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The Most Important Thing (Niki makes a decision)

Chapter 16

Corey put his arms around me, holding me close. My face nestles in the warm triangle where shoulder meets neck, and I can feel his carotid pulse beating against my cheek. He smells like soap and water, clean and nice. I place tiny kisses against his smooth neck, tears welling in my eyes.

“I want this Corey, I really do, but I’m not going to.”

“Niki…”

“I can’t. I’m not happy, but that doesn’t give me the right to hurt others. Maybe Liz is right. Maybe being happy isn’t the most important thing.”

“Niki…”

He tightened his hold of me, burying his face in my shoulder. I felt the sob rack his body, and when he released me, there were tearstains on my scrub top. Looking at me, he did not wipe the tears from his face.

“I get the idea there’s no discussion here.”

“I’m sorry Corey. This hurts me too. I’ve gotta go.”

I fumbled with the car door handle before opening it, and slipped inside. Corey stood immobile, watching me with tears silently streaming his face. I choked back my own, started the car, and drove away. In the rearview mirror, Corey stood among the empty cars of the parking lot. The morning sun cast a sharp shadow from him, as if he were a statue.

***

In the garage, I slide 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.

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 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.

I take a quick shower, towel off dry and practically fall into the unmade bed in our darkened bedroom. I cry into my pillow before falling asleep.

I dream I’m still at work. The monitor and pulse ox alarms are going off in a patient’s room. Inside, a crowd of people is gathered round a crib with a baby in it. The baby is blue. Horrified, I see the ventilator is disconnected. Triumphantly, the child’s mother holds up the breathing tube she has pulled from her own infant’s throat. She turns to me with zombie-like eyes, and says,

The roar of a passing motorcycle outside wakes me up abruptly before I can make out what she says. I sit up in bed, clutching the blanket to my chest while my heart beats wildly.

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Two Separate Worlds (Corey tells Niki how he feels)

Chapter 15

Corey’s hand is warm, and dry, its nails clipped and clean. I left my hand on the diner table under his longer than I should.

“Hey Niki,” he said.

I withdrew my hand.

“Um, we should go. Thanks for the bacon, Corey.”

I put a ten on the table as Corey flagged the server for the check. He pushed it back towards me. “I got this,” he said. “Wait, and I’ll walk you to your car.”

Walking alongside Corey, I felt butterflies of trepidation in my stomach, and that disconnected from my body feeling I sometimes get. We made small talk, but I don’t remember what we said.

“Well, goodnight,” I murmured, putting my hand on the car’s door handle.

Corey once again put his hand over mine, but this time his other arm encircled my back. I leaned into him sideways, resting my head on his shoulder. He smelled like soap, clean and nice. We stood that way for a minute or so before, turning me towards him, he framed my face with his hands, and placed his mouth on mine. I leaned in, kissing him back.

Corey’s touch was strong and gentle, confident. We kissed again.

Separating, I looked up at Corey’s face. His gaze was soft. I imagine it mirrored mine.

“Now what?” This time he was murmuring.

“I don’t know, I can’t bring you home,” I said.

“Sheila might show up unexpectedly at my place,” but before he finished his sentence I was already protesting, “Oh no, I can’t do that either.”

“Let’s get a room. I know that sounds bad, but this is not some cheap thing for me, Niki. I care about you. I have for a long time. You’re very special.”

“I care about you too Corey. I don’t want to, but I do.”

“Let’s get a room,” he pulled me close, his face against my neck.

I gazed past Corey’s shoulder as if I were disembodied, a member of an audience watching a movie or play. I saw the sharp shadows cast by the bright California morning sun from the empty cars in the parking lot. There was no place to hide from its glare. Everything was in clear focus to my painful eyes. Had it been the cover of night, in the parking lot of a bar instead, I would have remained lulled.

“Corey, I can’t do this, I’m sorry.”

“Niki, wait. I know it’s not right. I’m not a player. I haven’t done this before either. But you and me, we’re the same. We care deeply, and we give everything. Simon and Sheila don’t understand us like we do each other. This way, maybe we can stay married, and raise our kids with both their parents. You and I already live in two separate worlds: one in the hospital, and another not of the hospital. This will be ‘hospital.’ We deserve some happiness, Niki.”

