As an exotic Mediterranean warmth envelops Oakland, I drive from my home in the hills to the hospital downtown consumed by one thought. I am determined to put Jimmy's sweet baby feet in the grass before he dies. His nurse in the intensive care nursery tapes two feeding pumps to the bottom of the stroller as I strap him into place. It is impossible to roll past staff or visiting parents in the hallways without them stopping to coo at this irresistible little boy.
In the courtyard of the historically preserved buildings of Children's Hospital Oakland, I wheel Jimmy down the ramp toward the oval of grass. On our way, I pull several brilliant royal-purple petals from a Tibouchina tree. Jimmy has spent little of his short hospitalized life outdoors, and the sunlight is brutal on his eyes. He shakes his head from side to side. With one hand, I shield his face and, with the other, drag the stroller up the curb and onto the grass. I spread out the blue plastic blankets, cover them with extra cloth nursery ones, and lift Jimmy as far as the plastic tubing connected to his chubby body will stretch. I form a V with my legs to hold this dear baby, who reminds me so much of my own son. I toss my ID badge over my shoulder so the metal clamp won't dig into his head.
A delightful look of surprise flushes Jimmy's face as his toes touch the dewy blades of grass for the first time. He rhythmically flaps his arms to the sides before I gently bring them together and stroke his palms with the velvet flower petals. Before wheeling him back upstairs, I gather one fresh leaf and one crackling dry one from the giant magnolia. I want him to feel as many textures as I can gather during our brief time outdoors.
A few months later, Jimmy dies on the very same day my son, Max, enters kindergarten. Jimmy was seven months old. Max is now six years old. A lifetime apart, they lived for months in the same corner spot in the intensive care nursery.
It is a Tuesday morning at the beginning of my shift, and I am standing at one of the four stainless-steel sinks in the scrub room just off the central cross-shaped hallway that comprises the intensive care nursery. A very pretty mom, whom I recognize from Room C, rolls up her sleeves and reaches for a plastic-wrapped scrub brush. Simultaneously we peel back the packaging, push the knee valves on the water panel, pump the black pedal as the soap pours from a spigot onto our sponges, and lather up to our elbows in foamy antibacterial soap. Lynnette Gomez has cascading blonde hair and perfectly applied makeup. She glances sideways at me a few times, taking in my turquoise volunteer T-shirt and hospital ID badge before saying softly, "I understand you were once a mother in here?" I detect incredulity in her question. Her twin sons, who were fourteen weeks premature, have been critically ill. It is not easy for me to synthesize my reasons for returning, so I avoid answering directly. From where she now stands, it would be difficult for her to understand.
In tandem, we glance at the clock to confirm that our required scrub time is up. We pitch our sponge brushes into a common trash can that divides the two banks of double sinks, dry our arms with paper towels, and grab yellow protective gowns from a metal baker's rack in the corner. I follow Lynnette into Room C, the largest of the nursery's five rooms, where she heads for her babies lying in separate isolettes. She lifts Diego out of his plastic cocoon and invites me to sit next to her and rock her three-pound infant. She then places Miles on her lap. We sit knee to knee so that both boys can hear her identify herself as "mommy" in a melodic voice that premature babies automatically invite.
The neonatologist in charge of their case, the clinical nurse specialist overseeing the babies, three residents, and nurse Jeanette Wallace form a semicircle around us for daily rounds. Lynnette updates them on her twins' medical status, much as I did when my son was a patient. At this moment, I am aware for the first time that I am in a unique position among the unit's twenty volunteers. I am the only one to have been an intensive-care mom, though I find it more profound to reverse the equation: I am the only intensive-care mother to have ever returned as a volunteer.
To appreciate these neonatal intensive care nurses, one must see their world. The babies who are transported here are among the most critically ill in Northern California. Children's Hospital Oakland boasts an impressive number of pediatric subspecialists. Babies with life-threatening conditions, or those requiring surgery, are brought in from a wide network of birth hospitals. Once there, every subspecialist required is called in -- I witnessed this with my own son -- and every resource is applied to save the patient's life, regardless of ability to pay. Information released by the hospital shows that in 2001, more than half of the patients at Children's were covered by Medi-Cal.
In 1995, the year my son was a patient, 571 babies were admitted to the intensive care nursery. Annual admissions peaked at approximately 600 in 1997 and 1998, then dropped last year to 437 due to local hospital mergers that increased intensive-care options elsewhere. Despite the flux, the mortality rate has remained steady for the past two decades at between eight and ten percent a year. Linda LeFrak, a clinical nurse specialist who has worked in Children's nursery for 27 years, explains, "The babies that die are either the extremely immature, like the 24- or 25-weeker, or the child with congenital anomalies that are not compatible with life. And there hasn't been a technological advance to save those babies. We don't lose babies in certain categories anymore."
Children's intensive care nursery is rated Level 3, which means, among other criteria, that it provides life support through mechanical ventilation. Unofficially, some call it a Level 4 unit because it is one of only a hundred in the country that provides the pinnacle in lifesaving technology known as extra-corporeal membrane oxygenation. That treatment provides days-long heart-lung bypass for babies suffering from a number of conditions where the vessels constrict, denying adequate blood supply to the lungs and therefore insufficient oxygen to the body.
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