Posted on by jparadisirn

When Emotions Get in The Way of Judgement

Chapter 62

The next morning I report to work, and request Nathan for my patient.

Sue, our charge nurse, looks at me with squinted eyes, weighing the request.

“Niki, I’m not sure that’s a good idea…You’re too close to Liz.”

I’m ready for this. “Sue, everyone in the children’s hospital is close to Liz. You’re going to run out of staff fast if you’re using that as criteria.”

She shakes her head at me. “Okay, but if I sense for a minute that your emotions get in the way of your judgement, I’m going to pull you out of the room.”

“If my emotions get too strong, I’m going to be the first one to tell you.”

***

Liz is sitting in the bedside chair next to Nathan, still holding his hand. The cot made up for her hasn’t been slept in.

“Hey,” I say in what I hope is a normal voice. “How’s he doing?”

“His kidneys are working,” she smiles wanly. “He only needed mannitol once during the night. His blood pressure and CVP are normal.”

“That’s good news,” I affirm. “He’s young and strong. He’s going to make it through.”

“We haven’t been told the results of his cervical spine imaging yet. The neurologist said he wanted to see how Nathan did overnight.”

We look at each other in silence. I start my assessment, charting the results in the computer as I go.

“Can I bring you some coffee, Liz?”

“No, I’ll head down to the cafeteria when you guys start rounds. Maybe take a shower. The nursing supervisor offered me access to an empty patient room for as long as it’s empty.”

“That was thoughtful.
The silence becomes awkward, until Liz says, “Frank was here last night.”

“How did that go?”

“He cried. He raged a little, but then he went home. He said he’d be back later. I imagine he needed a drink.”

“Liz, I’m worried about your safety around Frank. Is there family or someone who can be with you when he’s here? I think we should let security know he’s volatile and have a plan in case he comes in drunk and angry.”

“Niki, I’ve dealt with him for years. I can handle him.”

She looks so small and helpless in the bedside chair. I wonder how someone as smart, sweet and kind as Liz ended up married to an abusive alcoholic like Frank.

Posted on by jparadisirn

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.

Posted on by jparadisirn

A Good Shift (Niki introduces two coworkers)

Chapter 2

One good thing about working twelve-hour night shifts in a Southern California hospital is driving against traffic for the commute. Californians don’t measure commutes in miles, but by how long it takes them to get there. Everyone knows to stay off the freeways, and take surface streets.

I pull into the hospital staff parking lot ten minutes before starting time, unwrap my stethoscope from around the rear-view mirror, and grab my sack lunch from the passenger seat. Then I sprint to the PICU for change of shift report.

Unconsciously, my nose wrinkles when I see on the assignment board I’m taking report from Kris. She’s nearing fifty, and thinks this gives her the right to treat me like I’m still a student, but I see through her. Her aging makes my youth threatening. Blonde hair, overly tanned skin; she’s so thin I’m sure she has an eating disorder. Last year she had a boob job, and when she returned from medical leave she pulled every one of us into an empty patient room for show and tell.  She’s currently dating the bass player of a struggling rock band that practices in her garage. Kris doesn’t have relationships with men, or girlfriends for that matter, only superficial encounters of varying lengths; it’s a frequent source of gossip among the nurses in our unit. However, she’s been a nurse almost thirty years. She’s worked ER, OR, and adult ICU. Even I have to admit she’s nursing muscle.

I brighten when I see I’m working with Liz tonight, and she’s charge nurse. Every bit as skilled a nurse as Kris, she’s a completely different type of person. She doesn’t hold my inexperience against me. Instead, she sees me as an opportunity to develop a coworker she can depend on. She understands I’m looking for the chance to sharpen my skills. Liz doesn’t wear any make up, and laughs too loud, but she is the rock star nurse in this pediatric intensive care unit. The doctors ask her opinion of their patients’ progress before they write their orders.

It’s going to be a good shift. I start every shift thinking it will be good. That’s how new I am to nursing.

Posted on by jparadisirn

Make Sure You Spell It Right (Introduction)

Chapter 1

 He was practically screaming at me over the phone at the nurses’ desk. I wondered how anyone could summon so much energy at 2 am on short notice.

“I want you to give that digoxin now, young lady!”

“If I give the digoxin, the kid’s heart is going to stop. He’s bradycardic; his heart rate’s 45,” I shot back, meeting his energy, but shaking.

“Then get another nurse to give it,” he barked.

“Doctor Rathmore, there’s no nurse here who will give the digoxin. If you want it given, you’re going to have to come in and do it yourself.”

I’ll have you fired! I’m reporting you in the morning! What is your name?”

“My name is Niki Rossetti, R-O-S-S-E-T-T-I. Make sure you spell it right on that report.”

Simultaneously, we slammed down our receivers.

My name is actually Maria Nicola Rossetti. Ever since I was a kid, I felt the name was too long, bigger than me. My parents had this thing about using nicknames, so all through elementary school I was Maria Nicola. “What a pretty name,” everybody said. I wished I had a short, American sounding name, like Kim or Jill. Then in junior high, Miss Crewe, the girls PE coach said my name was too long, and started calling me Niki. It stuck, at least when I was at school. At home, Maria Nicola was written in my mother’s beautiful script on every gift for me under our Christmas tree, and decorates the envelopes of the birthday cards she sends to me each year as if it were lace.

Back to Dr. Rathmore and his patient with the low heart rate: After we hung up on each other, I drew a STAT level from a small vein in the ten month-old’s arm. The result revealed a toxic level of digoxin, the medication I held. It’s what caused the slow heart rate. I copied the result onto a bright yellow sticky note and posted it on the patient’s chart for cardiology to find in the morning.

No report was filed. The digoxin was discontinued. Later, the patient was discharged home on a much smaller dose.

I am Niki Rossetti, RN, and these are my adventures.