The Nurses: A Year of Secrets, Drama, and Miracles with the Heroes of the Hospital (42 page)

Ever wonder what nurses are writing in your patient chart? If you say something offensive or off-the-wall, nurses chart it. If your family member creates issues, that goes in the chart, too. “I always chart when a patient is difficult or belligerent. I keep it objective and write direct quotes; it’s funny to have to type ‘Fuck you, bitch’ in medical documentation,” Molly said. Nurses chart everything because if a patient later sues the hospital, the evidence can diminish the patient’s credibility. Along those lines, Molly added, “If you claim to know someone, be someone, or say you’re going to sue, it doesn’t increase your chances of getting better service.”

“Sadly, doctors and doctors’ offices bully people into having tests and procedures they don’t really need, especially the elderly,” said a Tennessee travel nurse. Similarly, “If I could talk to my patients
before
open heart surgery, I would probably advise thirty percent of them not to have surgery,” said a New York nurse. “Our fee-for-service healthcare system incentivizes doctors and hospitals to advise aggressive, high-cost treatments and procedures. Doctors undersell how much rehabilitation the successful recovery from heart surgery requires. Most patients tell me they didn’t know the recovery would be as difficult as it is. Every time I see patients over eighty-five opt for an aortic valve surgery because they were becoming short of breath on exertion, I scratch my head because many of these high-risk patients will not get back all the faculties they had before the surgery, and some won’t even make it out of the hospital.”

They might not do it in front of patients, but nurses do cry about the people they treat, whether with patients’ families or on their own. “Because I’m a burly man, [people think] I am not affected as much, but I am,” said an Oregon murse. “Sometimes I cry on the way home from work.”

Some stories are too sad for even the most composed nurses to bottle away until after the shift. Nurses in Kansas, California, and other states told me about child abuse cases that led them to sob in the break room. A young Illinois nurse was taking care of a woman in her nineties and learned that “even when a patient can’t respond and their eyes are closed, they can probably still hear you.” While the nurse was talking to the patient, her preceptor laughed at her. “She can’t hear you and she’ll never open her eyes again. Stop wasting your time. We have a lot of other patients to get to,” she said and walked out the door. The nurse took the patient’s hand, squeezed it, and said, “I believe that you
can
still hear me, and I promise to take good care of you.” The woman lightly squeezed back. “I knew she heard me and I lost it right there. Even when patients may not be there all the way, they are still someone’s mother, father, sister, or friend, and deserve to be treated with respect,” the nurse said.

In reality, nurses manage many of the duties that viewers see doctors performing on TV, such as inserting an IV or catheter. “I laugh when I see shows like
House
or
Grey’s Anatomy
, where doctors are pining at the bedside of patients, giving them medications, or administering treatments. Doctors do nothing of the sort,” says an Arizona clinical education specialist. “They come by once a day, take a short look at the patients, review their chart, make orders, and leave.”

A New York hospital night-shift nurse said that sometimes his patients don’t see a doctor or a PA overnight. The nurse diagnoses the patient, determines the course of treatment, then treats the patient himself, sometimes without even calling the PA to approve the orders for fluid boluses, antihypertensives, diuretics, and other medications. “We reserve calls to the PA for fairly urgent matters, and handle whatever other issues arise ourselves. This can mean doing things that are beyond our scope of practice, but most of the PAs appreciate the uninterrupted sleep and will generally cosign any orders once they make their rounds in the morning.”

One major difference between TV and real-life hospitals is that many patients who survive in the shows would die in real life. A Texas clinical nurse specialist said, “In almost forty years, I can count on less than ten fingers the number of patients I’ve helped resuscitate who walked out of a hospital under their own steam. Even in a hospital, ninety-five percent of all codes fail to resuscitate the patient in an unwitnessed arrest” (if a person is found without a pulse and no one saw him/her collapse).

