Detours

by Vollbrecht, Jane

  Ellis answered for them. “Mary was impregnated with her ex-husband’s sperm for this baby. Since that same pairing produced a healthy girl almost eleven years ago, there didn’t seem to be any cause for concern.”

  “Did you do amniocentesis?”

  “No,” Mary and Ellis answered together, but Mary’s voice was thick and low, nearly unintelligible.

  “Why not?”

  “Because I knew I was going through with this pregnancy regardless of what the fluid showed.” Mary struggled to form each word. “Why waste our time and the insurance company’s money?”

  “All right, then.” The doctor examined the birth canal. “Looks like it’s about show time here. Since you’ve done this before, Mary, you know that you’ll have to keep your feet in the stirrups and do some pushing.” He gestured to Gloria. “You might want to take her other hand so she’ll have something to hold onto. Let’s get to it.”

  ∗ ∗ ∗ ∗

  Mary felt as though she were watching herself from someplace far away. The drug’s effects left her limbs like lead and her brain locked in impenetrable fog. If only she could wake up in their bed in Clarkesville and feel Ellis safe and protective beside her.

  She heard the doctor give orders to the three nurses and other strangers in white in the room, who went about each task in a very business-like manner. No happy banter, no speculation of baby’s gender, no questions about possible baby names or potential colleges. Mary thought back to Natalie’s birth. The nurses then had done their best to give nervous Nathan something else to think about, plying him with questions about everything from his favorite sports teams to how many toes was he hoping to see. The excitement in the room had been tangible, thrilling. A baby was being born, and angelic choirs were tuning up to herald the jubilant event.

  Not this time. She’d seen happier funerals. Oh, dear God, please don’t let my baby die. The doctor brought her back to the moment.

  “Push.” Pause, pause, pause. “Okay, push again.”

  Mary did as she was told.

  A few more pushes, and in a matter of minutes, the baby was out.

  The silence was horrifying. Why wasn’t the baby crying? Why wasn’t someone telling her if it was a boy or a girl? Why weren’t Ellis and Gloria saying something—anything?

  In a flash, one of the nurses grabbed the tiny form from between her legs, clipped the cord, wrapped a blanket around the baby, put it in the incubator, and whisked it away. All of the others who had been hovering in the room scurried out, leaving only an ominous feeling of dread.

  “Is my baby dead?” Mary’s voice seemed to come from every corner of the room.

  “No,” Doctor Grizzard said, “but we need to do a brain scan, set up a breathing monitor, get IVs running, and establish a sterile incubator environment as quickly as possible.”

  “How bad is it?” Mary asked.

  “I don’t know yet.” The doctor pulled off his latex gloves and rested his hand on Mary’s knee, still elevated from having her foot in the stirrup. “I don’t want to alarm you, but I don’t want to give you false hope, either. This is a very early birth. We’ll know better in a few hours.” He tossed his gloves into the waste receptacle. “Try to get some rest. We’ll see you sometime this afternoon.”

  ∗ ∗ ∗ ∗

  Minutes fell off the clock face so slowly that Ellis was sure the red oaks she saw from Mary’s hospital room window had grown another ring. Gloria had offered to leave Mary and Ellis alone, but they told her they needed her to be there to hear whatever it was the doctor would have to say.

  And so they waited. No one could come up with a safe topic of conversation. Somehow, everything led back to the frighteningly small bit of humanity that had left Mary’s body on the forenoon of September thirtieth. The silence gnawed at their ears. Ellis and Gloria had long since turned their cell phones off. How many more times could they tell Naomi that they didn’t know anything yet and that they’d call as soon as they did?

  Chapter 13

  “Mary, honey, can you wake up?” Ellis patted her gently on the cheek. “The nurse says we can go see the baby.”

  Mary sat bolt upright in bed. “Why don’t they bring the baby in here?”

  “The nurse told me it’s too risky.”

  “Because I delivered so early?”

  “Right. Fourteen weeks makes a big difference.”

  Mary shook her head as though dislodging cobwebs. “I guess I dozed off.”

