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.

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.

 

 

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.”

 

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.”

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.

Critical Values (Niki ponders on the job training for nurses)

Chapter 38

The chart notes written by the pediatric nurse caring for the little boy who died are scant. However, by searching the lab values, medication administration record, and the vital signs flow sheet in his medical record, I piece together a story of wrong assumptions combined with missed critical assessments.

The ER got the ball rolling well enough by drawing diagnostic blood work and admitting the boy to the pediatric unit, based on a phone consultation with our client, the pediatrician Dr. Straid. This small community hospital typically reserves a handful of beds designated “pediatric” for stable admissions, otherwise transferring unstable or critically ill children to larger, nearby children’s hospitals like the one I work for. Of course, someone would have had to recognize how sick this child was to trigger that response.

As I suspected, the results of the blood cultures drawn in the ER confirmed the severe bacterial infection, which ultimately killed the boy. These results were not available when he coded though, because it takes hours, sometimes days to grow out the killer organism. However, the complete blood count (CBC) results were available, including the differential, the cell-by-cell roadmap of the patient’s immune response. It’s white blood cell count (WBC) indicated a battle against infection, but it was the elevated number of new, immature white cells (bands) telling the story of the boy’s exhausted immune system. I searched the medical record to find documentation that this critical value was brought to Dr. Straid’s attention sometime before the child coded, but it wasn’t there. This is where the ball was dropped the first time: the nurse did not call in this critical result to the pediatrician if she had been aware of it. No one had, according to the patient’s chart. It’s the ancient law of the medical record: “If it isn’t written down, it didn’t happen.” I noted this on the yellow legal pad Grant had provided, to share with him later.

The nurse had entered a brief admission note, documenting the patency of the IV started in ER, administering the IV antibiotic, and that the bedrails were up. Her next entry described being called to the patient’s bedside by the parents, who were concerned about a pinpoint rash forming on their son’s trunk during the antibiotic infusion. The nurse called Dr. Straid at home, receiving an order for IV diphenhydramine and a steroid to treat what everyone assumed was an allergic reaction to the antibiotic. No mention of the CBC results during the phone call is recorded.

Of course, Dr. Straid could have taken it upon himself to come in from home to see his patient, I think to myself.

There are no further notes until the end of the nurse’s shift, when she recounts calling the code, and the failed resuscitation. I cringe for her while reading it. Poor woman. Was a lack of experience the reason for her failure to report the lab results, and the absent suspicion of an unidentified rash? I wonder how much pediatric training does this hospital provide its nurses? Cases like this one often become the catalyst for additional staff education, after the fact. Other times, nurses learn things the hard way, when a more experienced nurse catches their error during change of shift report, or from watching another nurse make a similar mistake.

I think about how Liz took it upon herself to mentor me when I was new to PICU, becoming a human safety net providing a layer of protection for my patients and me as I learned. I doubt this nurse had a Liz, at least not on this particular shift.

Poor patient. Poor nurse.

Seeking Justice (Niki reviews a nurse’s notes)

Chapter 37

In the conference room, Grant gives a brief explanation of the case I’m to review:

“According to the ER record, the parents reported their three-year old wasn’t interested in eating for a couple of days and when he stopped drinking fluids too they became concerned, bringing him to the hospital’s ER. A temperature of 102.5 was recorded, but otherwise his vital signs were normal, with a slightly elevated pulse. Concern for dehydration led the ER staff to draw blood tests, and start an IV. They decided to admit the boy to the pediatric unit for IV fluids, antibiotics, and observation overnight.

He arrived on the pediatric unit at 10:30 pm. According to the nurse’s admission note, he was lethargic. He received a dose of IV antibiotic within an hour of his arrival. After that, the order of events is vague. His mother noticed a rash on the boy’s chest and arms during the antibiotic infusion. The nurse called the attending pediatrician, who was at home, and reported the rash. The boy received a dose of IV diphenhydramine, and steroid to treat the rash assumed to be an allergic reaction to the antibiotic. The boy fell asleep.

The next entry in the nurse’s note records that an hour later she was called to the room by the boy’s parents. The rash had spread over his entire body. They were unable to rouse him.

The nurse documented a blood pressure of 67/45, a pulse of 50, and respirations of 10. She called a code, and the boy was intubated in the room. Resuscitation attempts followed. The attending pediatrician was summoned from home. He arrived half an hour later. Unfortunately, the resuscitation attempts were unsuccessful, and the child died.

Later, the results of the blood tests drawn in the ER revealed a severe bacterial infection, which was the cause of the rash, not an allergy to the antibiotic. The parents are suing the hospital and the attending pediatrician for wrongful death. Our client, the attending pediatrician, maintains that he is not at fault because the nurse failed to report the results of the blood tests, and how sick the child actually was. Therefore, the responsibility for the boy’s death rests on the nurse, and as her employer, the hospital.

