Posted on by jparadisirn

After The Flood (Nothing angers a PICU team like child abuse)

Chapter 22

At Raquel’s house, I sat on the sofa listening to The Cowboy Junkies with a blanket wrapped around my shoulders. Raquel brought me another mug of cardamom-spiced tea. Upstairs, Maddie played with her cousins.

Raquel sat on the sofa next to me, and put her head on my shoulder like she used to do when we were kids and something bad had happened.

“It feels like the flu, doesn’t it? The grief, I mean,” she said. “It’s weird how grief actually has physical symptoms: nausea, muscle aches, and shortness of breath.”

“How can you tell the difference between grief and an anxiety attack?” I asked.

“When it’s anxiety you can’t breathe at all,” was her answer.

“At least then I’d be unconscious. I might actually feel better,” I grumbled.

“I think it’s time we switched you to something stronger than tea. I’ll go open a bottle of wine. We’ll order pizza delivery for the kids’ dinner tonight. Grant can fend for himself.”

Maddie and I stayed the weekend with Raquel and Grant while Simon moved his things from our rented house into a near-by two-bedroom apartment. Because parenting Maddie was the only thing of value we shared, we were able to come to a divorce agreement through mediation. Our meager assets were split down the middle.

As for Maddie, we didn’t need King Solomon to decide what was best for her. Since she was at school during weekdays, Simon and I agreed that she would stay with him the nights I worked, and with me on my days off. We alternated weekends, and would take each holiday as they came.

“But Niki, that means you’re either at work, or have Maddie at home on your time off,” Raquel pointed out. “How are you going to have any sort of social life?”

“I’ll figure it out if it happens,” the words sounded doubtful, even to me.

 ***

I told Liz and Gerald about the divorce during a quiet moment at the nurses’ desk.

“Wow, Niki, I’m sorry to hear about you and Simon. I knew you were having troubles, but I always thought you’d work things out. I’m really sorry.”

“Thanks, Liz. The hardest part was making the actual decision. Once I knew that Simon was miserable too, the emotion sort of went out of it. I just hope Maddie will eventually understand.”

“How’s she doing?” asked Gerald.

“She seems okay. She uses it a little for sympathy. Like she complains about how hard it is to pack for her father’s during the week, so she wants new clothes to keep at Simon’s apartment. She also fibbed, ‘I forgot my homework at my Mom’s house,’ as an excuse to her teacher last week instead of owning up to not doing it. I guess it’s to be expected. Fortunately, the only thing Simon and I tend to agree on is how to raise her, so the rules are the same in both homes. Maddie’s the only thing we have in common anymore.”

“Have you told Corey yet?”

“No, I haven’t seen him lately.”

Liz said, “Oh,” but Gerald gave me this funny look before his pager went off, calling him to another unit.

***

 Around midnight, we admitted a seven-year old girl from the OR where a surgeon repaired her ruptured liver. A police officer trailed alongside her bed as it was pushed into the PICU room. He waited outside the door while Gerald connected her breathing tube to the ventilator, and I transferred the leads from a portable unit to the overhead monitor. A unit of red blood cells infused into her central line. Her vitals were stable.

The recovery room nurse read off report: a ruptured liver caused by blunt force trauma to her abdomen. This kind of injury often occurs during a bad car accident, but this little girl had been kicked in her stomach. Hard. By her mother’s boyfriend.

Horrified, I asked, “Why would a grown man kick a child?” then realized how naive I sounded.

The police officer answered, “The mother reports he kicked her after she brought home a kitten he’d told her earlier she couldn’t keep. He left the premises afterwards. We got the bastard. He made a call on his cell phone from a friend’s house. We picked him up a couple of hours ago.”

“Where’s her mother now? Was she with him?” I thought I might kill the guy if I’d been her.

“She’s the one who called the ambulance. The EMTs called us,” the officer continued. “She told them it was an accident, ‘he didn’t mean to get so angry, the girl doesn’t listen to what she’s told all the time.’ We have a detective interviewing her down the hall. She may be booked too, if there’s enough evidence.”

Nothing angers a pediatric intensive care team more than child abuse. We spend our careers saving the lives of children with defective hearts, lethal infections, or damaged in car accidents. Treating a perfectly healthy child whose parent battered them angers us more than pretty much anything. When the loving parents of our other patients see the police in the unit, they figure out the situation pretty quickly, and then the PICU becomes tense, more so than usual, fed by their anger too.

The Adventures of Nurse Niki is on holiday hiatus, resuming with the next chapter on January 2, 2014. Happy Holidays to all her readers!

