DAVID was born weighing 1 pound 12 ounces in the 28th week of the pregnancy.
My wife, Cheryl, had toxemia, a disease that rapidly diminishes the ability of the placenta to nourish. The doctors had put her in the hospital for evaluation and for a probable prolonged stay on her left side, a treatment for high-blood pressure that accompanies toxemia. Three hours later, after a long ultrasound examination and tests to determine the strength of David's heart, the high-risk pregnancy team at Yale-New Haven Hospital decided to immediately deliver David to save his premature life.
The same disease had taken our first child, Jennifer, exactly one year earlier at the same point in the pregnancy. Feelings of grief about her death were confused with feelings of apprehension about David's early birth. Numbed by the possibility of another stillbirth, I feared that we would never have children.
''He won't cry,'' the anesthesiologist whispered from behind Cheryl's head. That was good preparation, I suspect, for a silent delivery. For us, that silence might have carried different meaning; last year, there had been no heartbeat.
Our first good news came quickly that night. He cried.
Then we met David's doctors. ''Your son has a 50-50 chance of making it. There will be lots of problems. We will tackle them one at a time.'' We considered ourselves to be knowledgeable about pregnancy and childbirth. We had read books, articles, chapters, anything we could find to tell us what it would feel like to be parents. That night I learned there is no preparation for meeting your son in an intensive-care unit.
David was on a warming table in a room packed with 30 other premature babies. Attached to his chest was one set of wires to monitor his heart. A second set on his stomach monitored his body temperature and triggered a heat source from lights above his 13-inch body. An IV tube was connected to one arm. A miniature blood-pressure cuff encircled the other upper arm. Blood gases were being measured from one of his feet. A plastic tube was attached to the end of his penis, awaiting his first urine. Bright white-and-blue plastic tubing wound down his tiny throat connecting his lungs to a respirator. Two nurses and three doctors stood at the side of the table.
I think I expected to see a fetus; what I saw was my son. Small. Struggling. Alive. His skin was a bright pink, his head was wet, his eyes were closed and his arms and legs wiggled. This tiny little person, taken suddenly from the solitude of the womb, was fighting to survive amid the bright lights, tubes and gentle, probing hands.
Emotions that surface at childbirth are overwhelming under normal circumstances. With death or staggering handicaps as clear possibilities, I was afraid to fully express the love I felt for him, this squirming, struggling little boy on the warming table.
I touched him on the hand and his fingers grasped my thumb. I said, ''Hello David, this is Daddy.'' His eyes opened. There was no more hesitation. I loved him.
I held David for the first time on the sixth day. The nurse swaddled him in flannel receiving blankets and placed on his head a small blue cap knitted by a volunteer who works in the nursery. ''They use tennis balls as models,'' she said.
From his place on my lap, a trail of wires and tubes still connected him to all of the equipment at his station. There he was. My son. He had months of hospital care ahead of him, yet at the moment all that medical attention seemed secondary. The bonding had started.
The incubator: the label on the outside calls it an isolette; the nurses called it his condo; it was his home for nearly three months. Temperature, humidity and oxygen levels were continuously monitored and adjusted as his development progressed. We lined the clear plastic walls with photographs and brightly colored pictures. Stuffed animals nestled in the corners. We sat for hours at a time watching him, talking to him, stroking him through the two portholes.
Parents like to record ''firsts'' that their new babies accomplish, such as rolling over, sitting, speaking and so forth. When the baby is three months premature, there is a different list. For David, the first major accomplishment was breathing on his own, something other parents take for granted. In the first week, his little fingers grabbed the blue-and-white respirator tube and yanked it out of his throat, an astonishing accomplishment for a person weighing a shade over one and a half pounds. At two weeks, slow periodic feedings of sugar water were fed to his stomach through a nasal gavage tube. Then breast milk went through the tube in small diluted amounts. Finally, at six weeks, Cheryl was able to feed him at the breast.
Brain scans, chest X-rays, intestinal X-rays, spinal taps and blood transfusions became ordinary events. David's lungs were strong, but not fully ready for life outside of Cheryl, so he liked to give them a rest from time to time. When he did this his pulse rate dropped and an alarm beeped. For several weeks, he rested on a bump bed. A plastic surgical glove attached to a tube from an air pump was kept under David all the time. Every seven or eight seconds, the air pump quickly inflated and deflated the glove, giving David a little bump. This gentle action kept his lungs and heart working.
David was weighed daily. Parents of premature babies worry a lot about weight gain. We charted his growth, as each new ounce was a major achievement, a sign that his body organs were functioning well. It is surprising how elated I could feel when he reached two pounds. There will come a time when I am not as concerned about David's weight. With a strong will and exceptional medical care, David starts life as a survivor. He escaped the ailments that commonly afflict and often disable premature babies, especially those born weighing less than two pounds. He will have no memory of those early months.
David has come home to the nicest room in the house at the robust weight of four and a quarter pounds. Gone are the incubator, heart monitor, thermometer and medical charts. There are no more nurses. Just Mom, Dad and David. Cheryl stenciled a teddy bear pattern all around the room and I put up shelves for some of the dozens of stuffed animals that have gathered since his birth. Cheryl feeds him in Grandma's front porch rocker. Things seem pretty normal. Now we can celebrate his first attempts at rolling over, sitting and sleeping through the night.
Life is different with a premature child. Well-intentioned people feel compelled to remark, ''He's so small.'' They perceive this 6-month-old baby to be a newborn of just a few days and invariably ask how old he is, a question that carries a complicated answer. Since most people have scant experience with prematurity, they often offer sympathy.
Perspective is everything, however. One summer morning the three of us were walking around a local crafts fair when we saw one of his nurses. Her first words were, ''He's huge.'' Now at 10 pounds, to me, David is a giant.