ROANOKE TIMES
Copyright (c) 1997, Roanoke Times
DATE: Monday, January 6, 1997 TAG: 9701060078
SECTION: VIRGINIA PAGE: C-1 EDITION: METRO
DATELINE: NORFOLK
SOURCE: DEBRA GORDON LANDMARK NEWS SERVICE
SHE WEIGHED LESS than a pound at birth and the doctors didn't give her much of a chance. But when high-tech medicine had done all it could do, the struggle was only beginning.
They named her April, because she was supposed to be born in the fragile warmth of an early spring day.
But she came into the world during the January freeze, 16 weeks early.
She wasn't the youngest preemie ever in the neonatal intensive care unit - the NICU - at Children's Hospital of the King's Daughters.
But she was the smallest.
Weighing less than a pound, she fit easily into the palm of her father's hand. Her body was covered with fine hair, her eyes fused shut, and her skin translucent and gelatinous.
Seconds after the obstetrician pulled her from her mother's womb, a neonatologist threaded a tube smaller than a coffee stirrer down her throat and started her breathing with a miniature respirator.
She kicked fiercely, a good sign.
But everyone knew the odds.
Most babies born so early and so tiny die within 48 hours. Of the remainder, more than half leave the hospital with severe disabilities ranging from mental retardation to cerebral palsy or blindness.
April's mother, Lucy Catbagan, knew the statistics and wouldn't pump breast milk to feed her baby. ``What's the point?'' she asked. ``She's just going to die.''
But April held on. Past the critical first 48 hours. Through the infections, collapsed lung, broken bones, blood transfusions.
For six months, April lived in the NICU, a hushed, dim room whose only purpose is to save babies born too early or too sick.
It is a room of cutting-edge technology tempered by old-fashioned comfort. Where mobiles and stuffed animals share isolettes with ventilators and tubes. Where the unexpected beep of a machine interrupts a lullaby.
And where the very technology used to rescue babies can damage them.
Ventilators that help them breathe scar their lungs. Feeding tubes that bring vital nutrition provide pathways for fatal infections. Laser surgery to help their immature eyes see may cause cataracts.
The nurses and doctors who cared for April doubted she'd ever leave the hospital alive.
But on July 2, dressed in a frothy pink dress, April was bundled into a too-big infant car seat. Still on oxygen and attached to a heart monitor, she was going home.
Now it was up to her parents, Lucy Catbagan and Horace Lawrence Jr.
* * *
Luciana Catbagan, 46, and Horace Lawrence, 42, met at the computer disk manufacturer in Chesapeake where they worked.
Despite the differences in their backgrounds - Lucy, a tiny slip of a woman who had come to this country 11 years ago from the Philippines, and Horace, a bear-like black born and raised in South Norfolk - they began dating.
The pregnancy, while unexpected, was a blessing. Horace had no children; Lucy had a grown daughter and thought she was finished forever with babies.
On New Year's Eve 1995, the couple celebrated with their family, eating platters of heavy, spicy food, staying up late to see in the New Year.
So when Lucy began sweating profusely on New Year's Day, she thought it was from the salt she'd consumed the night before.
But it was a sign of toxemia, a potentially fatal condition of pregnancy marked by severely high blood pressure. Delivering the baby would cure it.
April was born by emergency Caesarean section three days later.
The couple spent every day at NICU, alternating shifts when they weren't working. They learned to bathe their daughter around the wires and tubes that tethered her to the isolette, to give her the injections needed to cleanse her body of excess calcium.
Lucy and Horace were terrified when they took the baby home. April, who weighed only 4 pounds, still turned purple when she cried. She needed six different medicines.
That first night home, the couple dozed on the narrow daybed in April's nursery. They tensed with every sigh or sneeze, anticipating the shrill alarm of her heart monitor each time they closed their eyes.
Six weeks out of the NICU and April still needed oxygen. Still needed to be awakened every three hours to eat, to get her medicine. Still had to stay in the apartment, lest her immature immune system fail to protect her. Couldn't start on solid food, like other 8-month-olds.
Life with April had lost much of the drama of the NICU, where every 1-ounce weight gain was celebrated, every milestone heralded.
Change came slowly, in nearly invisible, often mundane, increments.
It never seemed fast enough for Lucy. On leave from her job, she spent every minute with the baby, talking to her, singing to her, exercising her stick-thin arms and legs.
She traveled with a paper plate in her diaper bag, pulling it out during the long waits in doctors' offices and urging April to ``push, push'' her feet against it.
It looked like play. But with a baby like April - born too soon and way too small - it was serious work. To reach important developmental milestones that seem automatic for other babies - rolling over, reaching for a toy, sitting up, crawling and then walking - required hours of painful exertion.
A baby couldn't hold a toy if she couldn't bring her hands together in the middle of her chest. Couldn't roll over if she couldn't bring her hand down to her foot. Couldn't crawl if she couldn't roll over.
It was up to Lucy and Horace, together with the physical therapist who came each week, to help April reach those landmarks.
Lucy's life was April. She spent her nights on the daybed in the baby's nursery, her days trekking to doctor appointments, oxygen tank slung over her shoulder like a golf bag.
* * *
April's medical problems didn't end when she left the NICU.
She needed surgery to repair an inguinal hernia, a loop of intestine poking through her abdominal wall.
An operation to remove the cloudy lens that blinded her left eye, the result of laser surgery in the NICU.
