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I Thought Only Old People Died

Chapter 76

“Can I refill your coffee, Dad?”

“Sure sweetheart. Thanks”

Dad and I are drinking coffee this morning in my kitchen. Mom was up before either of us, did her morning yoga and meditation, and is now taking a walk to the neighborhood park.

“How’s Mom doing, you think?”

“Well, the news you were held hostage at gunpoint in the hospital shocked both of us. Neither of us could handle losing another child. Thank God, it didn’t happen.” Dad pauses, and looks at the ceiling, but not before I see he’s blinking back tears.

“I think she’s going to be okay, Niki. Just give her time to process. You know how she gets.”

Yeah, I know how Mom gets.

Later, Mom is busy cleaning the kitchen, and Dad has gone to a gym. I sit down with my journal. The therapist suggested I write down my thoughts. This morning, my thoughts are about my parents, and Joel:

Like I said, I was six when Joel was born, and I adored being his big sister. He was named after my grandpa. Joel was cherubic, with pale skin, and blue eyes that lightened and darkened with his mood, like the sea. He laughed easily, and was almost always smiling.

When he cried, I would race to get to his crib before my mom. I wanted him to know I would always be there for him. I loved pretending he was my child.

Joel was walking, just after his first birthday. He grew and thrived until the middle of his second year. Gradually, he became fussy, and less easy to console. He was a picky eater, and lost weight. Mom took him to the pediatrician, who assured her his behaviors were part of The Terrible Twos.

A few weeks before second birthday, Joel fell while standing in front of the TV. When he stood back up, he wobbled when he walked. Joel fell again, and then he threw up. I was scared. I called for Mom, who was in the kitchen, doing dishes.

Mom called Dad at work, and told him she was taking Joel to the emergency room. He met her there. Then she called our neighbor, who came over to watch me.

I was scared. I prayed that God would make Joel better.

When they came home, my parents told me Joel had a cancer in his brain, and he was going to need surgery. They said they needed to stay with him at the hospital when he had the surgery, and I was going to have to be a brave girl while they were away. My grandparents came to stay with me.

When my parents came home from the hospital with Joel after his surgery, I thought everything was going to be okay. I was extra careful to be gentle with him.

But Joel wasn’t okay. There were more doctor appointments. He had chemotherapy and radiation appointments. At home, Mom held him almost all of the time, even while he slept. Dad took over cooking dinner when he came home from work. On the days Joel and Mom stayed in the hospital, Dad went there after work, and sometimes stayed the night too.

Grandma and Grandpa stayed with us a lot. They drove me to school, and back. Grandma made me bagged lunches in sacks decorated with cute stickers. They listened to me practice reading, and spelling. They bought me presents, even though it wasn’t my birthday.

I waited for Joel to get better, but he didn’t. Dad started taking me to the hospital with him in the evenings to visit Joel at the hospital. Sometimes I had to wear a mask to see him. He was puffy, and didn’t look or act Iike Joel. I closed my eyes when I was prompted by my parents to kiss him on the forehead.

One day, Grandpa picked me up from school. I chattered away in the car, and Grandpa would smile, but his eyes looked sad.

At our house, the living room curtains were drawn closed. The room was dark. Dad, who was usually at work, was sitting in his chair. Mom sat on the sofa. Grandma sat next to her, her arms around Mom. All of them were crying.

“Come here, sweetheart,” Dad said.

I was afraid, but I didn’t know of what. I knew something really bad had happened. I couldn’t move.

“Niki, come here,”

I walked across the room to my Dad. He put me in his lap.

“Niki, sweetheart, your baby brother, Joel, died at the hospital today. He’s in Heaven now, and he’s not suffering anymore.”

I burst into tears.

“But why did he die?” I was furious. “How did he die?”

“Niki, Joel was very sick. Sweetheart, you knew he was sick. You knew he was going to the doctor’s all the time. We took you to visit him. He had a brain tumor.”

“But I didn’t know he was going to die. I didn’t know babies could die. I thought only old people died. I didn’t know I was never going to see him again. Am I going to die?”

My father held me tightly, and cried into my hair.

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At The Time I didn’t Know Either

Chapter 70

The nurse comes back. “You have a few visitors. “

Raquel rushes into the makeshift bay, and tries to hug me as best she can while I lay on the gurney. Following close behind are Grant, and Simon, escorted by Officer, I mean, Mike

“Raquel, Grant, how did you get here? And Simon?”

