Newport News -- The baby wasn't supposed to be so sick. She shouldn't have been this tiny - barely 4 pounds, with impossibly thin fingers that grasped at the nurses hovering around her. Her heart was beating too slowly. Her lungs wouldn't fill with air.
She was 2 minutes old, and she was dying.
Dr. Adel Abdallah didn't expect this, but he's good at surprises. His patients, the youngest and most delicate at Riverside Regional Medical Center, can never tell him what's wrong. He has to solve their mysteries, even if they're born with legs smaller than his pinky finger, eyelids still fused shut, heart defects, brain damage or twisted bowels.
"In my work," Abdallah said, "you cannot plan a thing."
As a neonatologist in Riverside's special care nursery, Abdallah is on the front lines of a battle that can be lost in a matter of seconds. His enemy is infant mortality, a health tragedy across the country, the state and, in particular, Hampton Roads.
Some women who have sick or underweight babies are poor and didn't get good prenatal care. Some are teenagers barely able to care for themselves, much less nourish a growing child. Some are drug addicts. A few gave birth in toilet stalls. Others carried two or more children after fertility treatments or went into early labor because of infections, high blood pressure, stress or unknown reasons.
And many more are devoted, financially stable parents who went to every doctor's appointment, ate the right foods and got plenty of sleep but still had something go suddenly - sometimes terribly - wrong. They learned how fragile the beginning of life can be.
Abdallah - who survived his own fragile childhood on the violence-plagued West Bank - tries to help them all.
Shortly into a recent shift, he hunched over the 4-pound baby as she struggled to breathe. Ayanna Fuller was a full-term infant who looked at least several weeks premature. Just plucked from her 21-year-old mother's womb during a Caesarean section, her skin glistened beneath the bright lights of the operating room.
Previous ultrasounds had suggested that Ayanna had a heart defect, but they also predicted that she'd be a healthy 7 pounds. And her lungs were supposed to be fine.
Abdallah frowned as he pressed a stethoscope against the baby's chest. Minutes later, Ayanna had a tube down her throat to deliver quick pumps of oxygen. Abdallah also wove two tiny catheters - each one not much wider than thick sewing thread - through the dark stump of her umbilical cord and into blood vessels in her heart. Those would monitor blood pressure and carry medicine and fluids.
Ayanna's face scrunched up as she cried, but it was a silent wail muffled by the tube against her vocal cords. Her mother, Renae Fuller, couldn't hear or hold her firstborn. A doctor finished stitching up Fuller's abdomen as nurses wheeled Ayanna to the special care nursery.
Compared with many babies there, Ayanna looked huge. One boy had been born at just 23 weeks, a little more than halfway through a normal pregnancy, and was still covered with the fine body hair that keeps fetuses warm in the womb. He's one of the medical miracles - babies who, not long ago, wouldn't have lived an hour. Even today, he had just a 5 percent to 10 percent chance of survival at birth. The downside to such miracles is that very premature babies often grow up with serious physical and mental disabilities, including brain damage, cerebral palsy, and vision and hearing loss. Some people, even some doctors, debate the wisdom of spending so much energy and money to try to save all of them.
Abdallah relies on a simple philosophy: "Give them the best chance, and if they fly, they fly. If they don't - well, they weren't meant to fly. That's when I can let them go."
A BUSTLING NURSERY
The United States, home of modern medical technology and some of the best doctors in the world, has a surprising problem: Too many of its babies are born sick and weak, and too many die. Hampton Roads is no exception. In fact, the region has struggled with infant mortality and low-birth-weight births for years. Poverty, substance abuse, teen pregnancy and a transient population that can isolate new mothers are likely factors.
When Abdallah came to Virginia to work in Riverside's special care nursery 11 years ago, he was averaging six patients a day. He now averages 20. Thanks to medical advances, those babies have a better shot at life than ever. Doctors can save infants born at just 22 weeks, though anything before 26 weeks remains a struggle. By 28 weeks, the chance of survival jumps to 90 percent. This year, a Chicago infant born weighing only 8.6 ounces - less than a can of soda - got to go home.
Unfortunately, survival does not guarantee good health. About 46 percent of children born between 22 and 25 weeks have severe or moderate disabilities by age 6, according to a study published this year in the New England Journal of Medicine. Thirty-four percent are mildly disabled, and the remaining 20 percent have no disabilities. Some grow up to be great athletes or scholars, bearing no signs of an early struggle for life.
Abdallah hopes that some of the luckiest babies are his.
Riverside's special care nursery is the only such unit on the Peninsula, so it's almost always bustling. A core team of two doctors - Abdallah and his partner, Raymond Amaker - and four nurse practitioners are on duty 24 hours a day, seven days a week. Abdallah stresses that everyone is equally dedicated. Shifts begin before 6 a.m. Abdallah and Amaker don't deliver babies, but they take over immediately after birth. They juggle about 35 patients a day - special-care babies and healthy newborns - until the afternoon, when they do three or four hours of paperwork. One is on call every night in case of an emergency.
