Wanted: Parents for a Baby!

Cassie nodded and quickly abandoned her charting, heading over to where they kept the portable warmer stocked with emergency equipment. “What about a physician?” she asked as she wheeled the warmer toward the door.

“Already paged him. Dr. Ryan should be there soon.”

Cassie’s stomach clenched with a mixture of dread and anticipation even as she tipped her head to indicate she understood. After wheeling the infant warmer into the hallway, she pushed the button for the elevator, relieved when the doors immediately opened.

Dr. Ryan Murphy was one of the best neonatal intensivists she’d ever worked with. Unfortunately, he was far too tall, dark and handsome for her peace of mind. Not to mention single. Widowed, to be exact. According to the gossip mill, he wasn’t interested in dating, much to the dismay of the single nurses working throughout the hospital.

To be fair, she wasn’t particularly interested in dating either—one deep betrayal and subsequent failed marriage had been enough to put her off men for a long time. But somehow in the six months that she’d been in Cedar Bluff, her body hadn’t seemed to get the message. Every time Dr. Ryan’s penetrating blue eyes met hers, her stomach did a series of backward flips and she blushed like a fool. She mentally cursed her fair skin for constantly betraying her.

The elevator doors dinged and opened on the ground level, so she wheeled the warmer out and quickly jogged down the hall to Cedar Bluff’s ER. There was a crowd of people gathered around the triage desk and, of course, Dr. Ryan’s dark head, clearly visible above the crowd, drew her gaze like a magnet. Even wearing blue scrubs and long white lab coat, he was distinctly noticeable.

He glanced over and caught sight of her, acknowledging her presence with a brief nod. He made a gesture with his hand. “Please, step back and make room for the equipment.”

Like the parting of the Red Sea, the group of people split down the middle to give Cassie the access she needed. She focused on the infant car seat that was propped on the desktop and frowned as she registered the fact that the baby was letting out a terrible high-pitched cry. “What happened? Where’s the mother?”

“She left,” Dr. Ryan said shortly. “This little girl is only a day or two old and desperately needs medical care. We need to get her in the warmer so I can examine her.”

“Her name is Emma,” Gloria, the ER nurse at the triage desk, supplied helpfully. “The mother said she was unfit and asked me to take care of Emma.”

Pretty name, Cassie thought as she quickly plugged in the warmer and turned on the heat lamps. She cracked open the oxygen tank and connected the tubing while Dr. Ryan lifted the tiny infant from the car seat. He set her gently in the center of the warmer, and the baby’s arms and legs flailed about in protest.

Emma’s high-pitched cry wasn’t easy to ignore, but Cassie focused on setting up the open end of the oxygen tubing so it would gently stream past her tiny nose and mouth. Dr. Ryan undressed the baby, who was wearing clean yet well-worn clothing, his fingers looking ridiculously large in contrast to the tiny baby. Using his stethoscope, he listened to Emma’s heart and lungs. Cassie placed small EKG patches on the baby’s bare chest and their fingers brushed as they both worked over the small torso.

Cassie ignored the tingling sensation that rippled up her arms at his touch and peered at the cardiac monitor, making note of the baby’s heart rate, which was higher than normal.

“Her lungs are clear,” Dr. Ryan said in a low tone. “But she has hyperactive bowel sounds.”

Cassie gave a nod. “Yes, she’s also tachy, in the one-eighties. Dehydrated, perhaps?”

“Maybe,” he agreed. “But could indicate something more serious. We don’t have any history on the mother, unless we’re lucky enough that the baby was born here. Let’s get her upstairs to the NNICU. She’ll need an IV and labs drawn.”

“Okay. I’ll check the records when we get upstairs, but I don’t think she was born here. I’ve been on the past three days and would have remembered.” Cassie disconnected the electrical cord and switched the warmer to battery power. “Ready? Let’s go.”

Dr. Ryan walked along on the opposite side of the warmer. Cassie steered the warmer while he kept a keen eye on Emma’s heart rate.

The elevator seemed to take longer this time, or maybe she was just acutely aware of Dr. Ryan standing next to her while listening to Emma’s high-pitched crying. Her maternal instincts wanted her to pick the baby up and cradle her to her chest, but that wasn’t possible just yet. When the elevator doors finally opened, she pushed the warmer inside with a sense of relief.

The doors closed and the elevator began rising to the third floor when Emma’s high-pitched cries abruptly trailed off and stopped. Cassie stared in shock as the heart monitor began triple-beeping in alarm as the baby’s heart rate shot up to two hundred beats per minute.

“She’s not breathing,” Cassie said, grabbing the emergency airway kit.

