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

Chapter 56

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

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

My third patient shares his room with another.

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

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

 

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

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

“Sure. Do you need help?”

“Nope.”

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

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

“Sure.”

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

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

“I’m hungry. Do you guys have bacon?”

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

“Thanks!”

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

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

“You’ve done this before, I see.”

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

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

“Nope, I got it. Thanks.”

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

“Hi. Do you need something?’

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

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

When I near his bed, Rocket growls at me.

“Do you want to pet him?”

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

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

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

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

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

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

One of them is Officer Mike.

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

How the hell does he know that?

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

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

Mike and his partner take their coffees from the counter.

Did he just look my way again before walking away?

Not a Morning Person (Niki Starts Dayshift)

Chapter 54

I am not a morning person.

The alarm of my cell phone rings loudly while the device vibrates maniacally against the top of the nightstand. Trying to silence it, I accidentally knock it to the floor where it continues to thrash. I get up and turn the damn thing off, replacing it on the nightstand. Padding to the kitchen I hit the start button of the coffee maker, filled the night before. I take a shower while it brews.

Transferring to day shift during the middle of winter was a bad idea. I wake up in the dark, drive to work in the dark, and then drive back home after a twelve-hour shift, in the dark. The PICU lacks windows, so on a three-day stretch I only have the vaguest idea of the weather outside, other than IT’S DARK.

I transferred to days to be home more with Maddie, and it’s working. Her grades have improved. She’s getting along better with Amber and Wade too, now that she’s home at night during the week, and only spends every other weekend with them and Simon.

Together we plan the grocery list, and in the evenings Maddie helps make dinner. Instead of eating in the dining room where Simon’s chair is conspicuously empty, we eat casually at the coffee table, watching a movie or TV. Some nights Maddie is quiet, but others she talks throughout evening about her friends, school, and her perspectives on life. I’m happy that we’re growing closer again, even if it means getting up in the dark.

I make sure Maddie’s up and getting ready for school before I leave.

“Bye Mom. I hope you have a good shift.”

“Thanks, Sweetie. You have a good day too. Don’t forget your lunch and homework.”

“I won’t Mom. You say that every time.”

“Love you Maddie.”

“Love you too, Mom.”

 

* * *

The challenges of day shift nursing differ from those of night shift.

For one thing, the residents arrive early to place orders. When they can’t locate what they want in the electronic medical record, they go ahead and order them wrong, and then we have to call them to change it, but they still don’t get it right. Eventually we put it in ourselves, and then the pharmacist calls nursing to say the medication can’t be ordered that way either. If the pharmacist is particularly nice, he calls the resident himself and gets the order corrected. So much for physician order entry.

There’s more friends and family members at the patient’s bedside on day shift too. At first it felt as though they were in the way, but lately I find I enjoy talking to them, explaining what I’m doing, and what they should expect. I like teaching so much in fact, I’ve volunteered to precept nursing students during my shifts.

Today as I enter the unit, I’m greeted by the day shift charge nurse, Margaux. “Niki, we’re overstaffed today in PICU. It’s your turn to float to pediatrics.”

 

Night Shift’s Dirty Little Secret (Niki comes to a realization)

Chapter 53

 If you ask night shift nurses they will tell you the truth: There are times we don’t remember driving home from work. It’ s not a case of being asleep behind the wheel. It’s more like getting into a zone or trance-like state. It’s night shift’s dirty little secret.

For me, the way it happens is I get into my car, drive out of the hospital parking lot, and the next thing I know I’m pulling into my driveway. It’s eerie. I’ll if remember the drive if another driver cuts me off or something like that. I’ve never run a red light. I’d know this, because California drivers are fast on their horns.  The slightest traffic infraction or lingering at a green light for more than a second will trigger the blare of a horn or a shouted expletive from another driver. That would get my attention. It’s like conscious sedation.

Some night shift nurses nap in their cars in the hospital parking lot before driving home. I never have. Instead, I’ll turn up the radio and if the weather’s good, roll down a window for fresh air.

This morning though, the weather’s not so good. It’s chilly, so I leave the windows rolled up. I turn on the radio, start the car, and drive home.

In my drive way, I use the remote to open the garage door and park the car inside. I turn off the radio, and then close my eyes for just a minute before going inside.

“Wake up! Wake up!”

