The Nurses: A Year of Secrets, Drama, and Miracles with the Heroes of the Hospital (29 page)

Jan started laughing. Molly continued, “The chest tube had just gone in, so they’re bagging him real fast and no one is noticing this but me. They started out normal testicle size but they were very large grapefruits by the time I figured out what was going on. The guy was naked and the air is tracking from around the chest tube hole through his lungs and into his groin. I had to say, ‘You know, his balls are blowing up every time you bag him.’ So they called in a cardiothoracic surgeon and had to suture the air leak shut.”

“I’m glad you didn’t tell me that beforehand,” Jan laughed. “Thanks for your help. I totally understand chest tubes now.”

Midshift, a 16-year-old girl was brought by ambulance to the ER from a school dance, where she had gotten drunk, thrown up, and passed out in the bathroom. When her father arrived, he screamed at her. Then the girl changed her story.

“Dad, I think when I was passed out, someone raped me,” the girl sniffled.

Her father immediately redirected his anger. He demanded that the nurses call the police and start an investigation. Everyone in the room except her parents knew the girl was lying.

Teen patients commonly said anything they could think of to avoid dealing with their parents’ reactions. Molly had treated dozens of teenaged girls who made up the same story, and not one of them had been sexually assaulted, creating what Molly referred to as “a ‘girl who cried wolf’ mentality.” Most patients didn’t realize that if police officers seriously considered somebody to be a sexual assault victim, they brought the patient to a hospital with a sexual assault nurse examiner (SANE) on staff, which Academy did not have at present. The patient wouldn’t come through triage or sit in the waiting room; the staff would usher her straight back to a private room for the SANE’s evaluation, a policy that Molly called “a very hush-hush process hidden in the ER.” Therefore, ER nurses knew that if EMS or the police brought a patient through triage, they did not believe the individual had been sexually assaulted.

When the father went into the hallway to call the police himself, Molly turned to the girl. “If you really were raped, we will do everything we can to help you,” she said. “If it’s not true, we have a big problem: Someone will get arrested, go to jail, and possibly serve time just so you can get out of trouble for drinking. Now tell me, what’s worse: being grounded for something you did or someone going to jail for something he didn’t do?”

The girl looked down. When her parents came back into the room, she muttered, “Maybe that didn’t happen. I don’t remember.”

On another occasion, the daughter of a local VIP got drunk at a school dance and passed out. A friend’s parents brought her to the ER. When the girl’s father arrived, he yelled so loudly that Molly closed the door to the patient’s room for a while. Soon after Molly opened the door again, the girl had an epiphany.

“Daddy, Daddy! Jesus is talking to me!” she shouted. “He’s showing me what I did wrong! Daddy! Kneel beside the bed with me and let’s pray! Dear God! Thank you for giving us your son to take away our sins! Thank you for showing me what I did today was wrong!”

The father fell for it. He knelt next to the bed with his daughter. “Praise God! Praise Jesus!”

“Daddy! We need to go to church when we leave here and let everyone know that alcohol isn’t the way. Jesus is the only way!”

Her father shook his head, feeling it. “Amen! Praise Jesus!”

“Daddy! I want to speak in front of the congregation and let them know that Jesus is good! Alcohol is not good! Daddy, this will never happen again!”

“Amen, baby. I love you.”

And the yelling was done. The Academy ER had a sticker sheet of glittery Oscar statues that were reserved for patients who put on Oscar-worthy acts. The nurses would stick one on a patient’s chart so that everyone who treated the patient knew what to expect. Some staffers didn’t like Oscar because it gave the practitioners preconceived notions. But Molly thought it was funny and a stress reliever.

Molly had to give credit to this resourceful teen. As a nod to her performance, Molly stuck Oscar onto the girl’s chart.

