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.

What Nurses Look Like (Niki Ponders Professional Identity)

Chapter 33

Back at work, the photo shoot is quickly forgotten in the revolving chaos of pediatric intensive care nursing. Despite the cute styles and print fabrics of the scrubs we wore on the set, tonight I’m wearing plain green scrubs pilfered from the OR.  You have to know someone with the keypad code to the dressing room to get them. Everyone in PICU wears OR scrubs, even the doctors. I suppose this confuses patients, who can’t identify the different roles of the myriad of staff entering their rooms. Despite Registered Nurse stamped in large letters on my name badge, I’m often asked by parents, “Are you the doctor?”

What makes a nurse look like a nurse?

Tonight I walk into a change of shift admission. In pediatrics this sometimes happens because everyone agrees that a child shouldn’t die in the ER if there’s time to transfer them first. Tonight, this is the case.

My patient is a two year-old near drowning. Near drowning is sort of like saying a patient has an infection. It describes a broad range of outcomes from “The kid swallowed a bunch of water, and we suspect aspiration pneumonia,” to “He’s brain-dead, and the parents requested organ donation. We’re waiting for the team to arrive.”

The parents of my patient have requested organ donation services.

Gerald sets the child up on the ventilator, Kris transfers the monitor leads, and Dr. Polk assesses the child, while Corey gives report.

“He was with a babysitter, while his mother went to work. The baby sitter is a close friend, like a grandmother. The two year-old had a cold, and he can’t be sick at daycare. The babysitter says she was only on the phone for a few minutes while the child watched TV. When she turned around, he was gone. After searching for him inside and out for about fifteen minutes, she called the police and the child’s mother. Waiting for them to arrive, she knocked on the doors of her neighbors, asking if they’d seen him. It did not occur to her to look under the heavy cover of her hot tub. She knew the cover was too heavy for a toddler to lift. It was the first place the policemen looked when they arrived. Somehow, the boy lifted the cover, and fell into the hot tub. His face had wedged below the water. CPR was started, and a heartbeat recovered. He was intubated at the scene, and arrived at code speed by ambulance to our ER.”

In my mind, I visualized the rest of the story:

In the ER, his heart stopped several more times. The doctors and nurses performed heroics, while a social worker wrapped her arms around the child’s sobbing mother, “Please don’t die, please don’t die.”

They stabilized his vital signs long enough to transfer him to PICU, where our nurses will guide his parents through the remainder of their child’s journey on Earth.

After report, I prepared myself to spend the next twelve hours in a room of suffering in close proximity to a shattered family. You only have one opportunity to get it right. You cannot take away their pain, but you owe it to them to not add to it. Any anxiety I have about the child’s care will be shared privately with my colleagues, not spoken out loud in front of the parents.

In nursing school, our instructors taught us to not show emotion in front of the family, no matter how heart wrenching the story. They told us that our job is to deliver care, and offer support. While I agree that families should never be put in the position of supporting a distraught nurse, in my experience, showing some emotion, even tears, is interpreted by the family as an acknowledgment of their loss. Nurses are the embodiment of humanity in what is dubbed the “technological fortress” of a hospital. The ordeals patients suffer matter to their nurses. We are nurses, because life and death matter to us. We serve by way of our skills.

That is what nurses look like.

I’m glad I wore plain green scrubs tonight. Tonight the PICU is not the place for cheerful prints.

You Do Important Work (Niki Makes a Purchase)

Chapter 32

The photo shoot progressed in ‘hurry up and wait’ format.

We patiently stood in front of the camera while lights were adjusted, and the angles of our faces repositioned, dressed in brightly colored scrubs, with improved, professionally applied make up. Even the male nurse’s eyebrows were shaped with pencil, and he had concealer applied to blemishes.

We held “nurse props” like stethoscopes and clipboards in the photos. While a light above my head was adjusted, it dawned on me that we could easily be a group of dental hygienists or veterinary technicians instead of nurses. Although nursing science has burgeoned, the visual cues of traditional white caps and uniforms remain iconic. Instead of standing out visually in clinical settings, as in the past, modern nurses blend into the melee of scrub attired workers. Is there a similar icon for physicians? All I can think of is the old-timey black medical bag of the past century. I’ve never actually seen a doctor carry one, and they don’t recur in popular imagery like the nurse’s cap.

I’m snapped back into the present by Todd. “Niki, look into the camera and smile for me, okay?”

At 1230, we’re given a lunch break. The table in the back of the room holds stacks of white boxes.  They contain sandwiches, salads, and a cookie from a catering company. I choose one. Todd taps my shoulder.

“Hey Niki, mind if I eat lunch with you so we can catch up?”

Todd and I carried our boxed lunches outside, and sat on the cement edge of a large fountain in front of the convention center.

“I’m impressed you’re a professional photographer Todd. I remember you as a nice guy taking photographs for the high school yearbook, and newspaper. How did you end up doing it for a living?”

