The Shift: One Nurse, Twelve Hours, Four Patients' Lives (19 page)

“I just don’t want to be here,” she says, “It’s my fifth twelve this week.”

“Your fifth nightshift this week!”

“Well, we’re short because they haven’t approved a new hire for nights and the truth is, I can use the money. Our furnace is on its last legs.”

Now I get it. She’s exhausted and broke.

I give quick verbal reports on Candace and Irving and she takes notes. The storm of her frustration has passed and she doesn’t even jump on me when she sees the list of new orders for Irving, which are more or less the standard package for his particular problem: insert an IV, administer evening medications, treat his abscess with two different intravenous antibiotics, but also consult infectious disease to make sure we’re not missing anything, take vital signs every four hours, record his fluid intake and output, infuse normal saline at 150 ml/hour, and serve him a “regular” diet. Since Irving is stable, there’s no urgency.

Beth walks by the conference room and gives a small wave. “Almost done,” she says, smiling.

“Hey, I’m gonna go see Ray,” I tell my replacement. “I’ll be in his room if you need me.” She’s in work mode now and waves the suggestion away. “I’ll be fine,” she tells me.

Ray’s alone in his room, reading
No Country for Old Men
by Cormac McCarthy and I ask him if it’s a good book. I’ve never read anything by Cormac McCarthy despite how much I like the repeating hard “c’s” in his cowboy-Irish name.

Ray says the book is good, then asks me if I saw the movie version, which won Best Picture in 2008.

“No. The previews made me think it would upset me.” That sounds so lame. I’m an oncology nurse; I should be tougher. But to me the movie looked nihilistic—lots of violence with no point or moral behind it. I can read about such things, but seeing them, even in movies that I know aren’t true, disturbs me. I guess I want to believe that at our core humans are always moral and caring.

“The movie was good,” he says, “but try the book. All his books are good.” He speaks deliberately, as if he has all the time in the world, as if we’re back in that coffee shop where we met only a few weeks ago. So often with patients I talk with them only about their illness because I think that’s what they need. But it seems like Ray wants to talk about books and movies instead of leukemia.

“I’ll buy it,” I tell him. “Then I’ll let you know how it is.”

“Well, I’ll be here,” he says, leaning back into the bed, running his clasped hands over his hair.

“Hey, where’s Liz? Is everything OK at her job?”

“She’s out getting dinner. She hates the food here.” He pauses for a second to think. “Me, too, but it’s free.” He looks rueful and turns his eyes away from me. Then he re-collects his calm and answers my question.

“Liz’s job is cool. They needed her to come in and plan for the next few weeks. You know, patient schedules, who’s covering whom.”

“So she’s not going to be fired for being here with you?”

“Nah. Nothing like that. Not even close.” He looks away again and I’m not sure what to think. If there were work issues this morning I guess they’ve been resolved, which is good. I would hate to be confronted with a choice between my husband and my job.

Ray’s work has been unbelievably generous to him and Liz. It’s a tradition among firefighters, at least in Pittsburgh, to cover for members who get sick. Individual volunteers from different crews around the city signed up for each of Ray’s twenty-four-hour shifts. They worked, but Ray got the money, so his leukemia diagnosis didn’t also lead to a sudden loss of income or health insurance.

Ray himself admitted that reading philosophy and postmodern novels on shift made him an oddball, but looking out for each other was integral to the culture of the job. His crew, some of whom might not have related to him that much, contributed further by buying dinner for every volunteer who took one of Ray’s shifts and Ray found out about the free dinners only after he was back at work. No one from his crew or another department ever said Ray owed him anything.

While the firefighters protected Ray’s livelihood, his fellow punk rockers looked after his and Liz’s two kids. Their son was finishing elementary school and their daughter middle school. Liz made a schedule: every day someone would be at the house to meet the kids after school, make dinner, help with homework, hustle them into bed on time, stay the night if needed, and then send the kids off to school the next morning. Night after night after night, so that if Liz had to be in the hospital with Ray she could be. An organized rotation of self-acknowledged social misfits with piercings, blue hair, tattoos, fishnet stockings and motorcycle boots kept their family life intact.

