The Making of a Nurse (34 page)

“I can’t,” Roberta said, throwing her hands up in the air.

Margaret crossed her arms across her chest and looked away, fuming.

“I suggest if you are concerned about your sister that you stay with her on the floor,” Roberta advised. “That’s what I would do if someone I loved was in the hospital. This is what we are dealing with right now in our health-care system. Choices have to be made.”

Roberta and I stepped out into the hallway to discuss the matter further. “Look, Tilda, the nurses downstairs will be able to handle this patient. I know she has a lot of needs, but what can we do?”

The resident came over. “I’ve written the transfer orders. She’s good to go.”

Well, what could we do in the meantime, but go for our lunch breaks? There had been a meeting of the managers that day, and there were sandwiches and éclairs. I had to chuckle at Casey, who was serving the Caesar salad, using tongue depressors as tongs.

“I can’t stand the waste of money,” Monica said and looked at
the fancy leftovers with disgust while we munched away. “Everyone knows our health-care system is in trouble.”

“Oh, come on, Monica. There are lots worse excesses. A few platters of food is a drop in the bucket,” I snapped. She was ruining my appetite with her griping, and that on top of my
real
problem. “I’ve got bigger issues on my mind.”

“Why are you being so difficult, Tilda?” she asked. “You know there’s another patient out there who is in worse shape.”

“I realize that!” I could hear a hysterical edge to my voice. “But don’t we also have a responsibility to the patient already in our care?”

“But that other patient deserves a chance at what the
ICU
has to offer, too,” Monica said. “It’s not like we’re sending her home. Don’t underestimate the nurses on the floor.”

“You know as well as I do that a patient like this can easily fall between the cracks.”

“Look, if the family is giving you a problem, call security.”

And smash this tiny ant with a sledgehammer? Was that the solution? How easy it was for them all to weigh in on the matter. Why was it never so easy for me?

“Xavier,” I said briskly when I came back, “I’m going to help you transfer this patient.”

He looked surprised at my change of heart.

“What!” shouted Margaret, who was sitting beside the bed.

“Your sister cannot stay in the icu.”

“You know what the right thing to do is, you are just not willing to do it.” Her eyes bored into me. “Look at her! She’s so frail. Imagine it was
your
sister. Please, keep her here,” Margaret pleaded.

“Unfortunately, we can’t,” I said crisply as I disconnected the patient from the cardiac monitor.

“I suppose you have someone sicker who you want to bring in her place,” Margaret sniffed.

I didn’t dare tell her she was right, but Roberta came over and she dared. “Yes, that’s exactly what is happening. Someone is in worse shape than your sister.”

Check
.

The porter arrived. Xavier released the brake on the bed. As we wheeled the bed out of the
ICU
, I fought back tears of rage at what we were forced to do.

Checkmate
.

I HONESTLY CAN’T SAY
I was shocked when I came back to work the next morning and heard that Carole Oxton had a respiratory arrest during the night and had to be brought back to the
ICU
, unconscious and re-intubated. I’m not even certain the wrong decision was made to transfer her out, given that our resources are not unlimited. We can’t always keep patients in the
ICU
because of the
possibility
that something could go wrong. But I did wish that it were possible for nurses all over the hospital to be in the position to give the kind of care that we give to our patients. The hospital is full of seriously ill people and don’t they all deserve
intensive care?
After all, what was most “intensive” and “caring” about the
ICU
was the nurses. It wasn’t merely a place with machines and equipment; it was a way of doing things. And since it wasn’t feasible to bring every patient to the
ICU
, perhaps there was some way that we could bring the
ICU
to patients?

S
uddenly, my life became more complicated. After standing by helplessly and watching what happened to Carole Oxton, I felt terribly disheartened. We hadn’t been able to keep her safe. We couldn’t do the right thing for her. All around me, I began to see more and more things I could no longer ignore. Nurses on the floor were overloaded and distressed. There was no one they could turn to for support or to ask questions. Nurses were leaving nursing, and I was beginning to understand why. Jessica, a friend of mine, left nursing. She became a nurse when she was in her mid-thirties, after a successful career as a musician in the symphony. But after less than a year in the workplace, she decided to leave the profession. She looked miserable and defeated as she told me about it.