I thought hard about his words. Their logic was seductive: Wouldn’t I be a better nurse, a better mother, and in a twisted way, a better wife by surrendering to the fact that I live my life straddling different worlds, playing different roles in each? I live a separate life from the one I lived in my parents’ home; yet keep the role of their daughter. As a mother, I play another role too, with different rules. It’s the same thing really, adapting to the different contexts of life.

I leaned back against my car, and let the morning sun warm my face.

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It’s Not Like You Work Five Days a Week (Twelve-hour night shifts are hard on marriages)

Chapter 14 

For the third night in a row, I returned to the PICU. Shortly after shift report, the father of the child I told how to ask for pain meds for his kid walks in carrying three large boxes of pizzas. He sets them in front of me, on top of the nurses’ desk.

“My wife and I want to thank you PICU nurses for the extraordinary care our daughter received while she was a patient in this unit, and we are  treating you to a pizza dinner.”  He looked at me.

“So how is your daughter doing tonight?” I ventured.

“Great!” Her surgeon talked to us by phone. He wanted to make sure her pain medications kept her comfortable. We really appreciate his concern for her well being. She had a very good day, and we’re going home tomorrow.”

“That’s great news,” I told him. “Thanks for the update, and the pizzas.”

“It’s our pleasure,” he replied. “Enjoy!”

After he left, Liz looks at me quizzically, but only says, “Well Niki, you certainly excel at the ‘concierge service’ the hospital keeps pushing on us. Obviously that family thinks you’re the bomb. Way to score pizza! Thanks!”

***

At breakfast the next morning I swear Corey to secrecy, and tell him about Dr. Eubanks, the dad, and the pizzas. It was two of us, because Liz had to take her mother to a doctor’s appointment.

“That’s awesome, Niki. Way to advocate for your patient. I’m tired of being told to ‘manage up’ without a way to honestly speak up when I see something wrong. What administrator’s going to support a nurse’s concern about an under medicated patient over a surgeon’s insistence that his patients don’t need it? Nurses are hospital employees, and in most cases, doctors are not.”

“I think nurses could push on an issue like this in nurse council, but it takes forever to change hospital policy. My patients can’t wait that long for help. It’s a problem.”

“Amen,” agrees Corey.

The server brings Corey’s breakfast. I only ordered coffee because of the pizza I ate last night, but Corey’s ordered bacon, eggs, hash browns, and his usual beer. The bacon smells so good, and Corey notices me eyeing his.

“Go ahead Niki, have a piece.”

“Oh no. I ate all that pizza last night. I don’t need any more calories. Plus it’s your breakfast.”

“No, really have some,” he insists, placing a couple strips of bacon on my plate with his fork.

Corey watches me eat the bacon. It tastes heavenly. I love bacon.

A smile breaks across his dimpled face, making him adorable. I smile back.

“So, Niki, maybe it’s none of my business, but last time we had breakfast with the gang, it sounded like maybe there’s trouble at home.”

“Oh I don’t know… No, that’s not true. Maybe I expect too much from Simon. I mean he’s a good man, and an affectionate father. He was out of work for a while, but now he’s teaching again. You’d think that would get us back on track, but when he tells me about his day, like normal people do, I try to be sympathetic, but I’m thinking, “When I have a bad day at work, somebody’s child died.” He doesn’t understand why I can’t let my work go when I get home, like he does. How about you Corey? You didn’t say much about your marriage.

“My wife, Sheila, is beautiful. When I met her, she was a high-powered realtor selling spectacular homes for the wealthy. She was so girly, you know: blonde hair, pumps, always wore dresses. I fell hard.

I think I’m a big disappointment to her. I know she doesn’t consider three 12-hour nights shifts a week in a trauma center full time employment. She actually says that out loud,

‘You know, Corey, it’s not like you work five days a week like my friends’ husbands. They don’t sleep all day either.’”

