Big Enough

I had my pediatric rotation during the third year of medical school. My first assignment was in the Newborn Intensive Care Unit of St. Paul-Ramsey County Hospital.  The NICU in those days was a new idea, and our unit was modest–a mere eight incubators with monitors and respirators.  My first patient: a premature baby boy weighing 500 grams (about 17 ounces).

The NICU director taught me how to intubate a premie struggling to breath, how to take advantage of the umbilical artery and veins during the first day of life, how to start an IV in a scalp vein. I learned to calculate fluids and nutrition within very narrow margins of error by the barest of guidance from limited labs, weight and physical examination. I learned about respirator settings for tiny human beings, the perils of too little and too much oxygen. I worked hard and learned a lot. The NICU director gave me great autonomy and an experienced nurse gave me lots of help. And I believed my little patient would live.

Then, forty-eight hours later, the baby died.

I was shocked. I had done everything right, done everything I could, and he died anyway. My knowledge and skill and willingness to work were not enough. The baby was too fragile.

The NICU staff was not surprised. Because the one thing I didn’t know, and everybody else did, was that a 500 gram baby had never survived. They had worked with me treating the baby because they hoped he would survive. I didn’t know any better; I believed he would.

Though we failed with that child, there now are a few babies who have survived, even thrived, from sub-500 gram birth weights because another generation of doctors not only hoped, but believed, the most fragile could survive.

I learned three things: babies are fragile, hope is good, belief is better.

This Christmas season I’ve found myself wondering about the baby Jesus and remembering that baby in the NICU.

History tell us that about two thousand years ago, the creator of the universe gave up being God and chose to become the frailest of human creatures, a baby. A very fragile baby. We know what happened next: The baby survived, grew in wisdom and strength, sacrificed himself thirty years later for the salvation of mankind.

But babies are frail. Did God risk the salvation of mankind by coming as a baby? Did He have an alternative plan if the baby Jesus had not survived? I don’t know. I feel that with the alignment of the stars, the signs in the heavens, the specific prophecies about Jesus going back several centuries, Jesus’ birth and life were planned since the beginning of time.

Maybe part of God’s message is about fragility. The nation of Israel had been hoping for a Messiah for hundreds of years, expecting some kind of celestial Superman who could save them from their enemies and restore their political and religious dominance.

Then Jesus arrived as a fragile baby, someone who needed constant care simply to survive, and a message from angels to keep him from being slaughtered with the other infants in Bethlehem by the evil King Herod. I mean, really, if you were there–say, a shepherd who had heard about this miracle from angels in the field–and you had to change a diaper, would you really believe this little guy was the Son of God?

I don’t know why God does things the way He does. The story we have about Jesus is so much more beautiful than the stories we have about the great political and military saviors in the Bible–Moses, Joshua, David, for example. But though the Jesus story is beautiful, it remains puzzling.

This Christmas season, I am thinking of Jesus as a metaphor. A baby Jesus is born into my heart. He represents all those beliefs that are beautiful and true: that I am a beloved child God, that my current experience only touches a true and deeper reality, that my life is not limited by time and space, that order reigns over chaos, that good triumphs over evil, that mercy is better than justice, that true wealth is in the heart, and love is real and stronger than fear and hate.

But He is small and frail.

I have moments, maybe many moments, when I can believe that reality is limited to the cold facts demonstrable by science, that life is limited to a short time on this small planet, that human law is the best we can expect out of justice, that mercy is weakness, fear is self-preservation, forgiveness is foolish, success is getting more, and that love is an illusion based on hormones and reproductive drive.

These are easy beliefs in our secular age. As a flinty-eyed realist, I should be able accept them and dismiss my hope for Jesus as sentimental foolishness.

But I can’t.

When Jesus was born in the stable at Bethlehem, He was small, fragile. Maybe He only weighed 500 grams. But by the grace and love of His Father, our Father, He survived.

He was big enough.

My baby Jesus, born in my heart, has been small sometimes, maybe only 500 grams. Who can measure these things? Sometimes He seems frail. But, by the grace and love of our Father, He survives.

He is big enough.

Miracles Deferred

Snow quiets a city like New Haven, especially at night.  Traffic slows, tire sounds and footsteps muffle.  Even the sirens seem softer.  Silent night, I thought.

