The Nurses: A Year of Secrets, Drama, and Miracles with the Heroes of the Hospital (2 page)

When the medics entered, the group quickly arranged themselves on either side of the gurney, hoisted the patient onto the ER stretcher, and whisked the gurney out of the way. As Molly hooked up the patient to the monitor, a technician started an IV.

One of the medics addressed the room: “Seventy-two-year-old male. Witnessed cardiac arrest while eating dinner at a restaurant. En route he was given three epi, two atropine. We bagged him because we were unable to intubate.” Bagging referred to a plastic mask attached to an oxygen source. Squeezing the ambu bag caused the mask, which covered a patient’s nose and mouth, to force air into the lungs.

The respiratory therapist had the intubation supplies ready. “Give me a 7.0 tube,” the doctor said. He intubated the patient, and said, “Molly, listen.”

Molly ducked under the medic, who was still performing CPR, now standing on a foot-high step stool. She reached under the medic’s arms with her stethoscope. She squeezed her head beneath the medic, and listened to the patient’s torso for air movement; air in the stomach meant the intubation tube was in the wrong spot. Then she listened to the lungs.

“Equal bilateral breath sounds,” Molly said.

The respiratory therapist attached a CO
₂
detector, bagged the patient, and watched. “Positive color change on CO
₂
detector.”

The clatter of the gurney carrying the second critically ill patient echoed from the hallway.

“Secure the tube,” Dr. Preston said. “Let’s run an ISTAT.” The tech quickly drew blood to test whether the patient had a chemical imbalance that could be corrected.

“When was the last epi?” the doctor asked.

“Four minutes ago,” said a medic.

“Give another round of epi. Let’s give two amps of bicarb and an amp of calcium,” Dr. Preston said. “Hold CPR.”

The medic stepped down from the stool, trading positions with a new tech. Because CPR was physically strenuous, CPR providers switched off with every pulse check, two to three minutes apart.

Molly quickly felt the patient’s femoral artery at the groin. “I don’t feel a pulse,” she said.

“Continue CPR,” Dr. Preston replied. The tech resumed compressions. “Bring me the ultrasound machine.”

Dr. Preston swiped gel on the patient’s chest. “Hold CPR,” he said. He passed the ultrasound wand over the patient’s heart.

“I do not see any cardiac activity. What is the total downtime on this patient?” he asked.

“We worked him for forty minutes prior to arrival,” said one of the medics.

The recorder nurse reviewed her clipboard. “We’ve worked him for twelve minutes.”

Dr. Preston looked around the room, making eye contact with each of the four staff members. Not all physicians did this. The staff appreciated that Dr. Preston treated them like part of a team. “Total downtime: almost an hour. There’s no cardiac activity. Does anyone have any other ideas?” The group agreed that they had tried everything.

Dr. Preston removed his gloves. “Time of death: 18:04.”

Erica stepped into the room. “Clark, the next one’s ready.” The doctor, nurses, techs, and medics dispersed.

Molly was left alone with the deceased. When she turned off the monitors, the room went startlingly silent. Dealing with patient deaths like this usually didn’t bother Molly; she didn’t even know this gentleman’s name. She imagined the deaths were much more difficult for floor nurses, who took care of patients for days, weeks, or months.

This was not to say that each death on a nurse’s watch didn’t mean something to her. Births and deaths, miraculous saves and sudden tragedies—all were expected outcomes in the microcosm of hospital life, and their frequency both intensified the experiences and desensitized the staff. But deaths were still sacred to the nurses, who were committed to respecting and preserving the dignity in dying.

Molly unhooked the patient from the monitor. He was still warm. She tidied the room in preparation for the family, trashing the plastic wrap from the intubation supplies and the empty glass medication vials. The room looked much more chaotic than the procedure had been. ERs had specific protocols, and everyone on staff worked from the same playbook; if the heart has this rhythm, give this medication; if the heart has that rhythm, shock the patient. Although they had not been successful this time, the staff had worked smoothly together.

