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: 25 (всего у книги 33 страниц)

“I’m Right There Wearing a Dress”: Why Murses Are Nurses

At six feet two inches, with 230 pounds of muscle and a 32-inch waist, WWE wrestler Dean Visk was enjoying a successful second career when he decided to leave professional wrestling because he missed nursing so dearly. “I thought to myself, ‘I’m a healthcare professional.’ The WWE is wonderful, but I felt like nursing was my calling,” he said.

Visk originally got into nursing because, as an amateur bodybuilder, he was interested in the prerequisite anatomy, chemistry, and biology classes. He was a full-time behavioral health nurse for five years before moving to Cincinnati to work part-time as a nurse while training for the WWE. He trained for four more years before the WWE offered him a contract. The other wrestlers didn’t mock him for working in a predominantly female field; instead, he said, they were impressed that he had such a stable career to fall back on.

Now Visk is an outpatient facility nursing director who continues to wrestle on the side for charity functions (and tells patients who recognize him, “I don’t fight anymore; I heal”). “I’ve had nothing but positive experiences in nursing,” he said. “If it’s a sisterhood, then I’m right there wearing a dress with all the other nurses. I’ve always been taken into the sisterhood without any issues.”

Out of 3.5 million nurses in the United States, approximately 330,000 are male. The highest percentage is concentrated in anesthesia: 41 percent of CRNAs are male, while 9.6 percent of registered nurses are male.

Because murses are so dramatically in the minority, some of them have had to deal with lingering public stereotypes that they are gay or effeminate, which both devalues gay nurses and contradicts an American Journal of Men’s Health study finding that male nurses “hold a high degree of masculinity.”

“You know what’s not fun in your early twenties? Being well-dressed, walking up to a girl at a bar, sparking a conversation, and then telling her you’re a nurse,” said a Virginia murse who has contended with these stereotypes. “I had to work backward to prove my heterosexuality. Now that I’m older, in a long-term relationship with a woman, and generally more confident, I don’t really care what people think. But those first few post-graduation years were rough.”

An Oregon critical care nurse said that his favorite jibe about his job is “So, you’re a male nurse, huh?” He likes to reply, “Yep, I tried to be a female nurse, but couldn’t afford the operation.” (He added, “I am not effeminate. I am a dude.”)

Comments about being gay, feminine, or “not man enough” helped push one nurse to join the U.S. Army, which deployed him to Afghanistan with an active combat unit, at his request. The guys in his unit good-naturedly referred to his medical supply bag as “the murse’s murse,” for the male nurse’s man-purse. “I got to apply and test my skill-set and medical knowledge, at times in the most adverse of conditions, producing some of the most powerful memories I will ever experience,” he said. “On a few occasions, I was the first person on the scene for people who were critically wounded in battle. The opportunity to create my own valuable experiences is something that nursing offers that most other career fields don’t. Nursing puts you in the driver’s seat.”

Most murses said that these stereotypes don’t bother them, and that their sexuality, gay or straight, is nobody’s business but theirs. What bothers them is when (typically older) patients assume that because they are men, they must be aspiring doctors. A Canadian ICU murse said that while he had originally planned to be a surgeon, he changed his mind during the month he spent at his father’s hospital bedside before he passed away. “I realized, after seeing the effect that the nurses had on me and my family, that I could have a much bigger impact on patients by being at the bedside all the time, instead of simply writing out orders and operating on someone, but never really being there for them,” the murse said. “I get offended when patients don’t understand why I wouldn’t want to be a doctor, or they keep asking about my ‘real aspirations’ in life. When that happens, I have to explain that my goal is to be a nurse, I love what I do, and I get to do more as a nurse.”

A Maryland medical floor murse had been on the job only a few months when, even after he had clearly introduced himself as a nurse, the patient and patient’s family continued to refer to him as “doctor” and the female physician as “the nurse.” A Delaware murse explained why this is insulting not only to the doctor but also to the nurse. “It insults my profession when people think that if I say something smart, I must be a physician,” the nurse said. “When I worked in the ER, patients would say, ‘You’re so good! Don’t you wish you were a doctor?’ No. I’m a nurse. It’s like telling a chef he’s so good, why doesn’t he become an IT programmer. It is absolutely infuriating. And female nurses never have to deal with it.” Dean Visk, who is finishing his master of science in nursing degree and plans to get a PhD, said that even when he becomes a Doctor of Nursing Practice, “I’ll still identify myself as a nurse. I’m very, very proud to be a nurse.”

