“It begins with the birth of a baby, though not a healthy baby. Born with holes in its brain and “showing an absence of grey/white differentiation”—as Doc put it. So bad that when the child first emerges into this world, he’s not even breathing.
“Kid’s cyanotic,” Dr. Nowell shouts and everywhere heart rates leap. The baby goes onto the Ohio, a small 2×2 foot bed, about chest high, with a heater and examination lights mounted above.
Dr. Nowell tracks the pulse on the umbilical cord while using a bulb syringe at the same time to suck out the mouth, trying to stimulate breath.
“Dry, dry, dry. Suck, suck, suck. Stim, stim, stim.”
He’s not always successful. There are times when these measures fail. This, however, is not one of those times.
Dr. Nowell’s team immediately follows up, intubating the baby and providing bag mask ventilation, all of it coming together in under a minute as they rush him into the ICU where he’s plugged into life support, in this case a Siemens Servo 300, loaded with red lights and green lights and plenty of bless and whistles.
Life it seems will continue but it’s no easy march. Monitors record EKG activity, respiratory functions, blood pressure, oxygen saturation, as well as end tidal CO2. There’s a ventilator. There are also IV pumps and miles of IV lines.
As expected, nurses, a respiratory therapist and a multitude of doctors crowd the room, all of them there simply because they are the ones able to read the situation.
The red and green lights follow the baby’s every breath. Red numbers display the exact amount of pressure needed to fill his fragile lungs. A few minutes pass and the SAT (oxygen saturation) monitor, running off the SAT probe, begins to register decline. Dr. Nowell quickly responds by turning the infant’s PEEP (Positive End Expiratory Pressure) up by 10 to compensate for the failing oxygenation, this happening while the EKG faithfully tracks every heartbeat, the curve of each P wave or in this case normal QRS, while also on the monitor, the central line and art line, drawn straight from the very source, a catheter placed in the bellybutton, records continuous blood pressure as well as blood gasses.
The mother, of course, sees none of this. She sees only her baby boy, barely breathing, his tiny fingers curled like sea shells still daring to clutch a world.
Later, Dr. Nowell and other experts will explain to her that he son has holes in his brain. He will not make it. He can only survive on machines. She will have to let him go.
But the mother resists. She sits with him all day. And then she sits with him through the night. She never sleeps. The nurses hear her whispering to him. They hear her sing to him. A second day passes. A second night. Still she doesn’t sleep, words pouring out of her, melodies caressing him, tending her little boy.
The charge nurse starts to believe they are witnessing a miracle. When her shift ends, she refuses to leave. Word spreads. More and more people start drifting by the ICU. Is this remarkable mother still awake? Is she still talking to him? What is she singing?
One doctor swears he heard her murmur “Etch a Poo air” which everyone translates quickly enough into something about an etching of Pooh Bear.
When the third day passes without the mother even closing her eyes, more than a handful of people openly suggest the baby will heal. The baby will grow up, grow old, grow wise. Attendants bring the mother food and drink. Except for a few sips of water, she touches none of it.
Soon even Dr. Nowell finds himself caught up in this whispered hysteria. He has his own family, his own children, he should go home but he can’t. Perhaps something about this scene stings his own memories. All night long he works with the other preemies, keeping a distant eye on mother and child caught in a tangle of cable and tubing, sharing a private language he can hear but never quite make out.
Finally on the morning of the fourth day, the mother rises and walks over to Dr. Nowell.
“I think it’s time to unplug him,” she says quietly, never lifting her gaze from the floor.
Dr. Nowell is completely unprepared for this and has absolutely no idea how to respond.
“Of course,” he eventually stammers.
More than the normal number of doctors and nurses assemble around the boy, and though they are careful to guard their feelings, quite a few believe this child will live.
Dr. Nowell gently explains the procedure to the mother. First he will disconnect all the nonessential IV’s and remove the nasogastric tube. Then even though her son’s brain is badly damaged, he will administer a little medicine to ensure that there is no pain. Lastly, he and his team will cap the IV, turn off the monitors, the ventilator and remove the endotracheal tube.
“We’ll leave the rest up to…” Dr. Nowell doesn’t know how to finish the sentence, so he just says, “Well.”
The mother nods and requests one more moment with her child.
“Please,” Dr. Nowell says as kindly as he can.
The staff takes a step back. The mother returns to her boy, gently drawing her fingers over the top of his head. For a moment everyone there swears she has stopped breathing, her eyes no longer blinking, focusing deeply within him. Then she leans forward and kisses him on the forehead.
“You can go now,” she say tenderly.
And right before everyone’s eyes, long before Dr. Nowell or anyone else can turn a dial or touch a switch, the EKG flat lines. Asystole.
The child is gone.”
–A passage from Danielewski’s “House of Leaves