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: 4 (всего у книги 33 страниц)

SAM

  CITYCENTER HOSPITAL, August

Just don’t kill anyone, Sam thought, taking deep breaths as the charge nurse distributed assignments. You’ll be okay. Just don’t kill anyone.

She could see herself in a mirror across the hall, her arms self– consciously wrapped around her ample chest. Petite and slender with long, dark hair usually tied back in a ponytail, Sam had large gray eyes framed by delicate wire-rimmed glasses. She was sure her normally olive skin had a green tint this morning.

Since she had awakened at 4:30 a.m., 24-year-old Sam had been fighting the nausea that accompanied her nerves on her first official day as a nurse. It wasn’t that she was inexperienced. She had interned here at Citycenter Hospital for three months after graduating from nursing school. Before nursing school, she was an ER technician at Pines Memorial. But this was different. Now she would be held personally responsible for potentially fragile lives.

Sam sighed with relief when the charge nurse assigned her to Zone 3. The Citycenter ER was divided into a minor care area for stitches and breaks, and three treatment zones: Zone 1 for the sickest patients, Zone 3 for the least sick. She would be less likely to accidentally kill a patient who wasn’t too critical to begin with. As the charge nurse wrapped up the meeting, Sam mentally ran through the phone numbers she had memorized. New nurses were given cards with phone numbers for the charge nurse, lab, radiology, computer help desk, and tube station, a pneumatic labyrinth of tubes that sent specimens and paperwork through the walls to various departments of the hospital. Sam had learned as an intern that if the staff believed a nurse didn’t know what she was doing, they gave her a hard time. She had worked her tail off to get here. She wasn’t about to lose any respect on her first day because she had to look up a phone number.

Sam went to the nurses station to check the computer for the outgoing nurse’s report. Because the night shift nurse’s patients all were discharged, triage had assigned a new slate of patients. “Room 12: Lac of unknown area.” A laceration sounded easy enough. Sam walked into the patient’s room. He—or she, it was difficult to tell—started talking before Sam had a chance to ask questions.

“I didn’t tell them at Registration, but I was really tired of this whole situation, so I decided to take matters into my own hands,” said Lou, whose chart identified her as female, pointing downward. “I went online and read about this banding procedure. I got hair ties, tied the hair ties around it, took some sterilized scissors, and I untied it, and I cut it off. But there was a lot of blood, so I tied the hair ties back around it.”

Sam didn’t know what the patient was talking about. “Oh, okay,” she replied. “Well, let’s just see what we’re working with here.” She lifted the gown. Her mind went blank except to register, Uh, there should be balls there. She cleared her throat. “Are you in pain?” she asked.

Lou’s voice was shaky. “Yes.”

“Okay, well I’ll definitely get you some pain medication, probably some antibiotics. I’ll go see what the plan is,” she said. She speed-walked to the nurses station, her thoughts reeling. Self-inflicted ball-removal had definitely not come up during nurse training.

She quickly checked the computerized board, which listed the patients, their chief complaints, their room, their nurse, and the residents or attending (the doctor in charge), as well as a small section for comments. Kathleen, a new physician’s assistant, was assigned to this patient. Sam found her in the hallway.

“Uhhh, Room 12?” Sam asked.

“I know. Urology’s coming,” Kathleen snapped, without making eye contact. “Someone else will deal with that.”

Sam had heard other nurses say that Kathleen was uncomfortable treating patients with more than minor injuries. She must have picked up Room 12 because triage had listed the chief complaint as “lac.” Some laceration. Evidently, the patient had told triage “I cut myself” without explaining the important details.

Lou wasn’t going to bleed to death, but her condition was serious nonetheless. Sam wasn’t about to let her wait in pain while Kathleen passed the buck. She found the attending ER physician outside another patient room. Bernadette Geiger was an African American woman with a high, childlike voice and a reputation for being extraordinarily compassionate. Sam knew she wasn’t supposed to approach an attending directly, but she didn’t know who or where the resident was and she worried the patient would suffer in Kathleen’s care.

“Um, could I please get pre-op labs, antibiotics, and pain meds for the patient in twelve?” Sam asked, her heart pounding.

“Sure.” The doctor smiled and wrote the orders.

Sam retrieved the medications quickly, then gave them to the patient intravenously. She tried to make conversation. If she kept Lou talking, she could distract her from the pain until the morphine kicked in. Keeping her calm and in the present moment would also help prevent her from going into shock. “We need to fix you up here, friend,” she said.

