For Anne Whitehead, the NICU incubator raises questions of precarity and resilience, and illuminates care as a layered series of interactions involving human and non-human agency. This is the final essay in a series addressing miscarriage, prematurity, stillbirth and neonatal loss, published by The Polyphony to coincide with Baby Loss Awareness week, which runs 9-15 October every year.
Standing in the middle of the ward in the Neonatal Intensive Care Unit (NICU), I took in the sheer, unexpected presence of the incubators. They were bigger than I had anticipated, or at least they appeared so all together in this room. And they were so very strange up close. What exactly was an incubator? An artificial womb? A life-support machine? A cot, made as domestic and homely—as intimately personal—as the clinical space would allow? A capsule, containing an infinitely precious and fragile cargo? It was, it seemed, all of these things and more, for the doctors, the nurses, the parents, and of course for the ‘preemies’ themselves, the occupants of these transparent vessels. There the incubators were, at any rate, and I tried not to get too close, not wanting to intrude on family privacy in a space where it already felt both precious and quietly protected. I tried not to breathe too much; never before had I experienced myself so forcefully as a mobile unit of infection. I did not know then that within a few months this would be how I—how we—would experience every encounter and every visit, as a continual assessment of potential harm.
Angela Woods and I have asked of the clinical scene: ‘what else … is in the room’ as well as the doctor and the patient, ‘and with what forms or modes of agency might it be associated?’ (Whitehead and Woods, 2016). On the NICU ward, the non-human presence of the incubators dominated the space, and their monitors and alarms seemed to direct the complex human choreography that circulated around and between them. In this particular clinical scene, it was impossible to ignore the machine, in and through which almost every interaction with the patient was necessarily rehearsed – with the vital exception of the skin-to-skin cuddling of the baby with the parents, the so-called ‘kangaroo’ sessions. Angela and I also highlighted the critical concept of ‘entanglement’, which refers ‘to the project of reconceiving how ways of knowing and acting, how bodies, technologies and environments are intertwined’ (Whitehead and Woods, 2016). Again, this term seemed palpably resonant on the NICU, in the literal entanglement of the babies in the incubators with a proliferation of wires and breathing tubes and feeding lines and monitors. How might this specific entanglement speak of the intimacy, and of the intricacy, of the boundaries between human and technology? What might the environment of the NICU tell us about how we know and how we act, and of the responsibilities that emerge, when premature and precarious lives are at stake?
To approach these questions, I turn to two writers who have recently thought about their own, very different, encounters with the incubator. Francesca Segal’s memoir Mother Ship (2019) documents her experience on the NICU as a mother of twin daughters who are born ten weeks prematurely. Helen Macdonald is widely known for her memoir of grief for her father, H Is for Hawk (2014), but the opening essay in Vesper Flights(2020) addresses both her own prematurity and the loss of her twin brother at birth, through the encounter with another kind of incubator – one in which the chicks of birds of prey are hatched.
Segal’s first impression of the NICU registers the same sense of strangeness that I experienced. Faced with ‘the banks of monitors, displaying incomprehensible data’, she compares it to ‘the cockpit of a space ship’, and her daughters are ‘small astronaut[s]’ wired up to what they require in order to survive (Segal, 2019). Seeing her daughters in the incubators for the first time, bathed in a blue light to treat them for jaundice, Segal reaches for imagery that captures their ‘superhuman’ qualities: ‘starfish hands’, ‘fine leaf-veining’, ‘oceanic’. To look at them through the Perspex walls of the incubator feels, even to her, like an ‘intrusion’: ‘they were not ready’. Her daughters are ‘caught in the act of becoming’, and, as she watches her eldest daughter fight off an infection, Segal ponders what she might remember and retain of this time: ‘the model she must be constructing is of life as suffering and solitude, deliberately inflicted’. Even as her daughter struggles to catch her breath, Segal is unable to hold her; the most that she can do is to speak to her through the porthole of the incubator and hope that her voice will provide comfort and solace. How do we care for others when we cannot hold them; when to care means, precisely, to withhold holding? The incubator is, in the words of American poet C M Burroughs, a ‘vital system’ (Burroughs, 2012). Incubator, infant, parents, doctors and nurses form an intricate assemblage of agencies that cannot ultimately be disentangled.
As Segal gradually learns to navigate around the NICU, the ward, dominated by the presence of the incubators, is complemented and countered by the environment of the expressing room or ‘milking shed’. With its breast pumps and pumping paraphernalia, this room is as technological and surreal as the ward, and Segal’s point of comparison is a ‘military helicopter’, with ‘pilot and co-pilot at the front, and everyone else in a close ring behind’. However, if the ward is the site of clinical consultations and procedures, the milking shed represents the solidarity of the mothers, who willingly share wisdom, advice and information. Segal charts the complex entanglements between the ward and the milking shed; in the process, she constructs a portrait of the NICU as the site of multiple ways of knowing and acting, of tensions and allegiances, and of resilience as well as of precarity. The milking shed is the ‘odd craft’ in which the mothers sail, and it is here that they enact a collective care for one another that is as vital and sustaining as that of the NICU for their premature babies.
