Despite the Nurse of the Month teasing, most of Lara’s coworkers were gracious. “You really deserve that,” one told her.

“I can see why you got it,” said another.

After work, Lara reflected to her friend. “I love nursing. I think I have the coolest, best job in the world,” Lara said. “I probably feel more passionate about it now than I ever have, because it got taken away from me. I am so lucky I didn’t go to jail. I am so lucky to be here with my amazing kids. Most nurses who did what I did lose their licenses or don’t get to return to an area that would be a trigger, like the ER. I am never going to stop being grateful that God gave me another chance to be a nurse.”

When she took the trophy home and told her children about it, they were so proud of her that they carefully placed her award on the shelf that displayed their soccer trophies.

SAM

  CITYCENTER MEDICAL, July

Since the charge nurses had begun to assign Sam regularly to Zone 1, the area with the sickest, most interesting patients in the ER, she was happier at Citycenter. Zone 1 procedures ran relatively smoothly on the night shift that could have been disastrous during the day. One night, the ER had two coding traumas simultaneously in the trauma bay, a CPR in progress on a patient with no pulse, and an unresponsive trauma patient. All eight nurses on duty came to work on them. Half the nurses were back-to-back, facing the gurneys; their bottoms kept bumping into each other as they worked. They were able to save one of the patients. Had this situation occurred during the day, Sam believed they would have lost both because the situation would have been even more chaotic.

Doctors on either shift made mistakes, particularly the new ones, particularly in July. One day, Sam watched with horror as a surgical intern inserted a chest tube into one of her patients and dropped the needle—a tree trunk of a surgical needle—onto the floor. “I’ll pick it up later,” he said, at Sam’s look. After the procedure, the surgeon strode toward the door.

“The needle!” Sam reminded him.

He briefly glanced around, said he couldn’t find it, then left the ER. It was a generally understood courtesy that doctors, nurses, and techs took care of their own sharps. Too often, new doctors didn’t clean up after themselves, or wouldn’t handle patients’ urinals, “as if they were too cool for school,” in Sam’s words. She was tired of these doctors “acting helpless when they’re really just lazy.” She paged the surgeon. He called her back ten minutes later.

“You need to find that needle,” Sam told him.

“I’m busy on the floor,” he said.

“I don’t care. The patient has HIV and hep-C. None of the nurses or cleaning staff are going to accidentally get stuck by that needle and get hep-C because your dumb ass dropped it and you won’t come find it.”

“I might be an hour.”

“That’s fine, but you better come down and find it because I am not your handmaiden.”

Shortly thereafter, the surgical team’s four medical students were in the patient’s room on their hands and knees. Sam scoffed. Who did the surgeon think he was? It was hardly safe for people to crawl on the ER floor. They found the needle within five minutes. The surgeon did not return downstairs.

There were a few physicians Sam enjoyed working with, like Dr. Geiger, who now would come to Sam specifically for assistance. But too many young doctors were careless. Recently, while a new surgeon was working on a patient, the connector between the chest tube and the drainage chamber came apart and fell onto the floor. The surgeon picked it up and put it back into the sterile chest tube. Sam stared openmouthed.

“Do you want another one? How about we change that out?” Sam said.

“Oh, well, yeah. Of course,” the doctor said, as if she had planned to all along. Sam ran to get another drainage chamber.

On her night off, Sam called William. He had ramped up the teasing lately, for no discernible reason. She wondered whether CeeCee had blabbed again, in which case Sam wanted to clear the air with him.

“I didn’t pee for at least eight hours last night,” Sam said by way of introduction.

“Me neither,” William said.

Sam smiled. “The fact that this conversation seems perfectly normal to us is odd in itself.”

“Hey, to do this job well, you need to be dedicated.”

“Yeah, in between getting berated and fighting with the lab, actually getting to help people is kind of awesome.”

“You have to keep it all in perspective,” William said.

Sam took a breath. “So what’s the deal?” she asked. “You’re acting like you’re twelve. Get your head out of your ass.”

“I’m interested in you, Sam.”

Sam almost dropped the phone. “Um, I guess I hadn’t noticed that.” Her heart pounded. Her dream guy was interested in her? This was the stuff of movies, not the kind of situation that happened in Sam’s real life.

“Well, yeah.”

“You have a girlfriend and I’m not going to be your little side fling.”

William paused. “Actually, things weren’t going so well. We broke up a couple of months ago.”

“Oh.” Gears turned. “You’re single?”

“Yes, I am.”

Sam processed this information. “I wish you’d told me that sooner. This whole time I thought you still had a girlfriend.”

“I don’t talk about my personal life at work, so there’s no way you would have known. And I didn’t know if you felt the same.”

“Well . . . maybe we should hang out,” she said.

“How about now?”

Within half an hour, he was at her door. They stood there for a moment.

“Hi,” she said.

“Hi,” William answered. They grinned sheepishly at each other.

Ten minutes later, they were settled on Sam’s couch, watching a movie. When William slid his broad muscled arm around her shoulder and leaned toward her, Sam’s mind raced. Okay, sure, I guess that’s what we’ll do now. As she kissed him back, she realized it didn’t feel awkward at all.

Nurse Confessions: Behind-the-Scenes Secrets from the Front Lines of Healthcare

As a fly on the wall of a hospital, you can learn a wealth of healthcare secrets, some of which are entertaining and some of which could save your or a loved one’s life. In front of an undercover reporter conducting research for this book, an exasperated attending physician at Citycenter shook her head as she corrected a colleague’s error. “Just trying to get through July,” she muttered. Her reason for saying so exposes a major secret about hospital life. Here is that secret, and others that nurses want you to know.

Don’t get sick in July.

Every year in teaching hospitals at the start of July, medical students become interns, interns become first-year residents, and each successive class of residents moves up a level. These new doctors are immediately thrust into direct patient care. As the National Bureau of Economic Research reported, “On day one, new interns may have the same responsibilities that the now-second-year residents had at the end of June (after they had a full year of experience).”

This upheaval causes what healthcare workers call “The July Effect” in the United States and “August Killing Season” in the United Kingdom (where the shift happens in August). The changeover harms patient care, increasing medical errors, medication dosage mistakes, and length of hospital stays. Most strikingly, in July, U.S. death rates in these hospitals surge 8 to 34 percent, or between 1,500 and 2,750 deaths. University of California San Diego researchers found that fatal medication errors “spike by 10 percent in July and in no other month.” In the U.K., August mortality rates rise by 6 to 8 percent as new doctors are tasked with surgeries and procedures that Britons say are “beyond their capabilities.” Patients in English hospitals have a higher early death-rate when they are admitted on the first Wednesday in August than patients admitted on the previous Wednesday.