This is Your Fault: Frank Lashes Out

Chapter 64

Liz is assisting me with Nathan’s trach care. The stoma is healing well, but still a tender pink, with frothy secretions. Carefully, I swab around the collar, while Liz measures and cuts new ties to replace the old ones.

“It sounds like Nathan’s going to begin weaning from the ventilator soon,” I say, trying to sound cheerful. “He’s starting to do more breathing on his own since Dr. Polk had us lighten his sedation.”

“He opens his eyes every now and then too, that makes me so happy,” says Liz. “I swear he squeezed my hand when I was talking to him last night. Maybe he’ll regain some movement in his hands.”

“That would be great, Liz. I’ve known patients who were able to use a computer, and navigate their mobility chair independently, using a single hand. He’s strong, and young.”

“Should we wash Nathan’s hair this morning, Niki?”

Before I can answer, I sense in my peripheral vision a shadow standing in the doorway. It’s Frank. He grasps the side of the doorway with one hand, swaying a little. I can smell the alcohol he’s been drinking from across the room.

He’s staring at Nathan in the bed, but doesn’t step further into the room. Something about him blocking the doorway sets me on edge.

“Hello, Frank.”

He doesn’t take his eyes off of Nathan.

Liz looks uneasy too, but ventures to speak to him, “We’re just finishing Nathan’s bath and trach care. He had a good night.”

Frank turns to Liz, fury in his voice. “You raised our boy to be a fucking pussy. How’s he going to learn to be a man and toughen up when you keep letting him be sensitive and all that shit? I told you time after time, and now look where he is. You made this happen, Liz. This is your fault!”

“Frank, that’s enough,” I say to him. I need you to calm down.”

“You’re a cruel asshole,” mumbles Liz, barely audible.

Frank takes a step forward into the room. “What did you just say?”

“Nothing, Frank. I didn’t say anything.”

Frank looks at Liz, and his shoulders relax. In a voice frighteningly calm, he says, “Oh, it was nothing.”

Then, with the speed, and precision of a striking rattlesnake, Frank grabs Liz by the throat, pulling her away from Nathan’s bed, and slams her head against the wall. He releases his grip, and she slides to the floor, unconscious.

I scream, “Call security! I need help!” from the room to the nurses’ desk.

And then Frank pulls out a handgun, and points it at my head.

A Bad Feeling About Frank

Chapter 63

Several days ago, the neurologist treating Nathan held a family conference, and updated them on his prognosis.

“Nathan’s spinal cord was severely damaged in the accident. While there maybe some improvement after several months of healing, he will be paralyzed for the rest of his life. However, I believe that Nathan will not be ventilator dependent as he is during this acute phase. Since it may take many weeks for Nathan to breathe on his own without mechanical support, I recommend we place a temporary trach until he fully recovers and gets stronger.”

As the nurse caring for Nathan this shift, I was present at the family conference. Liz was prepared for the news, but openly sobbed anyway.

Frank had a lot of questions for the neurologist.

“What makes you so sure Nathan’s spinal cord damage is permanent? What about alternative treatments?” and “If we transfer Nathan to another hospital that specializes in this sort of care, would they offer more advanced treatment that could heal him?”

The physician answered his questions with patience and empathy.

I watched Frank as the neurologist answered his questions. Chameleon-like, his facial expressions changed from sorrow, to anger, to tears, and then to stone. Sitting in a chair next to Liz, I noticed he was lightly kicking her in the ankle under the room’s coffee table. She appeared not to notice. I almost said something, but thought better of it. A few minutes after the conference ended, he left the hospital.

Liz stayed in the conference room, asking more questions about what rehab services for Nathan will be offered, and how long would he be there as an inpatient.

I went back to the PICU, and resumed Nathan’s care.

“How’s Liz holding up?” asked Sue.

“Like a nurse. She’s focusing on what’s next; asking about rehab services, and what equipment she’ll need when he comes home. I don’t think his dad, Frank, is doing so good though. He was kicking her under the table during the family conference.”

