Defying the odds, Part 1 of 2

Editor's note: In the first part of a two-part narrative, Associated Press Texas sports editor Jaime Aron recalls the birth of his twin sons, 17 weeks premature, and the struggle to keep them alive.

By JAIME ARON

The Associated Press

DALLAS -- The speech I was holding should only have been a backup. I knew the words by heart because I'd lived them.

It was the story of my twin sons and how their birth 17 weeks too soon changed everything for me, my wife Lori and our 4-year-old son, Zac.

I'd given this speech plenty of times, but never to an audience like this -- other parents of preemies.

We were at a national gathering of March of Dimes volunteers, and there were about 30 of us in a hotel ballroom for a session called "Every Baby Has A Story." Because I tell stories for a living as a sports writer for The Associated Press, I'd been asked to help run the meeting.

Eyes widened when I held up red and blue Beanie Babies that were as big as the real boys. Heads nodded when I held up my wedding band -- which a dime can just fit through -- and described it circling one baby's arm like a hula hoop.

Then I got to the middle of page 3. To the paragraph I'd typed through teary eyes a few days before.

"I'm sorry," I said, my jaw quivering, eyes puddling. I reached for a tissue, trying to stall long enough to regain my composure.

"This," I continued, "is the part where I always give the update. ..."

I tried again. And again.

But I couldn't get the rest out.

Until the birth of our twins, life had been good to Lori and me.

I grew up in Houston, a sports-loving boy determined to become a sports writer. A gofer job at the Houston Post my senior year of high school led to bylines while at the University of Texas, then a job with the AP in Dallas. That fall, I met Lori at a Rosh Hashana service. We married a few years later.

The first time Lori was pregnant, preterm labor symptoms forced her to go on bed rest at 23 weeks. She delivered Zac at 36 weeks, a month early, and complications sent her to intensive care.

Zac was a preemie, but that seemed about as significant as being brown-haired or right-handed.

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Once we were ready to make Zac a big brother, scar tissue from his traumatic arrival blocked the path to pregnancy.

After five operations and a failed in-vitro fertilization attempt, we gave IVF one last try.

It worked -- so well that two babies were created. But the initial sonogram signaled trouble.

"Baby A will probably be gone in a few days," our fertility doctor said. "I'm sorry."

But the next sonogram, a few weeks later, showed two normal heartbeats.

Doctors watched Lori's pregnancy closely. Sure enough, after only 17 weeks, she was back on bed rest. It didn't last nearly long enough.

I was covering an NBA playoff game in Dallas when a message popped up on my laptop.

"call lori asap"

Her water broke.

Only 23 weeks into what's supposed to be 40 weeks of gestation, the boys were "on the brink of viability," a doctor said. Even if they made it, their lungs, brains, eyes and ears were so underdeveloped, they might never work right.

Lori was put in a delivery-room bed tilted backward to let gravity help keep the babies in, and an IV dripped magnesium sulfate -- a "mag bag" -- to slow labor.

The next day, neonatologist Dr. Eileen Milvenan sat down to go over the grim prognosis.

Baby A was in jeopardy again. His water bag had ripped, depriving him of the amniotic fluid that's vital to development. No matter what, he was coming out soon. Baby B, meanwhile, was doing fine.

Doctors gave us three options: Focus on saving Baby A, focus on Baby B, or -- their recommendation -- "delayed delivery," having Baby A when necessary, then stopping the birth process and keeping Baby B inside as long as possible.

"We have to do what's best for both of them," Lori kept saying.

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Lori coughed all night. By morning, her skin looked green, her face puffy.

"It feels like encyclopedias are piled on my chest," she told her obstetrician, Dr. Kathryn Waldrep.

Septic fluid was pooling in Lori's lungs, caused by a combination of the mag bag and the tilted bed; our two biggest allies fighting off labor had turned against us.

"We have to take the babies now," Waldrep said. "You are my patient, not them. I have to do what's best for you."

The boys came out 2 minutes apart. Two teams of neonatal nurses sprung to action.

I locked in on Baby A -- or, rather, the nurse working on him. She squeezed a green oxygen bag, then paused, waiting to see if the air would kick-start his underdeveloped lungs.

She squeezed again. Still nothing.

He remained purple, and she seemed to be losing hope -- shaking her head "no" with such intensity that her brown ponytail brushed shoulder to shoulder across her back.

Things were going just as poorly for Baby B.

Each minute the babies didn't breathe lowered their chance of surviving.

Of the 4 million births in the U.S. that year, 2002, just 9,510 babies were born before 24 weeks' gestation. Nearly half in our boys' weight range (500 to 749 grams) died; the rate was above 53 percent for twins. Even if they lived, this lack of oxygen made them more likely to become disabled.

