05:30
Saturday, May 20th, 2006
Bethesda Naval Hospital
Surgical ICU
Mac's eyes darted around rapidly, in confusion, before settling into Harm's relieved depths. He didn't think he'd ever been so happy to see those big beautiful brown eyes in his life. He quickly stood and reached up to caress her face in comfort, "Mac, it's OK just relax and I'll go get the nurse." As he turned to go Mac grabbed his hand, eyes wide in panic and struggling against the breathing tube. Harm sat down on the bed took her hand and began rubbing circles on her palm with his thumb until she relaxed back into the bed. As she calmed she began looking around the room. She tried to lift her left hand but found it restrained by the arterial line and glanced back toward him in questioning gaze.
"Mac, sweetheart they had to do surgery last night…" before he could finish his explanation Mac pulled her right hand away and placed it over her abdominal incision. Her eyes again darted back to him then fell shut as tears began to leak from the sides. He froze in place for a moment thinking that she was in pain, but then surmised that she must have thought that she'd lost the baby. He quickly gathered her in as close as the equipment would allow and began to soothe, "No sweetheart, Sophie's OK…she in the NICU on a ventilator…she's alive and beautiful." He decided it was prudent to stop with that explanation for the time being; instead taking the opportunity to place a kiss on her temple.
Just at that moment, Lucy entered the room to check on the commotion. "Captain, I thought we had a deal…quiet and unobtrus…" she stopped mid thought as she noticed Harm on the bed holding onto his wife. "Harm what's going on…is something wrong with Sarah?" Lucy quickly stepped to the left side of the bed and was pleased to see Mac's eyes open at her touch. "Colonel, it's so nice to have you back awake. If you'll just relax a moment I'll go get the anesthesiologist to remove that breathing tube." Mac blinked her eyes in thankful understanding as Lucy turned to leave.
Harm kept his lips against her temple as he caressed her arm. "You scared me, Marine…please don't to do that again," his voice cracked as his eyes filled with tears. Mac pulled back to look into his face concerned at his reaction. "It's OK…I'm just relieved that you're awake." At her questioning gaze he continued, "Your blood pressure was very elevated…you had a seizure…they did an emergency C-section…." He had to stop, turning his face away as the tears began to fall. She cupped his cheek pulling him back to her and tenderly wiped away the tears.
Five minutes later, Lucy returned with the anesthesiologist and respiratory therapist to pull the endotracheal tube. Harm stepped away from the bed and into the hall to collect himself again. He paced an additional 5 minutes before deciding they'd had enough time and he needed to get back to his marine. As he entered the room, Lucy and Liz were settling Mac back into the bed. She looked pale and exhausted, but never more beautiful to him. Lucy stopped him as he approached the bed, "Harm, we're going to give Sarah some pain meds and then she needs to rest. Dr. Abrahms should be by shortly and hopefully we can start weaning her magnesium at that time. If all goes well maybe she can move out of the ICU in the next 24-hours. Now why don't you go visit your daughter for awhile, maybe they can take a picture of Sophie for you to bring to Sarah."
Harm was about to object to leaving when he saw Mac's eyes light up at the mention of Sophie. He acquiesced giving Mac a quick kiss before leaving the room and headed on a mission to the NICU. He scrubbed at the sink with extra care, threw a cheerful 'good morning' to Lois, the NICU unit clerk, and poked his head around the door to Sophie's room. He was met by the now familiar sound of 'plane engines' from the oscillator, "Hey Val, is it OK if I visit Sophie for a while?"
"Of course, Sir. I was wondering where you'd gotten to," smiled Lt. Valerie Snow. Harm frowned at the comment, would they think he was a bad parent if he didn't spend all his time at Sophie's bedside. Sensing the comment had been misinterpreted, Val continued, "I didn't mean that you had to camp out at Sophie's bedside. I was just exchanging pleasantries."
Harm frowned concerned, "Do most of the parents stay at their baby's bedside all the time?"
"No, of course not…you need to leave, to eat, to sleep…to give us poor bedside nurses a break," Val snickered to lighten the mood. Harm's gaze widened before he broke out in a grin.
"I get the picture. How's Sophie doing?" he reached out to brush his fingers through her wooly dark hair. He mused that it was bunched in little short tufts.
"It'll get longer and smoother as she grows." Harm glanced toward the nurse confused. "Her hair, the preemies tend to have shorter tufts more like lamb's wool. It'll straighten and become silky as it grows, unless she destined to have curly hair…is mom's hair straight?" asked Val.
