How to Sabotage a Shift (Niki Meets a Service Dog)

Chapter 56

Never, ever think your shift is easy and you may go home early. It’s the quickest way to sabotage it.

The shift started well enough. I did vitals and passed meds for the two post-open heart patients first. They each have private rooms, and I chatted a bit with their respective parents. Transferring their children from the PICU to the general floor makes some parents uneasy, even though they understand it means their child is getting well. In the PICU, they become used to their child receiving one-on-one nursing care. They become accustomed to the vigilance of a nurse dedicated to the care of only their child. On the pediatric unit, the nurses are assigned three or four patients plus their child. The parents are now required to practice vigilance for their previously critically ill child’s care. Understandably, some are more comfortable than others. My patients’ parents recognize me from the PICU. A familiar face eases their minds. Our rapport encourages my belief it will be an easy shift.

My third patient shares his room with another.

During report the night shift nurse said, “Niki, your patient, Travis, is a delight, you’ll love him. Unfortunately, his roommate is a bit of a handful, so we assigned him to another nurse. He saw Travis’ seeing eye dog, Reege, and insisted his parents bring his dog to stay with him. They brought him in last night, claiming it’s a service dog too. Fortunately, Travis’ dog is a professional, and ignores the little dog’s aggressive behavior towards him.”

“Well, if Travis and Reege can ignore the other dog, I guess I can too.”

 

“Hi Travis, my name’s Niki. Is this beautiful dog is your partner, Reege?”

“Hi Niki, I need to go to the bathroom. Can you put the IV pole where I can reach it please?”

“Sure. Do you need help?”

“Nope.”

I watch Travis handle the IV pole, and grip Reege’s harness with his other hand. Reege, a golden retriever, pads along silently, leading Travis the to the bathroom. Travis seems steady enough, but his fall risk makes me nervous, so I wait for them in the room.

On the return trip I try again, “Is it okay if I take the IV pole for you?”

“Sure.”

After Travis is back in bed and Reege settled at his bedside, I take his vitals.

“Travis, are you hungry or is your stomach still bothering you? The breakfast trays should arrive soon.”

“I’m hungry. Do you guys have bacon?”

“Of course, but if there’s no bacon on your tray, I’ll call down to the kitchen and get you some.”

“Thanks!”

As if on cue, the meal cart arrives, and I find Travis’ tray. Lucky me! There’s bacon.

I place the tray on his table, adjusting the bed and utensils so they’re within reach. Travis tells me he’s right-handed.

“You’ve done this before, I see.”

“Yeah, a few times,” he grins. Would you tell me what’s on the plate, and its place on the face of a clock?”

“Sure. Anything else? Do you want me to butter the toast or cut anything for you?”

“Nope, I got it. Thanks.”

“Hey Nurse. Hey!” It’s the kid in the other bed. He’s got his dog, a nondescript terrier mix, in his lap.

“Hi. Do you need something?’

“Yeah, can you get some bacon for Rocket?”

“Sure. I’ll make a call to the kitchen.”

When I near his bed, Rocket growls at me.

“Do you want to pet him?”

“Does he bite? I thought strangers shouldn’t pet service dogs.”

“People just say that because they think their dog is more special than Rocket.” The kid glares at Travis, who flips him off. I try not to laugh.

“He only bites if he doesn’t like you. If you give him some bacon, I’m pretty sure he won’t bite.”

“Um, okay. I’ll order the bacon and let your nurse know.”

I leave their call lights within reach, bed rails up, and take breakfast trays to my other two patients. After they’re done, I help their mothers with bathing and dressing them.

One of the perks of day shift is the café is open. There’s time to go downstairs and bring a latte back to the unit. I get in line. There are two police officers ahead of me.

One of them is Officer Mike.

“Hey, Nurse Niki. What are you doing, getting a latte before heading home? I thought night shift prefers beer for breakfast.”

How the hell does he know that?

