from Trance
Wintertime
Department of Homeless Services
Medical Team
To whom it may concern:
We are writing to request medical exemption for infant Baby Girl Z.
Baby Girl Z was born at 700 grams and 23 weeks gestation and is a Patient on our unit anticipated for discharge this month. Mother Ms. Z is currently undomiciled and will be seeking emergency housing for herself and the infant. We are writing to request this exemption so that the mother be processed without the baby, as baby is medically fragile and cannot safely travel to central intake. The baby has history of extreme prematurity, chronic lung disease, PDA ligation, IVH grade 2 bleed, cholestasis, and osteopenia. She will be discharged with home-oxygen system, as well as referrals for visiting nurse and home-based Early Intervention services. The infant is at very high risk for severe RSV, a respiratory infection that is life-threatening for children born premature, and should not be exposed to crowded conditions of central intake. For continuity of care, we are requesting shelter placement near our facility. Follow up appointments have been arranged with our outpatient clinics for pediatric cardiology, pulmonology, and neurology.
Thank you for considering this request.
Sincerely,
Neonatology attending physician
Neonatal ICU social worker
The Hills
To Mr. Hill the coffin was a shoebox with a doll inside. He worried about his wife, felt sick with sadness for her. Instead of twin babies, Mrs. Hill’s body now held something kin to nausea, kin to vertigo, kin to shortness of breath that was none of these things. Mr. Hill could feel it travel out of Mrs. Hill, into the cemetery ground and up into his legs. The wave of something else. Mr. Hill was disliked by his mother-in-law, who believed her disliking him was something he was silly to take personally. He wasn’t good enough, nothing personal about it. Mrs. Hill’s mother shimmered with weightless, boundless, unadulterated disappointment. She had wanted a granddaughter. The girl they buried today, her granddaughter, her first granddaughter, had lived 4 days. The other twin, now the survivor, was a boy. It was October and the ground was dark and looked wet but wasn’t wet but crisp underfoot with patches of leaves monarch yellow, monarch orange, and cranberry red. The trees were especially parental this year; not androgynous like angels, but hermaphrodites like God. It was easy to look up and fall into the trance of any individual tree or branch or stand. Mr. and Mrs. Hill looked up. On the neonatal intensive-care unit, two city neighborhoods away, the boy twin weighed less than 600 grams. He was part person part idea, he did not consider himself a self, they had named him and written the name in blue marker on a glossy tag stuck to the isolette. They put a blue-striped hat on his head. A ventilator oxygenated his lungs, which to the lungs was pure hideous disruption but the lungs gave way and kept organizing tissue under the new condition. He was smallest and, gestationally speaking, the youngest on the unit. What he had known without knowing he knew it was gone, was the past, was elsewhere, but there were others like him here. Twin space replaced by neonatal ICU space. Lung cells, heart cells, liver cells, generating, individuating. All of them here, tubed and attended to, holding down the present, manning it obliviously, hybrids of machinery and flesh, a neonatal neural net of life force forced and taking, forced and taking
Rounds
Baby Boy with necrotizing enterocolitis three inches viable gut. Baby of maternal diabetes, maternal fever, maternal utox, maternal HIV. Baby of domestic violence. Baby Boy they were trying for a girl this time. Baby Girl they were hoping for a boy. Baby the father’s Indo-Caribbean side will not accept your blackness. Baby intubated, brain dead on arrival, mother seized and expired prior induction. Baby born with one arm one leg external bladder but two perfect lungs and excellent heart breathing easy. Triplet A, born at 1,200 grams, home in 12 weeks; Triplet B born at 1,400 grams home in 12 weeks; Triplet C born at 800 grams never leaves never off the vent, on and off the oscillator high-frequency vent. Baby X of ambiguous genitalia. Baby, she whispers in recovery-room trance, of revenge rape, baby, she says to the aide in creole, of gang rape, baby of incest, one nurse notes to another in the hall about the baby. Baby with fused lids get ready to see, baby on new baby trache get ready to breathe, failed kidney baby recover your function, baby, filter and excrete, arrhythmia baby steady whenever you’re ready your baby baby baby baby beat.
Lactation Room
The Patient is ex-33-weeker born to 36-year-old mother admitted multiple times during pregnancy to hospital, under alias, due to history of domestic violence by baby’s father. Per Patient’s mother, Patient’s father has history of pushing, shoving, hitting, threatening Patient’s mother with weapon, threatening to harm Patient when in utero, and threatening to have Mother, who is undocumented, deported. Mother has one other child, a teenaged daughter residing with family in another country. Patient has been medically clear for discharge for six days and is now on social hold awaiting domestic-violence shelter placement. Mother continues to visit daily to participate in care and feeding and to use hospital breast pump. Hospital, already close to bankrupt, loses $2,500 a day maintaining medically cleared alternate-level-of-care infant and social worker will have to call Protective Services to have the baby placed in foster care and rip mother from baby if a DV shelter doesn’t come through soon. Social worker doesn’t pray but speaking rhetorically asks you to.
Faculty Meeting Room
Patient Baby Boy Triplet A is in-utero-growth-restricted ex-29-weeker born at 600 grams. (Triplet C was discharged to medical foster home at corrected age 35 weeks after uneventful hospitalization. Triplet B died at birth.) Patient has history of necrotizing enterocolitis and shortened gut syndrome, chronic lung disease, vent dependence, grade 4 IVH, liver failure secondary to prolonged TPN use. Patient has low chance of survival—contingent on both gut and liver transplant—and high chance of severe cerebral palsy and mental retardation. Meeting was held today with three members of ethics committee, Mother and Mother’s cousin, charge nurse, floor nurse, social worker, hospital chaplain, baby’s CPS (Child Protective Services) worker, neonatal attending and resident physicians, and GI attending physician to discuss goals of treatment. Medical and physician-assistant students were present and observing. NOTE: CPS worker was present only with Mother’s consent; though the patient is remanded by the agency, Mother still retains rights as medical decision maker. Social worker spoke separately to man identified by Mother as the Patient’s father; he verbally declined to be included in meeting, stating he is unconvinced of his paternity. Despite infrequent visits to the unit, Mother appears bonded to Patient and knowledgeable of Patient’s diagnoses and prognosis. When asked by committee, Mother was able to provide cogent summary of baby’s condition. On behalf of team, Mother was able to explain that the liver disease was a result of shortened gut syndrome and that baby would not be cured, as CPS worker suggested, by “just getting a new liver.” Funny or not, there were muffled chuckles of appreciation when Mother bragged Patient would “just burn through another liver.” Plan is for palliative care. Social worker and chaplain accompanied Mother back to neonatal ICU. Mother signed DNR with two physician witnesses.
Debora Lidov has published poems in various journals, most recently in Ars Medica, Cut Throat, Five Points, and Salamander. Prior to entering the field of social work, she taught poetry and fiction workshops at Hunter College, CUNY. All events and characters in the pieces here are fictional.