I don’t ask Ray how he feels about the relapse, if he’s afraid. He must be afraid. Who wouldn’t be? Afraid of getting the transplant and of not getting it. Maybe talking about Cormac McCarthy is enough. Maybe, like Sheila walking to the stretcher, Ray needs a dose of normal tonight.

Leaving his room I think I’m going home when the nurse taking over for me calls out to me at the nurses’ station. “Peter Coyne is on the phone,” she says, looking anxious. I wonder what’s wrong. Will Sheila not get operated on tonight? Perhaps her blood still takes too long to clot.

I click the phone off hold. “It’s Theresa.”

“Yeah, um, we don’t have a blood type yet on Sheila Field. Did the tubes get sent?”

“Yes, but the hang up might be the third tube.”

“The third tube?”

“It’s a rule now that if we’re doing a type and screen on a new patient we have to send two separate samples of blood thirty minutes apart to make sure the right patient is typed. That second sample is the ‘third tube’ of blood sent.”

“So the second sample wasn’t sent?”

“No, it was definitely sent, but not that long ago. They may not have finished with it.” I’m not telling him the third tube of blood wasn’t drawn when it was supposed to be. Briefly overdramatizing, I wonder if Sheila will not have her surgery and will die of sepsis because I bent the rule about triple-checking blood samples. But we would never allow something that awful to happen because of a mistake in procedure and the time the blood was drawn doesn’t affect its processing.

“This worked a lot better when we just had anesthesia do the type and cross,” Peter says, talking to himself more than to me.

“Yes, well, you know, if a system’s working they decide to make it more complicated.”

“And the oncologist is saying that FFP would help her, so that’s a couple more hours . . . and we’ll do her tonight.”

It takes me a minute to understand. Tonight? He will operate on Sheila tonight. He’s irritated, venting about the lab, the oncology attending, and the last-minute decision to give Sheila fresh frozen plasma (FFP), but I want to shout “Yahoo!”

Instead, “That’s great,” I say, with almost no affect at all, but I’m smiling now, grinning really, like Trace laughing with his dad or Beth after she talked to her daughter. It would have been so hard on Sheila and her family to postpone, possibly even dangerous, although proceeding tonight will not be easy for Peter or his team in the OR.

“Thank you,” I tell him. Of course he’s not operating tonight to satisfy me, but he is doing it. I feel my hand open up, the infinity of Sheila’s life finally, thankfully released.

I hang up the phone and that’s it—the shift is over. My ducks are all in a row and I can leave. Candace, Irving, Mr. Hampton, Sheila, and even Dorothy are no longer my patients. I am leaving, leaving, leaving. Another nurse, another good-hearted overworked soul in white will take over: night shift. And then tomorrow morning I’ll be back.

But for now I do not think about tomorrow. Now is
now
and I am leaving. I prop my portable phone into one of the chargers at the nurses’ station and am about to toss my papers in the shredder when I remember I may want them tomorrow. Throwing away my notes at the end of the shift always feels definitive, but it also makes me a little regretful. Legal requirements about patient confidentiality demand that my record of a day’s work ends up as thin strips of cheap copy paper, confetti made from the records of four discrete people’s lives.

Holding my notes, I head to the locker room and run into the owlish intern taking care of Mr. Hampton. He stops in the hall, head slightly bent, shoulders turned inward, exactly how he looked this morning. “He’s doing OK with the Rituxan?” he asks. His voice is low and soft and he blinks at me behind his thick glasses.

“He’s doing incredibly well,” I tell him, explaining that Mr. Hampton stopped needing the oxygen, that he sat up on his own in bed, his confusion diminished, and enthusiastically took part in conversation. I smile and the intern, his slightly woebegone expression unchanged, focuses on my face as I keep talking. “I was so worried about him, and he did great.”

“Well,” he says, “If we could know the future our jobs would be a lot easier.” He briefly makes full eye contact and I see again what I first liked about him this morning: underneath the tiredness, the working so hard just to stay afloat, there’s a humaneness that impresses me. It surprises me to realize that I feel a bond with him and I felt it this morning, even though we had only a whisper of acquaintance informed by his workmanlike politeness and the scrupulousness that put him outside Mr. Hampton’s room early in the morning.

I smile a trace of a smile at him and then scrunch together my eyebrows, thinking,
How can someone so young be so wise
?

