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MacKenzie Grace Kesler was born three months premature in August, the child of parents who were still teenagers themselves.

She weighed a pound and a half. Had she been born a week earlier, doctors said she would have been too underdeveloped to save.

As 16-year-old Brandy Parkhurst was still recovering from childbirth, doctors told her and her boyfriend, Chris Kesler, 18, that their daughter couldn’t breathe on her own.

They put MacKenzie on a ventilator. It was the first indication of the difficult decision the teenage couple would face over the next few weeks, as their daughter lay in an incubator at Carilion Roanoke Community Hospital.

They would have to decide whether to take their daughter off the ventilator that prolonged her life.

The couple soon learned their daughter had hemorrhaging in her lungs, bleeding in her brain and would likely be severely disabled.

“They said we could lose her at any time, because they didn’t know how serious the bleeding was going to get,” Chris said.

As many teens were buying back-to-school supplies, Brandy and Chris were spending their days and nights in the Neonatal Intensive Care Unit at Community Hospital, making decisions about life and death.

Legally, parents have most of the power to make decisions for their children, said Paul Lombardo, director of the Program in Law and Medicine at the Center for Biomedical Ethics at the University of Virginia. Courts can intervene when abuse or neglect is suspected. But for the most part, courts don’t try to second-guess parents when they make decisions, regardless of their age, he said.

That can lead to a situation in which teenage mothers may not be able to make medical decisions for themselves because of their age, but can for their child, because they are the parent, Lombardo said. And it is not rare for parents who are underage to make medical decisions for their children, he said.

But it’s the unusual cases in which a baby has been born extremely prematurely, or when there’s a dispute between doctors and family members about what is appropriate care, that draw attention, Lombardo said.

“I have say-so about her, because I’m her parent,” Brandy’s mother, Teresa Cook, said in an interview in August at her Daleville home. “But she has say-so over her baby.”

“Of course you wouldn’t have say-so,” Brandy replied. “It’s my baby.”

Early delivery
Brandy and Chris were students at Lord Botetourt High School when they started dating. They got into a water bottle fight at a pickup football game in Blue Ridge Park.

“And it went from there,” Chris said.

Chris was a senior who played on the football team; Brandy was a sophomore who wasn’t much into school spirit, Chris said.

They had been dating for about six months when they found out over spring break that Brandy was pregnant.

Brandy’s mother said her doctor thought Brandy got pregnant when she switched from birth control pills to a patch.

Chris said he was very surprised. He brought up the possibility of an abortion to Brandy. She wasn’t keen on the idea. And Chris said when he sat down and thought about it, he didn’t really agree with it, either.

They also decided against adoption. Brandy had qualified for aid under the federal Women, Infants, and Children program, and he was earning money, so he thought they could handle the financial responsibility.

“If you’re old enough to make a baby, you should be old enough to take care of one, whether you know it or not,” Chris said.

Brandy’s mother worried about the kind of life her daughter would have. Chris’ parents “thought young kids weren’t supposed to be having babies,” Chris said.

His mother did tell him he needed to take responsibility for his actions and not try to find ways out of the situation, Chris said.

The effect of the news and other tensions took their toll on Brandy and Chris. They broke up for a while, but got back together.

Chris decided the impending birth meant putting off plans to enroll at Virginia Western Community College after graduation, as he’d intended.

He had wanted to become a high school teacher, but decided he would postpone college for a year or two because of the baby and get a full-time job.

Planning for baby
After the shock wore off, the couple alternated between fear and excitement.

They bought a book of baby names. Chris would get to choose the name if they found out they were expecting a boy; Brandy, if they were expecting a girl.

The couple made plans. They decided Brandy would continue to live at her mother’s home with the baby and get home schooled. One of Brandy’s sisters, Jessica Miller, put a crib on layaway for them.

Brandy finished her sophomore year, and Chris graduated. He went to work full time as a cook at a Famous Anthony’s restaurant.

For Chris, impending fatherhood really sunk in when he accompanied Brandy to her second sonogram on June 30 — her 16th birthday. The couple learned then that they were expecting a girl.

A petite girl, Brandy wasn’t noticeably pregnant. She still fit into size 0 jeans when she was four months pregnant, and only later developed a little “pooch,” Chris said

But Brandy did not have an easy pregnancy.

“Morning sickness turned into 24-hour sickness,” her mother said.

Brandy’s doctor had warned her she might have complications because of her age and size. Brandy went to the hospital twice early in her pregnancy with light bleeding. Doctors checked her and said everything was OK.

When Brandy was about five months pregnant, they started painting a room in Brandy’s mother’s house for the baby.

Then on Aug. 11, at about 3 in the morning — three months before her due date — Brandy went into labor.

Chris was already up at his parents’ house, getting ready for a 5 a.m. shift at Famous Anthony’s. Brandy’s other sister, Audrey Parkhurst, called and told him Brandy was on the way to the hospital.

Chris raced out. As he drove onto Interstate 581, he saw a speeding ambulance, followed closely by Brandy’s stepfather’s car.

“About that point, my heart went into my throat,” Chris said.

At the hospital, doctors tried to stop the labor as long as they could.

“And three minutes later, the baby was out,” Brandy said.

Medical problems
MacKenzie was born at 24 weeks of gestation — a critical cutoff point for doctors. Had MacKenzie been born a week earlier, doctors said, they wouldn’t have been able to save her.

Only half of babies born at 24 weeks survive, said Roanoke perinatologist Larry Dennis, who specializes in prenatal care.

