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The Most Important Thing (Niki makes a decision)

Chapter 16

Corey put his arms around me, holding me close. My face nestles in the warm triangle where shoulder meets neck, and I can feel his carotid pulse beating against my cheek. He smells like soap and water, clean and nice. I place tiny kisses against his smooth neck, tears welling in my eyes.

“I want this Corey, I really do, but I’m not going to.”

“Niki…”

“I can’t. I’m not happy, but that doesn’t give me the right to hurt others. Maybe Liz is right. Maybe being happy isn’t the most important thing.”

“Niki…”

He tightened his hold of me, burying his face in my shoulder. I felt the sob rack his body, and when he released me, there were tearstains on my scrub top. Looking at me, he did not wipe the tears from his face.

“I get the idea there’s no discussion here.”

“I’m sorry Corey. This hurts me too. I’ve gotta go.”

I fumbled with the car door handle before opening it, and slipped inside. Corey stood immobile, watching me with tears silently streaming his face. I choked back my own, started the car, and drove away. In the rearview mirror, Corey stood among the empty cars of the parking lot. The morning sun cast a sharp shadow from him, as if he were a statue.

***

In the garage, I slide off my scrubs, dumping them into the laundry hamper. I’m always worried about bringing home germs from the hospital, and spreading them to Maddie. I put on the robe I keep on a hook before entering the kitchen.

Simon’s left the dirty dishes from last night’s dinner in the sink, and the wastebasket is brimming on the edge of overflow. Its contents defy gravity. Although exasperated, I admire Simon’s flair for sculptural design.

He’s left a sticky note in his methodical printing on the counter:

“I’ll take care of the dishes and trash when I get back.”

I wash the dishes, but leave the trash. I’ll sleep better the less Simon clanks around in the kitchen. I’ll clean the rest of the house tonight when I wake up.

I take a quick shower, towel off dry and practically fall into the unmade bed in our darkened bedroom. I cry into my pillow before falling asleep.

I dream I’m still at work. The monitor and pulse ox alarms are going off in a patient’s room. Inside, a crowd of people is gathered round a crib with a baby in it. The baby is blue. Horrified, I see the ventilator is disconnected. Triumphantly, the child’s mother holds up the breathing tube she has pulled from her own infant’s throat. She turns to me with zombie-like eyes, and says,

The roar of a passing motorcycle outside wakes me up abruptly before I can make out what she says. I sit up in bed, clutching the blanket to my chest while my heart beats wildly.

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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.

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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.”

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Collusion (Niki coaches a parent on talking to doctors)

Chapter 13

The next night I returned to the PICU, and found that the eleven year-old transferred to the regular pediatric unit on schedule. As predicted, Dr. Eubanks not only discontinued the Fentanyl infusion before the transfer, but the puny IV morphine pushes too. It was out of my hands now. Or so I thought.

Later in the evening, I see the eleven year old’s Dad standing at the nurses’ desk, asking for me. I go to talk with him.

“What did you do last night to get my daughter pain medicine?” He demands.

“Um, I asked the PICU doctor for it,” I said. I didn’t think I should say that this was because I knew the surgeon wouldn’t order it.

“How’s she doing tonight?”

“She had a pretty good day. In the afternoon she rode a wheelchair to the play therapy room, played some games, and then walked back to her room. Right now though, she’s screaming in pain, and her mom and I can’t get her to stop. I asked the nurse to give her pain medicine, and she told me Tylenol is the only thing ordered. We gave it to her, but it doesn’t stop the pain. How do I get her more pain medicine?”

“Oh, boy,” I think to myself. My role of patient advocate is clear; I’m trying to think of how to word my answer without getting fired.

The child’s father, advocating for his daughter, doesn’t allow me this luxury.

“Are you a mother?” he asks.

“Yes I am. I have a daughter about the same age as yours,” I admit.

“So, if this were your daughter, what would you, as a nurse, do to get your daughter more pain medication?”

Silently, I think to myself, “Well, I was looking for work when I found this job…”

Out loud, I tell him the truth:

“Dr. Eubanks is a very good surgeon, but he doesn’t like his patients over sedated, so he doesn’t order a lot of pain medications for them. Your nurse isn’t calling him for more, because he will probably yell at her if she does. She’s afraid of him.”

