“Was he on oxygen at home?” I ask Trace.
“Oh no. Never.”
I pucker my eyebrows. “Do you know why they started the oxygen here?”
“He was short of breath.” Trace tells me. “Just felt like he couldn’t get enough air.” Now he takes over the story of their vacation, talking about having to portage a canoe: emptying it out and then carrying it and its contents overland. He gestures with both hands and makes sure to include me by catching my eye as he talks.
“That was hard work,” Mr. Hampton says, chuckling. I’m so surprised I flinch. He understands. He speaks! He laughs!
Trace and Stephen laugh along with him and I realize that Mr. Hampton’s not a frail old man at the beginning of a tragic decline. He’s a lively septuagenarian whose manner for the past few days has been anomalous.
I can’t explain to myself what’s happening. Rituxan cannot work this fast, or if it does, it tends to cause serious problems. Could it have been the drugs he got beforehand? His Tylenol, Benadryl, and an intravenous steroid? Maybe, but I’ve given that drug combination to lots of people without it miraculously restoring their health.
I take his vital signs again and his numbers are perfect. He holds out his arm for the blood pressure cuff, smiles as I slide the thermometer under his tongue. I don’t understand it, and I can’t explain it, but it’s good.
“I’ll be back,” I tell them. Trace mouths, “Thank you.” Stephen bends forward in his chair, “. . . I only have to outrun the bear,” he says, and Trace laughs at the old joke. Mr. Hampton leans back on the bed, his breath coming without effort. I quietly close the door on my way out.
I myself don’t believe in miracles, but being pleasantly surprised, in the hospital or out, is always welcome. It feels good to think that the love of family or friends can bring on a turnaround that science can’t explain. Liz Tilberis, the editor-in-chief of Harper’s Bazaar, had ovarian cancer and in her memoir No Time to Die, she tells us that a phone call from Princess Diana raised her platelet count, making it possible for her to leave the hospital and spend the weekend in the Hamptons near the beach. “I believe the princess was single-handedly responsible for getting me home, and no one will ever convince me otherwise,” she writes. Princess Diana called and Liz Tilberis’s platelet count went up. Mr. Hampton needed oxygen and was confused until his son visited and they traded memories and jokes about past travels. My rational mind doesn’t believe getting better can be that easy, but hospitals are full of stories just like Tilberis’s, and whether it’s coincidence or the power of connection, the positive effects are real.
In the hallway Doris, the minister, is waiting for me at my medcart. “We said a prayer in case she doesn’t make it.”
I frown. It sounds so sad.
“No, it was nice,” she says, like someone at a different kind of job might say, “I just finished the meeting with Thompson. It went well.” That’s why I like her; she’s both spiritual and down-to-earth. Doris seems to adapt her faith to the occasion while keeping her belief just as strong. I find that flexibility comforting.
“It’s lucky they have a nurse who’s concerned about their spiritual welfare as well as their physical,” she tells me before she leaves.
I never thought about it that way before and it’s a nice compliment. However, truth is, they wanted a minister, so I got a minister; any other nurse would have done the same. It’s what we do. I once bought a newspaper for a patient because she was bored and wanted one. On a different shift, in the evening, I almost cried with frustration because I couldn’t get jam for a dying patient nibbling on dry toast. Another nurse on the floor regularly brought in Fruity Pebbles cereal for a patient who wouldn’t eat anything else.
“I gotta go,” Doris says, heading up the hall to minister to someone else. I watch her springy walk and wonder if I should have asked her to say a prayer for me before she left.
As I watch her leave I see one of our phlebotomists come down the hall. “I’m here to draw blood for Fields,” she says, pulling her metal cart filled with tubes, tourniquets, needles, and labels to a stop.
“What do you have?”
She hands me three labels for three tubes of blood to match Sheila’s blood type with our existing stocks of red blood cells in case she needs a transfusion. Two of those tubes are supposed to be drawn now and the third one thirty minutes later. If the tubes and the blood types match there’s no question it’s the same blood from the same person.
I’m guessing that someone (phlebotomist? nurse?) at some time made a mistake: The wrong patient’s name was put on a tube of blood that was sent to be typed and screened. As a result of this mistake, a patient’s blood was “typed”—labeled A+ or O-—incorrectly, which is a serious error because transfusing someone with the wrong type blood could make her very sick.
