Posted on by jparadisirn

You Remember What Night Shift’s Like (Niki & Kris Talk)

Chapter 48

 The following morning, I gave report to Kris, beginning with what I hoped she would interpret as an apology,

“Kris, I just want to say again that I’m really happy about your engagement. You must be super excited about going on tour with Spider.”

She smiled, and then added shrewdly, “Thanks Niki, but I get the feeling you have more to say on the subject.”

Busted, I decided to charge ahead,  “Aren’t you at all worried about giving up your nursing job? I mean you’re really a great PICU nurse. Do you think you’ll miss it?”

“What you mean is, ‘Aren’t you worried that marrying a rock star is a little crazy, and what if the marriage doesn’t work’?” replied Kris. “That’s the fun of being alive, isn’t it Niki? A willingness to be surprised. Letting go of things so you can go to the next adventure. I’ve tried many things in my life, and lived in most of the United States. Not everything has worked out, but I’m still standing, no worse for wear. I’m not the kind of person to put down roots for too long anyway.”

Maybe because I’ve been up all night, or maybe because I won’t see Kris much more, I let my guard down, “Do you ever worry that in the end you’ll be all alone?”

Kris’s upper lip begins to curl into laughter, but meeting my gaze, she changes her mind. “You mean, like when you die?”

“Maybe, I’m not sure what I mean exactly, but sometimes I wonder what the right choices for my life are; if I’m doing the things I’m supposed to do, or if I’m missing the point.”

My words don’t make a lot of sense, even to me. “I guess I worry a little that it will end, and I haven’t lived the life I want, or maybe I’m not living life right.”

“I’m not sure what you mean. Right by who’s standard, Niki? Like God? Like the life your parents wanted you to choose? Who’s standard of what’s right or wrong are you judging yourself by?”

I realize I’ve said more than I’d intended. “I’m just tired Kris. You remember what night shift’s like.”

Kris looks at me brightly, and then her eyes soften. “It’s hard being a nurse, taking care of everyone all the time, feeling as though you always have to have all the answers,” she says. “Don’t over think things, Niki. It doesn’t take much to wreck the best-laid plans: a car accident, a cancer diagnosis, or a debilitating disease. Try having more fun, and let go of some the responsibility for healing the world. Have you thought about transferring to day shift? Someone has to take my place. It might open up more of a social life for you.”

“Oh, I don’t know if I’d like day shift,” I hedge. “Too many phones, the doctors overrun the place on day shift.  I’d be expected to join committees.”

“Suit yourself, it was just a thought,” retorts Kris. “So tell me about this kid. Another case of measles? How many does that make this year?”

Posted on by jparadisirn

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.

Posted on by jparadisirn

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.

Posted on by jparadisirn

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.

Posted on by jparadisirn

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.

Posted on by jparadisirn

Angst and Cake (Niki’s smiling face)

Chapter 43

 “So what happens to Melissa now, Grant?”

“The hospital can file a complaint against her with the Board of Nursing if they choose, but that’s unlikely. She isn’t named in the suit, so she’s off the hook for that. Like I said, Dr. Straid filed against the hospital to protect his financial interests. With Melissa’s testimony, it’s clear the hospital has responsibility for not preparing their pediatric nurses better, and we can successfully throw in understaffing the unit too. There will be more discussions, but ultimately, the hospital will settle with the family out of court.”

“And Dr. Straid will still be a bully, and a child is dead.”

“I defend clients Niki, I don’t have to necessarily like them. You said it yourself, even if Straid had come in, the child still might not have survived.”

I drove home from La Jolla with feelings of angst. I think about how lucky I am to work with a good group of doctors in the PICU. Dr. Polk is respectful, even if he does sometimes forget he’s in a pediatric unit and cusses. He knows if a nurse says, “Come in and see this kid,” he’d better.

At home I sort through the pile of mail that collected while I was away, and am shocked by my smiling face on the cover of the latest issue of Call Lights Magazine: summoning the power of nurses! I remembered Todd saying, “Niki, look into the camera and smile,” before snapping the photograph. I had no idea it would be on the cover. Should I be happy or embarrassed? Have my friends at work already seen it? Probably. I’m sure I’m in for teasing of some kind.