“You know, it’s still bathing suit season and I can’t wear cute little bikinis when I have stuff down there,” Lou said.

Sam tried to be understanding. “Oh yeah, I know. Bathing suit season sucks. I’m a big fan of board shorts because they offer more coverage.”

“I hadn’t thought about board shorts,” Lou said. “They’re probably not my style.”

Sam kept the patient stable until she wheeled her to the OR, about an hour later. Sam was pleased that she had kept her cool during a relatively shocking case for a new nurse on her first day when the PA had been no help at all.

Sam had started volunteering as an EMT when she was 16. Every Friday night during her junior and senior years of high school, she slept at the firehouse, on call for the overnight shift. She always did more than was expected of her, always stayed later than her shift. The girls at her private Catholic school didn’t know what to do with her; she wasn’t “popular,” but neither was she an “I’m-going-to-eat-my-hair-in-a-corner person.” After college, Sam volunteered at a local rescue squad while she considered her career options. One night during a stop at Pines, she asked an ER nurse with whom she’d become friendly, “What am I going to do with my life?”

“This is what you’re going to do,” the nurse told her. “You’re going to get your second degree in nursing and some experience under your belt. Then you’re going to get your NP and be able to call your own shots. That’s what I’m doing.” Sam liked the idea of becoming a nurse practitioner, which required a master’s degree. So she followed her friend’s advice. She went right into nursing school, graduated, and interned. She hoped to apply to master’s programs after working in the field for a couple of years.

As a nursing intern at Citycenter, Sam had learned that being an introvert would not help her quest. Sam wasn’t much of a talker. She preferred to observe her surroundings quietly so that she could soak up as much information as possible. Her goal in most situations was to learn; there was always a way to improve her knowledge base. When she did speak, she was blunt, with a dry wit, and she spoke succinctly, which could unintentionally come across as curt or stiff. To her continued puzzlement, men had somehow interpreted this mannerism as mysteriousness, as if she were being coy. But Sam saw herself as just plain awkward.

During the first month of her internship, she had a patient who couldn’t stop vomiting. Sam needed an order for antinausea medication, but was intimidated by Dr. Spiros, the 35-year-old senior resident on duty. He was a tall, exceedingly good-looking man with tousled hair as dark as Sam’s ponytail. Sam had heard him speaking with other nurses in the halls about his interest in teaching medicine to doctors in developing countries. The other nurses swooned over Dr. Spiros, who was smart, sexy, and obviously smooth. Sam was not a swooner, but she could be painfully shy around suave men.

Instead, Sam approached Renée, the charge nurse: “My patient’s puking his brains out. Can I give him Zofran?”

“Go ask Dr. Spiros,” Renée said.

Sam pursed her lips and approached Dr. Spiros, who was looking over the board. She nudged her glasses up the bridge of her nose. “Um, can I get some Zofran for Mr. Nathan?”

“I don’t even know who that patient is,” he grumbled. “Ask someone else.”

Geez, it’s only Zofran, Sam thought, her face growing hot. It had a tendency to do that at inopportune moments. She returned to Renée, a Citycenter veteran. “That pompous guy wouldn’t give me Zofran!” Sam said.

Renée looked incredulous. “What are you talking about? Dimitri’s so nice!”

“That’s what you think,” Sam said.

Renée approached Dr. Spiros. “Hey, Dimitri, I need Zofran for Mr. Nathan.”

Dr. Spiros smiled at her. “Sure, anything you want,” he purred. “How’s it going?”

Sam’s gray eyes widened. Jerk, she thought. It’s a shame that such an attractive guy has to be such a douchebag. She managed to avoid Dr. Spiros for the rest of her internship and hoped she wouldn’t run into him again.

There were other annoying carryovers from her internship whom she now wouldn’t be able to avoid. On the interns’ first day, someone had asked if there were any questions. An intern named CeeCee asked, “You guys! Where do we get highlights done in this town?” Of all the questions. If Sam had been outgoing enough to ask a question, she would have chosen, “Where’s the bathroom?”

CeeCee was an overly peppy 22-year-old with meticulously crimped hair. She was a former cheerleader prone to doing celebratory high kicks. Her relentless chatter had a passive-aggressive edge. She and two of her sexy nurse friends made backhanded remarks with toothy smiles.