On a personal level, murses’ experiences as the minority gender can vary, depending on the unit: While many, like Visk, feel welcomed, others deal with occasional teasing from coworkers. Professional challenges can include “always having to take the infected patient because you’re the only one who can’t get pregnant,” a New York NP said. The Oregon nurse echoed a common murse observation that they are disproportionately assigned to the most difficult patients and often get called in to do the heavy lifting.

But they get paid more to do it. According to the U.S. Census Bureau, male nurses ride the “glass escalator”; although they are in the minority, they receive higher wages and faster promotions than women in the same jobs. The wage gap is smaller in nursing than in other professions, however. Compared with men, women earn ninety-one cents to the dollar in nursing occupations, versus seventy-seven cents to the dollar on average across other fields.

Some men become defensive about being in a field with mostly women, but the majority of the murses interviewed for this book didn’t consider the disparity to be a problem. “Yes, I’m in a job where I am surrounded by women. But guys, come on, I’m in a job where I’m surrounded by women!” said the Army nurse, who is now stationed at a base in Europe and engaged to a female physician. The murse’s female coworkers and the “sixty-five sisters” in his nursing school class provided him with “access to some pretty big answer keys,” he said. “I dress better than most of my male friends, I understand what I did or said to make a woman upset or happy, and I have an endless supply of opinions on gifts and date ideas.”

The murse, however, cautioned other potential male nurses, “As a general rule, you aren’t in the nursing field to get laid.” Instead, “If you’re the caregiving type of guy, you should join us because of the wide range of nursing opportunities. You could work in a hospital or nursing home, dabble in management and administration, you can travel, or you can stay put,” he said. “Don’t let the female-dominated work area intimidate you. Want to know what brings a smile to everyone in the ER? Seeing that big burly wall of muscle and testosterone who’s good with kids. There’s nothing like a nurse’s feeling of satisfaction at the end of the day.”

SAM

  CITYCENTER MEDICAL, August

One night, the charge nurse found Sam in Zone 1 to give her a five-minute heads-up that a trauma was on the way: a pedestrian who was struck by a car and thrown several feet. Five minutes was a decent amount of time for nurses to prepare for a patient; typically medics didn’t call Citycenter until they were practically on the back ramp. Sam arrived at the trauma bay at the same time as CeeCee. Before Sam could open her mouth, CeeCee announced, “I’ll be bedside and you can document.” CeeCee thought bedside nurses got all of the glory, but Sam didn’t believe that one nurse was less important than another.

Sam shrugged, uncomfortable about working with CeeCee. At least CeeCee had just returned from a three-week vacation and seemed relaxed and ready to work. Sam crossed her fingers for a drama-free night.

When the already intubated patient came in, a physician conducted an assessment while various doctors hooked the patient up to the vent and inserted a chest tube. Sam recorded all of these procedures while CeeCee took the patient’s blood pressure.

The moment the patient began to wake up and fight the ventilator, Sam pulled drugs from the Pyxis and handed them to CeeCee. CeeCee continued to monitor blood pressure and assist the doctors as Sam recorded. When the patient stabilized enough to move him to the CT room, Sam helped CeeCee hang units of blood before, during, and after the scan. (“The scaredy-cat doctors were all behind the glass watching us get irradiated,” Sam said.) Sam was surprised to notice that she and CeeCee worked well together, managing the flow of various doctors’ orders and dispensing medications.

Once CeeCee took the patient to the ICU, Sam began her hour-long stint at the computer to document the series of procedures coherently. When CeeCee returned from the ICU, she sat down for a few minutes to help. Sam hated to admit it, but CeeCee was a good nurse under pressure. She finished documenting with a newfound respect for CeeCee.

Sam had come a long way in only a year. She had realized that “everyone is going to come to the table with different opinions and personalities, but the goal is to take care of patients, so everyone getting along is important. As I learned, it’s hard to be on your best behavior for twelve hours when your coworkers are pissing you off. But you work extremely closely with them. I’ve worked with people who’ve touched my butt more than guys I’ve dated (it’s totally normal for people to take my trauma shears out of the butt pocket of my scrub pants). Patients come and go, but your colleagues can make or break your shift. So I can at least give everyone a chance.”

Sam’s next patient was an intubated man with carbon monoxide poisoning. She monitored his propofol, a powerful sedative that required just the right balance: enough to keep the patient sedated, but not so much as to lower his blood pressure excessively. Within a few minutes, the man started bucking the vent, agitated. His chest raised, his head strained against the stretcher, and his heart rate increased. Before the man could wake up, Sam increased the propofol. Three minutes later, the man’s blood pressure dropped. She lowered the propofol. Ten minutes later, the man became agitated again. Sam called in a tech to help her hold the man’s arms down so she could increase the propofol once more.

