MARQUETTE – The new baby arrived at UP Health Systems in Marquette by ambulance on a January evening, well past dark and nearing, maybe, the end of a long shift for nurse practitioner Kelly Kurin.
Barely a day old, he was a mess — his legs shook uncontrollably. His arms, raised to his head, his tiny fingers splayed, shook too. His skin was red and splotchy with upset; his gasping, desperate cry inconsolable.
The new baby was dope sick. He was in full-on, cold-turkey withdrawal from the opioids his mother took while pregnant.
Nurses and the youngest victims of the opioid crisis they care for in the Neonatal Intensive Care unit in Marquette, Mich. Romain Blanquart, Detroit Free Press
Kurin and the nurses in the hospital’s neonatal intensive care unit checked over the baby, quietly. They knew from experience that noise and commotion would further agitate him, his nervous system frayed. They measured him, wired him to a monitor to track his vital signs, offered him a pacifier in which he expressed mild interest for a couple of seconds before returning to his heartbreaking, gut-wrenching cry.
In a few hours, the infant would get his first dose of methadone, the old school stuff some junkies still receive when they want to get off drugs. A nurse would coax a few droplets into his mouth from a syringe. It would alleviate withdrawal symptoms — low-grade fever, shakes, rigid muscles, sneezes, crying — and help him to sleep.
After that, the NICU nurses would do what they always do with their drug-addicted babies. They’d swaddle him in a light blanket: The babies find the closeness of the fabric soothing. They’d feed him, change him and make him comfortable.
They’d love him because it’s difficult to resist a baby, so cute, so innocent, so vulnerable. And also because lots of times the parents of these drug-exposed babies disappear into the darkness of their own lives and the nurses are all the babies have. They are the only people to talk softly to them and hold them when they are miserable from stomach cramps or raw from diaper rash brought on by the diarrhea that often accompanies their withdrawal. The only people to tell them they are beautiful and special.
“Look at that dimple, so cute,” Kurin — who has seen it all in the 27 years she has worked in the NICU — cooed to the new baby.
Though still fretful, he was calming, settling into a crib parked across the room from four more drug-exposed babies and around the corner from another.
They made up half the population of the NICU that day, these babies born into addiction. And before winter’s end, the Marquette NICU would see many more of them. In the Upper Peninsula, newborns are hospitalized for drug withdrawal — almost always from opioids — at a higher rate than anywhere else in the state. They are the youngest victims, collateral damage, of the opioid epidemic that is ravaging the nation, especially its rural areas.
This is a story about the Marquette NICU. About the babies who ended up there the first three months of the year. About parents who loved them and others who didn’t — or maybe just didn’t know how. And about the nurses who hope for the best but fear the worst because sometimes really bad things happen.
Michigan’s Upper Peninsula is almost otherworldly in its remote beauty, with hilly forests of pine and white birch, rushing waterfalls, sparkling shoreline and skies so clear and uncluttered that on some days you can almost see to heaven.
There is skiing in the winter and snowshoeing and snowmobiling and ice hockey and ice fishing and trails for mountain bikes with fat tires.
In the summer, which is short and therefore especially precious, the tourists descend to camp — atrocious black flies and giant mosquitoes be damned — and to explore and hike and tour Pictured Rocks and bask in the unspoiled greatness.
There’s just so much empty space. The Upper Peninsula makes up 30% of the state’s landmass and stretches across two time zones. Itspopulation is sparse — and declining. Between 2010 and 2017 all but one of the Upper Peninsula’s 15 counties lost population to migration. And since deaths far outnumber births, the population will continue to shrink, unless there is an unlikely influx of newcomers. The U.P. is now home to only about 302,000 people or roughly 3% of the state’s population. The largest concentration of U.P. residents, or Yoopers, lives in Marquette, located on the Lake Superior shore. With 21,000 residents, several good restaurants (Lake Superior whitefish is a menu staple), a couple of breweries (blueberry beer) and Northern Michigan University (about 7,900 students), it is the region’s metropolis.
