The Shift: One Nurse, Twelve Hours, Four Patients' Lives (18 page)

There’s a word for this kind of thinking: crazy. I’m not being rational. “If wishes were horses, beggars would ride,” my mother often says. Well, fine. This is one wish I’m going to take out of the stable and see how far I can go on it. Once Sheila leaves here she’s out of my hands. I won’t be there to explain the diagnostic mistake, hold her hand and wipe her brow, or say, Please,
please
be careful with her. I trust the people I work with in the hospital, but they’re not me.

I open the door to Sheila’s room. This is the moment when I have to let go. “They’ll take good care of you. You’re in good hands now.” I must say good-bye with confidence, wish her all the best.

Her sister and brother-in-law flank her as she sits on the bed. Her breaths come deep and rough and she’s squinting as if to block out the pain. The last dose of Dilaudid hasn’t helped much. “We can move the stretcher in here if it hurts too much to walk.” I offer.

But Sheila herself shakes her head no at the idea of the stretcher being brought to her and instead slowly rises from the bed. Eyes closed, she bends forward just slightly and then straightens up. Her sister takes one arm, her brother-in-law the other. I walk in front of them, pulling the IV pump and holding out one arm toward Sheila as if to catch her should she slip and fall.

We move slowly. It’s maybe four feet from the bed to the door, four feet from the door to the stretcher. The time feels infinite. With every step Sheila lets out a contained “Hummph.”

Another nurse would call for the stretcher now, insist she shouldn’t walk. Not me. And maybe it’s not magical thinking. Maybe I believe in the power of normalcy.

At no time was this principle clearer to me than when the Twin Towers fell in New York on September 11, 2001. We were living in Princeton, New Jersey, close enough that what happened felt very real. Our daughters were just two and a half, our son five years old. I’d been doing research in the Princeton Public Library for the microbiology class I was taking as a prerequisite for nursing school. We had to write a short paper about West Nile virus.

I was reading articles, taking notes when I noticed a cluster of people in the library’s lobby all watching TV. Curious, I went over. “A plane flew into one of the towers,” one of the librarians told me, her voice low and tight, nervous in a way that seemed out of proportion. I didn’t understand. A small prop plane went wildly off course. Odd. Dangerous for the people involved, of course, but no more.

And then the first tower fell, on the TV screen right in front of me, all one hundred and ten stories of it collapsing into a giant pile of cement and fire and toxic dust. The second tower fell soon after. In my memory, the collapses are separated by only a few minutes, although the south tower fell at 9:58 a.m. and the north tower at 10:28 a.m., thirty minutes later. Afterwards I went back to my research and methodically finished up my notes, thinking,
Th
ings aren’t going to feel normal for a long time; I want one more dose of normal before that begins.

But of course there’s no way to be sure that Sheila herself preferred a dose of normal over having the stretcher brought to her. She’s such a stoic she would never say she couldn’t walk, especially since I presented walking to the stretcher as the first choice option. Hmmm. In my need to help her feel indomitable, have I inadvertently caused her pointless pain? I’ll never know.

Once Sheila makes it to the stretcher it’s almost too high for her to get up on and this one doesn’t adjust. What genius designed these stretchers? Sheila’s not tall but she’s not that short, either. “I’ll go grab a step,” the escort says, hurrying off as Sheila stands with her back to the stretcher, pulling in long, shallow breaths and letting them out with a raggedy exhale. She’s not sweating, so the walk didn’t completely tax her.

The escort returns quickly—“Here you go!”—putting a one-step footstool behind Sheila’s feet, then maneuvering the carrier just slightly backward to give her a little more room. The brake locks back in place with a loud
ka-thunk
. It takes the four of us to get her on. Sheila’s sister has one arm, her brother-in-law the other. I’m reaching in, my head close to hers, my arms under her armpits and the escort is standing on the other side of the stretcher waiting to help. I count out loud “one-two-three,” just like on TV, and we lift, except in real life it requires actual exertion, not just looking cool.

It works and we get Sheila onto the stretcher. She gives out a low moan, her eyes tightly shut.

“We’re going to lay you down now,” I tell her, making sure the IV tubing is out and away from her body. She doesn’t need that to be pulling on her arm.