They monitor vital signs, put in catheters and feeding tubes, read X-rays, watch for complications such as brain bleeds and run lots of tests, sometimes calling in neurologists, cardiologists and other specialists to help. On a recent day, one baby tested positive for syphilis, a sexually transmitted disease passed from the mother. With 10 days of penicillin, the doctors were able to cure a dangerous illness that might have taken years to appear.
Many premature babies also need regular doses of surfactant, a substance that normally coats the inside of the lungs. The typical preemie is born with just one-20th of the surfactant needed to breathe. They often have stiff, immature lungs that basically collapse each time they exhale.
Even with around-the-clock help, babies can go from stable to dying very quickly. The challenge is to stay calm and somewhat detached from all the squirming bundles - but also to know everything about them. Whenever Abdallah leaves the hospital, he takes a stack of white index cards with scribbled notes on each baby. If his phone rings at 3 a.m., he can grab for the cards as he rubs the sleep from his eyes.
Falling in love with these patients is easy. They gaze up with wide eyes, squeak as they drink milk and curl up to sleep with legs tucked under their stomachs. Abdallah has a particularly hard time with his latest miracle, the boy born at 23 weeks. Not because he's frail, but because of his name: Zachary. It's the same as the doctor's 6-year-old son.
Baby Zachary's mother, Sandra Reduto of Hampton, had no trouble during her first months of pregnancy, not even morning sickness. Then a mysterious infection put her into labor at 22 weeks. For six days, Reduto took medicine to stop contractions and lived in a hospital bed that tilted her head toward the floor. Literally, she tried to defy gravity.
Zachary was a stronger force.
"It has been so frightening," said Reduto, who had spent eight years trying to get pregnant. She now pumps breast milk every three hours to give her son strength. Zachary, born weighing 24 ounces, likely will need to spend three months at Riverside.
Abdallah, Reduto said, is a gift from God.
But the gift doesn't come with God's power. Sometimes, the odds are simply too steep.
Adel Abdallah knows something about overcoming odds. He was born in Surda, a small Palestinian village about 15 miles north of Jerusalem. Most people were poor. Abdallah's father, Zuhdi, immigrated to the U.S. Virgin Islands in the late 1950s to find a better-paying job. He worked as a door-to-door clothes salesman before opening a clothing store, travel agency and motel in St. Croix.
Abdallah's beloved mother, Hasiba, raised Abdallah and his four brothers. Hasiba was stricken with brain cancer when her children were young. Radiation treatments left her with facial paralysis that made her cough violently when she tried to eat. Her boys watched helplessly as she sobbed in frustration. Hasiba lived until 1989 and got to see her children grow up. Her years of suffering, though, first inspired Abdallah - her third child - to dream of becoming a doctor.
But Surda was a long way from medical school. The farming community had a single main street and just one school, an elementary education program with two teachers. First through third grade was in one room, fourth through sixth in another.
Everyone knew everyone. Most people worked the fields or did some other type of manual labor. Only two or three families owned a car. Others rode the bus to the nearest city, Ramallah, about two miles away. There, they could shop or go to school beyond the sixth grade.
Life was simple in many ways, but it wasn't peaceful. The conflict between Israelis and Palestinians was raging, and the children of Surda were caught in it. They ran to hide when army convoys rolled toward their village. On bus rides, soldiers often checked their identification cards and arrested people around them.
When Abdallah was 12, one of his neighbors was on a bus home from work when Israeli soldiers came aboard and shot him. Abdallah will never forget the bloodstains that soaked the white cloth wrapping the young man's body for burial. He doesn't remember being afraid, just sad and angry.
"I grew up with checkpoints, constant humiliation, demonstrations, bullets, tear gas, arrests and more," he said. "This is a usual day for those living under occupation. All I can say is that we are shaped the way we are because of the past experiences that we live through. Some of us use the past as a step to a better future; others harp on the past and never learn from it. I hope I am from the first group."
Abdallah threw his energy into education. He went to public middle schools in Ramallah and got into the Friends Boys School, a local high school founded by Quaker missionaries. Of the roughly 20 students in his class, Abdallah was the only one not from a privileged or well-educated family. But he was smart. After picking up English as a teenager and graduating in 1975, Abdallah got into the University of Jordan as a science student and stayed for medical school. He had to leave his family in Surda, going back to visit about once a year. His father paid the bills, but Abdallah learned to rely on himself.
As a medical student, he was drawn to the most innocent patients, the babies and children. None were sick because they had smoked cigarettes, eaten badly or not exercised. They were perfectly helpless - even more helpless than his mother had been when she gagged on her food.