In some ways, the Upper Peninsula’s isolation and scattered population have left it susceptible to problems. No magnet for industry, there are few jobs; the unemployment rate is higher than the state average, 8.3%, compared with 5.2%, according to the latest figures, which have not been seasonally adjusted. The county — Luce County — with the highest percentage of people in the state receiving public assistance is in the U.P. Drinking, something to ease the boredom of winter and to celebrate the summer and make the future seem brighter even when it’s not, is a well-established part of the culture. The five counties with the highest binge drinking rates in Michigan are located in the Upper Peninsula. “The U.P.,” said Dr. John Lehtinen, the Upper Peninsula’s only board-certified addiction medicine specialist, “is noted for alcoholism.”
But now, there is something else: drugs, lots of them.
People here dabble in crystal meth and cocaine and pot but the biggest draw are opioids. Which means heroin and painkillers, including ultra-potent fentanyl, but also buprenorphine — a safer opioid doctors prescribe for patients who want to get clean. It curbs cravings and softens withdrawal, though it often ends up on the street, where addicts who can’t find their drug of choice use it to stave off withdrawal sickness. And others just buy it to get high.
“The pendulum has swung,” says Lehtinen, who is 71, has no plan to retire, and has seen his practice morph over the last 20 years from one made up mostly of alcoholic patients to one that consists almost exclusively of drug addicts. “This problem isn’t going away any time quick,” he said. “It’s going to take awhile to get the train slowed down and going the right way.”
Or, as Michigan State Police Lt. Tim Scholander, who heads the Upper Peninsula Substance Enforcement Team of drug cops, said when describing the region’s drug problem: On a scale of 1 to 10, with 10 being the worst, “we’re really close to 10. … I don’t think the people from downstate that come here to visit realize it. They’re tourists. They’re typically not going to the areas where they would see this type of drug activity. It’s definitely here, always creeping around.”
No demographic is immune to the seductive lure of opioids; they make users feel too good.Getting high on heroin is like having a full-body orgasm, one of Lehtinen’s patients said as she fussed over her baby in the NICU. Another mom, who said she used to shoot up with her dad, compared her heroin high to being wrapped in a warm and cozy blanket, a hug, that made everything better. Until it wore off. And she needed more. And more. And more.
So people keep chasing their high; they keep using.
Some of those users get pregnant. Their babies are exposed to drugs in the womb. As many as 94% of those exposed to opioids, according to studies, experience withdrawal symptoms and health complications referred to as neonatal abstinence syndrome.
Nationally, the rate of babies diagnosed with NAS jumped from 1.5 per 1,000 births in 2004 to 8 per 1,000 births in 2014, according to a study by Vanderbilt University.The increase has caused hospital costs associated with treating NAS to skyrocket from $61 million a year in 2003 to $316 million a year in 2012, according to a government report released last year. In 2014, health care for Medicaid-covered infants totaled $462 million.
Michigan has also seen a significant increase in babies treated for drug dependence — from 4.1 per 1,000 births in 2010 to 7.6 per 1,000 births in 2016. But the problem is especially acute in rural areas, the farther north you go in Michigan, the bigger the impact. In the U.P., babies are treated for NAS at a higher rate than anywhere else in the state — 29 per 1,000 births in 2016. (The rate peaked in 2015 at 37 per 1,000 births.)
And because the hospital in Marquette has the only NICU in the Upper Peninsula, the only place equipped to treat them, most of the region’s drug-dependent babies end up here. By the beginning of April, a total of 15 babies — or 34.8% of all the babies admitted to the NICU — had been treated for NAS.
Dimly lit, and kept in a perpetual state of dreamy twilight because light, like noise, bothers them, the nursery is the babies’ first home.
We’re going on a run, Kurin announced as she hung up the NICU phone.
That’s how it begins. Another hospital calls, saying it has a baby who is withdrawing from drugs and the NICU transport nurses — usually two — and a respiratory therapist head out in an ambulance outfitted with every bit of medical machinery a baby in distress needs to stay alive.
