Posted on by jparadisirn

A Bad Feeling About Frank

Chapter 63

Several days ago, the neurologist treating Nathan held a family conference, and updated them on his prognosis.

“Nathan’s spinal cord was severely damaged in the accident. While there maybe some improvement after several months of healing, he will be paralyzed for the rest of his life. However, I believe that Nathan will not be ventilator dependent as he is during this acute phase. Since it may take many weeks for Nathan to breathe on his own without mechanical support, I recommend we place a temporary trach until he fully recovers and gets stronger.”

As the nurse caring for Nathan this shift, I was present at the family conference. Liz was prepared for the news, but openly sobbed anyway.

Frank had a lot of questions for the neurologist.

“What makes you so sure Nathan’s spinal cord damage is permanent? What about alternative treatments?” and “If we transfer Nathan to another hospital that specializes in this sort of care, would they offer more advanced treatment that could heal him?”

The physician answered his questions with patience and empathy.

I watched Frank as the neurologist answered his questions. Chameleon-like, his facial expressions changed from sorrow, to anger, to tears, and then to stone. Sitting in a chair next to Liz, I noticed he was lightly kicking her in the ankle under the room’s coffee table. She appeared not to notice. I almost said something, but thought better of it. A few minutes after the conference ended, he left the hospital.

Liz stayed in the conference room, asking more questions about what rehab services for Nathan will be offered, and how long would he be there as an inpatient.

I went back to the PICU, and resumed Nathan’s care.

“How’s Liz holding up?” asked Sue.

“Like a nurse. She’s focusing on what’s next; asking about rehab services, and what equipment she’ll need when he comes home. I don’t think his dad, Frank, is doing so good though. He was kicking her under the table during the family conference.”

Sue frowned. “I’ll have a talk with the nursing supervisor about that,” she said. “We may have to place some boundaries on Frank’s visits. Night shift said he came in late last night, intoxicated. When he started acting out they had security escort him to the hospital parking lot, and he took Uber home.”

I have a very bad feeling about Frank.

Posted on by jparadisirn

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.

Posted on by jparadisirn

For Whom the Phone Rings (Niki does ‘wine by phone’)

Chapter 10

After working a night shift, my soundest sleep occurs between 10 am and noon.

At 11 am the ringing of our landline phone wakes me. Drowsily, I pick up thinking it could be the school calling about Maddie. What if she’s sick, or hurt? But I forgot, the school only has Simon’s and my cell phone and work numbers. The landline is for Maddie.

It’s my sister, Raquel.

“Hullo?” I slur.

“Dammit, I woke you up, didn’t I? I’m sorry. I never know when you’re working.”

“It’s okay. I forgot to turn down the ringer.”

“Niki, why don’t you get rid of your landline and just use cell phones like normal people?”

“Because Simon and I think Maddie is too young for a cell phone. The landline is for Maddie.”

“You’re gonna have to let her grow up one of these days, Nik.”

“And this is why you woke me up?”

“No, I’m just checking in. Are you off tonight? Wanna do wine by phone?”

“Yeah, I am. Wine by phone is perfect. After dinner?’

“Yep. We’ll talk then. Goodnight, or whatever.”

“Goodnight.”

***

Raquel and her family live south of us, in La Jolla. It takes two hours to get there, depending on traffic, and the day of the week. It’s too far for us to get together regularly, so Raquel and I started wine by phone. Once a week or so, we each open a bottle of wine, and talk by phone for an hour or more. We sit in our kitchens drinking wine while catching up one each other’s lives. Our husbands and children are forbidden to interrupt wine by phone unless they are bleeding severely about the face or neck.

Besides being my sister, Raquel is my best friend.

“So Doll, things must be a lot better now that Simon’s working again, right?”

“Yeah, I think so. He’s happier for sure. He’s cut down on watching sports now that he has lesson plans and paperwork to do in the evenings. He helps Maddie with her homework more too. He’s preparing her for classes at Woodman next year. She loves the attention.

“What about you, Nik? Are things heating up a bit for the two of you?”

“I guess. I mean there’s more to talk about now that Simon’s working and has stories about his day. He’s spending time on his appearance again, and getting more exercise since he’s coaching too. If this lasts, maybe we’ll try to have another baby, although there’d be a big age gap between Maddie and a new brother or sister. Then again, we really should put money away for a down payment on a house. But there’s saving for Maddie’s college education too. I don’t know. I can’t seem to make up my mind. I think the weekend trip in Coronado will help. Thanks for taking Maddie for us”

“Niki, why don’t you stop worrying about the future so much and just make love to the man?

Silence.

“Right. Okay, so, how’s work? Are you still having breakfast with that ER nurse, what’s his name again?”

“Corey. Yeah, we go for breakfast once a week or so. Sometimes another nurse or two come along.

“Is Corey cute? Have you hooked up with him yet?”

“What? No! I mean, yeah he’s cute. No, we’re not hooking up. He has kids. He’s married.”

“So are you Niki.”

“What are you saying Raquel? What are you getting at?”

“Nothing Niki. Nothing at all. Don’t get all defensive.

