The Nurses: A Year of Secrets, Drama, and Miracles with the Heroes of the Hospital (32 page)

Sam didn’t mind being single, though it would have been helpful to have an extra ally in the hospital. She could admit to herself that she had a crush on William, but knowing he had a girlfriend, she would never act on her feelings. She was content to appreciate their growing friendship. Despite his teasing, Sam enjoyed working with William, and not only because he was an excellent, sure-handed nurse. He respected her and he made her feel appreciated. Sometimes he called her hospital cell phone just to say hi or to ask if she needed help.

One night, the charge nurse was doling out assignments and put William on Zone 1. In front of the staff, she asked him who he wanted to work with that night.

“Sam,” he said.

As Sam smiled to herself, proud and touched that William had chosen her out of all of the other nurses, she looked up and saw CeeCee glaring at her.

It was obvious that CeeCee assumed that she and William were close. Certainly, he was nice to her. CeeCee was always badgering him with social requests: “William, let’s do a group bike trip!” “William, come on the ferry with us this weekend!” Sam knew that William was warm to everybody. He had told Sam that he joined the young nurses’ social outings so that they would continue to feel comfortable seeking his help at work. He didn’t want them to think that because he was often the charge nurse, he was unapproachable.

Sam remembered when, as a nursing student, nearly everyone her senior seemed unapproachable to her. That had changed as she had gained experience treating patients and become accustomed to her colleagues. Without a doubt, William had played a major role in her growth, as a teacher and as a friend. He felt like a safety net, especially, as Sam put it, “when the place is so unsafe that I could lose my license.”

Now Sam was growing more confident day by day. She had a good general sense of the ER, knowing where the sick patients were even if they weren’t hers. She had learned how to get other people to work more efficiently with her; for example, if she needed lab results urgently, instead of inputting a lab request into the computer, she wrote it on a paper lab form, brought it down to the lab herself, and said, “We’ve done these labs. I need you to run them, please.”

One night medics brought in a 58-year-old trauma patient who had driven his car into a tree. He was awake and alert, though he didn’t remember the accident. While two residents examined the patient, Sam, as the recording nurse, stood in the back of the room taking notes. Shirley, the ER nurse practitioner, stood next to her.

As Sam watched the heart monitor, she noticed that the patient was having several premature ventricular contractions, extra heartbeats that disrupt the regular heart rhythm. While some PVCs are normal, the patient had many more than the average person. The patient’s nurse was busy drawing blood and the residents were engrossed in their assessment.

“Hey, Shirley, our buddy here is throwing a lot of PVCs,” Sam told the NP.

Shirley watched the monitor. “You’re absolutely right,” she said, then addressed the other nurse. “Let’s add magnesium levels to the labs and get a cardiology consult.”

The next night, Shirley approached her at the nurses station. “Sam, nice catch last night. The trauma patient turned out to be a cardio patient.” She explained that the cardiology team believed the man had had a heart attack or another massive cardiac event that had stopped his heart from functioning efficiently. The force of the air bag hitting his chest had probably restarted his heart, albeit at an irregular rhythm. The man had received a pacemaker that morning.

“Sam, you have good situation awareness and a good sense of what’s going on with your patients,” Shirley said. “I think you’d be a fantastic NP.”

Sam’s confidence soared.

Molly’s first patient of the morning was an unemployed, heavily tattooed gang member with a cocaine habit. He had a small bowel obstruction because he had been shot in the stomach a decade ago. Molly tried not to judge her patients. (She’d had several tattooed dudes come in and say, “I hate needles.” You just never knew.) Recently at Citycenter, Molly had treated a trauma patient who had been shot three times and killed the other guy. Molly was creeped out by the man, but pleased with her ability to treat a murderer by separating the man’s crime from the medical treatment he needed.

When Molly entered the room, the gang member was telling Maxine, a medical student, that he was in severe pain. “Can y’all please talk to the surgery resident and get an order for pain medication?” Molly asked the student.

“Okay,” Maxine said. “I already ordered a Foley.”