“Well Officer Mike, how nice to run into you again. No more nights for this nurse. I’ve transferred to day shift.”

“Congratulations. Welcome to the land of the living Niki. See you around.”

Mike and his partner take their coffees from the counter.

Did he just look my way again before walking away?

At The Raleigh (Niki & Gerald Go Out for Drinks)

Chapter 49

In an upscale restaurant overlooking Santa Monica Bay, I’m standing behind a long table. Every seat is filled with PICU nurses, and staff from other departments celebrating Kris’s bridal shower. Above the chatter and laughter, Kris holds up a scanty piece of lacy lingerie, a gift inciting a round of cell phone photos from the group.

Gerald sidled next to me, “Hey girlfriend, you’ve been working that same drink for an hour. Can I bring you something fresh?”

I smile at his thoughtfulness, “No thanks, this is fine.”

“How are you holding up, Niki? I’m worried about you.”

“Huh? I’m fine. Why are you worried about me?”

“I’m thinking how you might feel: Kris is getting married, your ex-husband is getting married. And Corey moved to Seattle with his family. You know.”

I didn’t know Gerald knew.

“You knew about me and Corey?”

“It was pretty obvious, especially when our group beer breakfasts ended.”

“I’m sorry Gerald. I haven’t been a very good friend lately, especially to you and Liz. I’m sorry.”

“Don’t be sorry Niki. I’m thinking you’re the one who needs friends now.”

Liz joins us. She’s carrying her purse.

“Leave it to Kris to live large,” remarks Liz. “I wish I was as fearless about life.”

“Why do you assume that quitting your job, and marrying a rock star to take care of his mother on tour is a risk?” asks Gerald.

The three of us pause to think about it, and then bust out laughing.

“So Niki, when’s Simon getting remarried?” asks Liz.

“Next week.”

“How are you doing? Does it feel weird?”

“A little. Maddie’s so excited about it. Amber took her shopping for a dress, and I realized she has a stepmother now. I’m trying to see it as a positive, you know, like another adult caring about my daughter’s welfare, but sometimes I think  Maddie’s comparing us.”

“You’ll always be her mother, Niki. Nothing will ever change that,” says Liz.

“I know.”

Someone pops a bottle of champagne, while Kris cuts pieces of cake passed around to the guests. A server brings the check. I notice Dr. Polk takes it and places his credit card into the leatherette folder without looking over the bill.

“You leaving Liz?”

“Yeah. I gotta get home, and check Nathan.”

“I was just telling Niki that the three of us should go out this weekend. Have drinks, some fun, and get our group back together. Are you in Liz?”

“I’d love too, but Nathan’s grounded, which means I am too. He’s been in some trouble lately, so I’m staying close to home.”

“I’m sorry to hear that. Anything I can do to help?”

“No,” says Liz, “but thanks for offering.”

“Well Niki, it looks like it’s you and me. Do you like cabaret?”

“I don’t know.”

“Meet me at the Raleigh on Saturday night, and let’s find out. Prepare for a good time.”

* * *

At the Raleigh, I hand my car key to a valet, grateful I don’t have to search for parking. Gerald’s at the club’s entrance, wearing a black v-necked tee, designer jeans, a grey sports jacket slung over one shoulder. His hair and light beard are neatly groomed. He smells nice when I hug him. I’m glad I decided to wear a little black dress, and pumps.

“Gerald, you clean up real nice!” I kissed his cheek.

“You too darling. I don’t know how toned your legs are when I only see you in scrubs. Love the heels.”

Gerald holds the door, and then takes me by the elbow, guiding us to a small table near the stage. A server in black slacks, and bow tie, but otherwise shirtless, instantly sets a scotch rocks in front of Gerald, and then waits for my order. “I’ll have a gin and tonic please.”

“Put it on my tab,” says Gerald, handing the server a bill, which he tucks into the waistband of his pants before walking away.

