!!!!!*****WORKING DRAFT*****!!!!!
During our summer-long road trip, Howard decided to go after a degree in Public Administration, rather than put his life on hold any longer while he tried again at the law boards. In order to qualify for a Master’s program, he needed several courses in statistics and political science he’d neglected as an undergrad, which he found at the University of Massachusetts in Park Square near the Commons.
He grumbled a bit about having to attend the state school. “I don’t mind at all that it’s not Harvard or even BU. It’s the monstrosity they’re building out at Columbia Point. That whole area was supposed to be subsidized housing, now it’s being taken over by the Boston educational-industrial complex. At least I’ll be done by the time they move – that would be a long trip every day.”
By the time Kagan returned from his sabbatical, I had linked up once again with Barry Brazelton’s Child Development Unit at Children’s hospital.
“Sarah, we need someone exactly like you for a couple of research studies we’re starting.” His twinkling smile and Texas drawl, softer now after all his years mixing with Yankees in Boston, welcomed me into a routine I’d been missing since graduation. “The one I think you’ll find most interesting is our follow-up to the work we just finished on newborn reactions to medication during labor. Ed Wernick’s leading that one, I’ll get you set up with him right away.”
Ed got right down to business. “Barry’s been interested in this for years now. He decided the tools he’d used for that first study, back when you were an undergrad, didn’t capture the full range of an infant’s neuro-behavior, and that standard neonatal neuro exams are not probing enough to capture subtle changes. So he came up with his own tool, his Neonatal Behavioral Assessment Scale.”
I’d read about that while in Kagan’s lab. Covering a couple dozen separate items, it produced a complete picture of the motor skills of these tiny little people, as well as their response to things like pinpricks, light flashes, and sound.
Ed went on. “I think you’d be perfect at performing and recording all those exams…”
Over the next six months I had a crash course, a post-graduate trial by fire, as I got up to speed on all the facets of the study Barry and Ed had so blithely outlined. First, I had to learn about the drugs used in labor: Nisentil and Phenergan as narcotic pain relievers, lidocaine as a local for episiotomies and spinals before forceps delivery, Marcaine for epidurals – my head spun as I absorbed pharmacology texts and the PDR, the Physicians’ Desk Reference on drugs. Once Ed discovered I actually had some charm, unlike the others on the team, scientists who hid behind data so they could avoid people, he assigned me as the liaison to gain the cooperation of the obstetricians and anesthesiologists we’d need at Brigham and Women’s. And then there were the endless meetings as we honed the study design.
“I think the problem with those previous studies, why they had trouble finding any pattern, was they were mixing up all sorts of Ob patients.” Lauren was the only other non-doctoral level person on the team, a graduate nursing student hoping to specialize in pediatric ICU care.
“Why so?” asked Ed.
“Labor is a stressful time, and there are so many different ways it can go, so many combinations of drugs and management strategies. Then there’s the difference in the length of labor, and mothers who have other medical problems, like diabetes. You mix up all those categories, the results we’re looking for can get lost in all the noise.”
“So we reduce the confounding stressors, limit the study to just a few simple drug regimens, you’re saying we might actually find some differences when it comes to, say, epidurals compared to that short-acting narcotic…what’s is called again, John?”
Dr. Stanton, the only MD on our team, responded succinctly, “Nisentil.”
“Right, Nisentil. Sarah, how long did you say that worked?”
I still got nervous, being treated as an equal by these serious and experienced researchers, but I had the information immediately available. “One hour, Ed, more or less. It works great, but it doesn’t last long at all. Studies show if they give only one or two doses, before a woman starts pushing, then it’s barely detectable…”
Ed cut me off. “One hour, right, it’s the one we need for the minimal drug group.”
We worried each element of our study in such meticulous detail, I feared we’d never actually get around to collecting the data, much less subject it to the analysis by Heidi, the CDU’s Ph.D. statistician, from which any answers must eventually emerge. Nonetheless, Ed had me begin writing a first draft of the introduction and procedures.
“Shouldn’t that be called ‘Materials and Methods?” I asked, reflecting all the papers I’d been plowing through. “That’s what they call it in…”
“Procedure – that’s what Barry wants, Sarah. Just do it his way, OK?”
So I outlined the subjects, grouped by the drugs to which they’d been exposed. I explained the behavioral assessment we’d be doing, and noted how we would eliminate all the confounding elements we’d agreed on, to ensure no extraordinary stresses on the mothers. “Beyond the stress of labor itself,” Lauren, a mother of two, said sardonically to me in one of the meetings. In the end, we had about as normal a group of 54 moms as possible: average age 27, length of labor 8 hours, gestational age 39 weeks, six days, infant weight 7 pounds 8 ounces. The babies all had to be normal, too. Apgars of 8 and 9, no congenital anomalies, no admission to the pediatric units after delivery.
“Sarah, wow, where did you learn to write like this?” Ed exclaimed when I hand my draft in.
I wanted to say, “Uhh, Radcliffe?”, but instead, I just said, “Thanks, this was helpful for me to understand what we’re doing. I just followed the standard formula.”
“Well, you picked it up a faster than any of our other research assistants.”
‘Research Assistant.’ There I was again, the lowest title on the group. So why did it seem like I was doing all the work?
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