One reason an Air Force nurse left civilian nursing was because her supervisor skimped on her unit’s training. When an oncologist decided to admit patients to her unit who needed twenty-four-hour chemotherapy treatments, a nurse gave the staff a brief talk on the chemotherapy administration. “After that talk, we were expected to hang the agent [administer the medication] whether we felt comfortable with it or not,” she said. “I told my supervisor I did not feel comfortable administering the agent to any patients and she told me I was trained to do it. I told her a brief talk does not validate my competence to hang the drug. To protect the patient, I refused to do it. People who treat these patients have years of experience on an oncology unit, generally. I was working on a multiservice unit with ten to twelve patients at a time and could not care for the patient receiving the chemo appropriately. I didn’t want to administer the medication if I couldn’t monitor it effectively. From that day on, I was criticized for not wanting to do anything out of my realm of comfort.”

Many nurses say that their work makes them appreciate the fragility of life. “Recently a perfectly healthy man slipped on the floor and severed his spinal cord. He will be dependent on others the rest of his life,” a Minnesota travel nurse said. “Think about not being able to hug your child, feed yourself, or scratch an itch. If every human spent even an hour on a nursing unit, it would change their perspective on what’s important. Before every hike I take, I dedicate it to one of my patients who will never be able to hike again. It’s a gratitude I never knew before I became a nurse.”

For nurses, each individual patient death is precious and, collectively, the deaths a nurse observes become a kind of
memento mori
, reminding her to cherish life. This appreciation is one of the threads that weaves nurses together. “Nursing keeps me grounded in my own mortality even when I’m helping someone die,” a former Army nurse in New Jersey said. “It’s a holy profession.”

California nurse Jared Axen was holding a dying hospice patient’s hand when he began to sing an old hymn. The woman, who didn’t speak English, hadn’t been responsive in days. But when Axen sang to her, she squeezed his hand, a response that soothed the woman’s family. Six years later, Axen, a classically trained musician, sings to some of his patients every day. “It gives them their humanity back,” he said. “Music is a common language that helps me connect with my patients.” Many patients also claim to feel better and to need fewer pain medications, Axen said. “It’s become a vital tool for my patients and their families.”

In 2012, Emory University transplant nurse Allison Batson donated a kidney to 23-year-old patient Clay Taber, a recent Auburn University graduate. The 48-year-old nurse, a mother of four, told the media that her children were around Taber’s age, so his sudden rare illness, Goodpasture’s Syndrome, hit her hard. Batson, a hero, saved his life, and Taber now considers her part of his family. “I wasn’t even supposed to be on her floor, but the floor I was supposed to be on was full. And now we joke that we’re kidney-in-laws,” Taber told me. “I’d been on dialysis almost a year-and-a-half by the time I got the transplant. It was definitely something I never expected her to do. Just how selfless she is, willing to do something for a stranger, to change my life on a dime, was very heroic. I like to say she’s an angel sent down to help people.”

Lara was attempting a new exercise as she worked out at her gym’s boot camp for the third time this week. Because she wasn’t taking her college classes, she had stepped up her already frequent exercising, determined to throw her energies into something that would give her a natural high.

“Take this,” her trainer said, handing her a forty-five-pound plate. Lara was skeptical; forty-five pounds was a lot of weight for a five-foot five-inch woman weighing 123 pounds. As she swung the plate from between her legs to overhead, she felt a horrible burning sensation in her stomach.

“Something doesn’t feel right,” she said.

“Wimp!” a boot camper called out.

“Wimp-ass!” shouted another. The trainer laughed.

“Oh my God, my stomach is killing me,” Lara said. This wasn’t a sore-muscle kind of feeling. It felt like someone was tightly squeezing the area near her belly button. Determined not to lose face, Lara finished the set of fifteen reps and moved on to her next exercise.

At work that afternoon, Lara noticed a bulge in her lower abdomen. She knew what it was right away. So did her coworkers. Every once in a while, she tried to push her intestine back where it belonged. “Girl, your shit is sticking out!” the nurses told her. “Quit pushing it back in!”