Molly thought about how strange it was that she knew this man was dead, but his family did not. She tuned out Dr. Preston’s instructions in the next room, where he had plenty of assistance. She could have followed the action, but just because this man had died didn’t mean he wasn’t her patient anymore. There were still things she could do to help him. Molly wiped the man’s face and closed his eyes to make him presentable for his family. Families usually wanted to see the deceased one last time. Molly liked to make the patient and the room look serene.

Moments later, the registration clerk came to tell Molly that the man’s family was waiting in the private family room. When Dr. Preston was finished with the other patient, he came to get Molly, wearing his white lab coat. He usually shunned medical coats, but Molly had told him once about a report that people believed doctors wearing white coats were more trustworthy and professional. He had donned the coat for family notification ever since. The moment he left the family room, though, that coat came right off.

When Molly and the doctor opened the door, the family members were seated and crying. “Did he make it?” one of them asked. This was almost always the first thing a family member said. Molly had difficulty avoiding eye contact with the family; she couldn’t let them read her sympathy. She kept her eyes trained on Dr. Preston.

As usual, Dr. Preston started at the beginning. “When EMS picked up your father, he wasn’t breathing and his heart wasn’t beating,” he said matter-of-factly, his bright blue eyes sincere. “So they started CPR and transported him to us. When he got here, he still wasn’t breathing and his heart wasn’t beating. We put in a breathing tube, continued with CPR, and gave him medications to try to restart his heart. I’m sorry to tell you that we weren’t able to do that. Your father has died.”

Dr. Preston offered his condolences. After a few beats of silence—rarely did a family say something right away—it was Molly’s turn. “Do you have any other questions for the doctor? I’m going to stay with you and let you know what happens next.” The man’s widow and her daughter shook their heads. Dr. Preston left the room.

Doctors and nurses told the family together so that after the doctor left, the nurse could deal with the emotional breakdowns and walk the family through the next steps. Many doctors first explained how they tried to save the life, before revealing that they were not able to, because, Molly said later, “It’s easier for them to have that gradual letdown. Once you say, ‘He’s dead,’ they’re not going to hear anything else. We want them to know how hard we tried.” Doctors specifically used the words “dead” or “died” so that loved ones couldn’t misinterpret the message.

Molly’s nursing school had offered no instructions on how to talk to the family; her psychology rotation covered only mental illnesses. The one official rule Molly had learned was that staff first had to notify the next of kin before letting nonrelatives know. When a patient collapsed in the workplace, coworkers often sat in the lobby for hours without knowing the patient was dead, because the ER staff couldn’t tell them before locating the family.

By watching physicians like Dr. Preston, who presented the news well—and, equally as helpful, those who did not—Molly had learned what the bereaved needed to hear at this crossroad. Many nurses hated this task. Molly didn’t mind it, particularly when she was paired with a doctor who was not good at it. She considered it her responsibility to soothe and assist the families, much as she had done with the patient.

Molly sat down next to the widow, who sobbed on her shoulder. Families usually wanted some physical contact with the nurse. Molly typically put her hand on a shoulder and let the person guide her from there. If the family member needed more comforting, she would lean into Molly’s shoulder or reach for a side hug. Molly remained quiet during these interactions. At this point, people didn’t want to hear, “It’s going to be okay.”

When the woman’s cries subsided, Molly spoke gently. “Next, you’ll need to contact a funeral home and let the hospital know which home you’ll be using. Your husband will be in our mortuary until you make that decision. Take all the time you need. Whenever you make that decision, Registration will make the arrangements to have him transferred over there.”

The widow looked up at Molly, still stunned. “Next week he was going to help drive his granddaughter to her first day of college,” she said.

Almost every family told Molly something specific about the deceased, as if subconsciously trying to prolong his life for just a moment longer. Molly always tried to come up with something positive and personal to say, so that the family would know that the hospital staff saw the deceased as a human being rather than a patient. “He must have been so proud that his granddaughter is going to college,” she said.

The widow and the daughter both nodded, smiling through their tears.

As soon as a nurse on the 7:00 a.m. to 7:00 p.m. shift got off work, she was supposed to “give report,” a recitation of her patients’ status for the incoming nurse. Molly already had been working for more than twelve hours without a break. She hadn’t even eaten. Nurses at Pines almost never got time off for lunch. There was rarely a chance to go to the cafeteria, break room, or simply outside for thirty minutes. Only once in the past two years had Molly been able to leave the department for a break. The usual scenario involved eating while working at the nurses station, which was an Occupational Safety and Health Administration (OSHA) violation.