“I felt I had no choice but to walk away. Can you understand, Tilda?” She felt she had to explain it to me, but I knew very well that hospitals could be very
inhospitable
places, not only for patients, but also for conscientious nurses like Jessica. “Patients were always dissatisfied with me because I wasn’t giving enough
care to them, but I was always off somewhere else, giving not enough care to another patient.”

“I guess you never had a chance to get to know your patients,” I murmured.

“Know them? I was lucky if I knew their names. All I knew was their room numbers.”

Why had I never walked away? I had been tempted long ago, when I worked on the floor and always felt so powerless and invisible. I had chalked it up to my personal problems at the time, but what if I went back to the floor now? I’m still not sure I could handle the conditions there. More than ever, I appreciated working in the icu. We could set goals, plan ahead, intervene early, and not always be scrambling to react to crises. As an
ICU
nurse you felt respected, that your voice was heard and that your contribution counted. I was beginning to realize that many nurses out there didn’t feel that way.

These impossible situations made me worry about my profession, but even more, about patients who don’t have enough nursing care. I didn’t know what to do, but I knew I couldn’t look away any more. (Of course it wasn’t all up to me to rescue the patients, save the hospital, and fix the problems in the health-care system, but at times, I felt like it was!)

I have never had a problem or a worry, either big or small, that couldn’t be made better by meeting with a girlfriend and talking about it over coffee. If only world leaders could do the same, I’m certain wars could be averted. I arranged to meet Monica at a café near her gym just before her spinning class. I knew she was finishing up her Master’s degree and I wanted to hear how that was going, but first, she was bursting to tell me about her thrilling love life that involved yet another married doctor.

“But what happened with you and Nick?” I asked. I thought he was steady at the time, but it was hard to keep track as she always had a steady and one or two on the side.

“Oh, Nick is strictly PG-13,” she said. “You won’t believe who I’m seeing now!”

Suddenly, I was disgusted with myself. I’d been listening to her stories for years and here I was, listening once again, to the
titillating details of her latest encounter, this one in the office of a prominent surgeon, while his waiting room filled up with patients. “He said to me, ‘For years, I’ve been dying to get my hands on you, Monica,’ and so you know what I said to him? ‘Well, then, do me.’ We had to stop when his secretary knocked on the door.”

I felt queasy. By listening, I was drawn in. I became a part of her deception.

“I’m having such fun.” Monica sighed and smiled to herself. She explained how she had to be unfettered by emotional commitment so she could focus on her career goals. I looked at her pretty face and her impossibly fit body with its perfect posture from years at Catholic school where nuns had tied a broomstick to her back to make her sit up straight. She was determined to have a fabulous career and fun on her own terms, but I wondered if she really could manage to “have it all.”

“How’s work going?” I asked. “You haven’t been in the
ICU
for a while.”

“I’ve been moonlighting at another hospital,” she said. “You wouldn’t believe what happened the other night. They sent me to a floor and I got a fresh post-op patient who wasn’t peeing. The doctor told me not to put a urinary catheter in, but after a few hours she still wasn’t peeing and I needed to get a better assessment of her fluid balance. So I decided to put one in anyway and …”

“I hope you didn’t do it, Monica, not against a doctor’s order.”

“It was political,” she said, avoiding my question. “The doctor said she’d be more alert by morning and wouldn’t need a catheter, but in the meanwhile she had zip urine output and I was worried. I was there with the patient. He was on his cell phone at home.”

“Yeah, and if you had put one in and the patient had developed a urinary tract infection or blood in her urine, your licence would have been on the line.”

“But he was digging his heels in and it was about power, not about what was best for the patient. I told him to get in here and see for himself. So, he came in and to be honest, he took one look at me and didn’t give me any further hassles about the patient. He invited me into his on-call room and, well …”

“Don’t tell me!” I interrupted. “You didn’t!”

