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Chapter One

It was midnight, it was raining.

I scrubbed at the sink as instructed, and went on in. The second set of double doors led into a corridor at the end of which, to the left, a woman sat at a U-shaped desk behind an improvised levee of computers, phones, stacks of paperwork and racks of bound files. She was on the phone, trying simultaneously to talk into it and respond to the youngish man in soiled Nikes and lab coat who stood beside her asking about results of lab tests. Every few moments the phone purred and a new light started blinking on it. The woman herself was not young, forty to fifty, with thinning hair in a teased style out of fashion for at least twenty years. A tag on her yellow polyester jacket read Jo Ellen Heslip. Names are important.

To the right I walked past closetlike rooms filled with steel racks of supplies, an X-ray viewer, satellite pharmacy, long conference tables. Then into the intensive-care nursery, the NICU, itself – like coming out onto a plain. It was half the size of a football field, broken into semidiscrete sections by four-foot tile walls topped with open shelving. (Pods, I'd later learn to call them.) Light flooded in from windows along three walls. The windows were double, sealed: thick outer glass, an enclosed area in which lint and construction debris had settled, inner pane. Pigeons strutted on the sill outside. Down in the street buses slowed at, then passed, a covered stop. Someone in a hospital gown, impossible to say what sex or age, slept therein on a bench advertising Doctor's Bookstore, getting up from time to time to rummage in the trash barrel alongside, pulling out cans with a swallow or two remaining, a bag of Zapp's chips, a smashed carton from Popeyes.

I found Pod 1 by trial and error and made my way through the grid of incubators, open cribs, radiant warmers: terms I'd come to know in weeks ahead. Looking down at pink and blue tags afixed to these containers.

Baby Girl McTell lay in an incubator in a corner beneath the window. The respirator reared up beside her on its pole like a silver sentinel, whispering: shhhh, shhhh, shhhh. LED displays wavered and changed on its face. With each shhhh, Baby Girl McTell's tiny body puffed up, and a rack of screens mounted above her to the right also updated: readouts of heart rate, respiration and various internal pressures on a Hewlett-Packard monitor, oxygen saturation on a Nellcor pulse oximeter, levels of CO2 and O2 from transcutaneous monitors.

      Baby Girl McTell
      Born 9/15
      Weight 1 lb 5 oz
      Mother: Alouette

I could hold her in the palm of my hand, easily, I thought. Or could have, if not for this battleship of machinery keeping her afloat, keeping her alive.

The nurse at bedside looked up. Papers lay scattered about on the bedside stand. She was copying from them onto another, larger sheet. She was left-handed, her wrist a winglike curve above the pen.

"Good morning. Would you be the father, by any chance?"

Reddish-blonde hair cut short. Wearing scrubs, as they all were. Bright green eyes and a British accent like clear, pure water, sending a stab of pain and longing and loss through me as I thought of Vicky. Teresa Hunt, according to her nametag. But did I really look like an eighteen-year-old's romantic other?

Or maybe she meant the girl's father?

I shook my head. "A family friend."

"Well, I had wondered." Words at a level, unaccented. "No one's seen anything of him, as far as I know."

"From what little I know, I don't expect you will."

"I see. Well, we are rather accustomed to that, I suppose. Some of the mothers themselves stop coming after a time."

She shuffled papers together and capped her pen, which hung on a cord around her neck. There was print on the side of it: advertising of some sort, drugs probably. Like the notepad Vicky wrote her name and phone number on when I found her at Hotel Dieu.

Tucking everything beneath an oversize clipboard, Teresa Hunt squared it on the stand.

"Look, I'm terribly sorry," she said. "Someone should have explained this to you, but only parents and grandparents are allowed – O, never mind all that. Bugger the rules. What difference can it possibly make? Is this your first time to see her?"

I nodded.

"And it's the mother you know?"

"Grandmother, really. The baby's mother's mother. We... were friends. For a long time."

"I see." She probably did. "And the girl's mother recently died, according to the chart. A stroke, wasn't it?"