It had already been a long day when I lay down in the call-room and closed my eyes, grateful for the quiet.  The time was just after midnight and it looked like I could get in six hours of sleep before the alarm and the chaos started again.

I heard a pop.  My eyes opened, and I thought gunshot.  The noise had come from somewhere out in those downtown streets where all the other sounds had been muffled.  I re-calculated my expected rest time to how long it would take for police to clear the scene, the ambulance to arrive, and the victim be transported to the ER.  Forty-five minutes maybe.

Then I closed my eyes again and tried to convince myself it was nothing.  A car could have backfired, I told myself, but I knew it wasn’t true.  I had heard handguns and I had heard cars.  This was a gunshot.

Then I reassured myself it was someone else’s problem.  I had heard only one shot, and whoever they were 1) could have missed, or 2) could have hit something other than the head or spine.

I dozed off.

Forty-five minutes later the phone rang.  The intern in the ER had a young man with a gunshot wound to his shoulder who wasn’t moving his legs.  X-rays were still pending, but maybe I could come and take a look?

By the time I arrived the x-rays had been done.  The bullet had entered the shoulder but skimmed along the top of the scapula and lodged in the middle of the thoracic spinal canal, a place normally reserved for the spinal cord.

I talked to the victim.  Apparently the issue had been a card game; he still swore he hadn’t been cheating.  His spinal cord injury was complete: no sign of any function in either lower extremity–no movement, no sensation, no reflexes.

I called our director for spinal cord injury, and he agreed with me that the prognosis for recovery was nil, but scheduled the patient for emergency surgery to remove the bullet and seal the wound to prevent infection.  I assisted in the surgery.  We opened the spinal canal and retrieved the bullet.  The cord was completely destroyed.  I remember the clank as the bullet dropped into the metal basin.

I didn’t see the patient again for five years, and would never have seem him again except for a quirk in the department schedule.  I had finished my residency, but was still on the payroll for another month.  The department chairman figured I could do some work in our research lab and specifically get some of the difficult data into our database for long-term outcomes of spinal cord injury.

The secretary gave me a file for a patient in Bridgeport, a bad neighborhood in a bad city.  The patient hadn’t been seen by our department since discharge to rehab five years before.  Although nobody thought his outcome would be anything except complete paralysis, an exam had to be done for the data to be entered.  I headed to Bridgeport.

The man who answered the door was the same man who hadn’t cheated at cards.  It had been five years, but it was clearly the same guy.  I remembered him specifically not only because I had reviewed the record but because I remembered hearing the gunshot that had paralyzed him.

The surprise was that he wasn’t in a wheelchair.  Yes, he had a wheelchair in the back corner of the living room and used it when he went out, but he got around the house on his own two legs using a cane or balancing himself on the furniture.  Though his gait was nowhere near normal, he walked sufficiently for self-care at home.

What I witnessed was a bonafide medical miracle.  Gunshot wounds to the thoracic spinal cord always, always, always result in complete paralysis.  Victims never walk.

But since that exam in Bridgeport, I never say always and I never say never.  I was humbled into allowing room for hope in every hopeless case.

I would like to claim that this miracle occurred because of radically new medical or surgical care, and I know he received good care–but only the same care that everyone else who never did walk received.  I would like to claim he was healed by the intervention of prayer and faith, but the card-player never mentioned it, and back then it never crossed my mind to ask.  So I have no explanation, or even a testimony, but that’s what miracles are always: unexpected hope without explanation.

But without hearing the gunshot on a quiet winter night five years before, I wouldn’t have remembered the circumstances and understood that what I saw later was a miracle.  I would have just filled out a form for the research project and been oblivious.

So here’s the curious thing about some miracles: you might not know you are witnessing the beginning of a miracle.  You might not get to see the end of the story.  Or, conversely, you might be witnessing a miracle, but because you don’t know the backstory, you don’t know it’s a miracle.

Sometimes God gives us signs, though.  To me he gave the sound of a gunshot on a silent night.  To shepherds outside of Bethlehem, He sent an angel.  To men who searched for the truth, he gave a star.  He sends us signs to remember so that when we are privileged to witness another sign five years later, or thirty years later, we will know it for the miracle it is.


