The Nurses: A Year of Secrets, Drama, and Miracles with the Heroes of the Hospital (35 page)

—a Texas ER nurse

Lara stood silently at the bed of a 9-year-old girl who had died of internal injuries sustained in a car accident. The car had crashed because the girl’s parents had been fighting in the front seat. In his rage, the father had swerved the steering wheel. Now the father, uninjured, was in the hallway yelling at the trauma team, “You killed my daughter!” The mother was being treated for shock.

Lara could not bring herself to leave the dead girl’s bedside. From the outside, it didn’t appear as if anything was wrong with the girl. She looked like a doll. She looked like she was sleeping peacefully. She could have been friends with Lara’s daughter. For the first time in her nursing career, Lara wept openly at the hospital, despite the bustle in the corridor, the other needy patients, and the footsteps that tapped into the room behind her.

An arm wrapped around her waist. Lara looked up. Brianne, a longtime ER nurse, embraced her. An elementary school nurse on her off days, Brianne was crying, too. Nurses mostly didn’t afford themselves the time to cry; they forced themselves to go on with their day. Lara believed that South General nurses were more “honest” about their emotions than nurses at other hospitals where she had worked. Lara felt they were “more real, more vulnerable, they let themselves feel the moment with colleagues and patients’ families. We let them know that we’re sad along with them.” Lara had seen South General nurses get on their knees with grief-stricken family members to pray with them.

From then on, Lara asked to work with Brianne whenever she had the chance. She got to know her as a good nurse and a good person. She watched the comforting way Brianne interacted with patients and families and she tried to emulate her. “I just felt closer to her after that. She’s a genuine person who makes people feel better just by speaking with them, and I want to learn how to have that quality, too,” Lara said.

After the 9-year-old’s death, the trauma team could have used the Relationship-Based Care committee’s debriefing room—the calm space Lara had wanted to set up for staff members to catch their breath after traumas—but it still didn’t exist. The committee hadn’t met in months. Lara thought she knew why. Originally, management had promised the committee that they would find coverage for the members to attend meetings. But the administrators didn’t do so for the last few meetings, effectively canceling them. Even the huddles had dissolved after a couple of weeks because only Lara, Rose, and Holly attempted to gather the group when they were on duty.

Without meetings, the committee couldn’t get anything done. The administrators also refused to provide any resources for the debriefing room. Now that the managers had essentially squashed the idea, Lara was out $50 for the paint she had purchased.

One day, Lara was in the resuscitation room, where nurses sent the sickest patients or performed CPR. Five other nurses, all African American, walked in, including Makayla. Makayla was obsessive about bringing her own cleaning products to the ER to make sure her area was clean, although outside cleaning products were not permitted in the hospital. Nurses knew when they were in Makayla’s assigned zone because they were knocked sideways by the overpowering smell of bleach. Apparently, someone had complained, because Makayla told the other four nurses, “And one of our
latte
nurses felt the need to write me up that I had wiped down the area to make sure it was clean.” The other nurses clucked sympathetically.

For the moment, Lara didn’t say anything because she was outnumbered. There were only three white nurses left in the ER. When the black nurses left, Lara called Makayla back. “Makayla, I have to talk to you,” Lara said, speaking slowly to think through how to avoid putting Makayla on the defensive. “I respect you as a nurse and I know that you work hard. But I have to tell you, your comment about latte coworkers is racist. It wasn’t cool and I was sitting right here. I’m surprised to hear a comment like that coming from you.”

Makayla balked. “Oh no no, oh my gosh, no. I call people my mocha sisters and my latte sisters, but it has nothing to do with color!”

Nevertheless, for the next month, Makayla went out of her way to be nice to Lara. Normally, Makayla was the type of nurse who shopped online while other nurses ran around taking care of patients. Now she leaped up to help Lara, greeting her enthusiastically. Lara wasn’t going to waste energy resenting Makayla, so she let the incident slide.

