“
Hey, you two. Do you have a minute?” Dr. Sheldon peeked
around the curtain of Danny’s incubator space. Adam and
Sophie invited him to pull up a chair.
“As you just saw, apnea is a problem in premature babies. It’s
called apnea of prematurity. You’ve probably heard of some adults
using a CPAP machine at night?”
They both nodded.
“That’s because they have sleep apnea. In preemies, apnea
happens because their immature brain forgets to breathe. If the
apnea continues for more than twenty seconds, then the heart
rate starts to drop. That’s why you hear a lot of alarms going off—
usually it’s because a baby has become apneic and they need a
little stimulation, something as simple as a pat on the back to
remind them to breathe. Danny has had a couple of these epi
sodes, but nothing bad, because the ventilator is there to breathe
for him if he forgets.”
He paused and distractedly rolled and unrolled the bottom of
his tie, adding a few more wrinkles to the already crumpled mess.
“We treat apnea of prematurity with caffeine citrate. It stim
ulates their brain, reminding them to breathe. Once they’re older
and more mature, usually around thirty-four weeks, they can usu
ally come off the caffeine.”
Sophie waited for Dr. Sheldon to get to the point.
“I’m doing a research study on caffeine citrate under the trade
mark name BrainHealth. I’m looking at how we can use caffeine
34
JULIE HATCH
in a different way. We think that, if caffeine is given early and
long enough, it can also help preemie brains to develop better.
Even without being in the study, Danny will likely be started on
caffeine because of his extreme prematurity. My study involves
tracking the caffeine through the body as it gets metabolized. I
also monitor brain activity in response to the caffeine. Are you
with me so far?”
Sophie and Adam nodded.
“Good. It’s important that you know, even if you decline to
enroll Danny in the study, his care will remain the same. He’ll
receive caffeine like any other preemie who needs it.”
“What will you be doing to him?”
“I’ll be running blood tests on him, which will coincide with
his daily blood tests. Every couple of weeks, I’ll be injecting his
caffeine dose with an isotope solution into his IV. When he’s
bigger, I’ll do a series of three brain scans.”
“Is it safe? I mean, we wouldn’t want to sign on to anything
that could possibly hurt him.”
“Of course. Like I said, he will in all likelihood be getting the
medication anyway. If you enroll in my study, it will just mean a
few extra tests that are paid for by the hospital.”
Sophie and Adam looked at each other, trying to read what
the other was thinking.
“I’ll tell you what,” Dr. Sheldon added. “How about I leave
you with some printed material to look at, and I’ll check back
with you later.”
“That sounds fine,” Adam said. “We need to talk about it
together.”
“Absolutely. We believe that the study will show that with
proper dosing and prolonged treatment, a preemie’s development
and later performance in school will be better.”
“Wait, what is this isotope you’re talking about?” Adam
asked. “It sounds a little sci-fi to me. Aren’t those dangerous?”
35
THE VERY BEST OF CARE
“You’re thinking of radioactive isotopes. We don’t use those;
we use stable isotopes. The isotopes are like little tracers that
attach to the caffeine molecules so that I can track them through
Danny’s body. I can assure you they’re completely harmless.”
He handed them a piece of paper with Informed Consent
printed at the top. “Read through this. I’ll come back later and
answer any questions you have.” Dr. Sheldon stood to leave.
“Whatever you decide is fine.”
Sophie looked down at the consent form with BrainHealth
written on the first line. At the bottom, she read, Not approved
by the FDA.
“Ah, Dr. Sheldon.” Sophie cleared her throat. “What is this?
Not approved?”
“That just means that the FDA hasn’t approved it for any
thing other than treating apnea of prematurity. If you read the
fine print, it says the BrainHealth patent is pending and that,
for now, using caffeine citrate to help with brain development
is only experimental. That’s why I’m doing this study. To get it
FDA approved for this new purpose. But the drug is perfectly safe.
We’ve been using it for years.”
Rihanna had been listening to the conversation. When
Sophie turned to her, Rihanna looked away
