The annoyed nurse took Sam’s report. Later, Sam learned that after seventeen hours of surgery, the patient would make a full recovery.

When he left the bar, William called Sam. He explained that someone had blurted out that she had dated the intern and a few of the residents, making her sound like the hospital tramp.

“Funny, I didn’t realize I was going on these dates,” Sam retorted. “Who said this?”

William sighed. “Okay, so what happened between you and CeeCee?”

“Oh. Well. CeeCee and I don’t make beautiful music together,” Sam said, and recounted when CeeCee had discovered that Sam said she drove her crazy.

William told her that the group had been drinking. Out of nowhere, CeeCee had declared that Sam had been hostile to her. She launched a diatribe about what a horrible person Sam was, and then claimed that Sam had dated four guys who worked at the hospital (none of whom Sam had dated). Dr. Spiros had chimed in, “Oh yeah, she went out with me, too,” as if something had happened between them. Dr. Spiros was now dating another tech.

CeeCee then burst into loud drunken tears. “Why do you even like her? She’s so mean!” she wailed to William. Surrounding bar patrons turned to watch her drama.

Eventually, CeeCee’s friends had dragged her out of the bar before she could make more of a scene. Later that night, CeeCee texted William: “I hope you and I are okay.”

Once again, Sam was beset by unfounded rumors of promiscuity at her workplace when she tried hard to avoid drama, let alone extraneous personal interaction in general. And self-absorbed girls like CeeCee didn’t even get embarrassed by their own ridiculous behavior.

People had done this to Sam since high school: Because she was quiet, they projected onto her a superficial image of the character they assumed she was. Because she was opinionated and did not mince words, that character was often negative, and because she was chesty and men found her attractive, that character was presumed to be a slut. Sam tried not to get caught up in what other people thought about her. But these types of rumors motivated her to work even harder. “I need to be really good at what I do if people are going to think ill of me without even knowing me,” Sam explained.

Sam didn’t claim innocence; she shouldn’t have said CeeCee drove her crazy when they were interns. But at least she had respected CeeCee as a nurse. Confronting CeeCee would only exacerbate the hostilities. “I feel like I should wear a plaid skirt and carry a backpack to work,” Sam told a friend. “It’s like high school, except for the dying people.”

MOLLY

  May

Citycenter Medical

Carl, one of Molly’s Citycenter patients, weighed more than 300 pounds and was missing a leg. He complained of chest pain but wouldn’t let anybody treat him. When Molly told Carl, who was homeless, that his discharge orders had come through, he crossed his arms. “I’m not going anywhere because I want to kill myself,” he said, smug.

Molly was unfazed. This was a popular game among homeless people so that they could score “three hots and a cot.” They would come to the ER, try to gain admission to the psych ward, refuse treatment, and get a warm bed and meals. Many hospitals automatically admitted any patients who mentioned depression or suicide, even if the staff knew they were bluffing. But here was one thing Citycenter did right: Molly called the crisis counselor, who spent three minutes with Carl, then told Molly to resume discharging him.

“But I’m going to kill myself!” Carl insisted.

“The crisis team thought there was a low likelihood of that, so here are your discharge instructions,” Molly replied.

“Just set them on my chest because when I go outside and kill myself, I want everyone to see them and know you don’t give a shit about me.” The man leaned back in his chair, splayed his arms dramatically, closed his eyes, and pretended to be dead.

Molly shrugged. “Okay.” She set the instructions on his chest and walked away. “I’ll call security to come help you,” she said while leaving. Carl wheeled himself out of the building.

Later that week, the hospital’s CEO sent an email to the ER staff. The Joint Commission had performed a follow-up investigation and had determined that the ER could keep its accreditation. Molly was stunned. “I can’t believe they found nothing!” she said.

The department had improved slightly; Molly didn’t get sick to her stomach on the way to work anymore. For her, the biggest difference at Citycenter was that the ER created a dedicated trauma nurse position. Because Molly was always assigned to the sickest patients, she was now able to concentrate on Zone 1 patients without having to abandon them immediately whenever a trauma came in.

The rooms still weren’t as clean as they should have been, however. Nurses were supposed to call housekeeping as soon as they discharged each patient, a practice that had quickly fallen by the wayside. And now that TJC had come and gone, Citycenter was trying to control the budget by creeping the nurse-patient ratios back up again.

Undercover observation conducted for this book during this time revealed multiple violations of TJC standards. At one visit, floors, supply drawers, carts, tubes, and equipment were spattered with dried blood; urine samples had spilled across a counter in a lab room; and bloody gauze was strewn over a sharps container. In the utility room where nurses brought pregnancy tests, a urine-soaked absorbent pad lay on the counter beneath a hospital binder.

Elsewhere, the ER didn’t use proper TJC notification systems, and a tech blatantly flirted with a visitor as he held down a patient who was being catheterized and moaning in pain. And when a pregnant woman came in with vaginal bleeding, worried that she had miscarried, the ER doctor discharged her without bothering to tell her that her fetus was fine.

Molly would continue to take shifts at Citycenter, but she knew that it wasn’t the hospital she was looking for. She didn’t like that Citycenter and Academy hired new grads directly into the ER and that she was considered one of the most senior nurses, with only ten years of experience. “There’s no one for me to learn from,” she said. And while Academy was easy, it was too easy for her to consider working there permanently: “There aren’t enough sick people there for me to help.”

Academy Hospital

Molly took a few extra shifts at Academy so that Jan, the grateful young nurse, could spend time with her long-distance boyfriend. Molly was in triage when she heard a familiar voice in the lobby. “How long have you been waiting?” a man asked other patients. “What’re you in for? I’m suicidal.” It had been only six days since Carl had visited Citycenter, at least when Molly was working.

Molly finished assessing her patient. When she finally called Carl back, he was sweet as pie. “I’m suicidal,” he repeated, giving her puppy eyes.

“Uh-huh,” Molly said.

“Are you a nurse?” he asked her.

“Yes, I am. I’ve also been your nurse at Citycenter.”

“Really? How’d you know it was me?”

Nurses called patients like Carl “frequent flyers” or “hospital hoppers.” One man called an ambulance at least once a day to visit the Pines, Academy, Avenue, or Citycenter ERs, complaining of “uncontrollable farting.” Molly was incredulous that EMS was required to transport him and that ERs gave him IV fluids, food, drinks, clean clothes from the hospital’s donation closet (collected mostly from staff), and a bed. Several drug-seeking frequent flyers claimed to have sickle cell disease and asked for Dilaudid. This was a shrewd tactic; nursing schools taught students not to treat sickle cell patients as drug seekers because they had legitimate pain. Many doctors went ahead and gave these patients six Percocets, then discharged them.