I’m Isaac Saul and this is Tangle, an independent, nonpartisan, subscriber-supported politics newsletter.
A little over six weeks ago, my wife gave birth to our first child. For today’s Friday edition, I decided to take a brief break from the news to share a bit about our experience, what I learned, and how having a kid has already begun to impact some of my politics. I hope you enjoy it!
We were seven months pregnant when we got the news. We weren’t even supposed to be there, really. My wife, Phoebe, had gotten Covid-19 early on in her pregnancy so the doctors were performing extra anatomy scans just to make sure our tiny little baby boy was growing like he was supposed to be growing. And he was. The scan seemed normal — fingers, toes, femur, spine, brain… all there. “Baby is practicing breathing,” the technician kept saying, in the awkward way doctors always refer to the baby as “baby” and not “him” or “her” or the name, which we were still very much keeping a secret. “Baby is moving around.” “Baby looks cozy.” “Baby is showing off.”
The technician left to get the doctor, who is the only one who can ever tell you anything, but always comes in and says in that cheery voice, “Your baby looks perfectly healthy,” then tells you to carry on with your day and then you go get a sweet treat and a coffee and daydream about the tiny little muffin arriving and squealing and grasping your forefinger with his genuinely hard-to-believe-they-are-so-small hands.
The wait was longer than usual, and when the knock at the door came it wasn’t the doctor but the technician again. This time she introduced someone else who was “shadowing” the doctor. “The doctor wanted another scan,” she told us. “An image we didn’t get the first time.”
It felt normal for a beat, then came the intrusive thoughts: Why is this interesting to someone shadowing a doctor? We don’t want this to be interesting. We want this to be boring and normal. Why another scan? What’s wrong? What didn’t they see? Where is the doctor? We ask softball questions, and she answers with rehearsed ambiguity: “Oh, the baby is practicing his breathing, which makes it hard to get the right image, ‘cause in this instance we actually want him to sit still.”
On the screen, red and blue dots map the flow of blood through his chest, and the technician keeps screenshotting it. She scans and jokes, moving the ultrasound wand across my wife’s belly, assuring us that “baby is an all-star.” Then, suddenly, the room fills with the audio of our baby’s chest — the sound of blood swooshing and whirring at 141 beats per minute. It cuts off after a few seconds. They didn’t capture the audio before, why now? An intrusive thought, I tell myself, and push it away.
“Baby won’t sit still,” they joke nervously, telling us yet again that he’s an “all-star.” On the screen, his diaphragm moves up and down as they try to capture still images but just don’t get what they want. The young man shadowing the doctor and standing beside the technician points and whispers, just out of earshot, something technical about a chamber or a valve in jargon that means close to nothing to me.
“We’re going to let you sit for a few minutes,” they say, “and see if he stops practicing his breaths.” They leave, and we exchange a worried glance knowing that none of this feels particularly comforting or quite right; but we’re seven months pregnant now, which means we’ve had these intrusive thoughts a million times and we know they never connect back to reality. I tap Phoebe’s belly and tell our boy to chill — so the doctors can do their thing, so we can go, so I can get back to work and get my massage tonight. We giggle, and Phoebe says “a massage sounds so nice” and then looks at me nervously. I assure her it’s okay, they just want to get all the images they can.
A couple minutes later they return. More gel on the belly. More scanning. More clicking. More whispered pointing, and then they tell us they are going to give this report to the doctor but, maybe, just stay in this position with the belly out and gelled up in case she wants to take a look. That didn’t happen last time and now my heart rate starts to increase, but I fake some confidence for my wife. The technician and young man leave. A minute goes by and there’s a quiet knock at the door; it creaks open, a nurse is in the wrong room and apologizes, shuffling away. More minutes. More exchanged glances. More reassuring.
Finally, the loud confident knock of a doctor sounds from the door and she enters before we can answer, trailed by the same young man who we were told is shadowing her today, and I hate everything about how she looks. I hate the tightness in her face and the forced smile and the focus, like she’s about to do something she doesn’t do every day and she knows she has to get it right.
“First of all, your baby looks healthy,” she says in a voice that conveys the important part is coming in just a moment. “But I’m seeing a few things that concern me.” My wife grabs my hand and her other hand goes to her mouth and I feel the room lift, as if it was just picked up by some great force I can’t see or touch or fight, and the words start falling from her mouth. I’m trying desperately to focus and hear every specific medical term, but the doctor seems slightly nervous and as she starts to explain how a heart works — why is she telling us how a heart works? — she pauses.
“Are you medical?” she asks. “No,” we both answer quickly and sternly, as if insisting she get to the point. “Okay, sorry,” she laughs, “sometimes I start talking like this and then the people I’m talking to are in cardiology or doctors and I just wanted to check.” I couldn’t really care any less about how this sometimes goes with other patients who “are medical” and I stare at her in a way that I hope conveys this.
“Basically, your baby’s heart is larger than it should be,” she says. Okay, I think, Lance Armstrong had a big heart, a third bigger than most humans, and look how he turned out. Big heart? Who cares? 20 minutes ago, before any of this was even on the radar, the doctor told us the baby’s head was bigger than average; we laughed. Big heads run in my family — poor Phoebe. Big heart. What’s the problem?
“This is often an indication of some kind of stress,” she explains. “If a heart is bigger than it should be, it could mean that it's working harder than it's supposed to be, which could mean that the baby is having some trouble transferring blood between the chambers of the heart.”
