She was glad to see that Ruby was on duty. A fifteen-year Pines veteran with wild curly black hair, Ruby was a recently divorced nurse who was prone to making off-color comments. She rubbed some colleagues the wrong way, but she had always been friendly to Juliette. On the few occasions when they worked shifts together, Juliette was quick to assist Ruby when she needed it and Ruby would reciprocate. It was helpful for nurses to have a partner like that.

Juliette was also relieved that Dr. Lee was the day’s trauma doctor. A small bespectacled Asian man, Dr. Lee was a favorite of the nurses. He was one of the rare Pines physicians who said “please” and “thank you” to them. He was patient, generous about sharing information with nurses, and receptive to nurses’ input. And another rarity: He was quick to respond when a nurse paged him.

Juliette moved as many intoxicated patients as possible into the hallway to clear the rooms. Even Dr. Preston stopped Juliette to whisper, “What are we going to do? We have no room for any new patients.”

“We just keep trying to move people out as best we can,” Juliette said.

At 11:00 a.m., Carla, a young nurse and a new member of the clique, approached Juliette. “Room Two is angry from waiting and may just go.”

“Fine, let her,” Juliette said. She stopped by the room. The patient, who had driven her Audi into a stop sign and had minor lacerations, was pacing and hollering, “I have to get out of here. I have to go.”

“You have to wait for the trauma doctor to give you discharge instructions,” Carla said.

“I want my clothes.”

“Your clothes were cut off of you at the scene because you crashed your car,” Juliette said. “The paramedics came to help you and you were put on a backboard.” The woman’s blood alcohol level was two times the legal limit.

“I want my fucking clothes!” she yelled. “I want my belongings!”

It was standard procedure for staff to cut clothes off of trauma patients for quick and easy access, if paramedics hadn’t already done so. “You wouldn’t believe how many people get upset because their clothes are cut off when we’re trying to save their life,” Juliette later explained. “If we can save an item because you’re awake and alert, we will, but if we can’t, we can’t. And the medics are prone to cutting things off right away.”

Juliette moved on to another room, expecting the woman to leave as soon as her discharge instructions came through.

The medic phone rang. “Pines, can you take two Priority One traumas?” Priority 1 meant a patient would die without imminent intervention.

Juliette gestured to the secretary. “Call Dr. Lee and find out if we can take them.”

“Stand by,” Juliette told the medics.

The secretary hung up the phone. “If it’s okay with you, he can do it, he says.”

“We’ll take them,” Juliette said to the medics. “Can you give me report?”

Juliette assessed her staffing. Her single trauma nurse was already overwhelmed and Juliette would need another. She assigned both of her techs to the incoming Priority 1 patients. She asked Ruby, who was in the center of the ER, to give report to her on her four patients so that Ruby could leave them to assist the trauma nurse. From that zone, Juliette could handle Ruby’s patients—mostly drunks—as well as her own and still observe enough of the ER to handle charge nurse duties.

Juliette moved a drunken dreadlocked man from Room 4 to the hallway, near a buxom 21-year-old who had vomited all over her low-cut minidress. When Dr. Preston walked by her, he shook his head to the nurses and murmured wistfully, “She was somebody’s New Year’s Eve dream date until she started puking on herself.”

The Priority 1s were an elderly couple who had been hit by a car. When the medics wheeled the couple in, Juliette assigned herself the patients. She was able to get the woman into the OR right away to treat abdominal bleeding, and the man into the OR within two hours for head bleeding. Juliette was glad she had accepted the traumas because they both needed immediate treatment. She later found out that both people survived.

After the couple moved upstairs, Juliette made her rounds. She could hear the Audi driver in Room 2 cursing at Carla. “You fucking bitch, I told you I want to talk to the doctor!”

Carla, looking stressed, exited the room. “What do you want me to do?” she asked Juliette.

“Just get her out of here. Discharge her.”

The woman was still yelling, between snippets of a conversation she was having on her room phone. Now she was refusing to leave. “I paid for this room!” the woman screeched. “I’m not leaving!”

Juliette picked up a hall phone and dialed 911. “I’ve got a verbally abusive, threatening patient I want out,” she told Dispatch. She returned to the patient. “Ma’am, you’re going to have to leave.”

The phone still at her ear, the woman paced in her blue paper scrubs. “I don’t have to leave, you fucking bitch.”

“You’ve been discharged. You have your things,” Juliette said.

“Whoever cut my clothes off is going to pay for them.”

“Fine. But I have a sick patient I need to put in this bed. You can wait in the hallway.”

“I’m not waiting in the hallway.” The woman resumed her phone conversation. “Can you believe these people?”

Juliette stretched a new sheet over the bed, then reached over and unplugged the phone from the wall. “I’ve told you: You need. To leave. The room.” She took the woman’s purse from the stretcher and handed it to her so she could clean the stretcher.

“Don’t you touch my shit!” the woman yelled. Juliette calmly headed to the room’s hand-sanitizing dispenser.

At that moment, the police arrived and ushered the patient out of the room while Juliette explained the situation to the officers. Immediately, the woman’s demeanor changed. In a saccharine voice, the woman said to Juliette, “I need some discharge instructions and you better have some backup for those things you’re saying about me.”

“Backup?” Juliette hooted. “I don’t need backup. It’s all written in your chart.”

Dr. Lee approached the patient. “I’m sorry it took so long. You are discharged. There’s nothing wrong,” he told her.

“Well, I need something for my pain,” she said.

Aha, Juliette thought. A drug-seeker. That’s why she demanded to leave, but then refused to. She just wanted a prescription.

Dr. Lee wrote her a prescription for Tylenol-codeine #3. The woman looked at the paper. “I’m allergic to that,” she said.

“Is it written in your chart?” Juliette said. She leafed through the chart. “Hmm, it doesn’t say here that you’re allergic to Tylenol number three.”

The woman glanced nervously at the police officers. “Never mind, I’ll just take it,” she mumbled.

The story in the ER for the rest of the day was how Juliette had heroically unplugged the phone on the patient. Afterward, three nurses told her that she had been a wonderful charge nurse. “You made New Year’s run smoother than usual, Juliette!” Ruby exclaimed. “It was so much less frantic. Great job!”

MOLLY

  January

Academy Hospital

Molly’s fertility doctor was offering her one last IUI cycle, her fifth. She would give herself shots for ten to twelve days, then have IUIs on two consecutive days. The protocol change meant that she had a clinic appointment on a morning she was scheduled to work at Academy. She hated to inconvenience Academy supervisors; Academy was the easiest money she made.

But the ER director assured her that the staff loved working with her and would try to accommodate her appointments. “You are an asset to our department,” the director said, and assigned Molly a 3:00 p.m. to 3:00 a.m. shift. She told Molly how much the managers appreciated that she was a hard worker, self-sufficient, and always willing to help other nurses.