“You listed me with the hospital as your emergency contact,” says Raquel. “They called me. It just happened Grant had a legal conference in LA today, and I came along to do some shopping. We weren’t far when I got the call. Oh, Niki…” Raquel starts to cry. I look for a box of tissues, but don’t see one. I let it go.

“Then I called Simon. I called Mom and Dad too. I’ll call again later and let them know I talked to you. If I call them now, we’ll never get either of them off of the phone.”

“Oh God, Mom and Dad know?”

“I had to call them Niki, after I found out. It was too serious for me to wait. I didn’t know if…”

Raquel doesn’t finish the sentence. I know what it was she didn’t know.

At the time, I didn’t know, either.

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Betting That Frank Doesn’t Know

Chapter 67

I forced myself to take a deep, inaudible breath before beginning.

Speaking slowly, I try to ignore Frank’s gun aimed at my face.

“Frank, okay. If you want me to put Nathan’s sedation back the way it was, then I need to take this little pump here off the IV pole, and put it on his bed. Is that okay, Frank? Is it okay for me to unclamp the pump from the pole so I can put the sedation back the way it was?”

Frank tilts his head and squints eyes, indicating he’s unsure if he believes me. Then he smiles, remembering he still has the gun. He answers confidently,

“Sure, that’s okay, but don’t try anything funny. I will shoot you.”

I nod my head to acknowledge I understand him. Gingerly, I unscrew the pump’s clamp lose, and remove it from the pole. I now have a projectile in my hands, but I’m unsure when or how to use it.

“Okay Frank, now I have to turn off the pump, and slide the syringe of sedation medication out of it. I’m going to give Nathan more of the sedation to make him sleep by pushing the plunger on the syringe.”

I know that if I push too much fentanyl too fast into Nathan, his back will arch stiff as a board from the bed, and he will code. But I’m betting Frank doesn’t know this. Maybe I can stall for time by giving Nathan just a tiny bit at a time.

God, please send someone to rescue us.

Like an answered prayer, the bedside phone rings.

Frank and I stare at it.

“Answer it,” demands Frank.

The phone rings again.

“Answer it!”

“Hello?”

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Exactly What I Hoped He Would Say

Chapter 66

My eyes are fixed on Frank and the gun, as I very slowly walk backwards towards the head of Nathan’s bed. Frank doesn’t say anything about hurrying up. The arm holding the gun has a bit of a tremor, which he tries to hide by bracing his wrist with the opposite hand.  

For a minute, I consider he might not be fully committed to euthanizing Nathan. He’s drunk and out of control. Maybe he’s as terrified of himself as I am. 

 Peripherally, I take a quick inventory of what makeshift weapons are available to me. Next to me are the IV poles, supporting their multiple pumps. There’s the board at the foot of Nathan’s bed that OT has us using intermittently to prevent foot drop. On the bedside table is the bottle of hydrogen peroxide I used to clean Nathan’s trach. I’m afraid to get close enough to Frank while he’s holding a gun to use them though. I look again at the IV pumps on the pole, and get an idea.  

“Frank, I utter softly, “Frank…”

“What?”

“Dr. Polk started weaning Nathan’s sedation medication this morning, because his trach is healing.” I point to the mini infuser pump clamped to the IV pole, with its syringe of fentanyl. “That means Nathan is more awake now, and can breathe some on his own, without the ventilator. If I unplug the ventilator from the wall, Nathan will struggle to breathe. He won’t die quickly. Frank, he’ll suffer if we unplug the ventilator.”

Frank looks confused. “You’re lying! How can that be?”

“I told you, Frank, Nathan isn’t brain damaged. He’s paralyzed. The parts of his brain and spinal cord that control his breathing still work. He’ll suffocate slowly, gasping for air if I unplug the ventilator.”

“I don’t know if I believe you.”

“He’ll suffer, Frank. Is that what you want?”

“No! Goddamnit! I want to stop his suffering. That’s why I’m here. I don’t want my son to suffer like this!”

We stare at each other in silence. I’m afraid to push Frank further. He’s too volatile and unpredictable. 

“Put the sedation back the way it was.”

“What?”

“I said, put the sedation back the way it was. Make him sleepy so he doesn’t feel anything.”

