by Ann Leary
Jack’s eyes blinked, and then it honestly appeared that he was gazing up at my father.
“I wonder if they can see,” my father said. “What can they see?”
“I think just vague shapes and shadows,” I said, and now I was leaning in, staring into Jack’s eyes, my face pressed close, almost touching my father’s, and it really seemed then that Jack was looking right back at us.
* My father was and is an electronics freak. I think it’s possible that he was one of the first private citizens to own a video camera. It was the giant, prehistoric model available in the late seventies
TWELVE
THE PREMATURE INFANT, in some ways, is like the prehistoric aquatic creature who has not quite evolved into a land dweller. His body is not yet equipped to deal with gravity and the wildly fluctuating temperatures of the surface world. The parts of his brain that coordinate the intricate timing of respiration have not fully developed, nor have the reflexes that enable him to suck. I suppose the hard realities of the extrauterine world come as a bit of a shock to all newborns, but full-term babies arrive equipped to survive out of water. Jack did not.
In 1902 Dr. J. W. Ballantyne, a lecturer in midwifery and gynecology at the Medical College for Women in Edinburgh, Scotland, said of the premature infant:
He is like some dweller in the hot plains of India who has been transported in a moment of time on some “magic carpet of Tangu” to the chill summits of the “frosty Caucasus”; with no opportunity for acclimatization such as a gradual transit affords, he is suddenly submitted to the severe strain which so marked a change in surroundings entails; it is possible that the marvellous adaptive mechanisms of the human body will overcome the difficulties of adjustment of capabilities to requirements, but there will be danger till this condition of physiological equilibrium is reached.
It was that ever-present sense of danger I found most harrowing about having a baby in a neonatal unit. It was like watching my child walk through a minefield and knowing exactly where the mines were hidden but not being able to tell him where they were. These hidden “mines”—infections, hemorrhages, and pulmonary disorders—had already brought down some of the other little inhabitants of the SCBU, and all I could do was sit back and hope and pray that Jack wouldn’t be stricken as well.
As the days and weeks passed, Jack and I slowly began to adapt to our new worlds. Jack’s body was learning to adjust to the air-breathing, gravity-bound realities of earth life, while I was unconsciously starting to incorporate words like “nappy” and “pram” into my vocabulary. I began to forget about my fantasy pregnancy, and I think Jack slowly let go of his warm memories of womb life, and we started to accept our predicament.
One factor that helped me gain this acceptance was the slow realization that we had been incredibly fortunate to have stumbled into one of the best hospitals for obstetrics and neonatology in the world. Later, when we returned to the United States, Jack’s pediatricians would look at his records and ask incredulously, “Did you actually meet Dr. Reynolds?”
“Sure,” I replied. Professor Reynolds, as he was called by the UCH staff, was always wandering in and out of the SCBU. He was a rather bedraggled-looking older fellow, and I assumed that he was an indulged academic eccentric from the university. In fact, Professor Reynolds is considered to be one of the most important pioneers in modern neonatology, and most neonatology students in American medical schools have studied his work.
Also, I learned that the betamethasone shots I received before Jack was born, which helped him develop surfactant in his lungs, had not yet been approved by the American Food and Drug Administration. When I returned to the United States, Jack was involved in follow-up programs with other low-birth-weight preemies, and none of the other parents could believe that Jack had never been on a respirator. Had he been born in the United States, undoubtedly he would have needed ventilation and would have suffered some of the unavoidable lung complications caused by the respirator.
I was slowly adapting to the daily stresses of having a baby in an intensive-care unit, but since the very moment of Jack’s birth, another change had been taking place for me. I was morphing into a besotted she-beast, a “mommy,” and the intensity of this new feeling—this dizzying, heart-bursting love I felt for my baby—was something I tried to resist at first. I cried to Denis the night after Jack’s birth that I was afraid to fall too much in love with Jack, because then he might die, and I didn’t think I could bear it. This is the kind of thinking that baffles Denis, who is, people are often surprised to learn, an unshakable optimist. “You already love him,” Denis said. “You’ll love him forever anyway, whether he lives or dies. Don’t try to protect yourself, for Christ’s sake. Jack needs us.” I knew that Denis was right, and so I surrendered to the waves of love and fear that washed over me the instant I laid eyes on our baby, every single time I saw him, and eventually the fear began to fade.
