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When every day is a gift

Modern aircraft can take people the 772 miles from Bermuda to Boston in just two and a half hours.But when you are rushing to the side of your sick infant son the journey the trip can seem like a lifetime.And when Wayne and Nicole finally reached Johnathan at the Children's Hospital in Boston the picture was bleak.

Modern aircraft can take people the 772 miles from Bermuda to Boston in just two and a half hours.

But when you are rushing to the side of your sick infant son the journey the trip can seem like a lifetime.

And when Wayne and Nicole finally reached Johnathan at the Children's Hospital in Boston the picture was bleak.

Wayne says: “They told me he was very sick, with a critical lung disease. He was just hanging in there.

“They were honest but I refused to believe he wouldn't survive even when they said he might not make it, just as I believed he would survive the trip to Boston. I believe in self fulfilling prophesies. If you say something enough it will happen. I wanted to increase his chances of survival.”

Wayne had to struggle to make the adjustment after the funeral.

He says: “It gives new expression to the phrase sweet sorrow, you have to be happy and upbeat for one child and grieve for the other.”

“Nicole was so happy to see Johnathan at last. She stayed by his side for about 24 hours. I had to pull her away to use the bathroom, she would not leave him.”

She kept up her vigil right through until September as Johnathan's life ebbed and flowed.

His worried parents felt lifted when their child's demand for oxygen support fell and he got stronger.

But each false dawn shattered their hopes as the support had to be increased when Johnathan took a turn for the worse.

Wayne said: “I felt he was going to make it and maybe we are going home soon and then he has a bad day and I knew that was unlikely.”

Constant blood tests were needed. But even this was an extra complication in a body so small.

“He needed blood transfusions because he didn't have much blood. He had four or five operations before he was three months old.”

By mid-June Wayne had to head home to earn for the family and then return to Boston at weekends.

Luckily his bosses had been understanding, luckier still was the fact his insurance covered the estimated $1.5 million cost of the treatment and travel. Nicole now had to cope without Wayne for long stretches. “Luckily when we got there, there was another family from Bermuda, that helped us. They told us where everything was.

“After they left another Bermudian family came. It's pretty cool to have someone from home. It's a long time to live out of a suitcase in a hotel.”

Doctors said bleeding in the brain could give Johnathan lethal brain damage, even the slightest noise could trigger this so a quiet room had to be set up.

Nicole says: “It was hour to hour, the first week, touch and go. If he could get through the first month we could then feel better.”

A computer logged his every change. “He had a little pump pushing out medicine. I remember counting 13 lines,” says Nicole. “There was morphine for sedation, caffeine to help him breathe and diuretics to help get rid of excess fluid on his lungs.”

Too fragile even for an incubator Johnathan was kept in a covered warmer, covered with a kind of Saran Wrap which kept in moisture likely to evaporate from his all too thin skin.

The cot had hinged sides for easy access for the constant attentions of medics - nurses monitored him 24 hours a day.

“A respirator ran from his nose. It was mind-boggling how my team kept him alive. For someone so tiny an intravenous (IV) line only lasts so long.

“They needed another IV in him so he needed to have surgery in his chest but he was so fragile they couldn't take him to the operating room, they had to do surgery right there but because they couldn't get the proper equipment in and do proper X-rays. They put it in the wrong spot.

“They had to do it again. We had to sign a consent form, they told us he could die. But he could still die any minute anyway. What do you have to lose? They tried to put a central line for the intravenous fluids and drugs. It's a major line and they had to do it because they could not get to the veins in the wrist, legs or head because they were so tiny.

“They didn't get it in the right spot and had to do it all again the next day. Luckily, the second time they found the right spot.”

A couple of days later medics had to act to close a valve in the heart which normally is sealed by the time the baby is born.

Medication failed to do the trick, surgery was needed. “It was the same thing, he could die.”

During the surgery the central line was lost.

“I saw the IV on the floor. I said ‘Oh my God!” All hell broke lose. Sometime during the surgery it had come out. Honestly you are just ready to snap, you are a mess you are sitting there with him.

“He was so tiny, but he had been through so much.” During these anxious days Nicole would watch her struggling infant and will him to keep breathing while alarms would go off every time his heart rate or the blood pressure dropped.

Nicole says: “Everyone keeps asking me now how did you cope with all this? You don't have any choice. I had to bury Christian, get a plane, go to the hospital, you get in a routine there.

“You spend 16 hours a day at the hospital. You get there between eight and nine o'clock and you leave at 11 or 12 at night and then you go home and crash, exhausted.

“You get up and do the same thing the next day, you are on autopilot. It became a way of life for four months. It's nothing unique or special.”

Soon a new IV line was required.

Nicole says: “They tried his head and other arteries then his leg. You are emotionally wiped out.”

“They said they would have to put that into his thigh, it was in his hip. It took three attempts to put in. I thought how much can one tiny body take? They weren't going to go through the chest, they were going to go through the leg. But you have no choice. It just about did him. He was sweating and grey.”

After seeing her child suffer so much Nicole had reached a turning point.

“I was saying I didn't have him just to put him through this. It was torture.

She vowed not to sign another medical consent form. “I said I can't put him through this anymore. Luckily they never came to us for another surgical procedure.” The strain took its toll on others says Nicole, including the team of 50 nurses, all of whom had to care for Johnathan at some time as they kept constant watch on his progress.

