Small Great Things
Stage One: Active Labor — Ruth 1
by Picoult, JodiThe chapter opens with Ruth, a nurse, recounting the birth of a severely deformed baby boy whose facial abnormalities were undetected during prenatal care. Despite his shocking appearance, the newborn was otherwise healthy, leaving the medical team and parents unprepared. The mother, though devastated, immediately bonded with her son, naming him Ian Michael Barnes, while the father initially recoiled in horror and denial. Ruth emphasizes the importance of acknowledging the child’s humanity, even in his brief life, and gently guides the father toward acceptance.
Ruth describes her professional approach to this tragic situation, focusing on helping the parents grieve and connect with their child. She contrasts the mother’s unconditional love with the father’s initial rejection, as well as a student nurse’s cruel description of the baby as a “monster.” Ruth intervenes, correcting the student and insisting the infant be treated with dignity. She later brings the student back to witness the parents’ profound love, challenging her prejudiced perspective and demonstrating that true love transcends physical appearance.
The narrative highlights the family’s ten precious hours with their son, including the mother’s attempt to nurse him and the father’s eventual emotional breakdown as he holds the baby. Ruth reflects on her role in facilitating this painful but necessary bonding process, believing it would prevent lifelong emotional damage. The baby’s peaceful death is followed by the creation of keepsakes for the parents, and Ruth later learns they went on to have a healthy daughter, underscoring the resilience of the human spirit.
The chapter concludes with Ruth’s personal reflection on beauty and perception, asserting that all babies are born beautiful until societal prejudices distort that view. This segues into her own postpartum experience after delivering her son Edison, where her immediate concern about her hair’s appearance contrasts with the profound themes of the preceding story, subtly illustrating how societal pressures can overshadow life’s most meaningful moments.
FAQs
1. How does the nurse (Ruth) demonstrate professional compassion in her handling of the baby with facial deformities and his parents?
Answer:
Ruth demonstrates profound professional compassion through several key actions. First, she immediately removes the shocked student nurse to protect the parents’ dignity. She then treats the baby with the same care as any newborn, cleaning and swaddling him despite his deformities. Recognizing the parents’ need to bond, she facilitates this by placing the baby in his mother’s arms and later persuading the reluctant father to hold his son. Her insistence that “It is a baby” (not a monster) shows her commitment to human dignity. Most importantly, she creates space for the parents to grieve and love their child during his brief life, understanding this is critical for their emotional closure.2. What contrasting reactions do the mother and father have to their baby’s condition, and how does Ruth address this disparity?
Answer:
The mother immediately bonds with the baby, naming him “Ian Michael Barnes” and nuzzling him with unconditional love, while the father initially rejects the child, calling him a “thing” and fleeing the room. Ruth recognizes both responses as valid parts of the grieving process but intervenes to guide the father toward acceptance. She frames his brief time with the baby as an opportunity to “give all the love you had stored up for his lifetime,” appealing to his paternal instincts. By bringing him back to his wife and placing the baby in his arms, she helps bridge their disparate reactions into a shared experience of grief and connection.3. Analyze the significance of Ruth’s statement: “It’s what we project on them that makes them ugly.” How does the chapter illustrate this theme?
Answer:
This statement encapsulates the chapter’s central theme about perception versus inherent worth. The student nurse sees only a “monster,” while the parents—guided by Ruth—see their beloved child. The physical deformity becomes irrelevant to the mother, whose love transforms the baby into “the most beautiful” she’s ever seen. Ruth’s observation underscores how societal biases (like equating physical normality with value) create ugliness, not the baby himself. The imagery of the mother trying to nurse despite the lack of facial features powerfully illustrates how love can redefine beauty. Ruth’s actions actively reshape the narrative from horror to humanity.4. What ethical dilemma does Ruth face regarding the father, and how does she justify her intervention?
Answer:
Ruth faces an ethical dilemma about whether to respect the father’s autonomy in rejecting the baby or to actively intervene in his grieving process. She chooses the latter, justifying it as preventive emotional care: she believes avoiding the reality would create a “hole” of unresolved grief that would expand over time. Her justification blends medical training (providing “closure for grieving parents”) with deep empathy—recognizing that confronting the trauma, though painful, would ultimately heal. The father’s eventual breakdown and bonding with the baby validate her decision, showing her intervention helped him begin healthy mourning.5. How does the anecdote about Ruth’s own postpartum experience with Edison connect to the broader themes of the chapter?
Answer:
Ruth’s concern about her hair post-delivery subtly parallels the chapter’s exploration of societal expectations versus authentic experience. Just as society projects ideals of “beautiful” babies, it also projects ideals of how mothers should look/feel after birth. Her admission of this vanity—contrasted with her professional wisdom about true beauty—humanizes her and underscores that everyone grapples with external judgments. This moment also foreshadows her later reflections on projection and identity, suggesting that self-perception (like parental perception of children) is often shaped by external standards rather than intrinsic worth.
Quotes
1. “The most beautiful baby I ever saw was born without a face.”
This opening line immediately establishes the chapter’s central paradox - that beauty and humanity transcend physical appearance. It introduces the profound medical and emotional challenge Ruth faces as a nurse.
2. “It was a monster… It is a baby.”
This sharp exchange between Ruth and the trainee nurse captures the chapter’s core message about human dignity. Ruth’s correction powerfully asserts that every life has inherent worth, regardless of physical differences.
3. “I could not stop staring—not because it was ugly or wrong, but because it was the most remarkable thing I’d ever seen. It felt like looking into the face of the sun.”
Ruth’s observation about the mother nursing her faceless baby illustrates the transformative power of unconditional love. The sun metaphor emphasizes how this pure maternal bond overwhelms conventional notions of beauty.
4. “It just goes to show you: every baby is born beautiful. It’s what we project on them that makes them ugly.”
These concluding lines crystallize the chapter’s thesis about societal prejudice. Ruth argues that ugliness comes from our perceptions, not inherent qualities, applying this lesson beyond the medical context to broader human relationships.