Sam
Present
Philadelphia, Pennsylvania
Age 23
ROUNDS ARE OVER, and Cassie and I settle into our daily routine. Today’s scrubs are baby monkeys. Monkeys swinging from vines. Monkeys eating bananas. Monkeys hugging each other. Cassie hates these particular scrubs because the background color is beige. And she hates beige.
“Ugh, I can’t do anything right today,” she exclaims as she tosses a feeding tube into the garbage. Beige also makes her pissy. I look around the room and it’s filled with babies. Very sick babies. Two monitors go off at the same time, and we both rush to opposite ends of the room to check the vitals of the babies causing the alarms.
Suddenly, the door flies open and yet another baby is brought into the already crowded room. “Suction,” Dr. Hagan directs Becky as they work on this new baby. Cassie closes Baby Grace’s incubator.
She walks back over to Ben to begin his feeding tube again and gets flustered. “There are too many babies in here,” she says, dropping the tube onto the floor. Her reaction is surprising to me since she usually remains so calm under pressure.
“Here, let me.” I grab a new, sterile tube and begin prepping it for Ben. “Cassie!” Dr. Hagan calls as she’s working on the new baby. “Get Terry on the phone, please. We need to make sure transport is ready to send this little guy over to CHOP once he’s stable.” Children’s Hospital of Philadelphia is another level 4 NICU in the city, and since ours is now beyond capacity, we need to make sure space is available elsewhere. This happens from time to time, and we do the same when other hospitals are over capacity. Baby Grace’s monitor alarms again while Cassie is quickly talking to the NICU at CHOP. Becky details the new baby’s situation. “Baby boy, full term. Hypertonic, exposed to various drugs. Mother tested positive for benzodiazepine, anti-depressants, and marijuana. Infant tox screen is pending. Mother is refusing transport.”
Great. A drug addict mom who doesn’t want to be with her sick baby. It never ceases to amaze me what some mothers will do to themselves, knowingly. I look around the room at all of the sick babies whose mothers did everything right, but they were all dealt a challenging hand. Two more monitors sound and I look down at Ben, who we’ve been trying to feed for the past hour. He’s miraculously off the breathing tube, for now, but this guy needs to eat.
Cassie makes the arrangements for transport while Dr. Hagan continues to work on the new baby boy. His screams are sharp and shallow and tear through my heart. The cries of drug-exposed infants are unique and heart wrenching. “Becky, we’ll need a tox screen on him. Cassie, please let social services know what’s happening. They’re going to want to speak with the mother.”
Cassie relays information to Heather, the hospital social worker, and quickly hangs up the phone, rushing to another monitor alarm. When it rains, it pours in here.
I get Ben’s feeding tube in place and turn on the drip. Dr. Hagan is finished examining the baby boy, and Becky wipes his foot clean of blood from the tests she just administered. Dr. Hagan leaves the room and sinks into a chair in the outer office. She looks exhausted.
Finally, the monitors have silenced, and Cassie, Becky and I all return to our standard routines.
“Where’s Olivia?” I ask, looking at the empty chair next to Ben’s incubator.
Cassie is pale and seems really off now. “I’m not sure. Her mother came to get her about ten minutes ago. There are some other people here to see her.” Cassie walks over to Mikey and turns on the lights above him. He’s here because he has severe jaundice and the lights help lower his bilirubin counts. Mikey’s large belly spills over his infant diaper. He’s huge. Well, huge for a baby in the NICU. Weighing in at almost eleven pounds, he’s the largest baby I’ve ever seen in this hospital. He’s perfect and fat and already has thighs that any mother would brag about. But since he has jaundice, he needs our help. He sleeps peacefully, full, content and looking so out of place here in the NICU. He’s been doing well, and if that continues, he should be going home by tomorrow. She adjusts the light above him and looks over at Ben.
“The bleed on the left side remains a grade three. Not good,” Cassie mumbles and sits on the stool in front of her computer.
“No, not good at all,” I say quietly, looking away from Mikey. It’s amazing how this room can go from frantic to quiet in a matter of minutes. “Cassie, are you okay?” I ask, concerned as to why she’s so off today.
“Yeah, it’s just…”
She stops talking as we hear a woman scream from the hallway, “No! No! No!”