Sam paged the attending doctor. “The propofol isn’t really working,” she said. “I think we need something else to sedate him.”

The attending nodded. “Good call. How about a Versed drip?”

Sam nodded and prepared the drip. He actually listened to what I said! He took me seriously! she thought.

After a few hours of standing by the patient’s bedside and watching his monitor, Sam noticed that he was having longer and longer runs of bigeminy, a heart rhythm that, while not immediately threatening, could lead to more dangerous rhythms. She checked his labs, saw that his magnesium levels were slightly low, and found the attending. This doctor was a reasonable man who had worked at the hospital for decades.

“His mag is one point two,” Sam said. “I think we should give him magnesium.” Low levels of magnesium could cause irregular heart rhythms.

“Good call,” the attending said. “Why don’t we give him two grams of mag.”

Sam hung the bag of magnesium on the IV pump. She was pleased. For so many months at Citycenter, the charge nurses had assigned her to zones that didn’t see seriously sick patients, making Sam feel as if the staff didn’t think she knew what she was doing. “Now I have a sick patient and the doctors are listening to me,” she realized. “Maybe I kind of do know what I’m doing after all.”

Everything seemed to be falling into place. Sam and William were happy together as a couple, but they kept their relationship under wraps at work. She didn’t want to fuel any more rumors, especially when she was finally gaining respect as a nurse. Her professional reputation was becoming, in her words, “I’m a no-nonsense hard-ass. We’re going to do things the right way and efficiently and don’t give me any crap.” She liked that reputation because it minimized drama. “If everyone is clear that’s the way it’s going to go from the start, then staff are less likely to sit around and have social hour.”

Even she and Dr. Spiros had gradually thawed. The gossip about Sam had tapered off, probably because of CeeCee’s vacation. Sure, nurses made comments here and there about Sam’s supposed love life, but Sam could let those remarks slide.

A woman in her early thirties came in one night with stress-induced supraventricular tachycardia, a dangerous arrhythmia in which the heart raced at more than 180 beats per minute. To treat SVT, staff first tried getting the patient to bear down as if having a bowel movement. This was a technique aimed at activating the vagus nerve—called a vagal maneuver—to slow down the heart. If that didn’t work to bring down the arrhythmia, the next step was to administer adenosine, a drug that stopped the heart for a few seconds so that it would hopefully resume at a slower rate. In the ambulance on the way to Citycenter, the medics fortunately had been able to use adenosine to convert the patient’s heart rhythm back to normal.

The ER doctor told the woman to follow up with her cardiologist, and ordered some Ativan to calm her down. Sam could hear through the curtain from the next patient area as the woman explained her fears to her husband. The patient was upset because she was under stress at work, which was leading to a cycle of increasing SVT episodes. She did not want to take Ativan. Sam guessed that the doctor had not adequately described the patient’s condition and treatment.

So she popped in to talk to the patient. “I thought you could use some more information,” Sam said. “Stress can activate a vicious cycle: You get stressed out, you get SVT, and that makes you even more stressed. So I can only imagine how stressed you are.”

The woman nodded.

“If I were given the option, I would take a really small dose of Ativan just to bring the stress down a notch. It could break the cycle,” Sam continued. She explained that Ativan wouldn’t affect the woman’s heart rate, but was intended to calm her so that her heart wouldn’t start racing again. She answered the couple’s questions and talked to them for ten minutes.

Sam was not a warm, fuzzy nurse. She probably never would be. In her opinion, giving a patient “all the information is more calming to someone than patting them on the head like, ‘There, there dear.’ ” By giving the couple thorough information about SVT and Ativan, she was hoping to provide them with “every tool they needed to make a good decision.”

The woman agreed to try the Ativan. As Sam walked away to retrieve it, she overheard the woman say to her husband, “She’s awesome. She gets it!”

Sam paused in the hallway for a moment to collect herself while her eyes filled with tears. She explained, “I think it meant so much to me because it wasn’t intended for me to hear. This is why I got into nursing. I was able to talk to her like a human being and help her understand what we were trying to do. There’s a different sense of satisfaction than when you work on an interesting trauma patient. With most traumas, you’re using your brain on a clinical and tasky level but you don’t really interact with the patient. Anyway, it was the nicest compliment.”

