Rashes & Fevers (measles admission)

Chapter 47

Once I clock in, there isn’t time to contemplate Kris’s engagement, Simon’s remarriage, Amber’s pregnancy, or Corey’s move to Seattle with his family. As charge nurse, I took the call from an ER nurse requesting three beds for immediate admissions.

“Three beds? What’s happening down there? Was there a bus accident?”

“No, but maybe as bad. We’ve got three kids from two different families with fevers and red rashes. It’s measles. We’re coding a three year-old now”

Ten minutes later the ER nurse calls back with an update, “The three year-old’s stabilized, but maybe not for long. He’s intubated. We’re transferring him to you guys now. We’ll get back to you about the other two.”

While Gerald sets up a ventilator for the three year-old, Liz helps me take vital signs, and change the IV fluids to our pumps. “I really hate seeing a child suffer when this could be prevented by immunization,” she comments. “Why have so many parents lost trust in science and medicine? If you mention vaccinations to some, they react like you want to poison their child.”

“I think measles, pertussis, and polio decreased so much from recent memory that today’s parents don’t believe there’s a threat. I’ve heard some say, ‘Gosh, what’s the big deal about a fever and rash?’ or, ‘We have antibiotics now, so these diseases aren’t as serious as they were in the old days.’

“Yeah, everyone thinks childhood diseases are a thing from Little House on The Prairie,” added Liz.

“Yeah, well measles killed a daughter of Roald Dahl, author of Charlie and The Chocolate Factory in the sixties, before the vaccination was readily available,” I agree.

Once Gerald finishes setting up the ventilator, he joins the conversation, “I remember the first kid with measles I saw in the PICU. That time, the ER nurse reported they had a kid with a high fever, and unidentified red rash. No one knew what it was. So we wore respiratory masks, and isolation gowns, which was a good thing after infectious disease diagnosed measles. None of us had ever seen it.”

” I was sure grateful the hospital makes us have updated MMR immunizations. It’s supposed to protect the patients, but they protect us too,” said Liz.

A fever and rash don’t sound particularly lethal, but what is often not remembered is that measles is a virus, so antibiotics are not effective, although they are used to treat secondary pneumonia or infection.  High fevers can cause febrile seizures, and encephalopathy, which may result in deafness or permanent brain damage. That’s what happened to the child with the first case of measles I saw. Previously a healthy third-grader, she has permanent brain damage and lives in a home for medically fragile children.

“No one knows better than PICU nurses the dangers of childhood,” I added. “Kids die from so many causes: Motor vehicle accidents, drowning, falling out of upper storey windows, SIDS, choking, cancer, school shootings, heart defects and illness. The list is practically endless. If medical science can shorten it through vaccination, I’m for it. My kid is vaccinated.”

“So’s mine,” says Liz.

* * *

Report on the newly admitted three year-old with measles goes like this: The outbreak started when one of the kids was exposed at his pediatrician’s office.

“Wow,” says Liz, “The kid catches measles from another kid in a doctor’s office. Go figure.”

“Yep, and he exposed the neighbor’s kids: Four kids from one exposure. What if there were infants too young to be immunized in that waiting room?”

By the end of the shift, the remaining two children have cases mild enough to be admitted to isolation rooms on the regular pediatrics unit. They’ll be treated with IV fluids, and comfort measures. If their conditions improve, they’ll go home in a few days. If they worsen, they will be admitted to the PICU.

Moving On (more changes)

Chapter 46

Taking Maddie and Kaylee out for dinner distracts me from the sadness of saying good-bye to Corey in the mall. We watch movies in the family room until I’m too tired to stay awake. In bed, alone in darkness, I listen to their laughter until sleep overtakes me.

The next morning I deep clean the house in a burst of energy. When every surface is scrubbed clean and polished, I start on the closets, pulling out their contents and filling boxes with items for donation. Having stayed up into the wee hours of the morning, the girls are asleep, curled in sleeping bags in the family room, only their is hair visible from the fabric cocoons. Though I pass them several times while loading the boxes of used household items into the car, they remain asleep. I drive the boxes of old clothes, flower vases, and linens to a parking lot donation site, where a volunteer asks me the estimated value of the goods, for the receipt. I struggle to come up with a dollar price for items I’ve already deemed disposable.

At the nearby big-box store, I buy three baskets of fuchsias, and hang them from the porch rail at home. The anticipation of hummingbirds feeding from them while I watch through the window, drinking coffee, tea, or a glass of wine makes me happy.

“Moving on,” I tell myself.

* * *

The next day is Monday. After dropping Maddie off at school, I finish drinking coffee at home, and then go for a run, weaving and bobbing between roller bladers, bicyclists, and people walking their dogs along The Strand. The morning low clouds usually clinging to the coast are gone, and sunspots glitter on the surface of the sea. Mothers with young children arrive, making a patchwork quilt of the sandy beach with their blankets and coolers.  It’s a beautiful day.

Before school lets out, Maddie texts:

DAD PICKING ME UP WILL BRING ME HOME L8R

Around 7:30, Simon’s car pulls into my driveway, and Maddie pops out. She slams the car door shut before running into the house, laughing and smiling. She gives me a hug, and then blurts out, “Mom, guess who’s getting married?”