As is so often the way in the hospital, we barely nod at each other and move on. Nurses and doctors—we come and go from our patients’ lives and each other’s with the anonymity of mail carriers, the efficient intimacy of the guy who reads the gas meter in the basement. That initial impression is what matters. Can I work with this person? Can I trust him?

In the locker room I take off my nurse shoes, put unused alcohol wipes and wrapped saline syringes back into my locker, toss in my notes from today with my pen clipped to the top, and pull out my tights for biking, along with my jacket and wraps. I’m making a reverse transformation from nurse back to ordinary person.

It’s all women working tonight, so I dress quickly in the locker room instead of changing in the bathroom—it’s one less step before I leave. I flatter myself that my black biking clothes peg me as a ninja, but I know I’m leaving the real action behind at the hospital. Besides, my bright yellow jacket completely ruins the ninja effect.

I run my ID card through the time clock and the computer asks me if I took a thirty-minute lunch break. I think we’re supposed to hesitate before punching “no.” It probably makes managers look bad if too many nurses say we didn’t get lunch, whether we got our thirty minutes or not. I punch “no.” The law’s the law.

Slinging my bag over my shoulder, I jab the down button outside the elevator and then, unwilling to wait, take the stairs. I’m impatient, but the stairwell is also quiet. There are no speakers here so the overhead pages don’t penetrate: no urgent calls for anesthesia, warnings about lost patients, or yet another fire drill will intrude. Down I go, down, down, down. The metal banister is cool under my hand and the cleats on my bike shoes make a gentle clicking noise on the stairs.

Halting briefly I glance out the window in the stairwell door and see a sign pointing right for the Medical ICU.
Mr. King,
I think. I slide my hand around the railing, stick my foot out to keep going down the stairs, then stop, turn and open the stairwell door and go through it, back into the hospital hallway.

I look again at the sign for the MICU and walk that way. ICU is a hard place for me since it’s often the last stop for our sickest patients. We oncology nurses and the ICU RNs don’t always get along so well, either. For some of us, the onc. patients are “ours” whether they’re in the ICU or not and we can be critical of the care they receive there. ICU nurses feel we send them patients almost dead from treatment and expect miracles.

I push through the double doors, retrieve my name tag from my bag to show that I’m official, and try to look open and friendly. “We’re all colleagues,” I remind myself.

A nurse at the desk looks up questioningly at me and I hold up my name tag. “I’m Theresa, here from medical oncology, wanting to see Frank King.”

“He’s, um, over there,” she gestures, then returns to her charting.

“Who’s his nurse?”

She looks up again, quickly, and reads down the whiteboard behind her. “Lemme see—it was Tim, but now it’s . . . Eva.”

“Cool. Thanks.” She ignores me and continues working.

I walk by several rooms on my way to Mr. King’s, seeing patients on ventilators, with multitudes of tubes and drips running in and out of them. The rooms are small and they beep and chirp from a variety of monitors and pumps.

I reach Mr. King’s room, set down my bag, and look inside. There’s a nurse with pale blond hair pulled back into a loose French braid standing by his bed.

“Are you Eva?”

She looks up, neutral. I show her my name tag. “Theresa, from upstairs,” I point with my index finger. “I wanted to see how he’s doing.”

“He’s awake,” she says. “He just can’t talk ’cause he’s on the vent.”

“He’s awake? That’s great.” I step into the room and make eye contact, give a big smile. “Hi, Frank.”

He blinks his eyes at me even though they’re almost concealed by the breathing apparatus coming out of his mouth. He looks very frail, but at least blood’s no longer dripping down his chin.

“Yeah, and his wife was in here earlier telling us this story about how she bought a dog for herself, but then the dog just fell in love with Frank and followed him everywhere and ignored her.”

“Really?” I had never heard that story. I look right into his eyes. “Well, obviously, Frank, that dog knew quality.”

Eva laughs and Frank’s eyes crinkle together.

I take hold of his hand where it’s lying on the sheet. “Listen, buddy—we all want what’s best for you. You’ve been at this a long time.” He blinks again.

“And everyone upstairs misses you.” I squeeze his hand, but he gives no pressure back.

An X-ray tech comes to the door and I see his machine parked in the hallway outside. “Portable chest,” he says. “You’re gonna have to give me some room in here.”