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.

Buy Yourself Another One (Foraging for food on night shift)

Chapter 27

While getting ready for work I struggle over wearing my hair loose around my shoulders, foregoing the usual scrunchy-bound topknot I wear when I haven’t bothered to wash it.

“Pull it together, jeez,” I reprimand myself. “He’s still married. Don’t set yourself up like this.”

Pulling into the staff parking lot, I look for Corey’s car, but I don’t find it. He may have parked elsewhere, because there are never enough close-in staff parking spaces. I unwrap my stethoscope from around the rear-view mirror, grab my tote from the passenger seat, and breathe deeply to calm my giddiness before entering the hospital.

“Jeez-us, you’re a grown woman. Calm down,” I repeat, but the butterflies in my stomach still flutter.

Corey catches me at the elevator just before I head up to the PICU. He’s holding a little pink bakery box.

“Hey, I brought you a cupcake for your break tonight. I’ll stop by if it’s not too crazy. You’re hair looks nice down.”

I take the box, hoping he sees how happy this makes me before I recover my normal expression and say, “Thank you.”

Corey waits in front of the elevator until the doors close and I am out of sight.

As it turns out, Corey’s gift of a cupcake is prescient.

***

One of the problems of nightshift nurses is foraging for food.

Budget cuts have limited hospital cafeteria hours, leaving nightshift without options besides bringing their food or snacking from vending machines. Occasionally, nurses will send a “runner” to an all night fast food place to pick up dinner for several coworkers, but that only happens if the department can spare the nurse. This was not one of those nights.

In the PICU all Hell broke loose.

The kid in bed two continually seized despite being in a medically induced coma, and no one knew why. This kept Kathy busy with frequent lab draws, adjusting drips, and administering anti-seizure medications, all the while trying to comfort distraught parents, and documenting the frequent changes.

Liz’s hands were full with a post-open heart surgery patient whose blood pressure repeatedly tanked in room five. She also had a second post-open heart patient weaning off of sedation in preparation for extubation from the ventilator in the morning; the short of this being that she had to keep that child from pulling out his breathing tube and IV’s while allowing him to breathe on his own.

And me? I was managing a new onset diabetic admitted on dayshift with a blood sugar of 400. This meant frequent blood draws for lab values, and several changes of IV fluid solutions, lowering the potassium as the insulin drip took effect, and the blood sugar normalized.

This did not prevent me from being up for the next admit, however: a stable neurology patient accompanied from the OR at midnight by his neurosurgeon, Dr. Kearney. The boy had an infected shunt, a surgically implanted device that drains excess cerebral spinal fluid from the ventricles in his brain, caused by a congenital condition. The infected shunt was removed, and a temporary external one now drained CSF through a tube into a buretrol. IV antibiotics were prescribed around the clock. Once the infection healed, the neurosurgeon would replace the implanted shunt with a new one in the OR.

Dr. Kearney sat at the nurses’ desk, calling lab for culture results, and entering orders. I overheard him saying into the phone, “What do you mean I can’t order ‘antibiotics per pharmacy protocol’?” There was a pause. “Well why isn’t there an ‘antibiotics per pharmacy’ protocol?”

Shortly before Dr. Kearney’s arrival, Liz had sat in the same seat at the nurses’ desk in which he now sat. In front of him was a small open bag of potato chips belonging to Liz, which she’d momentarily left unattended to answer an alarm in her patient’s room. She hadn’t had time to pack a dinner, and this bag of potato chips from the vending machine represented the only food she would probably eat tonight.

When she returned to the desk, the bag of chips was empty, and Dr. Kearney brushed the last crumbs from his mouth.

“What happened to my bag of chips?” demanded Liz.

“Oh, were those yours? I thought they were out here for everybody,” Dr. Kearney was unapologetic.

“That was my dinner,” growled Liz. “Now what am I going to eat?”