“I’ve never been to a male strip club,” I admit. “Or a female strip club either, for that matter”

“There’s a first time for everything,” laughs Gerald. “I think you’re going to have fun.”

Looking around, I agree. The dimly lit lounge is spacious. Couples and foursomes of men and women occupy the small tables surrounding the stage. Beyond the tables the bar is bustling and a small wooden dance floor already teems with people dancing to the heavy beat of music. Others stand around with drinks in hand, talking. In the far back a large group of women appear to be celebrating a birthday: gift wrapped packages and bottles of wine in velvet bags are piled in front of one of them.

The server returns with my drink, and places a small plate of cheeses, sliced meats, and bruschetta on the table. I notice there’s glitter on his chest.

“On the house,” he says.

“Tell Rubio, thanks,” instructs Gerald.

“You know the owner?”

“Yes. That’s how we scored a reservation for this table.”

“Very cool.”

The rest of the evening is almost a blur. The entertainers performed individually and then in groups. Our server keeps bringing us drinks. Buzzed, Gerald points out that if I look towards the stage through the bottom of his empty glass, “Things will appear larger.”

Laughing and nearly as buzzed, I wonder out loud, “What does it mean if you and I find the same dancers attractive, Gerald?”

“Does it matter?”

“No, it doesn’t matter at all.”

What Nurses Look Like (Niki Ponders Professional Identity)

Chapter 33

Back at work, the photo shoot is quickly forgotten in the revolving chaos of pediatric intensive care nursing. Despite the cute styles and print fabrics of the scrubs we wore on the set, tonight I’m wearing plain green scrubs pilfered from the OR.  You have to know someone with the keypad code to the dressing room to get them. Everyone in PICU wears OR scrubs, even the doctors. I suppose this confuses patients, who can’t identify the different roles of the myriad of staff entering their rooms. Despite Registered Nurse stamped in large letters on my name badge, I’m often asked by parents, “Are you the doctor?”

What makes a nurse look like a nurse?

Tonight I walk into a change of shift admission. In pediatrics this sometimes happens because everyone agrees that a child shouldn’t die in the ER if there’s time to transfer them first. Tonight, this is the case.

My patient is a two year-old near drowning. Near drowning is sort of like saying a patient has an infection. It describes a broad range of outcomes from “The kid swallowed a bunch of water, and we suspect aspiration pneumonia,” to “He’s brain-dead, and the parents requested organ donation. We’re waiting for the team to arrive.”

The parents of my patient have requested organ donation services.

Gerald sets the child up on the ventilator, Kris transfers the monitor leads, and Dr. Polk assesses the child, while Corey gives report.

“He was with a babysitter, while his mother went to work. The baby sitter is a close friend, like a grandmother. The two year-old had a cold, and he can’t be sick at daycare. The babysitter says she was only on the phone for a few minutes while the child watched TV. When she turned around, he was gone. After searching for him inside and out for about fifteen minutes, she called the police and the child’s mother. Waiting for them to arrive, she knocked on the doors of her neighbors, asking if they’d seen him. It did not occur to her to look under the heavy cover of her hot tub. She knew the cover was too heavy for a toddler to lift. It was the first place the policemen looked when they arrived. Somehow, the boy lifted the cover, and fell into the hot tub. His face had wedged below the water. CPR was started, and a heartbeat recovered. He was intubated at the scene, and arrived at code speed by ambulance to our ER.”

In my mind, I visualized the rest of the story:

In the ER, his heart stopped several more times. The doctors and nurses performed heroics, while a social worker wrapped her arms around the child’s sobbing mother, “Please don’t die, please don’t die.”

They stabilized his vital signs long enough to transfer him to PICU, where our nurses will guide his parents through the remainder of their child’s journey on Earth.

After report, I prepared myself to spend the next twelve hours in a room of suffering in close proximity to a shattered family. You only have one opportunity to get it right. You cannot take away their pain, but you owe it to them to not add to it. Any anxiety I have about the child’s care will be shared privately with my colleagues, not spoken out loud in front of the parents.