Doctors later told the family they thought the baby may have come early because Brandy had a soft cervix.

From soon after MacKenzie was born, doctors told Brandy and Chris to expect the worst.

“I was thinking, 'We’ve been through too much to have this happen now,’ ” Chris said.

Two days after Brandy gave birth, she was discharged from the hospital. MacKenzie remained in the NICU. (Medical care for both was covered by Medicaid.)

Chris and Brandy visited MacKenzie in the hospital every day after that — sometimes twice a day.

“Brandy swore up and down that she had my nose and my feet, but I couldn’t tell,” Chris said. “I was like, 'How can you tell? Her feet are the size of my fingernail.’ ”

The hospital wouldn’t let them put stuffed animals in MacKenzie’s incubator for safety reasons, but did let the couple put in a photo of them together.

But doctors told Brandy and Chris their daughter might be blind, unable to speak, and have severe cerebral palsy.

The couple had been talking with doctors and family about whether or not they should take MacKenzie off the ventilator since shortly after she was born.

Doctors made it clear to the couple that it was completely their decision, not anyone else’s. They also never directly said they thought MacKenzie should be taken off the ventilator, Chris said. But they began to hint after the second day that she wasn’t going to get any better.

“It just took awhile for that to sink in,” Chris said.

Lots of people had thoughts about what the couple should do.

They “heard about 20,000 different opinions, from doctors, family members — basically anyone who wanted to put their two cents in,” Chris said.

Some people told them they should give it more time. Others said they were prolonging the inevitable.

“And the whole time, I just wanted to tell them to shut up,” Chris said.

Wrestling with life and death
At first, Chris and Brandy didn’t want to take MacKenzie off life support.

Brandy said she didn’t want to “take her off just because she’s going to be handicapped. God wants you to accept people for who they are. It’s not right to take her off just because she’s going to have problems.”

Brandy asked one nurse early on if they should take MacKenzie off the ventilator. The nurse said she wouldn’t recommend it then, but she said she wouldn’t stop it either.

Family members also had their opinions.

Chris said his mother told him that no matter what they decided to do, she would be behind their decision.

But his mother also said that if the baby was in pain and suffering, she didn’t think that was fair to the baby, either, Chris said.

Brandy’s mother said early on she would help care for MacKenzie.

“The family will have to pull together and do what we have to do,” Teresa Cook said. “The bottom line is, God has control of the situation, and I don’t believe he puts no more on us than we can handle.”

But as MacKenzie’s condition worsened, Cook told Brandy that the longer they left MacKenzie on the ventilator, the more she was suffering.

“There comes a time when you have to love your child more than you love yourself,” Cook said she told her daughter.

The decision
By Aug. 25, X-rays showed the bleeding in MacKenzie’s brain had gotten worse. Within a day, the baby’s head had swollen by about 10 percent, Brandy said.

Doctors told the couple there was no chance she would get any better.

“We both just kind of looked at each other, and I think we both knew what we had to do, but didn’t want to do it,” Chris said. Together, they made the decision to take MacKenzie off the ventilator.

“That’s all we wanted, was to be 100 percent sure that there was no chance for a full recovery,” Chris said.

But they told the doctor they didn’t want to do it that day; they wanted to spend a little more time with her.

The doctors asked them if they wanted to have her baptized.

The next morning, Brandy and Chris stopped by Wal-Mart and bought MacKenzie a white headband with a bow. They were dreading going to the hospital.

In the NICU, nurses had dressed MacKenzie in a white baptism dress that the hospital orders specially for premature babies. It fit perfectly.

Some of the couple’s family and friends gathered around MacKenzie’s incubator in the NICU for the baptism.

A hospital chaplain dripped holy water on MacKenzie’s head and made three signs of the cross on her head. Then everyone prayed together.

Immediately after the baptism, the doctor asked the couple if they were ready to take MacKenzie off the ventilator.

They said yes. The couple went into a separate room and doctors brought MacKenzie in. She was still receiving oxygen from a tube.

Once MacKenzie was in Chris’s arms, the doctor removed the oxygen tube. Her heartbeat quickly dropped from 160 beats a minute to 50.

Brandy then held MacKenzie for a few minutes. Chris went and got some family members, who also held her.

Back in Brandy’s arms, MacKenzie grabbed onto her mother’s index finger for several minutes.

Then MacKenzie suddenly got very cold, Brandy felt her fingers let go.

“So I knew right then that she had gone,” Brandy said.

Healing
Nearly four months have passed. Brandy is getting straight A’s with her home schooling and is working part time at Wal-Mart.

On a chain around her neck, she wears a tiny gold baby ring that the NICU nurses gave her after MacKenzie died.

Chris is working for United Parcel Service. He has enrolled and paid his tuition for courses at Virginia Western, and plans to start in January.

He wears a necklace with some of MacKenzie’s ashes in a teardrop charm around his neck.

On Dec. 3, the couple and some of their relatives attended a remembrance service at Oakey’s Funeral Service for relatives and friends of people who had died over the past year.

Brandy and Chris sat together, flanked by their mothers, during the service. Brandy’s sister, Audrey, and her boyfriend, and Brandy’s home schooling teacher also attended the service.

At the end of the ceremony, everyone released colored balloons toward a gray sky in memory of the people who had died. The note Brandy attached to her balloon read: “Mommy loves you and misses you.”

The couple has now been together for about a year and two months. These days, they don’t fight about little things, Chris said.

“If anything, I think it’s brought us a lot closer and made us better as people,” he said of the experience. “We’ve grown up really quick.”