1.

A man caught mid-run, torso falling forward, right foot off the ground. This is what you see when you look at the scar. It begins from the top of my left ear and tapers at the crown of my head, hair sparsely growing around it. In the photograph, I am being baptised. My petite body rests on my mother’s bosom and she clasps her hands around me. I am fiddling with her necklace, my mouth pouted, caught mid-gibberish. Before her, a priest, hand raised in blessing. He wears a white soutane and reads from a missal, a Mass servant’s head peeking from behind him. 

Priest: What name will your child be known to God and to us?

Parents: …

In another photograph, my mother looks displeased. Her anger is directed towards my father, who stands off to the side holding a lit candle that will hold me enthralled in the following photograph. His frame is turned away from the camera but in the shadow the fluorescent light casts against the wall, there is what seems like an outline of a small recognisable smile. He is late to church. The baptism Mass is long over and the newly initiated babies are gone with their parents and godparents. My godmother, a beautiful dark-skinned woman I would come to know as Aunty Bene – of Italian origin and means well or good – is standing behind my mother, head slightly bowed, a purple-pink scarf draped over rich-black curly hair.

Over the years, Aunty Bene, like the rest of our extended family, always wanted to see the scar. Did it hurt? Was it smaller? Had hair grown over it? At salons, hairdressers asked what kind of accident I had been in. In school, teachers wanted to know what story it told. 

“Rough, very rough,” my mother says about those tumultuous weeks when they watched glass boxes empty around the neonatal intensive care unit (NICU), wondering if, wondering when. My baptism had been five months coming. I needed to grow a little more. My parents needed certainty that I would stay. 

Priest: What name will your child be known to God and to us?

Parents: Winifred.

The priest christened me Winifred. It is a Catholic name, belonging to a Welsh virgin martyr whose head, after she was decapitated by a jealous horny suitor for deciding to become a nun, rejoined her body through the prayers of her uncle, St Beuno. She was restored to life. I wonder if they knew this then or simply that the name, when traced to its Welsh origins (Gwenffrewi), possessed two root words: gwen, meaning blessed and frewi, meaning peace.

2.

Prior to the 19th century, premature babies were a non-issue to medical science. Fatalities were chiefly a result of infants’ inability to regulate temperatures steadily enough for their organs to keep blooming into maturity, in addition to partially developed organs or asphyxia in the absence of breathing support. The invention of an enclosed heating box changed the trajectory of their care. 

3.

In 1878, French obstetrician, Dr Étienne Stéphane Tarnier, spent an afternoon at the Jardin d’ Acclimatation in Paris looking at poultry hatching chambers. This inspection led him to a light-bulb moment: that premature babies under his care as the Chief of Obstetrics at L’Hôpital Paris Maternité could similarly be nurtured into maturity. After the Franco-Prussian War, birth rates were plummeting across the country and premature births were rising. So this discovery was really important to Tarnier. 

Following simple techniques that midwives across France had been employing to keep premature babies warm (such as lining cradles with hot bottles and placing swaddled infants in the middle), Tarnier’s couveuse (brooder) came to life in 1880. It was a double-layered fully-enclosed thick wooden chamber that held up to four infants in its upper station and underneath, and contained a small reservoir of water that was heated by an external boiler. 

Tarnier’s incubator quickly gained prominence in France due to the significant increase of survival rates of premature infants born at the time. In the decade that followed, obstetricians sought to improve upon this design in regards to warmth, ventilation, sterility, and hardware. With input from Dr Pierre-Constant Budin, who succeeded him as Chief of Obstetrics, Tarnier’s wooden hardware would become a complete sterile glass box that remains to this day the incubator’s choice of hardware. 

4.

A childhood fable. 

I was born nodding. Like a lizard. Not the proud folktale reptile who nods in self-admiration when silence echoes back after a daring leap from a tall Iroko. My mother recalls a clucking sound, a desperate gasping for air. 

