LARA

  SOUTH GENERAL HOSPITAL, December

A few weeks after Fatima’s meeting with administrators, Lara finally told her Thursday night NA group about her coworker. The women said that it was important to get to know Fatima better before mentioning the drugs because she had to trust Lara to allow her to help. Lara didn’t work night shifts, but she tried to make small talk the few times she passed by Fatima in the hall. “I don’t know her well enough to be like, ‘Hey, there’s a big suspicion about you,’ ” Lara said to the group. “I still have to ease into being her friend.” One woman suggested anonymously sticking an NA pamphlet in Fatima’s mailbox, but Lara worried she’d get paranoid.

Nothing had come of Fatima’s meeting, as far as Lara knew. Administrators couldn’t fire a nurse without a concrete case. Lara had noticed that Fatima was arriving early and staying late, another tactic Lara had used. She often entered other nurses’ patient rooms, clearly, Lara thought, looking to score leftover vials.

Working extra hours wasn’t necessarily a red flag to someone who hadn’t been in Lara’s shoes. Some nurses worked 3:00 p.m. to 7:00 a.m., a full sixteen hours. Recently, Lara had spoken with a nurse who had worked twenty consecutive hours. “You can work twenty hours? That’s safe? How is that even legal?” Lara had asked him.

“I don’t know, but here I am. It happens all the time,” he replied.

Lara continued to devote herself to her Relationship-Based Care committee work. December could be an especially tough month for nurses because they had to deal with their patients’ anxiety on top of their own holiday stress. The committee was encouraging people to make a conscious effort to be nicer to each other, with posters in the staff bathroom and reminders during meetings. They turned “RBC” into a mild reminder for coworkers to calm down. Rather than telling a nurse she was acting like a jerk, staffers would joke, “Hey, check yourself, that’s not very RBC of you.” Since the formation of the committee, there had been no fights on Lara’s shifts. The committee hoped the more empathetic atmosphere would improve employee relationships and the ambience for patients. As Lara said, “What if you brought your kid into the hospital and you saw nurses calling each other skanks?”

Lara also suggested that the department have huddles at every change of shift, so the day’s entire team could touch base about who would be working where and whether they needed more assistance. Lara explained, “The huddle is about how we can work well as a team. If you’re in triage and you do blood work for the nurse in the back, that’s going to take a load off her. A lot of people weren’t happy because some trauma nurses sit and do nothing when there aren’t any traumas. That’s one of the main things: If your area isn’t very busy and you have the time, there’s most likely someone who needs help, so what can you do to help them?”

Lara led the ER’s first huddle. “Okay, team, today’s going to be a good day,” she said. “We have ten nurses working today. Rose is charge. Rachel’s doing trauma. Peter is in triage . . .” She listed each staffer’s assignments, including the cleaning crew she had invited to the huddle because they were part of the team, too. This way, everyone knew they were accountable for their area, and also the entire group knew where the weaker or new nurses were, and could help them accordingly.

“Anyone got anything going on today? Willa, how are your knees?” Lara asked a nurse in her sixties.

“They feel rough today, baby,” Willa said.

“Okay, everyone, we gotta look out for Willa. If you see her pushing a stretcher, go help her. She should not be pushing a stretcher today,” Lara said. “Guys, remember there’s no ‘I’ in team. We’re all in this together!” She punched a fist in the air, intentionally cheesy. The group laughed and scattered to their zones.

The nurse manager told Lara that the huddles were the most helpful and positive meetings the department had ever had. Hopefully, once the huddles became routine, administrators would join them.

Lara’s next idea was to set up a specific room for post-trauma crisis intervention. The committee was still working on developing ways to help the staffers after something devastating happened, as with a recent case in which a 12-year-old died from a bullet wound. “People die on our shift, sometimes several people in one day, and then we just go back to work. Imagine if you just did CPR on a kid and it didn’t work. Then you deal with coworkers who are being rough on each other, and patients are angry because they’re waiting. And there’s no downtime,” Lara explained. “You can only hear a mother scream after coming to see her dead child once and you will be affected by it. That scream, I can’t even begin to describe it. The secretary answering the phone, security, janitors, everyone—they’re hearing this incredible anguish and are expected to be unaffected by it.”

At the start of a committee meeting, Lara presented her idea. “I was thinking we should have a debriefing room, a place where we can gather our thoughts after something awful happens. Everyone from the nurses who worked on the patient to the janitor who mopped the blood off the floor could take five minutes to think, talk, or pray.” Lara thought this strategy could ease the tensions that were typically high for hours after a tragedy.

“That’s a great idea,” said a tech. “We need a place to go and sit for a minute.”

“Which room should we use?” Lara asked.

“We could use part of the lunchroom,” said a unit secretary.

“Then we’d be focusing on eating instead of catching our breath,” a floor nurse said.

“Why don’t we use this room right here?” asked another nurse. “It’s only used for meetings sometimes anyway.”

The group became animated as they came up with low-cost ways to make the room more serene. “We could put in one of those little waterfall-on-the-rocks things!”

“And a white noise machine with peaceful sounds.”

“I have the perfect picture I can bring in to put on the wall.”

“I could bring in some lavender, that’s a therapeutic smell.”

“Ooh, I have a cool plant I can donate.”

Lara was so excited that once the committee settled on colors for the room, she volunteered to purchase the paint out of her own pocket.

•   •   •

Two weeks before Christmas, Lara went to her mother’s house one last time to finish clearing it out before it went on the market. She posted on Twitter that she was having a sad day. In the middle of the night, Lara opened her laptop and scrolled through dozens of replies about her mother and the house, which had been the neighborhood hangout. The uplifting messages made her smile.

Then she read the next post on her Twitter feed: John had tweeted to a woman with a half-naked photo, one of those porn star models that hundreds of men posted to daily, “Alabama, you’re so hot. I want to put this picture on my truck.”

Lara knew that John had cheated on her in the past, she knew about his gambling addiction, she knew about his sex addiction. But to post something like this where all of their friends and family members could see it, right after Lara’s tweet about mourning her last day at her childhood home? No. Lara was done. People had told her that the last straw before a divorce often was relatively insignificant compared to past transgressions. She understood that now.

Lara turned on the light in the bedroom. “Hey, John, when you tweet to another female, like your friend Alabama, everybody sees it,” she said. “So now everyone we know is looking at your conversation with the porn star.”

John jumped out of bed, looking panicked. He ran to his computer and started deleting tweets. Lara took a deep breath and whispered a quick, quiet prayer: “Please give me the strength to do this.”