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: 24 (всего у книги 33 страниц)

LARA

  SOUTH GENERAL HOSPITAL, July

Lara was attempting a new exercise as she worked out at her gym’s boot camp for the third time this week. Because she wasn’t taking her college classes, she had stepped up her already frequent exercising, determined to throw her energies into something that would give her a natural high.

“Take this,” her trainer said, handing her a forty-five-pound plate. Lara was skeptical; forty-five pounds was a lot of weight for a five-foot five-inch woman weighing 123 pounds. As she swung the plate from between her legs to overhead, she felt a horrible burning sensation in her stomach.

“Something doesn’t feel right,” she said.

“Wimp!” a boot camper called out.

“Wimp-ass!” shouted another. The trainer laughed.

“Oh my God, my stomach is killing me,” Lara said. This wasn’t a sore-muscle kind of feeling. It felt like someone was tightly squeezing the area near her belly button. Determined not to lose face, Lara finished the set of fifteen reps and moved on to her next exercise.

At work that afternoon, Lara noticed a bulge in her lower abdomen. She knew what it was right away. So did her coworkers. Every once in a while, she tried to push her intestine back where it belonged. “Girl, your shit is sticking out!” the nurses told her. “Quit pushing it back in!”

When Lara finally saw her primary care doctor, he diagnosed the hernia and sent her to a surgeon. “I have two things to tell you that you’re not going to be happy about,” the surgeon told her. “One, you need surgery. Two, you’re not going to be able to exercise for six weeks afterward.”

Immediately, Lara’s mind began whirling. I’m going to get painkillers! I get a free high! she thought. For the next two weeks, she was appalled at how quickly her thoughts corkscrewed into old, familiar patterns. This is so exciting! a little voice exulted. Maybe I should ask for the prescription ahead of time so I don’t have to get it after surgery. Maybe I should go pick it up now!

A few days before the surgery, Lara still hadn’t told anyone about it. At work, the vials beckoned once again.

JULIETTE

  PINES MEMORIAL, July

Care at Pines had continued to falter. The Westnorth Corporation had decreed that instead of having a second trauma doctor on call in case multiple traumas came in, which often happened with car crashes, the ER physician would be considered the second trauma doctor. The new policy alarmed Juliette. “The ER doctors have never, ever covered trauma,” she explained. “And now, in addition to covering patients in the ER, they’re also going to have to cover trauma? The hospital is doing that just to save money. They’re sacrificing the patients.”

One morning, Wendy, an older part-time nurse, came sauntering through the ER, flashing a large diamond ring. “I’m engaged!” she told an ER volunteer. “Guess what? I got engaged!” she announced to the secretaries. She navigated the department throughout the day, telling everyone except for Juliette. She kept walking by her, pretending Juliette wasn’t there.

Wendy hadn’t spoken to Juliette for about a year now, ever since a disagreement over a patient. A woman had come into the ER with a dislocated ankle. When Dr. Hughes, a resident who picked up ER shifts only occasionally, went into the patient’s room, Juliette was across the ER, in the bathroom. At the sound of a bloodcurdling scream, Juliette raced to her patient’s room to find that the resident had pulled her ankle into place without offering any pain medication.

Juliette gasped and rushed to the patient’s side.

“It’s okay,” the doctor said to Juliette as he turned to leave the room.

“He just relocated the ankle,” another nurse said.

“Without pain meds?” Juliette said. She turned to the patient, who was incontinent because of the agony. “I am so sorry he did that to you without any pain medication.”

“What are we giving her?” Juliette called out to the doctor.

“Dilaudid.”

Juliette rushed to the medication dispenser, pulled the medication from the machine, then ran back to the patient.

“Thank you,” the patient whispered, and reached for Juliette’s hand. Juliette sat with her for a few minutes, then changed the patient’s gown.

As the patient settled in to rest, Juliette took the other nurse aside. “Why wasn’t she medicated?” she asked.

“We asked for pain meds and the doctor said it was fine, she didn’t need it.”

“Juliette, hallway please,” the doctor said from outside the room.

“We had the pain meds to give her,” Juliette told him.

“I had to do it right away,” Dr. Hughes said. “There wasn’t time.”

“No, we could have medicated her,” Juliette said.

The doctor shook his head. “Next time that happens, you need to call me out of the room and tell me you have a problem with what I’m doing.”

“Fine, but I believe what you did was wrong,” Juliette said.

From the nurses station desk, Wendy, openmouthed, watched the conversation like a Ping-Pong match. “I can’t believe you said that to the patient and were disrespectful to Dr. Hughes!”

