Researchers at Book of Odds immerse themselves in probabilities. When 22-year-old Benjamin Kriss joined us in February, 2008, he began by compiling cancer odds. He then moved on to strokes, heart attacks, and kidney and liver failure. In the course of the past year and a half, he has sat in on countless presentations from other researchers, including ones on the chances of dying from an accidental fall, in a car crash, or in an airplane disaster. For some people, immersing themselves in scary probabilities leads to obsessive worry, like the hypochondria that often afflicts first-year medical students. Not Benny. “From the moment I was born, I was hit with the worst life could throw at me,” he declares. “I figure I have already survived.”

A shock of curly dark hair (and sometimes a backwards baseball cap) covers what Benny sometimes calls his “Harry Potter mark” and more often calls his “war wound.” He pushes away his hair to reveal the prominent, raised scar at the top of his forehead. “I was so tiny, this was the only access doctors had for a feeding line. The nurse made a mistake and I was burned.”

Benny stands 6’4” but he came into the world at just 12 inches. He now weighs 190 pounds, give or take, but on the day of his delivery, January 5th, 1987, he arrived at exactly 1 lb. 4 ounces. Benny and his twin sister, Meredith, were born at 26 weeks, after their mother, Lynn, had suffered seven miscarriages in previous pregnancies. “Survival rates have improved significantly since 1987,” explains Dr. Siva Subramanian,” director of the Neonatology Intensive Care Unit at Georgetown University Hospital, and the doctor who oversaw Benny’s care. “When Benny was born we were still two years away from having artificial surfactant”—a life-saving treatment which is introduced to the trachea and lungs of very premature babies and helps to keep tiny lungs from collapsing. And both Benny and Meredith were too small to be placed in an extracorporeal membrane oxygenation machine, a form of heart-lung machine which can buy an older term or close to term infant time for lungs to develop by externally providing oxygen to the blood.

Meredith had two things going for her that Benny did not—her weight and her gender. She weighed 2 pounds, a full 12 ounces more. “And female infants seem to have an advantage,” explains Dr. Subramanian. “For reasons we do not fully understand, a female born at the same gestational age, even at the same weight as a male, tends to do better."

Within hours of their birth, doctors told Lynn and her husband, Lenny, that Meredith had a good chance of surviving. Benny did not. He had been born with a hole in his heart, and an insufficient number of white blood cells—leading doctors to believe at first he had been born with a rare form of leukemia. “Within six hours of my birth, the doctors told my parents they did not expect me to live.” And then the situation went downhill.

“Everything bad that could happen did happen,” Benny says. He suffered a brain hemorrhage. “When babies have a significant brain bleed, survival can be difficult,” Dr. Subramanian explains. Benny’s was a Stage III on a scale of I-IV—a level which often leads to significant mental impairment.

Three times Benny came down with respiratory infections including once from Respiratory Syncytial Virus, a dangerous infection. Four times he suffered a collapsed lung. Three times he fully coded and had to be revived. Meredith had gone home after 5 weeks, but Benny spent a total of 3½ months in the hospital, the majority of the time on 100% oxygen. Even when he was discharged, Benny was readmitted to the hospital at least 5 times the first year. “They told my parents I might have cerebral palsy, that I might never walk, and I could be blind.” A study published in January, 2005 in the New England Journal of Medicine found that of male infants born at 25 weeks, only 16% had no overall disability, and in 48% the disability was moderate to severe.

But the medical staff had also seen the promise in Benny. In the very first days after his birth the nurses in ICU had taped a nickname to his incubator: “The Linebacker.” Nine months later he astonished his parents by standing up and walking across the room.

“I went to first grade on time, and not to brag, but I always had A’s on my report card,” Benny says. He had years of speech and physical therapy, but by the time he reached high school, Benny was a real linebacker. He shot up past his blonde, blue-eyed twin, who maxed out at 5’4”. He also became an EMT and volunteer fireman in the days before he headed to Boston University.

The circumstances of his birth have had a profound impact on how Benny looks at the odds. “I am not afraid of things,” he says. “When I was fighting a fire, I was never afraid to go into the building. When I was working in the hospital, I was never nervous about taking blood from someone with HIV. I don’t worry about what can happen because look what already did. I try to be happy. And I am grateful for my life.”

For the first 21 years of their lives, every January 5th the Kriss family made sure Dr. Subramanian and the Georgetown Neonatology unit received a cake. Many years the twins went in person, accompanied by their parents and older brother, Michael. “And when we couldn’t go, we had one sent.” They are remembered to this day by the staff, and Dr. Subramanian knows his experience with Benny and thousands more like him have informed not only the care he gives, but how he views probability.

“Neonatologists are by nature an optimistic group,” he declares. “It is our nature to push the envelope, but we always have to balance what we do with compassion and humanity, both towards the baby and towards the parents,” And his view of what is probable—or even possible—has shifted.

“Probability changes,” he notes. “There is probability now vs. probability back in 1987. And there is probability as understood by a first-year resident, a doctor in his first year of attending, or a doctor with many years of experience.” How a neonatologist assesses a tiny infant and calculates the odds that infant will survive changes not only with medical advances over time, but also with the maturing of the physician. A new calculator, developed by the National Institutes of Health, now gives young doctors the benefit of the wisdom of older doctors. “A physician can plug in the gestational age, condition, and gender of an infant and get a probability ratio of survival and quality of survival.”

One has to wonder the odds that would have been given for the tiniest linebacker.

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