What I need you to do, Niki, is review the chart, and find indications that the pediatric nurse neglected or did not follow standard practice in her care of this child; anything pointing to our client’s innocence.”

“Wow. Okay Grant. I’ll read through the record, and see what I can find.”

“Thanks Niki. If you need anything, let Claudine know. I’ll see in you in a couple hours. Raquel and I are looking forward to having you stay with us the next couple of days.”

“Me too. Thanks for inviting me, Grant.”

After Grant leaves the room, I settle into the leather chair at the large, polished table of the conference room, a hard copy of the medical record lying on it. Leafing through its pages, I feel queasy at the realization that whatever I find wrong will be used to blame another nurse. I dismiss the thought, however.

“I am a patient advocate,” I remind myself. “By reviewing the medical record, I’m helping a family receive justice.”

Something Cold & Diet (Niki turns nurse expert in a medical lawsuit)

Chapter 36

“I have to wait and see what happens next, Raquel. I won’t pressure Corey into leaving Sheila when she has breast cancer. There’s no moral ground for me to stand on. She’s his wife, after all.”

“It’s funny that fact only became important to Corey just now. That’s all I’m saying, Niki.”

“Jeez, Raquel, it’s cancer. What’s he supposed to do, abandon his wife, and kids? ‘Daddy’s sorry honey, he doesn’t love your Mommy anymore, but he’ll see you on the weekends!’ His girls are too young to understand. They’ll think he left because she got sick, and lost her hair. They’ll hate both of us.”

I’m sitting in my kitchen talking on the phone to Raquel, who like me, is sipping a glass of wine, our tradition of wine by phone.

“His girls are going to hate you for a while anyway Niki. You’re the woman he left their mother for.”

If he leaves Sheila, Raquel.”

“All I’m saying Sweetie, is look out for yourself. You nurses take care of everyone but yourselves. It’s your greatest gift, and your fatal flaw.”

“Let’s change the subject, okay?”

“Sure. Hey, I almost forgot: Grant wants me to ask if you’re interested in being a nurse expert on a case. He’s representing a pediatrician whose patient died. The family is suing, but the hospital maintains it’s the doctor’s fault, not their nurses. The pediatrician says otherwise. Anyway, Grant wants to know if you’ll review the medical record, and give your opinion. His office will reimburse your time and travel expenses. You can stay with us and make a weekend of it if you want.”

“Yeah sure. Tell Grant I’ll take a look. I have a four-day stretch off next week. It’ll take my mind off of Corey.”

“Thanks Niki. He’s hoping to keep his client out of court. You never want medical injury cases to go in front of a jury. It’s almost impossible for them not to side with the family. I don’t blame them. I’m mean really, a patient should be safe in a hospital, especially a defenseless child.”

“I know, right? It will be interesting to read the medical record.”

***

The next week I drive to La Jolla. Because it’s the middle of the school week, Maddie stayed with Simon, Amber, and Wade, which is her preference lately. I don’t blame her; of course she prefers their family household to my single mother lifestyle. What kid wouldn’t?

I take the elevator to Grant’s office, and check in with the receptionist. She makes a phone call, and in a few minutes Grant strides out of his office, giving me a big hug.

“How was the drive down?”

“Traffic wasn’t too bad.”

“Thank you so much for agreeing to do this Niki. It’s so helpful to have a pediatric intensive care nurse in the family, in more ways than one! I’ve had a table set up for your use in our conference room, with hard copies of the medical record. I can get you any other information you need. Just let me know. Have you had lunch?”

“You know, I’m not hungry yet. I saw a few restaurants in the neighborhood on my way in. If I get hungry, maybe I’ll take a break later and pick up something to eat. Is that okay?”

“Oh, sure, sure. Bring back the receipts. Your food and travel is on the firm. We really appreciate you using your time off for this case. Can I get you some coffee or a soft drink in the meantime?”

“Um, yeah, do you have something cold and diet?”

“Sure do.” Looking at the receptionist, Grant says, “Claudine, will you bring a cold drink to my sister-in-law in the conference room, please?”

“Of course.”

It’s What I Want (Niki gets a phone call)

Chapter 35

 I’m happily vacuuming my living room, thinking about a conversation Corey and I had last night during a quick break at work.

“Sheila was really calm when I told her I want a divorce. I think it’s all going to be okay. She isn’t happy either. We agreed she and the girls will live in the house, and I’ll get an apartment. Sheila says she’ll let me know what else she wants after talking with her lawyer. I’m okay with that. I just want out, and shared custody of our girls.”

“This is happening so fast, Corey. You’re sure this is what you want?”

“It’s what I want. I can’t wait until we can let everyone know we’re in love. You still want it too, right Niki?”

