“I’m not sure. It might be over,” she said. She described the end of the date.

“Oh yeah, you guys are done. Definitely,” William said.

“Thank you. That’s nice,” Sam said, sarcastic.

“Well, hey, that means you and I can hang out!” he said, batting her ponytail.

Sam huffed. What a flirt. William flirted with everyone. “You have a girlfriend.”

He started to say something, but Sam held up her hand and walked away.

The next time Dr. Spiros was on duty, Sam managed to avoid him by interacting only with a resident, which was unpleasant; the resident blatantly looked down on Sam and the other nurses. But Sam realized that although the resident was patronizing, she wasn’t intimidated by doctors anymore. Her dates with Dimitri had changed her perspective by dissolving the mystique around physicians. “You go into nursing bright-eyed and bushy-tailed, thinking the doctors know everything. You only see them at work, so you assume they’re like robots that go into sleep mode after work,” she said. “Getting to know Dimitri taught me that doctors are human, too, and they can be just as weird as you are.”

Sam vowed, “I’m just going to go up to them and say excuse me and say what I have to say. They won’t bite.”

MOLLY

  December

Academy Hospital

During a brisk week in December, Molly took two consecutive day shifts: one at Academy followed by one at Citycenter. At Academy, which typically wasn’t overwhelmingly busy even during the holiday season, she was surprised at the unusually high numbers of patients. Many of the patients in the Academy ER told her that they had already spent time at Citycenter that morning. After waiting in the Citycenter lobby for an average of three hours, when they finally received a room, nurses told them the doctor wouldn’t be able to see them for several more hours. They had come to Academy instead. Molly was mystified. Citycenter wait times were typically long, but not so long that patients were driven to another hospital. She wondered what was going on.

A patient came in with a systolic blood pressure of fifty-eight. Awake and talking, the patient was in her forties and bedbound with multiple sclerosis. Molly focused on getting the patient stabilized and improving her blood pressure. She gave the patient four liters of IV fluid, which did nothing. She administered a blood volume expander. She tried two different medications to increase the blood pressure. None of this was working, yet the patient was still awake and answering questions appropriately. Molly noticed the patient’s lactate—a blood lab that could indicate sepsis—was elevated and that she had a high white blood cell count. She did everything she could to raise the woman’s systolic pressure.

Finally, the patient’s systolic blood pressure reached seventy-one, the highest it had been since her arrival. Molly called the ICU, which sent a resident to write admission orders. “When she gets upstairs, I want her started on Dobutamine,” the resident said.

Molly called the ICU nurse. “Make sure y’all have a Dobutamine drip to get started when she gets there.”

“No problem,” the nurse said.

As soon as a bed assignment was available, Molly began to prepare the patient for transport.

Suddenly, the patient’s ICU doctor walked in, followed by a team of four residents lined up like ducklings. Molly inhaled sharply. It was Dr. Bitch. Dr. Baron whipped the curtain aside and strode into the room, followed by the four residents. She headed straight for the patient’s monitor, barely glancing at the patient. “Wait. This patient is not stable enough to go to the ICU,” she said.

“This is the best she’s been in the six hours she’s been here,” Molly replied.

“She’s too unstable for transport,” the doctor insisted.

Molly looked at the patient, who was listening to the conversation. One of the first things Molly had learned in nursing school was to treat the patient, not the monitor. The only information Dr. Baron had was the monitor’s blood pressure numbers. “Why don’t you talk to her?”

The doctor did not. “We can manage this patient. She can’t be transported like this.”

Molly bit her tongue. The ICU was just two floors up, perhaps a five-minute walk. “The patient has been in this condition—awake, talking, and joking—for six hours,” she said.

“I want her started on Dobutamine right now,” the doctor announced.

“We don’t carry it here, but the patient’s ICU nurse is getting it ready and will have it available upstairs,” Molly said.

“No. I want it now. Call the pharmacy and have them make it up.”

Molly was astounded. “She can be in the ICU before the pharmacy would have a chance to make it.”

“I don’t want this patient transported now,” Dr. Baron proclaimed, and stalked out of the room, leaving her residents behind.

It was 7:15 p.m., past the end of Molly’s shift. Once Molly and the residents were in the hallway, out of the patient’s earshot, Molly told them, “I do not care for your attending.”

“No one does,” one of the residents muttered.

Molly made eye contact with each of the four. “This patient has a room and will receive one-to-one care with an ICU nurse trained to manage a patient this sick. The ER is short-staffed tonight because two nurses called out. My priority is this patient, and being managed in the ER is not in this patient’s best interest.”

The residents stared at her blankly. “We cannot resolve this issue for you because she is our attending,” one of them said in a crisp foreign accent.

“What she’s doing is not in the patient’s best interest. What this patient needs is available in the ICU right now.”

“But she’s our attending,” said another resident.

“Y’all can’t give your opinion to someone?” Molly asked, surprised that none of these doctors was advocating for the patient.

No response. Molly said good-bye to the patient and walked out of the room. On her way out, a tech stopped Molly to say, “Thank you so much for sticking up for yourself, because no one ever says a thing to these doctors.”

Citycenter Medical

The next day, when Molly arrived for her Citycenter shift, the ER was teeming with hospital brass asking staff members about the department. Another nurse filled her in. The Joint Commission had sent surveyors to the ER for a surprise inspection. They were so disgusted by the lack of cleanliness and the nurse-to-patient ratio that they nearly shut down the ER on the spot. When the inspectors swabbed EKG lead wires, they found several different strains of bacteria. They gave the hospital forty-five days to fix the ER or TJC would close it. Citycenter ER administrators were frantically trying to set the department straight.

The mood among the nurses had lifted instantly. Until now, Citycenter nurses had believed they were stuck with their lot—that because their supervisor was part of the problem, they had nobody to approach for help. Even the patient load seemed more bearable because of the hope that TJC’s intervention would make the ER safer for patients and staff.

Molly’s favorite news was the charge nurse’s response to the inspection. Some charge nurses were given cue cards to follow so they could cover up some of the most blatant violations between the time inspectors registered at the front desk and reached the ER. Nurses were supposed to rush to move drinks from the nurses station, lock IV carts, relocate patient stretchers that blocked doors, secure oxygen tanks, clean rooms, and so on.

Citycenter’s charge nurse that day was Renée, the longtime veteran. When TJC checked in with the administration, a hospital official rushed to Renée in desperation and said, “TJC is in the building and heading here. Get the staff together and do what you can.”

To Molly’s delight, Renée answered, “No. I want them to see what this place is really about.”