Tiny Birthday 24 Weeks and 3 Days Old, and Counting
by LAINA RICHARDS
“I went in for just for a regular check up at my local doctor.”
Now she’s sitting at a table in the kitchen, with a half eaten sandwich and a glass of water in front of her. She’s calm. She has told this story before, about being told that her blood pressure was abnormally high, about how her doctor told her to come back the next day. “She told me I couldn’t work anymore throughout the pregnancy.” When she returned to her doctor the next day, the doctor put her in an ambulance. “My blood pressure got to 162/101. I don’t know much about blood pressure, but they were freaked out.”
There hadn’t been signs of the illness. Sarah was 22 and about to be a mother for the first time. She and her husband were married on the front lawn of her father’s home the summer before. She wanted a dog for her child to grow up with. She was in her twenty-third week.
* * *
The first thing I noticed at David’s House, a “home-away-from-home for the families of children receiving treatment at Dartmouth-Hitchcock Hospital,” were the hearts carved into the porch’s white wooden railing. The hearts, a subtler detail, were for the parents. So were the rocking chairs on the porch and the flowers along the path. The play set out front was for the children, brothers and sisters and even, sometimes, the patients themselves. Inside, among a scatter of toys, there was a teddy bear bigger than a child, light brown and slope shouldered, his head cocked inquisitively. I’d had a bear like that myself once, a gift from my uncle for my third birthday, and I don’t think any present since has made me so happy. For those who apply, staying there is free.
Heavy with shopping bags, a small group of volunteers and I walked towards the kitchen. “Here come the chefs!” declared a staffer. A teenage girl stared at us blankly from a chair at one of two tables, headphones streaming something into her ears. Neither she, nor the child with her, nor the two women busy with crafts at the table, acknowledged us with more than a momentary glance. I moved two packets of Infagrow Premium Toddler mix out of the way, along with the carefully laid out instructions on how to use them, and placed the shopping bags onto a gray kitchen counter that wraps around the stove. In a bowl of fruit beside the bags, there was a tootsie pop wedged between the bananas.
While we unpacked the groceries, a girl of five or six walked into the kitchen, dragging her father by the hand. They watched the floor as they walked; the mother bustled in behind them to prepare the girl a dinner of Spaghetti-O’s. I tried not to stare as the little girl sat down across from me. I had expected the sick children to be in the hospital. The little girl had a plaster head cast that wrapped around her skull and chin, decorated with stickers like a crown. The cast was white and hard, and looked heavy above her wiry frame. It was made of too much plaster, gauze and glue for such a young girl.
I faded into the background as the girl’s parents sat on either side of her, watching her eat. They had nothing for themselves; they just watched. When she finished the bowl, her mother insisted she eat more. The girl began to cry. The mother picked up the spoon, rubbed her back, and slowly and gently persuaded her to eat just a little more. The woman got up to wash the dishes, moving quickly and efficiently around us in the kitchen as we chopped vegetables. Her father stood up as well, but he hovered above his daughter, kissing her head over and over as she fiddled with the table or watched her mother, looking toward the kitchen the whole time. His hand rested on the shoulder of her small pink t-shirt. The girl didn’t look up each time he stooped down to kiss her cast or whisper something small into her ear. Her father, a very slender, pale man who looked too tired for his age, wore a black sweatshirt and a brimless cap stretched over his ears. “Can I go outside?” the girl asked, tugging on her father’s arm. Agreeing, he took off his hat and placed it over her plastered cast. Her mother, dressed in a faded black sweatshirt and sweatpants, led the way out of the kitchen. I watched them from the window for a while as I cut up tomatoes for the salad. The couple sat close together on a bench. The hat covered the girl’s cast perfectly as she ran around the brown and green yard.
A woman wandering through the hallway directed me to the bathroom. She looked as lost as I did. I’d later learn that she was living at the house with one of her children. Expecting stalls and multiple sinks, I was surprised to open the door on a single room with a bathtub, the curtains on the windows clearly handmade, with a green and purple ribbon sewn along the bottom.
