Preemies, Emotions, Inspiration

To the preemie I loved

Dear Joey Letter

[ to hear this letter as read by Trish, click here for the podcast ]

Dear Joey,

I know you don’t remember me, but I remember you. We met during an incredibly stressful time, under the bright glare and nervous energy of an operating room in a near panic. I was in surgical scrubs, cap, mask and gloves. You were newly born and struggling to live.

It was a long time ago, and yet I've never forgotten that day. I wonder if you've heard the story of your birth? People usually hear of their birth from their mothers and fathers, but because your birth mother didn’t raise you and your birth father wasn't around, I doubt they've ever been able to tell you. But I can.

And your family, your adoptive family, they weren’t there that day.  I'm sure they've told you what they could about your birth and the first months of your life, but they didn’t even know about you yet on the day you were born.

But I was there. I was your nurse, a newborn intensive care nurse, and my assignment that day was to rush to the emergency delivery happening in the OR. The room was pulsing with people, there to help both you and your birth mother. Both of you were in danger, both of you needed serious medical attention.

Amidst the beeps and chatter ofthe OR, the doctors quickly delivered you by c-section, lifting your fragile, tiny body out into the world, placing you tenderly into my hands. I carried you ever so gently over to the warming bed, wrapped you in cling wrap to keep you warm. I told you happy birthday, and told you what a handsome boy you were. You didn't make a sound or open your eyes, of course, but I smiled at you from behind that blue mask.

You see, the trouble was that you were born very, very early. Seventeen weeks too early, actually. Babies born earlier than that often don’t survive. You were just big enough that we knew we had to try and help you live. So our job was to do everything we could to help you.

Joey, you sweet little thing, you did not make that easy.

Have you seen pictures of yourself in those first few days? Have you ever seen a baby so small? Very few people ever have, but I got to hold you in the palm of my hand. You were so very tiny - have you seen your footprints from that day? Not a whole lot bigger than a postage stamp. Impossibly small.

The first and most important job you had was to breathe, and that’s where we almost lost you. You needed help, of course, all 23 week babies do. But you had an extremely narrow throat, making it challenging to get a tube in to deliver life-saving oxygen to you.  Because it was so hard, the doctor had to try again and again. And in the meantime, your little heart started beating slower and slower, stressed without the oxygen it needed to keep you going. I used my two fingers to press down on your wee little chest, willing your heart to keep beating.

I kept talking to you the whole time, telling you

“You can do it, little guy” and

“Let us help you, sweetie.”

And I wasn’t saying it aloud, but I was feeling it in my heart,

“You are loved.”

I thought you needed to know that. With nobody else in the room to say so, I needed you to know you were loved and there was a wonderful life ahead of you.

The circumstances behind why your mother, so young and alone, would not be keeping you were complicated. Truthfully I never did know the whole story. But I did know, at that moment of welcoming you into the world, that nobody in that room was going to be raising you, watching you grow, loving you. Nobody in that room was going to be your forever family - they hadn’t even been found yet, because your arrival was so sudden and unexpected.

So I welcomed you into the world all the more joyfully. In addition to helping you live, I made sure you came into the world feeling loved and celebrated and wonderful.

Finally, after maybe 4 minutes? Maybe 8 minutes? After what felt like an eternity of checking for heartbeats and trying to intubate and giving chest compressions and worrying about your fate, the doctor got the tube in, allowing us to deliver tiny, life-saving breaths to your lungs.  Just in the nick of time!

Once your heart got the oxygen it needed, we got you stable enough to transfer.  We very carefully moved you to the neonatal intensive care unit, which became your home for the next several months. You needed a ventilator to breathe, IV fluids to stay hydrated and nourished, and medications to keep you alive. You weighed just a little over a pound, with delicate translucent skin and eyes that weren't open yet. You were very small and very fragile, but through it all you had incredible strength.