I knew this was coming.

“Your Dad and Amber?”

“Yes! I’m so excited! I get to be a bride’s maid. Amber says I’m too grown up to be a flower girl, and she wants us to be really, really good friends!”

“Well, that’s wonderful Maddie. I’m sure they’ll be really happy. When are they getting married?”

“In six weeks. Guess what else?”

“What?”

“Amber’s pregnant. I’m going to have a new brother or sister!”

* * *

The next night I wear the new scrubs, clogs, and lipstick I bought at the mall. Once again there’s a cake in the PICU. This one has Congratulations Kris! scrawled across its top in blue icing. Kris stands in the middle of the room with her left hand extended. The diamond is so big and sparkly I can see it from the door.

“Congratulations Kris! You and Jon the bass player decided to get married?”

“Niki, where have you been? Liz laughs. “She’s not marrying Jon the bass player.”

“That was so four months ago, says Kris. I’m marrying Spider Rodrigo.”

“The lead singer of Kushion? That Spider Rodrigo? What happened to the rock band rehearsing in your garage, and that guy you were living with?”

“That was Kushion.”

“But they’re huge! How did I not know Kushion rehearses in your garage, and you’re marrying Spider Rodrigo?” I blush, realizing how I sound.

Kris just looks at me.

Liz intervenes, “You’ve been a little self-absorbed lately Niki. You’ve had a lot going on.”

I try to recover. “I’m sorry Kris. Really, I’m very happy for you. Congratulations!” I give her a hug to prove it.

“Thanks Niki. That’s not all. Kushion is touring to promote their debut album, and I’m going with them. Spider’s mother is a diabetic. He won’t leave her. I’m going to keep track of her blood sugars, and be her companion. I’ll be the tour’s nurse.”

“Congratulations, Kris,”

I mean it. I really do.

Your Problem Arises (Niki Confronts Corey)

Chapter 45

As soon as I realize I’ve bumped into Corey, I turn to run back into the women’s restroom, but he caught me by the shoulders before I reached sanctuary.

“Let go!” I hiss.

A woman shoulders past us, looks back, but determines I’m not in danger so she keeps going.

“Niki, will you just wait a minute, and hear me out?”

“I don’t have anything to say, Corey.”

“Don’t be like that. This isn’t only about you. It’s about us, and I have things to say to you.

I turn towards him, and he releases me.

“What do you have to tell me?”

“Okay then, um, first, I want to apologize Niki. I never thought about something happening to Sheila; that maybe I wouldn’t be the one leaving first. I mean, we have our problems, but I never wanted anything bad to happen to her.”

With an intentional look of annoyance, I interrupt him. “Corey, we already went through all of this. I get it. You’re not leaving Sheila. Go away, and leave me alone!”

“That’s what I’m trying to tell you Niki. I can’t leave you alone. I love you.”

“Right, you love me, but you can’t leave Sheila. Corey, your problem arises from between your legs.” I turned to escape down the hall, but Corey’s retort stopped me.

“Yeah, but what do you really think of me, Niki?”

Leave it to an ER nurse to know how to diffuse a tense public moment.

I laugh despite myself, and softly reply, “I really think I’m going to miss you, Corey.”

“I know. I miss you terribly, and that’s why we’re leaving.”

“Leaving? Where?”

“Seattle. You know, Sheila’s from there. She’s stayed in touch with her boss in the realty office. He’s offered her a job. The housing market has improved, and he needs someone. She’s nearly done with chemotherapy, and he said she could pick her own hours until she’s fully recovered. Her oncologist referred her to someone else; Seattle has a renowned cancer center.

Having cancer made Sheila see my skills are important, and how much she needed me to navigate the health care system for her. Now she understands that nursing is complex and an important job. She understands that she can’t expect me to carry everything on my shoulders. She’s ready to become a full partner in our marriage.”

I’m feeling annoyed again. “Well isn’t that special. What about you, Corey?”

“There’s more Niki. Remember I told you I applied to NP programs? Well, I was accepted to a program in Seattle. Sheila and I have a long way to go to make things right between us, but I owe it to her and our children to try. We don’t have the connection that you and I have Niki. You and me, we’re the same. So moving is a good idea. I’m too tempted by you.”

“What am I supposed to say, Corey?”

“Good luck?” He reaches out tentatively for a handshake.

I hesitate, staring at his hand. A flood of memories engulfs me. I reach out, pulling him into a tender hug. He lightly kisses my forehead.

“Good luck.”

“Thank you, Niki.”

Releasing me, Corey turns, and I watch him walk down the hallway to the food court and his family without looking back.

A Trip to The Mall

Chapter 44

I get home from work and fall into bed without showering first. Troubled about Corey, and tired from a long nightshift, I toss and turn through fragments of terrible dreams I can’t remember.