The problem is, although drawing and sending an extra “third tube” of blood may be an excellent safeguard against errors in blood typing it’s completely impractical. The phlebotomists cover the entire hospital and don’t have time to take blood from a specific patient and then return in half an hour to repeat the process. So, all three tubes of blood get drawn at the same time and one gets held back and sent down later. That tube of blood becomes the “third tube” even though it was drawn at the same time as all the others and thus in no way ensures the safety of blood typing in the hospital.
True to form, the phlebotomist looks at me guiltily and explains, “Um, I’m just gonna draw all three of these type and screens now. No way I can be back here in thirty minutes.”
I look at the metal clipboard on her cart and see that the lined top sheet of paper is entirely filled with patient names and the blood work they need.
“Just send that third tube a few minutes later. It’s what we always do.”
I nod. This is how the new rule plays and it’s a classic hospital work-around. Besides, we already have procedures in place to ensure 100 percent accuracy in labeling of blood tubes and if everyone followed those rules, mistakes wouldn’t be an issue. A type and screen requires that two staff members check the patient’s name and ID number against the preprinted labels from the lab. We’re also supposed to physically attach those verified labels to the filled tubes of blood in the patient’s room. These two steps make mislabeling a tube of blood impossible. Adding in a new rule is unlikely to encourage stringency in staff members who are either careless or too busy to carry out the required checks, but layering on protocols is a standard way hospitals respond to mistakes.
The phlebotomist goes into Sheila’s room to draw her blood and I follow her. She turns on the light and Sheila, her sister, and brother-in-law all blink at the sudden illumination.
“I’m here to draw your blood,” she says, all business. “Let’s see what you’ve got.” She bends down to Sheila’s right arm, then runs her fingers expertly up and down it. “Here’s a good one.” She snatches a tourniquet off her cart and ties it tightly around Sheila’s upper arm. I see a vein to the right of her elbow crease pop out.
I pick up Sheila’s left wrist so that I can read off her ID bracelet. “Sorry about this,” I say quietly. “How’s your pain?” She shakes her head and closes her eyes.
“Go ahead,” the phlebotomist says. She’s holding up the label for Sheila’s type and screen and peers at it closely while I read Sheila’s name and medical record number off the ID band on her wrist.
“Yeah. They match.” She quickly writes her initials and the time and date on the labels, then hands them to me to do the same.
“We need to check her blood type before the surgery,” I explain as the phlebotomist lines up her tubes for blood and unwraps a needle. Sheila’s sister nods, accepting.
“I’m gonna let you work,” I tell the phlebotomist, giving a wan smile as she slides the needle into Sheila’s vein. Sheila shuts her eyes shut tight, then lets out a loud breath.
“Hold on, Ms. Fields, I need three tubes,” the phlebotomist says as I leave.
The metal dietary cart comes into my pod and I catch an aroma of food. It’s bland enough that I don’t end up feeling hungry myself. As the meal delivery woman slides out the dinner trays and delivers them to Mr. Hampton and Candace I click on my computer tabs, looking for new orders. Thirty separate items pop up for Candace. The oncology fellow, Yong Sun, must have put them in; everything she needs before the transplant. I close my eyes.
The phone rings and I let it go. Once. Twice. Three times. A fourth ring. “T., what are you so busy doing that you’re not answering your phone?”
It’s the secretary and for the second time that day her friendly pestering irritates me. At this moment I find her irrepressible cheerfulness annoying.
“T., tell the truth. Were you in the bathroom?”
“Yep. I dropped the phone in and it took me a minute to fish it out.”
She snorts into the phone. “Is the room ready for Irving? I’m supposed to call and check.”
I glance through the door to Dorothy’s old room. “It looks ready.”
“Looks ready? T., after Candace Moore and her crazy shower curtain you need to get in there and make sure it’s clean.”
So now we’re doing housekeeping’s job. I step into the room, wipe my finger across the aluminum brackets on the wall that hold oxygen and suction. No dust comes off. I look under the bed and the floor is shiny—no bacteria balls. “It’s clean.”
“Great.”
What I wouldn’t give for a moment where nothing in my world rings, dings, or alarms.
Then Sheila’s call light turns on and I check my record of when she last got pain medicine. She’s overdue. I wonder if she was hurting when I was in the room with the phlebotomist and didn’t tell me. She’s also worried she’s going to die, if not tonight, then soon, and she’s being stuck with a needle.