Elisa thought she heard a bell, which was odd because her apartment didn’t have a doorbell.  If anyone ever came to her door they would have to knock.  Not that anyone ever came, except once, the UPS driver, only he had the wrong address.  And now it was five o’clock on Christmas Eve–a little late for delivery of anything.

She decided to get up and look.  After all, she was doing nothing except thinking about the eleven-to-seven shift at the hotel downtown.

She was just a security guard now.  But in a year or two, when she was twenty-one and finished a couple of years of college and got into the police academy, then she’d be a real cop.  Until then she still got to wear the cool security guard uniform.

Except, she needed a hat.  The job didn’t require it, because some assignments were always indoors and most of the guys and all of the women thought it stupid to wear hats indoors.  But her current assignment included patrolling outside and in the parking ramp.  Although it might be stupid to wear a hat indoors, it was definitely stupid to be without one out-of-doors in Minneapolis in December.

She knew what she wanted.  One of those round hats with the short brim in front like real cops wore.  Or like bus drivers used to wear, at least in the picture books Mom read to her when she was little.

Mom.  What would she think about a Minnesota winter?  She never left Florida after October or before May, and then only as far north as the Carolinas.  She wasn’t happy about Elisa leaving for Minnesota.  Especially not to follow that boy to welding school here.  Well, Mom was right about the future welder turning out to be nothing but a present day bum.  But Mom seemed less concerned about keeping Elisa warm than about keeping her close and controlled.

Her mother’s complaints echoed in her head.  Why couldn’t you be a teacher or a nurse.  Why couldn’t you settle down close to home, marry a nice boy, have babies.  Well, you could if you just spend a some time on yourself.  A little make-up wouldn’t kill you.

Elisa sighed.  She would rather face a Minnesota winter and a minimum wage job than go back to Florida and hear I told you so for the rest of her life.

She looked through the peephole at an empty hallway then opened the door.  A small, cardboard box lay on the mat, a smudge of melting snow on top.

She listened and it didn’t tick.  She shook it and it didn’t rattle.  Only a muffled thump, thump.  She slit open the seal with her pocket knife–a good cop always has a good knife–and opened it.

A hat.  A perfect hat.  Round, and blue like her uniform with a small, black brim in front, and lined for winter.  Even fold-down ear flaps. And it even had a thin, gold band all around the edge of the base.  Real metal, maybe brass.  Maybe even gold!  Elisa chose to believe it was at least gold-plated.

She tried it on.  Hats were hard to fit over her explosive blonde curls.  Can’t do a thing with it, her mother used to say.  Looks like a Norwegian afro.

Thanks, Mom.

But this one fit perfectly.  She admired herself in the mirror.  Of course, she looked goofy wearing the hat with her bathrobe, but still.  The hat was great.

She searched the package for a card or return address.  No card, no clue in the fine print on the label.  Maybe Mom.  Maybe she meant it as a message of forgiveness for moving, and affirmation for her ambitions, even if Mom wanted her to be something else.  Maybe it was all about love.

Snow fell heavily in the darkness as she left the apartment, her new hat snugged over her curls, coat buttoned to her chin.  She boarded the one lone bus that swayed and swerved through the nearly deserted downtown streets.

She trudged the last two blocks through knee-high fluff.  The snow continued to fall heavily, and the snowplows wouldn’t be able to clear the roads until morning.  The bus she left would be the last one of the night.  As she passed the fire station, four firemen shoveled the broad driveway, working as a unit and clearing the snow as it fell, looking like a team of horses in need of a sleigh to complete a Christmas card scene.  The parking lot for the Lutheran church next door wasn’t so lucky.  A plow had come earlier, but the snow looked to be a good six inches deep with lots more falling by the minute.

Entering the hotel, she was surprised to find it filled with plump, white-bearded old men.  The harried desk clerk filled her in.  Santa Claus convention.  All the Santas in the state were done with their seasonal duties and planned a three-day party to celebrate, compare costumes and tips, and get ready for next year.

“Filled every room,” he said.  “Had to turn away some poor, dumb guy from West Virginia and his wife.”

Elisa couldn’t imagine looking for a hotel in this storm.  She’d never even driven on snow.  “They’ll be okay?”

The clerk shrugged.  “I guess.  Anyway, we got enough trouble here already.”

