With tender memory of Megan-
The operating room was very cold, as usual. All the more important to have the radiant warmer ready and waiting; humming quietly in the heating mode. I was “gowned and gloved,” holding pastel colored, sterile blankets just below the heat source. Warmth, it’s easy to take for granted when your body is wrapped in all the right places with adipose tissue; vital organs protected and sheltered from the environment. Premature infants lack that important physical characteristic. The radiant warmth helps to minimize the impact of the temperature change from the mother’s insulating body to the relatively harsh climate of the room. The resuscitation team waited patiently for the scrub nurse to call out the time of the initial incision, knowing that in minutes, our expertise would be needed.
It is always a miracle; the birth of a child. I witnessed many such occasions and every single one was just that, a moment of pause and utter amazement. I watched expectantly as the surgeon reached gently into the surgical opening he had created moments before and brought forth a tiny baby girl, twin “A.” He stepped deftly around the operating room table while maintaining the sterile field and placed the limp infant quickly into my outstretched arms.
After receiving the delicate being with profound awe, I focused my attention on assessing her adaptation to the new surroundings. The first few minutes of life are critical as the newborn’s body, now beyond the protective boundaries of the uterus, establishes its new respiratory and circulatory patterns. The uterus is the perfect incubator for the developing newborn but there are times when the intricate process fails. At those times, mother and/or child are at great risk for morbidity, even mortality, without specialized medical intervention. That was the circumstance on the day of Megan’s birth.
Within moments, twin “B”, Sarah arrived and was placed in the competent care of a duplicate team. At 24 and 4/7 weeks gestation, the girls, respectively, weighed 1 lb. 3 ozs. and 1 lb. 9 ozs. Premature infants are tiny in stature but their meek size does not justly reflect their enormous spirits, their vitality. Individual personalities show themselves at even this early age.
My initial assessment took only seconds. Megan appeared quite frail, pale in coloring with weak muscle tone. Her skin had a pearly translucence. I don’t remember hearing a cry. Her respiratory effort was minimal and her heart rate half-committed to the exercise necessary for the transition to extra uterine life. I was not flustered as I gently but briskly stimulated her tiny torso, arms and legs, and so delicately her head, with the rubbing motion of my skilled hands, drying her little body at the same time. I counted her fingers and toes along the way while gauging her response to my touches. Her beautiful eyes, small beads of blue, too young in maturity to focus clearly, captured me with their innocence.
After a bit of coaxing with positive pressure breaths and supplemental oxygen, Megan “pinked
up.” Did I hear a delicate voice? Perhaps. Megan’s heart rate stabilized with more consistent
breathing and her ability to do some of the work herself. We had arrived at the desired
outcome of the initial resuscitation efforts. A few pint-sized karate kicks and pretend ball tosses
reassured me that Megan was holding her own for the moment, at least.
The team agreed that it was time to transfer Megan to the Newborn Intensive Care Unit. I swaddled her securely and placed her into the waiting mobile incubator. As we prepared to exit the operating room suite, my attention was drawn to Megan’s parents, both anxiously looking our way. Her mom was awake but drowsy with the effects of medication and her dad stared,
fixed on a stool close by his wife, now the mother of his two precious daughters. He wore an expression of helplessness. We had only briefly met but I felt an incredible closeness with them. Megan’s parents glanced longingly at their newborn through the window of the incubator. I tried to comfort them, assuage their fears, explaining that I would be by Megan’s side throughout the day. We would talk more soon.
I never left Megan’s side in the hours that followed. There was a constant flurry of activity around her bedside, though the finer details are now clouded in my memory. Doctors, respiratory therapists, and additional nurses joined my vigil. The air of commotion never lifted as the team supported Megan’s premature body’s valiant but gradually failing attempts to adjust to this new environment. My touch had to communicate what Megan could not understand in my voice. My hands caressed her sides as I tried desperately to shield her, protect her, from the onslaught of necessary medical interventions poised at saving her life. “I am here for you, my precious, I am here for you.” I nested her delicate body in soft blankets, supporting her fragile limbs.
Megan was connected to numerous monitors and lifelines of intravenous fluids. A respirator
stationed by the bedside offered mechanical breaths via a tube secured in her mouth. Megan
was now too weak to breathe for herself. Her lung tissue was very thin. It became impossible to
keep her blood optimally oxygenated without causing small leaks in her lungs’ air sacs. Two
small chest tubes had already been placed in an attempt to maintain the integrity of her lungs.
The most recent x-ray revealed a third leak.
Time stopped for all of us as we surveyed the chest x-ray. My heart sank heavily.
There are occasions when medical interventions are in themselves an assault on the person they are intended to help, fiercer than the alternatives. They do more harm than good; create agony. Together, the care team recognized the inevitable. It was time to accept the limitations of men and their medical technology. Time to let Megan die with dignity after her brave battle to survive.
Quiet came to Megan’s world as one by one, the machines were turned off, the tubes gently removed, the lights dimmed and the curtains drawn. I swaddled her as I had earlier, in warm blankets. She was a feather in my arms as I closely held her to me and again whispered, “I am here for you.” I gazed at her lovingly as she peacefully drifted away but not before she said
tenderly, with her angelic eyes, “And I am here for you.”
Megan’s earthly life was six hours long. She touched many hearts in her brief lifetime. Her life,
though short, was incredibly meaningful. She taught me more about courage, respect,
acceptance, and living a graceful life than I had learned in 50 years on my own. We all need one
Sarah remained hospitalized for 6 months before being discharged to home with mom and
dad. I enjoyed many hours caring for her during that time. She is now a first-grader and running
cross country. I am honored to have a beautiful friendship with this family.