“Hand me the Ambu bag, I’ll try to support her that way,” he said.

She nodded, handing over the tiny Ambu bag and then connecting it to the oxygen tank. Her gaze darted between the heart monitor and Emma as he pressed the bag over Emma’s nose and mouth, giving several breaths.

“It’s working,” she whispered. “Her heart rate is dropping back to the one-eighties.”

“Good.” Dr. Ryan’s intense gaze met hers and for a moment she saw a flash of relief and camaraderie reflected there.

She tore her gaze away to glance down at the baby. “Poor thing doesn’t have anyone to care about her,” she murmured.

“She has us,” Dr. Ryan said firmly. “We care about her. And we’re going to do everything possible to help her.”

She caught her breath at the emotion shimmering in Dr. Ryan’s eyes but the moment vanished as the elevator door opened on the third floor. She pushed the warmer down the hall slowly enough to allow Dr. Ryan the ability to walk alongside while providing breathing support for the baby.

When they entered the NNICU, Cassie headed toward the critical-care end of the twenty-bed nursery, knowing that it was possible Emma would eventually require ventilator support for her breathing.

“Cassandra, I hear you’re the best, so will you please start an IV?” Dr. Ryan asked as soon as they were situated.

“Of course.” Getting IVs placed in babies wasn’t easy, but it happened to be one of her best skills. The other nurses often asked her to start their IVs for them, so it shouldn’t have surprised her that Dr. Ryan was aware of her talent. She could feel her cheeks getting warm and tried to keep her head down as she gathered supplies.

She managed to find a vein in Emma’s left arm and quickly placed the catheter. Unfortunately, peripheral IVs generally didn’t last long in babies, twenty-four hours at the most, so the poor thing would likely need a new catheter placed tomorrow.

“What rate do you want the fluids to run at?” she asked, as she protected the catheter site with a plastic medicine cup cut in half and taped over the baby’s arm so Emma couldn’t dislodge it by accident.

“You have the IV placed already?” Dr. Ryan asked in surprise. “Good job. Let’s start with five ccs per hour for now.”

Cassie nodded and turned away to adjust the IV pump in an effort to hide her flaming cheeks. Ridiculous to respond like a high school cheerleader working with the star quarterback of the football team. It wasn’t as if Dr. Ryan had given her a personal compliment.

In fact, the nurses all talked about how nice it was to work with him, despite the fact that he kept an invisible but impermeable wall between himself and the rest of the staff. She’d heard a few of the nurses had tried to ask him out, only to be gently but firmly rebuffed.

Her hormones needed to get a grip on reality.

“Let’s see if she’ll breathe on her own now,” Dr. Ryan murmured, as he removed the Ambu bag and face mask from Emma.

Cassie leaned forward, watching the baby closely for a few minutes. She was just about to turn away when things changed abruptly, just like they had in the elevator. Emma’s breathing became shallow and her pulse skyrocketed.

“Give her a tenth of a milligram of midazolam,” Dr. Ryan ordered in a grim tone. “I need to intubate.”

“I’ll get the meds,” her coworker, Diane, piped up.

Cassie pulled out the intubation equipment while Dr. Ryan continued to breathe for Emma using the Ambu bag. When Diane returned a few minutes later, she held up the syringe for Cassie to verify the dose of the medication before injecting it into Emma’s IV.

“Midazolam is in,” Diane announced.

Cassie handed Dr. Ryan the tiny endotracheal tube. She found herself holding her breath, his words from the elevator echoing in her mind.

She has us. We care about her.

Soon Dr. Ryan had deftly placed the breathing tube down Emma’s airway, a task that sounded simple but wasn’t at all, not when working on a newborn baby. His large and capable fingers were never clumsy.

The entire procedure didn’t take more than a few minutes and Cassie quickly secured the tube in place while Dr. Ryan held it steady. Nancy Kramer, the respiratory therapist, was manning the ventilator. “What settings do you want?” she asked.

He rattled off the parameters he wanted then turned toward Cassie. “I need you to get a set of arterial blood gases and a full drug screen.”

“A drug screen?” Cassie glanced at what she could see of Emma’s tiny face, half-covered with the endotracheal tube holder. “You think her mother was a drug addict?”

“Yes, I hate to say it, but I have a strong suspicion. The mother dropped the baby off in the ER, saying she wasn’t a fit mother for Emma, and then left. Under the safe-haven law, we can’t go after the mother to obtain a medical history, so we have to figure out what’s going on ourselves. That high-pitched crying and the way she stopped breathing is a classic sign of narcotic withdrawal. We’ll also need to keep an eye out for seizures. Run the lab work and call me with the results.”