August 25, 2019, 2:38

Julius: The Story of a Premature Birth

Julius: The Story of a Premature Birth

The first hint that something was going wrong with Zoraida’s pregnancy came on the morning of Thursday, May 20, 2004. I got out of bed early to attend to our eighteen-month-old son, Marcus, who had woken up coughing. A few minutes later, Zoraida emerged from our bedroom. “I’m soaked,” she said, clutching at her pajamas. She called her obstetrician, and I got Marcus, who was still coughing, ready to see the pediatrician. At the time, we were both more concerned about Marcus’s condition than Zoraida’s. She’d just had her five-month checkup, at which she’d been told that everything was fine. We even had a series of smudgy gray closeups of Julius’s head and organs, like photographs of a poltergeist, to prove it. Marcus, on the other hand, had suffered from asthma symptoms for much of April, and the heavy spring pollen was giving him trouble. We hailed a cab and stopped first at NewYork-Presbyterian Morgan Stanley Children’s Hospital, where Zoraida had been instructed to go. Then Marcus and I went on to the pediatrician’s office, on the East Side.

Marcus’s ears and lungs were clear, and he was having no difficulty breathing. It was a cold; that was all. The pediatrician gave us a sample of Benadryl and sent us home. However, back at our apartment, in Inwood, there was a voice message from Zoraida telling me to come to the triage area of the Children’s Hospital. “It’s not good news,” she said. “The doctor will explain.” I feared that Zoraida would have to spend the next three months on bed rest. Marcus and I went back downstairs and took our second cab ride to the hospital.

NewYork-Presbyterian is like a city within a city. It occupies a half-dozen blocks around Broadway and Fort Washington Avenue, south of the George Washington Bridge. The streets are full of doctors, medical students, nurses, and E.M.S. workers. The Children’s Hospital, where Zoraida was waiting for me, sits on the corner of 165th Street and Broadway. It is a new building, made of sand-colored stone and shimmering glass. That morning, the ground-floor atrium was hosting a health fair for kids. Flocks of grade-schoolers were being shepherded into the building to join the carnival of noise in the atrium. Marcus and I made our way through the din to the main desk, where I was informed that I could not proceed with a toddler. That was a blow. Why wouldn’t they let Marcus in? Then I remembered the word “triage” in Zoraida’s message. Emergency rooms were no place for children. They were also no place for pregnant women who were doing just fine.

I called Zoraida’s sister, Wilma, who lived nearby, to see if she could look after Marcus, who, by then, had succumbed to the Benadryl and was asleep in his stroller. I told Wilma to meet me at Coogan’s, an Irish saloon on Broadway and 169th Street. While Marcus dozed, I sat at the bar, sipped a pint of Guinness, and ate a sandwich. The place had just opened and, except for the bartender, I was alone with my thoughts. I tried to prepare myself for the worst. I actually said that to myself: “Be prepared for the worst.” But what did that mean? That we’d lose the baby? As long as my sister-in-law didn’t show up, I wouldn’t have to find out.

Eventually, Wilma came to collect Marcus, and I walked back to the hospital and went up to the tenth floor. There I was directed to a wide, windowless door that led to the triage ward, a clean, quiet corridor with a nurse’s station at the end. A nurse looked up from her computer screen and directed me to one of the half-open doors. Behind the door was a sun-filled room where my wife was sitting up in bed.

“I’m three centimetres dilated,” she said. Her face contorted as she tried not to cry. “He’s coming out. I’m sorry, Jon. There’s nothing we can do.”

She explained, and then the obstetrician came in and explained it again. Zoraida’s cervix had started to open. Now that it had begun dilating, there was no going back. The amniotic sac had been exposed, and there was a serious risk of infection to the mother and the fetus. Julius was too premature to survive outside the womb.

For some time, I sat on the bed, holding my wife and absorbing the news. Ridiculously, a scene from the movie “Titanic,” which had been released during our first year together, and which Zoraida had only gone to see with me against her will, kept replaying in my mind. Late in the movie, after the ship has struck the iceberg, Kate Winslet encounters the Titanic’s designer on the stairs. He looks at her and says, “In an hour or so, all this will be at the bottom of the Atlantic.” I started weeping.

The obstetrician returned some time later to explain our options. Each was worse than the one before. The first option was to wait, to see if Julius might stay inside Zoraida until he reached a more viable age. He was twenty-two weeks and three days old. At that time, the earliest a premature baby could be born with some expectation of survival was twenty-four weeks. Even then, Julius’s chances would be slim, and there was the likelihood of severe brain damage. It wasn’t until twenty-six weeks that a premature child might be expected to live with a good chance of normal development. We’d fallen a month short. The doctor cautioned us again that waiting might result in infection to the mother and the child, and, given that Zoraida was three centimetres dilated, the possibility that we would make it through the weekend—never mind the next eleven days—was small, indeed.