I am the third of five children. By the time I arrived, about 12 weeks early, my mother had already encountered two anxious starts to motherhood. Her first child, a boy, had fallen terribly ill as a toddler and been at the brink of death. As the first son in my Igbo family, he was a prized possession and the occasion of losing him would have been disastrous. Her second child, a girl, had been born somewhat early and jaundiced. For a few days, she was illuminated under blue light to break down the bilirubin that coloured her skin yellow. Then there was me. A month before I was born, her cervix began shortening and opening up. The doctors stitched her cervix shut to slow time, to keep me in a little longer so that my lungs could at least reach an appreciable stage of maturity. They put out hope that I would hold off arriving till May or June. But on a Sunday evening in March, her amniotic fluid started to leak. At the hospital, with more fluid lost, the doctor advised that the suture be loosened for my delivery. I arrived so unbelievably tiny my father asked again and again why I looked inhuman and whether I was going to live. 

A century, a decade, and a year had passed since Tarnier’s incubator. The glass boxes – variations of Tarnier-Budin’s original – had travelled to Africa as part of the west’s industrialisation of the continent. So, while my mother still lay in the labour room at a private hospital in my hometown, an ambulance whisked me, her clucking baby, off to a neonatal intensive care unit at the university teaching hospital where I was handed over to Prof. Ibe, my panicked father in tow.

5.

The room is empty. A ceiling fan spins overhead. The harmattan air is dry and hot. Underneath my nose mask, tiny beads of sweat form. In an open cupboard stationed in front of the waiting room, shelves are filled with packs of Cheese Balls and a carton of Happy Hour. On the wall, a baby’s face fills a banner; oiled, chubby, with tear-filled eyes, her face advertises a pneumococcal vaccination to prevent deaths in children under five. Another bright-eyed toddler, whose hair is suffused with colourful hair ribbons, advertises vitamin A for good eyesight. A nurse stands behind a counter on the far side of the room filling in a notebook. As I wait, a woman comes in with her young son who restlessly meanders through chairs, clutching a small bag of biscuits. A brief flurry of activity heralds Prof. Ibe. He is just as I’ve always known him: sporting clear-rimmed, circle-framed glasses, a thin layer of grey hair encircling a bald patch at the top of his head, lazy eyes, a calm, sage-like demeanour that is almost reverential. 

I have travelled home back east from Lagos for a number of reasons, including a cousin’s wedding, and because I had begun looking into the story my premature birth, I figured I could call and ask to speak with him about what he remembers of that time, and broadly, what has changed in the care of preemies in the years since then. The first is an almost unreasonable ask. Three decades have gone by, hundreds, thousands of preterm babies I reckon, passed through his care. But one afternoon, I call anyway and he agrees to a visit. The last time we spoke, about four years ago, my father was insisting I get a second opinion from him about some medical tests I had taken. 

My family never severed ties with Prof. Ibe. Adversity is, after all, one of those ironic paths through which life leads us into some of the most impactful relationships. Prof. Ibe and my father had remained distant friends, and he became a kind of family doctor as the 90s wore on. When I grew into a teenager whose body shored up odd illnesses, from severe migraines to an allergic reaction that left huge, hurtful welts all over my back, he was the only physician my parents entrusted to know how to interpret and fix my broken body. 

Prof. Ibe’s office is sparsely furnished, the sterile aesthetics of a hospital merged with the antiquity of a government office: pale green walls, a plain examination table adjacent to a cupboard of medicines, laminated wall charts. 

Named after a British saint, Bede – of Anglo-Saxon origin and meaning prayer or supplication – Prof. Ibe cared for, possibly, more than half of the premature babies born in Enugu in the 80s and 90s as a professor of neonatology at the university teaching hospital. When he wasn’t there, he ran a private paediatrics practice at Royal Hospital, where my siblings and I recall one of us running down a flight of stairs from his examination room one night, terrified of receiving an injection to the buttocks. 

According to Prof. Ibe’s memories, I was born at 30 weeks and weighed 1.2 kilograms. He remembers that my parents were dogged in their care even when, all around them, the emotional and financial turmoil of the NICU experience saw parents abandoning their babies. Later that night, as I recounted our meeting, my father told a now-amusing incident of my maternal grandma physically charging at Prof. Ibe for wanting to carry out yet another medical procedure, insisting that the poking, the needles, and intubations were enough.

