Divine Secrets of the Yo-Yo Sisterhood

One woman's journey through motherhood, volunteerism, and life with the nurses in neonatal intensive care.

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.

I first saw such a unit while strolling my son through the intensive care corridor one night when he was about three months old. From the doorway, the nurses gave me a lesson in the massive system, which spans about four feet and takes up two bed spaces. One nurse attends the patient. Another nurse, who must undergo specialized and continuous training, manages the cart, which consists of the pump, monitoring equipment, warming device, and battery backup. It is difficult to see the baby, who must lie higher than the cart, through the maze of technology. The tubes are most noticeable, passively draining the baby’s blood through gravity into the unit’s pump where it is cleaned, oxygenated, and then returned. Carolyn Lund, clinical nurse specialist and unit coordinator, says the unit’s survival rate for newborns using this technology is 95 percent. When I was a mom, it was heart-wrenching to see another family’s baby relying on this treatment. Now, as a volunteer, I find it uplifting to hold and play with the same patient months down the road.

Max was born in May 1995 with a rare but reparable birth defect known as esophageal atresia and tracheoesophageal fistula. In lay terms, his esophagus was in two parts; one came up from his stomach, the other stretched eleven centimeters down from his throat. But in between, food and saliva had nowhere to go. As such, he required intensive care to suction his secretions and manage his heart rate, which was abnormally low due to stimulus of one of his cranial nerves. In other words, keeping his airway open was the name of the game. In addition, he was born with a benign extra set of ribs, part of a cluster of anomalies that can coincide with his condition. His pediatric surgeon, Dr. Steven Yedlin, placed a feeding tube in Max’s stomach when he was two days old, and opted to repair the esophagus when Max reached eleven pounds. A social worker provided my husband, Mark, and me with parking passes and laminated badges with our names on them. We were in for the long haul.

In our first months at Children’s, we were stunned by the level of noise and activity in Room C. The unit can support 52 babies, though it can fluctuate from 28 to 48 any given week. When it comes to sick and dying babies, there is no predictability, a condition that is stressful on the staff. For a parent, it is unsettling to come in one day and find a neighboring baby gone. It might have been moved to another spot, or sent home or to another facility. Or it could have died. There is very little about intensive care that is static.

When the census is up, as it was in 1995 when Max was there, the room feels overly crowded. The babies are often spaced only three feet apart, leaving barely enough room for a rocking chair. Small built-in desks with two drawers for patients’ belongings separate each spot. However, the nurses typically do the patients’ paperwork there, directly behind a rocking parent and baby. There’s a steady flow of neonatologists, residents, and specialists who lean over the rocker, above the nurse’s desk — and your head — for the hardbound chart high on the cluttered shelf. Phones ring and intercoms buzz. Feeding pumps frequently beep when the lines are occluded, and ventilators shriek to signal a problem. It was as if we had nested in an aviary of insane mechanical birds. I often felt overwhelmed by the noise and persistent activity. There is no privacy in intensive care. I learned from watching others that when I was at the end of my rope and just could not hold it in any longer, the thing to do was turn the large rocker toward the desk and cry. It was the universal symbol for “do not enter.”

In our three months as intensive-care parents, I met only two nurses who skewed the curve on the unflagging kindness and dedication these women habitually possess. One nurse came on after the 3 p.m. shift change, avoided saying hello, and left Mark and me to watch our son wallowing in his saliva. His surgeon had ordered suctioning “as needed” in place of a continuous catheter down his throat, which meant Max’s spit often pooled and foamed out of his mouth, a frightening and unpleasant sight. The nurse then walked across the room and spent the next half-hour on the telephone, home schooling her children, I later learned. She stared at us from across the room until we went home three hours later.

Still another nurse came on at 3:30 one day and, without introducing herself, turned to me as I held Max and asked, “When is Dr. Yedlin going to repair him?” The nurses often asked me this question, as if I were hardwired to our surgeon’s brain. While the question itself could have easily frustrated me, it was more the coldness in this nurse’s presentation that alarmed me. “When he is eleven pounds,” I answered. She then pulled out her pocket calculator, turned her back to me, and worked the numbers. She factored in his body weight and the amount of calories per ounce he was tolerating and swirled around with an answer.