“It’s only 9 pm. What I would do is tell the nurse I want to speak to Dr. Eubanks, now. She’ll make the call at the desk for you. When you get Dr. Eubanks on the phone, tell him your daughter is screaming in pain, and this is unacceptable; you expect her to be comfortable in the hospital. Tell him you want him to order appropriate pain medication for your daughter.”

“Got it!”  He said triumphantly. “Thank you.  Anything else?”

“Yeah, if you would not tell anyone that I coached you on this, I’d appreciate it. I’ll probably get written up if the pediatric nurses or Dr. Eubanks find out,” I solicited.

“Not a problem. I appreciate you honesty and help,” he promised, leaving the PICU, presumably looking for his daughter’s nurse.

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A Happy Shift (Niki explains PICU pain management)

Chapter 12

My next shift, I take report on a child admitted following surgery earlier that afternoon. The medical plan is for her to spend the night, and then transfer to the regular pediatric unit in the morning.

The surgery was successful, and the patient will make a complete recovery.

“I’m concerned that the surgeon hasn’t ordered enough pain medication for her,” the day shift nurse says.

I look over the prescribed medications. I agree.

“How’s her pain control been for you?” I ask.

“So far, she’s mostly slept since coming back from the OR, but when the residual anesthesia wears off, she’ll hurt bad. You may have a rough night.”

“Did you call the surgeon for more meds?” I glance at her chart for the surgeon’s name, which answers my question. Of course she didn’t call. It was a waste of time.

The child’s surgeon, Dr. Eubanks is skilled and well loved by his patients and their families. Among nurses, however, he is notorious for under-medicating for pain. A nurse requesting more on behalf of her patient gets an angry refusal for her trouble.

Before judging Dr. Eubanks as a sadistic bastard, however, let me explain how some nurses contribute in the development of this behavior in some surgeons.

Bear with me.

There are three kinds of nurses whose patients always code:

The first is the most skilled and experienced nurse. She or he has Rock Star status in their unit and is the go-to nurse for the most critically ill admissions. This nurse’s patients code frequently, because they nurse the sickest of the sick.

The second nurse is the up and comer. Not yet a Rock Star, she or he is on their way to joining the rank. This nurse possesses strong skills, but is still gaining experience. They’re trusted with patients unstable enough to go badly.

The third type of nurse doesn’t really have cardiac code patients. They have patients with respiratory arrest caused by a heavy hand with narcotic administration. Often these nurses work in habitually understaffed units. For others, a sedated patient makes a happy shift. Although causing respiratory arrest is not the intent of either nurse, it’s a side effect of their care. If these nurses’ patients are intubated, respiratory arrest doesn’t occur, but they are too drowsy to wean off the ventilator in a timely manner, causing extended ICU stays.

This drives surgeons crazy. They want to avoid pneumonia, and other hospital acquired infections for their patients. They want them out of bed, moving around, and discharged home as soon as possible.

When a surgeon accumulates enough bad experiences with the third kind of nurse, distrust ensues. This distrust leads to a habit of withholding orders, and under medicating for pain. In a twisted way, this surgeon believes he or she is protecting their patients by withholding narcotics.

Clearly, further pain management education for such a nurse and surgeon combination is needed. Meanwhile, the rest of us suffer.

***

Early in the evening, my patient begins complaining of pain. I give her acetaminophen along with the spit in the bucket dose of IV morphine ordered. She quiets down a bit, but an hour later her whimpers turn to howls, and her parents demand I treat her pain. I agree.

I call Dr. Polk, who’s in the call room, and he comes in to assess the patient. Then we go to the nurse’s desk to talk.

“I’m going to start a Fentanyl drip for the night, so she can get some sleep Niki, but you know Eubanks will discontinue it the moment he rounds in the morning. If the kid spends another night in PICU, I won’t be able to repeat this.”

“I know. I won’t over sedate her, I promise. Thanks Dr. Polk.”

I start the IV infusion, and shortly, the child is comfortable. She watches a DVD with her parents before falling asleep. Dad goes home for the night. Her mom says, “Thank you,” before settling into the window seat bed in the room. I turn the lights low, and pull the room’s curtain so they can rest.

It’s a happy shift.

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Beer for Breakfast (The night shift goes out for breakfast)

Chapter 11

Fortunately, the next two shifts are uneventful, which actually feels weird after a traumatic shift like the last one. There’s not enough time in between to process what happens to our patients, and the role nurses play.

