The Royal Brompton in Chelsea is one of three hospitals in London with the facilities and staff to treat children with heart defects. An estimated 5,500 to 6,300 babies are born with congenital heart disease in the UK each year, all of whom require specialised care. Some will need many operations throughout their life.
On Friday, the Guardian liveblogged from the Brompton, where congenital heart disease services are under threat of closure. Advocates of the change say concentrating services in fewer locations makes for better care; the hospital and its supporters say it is the best at what it does in the country. The Brompton treats children with heart and lung diseases aged from just days old to 16 years. It has a paediatric intensive care unit (PICU) for children after surgery with at least one dedicated nurse per child, the Rose ward for 30 inpatients, and four beds in a high-dependency care unit (HCU).
- Morning routines: the ward-around meeting, and breakfast on the fly for the nurses
Doctors, consultants and nurses tour the paediatrics department in the morning ward-around. It is a crucial opportunity to discuss the various cases and what to expect for the day ahead.
Kawaljit Kaur spends all day, every day, at the bedside of her first and only child, Ekam, who is five months and 19 days old, she says, and was born with a hole in his heart. “I play with him. He holds my hand. We talk to each other and he gives me a smile,” she says. Ekam, sleeping flat on his back with his face hidden by tubes, flails his limbs in the air. “He is very lively,” says a nurse.
After work, Kaur’s husband joins her before they go home for the night. And in the morning she is back. “On Saturday and Sunday we are both sitting here, watching what he is doing,” she says.
- Autumn Russell with her mother Keri
Fifteen-month-old Autumn Russell from Essex was transferred to the Brompton for specialist treatment for a case of empyema, a bacterial infection that develops in the slim space between the outside of the lungs and the inside of the chest cavity.
Time may pass slowly on the ward in the paediatric heart and lung unit, but for children like Ekam and their parents, the hospital becomes part of their life – a second home and a place of hope. Ekam’s veins are still too narrow for the heart operation he needs, so he has a succession of stents fitted – tubes inserted into blood vessels to increase the flow.
But these moments of private contentment, with the serenity and depth borrowed from the portraiture legacy of the Madonna and child, do not depict mothers with their infants. The women holding the children are nannies. Part of what’s striking about the pictures is that they position front and center a person who is often left on the editing-room floor when a family’s memories are being assembled. Nannies have told me that their employers crop them out of photographs of their children. On the wall of a West Los Angeles home, I noticed a blown-up photo of a baby in a pretty white dress, held by a pair of hands of a darker color. In her photos, Asselin captures a radiance between caregivers and children, often of different races.
When I met Asselin last month, she was pregnant, weeks away from having her second child. Over the course of two years, while her daughter was a toddler, she interviewed nannies in her TriBeCa neighborhood as she made their portraits. She told me she had been working as a commercial photographer — work that required her to travel. She liked the idea of long, in-depth undertakings closer to home, because they would allow her to spend more time with her children.
She mentioned that when referring to the person who was taking care of her daughter, she sometimes caught herself slipping between the term “nanny” — with its associations of full-time household staff in 19th-century — and “baby sitter” — with its connotations of a high-school girl, part time, perhaps off the books.
I smiled, remembering those strange codes. In a whole generation — the children of the novelist and her husband were now in their 20s, the photographer’s were a toddler and one not yet born — not much had changed in terms of the given ease women feel about working and child care, even in places like New York and Los Angeles. The transparency men have enjoyed for generations, about their ability to frankly work while also reveling in fatherhood, is still complicated for women. Which is not to say that anyone can have everything.
Slightly more than four million babies are born in the every year, and 55 percent of their mothers remain in the work force. We go to college, live together or marry and have kids — often with little more thought to the daily routines of raising children than our grandparents gave them, when women by and large stayed at home.
Given the mobility of American families (making a nearby grandparent a luxury) and the absence of public day-care options, a significant number of children (and not only those born into the 1 percent) are raised — at least for a few years — by paid helpers.
When I had my first child, I fell in with a group of nannies at a park near where I lived in . It was less terrifying than the mothers’ group I attended. The nannies congregated on the playground late afternoons, a better time for my writing schedule, dictated in those days by my son’s naps. I sat with the English speakers, who were mostly Filipinas: women whose children were grown and in graduate school, women whose babies were being raised by yayas across the Pacific and women who had not yet married. The leader of the group was a 52-year-old mother of five who made eight times what her husband earned as an executive back in . (And of the group, she didn’t even hold the highest-paying job. She worked for two college professors.) She grew up with servants. Her father was a judge. She was president of her neighborhood organization and a member of five social clubs. Here, she worked as a live-in nanny. She called herself the C.E.O. of Filipinas in Santa Monica.