“You mean you remember me being a camera geek using photography as a way to meet pretty girls on campus, but I appreciate your rendition. Actually, after high school I travelled around Europe, and stumbled into a job with a modeling agency. They were looking for American models for a company selling jeans. It was fun, but I like being behind the camera more than in front of it. So I got a job as the assistant for one of the photographers. After I returned to the States I started out like most freelance photographers, shooting weddings, taking graduation pictures, that stuff. Then one of the models I met in Europe, Maggie, asked me to do her wedding. Her father’s a big time publisher, and I met a lot of editors at the wedding. I started getting calls, and here I am. I got lucky. What about you?”

“My story’s not as exciting as yours. I went to college, became a nurse, got married. I have a fabulous daughter. I’m divorced.”

“What kind of nurse are you?”

“A good one, I think. I work in pediatric intensive care.”

“Oh wow, with all of those little preemies?”

“No, that’s neonatal intensive care. Sometimes my patients are premature, but mostly they’re newborn up to age eighteen. They have serious infections, surgeries, or are trauma victims. Most are on ventilators for at least part of their hospitalization.

“Wow, I couldn’t work with sick kids. It would break my heart. You do important work.”

“It breaks mine once in awhile, for sure. I always wanted to take up photography though. It must be great to make money doing something you love.”

“It’s like anything, really. I’m hired to produce specific work. It depends on the look the publication wants. The creativity is discovering my unique way of seeing it. I do fine arts photography on my own time. I have work in a couple of galleries.

“I would love to do something creative. The only photographs I take are with my phone.”

“If you’re serious about photography, I just upgraded to a new camera. I have a used kit I was dropping off at the photography shop to sell on consignment. If you’re interested, I’ll give you a good deal. The kit’s complete, lens, bag; the owner’s manual is there too. I can get you started using it today. You can text me with questions as you go along.”

Lunch was over. Todd and I returned to the shoot, which lasted the rest of the afternoon. Standing under the lights, I felt expansive, imagining all of the photographs I will take.

After the shoot, Todd explained the camera, and its accessories. He gave me a really great price, I think. To be honest, I don’t know a lot about cameras.

But I bought it anyway.

There’s Always Photoshop (Niki has a revelation about modeling)

Chapter 31

I arrive too early for the Call Lights Magazine photo shoot, because I was nervous about finding the location, but it was easier than I’d thought. So I’m waiting alone in the lobby of a small convention center room until the other real nurse models arrive.

The email from Call Lights Magazine with instructions about the shoot was rather vague, except in its insistence that all releases be signed and returned beforehand.

I have no idea what “real nurse” models wear, so I defaulted to the slacks, blouse and blazer I usually reserve for job interviews. I left my hair down, and wore some make-up.

One by one the other “real nurse models” arrive, dressed much the same way as me. The group of us looks to be in our late 20’s to mid-thirties. One of us is a man. I didn’t think to invite Corey to apply with the rest of us. Does that make me gender biased, I wonder?

Soon the doors open, and we’re ushered into the conference room, transformed into a photo shoot. There are three makeshift dressing rooms made of drapery hanging from curtain rods fastened to the walls. Two garment racks on wheels each hold dozens of scrubs sets of varying sizes, colors, and styles. Beyond these are make up, and hair styling stations. Floor lights and silver colored reflectors ring a fake hospital room backdrop. The carpeted floor is crisscrossed with thick cables secured by duct tape. At the back of the room is a buffet table laden with bottles of water, juice, coffee, hot water and an assortment of teas. I’m too nervous to drink anything at the moment, so I stand around with the other nurses making small talk.

“Niki?” I turn my head in the direction I hear my name called.

The voice belongs to a vaguely familiar man about my age wearing jeans, a white tee shirt and a light grey sports jacket with the sleeves artfully rolled up three-quarter length. He’s holding a camera with a huge professional lens in one hand.

“Niki Rossetti, is that you?”

Now I recognize Todd from high school. At least I think it’s Todd. He’s taller, or maybe just skinnier than I remember. He has a manicured, stubbly beard. His hair blonder than I remember.

“Todd?” 

“Hey, yeah, Niki! It’s me Todd. It’s been a really long time. What are you doing here?”

“I’m one of the ‘real nurse models’ for this Call Lights Magazine photo shoot. Are you a nurse?”

Todd laughs. “Hardly. I’m the photographer. So you became a nurse. This is wild!”

Before we could talk more, the heavyset lady with hipster glasses appears in the middle of the room, calling out, “Ladies, oh, I guess I’d better say, ‘and gentleman,’ we do have a male nurse model in our presence. Please gather by the make up and wardrobe stations where you’ll be matched with scrubs for the photos.

I stand with the other nurses waiting while the wardrobe woman sizes each of us up, selecting suitable sets of scrubs. Half of us are sent to the makeshift changing rooms to put on the scrubs. The rest of are directed to the hair and make up stations.

I’m instructed to sit on a stool under a lamp, by a woman wearing a white lab coat over her tattooed décolletage and black tube top.