I was right. I enter the PICU at change of shift to find every nurse on both shifts has a tiny photocopied print of the cover with my face taped over their picture of their employee name badges. Dr. Polk is there, and he’s wearing my face on his name badge too. So’s Gerald, and standing beside him, Corey, giving me a shy smile. It cracks me up; it’s so funny.

Kris walks over holding a copy of the magazine. “Great picture of you Niki. It’s too bad they didn’t Photoshop that crease between your brows though. You know, not taking care of that with a little Botox is sort of like having a unibrow.”

Is she kidding? I can’t tell. “Thanks Kris, I’ll keep that in mind.” I make a mental note to look more closely in the mirror when I get home tomorrow morning.

There’s a sheet cake in the staff lounge with the Call Lights Magazine cover airbrushed on it in sugar and food coloring. I cut into my face with the knife, and everyone has a piece during report.

Before taking his cake down to the ER, Corey touches my elbow, saying, “Congratulations, Niki,” and then quietly, “Let’s meet during our breaks tonight. I need to talk to you.”

“Okay. Text me.”

* * *

Around 0100, Corey texts me to meet him in the stairwell between our floors. Instead of bringing the lunch I’d packed from home, I cut two slices of what’s left of the ravaged cake, and bring them on paper plates with plastic forks. When I reach Corey several flights down, I see he read my thoughts: he’s holding two cups of coffee. I’m touched to see he’s remembered I like mine with half and half.

“You guys have half and half in your fridge?”

“No we don’t. All I could find was that irradiated or whatever stuff in those tiny plastic tubs that don’t need refrigeration. Sorry.”

While arranging the coffee cups and paper plates on the stairs, we’re uncharacteristically shy with each other. Seated, our hips touch on the narrow stair. He smells clean, of soap and water. Corey turns towards me, and I think he’s going to kiss me, but he pauses before placing his hand on the side of my face, brushing away the hair that fell loose from my ponytail.

“You’re beautiful, Niki. No wonder your face made the cover of the magazine.”

I don’t know what to say, so I start in,

“How’s Sheila? What’s been happening?” I’m afraid to go down this road, but we only have half hour breaks.

“She’s a fighter. She’s got a positive attitude, and the oncologist says there’s every chance they caught it early and she’ll beat it. I never knew Sheila was so strong, so vital.”

Uh oh. I braced myself for what was coming next.

“You’re staying, aren’t you Corey?”

“Niki, I,”

“No don’t, I get it. She needs you. You see her in a different light. She’s the mother of your girls.”

“Niki, it’s not that simple. I really love you.”

I will not cry.

“Corey, stop, it’s okay. We were both going through a rough time. No harm, no foul.”

“Niki, don’t, it’s not like that.”

I’m not going to be able to hold back the tears much longer. Shit, I have sick kids to take care of for the rest of the shift. I will not let this wreck me. I pick up my paper plate and cup, standing to leave.

“Thanks for the coffee Corey. I wish you the best.”

Corey’s also standing, and calls after me as I hurry up the stairs back to the PICU. “Niki, wait!” Behind me, the fire door closes more loudly than I’d intended, and I can’t hear the rest of what he’s saying.

Leaning against the door, I bite the inside of my mouth until the metallic taste of blood overcomes the sugary residue of cake. The pain forestalls my tears. I dump the cake and coffee into a wastebasket in the PICU’s empty family waiting room before entering the unit and return to my shift.

Posted on by jparadisirn

An Awkward Silence (the trouble with bullies)

Chapter 42

Melissa took a sip from the glass of water in front of her before speaking.

“It was supposed to be my night off, but I came in extra at 11 for an eight hour shift. There was a sick call, and when they got a third admission that night, the charge nurse asked me to come in. I took report on the new admit from the charge nurse, who’d settled him into his room with his parents, but nothing else, because she was busy helping another nurse with a transfusion.”

“Did you have other patients assigned to you that shift?” Grant interrupted.

“Yes, I had three other patients, besides, you know.  One’s IV was out, and I needed to restart it. I did vital signs on the new admit, and hung his antibiotic first, though.”

“So, you assessed Bobby and started his antibiotic within an hour of his arrival on the pediatric unit?”

“Yes.”

“And then you went to another patient’s room to start an IV?”

“Yes.”

“When did you return to Bobby’s room?”

“I went in when the pump alarmed that the antibiotic infusion was finished. That’s when the parents pointed out Bobby’s rash.”

“Were you concerned by the rash?”