Sam had assumed she needed to become a nurse practitioner in order to gain universal respect within the medical industry. As she said, “It’s been my mission to make doctors and laypeople realize this isn’t our grandmothers’ nursing. I don’t wear white and I sure as hell don’t stand up when a doctor enters the room.”

Now, after a year as a nurse, she could see that she didn’t need the doctors’ validation. Rather than view ER nursing as a stepping-stone toward a more prestigious degree, she knew that her job was about healing. She also didn’t need patients’ respect. Sam was a nurse to save patients’ lives, not to convince them to appreciate her. But oh, what a difference it made when they did.

JULIETTE

  EASTGREEN HOSPITAL, December

Juliette hesitated in front of the broad automatic doors of the Eastgreen ER, where she had landed permanently following eight weeks of agency work. After working full-time for a few months at Eastgreen, a hospital with a good reputation and a varied patient load, she had arranged a two-week unpaid vacation to spend quality time with her husband and daughter. Now, as she prepared to resume working, she remembered when she had returned to Pines after a three-week vacation and no nurses other than Molly had welcomed her back.

Eastgreen, which was not far from Juliette’s home, had a much larger ER, with twice the number of Pines’ staff. Juliette couldn’t help but wonder if some of her new coworkers had already forgotten her name. Thus far, the experience at Eastgreen already outclassed Pines. Most of the nurses Juliette had worked with were courteous. Unlike at Pines, Eastgreen nurses were diverse; they ranged in age, race, looks, weight, sexuality, and numbers of tattoos and piercings. The charge nurses made a point of thanking nurses who worked hard, like Juliette.

Socially, Juliette and several coworkers had started a book club. She was friendly with one of the ER doctors, and she had traded dog-sitting days with another colleague. A group of nurses had even invited Juliette to go on a whale-watching trip.

Despite all of this, Juliette worried about how they would react when she returned. After all, she had trusted Priscilla, but her judgment had been wrong. She took a breath and entered the ER. The first tech who saw her gave her a hug. “Juliette, we missed you!” she said.

At the nurses station, the nurse manager stopped her. “I’m so glad you’re here! How was your vacation?”

“Juliette’s back?” asked the ER doctor, looking up from his computer. “Hey, I got a new puppy! Come here and see the video.”

The nurse manager read Juliette a compliment from a patient evaluation that had come in while she was gone. The patient had written that she knew how busy ERs were. “Juliette took great care of us,” the patient said. “It made such a difference with our stay and we just want to acknowledge the care we received.”

Juliette beamed. Eastgreen wasn’t perfect. There were social groups that she wasn’t a part of, and staff members who were unhelpful. But already, she felt more comfortable at work than she ever was at Pines.

LARA

  SOUTH GENERAL HOSPITAL, August

The day before the surgery, Lara couldn’t stop thinking about the drugs. Remember how shitty you felt when you were trying to get clean? she pleaded with herself. You don’t ever want to feel that way again. Don’t do this to your kids.

Frightened that she would succumb to temptation, Lara went to an NA meeting and shared: “I’m going to have surgery and I’m kind of excited about getting my stomach muscle cut open because then I’ll need Percocet.” She was embarrassed, but the response was immediate. “It’s cool you’re making yourself accountable by telling us,” a man told her.

“Who do you have to hold your medicine?” a woman asked.

“I guess my ex-husband,” Lara said. He was the only adult whom she saw every day. She would be most accountable to him because he was watching their kids.

“Do you want me to drive you to a meeting?” asked someone else.

Lara had mixed feelings. She had been eager for the meds, and now a little voice scolded her, You just ruined your chance. But her relief that her NA network would not allow her to relapse offset her disappointment. Quickly, she told several people about the surgery so that they would watch out for her. But even up until the moment of the operation, Lara was scared by how thrilled she was to get cut open because she would get high.

•   •   •

When she woke up, Lara was giddy on her post-op pain medication. After John drove her home, Lara called in her Percocet prescription. Still high from the surgery, she decided to drive the three miles to the pharmacy herself although driving so soon after surgery was inadvisable.

Lara picked up the prescription and three bags of chicken from the restaurant next door. She balanced everything on top of the car while she gently opened the door, careful not to strain her surgery site, then loaded the chicken into the trunk. As she backed out of her parking spot, she heard a crunch. She glanced in her rearview mirror, saw nothing unusual, shrugged, and drove back to John’s. After dinner, she went to her car to get the Percocet. Her plan was to keep two pills at home and give the rest to John to hold for safekeeping. The prescription wasn’t in the car.

