A Nickel Trumps a Dime of Fate

AN: Only one more chapter after tonight. Monday will be the last post of 'A Nickel Trumps a Dime of Fate.' I'll try to start periodically posting the series of short stories this next week…so stay tuned! As always, thank you for your wonderful reviews.

Disclaimer: I don't own JAG or any of the characters. I just take them out and play with them on occasion before replacing them safe and sound back on the shelf.

Part 21a of two parts

04:20

Wednesday

2 February 2011

Neonatal Intensive Care Unit

UCSD Medical Center

San Diego, California

Harm followed the nurse and physician through the adjoining doors and into the NICU. He slowed his footsteps as they made their way through the sea of incubators and warmer beds. His face paled and his hands trembled as he listened to the never-ending shrill noise made from alarms and ventilators.

They stopped beside an empty warmer bed and the nurse looked up in time to notice the nervous father sway on unsteady feet. She reached for his arm, "Mr. Rabb, are you OK? Would you like to sit down?"

Harm shook his head and blinked rapidly to regain his composure. Breathing deeply, he planted his feet firmly, "No, I'm fine…it's just that," he waved a hand around the room, "…this is all a bit overwhelming."

The neonatologist spoke up, "I don't believe I've introduced myself…I'm Dr. Margaret Finnegan, one of the newborn intensive care doctors and this is Marilyn, one of our NICU nurses. Marilyn is going to be taking care of your little girl tonight." The physician motioned for Harm to come closer to the bed, "I know this place can be a bit unnerving, but your daughter is really doing very well…I don't expect her to need most of our services."

Harm watched as they transferred Ellie from the transport isolette and placed the swaddled bundle on the radiant warmer. Unwrapping the blankets, one by one, the baby's little body finally came into view. The nurse lifted the infant to place her on the scale. "Mr. Rabb, did you bring your camera?" When Harm frowned in question, Marilyn explained, "A lot of the parents like to get a picture of the baby on the scale with the birth weight displayed."

Harm's eyes widened, "I left the house so quickly; I didn't even think about bringing my camera."

Marilyn smiled, "That's OK, you can get a picture another time." Ellie's little arms and legs flailed in the cool air. She let out a cry as the scale rocked from the movements. Harm reached out a hand to calm his daughter just as the nurse announced, "She weighs 3 pounds-8 ounces."

His mouth gaped, "She only weighs 3-1/2 pounds? She's so small!"

Dr. Finnegan chuckled, "Actually she's one of our bigger preemies…we get some that weigh less than a pound."

He watched as the nurse carefully placed Ellie back on the warmer bed, connecting wires to her chest and affixing brown tape to her foot. "What's your little one's name?"

He reached out and gently picked up Ellie's hand, "Her name is Elizabeth Christine Rabb, but we're gonna call her Ellie."

"Ellie, what a beautiful name." Pointing to wires, she explained, "The leads that I've attached to Ellie's chest allow us to monitor her heart rate and breathing." Marilyn pointed to the tape on the baby's foot, "And this glowing device allows us to monitor her oxygen levels without having to stick her for blood."

Harm looked up to study the cardiac monitor, "Do her numbers all look good?"

Dr. Finnegan looked up from writing in the chart, "She looks perfect. Her heart rate is normal…and her breathing and oxygen levels are just where we want them. She doesn't show any signs of respiratory problems from immature lungs. We're going to draw some blood work from Ellie to rule out infection, but it takes a few days to get the final results. In the meantime, I'm going to start her on IV antibiotics just to be safe."

He turned the baby's tiny hand over to study the veins, "How do you draw blood and start an IV in someone so small?"

"We have special needles and catheters made just for babies," the physician smiled. "We're also going to start Ellie on an IV sugar water solution so she doesn't get dehydrated. Later today, if she continues to do well, we may start her on some small feeding through a tube placed from her nose into her stomach."

Harm looked up to the doctor, "But my wife wants to breastfeed, Dr. Sherman said that wouldn't be a problem."

"Well, Ellie is a little too premature to master that skill just yet. We usually start with tube feedings and then slowly work toward feeding by mouth over the next 2 to 4 weeks. I'll have the lactation specialist assist Mom with pumping to provide breast milk for Ellie."

Marilyn handed him a card, "I wrote down Ellie's birth weight and her length so you can show Mom. She's 18 inches in length…that's long for a preemie her size."

