Small Great Things Read online

  Sweeties are a little bit of sugar water, rubbed on the babies' gums to soothe and distract them from the discomfort. I would have given the baby sweeties before a circ, if I were his nurse.

  "I'm not taking care of this patient anymore," I say stiffly.

  Dr. Atkins raises a brow and opens the patient file. I see the Post-it note, and as she reads it, an uncomfortable silence swells, sucking up all the air in the room.

  Corinne clears her throat. "I gave him sweeties about five minutes ago."

  "Great," Dr. Atkins says. "Then let's get started."

  I stand for a moment, watching as Corinne unwraps the baby and prepares him for this routine procedure. Dr. Atkins turns to me. There's sympathy in her eyes, and that's the last thing I want to see. I don't need pity just because of a stupid decision Marie made. I don't need pity because of the color of my skin.

  So I make a joke of it. "Maybe while you're at it," I suggest, "you can sterilize him."

  --

  THERE ARE FEW things scarier than a stat C-section. The air becomes electric once the doctor makes that call, and conversation becomes parsed and vital: I've got the IV; can you get the bed? Someone grab the med box and book the case. You tell the patient that something is wrong, and that we have to move fast. A page gets sent from the hospital operator to anyone on the team who's outside the building, while you and the charge nurse take the patient to the OR. While the charge nurse rips the instruments from their sterilized paper bag and turns on the anesthesia equipment, you get the patient onto the table, prep the belly, get the drapes up and ready. The minute the doctor and the anesthesiologist run through the door, the cut is made, the baby's out. It takes less than twenty minutes. At big hospitals, like Yale-New Haven, they can do it in seven.

  Twenty minutes after Davis Bauer has his circumcision, another of Corinne's patients has her water break. A loop of umbilical cord spools out between her legs, and Corinne is paged from the nursery, an emergency. "Monitor the baby for me," she says, as she rushes into the woman's room. A moment later I see Marie at the head of the patient's bed, wheeling it with an orderly into the elevator. Corinne is crouched on the bed between the patient's legs, her gloved hand in the shadows, trying to keep the umbilical cord inside.

  Monitor the baby for me. She means that she wants me to watch over Davis Bauer. It is protocol that a circumcised baby has to be checked routinely to make sure that he's not bleeding. With both Marie and Corinne in the thick of a stat C-section, there is literally no one else to do it.

  I step into the nursery, where Davis is sleeping off the morning trauma.

  It will only be twenty minutes till Corinne comes back, I tell myself, or until Marie relieves me.

  I fold my arms and stare down at the newborn. Babies are such blank slates. They don't come into this world with the assumptions their parents have made, or the promises their church will give, or the ability to sort people into groups they like and don't like. They don't come into this world with anything, really, except a need for comfort. And they will take it from anyone, without judging the giver.

  I wonder how long it takes before the polish given by nature gets worn off by nurture.

  When I look down at the bassinet again, Davis Bauer has stopped breathing.

  I lean closer, certain that I'm just missing the rise and fall of his tiny chest. But from this angle, I can see how his skin is tinged blue.

  Immediately I reach for him, pressing my stethoscope against his heart, tapping his heels, unwrapping his swaddling blanket. Lots of babies have sleep apnea, but if you move them around a bit, change the position from the back to the belly or the side, respiration begins again automatically.

  Then my head catches up to my hands: No African American personnel to care for this patient.

  Glancing over my shoulder at the door of the nursery, I angle my body so that if someone were to come inside, they'd only see my back. They wouldn't see what I'm doing.

  Is stimulating the baby the same as resuscitating him? Is touching the baby technically caring for him?

  Could I lose my job over this?

  Does it matter if I'm splitting hairs?

  Does anything matter if this baby starts breathing again?

  My thoughts whip quickly into a hurricane: it has to be a respiratory arrest; newborns never have cardiac events. A baby might not breathe for three to four minutes, and still have a heart rate of 100, because its normal heart rate is 150...which means even if blood isn't reaching the brain, it's perfusing the rest of the body and as soon as you can get the baby oxygenated that heart rate will come up. For this reason, it's less important to do chest compressions on an infant than to breathe for them. In this, it's the opposite of the way you'd care for an adult patient.

  But even when I shove aside my doubts and try everything short of medical interaction, he doesn't resume breathing. Normally, I'd grab a pulse ox probe to get a monitor on his oxygenation and heart rate. I'd find an oxygen mask. I'd make calls.

  What am I supposed to do?

  What am I not supposed to do?

  Any moment now, Corinne or Marie might walk into the nursery. They'd see me interfering with this infant, and then what?

  Sweat runs down my spine as I hastily wrap the baby up in his swaddling blanket again. I stare at his tiny body. My pulse throbs in my eardrums, a metronome of failure.

  I'm not sure if three minutes have passed, or only thirty seconds, when I hear Marie's voice behind me. "Ruth," she says, "what are you doing?"

  "Nothing," I respond, paralyzed. "I'm doing nothing."

  She looks over my shoulder, sees the blue skin of the baby's cheek, and for a hot beat meets my gaze. "Get me an Ambu bag," Marie orders. She unwraps the baby, taps his little feet, turns him over.

  Does exactly what I did.

  Marie fits the pediatric face mask over Davis's nose and mouth and starts to squeeze the bag, inflating his lungs. "Call the code..."

  I follow her order; dial 1500 into the nursery phone. "Code blue in the neonatal nursery," I say, and I imagine the team being pulled from their regular jobs in the hospital--an anesthesiologist, an intensive care nurse, a recording nurse, a nursing assistant from a different floor. And Dr. Atkins, the pediatrician who saw this baby only minutes ago.

  "Start compressions," Marie tells me.

  This time I don't waver. With two fingers, I push down on the baby's chest, two hundred compressions per minute. As the crash cart is jostled into the nursery, I reach with my spare hand for the leads and affix the electrodes to the baby so that we can see the results of my efforts on the cardiac monitor. Suddenly the tiny nursery is jammed with people, all jockeying for a spot in front of a patient who is only nineteen inches long. "I'm trying to intubate here," the anesthesiologist yells at an ICU nurse who's attempting to find a scalp vein.

  "Well, I can't get an antecubital line," she argues.

  "I'm in," the anesthesiologist says, and he falls back to let the nurse have better access. She prods, and I push harder with my fingers, hoping to make a vein--any vein--stand out in stark relief.

  The anesthesiologist stares at the monitor. "Stop compressions," he calls, and I raise my hands like I've been caught in the middle of a crime.

  We all look at the screen, but the baby's rhythm is 80.

  "Compressions aren't effective," he says, so I press down harder on the rib cage. It's such a fine line. There are no abdominal muscles protecting the organs beneath that little pouch of belly; bear down a bit too much or a tad off center and I might rupture the infant's liver.

  "The baby isn't pinking," Marie says. "Is the oxygen even on?"

  "Can someone get blood gases?" the anesthesiologist asks, his question tangling with hers over the baby's body.

  The ICU nurse reaches into baby's groin for a pulse, trying to stick the femoral artery for a blood sample to see if the baby's acidotic. A runner--another member of the code team--rushes the vial off to the lab. But by the time we get the results in a half h