The Nurses: A Year of Secrets, Drama, and Miracles with the Heroes of the Hospital (12 page)

Patients in the waiting room were loudly gossiping about the woman, whom they assumed was a typical ER drunk. “What’s her problem?” they complained. “Just let her go home,” a security guard muttered. Gradually, patients yelled back at her directly: “Shut the fuck up!”

Lara couldn’t tell them not to judge. And she didn’t want the woman to go home; she wanted her to get the help she needed. She brought the woman back to triage with her, depositing her in a room where nurses did blood work and EKGs. The waiting patients were angry at Lara for not sending the still-ranting woman home and the woman was angry because she said it hurt too much to sit down. Lara tried to ignore the glares coming at her from all directions, reminding herself repeatedly,
This is not about me
. She didn’t know why, but she believed the woman.

At first, Lara had been slightly nervous to work at South General, where violence, including murder and rape, touched many patients’ lives. Now, South General was her favorite hospital. While some patients had been initially leery of the curly-haired blonde nurse assigned to them, they soon changed their minds. “Once they lose their attitude against me, they see I’m there to help them and we build a rapport,” Lara said. “I respect them, I’m taking care of them, I’m not judging them. I can give them a pillow or blanket or five minutes of my time to really listen, and they’re grateful. Sometimes I’ll even get a hug from a patient after they’re discharged.” That didn’t happen elsewhere.

Lara also liked working with her colleagues, despite racial tensions that separated the black nurses from the few white nurses. She was the only white nurse whom many of the black nurses treated the same way they treated each other. A veteran ER nurse named Rose, in particular, had gone out of her way to welcome Lara since she had first arrived at South General. Rose was a sweet woman with no edges. If any nurse needed help of any kind, Rose was there for her without hesitation. She kept an eye on her coworkers so that if one of them was struggling with her patient load, Rose would step in, offering to take a patient for a CT scan or an admitted patient upstairs. She was a true team player.

When the sexual assault nurse finally arrived to evaluate the still-ranting patient, she spent more than an hour examining the woman. Afterward, she told Lara she was right to keep her in the ER. The woman’s injuries corroborated her story.

Lara was a self-assured nurse, skilled and experienced. She’d been confident ever since she had made the correct call on her own child. When Lindsey was four months old, Lara happened to be taking a pediatric advanced life-support class. She was reviewing her textbook in bed and decided to quiz her husband. “Hey, John, what would you do if one of our kids was choking and I wasn’t home?” she asked.

He answered correctly. “And where would you take a pulse on a baby?”

John didn’t know that one.

Lara went to Lindsey in her crib and pressed her fingers on her upper arm. She counted. “Sixty?” she said. “That can’t be right.” She did it again. “Oh my God, her heart rate is sixty and it should be one-forty!” She ran to the book to show John the page. “It shouldn’t be sixty! Something’s wrong!”

“You’re overreacting. Lindsey’s fine,” her husband said.

The next day, she took her daughter to the pediatrician, who said that Lindsey’s heart rate was normal. “Umm, maybe she has a cold,” the doctor said.

“What does having a cold have to do with her heart?” Lara asked. There was no reply.

Unsatisfied, Lara made an appointment with a cardiologist. The morning of the appointment, Lara weighed whether to cancel it. “I feel like the freaky know-it-all mom. I don’t want to go there and have them look at me like I’m crazy,” she told her husband.

“You might as well keep the appointment since you made it.”

At the cardiologist’s office, even before Lindsey’s EKG results had finished printing, the doctor told Lara, “Your daughter is in heart block and needs a pacemaker this week.” Heart block referred to a dangerously slow heart rate because the electrical signals that caused the heart to contract were partially or totally blocked. Lindsey had a pacemaker inserted during open heart surgery. Two months later, she went into complete heart block, saved only by the pacemaker. The cardiologist told Lara that if she hadn’t detected the problem, Lindsey “would have been one of those babies who was put to bed one night and didn’t wake up.”

