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

Автор книги: Alexandra Robbins

сообщить о нарушении

Текущая страница: 14 (всего у книги 33 страниц)

Chapter 5

Burnt to a Crisp

:

How Nurses Cope–and Why Some Crack

“The nurse owes the same duties to self as to others, including the responsibility to preserve integrity and safety, to maintain competence, and to continue personal and professional growth.”

–Code of Ethics for Nurses, Provision 5

“Compassion fatigue made it so much harder to take care of patients. Here I was, using all of my might to drag myself out of bed and march on, and I’m seeing these people whining over hangnails and really minor problems while I’m holding back tears and contemplating killing myself.”

–A North Carolina ER nurse

“I love the free entertainment that patients provide. People say and do the most ridiculous things, and I’ve got a front row seat to the absurdity.”

–A Colorado travel nurse

SAM

  CITYCENTER MEDICAL, December

On weekend nights, Citycenter’s ER regularly saw hordes of boisterous drunken patients brought in by police, EMS, or, occasionally, friends. Many times, the patients demanded to leave, but hospitals were supposed to keep intoxicated patients because they could be a harm to themselves or to others; and many of them were injured but too drunk to know it. The staff was allowed to discharge these patients when they were clinically sober—able to follow commands, walk with a steady gait, and tolerate oral fluids—even if they were not legally sober.

One chilly evening, EMS brought in a patient who was particularly riled up.

“I’m leaving this fucking place!” said the patient, a large man in his twenties.

“No, sir, you can’t leave. You’re drunk,” Sam replied. She stepped to his bed and stood in his way, as nurses were supposed to, to prevent him from walking out.

“I’m not drunk!” He started to sit up.

“Yes, you are drunk. As soon as you sober up, we’ll let you leave,” Sam said.

“I am sober.” He swung his legs over the side of the bed.

Sam, composed, stood her ground next to the bed. “Lay back, take a nap. We’ll get you some juice if you want.”

“I don’t want any fucking juice!” the man yelled.

Sam looked him hard in the eyes. “I’m really sorry but you’re not leaving. That’s the way it’s going to go. You can sit down or we can have security help you sit down.”

The moment the man’s feet touched the floor, William was at Sam’s side. “Hey, buddy, you need to listen to what she’s saying,” William said.

The man eyed William’s imposing build and got back in bed.

In the hall, Sam said, “I didn’t need your help. I can take care of this myself.”

William looked amused. “You needed a little backup.”

Sam rolled her eyes and checked on her next patient. Police had arrested a man who told the officers that he needed medical treatment because he had “the shakes” from alcohol withdrawal. (If an arrestee told local police he needed his diabetes or hypertension medications, or even that he’d had abdominal pain for three weeks, the police would bring him in to the ER.) He obviously was looking for an excuse to decrease his time in a jail cell. Sam recognized the patient, a man in his midtwenties who’d come into the ER drunk the week before. As Sam entered the room, Dr. Bernadette Geiger, the compassionate attending with the high voice, joined her. A police officer was sitting in the visitor’s chair, bored to be babysitting his perp.

The patient, slouched in the bed, sat up eagerly when he saw Dr. Geiger. “Oh, Doc! You remember me from the last time I was here. You know my problems; you know I need to be admitted. I’m having a really rough go of things.”

“No, sir, I’m terribly sorry, I don’t remember you,” Dr. Geiger said as she conducted a quick exam. “I take care of so many patients every day. I’m sorry, but this is protocol. You seem fine to me.” The patient would go straight back to jail.

When Sam and Dr. Geiger left the room, Sam said, “Dr. Geiger, we had him last week!”

Dr. Geiger winked. “Of course I remember him, but he’s not going to play any games with me.”

Sam grinned, happy to learn a new tactic.

•   •   •

On their second date, Dr. Spiros cooked dinner for Sam at his apartment. She was already flustered when she arrived late, after getting lost and then spending an embarrassing amount of time attempting to parallel park in front of his building. Inside, she looked around while Dimitri drained ravioli and poured glasses of wine. It still felt strange to call him Dimitri.