“My first responsibility is to the patient, Wendy, not the doctor,” Juliette said. “The patient deserves care.”

At 65, Wendy was a nurse from a time when nurses stood up to give their seats to the doctors. “The doctor deserves respect and you shouldn’t speak to him that way,” Wendy scolded.

“Doctors aren’t God,” Juliette told her. “They need to be called out when they’re wrong.”

Wendy hadn’t spoken to her since. Meanwhile, Dr. Hughes and Juliette, who had a good professional relationship, easily resumed working together with no problems at all.

•   •   •

Juliette was eating lunch with Molly on their day off when Molly mentioned that she had seen Bethany at a nursing conference. “She said something that you’re not going to like,” Molly added. Juliette looked at her, puzzled.

“This is going to hurt your feelings,” Molly said. “This is going to upset you. But I have to tell you.”

“Okay,” Juliette said. She figured she had angered somebody at work. It wouldn’t be the first time.

Molly paused. “Well, Bethany said that in her interview for senior charge nurse, Priscilla told her, ‘I heard the only reason you were applying for the job was so Juliette wouldn’t get it.’”

“But I didn’t even apply!” Juliette said.

“I know. Bethany said you two were friends and she never thought that, much less said that,” Molly said. “But then Priscilla said, ‘Between you and me, I would never hire Juliette for senior charge nurse.’ ”

Juliette sat back hard in her chair. “Wow” was all she could say. Her eyes welled. She hadn’t applied for the job because she had no interest in it. She liked being charge nurse on occasion, and coworkers had told her she was great at it, but she didn’t want a full-time supervisory job. Her heart was bedside, with the patients, doing the job she loved.

Molly continued, “I wanted you to know what she said because Priscilla is not the same person to your face as she is behind your back. I know that you’ve trusted her and that you’ve been confiding in her. I thought you should know what she is saying to your colleagues about you because I’m worried she’ll tell people about your private stuff, too.”

Juliette was dumbfounded. She had believed that Priscilla liked and respected her. Priscilla had never written Juliette up, never called her into her office, never told her she was performing poorly at any aspect of her job; rather, she had frequently encouraged Juliette to be charge nurse. How was Juliette supposed to become a better nurse if her supervisor wouldn’t tell her what she was doing right or wrong? “Why would she do that to me? If Priscilla really felt that way, why wouldn’t she have told me during my evaluation? Why would she tell someone else?” Juliette wondered. “Priscilla was totally unprofessional, and it makes me angry and upset. The number of times I have been in Priscilla’s office and shared various confidences, felt that she was on my side, believed in me, thought I was a good nurse. To find out she said this to another employee is hurtful and a betrayal. And I didn’t even want the job! All I wanted was clin 4. She’s gossiping and trying to create fights. It’s staff-splitting. It’s wrong, it’s damaging, and I can’t possibly respect her after this.”

Priscilla’s slight was not only a personal betrayal from the one person left at Pines who Juliette had considered a confidante, but also a reflection of a toxic environment where cliques, gossip, and vendettas affected both staff morale and patient care. Good nurses were underappreciated and Juliette was a good nurse. “Priscilla is an ineffectual manager on so many levels. Her duplicity is too glaring to ignore, and Charlene’s poor managerial skills combine to make a miserable work environment. The emotional drain isn’t worth it anymore,” Juliette said.

During her next shift at Pines, Juliette found Bethany in the med room looking for supplies. “Bethany,” Juliette said, “I heard from Molly that Priscilla told you she would never give me the senior charge nurse job.”

“She did!” said Bethany, looking relieved. “I told Molly because I knew she’d tell you and I didn’t feel comfortable telling you that directly. Priscilla said she wanted to make sure I knew she’d never give you the job. But you didn’t even apply!”

“I’m just astonished she would say something like that,” Juliette said, disappointed that the gossip was true.

“It’s so completely unprofessional,” Bethany said, shaking her head. “What are you going to do?”

“I don’t know. I’ve been done with this place for so long anyway.” Juliette thanked Bethany and went on with her workday.

That evening, Juliette called Erica, the senior charge nurse who had resigned in November. She explained what had happened. “Can you believe she said that?” Juliette asked.

“I can absolutely believe she said that,” Erica replied. “I heard things that she said about me in that office. There’s an endless cesspool of information flowing from that back office to the ER. She fosters a sorority girl atmosphere with the gossip and the backstabbing, which is why I couldn’t wait to leave.”