In nursing school, our instructors taught us to not show emotion in front of the family, no matter how heart wrenching the story. They told us that our job is to deliver care, and offer support. While I agree that families should never be put in the position of supporting a distraught nurse, in my experience, showing some emotion, even tears, is interpreted by the family as an acknowledgment of their loss. Nurses are the embodiment of humanity in what is dubbed the “technological fortress” of a hospital. The ordeals patients suffer matter to their nurses. We are nurses, because life and death matter to us. We serve by way of our skills.

That is what nurses look like.

I’m glad I wore plain green scrubs tonight. Tonight the PICU is not the place for cheerful prints.

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.

It Makes Me Shudder (When the line between victim & perpetrator blurs)

 Chapter 23

 The police officer stands silently in the doorway of my patient’s room, watching as I listen to her chest with my stethoscope. Her breath sounds are clear and equal on both sides. Next, I check the tube threaded through her nose into her stomach. It’s draining dark green fluid into a suction canister fastened to the wall. I measure the amount of fluid in the canister and record that number in the electronic chart. I feel her pulses. They’re strong, and easy to find, coinciding with the numeric value for her heart rate on the monitor overhead.

When I’ve finished the assessment, the officer speaks. “I don’t know how you nurses do it. I couldn’t work with hurt kids. It would break my heart everyday.”

“I don’t know, I guess I think of it more as helping,” I offer. “I couldn’t be first on the scene like you police officers. I mean, putting yourself in lethal danger in order to protect the nameless public takes more heroism than I could muster.”

“I guess we just sort of pick the kind of work we’re able to do, then. By the way, my name is Mike.”

“Hi Mike, I’m Niki. I’d shake your hand, but I need to wash it first, after I take off the glove.  I don’t want to be rude, but I’m pretty cautious about spreading germs.”

“Understood. Thanks for the information.” Mike has a cute smile, and gentle eyes. “Well, I gotta go and see if the detective has any new information for me. If she’s cleared for now, is it okay if I send the mother in to see her kid?”

“Sure.”

“Well, Nurse Niki, if you have any questions about the case, or information for that matter, feel free to give me a call. Here’s my business card.”

I watch Officer Mike leave the PICU, holding his card in my hand. He seems like a nice guy. Maybe in a few weeks I will call him. Maybe it’s time I stop wearing my wedding ring on my right hand and take it off altogether. I put his card in the pocket of my jacket.

Half an hour later, my patient’s mother enters the PICU. She’s young, early twenties. She’s wearing grey sweats that hang from her slim hips over a pair of black plastic flip-flops. A blue and black hoodie drapes over her ribbed white tank top, revealing an equally skinny torso.  She looks like she doesn’t get enough to eat, but her acrylic nails sport elaborate nail art. She’s wearing huge gold hoops in her ears too. ‘Go large or go home,’ comes to mind.

Mariella, our social worker, accompanies her, and introduces me to the mother, who looks me up and down suspiciously before noticing her unconscious daughter on the hospital bed with all the tubes connected to her. She starts to cry. This is the cue I depend upon in order to form some sort of therapeutic bond with parents of abused children until who hurt the child? is established.

I drag a lounger from the other corner of the room to the child’s bedside, and Mariella settles the mom into it, and then fetches a cup of coffee, and a blanket from the PICU’s warmer. She wraps the blanket around the mom’s shoulders, before handing her her card, and leaves the unit.

An awkward silence fills the room.

“So. Do you have any questions?” I begin.

“How long is she going to be in the hospital?”

“We don’t know that yet. Hopefully, she’ll come off the breathing machine sometime tomorrow. She’ll probably stay another night here, then be transferred to the regular pediatric unit, and spend some days there too. She’ll go home when there’s no bleeding and the surgeon lets her up out of bed.” I avoided adding, “Unless social services removes her to their custody.”