That’s exactly what I hoped he would say.

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Code Silver

Chapter 65

Frank has a handgun aimed at my head.

Liz, still unconscious, lies motionless on the PICU room  floor.

I didn’t sign for this when became a nurse.

Silently, I begin to cry, thinking about Maddie, and that I may never see her again. Did I kiss her before she went to school today? Probably not; she’s too old for that. What was the last thing I said to her? I hope she knows how much I love her.

Frank slides the PICU room door shut.

“Code Silver! Pediatric Intensive Care Unit! Code Silver! Pediatric Intensive Care Unit!” is called loudly on the hospital’s PA speakers.

Thank God. Someone saw the gun.

Frank and I stare at each other, the gun pointed at my head. Facing each other, we stand like this for what feels like hours. How long have we been standing here?

I need to calm down if I’m going to survive. I need to keep my wits about me. I begin counting my breaths, focusing on the exhale.

Frank starts sobbing. “My son, my only son. Nathan, my Nathan. How could your mom let this happen? I’m not going to let you be a vegetable, son. I’m going to let you die like a man.”

I feel sick to my stomach, and try not to retch. “Frank, Nathan’s not a vegetable. He doesn’t have brain damage. He can probably hear us talking about him. He can probably hear you talking about him.”

“You fucking nurses are all alike; all positive, and thinking you can change people and fix everything. You don’t see what’s real, what’s really happening even when it’s in your face. You think if you keep cleaning up the messes, they’ll stop happening.

My boy is damaged. What kind of man lives his life in a chair? That’s no life for my son. You should of let him die the night of the accident.”

“Frank, Nathan’s heart never stopped. He never tried to die. He’s strong. He can go to college, get an education. He can inspire others going through something similar. He still has a meaningful life. This is a challenge, yes, but it’s not the end.”

“Shut up!”

“Frank…”

“I said shut up! Now, go over there, and pull the plugs.”

“What?”

“I said, go over there, and pull the plugs to all the machinery out of the wall. Especially the plug to that breathing machine.”

“Frank, I can’t…”

The gun is still pointed at my head, and I hear it click.

 

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This is Your Fault: Frank Lashes Out

Chapter 64

Liz is assisting me with Nathan’s trach care. The stoma is healing well, but still a tender pink, with frothy secretions. Carefully, I swab around the collar, while Liz measures and cuts new ties to replace the old ones.

“It sounds like Nathan’s going to begin weaning from the ventilator soon,” I say, trying to sound cheerful. “He’s starting to do more breathing on his own since Dr. Polk had us lighten his sedation.”

“He opens his eyes every now and then too, that makes me so happy,” says Liz. “I swear he squeezed my hand when I was talking to him last night. Maybe he’ll regain some movement in his hands.”

“That would be great, Liz. I’ve known patients who were able to use a computer, and navigate their mobility chair independently, using a single hand. He’s strong, and young.”

“Should we wash Nathan’s hair this morning, Niki?”

Before I can answer, I sense in my peripheral vision a shadow standing in the doorway. It’s Frank. He grasps the side of the doorway with one hand, swaying a little. I can smell the alcohol he’s been drinking from across the room.

He’s staring at Nathan in the bed, but doesn’t step further into the room. Something about him blocking the doorway sets me on edge.

“Hello, Frank.”

He doesn’t take his eyes off of Nathan.

Liz looks uneasy too, but ventures to speak to him, “We’re just finishing Nathan’s bath and trach care. He had a good night.”

Frank turns to Liz, fury in his voice. “You raised our boy to be a fucking pussy. How’s he going to learn to be a man and toughen up when you keep letting him be sensitive and all that shit? I told you time after time, and now look where he is. You made this happen, Liz. This is your fault!”

“Frank, that’s enough,” I say to him. I need you to calm down.”

“You’re a cruel asshole,” mumbles Liz, barely audible.

Frank takes a step forward into the room. “What did you just say?”

“Nothing, Frank. I didn’t say anything.”

Frank looks at Liz, and his shoulders relax. In a voice frighteningly calm, he says, “Oh, it was nothing.”

Then, with the speed, and precision of a striking rattlesnake, Frank grabs Liz by the throat, pulling her away from Nathan’s bed, and slams her head against the wall. He releases his grip, and she slides to the floor, unconscious.