After several hours I give up all hope of restful sleep, and lie awake in the darkened room. The extra cell phone charger I bought for Corey’s use sits on the nightstand across from me. I wrap it around itself before tossing it into the back of the drawer. Padding into the master bathroom, I remove the bar of soap, the brand Corey uses, from the shower tray, holding it to my nose, and breathing its fragrance into memory before tossing it in the wastebasket. Almost a year ago I purged Simon the same way.

I don’t bother to dry my hair after showering. Instead I make a cup of tea in the kitchen. Maddie will be home soon. Like a mantra, I count the many blessings in my life, beginning with Maddie: I am lucky to be her mom, and have a career by which I can support the two of us. Things will look up. I recover the sense of unexpected relief I felt when Simon left, and again when Corey first told me about Sheila’s cancer: “I don’t have to do this anymore.”

Maybe I’m not supposed to have long-term relationships? But the thought of spending the rest of my life alone chills me. In nursing school I saw too many elderly dying alone in hospital beds- their only visitors a hospital assigned chaplain, or the occasional neighbor checking in. What if I become a hoarder, or a crazy cat lady?

I reel myself in. Where do I get these thoughts? Simon’s right, I always jump to worse case scenario.

Next, I change my Facebook settings, making Corey an “acquaintance,” which seems more grown up than unfriending him. “You’re single,” I remind myself. “You can do as you please,” but I cry for a bit before placing cold, wet washcloths on my eyes to lessen the redness, hoping Maddie won’t notice when she gets home from school.

Her arrival is announced by the slamming of a car door in the driveway, and Kaylee’s mom driving off. Kaylee’s mom works at home. I admire her for being president of the PTA, and organizing social activities at our daughters’ school. I help out making snacks, occasionally manning a table, and carting boxes of chocolate bars, cookie dough, or gift-wrap to the hospital, and selling them to coworkers for fundraisers. I feel perpetually guilty for not being more of a presence.

So I quickly agree when Maddie, after throwing her backpack on the dining room table beside my tote bag, asks breathlessly, “Mom, will you take me and Kaylee shopping at the Mall this weekend? Can we see a movie too?”

“Sure,” I answer.

Maddie hovers over me, delivering a hug and quick kiss. “Thanks Mom! How was work? Did your friends like your picture on the magazine?”

“Yeah. They brought a cake, and taped little copies of the cover on their name badges. It was funny.”

“Cool! I’m going to text Kaylee and tell her you said yes.”

Simon and I agreed it’s time for Maddie to have a cell phone.

“Okay. Do you have homework?”

“Yeah. I’ll do it before dinner,” Maddie is already down the hall to her bedroom, shutting the door behind her.

***

On Saturday morning I’m up early for a three mile run while Maddie eats breakfast and gets ready for the mall; a complex ritual requiring phone calls to Kaylee, several changes of clothing, and experimenting with the small amount of make up she’s allowed to wear when out with her friends.

After my shower, I slide on yoga pants, a fluorescent pink tank under a jacket, and flip flops, which are essentially off-duty scrubs.

We pick up Kaylee. It’s a warm, sunny day and I’m looking forward to hanging out a bit with them. Their faces are pink and healthy, their bodies strong. I whisper a small prayer of thanks.

The girls chatter non-stop in the back seat of the car reading texts they send and receive. I have some shopping to do too, so we enter the mall together.

“So let’s meet back here after the movie. Text if you’re running late.”

“Mom, can we go out to dinner after? And can Kaylee spend the night?”

“Sure. Ask Kaylee’s Mom if it’s okay though.”

“We already texted her. She said it’s fine.”

“Well, okay then. Stay out of trouble. Text me if anything comes up.”

“We will. How many times are you going to tell us to text, Mom?”

Giggling, they run off to their exclusive universe.

***

At a department store counter I try on a new lipstick, scrutinizing my face in the small mirror the clerk hands me. The color is good, and brightens my mood, so I buy it.

In the uniform store, I find a set of scrubs I modeled for Call Lights Magazine. I buy them, and a new pair of clogs too. Having something new to wear will help me through the next post-Corey shift.

After aimless window-shopping, I take the escalator upstairs to the food court where a teenager wearing the same pair of disposable gloves to handle everything makes my smoothie. I settle at a table overlooking the ice rink two levels below. Children and adults glide over the ice to an instrumental version of “I Will Always Love You.”

Violently, I’m thrown from reverie by the sight of Corey in line at a food stand across the court. Beside him is Sheila, radiant in a pink sundress; a scarf artfully wrapped around her head. Next to her are their two daughters, also dressed in matching pink sundresses.

I can’t breathe.

I abandon the smoothie on the table, rapidly, and I hope inconspicuously, making my way to the women’s restroom. Ducking into the first empty stall, its door slamming behind me, I squat in front of the toilet, trying to avoid touching the seat. I vomit until there’s nothing left but dry heaves. I’m sweaty and chilled.

The retching stops and I can stand without crumpling to the white tiled floor. I exit the stall and splash cold water from the sink in my face until its color returns in the mirror. I comb my hair, and apply the new lipstick, but my bravado is gone.

After what seems like long enough, I venture out of the women’s restroom into the long hallway leading back to the food court.

I am taken aback by bumping into Corey outside the restroom door.