“The doctor didn’t order it,” the nurse said.

“But if he has blood in his urine, you need to make sure there aren’t any clots.”

“Well, I would have needed an order and it wasn’t ordered.”

Juliette stared at the night nurse long enough to convey that she knew the nurse had been lazy; she should have requested the order from the doctor. Juliette called urology, then explained to Mr. Morse what she was going to do.

“Mr. Morse, I have to flush your catheter with saline to get rid of the blood clots that are in your bladder,” she said. After a tech inserted a Foley catheter, Juliette rolled up her sleeves. With one hand, Juliette held the man’s penis, and with the other, she pushed saline from a 60-cubic centimeter syringe through the catheter until the output was no longer cranberry-colored. Periodically, she also dialed a clamp on a tube to transfuse the patient’s blood. The skinny old man resisted. “What are you doing?!” he yelled. “What are you doing down there?!”

Juliette looked up. Mr. Morse was feebly trying to bat her hands away from his penis. Finally, he gave up. He put his hands behind his head and, with a look of bemusement, said, “Young lady, you ought to be ashamed of yourself.”

Juliette laughed and again explained what she was doing. Throughout the morning, she kept returning to the room to irrigate, but sometimes she didn’t get to Mr. Morse quickly enough. When his catheter got blocked, his sheets would saturate with fluid. Mr. Morse would try to escape the wet sheets. The staff would find the man naked and halfway out of bed while undergoing both a blood transfusion and a three-way irrigation.

Her coworkers were annoyed with Mr. Morse, but Juliette liked him. He was funny, sweet, and slightly senile. “I wanted to make him better,” Juliette said later. “He required so much work, but I didn’t mind because he was sick and he needed help.”

She was checking on another patient when out of the corner of her eye, she saw Priscilla treading cautiously down the hallway. Uh-oh, Juliette thought. She left the patient’s room to investigate. There was Mr. Morse, naked in the hall, a bag of blood hanging from his arm, and a catheter hanging from his penis.

“That’s it, Juliette, you have to put him in restraints,” Priscilla said.

Juliette escorted him back to his room. She wasn’t going to put the poor man in restraints. Juliette stayed past the end of her shift to take Mr. Morse upstairs to the cardiac unit. He would undergo surgery the following day to find the source of his bleeding.

The next afternoon, Juliette called the urologist from home to ask what had happened to Mr. Morse. “He made it,” the doctor said. “We were able to close off the bleed.”

Nursing involved deaths and inevitable disappointments, hostile visitors and slacking coworkers. But just often enough, something wonderful happened to remind a nurse why she loved the field.

During her next shift, Juliette was meticulously sanitizing her cell phone when someone from the hospital’s professional development committee found her. He handed Juliette a certificate and her clinical ladder portfolio. “Congratulations! You got the promotion! You’re a clinical level four!”

Juliette grinned with pride. A step up on the clinical ladder was almost comparable to an extra degree after her name, and clinical level 4 was considered a major accomplishment. She had put in time and effort to develop her expertise and prove her work ethic. A $2,000 bonus and a raise accompanied the promotion but, to Juliette, the promotion wasn’t about the money. It was about recognition of a job well done.

Chapter 8

Don’t Get Sick in July

:

Nurses’ Secrets–What Patients Need to Know About Their Hospitals and Their Health

“Nurses are frequently put in situations of conflict arising from competing loyalties in the workplace, including situations of conflicting expectations from patients, families, physicians, colleagues, and in many cases, healthcare organizations and health plans.”

—Code of Ethics for Nurses, Provision 2.2

“Somewhere along the line, when we lost the long white skirts, pleated blouses, and nursing caps of yesteryear, we also seemed to have lost the public’s respect. I would gladly go back to the nursing days of Florence Nightingale and Clara Barton to have the respect they had from society. I wish I could start a revolution for ER nurses specifically; we are the rock stars of nursing, but are treated like the red-headed bastard stepchild.”

—a North Carolina ER nurse

“So many things are just simply bullshit. I don’t know why I was surprised. I guess I always thought that when it came down to people’s lives, things like making money no matter what wouldn’t be so important.”

—a Texas ER nurse

LARA

  SOUTH GENERAL HOSPITAL, June

A divorced South General nurse in her late forties was trying to get pregnant through IVF. Afraid to give herself the injections, she asked Lara if she could come to her house and inject the daily shots. Lara agreed without hesitation. The nurse repeatedly tried to pay her for her time. “I’m not taking your money,” Lara told her. “Just tell me, how did you talk to your first husband when you guys were separating? What did you tell him? What did you wish you didn’t say? Help me with advice.”

Friends called Lara all the time to ask medical questions or to have her look at their injuries. Before she had kids, Lara slept over at her friend’s father’s house for two weeks because the family couldn’t afford a twenty-four-hour nurse and the man had painful bone cancer. “I’d never accept money for stuff like that,” Lara explained. “I do that in a heartbeat.”

She loved that people felt they could ask her opinion and that she could almost always help them. Being a nurse was more than a job. “It’s kind of who I am,” she said. “Nurses can truly make a difference in someone’s life. In the ER, even if it’s not a true emergency, an accident is something a person will never forget. That ER visit for stitches could be one of the worst times for people, and a nurse can make it a little better for them, putting them at ease, alleviating some of their fear. Even a pillow or blanket for someone’s grandma can make a difference. It may sound silly, but that makes nursing special.”

Now that the bills had started to come in and she was paying them, Lara had begun to grasp how well she could manage life as a single mom. She could support her family. She couldn’t spend as much time at home with her children as she wanted to, but she was doing her best, and she knew that her kids were safe when she left them with John. She had started to emerge from her funk, though she was still disappointed that she wouldn’t be able to go to PA school. She put her bachelor’s degree classes on hold, unsure of when she’d be able to continue them.

At work, she was able to focus more on her patients. One morning, Lara was working trauma and precepting a nursing student when an ambulance brought in a heavyset woman in her forties. While driving, the woman had told her spouse she didn’t feel well, then pulled over and went into cardiac arrest. The medics had briefly brought her back to life twice by the time she arrived at South General with no pulse. She was blue from midchest up.

Dr. Alisa Hawkins, a well-respected ER doctor, ran the code. While the team performed CPR, she reviewed several possible algorithms that could have caused the heart attack. Dr. Hawkins stuck a needle in the patient’s chest in case fluid had pooled around the heart.

“It’s not fluid,” Dr. Hawkins said. “Did we cover our Hs and Ts?” (“Hs and Ts” was a mnemonic device to help medical professionals run through possible causes for a cardiac arrest.)

“We did,” Lara said.