After a while I come to the two consecutive exit ramps on the highway, each one leading to a town with a population less than ours. Small communities formed hundreds of years ago back when our town, which sits on the shore of Lake Ontario, was a bustling port and the mouth of the dark flowing river provided a means to ship goods south. Between the port and the farms, the residents of this area enjoyed prosperous times. But those times haven’t been seen in many years. Instead, a foreign enterprise erected three nuclear power plants, utilizing the bitter waters of Lake Ontario to cool the nuclear reactors and shipping the powerful current to the large cities of the northeast, providing jobs to only a few hundred of the local population. The farms have shriveled, resorting to employing immigrants only during the harvest seasons. So those of us who don’t work at the power plant or the local state college must travel the forty miles south to the city for employment. Evidence of our travel lie on the shoulder of the road, which is littered with dead wildlife: deer, opossum, skunks and foxes.
Last year, the local newspaper wrote an article announcing that our county has the highest unemployment rate in the state, but this was already assumed. We have watched many of the nearby neighborhoods fall into dilapidation and most of our family and friends have moved out of state. The newly found homeless started taking up residence under the two bridges which stretch over the river, connecting the east and west sides of our town. The most disturbing events have been the number of break-ins and unforeseen deaths from drug overdoses over the past few months. Others have resorted to jumping off one of the two bridges, unable to face the bleak life ahead of them. Instead of living with dire prospects, they chose to follow the rapidly flowing dark river, turning the once vital aspect of our town into our very own local River Styx. Every few weeks the local fire department is called to collect the bodies which have surfaced at the mouth of the river. We know that eventually we will have to move closer to the city to escape the commute and the growing disparity weighing upon our small town.
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After thirty minutes I reach evidence of civilization. There is an exit ramp ahead leading to a bustling suburb with a mall, department stores, restaurants and the large apartment complex where Sam, my brother, lives. I drive through the winding apartment complex roads and pull into an empty parking stop. I notice a small red car parked next to Sam’s truck. His girlfriend is there. I think her name is Stacy or Macy, something like that. She is the second girlfriend this year and probably won’t be the last.
I head inside and brace myself for the worst. I hate packing wounds.
The wound on the back of Sam’s neck is without a doubt disgusting and I’m glad he can’t see my face as I pull the gauze out of the wound, bright pea green pus strings to the gauze. I was hoping his girlfriend could make herself useful by handing me supplies, but she just stands on the other side of the room, squeaking and making “eww” sounds. I control the urge to tell her to shut it.
“Thanks for stopping on your way to work.” Sam speaks as I tend to his wound.
I would like to reply but I can’t open my mouth and risk puking on the back of his neck. I work as quickly as I can cleaning the wound, poking fresh, damp gauze into the gaping hole and then placing a dry bandage over it all.
“All set,” I pat Sam on the shoulder.
“Thanks sis.” He stands up, towering over me. He is supposed to be my little brother but my head barely reaches to his shoulders. Sometimes, it’s hard to believe that we are related with such extreme differences in height. Somehow he grew tall and athletic, while I retained the body size and shape that hints on a preadolescent; short and barely shaped as a normal woman my age would be.
I give him instructions on what medications to take, how to care for the wound and sleep comfortably for the night. Of what I’ve found in the medical field, once you are a nurse you are everyone’s nurse. And as soon as the word has been spread, be sure to welcome middle of the night phone calls and the inspection of rashes at holiday dinners.
“I’ll call you tomorrow.” I hug Sam and wave to the girl.
Next to Ian and Lina, Sam is all I have left. Our father died of cancer right before I graduated high school and then our mother’s death from an unsuspecting heart attack a few years after that were both hard on Sam. When our mother died, he was a junior in high school and I was pregnant with Lina. He was intent on living by himself, feeling orphaned and alone. I argued with him for weeks as we cleaned out our childhood home, trying to persuade him to live with us. I didn’t want him to be alone. Mostly, I didn’t want to be without him-the last survivor of my immediate family. Eventually he agreed, staying in our guestroom until he finished high school a year early. Not long afterwards he came to me, telling me he was enlisting in the air force. This brought on another tidal wave of arguments. I was afraid to lose him, I was afraid that he would be sent off to war and never come back. Finally, we settled on a four year plan where he would apply to medical school; something he had talked about before our mother’s death. He put his air force plans on hold, giving him plenty of time to enlist before he surpassed the age requirements if medical school didn’t work out.