“The Santas?”

“Well, that.  And electricity is out, phone lines are out, internet is out, and we’re running on emergency backup power.”

Elisa shivered.  She had never been in a blizzard before.  The celebrating Santas seemed incongruous to the weather.  Like a hurricane party, she thought.  Except cold.

She walked the hallways and checked the monitors in the security room.  The Santas played out around midnight, and the rooms became quiet.  The hallways and lobby were lit only by emergency lighting.  Silent night, she thought.  Except for the howling wind.

Carefully she removed the badge from her blue shirt taking care not to snag the pin and fray the cloth.  “Simpson’s Security” it read when you got up close.  But from three feet away, it looked like a badge a real cop could wear.  With equal caution she pinned it on her wool overcoat and went out into the storm.

She made a quick inspection of the alley and the street front.  Deserted.  She left the side exit of the hotel into the parking garage and started walking up the ramps.  Before the weather turned cold she rode her bike to work then used it to do the garage inspection; it took five minutes.  Now, walking the ramp, up and down, would take half-an-hour in the cold.

The garage was unheated, but sheltered from the wind, and with small enough openings between floors to let in only a little snow.  Driven by the cold she hurried up the ramp, puffing great clouds of vapor and stomping her boots.  By the time she reached the third level, she was out of breath and sweating.  She stopped and unbuttoned her coat.

That was when she heard the engine running somewhere above.  Certainly no one had come in recently; the car would have had to pass her.  And almost as certainly, no one was leaving.  Not on a night like this.

Still, that’s why she did patrols.  Sometimes, someone left their lights on.  Sometimes, they left the whole car on.

As she rounded the corner to the fifth level she was already thinking about re-buttoning her coat as her shirt front felt frozen to her skin.  Then she saw great clouds of exhaust fumes coming from an SUV.  Her gloved hands fumbled to retrieve her pen and writing pad.   All she needed to do was take down the license number and get the clerk to use his computer to find out which guest had left his car running.

West Virginia plate, she noted.  Had the clerk said something about someone from West Virginia?

The windows were fogged over.  Elisa walked to the driver-side door.  Maybe the same idiot who had left it running had left it unlocked, and she could shut it down, leave the keys at the desk, and save the guest a cold trip out to his car in the middle of the night.

She tried the door handle, but no luck.  But as she turned away, the door opened.  A guy in a wool shirt-jacket, way too thin for a Minnesota winter, poked his head out.  His hair was too long, and his beard untrimmed.  One leg came out of the car, his left hand on his knee, but he remained sitting, twisted, looking back at her.  She saw his eyes go straight to the badge then flip to the hat before looking down.

“The hotel clerk said we could park here,” he said.

“You’re the guy he sent away.”  She meant it to sound more like a question than an accusation.

“Yeah.” He kept looking down.  “But, see, I tried to drive away, and the car started skidding, and the wheels spinning, and I never drove in anything like this before.  So I turned her into the ramp.  Figured ain’t no one else gonna park here tonight.”  He looked up now, met her eyes for the first time, a little defiant, a little scared maybe.  “We ain’t doing nobody no harm.”

Then Elisa heard another voice coming from somewhere inside the car.  “Tell her, Joe.  She can help.”

Joe looked back over his shoulder into the car.  “She’s a cop, Marie.”

Elisa heard Marie again, this time more like a yelp, quickly choked into a groan.  Joe twisted back into the car.

“I’m not a cop,” Elisa said as the door thunked closed.  She stood a moment in the cold, pulling her coat across her chest, trying to decide what to do.  Joe didn’t want her help.  They weren’t hotel guests.  It wasn’t her responsibility.  She could just put it her report, and get back to someplace warm.

She turned and walked to the back of the car and wrote down the license number.  Exhaust still filled the vehicle lane.  She thought about carbon monoxide and the unexplained yelp, and couldn’t walk away.

She stomped up to the passenger-side door and yanked the handle.  This time it wasn’t locked.  The door jerked open and she saw Marie for the first time, a kid, maybe younger than Elisa herself, sweating, panting with her mouth open, her eyes fixed on something on the car roof, and holding both her hands over an enormous belly.

“Jesus,” Elisa said.

“My legs is all wet,” Marie said between gasps.  “Am I bleeding?”