To decide on paediatrics as a specialisation in Nigeria is something of a selfless response to a noble call to service. An answer to other people’s prayers. In 2011, there were only 476 active paediatricians in the country, one for nearly 200,000 children under the age of 15. At the core of Prof. Ibe’s career was a deep “interest to look after tiny people”, and when I asked what he found most challenging about practising in Nigeria all these years, his first response was dealing with parents who were apathetic towards their children’s wellbeing. The economic rewards, limited as they are, came second.

6.

Why babies arrive earlier than they should is often unclear. Sometimes though, root causes do come up, and they can range from pregnancies in older women or multiple births to underaged pregnancies or lack of foetal growth, say, in the event that a woman has a malignant or benign tumour competing for space with her unborn child. Socioeconomic status, which can affect where a pregnant woman receives antenatal care, also comes into play, Prof. Elizabeth Disu, an affable neonatologist in Lagos told me over Zoom. Structural challenges of the reproductive system, such as a cervical incompetence, which is what my mother had suffered from, or pre-eclampsia, a high blood pressure condition that can endanger the lives of mother and child, are contributory. Other predisposing conditions could be mental (stress, emotional turmoil, psychological disorders), or behavioural (alcohol consumption, smoking, drugs). 

Regardless of what the causative factors are, the instant a premature baby arrives, medical practitioners enter a race against time to fast-track developmental milestones that best occur in utero. 

The action of birthing is as rigorous for the infant as it is for the mother, says Prof. Ibe. He adds that infants typically lose weight for 14 to 21 days after they are born then begin to regain body mass as they are fed and sleep round the clock. A 1.2 kilogram-baby weighs about the same as the two cans of Campbell’s Family Size Vegetable Beef Soup in my pantry! To lose some of that weight still to attain maturity is perilous. My mother remembers those eight weeks as a constant loop: of releasing breast milk into sterilised feeding bottles at the hospital, of looking through unclear windows into the NICU, of watching nervously as nurses cleaned my paper-thin body with olive oil and changed incredulously oversized diapers before pumping milk, antibiotics, and other kinds of drugs into the mesh of wires that opened into a nostril or vein. 

An irony: every assistance a preterm baby needs to live could lead to a fatal outcome. It is not that these assisted biological events – breathing, feeding, excretion, interpreting stimuli – were not occurring similarly in the uterus but that early severance from uterine support and its en suite protection can have devastating consequences. 

For instance, food is crucial in the first few weeks after a preemie is born. An increase in body fat can help a baby start to better regulate its temperature. But their underdeveloped digestive tracts are delicate to work with. Food can often flow upward into the throat and lead to jerky breathing. When neonatal formula is given in place of breastmilk, the weak intestinal walls can be wounded and let bacteria into the stomach, leading to serious infections that can be fatal.

Preemies born under 28 weeks and weighing less than 1 kilogram often need oxygen support, but if this support is long, they can forget to breathe when they are weaned off it because their respiratory systems have failed to develop autonomy. If high volumes have been delivered, red blood vessels can grow in the eyes, rupture, and scar the retina, leading to blindness. Stevie Wonder, born at 34 weeks, is blind as a result of this. 

After attending to his last patient for the day, Dr Fortune Ujunwa, a neonatologist whose practice is set up in a hospital on the street of my childhood home, jokes that the sanitary rituals of the COVID-19 pandemic are child’s play. It’s been nearly a year of masking, sanitising, politicising, and dying. Child’s play, he says, when placed in context of the immune systems of premature infants. In the NICU, it is imperative that staff maintain the highest levels of hygiene because any slight contact with harmful microorganisms can determine if a parent leaves with a baby to name or a baby to bury.

7.

In a teaching hospital such as where I was born, parents currently spend about ₦6,000 to ₦10,000 per day just for a preterm baby to stay in an incubator if one is available. If you throw in ventilators, surfactants, drugs, neonatal formulas where breastmilk is unavailable, and diapers, the cost of a month’s stay in an intensive care unit might run anywhere from ₦600,000 to ₦1,000,000 in a public hospital. In a private clinic, parents can spend upwards of ₦2,000,000 monthly to keep a preemie baby alive. And even with this, what quality of life awaits the infant at the other end of the line is a gamble, particularly in Nigeria, where survival rates have seen minor improvements since 1991 despite advancements in the field of neonatology that better those odds significantly elsewhere in the world. 