“He will do the surgery in November,” she stated emphatically. This was late May, the Friday of Memorial Day weekend. According to this nurse’s unsolicited opinion, we had six more months of Max being suctioned incessantly and stuck in that glaring, cacophonous, crowded room. She put her calculator in her pocket and walked away without saying another word. I have never understood what possessed this nurse to treat a parent that way. Carolyn Lund, the nurse overseeing our case, was gone until Monday. My husband was in London finishing work on a project. Dr. Yedlin was unreachable. And I didn’t know the on-call surgeon well enough to express my anxiety. So I went home and threw up.

But those two nurses were the exceptions. The rule was that in our three months in intensive care, about ten of the most extraordinary women I’ve ever known signed on to be Max’s primary nurses. That means they were assigned to him each time they reported to work and, more importantly, knew his care and needs intimately.

Max’s nurses routinely gave me fascinating lectures on the compilation of Hyperal, the fluid containing fats, proteins, and sugars that provided his total nutrition in the early weeks. One day as I rocked Max, nurse Jill Pomnichowski gave me a lesson on the twelve cranial nerves so that I could better understand how they affected Max. In the years that followed, I would attend Jill’s wedding and the first baby shower for Max’s lead primary nurse, Cathy Wong. Jill broke the news to me when one of my favorite nurses, Cheryl Osborne, died. It was Cheryl who refused to let me leave one night tortured from watching Max writhe in pain. I did not know it at the time, but she had battled breast cancer for eleven years and was then grappling with a new diagnosis of multiple sclerosis.

“We don’t believe in pain,” she said, pushing morphine and lorazepam into the catheter in Max’s scalp. She let me go home in peace, a professional and gracious act of compassion I will never forget.

It was the small gestures and the greater ones that lead me to eventually dub these nurses the “Yo-Yo Sisterhood.” Like Rebecca Wells’ popular 1996 novel about a group of women who support one another through difficult times, their bonds are obvious in their conversations and interactions. A nurse will usually anticipate when a colleague needs assistance before she even asks. Everyone, it seems, reaches out physically and emotionally to help the others. The nurses carpool and celebrate special occasions. They appear inextricably bound together, no doubt through the uniqueness of the patients they treat. And from time to time, when they encounter a needy, anxious mother, their energy, coiled like a yo-yo on a string, forces them outward. Most nurses will agree that there is probably nothing worse than a hospitalized baby.

“I always try to put myself in their position,” says nurse Giselle Wardaugh. “Not everybody copes in the same way, and I don’t take it personally when they act out or when they are angry with me. I know it’s a projection of their own frustrations.”

The nurses are affectionate with the babies and used to dealing with crying. They are human too, though, and it is difficult for even the best nurses to concentrate when a baby is screaming, such as the one I am holding now. Nurse Susan Marlow has her hands full with her primary patient, a terminal baby who is quiet, but labor-intensive. Suse, as she is affectionately called, does not want me to put down Nathaniel, her other patient, who is hungry and fussing the day before his intestinal surgery. She facetiously promises to massage or even wash my feet as long as I keep holding Nathaniel. The nurses often thank me for holding inconsolable babies. I remind them it is my job; this is what I am there for. I view the volunteering as a privilege because it allows me to return some of the kindness the nurses showed me during our previous relationship. Perhaps it is due to my “time served” that the nurses often ask more of me than just holding their patients. I am happy to oblige.

Suse is trying to pass a naso-gastric feeding tube up the nose and down the throat of a beautiful baby girl who is just old enough to fight back with clenched fists.

“Come over here, hold her arms, and don’t speak,” Suse orders me. She is a tall, imposing nurse, but with a nature as soft as the streaks of gray hair that frame her face. I realize we are working on the girl the nurses have dubbed “the broken baby.” A disease has made the baby’s bones so fragile they spontaneously fracture. Suse peels back the paper from the Tegaderm dressing that holds the naso-gastric tube along the baby’s face, but the tape curls up, sticking to itself and rendering it useless. Suse has not cut enough pieces. So she takes my hand and places it over the tubing, across the baby’s face to keep it in place. This means I must hold the baby’s struggling fists with only one hand.

“What if I break her arms like this?” I ask, as Suse cuts two more sections.

“You won’t,” Suse says confidently. The baby and I must trust this veteran nurse. The tube is finally taped into place and the baby has worn herself out screaming.

“You are part of this team,” Suse tells me as I swaddle the baby and she sorts out loose plastic pieces from the blankets. I do not consider myself one of the nurses. I do not eat at their table in the cafeteria, nor do I share locker space with them. I am in an odd position as an intensive-care mom who is charting new territory as a volunteer.