  “You did, and that’s a good thing. We all could use some rest.” Ellis held Mary’s elbow as she jammed her feet into her slip-on shoes.

  “What time is it?” Mary asked.

  “Almost three. You slept a couple of hours.”

  “Are you sure I delivered a baby this morning? After Nat was born, I felt like someone had ripped most of my innards out.” She rubbed her stomach lightly. “I know the baby’s not inside me anymore, but I feel so hollow, so empty. It’s not at all like it was the day Nat arrived.”

  The nurse took them through the hospital corridors to the neonatal intensive care unit, NICU—which she pronounced “nee-cue.”

  “Why is the NICU so far from the maternity ward?” Gloria asked.

  “When the hospital was first built, it wasn’t equipped to handle premature births. The NICU area was added later.” The nurse paused outside the entry doors. “And it’s closer to the OR. Preemies sometimes need surgery quickly, and having the NICU close can save precious minutes.”

  Gloria, Ellis, Mary, and the nurse all scrubbed up thoroughly before slipping into disposable sterile paper gowns and paper shoe covers. Then they stepped into the heart of the NICU. The dim, iridescent light in the room reminded Mary of the hue cast by the special growing lights her mother used for her violets. The whoosh and hiss of various apparatuses blended in with the hushed voices of everyone in the room.

  Six incubators held the smallest human beings Ellis, Mary, and Gloria had ever seen. Nurses reached through special openings to administer care to babies so small and so fragile they looked like the merest of miscues would crush them.

  “He’s over here,” the nurse said.

  “So it’s a boy?” Ellis asked, clutching Mary’s hand. Gloria stood on Mary’s other side, dabbing at her eyes with a tissue. “I’ve been so worried about Mary, I didn’t even think to ask.”

  Mary peered into the incubator and burst into tears. “He’s barely even there. There’s nothing but skin and bones. He looks like a shrunken old man.”

  Tongue-tied and overwhelmed, Ellis and Gloria each wrapped an arm around Mary. They wept until Ellis was sure every possible tear had been shed, and then they wept anew.

  ∗ ∗ ∗ ∗

  An eternity later, Doctor Jenkins joined them at the incubator.

  “Hello, Mary. Nice to see you, Ellis. Congratulations on your new son. I’m sorry he got here so soon, though.”

  “Hello, Doctor. This is my sister, Gloria. What a relief that you’re here. Where’s the other doctor—the one who delivered the baby? Did he get a chance to update you?”

  “He did. And I’ve talked with others who were part of your NICU team, as well.” Doctor Jenkins gestured toward the door. “Let’s go to one of the consult rooms where we can talk.”

  “You’ll make sure my baby’s okay, won’t you?”

  “Everyone in the NICU will give him the very best of care, but a neonatal specialist will be handling your case from here on.”

  “Why?” Even Mary noted the shrillness of her voice and softened her tone. “I mean, why can’t you be our doctor?”

  “Your son is going to need a lot of care. You want to have a doctor who’s had experience with extremely premature babies. I’ve phoned Anthony Hill and asked him to come to the hospital as soon as he can. He’s the best in the area.”

  Doctor Jenkins ushered the three women into a small room down the hall from the entrance to the NICU. As they took seats, she opened the file folder she’d been carrying.

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p; “I’m sure you have a number of questions, but perhaps the way for us to begin is for me to tell you what we’ve learned about his condition so far.” The doctor looked from Mary to Ellis to Gloria and back to Mary. “I’ve got several pages of notes here, and I’m afraid it will feel rather overwhelming. Stop me if you need me to repeat something, okay?”

  Mary nodded mutely.

  Doctor Jenkins said, “He weighs a fraction of an ounce more than two pounds, and both his one-minute and five-minute APGAR results were very poor. We repeated the test in ten minute intervals for the first hour, and he never scored above a three.”

  Gloria interrupted. “Isn’t seven to ten considered normal or healthy?”

  “That’s correct, but APGAR doesn’t always indicate long-term outcome. We’ve got several monitors on him, and as you saw, the staff in the NICU is watching everything very carefully.”

