Текст книги "The Nurses: A Year of Secrets, Drama, and Miracles with the Heroes of the Hospital"

Автор книги: Alexandra Robbins

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Текущая страница: 10 (всего у книги 33 страниц)

JULIETTE

  PINES MEMORIAL, October

Nurses were buzzing about a cookout that Anastasia, the leader of the nurse clique, was hosting for hospital staff. Juliette could see Anastasia inviting several of their coworkers and mutual friends on their individual Facebook walls. She waited for Anastasia to invite her. Anastasia was calling it the Pines Memorial Cookout, for Pete’s sake. She had even invited Charlene, and Juliette knew that Anastasia didn’t like Charlene.

Juliette had considered unfriending Anastasia so that her Facebook posts wouldn’t torture her anymore. But everyone at Pines was Facebook friends with one another, and the nurses were constantly Facebooking at the nurses station. Juliette had joined Facebook when she was hired at Pines specifically because the network was an integral part of those nurses’ lives.

Juliette’s favorite tech noticed that Juliette’s mood had dipped. “What’s bothering you, Juliette?” asked Mimi.

“The whole Anastasia thing about the party,” Juliette said. “I can’t believe she didn’t even invite me.”

“Oh, I wouldn’t worry about that,” Mimi said.

“I do worry about that!”

“Anastasia’s the kind of person who will walk by me and not even say hello,” Mimi said.

“Really?” At least Anastasia was cordial to Juliette in person.

“Absolutely. She’s just part of that clique,” Mimi said, shrugging as she left to check on a patient.

Juliette wished she could ignore the clique’s behavior like Mimi did. Then again, Mimi probably didn’t have Juliette’s insecurities; she was slender and fit.

Juliette rubbed her temple and smoothed her auburn hair off her forehead. She had a terrible headache. She got migraines regularly, headaches that knocked her flat with pain and nausea. She had told only Priscilla, Molly, and Lara about them. Her primary care doctor didn’t believe in prescribing narcotics, but the medications he did prescribe rarely worked. In desperation, Juliette had asked for a Percocet prescription from a PA who had prescribed her antibiotics in the past. With the hours nurses worked, getting prescriptions at the hospital sure beat waiting for a primary care doctor’s appointment.

The Percocet soothed the migraines within forty-five minutes, but the headaches returned at least once a month and Juliette’s prescription was running out. Percocet was the most efficient, if not an optimal, solution. She did not have time to deal with headaches at work, and she certainly didn’t have time to deal with them at home.

Priscilla, Pines’ nursing director, was the only person at Pines who knew about Juliette’s home life; this was one of several secrets Juliette had confided to Priscilla. Juliette’s husband, a data center manager, was an unrepentant workaholic. Juliette knew this when she married him, but the problem had accelerated over the years. Nearly every night after dinner, Tim went back to the office for hours, endlessly stressed about earning enough money. The rest of the day, Tim was an attentive husband and father, smart, interesting, and helpful; he took Michelle to and from school and got her ready in the morning. But his insistence on working nights had put a strain on their marriage.

In the evenings, Juliette would rush around, trying to manage the household herself. She would go to bed later than she should, hit the snooze button in the morning, and fight traffic on the long commute to the ER. She often arrived at work five to ten minutes late.

That afternoon, after giving a patient a dose of Dilaudid, Juliette palmed the half-full glass cylinder. It was the length of her index finger and about 3 millimeters in diameter. It would be so easy to take this home, she thought. Prescription costs added up. No one will know if I take some. It’s not like I’m shooting up at work. It would just be a home injection of a med that we were going to throw out anyway. Patients often came into the ER seeking narcotics, and got them. Why couldn’t a nurse who truly needed the medicine have it, too?

When a new patient arrived, Juliette put the Dilaudid in her pocket. She would think about it later. The patient, a middle-aged woman with orange-tinted hair, was complaining of back and neck pain and trouble with urination. She told Juliette and the ER doctor that she had waited for an hour in the lobby. “This can’t take very long, because my dog’s in the car,” the woman said.

“Why did you bring your dog?” asked Dr. Mark Kazumi, a generally pleasant man. Juliette liked working with Dr. Kazumi. Other nurses teased him because he ordered a lot of labs. But Juliette appreciated that he tried to do right by his patients.

“I didn’t think it would take very long,” the patient said. Many ER patients assumed that service should be like fast food: Get in, get your orders, get out.

“Well, it’s going to take a little bit of time,” the doctor said. “I can’t make it quick for you. I’ve ordered a urinalysis and a CT scan.”

When Dr. Kazumi and Juliette left the room, he turned to her. “Juliette, I need you to check on the dog.”