Elisa looked across the car to Joe.

“We didn’t expect this,” he said.  “We thought we’d be okay til morning.”

Elisa’s reflex was to run.  Somebody qualified needed to be here.  A doctor, an EMT, even a cop.  She checked her cell phone to see if a signal had returned.  It had not.  She calculated the time it would take for her to run out of the ramp and down the street to the fire station.  In the snow.  A long time.

Marie took a breath and seemed to gain control.  She took one hand from her belly and grabbed hard for Elisa’s.  “Thank God you’re here,” she said, turning her head and locking eyes with her.

“Yeah,” Joe said.  “Thanks.  I didn’t mean nothing about you being a cop and all…”

“I’m not a cop,” she said, and they both looked at her as if she were speaking a foreign language.  Then Marie was racked with another contraction, and they both looked scared.

Elisa fought panic.  Women had babies all the time.  Sometimes in cars.  Cabbies delivered them.  Cops delivered them.

“Don’t worry,” she said.  “Everything is going to be just fine.  Great, even.”

Joe said, “Just tell us what to do.”   Marie nodded.

“You’re going to have a baby,” Elisa said with more confidence than she felt.  “A healthy, strong baby.  Probably the best baby in the world.  But first, we’ll move to the back seat where you’ll have more room.”

She swung Marie’s legs out the door and made sure her feet were planted on the pavement.  Then she took her hands and put them around her own neck.  “We’re going to stand up here.  You get a good hold, and when I say three, you stand up.”

Marie got to her feet and made a slow waddle to the rear door.  Elisa eased her in and made her lie back.  To Elisa’s great relief, Marie’s jeans were soaked with water, not blood.  Elisa pulled them off.  “Take my coat,” she said.

Her shirt was little barrier to the cold, but she barely noticed as she positioned Marie with both knees up and spread.  Don’t panic, Elisa told herself.  Act like you’ve done this a million times.

Then the baby’s head showed.

“What do you want me to do?” Joe asked, as he twisted around from the driver’s seat.

Boil water.  Go for help.  Deliver the baby.  She wanted him to do everything and trusted him to do nothing.  “Give me your jacket.  Your baby’s going to need it.”

Joe turned around to kneel in the driver’s seat, stripping off his jacket, then holding Marie’s hand.

No rings, Elisa noticed.  Like it made a difference now.  Marie cried out and pulled her knees up.  Her dark hair stuck to the sweat that covered her forehead.  Elisa took the jacket in her right hand and waited.  Her back froze, even as her face and arms felt the interior warmth of the car.  “It’s going to be okay,” she said, almost believing it.

Marie cried out again, and the baby’s head seemed to spread her thighs.

“Next time push, Marie.  Don’t be afraid.  You’re going to be fine.”

The baby’s face appeared, covered with blood and slime.  Then a shoulder.  Then a naked, slippery body.  Elisa caught the child in Joe’s jacket.

“It’s a boy,” she said.  “A perfect, baby boy.”

Joe and Marie tried to hug across the barrier of the seat and settled for holding both hands.

“I need you to come and stand here, Joe,” Elisa said.

Joe tore himself away and came around the car.  Elisa handed him the baby, the umbilical cord still attached, afterbirth still in the womb.  She pulled out her pocket knife and cut  strips from the lining of her coat to tie the cord.  She cut the cord and handed the baby to his mother.

So blue, so small.  He cried and coughed.  He cried again, now red-faced and mad.  Elisa closed the door and shivered without her coat.

“Joe, get back in there.  You have to keep them warm.”

His mouth still hung partly open, still in the shock that comes from witnessing new life, but as her words registered a new look of determination came to his face.  He marched to the driver door like he was marching to war, his assignment and duty clear.

“I’m going for help,” she said.

“We got an old Hudson Bay blanket in the back.  One of those white ones with the stripes.”

She nodded, grateful.  She would have had to make the effort anyway, but now she might survive.  She headed down the ramp and into the storm toward the fire station on the next block wrapped in the white blanket, the stripes dragging through the snow, making her nearly invisible except for her hat.

The station stood in the shadow of an old Lutheran church, and inside the church dim lights still shone out of stained-glass windows.  Elisa heard singing, probably from Christmas Eve attendees who were trapped by the blizzard and making the best of it.

