Betting That Frank Doesn’t Know

Chapter 67

I forced myself to take a deep, inaudible breath before beginning.

Speaking slowly, I try to ignore Frank’s gun aimed at my face.

“Frank, okay. If you want me to put Nathan’s sedation back the way it was, then I need to take this little pump here off the IV pole, and put it on his bed. Is that okay, Frank? Is it okay for me to unclamp the pump from the pole so I can put the sedation back the way it was?”

Frank tilts his head and squints eyes, indicating he’s unsure if he believes me. Then he smiles, remembering he still has the gun. He answers confidently,

“Sure, that’s okay, but don’t try anything funny. I will shoot you.”

I nod my head to acknowledge I understand him. Gingerly, I unscrew the pump’s clamp lose, and remove it from the pole. I now have a projectile in my hands, but I’m unsure when or how to use it.

“Okay Frank, now I have to turn off the pump, and slide the syringe of sedation medication out of it. I’m going to give Nathan more of the sedation to make him sleep by pushing the plunger on the syringe.”

I know that if I push too much fentanyl too fast into Nathan, his back will arch stiff as a board from the bed, and he will code. But I’m betting Frank doesn’t know this. Maybe I can stall for time by giving Nathan just a tiny bit at a time.

God, please send someone to rescue us.

Like an answered prayer, the bedside phone rings.

Frank and I stare at it.

“Answer it,” demands Frank.

The phone rings again.

“Answer it!”

“Hello?”

Exactly What I Hoped He Would Say

Chapter 66

My eyes are fixed on Frank and the gun, as I very slowly walk backwards towards the head of Nathan’s bed. Frank doesn’t say anything about hurrying up. The arm holding the gun has a bit of a tremor, which he tries to hide by bracing his wrist with the opposite hand.  

For a minute, I consider he might not be fully committed to euthanizing Nathan. He’s drunk and out of control. Maybe he’s as terrified of himself as I am. 

 Peripherally, I take a quick inventory of what makeshift weapons are available to me. Next to me are the IV poles, supporting their multiple pumps. There’s the board at the foot of Nathan’s bed that OT has us using intermittently to prevent foot drop. On the bedside table is the bottle of hydrogen peroxide I used to clean Nathan’s trach. I’m afraid to get close enough to Frank while he’s holding a gun to use them though. I look again at the IV pumps on the pole, and get an idea.  

“Frank, I utter softly, “Frank…”

“What?”

“Dr. Polk started weaning Nathan’s sedation medication this morning, because his trach is healing.” I point to the mini infuser pump clamped to the IV pole, with its syringe of fentanyl. “That means Nathan is more awake now, and can breathe some on his own, without the ventilator. If I unplug the ventilator from the wall, Nathan will struggle to breathe. He won’t die quickly. Frank, he’ll suffer if we unplug the ventilator.”

Frank looks confused. “You’re lying! How can that be?”

“I told you, Frank, Nathan isn’t brain damaged. He’s paralyzed. The parts of his brain and spinal cord that control his breathing still work. He’ll suffocate slowly, gasping for air if I unplug the ventilator.”

“I don’t know if I believe you.”

“He’ll suffer, Frank. Is that what you want?”

No! Goddamnit! I want to stop his suffering. That’s why I’m here. I don’t want my son to suffer like this!”

We stare at each other in silence. I’m afraid to push Frank further. He’s too volatile and unpredictable. 

“Put the sedation back the way it was.”

“What?”

“I said, put the sedation back the way it was. Make him sleepy so he doesn’t feel anything.”

That’s exactly what I hoped he would say.

Code Silver

Chapter 65

Frank has a handgun aimed at my head.

Liz, still unconscious, lies motionless on the PICU room  floor.

I didn’t sign for this when became a nurse.

Silently, I begin to cry, thinking about Maddie, and that I may never see her again. Did I kiss her before she went to school today? Probably not; she’s too old for that. What was the last thing I said to her? I hope she knows how much I love her.

Frank slides the PICU room door shut.

“Code Silver! Pediatric Intensive Care Unit! Code Silver! Pediatric Intensive Care Unit!” is called loudly on the hospital’s PA speakers.

Thank God. Someone saw the gun.

Frank and I stare at each other, the gun pointed at my head. Facing each other, we stand like this for what feels like hours. How long have we been standing here?

I need to calm down if I’m going to survive. I need to keep my wits about me. I begin counting my breaths, focusing on the exhale.

Frank starts sobbing. “My son, my only son. Nathan, my Nathan. How could your mom let this happen? I’m not going to let you be a vegetable, son. I’m going to let you die like a man.”

I feel sick to my stomach, and try not to retch. “Frank, Nathan’s not a vegetable. He doesn’t have brain damage. He can probably hear us talking about him. He can probably hear you talking about him.”

“You fucking nurses are all alike; all positive, and thinking you can change people and fix everything. You don’t see what’s real, what’s really happening even when it’s in your face. You think if you keep cleaning up the messes, they’ll stop happening.

My boy is damaged. What kind of man lives his life in a chair? That’s no life for my son. You should of let him die the night of the accident.”

“Frank, Nathan’s heart never stopped. He never tried to die. He’s strong. He can go to college, get an education. He can inspire others going through something similar. He still has a meaningful life. This is a challenge, yes, but it’s not the end.”

“Shut up!”

“Frank…”

“I said shut up! Now, go over there, and pull the plugs.”

What?”

“I said, go over there, and pull the plugs to all the machinery out of the wall. Especially the plug to that breathing machine.”

“Frank, I can’t…”

The gun is still pointed at my head, and I hear it click.

 

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.