Dr. Spiros’s apartment was decorated with matching earth-toned accents from the bathroom to the living room. Only the office was unadorned, with minimal furniture. Sam browsed photographs on the mantel to make conversation easier. They had seen each other at work only once since their last date; they had figured out tonight’s logistics via text. I should not be here, she thought, scolding herself for being unable to gently say no to a second date. When a guy cooks a girl dinner, he wants to get laid.

They sat down at a table complete with cloth napkins. She had to give Dr. Spiros credit: He had made the pasta and sauce from scratch. She wasn’t sure how to feel, though, when he started talking about his ex-wife. “She didn’t like my hours as a resident, and now she’s trying to get a hundred grand from me,” he said. “I’m not even an attending yet and she’s squeezing money out of me.” His phone dinged and he looked down at it. “Speak of the devil. An email about the money she wants.”

Sam looked down at her plate. Ohh, this is awkward, she thought. Not cool to have the phone at the table, either. Dimitri changed the topic by talking about his now-defunct relationship with the Citycenter tech. Was nothing private? Would he talk about Sam to coworkers, too?

After dinner, they chatted on the couch. There was a lot to like about Dr. Spiros. He was hot, although that wasn’t a priority for Sam. He had plenty of interests outside of medicine, yet could understand, as she said, “what it meant to have an awful, crazy day at the hospital.” But their conversations kept veering toward his plans to teach medicine in underdeveloped countries. He was barely a doctor and here he was, ready to share his supposedly vast experience with the world.

“Teaching is great and all, but I’m just trying to not kill people at this point,” Sam joked.

Dr. Spiros seemed to be trying to impress her, expounding on his work in the ER and talking about expensive nights on the town. He described his trips to far-flung locales, but Sam had never traveled outside of the continental United States. Sam noticed that he was nestled into the opposite end of the couch. Does he want me to jump his bones or something? she wondered. He made no moves, so neither did she. She decided he must have asked her out as a rebound after his relationship with the tech ended. Perhaps he was talking so much about himself because they had little in common besides Citycenter, and she was still so new to the hospital that she didn’t know their colleagues well enough to discuss them. She wondered if the great, suave Dr. Spiros was nervous.

After a while, she said it was late and she should go. Dr. Spiros gave her leftovers in a Tupperware container—a cordial, if grandmotherly, gesture. When they said good night, he went in for an awkward pat-on-the-back hug. “Okay, I’ll see you later,” he said, defeated.

On the drive home, she worried about how they were going to interact at work. The dates had been so awkward—were they even dates?—that she had no clue how to follow up on them. I need to not date anymore, she resolved. I’m going to just put my head down and do my job. Dating can come later in life.

During Sam’s next shift, William caught up to her in the hallway and wrapped a strong arm around her shoulders. The top of her head barely reached his chest. “So? How’s my competition?” he asked, cocking his head suggestively.

“I’m not sure. It might be over,” she said. She described the end of the date.

“Oh yeah, you guys are done. Definitely,” William said.

“Thank you. That’s nice,” Sam said, sarcastic.

“Well, hey, that means you and I can hang out!” he said, batting her ponytail.

Sam huffed. What a flirt. William flirted with everyone. “You have a girlfriend.”

He started to say something, but Sam held up her hand and walked away.

The next time Dr. Spiros was on duty, Sam managed to avoid him by interacting only with a resident, which was unpleasant; the resident blatantly looked down on Sam and the other nurses. But Sam realized that although the resident was patronizing, she wasn’t intimidated by doctors anymore. Her dates with Dimitri had changed her perspective by dissolving the mystique around physicians. “You go into nursing bright-eyed and bushy-tailed, thinking the doctors know everything. You only see them at work, so you assume they’re like robots that go into sleep mode after work,” she said. “Getting to know Dimitri taught me that doctors are human, too, and they can be just as weird as you are.”

Sam vowed, “I’m just going to go up to them and say excuse me and say what I have to say. They won’t bite.”

MOLLY

  December

Academy Hospital

During a brisk week in December, Molly took two consecutive day shifts: one at Academy followed by one at Citycenter. At Academy, which typically wasn’t overwhelmingly busy even during the holiday season, she was surprised at the unusually high numbers of patients. Many of the patients in the Academy ER told her that they had already spent time at Citycenter that morning. After waiting in the Citycenter lobby for an average of three hours, when they finally received a room, nurses told them the doctor wouldn’t be able to see them for several more hours. They had come to Academy instead. Molly was mystified. Citycenter wait times were typically long, but not so long that patients were driven to another hospital. She wondered what was going on.

