‘It’s not that part,’ Maria said. ‘I know you’ll get her right, but it’s me—what if I can’t do things right for her at home? The nurse tells me how to wrap her and how to lay her on her side so her legs curl up, but what if I get that part wrong? Or I have too much light or too much noise?’
She began to cry again.
‘It’s already my fault that she’s early, so what if I make things worse for her at home instead of better? Then it will be my fault again that she’s not catching up with other babies her age.’
‘Oh!’ Sophie said, looking up at Gib, wondering if he wanted her to answer or if he, knowing the woman and the circumstances of the birth, would step in.
He gave a shrug but the angry frown on his face suggested he was about to find whoever it was who’d overloaded poor Maria with information and string him or her up by the thumbs.
‘Maria,’ Sophie began, turning to face the distraught woman and taking hold of her free hand. ‘I don’t know Mackenzie’s history but unless you were jumping out of a plane without a parachute before you had her, I doubt very much if her premature birth was your fault. We all tend to blame ourselves when things go wrong, but it’s just bad luck and we have to accept that then see what we can do to make things better.’
She waited while Maria drank more coffee.
‘You’re already doing that—I saw Mackenzie, sick though she is right now, turn towards your voice. A lot of babies in the NICU never manage that much recognition of their parents’ voices. And as for looking after her at home, do you love her?’
Maria nodded, and smiled through her tears.
‘From the moment I knew I was pregnant I loved her. I talked to her and sang her songs and played with her with my hand on my tummy when she kicked.’
‘That’s probably why she recognises your voice. And will always do so. Here, in an NICU, we do all the medical and physical things we can to give the babies in our care the best possible start we can, but only you, a parent, can give them love. We can tell you to hold them this way, and to try to get them into good sleep patterns, and to swaddle them so their little legs tuck up, but the main thing every baby needs is love. As long as Mackenzie hears your love for her in your voice, and feels it in your touch, she’ll be fine. As Gib said, the staff are here for you as back-up with all the other stuff, and although when people hand you reams of information about caring for your preemie and it’s impossible to absorb when all you’re worried about is whether she will live or die, you’ll soon get the hang of things, mainly because she’ll tell you.’
Was she talking too much? Sophie glanced at Gib, who was leaning back against the table, his arms crossed across his chest, his body language suggesting he’d be happy for her to keep talking all day.
‘Tell me?’ Maria repeated, and Sophie smiled at her.
‘Of course she will. You probably already know when she’s upset. Think about what happens when you or one of the staff handle her—what does she like? What doesn’t she like?’
‘She doesn’t like to be held in one hand.’
Sophie chuckled at the positive response. She knew exactly what Maria meant, having occasionally seen a staff member display a tiny baby in one hand, usually marvelling that he or she could be held that way.
‘And how do you know that?’ she asked Maria.
‘She gets pink, like she’s angry, and it seems to me she has to breathe faster.’
‘There you are. She’s already telling you things—and you’re reading her beautifully. I’m not saying you’ll always do things exactly right, or that sometimes—maybe often—you won’t feel angry and frustrated because you don’t know what’s wrong with her, but you’ll be learning all the time, and she’ll get better and better at her communication. Eventually, of course, as her lungs develop and she’s better able to know something’s wrong with her, she’ll start fretting and crying when she’s uncomfortable, and you’ll get the message loud and clear.’
‘Then I’ll probably end up giving in to her and spoil her,’ Maria said, but the tears were gone and she was smiling at Sophie.
‘My gran always said you can’t spoil babies,’ Sophie told her, patting the hand she was holding and then releasing it.
Maria stood up, saying she had to get back to Mackenzie, but as Sophie made to follow her, Gib put out his hand and touched her arm, stopping her in mid-stride. She looked at him, wondering what he wanted, waiting for him to speak—too close to him to feel comfortable…
‘I—That shocked me, Maria worrying like that over taking Mackenzie home. Here I’ve been sailing along, thinking how good and clever we are to have covered every possible contingency we can think of and giving parents all the information we possible can, and what we’re, in fact, doing is terrifying them. Taking their baby home should be a special, joyous thing, not cause for even more anxiety.’