They pick up babies from 13 hospitals, including those in Ironwood and Hancock and Sault Ste. Marie, which is about seven hours round trip in good weather; when M-28 East, which runs along Lake Superior, between Marquette and Munising, gets slippery and snowy, it can take an eternity.
They pick up babies from Ishpeming.
And from the hospital in Escanaba.
Which is where they picked up the Snow Baby, a name the nurses gave the tiny baby because she had been delivered by emergency C-section after her 31-year-old mother allegedly overdosed on heroin and liquid benzodiazepine, and spent the night unconscious and outdoors in February temperatures that dipped well below zero.
Alive by luck — someone drove past, saw the baby’s mother on the ground and called for help — the Snow Baby was receiving methadone for drug withdrawal. Child Protective Services was already involved in her life; the hospital files a report whenever a baby is exposed to drugs. Doctors will be an ongoing presence, too, because the Snow Baby will most certainly have some special needs. She has brain abnormalities — perhaps from the cold that left her body temperature much lower than the normal 97.8 degrees for babies or from a lack of oxygen she suffered in utero while her mother lingered near death.
Symptoms of withdrawal, especially heightened muscle tone that makes the newborns look as if they’re purposely flexing their arms and legs and holding up their head on their own, could linger for months. Like many drug-exposed babies, the Snow Baby may be profoundly fussy. She may have delayed language, cognitive and motor skills. She may have behavioral issues. She may be at higher risk for future addiction. But all that was secondary to the fact that the Snow Baby was alive. “She’s a miracle baby,” said her maternal grandmother, who wants desperately to adopt her.
Every other day, the grandmother drove the hour or so to the hospital from her home in Gladstone so she could spend mornings feeding and burping and holding the baby and kissing her hands. “Another day, hey?” she said to the baby.
Sometimes the grandmother — who is 48 but looks older because heartbreak ages a person and she has had plenty of that — thought about her daughter. About how she had gotten mixed up with the wrong crowd and never managed to find her way free, becoming homeless and losing custody of her kids. “I know it was nothing I did,” the grandmother said. “I know she had a good family life. It can happen to anybody. It doesn’t matter what kind of family you come from.”
The overdose in Escanaba had been her daughter’s third in 12 months. She was hospitalized as a result and saw the Snow Baby in the NICU twice during that time. The grandmother is almost certain she saw tears in her daughter’s eyes during one of those visits, which made her hopeful that her daughter was coming around. But then, poof! She was gone. Discharged from the hospital, her daughter went back to her own life. As far as the grandmother knew, that meant living in a storage unit with the baby’s father, her feet infected from frostbite. Most probably, she was lost in her high.
“It’s not the point of, if my daughter dies, it’s the point now of when she dies,” the grandmother said more than once. It had taken her years to come to that reckoning, years of offering drug rehab only to have it rejected, years of pleading with her daughter to stop hurting the people who love her most. “When is your rock bottom?” she’d asked her daughter a few weeks after the Snow Baby’s birth. “You’ve lost (your) kids, you’re going to lose part of your foot, you’re living in a storage unit, like animals. When is it going to be, to hit your bottom?” Her daughter didn’t respond.
Adopting the Snow Baby was the grandmother’s priority now and she was already designated as the baby’s foster mother. She hadn’t planned on taking another of her daughter’s children. She already had the Snow Baby’s 8-year-old sister. A brother, 14 months, had been adopted by other relatives. In fact, those relatives had planned to adopt the Snow Baby, too, but one look at her and the grandmother couldn’t let her go. Her own daughter had almost died and that had left her shaken to her soul. “Almost losing her as many times as I did … I can’t let her children go. These children are part of her,” the grandmother reasoned. “If something happens to (my daughter) I will have my daughter in her children. These are the only things I have left of her.”
The grandmother leaned back in one of the nursery’s chairs and held the Snow Baby close, so very close, to her chest, the way you hold something when you’re afraid of losing it, the soft beep beep of the monitors an oddly soothing lullaby.
