The Nurses: A Year of Secrets, Drama, and Miracles with the Heroes of the Hospital

by Alexandra Robbins

  Nurses don’t necessarily choose to work fourteen- to sixteen-hour shifts. “When nurses have attempted to refuse this overtime, we have been told this would be considered ‘patient abandonment.’ Nurses are not willing to abandon our patients,” an Ontario nurse told the Canadian Federation of Nurses Unions.

  Don’t get sick on weekends, either.

  Depending on the hospital, weekends and nights can be riskier for patients, some nurses said. “Half of this hospital is unavailable during those hours. A STAT echocardiogram isn’t always STAT,” said a Midwestern nurse. “There isn’t maintenance available, so you have to wait for Monday to get things fixed, which can be frustrating when it’s a procedure light that could help you out, or you have to move a patient because the monitor broke. If you run out of supplies, you have to make do until Monday.”

  If a hospital’s technicians don’t work weekends, nurses might have to send special labs to outside techs, which can delay a patient’s care. Because some organizations’ housekeeping services are reduced on weekends, nurses have to take time away from patients to clean patient rooms or hunt down equipment themselves. If a hospital needs to work on the computers or the water system, the outages can also cause increased wait times. “It’s risky sometimes because of the staffing issues. We can’t staff for the what-ifs,” said a NICU nurse. “At night, our NICU nurses go to ER and Peds to draw labs and start IVs. That takes nurses off our unit and we’re temporarily understaffed. If there is a code or a delivery when this happens, it can be bad.”

  Sometimes we put alcohol in your feeding tube.

  If a patient with a history of alcohol abuse needs open heart surgery, a Maryland Cardiac Surgical ICU nurse said, he or she might get alcohol (supplied by the pharmacy) with hospital meals or through a feeding tube to prevent alcohol withdrawal symptoms such as elevated heart rate, anxiety, and shaking. A nurse in an Oklahoma cardiac unit who has administered this treatment to a patient said that, on physician’s orders, the pharmacy brought 60 ml of bourbon each night to the nurse and watched her pour it down a nasogastric tube. While this method is considered “old school”—hospitals more often give patients Ativan—“it is funny to say that you gave your patient a shot of bourbon as a medication order,” the nurse said.

  That’s going in your chart.

  Ever wonder what nurses are writing in your patient chart? If you say something offensive or off-the-wall, nurses chart it. If your family member creates issues, that goes in the chart, too. “I always chart when a patient is difficult or belligerent. I keep it objective and write direct quotes; it’s funny to have to type ‘Fuck you, bitch’ in medical documentation,” Molly said. Nurses chart everything because if a patient later sues the hospital, the evidence can diminish the patient’s credibility. Along those lines, Molly added, “If you claim to know someone, be someone, or say you’re going to sue, it doesn’t increase your chances of getting better service.”

  You might not need the surgery your doctor says you need.

  “Sadly, doctors and doctors’ offices bully people into having tests and procedures they don’t really need, especially the elderly,” said a Tennessee travel nurse. Similarly, “If I could talk to my patients before open heart surgery, I would probably advise thirty percent of them not to have surgery,” said a New York nurse. “Our fee-for-service healthcare system incentivizes doctors and hospitals to advise aggressive, high-cost treatments and procedures. Doctors undersell how much rehabilitation the successful recovery from heart surgery requires. Most patients tell me they didn’t know the recovery would be as difficult as it is. Every time I see patients over eighty-five opt for an aortic valve surgery because they were becoming short of breath on exertion, I scratch my head because many of these high-risk patients will not get back all the faculties they had before the surgery, and some won’t even make it out of the hospital.”

  We cry over you.

  They might not do it in front of patients, but nurses do cry about the people they treat, whether with patients’ families or on their own. “Because I’m a burly man, [people think] I am not affected as much, but I am,” said an Oregon murse. “Sometimes I cry on the way home from work.”