  “What are they watching for?” Ellis asked as she edged nearer to Mary so she could take her hand.

  “For one thing,” Doctor Jenkins said, “they’re monitoring body temperature. His thin skin makes it impossible for him to maintain any warmth. The incubator keeps him at a constant, viable temperature.” The doctor went through a long list. With each item, she gave a description of the symptoms, complications, and risks, but it was all Mary could do to hear each additional cause for concern, let alone absorb its full meaning. Jaundice, apnea, inability to breast-or bottle-feed, extremely low blood pressure and heart rate, underdeveloped digestive system, and probable incomplete nervous system, including possible brain damage.

  Mary interrupted. “He has brain damage?”

  “Not necessarily,” Doctor Jenkins said, “but because of the situation with his lungs, I felt I needed to mention it as a possibility.”

  “I don’t understand. Are we talking about his brain or his lungs?” Mary chewed on her lower lip.

  “Both. As I’m sure you know, to keep the brain—and the rest of a human’s organs—healthy, the blood has to be well-oxygenated. In your son’s case, this is especially worrisome. The most critical area of development in any premature newborn is the lungs. The alveoli—tiny air sacs—have to fill with air and remain open. They’re how oxygen gets into the blood. In the last stages of pregnancy, from thirty-four to thirty-seven weeks, the cells in the alveoli normally produce a substance called surfactant.

  “Surfactant reduces the surface tension of fluids that coat the lungs so the air sacs can expand at birth and the infant can breathe normally. If there’s no air in his lungs, they can collapse and cause respiratory distress syndrome. Because your baby arrived at twenty-six weeks, he didn’t have enough surfactant. His lungs were so stiff that he couldn’t breathe on his own. We’ve administered surfactant to try to help the situation. Without sufficient air, he can’t keep oxygen in his blood, and without that, all his organs—especially his brain—are at risk.”

  “Is he breathing on his own now?” Mary asked softly.

  “Yes, but his incubator is oxygenated. And I need to tell you that the treatments we’ve done to help him breathe carry the risk of causing inflammation of the lungs, but again, we’re watching him very, very closely.”

  “So that’s what he’s up against,” Ellis said.

  Doctor Jenkins paused before replying. “I wish I could say that was the complete list, but I want to at least mention some other possibilities.” She glanced at the notes on the chart in her hands. “As I’ve told you, he may suffer from episodes of apnea, which means forgetting to breathe. If the blood supply is interrupted to his brain, that will increase the danger of bleeding or injury to the brain. Also, because his brain isn’t mature, he very likely won’t have the usual sucking or swallowing reflexes needed for normal feeding.”

  No one else in the room spoke, so the doctor continued. “His immune system isn’t fully developed, which creates a risk of serious infections, including a generalized infection of the bloodstream, called sepsis. Some premature infants also develop an inflammatory disease of the intestines called necrotizing enterocolitis. That happens when feedings don’t properly pass through the intestine. We’ll know this is happening if we see blood in his bowel movements. He’s also at risk for a condition called retinopathy of prematurity, or ROP. His eyes are so sensitive that they might react to oxygen and light by growing extra blood vessels. Those blood vessels can pull on the retina and cause it to separate from the back of the eye. Obviously, this can cause vision problems for him.”

  Mary looked frantically from the doctor to Ellis to her sister and back to the doctor. This couldn’t be her baby boy the doctor was talking about. Not her precious, newborn son. Not Natalie’s baby brother. No, they had the wrong infant.

  “You’re not going to give us one shred of good news, are you?” Mary asked.

  “I’m sorry,” Doctor Jenkins said. “I could have given you this information in smaller doses, but I wanted to brief you as fully as possible before you meet with Doctor Hill.”

  “How much more do you need to tell us?” Ellis leaned wearily against the chair back, still holding Mary’s hand.

  “Not much. Only one or two other possibilities.”

  “I’d just as soon hear it all and be done with it.” Ellis looked at Mary. “What about you, babe?”

  “Might as well. How much worse can it get?”