“Hi. I’m Niki.”

“Hmmm,” she says, while placing a hand on my chin turning my face this way and that under the light.

“I need to add more make up. You’re supposed to look like a real nurse for these photos.”

“I am a real nurse,” I retort.

“Hmm,” she repeats, as if she didn’t hear me. “You should consider getting Botox for that furrow between your brows. These days, it’ almost as bad as having a unibrow. You’re pretty. Botox would make you look less tired.”

“Thanks. I’ll think about it.”

“Well, don’t make it any deeper by worrying about it. If the editor feels it’s distracting, there’s always Photoshop.”

I have the sense that this “real nurse model” stuff is separated from real nursing by a chasm much deeper and wider than the furrow between my brows.

Call Lights Magazine: Looking for Real Nurses (Niki & her friends apply for modeling)

Chapter 30

Walking into the staff lounge, I find Kris, Liz, and Kathy laughing and talking excitedly.

“Here she is,” says Liz. “I bet Niki will come with us.”

I head towards the phone to clock in and ask, “Go where?”

Kris holds up a magazine. “Call Lights Magazine is looking for real nurse models for an article on different types of scrubs. It’s an open call on Tuesday. The three of us are going. Wanna carpool with us?”

“What’s Call Lights Magazine?”

“It’s a new lifestyle magazine for nurses,” explains Liz. They print stuff like healthy recipes for packed lunches, tips on keeping your make up fresh during a twelve-hour shift, and articles about relationships. It’s pretty cool.”

“I read it, but I’m not sure why nurses need a magazine like this. There’s not much clinical information in it.” This from Kathy.

“There are over three million nurses in the United States, Kathy,” interjects Kris. Magazines like Call Lights give advertisers access to an otherwise untapped market. It’s pretty smart.” Kris is worldly wise, no doubt.

“Oh yeah, I’ve read that magazine. They’re looking for real nurse models? That sounds like fun. Yeah, I’ll go,” I say.

“Awesome! We’ll meet in the hospital parking lot on Tuesday at seven. We’ll stop for coffee. Liz will drive.

“This will be a blast, even if I’m not chosen as a model,” I muse.

“You never know. You can’t win unless you play,” adds Kris.

***

On Tuesday, Kris, Liz, Kathy and I pile into Liz’s car, and head over to a coffee shop close by the hospital. As the four of us enter the shop, we stop just short of bumping into a police officer making his way out.

“Excuse me,” says the officer, and then, “Hey, Nurse Niki!”

It’s Officer Mike, the cop who accompanied the child abuse patient a while ago.

“Officer Mike, hi! Finishing a coffee break?”

“Yeah, and now it’s back to work. Good to see you again, Nurse Niki.”

“And you, Officer Mike. Bye.”

“Didn’t we meet him in the PICU, Niki? asks Liz.

“Yeah, he brought in that kid with the lacerated liver, remember? He gave me his business card.”

“So did you go out with him? Kris asks.

“No, I’m not ready to start dating. It’s too soon after my divorce.”

Liz gives me a funny look, but doesn’t say anything.

With lattes in tow, we get back into the car and arrive at the address where screening the potential nurse models will take place. In reality, it’s a tiny, vacant storefront, with sheets in the window concealing a heavyset woman wearing hipster glasses, and designer jewelry. She’s seated at a folding table next to a fortyish looking man, also wearing hipster glasses. We don’t know this right away, however, because when we arrive we take our place in line on the sidewalk behind approximately 100 other nurses also wanting to be models.

The line moves slowly. Latecomers collect behind us. My feet are starting to hurt. Why is it I can run continually for a twelve-hour shift without my legs bothering me, but standing still in line is killer?

After a couple of hours, Kris, Liz, Kathy, and I are at the head of the line, where we’re handed clipboards bearing several forms to fill out.

“Wow, you have quite a turnout,” I remark to the woman in hipster glasses.

“Yes, we certainly do,” she agrees. “We used to do our nurse model calls by email, you know, asking for a jpeg photo, and information about the applicant, but we were getting applications from would-be actors, and models pretending to be nurses for the exposure. So now you have to present your nursing license or employee badge in person, and sign this declaration stating you are in fact a nurse before we accept your application. After that, we’ll take a photo of you, and attach it to your application. You’ll be contacted in a few weeks after we’ve made our decision.”

“How many nurses will you choose? asks Kris.

“Six for this particular shoot,” says the woman, “but we’ll keep everyone’s information; you may be contacted for future issues.”

After completing the forms we hand them to the guy wearing hipster glasses. He leads us further back into the storefront, where a camera is set up and a floor light next to it. He directs us to sit, one at a time, on a stool in front of the camera, and takes a full-face picture. Then he has each of us stand, and takes a full body shot too.

“Okay, ladies, that’s it for today,” he announces. Thank you very much for participating in a Call Lights Magazine event. You’ll be hearing from us soon.”

Several weeks later, we did in fact, and I was chosen as a Call Lights Magazine real nurse model!