“You are an important part of this team,” Suse reaffirms, as if reading the ambivalence in my face.

Edna Tso stands four-foot-ten in stocking feet, but she’ll boast an even five in her scuffed white clogs. Often she uses a stool marked “Save for Edna” in order to reach her patients if they are in a warming table that is higher than the cribs or isolettes. Edna has worked in Children’s intensive care nursery for 27 years. One day, while Max was still ventilated following his repair, Edna, standing at eye level with his body, reached over to suction the endotracheal tube that pumped air from the machine into his lungs. After three months of interference and a substantial amount of pain, Max had had enough. Despite a wooden splint holding an IV and one arterial line in place, Max lifted his left leg and kicked Edna in the cheek so hard he left a bruise on her face.

“You don’t need to see this,” she assured me, and sent me into the hallway until it was safe to return.

I always thought of Edna as a stealth nurse, the way she moved from patient to patient, silently chewing her gum and pushing up her glasses. I ashamedly recall giving her a hard time once about the temperature of Max’s bathwater. I had so little control over our lives in intensive care that insignificant moments could take on profound meaning. Edna let me have my way with the bath. At the time, I had no idea of the depth of dedication she had for her patients. Edna’s most recent primary patient, Brandon, was transported to Children’s the day after he was born. He was discharged just over a year later. Brandon suffers from a rare syndrome that included a heart defect, abdominal wall defects, and an enlarged tongue. He underwent multiple surgeries to correct the defects, as well as reduction of his tongue, which was long enough to protrude from his mouth for most of his first year, a sight some people could not get beyond at first.

Over the course of the year, Edna became so close to Brandon that, by her own admission, it became difficult for her to poke him for blood work. It became obvious she had fallen in love with him. She threw him a bonanza of a first birthday party in the nurses’ lounge, attended by nurses, volunteers, neonatologists, and his plastic surgeon; everyone who had eventually fallen for his irresistibly sweet nature. Edna even bought him an exerciser in the form of a purple sports car.

“Maybe it was a sense of protecting him because everybody came by and took a look at him and made faces, and I just felt, this poor guy, he has so many things wrong and he’s going to have a lot of problems and has a lot of obstacles to pass, so it maybe brought out a sense of protection in me, ” Edna says.

Brandon now lives in a less costly long-term recovery center south of San Jose. In his first two weeks there, Edna drove 43 miles, each way, from her home in the East Bay on every one of her days off to visit him.

“I’ve been trying to let go,” Edna tells me. “It’s easier said than done. I keep telling myself I have to learn to let go sooner or later. But I don’t want to let go totally. I feel that he’s a part of my life.”

The day of Brandon’s discharge, I helped Edna pack his books, tapes, and mounds of clothes she and his grandmother, Aureline, had purchased over the year. We left out two possible outfits for the long ambulance ride, Brandon’s first time outdoors or in a vehicle, aside from his initial transport to Children’s.

“Which one do you think he should wear?” Edna asked me. I chose the blue overalls with the tan-and-powder-blue shirt. She fretted he wouldn’t be warm enough.

“Maybe the gray baseball outfit,” Edna waffled. I realized she was caught in one of the mindless dilemmas that comprise much of motherhood.

For weeks following her first visits to the recovery center, Edna seemed distracted by Brandon’s crying and the fact that no one remembered to close his shades to the afternoon sun. She worried that the nurses weren’t reading her notes and giving him the right blanket to fall asleep with. I know the feeling of leaving your boy behind and wondering if a group of overworked nurses will remember to cuddle him when he cries. It seems I had traded places in life with Edna. I think of the yo-yo and wish that I could slide my finger through the loop on the string and pull Edna up to catch her in my hand.

I settle for telling her, from experience, that the nurses will care for her boy. She has to let go and trust. However, as we are talking, a nearby baby dies and the activity around us gains momentum. Life in the nursery goes on. Edna moves to another spot to worry about Brandon and to do paperwork on her new patient. I get out of the way and go in search of a new baby to hold.

Like a homing pigeon, I head toward a crying baby in Room B when I dovetail with Dr. Yedlin. The baby appears to scream louder as my son’s surgeon approaches, and I tease him, “They don’t cry like that when I get near them.”