“One nurse said she prayed every morning that she wouldn't have to look after him because she was so afraid he would die on her shift.”

But even when the operations were over there were still a million things which could go wrong according to Nicole. There were more fears when Johnathan's already low birth weight of 1.3 ounces dropped further to a pound. Johnathan recovered, but it was not dramatic as he used every once of strength to fight off constant infections.

“He took a long time to grow,” says Wayne.

Johnathan was in grave danger of picking up an intestinal disease common in premature babies.

He avoided that but got very sick when fungus developed in his blood requiring really strong medicine. The longed for moment came on June 11 when Nicole could at last hold Johnathan - six weeks after his birth.

“It was amazing, I was in awe of him. I held him to my chest but I could cup him in my hand.”

While it was an enormous comfort for her, it was a matter of survival for Johnathan, with medics keen that Johnathan should benefit from the healing effects of warm skin contact.

“It's called kangaroo cradling. I would do this for five hours straight, for as long as I could hold out. He did better with me than in the incubator.”

Wayne got to hold his infant on June 17 - making it a very special Father's Day. He says: “I can't think of anything better in my life than having that child at my chest for four hours.”

But efforts to wean Johnathan off the respirator ended in more trauma.

“His lungs collapsed. They had gone a little too low, they had to re-inflate him and start all over again. Then he had a partial collapse,” says Nicole.

Johnathan was put on steroids after the lung collapse - but it put the medics in a dilemma. In order to get better he needed to grow but the steroids stunted that growth.

Three months after his birth Johnathan was still incapable of breathing on his own - or so they thought.

Nicole had another heart-stopping moment when the hospital told her Johnathan had again pulled out his breathing pipe out.

“He was breathing on his own. I thought he was never going to breathe!”

But breathe he did, confounding the doctor's predications. They later confessed to the Smiths that they didn't think he would survive.

“I am glad they didn't tell me at the time!” jokes Nicole who adds: “He's a little miracle.”

Wayne adds: “They admitted they didn't have too much experience with babies this small.

Free from immediate danger there was still plenty to worry about. Medics believed high doses of oxygen he had needed would have damaging side effects on his eyesight. But their predictions that he would need corrective laser high surgery were proved groundless.

Even simple things were big issues with Johnathan. Nicole says: “The whole unit cheered his first bowel movement. It proved his system was working.”

And at at last, on September 7, the child was free to return to Bermuda, accompanied by medical notes more than a foot high.

Now Johnathan has been pictured on the front cover of the hospital's annual report as one of the smallest babies to pull through and the nurses who cared for him keep in touch with Christmas cards.

With the worst now over Nicole can joke that Johnathan had better be a good member society after the effort made to keep him alive.

“It is amazing just how much this boy has cost. The air ambulance alone was $10,000.”

Understandably each milestone in his development has been logged says Nicole who admits to taking a million pictures.

Now 13 pounds, Johnathan is beginning to prosper says Nicole. He's small for his age. But age is a complicated matter when you are born far too soon. Wayne explains: “He's nine months old but five months old corrected. He will catch up by the time he's three.”

The worry isn't over though. Johnathan's immune system is still weak and he will be susceptible to asthma, respiratory illnesses and pneumonia. He will have to be kept away from other children until he's three and able to deal with germs without serious risk.

His parents must wash their hands before they touch him and a highly-trained nanny keeps watch when the parents are not around.

But at last the family can begin to feel normal again. Wayne says: “I saw the dark side of losing a child even before I had had a child. Now I can enjoy the goo-gooing and the gag-gaging.

A noise Johnathan seems keen to make down the phone when his grandmothers call.

“He starts screaming if we don't give him the phone. He's an excellent baby. He only cries if he is hungry or has gas. It's the only way he can communicate. I definitely want more children. My wife and I said many times that if we knew the pregnancy would happen like this we would do all this again just for the simple pleasure of having him.

“Such is the joy that we would go through the whole gut-wrenching experience all over again.

Asked if the ordeal made her doubt her faith or strengthen it Nicole says: “Both. You do a hell of a lot of praying. You make bargains, you are going to be a saint if he survives.

“But when things are going wrong you think how much more do you expect me to take? For a long time I thought I must have done something really bad in my previous life.”

The experience has left its mark. Nicole says: “It changes you and your priorities. You realise how precious life is. Each morning Johnathan gets up I know how lucky I am that he's getting up.”

But for both Wayne and Nicole their joy at Johnathan's health will always be tinged with

sadness for Christian.

Wayne says: “You never learn to get over it, you learn to live with it. I got sad around Christmas because we found out Nicole was pregnant on Christmas Eve. That's why we called him Christian.

“I go to Christian's grave and have a little cry. I miss him, there's not a nano-second goes by that I don't wish that he was here.

“Every time Johnathan does something I wonder what it would be like to have two of them, what Christian would do in that situation, that's the burden I will have to carry for the rest of my life.

“Talking during therapy helps. I got counselling at Boston Children's Hospital as well as here in Bermuda.”

And as Johnathan gets older he too will have to learn to understand his parents wistfulness when certain dates come around.

Christmastime, Valentine's Day and Johnathan's birthday will all be tinged with melancholy. Nicole says: “How do I make him understand that when mummy has a far away look in his eye it's nothing to do with him.

“But you can't help but think what if?”