We’re happy to have Maddie for the weekend when you and Simon go to Coronado. So when are you going to get her a cell phone?”

Posted on by jparadisirn

No Good Deed Goes Unpunished (Niki gets a speeding ticket)

Chapter 9

After charting on the fourteen-year-old boy with the AVM, I left the PICU to the well wishes of my coworkers: “Get some sleep, Niki. Good job.”

As usual, I leave through the Emergency Department exit, glancing around before remembering that it’s after eight-thirty; Corey went home over an hour ago, and I stood him up for breakfast. He probably heard what happened in PICU from radiology. It’s not that large of a hospital.

The sun is almost blinding this time of morning. After wrapping my stethoscope around the rearview mirror, I search the glove compartment until I find my sunglasses, and put them on. Pulling out of the hospital’s parking lot, I head for home on surface streets. During prime time morning traffic they are congested, requiring my concentration.

While driving home, I relive the shift in my head, wondering if the boy will survive (he doesn’t), and if I’d missed any signs during the night, which may have gotten him help sooner. Lost in thought, I suddenly realize I’m driving in front of an elementary school as I careen a crosswalk at 35 miles an hour. On the curb stands a crossing guard wearing a neon green vest with several school-age children huddled around her.

“Oh shit,” I hiss at myself.

In the rearview mirror I see the flashing lights of a motorcycle officer pulling away from the curb after me. I signal, and pull over. From the mirror, I watch him note my license number, and call something in over his radio. He’s already writing the ticket as he approaches. By the time he gets to the passenger door, I have the window down, and am apologizing profusely. He asks for my driver’s license.

“Officer, I’m so sorry. I didn’t see the crosswalk. I forgot what time it is.”

“Ma’am, you were going thirty-five in a school zone. You just missed taking out a group of children and a crossing guard.”

“I realize that sir. I’m really sorry. I just got off work and I’m really tired. I know that’s no excuse. I’m really, really sorry.”

He contemplates what I just said, and takes a look into my car. I see him take note of my green scrubs, and notice the stethoscope hanging on the rearview mirror.

“Do you work at the hospital a few blocks from here?”

“Yes sir.”

“Are you a nurse?”

“Yes sir.”

“Dammit!” he says. Do you work night shift? Are you getting off late?”

“Yes. We had a bad last few hours.”

“Dammit!” he repeats. “I don’t ticket doctors or nurses. It’s bad Karma. For all I know, I may be a trauma patient in your hospital one day, but I already started writing the ticket. I can’t make it go away once I start writing a ticket.” He looked genuinely worried.

“Ticketing me won’t affect your Karma, Officer. Really. I deserve the ticket. I almost hit a group of kids. I was lucky this time. It doesn’t matter how tired I am, I need to be more careful.”

“Are you sure?”

“I’m sure. Give me the ticket.”

“Alright, well. I’m checking the box that says it’s okay for you to go to traffic school though. That way, it won’t affect your insurance premiums.”

“Thank you, Officer.”

He handed me the ticket.

I rolled up the window, and slowly drove away. When I was out of his sight, I pulled into a large commercial parking lot, locked the doors, and cried.

I didn’t go to traffic school. I wrote a check and paid the ticket.

Posted on by jparadisirn

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.”

Posted on by jparadisirn

The Center of This Body’s Universe (Niki needs caffeine and meets a nice family in the PICU)

Chapter 7

I can’t tell if my headache is caused by too much sleep or not enough.

Without coffee my night shift tuned body doesn’t know whether to wake up, or go to bed, since neither daylight nor darkness have circadian relevance anymore. Caffeine, not the sun,  is the center of this body’s Universe.

I fill the coffee maker and hit “start.”

Maddie is still asleep. Pausing in the doorway of her room I watch the even rise and fall of her chest. She is perfect, her skin creamy and unblemished. I’m constantly wonderstruck by her healthy color, unlike that of the sick children in the PICU.

Silently, I count the blessings: Despite her premature birth, we’ve made it safely past Sudden Infant Death Syndrome, and without childhood febrile seizures. Her bout with Chicken Pox was mild. Maddie’s learned to swim, and is forbidden from riding her bike without a helmet. I calculate my next bout of parental anxiety will begin when she’s old enough to drive.

Although I fix breakfast for Maddie and Simon, I only have coffee. I pack Maddie’s lunch while Simon showers before they leave for school together.

Simon got the teaching position at Woodman middle school, which Maddie will attend this fall. He’ll even supplement his pay by coaching after school, which he’s excited about.

This takes a lot of stress off of me, and things are better in our marriage. In fact, Simon and I have planned a weekend getaway to Coronado for our anniversary in a few weeks. We booked a luxury suite with an ocean view. Maddie’s staying with my sister and her family while we’re away. Simon and I haven’t taken a trip in years. I’m hoping this will refresh our marriage. Things are stale lately; actually it’s been longer than lately.

After Simon and Maddie left, I dressed in riding gear and rode my bike along the beach on the Strand, almost to Santa Monica. It’s not too crowded on a weekday. This morning the sun is out, and sunspots sparkled and danced on the ocean. I love how bicycle riding provides an opportunity to both see and interact with my surroundings.

