The Shift: One Nurse, Twelve Hours, Four Patients' Lives (10 page)

Peter glances at me and says, “With cookies,” then turns back to the computer screen.

Finally looking up from the computer screen, he announces, “I’m giving her to Akash. You’ll be the resident in charge of her case.”

This is excellent news for me. It’s much easier to work with someone you know than someone you don’t and even better if you know you like them.

Peter’s pager buzzes and he pulls it off his waist, checks the number, and nimbly reaches for the phone next to the computer. Akash walks over to me. “What’s her IV access?”

“She’s got a twenty-two gauge in her left arm.”

“Do you think it will hold?” He’s asking me if her IV will stay functional. The non-permanent intravenous lines can go bad at any time, though they usually work well enough for at least a couple days.

I raise my hands in an “I don’t know” gesture: “It’s working.”

“Fluids?”

“Normal saline at seventy-five.”

“Let’s increase that to one fifty. We want to keep her plenty hydrated.”

I nod. “I’ll put it in as a verbal.”

He looks at his watch. “You’ll be home late tonight,” I say. “Tell Monique that it’s all my fault.”

He laughs, then asks me to write down his cell number. “Can you call me when she’s on her way to the OR? It just makes it easier.” He sounds apologetic and I’m surprised that he’s asking me to call him directly rather than paging and waiting for a call back. That we carry phones, which have to be answered when they ring, whereas doctors have pagers that they can, at least briefly, ignore, sometimes feels unequal to me. But I also know that a page can be just as disruptive and annoying as a phone call. Docs aren’t as immediately on the hook as we nurses are with our phones, but the pressure to
call back
ASAP must be fierce.

I spent a day shadowing in the emergency department when I was in nursing school. An elderly woman who’d fallen needed a hole drilled in her skull to relieve the pressure from a bleed in her brain.

A neurosurgery resident was called in to do the job and a more tired-looking human being I hadn’t seen in a long time. His face was ashen and being unshaven only emphasized the lack of color on his cheeks. His scrub pants were too big and too long and his scrub top was so wrinkled it looked as though he’d slept in it.

He held the drill up to the back of the patient’s head with a narrowing of his eyes, hoping focus would keep his hands steady. As the drill went in small pieces of bloody tissue and bone spattered out behind the unconscious patient.

His pager kept beeping. Every time it beeped he would stop the drill, put his right forearm up to his forehead, pick up the pager and look at the number, then go back to the drill until the pager beeped again.

I thought that if I were having a hole drilled in my head I would not want the person doing it to be constantly interrupted, or interrupted at all. I picked the pager up from where he’d left it on the stretcher and mimed that I would be responsible for it until he was done.

He shifted his eyes over to me quickly and gave one shallow nod. Then he returned to the patient’s head, the application of the drill. It can’t take that long to make a hole in someone’s head and thread in a drain for the accumulating blood, but it felt like we stood there for hours, me holding the pager and writing down numbers when it beeped, him blinking to keep his exhaustion away.

When he was finally done he put his right forearm up to his forehead one last time. He set down the drill and without even looking at me took the pager along with the numbers I’d written down. He turned around to the phone on the wall behind the patient and started dialing.

Peter hangs up the phone now and our attention turns back to him. “I’m going to go back and talk to the family. Akash, you prepare.” The surgical residents nod and start to leave in a group, including Akash. “I’ll call you,” I mouth to him, holding up the paper where his number is written down. Then I follow Peter and his medical student back down the hall to Sheila’s room.

“How’s Arthur’s leg?” Peter asks. My husband badly broke his left tibia and fibula a couple winters before.

“It’s good, hurts occasionally.”

“Really?” he looks puzzled, but we’ve reached Sheila’s room, so I can’t ask him why Arthur’s continuing leg soreness seems confusing. He gives the door a quick rap before opening it. I pretend the medical student isn’t standing right behind me. If I ignore him he can’t keep me out of the room with questions.

Sheila is half-sitting up in bed and two more people, a man and a woman, roughly Sheila’s age, are also in the room. I’m guessing they’re relatives.

“Does anyone else in your family have this clotting disorder?” Peter asks. It seems abrupt, but then I remember he’s talked to them already. I was the one who missed that conversation.

