Discovering signs of life after death

Sunday, November 28, 2004

Barb Elfrink wouldn't realize until later how serious the situation was.

She still remembers how the nurses were all upbeat and wore happy faces. Their body language suggested otherwise. They flashed around Barb's bed with a purpose, constantly checking monitors and vitals, jotting down notes like journalists covering a natural disaster just before deadline. A slew of medical people came to ask questions; they made her sign all sorts of forms. Barb thought it was routine.

It's too early, she thought, confidently denying the danger.

She knew her water had broken. She knew she was having contractions two minutes apart. And she knew if her babies were born now, they'd probably die.

She had once before started having contractions -- nothing as serious as these -- and the doctors were able to stop them. With a been-here, done-this attitude, she didn't think, or at least didn't let herself think, the nurses' body language signaled any big deal.

But it was a big deal.

Barb was a freight truck barreling down the road at 100 miles per hour, carrying the most precious and delicate cargo in the world. With seven years of momentum behind her, the accelerator was stuck to the floor and the nurses were trying their hardest to slam on the brakes.

While concerned, Barb hardly considered the situation's gravity. She was 26 weeks pregnant. On some rare occasions, babies have been known to survive at just 25 weeks, but the chance of survival greatly increases at 28.

Barb made it a personal goal to hold out until 32 weeks based on her experience as a respiratory therapist at the hospital.

It's too early.

The brake fluid they pumped through Barb's veins was magnesium sulfate. Perhaps the reason Barb didn't understand how fast her body was speeding toward disaster was due to the side effects of this potent contraction stopper.

Before long, Barb's heart raced. Her forehead dripped with sweat. Her body shook. The Freightliner creaked and moaned in protest as the labor skidded to a halt at Barnes-Jewish Hospital.

The contractions slowed to three minutes apart. Then four. Slower and slower and slower.

The magnesium sulfate did what it was supposed to do. And Barb suffered all the more. The labor had stopped, but the needle on the RPM gauge was still in the red. It was impossible to relax with a racing heart and a sweat-drenched face, but Barb convinced Kenny to go home that night. He wanted to stay, but Barb told him he needed to get back to work so the family might be able to pay off all these medical bills in the next 50 years or so.

"I'll be OK," she told him.

Had she known exactly how miserable she would feel from the medicine, she would've asked him to stay.

After a few days in a regular room, she was allowed to stay in the antepartum section, an emergency-brake arm of the hospital where high-risk expectant mothers stay under constant supervision. The atmosphere is more relaxed than a typical hospital situation. Barb wasn't ill, but circumstances held her to the bed like invisible straps. She kept taking drugs that would prevent contractions.

The room was too small for Barb's taste, the smallest room she'd ever stayed in. Slightly claustrophobic anyway, Barb kept the door open at all times.

Her home for the next few weeks would be a bland space with a wall-mounted television, a bed and a white machine attached to the discs that kept an ear to Barb's belly.

From the window across the room, she could see the top of a parking garage and the traffic on St. Louis' Kingshighway.

Barb's friends and family visited as much as they could, particularly Barb's St. Louis friend, Stacey Money. Stacey was on pregnancy leave at the same time Barb was ordered to bed rest. When Barb was at home, the two would talk on the telephone for hours at a time.

Now that Barb was in her back yard, Stacey visited often. She even arranged for Barb and Kenny to have a special dinner on their anniversary.

Kenny visited every weekend. And every Friday, Barb played out his day in her mind.

At noon, Kenny's at lunch now. About seven more hours and he'll be here.

At 4:30, Kenny's getting off work now, heading to McDonald's. He'll order a double cheeseburger and a soda.

At 6, Kenny's probably around Arnold. He'll be here in about 30 minutes.

At about 6:30 p.m. every Friday, Kenny walked through the door to see his wife.

Kenny's face was the highlight of Barb's week. He would get Barb caught up on the home life. Barb would give the necessary updates. The most important thing, though, was just seeing him.

On Sundays, Trent would make the trip to the hospital with Donna Elfrink, Barb's mother-in-law.

Trent would sometimes ask what was going on, and Grandma would always answer the questions honestly.

The family would spend the day together Sunday. There was a lot of idle time, but the gang would find ways to entertain themselves. Kenny and Trent, for example, would blow up rubber latex gloves and make them look like cow udders. The boyish silliness made Barb feel, even just for a minute, that she was home.