She ran across the shoveled driveway and pounded on the station door.  No answer.  She pounded again and stepped back.  Lights came from the second story windows where she assumed the firefighters lounged between calls.  She threw a snowball at the windows.  Thump.  She shivered with cold and frustration.  She threw another.  Harder.  And another.

A window opened.  “Hey, cut it out down there.  Whattya think you’re doing?”

Elisa shined her light at the fireman.  “A baby’s been born!” she shouted.  “A perfect baby.  And he’s laying in an SUV in a parking garage.  Come quick!”

The fireman blinked and shielded his eyes from her light.

“Come on!” she shouted, waving her arm.

He turned and said something to the room.  In a minute the doors opened and the rescue van pulled into the driveway.  An EMT opened the door and stood on the running board.  “Okay, lady, hop in and show us the way,” he said.  “And this better not be some kind of gag.”

She jumped in and shivered in her blanket.  “The next block.  The parking garage next to the hotel.  Level five.  Please hurry.”

The siren must have roused someone in the church because the front doors flew open and the sounds of Joy to the World filled the street.

The rescue truck had no problem with the deep snow, and in less than five minutes they had found the SUV.  Then, in what seemed the blink of an eye, Marie and Joe and their baby had disappeared, whisked away to some warm hospital, leaving Elisa standing in the garage alone holding a wet and stained coat with a torn lining.

“Where’ve you been?” the clerk said, as her boots dripped onto the faux-marble tiles and snow flakes turned to water on her eyebrows.  A layer of snow topped her new hat.  “I had to send a waiter to break up a fight on the seventh floor.”

“A fight?”

“Yeah.  A couple Santas got into it.”

“You need me to got up there?”

“Naw. The bartender brought each guy a pint of whiskey, but only if they locked themselves in their rooms.”

“See?” she said, with a wink and a shrug.  “You don’t need me.”

She kept walking, seeking the solitude and the warmth of the security room where she could watch the world on a dozen little flat screens.  She examined her coat and decided it would be wearable in the morning, the blood stains around the fringes not so noticeable on the dark fabric.

Now that she was alone, the events of the night became like a story that had happened to someone else.  It didn’t seem real.  She didn’t even know the last names of those people.  They certainly didn’t know hers.

An intense experience might not turn into a vivid memory unless she could talk it out.  But she didn’t have anybody to tell, not at three-o-clock Christmas morning.   She would have to wait.

Her replacement was delayed by the weather, or maybe that was just a convenient excuse to let him have Christmas morning at home.  He arrived at ten instead of seven.  Buses were still not running, so she walked home.  By noon she was at her apartment, curled under a quilt, sleeping, her hat resting on the coffee table.

She woke at four, not rested but unable to sleep any longer, to the last light of Christmas Day.  She toasted to the holiday with a glass of orange juice, and polished the gold band around her new cap.  Good old Mom.  She came through after all.  Elisa checked her phone.  Cell service was back.  She could call home.

“Merry Christmas, Mom.”

“Well I hope you learned your lesson now, little missy, and next time you’ll think twice about leaving your mother alone.”

Elisa took a deep breath and let it out slowly.  “Yeah, well.  Merry Christmas.  I wanted to thank you for the hat.  So sweet of you.”

“I didn’t send you nothin’.  Wanted you to know the consequence of deserting your family.  ‘Specially at Christmas.”

Elisa, disappointed that she was not forgiven, perhaps not loved, waited, hoping that given the opportunity that silence allows, her mother would confess to the affirming gift, or at least say something of comfort or reconciliation.


Finally, Elisa said, “I helped a baby boy get birthed last night.”

“Don’t you be messin’ with me, girl.  You some kind a rent-a-cop at a motel or something.”

Elisa wondered if she could treasure a memory that she couldn’t share, if it was worth insisting on the truth when the truth would not be believed.  Maybe she could think of an alternative truth, one that could be believed, one that could be shared.

“Well, I got to play the part of an angel,” she told her mother.  “Got to wear a halo and everything.”

“That so, honey? Like in one of those Christmas pageants?  That’s nice.  Now, you get yourself home before next Christmas, girl, you hear?”

“Merry Christmas, Mom,” she said, pressed the End button, and still wondered who sent the hat.