“I’m not putting a Foley in a patient who is able to urinate on his own,” Molly said. She explained to Maxine that Foley catheters commonly caused hospital-acquired infections. If a patient developed an infection in the hospital, Medicare and Medicaid could refuse to pay for the visit. Hospitals had strict policies about which patients could get a Foley. Patients able to walk to the bathroom, like this man, were not supposed to have one.

“But we need to accurately measure urine output,” Maxine argued.

Molly held up a plastic urinal jug. “This has very accurate markings for measurement. The way we measure urine output in patients with Foleys is to empty the urine into the same urinal the patient would use to pee in, anyway. So I’m not putting the Foley in.”

The patient watched the back-and-forth with interest.

“But the resident wants it.” Maxine looked confused: If a doctor said it, it must be gospel.

“It’s not going to happen. Just because a surgery resident said it doesn’t change the policy,” Molly replied.

An hour later, the patient still hadn’t received pain medication. By now, he was technically no longer an ER patient; he was an ICU patient boarding in the ER because no ICU beds were available. His orders would come from the admitting team of ICU doctors rather than the ER. Although Molly was slammed with other work, as usual, she wanted to make sure that the patient was looked after. He was in obvious pain, but boarder patients were often the last patients the attendings would visit.

Molly found the ER doctor in the hall. As she was about to ask Dr. Ward for the meds, Maxine came out of the patient’s room, held up her hand, and said, “We’re taking care of it.”

“You told me that an hour ago and he still has no orders,” Molly said.

“I texted the surgery resident and she said she’d take care of it,” Maxine replied.

“When?”

Maxine paused. “I’m not sure.”

“That’s why I’m asking the ER doctor. He’s been in severe pain and vomiting since he came in here.”

Maxine tilted her chin condescendingly. “Don’t you think you should let
us
take care of it?”

“I’ve given you an hour to take care of it.”

Dr. Ward finally chimed in. “Imagine that’s your dad in the room. Would you sit there for an hour with him in severe pain and just wait around for someone to do something? How about you text
that
to your resident?”

Maxine looked sheepish. “Yes, sir.”

Five minutes later, the surgery resident was in the room. Molly followed her in and asked for the order, which the resident wrote immediately.

When the room emptied, the patient turned to Molly. “You’re the best nurse I ever had. Thanks for looking out for me.”

Molly considered patient advocacy the most important role for a nurse. She was surprised at how often she had to push hard for patients because doctors weren’t doing the right thing. She spent a great deal of time hounding doctors for pain medications for cancer patients and elderly patients. When Pines had offered to ban Daryl, Molly’s assaulter, from the hospital, Molly had declined because he could be a patient someday: “If he had a legit medical reason to seek treatment, I didn’t want his options limited.”

Similarly, she wanted to ensure that her patient was cared for as an ailing human being, not as a gang member. “I felt for this guy,” she said. “I’m sure he had received substandard care in his life because of his appearance and past. I treated him the way I’d like to be treated. To him, that was the best nursing care he’d ever had. That made me happy, but at the same time, it’s pretty sad.”

One day in late March, Molly took a shift at Pines on a day she knew the hospital could use the help. Because she was already established in the ER as a talented nurse with a strong work ethic, the ER office manager gave her hours whenever she wanted them.

Two hours into her morning, she decided to take a urine pregnancy test. It was more than two weeks after her IUI and she couldn’t let her hopes teeter for another day. She took a test and specimen cup from the lab room and went to the staff bathroom. With a pipette, she drew a few drops of urine from the cup and dripped it onto the test. Then she waited.
Please
.

This cycle had been Molly’s last chance to get treatment covered by insurance. After more than eight months of fertility tests, treatments, and appointments, besides wanting to conceive a baby, she yearned to be finished with the uncertainty in her life and back on track to work reliably for her employers. While the stakes increased with every cycle, these results seemed a great deal more important than the others. If the IUI didn’t work, she would have to undergo IVF, which would cost nearly $25,000 out of pocket for only a 30 percent chance of success. Molly and Trey would have to charge it on their credit cards.