He took them from me! Lara thought. She tore into the house, where she found John in the den. “Are you messing with me? Where’s the Percocet?” she asked.

“What do you mean?” John asked.

“The pain pills aren’t there! Did you take them?” she asked, panicking.

“Are you hiding them?” John asked.

Lara immediately felt guilty. Had she hidden them? She didn’t remember handling them, but she was still slightly loopy. This doesn’t look very good, she thought. They’re magically not there after I said I got them?

“Maybe your brother took them,” John said. “Maybe they fell out of the car.”

As she argued with her ex-husband, Lara remembered the strange crunching sound outside of the pharmacy. Oh no, she thought. No way.

She drove back to the parking lot and found the crushed bag. “No! No, no, no!” she shouted. Lara’s surgery site was now hurting so badly that she legitimately needed the Percocet. She scooped up the bag. The pills were pulverized, crushed into the shattered plastic they’d come in. I can’t believe I ran over my pain medicine.

Back in her car, Lara leaned her head on the steering wheel. It figured. The one time that she truly needed legally prescribed Percocet, she had accidentally destroyed the pills. She took a picture of the pills for evidence. Then she reconsidered. There is no way in hell I’m going to call the doctor’s office and tell them a) I was driving and b) I ran over my medicine and I need more, she thought. Later, she explained, “People come up with the most ridiculous stories to get pills. So I had to deal with having no pain medicine because I was too embarrassed to call the doctor and have them thinking I was drug-seeking.”

At home, Lara struggled through the agony and fought the urge to hunt down narcotics. Without her two major outlets—work and exercise, both of which were forbidden—she was lost. It rained every day. When the kids were home, she focused intently on taking care of them. When they were in school, she rested or watched TV, trying to ignore the pain in her stomach and the battle in her mind.

A few days into one of the hardest weeks of her life, Lara was sitting alone, tears streaming down her face because of the sharp pains. She couldn’t take the hurt any longer. I can send the doctor the picture to show that I’m not making this up, she thought. She picked up the phone to call his office. “Oh my God, you’re going to look like you’re crazy because you took the picture in the first place,” she told herself. “Forget it.” But the pills will take you out of this funk, a little voice nagged. She started to dial. “The pills aren’t going to take you out of the funk. You’ll get a little buzz, you’ll enjoy it, and then you’ll be going at it again.” She hung up the phone. How am I going to get through this?

For the next week, Lara refused to allow herself to think beyond the present moment. Forget day by day. Lara asked herself only, “What am I going to do right now?” Embarrassed and determined “not to be a drama queen,” she didn’t tell most of her friends about her predicament. But the people she did tell rushed to her aid. Angie, her former coworker and roommate, checked in with her regularly. Molly and Juliette brought her meals. Another nurse friend helped get the children through their nightly homework and bath routine. Friends from NA drove her to meetings every night; one even found a meeting site with no stairs so that Lara would strain her abdomen as little as possible. The South General ER nurses, who knew nothing about Lara’s addiction, sent a get-well basket with flowers and candy. Rose, Holly, and Brianne had tucked in personal notes.

Four weeks later, Lara was back in the gym. She was profoundly proud that she had recovered without being seduced by narcotics. She believed she could get through anything now: overwhelmingly busy days, single motherhood, maybe even dating. She would not be presumptuous enough to assume she had beaten her demons; NA meetings were a reminder that the disease was waiting for her, that just one slip-up would send her back into its arms. So she accepted what she called “a healthy fear,” which she would live with, always, because of the mistakes she’d made in the past.

Why did Lara return to ER nursing, the worst possible job for her addiction—tempting her with narcotics to administer, to throw out, to watch other nurses steal? “Because being a nurse is my passion,” she said. “When all my struggles were going on, my biggest fear was that nursing would be taken away from me. It truly makes me happy.”

For Lara, being a good nurse also made her feel like a good mother. “As a nurse, I feel strong, like I can protect my children. Because of my medical knowledge, I know when something’s not right with them,” she said. “Every parent wants to feel like they’re keeping their kids as safe as possible. As a nurse I can make sure my kids are safe. And nursing pays pretty well, so my kids and I will be okay. It’s not easy supporting the family by myself, but I will make this happen.”

Lara wanted other nurses to know there is hope, help, and life after addiction. “You can get help and you don’t have to feel like this ever again, like you’re never going to laugh again, never going to feel good,” she said. “It does get better and you can do this clean. You can do anything clean.”

She had proven that to herself repeatedly over the past year. But now she finally believed it.