  The doctor offered a thin smile. “He’ll probably be anemic for at least the first two months because he can’t produce new blood yet, and we’ll have a hard time keeping his blood sugar levels under control. We’re fairly certain his kidney and liver functions are compromised. You probably noticed his skin is already looking yellowish because of the excess bilirubin in his bloodstream. We’ll need to be on the lookout for kernicterus if his bilirubin levels get too high.”

  “What’s kerni—whatever you said?” Gloria asked.

  “A form of brain damage, but let’s not borrow trouble.” Doctor Jenkins closed the folder she’d been holding.

  “Like what you’ve just described isn’t trouble enough,” Ellis said.

  “I know this is disheartening. I’m sure Doctor Hill will suggest that you speak with one of the hospital’s counselors as soon as you can. You’ll be dealing with a lot of stressful experiences in the days to come, and the more support you get, the better you’ll be able to handle them.” Doctor Jenkins looked from face to face. “Can I answer any immediate questions for you?”

  “Is he going to live?” Mary’s even tone belied the gravity of the question.

  The doctor put her hand on Mary’s forearm. “We’ll do everything we can for him medically. Beyond that—”

  Tears rimmed Mary’s eyes. “I want to be with him now.”

  “Sure, sis,” Gloria said. “We’ll all go.”

  “No, just me.” Mary rose and left the room.

  “I’ve dealt with a number of premature births,” Doctor Jenkins said. “In almost every instance, the mother believes she’s somehow to blame.”

  “Is she?” Ellis asked.

  “No, certainly not. Spontaneous early birth is still, in large measure, a mystery.” She stood and offered her hand to Ellis. “I wish you and Mary all the best, Ellis. Later today I’m going to examine her carefully, and if everything checks out, I’ll sign discharge papers for her to go home in the morning. No need for her to spend more than tonight here. If you need anything, please don’t hesitate to call me.”

  After Doctor Jenkins left the room, Gloria and Ellis stared blankly at one another. At length, Gloria spoke. “What should we do?”

  “Damned if I know. I guess we should at least check on Mary.”

  They made their way back to the NICU. Through the glass panels on the entrance door, they saw Mary standing beside the baby’s incubator, watching her half-day-old infant son.

  “Do you think we should go in?” Gloria asked.

  “Uh-uh. Whatever is going on right now is strictly between her and the baby.” Ellis gazed at her devastated partner. “Maybe we s
hould grab something for us to eat and bring a sandwich back for Mary. I don’t think any of us has had a bite all day. Some of the nurses offered her some snacks after the baby came, but she wouldn’t touch a bite.”

  “We’ve all been too upset to eat, but I think I could eat something now,” Gloria said.

  “I’m not sure I can gag anything down, but we ought to try. And it would feel good to step out of this hospital, even if only for a little while.”

  Ellis tapped on the window to get Mary’s attention. She pantomimed walking away with fingers of one hand on the palm of the other and then feigned eating. Mary indicated she understood.

  On their way out, Ellis and Gloria passed through the waiting room. Clusters of Hispanics talked rapidly in their native tongue.

  “I think I know how they feel,” Gloria said, gesturing toward a group that seemed especially distraught.

  “What do you mean?”

  “Ninety-five percent of what’s been said to them today has been in a language they barely understand. For all I got out of what Doctor Jenkins told us, she might just as well have been speaking Swahili.”

  “Yeah, I know what you mean. And from what I did grasp, we’re all going to have to learn a lot of foreign languages to get through what’s ahead of us.”

  Chapter 14

  Ellis returned to the NICU and stood quietly beside Mary, who was still only inches from the incubator. “Hi, sweetie. You doing all right?”

  “How can I be doing all right? It’s three months too early. Everything’s all wrong.”

  Ellis saw a mixture of fatigue, disbelief, and confusion on Mary’s face. She tried again. “I know things aren’t right. I wondered if you might want to sit down for a while and have a chicken salad sandwich.” She lifted the brown paper bag a little higher so that Mary could see it. “Gloria and I found a nice deli a couple of blocks from here.”

  “Where is she?”

  “I sent her home. She was worried about how Barry would handle the three girls on his own. Besides, she was exhausted.”