The Baby Factory
At Houston’s Jeff Davis Hospital, where more than 10,000 babies are born every year, charity, idealism, and bureaucracy confront the ancient instincts of the flesh.
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The nurse told the boy he had to get a pass and pointed him down the hall, past a set of swinging doors where a nurse stood gossiping with an armed security guard. In a few minutes the boy returned with a piece of paper and held it up to the window of the Transitional Care Nursery. The nurse inside looked at it, then walked around the nursery reading the labels on the incubators and scratching her head, as if the baby had been misplaced. Finally she located it and held it up. The father looked at his son. Not knowing how to react, he simply nodded. The nurse held the baby out and mouthed a question—“Do you want to hold him?” The father could not understand her, probably could not, in his mild form of shock, have conceived of such a thing anyway. Thinking that she was asking to see his pass again, he held it up to the window for her inspection.
The boy was fairly representative of the general mood of the patients and visitors. To them JD was an acceptable place, because they did not think to ask questions or make demands. They seemed to regard its existence as unquestioningly as they regarded the phenomenon of birth itself. The hospital was there, it seemed to function, to fulfill its purpose. There was little else to be said about it.
I more or less shared that impression. Obviously there were severe problems at JD, but they were the sort of problems—too many patients, too few staff members—that one expected to find in a county hospital serving an indigent population in a region of unprecedented growth.
JD’s budget for 1979 was $17 million. “With the increase in volume we’ve had,” Lois Moore, the hospital administrator, told me, “the budget has just not been adequate to meet the needs. We budgeted for eighty per cent occupancy last year, and our occupancy has been up for several months of this year to as high as a hundred and six and a hundred and seven percent.”
I walked down the hall to the labor rooms and made the rounds with a group of residents. There were six labor rooms, with a total of seventeen beds. The women lay back warily as the doctors approached them, gripping the bed rail as the contractions came. They seemed utterly alone, bewildered. From machines next to their beds came the steady deep-ocean pinging of their babies’ hearts.
The delivery rooms were father down the hall, behind a pair of double doors that burst theatrically open whenever an emergency delivery was wheeled through them. No one was admitted back there without putting on a set of scrubs and the paper shoes and hats that one pulled out of a box that was like a giant Kleenex dispenser.
Only two of the six delivery rooms were in use, which constituted a sort of lull. But already the work was beginning to stack up in the labor rooms, where four or five women were close to delivery and four candidates for Caesarean section lay waiting.
“Yeah, we’ve got a lot of sections tonight,” an obstetrics resident named Robert Zurawin told me as he scrubbed his hands with a disposable soap-and-brush combination called E-Z-Prep. He was friendly, slightly sardonic in the accepted manner of young doctors.
“Maybe it has to do with the phases of the moon. One night, for instance, you might get nothing but ladies who are bleeding from their placentas. I remember one night we had all the chapters of the obstetrical textbook come in one right after the other.
“We see a lot of CPDs,” Zurawin went on, referring to cephalopelvic disproportion, a condition in which the mother’s pelvis is too small to accommodate her baby’s head. “You get an unbelievable number of those in Vietnamese. What happens is you have these tiny little people who are starving in Viet Nam. They come over here and start eating well, and then the first thing you know we have American babies coming out of Vietnamese bodies.”
Zurawin was originally from New York, where he had occasionally acted in amateur productions, until he realized that the life of a doctor satisfied his theatrical instincts. Like all the other residents at JD, he was on the staff of the Baylor College of Medicine, which provides doctors on a contractual basis to most of the hospitals in Houston.
For the most part, the doctors are just passing through. JD is simply another place they work on their rotation schedule. For the nurses the situation is different: the hospital is their place of employment, and fewer and fewer nurses are willing to subject themselves to it on a career basis. It is not, by any standard short of martyrdom, a pleasant place to work. “It’s a pit,” a doctor told me. “It really is disgusting. You’re in piss and shit and blood all day. You don’t have that at Methodist.”