Harm laughed, "I could have predicted that…both her Mom and I are tall."

Marilyn motioned toward the door to labor and delivery, "I'm going to draw Ellie's blood and start her IV. You're welcome to watch, but most parents don't like to see their little ones get stuck."

Harm inched backwards, "I think I'll go find my wife and fill her in on Ellie's condition. Can I come back later?"

Dr. Finnegan walked him to the exit, "You're welcome to visit almost any time. We block visitation from 6:30 to 7:30 morning and evening while the nurses change shift and discuss the patients. Other than that, you can stay with Ellie as much as you want…but don't allow Mom or yourself to get too worn out; no one expects you to be here 24 hours a day." She opened the door and pointed him toward the recovery area.

Harm walked down the nearly deserted hall and paused when he heard a baby's soft cry. Inhaling deeply, he looked down at the card in his hand…three and half pounds, she weighed less than half what Connor did at birth. The edges of his mouth tipped up in a smile…Ellie might be small in size, but she was strong in spirit. He whispered to himself, "She's just like her mom…feisty and tough." He shook his head and muttered, "My little Marine."

He was directed to Mac's bedside in the recovery room and poked his head around the curtain. "Hey Marine, how are you feeling?"

She opened her eyes, lids still drooping in sleep, "Pretty good…anesthesia hasn't worn off yet." She blinked, coming further awake, "How's Ellie doing?"

Harm beamed with pride, "She's great, Mac. She weighs 3 pounds-8 ounces and is 18 inches long. I guess she got our height. Her breathing is fine…she's not even on oxygen. They were getting ready to draw blood and start an IV when I left. The doctor thought she might be able to start a little food through a feeding tube, later today."

Mac's expression fell, "I can't breastfeed?"

He reached out to stroke his fingers over her cheek, "Dr. Finnegan said she's too premature to eat by mouth just yet. She's gonna have a breastfeeding specialist help you to start pumping later today."

She nodded in understanding, "Tell me about her, Harm? What does she look like?"

He smiled in full flyboy grin, "She's beautiful just like her mother. She has dark hair and your nose and mouth. She's little, but she's tough…like a Marine. I counted ten fingers and ten toes. Her arms aren't any bigger around than my thumb…and when she grabs hold of my finger, her hand just barely fits around it." He watched Mac's eyes slowly drift shut. Leaning over, he placed a kiss on forehead, "Get some sleep, sweetheart…you deserve it after what you went through tonight."

She cracked open one eye, "Harm, are you going home to get some sleep?"

He sat down beside her bed and reached for her hand, "I'm not going anywhere…my girls need me."

"But…"

He stroked his thumb over the back of her hand, "Ssssh, I'm just fine…go to sleep, sweetheart. Ellie's waiting to meet her mommy later today." She was asleep before he finished the sentence. He laid his head on the bed, tucked up against her arm and whispered as he nodded off, "I love you, Sarah. Thank you for the gift of my daughter."

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14:00

Wednesday

2 February 2011

Neonatal Intensive Care Unit

UCSD Medical Center

San Diego, California

Harm maneuvered the wheelchair through the NICU doors. Stopping before the scrub sink, he asked, "Are you ready to meet Ellie?"

Mac smiled with excitement, "I've never been more ready for anything in my life."

He helped her wash her hands and pushed her toward Ellie's bed 'spot.' Finding the radiant warmer empty, he turned in a panic when he failed to locate his daughter. One of the nurses noticed the fearful father and walked over to help, "May I help you?"

"My daughter," he stuttered, "…I can't find her. She was here in this bed earlier."

The nurse placed a hand on his arm to still the nervous movements, "I'm sure she's fine…let's go see if we can find her. What's her name?"

"Ellie…ah, Baby Girl Rabb," rushed forth, his eyes still wide with worry.

The nurse escorted them to the front desk and inquired about Ellie's location. Turning back to the troubled pair, she smiled, "It seems Ellie was doing so well that they moved her to the step-down unit. If you follow me, I take you to her bed spot."

Harm released a relieved sigh and pushed Mac's wheelchair behind the NICU nurse. "Do they move the babies around a lot?"

"Sometimes we move the little ones for staffing or to make room for the more critically ill infants. The fact that your daughter didn't need the higher acuity unit is a good thing."

