by Laura Iding
She chuckled at that, relaxing against him. Being here with him was nice, and as the exhausting events of the day were catching up with her, she closed her eyes and gave herself over to the comfort of his arms. Breathing deeply, she filled her head with his musky scent…
And slept.
The room was dark when she opened her eyes, except for the luminous dial of the small alarm clock. She’d instinctively woken up at four-thirty in the morning.
Or rather the needs of her body had woken her up, as she very badly needed to use the bathroom. Luke was still sleeping beside her so she took care not to wake him as she slipped from the bed. Her ankle gave a slight twinge, but held her weight.
She gathered the spare set of scrub pants he’d given her from the floor where she must have dropped them. Her fingers closed around her call-room key still in her pocket, reminding her there was a bathroom there for her to use which wouldn’t wake him up.
Before leaving, though, she gazed at Luke’s handsome face in repose. For a moment she wished he wasn’t a doctor. That she’d met him a long time ago, long before she’d met David.
The idea that he could be remotely attracted to her was astounding. The way he’d put her needs before his own was just as amazing. He had more self-control than anyone she’d ever met. Especially as it was obvious she wouldn’t have said no.
Her honest thought brought her up short. Caught in the thrill of being desired by Luke had almost made her forget her vow of independence. What was she thinking to get involved in a relationship so soon? She had a baby to take care of, a child that wasn’t Luke’s.
Her confused thoughts ricocheted through her brain like pinballs as she opened the door to Luke’s call room and eased through the opening, blinking in the brightly lit hallway. Feeling like a guilty teenager, she hurried down the hall to her own room. There wasn’t time to worry about Luke now. She only had time for the quickest shower known to man before she needed to head up to the ICU.
When she arrived on the unit, she was surprised to find the activity had settled down a bit. Caryn looked at the assignment board to see which second-shift nurse she was slotted to relieve from duty.
She took a two-patient assignment from Barbara, one of the second-shift nurses who started at five. Normally she’d have preferred to take the same patients she’d had earlier, but ended up receiving report on two completely different patients. She didn’t complain because there was nothing normal about working during a crisis. Although she longed for a huge mug of coffee to help burn the residual sleep from her eyes, caffeine wasn’t an option for the baby so she settled for filtered water, watching with barely concealed envy as the other nurses enjoyed a fresh pot. They offered to make her a pot of decaf, but what was the point? Without caffeine, coffee didn’t taste half as good.
She’d just finished her initial assessments of both patients when she overheard the on-call resident’s one-sided conversation outside her room.
“How far along? And you’re absolutely sure she needs to be intubated? Okay, I understand, but this is a decision my fellow needs to make. I’ll call you right back.” He hung up the phone and immediately began dialing again.
“What’s going on?” Curiosity got the better of her. “What decision?”
“There’s a pregnant woman in the ED having seizures because she’s in full-blown eclampsia. They’ve already intubated her and started her on continuous infusion of magnesium sulfate. They want to admit her here in the ICU to deliver her baby.”
“What? Why?” The phone rang and he jumped to it, explaining the whole thing to Luke. The details didn’t sound any more reassuring the second time around.
“OK, I’ll meet you down there.” The resident hung up the phone. “Get ready, because Dr. Hamilton agreed to admit the patient here.”
“But we don’t deliver babies in the ICU,” she protested. Too late. The resident was already gone.
Leaving her little choice but to ignore her apprehension while helping to prepare a room for the new admission.
Luke pushed Mary Webster’s bed through the hall himself, knowing that they didn’t have a lot of time. The minute he hit the unit he gave orders. “Call the neonatal unit. I want a team up here with an isolette and all the necessary resuscitation equipment.”
Caryn’s eyes were wide but she hurried to do his bidding. Thank goodness the OB/GYN attending was there with him as to his knowledge there still wasn’t a critical care intensivist around to cover him.
“I have a couple of our nurses bringing over some equipment as well,” Dr. Gephart said, before using a Doppler to listen for fetal heart tones.