A patient came in with a systolic blood pressure of fifty-eight. Awake and talking, the patient was in her forties and bedbound with multiple sclerosis. Molly focused on getting the patient stabilized and improving her blood pressure. She gave the patient four liters of IV fluid, which did nothing. She administered a blood volume expander. She tried two different medications to increase the blood pressure. None of this was working, yet the patient was still awake and answering questions appropriately. Molly noticed the patient’s lactate—a blood lab that could indicate sepsis—was elevated and that she had a high white blood cell count. She did everything she could to raise the woman’s systolic pressure.

Finally, the patient’s systolic blood pressure reached seventy-one, the highest it had been since her arrival. Molly called the ICU, which sent a resident to write admission orders. “When she gets upstairs, I want her started on Dobutamine,” the resident said.

Molly called the ICU nurse. “Make sure y’all have a Dobutamine drip to get started when she gets there.”

“No problem,” the nurse said.

As soon as a bed assignment was available, Molly began to prepare the patient for transport.

Suddenly, the patient’s ICU doctor walked in, followed by a team of four residents lined up like ducklings. Molly inhaled sharply. It was Dr. Bitch. Dr. Baron whipped the curtain aside and strode into the room, followed by the four residents. She headed straight for the patient’s monitor, barely glancing at the patient. “Wait. This patient is not stable enough to go to the ICU,” she said.

“This is the best she’s been in the six hours she’s been here,” Molly replied.

“She’s too unstable for transport,” the doctor insisted.

Molly looked at the patient, who was listening to the conversation. One of the first things Molly had learned in nursing school was to treat the patient, not the monitor. The only information Dr. Baron had was the monitor’s blood pressure numbers. “Why don’t you talk to her?”

The doctor did not. “We can manage this patient. She can’t be transported like this.”

Molly bit her tongue. The ICU was just two floors up, perhaps a five-minute walk. “The patient has been in this condition—awake, talking, and joking—for six hours,” she said.

“I want her started on Dobutamine right now,” the doctor announced.

“We don’t carry it here, but the patient’s ICU nurse is getting it ready and will have it available upstairs,” Molly said.

“No. I want it now. Call the pharmacy and have them make it up.”

Molly was astounded. “She can be in the ICU before the pharmacy would have a chance to make it.”

“I don’t want this patient transported now,” Dr. Baron proclaimed, and stalked out of the room, leaving her residents behind.

It was 7:15 p.m., past the end of Molly’s shift. Once Molly and the residents were in the hallway, out of the patient’s earshot, Molly told them, “I do not care for your attending.”

“No one does,” one of the residents muttered.

Molly made eye contact with each of the four. “This patient has a room and will receive one-to-one care with an ICU nurse trained to manage a patient this sick. The ER is short-staffed tonight because two nurses called out. My priority is this patient, and being managed in the ER is not in this patient’s best interest.”

The residents stared at her blankly. “We cannot resolve this issue for you because she is our attending,” one of them said in a crisp foreign accent.

“What she’s doing is not in the patient’s best interest. What this patient needs is available in the ICU right now.”

“But she’s our attending,” said another resident.

“Y’all can’t give your opinion to someone?” Molly asked, surprised that none of these doctors was advocating for the patient.

No response. Molly said good-bye to the patient and walked out of the room. On her way out, a tech stopped Molly to say, “Thank you so much for sticking up for yourself, because no one ever says a thing to these doctors.”

Citycenter Medical

The next day, when Molly arrived for her Citycenter shift, the ER was teeming with hospital brass asking staff members about the department. Another nurse filled her in. The Joint Commission had sent surveyors to the ER for a surprise inspection. They were so disgusted by the lack of cleanliness and the nurse-to-patient ratio that they nearly shut down the ER on the spot. When the inspectors swabbed EKG lead wires, they found several different strains of bacteria. They gave the hospital forty-five days to fix the ER or TJC would close it. Citycenter ER administrators were frantically trying to set the department straight.