Harm pulled out a picture of he and Mac from his wallet. It was taken as an engagement picture at the insistence of his mother. She'd wanted a picture to post in the La Jolla Village News. She'd insisted that 'she'd waited forever for him to get married and she planned on bragging about her son and future daughter-in-law on the society page.' The photographer had taken several poses, but this had been his favorite. They'd been dressed casually in jeans and white cotton oxfords with bare feet. He'd been teasing Mac between shots when she'd caressed his cheek and told him she loved him. They'd stopped talking and gazed into each other's eyes with soft smiles when the photographer caught them unawares. His mother had chosen several more 'posed' photographs, but this one was his favorite. He stared at the photo longingly lost in thought as he rubbed his thumb over Mac's face. He was roused from his memories by Val, "Is that your wife?"
"What…oh yeah, it's a picture of both of us," he smiled and handed the photograph to the nurse.
"Wow, she's beautiful. With the two of you for parents, Sophie's going to break some hearts."
Harm smirked, "She's not even going to look at boys until she's 25 and not dating until she's at least 40!" At Val's amused expression, his eyes twinkled, "I've been checking on private girl's schools and colleges."
"I see, does Sophie get a choice in the matter?" the nurse laughed.
"Only to pick from my list!" Harm laughed back. He realized it felt good to laugh. There hadn't been much to laugh about over the last few hours, but at least his marine was awake and that was certainly something to smile about. "My wife woke up a little while ago. They think she's gonna be fine," he glanced back toward Sophie in contemplation.
The nurse noticed the change in affect. "That's great…Sophie's hanging in there, too. How about we hang this picture of you and your wife on her bed so she knows that you're thinking about her even if you're not here," the nurse rose from her chair and taped the picture to the bed in Sophie's line of sight.
Harm picked up Sophie's foot and began caressing her leg with his thumb. "So how's she doing?" He watched for any movement from Sophie in response. Seeing none, he settled back into a bedside chair deflated but still continued his gentle caresses.
"Well, her oxygen is down from 90 to 75 and we've been able to wean some of the other ventilator settings as well. Harm's eyebrows flicked up in understanding. "We did need to start some IV medications to increase her blood pressure though?"
Harm jerked his head toward the nurse, "But I thought her blood pressure was high…that's why she needed the new ventilator and breathing medicine."
"That's true…her lung blood pressures were high…but…."
Harm interrupted, "Then why on earth would you start a new medicine to increase her blood pressure further." He was starting to get upset; it made no sense, why couldn't these people make sense.
"Sir, we're talking about two different…."
Harm stood and began to pace, "I don't understand…first you tell me one thing then another…it's like you're speaking a foreign language…."
"Sir, if you'll just calm down, I'll get Dr. Will…."
"…my wife is the language expert here not me…if you could just speak in English it might make sense," he ran his fingers through his hair in frustration. "Just when things start to get better, something else happens…."
At that moment Dr. Williams passed by the room, but doubled back and entered at the sound of the commotion. "Is there a problem, Captain?"
Harm turned toward the doctor. "The nurse was just telling me you started a new medicine to increase Sophie's blood pressure, but you told me that her blood pressure was already high. I don't understand what you people are doing to my daughter," he stated in a loud irritated voice.
"Captain, perhaps we can talk in the parent conference room…."
"No, I want…" at that moment Sophie's monitor began to alarm for low oxygen levels. Harm jerked back toward Sophie's bed with a look of horror. "What's going on?"
"Sir, remember I explained that we needed to keep Sophie quiet and relaxed…she's just responding to the noise. It'll be OK, we just need to keep it quiet in here," the doctor whispered. Harm relaxed as Sophie's oxygen saturations began to rise and the monitor stopped alarming. "Now Captain, maybe we can go discuss Sophie's condition in the other room?" Harm nodded contritely, attitude now subdued by the scare of the alarm.
They settled into the chairs in the dimly lit family conference room. "Alright Sir, I understand that you're frustrated that Sophie's so sick, but her clinical course so far is exactly what I expected. As I explained earlier, Sophie has PPHN or high blood pressure of the lungs. Do you understand what I explained earlier?" Harm nodded and shifted uncomfortably in the chair. "What Val was trying to explain just now is that Sophie has low systemic blood pressure. That means the blood pressure in the rest of her body. You know how you get your blood pressure taken in your arm? Well that pressure is what is low in Sophie right now. The lungs and body work in two different circuits and the blood pressures can go in two different directions."
Harm frowned, "So Sophie's low body blood pressure is similar to what Mac's high blood pressure was?"
"Exactly, the doctors used medication to lower the colonel's 'systemic' blood pressure and we're now using different medications to raise Sophie's 'systemic' blood pressure. It's very common for a sick baby to have low body blood pressure. We treat it with IV fluids and medications. In Sophie's case; she's on Dopamine to directly increase the pressure of the blood vessels and a steroid to help her body deal with the stress it's current under."