I ease her back on one side, her brother-in-law on the other, while her sister picks up her legs. We get her flat and she sighs and opens her eyes. “Better?” She shrugs.

I look at her. This is the moment when she will leave my care for good. Mine may be the last familiar hospital face she sees before she goes under and I want her to remember it as calm and present.

“I have to give you a hug,” I say.

“And a kiss,” she says in return, surprising me. What kind of a kiss, I wonder, is this?

Kisses in the hospital, real kisses, are as the six pomegranate seeds must have been to Persephone in the underworld: rare, enticing, a taste of life impossible to resist when you’re stuck in hell.

A few years ago the wife of a patient who had just died stood in the hallway and kissed me on the lips over and over again. “You’re an angel,” she murmured.

Well, no, but I had made sure he could die in the hospital on our floor, which had been his home and hers for the last few months. Reimbursement rules said he should go to hospice, which would involve a bumpy ride in an ambulance to deliver him and his wife to an unfamiliar place with nurses and doctors they didn’t know. He’d had tubes inserted so that his urine drained into bags outside his body and they never worked right. The end of his life was pain.

I made my case for not moving him with the nurse practitioner in palliative care. I don’t remember what I said. There was no medical reason for keeping him in the hospital—the guy was dying and people can and do die anywhere. The argument for moving him came down to money. Hospitals get reimbursed at a lower rate for hospice patients than those who are expected to live. He’d be using a bed the hospital could get more cash for.

I, however, didn’t give a damn about that. Either I persuaded the nurse practitioner of the wisdom of his staying or she was colluding with me, but we got the patient switched over to hospice in the hospital. It was our biggest room, too, supposedly for VIPs, with extra space for a sitting area, sort of like a suite room in a hotel, with a couch. The hospital bed was hidden behind enclosing curtains. What that wife had done for her husband over months as he fought the inevitable—she deserved at least a sofa and maybe a medal, too, for extreme selflessness without complaint. I know. I was there. She was the real angel.

I look at Sheila, put my arms around her neck as she lies on the stretcher, and go to kiss her on the cheek, but she moves and we kiss on the lips. Sealed with a kiss. Kiss and tell. A Judas kiss. The kiss of life.

The escort takes hold of the carrier and pushes her up the hall with her sister and brother-in-law following behind carrying her few belongings even though we could have transported them later. Away and away with nothing of her left in the room.
Good luck
, I think to myself, but I don’t say it out loud. Instead I swallow, and my phone rings.

“T., your admission is here.”

“Who?”

“Your admission. Irving. You’ve been waiting half the day for him! Wake up,” she laughs over the phone.

“Oh. Right.” My mind feels like a battleship trying to turn in shallow water. Irving. “Send him back once he’s checked in.”

And then I remember the final thing I need to do for Sheila. I call Akash, Peter’s surgical resident, my neighbor. “She’s on her way,” I tell him, just as he had asked me to do.

I don’t ask if they’ll take her tonight or if she’s just going down to be prepped by anesthesia. I had put in my pitch to Peter already and now all I can do is hope the surgery happens as soon as it’s safe for Sheila and not any later. Besides, it’s not Akash’s decision and he may not know right now anyway. Even Peter may not know, since doing the surgery depends on Sheila’s clotting time, which is tricky to evaluate because of her disease and the Argatroban.

I check the last box on her pre-op form—the one that records when she left the floor—and stick my hand in my pocket, feeling the “third tube” of Sheila’s blood that the phlebotomist gave me for her type and screen. Right. I had forgotten. I walk up to our pneumatic tube station and send the tube to the lab, more or less thirty minutes after the other two tubes went.

I’m back at my medcart when two burly EMTs push a loaded stretcher through the double doors that separate my part of the floor from the front section. Then I hear Irving’s whispery voice: “OK now. We’re here at the hospital now. OK.”

“Hi, Irving. It’s Theresa, but you may not remember me.”

He’s strapped down, but he looks up toward me. “I might remember,” he says, as the EMT hands me an envelope filled with paperwork and they wheel him into Dorothy’s old room.

CHAPTER 12

End of Shift

You guys OK in here?” The EMTs are lowering Irving’s stretcher, unstrapping him, putting the side rails down.

