Desperate for help, one of the doctors at the Cardiovascular Center drove out to a highway and found cellphone service. He placed a call to a former student who was now practicing in Miami, Dr. Darline Santana-Acosta, a pediatric cardiac intensivist for Nicklaus Children's.
Santana-Acosta said the hospital's executives and medical staff all were eager to help, but the logistics were daunting.
"We had a lot of obstacles in our path," Santana-Acosta said on Monday, describing the difficulties of arranging emergency flights into San Juan's airport after the storm and trying to communicate from Miami with doctors and medical staff on the island.
For transportation, Nicklaus Children's turned to its LifeFlight program, an air ambulance service that flies jets packed with advanced life-support equipment for transferring critically ill newborns from the Caribbean, and Central and South America to Miami for medical care.
"They're basically like a flying womb," Burke, the cardiovascular surgeon, said of the airplanes.
Santana-Acosta tapped her family on the island to relay messages from doctors on the island to the team of specialists waiting to receive the infants at Nicklaus Children's.
But there was another catch: the infants' parents had to sign consent forms allowing their evacuation to Miami, and once again Hurricane Maria transformed an otherwise routine task into a monumental challenge.
None of the parents had stayed with their children at the Cardiovascular Center in San Juan, and at least two of the children's parents had sheltered outside the capital in cities that were a few hours drive away, with clear roads.
Brian Nieves, who lives in Aguadilla, on Puerto Rico's northwest coast, used a machete to hack through fallen trees for two days in order to reach San Juan and sign the consent form for Liam to be sent to Miami, said Naialee Perez, the infant's mother.
"I was having a panic attack," Perez said Monday at Nicklaus Children's, describing the ordeal of trying to get her baby out of San Juan.