Sue frowned. “I’ll have a talk with the nursing supervisor about that,” she said. “We may have to place some boundaries on Frank’s visits. Night shift said he came in late last night, intoxicated. When he started acting out they had security escort him to the hospital parking lot, and he took Uber home.”

I have a very bad feeling about Frank.

When Emotions Get in The Way of Judgement

Chapter 62

The next morning I report to work, and request Nathan for my patient.

Sue, our charge nurse, looks at me with squinted eyes, weighing the request.

“Niki, I’m not sure that’s a good idea…You’re too close to Liz.”

I’m ready for this. “Sue, everyone in the children’s hospital is close to Liz. You’re going to run out of staff fast if you’re using that as criteria.”

She shakes her head at me. “Okay, but if I sense for a minute that your emotions get in the way of your judgement, I’m going to pull you out of the room.”

“If my emotions get too strong, I’m going to be the first one to tell you.”

***

Liz is sitting in the bedside chair next to Nathan, still holding his hand. The cot made up for her hasn’t been slept in.

“Hey,” I say in what I hope is a normal voice. “How’s he doing?”

“His kidneys are working,” she smiles wanly. “He only needed mannitol once during the night. His blood pressure and CVP are normal.”

“That’s good news,” I affirm. “He’s young and strong. He’s going to make it through.”

“We haven’t been told the results of his cervical spine imaging yet. The neurologist said he wanted to see how Nathan did overnight.”

We look at each other in silence. I start my assessment, charting the results in the computer as I go.

“Can I bring you some coffee, Liz?”

“No, I’ll head down to the cafeteria when you guys start rounds. Maybe take a shower. The nursing supervisor offered me access to an empty patient room for as long as it’s empty.”

“That was thoughtful.
The silence becomes awkward, until Liz says, “Frank was here last night.”

“How did that go?”

“He cried. He raged a little, but then he went home. He said he’d be back later. I imagine he needed a drink.”

“Liz, I’m worried about your safety around Frank. Is there family or someone who can be with you when he’s here? I think we should let security know he’s volatile and have a plan in case he comes in drunk and angry.”

“Niki, I’ve dealt with him for years. I can handle him.”

She looks so small and helpless in the bedside chair. I wonder how someone as smart, sweet and kind as Liz ended up married to an abusive alcoholic like Frank.

Nothing is Going to Help: Liz’s First Visit to Nathan’s Bedside

Chapter 61

I’ve given report on Nathan to the nightshift nurse relieving who’s me. He’s had a central venous line, an arterial line and an intercranial monitoring device inserted. He’s heavily sedated. I watch his vital signs normalize on the monitor above his bed while I finish cleaning the blood off of his face. I gently comb his hair as best I can. Liz is in the waiting room; she hasn’t seen her son yet. She must be out of her mind with fear for him. Hopefully my interventions will make seeing him like this for the first time just a little less shocking.

Quinn, the nightshift nurse, completes her assessment of Nathan’s vital signs, pulses, and infusions. “Okay, Niki, I’m ready for you to bring in Liz.”

I notice Quinn placing a box of Kleenex on the bedside table.

A social worker from the emergency department sits beside Liz in the waiting room. Liz has been crying, but when I go to her an hug her she’s stoic with shock. She feels utterly fragile in my arms, and I start to cry.

“It’s going to be okay Liz,” I blubber. We both know it’s untrue. Nothing’s going to be the same.

In Nathan’s room, Liz goes to his bedside, and holds the fingers of one his hands. I notice a bit of dried blood I missed between his thumb and index finger, and curse myself. Liz knows he’s been sedated unconscious, but like every parent of a child admitted to a pediatric intensive care unit, she quietly calls his name. “Mommy’s here, Nathan,” she says, looking at the monitor for a blip in his heart rate or breathing that might indicate he hears her, and knows she’s with him.

There is no blip.

“Frank is not going to be able to handle this,” she says.

“Why don’t I call a social worker to be here with you when he arrives?” I suggest.

“Sure, why not,” Liz agrees with a faraway look in her eyes, and then, “Nothing is going help with Frank.”

A shiver of fear travels down my spine.