The rest of the day I spent cleaning the house, followed by a short nap. There’s enough time for a quick dinner with my family before I leave for work.

In the PICU, Kris gives me report on an intubated fourteen year-old boy with an ICP bolt surgically implanted in his skull. It’s recording the pressure in his brain, which is represented as a number on the monitor screen overhead. During report, the number is normal. I assume that’s because he’s sedated.

“No ma’m, no sedation,” Kris informs me. “That’s the problem. He was at basketball practice and took a header into a wall. The coach and his teammates witnessed it. According to them, he didn’t hit the wall all that hard, but he lost consciousness. He’s roused a little, but he’s in and out, mostly out. The CAT scan showed a small bleed, which neuro removed in surgery, but he still isn’t coming to. He has a MRI tomorrow morning. In the meantime, they bolted him, just in case. This is a weird one.”

“It is weird. Is his family in the waiting room? I asked.

“Yeah,” said Kris. “They’re the nicest family.”

Of course they are. The nicest families always have the sickest kids. When a PICU nurse starts report by saying, “This is the nicest family,” you know something is going to go wrong.

Posted on by jparadisirn

Call 911 (Niki comes to the aid of a family in distress at the grocery store)

Chapter 4

The rest of that shift was uneventful. Once dayshift arrived, I gave report on the new admission, and my other patient too. I wash my hands, use the restroom, and wash my hands again.

Never get into a car with a full bladder.

I leave the hospital by the ER exit on my way to the parking lot.

From the driver’s seat, I wrap my stethoscope back in its place of honor around the rearview mirror, lowering the driver’s side window so the cool morning air can keep me awake on the drive home.

It’s seven forty-three am. Simon is getting Maddie ready for school about now, I think to myself. The morning sky is overcast, good weather for daytime sleeping. I can get in a few solid hours of sleep before Maddie comes home from school.

While sliding the key into the ignition, my cell phone rings. It’s Simon.

“Hello?”

“Hey Nik, it’s me. How was your night?”

“Uneventful. What’s up?”

“”I made Maddie pancakes for breakfast and used up the last of the eggs and milk.  Would you pick up some on the way home from work? Oh, and some elbow macaroni too. I’m going to make macaroni and cheese for dinner.”

“Why can’t you do it after you take Maddie to school?”

“Because, love, I have a job interview at Woodman at 10, remember? I need to come home and dress the part.”

“Sorry, I forgot. What about after that?” I whined.

“No good. I have to get home and put together dinner before picking Maddie up from school. The play-offs start today.”

“Can’t you record the play-offs and watch them later?”

Silence.

“Okay, I’ll stop at the store on my way home. Milk, eggs, and elbow macaroni, right?”

“Oh, and get some cheddar cheese. I just looked in the fridge. We’re out of cheddar cheese too.”

“Anything else?”

“Broccoli? Yeah, broccoli. Maddie needs to eat more vegetables. See you when you wake up, Hon. Love you!”

“Yeah. Okay. Me too. And Simon, good luck with the job interview. I know you’re the best candidate.”

I start the ignition, and drive home the long way, so I can stop at the store, feeling guilty I forgot about Simon’s job interview this morning. I should try to be a better wife.

Entering the grocery store, I perk up thinking that the good thing about early morning shopping is that there’s not a whole lot of people. The lines are short, and I can get in and out quickly. I grab a cart, mostly just to have something to lean against while going up and down the aisles after standing most of the night.

A distracted woman is pushing a cart with a boy sitting in it who looks about two years old. Alongside trails his brother, who looks about four. The kid in the cart is playing with a can of spray paint.

I know what happens next before it happens.

The two year-old takes the lid off of the can and in doing so sprays black paint all over his face. Screaming, he drops the can to the floor where it spins around on its side like one of those pinwheel fireworks, spraying black paint instead of sparks everywhere, because its nozzle is broken.

Now the woman and both her children are screaming and crying. The store manager appears, and disables the can. Someone yells, “Call 911!”

I go over to offer help. I’m wearing scrubs, and identify myself as a nurse. The two year-old is crying, but otherwise he’s not in visible distress. Most of the paint is on his chin and neck. Little was ingested, but I don’t know if inhaled fumes are dangerous or not.

I tell the store manager, “Call the poison control center number printed on the side of the can. They can advise us what to do.” The grocery store has a pharmacy, and if Poison Control advises vomiting, I figure Ipecac is probably available. My own phone is in my car.

The store manager stares at me blankly.

Turning my attention to the two children and their mother, I try to calm them. This turns out to be impossible. They continue to scream and cry.

Then a man runs up informing us that he has called 911.

By now a small group of people have gathered and are staring.

Relieved, I hear the sirens of the fire truck bringing the paramedics as it pulls into the parking lot.

I roll my cart to the checkout line. There’s nothing more I can do.

I overhear one of the paramedics ask as he arrives on the scene, “Has anyone contacted Poison Control?”

Sigh.

Posted on by jparadisirn

A Good Shift (Niki introduces two coworkers)

Chapter 2

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

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

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

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

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