The mood among the nurses had lifted instantly. Until now, Citycenter nurses had believed they were stuck with their lot—that because their supervisor was part of the problem, they had nobody to approach for help. Even the patient load seemed more bearable because of the hope that TJC’s intervention would make the ER safer for patients and staff.

Molly’s favorite news was the charge nurse’s response to the inspection. Some charge nurses were given cue cards to follow so they could cover up some of the most blatant violations between the time inspectors registered at the front desk and reached the ER. Nurses were supposed to rush to move drinks from the nurses station, lock IV carts, relocate patient stretchers that blocked doors, secure oxygen tanks, clean rooms, and so on.

Citycenter’s charge nurse that day was Renée, the longtime veteran. When TJC checked in with the administration, a hospital official rushed to Renée in desperation and said, “TJC is in the building and heading here. Get the staff together and do what you can.”

To Molly’s delight, Renée answered, “No. I want them to see what this place is really about.”

LARA

  SOUTH GENERAL HOSPITAL, December

A few weeks after Fatima’s meeting with administrators, Lara finally told her Thursday night NA group about her coworker. The women said that it was important to get to know Fatima better before mentioning the drugs because she had to trust Lara to allow her to help. Lara didn’t work night shifts, but she tried to make small talk the few times she passed by Fatima in the hall. “I don’t know her well enough to be like, ‘Hey, there’s a big suspicion about you,’ ” Lara said to the group. “I still have to ease into being her friend.” One woman suggested anonymously sticking an NA pamphlet in Fatima’s mailbox, but Lara worried she’d get paranoid.

Nothing had come of Fatima’s meeting, as far as Lara knew. Administrators couldn’t fire a nurse without a concrete case. Lara had noticed that Fatima was arriving early and staying late, another tactic Lara had used. She often entered other nurses’ patient rooms, clearly, Lara thought, looking to score leftover vials.

Working extra hours wasn’t necessarily a red flag to someone who hadn’t been in Lara’s shoes. Some nurses worked 3:00 p.m. to 7:00 a.m., a full sixteen hours. Recently, Lara had spoken with a nurse who had worked twenty consecutive hours. “You can work twenty hours? That’s safe? How is that even legal?” Lara had asked him.

“I don’t know, but here I am. It happens all the time,” he replied.

Lara continued to devote herself to her Relationship-Based Care committee work. December could be an especially tough month for nurses because they had to deal with their patients’ anxiety on top of their own holiday stress. The committee was encouraging people to make a conscious effort to be nicer to each other, with posters in the staff bathroom and reminders during meetings. They turned “RBC” into a mild reminder for coworkers to calm down. Rather than telling a nurse she was acting like a jerk, staffers would joke, “Hey, check yourself, that’s not very RBC of you.” Since the formation of the committee, there had been no fights on Lara’s shifts. The committee hoped the more empathetic atmosphere would improve employee relationships and the ambience for patients. As Lara said, “What if you brought your kid into the hospital and you saw nurses calling each other skanks?”

Lara also suggested that the department have huddles at every change of shift, so the day’s entire team could touch base about who would be working where and whether they needed more assistance. Lara explained, “The huddle is about how we can work well as a team. If you’re in triage and you do blood work for the nurse in the back, that’s going to take a load off her. A lot of people weren’t happy because some trauma nurses sit and do nothing when there aren’t any traumas. That’s one of the main things: If your area isn’t very busy and you have the time, there’s most likely someone who needs help, so what can you do to help them?”

Lara led the ER’s first huddle. “Okay, team, today’s going to be a good day,” she said. “We have ten nurses working today. Rose is charge. Rachel’s doing trauma. Peter is in triage . . .” She listed each staffer’s assignments, including the cleaning crew she had invited to the huddle because they were part of the team, too. This way, everyone knew they were accountable for their area, and also the entire group knew where the weaker or new nurses were, and could help them accordingly.

“Anyone got anything going on today? Willa, how are your knees?” Lara asked a nurse in her sixties.

“They feel rough today, baby,” Willa said.

“Okay, everyone, we gotta look out for Willa. If you see her pushing a stretcher, go help her. She should not be pushing a stretcher today,” Lara said. “Guys, remember there’s no ‘I’ in team. We’re all in this together!” She punched a fist in the air, intentionally cheesy. The group laughed and scattered to their zones.