One day an elderly woman was visiting a baby in the SCBU. Her great-grandson, who had been born at full term with complications, was in an isolette near Jack.
“Oh, he’s a dear little one, that,” the old woman clucked when she saw me gazing at Jack in his isolette. “How much does he weigh?”
“He’s about two and a half pounds,” I said.
“Oh. Just like me, Mary,” she said to her granddaughter, who was holding her whopping seven-pounder.
“What?” I asked.
“Granny was only a little over two pounds when she was born,” said the granddaughter proudly.
“You were?” I exclaimed. “Well, that must have been …”
“Eighty-two years ago,” said Granny.
“Wow,” I said, suddenly scrutinizing the woman’s appearance for defects. She looked totally normal. “Were you born in a London hospital?”
“No. We lived in the country. I was born in my mother’s bed. They kept me in a box under the stove. Fed me with an eyedropper, they did!”
A smile spread across my face then, and I felt like hugging this healthy old woman. For the very first time, I thought that Jack might live, not just today or until the end of the week but for eighty years or more.
ONE AFTERNOON I arrived in the unit to find that a camera crew had crowded itself into the tight space. Miss Borthwick informed me that the crew was from ITV, a British television news station. That day members of Parliament were set to vote on whether or not legal abortion should be permitted as late as twenty-eight weeks’ gestation. Because Jack had been born at twenty-eight weeks, they were wondering if they could film him for that evening’s news. Denis’s family was desperate to see Jack, so I consented, asking if they would give me a copy of the tape to send home.
A petite blond female reporter spoke into the camera outside the unit, and then the cameraman quickly filmed Jack lying sound asleep in his isolette. As they were packing up their equipment, I took my spot in the chair next to Jack’s isolette, and the reporter approached.
“Hello,” she said, smiling and extending her hand. “Are you Jack’s mum?”
“Yes, hi, I’m Ann,” I said.
“I’m Jo Andrews,” she said warmly.
Jo thanked me for allowing them to feature Jack in their spot. Then she asked me what part of America I was from.
“Boston,” I replied.
“Do you live in London now?” asked Jo.
These questions had become so familiar from other parents and visitors to the unit who recognized my accent that I entertained the idea of typing up a fact sheet and taping it on Jack’s isolette.
“No,” I said. “We were here on holiday, and I went into preterm labor.”
Yes, I had adopted some English phrases of my own. It just seemed easier to say we were “on holiday” now, for some reason.
“Where is Jack’s dad?” Jo asked.
“He’s in New York. Working.”
Then Jo asked a series of rapid-fire questions about the type of labor and delivery I had endured, where I was staying and how muc
h longer Jack would be in the SCBU. When she had satisfied her journalist’s mind by finding out every fact about our situation, she declared, “This is horrible!” and instantly Jo took me under her wing.
Jo had given birth to her baby daughter, Florence, six months prior, right there at UCH. She’d had a difficult delivery, and she was a new mother passionate about mothering. I think those facts contributed to her interest in helping me, but I think mainly that Jo represents all that is truly great about the English. Generosity, kindness, and loyalty had been bred into her, and once she was aware of my plight, she was constitutionally incapable of simply wishing me luck and getting on her with her life. Instead she stopped into the unit nearly every day to see how I was doing. She and her husband, Paul Walker, repeatedly invited me to their home. Jo found out about Nippers for me, a British support group for parents of premature babies. She took me out to lunch and to the House of Commons to view Question Time with Prime Minister Margaret Thatcher. Jo took me to the Chelsea Flower Show and to Camden Market. She became, instantly, a dear friend, a fierce advocate on my behalf, and my own personal tour guide.
Jo and I were both new mothers, but the similarity ended just about there. Although Jo was only a couple years older, I couldn’t help feeling that she was an adult and I was not. Jo and Paul had successful careers. They owned a home. They drove a minivan that had a car seat in it for Florence. What had I been thinking? I’d often wonder after an afternoon at Jo’s. Why hadn’t we waited until we had a savings account before deciding to have a child? Why hadn’t we done the mature, responsible thing and shown some restraint? The answer, I knew, was that I thought the day might never come when we could better afford a child. Also, in the back of my mind were two very American notions: If not now, when? And anything is possible.