“Why would she bleed? I thought the surgeon fixed her?” She eyes me suspiciously again.

“She repaired your daughter’s liver, that’s right, but a lot of the body’s blood travels through the liver. There’s always a chance that the wounds will still bleed. She could lose a lot of blood again if that happens. We’re watching her closely to prevent that. That’s what all of these machines are helping us do.”

“Oh.”

In my experience, parents involved in their child’s abuse take one of two stances with nurses: They are either angry and argumentative, or they campaign to win our sympathy. This mom chose the latter.

“He didn’t kick her, you know. He works hard, and when he comes home he expects things to be in order. Sasha isn’t a good girl. She doesn’t do what she’s told. I have to get on her all the time. She lies too. I don’t know why they think he kicked her. Maybe she’s got cancer and it’s making her bleed.”

“Sasha doesn’t have cancer. The doctors can see that with all the tests, and during the surgery too. He’s not Sasha’s father, right?”

“Naw. He left before Sasha born. He was no good.”

I fall silent taking in this information.

“Has he hurt you or Sasha before?” I know I’m going to have to chart her answer.

“He’s only mad when we deserve it. He don’t hit when we do what we should.”

“Have you ever thought that you and your daughter deserve to be safe in your home? That a man shouldn’t hit a woman or child, ever?”

“You got a man, Nurse? You know how hard to raise a child alone is?”

A sudden realization slapped me in the face: This woman and I are both single mothers, wanting to have relationships with men who are not the father of our children. I could be her. The thought chilled me.

We didn’t talk much the rest of the shift. In the morning, Mariella returned with a female police officer. They escorted the mother out of the PICU. Soon afterwards, Mariella returned.

“They’re taking her down to the station. The boyfriend is saying she kicked the girl. He says he tried to stop her.  We’re hoping she’ll file a report against him with the details of the assault, so he can be charged.”

“You might want to know,” she added, “The mom is known to us. We have an open file on her. Sasha was the result of rape by her mother’s boyfriend. And our boyfriend, we’ve seen him before too, when his father was arrested for breaking his arm.”

I can’t believe Mariella earned a Master’s degree to do this kind of work. I think her job is more difficult than mine.

Later, I talk to Liz about it. “I hate when the lines between victim and abuser are blurred like this. I don’t understand how a mother wouldn’t choose a better life for herself, and especially for her child.”

“You’re new at being a single mother Niki,” she said. “You’d be surprised how lonely it can be out there.”

Something about the way Liz says it makes me shudder.

I know I won’t be giving Officer Mike a call anytime soon, either.

After The Flood (Nothing angers a PICU team like child abuse)

Chapter 22

At Raquel’s house, I sat on the sofa listening to The Cowboy Junkies with a blanket wrapped around my shoulders. Raquel brought me another mug of cardamom-spiced tea. Upstairs, Maddie played with her cousins.

Raquel sat on the sofa next to me, and put her head on my shoulder like she used to do when we were kids and something bad had happened.

“It feels like the flu, doesn’t it? The grief, I mean,” she said. “It’s weird how grief actually has physical symptoms: nausea, muscle aches, and shortness of breath.”

“How can you tell the difference between grief and an anxiety attack?” I asked.

“When it’s anxiety you can’t breathe at all,” was her answer.

“At least then I’d be unconscious. I might actually feel better,” I grumbled.

“I think it’s time we switched you to something stronger than tea. I’ll go open a bottle of wine. We’ll order pizza delivery for the kids’ dinner tonight. Grant can fend for himself.”

Maddie and I stayed the weekend with Raquel and Grant while Simon moved his things from our rented house into a near-by two-bedroom apartment. Because parenting Maddie was the only thing of value we shared, we were able to come to a divorce agreement through mediation. Our meager assets were split down the middle.