“That’s because you don’t hurt them,” he jokes back. An aura surrounds pediatric surgeons whenever they enter the nursery. They either stride or step in quietly, depending on their personality. Nurses take notice right away, and patients’ parents often look up as if they sense imminent excitement. In front of a family, the nurses refer to the doctors by their last names. Alone, they use first names, as do I after all this time. Though years of training and a substantial difference in pay sets these professions apart, it seems the nurses unfairly miss out on the adulation. On July 24, 1995, Dr. Yedlin spent seven hours on his feet repairing Max’s esophagus. The fatigue that engulfed him when he came to tell us Max had survived the surgery is forever etched in my mind. Privately, I refer to him as the man who saved my boy. The nurses, though, are on the front lines 24-7. Once Max was out of the woods, we wrote Dr. Yedlin a letter expressing our gratitude, and gave him an exquisite bottle of champagne. As a volunteer, I try to find other ways to repay the nurses’ kindness.

It is easy to understand how the intensive care nursery might wear down a medical professional. Life and death run on parallel tracks. Adversity vies for top billing, although the staff is best at triumph. One day, I overhear another doctor talking to a nurse about a former patient.

“He’ll be lucky if he makes it to bag boy in Safeway someday,” the doctor says sarcastically. As the mother of a former intensive-care patient, I am horrified to hear this. A new mother is rocking her baby less than ten feet away, though I recognize her as Spanish-speaking and I can’t tell if she understood the conversation. I relate the story to a nurse who tells me, “You will hear a lot of bad things in here.”

A few years later, I can understand how the place will wear you down. I become emotional over a surgical patient who reminds me so much of Max. She was beautiful on the outside and suffered from what the surgeons call “plumbing problems” on the inside. I knew the baby’s mother was a teenager with another child already in foster care. So I found myself holding this girl more often than some of the others, heading for her crib each week to see how she was growing, putting extra blankets on her when her skin appeared mottled. I brought home her dirty laundry when it piled up. And at Halloween I bought her a pumpkin costume and her nurse unplugged the monitors so we could parade through the unit. Some nurses encouraged me to foster the baby, but I thought of Max’s ongoing physical issues, and balked at the thought of raising as second medically fragile child.

Then one day, I returned to find her gone, suddenly released into the foster care system. For a period, I regretted immensely not salvaging this baby girl’s life. Perhaps it was grandiose of me, but she had been dealt such a lousy hand, and I regretted not giving more of myself. I skipped my next shift, needing some mental space before returning to the emotional vagaries of the unit. Nurse Ardath Brandley summed it up this way: “I think working here, you learn very early how to attach and detach when the time comes. Because if you don’t, you don’t last and you go find some other job where you don’t have a long-term commitment to babies.”

It is July 1995, and Mark and I walk into Room C to see Max for the first time following his seven-hour repair. I feel someone’s arm slip around my waist and turn to see Alison Brooks, the p.m. charge nurse. She takes my left hand in hers and leads me to the warming table where two nurses are busily working over Max’s body, since the intensive care nursery serves as a recovery room for its surgical patients. Perhaps she is afraid I might faint. Max is so swollen, Mark and I struggle to recognize him. Dr. Yedlin and neonatologist Dr. Arthur D’Harlingue are to the side. I have to ask them if this is really Max. They nod affirmatively, and I am certain I will never again in my life see a baby as sick as this.

Five years later, I am making my usual rounds through the nursery, a yellow gown tossed over my shoulder, listening for a crying baby, watching for a nurse to flag me down. I come upon a newborn so swollen with fluid his skin appears waxy. Beyond the usual tubes and wires are three thick drainage tubes coming from his chest. At first, I squint through one eye to take in the devastating scene. It is customary for the nurses to explain just enough to help me understand this intense environment without violating patients’ privacy. The baby’s chest is still open because he was too engorged with fluid to close during the surgery. Vigilon, a clear plastic wrap, covers the opening while a four-by-four piece of gauze hides his beating heart. The nurse lifts it just as I move by and for the first time in my life, I see a heart beating inside a living human being.

On another occasion, I pass a very sick infant whose abdomen is open following surgery. A large plastic port, whose door opens much like a window on a ship, covers the wound. The nurse is cleaning around his intestines, underneath layers of muscle tissue. The nurse asks whether I am all right. Surprisingly, I am, though fascinated by how these women cope with such suffering year after year, decade after decade.

