Magary - Someone could get hurt : a memoir of twenty-first-century parenthood

W e all agreed that the child must be disemboweled. The doctor stood with my wife and me in the surgical waiting room and calmly explained what he was going to do. He would make a small incision in my sons belly. He would pull out my sons small intestine and lay it out on the table, all eight some-odd feet of it. He would check to make sure that blood was flowing to every part of the bowel. Then he would untangle the tangled parts, stuff them all back into the babys body, and hope that they stayed in place. My son, at the time, was nine days old.

Our third child was born seven weeks premature with a condition known as intestinal malrotation. The doctor explained it like this: When youre in your moms uterus, your intestines initially form outside of your body. Then they retreat into your abdomen, twist, and your abdomen seals up around them. If youre unfortunate enough to be born with this condition (5,000-to-1 odds, though more common in premature infants), that crucial twist never occurs, and you can end up with something called a volvulus, which sounds like a kind of Swedish superhero but is actually a dangerous condition in which the intestines get kinked, like a garden hose, and the path of digestion is cut off, restricting blood flow. You must have your belly split open so that everything can be put back in the proper order, or else you will die. If youre among the lucky souls born with properly ordered bowels, you should thank those bowels the next time they process a two-pound burrito on your behalf.

They found out that the baby had the condition when he began vomiting thick green fluid after his first feedings. The bile that he secreted to digest his formula was getting clogged in his intestines and was gurgling back up into his stomach, causing him to vomit over and over again. They placed a tube down into his stomach to suck up all the excess fluid and hoped the issue would resolve itself. Nights before the surgery, I stood by his isolettean enclosed plastic incubatorin the NICU and stared at the output of that tube, praying that it would turn yellow or clear, hoping to God that hed be spared the knife and that Id never see that horrible green shit come out of him again. But I did see it again. I would come to the NICU during the day and ask the nurses if he barfed, my fingers crossed tight enough to break. And they often said yes, he had an emesis. The first time I heard the word, I asked them if emesis meant barf, and when they said that it did, I wished they had just said that he had barfed instead.

The vomiting wouldnt stop. His insides werent going to just naturally fall back into place. He had to be opened. No one makes it through life unscathed, but you usually get a grace period at the start. My son would not be so lucky. At the time, he weighed five poundslarge for a preemie, but still just five itty-bitty pounds. No heavier than a dictionary. I wondered how the surgeons blades and instruments would fit inside him. Such a large surgery for such a tiny body, I thought.

The surgeon was talking us through the procedure as we all stood by the door to the OR. He had only a few moments to speak with us before our son had to go under. To wait any longer risked killing him.

Whats the survival rate for this surgery? I asked the surgeon.

If I dont find any salvageable bowel, the survival rate is zero. Doctors never explicitly say your loved one will die. They say things like the survival rate is zero. Its up to you to jump to the proper conclusion. But if the bowel is healthy, he said, the survival rate is one hundred percent. He suspected my sons bowels were still viable, but he didnt rule out the possibility that there would be dusky bowels, parts of the intestine that had lost blood flow permanently and were now dead and would have to be removed. Forever. I had never heard the term dusky bowels before. It sounded like a good name for a fantasy football team.

The doctor needed our consent before going ahead with the surgery. We didnt hesitate for an instant. In fact, we felt as if we had wasted enough of his time already. Its amazing how quickly youll agree to a procedure like this once you hear talk of survival rates. You take a leap of faith. You trust that a total stranger will know how to properly disembowel your child because you do not. He was a nice-looking doctor. He seemed to know what he was talking about. Fuck it. I signed the forms.

The doctor rushed back into the operating room to prepare, and a very nice NICU nurse named Kathy led my wife and me to our son, to see him one final time before he went to have his guts torn out. They had knocked him out with an anesthetic, so he was sleeping peacefully by the time we got there. He was in an isolette and had wires running from his mouth, chest, stomach, and foot. He looked like an IED. He was surrounded by a phalanx of adults who were all determined to prevent his death because the death of a child is the saddest thing in the world. He wasnt old enough or awake enough to know that he didnt want to die. We did all that worrying for him. Kathy opened the top of the isolette so we could kiss him on the headpossibly for the last time, possibly just another kiss in an entire lifetime of them.