During the internship, Sam happened to mutter to a tech that CeeCee drove her crazy. She didn’t usually talk about people behind their backs, but CeeCee’s insincere perkiness, fringed with entitlement, was grating. Within days, CeeCee texted Sam. “Someone told me you talked trash about me and said I’m dumb.”

Ugh, drama. Sam tried to avoid drama. She didn’t have the time or the personality to deal with it. She hadn’t told anyone other than the tech that CeeCee drove her crazy, and she hadn’t said anything more. Sam had never insulted CeeCee’s intelligence, nursing skills, or work ethic. “Those matter more to me than whether I like someone or they like me,” Sam explained. “And, if I put myself in her shoes, I’d say there’s no connection between whether you like me and whether I’m a good nurse. Either she somehow equates ‘she drives me crazy’ with being dumb, or someone exaggerated what I said.”

Sam replied with as upbeat a message as she could muster: “I’m sorry anyone said that because it’s just not true! I think you’re smarter than some of the more experienced nurses here!”

Not everyone at Citycenter was annoying. Sam’s preceptor as an intern was gorgeous—a chiseled, 30-year-old African American man with kind, hazel eyes. Intelligent and calm, William was just her type. But she had made the mistake of dating someone at her last hospital, and that had not ended well. In any case, William had a long-distance girlfriend, a nurse many Citycenter nurses had met and spoke of with admiration.

William was one of only two full-time murses (nurse-speak for male nurses) in the ER. He often went out of his way to help his coworkers. Sam knew she could go to William with questions and he’d answer without making her feel uncomfortable or naïve for asking. That was, if she could get to him. He always seemed busy at the nurses station with any number of nurses, engrossed in private conversations that Sam was hesitant to interrupt even with valid medical questions. Women flocked to him for advice, safe flirtation, and to squeeze his impressively sculpted biceps.

By the end of her internship, Sam was comfortable enough with William to barge in on his nurse station conversations. He listened to Sam, as if the few times she spoke up meant that she was saying something particularly important. He was too friendly to intimidate her, and remained unflappable no matter how dire the situation. “Plenty of people in medicine get worked up and freak out over things, so it’s nice when someone is reliably even-tempered,” Sam said. But just as she got comfortable with her favorite coworker, she was assigned the day shift, while he worked only nights.

The rest of the patients on Sam’s first day as a nurse weren’t nearly as complicated as the guy who cut off his own balls, but Kathleen made them seem just as bad. She refused to communicate in person, instead writing bitchy comments on the board. Sam wouldn’t hear from Kathleen for hours, and the PA would walk silently by her in the halls, but then Sam would go to the computer and see Kathleen’s latest comments, directed at her. “Labs drawn????” Kathleen wrote next to one patient’s name, though she hadn’t told Sam which labs she wanted. In Zone 3, the PA was supposed to act like a physician, but the physicians Sam had known, even the unfriendly ones, would at least tell the nurses what was needed. Kathleen was making Sam feel incompetent.

By 3:00 p.m., Sam, usually cool under pressure, was uncharacteristically shaken because she didn’t know the plans for her patients. Kathleen wasn’t telling her which patients were being discharged and which were being admitted. Disgruntled patients had been waiting for procedures, test results, or discharge papers, and they were taking out their frustrations on Sam, who couldn’t answer their questions.

Embarrassed, Sam talked them down. “We’re still waiting for the test results,” she bluffed. Or, “The CT scan isn’t ready yet.”

Sam was too daunted to confront Kathleen directly. She just wanted to get through her first day. Then a patient yelled, “I’ve been here for six hours! I don’t know what’s going on! You don’t know what’s going on, no one knows what’s going on, and I’m going to leave!”

Nobody wanted that to happen. “I’ll-I’ll go find out,” Sam said, feeling smaller than her five-foot-one-inch frame. “We’re still waiting for your test results.”

Sam couldn’t find Kathleen anywhere. In the hall, she saw Dr. Spiros heading toward the break room. Naturally he was working today, of all days. She was expected to go up the chain of command and he was the next person in line. He was also the only familiar face she saw.

“Umm, I’m having a bit of a problem,” she said. Remembering her previous encounter with Dr. Spiros made Sam even more flustered.

“What’s wrong?” Dr. Spiros asked, gazing into her eyes.

Sam was surprised that he seemed sincerely concerned. She spoke quickly, ignoring the deepening flush of her cheeks. “I don’t know what’s going on with my patients. Kathleen’s not talking to me, everyone’s getting mad, and I don’t know what else to do.”