Dr. Kearny said, “Here,” and tossed a couple of dollar bills into the empty bag on the desk. “Buy yourself another one.” Then he left.

Liz returned to the PICU ranting. “The damn vending machine ate both of Dr. Kearny’s dollar bills without giving me a bag of chips, even after I kicked it!”

Kathy and I shared our food from home with Liz, and I divided Corey’s cupcake three ways.

Little Earthquakes (Niki has a stress dream and learns about earthquake kits)

Chapter 5

I pulled into the driveway of our rented house. Simon’s left, so I park in the garage, closing the door. I removed the groceries from the backseat and set them on the washing machine before sliding off my scrubs, dumping them into the laundry hamper. I’m always worried about bringing home germs from the hospital, and spreading them to Maddie. I put on the robe I keep on a hook before entering the kitchen with the groceries.

Simon’s left the dirty dishes from last night’s dinner in the sink, and the wastebasket is brimming on the edge of overflow. Its contents defy gravity. Although exasperated, I admire Simon’s flair for sculptural design.

He’s left a sticky note in his methodical printing on the counter:

“I’ll take care of the dishes and trash when I get back.”

I put the groceries away, and then wash the dishes, but leave the trash. I’ll sleep better the less Simon clanks around in the kitchen. I’ll clean the rest of the house tonight when I wake up. Last night was my third twelve-hour shift in a row. I’m off tonight.

I take a quick shower, towel off dry and practically fall into the unmade bed in our darkened bedroom. In minutes, I am unconscious.

I dream I’m still at work. The monitor and pulse ox alarms are going off in a patient’s room. I go in and look at the baby lying in the warmer. He’s naked and uncovered. His skin is blue. I am terrified that I forgot he was my patient, and ignored him all shift. I can’t revive the baby, and the alarms keep ringing…

My heart is pounding from the dream when I wake up at two-thirty. It takes a minute to realize I’m not at work. In the still darkened room I feel around the foot of the bed, groping for the soft grey sweats and tee shirt I left there yesterday. I put them on, sliding my feet into rubber flip-flops before traipsing into the kitchen. The trash is still there from this morning. The sink is again full with the dirty utensils Simon used to make macaroni and cheese.

I maneuver the teakettle around the dirty dishes, filling it with water before setting it on a burner, and adjusting the blue flame to high. I drop a teabag, fragrant with cardamom, into my favorite mug and wait for the kettle to boil.

In the family room, I hit the random play button on the CD player before settling into the old rocker recliner. Rocking gently, sipping tea, my brain slowly rises from its fuzziness, much like the Southern California coast has emerged from the morning fog, which I notice burned off while I was asleep.

Twenty minutes later, Simon’s car pulls into the driveway. Two car doors slam shut, and I hear Maddie laughing as she runs into the house.

“Mom! We practiced earthquake safety at school today. We crouched under the desks and covered our heads with our hands. I have a note from Mrs. Marrs. Everybody has to bring an earthquake kit to school.”

“What’s an earthquake kit?”

I set down the mug as Maddie holds out a piece of folded paper. Sure enough, it’s from her teacher, explaining that every student needs an earthquake kit at school, in case of emergency. Each kit must be packaged in 2-quart Ziploc bags, double-bagged. The bags can’t be larger than 2 quarts because of space limitations in the classroom. The required contents of the kit are listed in bullets:

  • A lightweight hoodie sweatshirt
  • A packaged (not homemade) granola bar or snack
  • A juice box
  • A list of allergies, if any
  • Your child’s name, and the address of both parents, including home, work, and cell phone numbers on an index card
  • The name and cell phone number of a local, alternative emergency contact

I cringe; thinking, “Would I be able to get to Maddie if an earthquake happens while I’m at work?” then quickly dismiss the thought. I set the paper next to my mug on the table, reaching for Maddie to give her a hug.

Maddie cuddles into my chest. I touch her cheek with mine before kissing the top of her head. She says, “I can always tell when you worked Mom, because you wear the same old crusty clothes, drink tea, and rock.”

