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.
(Page 4 of 4)
Mrs. Peak spoke in a straightforward fashion, giving an impression of having unconsciously memorized and rehearsed her talk. She began by telling the girls about their neighborhood clinics, about the importance of having their babies vaccinated and of maintaining a shot record, about the hazards of becoming pregnant after the age of 35.
She showed them an anatomical chart of the vagina and the uterus, and warned them to keep their episiotomy incisions free from infection.
“There’s a culprit down below here,” she said, pointing with her ball-point pen to the chart, “which is your anus, or rectum. Everything in the barnyard is down there, and it can come up and infect your suture line.”
The nurse went on to talk about menstruation, which she said was “the weeping of a disappointed uterus,” and then began demonstrating the contraceptive devices, showing the girls how to load birth control pills into their little plastic dispensers. She held up a condom, identified it as “the oldest form of birth control known to man,” and had the girls pass it around. They handed it off to one another without looking at it as the nurse moved on to discuss the care of diaphragms.
“Wash it with soap and water, examine it in the light, powder it with Faultless Starch, and put it back into your case until you’re ready to use it again.”
One of the girls learned back against the wall and closed her eyes. She might have been thinking about her baby, about the radical course her life had taken, or for all I know she might actually have been thinking about the maintenance of diaphragms.
Mrs. Peak finished up with a little homily on how important it was for the girls to provide their own children with some form of sex education, implanting a suggestion that it was up to them to break the cycle of teenage pregnancy. They seemed in their vague way to accept her advice, to agree that their situation was a matter of real concern. When she asked for questions, they had none, so she began putting her birth control samples back into their carrying case. The girls sat there for a while after she left, looking dreamy, shell-shocked, as innocent in their way as the babies they had just brought into the world; then they stood up and walked painfully back to their rooms.
A baby born in good health at JD is moved, after its stay in the Transitional Care Nursery, to the main nursery, known as Newborn One, or to the rooming-in facilities in the old maternity wing. Those who need more attention are moved up from ICU to other nurseries known as High Risk, Low Risk—where babies born addicted to heroin are given paregoric to ease their withdrawal—and Low Birth Weight, where premature babies may spend months before they weigh enough to be discharged. Parents are encouraged to visit their babies in Low Birth Weight in order to participate in the crucial bonding that an infant requires in the first months of its life. Many parents do come in, of course, but it is not uncommon for babies to be left weeks past their release date with no word from the mother or father. Last year five or six babies were abandoned entirely.
Neonatal ICU is the crucible through which many of these babies pass in the first days and weeks after birth. I found it to be an outwardly pleasant place, housed in a spacious section of the Wallace Maternity Center, next to the delivery corridor. Inside the dozen or so incubators were wizened little human forms assaulted with IV tubes and sensors, with respirators taped into their mouths and black sleeping masks taped over their eyes. Some of them lay with their heads inside plastic oxygen domes; others had tubes running directly into the big veins in their scalps, which had been shaved to accommodate them.
One baby was larger than the others, almost full-term. He was suffering from a strep infection, from which in the past babies routinely died a few hours after birth. He had been given a drug that dilated his blood vessels, turning his skin a shade of maroon that was so bright I almost believed him to be a hallucination.
“Everybody here has a certain number of defense mechanisms for dealing with something like this,” Linda Rosen, one of the pediatric residents, told me when I asked her what working here did to her state of mind. “I may call this kid the Purple Pumpkin. Another kid had a cranial depression. Somebody called him Ashtray Head. It’s really sick, but that’s one way to deal with it.”
Rosen began to draw blood from a tiny baby that she suspected of having had a brain hemorrhage. With both hands in the incubator, pricking the baby’s foot with a needle, she reminded me of someone trying to build a ship in a bottle.
“He’s not doing much better,” she said. “He’s had some seizures and a low calcium count. I’ve had a hard time controlling that. He had some protuberance in his stomach but I think he just had a hard time with a glycerin suppository.”
I asked Rosen about the baby’s mother. She said she hadn’t been able to contact her. “She doesn’t have a phone and doesn’t speak English. The other day I got the Spanish interpreter to write a letter for me saying, ‘Your baby is ill, please come in.’ Since then he’s had a head bleed; that changes the picture some. If she doesn’t come in soon, I may have to write another letter to tell her that the baby’s dead.”
ICU is one of the places where the personnel shortage is most critical. The accepted nurse-to-patient ratio in a neonatal ICU is one to two. It is common for the ratio at JD to be one to four, with some of the nurses—hired on a short-term basis from a professional agency such as Nursefinders—having no experience in neonatal intensive care.
“One night,” a doctor told me, “we had eight kids on respirators, and we had two nurses and one medical student to deal with them. That’s it. It’s so blatantly, obviously ridiculous. You have a doctor walking lab work to the lab because there is no ward clerk to do it.”
The ICU doctors complain that the administration is not aggressive enough in trying to hire nurses, that they are out of touch with the day-to-day realities of the hospital. “I feel strongly that there could be more money available if someone cared enough to look for it,” one of them said. “If one of the county commissioners’ wives had a baby in this hospital and had to be cared for in ICU you can be sure they’d find the money someplace.”
I came in a few days later and saw that the Purple Pumpkin’s condition was even more hideous. He had been given a drug to paralyze his voluntary muscles, and he lay still on his back with his arms spread while various life-giving fluids and drugs coursed through his body. They had removed the oxygen dome and put a tube through his nose and pharynx to reach his trachea; almost every inch of his body was invaded by some sort of monitoring or supporting device.
“As sick as he is,” Todd Scharnberg, a doctor at JD on a neonatology fellowship, told me, “I think everyone around here is surprised he’s still going.”
Another baby, a girl, lay dying in an incubator that had been placed off to the side, as far away from the occasionally bustling center of the unit as possible. The baby’s parents sat there watching her, as they had done for three days now.
From the other side of the room Rosen noticed that all the instruments attached to the baby had stopped registering. She conferred with Scharnberg for a moment and then walked over to the parents, putting her hands on their shoulders, and telling them what they seemed already to know. They each nodded. The mother’s eyes were rimmed with red, but she sat there without crying as Rosen opened the door of the warmer and began pulling all the tubes from the baby’s veins. She cleaned the body off, washing the dried blood from the scalp where the IV tubes had been implanted, wrapped the baby up in a blanket, and turned off the light in the incubator.
The Purple Pumpkin lived for one more day.
Out in the hall nurses were shuttling babies around from nursery to nursery in little crib-carts covered with pink or blue blankets. I followed one of them down to Newborn One. There were about fifty babies there, lying side by side in their clear plastic troughs, trussed into place with blankets. It was just after feeding time, and all of the babies were asleep. Suddenly one of them jerked his head upward and moved it from side to side, like an adult who awakens with alarm in some place he cannot recognize. The baby laid his head back onto the mattress but kept his eyes open. He seemed concerned, pestered by some dim memory of the sloshings and stirrings he had known inside the womb.
In the overcrowded parking lot someone had blocked my car with his, and while I waited for the driver to come back and move it, I stared at Jefferson Davis Hospital. It rose eleven stories above Buffalo Bayou, a typical municipal monument of the thirties, built in “modern American style” and meant to suggest, in the best ham-handed style of architectural correspondence, the shape of a cross.
It was, one had to admit, a grim-looking place, but the least that could be said for it was that life began there—into whatever circumstances—far more often than it ended. I thought of the baby boy I had just seen in Newborn One. Someday he would be traveling with his mother—perhaps she would still be a teenager—along Allen Parkway, and she would point casually to the hospital and say the words that would transform the building forever in his imagination. Look. That is the place where you were born.
My Library
