Review by Professor Robert Abrams, Weill Cornell Medicine, New York

Review of ‘This Little Life’ (directed by Sarah Gavron, UK 2003)

‘This Little Life’ explores several timeless themes; it focuses on parental attachment and mourning in the specific circumstances raised by the birth of a premature infant and shines no less a revealing light on the psychological burdens of a neonatal ICU staff. In this wise and arresting film, one little life touches many.

When Dr Hughes (Peter Mullan), the neonatal ICU chief at a major UK medical center, first meets with the parents of a boy born after a five-month gestation, he matter-of-factly outlines the infant’s proportional and numeric chances of survival. But Nina (Linda Bassett), a veteran ICU nurse, has a more human style and emphasis. She quickly encourages Sadie (Kate Ashfield), the mother, and her husband Richie (David Morrissey) to call their son by the name they had planned to give him (“Luke”), and when possible, to touch him. She implies that these are gestures that should not be withheld for fear that the baby will not survive. Sadie is also advised to express her own milk for Luke, creating another physical and emotional bond, even if she cannot experience the intimacy of feeding him directly from her breast.

Nurse Nina knows that anything that can be done to help the parents regard this tiny infant as a person, with a name and certain identifiable character traits, will matter a great deal. For example, Luke is frequently referred to as “a fighter” by his increasingly proud mother and also as something of a prankster when he “wees” on Dr Hughes’s arm. Establishing the baby’s personhood, as if he were not just another intubated baby within the glass walls of an incubator, will be helpful whether the ultimate outcome is one of celebration or mourning, that is, whether little Luke survives or not. A central premise of This Little Life is that one cannot properly mourn a nameless premature infant, but one can, on the other hand, grieve the loss of a real, distinctively human person.

A subtheme of the film is the intuitive vision of women—the mature wisdom of Nurse Nina, for example, who is careful to offer hope only when it is warranted, allowing Sadie, in a memorable phrase, to “dare to hope.” Then there is the mutual empathy that flows between two women, Sadie and her fellow ICU mother, Nisha (Archie Panjabi). Meanwhile, Luke’s father, who has a name that is rarely, if ever, used, tries his best to participate emotionally but does not have many opportunities to do so and remains peripheral until nearly the end.

Crucially, the viewer also witnesses the deepening relationship between a mother and her child. Because of this growing connectedness, Sadie is pained when Luke must be stuck repeatedly with needles to establish an intravenous line; this is more than a vicarious phenomenon, because both baby and mother suffer with the pain. With a sad irony, it is this same mother-child closeness fostered by the ICU staff that eventually drives Sadie’s apprehensive maternal premonitions.

The men in this film do come around with time: Dr Hughes evolves from a “numbers man” to the warmhearted doctor who breaks the rules to give Sadie the code to open the ICU door and, building on the interventions of Nurse Nina, he offers the supremely useful suggestion that this mother should imagine Luke (Anthony Burrows) as a happy, healthy 7-year-old boy. Luke’s father has finally changed as well, having now voiced his long-contained resentment at being only a secondary supporter because of the financial need for him to work.

The toll that these fraught clinical and family encounters have on the ICU staff is also thoughtfully considered in this film, if not quite fully developed. How do doctors and nurses live with the irrevocable consequences of their errors? In This Little Life they have the sagacity to remain silent when parental rage is aimed directly at them in a personal and devastating way, knowing this reaction to be both natural and justified. In this instance they understand they have erred in dismissing Sadie’s concerns about the initially subtle changes in Luke’s condition, attributing her warnings to exhaustion and insisting that she take a break by going home.

Dr Hughes and his staff seem to realize that while they do share deeply personal moments of triumph and despair with parents, they are necessarily a half-step, or more, removed; and this degree of separation is what allows them to think dispassionately and carry on with their most pressing tasks. The staff members are themselves human, and sometimes, as Nurse Nina (always the voice of reason and solace) says, they too have to go home.