Sophie stepped back, needing to put space between herself and Gib, pleased she had work to talk about so she didn’t have to think about her body’s reaction to that casual, meaningless touch—to his closeness.
‘Don’t get all hung up about it,’ she told him. ‘Maria found the information overwhelming, but someone else might have wanted more. You can’t gauge how much every individual parent can absorb, so all you can do is have the information available, explain what you can, answer questions when they’re asked, and, as you do, have a help-line available for the questions no one thought of when the information booklets were prepared.’
‘Like how do you stop hiccups? That was the first question I was asked when I was the bunny on the help-line during my early neonatal training. I didn’t have a clue, and was considering all kinds of tricks I’d tried myself—could a mother breast-feed upside down?—when a kindly sister told me no one had a clue and usually they just went away.’
Sophie smiled at the story but, rather than smiling back at her, Gib frowned.
‘Come on,’ he said. ‘We’re here to tour the hospital and so far you’ve only seen the one part of it, you know.’
He led the way out of the quiet room but not back into the NICU. Sophie followed, uncertain what had happened to change him from a joking colleague to a boss again.
Not that it wasn’t for the best. She might be attracted to the man but she had no intention of falling in love with someone who still wore his wedding ring four years after his wife’s death.
Had Sunday’s guided tour helped her settle in, or was Sophie Fisher simply the most efficient colleague he’d ever encountered?
Gib was pondering the question as he sat in his office late on Wednesday afternoon. He was through work for the day, mainly because his new consultant had taken half his follow-up patients and a number of their parents had left messages with Marilyn so he knew none of them had objected to not seeing him in person.
She—Sophie not Marilyn—had made the suggestion she take some of them late that morning, when, by some miracle he was reasonably sure wasn’t entirely to do with his new team member, all their babies—apart from Mackenzie who was still on parenteral feeds, but appeared to be stabilising—were resting quietly—thriving even—not one of them showing imminent signs of NEC, or RDS, or BPD, or any of the other alphabet soup of complications neonates could suffer.
‘It would be nice to see some of your follow-up cases,’ was how she’d phrased it, and he’d been about to suggest she sit in on his consultations when Marilyn got involved, calmly decreeing which clients Sophie should take and which should go to him.
He was considering whether Sophie would become another female organiser in his life, joining Etty and Marilyn in their roles, when she knocked briskly on his door then toed it open, coming in with an armload of files.
‘Marilyn was saying that not all the old files have been computerised,’ she said, sitting down in one of his visitor chairs and resting the files in her lap. ‘I thought, if you didn’t mind, I could start doing some of them.’
‘Computerising them? Why would you want to do that? Th
ere are dozens of people already employed in this hospital whose job it is to do it, so I assume it will all eventually get done. And when would you have time? I know we’ve finished early today but, believe me, that’s an exception rather than the rule.’
She smiled at him, and though he was now used to the way this expression transformed her face, something inside him still stirred when he saw it. Though it wasn’t only the smile—something inside him stirred when he just thought of her, something he hadn’t felt for so long he was uncertain about its origins!
Well! Not entirely uncertain…
‘I won’t do them all at once, and as for time, take tonight, and tomorrow night. I’m on duty so I’ll be here at the hospital and I’ll be bored to tears if there are no crises. Then consider that if I’m going to be seeing follow-up clients when they come for appointments, I need to know their histories. But why just read the files when I can be typing them into a computer at the same time? I know the system they use here—my part-time job as a student was entering hospital files into computer systems.’
He stared at her, then shook his head, unable to believe she could be giving herself so much extra work.
‘Are you sure you want to do this?’