As for Maddie, we didn’t need King Solomon to decide what was best for her. Since she was at school during weekdays, Simon and I agreed that she would stay with him the nights I worked, and with me on my days off. We alternated weekends, and would take each holiday as they came.

“But Niki, that means you’re either at work, or have Maddie at home on your time off,” Raquel pointed out. “How are you going to have any sort of social life?”

“I’ll figure it out if it happens,” the words sounded doubtful, even to me.

 ***

I told Liz and Gerald about the divorce during a quiet moment at the nurses’ desk.

“Wow, Niki, I’m sorry to hear about you and Simon. I knew you were having troubles, but I always thought you’d work things out. I’m really sorry.”

“Thanks, Liz. The hardest part was making the actual decision. Once I knew that Simon was miserable too, the emotion sort of went out of it. I just hope Maddie will eventually understand.”

“How’s she doing?” asked Gerald.

“She seems okay. She uses it a little for sympathy. Like she complains about how hard it is to pack for her father’s during the week, so she wants new clothes to keep at Simon’s apartment. She also fibbed, ‘I forgot my homework at my Mom’s house,’ as an excuse to her teacher last week instead of owning up to not doing it. I guess it’s to be expected. Fortunately, the only thing Simon and I tend to agree on is how to raise her, so the rules are the same in both homes. Maddie’s the only thing we have in common anymore.”

“Have you told Corey yet?”

“No, I haven’t seen him lately.”

Liz said, “Oh,” but Gerald gave me this funny look before his pager went off, calling him to another unit.

***

 Around midnight, we admitted a seven-year old girl from the OR where a surgeon repaired her ruptured liver. A police officer trailed alongside her bed as it was pushed into the PICU room. He waited outside the door while Gerald connected her breathing tube to the ventilator, and I transferred the leads from a portable unit to the overhead monitor. A unit of red blood cells infused into her central line. Her vitals were stable.

The recovery room nurse read off report: a ruptured liver caused by blunt force trauma to her abdomen. This kind of injury often occurs during a bad car accident, but this little girl had been kicked in her stomach. Hard. By her mother’s boyfriend.

Horrified, I asked, “Why would a grown man kick a child?” then realized how naive I sounded.

The police officer answered, “The mother reports he kicked her after she brought home a kitten he’d told her earlier she couldn’t keep. He left the premises afterwards. We got the bastard. He made a call on his cell phone from a friend’s house. We picked him up a couple of hours ago.”

“Where’s her mother now? Was she with him?” I thought I might kill the guy if I’d been her.

“She’s the one who called the ambulance. The EMTs called us,” the officer continued. “She told them it was an accident, ‘he didn’t mean to get so angry, the girl doesn’t listen to what she’s told all the time.’ We have a detective interviewing her down the hall. She may be booked too, if there’s enough evidence.”

Nothing angers a pediatric intensive care team more than child abuse. We spend our careers saving the lives of children with defective hearts, lethal infections, or damaged in car accidents. Treating a perfectly healthy child whose parent battered them angers us more than pretty much anything. When the loving parents of our other patients see the police in the unit, they figure out the situation pretty quickly, and then the PICU becomes tense, more so than usual, fed by their anger too.

The Adventures of Nurse Niki is on holiday hiatus, resuming with the next chapter on January 2, 2014. Happy Holidays to all her readers!

Is Everything Okay? (Niki’s nursing assessment saves a baby)

  

Chapter 17

I woke up in the afternoon having slept poorly after the bad dream. Schlepping my way into the kitchen, I made a cup of tea.

Simon dropped Maddie off from school, and then went back to coach practice. I helped Maddie with her homework while starting dinner.

During dinner Maddie chatted animatedly about what her friends at school are up to. Simon tells us about a new project he’s introduced to his students. He notices my distraction and asks, “Is everything okay, Nik?”

“Oh, yeah, I’m fine. I just didn’t sleep well today.”

Simon gives me a curious look, but makes no comment.

I kiss them good-bye before leaving for work.

