured us that salmonella could be fatal in newborns, as if to make us feel better about what we’d been through. They sent us home with the proper antibiotics, which we gratefully accepted. Nevertheless, before we were even discharged, my wife was researching pro-biotics to restore our daughter's natural gastrointestinal flora.

We’ve speculated on how she got it, but the plausible explanations are either too absurd or too embarrassing to revisit. It took many months for her to fully recover. In some ways, I’m not sure she ever did.

After the spinal tap, another ER doctor saw how shaken I was and reassured me that she would never remember the pain. I believed that. But I’ve wondered often how much of her personality was shaped that day. I’m not a particularly spiritual person. When it comes to sentient souls, I’m a skeptic. But I believe it’s possible that some unconscious part of my daughter remembers what happened to her. Not many of us learn so early that the world is not a safe place. I wish I could unburden her. All I want is to make her world safe. But I can’t.

I learned that on day eleven.

1 comment:

  1. So sorry you had to endure that. I can't imagine the fear and agony of watching her in pain and not knowing the prognosis. Beautifully written- thanks for sharing.

    ReplyDelete