Harm nodded, "I suppose…it was just kind of scary when she wasn't where I left her. I thought something bad had happened," his voice cracked with the last statement.

"I understand your worry," the nurse acknowledged. "We didn't intend to scare you. If something untoward had happened, someone would have called to notify you."

Harm pondered that statement, "Then I guess it would be a good idea to leave my cell phone number and other alternative ways to reach us?"

The nurse stopped inside the special care nursery area and asked about Ellie's location. Motioning toward an isolette in the back of the room, she directed the wary parents to the bedside, "Here we are. Mr. and Mrs. Rabb, this is Beth…she's Ellie nurse for today. She'll be glad to give you a tour and some information on our visiting policies. There's a place for you to list grandparents' names and alternative contact numbers. Again, I'm sorry for all the worry; I better get back to my patient assignment."

Harm wheeled Mac closer to the incubator so she could see the baby. The nurse opened the portholes of the isolette, "You can reach in and touch her."

Mac sat back in the wheelchair, "I don't want to hurt her."

Beth reached in to turn Ellie's face toward her parents, "You won't hurt her. She needs to hear your voice and feel your touch…go ahead."

Mac reached out a tentative hand and stroked her finger down Ellie's cheek. The baby opened her eyes and stared at her parents. "Oh Harm, she's beautiful. I can't believe how tiny she is." She looked up to the nurse, "You're sure she's doing OK?"

Beth smiled, "Absolutely, would you like to hold her?"

Mac's eyes widened, "Do you think that's a good idea? I mean…I wouldn't want to do anything that might cause a problem."

Beth reached for a couple of blankets and began to wrap the baby, "She needs to know that you're here. Holding her won't hurt her in any way. This time I'll wrap her in blankets to keep her warm, but next time we'll do something called 'kangaroo care.' That's where…."

Harm chuckled, "We're well acquainted with kangaroo care."

Beth placed a hat on Ellie's head, "Here this will help keep her warm." She gently placed the baby in Mac's arms and closed the isolette door. Looking back toward Harm, she asked, "If you know all about kangaroo care then you've had a preemie before?"

He shook his head, "No, but our son had a history of drug exposure during pregnancy…he was really irritable and difficult to console. We found the only way to keep him calm, was to hold him skin-to-skin."

The nurse peered back with concern, "What drugs was your son exposed to?"

Harm squinted in concentration, "Let's see…cocaine, marijuana and methamphetamines. I think that's all…right Mac?"

Mac watched the nurse's expression change from concerned to guarded, and quickly amended the statement, "I think I should explain that Connor was adopted. His birth mother left him at one of the fire stations under the Safely Surrender Law. He was placed with us when he was about a week old. We're child advocacy lawyers and we work closely with Child Protective Services."

Beth's smile returned, "I understand…I was a little worried there for a minute. Typically we send drug screens on the babies if there's a history of drug use."

Harm shook his head, "We'd never do anything like that…we waited too long for our daughter to ever put her at risk. We have two little boys, both adopted. We didn't think we'd ever be able to get pregnant. We tried for two years, and went through every kind of fertility treatment imaginable, including IVF, without success. We finally gave up and decided we were just meant to have Ben and Connor. Then," he clicked his fingers, "…out of the blue, we found out Mac was pregnant. She fainted in the judge's chambers as he was finalizing Connor's adoption."

Beth chuckled, "You wouldn't believe how many times I've heard that same story. Not the fainting part, but the unexpected pregnancy after the parents had given up. So how is your son, now?"

"Connor? He's great…a terror at times, but wonderfully normal. He and his big brother keep up hopping."

The unit clerk came into the room and walked over to the bedside, "Mr. Rabb, you have a couple of visitors outside."

Harm frowned back in question, "Who would be visiting now?"

The clerk smiled, "A set of grandparents…I think they said they were your parents, sir. They also have a little boy with them, who says he's Ellie's big brother."

Harm motioned toward the door, "Mac, I'm gonna go see what's going on. If Mom and Frank are outside with Ben, I wonder who has Connor?" He started toward the door, but then turned back around, "Is it OK if my folks come in to visit?"

Beth nodded, "Of course, we allow 2 people at the bedside, besides the parents. How old is your son?"

