Then Everything Happens So Fast

Chapter 68

“Pick up the phone!”

I stop pushing the plunger, and set the syringe of fentanyl on Nathan’s bed, then reach for the phone on the nightstand. Hesitantly, I put the receiver to my ear.

“Hello?”

“Don’t say anything. Put down the receiver and move away from the window, NOW.”

There’s a click on the other end of the line.

Simultaneously, I see the red beam of a laser scope track a bead to Frank’s head from the window on the right side of Nathan’s room.

I step back further towards the head of Nathan’s bed, clear of the window.

Frank looks puzzled.

Then he turns toward the light, closes his eyes, and bows his head, before it shatters into a mosaic of fragments on the wall behind him.

The PICU room’s glass door slides open, and a two canisters roll into the room. The first makes a terrifying BANG! as it explodes in a burst of light. The other emits what looks like smoke, but the immediate burning irritation of my eyes tells me it’s gas. I begin coughing.

Then everything happens so fast.

A blanket is thrown over me, and my head pushed down, while someone drags me forward through the doorway. From this view, I see pairs of booted feet, followed by clogged feet, and then the wheels of three gurneys charge past me into Nathan’s room.

Still covered by the blanket, I’m pushed forward, almost faster than I can keep up, to the hospital’s exit stairway. At times I’m shoved against a wall to make room for more sets of booted feet charging up the stairs.

Eventually, we reach the lobby.

At the exit to the hospital’s parking lot, a familiar sounding voice I can’t place says, “Thank you officer. I know her. I’ll take her to the command center.”

I feel two sets of arms exchange me between them like a package.

“Niki, are you alright? You must be so scared. You’re safe now, Niki. I got you.”

Only then do I pull the blanket away from my head and stand up straight.

Leading me out of the hospital, with his arms around my shoulders, is Officer Mike.

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.

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.

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.

A Trip to The Mall

Chapter 44

I get home from work and fall into bed without showering first. Troubled about Corey, and tired from a long nightshift, I toss and turn through fragments of terrible dreams I can’t remember.

After several hours I give up all hope of restful sleep, and lie awake in the darkened room. The extra cell phone charger I bought for Corey’s use sits on the nightstand across from me. I wrap it around itself before tossing it into the back of the drawer. Padding into the master bathroom, I remove the bar of soap, the brand Corey uses, from the shower tray, holding it to my nose, and breathing its fragrance into memory before tossing it in the wastebasket. Almost a year ago I purged Simon the same way.

I don’t bother to dry my hair after showering. Instead I make a cup of tea in the kitchen. Maddie will be home soon. Like a mantra, I count the many blessings in my life, beginning with Maddie: I am lucky to be her mom, and have a career by which I can support the two of us. Things will look up. I recover the sense of unexpected relief I felt when Simon left, and again when Corey first told me about Sheila’s cancer: “I don’t have to do this anymore.”

Maybe I’m not supposed to have long-term relationships? But the thought of spending the rest of my life alone chills me. In nursing school I saw too many elderly dying alone in hospital beds- their only visitors a hospital assigned chaplain, or the occasional neighbor checking in. What if I become a hoarder, or a crazy cat lady?

I reel myself in. Where do I get these thoughts? Simon’s right, I always jump to worse case scenario.

Next, I change my Facebook settings, making Corey an “acquaintance,” which seems more grown up than unfriending him. “You’re single,” I remind myself. “You can do as you please,” but I cry for a bit before placing cold, wet washcloths on my eyes to lessen the redness, hoping Maddie won’t notice when she gets home from school.

Her arrival is announced by the slamming of a car door in the driveway, and Kaylee’s mom driving off. Kaylee’s mom works at home. I admire her for being president of the PTA, and organizing social activities at our daughters’ school. I help out making snacks, occasionally manning a table, and carting boxes of chocolate bars, cookie dough, or gift-wrap to the hospital, and selling them to coworkers for fundraisers. I feel perpetually guilty for not being more of a presence.

So I quickly agree when Maddie, after throwing her backpack on the dining room table beside my tote bag, asks breathlessly, “Mom, will you take me and Kaylee shopping at the Mall this weekend? Can we see a movie too?”

“Sure,” I answer.

Maddie hovers over me, delivering a hug and quick kiss. “Thanks Mom! How was work? Did your friends like your picture on the magazine?”

“Yeah. They brought a cake, and taped little copies of the cover on their name badges. It was funny.”

“Cool! I’m going to text Kaylee and tell her you said yes.”