And there is no price tag on the emotional turmoil those months can bring: fear, exhaustion, anger, hurt, resentment, and hope swirling like a whirlwind, threatening to reduce the lives of an infant’s parents to rubble.

8.

“All the world loves a baby,” said the slogan at the entrance to Martin Couney’s sideshows, but it was not quite so. He was a German pioneer of early neonatal technology who staged “child hatchery” shows of preemies at industrial fairs across Europe and America. A eugenics movement formed a part of Couney’s harshest critics. At the same fairs as his child hatchery were stalls where eugenicists propagated ideas of selective human breeding and the evolutionary benefits of survival of the fittest. Preemies, whom they often described as “weaklings” and “immature specimens”,most certainly did not have a place in the human race. 

A variant of this viewpoint existed beyond Europe and America. Love Breaks Through tells the story of Christian missionary Katie MacKinnon and a community in Kenya where premature babies were left by their mothers and medical personnel to die. When a premature baby was born, the Kipsigis declared that if God had wanted the baby to live, he or she would have arrived fully-formed. This belief was often strengthened by the infant’s strange appearance – itsy-bitsy frame, wrinkled skin, and a face that belied how long they had lived. The Kipsigis concluded that the baby had been hexed. Mothers othered their babies by referring to them as monkeys, and MacKinnon, eager to show the saving power of Christ, took the babies home and cared for them until their cheeks filled out, their lungs took in air on their own, and they could hold with the claw-like grips babies have that always surprise adults. 

This book was gifted to my mother by the Sunday School department of the pentecostal church we attended as children, and it was the only book on the subject we had at home. When I read it many, many years ago, and when I reread it now, I wonder. Did my mother read this book in those weeks following my birth? Did she believe I was hexed? Did she believe that God’s power was ever potent in preserving my life?

9.

It was after I was weaned from the incubator that my parents saw the scar. On my tiny skull, it appeared enormous. Savage. A blister had begun to spread from my scalp where an infusion of Rocephin, an antibacterial treatment, was administered, my mother told me recently. When we were much younger, she was insistent that a nurse may have dropped me in the NICU, shrouded as I was from her during my two-month stay. Prof. Ibe tells me about something called an extravasation injury. When an infusion is administered through skin and the solutions meant to be delivered into a vein make contact with surrounding tissues, it can cause blisters that spread if the incident is not discovered on time (in which case cleansing with salt water can halt the wounding process). A blister can quickly become a sore, which quickly becomes a wound that eats deep into nerves, tendons, and joints. It is a common NICU hazard, many of them arising from intravenous feeding. Prof. Ibe does not remember how long it was before the leak was discovered in my case. 

My parents say they were offered a skin graft to redress the scar tissue but, reluctant to further the physical and emotional distress on their baby and themselves, they chose to take me home with my scar. In the photographs from my baptism and in the other few from that period, I spot a cap or a bow artfully pinned to spread its wings across the scar.

10.

I was Kosisochukwu five months before I was Winifred, my mother’s name offering after St. Winifred. It is not a name people know me by. As with most Catholic baptism names, it admitted me into Christendom and sits between my first and last names on my birth certificate, registered on 24 January 1992, 10 months after I was born. 

Where I come from, names are stories. It is the first one a person tells you about their life. An Adaeze is her father’s first daughter. Taiwo tells you that they are the first of a twin set, that they were born before Kehinde. Akosua was born, like me, on a Sunday; Ochieng, at midday on a sunny day; Yaa, on a Thursday. And Kosisochukwu? A tale of surrender to God’s will in the most turbulent of circumstances. I’ve been called variations of my first name for most of my life: Kosi, Kosiso. None of these versions carry the entirety of the prayer that is its full version. Still, these are the names people who grew up with me – my family, my friends –know me by. 

I used to think I outgrew Kosisochukwu. There was a time not too long ago when I excused every dead end in my life with the story that my name told. God had willed it so. Then, my faith cracked open a fissure and in came flooding wisdom, or perhaps it was strength, to challenge the sense of resignation that always left me a tepid participant in my own life.

11.