Your birth mother did visit you, once, the day after your birth. She looked at you for such a long time. She didn’t say a word or ask a single question. As tears streamed down her cheeks, I brought her tissues, and she just looked and looked, as if she was memorizing your every feature, every detail. I encouraged her to touch you, and for just a moment she reached in and laid her fingertip across the tiny palm of your hand. Maybe she knew it would be the only time she saw you. She carried you for 23 weeks, she visited you just one time, and then she was gone. As long as you remained with us in the NICU, she never returned.

But you were never alone, Joey, and you were SO loved. By all of us, your team of caregivers - nurses, doctors, therapists, volunteers. In the beginning, we showed our love by keeping your incubator dark, warm and quiet. We found the most beautiful blanket to cover your isolette. We all wanted to be your nurse, to shower you with extra attention and tenderness.  When someone was talking too loudly near your bed, we shushed them. Whenever you fussed, we rushed to comfort you.

As you grew, we showed our love by picking you up & cuddling you. We fed you ever so carefully when you were learning that challenging task.  Some of us sang to you, some of us rocked you to sleep, some of us read books to you. We shared our hopes and dreams for you. We were the only family you had, but you had us 24 hours a day, 7 days a week, and there were so many of us to love you.

You surprised us all with your strength. Difficulties that many preemies faced were not all that hard for you. You didn’t need oxygen as long as many preemies, you needed very few medications. You learned to take a bottle quickly, which is not an easy thing for babies born so early.  And you grew into such a cuddly, snuggly baby - you seemed content and you rarely cried. Sometimes babies born that early have a hard time cuddling and calming, but not you. We were so proud.

For much of the time you were with us in the NICU, you had no family to visit you. Other babies came and went, with their moms and their dads and their families to visit them. None of them probably ever realized that you had no family to visit you.

But then, of course, the day arrived when your adoptive family was going to meet you. Can you imagine how protective of you we felt?  You had been ours and ours alone for months. We had grown very attached to you, and we all wanted to be sure your new family was going to be good for you. Luckily, your new family was fantastic. They respected us as your first family, while at the same time being single-mindedly determined to know you and love you. They asked us all about you, they had millions of questions. They learned your likes & dislikes, and stayed by your bed for hours, just watching you grow.  They, too, read to you, sang to you, rocked you to sleep.  They were patient, but so eager to have you home and become a family.

Our collective hearts sang with joy, knowing you were going to a wonderful home, while at the same time sighing with sadness, knowing you would have to leave us someday soon. And that day did come. When you were strong enough to leave us, after so many weeks, your family packed all of your things (many of the nurses and therapists had brought you gifts over the months), we shared many hugs and happy tears, and you were gone. Off to live your life with your family, far away from us.

Your leaving us left an emptiness. Babies come and go everyday in the NICU, but you were different. You were extra special to us. We talked about you often, wondered how you were doing. Mostly, we missed you dearly.

Joey, it has been so many years since I held your incredibly delicate body in my hands and willed your heart to keep beating and to feel loved. I don’t know how those years have been for you, although I think of you often. I hope the years have been good to you. I know you faced many hardships right from the very first breath, and I’m sure you have faced many more. Health issues, perhaps? Or family struggles? I hope you have been able to face all of those difficulties with the same tenacity and vigor that you always did.

And I hope that my love, our collective love for you, stays with you always and gives you strength.

I want you to know the story of your birth, and the story of how loved you were, at a time when you can’t otherwise remember.  And I want to thank you for letting us be your first family, for letting us love you. I hope we gave you a gift you’ll always have, by loving you and treating you as our own family.

You gave us a gift by allowing us the opportunity to remember how it feels to truly love the babies we care for.  I loved you then, and I still do.

[I often wish I could write to my former patients, to tell them the story of their birth and their NICU stay, because many babies don’t ever know their birth family nor their birth story. It is healing for me imagine my former patients all grown up, happy, healthy, and loved. It is healing to believe that my good intentions and love for those babies is felt by them, in some way.  For privacy reasons, of course, I have had to change important details. Joey is not an actual patient, but is a compilation of different babies and stories from my years of experience.]