When it Happens to One of Your Own: Niki’s Heartbreaking Admit

Chapter 60

It’s 1730, and I’m caught up on patient care. Not only this, but so are my coworkers. It’s been a quiet dayshift, but none of us say this out loud, because that’s the fastest way to jinx your shift. I helped Craig transfer his last patient to pediatrics, and he’s left early. The remaining three of us sit at our pods and finish charting. We have an hour left before night shift arrives.

Of course, it was too good to last. The phone rings and Sue picks up the phone. I can tell by what I overhear we’re getting an admission. A trauma. A motor vehicle accident.

It’s a fifteen year-old boy, intubated by paramedics at the scene. He was the unbelted passenger of the truck his buddy was driving. They crossed a freeway barrier, and hit an oncoming car head-on. Our patient flew at least thirty feet before hitting pavement. He coded on the scene. There was a fatality in the other vehicle. The driver of the fifteen year-old’s vehicle survived without significant injury.

We call respiratory, and a ventilator is set up in the room. I pull out kits for arterial and central line placement. Neurology calls to have us prepare for an ICP monitoring device insertion.

It’s all hands on deck as the paramedics roll the boy into the PICU. He is strapped onto a back board, and wearing a neck collar. I step up to the gurney as we prepare to transfer the young man onto the hospital bed. He’s unconscious, and there’s blood spattered on his face. His face: I take a closer look, and I recognize his face! Oh my god; it’s Liz’s son, Nathan.

Kris (The Pale Green Bed)

Chapter 59

She woke up choking for air, strangling. When she opened her eyes she saw it was only that she was tangled in the pale green silk bedspread. She had neglected to turn it down the night before. A trail of drool left a dark pool on its edge. She hoped it would dry unnoticed so she wouldn’t have to take it to the dry cleaner. But the concern was quickly forgotten with awareness of her blinding headache. She considered whether it was worth the trouble of going to the bathroom and hunt for ibuprofen.

It was. Naked, she climbed out of the bed, head down, and a hand shielding her eyes from the sunlight streaming in through a gap in the vertical blinds. After stumbling, she remembered the three carpeted steps leading down from the raised platform where the circular bed perched. Gingerly, she made her way to the bathroom. The reflection of her face in the mirror changed her opinion about the ibuprofen, and she took an Oxycodone from its orange prescription vial instead. Groping the dark wood paneled walls of the hallway, she felt her way to the kitchen, swigging down the pill with a mouthful of flat sparking wine from a bottle she didn’t remember opening, and left overnight on the counter. Then she made her way back to the bed, covering her head with the stained, pale green bedspread.

Twenty minutes later, the warm, lightheaded feeling with a twinge of nausea arrived. She was ready to face another day.

Still naked, this time she remembered the three shallow stairs and stepped onto the shag wall-to-wall carpeting. She didn’t open the blinds, instead creating a space for herself between the vertical strips in front of the glass to gaze at the view.

The west wall of the room was glass with a sliding door opening onto a patio of aggregated stone. The patio formed a half-circle around the house. Beyond was an expansive view of the Pacific Ocean shrouded in the low-lying fog known as June gloom. By sight alone she understood the weather was mild and the fog would burn off by afternoon. The ocean was placid grey. “Grey, the color of the day,” she crooned, like a child singing a nursery rhyme.

Silhouetted against the sea’s brightness, a life-sized bronze sea lion stood at attention, as if barking at an intruder. The sea lion was some kind of local celebrity with a familiar name like Ed, or Bud or something. The house’s owner made the sculpture. She tried to remember: The owner was a movie producer, or something; she couldn’t remember what the property manager had told her.

She turned and faced the room, its focal point the elevated, pale green circular bed. She had never seen a circular bed. She wondered where she could find a circular bedspread to replace the one she had stained. Maybe on Amazon. The bed brought to mind Old Hollywood glamour. Or maybe it just reminded her of a bedroom in an old Hollywood movie. That’s probably more like it.

The bed rested against the wall. Above, a shelf of teak and glass defied gravity. The little bit of Kris that was still a nurse thought hanging something so heavy above a bed in earthquake prone California foolishly dangerous. She imagined it crashing down on sleeping victims. On it sat a Danish-modern vase, and a small ceramic bull.

