Early Birds

Prologue Sam is breathing like a frog. I show my mother. I tell her, "I gave birth to a frog." She says, "They are going to be beautiful boys." And she adds, "But it's good you can say how you feel." I tell the nurse that Sam appears to be heaving more than Gus. I peek at someone else's baby in a neighboring isolette. His chest is not going from cream puff to concave each time he breathes. "They push the preemies here to see what they can handle," she says. "He's working hard, but we'll see what the doctor decides to do during rounds. He might want to put Sam back on the respirator. They have to keep testing the babies to see if they are ready to come off." My mother wheels me back to my room, and when she and Dan go down later to check on the twins they learn that Sam is indeed back on the respirator. One of his lungs has collapsed. "I knew it," I say. "I knew it. How could those nurses not have seen that something was wrong with him? Why did the doctors wait so long? They were pushing him too hard." Dan paces around my hospital room, playing with the remote. "Dr.Vanderbilt said you have to start walking," he says. I don't even try. I do not want to recover. Later that night, I am lying in my hospital bed sipping ginger ale; Dan is flipping through TV channels, when Alex, the nurse-practitioner, knocks on our door. With his gray beard and aquamarine scrubs, he resembles an elf. He says that Sam has taken a turn for the worse and we need to sign a release for a blood transfusion. Sam is in bad shape; his system has shut down. His oxygen levels are low. Alex tells us that we probably want to come downstairs. I have to keep reminding myself that Alex is not a doctor, although people make that mistake since he is the only male nurse-practitioner working in the neonatal intensive care unit. Partly because I am disoriented from painkillers, I still have no idea which turns we make to get to the patients' elevator despite having made this trip several times. Dan wheels me through the glass doors. A doctor in a white coat and several nurses hover around Sam's warming bed. They will not let us into the room. The head night nurse-practitioner steps out of the unit and steers us toward the nursing station. She has long, dark curly hair like Debra Winger in the eighties. She sits down on a desk and says, "Sam is very sick. He is not responding to our treatments. Of the forty-eight babies in the NICU tonight, I'm afraid Sam is in the worst shape.We are going to try him on an oscillator. It may be our last resort." Yesterday our nurse said we should be thankful that Sam was moved into Gus's room because it is overseen by nurse-practitioners, called NPs. Sam's old room was apparently run by residents, who were often making decisions based on a week's experience in neonatology. In contrast, most of the NPs have been working in the NICU for several years. But is the head night NP's knowledge of sick babies and last resorts even helpful? Is she employing a time-honored technique that gently forces parents to contemplate death as a possibility? Sam's CO2 level is too high, which means that although the respirator is pumping oxygen into his lungs, his body is not extracting the oxygen and releasing the carbon dioxide. The floor is silent.No one is visiting at this hour, and aside from the huddle around Sam, there are only incubators, occasional beeps coming from behind the glass wall. It is a scene from one of the science fiction movies Dan watches, miniature babies in plastic bubbles, hooked up to computer monitors, the life'sMinton, Jenny is the author of 'Early Birds ', published 2006 under ISBN 9781400043835 and ISBN 1400043832.