"It was." And I had sat beside her bed every night those last weeks, trying somehow to tell her what she had meant to me, trying to explain to us both why I hadn't seen much of her this last year since her marriage, watching light dwindle and fade in her eyes.

"Did she know Alouette was pregnant?"

I shook my head. "Their lives had gone separate ways many years back." So separate that I hadn't even known about Alouette. "She–" Say it, Lew. Go ahead and say her name. Names are important. "LaVerne had been trying to get back in touch, to find Alouette."

She looked away for a moment. "What's happened to us?" And in my own head I heard Vicky again, many years ago: What's w rong with this country, Lew? "Well, never mind all that. Not much we can do about it, is there? Do you understand what's happening here?" Her nod took in the ventilator, monitors, bags of IV medication hanging upside down like transparent bats from silver poles, Baby Girl McTell's impossible ark; perhaps the whole world.

"Not really." Does anyone, I wanted to add.

"Alouette is an habitual drug user. Crack, mainly, according to our H&P and the social worker's notes, but there's a history of drug and alcohol abuse involving many controlled substances, more or less whatever was available, it seems. She makes no attempt to deny this. And because of it, Alouette's baby was profoundly compromised in utero. She never developed, and though Alouette did manage to carry her as far as the seventh month, what you're looking at here in the incubator is something more on the order of a five-month embryo. You can see there's almost nothing to her. The eyes are fused, her skin breaks down wherever it's touched, there aren't any lungs to speak of. She's receiving medication which paralyzes her own respiratory efforts, and the machine, the ventilator, does all her breathing. We have her on high pressures and a high rate, and nine hours out of ten we're having to give her hundred-percent oxygen. Two hours out of ten, maybe, we're holding our own."

"You're telling me she's going to die."

"I am. Though of course I'm not supposed to."

"Then why are we doing all this?"

"Because we can. Because we know how. There are sixty available beds in this unit. On any given day, six to ten of those beds will be filled with crack babies like Alouette's. At least ten others are just as sick, for whatever reasons – other kinds of drug and alcohol abuse, congenital disease, poor nutrition, lack of prenatal care. The numbers are climbing every day. When I first came here, there'd be, oh, five to ten babies in this unit. Now there're never fewer than thirty. And there've been times we've had to stack cribs in the hallway out there."

"Are you always this blunt?"

"No. No, I'm not, not really. But we look on all this a bit differently in Britain, you understand. And I think that I may be answering something I see in your face, as well."

"Thank you." I held out a hand. She took it without hesitation or deference, as American women seldom can. "My name is Griffin. Lew."

"Teresa, as you can see. And since Hunt is the name on my nursing license, I use it here. But in real life, away from here, I mostly use my maiden name, McKinney. If there's ever anything I can do, Mr. Griffin, please let me know. This can be terribly hard on a person."

She removed vials from a drawer beneath the incubator, checked them against her lists, drew up portions into three separate syringes and injected these one at a time, and slowly, into crooks (called heplocks) in Baby Girl McTell's IV tubing. There were four IV sites, swaddled in tape. Almost every day one or another of them had to be restarted elsewhere, in her scalp, behind an ankle, wherever they could find a vein that wouldn't blow.

She dropped the syringes into the mouth of a red plastic Sharps container, pulled a sheet of paper from beneath the clipboard and, glancing at a clock on the wall nearby, made several notations.

"I don't know at all why I'm telling you this, Mr. Griffin, but I had a child myself, a son. He was three months early, weighed almost two pounds and lived just over eight days. I was sixteen at the time. And afterwards, because of an infection, I became quite sterile. But it was because of him that I first began thinking about becoming a nurse."

"Call me Lew. Please."

"I don't think the head nurse would care much for that, if she were to hear about it. She's a bit stuffy and proper, you understand."

"But what can one more rule matter? Since, as you say, we've already started breaking them."

"Yes, well, we have done that truly, haven't we, Lew. Do you think you'd be wanting to speak with one of the doctors? They should be along in just a bit. Or I could try paging one of them."