“Yes. I took another set of vital signs, which were unchanged. Then I called Dr. Straid at home.”

“To report the rash?”

“Yes. I was worried that it was serious. It was all over his body, even his cheeks. He seemed more lethargic than when I’d seen him earlier.”

“What time was this?”

“It was after midnight. Dr. Straid told me that Bobby’s lethargy was due to his needing sleep, and that I should stop over-nursing him.”

“But Dr. Straid was concerned about the rash, and ordered treatment for Bobby, didn’t he?”

“Yes, he ordered IV diphenhydramine and an IV steroid to cover the rash. The next dose of antibiotic wasn’t due until morning, and Dr. Straid said to hold the dose until he came in to assess the patient.”

“Did this sound like a reasonable plan to you?”

“No. Bobby seemed more sick than tired to me. His parent’s said he wasn’t acting like himself. I asked Dr. Straid to come in and see him then.”

“Because the boy had a rash, and was sleepy?”

“Lethargic, I used the word lethargic.”

“Were you aware of the severe neutropenia?”

Melissa looked at the hospital lawyer, then her hands folded in her lap before looking at Grant and answering softly, “No.”

“So Dr. Straid was unaware of the lab results. You asked him to come to the hospital in the middle of the night without looking at or reporting the lab results. Do you think that if Dr. Straid had been aware of the severe neutropenia he would have come to the hospital to see Bobby immediately?”

“Maybe. I don’t know.” Fierceness flashed in Melissa’s eyes at this inquiry.

“What do you mean, you don’t know?”

“I mean Dr. Straid has a reputation for not coming in to see his patient’s when asked by a nurse. I mean that most of the nursing staff is afraid of calling Dr. Straid in the middle of the night because he usually bites their heads off.”

“There’s no notation in this patient’s chart that Dr. Straid refused to come in, or that he was rude to you on the phone.”

“I’ve stopped writing about Dr. Straid’s behavior a long time ago. Writing him up doesn’t do any good. Nothing happens.”

“So you assumed Dr. Straid wouldn’t come in to see this patient because he is sometimes rude to nurses? You knew that reporting the lab results was useless?”

Melissa sat in awkward silence.

“Did Dr. Straid refuse to come in to see the patient after you told him the lab results?”

“Objection!” The hospital lawyer said quietly.

“Melissa, did you report the lab results to Dr. Straid?”

“No. I did not report the lab results.”

“Why not?”

“Because I hadn’t seen them.”

I sat in conflicted silence. She should have looked at the lab results before getting on the phone with Straid. She should have trusted her nursing instincts that the boy was gravely ill. Anxiety over calling Dr. Straid in the middle of the night, combined with a busy shift, and inadequate staffing got the best of her, an all too familiar story in nursing. The result was catastrophic.

 

 

Posted on by jparadisirn

A Tiny Diamond in Her Nose (The deposition)

Chapter 41

Extending his hand to introduce himself, Grant stood up to meet the nurse and hospital lawyer as they entered the conference room. Then he introduced me as part of the legal team.

I don’t know what I’d expected, but I was surprised the nurse facing deposition appeared to be in her thirties. Like me, she wore a dark blazer over a fitted blouse with dark slacks. Her blonde hair hung above her shoulders in an angled bob. Under the fluorescent lighting of the conference room, a tiny diamond above her pierced right nostril flashed when she turned her head, and a quarter-sized tattoo of the sun on her wrist was visible beneath the cuff of her blouse..

I also sport a tiny diamond in my nose, and a tiny red heart is tattooed at the nape of my neck. This is going to be harder than I thought.

I’d guess the hospital lawyer to be in his sixties, with a shock of thick, silver hair. The absence of telltale clipper marks as it formed around the shape of his head bespoke of a meticulous, and expensive scissor cut.  He wore a navy blue jacket, which he carefully removed before taking his seat at the table, revealing a pale blue dress shirt with French cuffs. His formal attire was at odds with Grant’ business casual look: a sport coat over an open neck dress shirt, no tie, and khakis. I got the sense something was being communicated between the two of them, but I couldn’t quite grasp the message.

After introductions, Grant explained that the deposition is a discovery process performed under oath, and would be videotaped.

“Before we begin, would anyone like a glass of water?”

“Yes, please.” Grant poured a glass of water for Melissa, the other nurse, from a pitcher of ice water and set of glasses conveniently placed on the table.

