The Nurses: A Year of Secrets, Drama, and Miracles with the Heroes of the Hospital (40 page)

Nurses always make vital contributions, but it is during these months in these hospitals that their vigilance is particularly paramount. Experienced nurses have seen more than inexperienced doctors. They know more about the hospital’s equipment and pharmacy system than someone new to the unit. “Nurses are correcting every error and preventing major mistakes every day,” said a Maryland solid-organ transplant nurse.

The residents who know enough to know what they do not know, and, therefore, listen to and seek out nurses for advice, are not the problem here. But too many residents, enamored of their MD status, won’t ask for help. “I’ve had doctors give orders for meds to be given IV that should never be given IV. And residents have asked me what a med was,” said a Washington State ER nurse. “They need to be guided and given lots of hints: ‘Would you like me to call the doctor who specializes in that? Would you like me to order that test?’ I don’t think they realize everything the nurse does for them and the patient. We cover their asses.”

Some patients who must be hospitalized in July for particularly complex procedures might consider avoiding teaching hospitals. Approximately 25 percent of U.S. hospitals are teaching hospitals, which patients can identify by checking the “About Us” page on a hospital’s website.

If you see a large gray box in the hospital hallway, that’s not meal services. It’s probably a container holding a deceased patient, a Pennsylvania nurse said. “The morgue is never labeled that, either. They’ll call it something like ‘Anatomical Pathology,’ so if someone passes by, they won’t think there are dead bodies inside.”

Nurses have much to say about the doctors with whom they work. Perhaps more than anyone else, they are certain which doctors they would trust with their lives and which ones to steer clear of. “If you want to know if a medical facility or a doctor is any good, ask a nurse [away from that facility],” said a Washington State nurse. “Unless she doesn’t like you, she will tell you the truth.”

Some of their observations include:

• After the procedures, when witnesses dwindle, doctors aren’t necessarily on their best behavior. An Arkansas nurse watched a cardiovascular surgeon check whether his female patient was awake. The doctor pulled down the sheet and twisted the patient’s nipple. “My reflex was as if he had done this to me: As soon as he touched her, I smacked him on the arm. He gave me the dirtiest look,” the nurse said. “A lot of nurses would like to smack their doctors once in a while.”
  
• “Sometimes residents practice procedures on a patient after a code [such as using a needle and catheter to remove fluid from the sac around the heart]. We put a stop to this in our hospital,” said a nurse in the South. This practice does not occur as often as it used to. Before simulators were sophisticated enough for doctor training, physicians would “spend up to eight hours practicing on the deceased, which prevented family from coming in, and they did not know why,” a North Dakota nurse said.
  
• “The highest-rated heart surgeon at my hospital, according to
  U.S. News & World Report
  , is the one I would least want to have operating on my family member,” said a nurse in the Northeast. “It seems that more of his cases come out of the OR with bleeding complications. The consensus among the nursing staff is that this happens with him more frequently than our other surgeons.”
  
• “Some physicians, especially psychiatrists, make rounds at night or very early in the morning so they don’t have to talk to the patients,” said a Texas nurse.
  
• “Doctors don’t always tell the truth, they often blame others to protect themselves, and some doctors are lazy. They want nurse practitioners to do the work and they bill for it [in the hospital],” said a Michigan nurse. “I’ve seen a lot of mistakes: misplaced lines, nonsterile technique, lying to patients or withholding information, wrong medication dosage. There was an incident where equipment in the OR was not used correctly and it affected the patient. No one told the family, but staff knew.”
  

Several nurses confess that they have wagered on patients. Guess the Blood Alcohol is a common game, where actual money changes hands. Other staffs try to guess the injuries of a patient arriving via ambulance. And surgeons have been observed playing “games of chance” during operations, placing bets on outcomes of risky procedures.

