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?”

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.

 

 

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.

 

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.

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.

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.

 

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!

 

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.

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.

A Mid-Tone Grey

Chapter 26

With his body wrapped around mine, Corey falls asleep before I do. Outside, the bright morning sun filters through the heavy window drapery, illuminating the bedroom to a mid-tone grey. I watched him sleep, wondering what will happen next.

As if he feels my gaze touching him, Corey wakes with a start, realizes where he is, and then nuzzles my ear and neck with his lips. “Hello, Beautiful. What time is it?”

“Ten, and I haven’t made breakfast yet,” I breathed back. “Is there time?”

“Not now. I work again tonight. You too, right?”

“Yeah,” I sighed.

“I better get going. Do you mind if I take a quick shower first?”

“No that’s fine. Any chance that Sheila’s going to be there when you get home?”

“It’s not likely. She has coffee with her friends after yoga class, but you never know.”

“What will you tell her if she is?”

“I haven’t gotten there yet. I don’t really have anything figured out past this moment, Niki.” He rubs my shoulders, and I want him again.

We make love sweetly. Languorous, I lie in bed listening to the running water while Corey showers. He’s humming.

I watch him put his scrubs back on before getting out of bed and slipping on my old flannel robe. Together we walk to the front door. Corey puts his hands on both sides of my face, and kisses me long and deep.

“You better go.”

“See you tonight Niki.”

Closing the door quickly, I watch him walk up the street to his car from behind the living room curtain.

“Oh lordy, what am I doing?” I’m smiling.

In the kitchen, I throw out the eggs, placing the bowl and whisk in the sink to wash later. I refill my tote bag with its scattered contents collected from the floor and place it back on the table.

Before sliding back into bed, I make sure the alarm is set, and the phone ringer off. There’s a text message from Corey on my cell, “Sweet dreams, Lovely.”

I text him back with an emoticon of a smiley face blowing a kiss.

I sleep better than I have in months. I wake up looking forward to going to work.