This makes sense. Too much sense. Okay. Big heart. Not good. Definitely maybe possibly a problem. She delivers this news in a brisk way that does not communicate that this might be a problem but that it is usually a problem; Phoebe starts crying, the doctor tries to keep talking calmly through it, and I try to swallow my fear. I kiss Phoebe’s forehead and whisper “it’s going to be okay, he’s okay,” and the shadow doctor sitting in the corner witnessing the now very obviously interesting thing happening today grabs a box of Kleenex and solemnly hands it to me.
There are some other issues, too. Some things the doctor wanted to see on the technician’s scans but didn’t. Some blood vessels. Some connections. She uses words like “venous” and “pulmonary” and something about quadrants or chambers or top or bottom portions, but she says if there is a problem they can fix it. “Fix it,” here, is doing a lot of work; all I can see in my mind’s eye is our child being cut open by some surgeon and hooked up to machines and wires and struggling to breathe and — I focus.
Okay, I’m here.
I squeeze my wife’s hand and kiss her again and tell her it’s going to be okay again; I will tell her this maybe 1,000 times in the next 24 hours but right now, I have the overwhelming sense that this is one of those turning points in life that I won’t ever forget, and I’m just trying to keep from vomiting in my lap.
“So I’m going to take a look,” the doctor says, and she asks if we’re ready, a question with no right answer. Gel. Belly. Phoebe looks at me as she begins and her eyes hold a panic that I’ve never seen.
An hour of quiet fills the room for 45 seconds. The baby’s tiny little heart is projected onto the big screen. More screenshots. More pointing and whispering just beyond my ear’s periphery. “His heart is structurally sound,” she says, and my shoulders drop a quarter of an inch. “Is that the pulmonary vein?” she asks the room out loud, as if anyone but her can know, and hovers her mouse over some dark blotch on the screen, circles it in yellow, and saves the image. This seems good. The images keep coming. My wife’s belly bounces up and down as she sobs, the doctors keep pointing, changing angles, explaining what they are seeing in ways we cannot come close to understanding.
“Okay,” she says. And she takes her gloves off and starts to wipe Phoebe’s belly down. “I think I’m seeing” — and I’m stuck on the word “think” already — “the veins that I was worried about were not there, but the baby’s heart is still a bit bigger than it should be.”
Her lips are moving and I’m trying to focus as hard as I possibly can, but none of it makes sense — his heart is working, structurally sound, doing what it should be; but it’s big and also maybe not moving the blood around properly. I hear Children’s Hospital of Philadelphia, fetal echocardiogram, cardiology — we’ll need an appointment and we’ll need it soon. “It could be nothing, just an abnormal-sized heart,” she says in a way that doesn’t inspire confidence. “Or it could be something that needs to be fixed.” Fixed. That word again. That’s a word that I know does not imply ibuprofen and water and rest: it means scalpel and flesh and a thumb-sized heart having its flaps cut and stitched and held together inside the four-inch cavity that is my son’s fetal chest.
“Do you have any questions?”
Any questions? Five minutes ago I was thinking about the two-hour massage I had scheduled for myself tonight as a celebration of surviving the workload of the 2024 presidential election and now you are asking me if I have any questions about my baby’s enlarged heart that might not be working anymore and might need fixing? Yes, I have some questions. I have a million questions. Let’s start with how could this be, maybe? What is this and did we give it to him and will he need surgery and when will we know and how do we get this fucking appointment today and what are the odds this is nothing and what are the odds it’s something and are you more confident now that you’ve “had a look” or less confident?
“So… his heart is too big?” I feel the words fall out of my mouth. The least helpful question I could possibly ask. “And that could mean it’s stressed?” I’m trying to get her to explain to me what I’m looking at and what we know, but the distance between her expertise and my layman’s knowledge is an ocean neither of us has the time to cross. “Yes. His heart is bigger than it should be, and that could mean it’s working too hard. So we want to know why.” She apologizes — she knows this is scary, and not the thing we want to hear. “A cardiologist really needs to look at this,” she explains, so we need to go to cardiology. To see the experts. To take another look. To figure out what’s happening.
She leaves the room and my wife and I both unfurl, weeping and sobbing and falling into each other. I promise her over and over it’s going to be okay, even though we just left our world and walked into some dark misty forest full of horrors we don’t know or understand. And it was in that moment, full of fear and angst and desperation to help my son, that I really felt the weight of being a father for the first time. Phoebe and I gathered ourselves and left the office, trying to put on straight faces for the other expectant parents in the waiting room we did not want to scare.
Our baby’s heart ended up being fine. It took the Children's Hospital of Philadelphia’s (CHOP) best cardiologists to determine and deliver the reassuring news, but it was unambiguous. In fact, due to a mix-up at the office, two cardiologists reviewed our file separately — both thinking we were their patients that day — and both came to the same conclusion: His heart was not a malady but merely “generous in size,” as one cardiologist put it — words that made me collapse into the table and weep again, this time in relief. The 72 hours between our first appointment and the one at CHOP were the longest three days of my life. The scare was a reminder, in stark bold print, of just how tenuous life really is.
And that really is pregnancy in a nutshell. The most incredible thing is that any of this ever works at all — and the grand finale is the labor and birth.
So now, before I look at my pregnancy and parenthood through the Tangle lens and get into the politics of it all, I’d like to tell you our story. And I’ll say clearly and for the record, to preempt the questions, that yes — I penned this piece with my wife’s consent, though her perspective on all of this is of course different and distinct. If you want to hear her first-person experience, you should listen to our third annual Valentine’s Day podcast (Phoebe might be the most popular guest I’ve ever had on the show).
In the movies, having a baby is pretty simple: A woman’s water breaks in dramatic fashion, the husband snaps into action, they rush to the hospital, nurses storm the room, a baby pops out, dad cuts the cord, and everyone starts crying and hugging.
The real thing is a lot different.