  Some stories are too sad for even the most composed nurses to bottle away until after the shift. Nurses in Kansas, California, and other states told me about child abuse cases that led them to sob in the break room. A young Illinois nurse was taking care of a woman in her nineties and learned that “even when a patient can’t respond and their eyes are closed, they can probably still hear you.” While the nurse was talking to the patient, her preceptor laughed at her. “She can’t hear you and she’ll never open her eyes again. Stop wasting your time. We have a lot of other patients to get to,” she said and walked out the door. The nurse took the patient’s hand, squeezed it, and said, “I believe that you can still hear me, and I promise to take good care of you.” The woman lightly squeezed back. “I knew she heard me and I lost it right there. Even when patients may not be there all the way, they are still someone’s mother, father, sister, or friend, and deserve to be treated with respect,” the nurse said.

  TV shows don’t get it right.

  In reality, nurses manage many of the duties that viewers see doctors performing on TV, such as inserting an IV or catheter. “I laugh when I see shows like House or Grey’s Anatomy, where doctors are pining at the bedside of patients, giving them medications, or administering treatments. Doctors do nothing of the sort,” says an Arizona clinical education specialist. “They come by once a day, take a short look at the patients, review their chart, make orders, and leave.”

  A New York hospital night-shift nurse said that sometimes his patients don’t see a doctor or a PA overnight. The nurse diagnoses the patient, determines the course of treatment, then treats the patient himself, sometimes without even calling the PA to approve the orders for fluid boluses, antihypertensives, diuretics, and other medications. “We reserve calls to the PA for fairly urgent matters, and handle whatever other issues arise ourselves. This can mean doing things that are beyond our scope of practice, but most of the PAs appreciate the uninterrupted sleep and will generally cosign any orders once they make their rounds in the morning.”

  One major difference between TV and real-life hospitals is that many patients who survive in the shows would die in real life. A Texas clinical nurse specialist said, “In almost forty years, I can count on less than ten fingers the number of patients I’ve helped resuscitate who walked out of a hospital under their own steam. Even in a hospital, ninety-five percent of all codes fail to resuscitate the patient in an unwitnessed arrest” (if a person is found without a pulse and no one saw him/her collapse).

  Some supervisors ask us to do things for which we’re not trained.

  One reason an Air Force nurse left civilian nursing was because her supervisor skimped on her unit’s training. When an oncologist decided to admit patients to her unit who needed twenty-four-hour chemotherapy treatments, a nurse gave the staff a brief talk on the chemotherapy administration. “After that talk, we were expected to hang the agent [administer the medication] whether we felt comfortable with it or not,” she said. “I told my supervisor I did not feel comfortable administering the agent to any patients and she told me I was trained to do it. I told her a brief talk does not validate my competence to hang the drug. To protect the patient, I refused to do it. People who treat these patients have years of experience on an oncology unit, generally. I was working on a multiservice unit with ten to twelve patients at a time and could not care for the patient receiving the chemo appropriately. I didn’t want to administer the medication if I couldn’t monitor it effectively. From that day on, I was criticized for not wanting to do anything out of my realm of comfort.”

  You make us value life.

  Many nurses say that their work makes them appreciate the fragility of life. “Recently a perfectly healthy man slipped on the floor and severed his spinal c
ord. He will be dependent on others the rest of his life,” a Minnesota travel nurse said. “Think about not being able to hug your child, feed yourself, or scratch an itch. If every human spent even an hour on a nursing unit, it would change their perspective on what’s important. Before every hike I take, I dedicate it to one of my patients who will never be able to hike again. It’s a gratitude I never knew before I became a nurse.”

  For nurses, each individual patient death is precious and, collectively, the deaths a nurse observes become a kind of memento mori, reminding her to cherish life. This appreciation is one of the threads that weaves nurses together. “Nursing keeps me grounded in my own mortality even when I’m helping someone die,” a former Army nurse in New Jersey said. “It’s a holy profession.”

  We will try to do everything we can to help you.

