In the Woods: On the Nature of New Life

By Amara Finch

The medical team waited with bated breath, listening to the piercing cries of the woman in labour, a mother unsure of her infant’s fate. Her sounds were guttural, born of pain, but also of fear, and likely of sadness. When the girl was finally born, she was both impossibly and unmistakably human. Her skin was as translucent and brittle as fallen leaves. Her eyes were fused shut, and her limbs were thick twigs. We weren’t sure we would have equipment small enough to save her: a tube narrow enough for her trachea, a mask tiny enough for her face. And as she teetered at the edge of survival, we weren’t sure that employing these tools would be the best decision, knowing full-well the risks and challenges of extreme prematurity.

***

A few days following the infant’s birth, as the sun dipped lower in the sky and the autumn air grew cool, I set out on a hike with my daughter. Having just turned one, she cooed happily in her hiking backpack while I slowly made my way uphill. I had walked this trail many times before, both at the height of summer and in winter while it was covered in snow. Now, in late October, the trees were muted shades of orange and brown and the trail was covered with leaves.

Although it’s not a particularly scenic trail, I’ve always appreciated it for its quiet tranquillity. Thanks to its lack of a clear destination or endpoint, it remains protected from the crowds clogging the nearby canyons. My family had left town the day before, and I was grateful for the solitude, the lack of conversation, and for this time alone with my child. I ambled along, one foot in front of the other, aware of her weight on my back.

As I walked, the forest hummed. The creek alongside the trail babbled loudly, and soon enough, the ancient, chaotic sound of running water and the cadence of my steps lulled my daughter to sleep.

***

Earlier that week, I stood among a throng of medical workers—physicians, nurses, respiratory therapists, and a social worker—in the hospital’s NICU where I work as a medical resident. The crowd had gathered to await the birth of a baby who had just completed 22 weeks of gestation, the youngest that most hospitals would consider old enough to treat. The room thrummed with anticipation, questions, and conjecturing. When I learned of the impending birth, I had combed through the mother’s chart, collecting details and clues that would help us anticipate what the baby might need to survive.

The pregnancy was desired and complicated: the mother conceived through IVF but was found to have massive fibroids impinging on the foetus in her womb. Over the previous week, she had experienced intermittent cramping and bleeding. Earlier that day, she arrived at the hospital in preterm labour, and there was no way of staving off her baby’s inevitable arrival. Doctors spoke with the expectant couple, explained that their child was considered "peri-viable”. It would be reasonable, they counselled, to choose not to intervene, to focus on comfort instead. The parents stated that they wanted everything done that might save their child’s life. Now, several hours after the couple arrived at the hospital, the mother gave one final push and her daughter emerged.

Within seconds of her birth, a nurse passed the infant through the window connecting the delivery room to the NICU: a common design feature in hospitals equipped to handle the most complex deliveries. The receiving nurse placed the infant’s limp body on the resuscitation table and wrapped her in plastic to keep her warm. A swarm of hands surrounded her, one flicked her feet to stimulate her, another placed a warm hat on her small head. In the midst of the quiet commotion, the baby’s father entered the room. He stood by the bed, watching it all, quaking like an aspen in the breeze.

One provider tried to guide our smallest endotracheal tube down her throat and failed. She tried again. She failed again. Next, a senior physician attempted, and in one smooth, delicate motion, he succeeded. Small puffs of air rhythmically inflated the infant's chest, her ribcage expanding and relaxing, all dictated by a stranger's steady hand. As air filled her lungs, it escaped from her father’s in a prolonged exhale. His relief was obvious. He slapped the back of the attending physician and went in for a high-five. “You did it,” he said, his voice victorious. “We got this.” The attending turned to him, stoic, and nodded. “We got the tube in,” he acknowledged. “But we are not out of the woods.”

***

After over an hour of ascending the trail, I set down my pack and placed my daughter on the soft ground. I offered her snacks, and she ate enthusiastically, practicing her voice with staccato consonant sounds and loud shrieks, intermittently picking up a pile of crunchy leaves and reaching towards the flowing water beside us as if offering incantations.

