by Joshua Furst
“What world?”
“That . . . drug world, or whatever you want to call it. Where life’s scary enough, real enough, that you have to figure out who you are.”
“What do drugs have to do with any of this?”
“I want to know what I’m missing. I’ve been thinking about heroin, too.”
“Where are you going to get that?”
“This ex I had coffee with knows somebody.”
Again, he held his tongue.
“I just . . . I want things to be exciting again. Things felt exciting when you were all fucked-up. I mean, here was this big sexy junkie who liked me and I thought, hey, that’s cool. But then you tried to protect me from all the dark shit you knew, like you couldn’t imagine that maybe I wanted to know it, too. That maybe that’s what attracted me to you. You know? Maybe I had demons of my own. And then you were trying to clean yourself up, and that was exciting. I got to be like an icon or something, which made me feel sexy, and everything was great. But now, you know, it’s boring . . . I’m sick of trying to live up to your expectations. I don’t want to be perfect. I want to know what’s out there.”
He wasn’t in a position to try to talk her out of anything. It seemed to him that if she was in some sort of pain, it wasn’t his place to judge her method of treatment. “What are you going to do with Sabrina while all this stuff is going on?”
“Maybe you could look after her sometimes. No. Fine. I’ll leave her with a sitter . . . or if I can’t find one, I guess I’ll bring her along.”
Disturbed, he walked her home.
At that time, I was undergoing a training rotation through the NICU, and while I was there, I helped monitor a premature infant, He’d been born at thirty-one weeks and weighed 1200 grams, so small he could fit into a coffee mug. His skin was translucent and loose on his bones, his fingertips and lips perpetually soft blue. At birth, he’d been outfitted with a monitor to track changes in his heart and respiratory rates. Within his first hour of life, he experienced two episodes of apnea and was diagnosed with respiratory-distress syndrome. A clear plastic hood connected him to a CPAP machine so that oxygen could be pumped into his lungs. He had a one-in-four chance of survival.
It was my job to stroke his small body, to provide the warm contact that’s been proven to bolster neonatal growth. I noted changes in his condition and monitored him for responses to the electrolyte solution he was being fed. I examined his papery skin for the white lines, like hairline cracks, that would imply he was malnourished or dehydrated. In some inchoate way, he seemed neither human nor inhuman, like he was teetering on the edge of being, just a hair more sentient than a fetus.
At 7:34 a.m., near the end of the fourteenth hour of his life, his respiratory system began to fail. I was across the room at the time, peering at a different child with the head nurse and two other trainees. His distress was discovered by a sensor connecting his body to a monitor. His chest was at war with the blue machine.
When this third episode of apnea tripped the alarm, the head nurse ran to him, did some quick tests and fiddled with the CPAP’s controls. Over her shoulder, I glimpsed him seizing and startling, curling in on himself, but I was quickly pushed back by the doctors who swarmed toward him. I was a peripheral presence, unnecessary, a thin, feeble cloud on the edge of the storm of hands passing equipment and flipping charts and performing operations I had not yet been taught. At the center of all this stood the head nurse, who, as I was told later, was pumping her thumb lightly against his minuscule rib cage. And then it was over. When the doctors dispersed, I went to the child, scooped him up and held him like an offering in two cupped hands. His skin had gone milky white. His veins glowed like coral lit up beneath glass. His oceanic eyes were wide open. His knees were bent, his arms crossed over his heart. He was dead.
I was told that even if he’d been discovered in time, if I’d been there to slow the oxygen, if I’d hooked him up to an ECMO, he’d still have died. He was frail and ill equipped, even for life on a water mattress or in an isolette under bili lights.