Sunday nights were the worst, almost unbearable. Kenny would stay as late as possible and Barb always hated watching him go.

Barb's father, Frank Bagbey, visited once a week to check in on his daughter.

Other relatives popped in and out occasionally. Nonetheless, the hospital was mind-numbing, and Barb caught cabin fever.

Two weeks went by, and Barb passed the 28-week mark, a critical point for pregnancies. Barb wanted to give her babies four more weeks beyond that. She felt that every day spent in the antepartum room was precious.

Two weeks later, on May 8, Barb's Meadow Heights Elementary friends threw her a baby shower in her hospital room. Barb accepted several sacks full of gifts, which usually came in threes. Three outfits, three blankets, three pacifiers.

That night after the party, Barb started bleeding worse than ever before, and it continued into the next day.

The discs on Barb's belly continued to find three heartbeats. Jacob, Madeline and Grace were holding on.

The next day, Barb bled profusely and the doctors decided it was time to take action.

"It's too early," Barb said.

"You've gone as far as you can go," the doctor told her. "If you don't do it now, you'll jeopardize all of them."

Barb immediately dialed Kenny at work. It was a Thursday, and Kenny dropped what he was doing and drove straight up. Barb's other relatives made arrangements to visit the next day.

The doctor told Barb she would be re-evaluated in the morning. Barb didn't sleep at all that night.

Her experience long ago as a respiratory therapist gave her a background of what to expect. She knew at 30 weeks, her babies would need help breathing. She knew they would be tiny and perhaps unhealthy. She had waited a long time to become a mother again, but she wasn't excited at all. She wanted her babies to wait in the womb as long as possible.

When the nurses brought her breakfast the next morning, she questioned them, asking if she should eat. After checking with some doctors, they took the food away.

A mother again

That's when Barb knew for sure that this day, May 10, 2002, was the day she would become a mother again.

The doctors scheduled Barb's Caesarean section that afternoon. Kenny made the calls. Relatives scrambled into action.

When they rolled Barb into surgery, the operating room was heavenly white with bright circular lights spotlighting the surgery table, a contrast to the nightmares Barb had not long ago. Surgeons tools lay neatly on a table, protected by sterile blue cloths.

Two operating rooms were set up. One for Barb, Baby B and Baby C. The other, because there was no room for a third bed, for the first-born.

The surgeons and doctors were all dressed in blue, too, their mouths covered with blue masks.

Not long after entering the room, Barb was overcome with a nauseous feeling, perhaps a reaction from the anesthetic. They gave her some medicine for that, but it didn't work. Barb threw up.

Three teams were set up to handle the delivery, one for each baby. In all, there were 24 doctors and surgeons prepared for the new half of the Elfrink family. The epideral numbed Barb but allowed her to stay awake during the delivery.

Despite a severe but short-lived blood pressure drop, Barb was fine through the surgery, but the surgeons, fearing for Barb's health, pulled out the babies quickly.

At 1:20 p.m., Baby A, the one Barb called Grace, was born.

Barb could feel the tugging and pulling.

The doctors cut the cord and whisked Baby A to a side room.

Just one minute later came Babies B and C, Jacob and then Madeline.

Dr. Kim Spence was among the doctors checking out Jacob and Madeline when she was called into the other room. Baby A was not doing well.

While doctors were sewing up Barb and combing over the newborns, Barb told Kenny to find out how their newborns were doing.

Barb couldn't tell what was going on. All of her babies were out of sight. One by one, however, she heard each one cry.

Kenny came back.

"How are they?" Barb asked.

"They're OK."

Because the premature babies needed intense attention, Barb wasn't given any time to spend with her babies right away.

Barb couldn't tell what the doctors were doing or saying. They were talking quietly, almost in whispers, and Barb wasn't able to hear over the soft humming of the equipment.

As Madeline was being wheeled out of the room, Barb reached over and touched her foot.

Jacob and Madeline were moved to St. Louis Children's Hospital, which is adjacent to Barnes, immediately. Doctors continued to work on Baby A in a room off to the side.

It turns out, Baby A wasn't a Grace after all. He was a Franklin. Franklin Nelson Elfrink, Barb and Kenny's second-born son.

They sewed Barb back up and took her to recovery before the doctors were finished working on Franklin. That made Barb nervous.

