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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The Secret Club

Nursing is among the most important professions in the world.

In no other profession do people float ably among specialties, helping to ease babies into being, escorting men and women gently into death, and heroically resurrecting patients in between. There are few other careers in which people are so devoted to a noble purpose that they work twelve, fourteen, sixteen straight hours without eating, sleeping, or taking breaks and often without commensurate pay simply because they believe in the importance of their job. They are frequently the first responders on the front lines of malady and contagion, risking their own health to improve someone else’s. Nursing is more than a career; it is a calling. Nurses are remarkable. Yet contemporary literature largely neglects them.

At 3.5 million strong in the United States and more than 20 million worldwide, nurses are the largest group of healthcare providers. The women who comprise 90 percent of the workforce are a unique sisterhood whose bonds are forged through the most dramatic miracles and traumas as well as the tedious, routine tasks necessary to keep human bodies functioning. Nursing, for brave men and women, is “like a secret club that holds immense emotional joy and fulfillment in spite of shared tragedies,” a Michigan nurse practitioner told me. Nurses call the profession a secret club because their experiences are so novel, their jobs so intimate and occasionally horrifying, their combination of compassion and desensitization so peculiar, that they imagine nobody else could understand what it is like to work in their once-white shoes.

Pop culture would have us believe that nurses play a small, trivial role in healthcare; medical television programs tend to show doctors lingering at patients’ bedsides while nurses flit and intone “Yes, Doctor” in the background. But this is not the case. As a Minnesota agency nurse said, “We are not just bed-making, drink-serving, poop-wiping, medication-passing assistants. We are much more.”

They are, for example, reporters. They discuss and document patient status, serving as the main point of contact for doctors, surgeons, therapists, social workers, and other specialists. They are watchmen, keeping vigil, meticulously monitoring vital signs, deciphering patients’ individual trends and patterns, painstakingly double-checking dosages and medications. They are detectives, investigating deviations, asking questions, listening carefully, searching for clues. They are warriors, called to serve at the first sign of outbreak, fighting infection, containing disease. They are gatekeepers, turning staff members away when patients need a break from procedures, a nap, or a moment to digest their circumstances. They are scientists, constantly learning, tackling sociology, psychology, physiology, anatomy, pharmacology, chemistry, microbiology. They are advocates, lobbying physicians for or against procedures, for pain assistance, for a few more minutes of time. They are teachers, educating people about their condition, demonstrating home healthcare to patients and parents: how to suction a tracheostomy, change an airway, inject a medication, breastfeed a newborn. They are the muscle, holding patients down to insert or remove tubes or needles, pushing people to get out of bed following surgery, breaking a sweat when performing CPR, lifting, moving, pushing, forcing, turning. They are confidantes, protectors, communicators, comforters, nurturers; easing fears, offering solace, cradling babies whose parents can’t be there, consoling loved ones who feel that all hope is gone. They are multitaskers: supporting, coordinating, and inhabiting all of these roles at once. And they are lionhearted diplomats, helping a patient die with dignity in one room, facilitating a recovery in the next, keeping their composure even when they are shaken to the core.

•   •   •

To examine what it is like to be a member of this secret club, I interviewed hundreds of nurses in the United States and several other countries. Essays based on their perspectives of the behind-the-scenes realities of nursing support stories that follow a year in the life of four ER nurses in an unnamed region of this country. Most of the people and hospitals in this book have pseudonyms and/or identifying details changed or omitted to protect their privacy. Some chronologies have been shifted.

The nurses I chose as main characters illustrate a variety of triumphs and struggles common in the profession. Confident, funny, and charmingly bossy, Molly is well loved by both patients and staff. When Pines Memorial’s anti-nurse policy changes lead her to quit her job, she signs with an agency instead. Molly has given herself one year to find a hospital that treats nurses and patients well enough that she would want to join its staff. At the same time, she begins fertility treatments that place her on the other side of the curtain.