“Are you serious?” Juliette asked. It was a balmy, breezy October day.

“Yeah. The dog can’t be left outside alone. It’s against the law,” the doctor said. “The dog could suffocate out there; it could be stolen. You need to find the dog, and I’m going to call the police on her if it’s not okay.”

Juliette sighed. “Don’t call the police.” She returned to the patient’s room.

“Where are you parked?” she asked the woman as she wheeled her to radiology.

“In front of the ER.”

That was helpful, Juliette thought. “Can you give me more of a description?”

“No. I’m in front of the ER.”

“What kind of car?”

“Accord.”

“What color?”

“Silver.”

While the woman was in the CT room, Juliette went outside. There was no silver Accord in front of the ER. There were, however, several silver Accords throughout the parking lot. Juliette grumbled to herself. I have four other patients but I’m out here searching for a Bichon in an Accord.

After ten minutes and eight empty silver Accords, Juliette called the tech in the CT room. “Can you please ask Mrs. Swirsky where exactly she parked?”

Juliette could hear the patient saying, “The dog is fine. I knitted him a blanket and he’s sleeping on it.”

The tech came back on the line. “She doesn’t remember.”

Juliette continued to wander the parking lot, her headache now weightier beneath the disappointments of drudgeries that had little to do with her job.

LARA

  SOUTH GENERAL HOSPITAL, October

On a crisp afternoon, Lara’s friend Juliette called to say hi. After some small talk, Juliette mentioned her migraines and her struggle with them at work and at home. “It’s really inconvenient, because my regular doctor won’t prescribe narcotics, so I got Percocet from a PA. It wouldn’t be a big deal if I took a wasted vial from the ER now and then, right? They’re just going to get thrown out. I still have one in my pocket because I forgot to waste it.”

Lara froze. This sounded all too familiar. “That would definitely be a big deal. I’m really worried about you,” Lara said. “You’re talking intramuscular use.”

“Oh, it’s just occasional,” Juliette said. “I was thinking I could give myself a shot of Dilaudid to get rid of my headaches. But only if they’re really bad.”

“Yeah, but I’m really worried. Narcotics are a slippery slope.”

“There’s nothing to worry about! It’s just for my headaches. You know how bad my migraines get. The Dilaudid would be only point-five milligrams at a time.”

“It’s still narcotic use and you’re talking about stealing,” Lara pressed.

“Only one or two times a month,” Juliette said.

“Juliette, listen!” Lara said. “You are using drugs. You’re using drugs! You’re softening it too much. I’m afraid you’re going to end up in a situation like I did where you have to have it or else you’re sick. When you use narcotics, you get rebound headaches. They’re the worst.”

“Oh, it’s just intramuscular. It’s not in a vein,” Juliette said.

“That’s bullshit,” Lara said. “No normal person brings home narcotics and gives themselves shots.” The first few times Lara brought narcotics home from the hospital, she, too, had rationalized it as “just occasional.” Then she told herself she did it because “I like the buzz.” And then “That guy was a jerk.” Eventually, she didn’t bother with excuses. Lara decided that Juliette had told her about the Dilaudid because she wanted help.

She took another approach. “From my history and experience, I’m afraid for you to go through the same hell I went through. It’s a nightmare. I don’t want that to happen to you. Throw it out.”

Juliette was silent. “Well, maybe you’re right,” she said. “I have enough issues with eating, anyway. I don’t need to have anything else. And I don’t want to get in trouble or disappoint Priscilla.”

That’s the least of your worries, Lara thought. Lara believed Juliette cared too much about what Priscilla thought of her because the nursing director was Juliette’s only confidante at Pines. Sometimes Lara wondered if Juliette was confusing Priscilla’s managerial tendency to let employee transgressions slide—in Juliette’s case, late arrivals to work—with friendship. Lara wished Juliette had more faith in herself. Juliette was a fantastic, knowledgeable nurse who was an unwavering advocate for her patients. She shouldn’t need to seek her supervisor’s approval to validate her self-worth.

A few days later, Juliette texted Lara. “I’ve been thinking about what you said. I threw out the vial and I’ll go ahead and look into some other options for my headaches.”

Relieved, Lara would pray for Juliette, both because she didn’t want anything bad to happen to her friend, and because she was grateful. “Listening to her downplay it reminded me I don’t want to be there again,” Lara said. “The whole Nurse Jackie thing is so prevalent. Not just nurses, but doctors, PAs. One of the NA meetings I go to is specifically for firefighters, nurses, doctors, and policemen. They don’t know who can help them watch their back.”

