The Seed of an Idea

What if...?

Photo by Joshua Hoehne for Unsplash

Many stories start with a “What if…?” idea. Those two words open the doors of imagination and creativity. It gives the writer full freedom to write without restriction and can be a compelling way to start a story. What if, at the ball, the princess fell for the bad boy instead of the prince? What if little red riding hood killed the wolf before she got to her grandmother’s house and the hunters came to thank her, but she thought they wanted to kill her? We’d have two very different fairytales.

The seed of my “what if …” started in March of 1996, a booming year for maternity hospitals. Medical advancements in neonatology were growing by leaps and bounds. Exciting new research with promises of new medications, revolutionary treatment modalities allowed younger and smaller premature babies to be saved. The gestational age of babies that could be saved fell from 28 weeks to 26 weeks, to 23 weeks during that decade - just slightly more than half way through pregnancy. Admitting a 500-gram (1.1 pound) infant to the Intensive Care Nursery (ICN) was not unheard of. The odds of such a baby going home from the hospital someday, improved every year.

With more babies surviving, ICNs needed to expand to keep up with the demand. The state-of-the-art ICN where I worked in the 1990’s was built to hold 40 premature and critically ill babies. All the equipment that came with each baby: ventilators, large-screen monitors displaying multiple physiologic parameters of each baby; IV poles, pumps and fluids; medications, syringes and needles; feeding tubes, suction catheters and cannisters; oxygen and air wall outlets. The list goes on.

Forty ICN spaces weren’t nearly enough to accommodate all the preterm and critically ill babies born that year. There were days when the unit was overflowing with preemies and the numbers often reached closer to sixty. Nurses learned to get creative. Cribs with babies who were close to being discharged would be lined up against the back wall where linen carts normally stood. Reclining chairs for parents to rest at their babies’ crib sides would be put in the hallway and replaced with a hard metal stool. With no windows and constant activity 24 hours/day, it was easy to lose track of time of day and day of the week. The noise level was ridiculously high. There was never enough room. Parents and nurses constantly bumped into each other, and there was not a stitch of privacy, driving the amount of stress on parents and staff to new levels.

On these busy days, administration would appear briefly, ensuring the place was humming along at beyond-full capacity. Those were the days the hospital was happily operating in the black and administrators wore big smiles. Other days, the rare times when the unit held only 25 or 30 babies, administration would walk through the unit, murmuring to themselves, and scowling at the numbers report in their hands.

No matter how crowded it got, there was almost always a way to squeeze in one more baby. There was nothing worse than a hospital turning away business because space had run out and a baby had to be transferred to another competing hospital. These babies were money-makers.

It was on one of these insanely busy, overcrowded days when my what if happened. I turned to one of my colleagues and said, “What if Nancy Shmuck [not her real name] is going out and pulling women in off the street and making them deliver?” We laughed at the image of our short, stout, no-nonsense VP of nursing wrestling with pregnant women and dragging them into the triage unit.

What started out as a seed of an idea from that loose, comic conversation turned into The Very Best of Care, a story of a young woman who falls victim to the dark side of medicine. Forced to deal with the patriarchal, corrupt hospital system, she becomes the David fighting Goliath. Ultimately, it’s a story of the power of a mother’s bond with her child.

The book, due out in bookstores on June 3, is now available for preorder.

Preorder Here