On my first day of boarding school in 2001, I arrived with my mother, new sets of belongings with my initials K.W.U. boldly imprinted on them, and a low afro. At the check-in station, as new students rolled their Echolac boxes by, their hairs trimmed close to the skull, I repeatedly asked my mother if they would let me keep my afro. She wasn’t sure but this was the only way she knew to keep my scar hidden and safe from whatever teenage unruliness lay ahead. A teacher confirmed they wouldn’t let me keep the hair, and so we exited the gates to find a barbing salon. I was a frail 10-year-old. My limbs were thin and dangly. My collar bones shot out from the neck of my uniform. In a powerful storm, my body could have been swept up with dirt and dust. And then, there was the scar. 

Tired of repeating the circumstances around my birth after the first week, I began telling teachers and students who asked that it was a birthmark. There was always a brief moment of disbelief then silence. In Igbo, a birthmark is called “e bum pụta ụwa”. Translated loosely, the phrase says, “I came into the world carrying this.” How do you question something so final? The scar and my sickly appearance became something that was pitied and taunted for most of the first three years of secondary school. Premature became not the innocent act of being a little early but a curse word that conferred on me a state of fragility I detested. Someone easily broken, unfit for a world that easily, gladly, breaks things.

12.

My parents like to say that I was one of a few preemies in the NICU during those months who left alive and unscathed save the skull injury. While many preemies increasingly go on to live well-adjusted lives, studies in recent years are bringing to light how the nature of care provided in NICUs can have more subtle cognitive impacts than was previously understood. Learning difficulties, attention deficit hyperactivity disorder (ADHD), anxiety, or higher than normal stress thresholds have been reported later in life and to various degrees depending on how early an individual is born.

Deep down, I’ve often pondered on this fragility and whether there is something irreparably broken in my mind or body, a malformed seed planted by an early arrival and all the care to make that arrival count, that will grow into a diseased tree someday. It’s an occasional anxiety on mornings when I wake with eyes blurrier than I recall or on nights when my lungs feel shallow, incapable, and I cannot fill them with air no matter how deeply I breathe.

13.

That I was born just at the cusp of severe prematurity and have gone on to lead a healthy life was always a miracle story growing up, and often, when I need to be pulled from one of my many hidey-holes into the difficult business of living, this story is all the sufficient cord. I think to myself, if the Universe/God/Fate/Science has conspired to keep me here, then surely, I can make it through a difficult month or year or years, many of which I have devoted to the ever-volatile business of being a writer.

In 2013, a close friend began to call me K. We were stationed in western Nigeria, ad hoc teachers on a compulsory national service year. It was a nickname I would later extend by two more letters to “Kay”, after a kind acquaintance I once knew in university. Taken by the idea of pseudonyms and the duality that they bestowed on writers, when I began to write, I signed off my short stories and poems as Kay Ugwuede. I was a shy young woman who wanted to write bold things, and this separation of first names, hence selves, was one way to achieve the interior demarcation that produced such a result. When I evolved into nonfiction writing, this name naturally transferred into my work. I have since published a number of essays and reportage under this name. 

The writer’s desire to separate the work from the self – out of inadequacy or a desire to place the work above everything else – is not new. “Kay”, however, morphed quickly from just a name that distinguished my writing into how I was addressed outside writerly contexts. Even I cannot remember when I last introduced myself by my real name. I say “I’m Kay” and struggle to explain how it is its own name when asked what the full name is. I attach it to yet another essay and my dilemma deepens about the public writer–private person dichotomy I was previously attempting. The writer, like any other human being, is an amalgam of private and public selves and regardless of a name demarcation, we are ever presenting a version of ourselves per time and as the situation demands. 

I may have been one of a few surprised to learn only after her death that Toni Morrision was Chloe Anthony Wofford. Toni was a nickname from her baptism name Anthony while Morrison was an ex-husband’s name. In 1994, a year after winning the Nobel Prize, she told the New York Times she was upset when she saw the cover of her first novel because “they had the wrong name”. “My name is Chloe Wofford,” she said. “Toni’s a nickname.” This seemed to be a lingering regret that trailed her dazzling career. In a 2012 New York Magazine interview, she said she regretted publishing The Bluest Eye under Toni Morrison. “Chloe writes the books,” she said. Toni Morrison was the public persona who did famous author things. “Wasn’t that stupid?” she said. “I feel ruined!”