I have met very few people in my life who are more suited to their occupation than is Jo, who has the inquisitiveness of a precocious child and the determination of a pit bull terrier. Jo absolutely must find out the answers to questions, and when she does, she’s able to dumb down the information so that even a dull-witted American like me might understand it.
Jo brought me up to date on the current political news. When I asked her about the poll tax, which seemed to dominate the news that spring, she explained that in the late 1980s Margaret Thatcher’s Tory Party had resolved itself to reform the system of collecting local taxes. They decided that the best way to do this was to introduce a poll tax, which was an identical sum to be paid by all members of a community, regardless of their income and landholdings. Residents would be taxed by their local councils rather than by the national government. What happened was that many councils considerably raised their tax rates, which meant that while wealthy landowners still paid significantly less than they had prior to the poll tax, many working-and middle-class citizens saw their tax rates skyrocket. Not surprisingly, the poll tax was wildly unpopular. Jo explained that the day of the poll-tax riots (when Denis had to make his way through bleeding mobs of angry protesters) had started out peacefully. Thousands of people had descended on Trafalgar Square to listen to speakers denouncing the poll tax. When mounted members of the city’s riot squad moved in, the crowd grew violent.
It wasn’t until Jo appeared on the scene that I realized how desperately I was in need of a friend. Jo was very interested in the goings-on at the SCBU, and she filled in some of the cultural gaps for me, such as why I was starting to feel an undercurrent of resentment from some of the other parents and hospital staff.
One afternoon I was in the SCBU chatting with Chloe’s mother, Sara, and Lynn, one of the nurses. Sara asked me if Jack was eligible for British citizenship, and I replied that from what I understood, he was not. Lynn confirmed this.
“It used to be that anybody born in the United Kingdom was automatically granted citizenship, but because of the huge amount of immigrants we’ve had in recent years, the laws have changed.”
Then she said, “Still, you don’t have to be a British citizen to benefit from the same services that British taxpayers are entitled to.”
“Hmmm,” I replied, gazing into Jack’s isolette.
“After all,” said Lynn, “you must think yourself very lucky to have been here in England when you went into labor with Jack. British hospitals are not allowed to turn away patients. Whether they’re tax-paying citizens or not, if they walk into an NHS hospital, they will receive free treatment.”
I had heard this tune before. When I was in the antenatal unit, one of the other mothers had asked me how it felt to get free medical care for a change, leaving me to wonder how many others considered me a freeloader.
“You know,” I said to Lynn, “the NHS is billing my insurance company for Jack’s and my hospitalization. We’re not getting free care.”
“Yes,” said Lynn. “But even if you had no insurance, you’d receive exactly the same care you’re receiving now. If I was on holiday in America, and I went into labor like you did, I don’t carry insurance, so I’d be out of luck, wouldn’t I?”
“No,” I replied. “American hospitals are also required to take emergency patients, regardless of their ability to pay. American hospitals, especially in the cities, are filled with citizens and noncitizens who have no insurance.”
Lynn and Amy gave each other a look, and I realized that just as Americans tend to believe, wrongly, that socialized medicine leads to substandard health care, many Europeans believe that uninsured people in America are denied any access to doctors. They seem to envision women giving birth on the streets, children amputating their own limbs, and people blithely stepping over the sick and dying as they walk to work.
Later, having tea with Jo, I said, “I actually get the feeling that some people at the hospital think it was some kind of opportunistic scheme of mine to have Jack born here, at the expense of the British.”
“Don’t worry about what people say,” Jo insisted. “The National Health Service is going broke, and it’s a touchy subject for many, especially those who are employed by it. The whole institution has been so understaffed, underloved, and underfinanced that the inmates have gone pretty much mad. That said, I believe, as do most of my fellow Brits, that it’s still the best universal health service around.”
“Besides,” she added, “I do think it was rather clever of you to rupture that amniotic sac at will.”
PART THREE
The Ugly American
THIRTEEN
DESPITE MY HOMESICKNESS and uneasiness at being foreign, I felt increasingly secure in the hands of Britain’s National Health Service. I began to view the NHS as a maternal entity that, while not necessarily clutching me to her bosom, was nevertheless firmly committed to the nurturing care of Jack and me. This cosy feeling of security evaporated, however, the minute I stepped outside the hospital.
