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.”
Cassie nodded, feeling sick to her stomach. She had to admit Emma’s high-pitched cry did sound similar to those of the two other babies she’d cared for early in her career who’d been going through withdrawal. And the timing was right, too. No doubt the baby’s mother hadn’t been able to stand the baby’s constant crying, which had likely gotten worse over the hours since the baby’s birth.
She’d asked Alice to go through the records to see if Emma had been born at their hospital, but soon discovered she was right, there was no record that matched this baby. So where had Emma’s mother given birth? At home? Was she a resident of Cedar Bluff?
Even though Cassie had only worked at Cedar Bluff Hospital for the past six months she knew a safe-haven baby was a rare occurrence. Obviously they did get them, but not often.
She was glad Emma’s mother had been unselfish enough to give up her baby, rather than neglect her or, worse, hurt the child.
Still, it wasn’t easy to see how some mothers would easily give their babies away, when others, like herself, had been unable to carry one to term.
A loss that still left an empty feeling inside her.
Ryan strode out of the NNICU, a dull roaring echoing in his ears.
He knew the baby’s blood tests would turn out positive for opiates. Thankfully he hadn’t cared for drug-addicted babies often, but the few times he had were seared into his memory.
But worst of all, Emma was a painful reminder of the fact that if his son had lived, he would have made that same, high-pitched cry. Would have been born addicted to narcotics and would have suffered the same symptoms of opiate withdrawal.
At least Emma had been given a chance to survive. And, hopefully, thrive.
A chance his son hadn’t been given.
He pinched the bridge of his nose with his fingers, trying to freeze out the horrible memories and the deep stabbing guilt. Three years had passed, yet the image of Victoria’s pale, cold, lifeless face still haunted him.
He should have known. Somehow he should have known his wife had been addicted to painkillers. How had he missed the signs? Had he really been that blind to what had been going on?
Why hadn’t he figured out the truth before it was too late? Before he’d found his wife and unborn son dead in the front seat of her car?
His fault. His son’s premature death was his fault.
The elevator doors opened, and he pulled himself together, trying to remember where he was going. Oh, yeah, back to the ER. He doubted anyone would remember more than what he’d already been told but he felt compelled to ask.
The triage nurse—what was her name, Gloria?—was still sitting where he’d left her. “What do you remember about the mother?” he asked bluntly.
Gloria didn’t seem too surprised by his question. “She had stringy blond hair and was young, not a teenager, maybe early to midtwenties? Her skin was super pale, as if she never stepped outside into the sun. And she wore long sleeves. Her arms shaking as if the car seat was too heavy for her.”
Definitely drugs, he thought with a sigh. “Did she look at all familiar?”
“Not to me or anyone else