The death of this child had an odd effect on me. I found myself lingering over the memory of having held his dead body in my hands. I’d blink and I’d see his blue head, gigantic, almost as big as his torso. I’d blink again, and there would be his eyes, black and deep as the future. I could only half listen at the weekly sharing seminar that Thursday morning. I only half read the handbook that was our vocational bible. I watched without seeing the head nurse’s step-by-step tutorial on how to perform an electrocardiogram. The child kept squirming in my head. I wondered if his parents had named him or if he had siblings or if his parents had bought him mobiles and plush blankets and blue stretchies with feet, if they had a crib and a playpen and a changing table set up in a dark alcove of their home, if there was a room they were now afraid to enter. I didn’t look for answers to these questions, just let them rattle around in my mind. I lost my appetite. I couldn’t sleep.
Almost a week after he died, I was still disturbed. At lunch in the hospital cafeteria with my fellow trainees, I picked at my gluey lasagna and failed to laugh at the intrigues involving spilled bed-pans and missing pharmaceuticals that baroquely peppered their gossip. The child had no name. He’d died before his parents had fully imagined him. He was anonymous—Baby Boy, Martin— Patient Number u30.1157204. I christened the dead baby Michael, and having named him, I realized I hadn’t been mourning. Not exactly. I’d been brooding, wondering why he’d died and whether he’d chosen this death himself. It seemed quite possible that he’d known where he was, that while in the womb he’d heard the world swarming around him, the footsteps of his father, the heavy sighs of his mother. I wondered if he’d known whose hearth he was crossing, and if it had filled him with dread. I could almost see the place, a blur of green lawn on a treeless plot surrounding a lowly ranch house, the kind that boldly proclaims its allegiance to dreams its inhabitants cannot attain. I could almost see his parents, ineptly striving, I couldn’t tell what for, but I saw them frustrated in their attempts. I could almost see Michael desperately trying to flee.
Sabrina’s eyes were a pale gray, verging on blue-white like faint clouds that bespeak nothing but beauty on a warm day. When they were open, the lids spread so wide that her corneas seemed to be floating in milk; when closed with sleep, they were still partly open, as if she were watching the action around her from behind her bramble of lashes. Her mouth was small and delicate, a mouth made for soft kisses. Her hair was slow to grow, a wisp of down crowning her head like a Mohawk, offering no protection. She already knew five words. She liked to wear hats, floppy fisherman’s caps, gnomic thermalwear with earflaps that could be tied under her chin, anything with loose parts that she could yank down. “Saf, saf,” she would say. She liked to be covered. She had learned to stand early, and though she wobbled, her legs rarely buckled. By lunging from the arm of a chair to the edge of a coffee table to the seat of the couch to the TV set, she was able to maneuver through any room, grabbing pens and coins, paper clips, dust bunnies, remote controls, anything meant for adults, anything but her own toys, to jam in her mouth and gnaw on, to drop, to throw, to pound and scrape surfaces with, or to place nicely, with a coy smile and the word “nut,” the opposite of “yed,” into a parent’s hand. She hated shoes but loved socks. Her father would slip her socks onto her feet and she would erupt in giggles. “Saf, saf, saf.” Her father thought this meant safe. She seemed to say it most while being dressed. It wasn’t until she pulled the neighbors’ cat’s tail that he understood it meant “soft.” Sabrina was smart for her age and cute for her age and big for her age. A precious child. I thought so, anyway.
She knew two other words. “Day-yay” was “Daddy.” “Mumum” was “Mom.” And I think she knew things about these two people that she couldn’t express with words. Day-yay liked to play Where’s Sabrina while he was dressing her. He liked to play Little Piggy. He liked to play Got Your Nose. Lots of times, Day-yay wasn’t home; he was
away at school learning how to be a grown-up. Mumum took Sabrina for rides in the car sometimes in the middle of the afternoon; sometimes Mumum cried before these rides. One time Sabrina screamed “Mumum” over and over as loud as she could and Mumum forgot to answer even though she was sitting right there with her eyes open. Day-yay loved Mumum, but he was afraid to talk to her unless she started talking first. I think she knew all this. I believe these were her thoughts.