•   •   •

Lara was giving report on the phone when she heard one nurse say to another, “Your girl’s marked off the schedule permanently.”

“That bitch is not my girl,” the other nurse replied.

Lara put her hand over the mouthpiece. “Hey, you guys, you shouldn’t gossip without me! Hold on!”

After Lara hung up, they told her what had happened. The day before, Fatima had been in other nurses’ rooms again, hovering around patients. To the other nurses, her behavior was simply annoying. To Lara, this was an obvious sign of an addict; she was hopping from room to room in search of narcs. One of the nurses Fatima tried to “help” happened to be Ursula, who notoriously preferred to work alone, which Fatima, a night shift nurse, wouldn’t have known.

Fatima saw an order for Dilaudid and took the medication from the med room. She charted that she gave the patient the medication, then apparently put it in her pocket.

Two hours later, the patient was still rolling around in pain. “Did anyone give you pain medication yet?” Ursula asked. “I see it was ordered.”

“No one’s been in here yet,” the patient said.

Ursula looked up the patient’s file and saw that someone had taken out Dilaudid under the patient’s name. She rounded up the charge nurse and the nursing supervisor and they pulled Fatima into an office. They told her their concerns.

“No, no, I was just helping medicate the patient,” Fatima said.

“
Did
you medicate the patient?” the supervisor asked.

Fatima tried to evade the inquiry.

“You need to answer this question: Did you give that patient the pain medication that you took out under his name?”

Again, Fatima gave a nonanswer.

“We believe you are taking narcotics. This has been a concern for a while. We need a urine sample.”

“No,” Fatima said, changing tactics. “I have the pain medication right here! I just didn’t have the chance to give it yet.” Ostensibly, she went to pull the patient’s vial from her pocket. Lara wondered later if Fatima had been so nervous that she didn’t think about what she was doing. The average Dilaudid dose was 0.5 milligram to 1 milligram. Fatima pulled out three 2-milligram vials.

“We’re going to have to ask you to leave if you won’t give a urine sample.”

Fatima wouldn’t provide the sample. She quit on the spot.

After the nurses told Lara the story, Lara tried to refocus their slant so that the narrative wasn’t about Fatima’s character. The South General nurses didn’t know about Lara’s own addiction. “Wow, she’s got a horrible disease,” Lara told them. “I hope she’s going to be okay. I’m going to say a prayer for her because I’d hate for her to overdose.”

Her coworkers were more empathetic toward Fatima than Lara had expected. “Drug addiction is more rampant than people would like to admit, and everyone knows it,” Lara theorized. “It’s not like ‘Oh my God, what a shock.’ It happens a lot.”

Lara had mixed feelings about Fatima getting caught. She felt bad that she had not gotten through to Fatima in time. But she also was relieved. “When I got caught, because I was so scared, there was a weird sense of relief,” she said. “So I’m relieved for her, too. She can move forward.”

The same week, Nicola, a younger nurse, approached Lara for advice. She had been cited for drunk driving over the weekend. Lara supposed that a mutual friend must have told Nicola that Lara didn’t drink. “I don’t know what to do,” Nicola said. “I don’t want to drink anymore, but I see things here and they’re sad. I go home and I don’t know how else to deal with the sad things or the frustration when people are mean at work. I drink to forget about the day.”

“That’s why I don’t drink,” Lara said. “I did the same thing. I didn’t just have a beer. I ordered double vodka sodas to forget stuff. But it didn’t really work, and then more stuff would pile on. So I just stopped. Do you want me to help find you a sponsor?”

“Nah, I’ll try to stop by myself first,” Nicola said.