Chapter 4

When Nurses Bully Nurses

:

Hierarchies, Hazing, and Why They Eat Their Young

“The nurse treats colleagues, employees, assistants, and students with respect and compassion.”

–Code of Ethics for Nurses, Provision 1.5

“I knew the minute it came out of my mouth that I had just ‘eaten my young.’”

–a pediatric oncology nurse in Arizona

MOLLY

  November

Riverport Hospital

One day, for variety, Molly took two shifts at Riverport, a highly regarded local hospital, despite another nurse’s warning that “some of the charge nurses try to set up agency nurses to fail.” Molly didn’t mind; the timing worked with her fertility schedule. Her first IUI had been unsuccessful and she was now preparing for her second.

She didn’t let the results get her down. Her fertility treatments affected her work life only in that she cared even less about the drama among coworkers. She had always been a diligent, focused nurse, but now that conceiving a child was at the top of her priority list, she wasn’t about to spend time or energy getting emotionally involved with non–work-related nonsense. Her goal was to come in, do her job, and go home. At Academy and South General, she could do this well. At Citycenter, it was more difficult because the conditions were so unsafe.

At Riverport, Molly learned quickly that the warning about other nurses was accurate. The charge nurse assigned Molly four critical Priority 1 patients, each of whom needed one-to-one care. When Molly said the patients needed more attention, the nurse snapped, “I just figured you could handle it. I guess not.”

Molly gave report that night to an incoming nurse who happened to be someone she had worked with at Citycenter. Molly told her what had happened.

“Yeah, they are such mean girls here,” the nurse said. “No one helps anyone out, and there’s definitely a social hierarchy.”

Molly noticed the hierarchy during her shift the following day. Seven nurses were apparently the “cool” nurses in the ER. They were 22– and 23-year-olds who, as Molly observed, “do their hair and makeup like they’re going clubbing.”

The cool nurses hung out together exclusively, which was fine with Molly, but the techs wanted to help only the cool nurses, which was not fine. Molly happened to be charting at the nurses station next to Lena, the clique leader. Whenever another “cool nurse” walked by, Lena stopped her. “Hey, we’re going to happy hour tonight, but don’t tell anyone, because I only want the cool people there,” Lena would say.

Molly shook her head in disbelief. After six cool nurses—and fifteen apparently uncool nurses—passed by, Lena turned to Molly. “I guess you can come, too”—she paused—“if you want.”

At first Molly was astonished by the nurse’s immaturity. She had to remind herself that these were girls, not women, and that they weren’t that many years out of high school. She was constantly amazed by the ways that some of these young nurses could act like teenagers one moment, then flip a switch and impassively handle high-pressure patient situations the next. ERs could hire new grads to work on codes when they were doing keg stands a month ago. Molly decided not to call the nurse out on her behavior because it didn’t affect her, unlike the charge nurse’s attitude toward agency nurses. “I already have plans,” she said. She would not return to Riverport again.

Molly had heard that some staff nurses treated agency nurses poorly, but she was surprised now that it was happening to her. “If the agency nurses weren’t there, the staff nurses would have a much higher patient ratio,” she explained. “We make their job easier, but they’re rude and unfair.” Another agency nurse had told Molly that one day she had arrived at an ER that had a total of seven patients. The charge nurse assigned her all seven. When the nurse asked why, the charge nurse said, “You’re agency. You’re getting paid more than us. You can handle it.”

Some hospital administrators were partly to blame for creating an us-versus-them mentality. During October’s Emergency Nurses week, one of two nurse appreciation weeks during the year (the other is National Nurses Week in May), hospitals usually gave nurses tokens of appreciation. At an Academy Hospital staff meeting Molly was required to attend, the ER manager had given plush blankets with Academy’s logo to every nurse in the room except Molly. “Sorry, these blankets are for staff,” she said. How easy would it have been to give out one extra blanket instead of making me feel like I don’t contribute to the department? Molly thought.

Molly cared less about the gifts than the sentiment. Academy supervisors had repeatedly told her that she was a valuable nurse and had asked her to pick up extra shifts. “I probably would’ve used it as a dog blanket anyway. But really, right in front of me? ‘You’re agency, so we can’t give you one?’” she groused to a friend. “Why are you going to make people feel excluded when we’re there to help you? All of the agency people are experienced nurses. Why are y’all trying to create animosity between the two?”

Citycenter Medical

By the time Molly finished an exhausting shift at Citycenter, 110 patients waited in the ER, more than many ERs saw in an entire day. That night, Molly vented to Trey about Citycenter. He listened patiently to her, like he always did.

“So stop working there,” he said. As usual, a man of few words.

