“You don’t know what you’re doing!” Tashia yelled. “You’re incompetent! You’re a horrible nurse!”

The nurses station quieted. Tashia, who was nearing retirement, was known to be a bully, but this was different. She was yelling at Lynn in front of other nurses and patients on stretchers in the hallway, including the patient in question. From their rooms encircling the nurses station, ER patients peered through the curtains at the spectacle.

Lynn raised her voice right back. “Don’t you dare call me names!”

Tashia got into Lynn’s face, her finger within poking distance of Lynn’s eyes. “You want to hear name-calling? Fine! Everyone thinks you’re a skank!” Lara hadn’t heard that before. Lynn was a petite, beautiful black woman. Lynn didn’t say anything. She walked away.

When Lara finished her charting, she caught up with Lynn in the hallway. Rose was already there, patting Lynn on the back. Lara asked if she was okay.

“Yeah,” Lynn said. “I felt like if I came back at her, I’d be yelling at an old woman. She’s an angry, bitter woman.”

Still, Lara could see that she was shaken by Tashia’s outburst. This was Lara’s only complaint about South General: A small but unavoidable group of the nurses was verbally abusive. While at other hospitals, the bullying could be more covert or passive-aggressive, at South General, hostilities were blatant. “There’s some serious attitude here. Maybe it’s from years of having grown up in this rough area,” Lara observed. “People put up an angry, defensive wall. It’s difficult to break down that attitude with each individual coworker.”

Despite racial tensions, Lara, one of the few white nurses at the hospital, hadn’t landed in anyone’s crosshairs. Evidently someone had noticed that Lara seemed to get along with everyone, because in November, the ER director selected her as one of fifteen people to join a new hospital-wide committee. A healthcare management company had developed the Relationship-Based Care program with the goal of improving staff members’ attitudes toward each other so that they could work better as a team. South General had just signed up.

The committee’s mission was compassionate and holistic. The mandatory three-day RBC conference emphasized the message, “If you take care of yourself, you’ll be a better person, better mom, better wife, better coworker, better nurse. When your coworkers are looking out for each other, it will become a more therapeutic environment,” Lara said, excited to help. The instructors asked the groups to brainstorm what they could do to improve relationships in their hospitals.

Lara’s committee, consisting of six ER staff members and six nurses from other floors, decided that their first short-term goal would be to set up crisis intervention help for staff. Hospital professionals grappled with traumas and tragedies in different ways. Lara suspected that another South General nurse was turning to narcotics to cope. Fatima was a 28-year-old night-shift ER nurse. A tech recently had told Lara that just before shift change, he had seen Fatima roll a needlebox cart into a storage closet. That’s a good idea! Lara couldn’t help thinking, understanding immediately that Fatima was desperate enough for partially used vials of narcotics that she would stick her hand into a box full of used needles in a hospital that treated many patients with HIV and tuberculosis.

The tech had followed Fatima into the closet and turned on the light to see Fatima’s hand in the needlebox. “What are you doing?” he asked.

Fatima immediately withdrew her hand. “Uh, the box was full, so I’m putting it away,” she said.

“So why’s your hand in there?”

Fatima mumbled an unintelligible excuse and the tech had let her go.

During Lara’s next shift, she was heading toward an RBC meeting when she saw Fatima in the hall. Lara recognized the signs: Fatima was pale, sweaty, and sluggish. Her face had a greenish sheen. Oh my God, you are dope sick, Lara thought. She played dumb. “Hey, Fatima, isn’t your shift over?”

“I got called into the office. When people don’t like you around here, they make stuff up about you. So I’m here to tell my side of the story,” Fatima replied.

She probably doesn’t even see it, just like I didn’t, Lara thought. She wanted to help Fatima, to tell her that she could still turn herself around without losing her nursing license. But she wasn’t sure how to convey that she knew about her habit. Lara worried that Fatima could accuse her of slander and get her fired. Fatima was barely an acquaintance; they passed each other in the hallway only occasionally during shift change.

Lara decided to ask her Thursday night group what to do. For years, her group of eight women—all friends from NA—met once a week to check in with each other. They could tell Lara how to handle the situation.

But at the network’s next meeting, Lara didn’t have a chance to discuss Fatima. The bulk of the dinner was spent consoling a woman whose father had died, so Lara didn’t mention some recent disappointments in her own life. She had learned that she wouldn’t be able to volunteer occasionally as her kids’ school nurse after all. School nurse volunteers were required to take a CPR course run by the county, but the course was offered only once per semester and Lara wasn’t able to attend that day. The county wouldn’t allow Lara to work in the school even though she was a CPR-certified nurse who cared for critical patients regularly.

Also, Lara’s marriage was deteriorating. John was openly flirting with other women and gambling again but denying that he had a problem. Sometimes Lara thought about leaving him, but she didn’t know how her family would manage. Even though he still wasn’t working, Lara couldn’t fathom being a single mom on a nurse’s salary without having John around for childcare. “If the kids say, ‘Can I join T-ball’ or ‘Can we go to the movies,’ I don’t want to be in a place where I can’t give them that basic childhood stuff,” she said. She soldiered on.

JULIETTE

  PINES MEMORIAL, November

Juliette was in the doctors’ back office, joking around with Clark Preston. The doctors’ office was a relatively large room with five computers spread across a U-shaped desk. It wasn’t unusual to see doctors flirting with the cute nurses back there. Juliette, who had good working relationships with most of the doctors, ventured into the office when she had questions about patients or to hang out with Clark, who liked the same sports teams and TV shows she did. Clark usually had a funny video or photos of his dogs to show her.

On Juliette’s way out of the office, she saw Dr. Fontaine and red-haired Nancy—the nurse-dating womanizer and his former girlfriend—sitting across from each other in close quarters. Nancy, who was on the phone, was pointedly looking down so that the doctor wasn’t in her sight line. She wouldn’t meet Juliette’s eyes, either.

It was a shame that Juliette couldn’t forget that Dr. Fontaine had dated three nurses behind Nancy’s back. He was otherwise a charming and skilled practitioner. She shook her head and went to the nurses station, where she was charge nurse for the shift. After checking the boards, she went to triage to help out.

When a patient came in with abdominal pain, Juliette flagged Lucy, the tech assigned to triage, in the hallway. Lucy was a lazy tech who got away with dodging her responsibilities because she occasionally babysat for a few of the supervisors. Once, when Lucy had called in sick, her Facebook page revealed photos of herself at a festival.

“Please put an IV in this patient. He has abdominal pain,” Juliette said, gesturing to the 55-year-old patient in a wheelchair. The man was vomiting into an emesis basin.

Lucy blinked at her. “Is the patient going to go to the waiting room?” she asked in her thick Dominican accent.