Luke’s stomach clenched. “Do you anticipate taking Ms. Webster to the OR for a crash C-section?”
“No.” Dr. Gephart shook his head. “If at all possible, I’d like to deliver her vaginally.”
Luke didn’t think it was possible for Caryn’s eyes to grow any wider. “A vaginal delivery?” Her voice rose in a frightened squeak. “Here?”
“So far the fetus is doing fairly well, but I need you to bring down Mary Webster’s blood pressure while maintaining her oxygenation saturations in the high nineties. And I want the critical care experts to take care of her once the baby has been delivered.”
“I get that part, but here?” She didn’t seem to realize she was repeating herself. Caryn glanced around the already crowded bedside. “There isn’t enough room to deliver a baby.”
“We have to make room.” Dr. Gephart obviously wasn’t taking no for an answer. While he shared Caryn’s trepidation, they didn’t have time to waste arguing. He could have delivered the baby at a pinch but he was thankful he wouldn’t have to this time.
“All right, Caryn, you and I are going to focus on taking care of the mother.” Right now any structure was better than nothing and defining their roles helped to remind everyone they weren’t doing anything they weren’t trained for. He turned toward Dr. Gephart. “Delivering this baby is up to you and your nurses. This is not my area of expertise.”
Dr. Gephart nodded and asked, “Where’s the neonatal team?”
“On their way.” Caryn’s face was pale.
A couple of OB nurses entered the room, pushing a cart full of supplies. There was already a fetal heart monitor in place, and Luke was relieved to hear the reassuring yet rapid beat of the baby’s heart. He dragged his attention to the matter at hand. His job was to care for the mother.
Don’t think about Lisa. Don’t.
“Caryn, let’s draw another set of blood gases and I’d like to see Mary’s systolic blood pressure maintained in the 160-170 range.”
She nodded, drawing the blood from the patient’s arterial line before he’d finished speaking. “I’m not familiar with the effects of magnesium sulfate. Can we add a vasodilator for her blood pressure?”
Dr. Gephart looked up from where he was arranging his equipment. “Yes, actually a vasodilator would be good for keeping the blood supply open for the baby, too.”
“Go ahead and start some nitroglycerine,” Luke told her.
She left the room with the blood gas specimen then returned a few minutes later with the bottle of nitro and tubing.
While she was hanging the medication, the neonatal team arrived, pushing a tall isolette and another tray of supplies. Since there wasn’t enough space in the room, they placed the isolette just outside the door.
“All right, let’s see if we can deliver this baby.” Dr. Gephart didn’t seem at all concerned about working in less than optimal conditions.
“The mother’s blood pressure isn’t responding to the nitro,” Caryn said, worry evident in her tone. “She’s still pretty high at 204 over 112.”
Luke nodded, wondering if the pitocin that the OB nurse was infusing to cause contractions was also causing the patient’s high blood pressure. “Increase her morphine, then. I want to make sure she’s not awake through this.”
Caryn increased the amount infusing from the IV pump, then swayed when the OB
team propped up Mary Webster’s legs, while doing their best to maintain her privacy. Luke grabbed her arm to keep her steady. Of all the nurses in the unit, it just figured she’d be the one forced to assist in this. If he thought he’d be able to convince Caryn to leave, he’d give it a try.
But one look at the thrust of her stubborn chin convinced him arguing was useless.
“She’s still only seven centimeters dilated,” Dr. Gephart observed. “We’ll need to wait until she’s reached ten centimeters.”
Luke nodded, wondering for a moment where the expectant father was. Impending fatherhood had to be stressful enough without this added complication. Then again, it was possible the father wasn’t involved.
He glanced for a moment at Caryn. If he was going to be a father, he’d insist on being a part of the baby’s life. No matter what. As scary as fatherhood was, he’d never abandon his child the way his father had abandoned him.
One of the ICU nurses poked her head into the room, interrupting his thoughts. “Stat blood gas results for your patient on line one, Caryn.”
Caryn pushed her way past the OB team, taking care not to gawk at the nearly crowning baby as she went to pick up the phone outside the room. In a few minutes she returned.
