“We need another Ambu bag, stat!” Miles yelled at Trish.
“That’s the only one for newborns we have in the OR! I’ll go get one from the delivery room on unit 4!” She darted out of the room. Our child lay inert on the table. Catherine started mouth-to-mouth resuscitation. Miles took over chest compressions.
I was standing in the hallway just outside the OR when Trish burst through the sliding doors. Arms and legs flailing, she looked like the devil himself was chasing her. When she saw me she stopped running, said “Hi” nervously, and speed-walked over to the door to unit 4. She went in and shut the door quietly behind her. The instant it closed I could hear her sprinting down the hallway. I leaned against the wall and tried to breathe. I didn’t know what to do. Should I go inside and try to help? Would I be able to make any sort of meaningful contribution, or would I just get in the way?
Trish came thundering back. As soon as she came through the door she glanced at me furtively and slowed to a walk. She was carrying a neonatal Ambu bag. I wanted to scream, “For God’s sake, Trish, run!” When she disappeared through the operating room’s opaque sliding doors she started running again.
Roughly 20 minutes later Miles came out to see me. He looked grim. I steeled myself for the news that our child was dead.
“It’s a girl,” he said. “The cord was wrapped around her neck four times and she came out flat. Her one-minute Apgar was only one. We ventilated her and did chest compressions…”
…but she didn’t make it…
“…and she recovered.”
“What?” I couldn’t hear anything over the blood pounding in my ears.
“She’s okay, Donovan, at least for the time being.” He smiled.
“Oh, God. Thank you, Miles.”
“I’m going to transfer her to Timmins because I’m concerned she may develop delayed respiratory problems.”
“Okay.”
I went into the OR to meet my new daughter. She had beautiful brown eyes and a shock of curly black hair. Aside from her rapid respiratory rate she looked remarkably well, considering what she had just been through. Catherine and Trish let me hold her for a little while. I wanted to talk to Jan, but she was still deeply anaesthetized. I asked Trish to tell her I’d call at the first possible opportunity. After that I raced back to our house, sent the babysitter home and arranged to have a neighbour stay with Ellen and Kristen until Jan’s parents could fly in from Winnipeg. Once all of that was done I packed an overnight bag and began the long drive down highways 11 and 655 to Timmins.
I arrived at the Timmins and District Hospital to find our EMTs unloading the patient with heart block from the ambulance. He and my daughter had travelled together in the same rig. The attendants informed me they had already taken my daughter to the neonatal unit. When I got there a pediatrician named Dr. Inman was examining her. Her breathing seemed to be more laboured than it had been earlier, but it was hard for me to be sure – it’s difficult to maintain any semblance of objectivity when the patient in question is your own child. When he completed his evaluation he told me she was stable for the time being, but that he intended to keep a close eye on her over the next several hours. He felt that due to the asphyxia and meconium it was possible her respiratory status could worsen, and if that occurred she might require intubation. The word intubation made me wince – I had visions of barotrauma, collapsed lungs, chest tubes, chronic pulmonary disease… . He patted my shoulder.
“Try not to worry,” he said. “She looks like a fighter. I think she’ll do all right.”
I had planned to rent a room at a nearby hotel, but the pediatrics staff kindly arranged for me to use one of the hospital on-call rooms. I telephoned Jan to let her know what was happening. She described how awful it had been waking up after the C-section to find the baby and me both gone. I tried to reassure her and promised I’d call back soon. After that I went to bed. It took a long time for me to fall asleep. A few minutes later the telephone rang. It was Dr. Inman.
“You’d better come back to the unit. Your daughter’s getting worse. I think we’re going to have to intubate her.”
“I’ll be right there.”
I hung up the phone and cried.
She looked ghastly. Her respiratory rate was well over 70, and her chest and abdomen heaved with each breath. Despite maximal supplemental oxygen her blood oxygen saturations (sats) were only in the low 80s. Dr. Inman explained that although it still wasn’t clear whether the problem was transient tachypnea of the newborn, respiratory distress syndrome or meconium aspiration, if she wasn’t put on a ventilator soon she’d tire out and stop breathing. I gave my consent for the procedure and left the room. I wanted to stay with her, but I couldn’t bear to witness my own child being intubated.
When I returned the tube was in place and a respiratory therapist was bagging her. Her oxygen sats had climbed to 90 percent and her colour was better.
“The procedure went well,” Dr. Inman said. “Right now she’s heavily sedated. You’d better go get some sleep. You have a long day ahead of you tomorrow – we’ll be flying her down to the neonatal ICU at McMaster first thing in the morning.”
The Medevac jet arrived at 10:00 a.m. The transfer team consisted of two NICU nurses. Like everyone else who had treated our daughter (now named Alanna) thus far, they were real pros – meticulous, skillful, and caring. They reviewed the entire case, examined her thoroughly, started two more IVs and switched her over to their own infusion pumps. After communicating with their base neonatologist they adjusted some of her medications. They then detached her from the hospital ventilator, put her in their specialized transfer isolette and reconnected her to a portable ventilator. Once all that was finished they pulled out a Polaroid camera, snapped a picture of her and handed it to me. I thanked them and put it in my knapsack. I later found out that in cases where critically ill infants die shortly after Medevac, oftentimes the pre-transfer snapshot is the only photograph the parents have of their baby taken while the child was alive. I asked the team how I’d find McMaster Children’s Hospital when I got to Hamilton. They said as long as there were no other patients requiring air ambulance evacuation they’d make room for me on the jet. I could hardly express my gratitude. An hour later we were in the air.
A ground ambulance met us at the airport in Hamilton and drove us to the hospital. Alanna had held her own during the transfer. It was beginning to look like she might survive this ordeal. As we navigated the hospital corridors on our way to the NICU, thoughts I had been keeping tightly caged broke free: Did she go too long without oxygen? Was she brain-damaged? Would she develop cerebral palsy or be profoundly handicapped? The uncertainty was maddening.
The NICU was a brightly lit sea of chaos. Each isolette was like a life raft bobbing in the turbulence. Some of the infants within the isolettes weren’t much bigger than the palm of my hand. It was hard not to stare. I tried to stay out of the way as the transfer team got Alanna settled in. Once the changeover was complete I had a brief meeting with the attending neonatologist. He said he planned to keep Alanna on her existing ventilator settings for the rest of the day. If she remained stable, they would start trying to wean her off in the morning. He asked me where I’d be staying in Hamilton. I had no clue. He gave me the phone number and address of a nearby Ronald McDonald house. I called them and secured a room. I then pulled up a seat and spent the rest of the day watching my daughter’s fragile little chest rise and fall in synch with the mechanical bellows.
To everyone’s surprise, Alanna tolerated weaning exceptionally well. After two days of respiratory support she graduated to breathing on her own. Shortly after she was liberated from the ventilator her nurse wrapped her in a warm blanket and let her sit with me in a rocking chair. It was wonderful. I wanted to cradle her in my arms forever.
That afternoon I asked the neonatologist if he had any idea how she was doing cognitively. He said it was difficult to predict such things this early in the recovery phase, but that NICU infants who were able to breastfeed successfully had a significantly higher likelihood of being neurologically intact. He recommended Jan be brought to Hamilton to bond with Alanna and initiate breastfeeding. I spoke to Miles about it. He worked some phone magic, and two days later Jan was admitted to one of McMaster’s postpartum wards.