Pep talks for parents
Their baby was responding to treatment, but the 28-year-old mom from Sault Ste. Marie, whose pierced lip and eyebrow probably made her seem hip or edgy on most days, looked especially vulnerable. And nervous. And kind of defeated — anyone who saw her could tell that, the way she sat with her eyes cast toward the floor, picking at her fingers, looking small in the chair positioned against the wall in the corner of the NICU meeting room.
You’re doing right by your baby, said Kurin, who called the meeting because sometimes the best thing she could do for her patients was to encourage their parents, to give them the confidence to do their best.
The mom was in treatment with a doctor from downstate, receiving buprenorphine to keep her from relapsing on the pain pills she’d started using as a teenager to cope with the death of her parents; she was also taking gabapentin, an anti-seizure medication that also acts as a mood stabilizer, for anxiety. She took smaller doses than prescribed during her pregnancy, hoping that doing so would spare her baby from the ugliness of withdrawal, though, of course, it hadn’t. And she was disappointed. She hated that her mess had become her baby’s mess. But no one could do anything about that. It was all in the past. Kurin was trying to make her see that. Because being stuck in the past meant never moving forward. You’re doing all the right things, Kurin said.
A few minutes after their talk ended, the mom was bathing her son in one of the NICU sinks, holding the back of his head to protect it from harm while the baby’s father took pictures on his phone.
That the parents had come to the hospital and planned to stay through their son’s treatment was unusual.
They had no clear idea how long they would be away from home. The baby was receiving methadone twice a day and once his withdrawal symptoms subsided, the nurses would begin weaning him. The process usually takes 17 days from the date a baby is stable. Sometimes babies can go home before they are weaned completely and a visiting nurse or family member without a history of substance abuse would administer the final doses of methadone. Other times, babies have difficulty with the protocol and weaning might take a month, or even longer, if there are other health problems.
And while Kurin and the team encourage parents to stay in a hospital room with their babies to bond and learn to better care for them, few parents of drug-addicted babies ever did so for more than a night.
The parents of the preemies and babies with other health problems were in and out of the NICU with great frequency, but parents of drug-exposed babies didn’t visit much. Some didn’t come at all, especially over the winter. They’dsay they couldn’t find a ride or were too busy with other responsibilities or that the NICU was claustrophobic or the nursing staff or doctors didn’t like them.
Sometimes, the moms of withdrawal babies would bust into the nursery with all sorts of toys and clothes a newborn couldn’t possibly use or wear, as if they were trying to convince others, and maybe themselves, that they could be candidates for Mother of the Year. And then they would back away and not return for days or even weeks. “The addictive personality,” Kurin said wearily, “is a party of one.”
But even parents who came to the nursery could be a challenge.
They might arrive high, eyes glassy, faces puffy and words slurred beyond recognition. And the nurses, would — as required by law— alert a hospital social worker. And then there’d be a scene and lots of bad feelings. After one run-in, Kurin — who is confident, compassionate and outgoing and doesn’t scare easily — was so shaken, so worried that an upset mom and her entourage might try to attack her, that she called her husband at the end of her shift and kept him on the phone as she walked from the hospital to her car. Safely inside her car, she said she felt silly.
Sometimes parents didn’t want their baby to receive methadone treatment and even though they never came right out and said it, it wasn’tdifficult to figure out why. Having a baby on methadone is a clear signal the mom had done drugs, and most moms — even those whose judgment is blurred by drug use — hate knowing, or having anyone else know, they’ve done something to harm their baby. The nurses would have to explain: No one expects an adult to quit drugs cold turkey, so why should a baby?
Sometimes parents ignored nurses’ instructions to not wake sleeping babies. “I don’t understand why you think you can tell me what to do. It’s my baby,” parents complained over and over, trying to establish some sort of authority over their child in a place where they feared they had none.
The moms are ill, addiction is a disease, the nurses know that. And the moms’ lives are complicated, full of dysfunction that led them to seek solace in drugs. But none of that makes their situations any less maddening or upsetting. “I have tended to stay away from some of the drug babies because I don’t want that attachment,” Cathy Hebert, a NICU nurse, confided through tears. “You don’t know what’s going to happen to that baby when it goes home. If that mom can’t take care of herself, how can she care for another life?”