The sound of someone pounding on the car’s windows wakes me abruptly. Through the glass I hear muffled voices:

“Tom, what if she’s trying to kill herself?”

“Well, if she is, she’s not very good at it!”

“Wake up!”

Oh God, it’s my elderly neighbors, Tom and Vera. I’ve fallen asleep in my car and the engine’s still running! Oh God!

Now that I’m awake, Tom puts his arm around Vera, who’s standing on the driver’s side of my car. Concern draws deep lines to their already wrinkled faces. I turn off the engine, and roll down the window.

“Niki, are you all right? Tom, call 911.” directs Vera

“911 don’t come out if no ones hurt, Vera. Are you hurt? Tom sticks his head partially through the open window, further assessing my condition. “You haven’t been drinking have you?”

“No! I worked last night. I’m fine. I just fell asleep in my car. I’m sorry I frightened you.”

“The garage door was open, and your car was running. I got Tom, and we found you slumped over the steering wheel. We thought you hit your head or something,” explained Vera, still visibly shaken.

“You were drooling,” comments Tom.

Note: All night shift nurses drool when we fall asleep. Try staying awake while rocking a baby in a bedside chair in a dark patient room during a twelve-hour shift on a slow night. Welcome to pediatric and neonatal nursing.

“No, I’m fine really. I’m sorry I worried you. Thank you for checking on me.”

I am so embarrassed.

Tom and Vera walk slowly across the lawn to their home. I gather my tote and enter my house as the garage door closes behind me.

As if scaring my neighbors isn’t bad enough, Maddie’s algebra book glares at me accusingly from the kitchen counter. She forgot it there when I took her to Simon and Amber’s house yesterday. I hope she didn’t need it.

It’s time to move to day shift.

Their Pounding Hearts (parenthood is hard)

 

Chapter 52

“Maddie certainly is your daughter, Niki. The family resemblance is startling,” laughs Gerald when I tell him and Liz about Maddie’s pranks.

“Gerald, are you calling me a smart ass?”

“Uh, yeah.

“Amber should lighten up a little,” says Liz. “I’d give anything if Nathan pulled simple hijinks like that instead of staying out all night, and skipping school. Amber has no idea how difficult a teenager can become.”

“How is Nathan?” I ask.

“He was suspended for smoking on campus again. When his locker was inspected, they found some pot. He’s missed so much school this year I’m afraid he will have to repeat his junior year unless I can get him into summer school. He used to be such a good student, a good boy. I can’t find a way to reach him.”

“Is his dad any help?” asks Gerald.

“Frank? No Frank’s part of Nathan’s problems. He’s an alcoholic. Our marriage was pretty bad. It took me a long time to learn that I couldn’t save him from his drinking. Or that it wasn’t my fault he hit me. Nathan got between us once, and Frank hit him really hard. That was when I finally realized we needed to leave. I thought I was helping Nathan by keeping our family intact, but I stayed too long.”

“That’s a hard decision to make sometimes, Liz. I’m sure Nathan will have more understanding when he gets older,” I volunteer.

“I can only hope. His behavior is so reckless, I fear for him. Every time we admit a trauma from the ED, my heart pounds with dread, wondering if it’s Nathan.”

I give Liz a hug, and Gerald pats her shoulder.

“Have you considered taking Kris’s day shift position, Liz? Would that help things at home?”

“It wouldn’t help. I’ve lost control. Nathan walks in and out as he pleases. I can’t afford to lose the night shift differential either. Money’s tight on a single income.”

Something about Liz’s words gives me goose flesh.

* * *

We get two admits from the ED. The first is an eight-year-old new onset Type 1 diabetic. He’s admitted with a blood sugar of 550, and semi-comatose. Dr. Polk intubates him, and we start IV fluids and an insulin drip, drawing blood sugars hourly.

His parents are devastated by the news that their child needs daily blood sugar monitoring, and insulin shots. Then Dr. James, the pediatric endocrinologist arrives. It doesn’t matter what time of day or night a new diabetic is admitted to our PICU; Dr. James shows up and spends as much time as needed to explain to the parents that their child’s diabetes is manageable. He cheers them up with stories of athletes and celebrities who are diabetics. He’s so kind and gentle. I love standing in the room watching the parents’ anxiety come under control while he teaches. He is passionate about his practice, and my favorite physician.