If Segal’s experience as a mother is of looking into the incubator, Macdonald seeks to take us imaginatively inside it, probing what it might feel like to be born too soon. More particularly, she is interested in what the experience of the incubator might leave behind; what of her own time in the incubator has impressed itself upon her? Known as a nature writer, Macdonald’s ‘Introduction’ to Vesper Flights sets out her intention to honour difference in nature, rather than seeing it as a mirror for our own fears and desires (Macdonald, 2020). ‘Nests’ takes us into an egg incubator at a falcon breeding centre in Wales, where Macdonald used to work. Her job was to weigh the eggs each day and, holding them to a light, to outline on the shell the shape of the developing chick within. Macdonald notes that each visit to the egg incubator left her feeling ‘unaccountably upset’ and with a slight, but discernible, sensation of ‘vertigo’. She identifies the source of these responses when, leafing through family photograph albums, she finds a picture of herself in a human incubator, a few days after her birth. Macdonald considers that the weeks she had spent there ‘had done something wrong to me that echoed with a room full of eggs in forced-air boxes, held in moist air and moved by wire’. The egg incubator brings back to her the ‘loneliness’ of the human incubator. Macdonald opens up the question of our relation, not only to the technology of the incubator, but also to the natural world of the avian. How, we are asked to consider, does the egg incubator coincide with and differ from the human incubator? What is the relation, and what is the distinction, between the premature infant in the photograph, and the falcon chick in the egg that Macdonald holds up to the light?
The ‘loneliness’ of the incubator that Macdonald identifies is also bound up with grief: her twin brother did not survive his birth and so the incubator is where she first experiences ‘isolation’ without him (Macdonald, 2020). Segal also frets at the question of how her twin daughters are experiencing their first separation from each other in the incubators. When she holds them both outside of the incubator for the first time, the twins inch together, forehead to forehead, and sleep with their pulses ‘beating perfect time’ (Segal, 2019). As one of her daughters is moved to another NICU and her incubator is wheeled away, Segal asks whether the remaining twin ‘will realise, when she wakes, that she is alone’. Although the separation of the twins is temporary, unlike Macdonald’s, it nevertheless troubles Segal, especially as it means that she can only be with one of her daughters at a time until they are reunited. Macdonald closes her essay with the memory of a day in the egg incubator when she discovered that, by holding the egg close to her mouth and calling through it, the chick that was ready to hatch would call back through the shell. She converses in this way with a falcon that will soon ‘spire up on sharp wings’, and, as she does so, she weeps. It is hard not to read the chick as freighted with all of Macdonald’s grief and desire; it represents at once her own premature infancy and her lost twin brother. In this sense, Macdonald’s writing reveals the difficulty of sustaining an encounter with difference. Read together with Segal, however, the essay also considers the bond between twins, and how we experience and survive separation.
What, then, is the incubator? These two writers have suggested the particular power of this medical object to raise questions of precarity and resilience, of the nature and boundaries of the human, of memory and loss, and of separation and survival. Considered within the context of the NICU, the incubator illuminates care as a complex and layered series of interactions, involving both human and non-human agencies. In what we might term an incubator imaginary, these literary texts communicate, from different perspectives, what it might mean to live in and with times of vulnerability and harm. They ask how we act to care for those lives that are most at risk. They examine the nature and the meaning of isolation. They articulate strategies of communication, agency, and solidarity. The meanings of the incubator are mobile, like the object itself. It is, perhaps, its very strangeness that renders the incubator such a suggestive object for our present times, and one that it has become so resonant to encounter.
Burroughs, C M, The Vital System: Poems (North Adams, Mass.: Tupelo Press, 2012).
Macdonald, Helen, H Is For Hawk (London: Jonathan Cape, 2014).
Macdonald, Helen, Vesper Flights (London: Jonathan Cape, 2020).
Segal, Francesca, Mother Ship (London: Chatto and Windus, 2019).
Whitehead, Anne and Angela Woods, ‘Introduction’, The Edinburgh Companion to the Critical Medical Humanities, ed. by Anne Whitehead and Angela Woods with Sarah Atkinson, Jane Macnaughton and Jennifer Richards (Edinburgh: Edinburgh University Press, 2016), pp.1-31.
Anne Whitehead is Professor of Modern and Contemporary Literature at Newcastle University UK. She was co-editor of The Edinburgh Companion to the Critical Medical Humanities (Edinburgh University Press, 2016) and author of Medicine and Empathy in Contemporary British Fiction (Edinburgh University Press, 2017). She is currently writing her next monograph, Relating Suicide, which is under contract with Bloomsbury Press.