Cassie and I turn our heads and see Olivia outside the NICU window, throwing herself into a large man, punching his chest. My heart grabs in my chest when I see another man next to him wearing similar clothes. Military.
“Oh no,” Cassie exhales and stands up.
Olivia’s wails turn to sobs, and her mother pulls her off of the Marine. She holds her daughter tight against her chest as the two Marines stand quiet and respectful.
“That can’t be good,” Cassie says. “When my cousin was visited by two Marines, she found out her husband was killed in Iraq. It’s never good when there are two of them. Never.” Her voice trails off as she moves to the window and peers out at them.
Olivia is shaking her head and then collapses onto the floor. One of the Marines bends down to a knee and scoops her into his arms, carrying her over to the couch in the lounge area. She doesn’t look conscious, and I call out to Dr. Hagan, who lifts her head from the desk. “Can you help? Olivia just passed out in the hallway.” She grabs smelling salt taped to the cabinet door and rushes out.
As soon as Dr. Hagan swipes the salts under Olivia’s nose, she opens her eyes and immediately begins to sob and wail. Her mother slides on the couch next to her, cradling her head in her lap. I can’t bear to watch this any longer.
“I hope to God she didn’t just hear what I think she did, but my instinct tells me she just found out her husband is gone.” Cassie pulls the blinds shut, giving Olivia privacy from our curious eyes. My chest tightens, and I try to fight the grief I feel for this young mother and her new family.
I look over at Ben and close my eyes. “God, please let this boy grow up strong and healthy,” I whisper quietly.
His monitor suddenly starts beeping wildly, jolting me from my silent prayer. Cassie and I both rush to the incubator and open it. His color is grayish and his heart rate is dangerously low. The monitors go off again, indicating something is wrong with his tube. The brand new tube that I just inserted. I feel faint and desperate.
Cassie puts her stethoscope to his chest and gasps. “His lungs are filled with fluid.” She begins working on him as Becky runs into the hallway to alert Dr. Hagan.
Several other nurses rush in with the doctor and I back away into the corner. I’m frozen as I watch them work on Ben. Cassie looks over at me, shaking her head. Her eyes are frantic and questioning. I look out of the blinds and see Olivia sitting up, drinking juice that one of the nurses brought to her. The Marines are still there, trying to give her space but also to comfort her. I look back toward Ben and I can’t see him. He’s surrounded by doctors and nurses.
Cassie’s eyes meet mine and I know.
We’re losing him.
I’M SEATED NEXT TO CASSIE inside the hospital administrator’s office.
I’m numb.
“Miss Weston, can you answer me?” Jim Burke, Chief of the NICU, asks again.
“I don’t know how it happened,” I say quietly. It’s my fault.
“You don’t know how the feeding tube was placed in his lungs instead of his stomach?” he asks accusingly.
“No, sir. I listened to his chest. I heard it in his stomach. I didn’t think it was in his lungs.” Cassie grabs my hand and squeezes. Did I actually listen to his chest? I don’t even remember. Holy fuck.
I’ve inserted hundreds of feeding tubes in babies tinier than Ben. Hundreds of tubes placed in the exact spot they were supposed to be placed. All the right way, never in their precious lungs. Lungs so tiny and desperate for air. Lungs trying to work hard to keep Ben alive.
Ben.
“Miss Weston, we’re placing you on administrative leave until we can conduct a full investigation into this situation.”
I inhale as Jim stands up behind his desk.
“But…” I say and break down. “I didn’t mean to, Jim. I did everything right. I don’t know what happened. Oh my God.”
It begins to sink in exactly what I’ve done. Cassie grabs me by my shoulders and guides me out of the room.
“Cassie.” I sob and fall to my knees in the hallway.
It’s my fault.
It’s my fault.
IT’S MY FAULT.
“Hush, Sam.” She sinks to the floor next to me and throws her arms around me. “Don’t say anything, okay?” She begs me not to confess. Not to tell her what I did.
“Whatever happened was an accident. Do you understand? The NICU was a zoo today. So much was going on. Too much was going on.” She rubs my arms, pulling me against her. I can hear the regret in her voice. She was assigned to Ben today, and it was her feeding tube that I inserted wrong. Her guilt is tangible, but not as thick as mine.
An accident? It was neglectful. Sloppy. Wrong.
“I killed him,” I whisper into her shoulder. “I killed Ben.”