Where Miracle of Life Collides With Forces of Nature

New parents are often inclined to talk about the miracle of birth, of that profound moment when they realize that life is suddenly more than the sum of all their hopes and dreams. In the delivery room, everything--the past, the present and the future--suddenly slips away and is made meaningless by a strange ecstatic cry, a cry looking to be held, a cry looking to be comforted.

But however awesome the miracle of birth may be, it is the miracle of survival for some babies that grants us a grander perspective. Life so close to death is always more precious, and death so close to living is always more terrible. This is of course a truth most parents-to-be never want to consider, and for the parents who have lived it, it is a truth that will never be forgotten.

When Edward Humes’ daughter started running a fever, barely a day home from the hospital, the pediatrician wasted no time telling him to get her to the neonatal intensive care unit. It was, he tells us in the preface to “Baby E.R.,” the beginning of the worst week in his family’s life.

Gabrielle Humes was to recover (she suffered from a kidney infection) and, six years later, Humes was to return to the hospital, this time not as a parent but as a journalist. Humes--who brings to the story the same narrative skills and superb reporting that made his previous books, especially “No Matter How Loud I Shout,” a tale of life inside juvenile court, so compelling--chronicles in “Baby E.R.” the days and nights of the doctors, the nurses and the parents who have no choice but to consider the miracle of survival. It is a remarkable and searing book: Some cries, we quickly learn, can never be comforted; some silences can never be coaxed into a cry.

Room 288 in the Neonatal Intensive Care Unit, or NICU, of the Miller Children’s Hospital--one of the largest units in the country, accommodating up to 70 babies--at Long Beach Memorial Medical Center is a constant blur. Neonatologists, nurses, respiratory therapists, lab techs and medical specialists in surgical scrubs circle among 12 aquarium-sized incubators cradling 12 babies.

The swooshing and beeping machinery in the room--oscillating ventilators, cardiac monitors and oximeter sensors--is a painful reminder of the one sound you will never hear in this place: the sound of a baby crying. The children here are simply too sick for that. Some weigh less than 2 pounds. (Humes at one point describes a baby whose foot, “perfect in [its] humanity . . . [was] impossibly little, the smallest toe no bigger than the head of a pin.”) Some will stay a few days, some a few months, and some will not leave alive.

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Most of the patients in Room 288 are preemies. Humes explains why: One out of 10 babies--more than 400,000 a year--born in America is premature; one out of 12 has a dangerously low birth weight. One out of 10 infants--40,000 a year--will need a place like Room 288 because of prematurity, birth defects or infection. And it’s only getting worse: The prevalence of babies born with low birth weights (less than 5 pounds, 8 ounces) has increased over the years due to factors ranging from drug use to more aggressive fertility treatments.

America ranks in the lowest 25% of industrial countries when it comes to infant mortality and life expectancy, and many hospitals are woefully unprepared for the needs of premature babies.

It’s a chilling litany of numbers that seldom gets reported, but it is not surprising: Since the time of Hippocrates, Humes reminds us, it was generally accepted that no fetus coming into the world before the seventh month of pregnancy could survive. Then a little more than 100 years ago a French doctor, Pierre Budin, began experimenting with incubators, oxygen masks and new feeding methods. The results were immediately positive.

Since then, however, medical science has attended to premature babies in fits and starts, a fascinating and disgraceful history that Humes splices into his account of the parents and babies battling the odds. Fifteen years ago, babies born in the 24th week, at the end of the sixth month, were miscarried. Ten years ago their survival was doubtful. Today, many born at this stage will not only survive, “they will thrive, with few or no lasting aftereffects.”

But there is still need for improvement. Today, children born at 23 weeks have more than a 90% chance of dying; after 26 weeks, they have a 90% chance of survival. It is in this range that Humes finds the greatest source for triumph and tragedy.

There are the Lee triplets, micro-preemies, each weighing less than 1 1/2 pounds, the result--as one nurse says--of perhaps a too-aggressive fertility treatment. (In the epilogue, Humes raises important concerns about the dangers of such treatments including the transfer of more than two embryos in the in vitro fertilization process.)

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There’s Baby Girl Berger, who codes--stops breathing--immediately after her birth. Twelve minutes later, 12 minutes desperately spent trying to resuscitate her, 12 minutes without a heartbeat, she suddenly comes back. But, as the doctors and nurses wonder, at what price?

And there’s Elias Allman, born in his 28th week, all of 3 pounds. It is a terrible thing, Humes writes, for parents to do everything to ensure a safe and healthy pregnancy--unlike mothers of the drug babies who are regularly transferred here--only to discover in the delivery room that something is seriously wrong.

Using Elias as the centerpiece for his story, Humes quickly puts the reader on the same roller coaster as the Allmans, playing out the tension as Elias’ stats rise and fall--complications arising from respiratory distress syndrome--as one week becomes two, then three and four, and finally as Elias has surgery to repair a bowel obstruction. The Allmans wait for something as simple as the opportunity to change a diaper but find themselves cheated, time and again.

Humes draws out the desperation and insecurities, the prayers and faith of the parents with enormous skill. At one point he catches a mother placing a picture of the family inside the daughter’s incubator. Later he listens to her favorite fantasy, seeing “herself on a lazy Sunday morning, balmy air billowing the curtains . . . lounging in bed with the papers, a cup of coffee in hand, just watching Nikkol sleep next to her.” It is a moment she will never know.

Death in Room 288 and in “Baby E.R.” is all the more heartbreaking when seen against the innocent optimism of the parents. Life in the NICU--and Humes is not afraid to state the obvious--would be unbearably sad but for one thing: Every day babies go home. In fact, the accomplishments of NICUs such as the one in Long Beach put hospitals without such facilities to shame. “Here,” Humes reports, “sick children have a 38% better survival rate than in hospitals with small or no neonatal programs.”

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Appropriately he lavishes equal attention on the staff that makes this possible in spite of the pernicious shadow cast upon their efforts by managed care. Room 288 may be the one place in the hospital “even surgeons are afraid of,” as one nurse says, but for the doctors and nurses who do work here, there is clearly no alternative.

The director of the unit came to this field of medicine after working with adults who refused to take care of their own health. “But babies,” he says, “were different: They came into the world pure, blameless.”

It is the dedication of this staff that cast such a critical light on the birth business in America today, where parents are lured to hospitals with the promise of gourmet meals, HBO and luxurious birth suites without a word about the life-saving facilities the hospitals don’t have. “The market for delivering the nation’s 4 million babies each year is among the most profitable in medicine,” Humes writes.

The NICU is ultimately a world where the capriciousness of nature collides with our expectations for life. In “Baby E.R.,” Humes has written a book that is hard to forget, a picture of sadness and joy that is all the more beautiful for its pervasive humanity and its inherent mystery. When one nurse comments, “You know, you work here, you can’t help but believe in God, that there’s something more going on here than what we do and what the doctors do and what the drugs do,” you can’t help but believe her.