Abdallah spent a year working at St. Croix Community Hospital before heading to Children's Hospital in downtown Detroit on a recommendation from a fellow doctor. He couldn't believe what he saw: So many babies were born addicted to drugs - shaking, screaming, sweating and suffering raging bouts of diarrhea. Abdallah couldn't imagine how a mother would forgive herself.
As he worked through culture shock, Abdallah met a kind and devoted nurse named Bonnie. Absorbed in their jobs, the two did not start dating until eight years after they first crossed paths. They married two years later. His wife is now a homemaker in York County and the mother of Allison, 7, and Zachary, 6. Abdallah has never taken his family to Surda, fearing the trip would be too dangerous. Luckily, all his brothers have immigrated to the United States with help from their father - still running his clothing store in St. Croix at 77 and now a U.S. citizen.
Co-workers describe Abdallah, 48 and also a citizen, as the ultimate family man. But unlike his wife, he was sure he didn't want more than two children. He had seen too much of what could go wrong, and he couldn't ask for another miracle for himself. For a person who - by all accounts - is sensitive, warm and humble, working in the special care nursery is draining enough.
"I know he takes it home with him," said Natalie Erger, a Riverside nurse practitioner and one of many co-workers whom he calls "ma'am." "He thinks about these babies a lot, even when he's looking at his own kids. Maybe especially when he's looking at them and rejoicing at his luck."
NOTHING IS A GIVEN
That's true, Abdallah says. That's the joy that he wants every parent to experience. But if a baby is too sick for that to happen, he and the nursery staff can't help but mourn. About once a month, the worst happens: They have to watch a child die.
Despite the smile on his face, Abdallah describes himself as a "glass half-empty guy." He takes nothing for granted. As much as he loves babies, for example, he hates baby showers. "How can you celebrate before you know they're going to be all right?" he asked. "How can you assume?" When parents see those assumptions shattered, their first reaction often isn't sorrow but anger. One new father exploded as Abdallah fought to save his daughter. "You're wrong!" the man shouted. "Babies don't have heart disease!"
Abdallah rarely snaps. He considers these devoted and overwhelmed parents - not himself - the real heroes of the special care nursery. Parents who have spent days, weeks, even months in the nursery disagree. "He has given us exactly what we needed because he never hid anything," said Jessica Carter, whose daughter Anaisa was on a breathing machine for three days after her birth. "He gave it to us straight but with compassion."
Carter and her husband, David, have three other children, all born healthy. When Anaisa was born with a suspected heart defect, they felt lost. Patiently, Abdallah explained all the equipment and told them when it was safe to hold their daughter. He celebrated with them when a cardiologist said Anaisa's heart was healthy enough for her to go home. "We really felt that he loves these babies," Jessica Carter said. "When he has bad news, he always says he hopes the baby can't hear him."
Abdallah laughs when he says that, but she doesn't think he's joking. How could he joke, really, when some of his patients are in so much pain? Beyond the babies addicted to drugs, some constantly throw up their food for reasons ranging from acid reflux to brain tumors. Some yank at the tubes keeping them alive. Others cling to life for weeks, only to die of an illness that a stronger baby could beat.
Keeping them alive can be a pricey and high-tech battle. Premature babies who can't maintain their body temperature live in $35,000 incubators. The newest breathing machines, called "smart ventilators," can tell exactly when babies need more oxygen and control the length and depth of each inhalation. High- frequency ventilators can pump extra oxygen by forcing infants to take 600 to 700 breaths a minute, compared with 60 to 70.
Before dawn, doctors and nurses are alone with the babies and machines. Their jobs range from draining fluid around an infant's brain to removing early, loose teeth that pose a choking risk. They coo over the babies and hug the ones they can. Sometimes, they kid around to break the tension or drown out the crying in the background.
On a recent day, registered nurse Vanessa Deuell playfully imitated Abdallah's accent as he talked to a week-old baby who had been spitting up his formula. "No SPEET-ting," she said. Abdallah laughed. He considers his co-workers family, so they're allowed to tease.
"He's wonderful," Deuell said as Abdallah left to check a baby's X-ray. "There aren't many people who could do this all the time without cracking."
Sometimes, the mystery of what's made a baby sick isn't so hard to solve - or to fix. Little Ayanna Fuller turned out to have a heart defect called Tetralogy of Fallot, a hole in the wall between her two pumping chambers, and limited blood flow to her lungs. Doctors usually can solve that problem with surgery before a child's first birthday.
Once Ayanna's life was out of danger, she was moved to Children's Hospital of the King's Daughters in Norfolk for more tests and care.
Abdallah's time with her was over, but plenty of other babies still needed him.
Watching little Zachary Reduto sleep in his incubator, Abdallah marveled that the baby's once-transparent skin had grown thick.
At 9 weeks, Zachary was off his ventilator and starting to drink from a bottle. He was still fragile, but he was getting stronger every day.
Sometimes, the greatest surprise isn't how sick a baby is.
It's how a child born so weak, so helpless, can fight so fiercely for life.
Published: February 27, 2005