“When the bottom fell out of the real estate market, Sheila went on hiatus. She’s home with the kids while I work, “single mothering it,’ as she calls it. On my days off I get the girls ready for school, drop them off, pick them up, shuttle them to and from dance classes, and then start dinner. Sheila leaves the house early in the morning for a full day of Pilates, a pedicure, her book club or shopping, and then happy hour with her girlfriends, but not before making a ‘honey do’ list of repairs around the house for me. Occasionally she texts me something she forgot. It’s pretty clear she doesn’t respect nursing as a career for a man.”

“Corey, I’m sorry. Your wife should spend a night watching you work in the ER. A lot of people are alive because you’re a great nurse.”

“Sheila would never willingly enter a hospital. She doesn’t want to know about the ‘blood and guts’ of my job. When I try to explain it to her, she tells me it’s not an appropriate conversation for our daughters to overhear.

“So, I pick up as much overtime as I can handle. I don’t know if it’s for the extra money, or to avoid being home anymore, but I get a lot of satisfaction from nursing. I’m part of a team there. It’s like I matter to something larger than myself.”

Corey and I have a silent moment of eye contact. He reaches across the table and touches my hand.

“Thanks Niki.”

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Collusion (Niki coaches a parent on talking to doctors)

Chapter 13

The next night I returned to the PICU, and found that the eleven year-old transferred to the regular pediatric unit on schedule. As predicted, Dr. Eubanks not only discontinued the Fentanyl infusion before the transfer, but the puny IV morphine pushes too. It was out of my hands now. Or so I thought.

Later in the evening, I see the eleven year old’s Dad standing at the nurses’ desk, asking for me. I go to talk with him.

“What did you do last night to get my daughter pain medicine?” He demands.

“Um, I asked the PICU doctor for it,” I said. I didn’t think I should say that this was because I knew the surgeon wouldn’t order it.

“How’s she doing tonight?”

“She had a pretty good day. In the afternoon she rode a wheelchair to the play therapy room, played some games, and then walked back to her room. Right now though, she’s screaming in pain, and her mom and I can’t get her to stop. I asked the nurse to give her pain medicine, and she told me Tylenol is the only thing ordered. We gave it to her, but it doesn’t stop the pain. How do I get her more pain medicine?”

“Oh, boy,” I think to myself. My role of patient advocate is clear; I’m trying to think of how to word my answer without getting fired.

The child’s father, advocating for his daughter, doesn’t allow me this luxury.

“Are you a mother?” he asks.

“Yes I am. I have a daughter about the same age as yours,” I admit.

“So, if this were your daughter, what would you, as a nurse, do to get your daughter more pain medication?”

Silently, I think to myself, “Well, I was looking for work when I found this job…”

Out loud, I tell him the truth:

“Dr. Eubanks is a very good surgeon, but he doesn’t like his patients over sedated, so he doesn’t order a lot of pain medications for them. Your nurse isn’t calling him for more, because he will probably yell at her if she does. She’s afraid of him.”

“It’s only 9 pm. What I would do is tell the nurse I want to speak to Dr. Eubanks, now. She’ll make the call at the desk for you. When you get Dr. Eubanks on the phone, tell him your daughter is screaming in pain, and this is unacceptable; you expect her to be comfortable in the hospital. Tell him you want him to order appropriate pain medication for your daughter.”

“Got it!”  He said triumphantly. “Thank you.  Anything else?”

“Yeah, if you would not tell anyone that I coached you on this, I’d appreciate it. I’ll probably get written up if the pediatric nurses or Dr. Eubanks find out,” I solicited.

“Not a problem. I appreciate you honesty and help,” he promised, leaving the PICU, presumably looking for his daughter’s nurse.

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Something Goes Wrong (Nice families always have the sickest kids)

Chapter 8

Besides my fourteen year-old head trauma there is only one other patient in the PICU.  Because that one is stable and expected to transfer to the regular pediatric unit in the morning, staffing for our night shift dropped down to two nurses, Kathy, and myself.