One afternoon, medics brought in a woman who had attempted suicide by turning on a barbecue grill in her bedroom and inhaling the gas. It looked like she would survive. As Molly documented at the nurses station, a pregnant nurse walked by and sniffed. “Ta’quisha, you get grilled hot dogs for lunch?” she asked loudly. Ta’quisha, a tech, told the nurse about the attempted suicide; she was smelling the fumes off the patient.

“Now I’m hungry!” the nurse said.

At the end of the day, an ambulance brought in a 60-year-old man who had been found slumped over at his desk at work. The man twitched and his eyes rolled toward the back of his head. The staff at the nurses station was busy watching the attending doctor question the EMT to determine whether the patient had suffered from a stroke or a seizure.

“Is anyone watching him?” Molly asked, jumping up to help. “Does he have a line?”

After the patient was intubated and sedated, Molly brought him into radiology for a CT scan. The neurology team crowded into the viewing room, excited to see what had gone wrong in the man’s brain. As the scan materialized on the monitor, a voice behind Molly shouted, “I win!” She turned to see the neurology resident making the victory sign. “It’s not a stroke, it’s a seizure!” he said happily. “Who else had seizure?”

Many hospital staff members got through the day by relying on a morbid sense of humor. Molly had come to know the funnier doctors well enough that they joked with her frequently. It was impossible not to laugh at some of the patients, too, like the guy who came in with his penis stuck in a metal washer (it was a large washer). Or the middle-aged man who decided to experiment with his garden bounty one night when his wife was out of town. Unfortunately, he couldn’t then remove the cucumber from his anus. In the hospital, he was moved from the ER to the OR because, the small-fingered doctor told her nurses, “I wasn’t able to get it and it’s sideways now.” Molly noted, “There’s a multibillion dollar sex toy industry that’s discreet and online. Why do people use common household produce?”

Staff played games to make the day more fun, including Guess the Blood Alcohol Level pools. Some of the nurses kept a running list of the most amusing patient names to come into the ER. One doctor tried to crack up his nurses by writing ridiculous discharge papers, such as: “Dear Homeless Guy, I am disappointed that you are both drunk and smelly. That won’t get you any pussy.” This doctor also liked to joke with Molly about how to break fatality news to family members: “Raise your hand if your loved one is still alive. . . . Not so fast, you two!”

Humor and pranks might seem crass in an emotional environment where people are coping with or fighting illness, trauma, tragedies, or death. But that’s exactly why nurses depend on them.

Researchers have found, historically, that healthcare professionals use humor with their patients and each other in all but three circumstances: around uncooperative patients, with patients who are upset, and when interacting with dying patients’ loved ones. Plenty of studies have shown that humor can help patients; in addition to spontaneous banter, many doctors (such as oncologists) use prepared jokes about their treatments. Studies also reveal that nurses use humor with patients more frequently than doctors do.

What’s less well known is that behind the scenes, doctors’ and nurses’ humor among colleagues is different—and darker than might seem appropriate to an outsider.

At the milder end of the spectrum, nurses try to lighten the mood by staging pranks on each other or unsuspecting doctors. Some nurses like to crouch in an empty room, turn on the call light, and when the summoned nurse enters, jump out to scare the bejeezus out of her. In one hospital, a nurse hid under a sheet on a gurney that two nurses were told to transport to the morgue. On the way, the hidden nurse groaned and then began to sit up, sending her coworkers shrieking down the hallway.

A California nurse has sprayed Mucomyst (an inhaled substance that treats breathing problems) into the top gloves in the supply box so that the next taker would have sticky, smelly hands. Nurses have awakened night shift colleagues with a sternal rub, an uncomfortable method to test for unconsciousness by firmly fist-rubbing midsternum. An Illinois nurse remarked, “I am not the only nurse I know who has farted in a sedated patient’s room and blamed it on the patient when someone walked in.” Nurses are not above leaving fake poop in bedpans for unsuspecting staffers (including on the front seat of an ambulance). A unit in Oklahoma has a pranking tradition that sends new nurses on a scavenger hunt for a “window that opens” on a floor where no such window exists.