Posted on by jparadisirn

Beer for Breakfast (The night shift goes out for breakfast)

Chapter 11

Fortunately, the next two shifts are uneventful, which actually feels weird after a traumatic shift like the last one. There’s not enough time in between to process what happens to our patients, and the role nurses play.

Every so often, someone in hospital administration suggests holding “debriefing” meetings for the nurses after a particularly distressing patient death, but the meetings never develop meaningfully. In my opinion, this is because the meetings happen on day shift, which is too busy for those nurses to leave the unit to attend, and too late in the day for night shift to stay up. Besides, in units requiring ICU technology skills, many a nurse’s days off are consumed at the hospital in the form of mandatory in-services, skill competency workshops, CPR renewal, PALS re-certification, staff meetings, etc. We get paid for the time spent attending, but at a certain point, it’s a case of diminishing returns to spend more time at the hospital. So I don’t attend the few debriefings that occur. Besides, I don’t want to talk about my feelings and sing Kumbya in front of my coworkers.

What I do enjoy with coworkers is going out for breakfast after a shift, especially if I don’t work the following night. This morning, a few of us are meeting at a popular diner a few blocks from the hospital to do just that.

Besides Corey from ER, Gerald the respiratory therapist, and Liz join us in the booth. The guys order large, while Liz and I share an omelet, and order coffee. Corey and Gerald drink beer. When Liz comments on this, Corey speaks up,

“Because Liz, that’s what dudes do after work. We go out for beer.”

“If I have a beer after a twelve hour night shift, I’ll have to sleep in my car before driving home,” I laugh.

“That’s because you’re a light weight female nurse Niki,” Corey teases. “ER nurses are manly men, despite the media’s and society’s feminization of our kind.”

We laugh.

Changing the subject, I interject:

“Hey Gerald, guess what happened last night in the PICU.”

“Buh.”

“No really, Gerald. You know that mom from bed two? Well, she came over to the nurses’ desk, and told me,

‘I don’t know who to report this to, but someone working in this hospital is hitting a child on the chest and back in room seven.’

So I get up and look in room seven, and Gerald, it’s YOU, giving chest percussion to a toddler!! I almost burst out laughing trying to explain to her that you’re a respiratory therapist, and what you were doing helps the patient breathe. I told her the kiddo’s doctor prescribed it.”

“Gee thanks, Niki. I owe you one. Probably saved me from being arrested as a child abuser or something. You nurses complain about not getting recognized for your work, but when was the last time you saw a respiratory therapist character on a TV show?”

“Whatever possessed you to become a respiratory therapist anyway, Gerald? You hold nebulizers in patients’ faces, and then suction snot out of their tubes. I nearly gag just listening to someone with a wet, hacking cough. How can you stand your job?”

There’s laughter around the table.

“Well, Niki, it’s because I want to work ‘in the exciting world of doctors,’ and have my life choices questioned by bitchy nurses like you. Keep your opinions to yourself girlfriend, and kindly ask the server to bring me some coffee while I go use the head, okay?”

There’s more laughter, followed by a brief silence while the server brings our food, and Gerald’s coffee.

Corey asks, “Does your husband take your daughter to school in the mornings after your shift Niki?”

“Yeah, and brings her home. Simon’s a school teacher.”

“And what about you, Liz, do you have kids?”

“Yes, a son. His name is Nathan. He’s fifteen, and takes the bus. Next year, he’ll learn how to drive, and I won’t have to depend on other people to shuttle him to baseball, and basketball practices while I work.”

“How long have you been divorced, Liz?”

“Seven years.”

“Are you dating anyone?”

“On nightshift?”

“It’s probably hard being a single mom, but on the other hand, maybe it’s not so bad having control over your own life,” I realize I’m musing out loud.

“There’s a lot to be said for marriage, Niki, like having someone there to divide up the work. Sometimes I think people are too caught up pursuing happiness, and it gets in the way of commitment. Maybe being happy isn’t the most important thing in life,” says Liz.

“I don’t know, that’s sort of heavy,” says Corey. “Just because you’re married doesn’t mean you have a partnership. I think it depends on expectations. Sometimes one spouse has more expectations than the other. It doesn’t always work. I don’t know if sticking it out for the sake of commitment is the right answer.”

“I’ve always felt that a happy marriage or partnership is a wonderful thing,” says Gerald. “But it’s better to single than married and unhappy. Nothing is lonelier than an unhappy marriage.”

“You can say that again,” I mumble while shoving a bite of omelet into my mouth.