Another smile. ‘As against Marilyn beating me with her feather duster and insisting I get cracking on it?’ she teased, and Gib knew it was more than her smile he found attractive.
Why her?
Why now?
Did it matter?
There’d been other women since Gillian had died. Women he’d dated for a while, enjoying their company, but always making sure they knew it was only for a while—that a serious, long-term relationship wasn’t and never would be on the cards.
How could it be when he’d already failed one woman so badly?
And Sophie, a single parent with responsibilities to her little boy, wouldn’t be a candidate for a short-term affair. If, indeed, she wanted a relationship of any kind!
He had no idea.
‘Can I take your silence as a yes?’ she said, still smiling slightly, or maybe not smiling, although a teasing note was lilting through the words.
‘Of course,’ he managed, wondering how long he’d sat there, contemplating things that had nothing whatsoever to do with computerising patient files.
Cautiously balancing her armload, she stood up, smiled again and walked towards the door. Gib’s eyes were on her slim, straight back and the neat roll of black hair—his mind wondering what it looked like down, splayed across her pale skin…
Or a pillow…
CHAPTER FOUR
THURSDAY began badly and got worse. At two in the morning, the sister on duty called Sophie to say Mackenzie’s condition was deteriorating.
They’d been worried about her all week, as she was losing weight in spite of the IV feeding, but when Sophie had checked her at 10 p.m. before heading to the on-duty room for a sleep, she had been stable.
‘Temp up, rapid heart rate—the little mite is really battling.’ The look of strain on Albert’s face told her how stressed he was over this special charge.
Abdominal X-rays, now being taken every six hours, had shown Mackenzie had progressed to stage two of the disease. When her 6 p.m. blood test revealed a drop in platelets to below twenty thousand, Sophie had infused replacement platelets, staying in the unit until test results showed the increase.
Now she had to worry if the infusion had somehow caused the deterioration in Mackenzie’s condition or if something else had happened. She checked everything, knowing the little girl needed more fluids and electrolytes than other babies her size because of the fluid loss from her intestines.
‘Perforated bowel?’
Albert whispered the words Sophie didn’t want to hear. Mackenzie was far too small for an operation to remove damaged bowel, but if liquid from her gut was leaking into her abdomen it would be poisoning her whole system in spite of the antibiotics they were pumping into her.
‘Let’s take another X-ray, and see what we can see,’ Sophie said. Albert needed no second telling, removing monitor leads before moving the baby, crib and all, to the imaging room.
The X-ray results showed the symptoms of NEC but it was hard to see a perforation.
‘I’ll put a drain into her abdomen, and we’ll test what we get out of it for any strains of bacteria we might not be treating. Maybe changing the antibiotics will help until Gib and the surgeons decide if she needs a laparotomy.’
They shifted Mackenzie to the procedures room, where Sophie inserted a small tube to drain fluid from the little girl’s abdomen. She ordered increased suctioning of her stomach, warning Albert at the same time of the need for care so the fragile, immature cells lining the stomach and intestines didn’t suffer further damage.
Then they waited, knowing with tiny neonates they should see a quick response if the measures they had taken were going to work.
‘Looking good,’ Albert said at last, and Sophie had to agree. The little girl had stabilised, but this was only a temporary measure. If her bowel was perforated and continued to leak its contents into the abdomen, surgery would be the only option, no matter how small she was.
As Sophie made her way back to the on-duty room, thinking a couple of hours’ sleep would be better than none, she wondered if she’d done the right thing, taking the decision to insert the drain. Should she have called Gib?
Gib. Amazing how easy it was to call him that now. And amazing how helpful and supportive he’d been throughout the week, guiding her into their way of doing things without preaching or taking over himself.
Gentle with the patients and with their parents—care and compassion in everything he did.
Nice man.
Thoroughly nice man!
Thoroughly nice man who made her feel things she didn’t want to feel…
‘So, little Mackenzie, what are we going to do with you?’