“Okay, let’s begin,” Grant started. “Melissa, how long have you been a Registered Nurse?”

“Seven years.”

“And, have you been employed at Sand Bluff Hospital for all of that time?

“No. Only for five years.”

“Have you worked all of those five years on their pediatric unit?”

“No. Only the past three years.”

“Were pediatrics part of your nursing school curriculum?”

“Yes.”

“What pediatric education or training have you received since nursing school?”

“I’ve taken a few pediatric continuing education courses.”

“Describe these pediatric continuing education courses, please.”

“I’ve completed a course in common pediatric diagnoses, and an overview of pediatric assessment.”

“Were these courses provided to you by your employer, Sand Bluff Hospital?”

“No. I took these courses on my own, as part of the continuing education required by the state of California to renew my license.”

“Has Sand Bluff Hospital provided you or other nurses in your unit with pediatric specific education?”

“Yes. All nurses assigned to the pediatric unit must complete age-specific competencies, and have current PALS certification.”

“And what is PALS certification?”

“Pediatric Advance Life Support.”

“Does this certification make you competent in the care of pediatric patients?”

“Objection!” This from the hospital lawyer.

“Okay,” says Grant, “Let me rephrase the question. What is the significance of PALS certification for nurses?”

“PALS certification signifies a nurse is competent in the necessary skills to assist in a pediatric code under the supervision of a physician.”

“But not specific to a particular diagnosis?”

“No. PALS certification is not specific to diagnosis. PALS certification outlines responses to specific patient conditions.”

“Like respiratory failure or cardiac arrest?”

“Yes.”

“PALS certification and, what did you say, age-specific competencies are provided to you by Sand Bluff Hospital, at their cost?”

“Yes.”

“So further pediatric nursing education regarding specific diagnoses is something, for the most part, you have taken on your own initiative, at your own expense?”

“Yes.”

“With no other education provided by Sand Bluff Hospital other than what you’ve just described?”

“Yes.”

“Melissa, have you reviewed the medical chart of the deceased patient from the night of the event”?

“I went to medical records and reviewed them once.”

Grant gives a sharp look to the other lawyer. I know what he’s thinking. This nurse isn’t the target of the suit, so no one’s taken time to prepare her for this deposition. That energy’s been reserved for damage control for the hospital. They’re the “deep pocket.”

“Melissa, tell us about that night, leading up to the event.”

 

Posted on by jparadisirn

The Wrong Side of a Sentinel Event Review (Niki empathizes)

Chapter 40

I woke up in Raquel’s and Grant’s guest room when a bright shaft of morning light slipped between the honeycombed shades and into my eyes. This never happens at home where I’ve installed black out shades in my bedroom, because I work night shift. My hand, tingly-numb from sleeping on it, reaches for and locates my phone on the nightstand. I check it for texts.

There’s one from the PICU manager asking if I’m interested in picking up an overtime shift. She doesn’t realize I’m out of town.

Next, Maddie’s sent a selfie of her and Wade eating hot dogs in Amber’s backyard after our phone conversation yesterday.

I’m disappointed there isn’t one from Corey. It hurts a bit, but I remind myself this is a tough time for him. Then I dismiss the matter from further thought.

After a serving a quick Raquel drops her kids off at school, we go to a cross fit workout at her gym. She’s is an animal, performing amazing feats with weights, pull-ups, and standing squats. I admire her “guns,” the well-defined muscles of her upper arms, noticeable in her tank top.

“Niki, you should work on your core. You’d gain a lot of strength with a little work,” observes Raquel.

“Maybe, but I rarely go to gyms. Don’t judge me. I like the outdoors, running or riding a bicycle. Maybe because hospitals are such closed environments. You are a lot stronger than me though.”

Afterwards, we stop for smoothies before going home. Then I shower, and borrow a pair of slacks and a blazer from Raquel, hoping I don’t look out of place at the deposition this afternoon.

Grant greets me in the conference room at his office building, fifteen minutes before the deposition is scheduled. We choose our places at the conference table, facing the door before the other nurse and her legal representative arrive.

“Thanks for coming Niki. I realize you hadn’t expected to sit in, but I think it will be useful to us. I don’t want you to say anything, just listen. Have you sat at deposition before? No, of course you haven’t, because I would have been there for you. Sometimes it’s good to have a lawyer in the family, right?”