Monthly appointments with the endocrinologist to track her growth and monitor the abnormally high levels of calcium in her blood.
Coordinating it all was the NICU follow-up clinic.
The Children's Hospital clinic involved nurses, doctors, social workers and therapists to track the progress of NICU babies. Officials hooked up preemie parents with early intervention programs, nutritionists, occupational, speech and physical therapists, home health - the people necessary to ensure these infants had the best possible start.
April's first visit began, as all clinic visits did, with a Polaroid picture of baby and mom. Clinic director Martha Jones posts the pictures in the NICU employee lounge so unit nurses and doctors can track the progress of the babies.
To the nurses in the follow-up clinic, many of whom had seen April in the NICU, the 5-pound, dark-haired baby was enormous. But clinic nurse Tracy Duke had never seen April before today.
``She's so tiny!'' she exclaimed, aiming the camera. ``How much did she weigh at birth?''
``Thirteen ounces,'' Lucy said.
``Really? She's a miracle baby.''
The ``miracle baby'' lunged at the air with her arms and legs as she was weighed and measured, sucking furiously on the pink pacifier that covered half her face.
Then nurse practitioner Lisa McGonagal pulled out her blue bag of tricks to test April's development. She rang a silver bell on the left side of the baby's head and April startled, turning toward the sound.
``She hears it. She doesn't like it, but she hears it. That's good,'' McGonagal said.
When she tried to capture April's attention with a red plastic hoop on a string, however, the baby closed her eyes and dozed.
``She's not going to perform for me. She's saying, `I've had it,''' McGonagal said.
But the nurse had seen enough to know April was doing well. Although 8 months chronologically, her gestational age - the age she'd be if she'd spent the full nine months in Lucy's womb - was just 4 months. And because of her size, she was expected to function at an even lower level.
``In general,'' said the clinic's medical director, Dr. Jamil Khan, after his examination, ``she's coming along OK. You guys are doing a great job with her at home.''
* * *
On an oddly warm day for December, April, dressed in a frilly red-and-white dress, had her second visit at the NICU follow-up clinic.
This time, she weighed 8 pounds, 4 ounces and was 21 inches long. At nearly 1 year, she was finally the size of the average newborn.
She was off the oxygen, had outgrown her preemie-sized clothes, and was eating baby food - a major milestone.
She'd had her cataract removed, and was being fitted for a miniature contact lens. Otherwise, her vision seemed fine.
She was the size of a day-old infant, but she had the personality and mannerisms - smiling, rolling over, playing with toys - of a 6-month-old.
This visit, April made it through nearly half an hour of developmental testing, easily following toys with her eyes, reaching for them, putting them in her mouth.
``Does she say mama?'' asked the neonatal nurse practitioner, Therese Cooper.
``Not yet,'' Lucy said.
``You ungrateful girl,'' Cooper scolded.
Developmental pediatrician Dr. Frank Aiello had another question.
``Does she blow raspberries?''
Lucy shook her head.
``Do you blow them to her?''
Lucy looked alarmed. ``No one told me to do that,'' she said, concerned that she'd missed something crucial.
``It's OK,'' Aiello said quickly. ``You haven't done any serious developmental damage. Just start blowing raspberries.''
Lucy shyly asked about April's development.
The news was good. Although April was 11 1/2 months old, her adjusted age was 7 months and she was functioning at the level of an 8- or 9-month-old physically, Aiello said.
Her language skills, however, were at about the 4-month level.
He warned Lucy that April may not walk for another six months or more. ``But if she didn't walk at 15 or 16 months, I still wouldn't be too worried. Because we just don't have much experience in seeing how 300-plus-gram babies do.''
Then came the really good news: There were no signs of cerebral palsy.
The room erupted with whoops. For once, Lucy's reserve shattered and she grinned broadly, even as she wiped the wetness from her eyes.
You guys did it, Aiello told Lucy.
It came as no surprise to Thelma Lawrence, Horace's mother and April's grandmother. She'd spent nearly every day the past year watching her son and Lucy with April.
``If love was a drug to see her through, she'll be here a long, long time.''
* * *
There were pink balloons floating up to the ceiling. A pink-iced cake, pink-and-white party hats and cherry-flavored punch. On the table, a 4-foot stuffed bear - bigger than April - stared blankly at the gathering.
The Lawrence and Catbagan clans, two families who barely knew each other a year ago, came together in the South Norfolk recreation center's all-purpose room to celebrate this miraculous anniversary.
Saturday, April Marie Lawrence turned 1 year old.
LENGTH: Long : 217 lines ILLUSTRATION: PHOTO: BETH BERGMAN Landmark News Service. 1. At right, Aprilby CNBLawrence lies on the floor before taking a nap. 2. At far right,
tiny April and another premature baby, also called April, wait to
see a doctor. April Lawrence, 8 months old and born 4 months early,
is barely visible in her carrier. April Parker is two months younger
but only 2 months premature. 3. Horace Lawrence bends over to kiss
his daughter April while she lies in the doctor's office before yet
another examination. color. 4. Catbagan snuggles up to her daughter
April Lawrence during a doctor's appointment. At right is Dr. Buu
Lien, a pediatrician. 5. Lucy Catbagan (left) and Thelma Lawrence,
April's paternal grandmother, appear weary after a day full of
doctor appointments with April, who is having her eyes examined by
Dr. Jamil Khan, NICU medical director.