A circular bed on a circular platform, a circle within a circle.

Strewn over the floor of the room, her clothes defied its sense of order.

 

Bruises Not Scratches (Niki Discovers Something Unsettling)

Chapter 58

“Raquel, it was absolute mayhem. The little dog took off down the hall after the bunny, and then the charge nurse called Security to help round them up. Of course, Security didn’t have any idea of what to do. Eventually, two officers cornered the animals, grabbed Rocket, and the pet therapist gathered up the bunny, but not before the blind kid, Travis, somehow felt his way to the fire alarm, and pulled it. The sprinkler system went off, and the fire department arrived. No, I didn’t leave early. After we settled everyone down, finished the shift, and gave report, it was 9 pm before I finally I got home, and reheated for dinner the lunch I didn’t get to eat. I’m ready for a second glass of wine, are you?”

This story was just to good not to call my sister Raquel and tell her about it over wine by phone.

* * *

I had a couple of days off before my next shift. Like I said before, day shift is challenging in its own ways.

“Niki, the phone’s for you.”

I take the call from the pod outside my patient’s room. It’s Finch, one of the day shift pharmacists.

“About that Ancef dose your resident ordered,” he begins.

I block, “He’s not my resident. He belongs to the attending,”

“Well, whoever he belongs to, he’s placed an order in the EMR for Ancef.”

“Yeah.”

There’s not enough Ancef in all the hospitals in the city to cover the dose. You need to call him and point out that the kiddo only weighs 10 kgs.”

“Finch, the RT is here and we’re about the re-tape his ET tube. Can you call and get the order changed, please? You can educate him about placing orders while you do it.”

“That’s not really a function of pharmacy, Niki.”

“It’s not a nursing function either, Finch. Why does everything get turfed to nursing? Health care is a team sport, no?”

I interpret the the silence on the other end of the phone to mean he’s strategizing an offense.

“Alright, Niki, I’ll do it this time.”

“Thanks Finch, you’re a real gem.”

“Phfffp,” he mutters before hanging up.

* * *

At change of shift, I give report to my old night shift buddy, Liz, first telling her about the patient, and then Finch’s one-liner that the resident ordered more Ancef than what’s available in the city that was pretty hilarious, when I notice the bruises on her neck, three of them. They’re long and suspiciously resemble fingers. I can’t help myself, “Liz, what’s up with the marks on your neck. They look like bruises. What happened?”

Her gaze drops downward, and she turns her head the other direction attempting to hide the bruises, but not before I see her cheeks flush bright red.

“It’s nothing, Niki. I scratched myself.”

She’s lying.

“Liz, those aren’t scratches, they’re bruises. It’s me, Niki. We’re friends, remember? What happened?”

“I’m having problems with Nathan. He’s skipping school and failing his classes. He got suspended for smoking pot on campus. I called his dad, hoping he could talk some sense into him.”

“Frank, you’re ex did this to you?”

“I thought he could help, but when he came over to talk to Nathan he starting hitting him. I got between them. When I started yelling at Frank to leave, things got out of control.”

“He choked you? Oh my god, are you okay? Have you seen a doctor? Did you call the cops?”

“This is exactly why I didn’t want to tell you Niki. I knew you would overreact.”

“Overreact? Jeez, Frank was strangling you! He should be in jail.”

“Mind your own business, Niki. I appreciate your concern, but mind your own business,” was all Liz said as she stood up and entered her patient’s room.

You Can’t Make This Stuff Up (Niki’s easy shift )

Chapter 57

One of my two post-open heart patients has discharge orders. The better part of an hour is spent reviewing the discharge instructions with her parents, and observing them practice drawing up the right amount of each of the liquid home medications using syringes and a cup of water. This demonstrates they understand the difference between dose and volume, because too much digoxin or potassium can stop a child’s heart; not enough won’t do the job. I never get over the fact that we send parents home with newly taught skills that took weeks for me to master in nursing school. Most of them do just fine, but still…

Later, I’m helping Travis gather his things, because he’s discharging home too. When it’s time to remove his IV, I begin by carefully taking down the tape holding it secure.