“If I go agency, would you write me a letter so that I can update my recommendations?” Juliette asked.

“Of course I will.”

The next day, Juliette came to a decision. Molly had been trying to persuade her for months that she would be happier if she went back to the agency they had worked for previously. It was finally time to give up on Pines. Like many talented nurses continually defeated by poor working conditions, Juliette quit.

Juliette found Priscilla in her office. “I’m resigning and this is my two weeks’ notice. I’m going agency so I can look for work closer to home,” Juliette lied. She saw no reason to tell Priscilla the truth. As Molly would say, how would you get that horse back in the barn? Juliette was proud of her work, doctors and nurses complimented her on it, and it had been good enough to make her one of the few Pines ER nurses to achieve clinical level 4. If the nursing director couldn’t respect that but wouldn’t tell her to her face, then it was simply time to move on.

“Okay,” Priscilla replied. She said nothing further. She resumed her paperwork and Juliette never saw her again.

The doctors had a different reaction. “I’m sorry to see you go,” Dr. Kazumi told her.

“That’s really bad news,” another doctor said.

On her way out of the building, she told Dr. Preston that she was leaving Pines. “Well, you’ve finally done it, Clark. You’ve driven me off.”

“I knew it wouldn’t take long,” he joked back.

Juliette smiled. There were some people she would miss at Pines. Her eyes watered.

“They’re jackasses if they don’t treat you right,” he said, squeezing Juliette’s shoulder.

“I love you; that was really nice,” she said.

“I’m not such an asshole.”

Juliette hugged him. Then she unfriended the clique on Facebook.

MOLLY

  July

The Fertility Clinic

On a warm summer morning, Molly wearily listened to Jennifer, her fertility clinic nurse, list the names and prices of the medications she needed for IVF.

“Man, it’s expensive to buy a baby,” Molly half-joked. “We need all of those?”

“Yes. But I can give you some,” Jennifer said. “We have some leftover medications from people who had more than they needed, and I can also put together some samples from the drug companies for you. That should save you about four thousand dollars.”

“Are you serious?” Molly exclaimed. “Thank you, thank you, oh my God, thank you.” She hugged Jennifer.

Jennifer smiled. “We nurses need to stick together!” she said.

Exactly thirty-six hours before the egg retrieval operation, Molly had to give herself an ovulation trigger shot. While her previous injections had been subcutaneous shots with small needles, this was a large needle that she was supposed to inject into her thigh muscle. She had only one chance to get it right. Because Trey had to work that night, Juliette had offered to do the injection, but Molly didn’t want her to have to get up at 2:30 a.m. Molly sat on the toilet seat, her hand shaking. Schoolchildren can do their own insulin injections but the almost 40-year-old broad who gave countless shots to other people today is a huge wuss. Needles didn’t bother her; she worried she would hesitate, flub the injection, and lose that expensive dose. As a nurse, she knew what to expect, but as a patient she felt vulnerable.

Molly counted to three, exhaled forcibly, and jabbed the needle into her thigh. Success. She was so amped with relief that she couldn’t get back to sleep. She toyed with the idea of calling Trey, who was at the station, but he was trying not to emotionally invest too much in the process in case it didn’t work. His self-preservation was probably wise. Nonetheless, for a few minutes, she let tendrils of daydreams hazily curl into the image of a baby.

The next week, Molly and Trey were in a surgical room with an ultrasound and video monitor. The screen displayed a picture of two embryos, one with eight cells and one with four. Those could be our babies! Molly thought, mesmerized. She turned to look at Trey, who was silent as usual, but noticeably wide-eyed, staring at the picture, too.

The embryologist presented her with a photo of the embryos in a small paper frame. Molly didn’t want to get her hopes up, not with her low chance of success. But she couldn’t stop staring at the picture.

Citycenter Medical

At Citycenter, a woman came into the ER with a severe allergic reaction to nuts. Molly was in the medication room when another nurse, who was new to the ER, came in to get the epinephrine that a resident ordered. The nurse stared at the vial. “Can I ask you something?” she said to Molly. “The new resident ordered point-three milligrams of one to ten thousand epi. That doesn’t seem right.”

“It’s not. It’s one to one thousand given subcutaneously,” Molly said. She showed the nurse the dosage in the hospital’s drug guide and pulled out the proper vial. Molly was swamped with her own patients but accompanied the nurse to the allergic patient’s room. This was a high-risk situation with a high-risk drug and she didn’t want to put the new nurse on the spot in front of the resident.

“I’m giving one to one thousand,” the nurse told the resident, who was in the patient’s room.