"But Dr. Abrahms didn't want Sophie exposed to anymore steroids…he said it could affect her growth."
"Well, we're talking about different steroids and dosages. Our bodies normally make steroids all the time and in times of stress release even higher quantities. Sometimes when babies are sick, especially preemies, they don't make enough of the internal steroids to respond to the stress. If that occurs the baby will have trouble maintaining a normal blood pressure. When that happens, we give small amounts of steroids IV to help the baby respond normally to the stress. Does that make sense?" the doctor explained.
Harm inhaled deeply and nodded his head in affirmation. "I'm sorry for my outburst earlier. It's been a really long and stressful night. My wife's finally awake, but every time I think things are finally getting better something else goes wrong."
"I understand, Sir…but in Sophie's case nothing has gotten worse in the last few hours. She seems to be slowly responding to our therapies…and as I stated the low blood pressure is to be expected in a baby as critically ill as Sophie. You just need to take it one step at a time, otherwise you're going to wear yourself…and us," the doctor smiled to take the sting out of the words, "…out. Now why don't you go visit your daughter for a little while longer. The NICU closes to visitors from 0630 to 0800 so the nurses can change shift."
"Thanks Dr. Williams and again I apologize for my behavior," Harm returned a disarming smile.
"Captain, just so you know…none of us take any of that personally. We expect parents to have occasional…'meltdowns'," the doctor grinned, "…but you're Sophie's best advocate here. She can't stand up for herself and complain when something goes wrong. So, if you're concerned or don't understand her care just ask and we'll be glad to explain. You and Mom will be the two most constant caregivers on Sophie's team. Since you're here everyday, you may notice subtle changes in her condition that we don't see, so don't be afraid to point them out or to complain if you think something is wrong…OK?"
"I get it…thanks again. Oh, by the way Mac's awake but can't come down to visit yet…is there anyway I can get a picture of Sophie to take back to the ICU for her?" he questioned on his way out the door.
Sure, I'll let Val know to take a Polaroid."
Harm sauntered back down toward Sophie's room, but paused outside the door as he heard two nurses talking.
"How's this little one doing?"
"She's had a rough night," stated Val. "She was in bad shape when she came in, but she's starting to respond to therapy now. The family's had a rough time too. The Mom's in ICU and Dad's been running between the two places."
"Was that the commotion I heard earlier?" Harm grimaced at the statement, had he been that loud he wondered.
"Yeah, Dad was a little frustrated, but it's to be expected…he's had a long night…me, too. What I wouldn't give for a café mocha right about now," Val mused longingly. "Scratch that, I work again tonight. Maybe I better settle for a cup of chamomile tea and a warm bath…I need to get some sleep."
Harm checked his watch and smiled. If he hurried he just might have enough time, he thought as he rushed out of the NICU.
He arrived back in Sophie's room 20 minutes later, hands behind his back and smile in place. "Hey Val, do I still have time to say goodbye to Sophie."
"Sure," Val responded never looking up from her paperwork.
"I want to apologize about earlier."
"That's OK, don't worry about it," Val looked up from the chart just as Harm pushed a cup in front of her. "What's this?"
"Chamomile!"
"Sir, you didn't have to…."
"Yes I did. And if I act like that again, you have my permission to call me on the carpet. Rank doesn't matter when it comes to my little girl's care," he smiled. "Oh, and this is for tonight's shift," Harm withdrew a certificate from behind his back, "…it's good for one café mocha at the gourmet coffee shop downstairs." The flyboy smile was firmly back in place. "Thanks for taking care of Sophie."
Harm settled back in at Sophie's bedside for a brief visit as Val continued charting. She looked up a few minutes later at the sound of music and glanced toward Sophie's bed. "What's that your humming, Captain?"
Harm looked up startled, "I'm sorry what was that?"
"I asked what you're humming?"
He blushed, "I didn't even realize I was?"
"It was a beautiful melody. I just wondered what the song was?"
"I don't know, I don't remember hearing it before," puzzled Harm.
"Oh by the way, here's the picture for your wife," Val handed him a photo across Sophie's bed
Harm took the Polaroid and smiled. On the picture the nurse had written 'To Mommy, I love you, Sophie'. "Thanks," he glanced at his watch, "I better get this back to the ICU before visiting hours are up."
He managed to get back to the SICU just at change of shift, but when he flashed Lucy another 'flyboy' grin he was allowed a few minutes to visit with Mac. He presented the picture of Sophie as though it were a 'prized masterpiece.' Then with an exchange of kisses and few whispered endearments, he left the hospital to head home for a much-needed shower and breakfast.