Simon and I agreed it’s time for Maddie to have a cell phone.

“Okay. Do you have homework?”

“Yeah. I’ll do it before dinner,” Maddie is already down the hall to her bedroom, shutting the door behind her.

***

On Saturday morning I’m up early for a three mile run while Maddie eats breakfast and gets ready for the mall; a complex ritual requiring phone calls to Kaylee, several changes of clothing, and experimenting with the small amount of make up she’s allowed to wear when out with her friends.

After my shower, I slide on yoga pants, a fluorescent pink tank under a jacket, and flip flops, which are essentially off-duty scrubs.

We pick up Kaylee. It’s a warm, sunny day and I’m looking forward to hanging out a bit with them. Their faces are pink and healthy, their bodies strong. I whisper a small prayer of thanks.

The girls chatter non-stop in the back seat of the car reading texts they send and receive. I have some shopping to do too, so we enter the mall together.

“So let’s meet back here after the movie. Text if you’re running late.”

“Mom, can we go out to dinner after? And can Kaylee spend the night?”

“Sure. Ask Kaylee’s Mom if it’s okay though.”

“We already texted her. She said it’s fine.”

“Well, okay then. Stay out of trouble. Text me if anything comes up.”

“We will. How many times are you going to tell us to text, Mom?”

Giggling, they run off to their exclusive universe.

***

At a department store counter I try on a new lipstick, scrutinizing my face in the small mirror the clerk hands me. The color is good, and brightens my mood, so I buy it.

In the uniform store, I find a set of scrubs I modeled for Call Lights Magazine. I buy them, and a new pair of clogs too. Having something new to wear will help me through the next post-Corey shift.

After aimless window-shopping, I take the escalator upstairs to the food court where a teenager wearing the same pair of disposable gloves to handle everything makes my smoothie. I settle at a table overlooking the ice rink two levels below. Children and adults glide over the ice to an instrumental version of “I Will Always Love You.”

Violently, I’m thrown from reverie by the sight of Corey in line at a food stand across the court. Beside him is Sheila, radiant in a pink sundress; a scarf artfully wrapped around her head. Next to her are their two daughters, also dressed in matching pink sundresses.

I can’t breathe.

I abandon the smoothie on the table, rapidly, and I hope inconspicuously, making my way to the women’s restroom. Ducking into the first empty stall, its door slamming behind me, I squat in front of the toilet, trying to avoid touching the seat. I vomit until there’s nothing left but dry heaves. I’m sweaty and chilled.

The retching stops and I can stand without crumpling to the white tiled floor. I exit the stall and splash cold water from the sink in my face until its color returns in the mirror. I comb my hair, and apply the new lipstick, but my bravado is gone.

After what seems like long enough, I venture out of the women’s restroom into the long hallway leading back to the food court.

I am taken aback by bumping into Corey outside the restroom door.

The Wrong Side of a Sentinel Event Review (Niki empathizes)

Chapter 40

I woke up in Raquel’s and Grant’s guest room when a bright shaft of morning light slipped between the honeycombed shades and into my eyes. This never happens at home where I’ve installed black out shades in my bedroom, because I work night shift. My hand, tingly-numb from sleeping on it, reaches for and locates my phone on the nightstand. I check it for texts.

There’s one from the PICU manager asking if I’m interested in picking up an overtime shift. She doesn’t realize I’m out of town.

Next, Maddie’s sent a selfie of her and Wade eating hot dogs in Amber’s backyard after our phone conversation yesterday.

I’m disappointed there isn’t one from Corey. It hurts a bit, but I remind myself this is a tough time for him. Then I dismiss the matter from further thought.

After a serving a quick Raquel drops her kids off at school, we go to a cross fit workout at her gym. She’s is an animal, performing amazing feats with weights, pull-ups, and standing squats. I admire her “guns,” the well-defined muscles of her upper arms, noticeable in her tank top.

“Niki, you should work on your core. You’d gain a lot of strength with a little work,” observes Raquel.

“Maybe, but I rarely go to gyms. Don’t judge me. I like the outdoors, running or riding a bicycle. Maybe because hospitals are such closed environments. You are a lot stronger than me though.”

Afterwards, we stop for smoothies before going home. Then I shower, and borrow a pair of slacks and a blazer from Raquel, hoping I don’t look out of place at the deposition this afternoon.

Grant greets me in the conference room at his office building, fifteen minutes before the deposition is scheduled. We choose our places at the conference table, facing the door before the other nurse and her legal representative arrive.