Every so often, someone in hospital administration suggests holding “debriefing” meetings for the nurses after a particularly distressing patient death, but the meetings never develop meaningfully. In my opinion, this is because the meetings happen on day shift, which is too busy for those nurses to leave the unit to attend, and too late in the day for night shift to stay up. Besides, in units requiring ICU technology skills, many a nurse’s days off are consumed at the hospital in the form of mandatory in-services, skill competency workshops, CPR renewal, PALS re-certification, staff meetings, etc. We get paid for the time spent attending, but at a certain point, it’s a case of diminishing returns to spend more time at the hospital. So I don’t attend the few debriefings that occur. Besides, I don’t want to talk about my feelings and sing Kumbya in front of my coworkers.

What I do enjoy with coworkers is going out for breakfast after a shift, especially if I don’t work the following night. This morning, a few of us are meeting at a popular diner a few blocks from the hospital to do just that.

Besides Corey from ER, Gerald the respiratory therapist, and Liz join us in the booth. The guys order large, while Liz and I share an omelet, and order coffee. Corey and Gerald drink beer. When Liz comments on this, Corey speaks up,

“Because Liz, that’s what dudes do after work. We go out for beer.”

“If I have a beer after a twelve hour night shift, I’ll have to sleep in my car before driving home,” I laugh.

“That’s because you’re a light weight female nurse Niki,” Corey teases. “ER nurses are manly men, despite the media’s and society’s feminization of our kind.”

We laugh.

Changing the subject, I interject:

“Hey Gerald, guess what happened last night in the PICU.”

“Buh.”

“No really, Gerald. You know that mom from bed two? Well, she came over to the nurses’ desk, and told me,

‘I don’t know who to report this to, but someone working in this hospital is hitting a child on the chest and back in room seven.’

So I get up and look in room seven, and Gerald, it’s YOU, giving chest percussion to a toddler!! I almost burst out laughing trying to explain to her that you’re a respiratory therapist, and what you were doing helps the patient breathe. I told her the kiddo’s doctor prescribed it.”

“Gee thanks, Niki. I owe you one. Probably saved me from being arrested as a child abuser or something. You nurses complain about not getting recognized for your work, but when was the last time you saw a respiratory therapist character on a TV show?”

“Whatever possessed you to become a respiratory therapist anyway, Gerald? You hold nebulizers in patients’ faces, and then suction snot out of their tubes. I nearly gag just listening to someone with a wet, hacking cough. How can you stand your job?”

There’s laughter around the table.

“Well, Niki, it’s because I want to work ‘in the exciting world of doctors,’ and have my life choices questioned by bitchy nurses like you. Keep your opinions to yourself girlfriend, and kindly ask the server to bring me some coffee while I go use the head, okay?”

There’s more laughter, followed by a brief silence while the server brings our food, and Gerald’s coffee.

Corey asks, “Does your husband take your daughter to school in the mornings after your shift Niki?”

“Yeah, and brings her home. Simon’s a school teacher.”

“And what about you, Liz, do you have kids?”

“Yes, a son. His name is Nathan. He’s fifteen, and takes the bus. Next year, he’ll learn how to drive, and I won’t have to depend on other people to shuttle him to baseball, and basketball practices while I work.”

“How long have you been divorced, Liz?”

“Seven years.”

“Are you dating anyone?”

“On nightshift?”

“It’s probably hard being a single mom, but on the other hand, maybe it’s not so bad having control over your own life,” I realize I’m musing out loud.

“There’s a lot to be said for marriage, Niki, like having someone there to divide up the work. Sometimes I think people are too caught up pursuing happiness, and it gets in the way of commitment. Maybe being happy isn’t the most important thing in life,” says Liz.

“I don’t know, that’s sort of heavy,” says Corey. “Just because you’re married doesn’t mean you have a partnership. I think it depends on expectations. Sometimes one spouse has more expectations than the other. It doesn’t always work. I don’t know if sticking it out for the sake of commitment is the right answer.”

“I’ve always felt that a happy marriage or partnership is a wonderful thing,” says Gerald. “But it’s better to single than married and unhappy. Nothing is lonelier than an unhappy marriage.”

“You can say that again,” I mumble while shoving a bite of omelet into my mouth.

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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?”

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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.

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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.