Lara, an able, trustworthy, committed ER nurse at South General, continues to battle the temptations of prescription drugs that are preposterously easy to steal, and doesn’t know that the coming year will bring major events that could trigger her downfall. Juliette, an ER nurse at Pines, is a hard worker who doesn’t hesitate to advocate loudly for her patients even when it is not in her own best interest to do so. Her blunt outspokenness does not endear her to many of her colleagues. Subsequently, she feels unwelcome in a workplace where patients’ lives depend on collegiality and communication among staff. And at Citycenter Hospital, Sam is a new nurse, young and awkward, whose introversion can come across as unprofessional. Sam is discouraged by her doctors’ and administrators’ overall lack of respect for nurses, but she has to overcome other hurdles, including rumors about her promiscuity.

These four women and the other nurses I interviewed voice a rallying cry for their colleagues. Through their stories and others’, this book presents an extensively researched snapshot of a subculture as well as an investigation of the medical industry’s treatment of the nursing profession. Physicians grapple with some of the same problems as nurses, and countless skilled and compassionate doctors treat patients, solve medical mysteries, and save lives. Physicians’ voices are already heeded, however. This is not their story. As such, some doctors may be depicted negatively in the stories to follow, but this book does not intend to denigrate doctors, techs, or, for that matter, patients. It is meant to represent nurses’ perspectives and to celebrate them.

In doing so, this book does not romanticize the career. Nurses want the public to know the truth about nursing. It can be a difficult, exhausting, exasperating, and dangerous job in which they are often overworked and understaffed. But it is also joyous, rewarding, challenging, fascinating, exciting, and meaningful. Nurses want current and future patients and their families to know the healthcare secrets that can save their lives. And they want potential future nurses to know how deeply and passionately they love what they do. “Nursing is not a job. It is a life,” a Kansas nurse manager said. “It is who you are.”

The nurses who shared their thoughts and stories for this book invite you to peer behind the Staff Only door at the controlled chaos beyond: the jubilance and heartbreak; the temptations, drugs, lies, and violence; the miracles and wonders; the dark humor and innuendo; and most of all, the people who care for us when we are at our most vulnerable and bolster us on what could be the worst or best or last days of our lives.

“Doctors breeze in and out. They do not share the most intimate moments with the patients, but they are the ‘important’ ones who get the media accolades,” a New Jersey nurse practitioner said. “It is the nurse who holds the hand of a patient without a family, who talks to them while they take their last breaths, who aches for them while they die alone. It is the nurse who cleans the patient’s body, wipes away the blood and fluids, and closes his eyes. It is the nurse who says good-bye to the patient for the last time,” she said. “Our story needs to be told. We want to be heard.”

They will be. And you will never view healthcare the same way again.

JULIETTE

  PINES MEMORIAL, August

When she left the patient’s room, Juliette retrieved an alcohol swab from her pocket and began to wipe down the pen the man had used to sign his discharge papers. Then she thought better of it. The patient was crazy and probably didn’t bathe often. She threw out the pen, stripped off her gloves, and trashed them, too. Back at the nurses station, she scrubbed her arms, hands, and neck with hand sanitizer, even though she had been wearing a yellow contact isolation gown.

Juliette’s husband made fun of her for being a germaphobe nurse, but she didn’t care. She sanitized her hands so often they were red and chapped. All day long she saw sick patients who didn’t wash their hands, who touched their faces (or worse), and then touched everything in the room. She reminded patients to cover their mouths when they coughed or sneezed, and still, they sprayed the triage booth unapologetically. The first couple of years she had worked as an ER nurse, she was constantly sick with respiratory or GI illnesses. Now she rarely got sick, but she was determined to protect her family from those germs. Even at home, Juliette made her daughter, Michelle, wash her hands constantly. Molly—the opposite of a germaphobe—teased Juliette that she bathed her child in Purell.

The ER felt different without Molly. In the three weeks since Molly had left, the unit had been noticeably quiet and boring. Without Molly’s witty sarcasm and infectious laugh, it was harder to deal with Charlene, the insufferable nursing supervisor. Without Molly, Juliette was lonely at work.

Socially, Pines Memorial hadn’t panned out as Juliette had hoped. At Avenue, the hospital where Juliette, Molly, and Lara had worked together before, the nurses had formed a lasting bond. They were together constantly, at and outside of work. When the Avenue nurse manager, whom Juliette had adored, left, and a disorganized, inexperienced manager took over, the nurses scattered to various hospitals across the region. But they had grown so close that three years after leaving Avenue Hospital, they still gathered a few times a year for parties and called each other for advice or comfort. Juliette and Molly were particularly tight. Neither woman was afraid to speak her mind.