Actually, Lara had been tempted to drink lately. Now that she was truly on her own, her worries overpowered her. It had been harder than usual to stay clean this season, because she’d paused her college classes, which had been one of her distractions. Without John at home, classes and childcare were prohibitively expensive. Trying to work out her frustrations at the gym wasn’t enough. “I’ve been in such a funk lately that I’m thinking being dead would be better than this,” Lara admitted. “I feel like I don’t have enough outlets for my fears. And I’m so tired. It pops in my head,
If you drank or got high tonight it would be okay, just for tonight
. So I’m sort of on watch.”

Lara still didn’t feel like herself at work; her personal issues had eroded even her confidence as a nurse. Often she came to the ER hoping she wasn’t assigned to seriously sick patients because she wasn’t sure that she would be able to think clearly enough to help. But sick patients always came in anyway, and, despite her misgivings, Lara found that “I don’t have time to be up in my head feeling sorry for myself, because people are sick and they need my attention.”

The patients at South General reminded her that her situation could be worse. One day, she spent three hours entertaining a toddler while his mother was evaluated. The patient had confronted her husband about his girlfriend and he had responded by choking her, hitting her, and kicking her pregnant belly. After the evaluation, the woman returned home and did not press charges.

Lara’s coworkers continued to create last-minute openings, using her as a floater to cover for nurses during lunch, or assigning her as an extra trauma nurse. Some of the other nurses confided to her that when they got divorced, they coped by working long hours, too. “We’re going to see more of you here,” one of the women told her. It was nice to know that her colleagues had her back. Lara regularly volunteered to work twelve-hour shifts on three consecutive days.

On the nights that she cried herself to sleep because she felt like “a horrible mom” for missing so much of her children’s lives, she reminded herself repeatedly that she was doing what was best for them. “I’m going to meetings to get mentally focused. I’m going to work to pay the bills and to cover their health insurance,” she told herself. “This is making me a better person so that I can be the best mom for them.”

Lara was an outstanding nurse who recognized that Fatima had an addiction. Her own troubles aside, why didn’t she act sooner to try to save her colleague from what has been called “one of the most devastating diseases in the nursing profession”?

Many nurses speak about a “code of silence,” an implicit vow of loyalty and protection that includes a reluctance to intervene when a fellow nurse’s job or reputation may be at stake. When they observe incompetence or suspicious behavior, some nurses might look the other way if a coworker is generally skilled or if they sympathize with her professional stresses or difficulties at home. This “don’t talk rule,” as it has been called, is akin to “What happens in the unit stays in the unit.” According to materials from a nurse home-study program, nurses “bend rules or . . . may not report other nurses for fear of being perceived as snitches or labeled as whistle-blowers. These nurses may be concerned about retribution for reporting, such as having their own work scrutinized and criticized. Some nurses do not want to become involved because confronting someone who may become angry, deny the problem, or plead for another chance can be difficult.” Lara hesitated for all of these reasons.

If they report a nurse for substance abuse, nurses worry that their colleague will lose her job or her license and/or be arrested. The public, as well as fellow healthcare providers, can be quick to stigmatize substance-impaired nurses, perhaps more readily than they condemn people in other fields. As the home-study material explained, “Society, in general, views nurses as angels of mercy; nurturers par excellence; or the lily-white, starched presence of yesterday’s movies. Being placed on such a pedestal has its consequences when a nurse becomes a ‘fallen angel.’ Society and other healthcare professionals are quick to demonize this fallen angel as a ‘bad person’ who now steals our grandmother’s pain pills.”

It’s easy to see why the stigma persists: Disturbing examples abound in the news. In several states, nurses (and other healthcare providers) have been caught stealing drugs from hospitals or nursing homes for personal use. In Texas, an army medical center nurse used his own syringe to steal fentanyl, a painkiller, from vials that the center then used for other patients; he infected at least sixteen patients with hepatitis C. Nurses across the world have stolen narcotics and replaced or diluted them with tap water or saline solution, leading patients to receive saline instead of pain medication during surgery. A nurse at a nursing home in England was charged with killing a patient and taking her medication. The nurse became hooked on painkillers when she was prescribed medication for her migraines.