At South General, Rose, the ER’s kindest nurse, connected Lara with Holly, a skilled, businesslike African American nurse whom Lara liked but had not gotten to know well. Holly, it turned out, had just divorced a cheating husband whose behavior was eerily similar to John’s; the women joked that but for the racial difference, their husbands could have been the same man. Every shift they shared, Lara and Holly made a point of checking in on each other, exchanging quick hugs and comparing stories. It was a relief for Lara to hang out with someone who understood her situation.
Several other nurses were so supportive that Lara felt as if she had a sisterhood looking out for her at work. To her knowledge, no one had complained that the nurse manager let her come to work whenever she wanted. Once, Lara was crying in a bathroom stall when she overheard the charge nurse say, “Lara’s here but don’t give her anything stressful. Just keep her busy.” Lara smiled, warmed because, despite some poor choices she’d made in life, she had chosen a career that was flexible enough to accommodate a single mom and that attracted the kind of women who protected each other.
One day Fatima approached her at shift change. “I heard you were having a hard time with your separation,” Fatima said. “I hope it goes better than mine did.” She told Lara about the fighting and drama that had plagued her own marriage and subsequent divorce. She mentioned that her ex-husband had been an alcoholic, a fact Lara filed away for future reference. Sometime when they were alone, she could talk to Fatima about her own family’s battles with alcoholism to segue into a discussion about addiction.
Lara was glad that Fatima felt comfortable enough to approach her. She couldn’t mention the drugs because they were in the middle of the ER, but she wanted to. She wanted to say that she knew why Fatima always wore long sleeves in the heated ER (track marks), and that she knew why Fatima’s hands were red and puffy (frequently shooting into a vein impeded blood flow). Perhaps after a few more conversations they would be friendly enough that Lara could raise the issue.
She sensed that time was running out.
JULIETTE
PINES MEMORIAL, February
On a relatively slow afternoon, Juliette was documenting at the nurses station. While she relished the adrenaline rush of busy workdays in the ER, she also treasured the occasional quiet spell that allowed her to chat with her coworkers or in the back office with Clark Preston.
Molly had been trying to convince Juliette to leave Pines because the clique bothered her so much. “Why don’t you work agency? There’s no reason not to,” Molly had told her. “You can work anywhere you want, you don’t have to do holidays or weekends, and the pay is higher.”
Juliette had resisted because the devil she knew was better than the devil she didn’t. She had anxiety about putting herself in new work situations. And while the clique overshadowed her job, she was still able to find positive connections with patients and some of her coworkers.
Ruby, the recently divorced nurse, stopped by the nurses station to say hello. “So what’s the deal with him?” she asked, pointing to a good-looking murse who was an incorrigible flirt. “I know he’s young for me, but what’s the deal?”
“If my daughter were in her twenties, I would not let her date him,” Juliette replied. “He cheats on his girlfriend every six months.”
“I gotta get laid. My little toy isn’t doing it for me anymore,” Ruby said.
Juliette was both surprised and pleased by the confession. She liked Ruby and respected her as a nurse, but they had not spent time together outside of work. How refreshing it was to gab with a coworker about something personal. “I know someone who’s more than willing,” she said. On a scrap of paper, she scribbled the name of the womanizer whose dalliances with several nurses had caused his secretary girlfriend to have a panic attack. She handed it to Ruby.
“Hmm, Dr. Fontaine. Isn’t he a little short? Cute, though,” Ruby said.
“He’s always down here. But apparently he’s been around the block a number of times.”
“Well, I’d just have to wrap his thing up twice then,” Ruby said, pondering the piece of paper.
Juliette cracked up. “Are you going to triage? I’ll walk you there.”
The women walked past the waiting area and stopped abruptly. Erin, a likeable young nurse, was heading toward the back wall with a large pair of forceps. “Uh, what are you doing, Erin?” Juliette asked.
“I have to get some candy out of the vending machine,” Erin said.
“Why, does a diabetic patient need some sugar?” Juliette joked, and followed her.
Two techs were kneeling in front of the machine. A dozen snacks were caught between the glass and the shelves. In front of an audience of patients and families in the waiting room, Erin tried using the forceps to reach the bags. No dice.
A few minutes later, Gabriel, the secretary, came over, rolling up his sleeves to reach inside the machine. “I can do it!” he announced. He couldn’t do it.
A murse brought a splint instrument that he had manipulated into the shape of a hook. The techs tried to grab the candy with the hook. “What if I get a lacerated finger?” one of them asked.
“That’s workman’s comp!” Juliette answered. The group laughed.
Soon, Dr. Preston came by. “Come on, Dr. Preston, you can do it!” someone shouted.
Ruby elbowed Juliette. “I bet those fingers can do anything.”
The staff and the patients watched as Dr. Preston reached his exceptionally long arm far into the machine and jarred loose a bag of Doritos. Finally, the chips and sweets tumbled from the machine. A cheer went up from the waiting room. Dr. Preston bowed and left.
Back at the nurses station, Juliette saw Dr. Fontaine flirting with a nurse. Ruby sidled by and bent toward Juliette’s ear. “Really?” Ruby whispered. Juliette grinned, raised her eyebrows, and nodded.
When Juliette got home that evening, she was still on a high from a fun day at work. As usual, she stripped off her dirty scrubs in her garage so as not to bring the germs into her house, painstakingly washed her hands and arms up to her shoulders, and pecked Tim on the cheek. She found 7-year-old Michelle on the couch.
She hugged her daughter tightly in greeting, but Michelle didn’t smile.
“Mommy, do you work tomorrow?” she asked.
“Yes, honey. It’s Tuesday.”
Michelle’s shoulders slumped. “It seems like you never have a day off. I want you home in the mornings to help me get ready. I wish you could work just in the afternoons.”
Juliette’s cheerfulness dissipated beneath her guilt. If she took shorter shifts, she’d lose not only wages but also opportunities to bond with her coworkers, as she had today. She decided then and there to apply for a clinical ladder promotion.
In the past, nurses who wanted to advance their career could study for extra degrees or apply for jobs in management. Juliette had no interest in applying for Erica’s vacant senior charge nurse position, or for any other administrative role, because she preferred to care directly for patients rather than supervise her peers.
Juliette loved bedside nursing because she cherished the direct interactions with patients. “I love being around them, being able to make all types of patients feel better,” she explained. “I love the moments of connection with the patient and with the family.”
Clinical ladders offered nurses like Juliette opportunities for a raise and recognition without having to leave the bedside. While the stages could vary by the hospital, Pines’ ladder offered four rungs of recognition: clinician level 1 (entry level), clinician level 2 (proficient), clinician level 3 (advanced), and clinical level 4 (expert). Each level required research, initiative, and a demonstrated level of clinical knowledge and advanced practice work. Juliette had reached advanced clinician level 3 a while ago. She didn’t have too much left to do to finish her application for clinical 4. She resolved to complete the requisite research project (which she had started and set aside last year) to reach the top level as a validation of her skills and a rationalization for keeping a demanding job that took time away from her daughter.