To the Mother of the Baby I Brought Back to St. Kitts
On a snowy December night in 1995 I worked the overnight shift in my pediatric intensive care unit (PICU). Fortunately, only three critically ill children would be spending Christmas in the PICU this year. Our tiny patients were quiet that night, requiring only routine assessments and interventions, so with the lights dimmed, and monitors softly sounding to the rhythmic beating of hearts, the other nurses and I felt we were in for a peaceful shift.
The calm was broken by the ringing of the phone, “Pediatric ICU, this is Claire.”
I picked up quickly so not to awaken our sleeping babies. At first, no one spoke. I was about to hang up, thinking it was a wrong number,
“Claire? It’s Sue.”
“You sound upset. Is everything alright?”
“Amnoe’s mother called me from St. Kitts. He died today.”
My heart sank and I wept with Sue. Amnoe had suffocated from a clogged airway during an afternoon nap. The nurses and doctors decided he didn’t need his breathing monitor because he was doing so well. No one knew that couldn’t breathe. No one knew until it was too late.
I slumped into the nearest chair. “It’s only been six weeks since we left him there! His birthday is in two days! How did we fail? We were certain that they understood what we taught them…weren’t we?”
“Yes. We didn’t fail, Claire. His mother was right.”
Amnoe, your sixth child, was born on December 23, 1993, with a constellation of life threatening birth defects. He was flown to a US hospital in Hartford, Connecticut by Healing the Children Foundation. The intensive care required to save his life was not available in St. Kitts, your home. Amnoe was feverish with bacterial sepsis; his abdominal skin was painfully eroded around the ill-fitting, surgically inserted feeding tube; he had a defective heart, esophagus and trachea, yet made it to Hartford Hospital’s neonatal intensive care unit (NICU) alive. As a mother, I dared not imagine the pain of relinquishing your precious newborn infant to strangers who would transport him to a far away, foreign country.
For eight months, while Amnoe was a patient in the NICU, he endured multiple surgeries and other painful procedures. He couldn’t feed or breathe without mechanical support. Three months into his stay, with generous donations from hospital personnel and charitable organizations, you and your husband, James, came to visit. Amnoe’s nurse guided you to the sink to scrub your hands and helped you into sterile isolation gowns. The two of you peered nervously into Amnoe’s isolette, softly telling him you were here and that you missed him so.
“Might I please hold him now?”
As his nurse gently removed him from the isolette and placed him in your lap, your eager arms embraced his tiny body, deftly placing your hands between IV lines and monitor leads, and protecting his breathing tube from disconnection, as though you had practiced it in your mind a million times. James failed to stifle his sobs. His joyful tears, abundant as yours, blurred his long-anticipated vision of your frail little son, whose bright eyes and ample cheeks proved he was yours.
You listened intently to the story of Amnoe’s time with us and the prognosis for his eventual return to St. Kitts. With startling resolve you implored us to understand, “Amnoe will not survive in St. Kitts. They can’t possibly do what you do for him here.”
In August of 1994, after defiantly surviving near insurmountable challenges, including several cardiac arrests, Amnoe outgrew criteria for NICU care. He was transferred to the PICU, where he would live until he was well enough to go home. For nearly one year, I was his primary nurse. I cared for him nearly every time I worked. I monitored his responses to care and documented his progress. Notwithstanding the unimaginable traumas he had endured, Amnoe was becoming quite a charming and spunky little guy. His cheeks reminded me of a hamster’s filled to the max with nuts and seeds, far out-sizing his very tiny nose. His big black eyes sparkled over that wide, gleeful smile, and like every toddler I’ve known, overdramatic temper tantrums let us know what made him angry.
Amnoe’s many long days were spent playing peek-a-boo with anyone who entered his room, sorting plastic shapes into their holes in the ball, building block towers, and dancing to his favorite Sesame Street songs. He would jump and laugh with excitement when I would put him in his wagon, portable oxygen in tow, and walk him to his play therapy sessions with the Child Life Specialists.
Months passed and Amnoe thrived with supportive medical care, respiratory rehabilitation and physical and occupational therapy. He reached unexpected milestones, most notably, learning sign language. The multidisciplinary team believed it was time to determine his survivability in the real world.
Before Amnoe landed on American soil, Healing the Children had recruited a Connecticut family to “foster” him throughout his time in the hospital. Sue, a suburban, stay-at-home mother, her husband and her two children became his adoring foster family. They visited regularly, prayed for him, read to him, held him, and ultimately fell in love with this frail little stranger. When the time came, they couldn’t wait to take him home to live in the room that they cheerfully decorated for him. They all learned to use his breathing machine, to clear his throat of mucus, and to feed him via the tube. Most critically, they learned to respond in an emergency.
They brought him to concerts in the park, to family events, and anywhere else they would go, equipped with all of the cumbersome medical equipment needed to sustain his well-being. The trial went seamlessly.
By September, 1995, Amnoe’s return trip was scheduled. Glen, Amnoe’s respiratory therapist, Sue and I formed the team that would bring him home. We would stay for a week to teach his caregivers to carry on with his plan of care. We left the US on November 1, delayed due to hurricane damage to the hospital in St. Kitts.
We changed planes on the tarmac at San Juan International Airport. The small, flat-sided plane that would fly us to St Kitts looked like one of my son’s toys. I thought it was made of wood. When I stepped inside and saw the single row of seats, my heartbeat nearly doubled. Once we all settled in and saw that Amnoe was comfortably restrained in his seat, we took off. The spectacular view from my window provided needed calm over my masked terror that we would inevitably splash, nose first, into the bluest of blue Caribbean Ocean.
An hour into the flight, a reassuring sight arose from the sea; a beautiful, towering mountain of medieval design, its peak encircled by clouds, dense with the greenery of the rainforest. Our eyes explored the tropical landscape, enlarging slowly during our seemingly endless approach. The welcome sight of the volcanic island of St. Kitts reassured us we would soon land, intact.
An anonymous benefactor offered us lodging in his condo with a bird’s eye view of lengthy white beaches incessantly lapped at by white, foamy waves. Glen and I traded off night shifts at the hospital to oversee Amnoe’s care. We spent hours each day teaching the doctors and nurses to use the ventilator, feeding pump, and respiratory monitor. They would, in turn, demonstrate their ability to assess his condition and intervene as needed. Sue spent her time playing with her foster son, and introducing the staff to his favorite activities.
Our interactions with the doctors and nurses at the hospital—an open air anachronism to the world we left behind--while welcomed and productive, revealed our palpable cultural differences. Our type-A, American personas, ever in critical care mode, were skeptical of the “don’t worry, be happy” personas, characteristic of Caribbean natives. We began to understand your fears.
At the end of the week, Glen, Sue and I were confident in the hospital's understanding and ability to care for Amnoe. You and James graciously treated us to dinner at a lovely restaurant overlooking a twinkling harbor the night before we left for home. You talked lovingly about your other five children who were happy that their little brother was home. Over and over you told us, “ We would never have imagined that people like you live in this world. People who have so much dedication for children that they leave their own homes and their families, to travel this distance, to bring a child back home to his family. Your loving care of Amnoe will not ever be forgotten.” After we exchanged our long embraces, we left with cautious optimism that, before long, Amnoe would transition to his home.
I write this, now 25 years later, with the same sinking feeling in my heart as the moment I answered the phone on that cold December night. I am so sorry that your fears came to fruition. It is my profound privilege to have known, cared for and loved your Amnoe, and to have had the immeasurable pleasure of bringing him home to you. My deepest hope is that you have found peace with your tragic loss, and that you know how many lives were indelibly, delightfully touched by Amnoe.