“Well, we think our mom probably had it,” the woman in the room says, “and our brother maybe, too.” She glances at Sheila. “We don’t hear a lot from him, though.” She shakes her head. “But the rest of us are close.”

The man, sitting in a lounge chair in the room’s back corner and wearing a baseball cap, is half in shadow and has a thick black beard. Peering, I see that his wedding ring looks like it matches the one Sheila’s sister is wearing. The brother-in-law. His baseball cap has a wrench printed on it and I can just make out the writing in the dark,
FIELDS’ PLUMBING
. I remember a note about a family business. Maybe the three of them all work together.

Peter describes the operation Sheila will have in detail, how they’ll remove part of her colon and most likely leave her with a colostomy. A colostomy is a diversion of the bowel to the wall of the abdomen. The end of Sheila’s colon will be relocated to the skin of her belly and her large intestine will drain into a bag that attaches there. When I first learned about colostomies I found them unsettling, even repellant, but a nursing instructor reminded me, “Life is precious.” All it does is change where the shit comes out; that is not worth dying for.

Peter explains that some colostomies are reversible and some aren’t. Sheila’s probably will be, but doing any surgery on her is risky because of the antiphospholipid antibody syndrome. In the end he would probably advise against restoring her bowel to its natural configuration: the potential risks of bleeding or clotting seem to permanently outweigh the benefits of returning to normal.

Then the conversation turns darker. Nothing changes in Peter’s demeanor, but the things he says come across as almost cruel. “You’re a smoker and you’re overweight,” he tells her. Both things will cause Sheila to heal more slowly than normal and she’s going to have a big incision.

Then he drops the other shoe and it’s a big one: “There’s a twenty percent chance you won’t survive this operation.”

I look over at him. He’s wearing a dark suit, holding a sheaf of papers in his hand. His expression hasn’t changed. There’s maybe a little more intensity around the eyes, but he’s very clear and not impersonal. He could be a lawyer, an accountant, a corporate vice-president—anyone but a surgeon. Except that he is a surgeon.

I would not want to give Sheila such news, but he does it without flinching; he just says it. He is a kind man, a good doctor. I know both those things. How does it feel to tell someone there’s a one in five chance the operation she is preparing for will kill her?

I could ask him, probably will ask him at some point, but I already know he won’t tell me the truth. Instead he’ll say he was thinking about what’s for lunch, or remembering some joke one of the nurses in ICU told him earlier, or that he’d kill for a cup of bad coffee.

Myself, I feel charged up. I guess it’s an adrenaline rush, the same one that started when I heard we would give Mr. Hampton Rituxan, and that ramped up even more when the radiologist called me about Sheila. What if we kill him and can’t save her?

Peter finishes talking and Sheila starts to cry quietly. He’s already on his way out, trailed by the medical student. We’re all too damn busy. I’m sure this emergency has been shoved into a completely packed schedule. He has no time to be gentle.

Sheila looks as if she’s having an internal struggle. She is afraid, but is also telling herself not to be a baby, to stop crying. I want to validate her more vulnerable feelings.

“This is big,” I say, hoping that doesn’t just increase her anxiety and wishing I could stay in the room with her and her family. Instead I hand her the Kleenex box and rush out after Peter. “I’ll be back,” I announce, “I want to ask him a few more questions out in the hall.”

At the nurse’s station Peter is on the phone with Dr. Martin, Sheila’s physician who felt out of his element on morning rounds. “Can we give FFP? Platelets?” He wants to use a blood product that promotes clotting—fresh frozen plasma, a transfusion of platelets—to make surgery safer and faster. But when Peter gets off the phone he reports, with just a touch of irritation in his voice, that according to Martin transfusions will not speed up Sheila’s clotting time; we all just have to wait.

Peter’s too polite to say anything like this directly, but I suspect he feels blown off, as if the cancer doc, already bothered by having a patient with an unusual blood disorder, is even less inclined to be thoughtful now that she’s been found to have a surgical problem. He could also just be frustrated there is no quicker fix than waiting.

We don’t talk about Dr. Martin, but we do talk about what will most likely happen to Sheila and when. I need the process to be clear so that I can explain it to Sheila and her family.