“Oh yeah, we know Irving.” EMTs have a reputation for being adrenaline junkies, hardened to the job, and they see a lot: people dead from sudden heart attacks, gunshot victims with clothing covered in blood, accidental overdoses by the young. The adrenaline rush is good, I imagine, and the ability to stay calm when all external signals are screaming “panic!” must be gratifying, too. The pulseless body, the crying wife, could become intoxicating; called in daily to traverse the border between life and death. Licensed to save. But that kind of grind could wear on a person because there would be many times when the patient couldn’t be rescued.

It’s probably a relief to ferry around someone like Irving, and they seem to really know him. They may have taken him to his outpatient chemo appointments and his doctor visits, becoming part of the family he doesn’t have. EMTs’ talk can be rough, their manner brusque, but it seems obvious they care about the people they’re responsible for. After all, why else would they do the job?

My daughter Sophia, when she was seven, swallowed a nickel. She’d put it in her mouth the way kids do, maybe to explore the impressions on its smooth surfaces, trace the roundness of its edges with her tongue. It was in her mouth and then down her throat when she called out. I had just started nursing school, but knew that if she could talk she could breathe. Her airway wasn’t blocked. I also knew to call 911 and soon enough the ambulance came, bringing two EMTs. One, a woman, strikingly pretty with dark skin and hair in small tight braids, fit the tough EMT stereotype. But the other one, a guy, youngish with sandy blond hair, had a gentleness that surprised me.

They told us our daughter was fine, but after talking into the walkie-talkies strapped to their chests the guy, oh so softly, said, “We’re gonna have to take a ride.” Crap. It was nine o’clock at night. I was hoping to avoid the hospital. But, again, I’d been in nursing school long enough that I didn’t argue. If they wanted to take us in, I figured there was a reason.

My daughter and I, she in her footie pajamas because she’d been getting ready for bed, went downstairs to get into the ambulance. Rudyard Kipling’s story “Rikki-Tikki-Tavi” was sitting out and I grabbed it. It was a good pick. Rikki-Tikki is a brave little mongoose. To protect his adopted British colonial family in India he must kill two full size cobras, who are husband and wife, and destroy all their eggs before the new little cobras hatch. He gets some help from other animals, but Rikki-Tikki is the hero of the story, constantly cautioning himself to stay on guard and figure out the best way to win a fight.

The kindly EMT sat in the back of the ambulance with my daughter and me and listened while I read: “This is the story of the great war that Rikki-Tikki-Tavi fought, all by himself . . . .” When we arrived at the hospital it felt too soon; I was only two-thirds of the way through the book. “I’d like to hear what ends up happening to Rikki-Tikki-Tavi,” the EMT said before he lifted my daughter, wrapped in a thin but enormous white blanket, out of the ambulance and deposited her, like a princess on a chair in the waiting room of the emergency department at Pittsburgh Children’s Hospital.

“It is impossible for a mongoose to stay frightened for very long,” I had read, and the EMT seemed to like that idea. Long, long after my daughter got the X-ray showing the nickel wasn’t lodged in her esophagus and the whole event became just another family story, I thought about finding that EMT and giving him his very own copy of “Rikki-Tikki-Tavi,” but I’d never even learned his name.

“Here, I’ll help you,” I tell the EMTs today. “We always like having Irving on the floor.”

Unstrapped, Irving gets himself up off the stretcher and walks over to the chair in the room. It’s not one of the good armchairs, but he sits down in it with an expression of placid contentment. “That’s nice.” His voice is a whisper we can barely hear as he rubs his hands back and forth a few times over the armrests, satisfied in a way that suggests life has lost its ability to disappoint.

“OK, Irving,” one of the EMTs calls out, his voice overly loud but friendly. “We’ll be back to get you when you’re ready to come home.” They pull the stretcher up to waist height, making it easier to push, and head out.

“Is this Irving Mooney?” a young woman in a long white coat looks cautiously through the door. She must be the intern assigned to Irving. She’s petite and her straight black hair ends in a modern stacked cut just at the nape of her neck. She comes into the room, extends her hand to Irving. “I’m Meredith.”

Irving doesn’t seem to see her hand, or else doesn’t understand why she’s holding it out to him, but he nods slowly, looking up.

“And you have a rectal abscess, right?”

“A . . . what?” He cocks his head to one side.