Barb was greeted by an aunt and an uncle who were visiting for the first time. They picked the right day. Barb's grandmother was there too. She helped Barb keep the oxygen mask up to her face.

Stable start

Stable. That was the first report back to Barb from the recovery room. All three babies were stable.

"What were their weights?" Barb asked.

The nurse didn't know, which Barb thought was odd. Later the nurse came back with answers.

Jacob was 3 pounds 8 ounces, Madeline was 3 pounds 1 ounce and Franklin was 2 pounds 14 ounces.

The separation was torture. Barb had waited so long. Now her babies were finally here and they weren't even in the same hospital, let alone the same room.

It wasn't easy for Kenny either. His wife just had a C-section and was miserable in one hospital. His newborn sons and daughter were somewhere down a long, long hallway, resting in plastic-covered incubators. His focus and worries continually flipped from Barnes to Children's and back again.

Barb stayed in recovery for a couple of hours. Kenny stayed with her. When Barb was moved to a regular room with two beds, Kenny and Donna went over to Children's to see the new family additions.

They both got all scrubbed up and made the walk over to Children's. They were allowed to stay in the nursery as long as they wanted. They took some Polaroid photos to take back to Barb.

Kenny and his mother were disturbed, at first, by the images. Wires everywhere, including one down the children's throats that helped them breathe. But once they got past the wires, they saw the beauty of their own flesh.

"They're beautiful babies," Donna said.

In truth, the triplets weren't exactly proportioned correctly, especially Franklin. The babies had been squeezed inside their 5-foot-2-inch mother for 32 weeks. Franklin's foot was a bit crooked. So was his nose.

But Kenny and Donna didn't care. They were all alive. Stable.

Kenny and Donna returned to Barnes and showed Barb the Polaroids. Barb couldn't have been happier. She thought everything was going well.

The call

The mood was happy and upbeat in Barb's room. Barb's mother and stepfather, along with Kenny and Trent, had visited, and the conversation was light and cheery most of the afternoon. Loretta and Joseph Mohorc along with Trent were on their way back home when a nurse popped in and asked Kenny to take a telephone call at the nurse's station.

Kenny came back into the room, a somber expression written on his pale face.

"They don't think Franklin's going to make it," he said.

Barb asked what was wrong, and Kenny said he didn't know exactly.

Barb then asked if she could go see him, and the nurse said it was OK.

Loretta, Trent and Joseph were called back to the hospital.

Escorted by nurses, Kenny pushed Barb through the hallways and tunnels that led to Children's. It was a 10-minute walk, one that seemed like an eternity to a sore mother who was in a hurry to see her vulnerable son.

When they finally got to Children's newborn intensive care unit, Barb's mom asked what the problem was.

"We can't get his oxygen level up," a doctor said.

Again Barb's experience as a respiratory therapist came into play. She knew there was a huge difference between "getting" the oxygen level up and getting it to "stay" up.

"Do you mean you can't get it up or you can't get it to stay up?" Barb asked.

"We can't get it up. We can't get his blood pressure up either."

The news made Barb nauseous. She knew how important the oxygen level was. She assumed that, at the very least, Franklin would have some brain damage.

The doctors found that Franklin's lungs were well under-developed. In newborns, especially premature newborns, a single flaw can lead to so many other problems.

Because Franklin's lungs were so rigid, they had to use higher air pressure to get them going. That in turn puts pressure on the heart and can cause the baby's blood pressure to drop. His lungs weren't working well. His heart was weak.

Still seated in a wheelchair, Barb peered at her son for the first time.

"Fight, Franklin. Hang on."

No one knew how much time Franklin had left, so someone from the staff took a family photo. Just a couple hours ago, this had been the happiest day of Barb's life. She looked around at her family, who surrounded Franklin's bed. She looked up at her husband. For the first time ever, she saw him cry.

Barb was scared that there might not be a priest available. According to Catholic custom, Franklin had to be baptized before he died. She was told that there was a priest on staff at the hospital, but he wasn't available at the time. Barb's step-father, Joseph, a Catholic layman, baptized Franklin.

Seemingly out of nowhere, Barb's dad arrived. He hadn't heard the bad news yet. Barb told him how the doctors didn't think Baby A would make it, how they were having trouble getting his oxygen and his blood pressure up.

Barb wished her following sentence could have come under much different circumstances.

