The Nurses: A Year of Secrets, Drama, and Miracles with the Heroes of the Hospital (6 page)

Charlene thought she was part of the clique. The nine nurses kissed up to her so that she would give them the plum assignments, and the ploy worked: Charlene blatantly favored Andrea and the other dominant clique members when it came to scheduling. But Juliette had heard them laugh about Charlene behind her back. The childishness of this behavior exhausted Juliette, who did not want juvenile social maneuverings taking up brain space that she hoped to devote to patient care.

Juliette’s patient was now completely unresponsive. His Glasgow Coma Scale, a range from 3 to 15 used to measure consciousness, was a 3: He was not opening his eyes to painful stimuli, talking, or moving any extremities. Without the central line dispensing medication, he couldn’t be intubated.

Finally, the tech got the line in. Juliette immediately started the medications to prepare the patient for intubation.

When the respiratory tech arrived to take over, Juliette and Noelle made sure their other patients were stabilized. Then Juliette stripped off her gloves, sanitized her hands, and found Charlene at the nurses station, where Andrea was still shopping online. “I’m done. I’m going to minor care for the rest of the day,” Juliette said. “I’ll meet you there,” she told Noelle.

“Okay,” Charlene said. “But you have to give report to ICU.”

“Andrea can do that,” Juliette said, frustrated. Charlene should never have assigned her three ICU-bound patients simultaneously when each of them required a nurse’s undivided attention.

Andrea scowled at Juliette.

“Never mind. I’ll do it,” Juliette said. She wiped down the phone with an alcohol swab before picking it up.

Later, Juliette found Charlene in the break room. “Why didn’t you give that patient to Andrea?” she asked.

“Because it was fine for you and your preceptee to take him. You guys could handle it together,” Charlene said. “And it was wrong of you to tell Andrea to call report.”

Juliette looked Charlene in the eye. “Sometimes I feel like Andrea does a lot more talking than working, and I took it out on her.”

“I understand,” Charlene said, matter-of-factly. “I do that in my work assignments sometimes.”

“Sounds like you’re admitting to favoritism,” Juliette said.

Charlene rolled her eyes.

The next day, Charlene assigned Juliette four seriously ill Cardiac Care Unit–bound patients, while other ER nurses had only the relatively low-maintenance run-of-the-mill ER cases, none of whom would be admitted to the CCU.

Juliette was a first-rate nurse, and could handle difficult patient loads. But every ICU and CCU patient needed a nurse who could spend time with them one-on-one. On a personal level, Juliette could ignore that Charlene and some other coworkers didn’t like her. She knew that stressful working conditions affected how she spoke to people. However, she worried about how tensions and exclusions, power trips, and freezing out among the nurses could impinge on patient care. Perhaps that was why the clique’s snubs bothered her so much. They weren’t folding sweaters here. Juliette took great pride in being a hardworking nurse who cared intensely for her patients.

Oh, who was she kidding? Of course she took the rejections personally. Between her weight and family issues, she had been socially insecure her entire life. Maybe what bothered her most was that people could lower her self-esteem in an arena in which she felt confident that she was good at what she did.

Just don’t kill anyone
, Sam thought, taking deep breaths as the charge nurse distributed assignments.
You’ll be okay. Just don’t kill anyone.

She could see herself in a mirror across the hall, her arms self- consciously wrapped around her ample chest. Petite and slender with long, dark hair usually tied back in a ponytail, Sam had large gray eyes framed by delicate wire-rimmed glasses. She was sure her normally olive skin had a green tint this morning.

Since she had awakened at 4:30 a.m., 24-year-old Sam had been fighting the nausea that accompanied her nerves on her first official day as a nurse. It wasn’t that she was inexperienced. She had interned here at Citycenter Hospital for three months after graduating from nursing school. Before nursing school, she was an ER technician at Pines Memorial. But this was different. Now she would be held personally responsible for potentially fragile lives.