“Absolutely Grant, I just hope I never need you. The long-term goal of my career is to never sit on the wrong side of a sentinel review committee.”

“Well, unfortunately, it happens to very good nurses sometimes. I’ve seen my share,” admits Grant.

“I guess I’m kind of feeling bad for this nurse I’ll meet today, Grant. I mean, good or bad aside, I don’t know anyone in health care who starts a shift thinking, ‘today I’m going to hurt a patient.’ People go into nursing to help others, not to cause accidental harm.”

“I understand, Niki. What you have to realize, is that this case isn’t really about placing blame on the nurse. What we want to establish is that an employee of the hospital, in this case a nurse, made a mistake contributing to a wrongful death, making it the hospital’s responsibility. Nobody is interested in suing the nurse. We’re defending Dr. Straid from being sued. He stands to lose a considerable amount of his financial assets. He has a couple kids in college, a house, and a business to protect.

Maybe the nurse won’t get sued, but she’s going to have to find a way to sleep at night for the rest of her life if she’s blamed for contributing to the death of a child, I think to myself. I keep forgetting which team I’m on.

“But Dr. Straid’s not guilty, is he Grant?”

“Of course not, the nurse didn’t inform him of how sick the boy was. The hospital is the deep pocket here Niki, not the nurse. A patient should be safe in a hospital, right?”

“Yeah, you’re right, Grant. Patients should be safe in any hospital.”

“That a girl. Now, here comes the nurse, and the hospital lawyer. Remember, don’t talk just listen.”

Posted on by jparadisirn

It Happens (Niki sees in contrast)

Chapter 39

“Good work, Niki. Knowing the lab results and rash indicated a severe infection, yet this information was not reported to our client, Dr. Staid until after the boy’s death points the responsibility away from him, towards the nurse, and therefore at the hospital. That’s exactly the thing we’re looking for in the chart.

There’s an old saying among lawyers though, ‘Never ask a question in court that you don’t already know the answer to.’

So Niki, my question is: What difference would it have made in the patient’s outcome if Dr. Staid had been informed of the critical lab value and the rash sooner? Would the boy have received different care? Would he have survived?”

“I can’t answer that definitively, Grant. I mean, had the severity of the boy’s infection been diagnosed sooner, the shock that killed him would have been anticipated. Once the antibiotic came in contact with the bacteria in the boy’s bloodstream, the the bacterial cell walls burst, releasing their toxins and setting up a cascading circulatory reaction. That’s why the rash worsened from pinpoints to the huge purple blotches the nurse describes in her late entry note after the failed code. If this reaction had been anticipated, perhaps the boy would have been transferred to a pediatric intensive care unit where the technological support he needed was available, instead of admitted to a hospital unfamiliar with pediatric emergencies. Maybe he would have survived if that had happen. Maybe not. This kind of infection spreads like wild fire through the body of its host. Saving the boy’s life would have been challenging even for a PICU team. However, by the time they realized how sick he really was, it was too late. A small community hospital without a PICU couldn’t keep up. I feel bad for the family and for the staff.

As a nurse, Grant I have to admit I wonder why Dr. Straid didn’t come in to assess the child when it was decided to admit him? I know that happens a lot though. They leave it in the hands of the ER doc or a resident, and then see the patient in the morning. We have hospitalists where I work. A pediatrician is available both day and night.”

Mentally, I think of all of the times we’ve summoned Dr. Polk from the call room because a patient needed him.

“That question has been addressed,” replied Grant. “It’s our theme that, had he been informed of how sick the child was, he most certainly would have been at the bedside long before the code, when more treatment options could have been considered. The nurse did not inform our client of how sick his patient was in a timely manner, limiting our client’s ability to help the child.”

“Well, then you’ve got what you need, I guess.” Why does my stomach churn every time Grant and I reach this conclusion?

“Yes, and thank you Niki. We’re deposing the nurse tomorrow. Are you willing to sit in? I don’t want you to say anything, but maybe by hearing her deposition you’ll pick up on something else to strenghten our defense.”

The idea of being face to face with a nurse whose testimony I’m hired to shred makes me uncomfortable, but since I don’t have to ask her any questions, just listen, I figure it will be alright. I’m sort of interested in this whole legal process anyway.

“Sure. I’ll do that,” I tell Grant.

“Excellent,” he replies. “We meet in this conference room in the afternoon.