Re-writing Nicole’s Future

When Eileen Costello, MD, chief of Ambulatory Pediatrics at Boston Medical Center, entered the room to see her next patient, the last thing she expected to hear was, “I can’t believe it, it’s Doctor Costello!” The surprised response came from a familiar face, one that she had not seen for more than 15 years. Now bringing her own children to see Costello, it was a vast change from when Nicole St. Pierre was last in her office, as a patient herself. At that time, only in her teens, Nicole was facing unfathomable challenges after the loss of both of her parents. Sadly, this only scratched the surface of what she would endure in the years to come.

Homeless and addicted to drugs, Nicole spent nearly 10 years living under a bridge in Boston and going in and out of prison. When she became pregnant, she was deep in the throes of a powerful addiction and a dangerous lifestyle, posing many risks to her unborn baby. Thirty weeks pregnant with little prenatal care and the odds seemingly against her, she decided to seek help and knew exactly where to turn. “Everyone knows that if you are pregnant and hooked on drugs, you can go to BMC,” Nicole explains.

Waiting to welcome Nicole was the team at BMC’s Project RESPECT, which extends medical and obstetrical care to expectant mothers struggling with substance use. Key to the mission of Project RESPECT, as described by Director Kelley Saia, MD, is “to provide pregnant women, with substance use disorder, a nonjudgmental medical home [a patient-centered model of care focusing on comprehensive, team-based health care delivery] which empowers them to forge a path to long-term recovery.” Although Nicole was not ready to become sober, her providers at Project RESPECT treated her with dignity and offered any care she was willing to accept. “I didn’t want to use drugs and do what I was doing, but I couldn’t stop,” she notes. “So I just kept asking for help. Nobody ever made me feel bad. They were so good to me.”

Through Project RESPECT, Nicole was connected to a local women’s shelter to spend the remainder of her pregnancy in a safe environment. A few weeks into her stay—and 12 days into her sobriety—Nicole went into labor early, delivering a baby boy through an emergency cesarean section at BMC. “They held him up so I could see him and then immediately took him away,” Nicole recalls of her first moments with her son, Sammy. Premature, suffering from numerous congenital issues—including a heart condition and underdeveloped lungs—and exposed to drugs, Sammy was intubated and taken to the neonatal intensive care unit (NICU), under the care of neonatologist Alan Fujii, MD. “Sammy was really quite sick,” explains Fujii. “Even his blood pressure was low because he had used up all of his stress steroids staying alive in the womb.” In the weeks he spent in the NICU, doctors and nurses worked around the clock to transition Sammy from drug exposure and help his lungs develop.

With each passing day, Sammy gained more strength. And Nicole did, too. “Before Sammy was born, I didn’t have anyone in the world,” she says. “I needed a support system, and all of the doctors, nurses and social workers along the way—from Project RESPECT to the NICU, to pediatrics—became that for me. They advocated for me and made me feel that I could be a good mom. I never experienced that kind of support before.” In the same way they were committed to Nicole’s well-being, the NICU team strove for Sammy to beat the odds. “Sammy responded nicely to all of our treatments and was eventually able to go home in good condition,” says Fujii. “But he kept us busy that first 24 hours in the NICU.” “Dr. Fujii saved his life,” adds Nicole.

Dedicated to her newfound faith in herself and son, Nicole continued on a path of sobriety, building and extending her support system. Sammy continues to have a long road ahead of him, requiring close care for his complex needs, which include lung disease, developmental delays and vision issues. Life has come full circle for Nicole and her family, and just like his mom, Sammy is now treated and monitored by Costello. “Sammy has come a long way,” she notes. “He is a cute, affectionate kid. Just a happy camper.” Costello has had the unique pleasure of seeing Nicole change the trajectory of her life, finding healing and stability through hard work and dedication, to which she credits BMC. “Nicole’s time at BMC has been therapeutic by virtue of interacting with adults who genuinely care about her,” says Costello. “Something like that is key for extremely vulnerable women like Nicole, who never had a loving family to go home to.”

Today, Nicole has a loving family of her own, and Sammy is a proud big brother. Nicole and her boyfriend welcomed a healthy baby boy in early 2016. “I was given a chance and all the right people were put in my life,” recalls Nicole of how she turned her life around. “I was finally willing to accept the help.”

“People like Nicole are the reason I work at BMC,” concludes Costello. “She survived. It’s breathtaking.”