The second option was not to wait but to induce labor. Zoraida would deliver Julius with the knowledge that he likely wouldn’t survive.

The third option was a late, second-trimester abortion. The doctor, sensing our mood, did not give us a description of this procedure. We questioned her at length about the details of the first two options. She answered every question and then left us, saying we could take as long as we needed. We could stay in the hospital overnight if we didn’t want to decide until the morning.

We agreed, without much discussion, that the only course of action we wanted was to induce labor. “You know what’s killing me?” Zoraida said, touching her belly. “As long as he’s in here, he’s safe. Why can’t he just stay in there?”

When informed of our decision, the obstetrician said that she would need to speak to hospital administrators to be sure that this would not pose a problem. Our son was on the cusp of being viable outside the womb. If he came out breathing, would the hospital be compelled to attempt to resuscitate him when he died? An hour later, the obstetrician returned. “I’ve spoken to just about everyone in this building,” she said. “Your decision is fine.” She told us that we would be taken to a delivery room and that Zoraida would be given a drug to accelerate labor.

It was late afternoon. I went downstairs to get something to eat and to make some calls to our families. Then I went back up. Zoraida’s delivery room was like the studio apartment that everyone in New York dreams of having: high ceilings, honey-colored wood flooring, and a wide picture window overlooking Washington Heights, the Hudson River, and the midtown skyline.

Our decision made, we entered a brief state of blissful denial. We were feeling relieved about having made this terrible bargain, without yet having to face the consequences. It still seemed, somehow, that everything might be all right. There was time yet for a miracle. Perhaps Julius was more advanced than we thought. Perhaps he would survive and thrive, against all odds. We did not speak these thoughts, but, as I sat beside my wife on the bed, we talked, even making a few jokes. It was during these moments that Zoraida and I placed our hands on her belly and felt Julius kick for the last time.

A nurse came in and talked to us about what to expect. She told us what the baby would look like at this age, warned us that his eyes would be closed and that he might not take a breath. She asked us what we wanted to do with the body. She took our address and other information and then left us alone. Beyond the window, the sun was setting, and the lights of the city were coming on.

And so we waited for the drugs to take effect, waited for the contractions to begin. Perhaps the most disquieting part of the experience was that it was exactly like Marcus’s delivery, except that we knew from the start that Julius would not survive. I held my wife’s hand, held her leg, told her to breathe. I told her she was doing great, because she was doing great. She was being incredibly brave. I watched the monitor and called out the contractions as they began and faded. The only difference was that, during Marcus’s birth, the amplified heartbeat was with us through the entire labor, a goad, and solace. This time, we could not hear the fetal heartbeat.

I kept coaching Zoraida through the contractions, but my attention was increasingly drawn to Julius. I’d forgotten that he was breech, and I tried to discern his head; soon enough, I realized my mistake and saw that he was coming out ass first and bent double. On the next contraction, his legs were released, and, on the following, his head. His umbilical cord was wrapped twice around his neck, and the obstetrician unwound it like a sailor working a rope. His body could be held comfortably in her hand, with his legs and head flopping slightly with the gentle movement of her unwinding. On the downstroke, I thought I saw his mouth open, as if he were trying to breathe. Then the umbilical was cut and he was gone, taken to a nearby cart, with no word from the doctor. There followed the second part of the labor, in which the placenta was expelled. A moment later, the doctor told us that Julius had shown no sign of life, that he had died either during delivery or immediately after.

Some time passed before we got to hold him. We must have been talking to the doctor or the nurse, because I remember that I kept looking over at the little cart where he lay, covered by a swaddling cloth. He was so small that I could not see the outline of his body among the folds of the cloth. The nurse wrapped him the same way Marcus had been wrapped and brought him to us, with only his face showing. His skin, mottled purple and red, felt recognizably like skin, though cooler. He looked like Marcus. They had the same face shape, the same small nose, the same cleft chin. His head was bald, except for a few stray curls near the eyebrows. As we had been told, his eyes were closed. Zoraida cradled him in her arms, talking to him very much as if he were alive.

She handed him to me and I started weeping a quiet but unstoppable stream of tears. I felt the weight of all that we had lost with him.

Zoraida said, “Don’t you want to take him to the window?” I did, very much. I walked him across the room and held him up before the panorama of the midtown skyline at night. “This is New York City,” I said. “This is where you were born.”

Source: newyorker.com

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