Sam sighed with relief when the charge nurse assigned her to Zone 3. The Citycenter ER was divided into a minor care area for stitches and breaks, and three treatment zones: Zone 1 for the sickest patients, Zone 3 for the least sick. She would be less likely to accidentally kill a patient who wasn’t too critical to begin with. As the charge nurse wrapped up the meeting, Sam mentally ran through the phone numbers she had memorized. New nurses were given cards with phone numbers for the charge nurse, lab, radiology, computer help desk, and tube station, a pneumatic labyrinth of tubes that sent specimens and paperwork through the walls to various departments of the hospital. Sam had learned as an intern that if the staff believed a nurse didn’t know what she was doing, they gave her a hard time. She had worked her tail off to get here. She wasn’t about to lose any respect on her first day because she had to look up a phone number.

Sam went to the nurses station to check the computer for the outgoing nurse’s report. Because the night shift nurse’s patients all were discharged, triage had assigned a new slate of patients. “Room 12: Lac of unknown area.” A laceration sounded easy enough. Sam walked into the patient’s room. He—or she, it was difficult to tell—started talking before Sam had a chance to ask questions.

“I didn’t tell them at Registration, but I was really tired of this whole situation, so I decided to take matters into my own hands,” said Lou, whose chart identified her as female, pointing downward. “I went online and read about this banding procedure. I got hair ties, tied the hair ties around it, took some sterilized scissors, and I untied it, and I cut it off. But there was a lot of blood, so I tied the hair ties back around it.”

Sam didn’t know what the patient was talking about. “Oh, okay,” she replied. “Well, let’s just see what we’re working with here.” She lifted the gown. Her mind went blank except to register,
Uh, there should be balls there
. She cleared her throat. “Are you in pain?” she asked.

Lou’s voice was shaky. “Yes.”

“Okay, well I’ll definitely get you some pain medication, probably some antibiotics. I’ll go see what the plan is,” she said. She speed-walked to the nurses station, her thoughts reeling. Self-inflicted ball-removal had definitely not come up during nurse training.

She quickly checked the computerized board, which listed the patients, their chief complaints, their room, their nurse, and the residents or attending (the doctor in charge), as well as a small section for comments. Kathleen, a new physician’s assistant, was assigned to this patient. Sam found her in the hallway.

“Uhhh, Room 12?” Sam asked.

“I
know
. Urology’s coming,” Kathleen snapped, without making eye contact. “Someone else will deal with that.”

Sam had heard other nurses say that Kathleen was uncomfortable treating patients with more than minor injuries. She must have picked up Room 12 because triage had listed the chief complaint as “lac.” Some laceration. Evidently, the patient had told triage “I cut myself” without explaining the important details.

Lou wasn’t going to bleed to death, but her condition was serious nonetheless. Sam wasn’t about to let her wait in pain while Kathleen passed the buck. She found the attending ER physician outside another patient room. Bernadette Geiger was an African American woman with a high, childlike voice and a reputation for being extraordinarily compassionate. Sam knew she wasn’t supposed to approach an attending directly, but she didn’t know who or where the resident was and she worried the patient would suffer in Kathleen’s care.

“Um, could I please get pre-op labs, antibiotics, and pain meds for the patient in twelve?” Sam asked, her heart pounding.

“Sure.” The doctor smiled and wrote the orders.

Sam retrieved the medications quickly, then gave them to the patient intravenously. She tried to make conversation. If she kept Lou talking, she could distract her from the pain until the morphine kicked in. Keeping her calm and in the present moment would also help prevent her from going into shock. “We need to fix you up here, friend,” she said.

“You know, it’s still bathing suit season and I can’t wear cute little bikinis when I have stuff down there,” Lou said.

Sam tried to be understanding. “Oh yeah, I know. Bathing suit season sucks. I’m a big fan of board shorts because they offer more coverage.”

“I hadn’t thought about board shorts,” Lou said. “They’re probably not my style.”

Sam kept the patient stable until she wheeled her to the OR, about an hour later. Sam was pleased that she had kept her cool during a relatively shocking case for a new nurse on her first day when the PA had been no help at all.

Sam had started volunteering as an EMT when she was 16. Every Friday night during her junior and senior years of high school, she slept at the firehouse, on call for the overnight shift. She always did more than was expected of her, always stayed later than her shift. The girls at her private Catholic school didn’t know what to do with her; she wasn’t “popular,” but neither was she an “I’m-going-to-eat-my-hair-in-a-corner person.” After college, Sam volunteered at a local rescue squad while she considered her career options. One night during a stop at Pines, she asked an ER nurse with whom she’d become friendly, “What am I going to do with my life?”