“He said, ‘You’re so hot, Monica,’ and so I locked the door and we made out a bit on the couch and then I told him he was wrong about the catheter, and about a few other things, too, and he was pretty weakened at that point, and gave in to me. Anyway, the point is, I can’t stand it when a nurse sees a problem, knows what to do, but her hands are tied.”

She may have meant that literally. She had a penchant for kinky things and did take pride in her claim that she’d try anything once. She looked pleased with herself, as much for having fought for what she believed was best for the patient, as for making another conquest along the way.

I got up to leave. Monica looked surprised. “Why are you going so soon? We didn’t even get to what you wanted to talk about.” I had had enough. Monica was so completely at ease with her secret, lying life and relentless pursuit of pleasure that it brought her integrity into question – and mine, too. Who Monica was as a person tainted who she was as a nurse. I no longer respected her or valued her opinions.

I WANTED TO SEE
how Chandra was doing and we arranged to meet. She had been a fabulous critical care nurse, but never regained her confidence after making that terrible medication error. Her new job was in a five-bed
ICU
in a small community hospital in the suburbs. She said she chose it for the convenience of being closer to home, but I think she may also have been hoping it would be a less stressful environment. She soon discovered that even there the issues were just as big and the stakes just as high.

“I have to tell you what happened on my last shift,” Chandra said, launching right into the story. “A sixty-year-old man came in with pneumonia. On my shift he developed chest pain and I saw
ST
wave changes on the monitor that could indicate ischemia to the heart, so I gave him oxygen by nasal prongs, did a twelve-lead
ECG
, and called the staff doctor at home to tell him what was going on, but he just blew me off. ‘He doesn’t have a cardiac history,’ he says. ‘It’s respiratory. I’ll see him in the morning.’ But I had an
uneasy feeling and so I called him back at two and then again at two-thirty and by four, after a whole night of pressuring him, he finally came in. By then the patient was in really bad shape. He said, ‘Chandra, I want to speak with you privately.’ Okay, this is it, I thought. What’s he going to do? He’s either going to rake me over the coals or report me to the College of Nurses. He stood there, looking from side to side. He couldn’t face me. ‘Okay,’ he said. ‘Help me. What should I do?’ That broke the tension a bit, and then I told him, ‘Make some calls and have the patient transferred immediately to a cardiac centre.’ So then, he goes out and tells the family about life support and scares them to death, but this is someone we can actually save – that part he forgot to mention. I hear them saying, ‘No, Dad wouldn’t want to be kept alive if he was a vegetable.’ So I explained it to them. ‘No, it’s not like that at all. It would be a temporary measure to get him through this crisis. We only want to transfer him out so that we’ll have a chance to save him.’”

“What happened?”

“I got him transferred out. He had a massive heart attack, but last I heard he’s improving.” She looked me in the eyes. “Why don’t they listen to us?” she asked, as if I knew.

“What’s the answer?” I asked, as if she knew.

ABOUT TWO YEARS AGO
, people with minds much greater than mine must have been seeing the same problems I was seeing because they came up with the idea to create a mobile team of doctors and nurses that would scout out patients in trouble wherever they were in the hospital and nip problems in the bud. Nurses and doctors could page the team at any time and an
ICU
nurse would be the first responder on the scene. Not every patient could come to the
ICU
, but the
ICU
(at least, what it provides) could come to every patient in the hospital who needed it. It would be like a virtual
ICU
, an
ICU
without walls, they said. (They had recently created a Virtual Library at the hospital where you could access the library materials wherever you were, regardless of library hours, and without the need to physically go to a place where the materials existed in hard copy.)
A virtual
ICU
would be here, there, and everywhere and the nurses would be the driving forces behind it. The nurses chosen for the team were some of the best of the
ICU
and they even underwent additional preparation and examinations on making patient assessments, interpreting cardiac rhythms, treating electrolyte imbalances, and instituting emergency procedures.