When a young Southern nurse asked an older nurse how to warm a bag of blood before administering it to a patient, the older nurse joked that she should microwave it. The gullible nurse’s resulting explosion resembled a crime scene.

During a Virginia nurse’s first week in the ER, a physician exited a patient room holding up a large splotch of brown mush on a gloved finger. The doctor asked the nurse, “Hey, do you think this looks like it has blood in it? I can’t decide.” The nurse recalled, “Horrified that he’s walking over to the nurses station with shit on his finger, I stutter and tell him I don’t see anything. He looks perplexed. He then proceeds to lick the sample off his finger. ‘It doesn’t taste bloody,’ he says. It was chocolate pudding. I’d been punk’d.” Juvenile, yes, but a common hospital prank.

A doctor at Pines Memorial set up new students by teaming with a nurse like Molly to hand him a urine specimen cup full of apple juice. When teaching the med students how to diagnose, he’d drink the juice and say, “It tastes infected.” Molly joked that someday she was going to hand him a cup of urine without telling him.

Nurses say that urologists tend to have a lewd sense of humor and a strong affinity for penis jokes (“Urology department—can you hold?”). Operating room nurses proudly boast that their unit has the bawdiest sense of humor in the hospital. “We get very naughty; we blame it on the fact that we wear what look like pajamas all the time. Just about everything that comes out of our mouths is a double entendre that probably borders on harassment, but that’s how we get through the days,” said a Pennsylvania OR nurse.

When the Pennsylvania nurse pokes her head beneath surgical drapes to check a patient or flush a catheter, her male colleagues make slurping blow-job sounds. If the surgeons turn the lights off to better view the monitor, they announce they do their “best work in the dark.” As the nurses help them fasten their surgical gowns, the doctors quip, “Tie me up like you mean it.”

Much of the time, hospital humor is harmless because nobody is offended. But when the patient isn’t unconscious or family members are within earshot, doctors’ and nurses’ jokes can be misinterpreted. A Texas nurse remembered a case when a patient stopped breathing; staff hustled his brother from the room so that they could work the code. The patient died. Afterward, the brother furiously reported the nurses and doctors to hospital administrators because he saw them joking with each other as they tried to save his sibling’s life.

What were they thinking? And what could have been so funny during such a traumatic time? Few outsiders are aware of doctors’ and nurses’ reliance on “gallows humor,” a phrase popularized by Sigmund Freud in reference to a story about a man joking as he goes to the gallows to die. Also known as dark humor or black humor, gallows humor is a morbid way to joke about, or in the face of, tragedy or death. Gallows humor describes, for example, when a doctor calls out a patient’s long list of extensive injuries to a nurse and then adds, “and he’s got a stubbed toe, too.” Or when nurses call a coworker “Grim Reaper” because, through no fault of his own, three of his ER patients die in one night.

When patients are dying, some doctors and nurses say they are “circling the drain,” “headed to the ECU (the Eternal Care Unit),” or “approaching room temperature.” A nurse team calls motorcyclists who don’t wear helmets “donor-cycles.” Some staff refer to the geriatric ward as “the departure lounge.” Gunshot wound? “Acute lead poisoning.” Patient death? “Celestial transfer.” That’s gallows humor.

One of the best true-life examples of gallows humor occurred a few decades ago. In the middle of the night at a hospital in an unsafe neighborhood, three ER residents were waiting for their pizza delivery when a gunshot victim was rushed inside: It was the delivery boy, who had been walking toward the building when a mugger shot him.

The doctors tried to save the victim, but had to call his time of death after forty minutes of resuscitation efforts. “The young doctors shuffled into the temporarily empty waiting area. They sat in silence. Then David said what all three were thinking. ‘What happened to our pizza?’ ” recounted bioethicist Katie Watson in a 2011 Hastings Center Report. “Joe found their pizza box where the delivery boy dropped it before he ran from his attackers [and] set it on the table.” The hungry doctors stared at the box. Then one of them asked, “How much you think we ought to tip him?”