The ER doctor told the woman to follow up with her cardiologist, and ordered some Ativan to calm her down. Sam could hear through the curtain from the next patient area as the woman explained her fears to her husband. The patient was upset because she was under stress at work, which was leading to a cycle of increasing SVT episodes. She did not want to take Ativan. Sam guessed that the doctor had not adequately described the patient’s condition and treatment.

So she popped in to talk to the patient. “I thought you could use some more information,” Sam said. “Stress can activate a vicious cycle: You get stressed out, you get SVT, and that makes you even more stressed. So I can only imagine how stressed you are.”

The woman nodded.

“If I were given the option, I would take a really small dose of Ativan just to bring the stress down a notch. It could break the cycle,” Sam continued. She explained that Ativan wouldn’t affect the woman’s heart rate, but was intended to calm her so that her heart wouldn’t start racing again. She answered the couple’s questions and talked to them for ten minutes.

Sam was not a warm, fuzzy nurse. She probably never would be. In her opinion, giving a patient “all the information is more calming to someone than patting them on the head like, ‘There, there dear.’ ” By giving the couple thorough information about SVT and Ativan, she was hoping to provide them with “every tool they needed to make a good decision.”

The woman agreed to try the Ativan. As Sam walked away to retrieve it, she overheard the woman say to her husband, “She’s awesome. She gets it!”

Sam paused in the hallway for a moment to collect herself while her eyes filled with tears. She explained, “I think it meant so much to me because it wasn’t intended for me to hear. This is why I got into nursing. I was able to talk to her like a human being and help her understand what we were trying to do. There’s a different sense of satisfaction than when you work on an interesting trauma patient. With most traumas, you’re using your brain on a clinical and tasky level but you don’t really interact with the patient. Anyway, it was the nicest compliment.”

Sam had assumed she needed to become a nurse practitioner in order to gain universal respect within the medical industry. As she said, “It’s been my mission to make doctors and laypeople realize this isn’t our grandmothers’ nursing. I don’t wear white and I sure as hell don’t stand up when a doctor enters the room.”

Now, after a year as a nurse, she could see that she didn’t need the doctors’ validation. Rather than view ER nursing as a stepping-stone toward a more prestigious degree, she knew that her job was about healing. She also didn’t need patients’ respect. Sam was a nurse to save patients’ lives, not to convince them to appreciate her. But oh, what a difference it made when they did.

JULIETTE

  EASTGREEN HOSPITAL, December

Juliette hesitated in front of the broad automatic doors of the Eastgreen ER, where she had landed permanently following eight weeks of agency work. After working full-time for a few months at Eastgreen, a hospital with a good reputation and a varied patient load, she had arranged a two-week unpaid vacation to spend quality time with her husband and daughter. Now, as she prepared to resume working, she remembered when she had returned to Pines after a three-week vacation and no nurses other than Molly had welcomed her back.

Eastgreen, which was not far from Juliette’s home, had a much larger ER, with twice the number of Pines’ staff. Juliette couldn’t help but wonder if some of her new coworkers had already forgotten her name. Thus far, the experience at Eastgreen already outclassed Pines. Most of the nurses Juliette had worked with were courteous. Unlike at Pines, Eastgreen nurses were diverse; they ranged in age, race, looks, weight, sexuality, and numbers of tattoos and piercings. The charge nurses made a point of thanking nurses who worked hard, like Juliette.

Socially, Juliette and several coworkers had started a book club. She was friendly with one of the ER doctors, and she had traded dog-sitting days with another colleague. A group of nurses had even invited Juliette to go on a whale-watching trip.

Despite all of this, Juliette worried about how they would react when she returned. After all, she had trusted Priscilla, but her judgment had been wrong. She took a breath and entered the ER. The first tech who saw her gave her a hug. “Juliette, we missed you!” she said.

At the nurses station, the nurse manager stopped her. “I’m so glad you’re here! How was your vacation?”

“Juliette’s back?” asked the ER doctor, looking up from his computer. “Hey, I got a new puppy! Come here and see the video.”

The nurse manager read Juliette a compliment from a patient evaluation that had come in while she was gone. The patient had written that she knew how busy ERs were. “Juliette took great care of us,” the patient said. “It made such a difference with our stay and we just want to acknowledge the care we received.”

Juliette beamed. Eastgreen wasn’t perfect. There were social groups that she wasn’t a part of, and staff members who were unhelpful. But already, she felt more comfortable at work than she ever was at Pines.

LARA

  SOUTH GENERAL HOSPITAL, August

The day before the surgery, Lara couldn’t stop thinking about the drugs. Remember how shitty you felt when you were trying to get clean? she pleaded with herself. You don’t ever want to feel that way again. Don’t do this to your kids.

Frightened that she would succumb to temptation, Lara went to an NA meeting and shared: “I’m going to have surgery and I’m kind of excited about getting my stomach muscle cut open because then I’ll need Percocet.” She was embarrassed, but the response was immediate. “It’s cool you’re making yourself accountable by telling us,” a man told her.

“Who do you have to hold your medicine?” a woman asked.

“I guess my ex-husband,” Lara said. He was the only adult whom she saw every day. She would be most accountable to him because he was watching their kids.

“Do you want me to drive you to a meeting?” asked someone else.

Lara had mixed feelings. She had been eager for the meds, and now a little voice scolded her, You just ruined your chance. But her relief that her NA network would not allow her to relapse offset her disappointment. Quickly, she told several people about the surgery so that they would watch out for her. But even up until the moment of the operation, Lara was scared by how thrilled she was to get cut open because she would get high.

•   •   •

When she woke up, Lara was giddy on her post-op pain medication. After John drove her home, Lara called in her Percocet prescription. Still high from the surgery, she decided to drive the three miles to the pharmacy herself although driving so soon after surgery was inadvisable.

Lara picked up the prescription and three bags of chicken from the restaurant next door. She balanced everything on top of the car while she gently opened the door, careful not to strain her surgery site, then loaded the chicken into the trunk. As she backed out of her parking spot, she heard a crunch. She glanced in her rearview mirror, saw nothing unusual, shrugged, and drove back to John’s. After dinner, she went to her car to get the Percocet. Her plan was to keep two pills at home and give the rest to John to hold for safekeeping. The prescription wasn’t in the car.

He took them from me! Lara thought. She tore into the house, where she found John in the den. “Are you messing with me? Where’s the Percocet?” she asked.

“What do you mean?” John asked.

“The pain pills aren’t there! Did you take them?” she asked, panicking.