Mac chimed in, "Ben is 4-1/2 years old. Connor is 17 months, but I doubt they brought him along."

"I don't suppose you have Ben's immunization record with you?"

Mac nodded, "I have it in my purse back in the room."

"If you promise to bring it in next time you visit, I'll let Ben come see his baby sister." The nurse added, "We allow siblings to visit, as long as their immunizations are up-to-date and they aren't sick. Just have the unit clerk do a quick health screen and take Ben's temperature before you bring him back."

Five minutes later, Harm reappeared with Ben tagging closely behind, hand firmly clutched in Daddy's. As he got close to the bedside, Ben released his grip and hurried to Mac's side, "Mama, I missed you!"

Mac leaned over to place a kiss on his cheek, "I missed you too. Did you come to visit Ellie?" Ben nodded his head and peered at the bundle in Mama's arms.

Beth bent down to the little one's level, "Would you like to see your sister?"

Ben tucked his head against Mama's arm and played shy. Harm squatted down and took Ben into his arms, "Come here, little man." He placed a kiss on Ben's cheek and maneuvered the little boy closer to his sister. Pulling the blankets away from Ellie's face and chest, he smiled at his son, "What do you think, Ben? She's little isn't she?"

Ben stepped closer and reached out his hand to gently grasp Ellie's. Leaning in, he placed a kiss on her forehead, "She's way littler than Connor was." He stroked his finger over her head, "When can she come home, Mama?"

Mac pointed toward the nurse, "I'm not sure…why don't you ask Beth?"

Ben looked up with eyes wide, then leaned toward his mother and whispered, "I don't want to…you ask her?"

Mac chuckled, "Beth, Ben wants to know when Ellie can come home?"

The nurse leaned down to the little boy, "Well, your sister was born about two months early. So I expect she'll have to stay here for about a month or so."

Ben looked back toward Mac with a puzzled expression. She wrapped her arm around her son, "That's about four weeks or…30 days or so." At his continued look of confusion, she smiled, "That means she'll be here for a little while. She needs to learn how to eat, and stay warm, and get bigger before she can come home."

Ben's eyes clouded over, "Mama, do you have to stay that long? I want you to come home."

Mac pulled the boy closer to her chest and kissed his cheek, "Mama should be home in a couple of days, punkin. Just, Ellie has to stay longer, but we can come visit her everyday."

Ben buried his face in her neck and muttered, "Okay."

Harm reached down and picked the little boy up in his arms, "Are you ready to go see Papa?" Ben nodded and held on tight, nuzzling his face in Daddy's neck. Harm patted his back and pointed toward the door, "I'll take Ben back outside and send Mom in to see Ellie."

As they walked toward the door, Ben waved, "Bye, bye Mama…I love you, Ellie."

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11:00

Saturday

5 February 2011

Neonatal Intensive Care Unit

UCSD Medical Center

San Diego, California

Beth smiled at Ellie's parents as they entered the room, "I see you're getting around better today."

Harm nodded, "Oh yeah, she gets to come home…so I guess it's time to give up the wheelchair." He helped Mac into the bedside recliner and turned back to the nurse, "How's my little girl doing today?"

Beth opened the portholes to adjust Ellie's position, "She doing really great. We advanced her feedings some more…I expect her to lose the IV nutrition later today." She looked at Mac, "Would you like to hold her?"

Mac nodded with excitement, "Of course…this will be the last time before I'm discharged today."

Beth removed the t-shirt from Ellie and changed her diaper, "Daddy, if you'll pull the curtain around the bed, Mom can undo her gown." Harm complied, as Mac situated herself in the recliner. Beth placed Ellie up against Mac's chest skin-to-skin. Ellie initially began to whimper and fidget, but quieted when she felt Mama's embrace.

Harm took a seat next to his girls and stroked a finger over Ellie's cheek. The baby turned her face toward the finger and began to root. Harm smiled at the reflexive movement, "Look at that…she's trying to suck. I haven't seen her do that before."

Beth leaned in close, "Mom, do you want to try and breastfeed?"

Mac's eyes widened, "Do you think she's ready? They tried a bottle yesterday and she wasn't interested."

"Why don't we give it a try? At 32 weeks gestation, her suck-swallow reflex is just developing. I don't expect she'll do a lot, but giving her the chance to nuzzle and suck helps her to develop that normal feeding response. Plus, she can control the flow of milk a lot easier at the breast."