Different “codes” mean different things at the hospitals that announce them over the loudspeaker, but here is a sampling of what they can stand for (some hospitals use different colors to refer to these scenarios):

• Code Blue: patient in cardiac arrest
  
• Code Pink: infant abduction (all exits are secured)
  
• Code Red: fire
  
• Code Orange: hazardous material spill
  
• Code Silver: hostage or weapon situation
  
• Code White: communications equipment or computer system failure
  
• Code Green (or Condition Green): combative patient
  
• Code Gray: tornado warning/severe weather; a combative or violent patient or visitor
  

Depending on the hospital, a bomb threat can be a Code Gold, Code White, Code Black, or Code Yellow (among others).

Some hospitals further disguise codes to announce bad news. A page for Dr. or Mr. Firestone can indicate a fire. Code Strong signals hospital security that a patient or visitor is becoming aggressive. “MSET” (Medical Surgical Emergency Team) alerts staff to an unresponsive patient. At some hospitals, Code Lavender means that a doctor or nurse is overtaxed; at Ohio’s Cleveland Clinic and Hawaii’s North Hawaii Community Hospital, a rapid response team including a chaplain and a holistic nurse offers the healthcare provider Reiki, light massage, healthy snacks, water, and a lavender bracelet so that he or she remembers to take it easy.

Actually, Code Lavender, which is called approximately once or twice a week, is meant to achieve what Lara had hoped for with the debriefing room. Originally, Cleveland Clinic’s healing services team was created in 2008 for patients. “Then we started getting called more and more often for staff. If you care for one nurse, you’ve cared for twenty patients,” said the Reverend Amy Greene, director of spiritual care. Healing services is most often summoned for staff after an unexpected death. The team arranges backup coverage and finds the nurse or doctor a quiet corner in a break room or broom closet where she can listen to meditative music, talk to a chaplain, or simply find a few moments of peace.

The break lasts approximately ten minutes, which is enough to recharge someone, Greene said. “Compassion is self-perpetuating and reinvigorating, and it doesn’t take that long. Symbolically, this says that what happened to you is important, you’re important, and the institution has your back. Caring for the caregivers is much more important than we thought in times past.”

The most universal code that nurses call among themselves is a Code Brown, an elegant designation for an inelegant situation: a defecation mess. If you hear nurses referring to “liver rounds,” they are probably talking about happy hour. Non-gastrointestinal doctors who say they are doing “G.I. rounds” are likely taking a break to eat.

A medical/surgical nurse who has worked in a pediatrician’s office warned that when you call a doctor’s office to speak to a nurse, you might not actually reach one. “Parents call to ask the nurse a medical question about their child. The medical assistants, who
are not
nurses, pick up the phone, say, ‘Hello, this is the nurse,’ and then give advice,” she said. “This is illegal and dangerous. Parents have no idea this is going on. MAs have taken a one- or two-year certificate training program, may not have a college degree, and do not have a license. I’ve heard them give incorrect advice. We worked hard to get where we are and it makes me mad when people think they can easily do our job. We have a two- or four-year college degree and a Registered Nursing License. If you are calling in to a doctor’s office, make sure you know who you are speaking to.” Ask whether you are speaking to a licensed nurse or to a medical assistant.

When a department is slow (more likely on the night shift), hospital staff members have several props with which to entertain themselves. Nurses told me about wheelchair-racing down the hall, playing darts with needle syringes and rubber-glove balloons, having squirt gun fights with saline syringes, and bowling with (empty, clean) urinal jugs for pins. A Louisiana nurse and her coworkers do lunges down the hall at three in the morning to stay awake during the night shift. On slow nights in a Virginia ER, nurses used to pull clothes out of the donation box and have runway fashion shows. “The little things you do with coworkers can make your shift exponentially better,” said a Minnesota travel nurse. “We listen to music all night, do the wobble wit (a group dance like the electric slide) at the nurses station, or have catwalk competitions down hospital hallways.”