“This is what you’re going to do,” the nurse told her. “You’re going to get your second degree in nursing and some experience under your belt. Then you’re going to get your NP and be able to call your own shots. That’s what I’m doing.” Sam liked the idea of becoming a nurse practitioner, which required a master’s degree. So she followed her friend’s advice. She went right into nursing school, graduated, and interned. She hoped to apply to master’s programs after working in the field for a couple of years.

As a nursing intern at Citycenter, Sam had learned that being an introvert would not help her quest. Sam wasn’t much of a talker. She preferred to observe her surroundings quietly so that she could soak up as much information as possible. Her goal in most situations was to learn; there was always a way to improve her knowledge base. When she did speak, she was blunt, with a dry wit, and she spoke succinctly, which could unintentionally come across as curt or stiff. To her continued puzzlement, men had somehow interpreted this mannerism as mysteriousness, as if she were being coy. But Sam saw herself as just plain awkward.

During the first month of her internship, she had a patient who couldn’t stop vomiting. Sam needed an order for antinausea medication, but was intimidated by Dr. Spiros, the 35-year-old senior resident on duty. He was a tall, exceedingly good-looking man with tousled hair as dark as Sam’s ponytail. Sam had heard him speaking with other nurses in the halls about his interest in teaching medicine to doctors in developing countries. The other nurses swooned over Dr. Spiros, who was smart, sexy, and obviously smooth. Sam was not a swooner, but she could be painfully shy around suave men.

Instead, Sam approached Renée, the charge nurse: “My patient’s puking his brains out. Can I give him Zofran?”

“Go ask Dr. Spiros,” Renée said.

Sam pursed her lips and approached Dr. Spiros, who was looking over the board. She nudged her glasses up the bridge of her nose. “Um, can I get some Zofran for Mr. Nathan?”

“I don’t even know who that patient is,” he grumbled. “Ask someone else.”

Geez, it’s only Zofran
, Sam thought, her face growing hot. It had a tendency to do that at inopportune moments. She returned to Renée, a Citycenter veteran. “That pompous guy wouldn’t give me Zofran!” Sam said.

Renée looked incredulous. “What are you talking about? Dimitri’s so nice!”

“That’s what you think,” Sam said.

Renée approached Dr. Spiros. “Hey, Dimitri, I need Zofran for Mr. Nathan.”

Dr. Spiros smiled at her. “Sure, anything you want,” he purred. “How’s it going?”

Sam’s gray eyes widened.
Jerk
, she thought.
It’s a shame that such an attractive guy has to be such a douchebag
. She managed to avoid Dr. Spiros for the rest of her internship and hoped she wouldn’t run into him again.

There were other annoying carryovers from her internship whom she now wouldn’t be able to avoid. On the interns’ first day, someone had asked if there were any questions. An intern named CeeCee asked, “You guys! Where do we get highlights done in this town?” Of all the questions. If Sam had been outgoing enough to ask a question, she would have chosen, “Where’s the bathroom?”

CeeCee was an overly peppy 22-year-old with meticulously crimped hair. She was a former cheerleader prone to doing celebratory high kicks. Her relentless chatter had a passive-aggressive edge. She and two of her sexy nurse friends made backhanded remarks with toothy smiles.

During the internship, Sam happened to mutter to a tech that CeeCee drove her crazy. She didn’t usually talk about people behind their backs, but CeeCee’s insincere perkiness, fringed with entitlement, was grating. Within days, CeeCee texted Sam. “Someone told me you talked trash about me and said I’m dumb.”

Ugh, drama. Sam tried to avoid drama. She didn’t have the time or the personality to deal with it. She hadn’t told anyone other than the tech that CeeCee drove her crazy, and she hadn’t said anything more. Sam had never insulted CeeCee’s intelligence, nursing skills, or work ethic. “Those matter more to me than whether I like someone or they like me,” Sam explained. “And, if I put myself in her shoes, I’d say there’s no connection between whether you like me and whether I’m a good nurse. Either she somehow equates ‘she drives me crazy’ with being dumb, or someone exaggerated what I said.”

Sam replied with as upbeat a message as she could muster: “I’m sorry anyone said that because it’s just not true! I think you’re smarter than some of the more experienced nurses here!”