"Dad," she said. "He's named after you."

May 10, 2002, was the first time she saw her dad cry, too.

Loretta and Frank, divorced for 27 years, were standing next to each other but watching themselves. Frank was Kenny. Loretta was Barb. Franklin was Elizabeth. More than 30 years ago, they stood in Kenny and Barb's shoes, on the brink of losing an infant. Bitter fate had brought them back here again, watching it through their daughter's eyes this time. Frank grabbed Loretta's hand. Whatever distance 27 years of divorce had created was temporarily wiped away.

They all stayed for awhile, not knowing exactly what to do, what to say. Eventually, a doctor came over and told them that Franklin was stable enough for Barb to go back to her room. The family was assured it would be notified if the situation changed.

Barb and Kenny, out of pure exhaustion, did sleep some that night, side by side in separate hospital beds.

At 5 a.m., they received a call that they'd better come back to the nursery.

Franklin was still connected to all the equipment. Barb felt so sorry for him. She looked down and saw his clubbed foot, his squished nose. She loved him all the more because of that. He must have been pretty uncomfortable in the womb for the past seven months.

Last hope

Barb still held out hope. There was still a chance. If she could get pregnant after all those years of trying, if she could miraculously fall into the right time frame to be considered for a fertility drug experiment, if her fertility drugs could work on the 45th and final day of the dose, if Franklin could survive in her womb for so long, then surely he could still pull out of this.

She looked down at Franklin and then up at the doctor who was standing nearby.

"If he survives, will he have to have surgery to correct his foot?"

The doctor answered in the most delicate way he knew.

"We're just waiting for the priest, then we're going to let him go."

The doctor had pulled the hope out from under Barb's soul. She resigned herself to the inevitable horror of losing her Franklin.

The priest came and gave Franklin a special blessing. And while he was there, he blessed Jacob and Madeline, too.

When the time came to unplug the machines, the nurse suggested that Barb hold Franklin while he died.

The nurse placed the tiny baby in Barb's arms, and the mother cradled him. The nurse took the tubes out one by one, leaving only the heart monitor attached. The monitor's swooshing sound continued as Franklin hung on.

Barb cherished the moment. Her only moment.

"It's OK for you to go now," she said in a squeaky voice as if it was she, and not Franklin, who was short on oxygen. "You've done such a good job at protecting your brother and sister."

Franklin's skin began to turn cold, but his heart was still beating. Barb asked for a blanket.

Then she looked up at Kenny.

"Would you like to hold him?" she asked.

"I don't want to take him away from you."

After a few moments, Franklin sucked in a few last breaths.

"It's OK to go Franklin," Barb said. "It's OK now."

Barb cradled her son until his heart stopped beating. And then she handed him back to the nurse.

The drugs that produced two miracles also produced the hardest of heartbreaks. Barb was one of about 6.1 million Americans who dealt with infertility issues in the year 2001. She was one of those who wanted children bad enough to try fertility drugs. Of those who tried fertility drugs, she was then one of the 25 percent to 30 percent to conceive multiples. Unlike some, she chose not to "selectively reduce" her children, instead going where life and science took her. Life and science brought her here, to this small lonely room in Children's Hospital, handing her dead son to a nurse.

Barb shut herself down for a few days. She refused to talk to anyone except her husband and parents. She wouldn't even take phone calls from her pals from work.

What could they possibly say? Nothing that would make her feel any better.

Still incredibly sore from her surgery, the pain of losing a child was worse, so much greater than the disappointment she felt during her numerous failed attempts at getting pregnant. Not being able to produce life was hard enough. Not being able to prevent death was so much harder to bear.

And it didn't matter that Franklin was one of three.

A son is a son. A baby is a baby. A life is a life.

Jacob and Madeline didn't make Franklin's death easier to accept. But they did make Barb's life easier to endure.

Barb had two reasons to make the slow, steady climb out of the darkness. They were still lying in tiny beds.

Kenny made all the phone calls to relatives and friends. He couldn't bear the call to the funeral home. His mother did that for him.

Several days later, Barb picked out a headstone. She found the perfect one decorated with pictures of a dump truck and a teddy bear.

The family held a graveside service for Franklin. Barb, still sore from the surgery, sat down near the casket. Her grandma stood behind her, rubbing Barb's temples. The service was only a few minutes long. There was not much to say. Franklin lived only 18 hours.