Call 911 (Niki comes to the aid of a family in distress at the grocery store)

Chapter 4

The rest of that shift was uneventful. Once dayshift arrived, I gave report on the new admission, and my other patient too. I wash my hands, use the restroom, and wash my hands again.

Never get into a car with a full bladder.

I leave the hospital by the ER exit on my way to the parking lot.

From the driver’s seat, I wrap my stethoscope back in its place of honor around the rearview mirror, lowering the driver’s side window so the cool morning air can keep me awake on the drive home.

It’s seven forty-three am. Simon is getting Maddie ready for school about now, I think to myself. The morning sky is overcast, good weather for daytime sleeping. I can get in a few solid hours of sleep before Maddie comes home from school.

While sliding the key into the ignition, my cell phone rings. It’s Simon.

“Hello?”

“Hey Nik, it’s me. How was your night?”

“Uneventful. What’s up?”

“”I made Maddie pancakes for breakfast and used up the last of the eggs and milk.  Would you pick up some on the way home from work? Oh, and some elbow macaroni too. I’m going to make macaroni and cheese for dinner.”

“Why can’t you do it after you take Maddie to school?”

“Because, love, I have a job interview at Woodman at 10, remember? I need to come home and dress the part.”

“Sorry, I forgot. What about after that?” I whined.

“No good. I have to get home and put together dinner before picking Maddie up from school. The play-offs start today.”

“Can’t you record the play-offs and watch them later?”

Silence.

“Okay, I’ll stop at the store on my way home. Milk, eggs, and elbow macaroni, right?”

“Oh, and get some cheddar cheese. I just looked in the fridge. We’re out of cheddar cheese too.”

“Anything else?”

“Broccoli? Yeah, broccoli. Maddie needs to eat more vegetables. See you when you wake up, Hon. Love you!”

“Yeah. Okay. Me too. And Simon, good luck with the job interview. I know you’re the best candidate.”

I start the ignition, and drive home the long way, so I can stop at the store, feeling guilty I forgot about Simon’s job interview this morning. I should try to be a better wife.

Entering the grocery store, I perk up thinking that the good thing about early morning shopping is that there’s not a whole lot of people. The lines are short, and I can get in and out quickly. I grab a cart, mostly just to have something to lean against while going up and down the aisles after standing most of the night.

A distracted woman is pushing a cart with a boy sitting in it who looks about two years old. Alongside trails his brother, who looks about four. The kid in the cart is playing with a can of spray paint.

I know what happens next before it happens.

The two year-old takes the lid off of the can and in doing so sprays black paint all over his face. Screaming, he drops the can to the floor where it spins around on its side like one of those pinwheel fireworks, spraying black paint instead of sparks everywhere, because its nozzle is broken.

Now the woman and both her children are screaming and crying. The store manager appears, and disables the can. Someone yells, “Call 911!”

I go over to offer help. I’m wearing scrubs, and identify myself as a nurse. The two year-old is crying, but otherwise he’s not in visible distress. Most of the paint is on his chin and neck. Little was ingested, but I don’t know if inhaled fumes are dangerous or not.

I tell the store manager, “Call the poison control center number printed on the side of the can. They can advise us what to do.” The grocery store has a pharmacy, and if Poison Control advises vomiting, I figure Ipecac is probably available. My own phone is in my car.

The store manager stares at me blankly.

Turning my attention to the two children and their mother, I try to calm them. This turns out to be impossible. They continue to scream and cry.

Then a man runs up informing us that he has called 911.

By now a small group of people have gathered and are staring.

Relieved, I hear the sirens of the fire truck bringing the paramedics as it pulls into the parking lot.

I roll my cart to the checkout line. There’s nothing more I can do.

I overhear one of the paramedics ask as he arrives on the scene, “Has anyone contacted Poison Control?”

Sigh.