“Her PO2 is barely ninety,” she said, handing Luke the results she’d hastily written on a scrap piece of paper. “And her PH is too high.”
He didn’t think trying to correct Mary Webster’s alkalosis would work just yet, especially as the magnesium sulfate was probably the cause. But he planned to get everything ready for the moment she delivered. “We’ll keep an eye on it. I’m sure her magnesium level is high, too.”
“Do you want me to send another set of electrolytes?” she asked. When he nodded she drew those, too, then once again left the room to send the blood sample to the lab. He watched Caryn walk away, wishing she’d had more than eight hours off after a twelve-hour shift.
He was also mad at himself for not waking up when she’d left.
She came back into the room in time to see Dr. Gephart pull out a large pair of forceps. The remaining color drained from her face.
“Stay with me, Caryn.” Luke’s sharp tone made her glance toward him and he held her gaze, willing her to focus on what needed to be done. “Come here, we have work to do.”
For a moment she didn’t move, then came around toward the head of the bed.
“Listen to the baby’s heartbeat,” he urged, as he changed the ventilator settings to provide more oxygen to mother and baby. Helping to keep Caryn calm was keeping his own anxiety under control. He could only be thankful he didn’t have to participate in the actual delivery. “Don’t dwell on what they’re doing, let’s just worry about the mother.”
“All right.” Her voice was faint but she picked up the clipboard and began writing down vital signs, although he’d be surprised if anyone would be able to decipher her handwriting the way her hands shook.
“She’s at ten centimeters, so get ready.” Dr. Gephart had already draped the entire area in preparation for the birth. Luke was glad he and Caryn weren’t able to see much from their location at the head of the bed.
“Here we go. There’s the head. Now swipe the mucus away from the baby’s mouth. There she is! Grab hold of her and clamp off the cord. Time of birth—0605.”
The neonatal team surrounded the infant and once the umbilical cord was tied off and cut they whisked the baby to the isolette, providing necessary medical care.
“It’s a girl.” Dr. Gephart announced proudly as he prepared to receive the afterbirth.
Luke caught Caryn’s gaze over the width of Mary Webster’s bed.
Then he grinned, hearing the distinct sound of a baby’s cry. Caryn smiled, too, her eyes suspiciously bright.
“The baby’s fine, breathing on her own,” Dr. Gephart said, bringing the newborn over.
Luke took the small bundle, looking down into the baby’s wrinkled, crying face, and felt a sense of peace. As if by helping to save this tiny infant’s life, he had eased some of the guilt he carried regarding his sister.
He raised his head and looked at Caryn. The hopeful expression on her face tugged at his heart. With a smile he handed the baby over to her and between them they arranged the mother’s arms so they could place the infant next to her, regardless that Mary was still sedated.
As his fingers brushed Caryn’s he realized how much he wanted to be there for her when it was her time to deliver.
And for her baby.
CHAPTER NINE
CARYN held onto the side rail of Mary’s bed, gazing down at the tiny baby tucked in next to her mother. When Dr. Gephart had pulled out the most humungous forceps she’d ever seen, she’d wanted to shout “No” and throw herself in front of the mother, like a protester at a rally.
But Dr. Gephart obviously knew what he was doing, as Mary’s baby was alive and fine. More than fine. Perfect. Beautiful. She glanced up at the monitor and noticed Mary’s blood pressure had already dropped a few more points. Once the placenta had been delivered, Mary’s blood pressure had begun dropping to a safer level. She was confident it would soon return to normal, as the treatment for eclampsia had simply been to deliver the baby.
Dr. Gephart finished with the episiotomy and stepped back. Keeping her gaze averted, Caryn stared at the monitor then jotted vital signs on the clipboard. There was no way she wanted to watch that part either. What on earth had she been thinking to get pregnant? She wasn’t ready for this. To have a baby. To go through the process of giving birth.
She didn’t need Debbie to act as a birthing coach—she needed a surrogate mother to have this baby for her.
