BABY GIRL | Erin George
You fit into the palm of my hand. I carry you down the stone steps while the pediatrician pumps air into your lungs, stunned by your tiny size. We lay you on a warming table and I fit a neonate mask over your face. The mask is too big for you, but it is the smallest size we have. If you were born in the United States, you could potentially be ventilated forever, a machine bringing oxygen to your body until you could breathe on your own or until someone decides it’s time to let you go. But you were born in rural Haiti, 28 weeks gestation by emergency Cesarean section in a place where mechanized ventilation is nowhere to be found. Instead, baby girl, you have me and the ill-fitting respiration bag hooked up to an oxygen tank. There is no evidence to support how long you should be hand-ventilated. An expert neonatologist interested in resource-poor settings gave us the guideline of hand-ventilating for six hours, based on the scant literature that exists about what to do for babies like you. He hopes it is enough time to give babies born prematurely a chance to breathe on their own.
So here we are, you and I, in the eight bed neonatal intensive care unit, where we have incubators but no ventilator. I have one hand on your face mask and one hand pumping the respiration bag, giving you the breaths that you are struggling to take in on your own. The quiet unnerves me after awhile. There are no other babies here today and, though I can hear the distant laughter of children playing downstairs in the courtyard, I become intensely aware of the lack of sound where we are. I want you to hear a voice so you know you are not alone. As I rhythmically squeeze the bag, I say that I know your mama is thinking of you and she wishes she could be here. I tell you stories about the children who keep walking up to the glass enclosing the room we are in to make funny faces at me. They are brave patients like you, coping with lots of different injuries and illnesses. I recount the courage of my colleagues at the hospital, all of whom worked for days on end when a flood of injured people came in from the capital, following the earthquake that struck your country. They worked without knowing the fate of their families and loved ones and then they continued working as they began to learn of their dead. Everyone lost at least someone.
After several hours, the few breaths that you had managed to take on your own stop. The pediatrician comes in to check on you and tells me you probably aren’t going to make it. For now, you are still alive and I start singing to you, song after song in a jumbled mix of genres. I want you to know that if you die, you had a team of health care providers fighting to save you. At hour six, the pediatrician comes by one last time and checks your pupils. They are fixed and dilated, and he silently shakes his head. We turn off the oxygen, remove your mask and wait to see if by some miracle you breathe. Your little body lies still while your eyes and mouth remain closed. We wrap you in a blanket and go to your mama to let her know you are at peace. As we walk up the steps I carried you down hours before, the pediatrician and I exchange the customary we-did-all-that-we-could conversation, and it’s true: we did all that we could with the resources we could access in rural Haiti. You didn’t die alone, baby girl, but your death stands testament to the immense inequity in our world.
Erin George is a Certified Nurse-Midwife at Cambridge Hospital and Birth Center in Cambridge, MA. Erin completed her midwifery training at Yale University and is also an alumna of Bryn Mawr College and MGH Institute of Health Professions. She has published on topics related to global health and health disparities within nursing texts and is currently writing a book about the personal breastfeeding experiences of health care providers.