  California nurse Jared Axen was holding a dying hospice patient’s hand when he began to sing an old hymn. The woman, who didn’t speak English, hadn’t been responsive in days. But when Axen sang to her, she squeezed his hand, a response that soothed the woman’s family. Six years later, Axen, a classically trained musician, sings to some of his patients every day. “It gives them their humanity back,” he said. “Music is a common language that helps me connect with my patients.” Many patients also claim to feel better and to need fewer pain medications, Axen said. “It’s become a vital tool for my patients and their families.”

  . . . And to save you.

  In 2012, Emory University transplant nurse Allison Batson donated a kidney to 23-year-old patient Clay Taber, a recent Auburn University graduate. The 48-year-old nurse, a mother of four, told the media that her children were around Taber’s age, so his sudden rare illness, Goodpasture’s Syndrome, hit her hard. Batson, a hero, saved his life, and Taber now considers her part of his family. “I wasn’t even supposed to be on her floor, but the floor I was supposed to be on was full. And now we joke that we’re kidney-in-laws,” Taber told me. “I’d been on dialysis almost a year-and-a-half by the time I got the transplant. It was definitely something I never expected her to do. Just how selfless she is, willing to do something for a stranger, to change my life on a dime, was very heroic. I like to say she’s an angel sent down to help people.”

  LARA   SOUTH GENERAL HOSPITAL, July

  Lara was attempting a new exercise as she worked out at her gym’s boot camp for the third time this week. Because she wasn’t taking her college classes, she had stepped up her already frequent exercising, determined to throw her energies into something that would give her a natural high.

  “Take this,” her trainer said, handing her a forty-five-pound plate. Lara was skeptical; forty-five pounds was a lot of weight for a five-foot five-inch woman weighing 123 pounds. As she swung the plate from between her legs to overhead, she felt a horrible burning sensation in her stomach.

  “Something doesn’t feel right,” she said.

  “Wimp!” a boot camper called out.

  “Wimp-ass!” shouted another. The trainer laughed.

  “Oh my God, my stomach is killing me,” Lara said. This wasn’t a sore-muscle kind of feeling. It felt like someone was tightly squeezing the area near her belly button. Determined not to lose face, Lara finished the set of fifteen reps and moved on to her next exercise.

  At work that afternoon, Lara noticed a bulge in her lower abdomen. She knew what it was right away. So did her coworkers. Every once in a while, she tried to push her intestine back where it belonged. “Girl, your shit is sticking out!” the nurses told her. “Quit pushing it back in!”

  When Lara finally saw her primary care doctor, he diagnosed the hernia and sent her to a surgeon. “I have two things to tell you that you’re not going to be happy about,” the surgeon told her. “One, you need surgery. Two, you’re not going to be able to exercise for six weeks afterward.”

  Immediately, Lara’s mind began whirling. I’m going to get painkillers! I get a free high! she thought. For the next two weeks, she was appalled at how quickly her thoughts corkscrewed into old, familiar patterns. This is so exciting! a little voice exulted. Maybe I should ask for the prescription ahead of time so I don’t have to get it after surgery. Maybe I should go pick it up now!

  A few days before the surgery, Lara still hadn’t told anyone about it. At work, the vials beckoned once again.

  JULIETTE   PINES MEMORIAL, July

  Care at Pines had continued to falter. The Westnorth Corporation had decreed that instead of having a second trauma doctor on call in case multiple traumas came in, which often happened with car crashes, the ER physician would be considered the second trauma doctor. The new policy alarmed Juliette. “The ER doctors have never, ever covered trauma,” she explained. “And now, in addition to covering patients in the ER, they’re also going to have to cover trauma? The hospital is doing that just to save money. They’re sacrificing the patients.”

  One morning, Wendy, an older part-time nurse, came sauntering through the ER, flashing a large diamond ring. “I’m engaged!” she told an ER volunteer. “Guess what? I got engaged!” she announced to the secretaries. She navigated the department throughout the day, telling everyone except for Juliette. She kept walking by her, pretending Juliette wasn’t there.