“I think there’s a real misconception that nurses become hardened towards the whole thing,” says Linda LeFrak, the clinical nurse specialist. “It’s just as tragic every time it happens, so we find different ways to cope.” Linda says nurses meet on break, in carpools, or in social situations to express their grief about some of the unique tragedies in neonatal intensive care.

“If nurses told the stories of what we see in this unit, with injuries, disease, trauma, and social ills, I mean everyone we would ever tell the story to would either faint, throw up, or cry,” Linda says. “We’ve seen that happen. So we don’t talk to our non-nurse friends about it, because it’s too traumatizing.” Linda asks who helps me with what I see. I tell her my husband will drop whatever he is doing to hug me when I cry about a baby. However, as a child, on two occasions he suffered life-threatening injuries with permanent damage, and has a limit to what he can hear. I have wonderful friends, but most of them, I sense, do not want to “go there” — not about Max then, not about my life now.

Frequently, someone will ask me how I can hold a baby knowing it is dying. I wonder how can I not? Suse Marlow has been the primary nurse for many dying babies. “Just because she’s considered terminal doesn’t mean she’s going to die right away,” she says of a recent patient, “and she needs the best care and a good quality of life while she’s here.”

That is how I viewed my seven months with Jimmy. I held him one day when he was in extraordinary pain and while the staff worked earnestly to determine the cause and manage the symptoms. I remember thinking, “Thank God it’s me and not his mother seeing this.” That was the day a doctor took me aside to affirm that Jimmy was not considered “viable” so I would not be shocked when he died. I held him often and strolled, when his health allowed, to each fish tank and giant stuffed animal in the hospital complex.

At the funeral, a group of us took turns saying our good-byes to Jimmy in his tiny white coffin. My tears splashed onto his blue-and-white plaid blanket, and as I turned away, a flash popped in my face. The family recorded the entire service in photos and on videotape. On the face of it, I was surprised. But deep down I understood their need to do so. I had compulsively recorded Max’s life in the nursery. In the end, though, I had my son. As the mother of a survivor of that unit, there are times when I grapple with one powerful question that the nurses cannot help me with. How did we get to be so lucky?Empirically, if not statistically, the Bay Area is one of the most diverse regions on earth. It is an amalgam of every religion, culture, and socio-economic strata imaginable. Children’s Hospital Oakland is a microcosm of that. The nurses in intensive care will affirm there is nothing they have not seen. There is an abundance of what they call “good families” and no shortage of lousy families or abandoned, terminal, and abused babies. There are infants whose prognoses are stellar and those who defy the odds. These nurses see every birth defect and cusp-of-life preemie imaginable. Every once in a while, however, there is a baby about whom a nurse will admit, “We have not seen something quite like that.”

I peek over the crib railing and I am not sure what I am looking at. This girl has the face of a baby but the body of an infant. She is exquisitely beautiful and I ask a nurse if I may hold her because of the sad, continuous wail she emits. The nurse decides to change her diaper first and I am stunned by how rigid the baby is. Her arms and legs are outstretched and completely unbending, like rigor mortis in a live being. Together we struggle to push the baby’s arms and legs into her sleeper. Once she is dressed, I ease her into the rocking chair with me, terrified I will drop her for lack of any kind of cuddle or grip. Her back is against my chest and I stretch my left arm across her body and grip her diapered crotch to keep her board-like body from sliding onto the floor. She is inconsolable and I must appear tentative.

“I hear she likes to have her chest thumped,” her nurse, who has turned from her other patient, tells me. I am doubtful, but I pull back my fingers and with the heel of my right hand, begin to thump. Her head is still turned to the side and her dry wail is unabated.

“Harder,” the nurse instructs me. The action feels counterintuitive, but I begin to pound the baby’s sternum as hard as seems fitting, repeatedly thumping her thin chest. She quiets down and turns her head upward to gaze at me. Her eyes rest on my gold loop earring. In the ensuing silence, the nurse enlightens me. The girl weighs now what she weighed at birth. Her family starved her for the seven months of her life. I cannot believe what I am hearing. I am torn between wanting to hold this baby closer and ripping off my badge so that I can run from the horrors of this unit, never to return.

The nurse announces she is going on break. She has worked all night and is part way through a half-double, or four hours of a day shift. She unpins the keys to the narcotics cabinet from her smock and hands them to another nurse across the room.

I detect resignation in her wake as she shuffles out of the room. Again, I find myself pondering the eternal question: what invisible motor propels these extraordinary women through the endless detritus of others’ lives?

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