Holiday Letter 2023
20 November 2023
My daughter’s brother, John Reuben Unkovic, was carved out of my abdomen on the 10th of March, 2023. As he was raised up into the light, he kicked and he cried, which constituted — easily — the most beautiful cacophony I will ever hear. A neonatal intensive care unit (NICU) team was in the operating room — he was in respiratory distress, and they took him immediately, claiming him as one of their own. I wasn’t scared. I trusted them. And I trusted that tinny tough little voice that had emanated from my son.
From March 10th to August 10th, Reubey lived in the Georgetown University Hospital NICU. He grew fatter and stronger and, if possible, even sweeter. I want to teach you words like atresia, and anastomosis. Taste these words, saliferous and stretchy and rich. Find them as beautiful as I do, because they apply to my son. He was born with esophageal atresia, meaning his esophagus was in essence cut into two. He had no pathway from mouth to stomach. To keep him from aspirating, he had a large replogle, technically a sump pump, in his throat at all times. It whistled and hummed and sucked up secretions so he didn’t breath in his own spit. He had leads, three round stickers stuck to his chest and stomach, connected to wires, measuring his heart and breathing rates. Another wire wrapped around his foot to track his oxygen saturation.
When Reubey was three months and one week old, he had an esophageal anastomosis, meaning that the two parts were stretched and sewn into one. He spent a week drugged and intubated with a chest drainage tube dripping pink fluid. A peripherally inserted central catheter (PICC) delivered total parenteral nutrition (TPN) directly into his blood. I spent that week living in the NICU guestroom, by his side except when I was eating or asleep. His grandmother came daily to read to him.
I remember the first time I held him with no strings attached; we spun and danced our way to the hospital’s plastic infant bath tub. He was almost five months old.
He was discharged, and we came home, to the loving licks of our doggo, Odie, but three days later Reubey was having retractions — using his chest muscles to pull air into his lungs. We presented to the emergency department (ED) at Children’s National Hospital. He had caught rhino-entero — a strain of the common cold — and we couldn’t manage it alone. We lived at Children’s for another four weeks.
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Now, at eight and a half months old, Reubey is a dream of a child. Happy. Curious. Constantly amused. Sharp as a tack. Taking nutrients orally — nursing, in fact, a skill he learned at approximately 200 days of life. How do I encapsulate him in text on a page? So often, I glance over at him and find his eyes already on me, watching me. He smiles when he sees me see him. He is happy to be held by anyone who will lift him up and help him jump. He has his sister’s nose and chin and his grandfather’s eyebrows. People have said that he has my eyes, something too flattering for me to claim. One of his ears is pointier than the other. He can do a yoga backbend better than Cirque Du Soleil. He lights up for mango puree. He loves his Wubbanubs, rattles, and chewing on everything. He periodically tries to eat the locket I always wear around my neck, which holds a clip of his sister’s hair.
Reubey still has periodic maintenance surgeries, called dilations, on the scarrage — or stricture — from the anastomosis, but the time between these is growing in length. He had his last one five weeks ago, and the next one isn’t scheduled for another eleven days. One day soon, there will be no dilation looming ahead of us on the calendar.
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Eighty years ago, esophageal atresia was a death sentence. Now it is medically anticipated that children will live, and live well — wholly typical lives, healthwise — if they have access to healthcare.
I am grateful to the nurses, doctors, and therapists who kept my son alive, and I am grateful to their ancestors and my own, and ancestors of folks the world over, who slowly and painstakingly over thousands of years made the medical advancements that led to the saving of his life. These medical advancements are the rightful inheritance of every single human on earth, not just those with privilege like me and Reubey. That there are children in this world today who are blocked access to this healthcare, and who die for the lack of it, is egregious, horrific, and must be stopped.
“The children are always ours, every single one of them, all over the globe; and I am beginning to suspect that whoever is incapable of recognizing this may be incapable of morality.” — James Baldwin
I know what it is to hold your dead child. I held mine three years ago, in a fancy DC hospital room in relative comfort, with predominantly woman healthcare workers surrounding me. They petted my hair, they told me that my daughter was beautiful. Her body was treated with immense dignity and love.
That there are parents in this world today losing their children to man-made violence, to bombs, guns, starvation and dehydration, to attacks on hospitals, and that these parents are often simultaneously wrested from their communities, forced to mourn in isolation, is almost unspeakable. But it must be spoken. If you are a U.S. citizen, remember: (202) 224–3121.
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Every Monday morning, Reubey has physical therapy at Georgetown University Hospital. We stop by the NICU afterwards, hitting the call button, smiling at the camera, being buzzed in. We are — always — greeted like celebrities. It has only ever been seven days since we last stopped by, yet we are celebrated like long lost family members, like prodigal sons. Reuben is exclaimed over, admired, praised, and hugged. I am, too.
I am happy. I live a happy life, even as Ruthie Mae is missing from it. My happiness is made possible because I do not carry her memory alone. Her name is said to me spontaneously multiple times each week, by family and friends, each syllable like a gemstone I am given to clutch, like an amulet that protects me as I move through the world.
As her brother moves through the world beside me.