“Thanks for coming Niki. I realize you hadn’t expected to sit in, but I think it will be useful to us. I don’t want you to say anything, just listen. Have you sat at deposition before? No, of course you haven’t, because I would have been there for you. Sometimes it’s good to have a lawyer in the family, right?”

“Absolutely Grant, I just hope I never need you. The long-term goal of my career is to never sit on the wrong side of a sentinel review committee.”

“Well, unfortunately, it happens to very good nurses sometimes. I’ve seen my share,” admits Grant.

“I guess I’m kind of feeling bad for this nurse I’ll meet today, Grant. I mean, good or bad aside, I don’t know anyone in health care who starts a shift thinking, ‘today I’m going to hurt a patient.’ People go into nursing to help others, not to cause accidental harm.”

“I understand, Niki. What you have to realize, is that this case isn’t really about placing blame on the nurse. What we want to establish is that an employee of the hospital, in this case a nurse, made a mistake contributing to a wrongful death, making it the hospital’s responsibility. Nobody is interested in suing the nurse. We’re defending Dr. Straid from being sued. He stands to lose a considerable amount of his financial assets. He has a couple kids in college, a house, and a business to protect.

Maybe the nurse won’t get sued, but she’s going to have to find a way to sleep at night for the rest of her life if she’s blamed for contributing to the death of a child, I think to myself. I keep forgetting which team I’m on.

“But Dr. Straid’s not guilty, is he Grant?”

“Of course not, the nurse didn’t inform him of how sick the boy was. The hospital is the deep pocket here Niki, not the nurse. A patient should be safe in a hospital, right?”

“Yeah, you’re right, Grant. Patients should be safe in any hospital.”

“That a girl. Now, here comes the nurse, and the hospital lawyer. Remember, don’t talk just listen.”

Seeking Justice (Niki reviews a nurse’s notes)

Chapter 37

In the conference room, Grant gives a brief explanation of the case I’m to review:

“According to the ER record, the parents reported their three-year old wasn’t interested in eating for a couple of days and when he stopped drinking fluids too they became concerned, bringing him to the hospital’s ER. A temperature of 102.5 was recorded, but otherwise his vital signs were normal, with a slightly elevated pulse. Concern for dehydration led the ER staff to draw blood tests, and start an IV. They decided to admit the boy to the pediatric unit for IV fluids, antibiotics, and observation overnight.

He arrived on the pediatric unit at 10:30 pm. According to the nurse’s admission note, he was lethargic. He received a dose of IV antibiotic within an hour of his arrival. After that, the order of events is vague. His mother noticed a rash on the boy’s chest and arms during the antibiotic infusion. The nurse called the attending pediatrician, who was at home, and reported the rash. The boy received a dose of IV diphenhydramine, and steroid to treat the rash assumed to be an allergic reaction to the antibiotic. The boy fell asleep.

The next entry in the nurse’s note records that an hour later she was called to the room by the boy’s parents. The rash had spread over his entire body. They were unable to rouse him.

The nurse documented a blood pressure of 67/45, a pulse of 50, and respirations of 10. She called a code, and the boy was intubated in the room. Resuscitation attempts followed. The attending pediatrician was summoned from home. He arrived half an hour later. Unfortunately, the resuscitation attempts were unsuccessful, and the child died.

Later, the results of the blood tests drawn in the ER revealed a severe bacterial infection, which was the cause of the rash, not an allergy to the antibiotic. The parents are suing the hospital and the attending pediatrician for wrongful death. Our client, the attending pediatrician, maintains that he is not at fault because the nurse failed to report the results of the blood tests, and how sick the child actually was. Therefore, the responsibility for the boy’s death rests on the nurse, and as her employer, the hospital.

What I need you to do, Niki, is review the chart, and find indications that the pediatric nurse neglected or did not follow standard practice in her care of this child; anything pointing to our client’s innocence.”

“Wow. Okay Grant. I’ll read through the record, and see what I can find.”

“Thanks Niki. If you need anything, let Claudine know. I’ll see in you in a couple hours. Raquel and I are looking forward to having you stay with us the next couple of days.”

“Me too. Thanks for inviting me, Grant.”

After Grant leaves the room, I settle into the leather chair at the large, polished table of the conference room, a hard copy of the medical record lying on it. Leafing through its pages, I feel queasy at the realization that whatever I find wrong will be used to blame another nurse. I dismiss the thought, however.

“I am a patient advocate,” I remind myself. “By reviewing the medical record, I’m helping a family receive justice.”