“Yes, it’s what I want.”

We’re in love. I just have to be patient a few more weeks. Jumping ahead, I wonder if it’s better to introduce Maddie to Corey at a restaurant, or a quiet dinner here at home? I wonder what his daughters like to eat? I wonder if either of them have food allergies? I make a mental note to ask Corey.

The phone rings, startling me out of my daydreaming. There’s a ping of anxiety in my stomach when I see it’s Corey. He never calls in the middle of the day. Then I remember he’s told Sheila he’s leaving. It’s okay. We don’t have to hide anymore.

“Hey! What’s up, babe?”

“Um Niki, I can’t talk long. I’ve got something to tell you,” his tone is serious, and then his voice breaks. I can tell he’s on the verge of sobbing.

“Corey, what is it? Are you okay? Are your girls okay? What’s wrong?” He inhales deeply before speaking. “It’s not me or the girls, Niki. It’s Sheila. She found a lump in her breast. We just came back from the doctor’s office. It’s cancer. Sheila has breast cancer.”

“Corey, I’m sorry. That’s terrible. How’s she’s taking it?”

“She’s upset, of course, but otherwise taking it pretty well. We won’t know more until we see the oncologist. They have to run more tests. We haven’t told the girls yet; we want more information first. I’m taking her to the appointments, and helping her ask questions of the doctors, finding out her options. I’m on stand by for now, Niki.”

“I understand, Corey. Do what you have to do, and keep me updated.”

“Thank you Niki. I will.

“Let me know what I can do to help.”

“I gotta go. I love you Niki.”

“I love you too, Corey.”

After Corey hangs up, I finish vacuuming, no longer worried about introducing him to Maddie for now. My emotions are jumbled: guilt, and concern for Sheila, disappointment that Corey’s and my plans are on hold. I hear my mother’s words from childhood, “Don’t count your chickens before they hatch. Don’t get your hopes up about things before they actually happen, you’ll always be disappointed.”

Maybe if I were more spiritual, I’d consider this Karma. Maybe I’ve attended too many pediatric deaths to believe. Maybe I’m too numb to know how I feel at this moment: There’s sadness, and guilt, for sure, but deep down inside, unexpectedly I detect a small amount of relief too.

Secret Valentine (Corey shares a revelation)

Chapter 34

Standing next to me on the front step as I unlock the door to my house, Corey asks, “How was your shift?”

I stop for a moment in the open doorway thinking about my answer.

“Well, it’s a stressful shift when I use cuss words as punctuation; silently of course, I’m a peds nurse.”

He laughs while putting his arm around my shoulders. “Understood. Let me help you relax.”

After making love, Corey rubs my feet, and then paints my toenails. I hold the camera, and photograph him while he works, using the macro function. I capture the images one after another: His hands, my feet. A bottle of red nail polish. My secret valentine.

Corey is in silent concentration, laying down each stroke of polish perfectly. Occasionally, his touch tickles me. “Don’t move,” he murmurs, “Don’t move.”

I’d stay like this forever, if it were possible.

After he’s finished, Corey sits next to me in the bed, resting on a couple pillows propped against the headboard.

“Let me see the camera, Niki.”

He points the lens towards me, and after making a few quick adjustments, he takes a photograph.

“Il mio bellissima amore,” he says.

“Did you learn that in Italian for me?” I’m a little impressed.

“Si, il mio amore.”

“Grazie.”

He hands the camera back, and carefully I set it on the bedside table.

“Niki, I love you. I don’t want to sneak around anymore. I’m going to leave Sheila.”

Unsure of my response, I try to remain neutral.

“I’m not sure what to say Corey. What does the future look like to you?”

“I’m spending it with you, Niki.”

I can’t help it. I’m happy. I lean in and kiss him. “And what are we doing in our future?”

“I’m thinking of going back to school. I’ve applied to a few NP programs; a couple are out of state. I’d like to stay local though, near my kids. I’d get an apartment. We could give our kids time to get to know ‘us’. After they’re used to the idea, we could move in together. I love you Niki. I think we should give it a real try.”

“I love you too, Corey. Of course I’ve thought about it, but I never really expected you to leave Sheila. This is really big.”

“I know. It is big. Sheila and I have been unhappy for years, but I always thought I’d stay until the kids finished school. But every shift in the ER I see patients who thought they had more time, more years, one more day. Then they smash into a semi-truck, or are shot behind the counter of a convenience store. Or cancer invades their bodies, or their heart stops suddenly, just like that. Life is fragile Niki, and no one’s promising us anything. Life is too short to waste time being unhappy. I want to be happy, Niki. And I want you to be happy too. I want to be with you.”

“Corey…” Before I can finish the sentence, we’re kissing, and making love again, smearing red nail polish all over the white sheets of my bed.