  Wendy hadn’t spoken to Juliette for about a year now, ever since a disagreement over a patient. A woman had come into the ER with a dislocated ankle. When Dr. Hughes, a resident who picked up ER shifts only occasionally, went into the patient’s room, Juliette was across the ER, in the bathroom. At the sound of a bloodcurdling scream, Juliette raced to her patient’s room to find that the resident had pulled her ankle into place without offering any pain medication.

  Juliette gasped and rushed to the patient’s side.

  “It’s okay,” the doctor said to Juliette as he turned to leave the room.

  “He just relocated the ankle,” another nurse said.

  “Without pain meds?” Juliette said. She turned to the patient, who was incontinent because of the agony. “I am so sorry he did that to you without any pain medication.”

  “What are we giving her?” Juliette called out to the doctor.

  “Dilaudid.”

  Juliette rushed to the medication dispenser, pulled the medication from the machine, then ran back to the patient.

  “Thank you,” the patient whispered, and reached for Juliette’s hand. Juliette sat with her for a few minutes, then changed the patient’s gown.

  As the patient settled in to rest, Juliette took the other nurse aside. “Why wasn’t she medicated?” she asked.

  “We asked for pain meds and the doctor said it was fine, she didn’t need it.”

  “Juliette, hallway please,” the doctor said from outside the room.

  “We had the pain meds to give her,” Juliette told him.

  “I had to do it right away,” Dr. Hughes said. “There wasn’t time.”

  “No, we could have medicated her,” Juliette said.

  The doctor shook his head. “Next time that happens, you need to call me out of the room and tell me you have a problem with what I’m doing.”

  “Fine, but I believe what you did was wrong,” Juliette said.

  From the nurses station desk, Wendy, openmouthed, watched the conversation like a Ping-Pong match. “I can’t believe you said that to the patient and were disrespectful to Dr. Hughes!”

  “My first responsibility is to the patient, Wendy, not the doctor,” Juliette said. “The patient deserves care.”

  At 65, Wendy was a nurse from a time when nurses stood up to give their seats to the doctors. “The doctor deserves respect and you shouldn’t speak to him that way,” Wendy scolded.

  “Doctors aren’t God,” Juliette told her. “They need to be called out when they’re wrong.”

  Wendy hadn’t spoken to her since. Meanwhile, Dr. Hughes and Juliette, who had a good professional relationship, easil
y resumed working together with no problems at all.

  •   •   •

  Juliette was eating lunch with Molly on their day off when Molly mentioned that she had seen Bethany at a nursing conference. “She said something that you’re not going to like,” Molly added. Juliette looked at her, puzzled.

  “This is going to hurt your feelings,” Molly said. “This is going to upset you. But I have to tell you.”

  “Okay,” Juliette said. She figured she had angered somebody at work. It wouldn’t be the first time.

  Molly paused. “Well, Bethany said that in her interview for senior charge nurse, Priscilla told her, ‘I heard the only reason you were applying for the job was so Juliette wouldn’t get it.’”

  “But I didn’t even apply!” Juliette said.

  “I know. Bethany said you two were friends and she never thought that, much less said that,” Molly said. “But then Priscilla said, ‘Between you and me, I would never hire Juliette for senior charge nurse.’ ”

  Juliette sat back hard in her chair. “Wow” was all she could say. Her eyes welled. She hadn’t applied for the job because she had no interest in it. She liked being charge nurse on occasion, and coworkers had told her she was great at it, but she didn’t want a full-time supervisory job. Her heart was bedside, with the patients, doing the job she loved.

  Molly continued, “I wanted you to know what she said because Priscilla is not the same person to your face as she is behind your back. I know that you’ve trusted her and that you’ve been confiding in her. I thought you should know what she is saying to your colleagues about you because I’m worried she’ll tell people about your private stuff, too.”