The fourteen year old’s parents had been at the bedside since his return from the OR. Throughout the evening his siblings, grandparents, and extended family visited two at a time until visiting hours were over at nine o’clock.  His parents, who really are very nice, took advantage of our empty waiting room across the hall, deciding to spend the night sleeping on the sofas. Kathy and I outfitted them with sheets, blankets, and a couple pillows. I promised to wake them if anything happened.

Around two am, Corey came up from the ER on his break. “Hey Niki, let’s have breakfast after our shifts in the morning, okay?”

“Sure Corey. That sounds great.”

Corey and I met at New Employee Orientation when we were hired. He’s married with two small kids. He’s become one of my best buddies at work. We regularly go out for breakfast after our shifts.

***

The shift nearly passed without mishap.

Around six am, I was taking vital signs on the fourteen year-old. Nothing changed all night. I charted the oxygen saturation and TCO2 monitor readings to check against the results of the arterial blood gas I’d just drawn with his morning labs. Suddenly the monitor alarmed loudly.  Glancing at the screen, I see the ICP numbers are rising, and then out of the corner of my eye I see bright red blood pulsating inside the clear plastic ICP device in the kid’s head and backing up into the tubing it connects to. What the Hell?

Then I shout,

“I NEED HELP!”

Kathy runs in, sees the blood, and says, “Oh my God, what’s happening?”

“I don’t know! I’m not even sure what to do. Should his head go up or down?”

I pondered this while quickly verifying his peripheral pulses and blood pressure manually. I take him off of the vent and begin hand-bagging him, hoping to control the rising ICP. Then I hit the code button. Meanwhile, the boy starts seizing.

Immediately, Gerald, the respiratory therapist runs in. The blood pressure and pulse are high, not low, so we don’t begin chest compressions, but Gerald takes over the hand bagging.  Dr. Polk runs in from the call room as the dayshift nurses begin to arrive.

Dr. Polk orders ativan and a loading dose of phosphyenatoin, which I run to retrieve from the automated drug dispenser.

Immediately, Kris is at the bedside:

“Keep his head up! Call CAT scan. Tell them we’re coming down NOW, this is an emergency. Draw a type and match too,” she commands.

Dr. Polk is entering orders for the scan, and phones the neurosurgeon.

“Should we clamp the ICP tubing?” Kathy asks.

“NO!” both Kris and Dr. Polk yell out.

Dr. Polk asks, “Niki, what happened?”

“Nothing. He was stable all night, then this.”

Meanwhile, the rest of day shift arrives, and a team of nurses flurry into action, transferring the boy’s monitor leads to a portable unit, drawing more labs, and gathering equipment. A green O2 tank is slid into a rack on the bed for the ambu bag. Gerald continues hand-bagging him for the trip downstairs. Another respiratory therapist appears to roll the ventilator down with us.

“Has anyone told the parents yet?”

I awaken them in the waiting room, and bring them back to the PICU. When we get there the team has already wheeled the boy in his bed out the door, with Kris at the helm. Trailing behind, I explain what’s happening. The three of us take a second elevator to CAT scan. Once the parents are seated in the anteroom, I help Kris and the radiology techs transfer the boy onto the narrow table that slides into the tube-like machine.

Behind me, Dr. Polk and the neurosurgeon view the black and white images with grave expressions. The neurosurgeon makes a phone call and instructs OR to prepare a suite.

The CAT scan reveals the cause of the bleeding is an ateriovenous malformation, an AVM, deep in the boy’s brain. Most likely, it’s lurked there undetected since birth. Though no one knows for sure, it’s assumed that when the boy hit his head against the wall, the AVM began leaking, causing the original small bleed, but wasn’t picked up on the original CT. Apparently the bleeding continued, the pressure building until the AVM blew like an old rubber inner tube.

The boy is rushed to OR. I return to the PICU, where I struggle to grasp the medical terms I need to document the incident in the nurse’s note. My adrenaline level is so high, I have difficulty concentrating and keeping the events in order.

Kris comes back up for report. “You did okay, Nik. It wasn’t anything you could control.”

“Thanks Kris. I appreciate that, and your help too. I really do.”

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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.”

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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.

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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.

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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.