Soon, we heard the beat of footsteps and the low tones of other hikers in conversation as they approached from above.

“Hey,” one called out as they neared us. “There are a couple of moose just over the hill. It’s a mom and her baby, so she might be feisty. Be careful.”

“I get it,” I responded, without irony in my voice. “That’s my sign to turn back.”

***

Once our patient was intubated, her mother arrived, pushed in a wheelchair by a young nurse. She was shockingly placid, a sharp contrast to the primal wails that we heard through the walls as she delivered. Now, she stared at her daughter’s delicate face. Whereas her husband had seemed celebratory, she was not so triumphant. Watching her, I remembered the first time I laid eyes on my own daughter, my sense of gratitude and bewilderment. I wanted to speak to this new mother, to say the right thing.

“You’re incredibly brave,” I told her, aware of how inadequate it seemed.

“Nobody prepares for this,” she responded. “But here we are.”

***

The hike downhill went quickly. I walked fast, my legs relieved to be working with gravity, and my steps fuelled by the chill in the air. My daughter, satiated, fell sound asleep once again. I passed a handful of hikers who had just begun their ascents, braving the sinking sun in favour of one more weekend walk. As the trail approached the parking lot I saw the colourful glint of cars through the trees, and I fumbled in my pocket for my keys.

By the time night fell, we were back in the warmth of our home just twenty miles away. I fed my daughter warm squash pancakes, and she squealed and grunted with glee after each bite. I drew her a bath, the water gushing steadily as it filled the tub. When I stripped her soft clothes from her even softer skin, flakes of dried leaves emerged and drifted down to the floor.

***

A week after our hike, I learned that the 22-week infant had died. She lived for 10 days before succumbing to an invasive infection that could not be controlled. I was not surprised. When saving her life, we had known it was going to be an uphill battle. But the sadness of her loss loomed large in my mind. I found myself imagining her mother’s calm face, her father’s moment of revelry. I wondered what stories they would tell themselves as their daughter turned from a medical miracle into a memory. I wondered if they would consider her brief life a victory, a flicker of hope, or a devastating realization of what was barely possible to begin with.

***

Snow has come to our corner of the world now, and from the hospital windows, I can see the nearby mountains blanketed in white. Inside this building, more babies are born every day. Outside, the trees cling to their last remaining leaves. Moose cows cradle young embryos in the caves of their wombs while last year’s calves remain by their side. Between patients, I run a mental inventory of what I will need to prepare my daughter for the season: snowsuit, hat, mittens, boots. A year ago, she spent her days sleeping, nestled within my coat. This winter, she will be walking on her own.

Before she was born, I was desperate for my baby to survive. I fixated on her well-being, coveted the numbers and graphs telling the story of her growth. I craved the feeling of her movement in my belly, evidence that she was still there. Despite never feeling particularly spiritual, I found myself returning frequently to prayer: that deepest longing in the absence of guarantee. Well-meaning family members told me not to worry, reminding me that the odds were in my favour. But I could not forget what I had seen so many times before: the way the ancient, unpredictable forces of nature can steal the dreams of any parent.

Even now, with our tiny tubes, our plastic wrap, and our ability to blow air into the tiniest lungs, we are not above the biological processes that govern birth, life, sickness, and death. There are still pregnancies that end too soon and infections that cannot be tamed. We may practice our craft behind sturdy walls, but we are not separate from the wildness of the world.

“We are not out of the woods,” the attending physician had said that day in the NICU, an ominous assessment of a dire situation. But perhaps that idiom should be taken as more of a truism and less of a warning.

It is a solemn acknowledgement that we can never rise above the fragility that comes with being part of a natural, complex, and ever-evolving system.

As a parent, I know the fierce, instinctive and immutable desire to protect our young. And as a doctor, I know it is not always possible. In my stronger moments, I take solace in this knowledge; I find something comforting in the fact that our species remains connected to the natural world by an invisible, uncuttable cord. It is the opposite of exceptionalism, an antidote to loneliness. And so I walk through the woods and the hospital hallways, attempting to acknowledge the beauty of the light through the leaves, not just the threat of the cold.