When Lara finally saw her primary care doctor, he diagnosed the hernia and sent her to a surgeon. “I have two things to tell you that you’re not going to be happy about,” the surgeon told her. “One, you need surgery. Two, you’re not going to be able to exercise for six weeks afterward.”

Immediately, Lara’s mind began whirling.
I’m going to get painkillers! I get a free high!
she thought. For the next two weeks, she was appalled at how quickly her thoughts corkscrewed into old, familiar patterns.
This is so exciting!
a little voice exulted.
Maybe I should ask for the prescription ahead of time so I don’t have to get it after surgery. Maybe I should go pick it up now!

A few days before the surgery, Lara still hadn’t told anyone about it. At work, the vials beckoned once again.

Care at Pines had continued to falter. The Westnorth Corporation had decreed that instead of having a second trauma doctor on call in case multiple traumas came in, which often happened with car crashes, the ER physician would be considered the second trauma doctor. The new policy alarmed Juliette. “The ER doctors have never, ever covered trauma,” she explained. “And now, in addition to covering patients in the ER, they’re also going to have to cover trauma? The hospital is doing that just to save money. They’re sacrificing the patients.”

One morning, Wendy, an older part-time nurse, came sauntering through the ER, flashing a large diamond ring. “I’m engaged!” she told an ER volunteer. “Guess what? I got engaged!” she announced to the secretaries. She navigated the department throughout the day, telling everyone except for Juliette. She kept walking by her, pretending Juliette wasn’t there.

Wendy hadn’t spoken to Juliette for about a year now, ever since a disagreement over a patient. A woman had come into the ER with a dislocated ankle. When Dr. Hughes, a resident who picked up ER shifts only occasionally, went into the patient’s room, Juliette was across the ER, in the bathroom. At the sound of a bloodcurdling scream, Juliette raced to her patient’s room to find that the resident had pulled her ankle into place without offering any pain medication.

Juliette gasped and rushed to the patient’s side.

“It’s okay,” the doctor said to Juliette as he turned to leave the room.

“He just relocated the ankle,” another nurse said.

“Without pain meds?” Juliette said. She turned to the patient, who was incontinent because of the agony. “I am so sorry he did that to you without any pain medication.”

“What are we giving her?” Juliette called out to the doctor.

“Dilaudid.”

Juliette rushed to the medication dispenser, pulled the medication from the machine, then ran back to the patient.

“Thank you,” the patient whispered, and reached for Juliette’s hand. Juliette sat with her for a few minutes, then changed the patient’s gown.

As the patient settled in to rest, Juliette took the other nurse aside. “Why wasn’t she medicated?” she asked.

“We asked for pain meds and the doctor said it was fine, she didn’t need it.”

“Juliette, hallway please,” the doctor said from outside the room.

“We had the pain meds to give her,” Juliette told him.

“I had to do it right away,” Dr. Hughes said. “There wasn’t time.”

“No, we could have medicated her,” Juliette said.

The doctor shook his head. “Next time that happens, you need to call me out of the room and tell me you have a problem with what I’m doing.”

“Fine, but I believe what you did was wrong,” Juliette said.

From the nurses station desk, Wendy, openmouthed, watched the conversation like a Ping-Pong match. “I can’t believe you said that to the patient and were disrespectful to Dr. Hughes!”

“My first responsibility is to the patient, Wendy, not the doctor,” Juliette said. “The patient deserves care.”

At 65, Wendy was a nurse from a time when nurses stood up to give their seats to the doctors. “The doctor deserves respect and you shouldn’t speak to him that way,” Wendy scolded.

“Doctors aren’t God,” Juliette told her. “They need to be called out when they’re wrong.”

Wendy hadn’t spoken to her since. Meanwhile, Dr. Hughes and Juliette, who had a good professional relationship, easily resumed working together with no problems at all.

•   •   •

Juliette was eating lunch with Molly on their day off when Molly mentioned that she had seen Bethany at a nursing conference. “She said something that you’re not going to like,” Molly added. Juliette looked at her, puzzled.

“This is going to hurt your feelings,” Molly said. “This is going to upset you. But I have to tell you.”