When the sexual assault nurse finally arrived to evaluate the still-ranting patient, she spent more than an hour examining the woman. Afterward, she told Lara she was right to keep her in the ER. The woman’s injuries corroborated her story.

Lara was a self-assured nurse, skilled and experienced. She’d been confident ever since she had made the correct call on her own child. When Lindsey was four months old, Lara happened to be taking a pediatric advanced life-support class. She was reviewing her textbook in bed and decided to quiz her husband. “Hey, John, what would you do if one of our kids was choking and I wasn’t home?” she asked.

He answered correctly. “And where would you take a pulse on a baby?”

John didn’t know that one.

Lara went to Lindsey in her crib and pressed her fingers on her upper arm. She counted. “Sixty?” she said. “That can’t be right.” She did it again. “Oh my God, her heart rate is sixty and it should be one-forty!” She ran to the book to show John the page. “It shouldn’t be sixty! Something’s wrong!”

“You’re overreacting. Lindsey’s fine,” her husband said.

The next day, she took her daughter to the pediatrician, who said that Lindsey’s heart rate was normal. “Umm, maybe she has a cold,” the doctor said.

“What does having a cold have to do with her heart?” Lara asked. There was no reply.

Unsatisfied, Lara made an appointment with a cardiologist. The morning of the appointment, Lara weighed whether to cancel it. “I feel like the freaky know-it-all mom. I don’t want to go there and have them look at me like I’m crazy,” she told her husband.

“You might as well keep the appointment since you made it.”

At the cardiologist’s office, even before Lindsey’s EKG results had finished printing, the doctor told Lara, “Your daughter is in heart block and needs a pacemaker this week.” Heart block referred to a dangerously slow heart rate because the electrical signals that caused the heart to contract were partially or totally blocked. Lindsey had a pacemaker inserted during open heart surgery. Two months later, she went into complete heart block, saved only by the pacemaker. The cardiologist told Lara that if she hadn’t detected the problem, Lindsey “would have been one of those babies who was put to bed one night and didn’t wake up.”

Lindsey, who still had the pacemaker, was now a healthy 5-year-old. The experience bolstered Lara’s faith that she was “supposed” to be a nurse. Between the pacemaker and Lara’s addiction recovery, “Weird things have happened to me. I look at them as ways to grow,” Lara explained. “I am a stronger, more confident woman now. I tell my patients all the time to listen to their gut. I tell parents who seem self-conscious or unsure, ‘You know your kid better than we do.’ ”

She wished she were as confident in her marriage, but John was making that difficult. His own addictive personality led him to relate to and help her with hers, but dealing with his gambling and cheating—he said he had a sex addiction—added to her stress. He loved her, she knew, but he said he couldn’t curb his behavior. She stayed with him because Lindsey and her 6-year-old brother, Sebastian, were young. Lara and John made a good living together; at least, they had, until he got laid off from the heating and air conditioning company. They led separate lives anyway, with their own interests and friends. “I have a beautiful home, beautiful babies, and a good life, just a ridiculous husband,” she said. “When my mom got sick, I didn’t have time to focus on his stupidity.”

She remembered during her mother’s illness, she was working full-time, taking care of her children, and shuttling back and forth to her mother’s home twice a day. The week she put her mother in hospice care, her husband was cheating on her in Vegas. When Angie, Lara’s former coworker and roommate, asked Lara why she put up with it, Lara had replied, “I don’t have time to focus on John right now. My mom is dying and she is my focus.”

Lara still wasn’t ready to address her marriage. For now, she had plenty of other distractions. She was taking college classes toward her bachelor’s degree, and she was hoping to volunteer once a week as an elementary school nurse to spend more time around her children and their friends. Volunteering was also an outlet to express her gratitude. She said, “I’ve messed up so much in my life, and this is a way to give back. I made a lot of mistakes and God kind of let me off.”

JULIETTE

  PINES MEMORIAL, September

While Priscilla, Charlene, and Erica managed the ER nursing staff, in that order, rarely did all three work the same shift. The day’s supervisor directly affected Juliette’s workload: Priscilla and Erica were fair, Charlene was not. Juliette wished her work life weren’t so tied up in her feelings about her coworkers, but nursing was a deeply interpersonal profession in which people had to depend on others—doctors, techs, fellow nurses—to do their job well.

Erica made Juliette want to be a better nurse. As senior charge nurse, she advocated for fellow nurses: If a doctor talked down to a nurse, Erica would march up to him or her and announce, “You can’t talk to my nurse that way.” She was a good charge nurse, a good manager, and a good teacher; she had taught Juliette how to be a good charge nurse, too.

Juliette was eager to please her supervisors because positive reinforcement inspired her to work harder, perform better, learn more. At Avenue Hospital, the ER director had made clear that she appreciated Juliette. Every few months, she emailed Juliette a positive message: “The charge nurse told me what a great job you did last night” or “We’re so happy you’re part of our staff.”

At Pines, Juliette had been dismayed to learn that Priscilla, the nursing director, was a member of the exclusive nurse clique (and that Charlene thought she was part of it, too). Juliette cared so much what her manager thought of her that she shared personal secrets with Priscilla, wanting her to understand everything she could possibly need to know about her. That way, like the Avenue director, Priscilla could encourage her to be the best nurse she could be. Priscilla appeared supportive of Juliette and had a good rapport with several of the nurses. Juliette had made an extra effort to show Priscilla that she was a hard worker, hoping to get the same positive reinforcement that she had received at Avenue. She was still waiting for it.

On a warm September morning, Juliette walked into the building thinking, as usual, Please don’t be Charlene, please don’t be Charlene.

It was Erica. “Yay! Erica, I’m so glad to see you!” Juliette exclaimed.

“I’m glad you’re here, too!” Erica said. “We’re staffed well today. Where do you want to be, with Mimi?”

Erica assigned her to a zone with Juliette’s favorite tech, Mimi. A good tech could make an enormous difference to nurses; procedures went smoothly and nurses could use their time more efficiently. Mimi, a Filipina woman in her forties, was a conscientious tech who had been at Pines for twenty years. Mimi would do whatever a nurse needed without hesitation. It wasn’t uncommon for techs to stand around reading magazines when new patients were wheeled in, despite knowing that when a patient with chest pain arrived, for example, he needed an IV, EKG, and a monitor. Nurses had to ask most of Pines’ techs to do each task. They didn’t have to ask Mimi for anything.

When a patient arrived in the ER with mild chest pain, Mimi ran an EKG. The patient had been waiting awhile. He was 55, the pain was on his left side, and he was sweating. Juliette made an executive decision to test his troponin levels, which could indicate damage to the heart muscle. At Pines, nurses were allowed to run advanced treatment protocols like this without waiting for doctor’s orders, if the doctor hadn’t yet seen the patient.