Dr. Spiros patted her on the back. “It’s okay.” He walked her to Dr. Shannon, another senior resident, whom Sam hadn’t noticed. Dr. Spiros’s shift was over, Sam thought, wanting to disappear. “Brad, this is Sam. She needs some help.” He patted Sam again and left for the night.

“The foot lady wants more Dilaudid, the guy in six needs his discharge—he’s been ready for an hour—the guy in sixteen is still puking and he’s already had two rounds of Zofran, and I have no idea what’s going on with the fourth patient,” Sam said, her voice rising.

Dr. Shannon’s voice was soothing, as if he had plenty of time to help her. It was no secret that Kathleen was a difficult PA to work with. “Okay, I can tell you what’s going on with that first patient. I will find out about the second and third patients. And discharge papers are being written up for the fourth patient.”

As she followed him down the hall, Sam wondered whether she had made a mistake: Maybe nursing was not the right career for an introvert. She decided to try the night shift instead.

MOLLY

  September

South General Hospital

After quitting her staff job at Pines, Molly immediately signed with a nursing agency. The scheduler, whom she would interact with only over the phone, assigned her to rotate among three different hospitals. Molly chose to work twelve-hour shifts, three to four days per week.

Academy Hospital was a brand-name hospital with first-class doctors and pretentious medical students. Most of the nurses, young and cliquish, were just out of school; Molly dubbed them “baby nurses.” Citycenter Hospital was a teaching hospital with a poorly run ER. And South General was a Level-1 trauma center in an impoverished neighborhood. Molly had to leave her house at 4:30 a.m. to get to South General in time for her 6:00 a.m. shift. South General was in such need of experienced nurses like Molly that administrators put her to work after only an hour of orientation, rather than the usual four to twenty-four hours.

During her first week at South General, Molly ran into Dr. Lee, a wonderful trauma doctor who also worked at Pines. Dr. Lee was prone to self-deprecating humor, which was relatively rare among surgeons and a good way for physicians to get nurses to appreciate them. “Molly! Welcome to The South,” he said. “I heard you left Pines because of the uniform.”

Molly laughed. “You’ve got to be kidding me. Do you think I’m that big of an idiot?”

Dr. Lee nodded. “I thought that was a little weird. So you left because I’m based at Pines, then?” he joked.

“Ha. The uniform policy was just the last thing I was willing to tolerate,” Molly said. “I wanted something different.”

“Well, this is different!” he replied cheerfully, and left to check on a patient.

Over the next few weeks, as the agency circulated Molly among hospitals, she came to understand what he meant. South General nurses had nerves of steel. In this particularly disadvantaged part of the state, they saw extreme cases of medical and psychological distress. By contrast, on Molly’s first day at Academy, a college-aged patient had a psychotic break. She sat on her bed laughing and talking to an emesis basin that she held to her ear like a telephone. Molly could hear the “baby nurses” whispering, “Can you believe how crazy she is?” “They thought she was the most psychotic person they’d ever seen,” Molly said. “My thought was ‘That’s a big deal to y’all? That’s crazy?’”

At South General, medics once brought in a homeless guy high on PCP. When they tried to move him from the gurney to a stretcher, he jumped up, ripped off his clothes, ran naked into the full waiting room, and “helicoptered,” gyrating so that his noticeably long penis spun like a propeller. “To impress a chick, HELICOPTER DICK!” he shouted. While one nurse called security and gathered staff—it usually took several people to hold down patients on PCP because they had herculean strength—other nurses calmly ushered people to the other side of the large lobby, far from the now naked man.

“The South General nurses were like, ‘Hmm, naked man helicoptering in the lobby. Security was called, no big deal.’ That’s why I like South General,” Molly explained. “When he started screaming—‘Waaaa!’—and dove out the plate glass window, then he became a trauma.”

Citycenter Medical

On Molly’s first day at Citycenter, she felt sick to her stomach. She was not the nervous type, and certainly had never been anxious about a job before, even as a new grad. But she could see that Citycenter’s ER was extremely unsafe. First, the entire department was filthy: Blood spattered the walls, full urinals sat on counters in rooms that were supposedly ready for a new patient, and dried urine covered a utility room counter. Second, patient wait times were inordinately high. And because there was no dedicated trauma nurse, a nurse in Zone 1 was expected to drop all of her patients—the sickest bunch in the ER—when a trauma patient came in. Trauma patients could require one-to-one care for several hours, leaving the sickest patients neglected and in danger.

