The nature of a baby with hypoplastic left heart (a “hypo-plast,” as we call them) means that oxygen – the life-giving, life-saving drug that we routinely use during medical emer¬gencies – can kill. There is a tiny duct that is helping to keep the baby alive, their foetal underwater circulation. Usually this closes a few days after birth, but Baby Murphy’s duct needs to stay open. Oxygen can speed up the closure of this hole. If these babies cry, they let in too much oxygen. Much of a nurse’s job caring for a pre-stage-one Norwood procedure – the first of three major re-plumbing operations to treat hypoplastic left-heart syndrome – is to make sure these babies don’t cry: so much resting on such a simple thing. If Baby Murphy needs help breathing when he is born, my task is to hand over the canister of air instead.
Claire is surrounded by people. Her dark hair is fanned out over her pillow and her T-shirt is scrunched up around her middle. I look at her fluffy pink-and-purple-striped socks. She is looking at Richard, and I watch the look that passes between them. Fear. He stays at the top end of things and focuses on his wife’s face. Claire now pushes and screams and pushes.
“Listen to my voice,” Preeti says.
The neonatologist, the other midwife and the paediatrician all stand back near the equipment. I stand as close to the door as possible. My only role is to hand over the canister of air if there are immediate problems, and to make sure nobody gives oxygen. An oxygen-gatekeeper. It is a nothing job – a task that anyone can do. But I hold my breath, wishing the baby to be born okay.
Claire’s face changes colour. She pants. I watch Baby Murphy come out in a rush, a flurry, an instant. Preeti has unhooked the cord, which was around the baby’s neck, and reaches up to place the baby on Claire’s stomach, which is already deflating like an old balloon.
“You have a son,” she says.
He cries, a tiny bit. The sound of a baby’s first cry is a wonderful thing, but this time I will it to be brief. Baby Murphy cries a fraction, then stops. I exhale.
Preeti holds her hands backwards to prevent the doctors coming closer. Everyone is anxious. We all look at the baby and wait. The other midwife gets a warm towel and hands it to Preeti. The doctors edge closer still. Preeti looks back at them. “A few seconds more,” she says.
Richard sobs. He lets go of the chair and holds Claire’s face in his hands. He kisses Claire like I’ve never seen anyone kiss. “A son,” he whispers. He looks at the baby. “I don’t think I can cut the cord. Can you do it?”
Claire looks down at the baby. ‘Can we leave it?’ She looks at Preeti. “For just a moment longer?”
Preeti’s voice is calm and clear. “Take as long as you need.”
I care for Baby Murphy following the first of three big operations. It is known as a stage-one Norwood procedure, which makes it sound almost minor. It is a huge surgery, a re-plumbing that involves, among other things, cutting major arteries and placing a connection called a shunt to divert blood flow.
He is still nameless. As with many babies having cardiac surgery, his tiny chest is not yet big enough to allow for the swelling of his heart, so the surgeons have to leave his chest completely open, his walnut-sized heart frantically beating in front of me, covered by a thin piece of gauze. I remember an infestation on the ward with fruit flies. Open hearts and fruit flies. They hover around the air like dust particles. We do not know where they are coming from. The ward is stripped clean and everything is removed: the carpets, the furnishings. We find that the flies are coming from the staffroom where we make coffee. “Only go into the coffee room to make coffee from the machine,” we are told by managers. Everything is taken out. But eventually they find the nest: inside the coffee machine. We stop drinking coffee, for a while.
After much discussion, Baby Murphy’s six-year-old sister, Frances, comes to see him in the intensive-care ward. He is hooked up to so many machines, with swollen eyes, pacing wires sticking out of him, chest drains and lines going into him. Everyone is worried about how Frances will react, but is more worried about her reaction to not seeing him.
Frances is fearless; touches his head feather-soft, smiles a wide smile. “My brother looks like a robot,” she says, looking at all the machinery and equipment.
And Robert Murphy gets his name.