***

Corey brings a ventilated baby with pneumonia to the PICU at change of shift. He turns his head away, but not before giving me a look so sharp I catch my breath.

Pointedly, Corey gives the report to Kathy. As he leaves the unit, he looks at me again. Silently, I mouth the words, “Can we talk?” but he puts his head down, rapidly disappearing down the corridor outside the PICU.

Kris is finishing her day shift charting at the nurses’ desk. I suddenly realize she’s seen all of this.

“Everything okay, Niki?”

“Yeah, why?”

“I’ve never seen Corey transfer a patient so fast when you’re here, that’s all.”

“Mind your own business, Kris.”

She raises an eyebrow at me, and returns to her charting.

***

Later in the shift, the pulse ox alarm in Kathy’s patient’s room sounds, and she gets up to check on it. Poking her head out the room’s door, she says, “Niki I need to suction him. Would you help?”

At the crib, I manage the ambu bag; manually giving the baby breaths of oxygen while Kathy suctions its breathing tube to remove secretions. Nothing comes up, so she places a few drops of normal saline down the tube before making another pass. A bit of yellow-green mucous comes up. She replaces the ventilator tubing, and silences the pulse ox alarm again when it continues to read 90%.

“That’s funny. His oxygen saturation should improve after suctioning,” she observes out loud.

“Maybe he’s due for a respiratory treatment,” I offer. “I’ll page Gerald.”

Gerald administers an aerosolized medication into the ventilator tubing, and then gently taps on the baby’s chest and back with a soft rubber percussor. Kathy suctions again, while Gerald bags. Still, no significant secretions. The baby’s oxygen saturation drops to 85%.

I listen to his chest with my stethoscope. There’s breath sounds on both sides. However, the little guy begins pulling hard with every breath. We watch as the tiny muscles between his ribs pull in with the work of breathing.

“He’s getting worse.”

Gerald takes him off of the ventilator, and starts hand bagging again. I suction without secretions, while Kathy pages Dr. Polk.

“He’s down in the ER, assisting with a pediatric trauma. He said to keep bagging.  He’ll be up as soon as he can.”

“I’m not sure we can wait that long,” I said. Not only were the sats less than 80%, but now the baby’s heart rate was dropping.

“What’s wrong?” Kathy called out.

Insight flashed before me, “His breathing tube is blocked.”

“Are you sure? asked Kathy. “How do you know?”

“It has to be. His chest sounds are good. He’s moving air, but he’s not getting oxygen from either the vent or the bag. We’ve got to pull the tube out now!”

“Dr. Polk said to continue bagging until he arrives,” warns Kathy.

“The baby is going to code if we don’t pull the tube now,” I insisted.

“Yeah, and who’s going to take responsibility for that, Niki?” Gerald cautioned.

“I will,” I said. “I’m pulling the ET tube.”

I removed the tape from the baby’s face, allowing the tube to slide out easily. At its end was a glob of thick, white secretions half the diameter of a ping-pong ball. It resembled a wad of chewed up bubble gum. I laid the mucous-blocked tube on a paper towel, and placed it on the bedside table. The baby started to cry.

“Well lookee there,” said Gerald. Immediately the oxygenation returned to 100%, and his heart rate returned to normal.

The three of us remained at the baby’s crib, watching him breathe; Gerald helping him out with occasional bagged breaths until Dr. Polk arrived.

Flying into the room, Dr. Polk saw Gerald bagging his extubated patient.

“Who pulled out the goddamn ET tube?” he roared.

“I did, Dr. Polk.” I held up the gelatinous ET tube for him to see.

“Good job,” he said. “Everything looks okay.”

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

Chapter 14 

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

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

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

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

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

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

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

***

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

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

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

“Amen,” agrees Corey.

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

“Go ahead Niki, have a piece.”

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

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

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

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

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

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

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

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

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

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

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

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

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

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

“Thanks Niki.”

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.