Molly paused for a moment to reflect. Why wouldn’t she simply stop working at Citycenter? Academy was easier (though less interesting). “I don’t want this job to beat me,” she said. “I don’t want anyone to think I can’t handle it. I don’t think any job is too hard for me, and I don’t want to walk away.”

“If you’re getting burned out, just work a day or two every once in a while,” Trey suggested. “Lowering your stress level might make it easier to get pregnant anyway.”

“That’s true, but I’m not stressed. I’m just angry. And full-time Citycenter nurses are putting themselves through those conditions every single day. If I walk away, I’ll feel like they are stronger nurses than me.”

“You took the agency jobs to see if there are better hospitals than Pines,” Trey said, affectionately squeezing her shoulder. As he left the room, he added, “Maybe there aren’t.”

The next day, Molly had just given report to a night-shift nurse when an ambulance brought in a little old lady who had fallen. She had been assigned to a room, but the Citycenter nurses were swamped with other patients.

As Molly passed by the woman’s bed, she noticed that the woman had urinated on herself. Molly was weary and off the clock, but she knew that if she didn’t help the patient, she would be sitting in wet clothes for hours. Molly worked up a sweat as she struggled to change the woman’s clothes.

The woman was grateful. She said sweetly, “I think anyone who is an ER nurse must really want to be an ER nurse. It’s such a difficult job.”

“I think so, too!” Molly said.

On her way home that night, Molly reflected that the woman was correct. “As much as I complain about all the B.S., if I didn’t want to do it, there are lots of other options in nursing. But I choose the ER. There’s a sense of satisfaction that comes with ‘fixing’ people,” she said. “In so many areas of healthcare, people have long-term treatment for things they may not recover from. In emergency medicine, a person comes in with crushing chest pain, gets diagnosed with a heart attack, gets meds, gets shipped to the cardiac catheterization lab, and gets fixed. A person comes in with abdominal pain, gets diagnosed with appendicitis, goes to the OR, and gets fixed. I need to remember that I chose this specialty. The reality is healthcare is broken. I need to figure out how to either let it go or decide how I can contribute to fixing it.”

Molly had no desire to be a floor nurse. At every hospital where she had worked, there was a rivalry between the ER and the other nursing departments. “We think they’re lazy and they think we’re bitches,” Molly said. One of the most frequent complaints ER nurses had against floor nurses was that floor nurses tried to avoid getting new patients as shift change approached.

Many floor nurses made excuses to Molly and her colleagues for why they couldn’t take a patient at shift change. “The room’s not clean” was one of them. More than once, Molly had gone upstairs to the floor, found the room to be clean, and called the nurse’s bluff. Another favorite was “There isn’t a bed in the room,” which meant housekeeping would have to bring up a bed. When one floor nurse used this excuse, Molly discovered that the nurse herself had pulled the bed into the hallway to avoid getting a new patient when she wanted to leave work.

During Molly’s next Citycenter shift, she called the medical/surgical floor to give report on a patient. The nurse who answered the phone said that the patient’s nurse-to-be was on break.

“Okay, I’ll give report to whoever is covering for her,” Molly said.

“There isn’t anyone covering,” the nurse said.

Right, Molly thought. This hospital is so fucked up. “So if one of her patients needed something while the nurse was at lunch, who would help them?”

“Me,” the nurse answered.

Molly didn’t miss a beat. “Okay, then you’re going to be getting a forty-four-year-old female admitting for intractable vomiting . . .”

LARA

  SOUTH GENERAL HOSPITAL, November

In the middle of the nurses station, two nurses were screaming at each other. Lynn, a young ER nurse, was trying to move a patient to the psychiatric department, but the patient’s blood sugar was high, at 200 mg/dL, when normal levels ranged from 70 to 100. Tashia, a psychiatric nurse who had been at the hospital for many years, wanted the patient’s blood sugar stabilized before moving the patient upstairs. She told Lynn, “No, we’re not taking her yet.”

“You’re a nurse. You can treat the blood sugar just like we can. We need her upstairs. She’s being admitted for treatment,” Lynn protested.

“You don’t know what you’re doing!” Tashia yelled. “You’re incompetent! You’re a horrible nurse!”

The nurses station quieted. Tashia, who was nearing retirement, was known to be a bully, but this was different. She was yelling at Lynn in front of other nurses and patients on stretchers in the hallway, including the patient in question. From their rooms encircling the nurses station, ER patients peered through the curtains at the spectacle.

Lynn raised her voice right back. “Don’t you dare call me names!”