The nurses still cry when they talk about the baby who died last year, a couple of days after being discharged from the hospital. He’d been with them long enough to be aware of his surroundings and to coo and smile at the nurses, which made them love him all the more. They knew he wasn’t going home to a good family situation, which worried them. His mother, they recalled, was so medicated, on something, that she had difficulty forming coherent sentences; she even had difficulty staying awake during meetings at the hospital. They didn’t have much faith in the baby’s father, either.
“We repeated that concern to several people from several agencies,” Kurin remembered, her voice tinged with anger and hurt. But the baby’s dad ended up getting custody. And he took the baby home.
What exactly happened, the nurses aren’t quite sure. But knowing that withdrawal babies are fussy and that they sometimes suck voraciously on their bottles — not so much because they’re hungry but because the sucking motion is comforting — the nurses wondered if someone mistook the baby’s actions for hunger and kept feeding him until he aspirated his food and suffocated. Or if someone put the fussy baby in bed with an adult who rolled over on him.
“Take care of this baby,” were the last words Kurin said to the baby’s dad when he and his infant son left the hospital. And the next thing she knew, she and two other nurses were in a car on the way to a funeral at the home where the baby had lived for barely any time at all.
The baby’s mom hugged the nurses and introduced them to her other children, but the nurses hadn’t gone to the funeral to offer their support to the baby’s mother or father. They’d gone because they loved theirbaby and wanted him to be surrounded by love. “He wasn’t just Baby Boy Blah Blah Blah that people would feed every three hours,” Kurin said later. “It’s part of the casualty of war that you get to know the patients and you get attached to them because you’re with them every damn day and the parents aren’t. Everybody needs to think that somebody loves them and somebody wants to hold them.”
‘Most of my family were drug addicts’
Most days, 20-year-old Chelsea Reichel of Marquette — a pretty young woman who had dropped out of high school and always sounded as if she was half asleep — arrived at the hospital and went straight to the NICU because her baby, who was withdrawing from buprenorphine, was the most important thing in her life. The person she loved most. The person she couldn’t wait to take home and mother.
But on a cold day in March, she had somewhere else to go first — and she was late. She’d thought her appointment was at 2:45 p.m. but it was scheduled for 1:40 p.m. and now, at 3 o’clock, she was just checking in to see the substance abuse specialist, Dr. Lehtinen — the doctor who gave her buprenorphine, which she credited for keeping her from relapsing on heroin during her pregnancy. The guy she would need to continue to see if she wanted to stay off heroin and maintain custody of her newborn daughter.
Drugs were part of Reichel’s heritage. She’d started with pot when she was 13. By 14, she’d moved onto pain medication — near as she can remember a friend of her brother’s introduced her to Vicodin. (“It sounds stupid, but I just got interested,” she said. “Most of my family were drug addicts. I grew up around that.”) Her dad, she told people, shared his pain medication, doling out pills for her each morning to help her get through the day. When he ran out and couldn’t get a refill, she took whatever she could find. She’d ask friends, sometimes she’d hang around the bus station, looking to meet people who looked like they used pills. “You get a vibe,” she said. She liked downers; speed made her too anxious and she already had a problem with anxiety. Then, she fell in love with heroin. “Heroin,” she said, “was 10, 20 times stronger than painkillers. Your whole body gets warm. You just don’t care about anything, it’s just a happy feeling.” (She liked fentanyl, too, but it was more difficult to get.)
She didn’t like that her dad had started using heroin with her. She worried he would overdose and die but she never worried about herself and would admit later there came a point in her addiction when she didn’t care whether she lived or died. All she cared about was the high.
Then, a turning point: In December 2016, Reichel chose shooting up in the bathroom instead of being at the bedside of her dying grandfather. And when her mind cleared, she was so disgusted with herself, so disappointed that she hadn’t honored a man she loved, that she went into treatment. (She said her father did too.) And she finished in time for her father to see her get clean before he died.
Eventually, she found her way to Lehtinen. He honored her appointment even though she was late; his patients are often late.