Before I return to Sheila’s room I ask the secretary to call maintenance and make sure they got the new shower curtain for Candace. I haven’t seen anyone on the floor but I might have missed him.

“Shower curtain? They were brand-new a month ago. These are the new ones that, um, you know, keep off germs.”

“I gotta go,” I tell her, frowning just enough to look hang dog without being pathetic. “Can you just call for me?”

“If you stop making that awful face,” she says.

I laugh out loud. “Deal!” Then I head back down the hall and see Sheila’s intern in our secondary computer room off the hallway.

“Hey,” I say, and she nods at me. “Surgery’s been here. Peter Coyne, do you know him? We’re increasing her fluids to 175, normal saline—”

She interrupts me. “It’s not my case anymore.”

“What?”

“She’s switched over to surgical. She’s not my patient.”

“Oh.” I wonder why no one told me. It’s the kind of change that should go on our whiteboard, too, but often gets forgotten.

“I like hearing how she’s doing, so thanks.”

“Sure. No problem.”

I go back into Sheila’s room. She’s quietly crying and her shoulders gently shake as one tear after another slides down her face. She looks at me with that same guilelessness I noticed this morning. Her sister, however, won’t look at me at all.

“She thinks it’s wrong for doctors to give odds like that,” the husband says, indicating his wife. He’s leaned forward out of the shadow so that I can see his face. Above his bushy black beard his eyes look pained. His thick fingers are spread out straight on his solid thighs and he holds his torso stiffly. “She thinks it does more harm than good.”

Sheila’s sister is right, of course she’s right, but she’s wrong, too. If the worst happens isn’t it better to have some forewarning, to know before surgery that her sister may not come out of the OR alive? Wouldn’t we all want to know that? Or is that just me, stubbornly wedded to the truth no matter how painful it is or how remote? The odds are in Sheila’s favor, but it’s not my sister who’s going under the knife; maybe if it were I wouldn’t want to know the risks, either.

“Yes,” I say. There’s no need to convince her that Peter’s honesty was ethically correct or even essential for informed consent. Sheila will get the operation and she will probably survive it. Why argue about the right or wrong thing to say? Fixing Sheila’s perforated bowel will threaten her life but if we do not fix it she will die.

I say nothing else and Sheila’s sister turns around to look at me. Her face is drawn and she’s dark where Sheila is pale, but their features are very similar: the same round eyes, the same cute button nose. Right now, more than anything, the entire family needs someone to trust.

One summer when I was a kid a group of us were playing outside—me, my brother, the Allen boys, my best friend Erica—and it started to lightly rain, but only in small, separated patches. In southern Missouri, where I grew up, summers are hot and the rain felt good, but it was unusual, startling, how it fell in one spot for just a minute, then stopped, moved a couple of yards and started up again.

We ran after the rain, chased it, wanted to always be under it as sunlight glinted through the drops, making a lattice of light out of the bursts of gently falling water. “It’s over here,” one of us would call out, running to the rain. “No, now it’s here,” someone else would say, heading off in the opposite direction: “I’ve got it! I’ve got it!”

There were no interruptions to this summer idyll, no adults asking what we were doing, just us kids, breathless, moving fast. Did it last for five minutes? Ten? It wasn’t any longer than that, but I can recall the joy I felt. How rare—the chance to catch a rainstorm.

To see a World in a Grain of Sand

And a Heaven in a Wild Flower

Hold Infinity in the palm of your hand

And Eternity in an hour

William Blake wrote those lines more than a century ago and he was on to something. It’s not exaggerating to say that Sheila could be dead tomorrow. Today this is the storm we chase: the infinite potential of Sheila’s continuing life, held in the hand of the hospital. As a child I experienced only wonder while running after flashes of rain; I saw a world, a heaven. Now, grown-up, I try to draw on my child’s sense of awe and commitment as I help Sheila confront, perhaps, the end of her time on earth.

She will have pain, her blood pressure will need watching, and her blood itself has already been revealed as untrustworthy. Getting the timing right is critical, so I’ll be following the rain, but looking for the light. I believe there will be light if only I can find it in the storm.