Too bad she hadn’t thought of that alternative before getting pregnant.
Her blanched face drew Luke’s attention. “Don’t worry. This is an extreme case. The chances are slim anything like this would happen to you.” Luke’s tone held a false sense of cheerfulness she wasn’t buying. “You’ll be fine.”
She bit back a tart response. Luke stared at her as if he wanted to say more, but he didn’t.
Just as Dr. Gephart finished cleaning up the area, a man came running down the hall. “Is she here? Mary? Is my wife here?”
She exchanged a surprised glance with Luke then stepped back to allow the breathless man to come up to the bedside.
“Mr. Webster? I’m Dr. Hamilton. Your wife is still sedated but your daughter is fine.”
Mr. Webster stared down at his tiny daughter, then back to his wife, who was still breathing with the help of the ventilator. Caryn’s heart squeezed when his eyes widened in alarm. “Dear God. Will she be all right? Will she wake up? Breathe on her own?”
“Yes, we had to put the breathing tube in because she was having seizures, but she’s all right now,” Luke assured him. “As soon as all her vitals return to normal and she wakes up, we’ll be able to take the breathing tube out.”
“Thank God.” Mary’s husband closed his eyes for a minute then leaned over to kiss his wife and his newborn daughter. His voice was low, husky. “If we had a girl, Mary wanted to name her Lindsey, after her mother.”
Caryn smiled, the obvious love in his eyes bringing her close to tears. “Lindsey is a beautiful name.”
He reached for the baby, then hesitated and glanced at Caryn as if to seek permission. “Is it all right if I hold her?”
“Of course.” She lifted Lindsey from where they’d tucked the baby next to her mother and handed the bundle over. Mary’s husband stared down at his daughter with a look of awe.
Suddenly Caryn was ashamed at how she’d feared the process of giving birth. The miracle of creating a tiny life was worth every ounce of discomfort. The devoted love shining in the new father’s eyes filled her with a mixture of hope and envy.
She caught Luke staring at her from across the room and wondered what it would be like to have his strength and support when her time came.
But then she looked away, knowing deep down she was greedy. Because she’
d didn’t just want Luke’s strength as a friend. Friends were important, but she wanted more.
She wanted love, like Mary Webster had from her husband.
She wanted it all.
“We’ll send an OB nurse over each shift to check on Mom,” Sally, the OB nurse, promised, once all the excitement had died down. “And, of course, Dr. Gephart and his team will keep an eye on her, too.”
“Will someone bring the baby back when she wakes up?” Caryn asked.
“Give us a call when the medication wears off and we’ll arrange a visit,” Sally assured her.
Once everyone had left, Caryn tried to concentrate on what she needed to do next. Routine ICU care seemed a bit anticlimactic compared to the excitement of delivering a baby.
“Are you sure you’re all right?” Luke asked, coming up behind her.
“Yes.” She was hyper-aware of his presence, remembering those stolen moments in his call room. She’d never felt as safe as she had in Luke’s arms. “I need to thank you,” she said in a low voice. “Your calm attitude kept me from freaking out during Mary’s delivery.”
He shook his head. “You don’t have to thank me. Believe me, I understood how you felt. For a few minutes there I wasn’t doing too well myself.”
Luke was being awfully nice about this. Especially since she knew very well she wouldn’t have made it through without him. “You were great. I can only hope and pray that my delivery goes without any complications.”
“It will.” He frowned. “Although, now that I think about it, maybe we need to hire you a birthing coach. Someone who’s an expert in the field.”
Her brows shot up at his suggestion. “No, I don’t think that’s necessary.” There was no way she could afford something like that. “I trust my doctor. She’s the expert, right?
“I just don’t think you should go through this alone,” he said in a serious tone.
It was on the tip of her tongue to suggest he take the role, until she realized how pushy that sounded. A few kisses didn’t mean anything. Heck, she didn’t think Luke was in the market for a ready-made family. She cleared her throat. “Ah, David’s sister Debbie volunteered to be my birthing coach. Don’t worry, I won’t be alone.”