“A rectal abscess. A sore, um, on your bum.”

“Oh, yes. On my backside.” He turns a little, angling his right side out toward Meredith and me. Then he reaches back with his right hand and points to a spot on his lower back just above his waist. “It hurts . . . off and on.”

Meredith frowns. “I’m confused. Your back or your backside? Your back or your rear end?” She says each word distinctly.

“My backside. Here—” He angles the left side of his body away from us and points to his right side again, explaining in that low soft voice, “Here—it’s on my back. Right here.” Then he straightens and sits normally in the chair, his hands folded one over the other in his lap.

Another time when Irving was admitted to the hospital his scrotum was badly swollen, which is unusual but happens more than the average man might like to think. It’s embarrassing and, I’ve heard, pretty uncomfortable. During morning rounds that day Irving told the medical team, “I’ve got this problem with my balls,” in a voice so soothing it surprised me to realize what he’d actually said.

“Meredith!” Another woman, a little older, taller, also wearing a long white coat, comes into Irving’s room. “Is this the rectal abscess?”

“Um, no. He says it’s on his back.”

“His back?”

“The side of his back.” She walks over to Irving and points to the right side of his back.

“So, not a rectal abscess at all?”

Meredith shakes her head no. It’s one of those moments when the hospital is like that childhood game, Telephone. I always wondered if some kid passing on the whispered message deliberately changed it to make sure the game worked and was funny, but I’ve seen it happen often enough in the hospital: the side of the back becomes the backside, which becomes the rear end, which somehow becomes the rectum. Good thing we don’t need a scan to find out the truth for Irving; all we have to do is look.

“Mr. Mooney, I’m Eileen, the resident on this case. I’m working with Meredith and we need to see the abscess—the sore—on your back. Is that OK with you?” She’s friendlier than when she first came into the room and I wonder if she’s relieved to be dealing with an infected lesion in a much less intimate location.

“Fine, fine.” Irving seems to be confirming something for himself more than talking to Eileen, but she doesn’t slow down.

“Good! Because the sooner we see it, the sooner we’ll know what we’re dealing with.” She turns to me. “Are you his nurse?”

I look at my watch. “Only for about forty more minutes.”

“You can go. We’ve got this.” I look at her.
You can go
. Am I being dismissed or given a breather? She doesn’t seem rude, just purposeful, not unlike my behavior toward the EMTs who dropped Irving off.

I nod at the two of them. “Call me if you need anything—if he needs anything.”

“Sure,” Eileen says. Turning back to Irving: “Now if you can lie on the bed, Mr. Mooney.”

Chuckling to myself about the “rectal abscess” mix-up, I close the door on my way out. Candace’s call light is on in the hallway, but so is Mr. Hampton’s. I step into his room first.

“Everything OK in here?”

Trace’s head is thrown back in a laugh and I see that even his teeth are perfect. “The call light’s on. Did you need me?” I step into the room and shut the door. That way I don’t hear the ring accompanying Candace’s call light and I won’t see it. Out of sight, out of mind. If she were really in trouble her cousin would probably have burst out of the room yelling for help, or that’s what I tell myself.

Trace collects himself, looks up at the light flashing on the wall. “Oh, no, we’re fine. It must have been an accident.”

I walk over to the bed and fish out the remote from under Mr. Hampton’s knee.

Mr. Hampton shakes his head. “Mistake,” he says.

“Hey—sorry,” Trace tells me.

“No problem. Like I said, I’d rather come in and have it be nothing than walk into an emergency because you didn’t call.” I reach behind the bed to turn off the alarm. “I’ll be leaving soon; it’s the end of shift. Can I get anyone anything before I go?”

“Oh. No. Nothing,” Trace says. “But thanks for everything.” He gives me a sincere look, without the movie-star smile.

I’m ready to brush off his gratitude, to say I’m only doing my job, when I bite my tongue. “You are very welcome,” I say, taking all three of them in with a glance.

Candace’s call light is off once I get back in the hallway. The aide must have answered it.
Th
at’s a relief
, I think, and then I remember the chair. Sheila’s comfy armchair, the one her brother-in-law spent all day sitting in; I was going to give it to Candace as a kind of peace offering and because it would be a nice thing to do.