“Just rip it off, Niki, okay? I want to get out of here sometime today.” He’s laughing at me, and I’m reminded again of how resilient kids are. It makes working with them so rewarding.

“Okay Boss, you got it.” I ripped off the first piece.

“Ouch! Shit! Leave some skin on my arm, would ya?”

“Okay, I’m going to get some adhesive remover. I’ll be right back.”

As I turn to leave the room, I see the animal therapy volunteer standing in the doorway. A medium sized brown rabbit is cradled in his arms.

The kid in the other bed has his little dog in his lap, and I know what will happen an instant before it does: Rocket catapults from the boy’s arms in a perfect arc, his forelegs stretched in front of him, his hind legs straight out behind. He touches down momentarily at the feet of the animal handler, bounces once, and then vertically leaps upwards nipping the rabbit’s backside. The rabbit launches from the arms of his handler, and they’re off. The animal therapist chases after, and Rocket’s boy starts screaming for him from his bed. Travis laughs, and Reege continues to lie placidly on the floor by his bed.

I run to the hallway, where Rocket is chasing the rabbit around and around the nurses’ station, until the rabbit leaps onto the desk before making a break down the hallway with Rocket in pursuit. In the other patient rooms, parents alarmed by the commotion, carry their children to the doorways to find out what’s happening. Several nurses chase the animals down the hallway, trying to catch them.

You can’t make this stuff up. There goes my quiet shift.

 

How to Sabotage a Shift (Niki Meets a Service Dog)

Chapter 56

Never, ever think your shift is easy and you may go home early. It’s the quickest way to sabotage it.

The shift started well enough. I did vitals and passed meds for the two post-open heart patients first. They each have private rooms, and I chatted a bit with their respective parents. Transferring their children from the PICU to the general floor makes some parents uneasy, even though they understand it means their child is getting well. In the PICU, they become used to their child receiving one-on-one nursing care. They become accustomed to the vigilance of a nurse dedicated to the care of only their child. On the pediatric unit, the nurses are assigned three or four patients plus their child. The parents are now required to practice vigilance for their previously critically ill child’s care. Understandably, some are more comfortable than others. My patients’ parents recognize me from the PICU. A familiar face eases their minds. Our rapport encourages my belief it will be an easy shift.

My third patient shares his room with another.

During report the night shift nurse said, “Niki, your patient, Travis, is a delight, you’ll love him. Unfortunately, his roommate is a bit of a handful, so we assigned him to another nurse. He saw Travis’ seeing eye dog, Reege, and insisted his parents bring his dog to stay with him. They brought him in last night, claiming it’s a service dog too. Fortunately, Travis’ dog is a professional, and ignores the little dog’s aggressive behavior towards him.”

“Well, if Travis and Reege can ignore the other dog, I guess I can too.”

 

“Hi Travis, my name’s Niki. Is this beautiful dog is your partner, Reege?”

“Hi Niki, I need to go to the bathroom. Can you put the IV pole where I can reach it please?”

“Sure. Do you need help?”

“Nope.”

I watch Travis handle the IV pole, and grip Reege’s harness with his other hand. Reege, a golden retriever, pads along silently, leading Travis the to the bathroom. Travis seems steady enough, but his fall risk makes me nervous, so I wait for them in the room.

On the return trip I try again, “Is it okay if I take the IV pole for you?”

“Sure.”

After Travis is back in bed and Reege settled at his bedside, I take his vitals.

“Travis, are you hungry or is your stomach still bothering you? The breakfast trays should arrive soon.”

“I’m hungry. Do you guys have bacon?”

“Of course, but if there’s no bacon on your tray, I’ll call down to the kitchen and get you some.”

“Thanks!”

As if on cue, the meal cart arrives, and I find Travis’ tray. Lucky me! There’s bacon.

I place the tray on his table, adjusting the bed and utensils so they’re within reach. Travis tells me he’s right-handed.

“You’ve done this before, I see.”

“Yeah, a few times,” he grins. Would you tell me what’s on the plate, and its place on the face of a clock?”

“Sure. Anything else? Do you want me to butter the toast or cut anything for you?”

“Nope, I got it. Thanks.”