When they left Avenue, Juliette and Molly had worked briefly for an agency that had sent them to Pines, where they eventually signed on to work full-time. At Pines, they had joined an ER that was dominated by a clique of beautiful nurses. Pines was known for its attractive nurses and dreamy doctors, but the ER nursing clique outshone the rest. They were a group of nine women who lived in the same town and scheduled frequent social events, including playdates for their children. They invited Molly, who did not have children. They did not invite Juliette, who did. For years, Juliette had tried to gain entry. She often complimented various members of the clique and she frequently mentioned her 7-year-old daughter.

It didn’t work. They chatted about their get-togethers at the nurses station, right in front of Juliette. They posted on Facebook, arranging outings and rehashing them afterward, even though Juliette could see every exchange, every ebulliently posed photo. They were pleasant enough in the ER, but they never made her feel included. They acted, and looked, like a sorority.

The clique loved Molly—everyone did—but she didn’t hang out with them. Instead, she was a loyal friend to Juliette. Juliette was 42 years old, and it still hurt to be left out. She wondered if they rejected her because she was six feet two inches tall and overweight. Between her size and her bright auburn bob, she couldn’t have looked more different from the clique. Juliette wasn’t looking for best friends. She just wanted to feel like part of a team. And the fact that Priscilla, the nursing director, was part of the clique made Juliette feel even more excluded.

Didn’t they already have something in common, something that could supersede the bonds of colleagues in other professions? They were healers, all of them, whose job was to reach people, to connect with them, to make them whole. Why couldn’t they be as compassionate to each other as they were to their patients?

“You don’t need them. You have me!” Molly would say.

But not anymore. Molly’s resignation was a blow to Juliette and to the ER in general. Dr. Preston, himself a large personality, had told Juliette that Molly’s leaving was a major loss to the department. Clark, who had light blue eyes and curly white-blond hair, was loud and hilarious, livening up the ER. He was one of the few doctors to insist that nurses call him by his first name, which seemed to soften the medical hierarchy. He could often be found joking around with the nurses, particularly the cute ones. Although he was a risk-taker with his patients, he was also straight– forward, which patients and nurses appreciated.

Once, a successful high school sprinter had come to the ER with a badly fractured ankle. “He can’t race tomorrow,” Dr. Preston told the boy’s parents, who were obviously overbearing and competitive.

“What will happen if he races?” the boy’s father asked, prioritizing the sport over his son’s health.

Dr. Preston smiled. “He’ll lose.”

Right now there wasn’t time to dwell. In addition to four other patients, Juliette had two rapid heart rate patients who needed constant monitoring. She was also precepting—training—a new nurse, which meant having someone at her heels and explaining everything she did throughout her shift. Juliette enjoyed precepting because she liked teaching and working closely with another nurse, but it did add to the busyness of the day.

Juliette and her precept, a freckled girl named Noelle, had just transported a complicated stroke patient to the Intensive Care Unit, when Charlene assigned them another extremely critical patient, a 60-year-old man who had fallen in the shower and hit his head. As Juliette and Noelle worked him up, Charlene told her, “We have another LOC [loss of consciousness]. Room 18. Brain injury.”

Hurrying down the hall, Juliette saw that Room 8, which was directly in front of the nurses station, was empty. Andrea, the nurse assigned to that zone, was idly surfing the Web. Why is Charlene giving me so many critical patients when Andrea has none? she thought. Suddenly, the monitors started beeping from Room 18. The new patient was crashing, unable to maintain his vitals.

When Juliette entered the room, she saw a neurological physician’s assistant frantically attempting to insert an IV into the brain injury patient. “I can’t get IV access,” the PA said. She had to prepare the patient for a central line, an IV line going into the major vein near the groin. Sometimes central lines could be difficult to place.

Charlene had overloaded Juliette with critically ill patients as if the preceptee were an assistant, rather than extra work for Juliette. Trainees were supposed to be learning directly from a preceptor, not thrown into the deep end as full-fledged nurses. Quickly but gently, Juliette instructed Noelle how to help. “Go check on the patient with the cardiac drip. Ask him if he’s having any further chest pains, and then check to see if the cardiac drip needs to be titrated based on his chest pain. Check on Room 16’s level of abdominal pain. Then come back here to see what else we can do for this brain injury patient before we assess him again.”