The second admit is a six month old with a respiratory infection. After failing to respond to Gerald’s inhalation treatments and chest percussion, he buys an intubation tube and ventilator. His mother sleeps in the cot by his crib, finally able to rest after hours of worry about her baby.

It’s three in the morning before I sit down to eat the sandwich I brought from home  while catching up on my charting at the nurses’ desk.

Pink Hearts, Yellow Moons & Green Clovers (Maddie Acts Out)

Chapter 50

Simon and Amber were married. The baby is due soon. Maddie is silent regarding updates about the birth, however. Shortly after the wedding, she stopped talking about home life with her father. I know something’s brewing.

Kris married Spider Rodrigo, and left the PICU to tour with Kushion. Her day shift position is open. I wonder if I should take it? I’d miss my friends on night shift, and I don’t know if I want to deal with the doctors, phone calls and busy-ness of day shift. The idea of a normal sleep cycle is appealing.

*  *  *

I’m finishing the housework, and thinking about dinner when Simon’s car pulls into the driveway. Before he can set the parking brake, Maddie ejects herself from the passenger seat, leaving the car door open. She’s obviously upset as she bursts through the front door. Simultaneously, the phone rings. Maddie yells, “I don’t want to talk to her! Tell her I don’t want to talk about it!” while running into her room, and slamming the door behind her.

I put down the vacuum cleaner and pick up the ringing phone. From the living room window I watch Simon back out of the driveway and drive away.

Hmmm.

“Hello?”

“Niki, it’s Amber. Put Maddie on. I want to talk to her.”

Hmmm.

“Amber, hi. Maddie, uh, doesn’t want to talk to you right now. She’s pretty upset. What happened?”

“I want to talk to Maddie.”

“That’s not going to happen Amber. Tell me what happened.”

“Your daughter is bullying Wade.”

Your daughter? Hmmm.

“I’m surprised to hear that. Maddie thinks the world of Wade. She calls him her little brother.”

“Well things have changed since Simon and I got married. Maddie’s become a stranger. She won’t talk about the new baby, and she’s picking on Wade. This last time is too much.”

“What did she do?”

“Two things, really. First, last night at dinner while Simon and I are talking, Wade throws up milk all over the table. I took him to the bathroom to clean him up and take his temperature, and he tells me he drank an entire quart of milk in one sitting. I asked him why. He said Maddie made him do it.”

“How did Maddie make him drink an entire quart of milk at the dinner table in front of you and Simon without your knowing it?”

I’m starting to wonder about Amber. And Simon.

“Well, I asked Maddie that. She said she dared him to do it, one glass of milk at a time.”

“What?”

“She pretended she was racing him. She poured herself the last glass of milk from another carton, and then poured Wade a glass from a fresh carton. She dared him to finish his glass of milk before she finished hers. So he did. Then Maddie told him, “I bet you can’t do it again,” so he did it again, and again, until he drank the entire quart. Then he threw up.”

I composed myself to keep from laughing. “Amber, I’m sorry. How old is Wade again?”

“He just turned five.”

“Well, he’s no rocket scientist,” I think to myself, but of course, that doesn’t excuse Maddie torturing the boy.

“What else did Maddie do to Wade?”

“This afternoon she took a brand new box of Lucky Charms cereal, emptied it, and picked out every last marshmallow charm, all the pink hearts, yellow moons, and green clovers. She ate them, and then put the oat cereal back in the box, and sealed it again. When Wade came home he wanted a bowl of cereal and cried because there were no marshmallow charms. Maddie told him the cereal company was to blame. She helped him write a letter to complain. I found out when he asked me to mail the letter. Maddie has to stop picking on Wade.”

Now I’m thinking my daughter is a comedic genius, but I’m going to have to teach her to use her power for good and not evil.

“Amber, I see why you’re upset, but isn’t this just normal sibling behavior? Maddie’s been through a lot of changes lately. Maybe she’s regressed a little bit.”

“I won’t have this behavior in my home! Your daughter is a bully. No wonder Simon left you.”

Okay, she’s pregnant. Allow the woman some slack.

“Look Amber, I’ll talk to Maddie. For all of our sakes though I think it’s best if you leave Simon’s and my marriage out of this.”

“Do something about your daughter!”

I’m left holding the phone after Amber slams hers down on the other end of the line.