Molly’s anxiety was justified. That morning, she was assigned at least seven patients at a time, sometimes nine, which was more than she’d ever had at Pines, and too many for her to care for adequately. “How do you handle this kind of patient load?” she asked the other nurse in her zone.

“We can’t,” the nurse replied. “People are quitting left and right, which means an even bigger workload for the rest of us.”

One of Molly’s patients was a 400-pound drug addict who had been running around the city without pants. It had taken nine police officers to bring the man in. The ER staff had shackled him in four-point leather restraints and left him alone in an empty room. When Molly saw the patient, her jaw dropped. As Molly understood it, The Joint Commission instructed that patients in four-point restraints should have a one-to-one staffer who was supposed to document the patient’s behavior, note medical interventions, and offer nourishment and toileting every fifteen minutes. If the patient became cooperative, the staff was supposed to release him from the restraints. The patient’s chart said that since he had been in the ER, he had been quiet and cooperative, but tied down for hours.

Molly found Sarah, the charge nurse. “Where’s his sitter?” she asked.

“There isn’t one,” Sarah said.

“But TJC recommends a sitter for patients in four-point restraints,” Molly pointed out.

Sarah shrugged. “We tie people down here all the time. With the patients we get, we prefer it that way.”

The staff was generally competent and dedicated but spread so thin that they couldn’t consistently provide quality healthcare. Citycenter, where Molly was scheduled for several upcoming shifts, was in even worse shape than she had expected.

The Fertility Clinic

The next day, Molly was off from work so that she could attend her first appointment at the fertility clinic. The nurse at the desk showed her the list of tests the clinic wanted for the initial blood draw. Molly scanned it, concerned. Her husband’s health insurance covered only up to $10,000 of certain fertility treatments and didn’t cover in vitro fertilization. As a nurse, Molly typically made about $60,000 a year before taxes. Trey’s police officer salary brought in $77,000 before taxes. They were trying to save for a down payment on a house, but too many out-of-pocket fertility treatment costs would wipe out their savings.

Molly crossed the varicella, rubella, HIV, and hepatitis C tests off the list. She had been tested for all of them within the last two years.

“Why are these crossed out?” the nurse asked.

“I had those tests performed less than two years ago and I only get a certain amount of insurance funds, so I’d like to save money on tests that have been performed recently,” Molly said. The nurse shook her head and led Molly to the back room to draw blood.

The nurse frowned as she poked Molly. “You’re as tight with your blood as you are with your money,” she carped.

Molly ignored the dig. “I didn’t know what two of the tests on that list were. Could you tell me?”

The woman didn’t answer. After the draw, Molly watched the nurse label the tubes. She pointed. “These two here—what are those?”

“I can’t tell you,” the nurse said. She didn’t even look at Molly.

“Because you don’t know or because you aren’t allowed?” Molly asked, confused.

“Our policy is to not tell people.”

“That doesn’t make sense,” Molly said. “I’m paying for these. These are elective tests.”

“You’re a nurse. You understand,” the nurse said.

“No, I don’t understand. When my patients ask what a test is for, I tell them,” Molly said. The woman glowered at her and left the room.

Safe in the elevator hallway, Molly composed herself. Struggling with infertility was difficult enough; why did the clinic have to make the process so unpleasant? Typically, she chose her doctors based on their bedside manner, but she had selected her fertility clinic because of its success rates. Patients here dealt mostly with the nurses until the actual procedures. Still, she couldn’t help yearning for “someone to make eye contact, to have some inflection in their voice that shows they care about me, not just keeping their profits up,” as she phrased it. “At a fertility clinic, a little warm fuzzy would go a long way.”

That experience, and subsequent visits to the clinic, left Molly feeling like a number. On no occasion did clinic doctors or nurses introduce themselves before performing a procedure. As a result, Molly vowed to introduce herself clearly to each of her patients, to show them her badge, and to explain her role. “People aren’t taking the three seconds to say, ‘Hi, I’m Sandy and I’ll be doing a transvaginal ultrasound on you today,’ ” Molly said. “As a healthcare worker, I’m generally less sensitive to that type of stuff, but the fertility experience is making me feel horrible. My patients see me during an emergency. They’re probably more scared than someone going in for routine fertility testing. I will do a better job of putting ER patients at ease.”