Small: Life and Death on the Front Lines of Pediatric Surgery

12 | The Lost and Found

the lost and found At three in the morning on Christmas Eve we meet for the first time, sitting side by side in bolted-to-the-floorfaded turquoise chairs. You are the father of a newborn who needs an emergency operation , as in right now. Your baby, just three days old, is being wheeled through the halls of the hospital en route to an operating room one floor below, where he will be put to sleep and readied for an exploration of his abdomen. I am your baby’s surgeon, someone who should be dashing down the hall after his isolette, but first I must talk to you, and it is not going to be easy. These attempts to explain sudden catastrophe and what comes next are never easy. In residency we referred to chats like this as “hanging crepe,” as in black crepe draped across the steam engine of Lincoln’s funeral train. If you have managed to cling to any shred of denial up to this point, I’m about to peel it away like a burn victim’s scorched skin from the underlying flesh, leaving the nerve endings raw and exposed. Christmas, scalpels, dead gut—a cruel and awkward combination of realities at best, a disaster at worst. Fate has pressed us together on these hard plastic chairs, under the unflinching gaze of fluorescent lights, looking down at the stained linoleum floor. Me, an overworked surgeon emerging from a deep sleep, stoked by adrenaline surging through my veins, and you, a person who could be my brother-in-law, the captain of the lost and found ( 187 ) the football team, the neighbor two houses down who mows his yard on the weekends. Your eyes, puffy and red, lock onto mine. Oh, God, not this guy tonight, I think. Not a guy sitting here in his Dockers, polo shirt, and sockless loafers whom I can relate to without even trying. How will I ever stand to tell him if this doesn’t turn out well? I have the unfortunate but necessary obligation to tell you that your firstborn, your son, your Christmas baby, anticipated with all the hope and joy one person can hold for another, may not make it out of the operating room alive. I hate to even think the words, much less speak them, after everything you’ve been through. You deserve respite, reassurance, relief—but I can’t offer any, only a sliver of hope and not much more. Just like you have no choice about what you’re going to hear in the next ten minutes, I have no choice about what I’m going to say. Riding my own roller coaster through long stretches that leave me crumpled and drained, I know about stress, disappointment, and defeat: but even on my worst days I will in no way be facing the hell you are this holiday season. First your baby, misidentified as “healthy” at delivery, was relabeled within hours as “extremely unstable,” with a probable heart defect. The defect was not anything as simple as a hole between the chambers that might close on its own. It was something much worse: truncus arteriosus, a rare condition in which the main arteries feeding the lungs and the body fail to separate during gestation. It is a serious heart malformation , one that can be repaired with a major operation but that has moved to the back burner at the moment. He has to make it through this more imminent threat first. The bad news just keeps coming, rumbling along, funneling us like traffic past an accident scene to this rushed and regrettable introduction. You’ll spend more time with the clerk who checks your groceries or the teller at the drive-through window than you will with me, a complete stranger, before I cut your baby open and preside over what could be the ultimate event in his life. ( 188 ) s m a l l I know the scenes that have been flashing before your eyes like some kind of big-screen action adventure movie you’d rather not have a part in—the helicopter transfer to a children’s hospital in a strange city, the urgent echocardiogram, the heart defect diagnosis , and, as if that wasn’t enough, now this unexpected surprise. A few hours after arriving here, your son started vomiting, his belly swelling to ripe-melon firmness. His skin...