Later, a man from the funeral home said, "At least you have two other babies."

Barb said nothing.

When you drive down Route N on your way to Leopold, the signs of life are everywhere. Out here, it's hard not to notice the beautiful landscape, a combination of rolling hills and flat pastures full of grass and trees and cattle. It's hard not to notice the large families, the big Catholic church, the "Hail, Mary" prayer written along fence posts. And those yellow "Vote Pro-Life" signs.

When Barb thinks about Franklin, there is only one thing she regrets. She wishes she would've held him up to her shoulder instead of cradled him. There is something spiritual about holding a baby heart-to-heart. Distracted by the ticking of death's clock, Barb didn't think to do that.

There was so little time. That's what bothers Barb the most. Very few tangible things are left to quantify his life. A Ziploc bag with a few strands of hair, a hospital bracelet, and a tiny hat he wore are among the few things Barb keeps protected in plastic bags.

She is thankful for the time she did have. Because Franklin lived 18 hours, Barb can truly celebrate Jacob and Madeline's birthday. She grieves the next day.

Barb's mother, who had been in her daughter's position many years ago, didn't offer much advice simply because she knew there would be nothing she could say to ease the hurt. Loretta told her daughter that life would get a little easier every day, but the pain will not go away.

Barb will look at Jacob and Madeline throughout different stages of their lives and think about the toddler, the teenager, the man who is missing. She will always be asked how the "twins" are doing and she will respond by saying Jacob and Madeline are not twins. They are triplets.

Kenny doesn't talk much about Franklin. He grieves in his own private way.

But Franklin's death is only a third of the story.

When you pull into Kenny and Barb's driveway, Leopold's life signs continue. A dog greets you, wagging his tail. A plastic basketball and toddler-sized bench sit out in front of the house.

Barb greets you at the door, smiling.

"You'll have to excuse the mess," she says.

You cross the threshold and a mischievous-looking 2-year-old boy with bright, blue eyes and blond hair greets you with his arms raised. You pick him up because you can't refuse his smile. You notice the boy's hair sticks up a little in the back.

A curly-haired blond girl with those same blue eyes stands back several feet. She's more of an observer than a go-getter like her brother.

The house is not messy at all, really. Sure, farm toys and teddy bears are scattered around the two Winnie the Pooh chairs in the living room.

But there is a reason why they call it the living room.

In the kitchen now, Jacob and Madeline go back to their supper. Madeline steals a piece of chicken off Jacob's plate, but he doesn't seem to mind. Jacob and Madeline, like all siblings, squabble over toys and attention, but for the most part they don't mind sharing. They share toys, hugs and kisses, a mom, a dad, and a playful 12-year-old brother.

After supper, Jacob gives an indication he's almost ready for potty training. He tells Barb in toddler-speak he needs his diaper changed.

"They're growing up so fast," she says. "They do everything before I'm ready."

Barb excuses herself and takes Jacob into a back bedroom.

After a minute or so, Jacob begins crying. Concern written on her face, Madeline trots down the hallway to make sure "Acub" is OK.

Later on, Trent throws Jacob over his shoulder. Big Brother is a walking playground. When Kenny comes home, he wrestles his young son and daughter to the couch, and they begin to use it as a trampoline.

Barb smiles as her children giggle and squeal. She rolls her eyes.

"Don't let them fall," she says.

Barb encourages safety. Kenny, a hand on the back of each child, encourages the bouncing.

The empty feeling Barb had for six years is long gone now. The void has been filled with love and joy and responsibility.

Raising two infants was tough, but as they grow older, Jacob and Madeline have already begun taking care of each other. That's what families do.

A large part of the emptiness has been filled with grief, too. But when Barb's blue eyes gaze upon her two newest children, she realizes the journey was worth it, that Jacob and Madeline are beyond anything she could have prayed for. She realizes Jacob and Madeline are only alive today because Franklin toughed it out for 30 weeks inside her womb. She takes some comfort in that.

She also takes comfort in her family, her work and her life. Barb is a happy person, one who laughs at herself, her husband and children. Her classroom at school is decorated in bright smiley faces, a reflection of her own personality.

The real happiness comes from home, however, off Route N, surrounded by the teasing and the laughter and the wonderful challenges of motherhood.

Jacob and Madeline have brought immeasurable love into this family.

The signs of life are everywhere.


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