These were all the horrible things Milvenan had talked about the day before. Now, she was walking to me.

"Should we keep trying?" she said.

This was not one of the scenarios we'd discussed.

"Hell, yes!" I blurted. Saying no would've meant death, and I wasn't giving up that easily.

But what if I'd just sentenced our boys to a lifetime of suffering?

Finally, in his 10th minute, Baby A pinked up. Baby B showed that beautiful color two minutes later.

As they were being whisked to the Neonatal Intensive Care Unit, I couldn't stop staring.

The boys were so tiny, like newly hatched birds, with their eyes fused shut and their skin a creepy, shiny, almost translucent color.

But perfect.

It was as if someone had taken Zac, small as he was at birth, and copied him at a 25 percent setting.

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Our boys were born before their bodies produced a substance called surfactant, which makes it easier for lungs to open and close. They were given an artificial version during delivery, but it would take time to know whether the boys would ever be able to inhale, process oxygen and exhale on their own. That is, if the ventilators didn't rip apart their lungs first.

Bleeding in the brain is the other big fear. Babies born this small, this early, strain for each breath -- hard enough to rupture blood vessels in the brain. It's usually a question of how many, not if.

Their fused eyes eventually would open, but it would take months to know if they work. Ditto for the ears. And other body parts.

If the boys cleared all those hurdles, another obstacle course awaited. It was filled with conditions they were at high risk for -- cerebral palsy, cystic fibrosis, muscular dystrophy.

It all boiled down to this: Could these 1-pound, 2-ounce babies develop "in the real world" like nature intended them to in the womb?

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On Monday, the boys' third day, the ID cards above their incubators still read "Aron Twin A" and "Aron Twin B."

They needed names.

In our families, babies are usually named for a deceased relative. But the boys arrived before we'd picked anyone to honor. So we went with a theme: Biblical warriors who overcame long odds.

Rabbi Debra Robbins visited and helped us narrow our list. She also taught us about the concept of renaming babies. Previous generations did this when a child became frighteningly ill, as a way to "trick the angel of death."

Most of all, she urged us to make a choice.

"The caregivers need names to feel a more personal connection to the babies," she said.

We chose Jacob Benjamin and Joshua Caleb.

Jake and Josh.

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Everyone is born with a hole in their heart. It closes within 72 hours for most babies. But 23-weekers aren't always that lucky.

By Tuesday, Jake's hole was starting to close. Doctors recommended giving him medicine to help speed things up, and we agreed.

Josh's hole was wide open. He needed surgery.

Heart surgery. On this tiny baby.

Jarring as it seemed, everyone told us this operation was routine. They were right. The surgery was Wednesday morning and it went perfectly.

The next morning, Jake's tummy was swelling and turning purple. He was bleeding internally.

On Friday morning, doctors tracked the source to his small intestine, likely caused by the medicine he'd been given to close the hole in his heart. It's the most common stomach problem for babies born so small -- and it claims about 1 in 7 who develop it this soon.

A surgeon was on the way.

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All week, we had to sneak a hand into the incubators to touch the boys; now, we were being encouraged to touch Jake.

Nurses urged us to take lots of pictures. Someone recommended putting my wedding band on his hand to show how small he was. It went over his knuckles with ease. His arms -- even his legs -- were hardly thicker than a pencil.

Given one last moment with Jake, Lori and I talked about what a fighter he was, ever since that first sonogram.

"At least we had him for a week," I said. "No matter how the surgery goes, he'll be better off either way."

Just then, Jake's arm jerked -- almost like a punch.

Lori saw it as a sign. Through held-back tears, she showed a hint of a smile.

There was only one thing left to do.

Jake needed a new name. To trick the angel of death.

We changed his Hebrew name from "Ya'akov" to "Chaim." We chose it for its English translation:

Life.

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The anesthesiologist warned us that if someone returned in a half-hour or less, it was bad news. Over an hour meant they were working to save him.

Right around 50 minutes, in walked the surgeon.

"It was the best-case scenario," he said.

Talk about joy! Relief. Our little fighter did it!

The following weeks remained tense, but our ride on the preemie parents' roller-coaster had more side-to-side jarring than 90-degree drops.

On their 1-month birthday, each boy weighed 1 pound, 8 ounces, up 6 ounces from birth.

The biggest medical news was that their brain scans showed hardly any bleeding.

To us, it meant another dodged bullet. To the caregivers, it was further proof these guys might be odds-defying exceptions.

Coming Monday: New challenges and a steadfast goal.

On the Net:

www.marchofdimes.com