For one, I never quite got over the nagging suspicion that my watchful presence was the only thing that galvanized Jack’s pulmonary system. I feared that the minute my back was turned, his heart and lungs would decide that while the cat’s away, the mice shall play, and they would kick back and relax a little. Sometimes I would be almost out the door and then suddenly be compelled to turn on my heel and sprint back to the SCBU. I imagined I would find Jack’s monitors blasting and the nurses trying to prod Jack’s chest back into service, but of course this was usually not the case. Slowly I came to understand that Jack’s body, and the SCBU as a whole, functioned just as well with or without my hovering presence.
There was something else, though. While the hospital had become my home and seemed very, very real, whenever I tried to leave I had the uneasy sense that I had penetrated the “fourth wall” and was now a character in one of my favorite films. The taxis and double-deckers and streetlights and phone booths all seemed to be carefully arranged by a set designer, and in the beginning I wouldn’t have been surprised to find Dick Van Dyke leading a dancing gang of chimney sweeps down Huntley Street.
Despite my protests, the nurses began strong
ly encouraging me to get out and about more, and, as NHS employees, they knew what it was like to live in London on a fixed budget and were able to steer me toward free or cheap attractions. After my food and rent money, I was left with only a couple of pounds for diversions, but fortunately most of London’s museums are free and their public-transit system is very inexpensive and efficient.
I had been in London several weeks before I discovered that Regents Park is only a ten-minute walk from the hospital, and almost every day I wandered through its gardens. Regents Park is beautiful. I don’t know of an American park to compare with it. Central Park, which I love, has great trees and ponds and interesting rock formations, but Central Park, especially on weekends, is a bustling, energetic place. Comparatively, Regents Park is quiet and serene. The grass is impeccably maintained. You can sprawl out on it without a blanket or chair, and when you stand, there will be nothing stuck to you but a few grass clippings. No cigarette butts or condoms to brush off your clothes. Most people walk quietly in London’s parks. Many, I noticed that spring, not only admired the beautifully planted flower beds but actually studied them, sometimes even jotting down notes.
I usually went to the park at the time each morning when the doctors made their rounds in the unit, and I often saw the same people each day: the elderly couple tossing bread crumbs to the rioting geese, the attractive mother with her two little boys heading for the playground, or the nurse pushing an old man around in a wheelchair. Of course there would be groups of boisterous tourists and sometimes kids cutting school, but for the most part Regents Park was an oasis of tranquillity, a place for contemplation, and, I thought, probably similar to what Frederick Law Olmsted had in mind when he designed Central Park.
Central Park, in those pre-Giuliani days, was a place where one might go to contemplate … the decline of the human race. As you entered the park, at least from the Seventy-second Street entrance on the West Side, you first encountered what Denis called Drunkards Row—benches lining both sides of the sidewalk—where encrusted and befungused men in various stages of undress would sleep, drink, masturbate, and still find the time to greet young women with hearty gestures and guttural propositions. A short distance ahead, you had to somehow navigate Park Drive, which, on weekends, was a mad runaway river of humanity. Bicyclists, roller skaters, joggers, unicyclists—basically anything that could move of its own volition at speeds exceeding thirty miles an hour made its way along that drive, paying no attention to traffic signals. Crossing was treacherous. (I once saw a small child who stepped off the curb and was swept up by the leg of a skater. Flailing desperately for his mother’s outstretched hand, the tot was carried, plastered to the skater’s leg, at least a hundred yards down the drive before his frenzied mother could rescue him.) Once you successfully crossed Park Drive, you found yourself in the very heart of things. The Great Lawn spread before you, bejeweled with litter and dog waste. Sweatshirt-hooded men sidled up to you, regardless of your age, and offered “smoke,” “sense,” and “X” with the tenacious goodwill of all salesmen whose supply never meets demand. Oh, the rats, the cries of gay lovers from the woods—these were the sights and sounds of Central Park in 1990, so it’s no wonder that when I entered Regents Park, I often felt as if I had jumped into one of Bert’s sidewalk paintings in Mary Poppins.