The PA tried again to insert the IV, but couldn’t. The pressure was getting to her. “Get me an ICU nurse! We need more people in here,” she hollered.

Juliette rushed to the hall to ask Charlene to check on Noelle and Juliette’s other critical patients. Charlene was nowhere to be found.

Scatterbrained and prone to favoritism, Charlene spent much of her day gossiping in her office, rather than making sure that patients received proper attention. She was hard on Juliette for coming into work five or ten minutes late when traffic was particularly bad, but said nothing to clique nurses who arrived half an hour late without explanation. She was overly focused on getting patients out the door as quickly as possible, so she could bring in more patients and increase hospital profits. And she certainly didn’t prioritize the overall safety of the ER. Recently, when a loud bang sounding like a gunshot occurred near the nurses station, Charlene shoved another nurse out of the way and bolted out the front door. For weeks, the nurses made fun of her for abandoning staff and patients to save herself, especially because the noise turned out to be a harmless equipment malfunction.

Charlene thought she was part of the clique. The nine nurses kissed up to her so that she would give them the plum assignments, and the ploy worked: Charlene blatantly favored Andrea and the other dominant clique members when it came to scheduling. But Juliette had heard them laugh about Charlene behind her back. The childishness of this behavior exhausted Juliette, who did not want juvenile social maneuverings taking up brain space that she hoped to devote to patient care.

Juliette’s patient was now completely unresponsive. His Glasgow Coma Scale, a range from 3 to 15 used to measure consciousness, was a 3: He was not opening his eyes to painful stimuli, talking, or moving any extremities. Without the central line dispensing medication, he couldn’t be intubated.

Finally, the tech got the line in. Juliette immediately started the medications to prepare the patient for intubation.

When the respiratory tech arrived to take over, Juliette and Noelle made sure their other patients were stabilized. Then Juliette stripped off her gloves, sanitized her hands, and found Charlene at the nurses station, where Andrea was still shopping online. “I’m done. I’m going to minor care for the rest of the day,” Juliette said. “I’ll meet you there,” she told Noelle.

“Okay,” Charlene said. “But you have to give report to ICU.”

“Andrea can do that,” Juliette said, frustrated. Charlene should never have assigned her three ICU-bound patients simultaneously when each of them required a nurse’s undivided attention.

Andrea scowled at Juliette.

“Never mind. I’ll do it,” Juliette said. She wiped down the phone with an alcohol swab before picking it up.

Later, Juliette found Charlene in the break room. “Why didn’t you give that patient to Andrea?” she asked.

“Because it was fine for you and your preceptee to take him. You guys could handle it together,” Charlene said. “And it was wrong of you to tell Andrea to call report.”

Juliette looked Charlene in the eye. “Sometimes I feel like Andrea does a lot more talking than working, and I took it out on her.”

“I understand,” Charlene said, matter-of-factly. “I do that in my work assignments sometimes.”

“Sounds like you’re admitting to favoritism,” Juliette said.

Charlene rolled her eyes.

The next day, Charlene assigned Juliette four seriously ill Cardiac Care Unit–bound patients, while other ER nurses had only the relatively low-maintenance run-of-the-mill ER cases, none of whom would be admitted to the CCU.

Juliette was a first-rate nurse, and could handle difficult patient loads. But every ICU and CCU patient needed a nurse who could spend time with them one-on-one. On a personal level, Juliette could ignore that Charlene and some other coworkers didn’t like her. She knew that stressful working conditions affected how she spoke to people. However, she worried about how tensions and exclusions, power trips, and freezing out among the nurses could impinge on patient care. Perhaps that was why the clique’s snubs bothered her so much. They weren’t folding sweaters here. Juliette took great pride in being a hardworking nurse who cared intensely for her patients.

Oh, who was she kidding? Of course she took the rejections personally. Between her weight and family issues, she had been socially insecure her entire life. Maybe what bothered her most was that people could lower her self-esteem in an arena in which she felt confident that she was good at what she did.