Molly consulted her watch. Three minutes had passed. She looked at the pregnancy test. No color change. Negative. Molly stared sadly at it. Her stomach dropped.

But Molly had to return to work; there were no breaks at Pines. Nurses had no room for their own personal struggles in the hospital. She tried to brush off her emotions.
Oh well, at least I’ll earn lots of credit card points toward cash back
, she told herself.
And now I need to get back to my patients
. She trashed the pregnancy test and returned to the ER.

That afternoon, Bethany—the nurse whom Juliette had assumed was part of the clique—sought Molly out to talk. Priscilla had given the senior charge nurse title to three of the four nurses who had applied for the job that Erica had vacated. (Charlene had complained about this, but made sure to tell everyone, “They’ll all be equal, but I’ll still be over them.”) Bethany was the only rejected applicant. When Bethany asked Priscilla about it, Priscilla said she had heard the only reason Bethany applied was to prevent Juliette from getting the job.

“That’s not true at all. Why would I do that?” Bethany told Molly.

“Juliette didn’t even apply,” Molly said. “She didn’t want a new job; she’s working really hard for clinical level four.”

“Right,” Bethany continued, “and then Priscilla said, ‘Between you and me, I would never hire Juliette for that position.’ A manager should never talk to employees about other employees!”

Molly was floored. Priscilla gave Juliette the impression that she loved her. Juliette was a hardworking nurse who always tried to do right by her patients, and she was assembling a strong portfolio for her clinical ladder application. “If she feels this way about Juliette, she should tell her, and her performance evaluations should reflect it,” Molly said. She struggled with whether to tell Juliette because she knew it would hurt her feelings. But Juliette needed to know that the private information she shared with Priscilla might not be remaining confidential.

Staff politics were only one of many reasons that Molly was glad she had left Pines. Pines had the best educated and best insured patients that Molly had seen; they were probably among the smartest and wealthiest in the area. They were also the most demanding patients Molly had ever met.

Recently, the Westnorth Corporation announced to staff that care should be tailored to the patient surveys that were administered randomly after discharge. Thanks to the Affordable Care Act (also known as “Obamacare”), hospitals took their patient satisfaction surveys very seriously because their scores affected the amount of federal money they received. Since Westnorth had taken over the hospital, patient satisfaction scores had dropped. Administrators now were scripting nurses’ discussions with patients and ordering them to use memorized key words in what the hospital called “guided conversations.” For example, the survey asked, “Did your nurse educate you on your condition?” Patients tended to answer no, despite receiving discharge instructions about their diagnosis and treatment. Therefore, Westnorth now instructed nurses to say, specifically, “I am going to educate you on your diagnosis.”

At Pines, the patients could be difficult to please. “You can come in with appendicitis and we fix you but your room was cold, so you’re pissed off and give us a poor rating,” Molly said. “I don’t care whether the patients are ‘satisfied.’ I care that they get the treatment they need.” A patient once found Molly in a room performing CPR and yelled, “I ASKED YOU FOR A PILLOW FIFTEEN MINUTES AGO!” During CPR!

Too often, Pines patients demanded specific procedures, after speaking with doctor friends or searching for ideas on the Internet. If the patient’s orders didn’t match the doctor’s orders, the patient might leave the hospital dissatisfied, even if he was cured, simply because he didn’t receive the treatment he demanded.

One of the worst patients Molly could remember was an annoying woman who pressed her nurse’s call light every few minutes. “I’m cold,” she’d say, so Molly would cover her with a blanket. Molly would just be sitting down at the nurses station when the woman rang again. “I want some water.” Molly brought her the water. Five minutes later: “I don’t like it with ice.” Molly brought her water without ice. Another few minutes, then: “It’s too warm. I want one piece of ice.”

Thinking the woman should have to “work a little harder” to contact her nurse, Molly moved the call light out of reach. The woman called her on the room phone, asking for another blanket. Molly complied. Three minutes later, the patient rang her again. Molly was wise enough to know that some patients were difficult because they were lonely and scared. But she had four other patients just as lonely and scared as this woman, who was taking up way too much of her time. Nurses flipped coins to avoid patients like her.