I studied the children in Intensive Care more carefully now. They had slow heartbeats, blue fingers and toes, sluggish—sometimes nonexistent—responses to the doctors’ slaps and prods, low birth weights, malfunctioning internal organs. They were born with port-wine stains on their shoulders, strawberry marks across their faces, swollen eyes leaking pale yellow pus. This one had thrush. This one had jaundice. This one did not have a startle reflex. Sometimes the only thing wrong with them was that they just wouldn’t grow— failure to thrive, it’s called—and I found these to be the most disturbing; I wondered if, maybe, they were rebelling, psychosomatically saying No as they tried to crawl after Michael.
According to their corrected ages, the preemies were each minus zero; sometimes minus one month, sometimes three, none of them were born yet. They were here, they were out, but they were still gestating. I wondered who would be the next to fail to survive, and if this could truly be called a failure. Maybe, until they were zero years old, the preemies were not yet fully alive and though they were out in the world, breathing through machines, eating through plastic tubes, their beings, their essences, whatever it was that constituted their incorporeal parts, were as unprepared for life as their bodies were. And maybe, because they were younger than the youngest baby, they were also older than the oldest septuagenarian—the aged always look like infants. Maybe they were ageless, and from this vantage they could see their futures and choose to accept or reject them. Maybe those whose bodies stopped pressing toward life were opting out while they still had a choice.
And maybe that glimpse I’d had in the cafeteria of Michael’s future was more than my imagination. Maybe I saw what he’d seen, or a portion of it. Maybe he’d meant for me to see the sadness his life had promised him. Why? To what end? To make me a better nurse, I thought.
I searched the preemies for glimmers of personality, for visions similar to those Michael had shown me, but I saw nothing. Life begins when the spirit inhabits the body, when the body is able to survive and thrive on its own, with the help of its nurturing parents. Science was keeping these bodies going, and I believe their spirits still hovered on the hand of God, a perch from which they could see me searching for them. So they hid. They still weren’t sure if they wanted the lives these bodies would give them. Their pain still floated in the what-might-be and they didn’t need me to see the what-will-be. They could take care of themselves.
I wish now that I’d paid more attention to the full-term babies. They might’ve been more communicative. I try to remind myself that the ailments they suffered were physical, and that I’m more concerned with the bloodless ruptures, the spiritual ailments, in my patients’ lives. I try to convince myself that the distressed bodies of the full-term babies in the NICU will ensure that they are attended to, cared for and comforted throughout their lives, but I know this isn’t true. There must have been one, at least one, for whom I could have done good. Even the physically handicapped fall prey to shattering sadness. Even the kid with the hole in his heart might one day find that heart too heavy. At the time, though, I still didn’t understand my calling.
Sabrina’s father began to have trouble accessing his emotions—he knew they were inside him, even knew which ones he needed to feel, but they wouldn’t come out. He was so alone that even his own feelings refused his company. He wandered with plodding steps, like a nomad, across the cracked earth of his home. The way he described it, his bones felt like they’d been emptied of marrow, the blood in his veins as thick and rank and slow-moving as sewage. It took all of his effort to form the simplest thoughts: change the baby; feed the baby; rise above yourself and play with the baby now.
Time moved so slowly. There was too much of it. Sabrina’s mother came home sporadically. He couldn’t tell her to change her lifestyle. He couldn’t tell her anything. She’d put up with him, and now it was his turn to put up with her. Already she claimed it was unfair for him to demand that the changes she was making stay outside the house. “When did you get to be so high and mighty?” she said. When he tried to explain it wasn’t for his sake, but for Sabrina’s, she wouldn’t listen. He had no credibility.
Sometimes she took Sabrina out with her—he’d come home from school and find the house empty. Then time stopped moving completely. He lay on the futon staring at nothing, thinking of nothing, becoming as close to nothing as he could, waiting for time to move again or, if not that, to end altogether.
He knew he’d eventually get past this numbness. Something would happen, then time would speed up and crash into his emotions, knocking them loose, maybe shattering them. The emptiness wouldn’t matter as much if he could have Sabrina with him, if he could carry her everywhere on his hip, if he could always be sure she was okay.