Lindsey, who still had the pacemaker, was now a healthy 5-year-old. The experience bolstered Lara’s faith that she was “supposed” to be a nurse. Between the pacemaker and Lara’s addiction recovery, “Weird things have happened to me. I look at them as ways to grow,” Lara explained. “I am a stronger, more confident woman now. I tell my patients all the time to listen to their gut. I tell parents who seem self-conscious or unsure, ‘You know your kid better than we do.’ ”

She wished she were as confident in her marriage, but John was making that difficult. His own addictive personality led him to relate to and help her with hers, but dealing with his gambling and cheating—he said he had a sex addiction—added to her stress. He loved her, she knew, but he said he couldn’t curb his behavior. She stayed with him because Lindsey and her 6-year-old brother, Sebastian, were young. Lara and John made a good living together; at least, they had, until he got laid off from the heating and air conditioning company. They led separate lives anyway, with their own interests and friends. “I have a beautiful home, beautiful babies, and a good life, just a ridiculous husband,” she said. “When my mom got sick, I didn’t have time to focus on his stupidity.”

She remembered during her mother’s illness, she was working full-time, taking care of her children, and shuttling back and forth to her mother’s home twice a day. The week she put her mother in hospice care, her husband was cheating on her in Vegas. When Angie, Lara’s former coworker and roommate, asked Lara why she put up with it, Lara had replied, “I don’t have time to focus on John right now. My mom is dying and she is my focus.”

Lara still wasn’t ready to address her marriage. For now, she had plenty of other distractions. She was taking college classes toward her bachelor’s degree, and she was hoping to volunteer once a week as an elementary school nurse to spend more time around her children and their friends. Volunteering was also an outlet to express her gratitude. She said, “I’ve messed up so much in my life, and this is a way to give back. I made a lot of mistakes and God kind of let me off.”

While Priscilla, Charlene, and Erica managed the ER nursing staff, in that order, rarely did all three work the same shift. The day’s supervisor directly affected Juliette’s workload: Priscilla and Erica were fair, Charlene was not. Juliette wished her work life weren’t so tied up in her feelings about her coworkers, but nursing was a deeply interpersonal profession in which people had to depend on others—doctors, techs, fellow nurses—to do their job well.

Erica made Juliette want to be a better nurse. As senior charge nurse, she advocated for fellow nurses: If a doctor talked down to a nurse, Erica would march up to him or her and announce, “You can’t talk to my nurse that way.” She was a good charge nurse, a good manager, and a good teacher; she had taught Juliette how to be a good charge nurse, too.

Juliette was eager to please her supervisors because positive reinforcement inspired her to work harder, perform better, learn more. At Avenue Hospital, the ER director had made clear that she appreciated Juliette. Every few months, she emailed Juliette a positive message: “The charge nurse told me what a great job you did last night” or “We’re so happy you’re part of our staff.”

At Pines, Juliette had been dismayed to learn that Priscilla, the nursing director, was a member of the exclusive nurse clique (and that Charlene thought she was part of it, too). Juliette cared so much what her manager thought of her that she shared personal secrets with Priscilla, wanting her to understand everything she could possibly need to know about her. That way, like the Avenue director, Priscilla could encourage her to be the best nurse she could be. Priscilla appeared supportive of Juliette and had a good rapport with several of the nurses. Juliette had made an extra effort to show Priscilla that she was a hard worker, hoping to get the same positive reinforcement that she had received at Avenue. She was still waiting for it.

On a warm September morning, Juliette walked into the building thinking, as usual,
Please don’t be Charlene, please don’t be Charlene
.

It was Erica. “Yay! Erica, I’m so glad to see you!” Juliette exclaimed.

“I’m glad you’re here, too!” Erica said. “We’re staffed well today. Where do you want to be, with Mimi?”