Now he’s spending the summer working as a security guard at the local mall until the fall when he enters the University. Each time I see him I hope that he will reconsider his air force plans because I’m sure our current government would have no problem sending my baby brother into a harsh life he’s never imagined, one where we have to go on without each other, splitting up the last of our family.
chapter three
I walk through the tunnel that passes under the street, connecting the hospital to the parking garage. When I reach the hospital entrance, I nod hello to the guard sitting at the desk and lift my badge so he can see it. Just as I do, the elevator dings and I jog to the open door. I know if I don’t get on now I will be waiting a long time for the next one, making me late for my shift. The elevator is packed full, a mixture of workers and visitors. Someone is carrying a tray from the cafeteria and the smell of fried fish wafts out from under the foil, making my stomach turn. I hold my breath and push the button for the twelfth floor, then squeeze myself to the back of the elevator since I will be the last to get off.
“Going all the way up, huh?” asks a man with a visitors tag on his shirt. I smile and nod at him, the heavy fish odor making it impossible for me to open my mouth and speak.
The elevator stops on almost every floor, each time a few people get off and the air around me feels a little bit lighter. The person with the fish gets off on the ninth floor. Finally, I can take a deep breath, inhaling the fishless air. There is only one other person remaining in the elevator with me and we stop on the twelfth floor. I wait for her to get off first. She turns right towards the visitor doors carrying a diaper bag and a handful of tissues. Without asking I can tell she is one of our mothers returning to the hospital to spend time with her ill infant.
I turn left towards the employee entrance and swipe my badge. The automatic doors open with a heavy click. A breeze rushes past me filled with the scent of diapers and baby shampoo and the buzz of tension in the air. There are clicks, beeps, and buzzes from monitors, IV pumps, and warming beds. It reminds me of that widespread misconception that the Eskimos have over a hundred words to describe the snow. Well, nurses have over a hundred ways to describe the beeping of alarms. Most visitors get tense as they listen to all the noise, shooting us questioning glances when we don’t rush to answer an alarming monitor. Usually we continue on with our task at hand because the truth is, we know what alarm deserves a rush to the bedside.
There is a crowd of nurses waiting to search the assignment board for their name and the names of the babies they will be taking care of. While I wait to see what my assignment is, I glance up at the dry erase board which holds a listing of the nurseries in the neonatal ICU and the babies in them. We are up to fifty-five babies. It has been a busy spring, the majority of our babies have been pre-term and an abnormally large n
umber of babies have been born with anomalies and genetic diseases. The shortage of nurses has left ample opportunities to pick up overtime, and this is an overtime night for me. The dread of a less than stellar assignment hangs over my head.
The crowd has finally filtered out, my coworkers walk off with handfuls of paper containing the lists of medications and doctors’ orders for the two, three, or four babies they will be taking care of tonight. I hear a multitude of grumbles and curse words as they pass me. It seems the assignments are not good. I find my name on the sheet and the three babies I’ve been assigned. I collect the order sheets for my patients and head to their bedsides.
As I step into my assigned nursery I am grateful for a few things, one being the large picture window which spans the length of the nursery, facing to the north. Second, I am not assigned to the baby in the far left corner-the gastroschisis-born with his intestines spilling out of the hole in his abdomen where the umbilical cord once attached to him. He lies upon on a small elevated bed. He’s ventilated with a breathing tube, has seven IV pumps running, and a central line taped to the top of his scalp. His abdominal contents are contained in a plastic bag suspended from the warming unit above him.
