“OK,” I said, unclear on what I was agreeing to or if my consent had even been requested.
A nurse came over to look at Gracie’s veins. “Is she a hard access?” she asked. I hesitated. I wasn’t sure what a hard access was, and I didn’t want to brand her as a difficult patient. She wasn’t yet a month old. But on the other hand, what if being a hard access qualified her for special treatment? I remembered our experience with the brutal nurse the night of her first transfusion. If there was a team of crackerjack IV placers, we wanted them.
“She’s very hard,” I said. “Super hard.”
“Most infants are,” said the nurse. She was slight, waifish, a dishwater blonde with a delicate crucifix at her throat. She stroked Gracie’s forehead and picked up one hand, bending it at the wrist so that the hand stretched flat at a ninety-degree angle. A padded layer of baby fat lay between the skin and the veins; no amount of stretching would disperse the fat completely. The veins, visible as they were, would be hard to hit at the precise angle necessary. From the way the nurse touched Gracie, looked at her, looked back at me, I could tell she was on the side of babies everywhere.
“What’s your name?” I asked, making a mental note to write it down in my notebook later as “kind one with crucifix.”
“Marybeth.” Her attention was on the baby.
Marybeth put down Gracie’s arm and picked up a foot. “I’m just looking,” she said. “Just looking, baby.” On the inside of the ankles are large veins, the saphenous veins. Over time I learned that nurses don’t like to use them for IV insertion because it is hard to keep pediatric patients from kicking the IV off. Plus ankles are surprisingly sensitive, dense with nerve endings. But in a pinch the saphenous veins are your man. The ankle is easy to rotate, and its veins are big enough to enter. Marybeth liked the look of the left foot. She turned to me. “The more you can nurse her, keep her hydrated, the better,” she said. “That makes the veins plump up. But don’t worry, I’m usually lucky.”
I didn’t want to rely on luck; I wanted someone with skill. Someone stellar at threading a tiny needle into a tinier vein. But I didn’t protest when she wiped the baby’s ankle down with alcohol and picked up the IV needle.
She felt around the inner ankle with her fingertips, searching for the pulse. She took a short breath and slid the needle in. Done. Gracie, who had been dozing, woke with a scream and a jerk. She opened her eyes and shut them instantly in a wince, winding up into a rhythmic cry. The needle had an open back, and blood began to drip out that end. Marybeth taped the needle against the skin and screwed on a syringe to collect blood. I was allowed to pick up Gracie and comfort her. She quieted down.
“Thank you,” I said. “The last time that took six or seven tries.”
“Don’t thank me.” She twisted the delicate chain of her crucifix with one index finger and pointed upward with the other. “Thank him.”
A sample of the baby’s blood was sent to the lab. I waited with her in a rocker in the NICU. Once again, we’d landed in a room with plastic boxes holding sick babies.
A young couple nearby was trying to commune with their preemie son through the plastic incubator walls. They looked like they’d wandered off a movie set into the totally wrong room. The woman’s hair hung in a sleek sheet halfway down her back; the man was tall, athletic, and wearing pale green suede loafers. Their baby was fit-in-a-teacup tiny. He had wires and leads running off every limb. The man glanced up at me. Even in his expensive shoes, he was rumpled and half-mad. I offered a wan smile. “They are stronger than they look,” I said. But I thought, Nothing can protect you: not youth, beauty, true love, not money, not Italian loafers. Anyone can end up bent over their child, helpless and afraid.
Anyone.
At a little under six pounds, Gracie seemed huge in comparison to the preemie babies. I smelled her head, an intoxicating mix of curdled milk and burnt sugar cookies. I wanted to take a bite. Or swallow her whole, put her back out of harm’s way.
The nurse Marybeth found us with Gracie’s lab results. “Well, she’s real low,” she said. “But she’s gonna be a whole lot pinker in a few hours.”
I looked down at Gracie, about to receive her second blood transfusion at three weeks old. “This is becoming a bad habit,” I said. “A really bad habit.”
Dr. Eric came by to tell us what to expect. “Giving blood to infants is tricky,” he said. “You have to be careful not to give too much blood, or it can overwhelm the heart.”
“Right,” I said, “I remember that from the first time.” If the whole baby weighed under six pounds, how big could her heart be: the size of a prune or a cotton ball? How could they possibly calibrate the volume precisely enough to avoid overwhelming a cotton ball?
“Let them do the math,” my mom said. “That’s what they do.”
“Plus,” Dr. Eric continued, “the blood has to be typed and crossed, to make sure that the donor and the baby are fully compatible.” He explained that this screening process was necessary because incompatibility could induce adverse reactions, including anaphylactic shock. He handed me a release form, spelling all this out. I signed in big loopy illegible letters, thinking, If this goes south I’ll disavow the signature. Near the door was a crash cart, with the paddles, the electric current to restart the heart. “Don’t worry,” Marybeth said. “We almost never use it.”
Dr. Eric added, “To reduce the possibility of a reaction, she’ll receive washed blood.” Washed blood? Wasn’t it all washed? I definitely didn’t want her to get dirty blood, off-brand blood.
I called Brian. “We’ve been readmitted,” I told him. Surely the worry of two parents, even on separate coasts, was better than the worry of one. I added that the new hematologist seemed nice, like a Midwestern grandma, who happened to be summa cum laude from Harvard, and that we were waiting to be transfused, again, and that they planned to wash the blood even though washing a liquid sounded ludicrous, and that the baby’s heart was no bigger than an apricot pit, so the doctor would try not to overwhelm it or chill it. Brian was silent except for the sound of pen on paper.
I waited for him to say, “I’ll be right there.”
He said, “I’ll call you in an hour.”
When our blood arrived, Dr. Eric said, “We’ll run it extraslow, to give the heart a chance to catch up.” I had an image of Gracie paddling furiously upriver in a canoe, chased by her heart in a tiny canoe of its own.
“Do I have to put her in the incubator?”