“They try to make it feel like home,” Sarah says. Her home is an hour and a half away. “Everybody’s really nice,” she says. There are curtains in the kitchen, too.
When I returned to the kitchen, the girl with the headphones and her companions were gone and a couple dressed in gray had settled at that table. I rejoined the volunteers by the stove and we started throwing the chicken into pans. The couple at the table was huddled together as if for warmth. I wondered why they had chosen the hard, wooden chairs in the overcrowded kitchen over the living room beside it, with plush couches surrounded by children’s toys. Their faces were red and puffy, their eyes downcast. They spoke in husky whispers if at all. They looked at each other as if they meant to say something; but they didn’t, and their eyes fell back to the table. We continued to flip chicken in the pans.
When the man turned, I saw his scars. Two, hook shaped scars on the right side of his shaved scalp dug deep into his head as if carved, one scar hooked inside the other. The couple sat there for a long time as we cooked, their shoulders closed to us in privacy despite their close proximity.
Other couples and families wandered into the kitchen as we packed up, but it was the man with the scars who stood up from the table with his companion as we began to walk out. “Hey, thanks,” he said, looking me in the eyes for the first time in the hour we had spent in the same room. “This looks really great right now.”
* * *
And so I went back. The next time I walked past the white fence with hearts cut out of it and through the front door of David’s House, I met Sarah. Again, we carried in the groceries and set them on the counters. We began unpacking food while residents, staff members, and volunteers moved through the kitchen around us. It was busy that day. Some of them stopped, asking us what was for dinner even though the menu was written on the whiteboard across from the counter. One woman ate a slice of the cheese that we had brought to snack on as we cooked. Another woman lingered, young and brunette. That was Sarah, alone at David’s House half the week while her husband, Scott, commutes to his job in Berlin, Vermont, which is 80 miles away. I asked how long she had been staying at David’s House.
“About eight weeks, and I’ll probably be here for two months more. I have a baby in the hospital.” Her son, John, should have been born in July, but he was sixteen weeks early. Four months. He weighed less than two pounds when he was born. Sarah and another woman at the house call themselves the “twenty-four weekers” because that’s how long both of their babies were gestational before they were born. “John was born at 24 weeks and 3 days,” Sarah said. The other woman delivered her baby at 24 and 2. Sarah launched into a description of the other twenty-four-week mother. Her baby, a girl, “was born a month before John and was an ounce lighter and an inch shorter.” Sarah spoke of premature babies in terms of numbers. She knew how premature the other babies were, down to the day. She knew the weight and height of every premature baby.
“It’s sort of like a club,” she explained, standing on the other side of the counter while I chopped peppers. She watched as she spoke, her arms folded across her chest, standing in the middle of the kitchen. “Sometimes, when we get back from the hospital, we all sit around that table in the kitchen.” She motions to the table on the other side of the room. “And we just talk. Most of us are at the hospital all day. When I get back here I just need to rest and think.” She spoke fast, describing what she had been through in mostly technical terms: “C-PAP,” “platelets.”
Later in the evening I would meet one of these other women with a premature child in the hospital. She would sit down at the table next to the counter, holding a tiny baby girl. During pregnancy, this woman’s hips separated, and one of the hipbones cracked. “I let her kick my butt because I love her,” she would tell me, and then look down at her daughter, “you can kick my butt because I love you.”
She would warn me. “Carrying more than one is hard,” she said. “We were carrying three but… It’s hard. Don’t let anyone ever tell you that it’s easy.” There’s a twin, a boy, still in the hospital. “His little lungs,” she said. The third triplet did not make it, and that is all that would be said about that, even by the others at the house. She would tell me how, as much as she loves her daughters, she has a soft spot for little boys and I would wonder what gender the third triplet was. I would tell her at one point that I loved the baby girl’s little hands, which flexed open and closed as she furiously surveyed the room around her. The mother would admire her baby’s hands for a second before saying, “Look at this, her hand wasn’t even this big when she was born.” She would make a circle with one hand onto the palm of another; a circle about the size of a nickel. I would think for a little while that the baby girl, sitting up in her mother’s lap, wide-eyed and alert, was the smallest baby I’ve ever seen, until another mother walked in carrying what looked like a bundle of baby’s clothes. It would take us all a moment before someone whispered, “that’s a baby.”