One of our new nurses stands at the bedside. She has been here for almost six months now and her hands quiver over her order sheets as she receives report from another nurse. She’s thinking the same thing we all did when we first started. I hope I don’t kill this patient. She will be assigned to some of the sickest patients for at least another three months, something she was never told when she agreed to work here. If she’s lucky she will be assigned in the same room with senior nurses who are willing to help her, who will answer her questions without ridicule, who will check her medications and let her know when her patient is about to die. Some of the senior nurses will sit by and watch, not helping, assessing in their own minds if this new nurse has what it takes to work here.
Some nurses eat their young; they tear at their flesh with razor sharp teeth until they are a bumbling bleeding mess and want nothing more to do with being a nurse. That is a true story.
It’s almost eight at night. I get a detailed report from Jan, the nurse I am replacing. She talks quickly; I’m sure so she can rush home to her four children and see them before they go to bed. She assures me that I have a “good assignment,” the kiss of death, which means in a few hours something will go terribly wrong. She should know better.
I lift the quilt that’s covering the isolette, which is nothing more than a Plexiglas box, and get started taking care of my first patient. Inside is a small baby girl, sleeping on her stomach. She is scrawny, all arms and legs with a large head. Her preemie sized diaper is too large, covering most of her back, all the way up to her bony shoulder blades. I open the portholes in the front of the isolette and put my arms through. The air inside is warmed to regulate her body temperature so she can retain her fat stores and gain weight. I gently grasp her head and her hips and flip her, placing her on her back. I take her temperature, her blood pressure, and listen to her with the pediatric stethoscope which hangs at her bedside. The diaphragm is the size of a quarter, covering almost half of her little chest. I watch the skin on her chest retract when she breathes, almost able to count each tiny rib. The whole time she sleeps, exhausted from being born too early, her body now responsible for doing things that the placenta normally would. She barely opens her eyes when I run my fingertip over the top of her head to feel her soft fontanel and ridges of her skull. I put a clean diaper on her and fold down the front so it doesn’t look so large on her. At the bottom of her isolette is a pink blanket about half the size of a normal baby blanket. I lift her up with one hand, my thumb and ring finger under each of her bony armpits, and place the blanket under her then swaddle her in the blanket to keep her warm.
“Back to sleep baby,” I whisper to her as I close the portholes to the isolette. She turns her head away from me, falling back into a deep slumber of growth.
I write in the infant’s chart, listening to the chatter in the nearby nurseries as the other nurses talk amongst themselves, not bothering to talk to me. I am still under the impression that many of my co-workers mistake my silence for ignorance, since I’m not very talkative. I remember when I was done with orientation and the unit supervisor told me the other nurses thought I was too quiet. As if changing occupations wasn’t hard enough; my inability to fit in here has been even harder. My response to her was that I was observing the unit. And I was watching my new co-workers; figuring out who I could trust, who I could go to for help, and who to stay away from. It doesn’t help that sometimes I just feel like I don’t fit in here quite yet. And if it weren’t for the innocent babies, who I enjoy taking care of so much, I might look for work elsewhere.
“Andie, can you help me for a minute?” I look to my left to see Lauren standing in front of her patient, green gloves on her hands. I walk over to her. “I’ve never had a gastroschisis. I don’t know where to start.” She says flatly.
We both pause, watching its intestines hanging in the plastic tube, the fluid floating around them to keep them moist jiggles with each breath delivered by the ventilator. If this baby survives, the surgeons will slowly squeeze the intestines back into the baby’s abdomen then suture it up. Hopefully he will go home in twelve to sixteen weeks, like a normal newborn, with only a small straight scar an inch long across his abdomen instead of a belly button. But right now this baby resembles something barely human. Machines are breathing for him; we are feeding him through IV lines and have suspended his vital organs in a bag outside its body.
Lauren turns to me with that look on her face. I’ve seen it before. It’s how the new nurses look right before they run to the unit supervisor and tell her they can’t work here anymore, that it’s not for them, that they can’t do this. Then they quit and leave, moving on to explore other units within the hospital, eventually finding a unit that they are more comfortable with.