I scream, “Call security! I need help!” from the room to the nurses’ desk.

And then Frank pulls out a handgun, and points it at my head.

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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.

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Kris (The Pale Green Bed)

Chapter 59

She woke up choking for air, strangling. When she opened her eyes she saw it was only that she was tangled in the pale green silk bedspread. She had neglected to turn it down the night before. A trail of drool left a dark pool on its edge. She hoped it would dry unnoticed so she wouldn’t have to take it to the dry cleaner. But the concern was quickly forgotten with awareness of her blinding headache. She considered whether it was worth the trouble of going to the bathroom and hunt for ibuprofen.

It was. Naked, she climbed out of the bed, head down, and a hand shielding her eyes from the sunlight streaming in through a gap in the vertical blinds. After stumbling, she remembered the three carpeted steps leading down from the raised platform where the circular bed perched. Gingerly, she made her way to the bathroom. The reflection of her face in the mirror changed her opinion about the ibuprofen, and she took an Oxycodone from its orange prescription vial instead. Groping the dark wood paneled walls of the hallway, she felt her way to the kitchen, swigging down the pill with a mouthful of flat sparking wine from a bottle she didn’t remember opening, and left overnight on the counter. Then she made her way back to the bed, covering her head with the stained, pale green bedspread.

Twenty minutes later, the warm, lightheaded feeling with a twinge of nausea arrived. She was ready to face another day.

Still naked, this time she remembered the three shallow stairs and stepped onto the shag wall-to-wall carpeting. She didn’t open the blinds, instead creating a space for herself between the vertical strips in front of the glass to gaze at the view.

The west wall of the room was glass with a sliding door opening onto a patio of aggregated stone. The patio formed a half-circle around the house. Beyond was an expansive view of the Pacific Ocean shrouded in the low-lying fog known as June gloom. By sight alone she understood the weather was mild and the fog would burn off by afternoon. The ocean was placid grey. “Grey, the color of the day,” she crooned, like a child singing a nursery rhyme.

Silhouetted against the sea’s brightness, a life-sized bronze sea lion stood at attention, as if barking at an intruder. The sea lion was some kind of local celebrity with a familiar name like Ed, or Bud or something. The house’s owner made the sculpture. She tried to remember: The owner was a movie producer, or something; she couldn’t remember what the property manager had told her.

She turned and faced the room, its focal point the elevated, pale green circular bed. She had never seen a circular bed. She wondered where she could find a circular bedspread to replace the one she had stained. Maybe on Amazon. The bed brought to mind Old Hollywood glamour. Or maybe it just reminded her of a bedroom in an old Hollywood movie. That’s probably more like it.

The bed rested against the wall. Above, a shelf of teak and glass defied gravity. The little bit of Kris that was still a nurse thought hanging something so heavy above a bed in earthquake prone California foolishly dangerous. She imagined it crashing down on sleeping victims. On it sat a Danish-modern vase, and a small ceramic bull.

A circular bed on a circular platform, a circle within a circle.

Strewn over the floor of the room, her clothes defied its sense of order.

 

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It’s Not All Cute Print Scrubs and Bunny Blankets (Niki Floats to Pediatrics)

Chapter 55

 

I leave PICU, and report to the pediatric unit.

No offense to my pediatric nurse colleagues, but no PICU nurse enjoys floating to pediatrics. Not because you aren’t incredibly good nurses, you are. It’s because you work way too hard in a way different from PICU nursing.

In the PICU, I’m assigned one or two critically ill patients. I run my butt off evaluating vital signs and pulses up to every fifteen minutes, unless the patient is on the verge of coding and then it’s at least every 5. I titrate powerful drip medications, and monitor serum blood levels drawn from a complex highway of lines criss-crossing a patient’s body as he or she rests in a drug induced coma. It’s intense, challenging work, but I’m able to focus on just one or two very sick patients, developing a dynamic rhythm of patient care.

As a patient improves, they’re allowed to come up from sedation. Keeping a three year-old intubated until an intensivist decides they can protect their airway and orders removal of the breathing tube is hell on earth for a PICU nurse, but once it’s done the patient usually transfers quickly to the general pediatric floor, right about the same time they are no longer willing to stay in their crib.