"Is there anything they can tell me that you can't?"

"Not really, no."

"Then I don't see any reason for bothering them. I'm sure they have plenty to do."

"That they have. Well, I'll just step out for a few minutes and leave the two of you to get acquainted. If you should need anything, Debbie will be watching over my children while I'm gone."

She nodded towards a nurse who sat in a rocking chair across the pod, bottle-feeding one of the babies.

"That's Andrew. He's been with us almost a year now, and we all spoil him just awfully, I'm afraid."

"A year? When will he leave?"

"There's nowhere for him to go. Most of his bowel had to be removed just after birth, and he'll always be needing a lot of care. Feedings every hour, a colostomy to manage. His parents came to see him when the mother was in hospital, but once she was discharged, we stopped hearing from them. The police went out to the address we had for them after a bit, but they were long gone. Eventually I suppose he'll be moved upstairs to pediatrics. And somewhere farther along they'll find a nursing home that will take him, perhaps."

I looked from Andrew back to Baby Girl McTell as Teresa walked away. Names are important. Things are what we call them. By naming, we understand. But what name do we have for a baby who's never quite made it into life, who goes on clawing after it, all the while slipping further away, with a focus, a hunger, we can scarcely imagine? What can we call the battles going on here? And how can we ever understand them?

Through the shelves I watched people gather over an isolette in the next pod. First the baby's own nurse, then another from the pod; next, when one of them went off to get her, a nurse who appeared to be in charge; finally, moments later, the young man in lab coat and Nikes who'd earlier been standing at the desk in front. Various alarms had begun sounding – buzzers, bells, blats – as the young man looked up at the monitors one last time, reached for a transparent green bag at bedside, and said loudly: "Call it." Overhead, a page started: Stat to neonatal intensive care, all attendings. He put a part of the bag over the baby's face and began squeezing it rapidly.

Then I could see no more as workers surrounded the isolette.

"Sir, I'm afraid I'll have to ask you to step out," Debbie said. She stood and placed Andrew back in his open crib. The child's eyes followed her as she walked away. He didn't cry.

I filed out alongside skittish new fathers, smiling grandparents, a couple of mothers still in hospital gowns and moving slowly, hands pressed flat against their stomachs. An X-ray machine bore down on us through the double doors and lumbered along the hallway, banging walls and scattering linen hampers, trashcans, supply carts. Where's this one? the tech asked. Pod 2, Mrs. Heslip told him.

Most of the others, abuzz with rumor, clustered just outside the doors. Some decided to call it a night and went on to the elevators across the hall, where I knew from experience they'd wait a while. I found stairs at the end of a seemingly deserted hall and went down them (they smelled of stale cigarettes and urine) into the kind of cool, gentle rain we rarely see back in New Orleans. There, when it comes, it comes hard and fast, making sidewalks steam, beating down banana trees and shucking leaves off magnolias, pouring over the edges of roofs and out of gutters that can't handle the sudden deluge.

I turned up the collar of my old tan sportcoat as I stepped out of the hospital doorway just in time to get splashed by a pickup that swerved towards the puddle when it saw me. I heard cackling laughter from inside.

Earlier I had noticed a small café on the corner a few blocks over. Nick's, Rick's, something like that, the whole front of it plate glass, with handwritten ads for specials taped to the glass and an old-style diner's counter. I decided to give it a try and headed that way. Moving through the streets of the rural South I'd fled a long time ago. Bessie Smith had died not too far from here, over around Clarksdale, when the white hospital wouldn't treat her following a car accident and she bled to death on the way to the colored one.

At age sixteen, I had fled. Fled my father's docility and sudden rages, fled old black men saying mister to ten-year-old white kids, fled the fields and the tire factory pouring thick black smoke out onto the whole town like a syrup, fled all those faces gouged-out and baked hard and dry like the land itself. I had gone to the city, to New Orleans, and made a life of my own, not a life I was especially proud of, but mine nonetheless, and I'd always avoided going back. I'd avoided a lot of things. And now they were all waiting for me.


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