Hospitals were required to give nurses breaks, yet the constantly short-staffed Pines nurses never had time for them. Technically, nurses were prohibited from bringing food or beverages to the nurses station to prevent them from contaminating patient labs and vice versa. Priscilla, the nursing director in charge of supervising every nurse in the ER, let the OSHA rule slide because the odds of getting caught were low. When The Joint Commission—the governing body and accreditation group for hospitals—sent inspectors, they had to check in at the front desk. Immediately, a hospital-wide page would announce, “Pines Memorial would like to welcome the TJC inspectors.” Molly said the announcement meant “Hide your food!” She explained, “After the announcement, we have about ten minutes before the inspectors get to us. It’s so obvious, like, ‘Warning! Mayday! All the stuff that shouldn’t be out—hide it!’”

Priscilla let many rules slide, actually. She seemed to try to look out for the nurses as best she could, which couldn’t have been easy because she also had to enforce the new policies thrust upon them by the Westnorth Corporation, the giant healthcare system that had taken over the hospital six months earlier.

At 7:20 p.m., the charge nurse assigned Molly to put a Foley catheter in an obese paralyzed patient, a somewhat time-consuming procedure that required assistance. Molly walked to the nurses station, where five nurses were giving report to the oncoming shift. “Y’all, can I get a little help in Room 3 with the Foley?” she asked. The nurses ignored her. They didn’t even make eye contact with her.

These weren’t generally uncivil nurses; they were just busy. The outgoing nurses were determined to give report and go home, and the incoming nurses didn’t want to be bothered with someone who was not their patient. The nurse Molly would give report to was already working on a trauma patient. Molly knew that if her friend Juliette had been on duty, she would have been at Molly’s side in a heartbeat.

Molly looked over each of the nurses with her piercing green eyes. A tall, striking brunette, she was hard to miss. Five people were ignoring her—and she was not a quiet person. She had hoped that one of them would sense her frustration and offer to assist. But she would not badger them into helping her out.

Typically, many of the nurses at Pines worked well together, giving aid when needed, knowing they were in it together. Erica, for example, was constantly assisting her coworkers at bedside on top of her supervisory duties, as she was today. Ever since the buyout, however, the atmosphere had changed. The morale was as low as Molly had ever seen it. People were just too tired and angry to help each other out. The staff knew why Pines had allowed the buyout: Independent hospitals across the country were having trouble turning a profit because new insurance guidelines made getting reimbursement for medical care more difficult. Westnorth had instituted several changes that angered the nurses, including cutting their weekend overtime pay and slicing vacation accrual in half.

One of the worst new policies forced nurses to pay for parking at the hospital while techs and physicians could still park for free. The nurses who didn’t want to pay for the covered garage would have to park at a satellite garage that was a shuttle bus ride away from the hospital. To catch the bus, nurses would have to get to work thirty minutes before their shift began and wouldn’t get back to their cars until at least thirty minutes after their shift ended, effectively adding an unpaid hour to their workday.
What kind of company wants to make money off its employees like that?!
Molly had wondered, dismayed.

The hospital takeover had directly and indirectly affected patient care, too, which was evident when Molly ended up struggling to insert the Foley alone. The procedure took longer than it would have if another nurse had helped to lift the obese patient. ER staffing was supposed to be determined by the number of patients who came in. The number had increased drastically enough to justify an additional staff nurse for every shift, but Westnorth had refused to hire anyone. Consequently, waiting time to get into the short-staffed ER had increased from an average of thirty minutes to three hours.

That night, on the drive home, Molly cried with frustration. She was known as being thick-skinned rather than a crier. She was so tough that once while playing pickup basketball, she tripped and broke her arm, but waited hours before going to the hospital because she was having too much fun to stop playing. Now she cried because the once tight-knit hospital no longer seemed to care about the welfare of its nurses, and her usually co- operative coworkers were so worn down that they “acted like I was invisible.”