“It looks good to have it on your résumé,” was the reason one nurse gave for working at the hospital. “People will take you more seriously when you apply for a job at a nicer hospital—it’s considered good experience to have worked here.” The experience includes a tangible racial tension heightened by the stress involved in ministering to screaming mothers, placating outraged relatives, and trying to communicate with departmental fiefdoms that are sometimes run with an obsessive devotion to protocol.
“At JD,” Lois Moore told me, “we’ve tried to remain competitive with the salaries nurses get in the Medical Center, and we have. We have ten holidays a year, excellent insurance, a fully paid pension plan. The benefits are good, the salaries are good, but when you add the stress that you have here you just get fewer takers. Maybe we could raise the salaries to such a level that they would provide a real incentive for people to work here, but we’re a tax-supported institution, and who are we to pay these high salaries when they’re not getting that in the private sector?”
A woman walked by pushing a used obstetrical tray littered with bloodstained instruments and swabs and a stainless-steel container, about the size of a cereal bowl, that held a placenta. It looked like a piece of meat someone had left out to marinate.
The lull continued for a while, then the double doors banged open and a woman was wheeled into the hall.
“I’ve got to do a forceps on her,” the doctor who was with her announced. “Her FHT has dropped to about eighty. She’s also meconium.”
What all that meant was that the fetal heart monitor had detected a sudden drop in the rate of the baby’s heartbeat. The baby had also had a bowl movement in the womb, excreting a dark greenish substance called meconium. If he drew it into his lungs with his first few breaths, it could cause pneumonia.
Seven people, including a pediatrics nurse from the Neonatal Intensive Care Unit across the hall, crowded around the mother in the delivery room. They put her feet in the stirrups and draped her body with blue surgical paper. The woman was screaming desperately, awash in the pain of childbirth. One of the doctors—an intern—began to probe with the forceps. I was surprised at what a tenacious, prying motion he used. The intern worked the forceps back and forth like a gardener trying to dig up a stubborn root.
The mother lay with her head turned to the side. “Oh God, oh God, oh Gaaawwwwed,” she shouted, panting for breath at the same time. The intern worked over her, diligently and dispassionately. It was a strange tableau of finesse and brutal pain, of abandon and precision.
The nurse from ICU stood by with a towel, ready to receive the baby before it took its first breath. She stood poised on the balls of her feet, flexing her knees. When the baby came, the doctor pulled it free like a quarterback taking a snap and handed it off to the nurse, who took off running. She tore through the swinging doors that led to ICU and placed the baby in a crib that was part of a tall bank of instruments and monitors. She inserted a clear plastic tube down its nose and, using her lips, siphoned the meconium out of its lungs.
“Life is the pits, isn’t it, honey?” she said to the baby as she withdrew the tube. They were the first words ever spoken to him. The baby calmed a bit as the nurse checked his other vital signs—his crying modulated from a high, distressed gasping to a sound that was like the baa of a lamb. As I watched, the baby’s skin changed in color from the bloodless gray of the womb to a healthy pink.
I wandered back out into the delivery corridor in time to see Zurawin beginning a Caesarean section on a girl who looked no older than fourteen but who, I learned later, was eighteen and delivering her second child. I watched through a large window in the hall as Zurawin muttered some words of comfort to the girl before the anesthesiologist put her under. While he waited for the anesthetic to take full effect, he stood over her, doing the twist and twirling his scalpel over the prepped yellow summit of her abdomen. He was two-thirds of the way through his 36-hour shift and seemed to be settling into a sustaining manic pace. When the time came to touch the surgical steel to the girl’s skin he began to recall all the random energy he had been throwing out; in an instant he was focused, concentrated.
The incision was deep and swift—from out in the hall I could hear the sound of the scalpel as it cut through the girl’s flesh—and there was an immediate welling-up of blood, enhanced by the sharp surgical lights overhead. I could not believe how simple it was. Zurawin opened up the patient’s stomach like a valise, looked inside, then reached in with both hands and lifted out a baby girl, covered in blood, taken absolutely by surprise. The baby looked alarmed and betrayed. She was small, less than five pounds, and so a nurse took her over to ICU.
“You got gypped on the groceries, didn’t you?” the nurse said to the baby as she walked down the hall.
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