This baby may have been tiny, swallowed by the tiny jumper he was wearing, almost imperceptible as he was cradled in his mother’s arms, but he was out of the hospital, unlike this woman’s baby with his little lungs, the third triplet who didn’t make it, or the young girl who had just had a tube surgically implanted in her stomach, and whose mother I had met earlier. They were still in the hospital and that was why all of these families were there.
Sarah was still talking. I caught the word preeclampsia, a condition marked by high blood pressure that I know could lead to eclampsia, severe seizures that can be life threatening, if not treated properly. In Sarah’s case, HELLP syndrome developed from the pre-eclampsia. Hemolysis, Elevated Liver enzymes, and Low Platelet count. “HELLP syndrome,” said Sarah, “is when your liver and kidneys and other vital organs start to shut down.” Her mother had suffered from HELLP, too.
“Something to do with the placenta,” she said. “Probably hereditary.”
Sarah had been hospitalized because of her high blood pressure. “I was supposed to go home Monday,” she told me, sitting at the table a week later. “Sunday night, all through the night I ended up having this terrible back pain that just wouldn’t go away. And so they drew some blood and they found out that my platelet count was down to 32, it was supposed to be, like, between like one-fifty and three-hundred. And, my liver enzymes went from 17 all the way up to six-hundred and eighty-five. So, the day I thought I was going home, they were like, ‘we’re going to have to do an emergency C-section because you just got HELLP and your liver is shutting down.’” She doesn’t say anything for a moment. “He was born at 6:48 in the morning.”
In the kitchen the day we met, I’d had asked her how long it took for her to recover from the preeclampsia and HELLP syndrome. She’d shrugged, “all my problems went away as soon as they got him out.”
* * *
Today is John’ nine-week birthday. A “tiny birthday,” Sarah says. She sits down at that table in the kitchen with a sandwich and a glass of water and smiles as she lets me back into her world, making small talk as I fumble with the voice recorder. Her husband is at work and will not be coming back to David’s House tonight.
Sarah grew up in Northfield, Vermont, and when she talks about going home from the hospital, that is where she and her husband will return. I ask Sarah how many times she has been home since she first entered the hospital.
“I’ve gone home a couple of times,” she replies. Then, after a pause, “Six.”
Her father has visited Lebanon and the hospital multiple times as well. “My dad got to meet John first. And he wouldn’t touch him because he was too small. He was like, ‘I don’t want to, I’m going to just, uh, wait a minute.’ But the second time he came, he actually touched him. Touched his little cheek and his little hand. I was like, well, that’s progress. And then this last time, he even held his pacifier for him.” Her husband’s mother had an even harder time. “She almost cried when she had to leave him. She was like, ‘I don’t know how you do it!’ And I was like, ‘It’s not easy!’”
Sarah is a student at Vermont Technical College, in Randolph, Vermont, almost finished with her degree. She only needs two more classes, five credits, to earn her Bachelors in business. “I have my associates already,” she explains. “I would have been able to do it, but I got pregnant. And my grandmother got pneumonia.” She goes straight into talking about credits and classes and degrees. “I love accounting, so I could have done accounting, but I decided to just go with the general business so that no matter what situation I was in, I could get a degree.”
It’s 5 PM. Later, the other residents will gather at this table, winding down from their time at the hospital, discussing their children into the night.
“We’ve become like family, really,” she says. “Those of us who are here for any length of time, anyway. We all get to know each other. And we cook dinner with each other, and… It’s great.” A second later she continues with this train of thought, “It’s sad and happy when people get to get discharged because you’re like, ‘Oh they’re not going to be here anymore. But, hey, they get to go home!’”