As I draw near to the end of the MFA programme that brought me to the US, and as I think about the next few years of my career as a writer, I’ve begun to wonder if there will be something akin to Morrison’s feeling of ruin at the end of my career should I continue to append this name that is but isn’t quite mine to the work most important to me. 

One of the reasons why I stuck with Kay for so long was my unravelling faith in God. I had been taught His will was perfect and good but this belief came into serious scrutiny when my personal and family life grew more difficult in ways I couldn’t have envisioned. Kay, a Greek variant of Katherine, alternates between “pure” and “rejoice” in meaning. It seemed like a healthy compromise to adopt it: while I questioned God’s will I would remember to “rejoice” when someone called me Kay. Because when someone calls your name, they are saying a prayer, and they are repeating back to you familiarity, tenderness, intimate knowledge, or a specific origin story. 

I guess this, a missing specific origin story, is the root of the sense of loss I have been feeling in the past year as I revisit the circumstances of my birth and the names that were given to me by my parents, both deeply thought out and evidence of their love, their prayers and hopes for my life. “Kay” tells you nothing about where I have come from and when I am called Kay, it doesn’t repeat all the events that have conspired for me to be here, which I have recounted to you and back to me. And as I ponder about this work that I do, documenting, as it were, the many fragments of my identity as a woman, sister, or daughter, as an Igbo, as I live, as I think, as I write, and as I photograph, I’m concerned that the one thing that is the basest identity marker appended to them, “Kay”, holds very little meaning. I say all of this with the caveat that, deep down, I am yet to affirm to what extent my life is surrendered to God’s will as a non-committed Mass-goer and one whom the practice and institution of religion holds in earnest fascination and disillusionment.

I am one of many for whom Morrison’s work remains a monumental inspiration. The brilliance of the work that she did is not undermined by what name accompanied her age-defining novels and essays. Yet, this blunder in nomenclature seemed to linger throughout her life, more so because naming was one of the subjects that featured prominently in her oeuvre. It matters what you call a thing. Or a person. 

There are a number of biblical accounts where God changes the names of certain individuals. Abram, exalted father, to Abraham, father of many nations. Sarai, my princess, to Sarah, woman of high rank. Jacob, supplanter, to Israel, a man who fights God and wins. Names are also keys. To unlock what future lay ahead, it was important to bestow a new name, a new identity, a new prayer, a new lighthouse far ahead in the future beaming into the present. In the past, literature was awash with author pseudonyms, names that unlocked a varied number of things: a non-biased audience, an opportunity to explore a new genre, a shield. While Kosisochukwu Winifred is not a new name, there is a sense of trepidation that there may be something to lose by journeying back to it at this point in my writing life. In the three years between The Bluest Eye and Sula, I wonder if Morrison weighed the cost of publishing as Chloe Wofford and decided against it. 

But Morrison was already incomparable by the time her first novel was published, a voice in my head says. This preoccupation with author names, often undertaken by writers with a substantial body of work, is not only immature but pompous, this voice insists. Who cares what my name is if the essays I write are not compelling, the language artfully wrought? What reader recalls the name of a writer who cannot bring them to feel more deeply the beautiful contortions and the bottomless complexities of our humanity? Were it not for her brilliance, Wofford or Morrison, would it have mattered? 

For all I know, there may not be acclaim now or later, but it matters what we choose to call ourselves or the things that are valuable to us. And I want, everytime my names are said or seen, when they accompany the work that is most important to me, to be reminded – and now, for you too to be reminded – of my parents’ hopes and prayers as they walked the corridors of that teaching hospital all those years ago, calling me into blessed peace, willing me to stay.

Kosisochuwku W. Ugwuede is an essayist & photographer from Enugu, Nigeria. She is currently studying for a Master’s degree in nonfiction at Oregon State University and holds a Bachelor’s degree in Microbiology & Biochemistry from the University of Nigeria, Nsukka. Her essays and photographs have been published in Agbowó Magazine, The Arkansas International, The Sole Adventurer Contemporary Art Magazine, The Forge Literary Magazine and elsewhere.