“Hey Nurse. Hey!” It’s the kid in the other bed. He’s got his dog, a nondescript terrier mix, in his lap.

“Hi. Do you need something?’

“Yeah, can you get some bacon for Rocket?”

“Sure. I’ll make a call to the kitchen.”

When I near his bed, Rocket growls at me.

“Do you want to pet him?”

“Does he bite? I thought strangers shouldn’t pet service dogs.”

“People just say that because they think their dog is more special than Rocket.” The kid glares at Travis, who flips him off. I try not to laugh.

“He only bites if he doesn’t like you. If you give him some bacon, I’m pretty sure he won’t bite.”

“Um, okay. I’ll order the bacon and let your nurse know.”

I leave their call lights within reach, bed rails up, and take breakfast trays to my other two patients. After they’re done, I help their mothers with bathing and dressing them.

One of the perks of day shift is the café is open. There’s time to go downstairs and bring a latte back to the unit. I get in line. There are two police officers ahead of me.

One of them is Officer Mike.

“Hey, Nurse Niki. What are you doing, getting a latte before heading home? I thought night shift prefers beer for breakfast.”

How the hell does he know that?

“Well Officer Mike, how nice to run into you again. No more nights for this nurse. I’ve transferred to day shift.”

“Congratulations. Welcome to the land of the living Niki. See you around.”

Mike and his partner take their coffees from the counter.

Did he just look my way again before walking away?

It’s Not All Cute Print Scrubs and Bunny Blankets (Niki Floats to Pediatrics)

Chapter 55

 

I leave PICU, and report to the pediatric unit.

No offense to my pediatric nurse colleagues, but no PICU nurse enjoys floating to pediatrics. Not because you aren’t incredibly good nurses, you are. It’s because you work way too hard in a way different from PICU nursing.

In the PICU, I’m assigned one or two critically ill patients. I run my butt off evaluating vital signs and pulses up to every fifteen minutes, unless the patient is on the verge of coding and then it’s at least every 5. I titrate powerful drip medications, and monitor serum blood levels drawn from a complex highway of lines criss-crossing a patient’s body as he or she rests in a drug induced coma. It’s intense, challenging work, but I’m able to focus on just one or two very sick patients, developing a dynamic rhythm of patient care.

As a patient improves, they’re allowed to come up from sedation. Keeping a three year-old intubated until an intensivist decides they can protect their airway and orders removal of the breathing tube is hell on earth for a PICU nurse, but once it’s done the patient usually transfers quickly to the general pediatric floor, right about the same time they are no longer willing to stay in their crib.

Of course, caring for children too sick to go home, but too well to stay in their crib is the job of the pediatric nurse. In the PICU, most medications are administered IV, but on the floor it’s often changed to oral. I don’t care how much the pharmaceutical company labels medications as “fruit flavored,” no kid willingly takes medication that comes from pharmacy in a syringe, even if you convince him there’s no needles involved. For infants, you can squirt a few drops of the med at a time into just enough formula to fill a nipple, and they’ll suck it right down especially if you allowed them to get hungry enough. A toddler, however, is on to you right away, and spits out the spoonful of pudding or juice laced with medication. The last alternative no one enjoys is holding the child down on his back, sliding the needless syringe into the side of his mouth, towards the back, which makes him swallow as you squirt it in.

Of course, none of these skills or the extra workload carried by pediatric nurses prevents a patient from suddenly decompensating, and a code being called. All of this, with the family watching from the bedside. It’s not all cute print scrubs and bunny blankets for pediatric nurses. Theirs is a very special brand of vigilance and expertise.

I took report from a day shift nurse I don’t know. She gave me three patients. Two are post-open heart surgery, transferred from PICU, on the mend and getting ready to discharge. The third is a 14 year-old boy who is blind as a result of treatment for childhood Rhabdomyosarcoma. He had a bout with influenza and was admitted for dehydration. He’s going home today too. His parents spent the night at home. In their place, his Seeing Eye dog, Reege, a golden retriever, lies calmly alert on the floor by his bed.

I realize they gave me a pretty simple assignment. In fact, it’s possible all three of my patients will be discharged. I might get to go home early!