Of course, caring for children too sick to go home, but too well to stay in their crib is the job of the pediatric nurse. In the PICU, most medications are administered IV, but on the floor it’s often changed to oral. I don’t care how much the pharmaceutical company labels medications as “fruit flavored,” no kid willingly takes medication that comes from pharmacy in a syringe, even if you convince him there’s no needles involved. For infants, you can squirt a few drops of the med at a time into just enough formula to fill a nipple, and they’ll suck it right down especially if you allowed them to get hungry enough. A toddler, however, is on to you right away, and spits out the spoonful of pudding or juice laced with medication. The last alternative no one enjoys is holding the child down on his back, sliding the needless syringe into the side of his mouth, towards the back, which makes him swallow as you squirt it in.

Of course, none of these skills or the extra workload carried by pediatric nurses prevents a patient from suddenly decompensating, and a code being called. All of this, with the family watching from the bedside. It’s not all cute print scrubs and bunny blankets for pediatric nurses. Theirs is a very special brand of vigilance and expertise.

I took report from a day shift nurse I don’t know. She gave me three patients. Two are post-open heart surgery, transferred from PICU, on the mend and getting ready to discharge. The third is a 14 year-old boy who is blind as a result of treatment for childhood Rhabdomyosarcoma. He had a bout with influenza and was admitted for dehydration. He’s going home today too. His parents spent the night at home. In their place, his Seeing Eye dog, Reege, a golden retriever, lies calmly alert on the floor by his bed.

I realize they gave me a pretty simple assignment. In fact, it’s possible all three of my patients will be discharged. I might get to go home early!

 

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It Happens (Niki sees in contrast)

Chapter 39

“Good work, Niki. Knowing the lab results and rash indicated a severe infection, yet this information was not reported to our client, Dr. Staid until after the boy’s death points the responsibility away from him, towards the nurse, and therefore at the hospital. That’s exactly the thing we’re looking for in the chart.

There’s an old saying among lawyers though, ‘Never ask a question in court that you don’t already know the answer to.’

So Niki, my question is: What difference would it have made in the patient’s outcome if Dr. Staid had been informed of the critical lab value and the rash sooner? Would the boy have received different care? Would he have survived?”

“I can’t answer that definitively, Grant. I mean, had the severity of the boy’s infection been diagnosed sooner, the shock that killed him would have been anticipated. Once the antibiotic came in contact with the bacteria in the boy’s bloodstream, the the bacterial cell walls burst, releasing their toxins and setting up a cascading circulatory reaction. That’s why the rash worsened from pinpoints to the huge purple blotches the nurse describes in her late entry note after the failed code. If this reaction had been anticipated, perhaps the boy would have been transferred to a pediatric intensive care unit where the technological support he needed was available, instead of admitted to a hospital unfamiliar with pediatric emergencies. Maybe he would have survived if that had happen. Maybe not. This kind of infection spreads like wild fire through the body of its host. Saving the boy’s life would have been challenging even for a PICU team. However, by the time they realized how sick he really was, it was too late. A small community hospital without a PICU couldn’t keep up. I feel bad for the family and for the staff.

As a nurse, Grant I have to admit I wonder why Dr. Straid didn’t come in to assess the child when it was decided to admit him? I know that happens a lot though. They leave it in the hands of the ER doc or a resident, and then see the patient in the morning. We have hospitalists where I work. A pediatrician is available both day and night.”

Mentally, I think of all of the times we’ve summoned Dr. Polk from the call room because a patient needed him.

“That question has been addressed,” replied Grant. “It’s our theme that, had he been informed of how sick the child was, he most certainly would have been at the bedside long before the code, when more treatment options could have been considered. The nurse did not inform our client of how sick his patient was in a timely manner, limiting our client’s ability to help the child.”

“Well, then you’ve got what you need, I guess.” Why does my stomach churn every time Grant and I reach this conclusion?

“Yes, and thank you Niki. We’re deposing the nurse tomorrow. Are you willing to sit in? I don’t want you to say anything, but maybe by hearing her deposition you’ll pick up on something else to strenghten our defense.”

The idea of being face to face with a nurse whose testimony I’m hired to shred makes me uncomfortable, but since I don’t have to ask her any questions, just listen, I figure it will be alright. I’m sort of interested in this whole legal process anyway.

“Sure. I’ll do that,” I tell Grant.

“Excellent,” he replies. “We meet in this conference room in the afternoon.