I remember a woman I had seen through the kitchen window on a previous visit. I’d watched her moving out of David’s house, carrying a round of her belongings towards her car. There were three women carrying many items, including a bulletin board, a case of Mountain Dew, and five bags.
This week, John has started doing things at the hospital that he isn’t supposed to be ready for. Sarah says it’s as if he has decided that he is ready to go home. They’ve started feeding him with bottles. “They just stopped his caffeine,” she explains. “That’s supposed to prevent apneas and bradycardias.” Bradycardia is when the baby’s heart stops momentarily. The caffeine was to keep him breathing. To keep his heart from stopping. I ask if that means she will be going home earlier than expected.
“A lot earlier, I’m pretty excited.” Perhaps she will only have to spend three, not four or five months at this home that is not really her home. Perhaps, three months after giving birth to her son, she will be able to bring him home from the hospital. First, they have to wait for the caffeine to leave his system. Then, he has to go a week without his breathing or heart stopping at all. He also needs to get his feeding on schedule. “He’s not going to have the feeding on schedule, so it will probably be more like a month.” She doesn’t address the possibility of apneas and bradycardia again.
Sarah remembers something the doctors told her, something she has held on to for these past few months. “If anything they said that it might have helped him mature faster,” she tells me. Being premature. “I guess, babies who are in a stressful situation, like people with HELLP or people with gestational diabetes, and stuff like that, they mature faster, because our bodies tell them, ‘you have to hurry up, because you’re going to be coming out early!’” She laughs. “They think that’s why he’s doing so well now. So in a way it was a bad thing, but it was a good thing.” Her liver shut down and her kidneys would have been next to go, but they might be able to go home from the hospital sooner because of it, and that is what matters to her right now.
John is still only about seven months old. Seven months from the date of his conception, that is. She thinks for a second, maybe about her baby alone in his crib at the hospital. “They act more like their gestational age, too. They don’t really act like a normal two-month-old.” I picture these little humans, tinier than the babies I had seen at David’s House the other day, curled up in their cribs as if still in the womb, not moving, their breath almost imperceptible.
“The nurses are shocked on how active he is,” Sarah continues. “He’ll be awake an hour and a half, two hours at a time. And normally it’s ten minutes and then they’re zonked again. He loves to cuddle. I held him for like eight hours the other day.” John was moved to an open crib this week, which means that when Sarah visits she can pick him up whenever she wants. “Even if he’s asleep now, because he’s in the open crib, I can pick him up. It’s beautiful.”
Now that John is progressing, they are experiencing lots of tiny milestones together. “He had his second bath today. The nurses thought that he would be screaming and everything, and he loves it. John had a bath and then this little boy next to him had a bath right after. Then the other baby just started screaming.” I try to imagine this tiny baby shrieking as he touches the water, not ready yet at two months old, because really his birth date is still months away.
“He’s got all the nurses wrapped around his little fingers,” Sarah says, smiling warmly and looking past me as if she’s remembering so much more than she can tell me. “He’s got the best facial expressions. You know exactly what he’s thinking about. Which is probably not a good thing for him later on. Because I’m going to be like, ‘don’t you dare!’” She’s already planning John’s curfew.
It takes me a while to ask the most important question. I fumble over my words and the ones I eventually find make no sense at all. “So, it’s just the mother? Aside from the premature birth, it’s just the mother, right?” Sarah knows what I mean. I want to know if John is going to be okay, a question that has been consuming her for the months now. I want to know what she’s expecting when she does take him home.
“It can affect the baby,” Sarah tells me. “You know everything’s…” She trails off. “Too much blood rushing to them, or not enough blood rushing to them,” She explains. “But, I was lucky enough that John didn’t get harmed at all.” And so now, Sarah waits for her son to have birthdays past his gestational age. She waits to go home.