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Bruises Not Scratches (Niki Discovers Something Unsettling)

Chapter 58

“Raquel, it was absolute mayhem. The little dog took off down the hall after the bunny, and then the charge nurse called Security to help round them up. Of course, Security didn’t have any idea of what to do. Eventually, two officers cornered the animals, grabbed Rocket, and the pet therapist gathered up the bunny, but not before the blind kid, Travis, somehow felt his way to the fire alarm, and pulled it. The sprinkler system went off, and the fire department arrived. No, I didn’t leave early. After we settled everyone down, finished the shift, and gave report, it was 9 pm before I finally I got home, and reheated for dinner the lunch I didn’t get to eat. I’m ready for a second glass of wine, are you?”

This story was just to good not to call my sister Raquel and tell her about it over wine by phone.

* * *

I had a couple of days off before my next shift. Like I said before, day shift is challenging in its own ways.

“Niki, the phone’s for you.”

I take the call from the pod outside my patient’s room. It’s Finch, one of the day shift pharmacists.

“About that Ancef dose your resident ordered,” he begins.

I block, “He’s not my resident. He belongs to the attending,”

“Well, whoever he belongs to, he’s placed an order in the EMR for Ancef.”

“Yeah.”

There’s not enough Ancef in all the hospitals in the city to cover the dose. You need to call him and point out that the kiddo only weighs 10 kgs.”

“Finch, the RT is here and we’re about the re-tape his ET tube. Can you call and get the order changed, please? You can educate him about placing orders while you do it.”

“That’s not really a function of pharmacy, Niki.”

“It’s not a nursing function either, Finch. Why does everything get turfed to nursing? Health care is a team sport, no?”

I interpret the the silence on the other end of the phone to mean he’s strategizing an offense.

“Alright, Niki, I’ll do it this time.”

“Thanks Finch, you’re a real gem.”

“Phfffp,” he mutters before hanging up.

* * *

At change of shift, I give report to my old night shift buddy, Liz, first telling her about the patient, and then Finch’s one-liner that the resident ordered more Ancef than what’s available in the city that was pretty hilarious, when I notice the bruises on her neck, three of them. They’re long and suspiciously resemble fingers. I can’t help myself, “Liz, what’s up with the marks on your neck. They look like bruises. What happened?”

Her gaze drops downward, and she turns her head the other direction attempting to hide the bruises, but not before I see her cheeks flush bright red.

“It’s nothing, Niki. I scratched myself.”

She’s lying.

“Liz, those aren’t scratches, they’re bruises. It’s me, Niki. We’re friends, remember? What happened?”

“I’m having problems with Nathan. He’s skipping school and failing his classes. He got suspended for smoking pot on campus. I called his dad, hoping he could talk some sense into him.”

“Frank, you’re ex did this to you?”

“I thought he could help, but when he came over to talk to Nathan he starting hitting him. I got between them. When I started yelling at Frank to leave, things got out of control.”

“He choked you? Oh my god, are you okay? Have you seen a doctor? Did you call the cops?”

“This is exactly why I didn’t want to tell you Niki. I knew you would overreact.”

“Overreact? Jeez, Frank was strangling you! He should be in jail.”

“Mind your own business, Niki. I appreciate your concern, but mind your own business,” was all Liz said as she stood up and entered her patient’s room.

Posted on by jparadisirn

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.”

 

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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.

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I Hate This, All of It (Maddie Talks to Niki)

Chapter 51

“Maddie, open the door.”

“Go away!”

“Maddie, I know you’re upset, but we need to talk.”

“I don’t want to talk. I hate you! And Amber, and Dad too!”

“Maddie, I’ve heard Amber’s side of the story, now I want to hear yours. Please open the door and talk to me. 
”

I stand at Maddie’s bedroom door not hearing a sound. I’m about to knock again when I hear footsteps. The door opens revealing Maddie’s face, reddened and damp with tears.

“Can I come in?” I ask.

Wordlessly, Maddie steps away from the door, allowing me entrance. We face each other awkwardly before I give her a hug.

“So what’s going on? Amber says you’ve been picking on Wade. I thought you loved having a little brother.”

Maddie remains silent.

“I have to admit picking out all the marshmallows from the box of cereal was clever.”

Maddie cracks a smile, and we both start laughing. “You should’ve seen his face, Mom. He kept turning the cereal box upside down and shaking it, looking for the marshmallows.”

Still laughing, I work the conversation. “It is funny, but was it still funny after Wade found out you tricked him?”

Maddie stopped laughing. Her eyes squinted at the memory. “He made a face at me, and then ran into his room.”

“How did that make you feel?”

“Kind of bad. He used to look up to me. He trusted me.”

Putting my arm around Maddie’s shoulders, I guided her to her unmade bed where we sat down. “What’s this all about Maddie? What’s bothering you?”

“Ever since you and Dad got divorced, my life has changed.”

“The divorce changed all of our lives Maddie. It isn’t easy for any of us.”

“Yeah, but you and Dad got to choose. Nobody asked me what I wanted. Now Dad’s married to Amber, and she expects me to do all kinds of stuff around the house, like keeping track of Wade while her and Dad spend time together. At first I thought Amber thought I was grown up, but now I know she just wants me to stop being a kid and take care of things for her. I didn’t sign up for that. I’m still a kid.”

“I’m sorry Maddie. I didn’t know this was happening. Why didn’t you tell me?”

“Because you’re always at work. If you’re not at work, you’re sitting around drinking tea and listening to music. I don’t think you want to hear about Dad and Amber anyway. I feel like I have to pick. And you know what, it’s not easy always having to pack my stuff back and forth between your house and theirs. Sometimes I forget my homework at the wrong house, and I get in trouble for it at school. I hate this, all of it.”

How did I not know how hard this has been for Maddie? I’ve been way too distracted with my life, and it’s hurt my daughter. I need to get my priorities straight.

“Maddie, I’m sorry. I didn’t know you felt this way. I’m glad you told me. I see I need to make some changes around here. I’m going to make things better for you, I promise.”

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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.