Page 19 of Holiday Haven

“Yes.” Brittany’s pulse oximeter reading remained on the low side at 88% despite the assistance of the Ambu bag, so she understood his concern. Her tone was a tad defensive. “I carried out all the orders you wrote before I went to lunch.”

Adam nodded and she realized he wasn't really questioning her nursing care. “Thanks.” He crossed to the computer in the corner of the room and logged in. “Keep bagging her unless her pulse ox drops below 85 percent.”

Everyone fell silent as Adam reviewed the X-ray on the computer. She felt helpless as Kevin Irvine continued to gently breathe for Brittany with the Ambu bag. Was there something she'd missed while caring for the baby? Some subtle sign that may have foreshadowed her changing condition? Something a more experienced nurse may have picked up on sooner?

“She has a severe lung deformity.” Adam’s voice broke into her thoughts. “Her pulmonary artery is constricted to the point where it looks almost completely obliterated. Krista, get a cardiothoracic surgeon in here ASAP.”

She didn't hesitate, calling the operator to request the CT surgeon to respond, STAT. Adam continued addressing the team. “Kevin, she needs to be intubated as soon as possible.”

As she waited for the surgeon to respond, she watched as the emergency team worked on Brittany. The phone rang. When she answered, she quickly filled the surgeon in on what was happening. She finished with, “Dr. Adam Monroe would like you to come up as soon as possible.”

“Understood.” He disconnected from the line.

“Dr. Ben Timmerman is on his way.” She tried to keep her voice from shaking. “I’ll call to reserve a PICU bed for her.”

“Thanks.” Adam’s gaze was riveted on the team working over Brittany. After arranging for a bed, she glanced at the portable heart monitor over the baby's head. Her stomach dropped when she noticed Brittany’s heart rate was rising at a steady rate.

Adam noticed it, too. “Her pulse is well over two hundred. As soon as you're finished with the breathing tube, you'll need to cardiovert her.”

“I just need to verify placement.” Before Kevin had finished speaking Adam pulled his stethoscope out and was listening to Brittany’s lungs. Krista leaned over to place the small end tidal carbon dioxide detector on the end of the breathing tube. “Good color change,” she announced.

“The tube is in.” Adam removed his stethoscope from his ears. “Get ready to cardiovert.”

Dr. Ben Timmerman walked into the room. “What's going on?”

Adam gestured for the surgeon to join him at the computer. “Here’s her most recent chest X-ray. It shows a severely constricted pulmonary artery.”

Ben Timmerman’s expression was grim as stared at the screen.

Krista jumped when Dr. Kevin Irvine shocked Brittany out of her fast heart rate. She felt like a complete failure as a pediatric nurse. She never should have left the unit to go to lunch.

Ben looked up from the computer. “Transfer her to the PICU, I'll call the OR and get a team ready.” He frowned, looking over the group gathered in the room. “Where’s her mother?”

She sucked in a quick breath. How could she have forgotten about Brittany’s mother? “I'll call her.” She reached for the phone then turned the computer so she could access the number from Brittany’s medical record.

“Hello?” The voice on the other end of the line sounded weary.

“Mrs. Meyer? This is Krista from Children's Memorial calling. Brittany has taken a turn for the worse. She's okay,” she hastened to reassure the woman. “But I have Dr. Ben Timmerman here who needs to talk to you.” She quickly handed the phone to the cardiac surgeon.

As Dr. Timmerman explained the situation, Krista pitched in to help prepare the baby for transfer. Brittany's mom must have given permission for the surgery because Ben placed another call to the operating room.

“Two transfers to the PICU over the course of four days isn't a very good track record,” Adam said under his breath.

She silently agreed. The only bright spot was seeing Denny's name on the whiteboard census of the ICU, which meant he was still hanging in there.

Somehow, she held herself together long enough to get Brittany settled. Bitter guilt coated her tongue and as soon as possible, she turned and escaped the intensive care unit.

“Krista?” She ignored Adam, but he caught up with her and took her arm. She shrugged him off, knowing she was on the verge of losing control. “Wait, talk to me.”

“About what?” She stopped and swung toward him. “I'm responsible for this. I left her alone.”

“You didn't leave her alone, you left her in the care of another nurse. You need to eat, too.”

She wished she could believe him but knew better.

He pulled her into an empty room and close the door. Her eyes burned with unshed tears. “It will be my fault if that little girl dies.”

“That’s not true.” He pulled her into his arms and heaven help her, she leaned against him desperate to absorb some of his strength. She buried her face in the warmth of his chest and inhaled his comforting, musky scent. “Nothing you did caused her pulmonary artery constriction. If you want the truth, there should have been a better physical examination and follow up prior to her admission. My partner didn't tell me much, just that he thought there might be some bonding issues between the mother and the baby.”

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