The nurse manager told Lara that the huddles were the most helpful and positive meetings the department had ever had. Hopefully, once the huddles became routine, administrators would join them.

Lara’s next idea was to set up a specific room for post-trauma crisis intervention. The committee was still working on developing ways to help the staffers after something devastating happened, as with a recent case in which a 12-year-old died from a bullet wound. “People die on our shift, sometimes several people in one day, and then we just go back to work. Imagine if you just did CPR on a kid and it didn’t work. Then you deal with coworkers who are being rough on each other, and patients are angry because they’re waiting. And there’s no downtime,” Lara explained. “You can only hear a mother scream after coming to see her dead child once and you will be affected by it. That scream, I can’t even begin to describe it. The secretary answering the phone, security, janitors, everyone—they’re hearing this incredible anguish and are expected to be unaffected by it.”

At the start of a committee meeting, Lara presented her idea. “I was thinking we should have a debriefing room, a place where we can gather our thoughts after something awful happens. Everyone from the nurses who worked on the patient to the janitor who mopped the blood off the floor could take five minutes to think, talk, or pray.” Lara thought this strategy could ease the tensions that were typically high for hours after a tragedy.

“That’s a great idea,” said a tech. “We need a place to go and sit for a minute.”

“Which room should we use?” Lara asked.

“We could use part of the lunchroom,” said a unit secretary.

“Then we’d be focusing on eating instead of catching our breath,” a floor nurse said.

“Why don’t we use this room right here?” asked another nurse. “It’s only used for meetings sometimes anyway.”

The group became animated as they came up with low-cost ways to make the room more serene. “We could put in one of those little waterfall-on-the-rocks things!”

“And a white noise machine with peaceful sounds.”

“I have the perfect picture I can bring in to put on the wall.”

“I could bring in some lavender, that’s a therapeutic smell.”

“Ooh, I have a cool plant I can donate.”

Lara was so excited that once the committee settled on colors for the room, she volunteered to purchase the paint out of her own pocket.

•   •   •

Two weeks before Christmas, Lara went to her mother’s house one last time to finish clearing it out before it went on the market. She posted on Twitter that she was having a sad day. In the middle of the night, Lara opened her laptop and scrolled through dozens of replies about her mother and the house, which had been the neighborhood hangout. The uplifting messages made her smile.

Then she read the next post on her Twitter feed: John had tweeted to a woman with a half-naked photo, one of those porn star models that hundreds of men posted to daily, “Alabama, you’re so hot. I want to put this picture on my truck.”

Lara knew that John had cheated on her in the past, she knew about his gambling addiction, she knew about his sex addiction. But to post something like this where all of their friends and family members could see it, right after Lara’s tweet about mourning her last day at her childhood home? No. Lara was done. People had told her that the last straw before a divorce often was relatively insignificant compared to past transgressions. She understood that now.

Lara turned on the light in the bedroom. “Hey, John, when you tweet to another female, like your friend Alabama, everybody sees it,” she said. “So now everyone we know is looking at your conversation with the porn star.”

John jumped out of bed, looking panicked. He ran to his computer and started deleting tweets. Lara took a deep breath and whispered a quick, quiet prayer: “Please give me the strength to do this.”

“John, I cannot do this anymore,” she said, her voice steady. “I’m going to move out. You have health insurance. Get help for this sexual addiction. You need to make an appointment.”

“Stop playing this bullshit game,” he said.

Lara had thought for sure that he would beg her to stay, but he didn’t. “I’m not going to your family’s holiday party tomorrow,” she said.

He didn’t believe her. The next morning, he loaded the car while Lara finished feeding the kids breakfast. “Just get your suitcase and come on,” he said.

“I’m not going,” she said.

“Get your goddamn suitcase. You know you’re going to go.”

“No, I’m not,” she said.

He looked momentarily surprised, then began to usher the kids out the door. Lara kissed her children good-bye and told them that she had to go to work. As soon as the door shut behind them, Lara burst into tears. She was proud of herself for finally standing up to him, but wondered, still, whether she was giving up too soon.