Page 11 of Holiday Haven

“I need to check on Joy.” She edged to the door, fighting tears. “Her breathing has been better, but her fever was still high the last time it was checked.”

His gaze sharpened with interest. “How high?”

“Still hovering at about 38.9 degrees Celsius which is still 102 degrees Fahrenheit.”

He nodded thoughtfully. “I'd hoped it would have come down by now. Have you been notified of any results yet from her cerebral spinal fluid? I don't see them in the chart.”

“No, but sometimes they take twenty-four hours.”

“Okay. I'll stay here with Denny while you check on Joy.”

He obviously didn't feel comfortable leaving Denny alone. Not that she could blame him. She was worried about the baby herself, half hoping the infant would need to be transferred to the pediatric ICU. She'd never lost a young patient in her short career and didn't want to start today.

Joy was crying when she went into the room, but immediately quieted down when she picked the baby up. “I'm here, little one.” She stroked her finger down the baby's cheek. “What's the matter? Are you finally hungry?”

The way Joy squirmed in her arms and gnawed on her fist, she suspected it was time to try the bottle of formula again. She would have loved to feed the baby herself, but Denny's condition worried her, so she called for one of the nursing assistants to help.

After she had safely handed Joy over to the nursing assistant, Rachel who was more than happy to sit and feed the baby, she headed back to Denny's room.

“How is Joy?” Adam asked.

“Good. Our nursing assistant, Rachel, is feeding her.”

“I'm glad. I hope she turns the corner soon.” The satisfaction in his eyes dimmed as he glanced down at Denny. “Will you call the lab and ask about that ammonia level? I'm worried he's getting more lethargic.”

“Of course.” She picked up the phone and called the lab. In less than a minute she had the ammonia level. “It's high at 65.”

“That's what I was afraid of. Normal is less than 20.” Adam frowned. “We can’t delay, he needs to get to the PICU.”

“I'm on it.” Unable to hide her relief she quickly called the pediatric ICU and the admitting department to let them know about the transfer. As she and Adam were rolling Denny's crib down the hall, his mother arrived.

“What's going on?” She asked in alarm.

Adam glanced at Krista and she nodded, understanding his unspoken request. “I'll take Denny over so you can talk to her.”

“Thank you.” Adam took Mrs. Gibson's arm and led her into a quiet corner. Krista could hear the woman sobbing behind her as she continued rolling Denny's crib down the hall.

Thankfully the pediatric ICU was located right around the corner from Six South. Denny wasn't the first patient she’d transferred to critical care, but he was by far the sickest.

She did her best to give the attending physician an accurate report and Denny's condition. “Dr. Monroe is talking to Denny's mother, but his main concern is lethargy with a serum ammonia level of 65. We've had Denny on a bicarb infusion for almost an hour, we have not yet rechecked his basic chemistry panel.”

The attending physician nodded. “What's his anion gap?”

Rats, she should have asked Adam to explain it to her. “I'm not sure,” she confessed. She took out her scribbled notes. “Here are his chemistry results. Adam thought the anion gap was significant.”

“Yeah.” He glanced at the numbers then nodded. “Yes,18 is pretty significant all right. Okay, we're going to need to intubate this little guy.”

She stepped back, watching as the team of pediatric ICU nurses and doctors took over Denny's care. A few minutes later Adam brought Denny's mother in, too. With Mrs. Gibson between them, Krista and Adam offered support until her son had been intubated.

“I need to call my husband,” Mrs. Gibson whispered.

Krista kept a supporting arm around her waist as they crossed to the nearest phone. After Mrs. Gibson placed the call, they were allowed in to see the baby. Denny looked so defenseless with the breathing tube in his throat. The critical care nurses took Denny's mother under their wing, allowing Adam and Krista to return to the floor.

Sobered by the seriousness of Denny's illness, she fell into step beside Adam as they walked back toward Six South. She couldn't think of a single thing to say that didn't sound trite or placating.

Losing a patient was never easy. Not for doctors or nurses. The grim expression on his face tore at her heart. He was truly upset about Denny, as she was. As they approached Joy’s room, she lightly touched his arm. “I'm so sorry Adam.”

He stared down in her hand on his arm and then gave a jerky nod. “I know. There are some diseases that we can't fix.”

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