Plenty of nurses confessed that they gossip about their patients, although they take care to respect the patients who respect them. “If there’s something really different, salacious, or disgusting, we love to tell our coworkers,” said a Washington State nurse. One story involved a mentally disturbed patient who went into the bathroom, cut off his penis, and threw it across the waiting room. Most patients don’t have to worry, though. A Maryland cardiovascular ICU nurse said, “The funniest stories involve the crazy patient who did something with poop.”

In a practice that is not often discussed in the medical profession, some nurses occasionally use larger needles than necessary to “punish” obnoxious patients, as Molly did with the drug seeker.

If breaking a rule will help a patient or protect a colleague, some nurses will break it. A Midwestern nurse at a hospital that refuses to give nurses overtime has clocked out before she was finished so she wouldn’t get written up for working overtime, and then risked being penalized anyway by returning to the unit to care for her patients for free. “That used to never happen, to work in a place where you’re afraid to make a mistake or you’ll be fired,” she said. “Overstaffing the next shift is a mistake, ordering too many or too little supplies is a mistake, not answering the phone within the first few rings is a mistake.”

In an Indiana NICU, “personal interaction is against policy,” a nurse said. Nevertheless, “When the kids are hurting or dying and the parents aren’t there, we will sing, kiss, rock, and love on the babies. We pull the curtain for privacy. You can’t help but smooch their tiny feet. That spot behind their neck is especially a sweet place to nuzzle. They love it.”

Nurses occasionally lie to protect a patient’s feelings or to make him feel more comfortable. A New York nurse told
Reader’s Digest
, “When you ask me, ‘Have you ever done this before?’ I’ll always say yes. Even if I haven’t.”

“We usually know the results of your tests before the doctors talk to you. We can tell when a loved one will have a bad neurological outcome but can’t tell you,” a Virginia pediatric nurse said. “We usually know what we would do, but can’t tell you what it is. We have to give you information in a nonbiased fashion so that you can make those decisions, even if we are dying to tell you what to do.” Even if patients specifically ask nurses, “What would you do in my situation?” some healthcare institutions have told nurses they cannot answer directly.

Nurses use toilet humor and are known for telling disgusting medical stories over meals (to the chagrin of non-nurse dining companions). And when they are out in public, “we are secretly looking at people’s arms to determine where we would start an IV,” an Arizona nurse said. “Sometimes if I’m out with a group of nurses, we’re like, ‘Wow, look at those veins. I could hit those from across the room.’”

At Pines, medics once brought in a 90-year-old man who had passed out after choking. A nurse grabbed a pair of forceps and pulled out a piece of chicken the size of half a deck of cards from his trachea. By then the man had gone too long without oxygen. Once his time of death was announced, Molly helped clean him up and tidied the room. “Then I washed my hands and immediately went and ate my lunch: leftover chicken!” she said. “Nurses are gross.”

Nurses in several states confirmed Dr. Clark Preston’s statement to Juliette that a family member can override a DNR, or Do Not Resuscitate order. While some nurses said that at their hospital, patients with signed, current DNRs are not resuscitated, several nurses told me that saving patients with DNRs “happens all the time.” The most common scenario occurs when an elderly or chronically ill patient with a DNR requires resuscitation and a family member tells the medical team to “do everything you can” to save the patient. Particularly if the family member has power of attorney (POA), nurses said he can change the plan of care.

“Theoretically we’re supposed to honor the DNR, but oftentimes the family will want the patient treated because they see the DNR as ‘giving up.’ We tell the families that the DNR means the patient didn’t want to be worked on if they’re in this situation. If the family tells us to do everything, though, then usually we have to, because the POA has the legal right to make medical decisions even if it overrides the DNR. Even if there isn’t a POA present, the next of kin still have the right to make decisions,” said a travel ER nurse based in Texas. “Families want us to ‘do everything,’ and if we let the patient die, we’re accused of killing them by refusing care. Because a POA can decide for the patient, it gets tricky if we try to honor the DNR. Basically it’s a lose-lose scenario.”