I remember precisely the words on the note attached to the door: “Kim is at the hospital—emergency.”
I had been hiking in the mountains a couple of hours away and returned home at about 4 p.m. to find the note. While I was gone, my wife had suddenly begun bleeding and had been rushed to the hospital by our neighbors. She already had endured three years of disappointment trying to conceive and carry a child to term. There were early miscarriages, months of hormone injections, dozens of fertility-clinic visits. Now, finally, she was four months pregnant. The thought of losing the child seemed too devastating to ponder.
By the end of the day, the doctor had determined that the baby was fine, and with a few days’ bed rest, Kim would be fine, too. Even so, it took a while for the knot in my stomach to dissolve.
Just to be safe, the doctor ordered an additional sonogram a week later, and I saw our child for the first time. He was already an energetic little sprat, doing what appeared to be back flips. I must have looked like a slack-jawed teenager meeting his favorite rock star in person—I just stood there and stared in quiet amazement. Wow. Look at that.
Nowadays, the back flips are performed on the trampoline in our backyard—the baby in the sonogram is a first grader. Someday I will show him the journal entry I wrote that day his mother went to the emergency room, a letter, really, full of yearning and hope.
I was reminded of those feelings as we developed this issue’s cover story on the neonatal intensive care unit at Lucile Packard Children’s Hospital. The elemental human drama that plays out in this place every day renders much of what happens at Stanford ordinary by comparison. And that is saying something.
Infants as much as four months premature, so tiny they would fit comfortably in a shoebox, are coaxed through treatments and risky operations that stretch credulity. Even as I read Chris Vaughan’s story, I found myself thinking, “How is this possible?” Stanford doctors and researchers, at the forefront of neonatal medicine, have helped make it possible, and Packard Children’s Hospital has become a magnet for the most difficult cases.
The next time you are thinking about how hard your job is, consider what it might be like to get up every day and repair a human heart the size of a grape. Day after day, these doctors wade into territory where only a handful have ever been, and deliver seemingly miraculous results. And always with the weight of a family’s hopes and dreams strapped to their backs.
As if the procedures themselves weren’t complicated enough, caring for severely premature infants also brings a set of ethical dilemmas. Just as the advance of medicine has defied death later in life, we must now grapple with issues such as whether to resuscitate at the beginning of life. How much intervention is too much in attempting to save these tenuous lives?
Nature does provide certain parameters. Had our son been delivered that day his mother went to the emergency room six years ago, he could not have survived. Until 22 to 23 weeks of gestation, a fetus simply isn’t viable outside the womb, and there’s nothing medicine can do to change that. But doctors have pushed the frontier right up to that doorstep.
Of course, for the parents whose own child arrives too soon, the question is not abstract. Once they have seen their child, and named it and touched it, any option other than fighting for life must surely seem unbearable. At least now there is hope.
You can reach Kevin at jkcool@stanford.edu.
