I finished my Pediatric residency in June of 1986. Stacy and I and our daughter Andrea headed to solo Pediatric practice in El Dorado, Arkansas, a town of about 25,000. Located not many miles from the Louisiana border, it is also a couple of hours from any neonatal referral centers. The handful of Pediatricians there also took care of premature babies even on ventilators, something I was keen to continue doing in private solo Pediatrics.
In my six plus years in El Dorado, I cared for some 69 premature or sick newborns. The smallest baby was just 1 pound 13 ounces and went home after three months and had minimal problems later despite being so early.
It was during this time, that the first artificial lung surfactant called Exosurf was developed. Babies exert tremendous energy taking their first breath because the tiny air sacs have to suddenly inflate and instantly begin to transfer oxygen to the bloodstream. Full term babies normally have a substance called surfactant which reduces the energy required for the closed air sacs to expand. It is the lack of surfactant in premature babies that has historically been the primary cause of their death.
Because our little hospital and small group of Pediatricians was taking care of so many premies, we were accepted to part of the final clinical stages of study before the drug was approved for general use. As far as I know we were one of only a couple of places in Arkansas using Exosurf. And we were seeing amazing results such as the small baby I mentioned above.
I was working often twelve to sixteen hours a day. Sometimes I was up most of the night in the nursery and after seeing a full office load that day, then working a full load the next day. My professional confidence grew. I was tired but excited about practice and about life. Little Andrea was growing. Stacy and I were still in love more than ever after ten years of marriage.
As most people find out, life’s road has deep and sometimes frame-rattling potholes. Stacy and I ran over one in 1987 when she found out she was pregnant with Laura. It wasn’t because of the pregnancy itself of course that I call this a pothole. We loved children and we loved Laura always.
Stacy who had complexion problems since early adolescence, had been on a new medication called isotretinoin, known more commonly as Accutane. It really helped her. We thought we were being careful and had been using not one, but two forms of contraception. It was thought then that some 25% of unborn children exposed to that drug would experience a range of significant birth defects.
Despite being careful, Stacy became pregnant with Laura. She was only on Accutane for about the first 16 days of pregnancy and stopped it immediately when she knew she was carrying Laura.
I had read all the potential side effects of the drug. I read and reread everything that I could find. At that time there just wasn’t much experience with children affected at birth by Accutane. Even more disconcerting was that some children exposed for much longer than Laura, appeared to have no defects, even after their mother continued to take the medication knowing they were pregnant.
I was terribly upset. I simply knew too much. I had seen too much at the EOPC even in my short career. Afraid and sensing that my unborn child would not only be affected, but suffer terribly, I began to consider the unthinkable. Stacy was the one with the courage. My vast knowledge did nothing but bring me fear.
Bolstered by her courage we had to begin trusting in our Father. I had to let go of my fear of the unknown. After all, I told myself as time went on, the ultrasounds at the time seemed to show no problems. She might just be fine. Besides, I thought again, Stacy was only on the medication for some 16 days.
Stacy’s water broke a little early. One thing led to another and she delivered Laura by C-section. Our worst fears were quickly apparent in Laura’s smaller, misshapen ears and her little crooked grimace when she cried. Her elbows were a little tight and she didn’t close her left eye fully. She was a bit tinier than Andrea when she was born.
I was devastated. Stacy was too, but her unfailing first priority was to love Laura. I have forever emblazoned in my mind the picture of her lying in bed tenderly holding Laura in the crook of her neck. On her face shines a satisfaction that says “mother’s here and I’m so glad to see you! I love you so much!”
My heart was broken. I already knew inside, and painfully so, what Laura might face. I didn’t really know though that our watchful Father had already heard our tearful prayers even long before she was born.