Before she can say anything, I speak quietly so the other nurses won’t hear. “You’re a good nurse, Lauren. Soon you’ll be doing this by yourself, no problem. Just hang in there.” I rub her shoulder and she smiles a little.
I help her sedate the baby boy. We change the gauze around the plastic tube which holds the baby’s intestines since the fluid seeping from the infant’s abdomen keeps saturating the gauze with bloody yellow fluid. We suction the secretions out of the baby’s breathing tube. And after a few hours Lauren is finally comfortable with taking care of her patient without my help. I return to the three infants I have been assigned and continue with their care.
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At five in the morning I decide it’s time for a break. My hands are shaking from hunger, my throat is dry, and I feel like my bladder is going to explode. Only then do I realize I never called home to tell Ian or Lina goodnight. A pang of guilt hits me. I know Ian probably spent most of the night telling Lina I was busy taking care of the sick babies and trying to get her to go to bed so she will be rested for Kindergarten in the morning.
I know what Lina will say when I get home; “Mom, you never called me last night. I missed you so much.” And then I will hug her and kiss her and let her eat some sugary cereal for breakfast to make up for it. I can only hope Ian gave her a bath like I asked.
I swipe my badge to get into the break room. Someone made coffee and it smells fresh-not good-but fresh. I pour some into a Styrofoam cup adding two packets of sugar and some milk. I know the first sip will taste terrible and bitter, the sugar and milk barely making it palatable, but I will drink it anyway because I need the caffeine to make it through the next few hours.
I take a plastic lid and walk to the nearby window while I stir the coffee. The best part of working on the twelfth floor is the view. We can see the hills, the valleys, and the soothing lights of the city at night. I watch a group of crows land on the roof of the building across the street. They look to the sky and one cocks its head to the side. I follow their gaze. The sun is st
arting to come up, decorating the sky in pink and orange. I take another sip of the bitter hospital coffee and write my name on the side of the cup so I don’t have to worry about someone else drinking from it. I try to relax and think of my plans for the day, once I get out of work.
After I drop Lina off at school I can sleep for a few hours before she has soccer. Thankfully, I don’t have to worry about cooking since there is a roast ready to go in the crock pot and fresh bread I made a few days ago. I think of the piles of dishes and toys waiting for me to clean up at home, making a mental note to add a few glasses of wine to my dinner. Ian and I struggle with dividing the household responsibilities, but we try to make it work with both of us employed full time. We’re very grateful for what we’ve found together. Especially since over the past eight years as we’ve watched family and friends struggle with their marriages, their divorces, and fighting over custody of their children. Each time the children are the ones who lose the fight. We both agree that we don’t ever want Lina to experience that.
Looking out the window one last time, I glance up at the sky and see a large airplane taking off from the nearby airport, the nose of the jetliner pointing up in the heavens. It looks like it’s barely moving against the gray-blue morning sky. Then, I hear a high pitched whistle and a deep rumble, vibrating the double pane window glass. To the right of the jetliner six army jets race by, headed north, probably headed for the army base. My heart skips a few beats when I see how close they are to the Jetliner, but it continues its ascend while the army jets continue speeding to the north. Strange, I’ve seen plenty army jets flying over the city but I’ve never seen them risk flying so close to a commercial aircraft before.
I leave the break room and head back into the NICU. The momentary silence from the chatter of nurses, beeping of monitors and crying of babies has been relaxing. Feeling refreshed I swipe back into the unit and the doors open towards me. The noise creeps up to me, muted at first, then louder as I walk to the nursery where my patients are. I wave across the wall partition at another nurse who is watching me. She turns back to the group of nurses she is standing with, speaking in hushed tones. Another one looks at me so I keep walking and pretend I don’t notice. Who knows what they are gossiping about today? I see Lauren is looking much more relaxed, the tension gone from her brow. I take small sips of the bitter coffee as I walk, holding back a grimace each time I swallow, praying that it won’t actually put hair on my chest. I stop in front of the large nursery window and take in the panoramic view of the city as the sun rises.
The Phoenix Project Series: Books 1-3: The Phoenix Project, The Reformation, and Revelation Page 2