Lehtinen, who is also the doctor for the Northern Michigan University varsity sports teams, comes across as part concerned father figure who wants to know how his patients are feeling and how their babies are doing. Part hard-ass who threatens patients who mess up with a kick “in the anatomy” or a visit to “the principal’s office.” And part cowboy who doesn’t like to be pushed around. “Come on, make my day,” he said, taunting a young man who became belligerent when he refused to prescribe medication. “He was a little runt of a guy,” Lehtinen recalled. “So he went bye-bye.”
It takes two to three months for a new patient to get an appointment with Lehtinen, although if a woman is pregnant, she can get in within a week. Getting her off heroin or painkillers and getting her on to buprenorphine is a priority. Even though it’s still an opioid, Lehtinen believes it’s safer to have a pregnant woman on doctor-monitored doses of buprenorphine than on heroin or something else off the street.
Many of his patients saidhe saved their lives. They saidhe listened to them. That he didn’t judge, although he did point out to women with boyfriends he thought were losers — including Reichel, whose own boyfriend refused to visit their baby in the hospital — that they sure “know how to pick them.”
Lehtinen knows that many of his patients are embarrassed to be addicts. One woman, who received buprenorpine because she grew addicted to the pain medication she took for a bad back, kept her status as one of his patients secret from everyone except her mother and boyfriend. (She said when she thinks of drug addicts, “I don’t think of good people, and here I am, one of them.”)
Lehtinen knows what many of his patients have been through — sexual abuse, domestic violence, low self-esteem, mood disorders. “Hollywood couldn’t script it, what you hear, what these people go through,” he said “So much abuse, so much trauma in their lives, that’s the environment they live in. … How to make them survivors is really challenging.”
Lehtinen also knows his patients sometimes lie to him. They’d say they lost their buprenorphine or that someone has stolen it and they needed a refill, though in most cases they were probably just selling it on the street. So Lehtinen would put them on weekly refills — and do pill counts — instead of monthly refills. He doesn’t believe in disciplining patients by kicking them out of his practice. All that would do is insure that they never got off drugs.
Some people dislike his practice, he knows that, too. They blame him for contributing to the drug problem because he prescribes buprenorphine. “In our business, we run into a lot of his patients,” Scholander, the Michigan State Police lieutenant said. “He primarily prescribes Suboxone,” the brand name for buprenorphine, which Scholander said is frequently diverted, or sold on the street.
Lehtinen’s critics also disapproved of his decision to prescribe gabapentin — an anti-seizure medicine which he believes works as a mood stabilizer. They fear it makes babies’ withdrawal especially difficult. It too often ends up getting sold on the street.
But to Reichel, Lehtinen was the best doctor ever. She’d gone to him at the end of her pregnancy, worried she would relapse on heroin. He gave her a prescription for buprenorphine, which she takes and credits for keeping her away from heroin. Although the cravings never really went away. There are days when all she wanted was to get high, days when she longed to slip into another dimension. But she didn’t. She talked herself out of it because she knew that her baby needed her as much as she needed her baby.
Lehtinen went over her drug screen results. When he saw that she wasn’t positive for anything illegal, he high-fived her and she smiled because few people besides her mother ever let her know they were proud of her for staying off drugs or for anything else. But she didn’t say much, she seldom did.
After that, Reichel went to the NICU, sat beside her sleeping baby. took out her phone and scrolled through pictures of the room that would belong to her baby once she got her home to the apartment she and her boyfriend shared. Reichel had worked hard furnishing and decorating the room. She’d painted wooden letters pink, shined them with glitter and arranged them so they spelled out her baby’s name: W-I-L-L-O-W.
Kurin and the nurses looked in on her a few times, but she seemed lost in thought in the quiet nursery.
At the beginning of April, Reichel finally took her daughter home.
Because of the sensitivity of the subject matter, not all parents or guardians in this article agreed to be quoted by name.
Georgea Kovanis writes about the opioid crisis in Michigan. To contact her: firstname.lastname@example.org or 313-222-6842.
This content was originally published here.