After my stint in the NICU I was rotated to the maternity ward, where I eventually was given a full-time job. I worked there until yesterday. The maternity ward differed from the NICU in a variety of ways, chiefly in that the babies there had passed their Apgar tests, which meant they were healthy, physically prepared to thrive in the world. Three of us, Kim and Cheryl and I, worked two at a time in staggered night shifts.
Cheryl was older, in her late forties. She was a light-skinned black woman, with freckles that rose from her cheeks, and was deeply involved with the Jehovah’s Witnesses. She never slouched, and her head rode high on her neck like that of a teacher obsessed with discipline. Her personality was like her posture, strong-willed, rigid and certain. She impressed and intimidated me. She had none of the cracks that I connect with in people, nor did she abide these cracks in others. In my first few days she seemed to take glee in correcting me, mostly about minute procedural details. When you burp the children, you fold the towel like this, not like that, you don’t want gunk all over your scrubs. Throw the wet wipe out immediately, don’t put it in your pocket and spread germs around to the other children, we can’t have that. Part of me aspired to be more like her, to be convinced of the rightness of my methods, but another part of me wished she’d just leave me alone.
Kim had boyfriend problems and a cigarette addiction. She exhausted me. She spent most of her time in the windowed room off the nursery, listening to her Walkman and leafing through the new issues of the complimentary magazines, People and Parenting and Cosmopolitan, even GQ and Sports Illustrated, using them up before dropping them back into the Formica cubes in the waiting room. I minded this less than when she chose to talk to me; then the air thinned out, and I suffered from lack of oxygen and vertigo. The topic was almost always the same: she wanted advice on her boyfriend, but if she got it, she’d decide the advice was wrong.
I kept my distance from both of them and gave my attention to the babies. At this age they were all the same, barely sentient lumps of flesh, covered in vernix caseosa and a downy layer of lanugo, needing almost nothing, only food, warmth. Each started wet and, while drying out, slowly solidified. They burped up mucus and embryonic fluids. They leaked sludge-like meconium into their diapers. Their bodies made so many after-the-fact preparations. The points at the top of their heads receded. Their skin darkened and thickened, eye color deepened, noses and ears changed shape, firmed up, realigned. They hardened as their bodies primed for the future, and if they’d been seals or fawns or kittens this would’ve been enough; but they were born human and as such they’d eventually start asking questions that had no answers, searching for patterns that didn’t exist, falling prey to dangers of their own creation, from which instinct could not protect them. They slept and slept and slept, and upon waking, they tired quickly, fleeing back t
o sleep after five minutes of consciousness.
Most mothers roomed in. They had rooms with windows and flowers and mounted TVs, with collapsible curtains that could be unfurled for privacy while they nursed. They planned ahead and made various demands: no pacifiers, no bottles, hard-to-come-by foods and visiting rights for their extended families, no nurses. Their babies were the culmination of long-held dreams. But the children in the nursery had problems. They were the children of frail, wealthy women in need of extra recovery time, or poor women there without family, or women whose husbands were out at the bar, whose boyfriends were in jail, whose handful of lovers had no idea—and never would—that they’d just given birth; these were the children of children who would never see them, of women who would never want them, of parents already beginning to feel guilty for being less capable than they knew they should be.
I wondered how healthy these babies really were. Physically, yes, they were fine, but that was small comfort. Only a few hours out of the womb and already they were deficient. For a host of reasons, their lives were already difficult. This one bawled when his arms were trapped in his swaddling blanket. This one had two pre-teeth wobbling in her gums, abrading them, causing soreness and bleeding and unending agony. This one blinked so slowly it seemed that the world might end before she next batted a lash. This one wouldn’t take a bottle. This one didn’t cry. Already, they were individuals.
They made me sad. I mixed their formula. I stuck thermometers into their armpits. On my rounds I tried to treat them tenderly, but I felt like a fraud; with every kind act I promised a lie, set an impossible precedent. What happened after they were taken home was out of my control. The temperature would no longer be fixed at a constant 65°. The length of the day would no longer be decided by the rheostat. The institutional stability of the hospital would be replaced by messier, less controllable circumstances.