Beth helped Mac to position the baby at her breast. As Ellie's mouth came in contact with the nipple, she opened wide and stuck her tongue out to lick, before latching on. Sucking a couple of times, Ellie paused to breath. She continued in a slow intermittent feeding pattern, sucking a few times before resting for long intervals. Mac's eyes widened further as a smile broke free on her face, "She's doing it!"

Harm leaned in to place a gentle kiss on Ellie's soft hair, "Yes, she is…that's my girl."

The trio sat enjoying the private moment for the next 15 minutes. When Ellie fell asleep at the breast, Mac tried to pull her into an upright position. As the nipple began to slip from her mouth, Ellie instinctively sucked harder. Beth leaned in to help, "Mom, if you'll just insert your finger into the side of her mouth, you can break the suction. If you try to just pull her off, you'll hurt your breast."

Mac successfully removed the baby's little mouth with the next attempt. Ellie stretched and scrunched up her face, before falling back asleep. Mac patted her back until she released a quiet burp. Kissing the baby's cheek, she turned to Harm, "Do you wanna hold her for a little while?"

He looked back toward the nurse, "Would that be alright? I don't want to stress her too much?"

Beth nodded, "Of course, let me lift the baby from Mom and then you can switch positions." Mac slowly stood up from the chair, carefully holding her C-section incision. Once she'd moved to the adjoining chair, Harm sat down and opened his shirt. Ellie snuggled in on contact with Daddy's chest. He gently rocked her back to sleep, while softly humming a lullaby.

Ten minutes later, Harm startled when the baby's heart rate alarm began to sound. As he looked up to the monitor screen, he saw the EKG complexes begin to widen out as the heart rate fell from 140 to 100 to 80 and finally 60. He panicked and pulled Ellie back away from his chest. "Something's wrong…I don't think she's breathing!"

Beth stepped in beside the chair and rubbed a hand vigorously up and down Ellie's back. The infant startled and took a deep breath. The heart rate immediately accelerated back to a normal level. "There we go…all better. Ellie, you shouldn't scare Mommy and Daddy like that."

Harm's mouth hung agape as he tried to form words. Tears glazed Mac's eyes and she trembled in response to the alarms. Harm lifted the baby and handed her to the nurse, "Maybe you should put her back."

Beth settled Ellie back into her incubator. Turning back to the terrified parents, she explained, "It's OK…Ellie just had an apnea and bradycardia spell. Most preemies have them. That just means, she forgot to breathe and then her heart rate slowed down. It happens because the brain is still immature and the brainstem doesn't always remind them to breathe. She's just fine. At her age, most babies have a few, but they rarely ever require more than a little stimulation to remind them to take a deep breath. Most everyone outgrows them before they go home."

Mac finally found her voice, "I certainly hope so…I don't wanna take her home doing that."

Beth shook her head, "I promise we won't send her home until she's stable. As her brain matures, she'll stop having the A and B events. An occasional baby may still have a few at discharge; in that case, we send them home with a monitor…but usually that's not necessary."

Harm stood up and reached out to grab Mac's arm, "Come on Mama, I should probably get you home."

Mac leaned into his side and buried her face in his chest. He felt the dampness of tears through his shirt. Tilting her face up to his, he wiped away the tears, "What's this? Beth said that Ellie's OK."

Mac sniffed, "I know, but I don't wanna leave her behind."

He pulled her into his arms and rubbed a hand up and down her back, "I know, sweetheart…but Ellie's not ready to come home yet." He felt her body tremble against his.

Beth touched a hand to Mac's arm, "It's OK, Mom…your response is pretty normal. No mother wants to leave her baby behind in the hospital. It's not fair to go through all that you did and still, not get to take Ellie home. She's not ready yet, but it won't be long. In the meantime, you can visit everyday." The nurse glanced toward Harm, "Just don't wear yourselves out…no one expects you to be here 24-7."

Harm reached for some tissues and wrapped an arm around Mac's waist, "Come on, sweetheart…let's get you off your feet. Besides, I bet Ben and Connor are anxiously awaiting Mama's return." He slowly led her through the NICU doors and into the hall. Now came the hard part, getting Ellie big enough and strong enough to come home.

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Continued in part 21b