“No, you’ve pulled the wrong vial,” the resident insisted.

Molly spoke up. “If I were giving one to ten thousand, I would have to give three milliliters instead of point-three and you don’t give that volume subcutaneously.”

Molly glanced at the patient, whose lips had swollen practically to the size of Twinkies. Epinepherine was risky because too high a concentration could put the patient in cardiac arrest; too low wouldn’t reverse the allergic reaction. This patient didn’t have time for the doctor to make the wrong call. Molly drew up the dose from the correct vial and injected the medication while the resident argued with the other nurse.

Once the resident saw what Molly was doing, she stalked out of the room.

“Go get the attending physician,” Molly told the other nurse.

The attending confirmed that Molly had been correct and the resident’s order had been wrong. Nobody thanked the nurses.

This was typical. If a nurse made the wrong call, she could get fired. If a resident made the wrong call, the nurse could get fired simply for carrying out her orders. And when the nurse made the right call, residents often took the credit. One afternoon, a Citycenter patient came in with an obviously broken leg. Because Molly couldn’t feel a pulse, she used a Dopplar machine to check for blood flow. When the brand-new resident came in, she told him what she had done.

A moment later, the attending physician entered the room. “What’s going on?” he asked.

The resident’s chest puffed. “Obvious fracture. I got the Doppler and found a pulse,” he said.

“Good job!” the attending said.

“How can they take credit for my work right in front of me?” Molly wondered later. “They want so desperately to look smart in front of the attendings. How hard would it be to use the word ‘we’ rather than ‘I’?”

Residents weren’t the only doctors who made medical errors, of course. At Avenue Hospital one day, an ER doctor had prescribed a clot-busting medication used for heart attack or stroke patients. Molly had never given this medication before, but the dose seemed high. When she asked the doctor to double-check, he pulled out his calculator, re-entered the patient’s weight, and said, “It’s right.”

Molly sent the order to the pharmacy. When the medication was ready, she started the medication pump, which began working extremely quickly. That doesn’t seem right, Molly thought, and stopped the pump. She opened the drug book the hospital kept in every room, but the medication wasn’t listed. Molly returned to the doctor and told him she didn’t think the dose was correct.

“It’s right,” he said again. Molly verified the dose with the doctor a total of six times.

By the time Molly brought the patient to the ICU, the entire dose had been administered.

“When did you start this?” the ICU nurse asked.

“Twenty minutes ago,” Molly said.

The nurse’s eyes widened in alarm.

The next day, the ER nurse manager called Molly into her office. The ICU nurse had written an incident report about the dose, which had been wrong. The patient could have died. “I have to write you up because it was a medication error,” the nurse manager said.

“Y’all can ask the doctor, the pharmacy, all of the people I asked for information on this medication that I tried to confirm the dose,” Molly said.

“Yes, but you were the one who gave the medicine,” the nurse manager said.

Molly didn’t confront the doctor because she learned that the doctor told the patient what had happened and had accepted responsibility (which didn’t change the fact that the incident was documented in Molly’s file).

At another hospital, Molly remembered when a doctor ordered the wrong medication for a patient. As per protocol at that hospital, the patient’s nurse acknowledged the order on the computer and clicked a button when she had given the medicine. Later, when the nurse returned to the computer to update the patient’s chart, she saw that the medication order, which she had already administered, was gone.

In the fallout, the doctor claimed he had never ordered the medication. The hospital fired the nurse. The nurse responded by filing a lawsuit, forcing the hospital to research the records. After four months, the hospital admitted that the doctor had lied, and agreed to rehire the nurse. “But the doctor is still there! He wasn’t fired!” Molly said. “They blindly trusted the doctor over the nurse. That kind of thing happens all the time.”

Chapter 9

What Makes a Hero

:

Why Nurses Do What They Do

“Nursing is a calling, a lifestyle, a way of living.”

–The Nightingale Tribute, developed by the Kansas State Nurses Association to honor deceased nurses

“Nurses are the glue that holds healthcare together. They live to assess, treat, coordinate care, and advocate for patients, and they do it all under the most direct of pressures with the littlest of concern for their own health or well-being. There is no one less self-concerned than a nurse. They are the implementation masters of coordinated care.”

–a Virginia women’s health nurse

“It’s incredibly fulfilling. As a nurse, you have the opportunity to provide hope and comfort to people on what is often one of the worst days of their lives. I feel whole when I am caring for others, teaching them to care for themselves, and helping them heal.”

–a Washington, DC, cardiothoracic surgery nurse