They were doing rounds and although Sophie had seen Gib earlier and told him about the drama in the wee hours of the morning, he hadn’t made any comment, content to let her complete her account of all that had happened. But there were two men she hadn’t met before at rounds, one introduced as a paediatric surgeon, the other as a gastro-enterologist. Both here for Mackenzie, she assumed, which was why this particular baby had been left until last.
‘Perhaps Dr Fisher will tell us where we are at with Mackenzie,’ Gib said, and it took Sophie a minute to remember she was Dr Fisher, as first names were the norm in this NICU.
Sophie ran through the events leading up to their suspicions of NEC.
‘She’d been on enteral feeding for four days, with very small increases in volume each day. She then showed typical symptoms—less active, more incidents of apnoea, respiratory problems, vomiting and greenish stools. But it was the mother who pointed out her slightly distended tummy. We shifted her to NPO and began parenteral feeding. Her condition improved, and we were considering trying her again on enteral feeding when she showed signs of severe sepsis at two this morning. X-rays showed mucosal necrosis and submucosal haemorrhage with some intramural air pockets. I inserted an abdomen drain and, after a culture of a fluid sample from the drain, changed her antibiotics.’
‘Was the X-ray clear enough to see a perforation?’ The gastroenterologist asked the question.
‘No,’ Sophie told him. ‘There were dark areas that could have been damaged bowel or blood. There was no way to tell, although the scans Dr Gibson ordered when he came on duty this morning might show what’s happening more clearly. I haven’t seen those yet.’
‘They don’t,’ Gib said. ‘I had our top imaging techs at work, but there’s no way you can sort out what’s happening in that tiny abdomen.’
‘She’ll need a laparotomy?’ the surgeon asked, and Sophie knew from something in his voice that he would find the challenge of operating on so small a child quite exciting.
‘Hard to agree to when she’s so small, but if we don’t do it we’ll never know what’s goi
ng on in there,’ Gib told him.
‘And is that all you want—find out what’s going on?’ the gastroenterologist asked.
Million-dollar question! In a larger and more stable child, if a piece of dead bowel was found, it could be resected—cut out—and the two healthy ends joined. If the damage was severe, then the upper end could be diverted out through the skin in a stoma then later, in a second operation, joined up again. But intestines could also heal themselves, as the gastroenterologist was subtly reminding the gathering.
So who would make the decision? Sophie wondered as the surgeon and gastroenterologist argued amiably, mainly for the benefit of the interns and medical students attending the rounds. Mackenzie’s parents would be consulted and would have the final say on any major procedure the doctors would perform on Mackenzie, but would Gib just listen to both the consultants and weigh things up himself before he put it to the parents, or did he favour taking the advice of the specialists he called in?
Sophie didn’t have to wait long to find out.
‘I know she’s small, but I think the operation is the only way we’ll find out what is happening,’ Gib said. ‘But we need to talk about the risks involved so I can explain them to the parents. Sophie, come with us—we’ll put together some figures for mortality and morbidity rates in operations in case Maria and Josh ask.’
‘But surely the mortality rate for not operating if the bowel is perforated is one hundred per cent,’ the surgeon said, as Sophie followed the other three specialists towards Gib’s office. ‘Isn’t that the only stat they’ll need to know?’
‘Not really,’ Sophie said quietly, when they were all seated. ‘They’ll want to know how the operation will affect Mackenzie, not only now but in the future. They’ll want to know if it’s worth putting her through this operation when she’s already so frail and sick. Will it make her better? Can we tell them that? Not really. All we can say is that it might. I don’t know that giving already stressed parents percentages is much help. What are the figures? Off the top of my head, something like forty-seven per cent are OK after surgery, but that’s with older, larger and definitely more stable infants. Even with all the odds in their favour, ten per cent have significant gastrointestinal problems for ever and fifteen per cent end up with damage to their central nervous system—and that’s not counting the ones that have other negative consequences of the operation.’
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