Tashia got into Lynn’s face, her finger within poking distance of Lynn’s eyes. “You want to hear name-calling? Fine! Everyone thinks you’re a skank!” Lara hadn’t heard that before. Lynn was a petite, beautiful black woman. Lynn didn’t say anything. She walked away.

When Lara finished her charting, she caught up with Lynn in the hallway. Rose was already there, patting Lynn on the back. Lara asked if she was okay.

“Yeah,” Lynn said. “I felt like if I came back at her, I’d be yelling at an old woman. She’s an angry, bitter woman.”

Still, Lara could see that she was shaken by Tashia’s outburst. This was Lara’s only complaint about South General: A small but unavoidable group of the nurses was verbally abusive. While at other hospitals, the bullying could be more covert or passive-aggressive, at South General, hostilities were blatant. “There’s some serious attitude here. Maybe it’s from years of having grown up in this rough area,” Lara observed. “People put up an angry, defensive wall. It’s difficult to break down that attitude with each individual coworker.”

Despite racial tensions, Lara, one of the few white nurses at the hospital, hadn’t landed in anyone’s crosshairs. Evidently someone had noticed that Lara seemed to get along with everyone, because in November, the ER director selected her as one of fifteen people to join a new hospital-wide committee. A healthcare management company had developed the Relationship-Based Care program with the goal of improving staff members’ attitudes toward each other so that they could work better as a team. South General had just signed up.

The committee’s mission was compassionate and holistic. The mandatory three-day RBC conference emphasized the message, “If you take care of yourself, you’ll be a better person, better mom, better wife, better coworker, better nurse. When your coworkers are looking out for each other, it will become a more therapeutic environment,” Lara said, excited to help. The instructors asked the groups to brainstorm what they could do to improve relationships in their hospitals.

Lara’s committee, consisting of six ER staff members and six nurses from other floors, decided that their first short-term goal would be to set up crisis intervention help for staff. Hospital professionals grappled with traumas and tragedies in different ways. Lara suspected that another South General nurse was turning to narcotics to cope. Fatima was a 28-year-old night-shift ER nurse. A tech recently had told Lara that just before shift change, he had seen Fatima roll a needlebox cart into a storage closet. That’s a good idea! Lara couldn’t help thinking, understanding immediately that Fatima was desperate enough for partially used vials of narcotics that she would stick her hand into a box full of used needles in a hospital that treated many patients with HIV and tuberculosis.

The tech had followed Fatima into the closet and turned on the light to see Fatima’s hand in the needlebox. “What are you doing?” he asked.

Fatima immediately withdrew her hand. “Uh, the box was full, so I’m putting it away,” she said.

“So why’s your hand in there?”

Fatima mumbled an unintelligible excuse and the tech had let her go.

During Lara’s next shift, she was heading toward an RBC meeting when she saw Fatima in the hall. Lara recognized the signs: Fatima was pale, sweaty, and sluggish. Her face had a greenish sheen. Oh my God, you are dope sick, Lara thought. She played dumb. “Hey, Fatima, isn’t your shift over?”

“I got called into the office. When people don’t like you around here, they make stuff up about you. So I’m here to tell my side of the story,” Fatima replied.

She probably doesn’t even see it, just like I didn’t, Lara thought. She wanted to help Fatima, to tell her that she could still turn herself around without losing her nursing license. But she wasn’t sure how to convey that she knew about her habit. Lara worried that Fatima could accuse her of slander and get her fired. Fatima was barely an acquaintance; they passed each other in the hallway only occasionally during shift change.

Lara decided to ask her Thursday night group what to do. For years, her group of eight women—all friends from NA—met once a week to check in with each other. They could tell Lara how to handle the situation.

But at the network’s next meeting, Lara didn’t have a chance to discuss Fatima. The bulk of the dinner was spent consoling a woman whose father had died, so Lara didn’t mention some recent disappointments in her own life. She had learned that she wouldn’t be able to volunteer occasionally as her kids’ school nurse after all. School nurse volunteers were required to take a CPR course run by the county, but the course was offered only once per semester and Lara wasn’t able to attend that day. The county wouldn’t allow Lara to work in the school even though she was a CPR-certified nurse who cared for critical patients regularly.

Also, Lara’s marriage was deteriorating. John was openly flirting with other women and gambling again but denying that he had a problem. Sometimes Lara thought about leaving him, but she didn’t know how her family would manage. Even though he still wasn’t working, Lara couldn’t fathom being a single mom on a nurse’s salary without having John around for childcare. “If the kids say, ‘Can I join T-ball’ or ‘Can we go to the movies,’ I don’t want to be in a place where I can’t give them that basic childhood stuff,” she said. She soldiered on.