Erica assigned her to a zone with Juliette’s favorite tech, Mimi. A good tech could make an enormous difference to nurses; procedures went smoothly and nurses could use their time more efficiently. Mimi, a Filipina woman in her forties, was a conscientious tech who had been at Pines for twenty years. Mimi would do whatever a nurse needed without hesitation. It wasn’t uncommon for techs to stand around reading magazines when new patients were wheeled in, despite knowing that when a patient with chest pain arrived, for example, he needed an IV, EKG, and a monitor. Nurses had to ask most of Pines’ techs to do each task. They didn’t have to ask Mimi for anything.

When a patient arrived in the ER with mild chest pain, Mimi ran an EKG. The patient had been waiting awhile. He was 55, the pain was on his left side, and he was sweating. Juliette made an executive decision to test his troponin levels, which could indicate damage to the heart muscle. At Pines, nurses were allowed to run advanced treatment protocols like this without waiting for doctor’s orders, if the doctor hadn’t yet seen the patient.

When Dr. Preston came in, he reviewed the patient’s chart. “I wish you hadn’t run troponins on him. His EKG didn’t show any changes.”

Clark Preston was an efficient doctor. He didn’t order more tests than necessary. He decided quickly on a patient’s diagnosis, then focused his testing on that diagnosis rather than conducting a broad spectrum of tests to make sure. This was easier on the nurses, who knew that his diagnoses were likely to be correct. But the nurses, who looked out for him because he was fun to work with, still worried that sometimes he was too brazen, too quick to assess. So far, he had not been sued. In this case, he wanted to examine the patient before running cardiac labs. Based on the EKG and the patient description of the pain, the problem could have been GI-related.

Forty-five minutes later, the lab called Juliette. She found Dr. Preston in the doctors’ back office. “Troponins came back positive,” she told him. The patient likely was having a heart attack and required further cardiac evaluation.

Dr. Preston leaned back in his chair, palms up, content to give Juliette credit. “Well,” he said with a disarming grin, “I’d rather be proven wrong than have to explain a dead guy.”

Juliette laughed, and went to administer the patient’s cardiac medications and reassess his pain and vital signs.

Midshift, Erica switched Juliette to triage to help improve patient flow. Knowledgeable, experienced nurses were more efficient at getting patients the right care. Soon afterward, someone from the Employee Health Department wheeled in a young, red-haired woman who was weeping uncontrollably. Juliette recognized her right away; she was a secretary who worked in the ICU. When they were alone, Juliette asked her name, per protocol.

“Nancy. You know who I am.”

Juliette smiled compassionately. “What brings you to the ER today?”

Between sobs, Nancy said, “I’m stressed and I can’t work and it’s horrible up there and I just can’t take it anymore!”

Juliette handed her some tissues. “What’s going on?”

“I’m . . . having . . . boy problems,” she said through gasping breaths.

Gradually, Juliette coaxed out the story. Nancy’s boy problem was that for nearly a year she had been dating Dr. Fontaine, a sexy charmer who worked in the ICU. That morning, Nancy had learned that Dr. Fontaine was also dating three nurses at Pines, and one of them was pregnant with his child. The pregnant nurse had told Nancy in person. Nancy was heartbroken. She couldn’t eat.

As Juliette triaged her, diagnosing anxiety and a panic attack, she offered what consolation she could. “I am so sorry this happened,” Juliette said. “Try to relax and we will take care of you. We’ll get you a private room in the back so you don’t have to see anybody.” Juliette was glad that the ER doctor that day was sympathetic. The doctor gave Nancy antianxiety medication and discharged her.

Juliette would never be able to look at Dr. Fontaine the same way. Nurses liked him because he was friendly and didn’t order too many ER tests per patient. The ER nurses’ goal for ICU patients was to get them quickly upstairs, where they could be stabilized and receive proper care. Many specialty doctors asked the ER nurses to do the initial tests, or they ordered extra labs and tests for the sake of ordering them. Dr. Fontaine usually said, “We can do everything upstairs.”
Oh, that’s why he didn’t order a lot of tests
, Juliette thought.
He wanted to get back upstairs to get busy with all of his girls
.