I think over what else I have to get done. I recorded report on Mr. Hampton once it was clear he would do OK with the Rituxan. Candace doesn’t have much going on and Irving just got here, so report for him will be easy. No need to do voice care on Sheila, because even if they don’t operate tonight she’ll almost definitely go to ICU instead of returning here, and Dorothy is long gone. I’ll give face-to-face reports—what we call “verbals”—for Candace and Irving. We’re supposed to always record change of shift information for the oncoming nurse, but with new admissions we often don’t. It’s easier just to talk to the nurse taking over.

It’s 6:55 p.m. I need to be in the conference room in five minutes. Moving fast, I grab some Clorox wipes out of the dispenser on the wall and go into Sheila’s room to wipe down the chair. Candace will wipe it down again of course but I don’t want to offend her by introducing a dirty chair into her clean room.

The chairs are big and look solid but they’re actually very light. Disinfection accomplished, I push the chair out of Sheila’s room to Candace’s door. I knock.

Two voices call out, “Come in.”

Opening the door I see Candace and her cousin eating pizza. When did that pizza get here? It must have been when I was in Irving’s room. I catch a whiff of the pepperoni and cheese and I feel a twinge in my stomach. No surprise.

“Hey. I thought you might like one of our primo armchairs.” I gesture toward it. “I just cleaned it. Another patient had it but she’s gone to the OR and won’t be coming back.”

Candace stands up to look at the big brown chair. I can’t tell what she’s thinking. “I’ve got a chair in the room right now.”

“I know, but this one’s a lot more comfortable and I can trade yours. We move furniture around all the time.”

“Can it be cleaned with bleach?”

“Uh-huh. Just like all the others.”

She stands there for a minute longer, saying nothing. “OK. That’s great. But we can do it.” Following some unspoken command, Candace’s cousin hops up and starts moving the smaller armchair out of Candace’s room while Candace takes the comfy chair and maneuvers it inside the door. “We’ll have to wipe it down,” she says aggressively. Then she stops pushing and looks at me. “Thank you.”

“You bet,” I tell her, taking the old chair from her cousin so that I can put it in Sheila’s room.

In the conference room the nurse taking over for me has her papers and is sitting down to listen to voice care. I tell her she’ll be getting verbals for my two admissions and she nods, punching in the right codes to hear report on Mr. Hampton.

Maya the aide, who’s heading into a double shift, is eating a piece of pizza. Each pepperoni has an opalescent drop of grease inside it, but looking at it makes my mouth water.

“Where’d you get that?” I try to sound nonchalant.

“Candace,” she says while chewing, and for a minute I feel bad they didn’t offer me a slice when I went in.

“She said she would have given you some, but you must not have heard the call light.”

“Oh.” I feel my face fall. I’m suddenly that hungry.

“So I asked for a piece for you anyway.” She holds up another plate, covered with an unfolded napkin, and underneath the napkin is a second piece of pepperoni pizza, also shiny with grease. I don’t even really like pepperoni, but the happiness I feel about this cold oily piece of pizza blooms like a tea flower dropped in hot water.

“You are wonderful.” I take the plate from her, lean up against the computer table in the conference room and start eating. The pizza hits me like a drug as I chew and swallow, barely pausing.

“Did she need anything?”

“Nah!” Maya says. She takes an index finger and circles it around in the air next to her temple—the universal symbol for crazy. “She’s batshit.”

I laugh. I ought to tell her she’s wrong, that Candace has been through a lot, that any of us might react to being hospitalized the way she has. But I don’t. I just eat.

The nurse taking over for me finishes report on Mr. Hampton and clicks off her phone. “So he’s getting Rituxan until two in the morning?” she snaps. The thought of taking several sets of vital signs during the night must be annoying.

I raise my hands, palms up, a placating gesture. “He’s doing fine with it.”

She sighs. “Rituxan, Candace Moore, an admission who just got here, Beth’s patient up front who can’t walk and needs to pee constantly and whatever other train wreck comes our way tonight since I’ll get the next admission, too.”

“Candace is content right now and nothing starts for her until tomorrow. She came early because she was worried about her central line—which is fine—so no worries there. Irving should need only IV antibiotics and fluids.” More placating. “And I’m here tomorrow,” I tell her, which makes giving report in the morning easier since we usually get our previous patients back.