One of her protégés was a woman in her 30s from Mindanao, who was educated as a doctor before she came to the United States with her sister. She intended to study for the tests she needed to pass to become a doctor here. She heard of a job taking care of a newborn, and though she had never been in charge of a baby before (she was the youngest in her family), she accepted the position, thinking she would do it for a year or two. A few months later, already working, she learned that her mother died across the Pacific. But she and her sister had come on visitor visas. They couldn’t leave the United States and return. They stayed and spent money they saved from their jobs to buy black clothes, which she laundered every night during the months of their mourning. She told the baby boy she took care of about her mother.
We don’t like to mix love with money. We want love to come as a gift that offers as much pleasure and reward to the giver as to ourselves. No one receiving love wishes to break it down to its component parts, of good sense and feasibility, much less to consider that payment may be necessary to inspire the whole project.
Even more than we want good love for ourselves, we want it for our children, those vulnerable satellites of our hearts that we send, unsteady, into the world. Lewis Hyde, in his study of gift-exchange societies, tells us that in those economies, the gift needs to go “around a corner.” There must be a middle person or the gift becomes a trade. So the person handing over the money cannot be purchasing love for herself. This is an alchemy that works for working parents. You can pay a person who almost certainly will not love you but, with any luck, may love your child.
A husband and wife I knew during those early years had a nanny who became certified as an R.N. Their son, a toddler, was attached to her. She had asked for an increase that would amount to doubling her salary. She could earn that as a nurse, she said, but she would stay because she loved him.
The husband used clichés: “held up” and “highway robbery.”
The wife said she would pay anything. Her son loved the nanny. But they gave their nanny two weeks’ notice.
I remember thinking their son might not recover. But by all visible signs, I was wrong.
One day, the woman who called herself the C.E.O. of Santa Monica’s Filipinas was given notice when the boy she took care of was old enough for preschool. She devoted her last weeks with him to a crash course in memory making. She took him to a machine that took pictures and paid $7 at Kinko’s to have the picture put on a mug.
Her next charge was a girl who had given $5 to another girl at school to be her friend. The nanny had never had this problem at home. With her own daughters, the problem was the opposite: too many friends.
“When you try to buy things that should never be sold,” she said to the girl, “they turn into something else, like the princess who turned into a .” She said, “Money cannot buy love.”
But maybe it could. Her employer paid her, and she loved the daughter.
My children are no longer babies, and the women who helped me raise them, both the people I hired and the women from the playground, have moved on. The C.E.O. of Santa Monica worked for a movie director in , taking care of two children whose monthly clothing budgets nearly matched her salary, and now, at 70, she has retired, back in the , home, as she always planned. I recently received a text from her: “I am O.K. Little bored.”
The young woman from Mindanao did not become a doctor here. She married and had two children. She and her husband own their home in . When she took the children to see the Philippines, I tagged along to do research for a novel I was writing. We went to see her nephews, outside Manila, and delivered basketball jerseys and athletic shoes from their mother, a nanny I knew who was working in Los Angeles. The boys lived in a house their parents owned, but neither parent was there. They were on two different continents, making the money that paid for the house and for private school. Their yaya set dinner on the table. She was the daughter of someone who worked in the family house in the province, when their mother and her sister were growing up there.
The yaya seemed more gifted as a nanny than their mother, I whispered to my friend.
“Well, of course,” my friend said. “My sister is educated. Think of you, if you were a nanny.”
Now that my children are older, all this feels a little less poignant, and a few things seem clear.
Pity is a satisfying emotion, easy to set off and without the imaginative moral challenge posed by real empathy. And it is easy to make a case for the tragedy of women taking care of affluent American babies while their own children grow up, parentless, across an ocean or south of a border. Even in places like New York and Los Angeles, where some nannies are paid more than they could make in other jobs available to immigrants, their positions are perilous, subject to the will of one or two bosses. (In 2010, New York passed a basic bill of rights for domestic workers, requiring overtime compensation and three paid days off a year to cover sick days, holidays and vacation. Legislation is pending in but with no provision for paid days off.)
But few of these immigrants wish to return home, where their families would be paralyzed without the infusion of cash sent from here.
Economists posit that pink-collar jobs — work usually done by women — are underpaid, not least because we like to believe that the products involved (love, tenderness, care) are given not sold.
I once asked the nanny from Mindanao who was educated as a doctor whether she minded her job here. She shrugged and said: “No, Mona. It is dignified work.” Though less recognized and less valued in our culture, nannies understand the significance of their contribution. They know it every night, as they are being tugged at and begged not to leave.
No one can dispute the importance of raising a child. Most parents, holding a new baby, face the most monumental work of their life. Perhaps the reason we often deny caregivers the social position and the respect they deserve is that we are uncomfortable with our absence from the particular chair they occupy, many hours of the day, many days of the year.
When I started out as a mother, I knew two older women who were raising children and working. One hired au pairs, a different one every year, and then helped the young women get jobs. The other, who had work that required her to travel, had a full-time nanny who stayed with the family for years. I remember thinking that it must have been easier for the mother who hired the au pairs.
I attended a wedding a few years ago. The nanny who stayed with the family for years stood next to the two parents (by then long divorced) for the marriage of the girl they had all raised.Continue reading the main story