“Why did you bring your dog?” asked Dr. Mark Kazumi, a generally pleasant man. Juliette liked working with Dr. Kazumi. Other nurses teased him because he ordered a lot of labs. But Juliette appreciated that he tried to do right by his patients.

“I didn’t think it would take very long,” the patient said. Many ER patients assumed that service should be like fast food: Get in, get your orders, get out.

“Well, it’s going to take a little bit of time,” the doctor said. “I can’t make it quick for you. I’ve ordered a urinalysis and a CT scan.”

When Dr. Kazumi and Juliette left the room, he turned to her. “Juliette, I need you to check on the dog.”

“Are you serious?” Juliette asked. It was a balmy, breezy October day.

“Yeah. The dog can’t be left outside alone. It’s against the law,” the doctor said. “The dog could suffocate out there; it could be stolen. You need to find the dog, and I’m going to call the police on her if it’s not okay.”

Juliette sighed. “Don’t call the police.” She returned to the patient’s room.

“Where are you parked?” she asked the woman as she wheeled her to radiology.

“In front of the ER.”

That was helpful, Juliette thought. “Can you give me more of a description?”

“No. I’m in front of the ER.”

“What kind of car?”

“Accord.”

“What color?”

“Silver.”

While the woman was in the CT room, Juliette went outside. There was no silver Accord in front of the ER. There were, however, several silver Accords throughout the parking lot. Juliette grumbled to herself. I have four other patients but I’m out here searching for a Bichon in an Accord.

After ten minutes and eight empty silver Accords, Juliette called the tech in the CT room. “Can you please ask Mrs. Swirsky where exactly she parked?”

Juliette could hear the patient saying, “The dog is fine. I knitted him a blanket and he’s sleeping on it.”

The tech came back on the line. “She doesn’t remember.”

Juliette continued to wander the parking lot, her headache now weightier beneath the disappointments of drudgeries that had little to do with her job.

LARA

  SOUTH GENERAL HOSPITAL, October

On a crisp afternoon, Lara’s friend Juliette called to say hi. After some small talk, Juliette mentioned her migraines and her struggle with them at work and at home. “It’s really inconvenient, because my regular doctor won’t prescribe narcotics, so I got Percocet from a PA. It wouldn’t be a big deal if I took a wasted vial from the ER now and then, right? They’re just going to get thrown out. I still have one in my pocket because I forgot to waste it.”

Lara froze. This sounded all too familiar. “That would definitely be a big deal. I’m really worried about you,” Lara said. “You’re talking intramuscular use.”

“Oh, it’s just occasional,” Juliette said. “I was thinking I could give myself a shot of Dilaudid to get rid of my headaches. But only if they’re really bad.”

“Yeah, but I’m really worried. Narcotics are a slippery slope.”

“There’s nothing to worry about! It’s just for my headaches. You know how bad my migraines get. The Dilaudid would be only point-five milligrams at a time.”

“It’s still narcotic use and you’re talking about stealing,” Lara pressed.

“Only one or two times a month,” Juliette said.

“Juliette, listen!” Lara said. “You are using drugs. You’re using drugs! You’re softening it too much. I’m afraid you’re going to end up in a situation like I did where you have to have it or else you’re sick. When you use narcotics, you get rebound headaches. They’re the worst.”

“Oh, it’s just intramuscular. It’s not in a vein,” Juliette said.

“That’s bullshit,” Lara said. “No normal person brings home narcotics and gives themselves shots.” The first few times Lara brought narcotics home from the hospital, she, too, had rationalized it as “just occasional.” Then she told herself she did it because “I like the buzz.” And then “That guy was a jerk.” Eventually, she didn’t bother with excuses. Lara decided that Juliette had told her about the Dilaudid because she wanted help.

She took another approach. “From my history and experience, I’m afraid for you to go through the same hell I went through. It’s a nightmare. I don’t want that to happen to you. Throw it out.”

Juliette was silent. “Well, maybe you’re right,” she said. “I have enough issues with eating, anyway. I don’t need to have anything else. And I don’t want to get in trouble or disappoint Priscilla.”

That’s the least of your worries, Lara thought. Lara believed Juliette cared too much about what Priscilla thought of her because the nursing director was Juliette’s only confidante at Pines. Sometimes Lara wondered if Juliette was confusing Priscilla’s managerial tendency to let employee transgressions slide—in Juliette’s case, late arrivals to work—with friendship. Lara wished Juliette had more faith in herself. Juliette was a fantastic, knowledgeable nurse who was an unwavering advocate for her patients. She shouldn’t need to seek her supervisor’s approval to validate her self-worth.

A few days later, Juliette texted Lara. “I’ve been thinking about what you said. I threw out the vial and I’ll go ahead and look into some other options for my headaches.”

Relieved, Lara would pray for Juliette, both because she didn’t want anything bad to happen to her friend, and because she was grateful. “Listening to her downplay it reminded me I don’t want to be there again,” Lara said. “The whole Nurse Jackie thing is so prevalent. Not just nurses, but doctors, PAs. One of the NA meetings I go to is specifically for firefighters, nurses, doctors, and policemen. They don’t know who can help them watch their back.”

Chapter 4

When Nurses Bully Nurses

:

Hierarchies, Hazing, and Why They Eat Their Young

“The nurse treats colleagues, employees, assistants, and students with respect and compassion.”

—Code of Ethics for Nurses, Provision 1.5

“I knew the minute it came out of my mouth that I had just ‘eaten my young.’”

—a pediatric oncology nurse in Arizona

MOLLY

  November

Riverport Hospital

One day, for variety, Molly took two shifts at Riverport, a highly regarded local hospital, despite another nurse’s warning that “some of the charge nurses try to set up agency nurses to fail.” Molly didn’t mind; the timing worked with her fertility schedule. Her first IUI had been unsuccessful and she was now preparing for her second.

She didn’t let the results get her down. Her fertility treatments affected her work life only in that she cared even less about the drama among coworkers. She had always been a diligent, focused nurse, but now that conceiving a child was at the top of her priority list, she wasn’t about to spend time or energy getting emotionally involved with non–work-related nonsense. Her goal was to come in, do her job, and go home. At Academy and South General, she could do this well. At Citycenter, it was more difficult because the conditions were so unsafe.

At Riverport, Molly learned quickly that the warning about other nurses was accurate. The charge nurse assigned Molly four critical Priority 1 patients, each of whom needed one-to-one care. When Molly said the patients needed more attention, the nurse snapped, “I just figured you could handle it. I guess not.”

Molly gave report that night to an incoming nurse who happened to be someone she had worked with at Citycenter. Molly told her what had happened.

“Yeah, they are such mean girls here,” the nurse said. “No one helps anyone out, and there’s definitely a social hierarchy.”

Molly noticed the hierarchy during her shift the following day. Seven nurses were apparently the “cool” nurses in the ER. They were 22- and 23-year-olds who, as Molly observed, “do their hair and makeup like they’re going clubbing.”