And like that I’m back. I turn myself around, go to her room, open her door and reach in to turn off the call light. “Do you need more Dilaudid?” I ask her, my voice steady and clear.
This is what I’m here for.
CHAPTER 11
Revolving Door
After going through the usual procedure—pass code, accu-dose code, count, and confirm—I’ve got the Dilaudid. I check the concentration on the vial one more time, draw up the drug, and dilute it in 10 ml of saline. Check the volume. Drop the glass vial into the sharps’ container attached to my medcart. In nursing school they told us that addicts have been known to dig empty vials out of the trash to get whatever drops of narcotic are left inside clinging to the walls of the empty syringes. I have no idea if that’s true but I treat empty narcotic vials as if they’re contraband.
I go into Sheila’s room. The phlebotomist is finishing up and surreptitiously hands me the “third tube” for Sheila’s type and screen. “I’ll send these to the lab right now,” she says overly loudly, holding up the other tubes.
Sheila’s sister looks up briefly when I come in, then returns her gaze to the floor. Sheila’s eyes are closed, her lips held tight together from the pain. I pick up her left arm and shoot the Dilaudid into her IV, follow it up with a saline flush.
“Did the pain get away from you?” I ask.
“It was OK,” she says, closing her eyes tightly, “and then it”—she gasps—“wasn’t.”
She looks up at me now, apologetically. “I need to pee.”
“Of course. Can you roll toward me on this side? It’s less walking then.” She nods, then slowly rolls to her left. Her eyes flitter open, then close again. She pants.
I didn’t ask her to rate her pain with ten being “the worst pain ever.” Some people, and Sheila is probably one of them, could have an arm half cut off and would cry out “six,” covered in sweat, straining to make their voices sound normal. Patients like that also rarely ask for pain medicine before they’re in agony because they believe their pain never rises to the level of deserving to be treated. Although I explained the physiological reasons for staying ahead of her pain to Sheila, I should have realized she might not follow my suggestion. The trick with a patient such as her is to watch her face, see how she moves, or doesn’t. Faces rarely lie about pain, but sometimes you have to look closely and today I haven’t done that. I was persuaded by Sheila’s stoicism, fooled into thinking she needed less pain medication than she probably did. Trouble is, the joke’s not on me—she’s the one who has suffered.
Pain is awful. It hurts. But narcotics, the drugs that best treat pain, come with their own patina of shame, even here in the hospital. There are health care workers who reserve a special kind of scorn for drug abusers, probably because we’ve all heard stories about being burned by an addict: a patient someone went the extra mile for only to discover the patient wasn’t actually in pain, she just wanted to get high. Patients with chronic pain are often labeled “drug-seeking.” Sickle-cell patients, who live lives filled with pain and during disease crises can get relief only from large doses of opioids, sometimes get dismissed as junkies. Do we in health care hate the need for narcotics due to their high potential for abuse or is it the pain itself we find outrageous? We can’t see it, can’t test for it objectively. We’re taught “Pain is whatever the patient says it is,” but then we don’t believe our patients, and in that lack of belief we miss the message of pain. People born without a sense of pain—a rare affliction called congenital insensitivity to pain—are in constant danger. Pain is a neural explosion telling us that something is very wrong. Today I missed the full import of Sheila’s pain.
“Do you think you can stand up to go to the bathroom? Let me help you.” I reach down for Sheila’s arm when my phone rings.
“This is the OR. We’re ready for your patient Fields.”
“Oh.” I look at my watch. “You’re early.” I don’t intend to sound accusing but I do.
“We had a cancellation. And they wanted to get this one down ASAP.”
This is good news for Sheila, but my work for her isn’t done yet. She needs to pee and there’s paperwork to finish.
“That’s the OR,” I tell her and her family, hanging up my phone. “They’re ready for her.”
“Ready? But it’s early,” her sister says.
“They were able to make room for her. So I just need to complete her paperwork, after she goes to the bathroom, that is.” I smile at Sheila, whose eyes are slits.
“No. We’ll get her to the bathroom,” her sister says. “You go and get her ready.” She stands up and her husband stands up, too.
“Are you sure? Can you manage?”
“We’ll be fine. We’re fine. She has to get down to that operating room.”
I nod. “Call if you need me.” Back at my medcart I pull up Sheila’s pre-op form. More boxes to check and click.
What are her vital signs? Does she have allergies? Was there a history and physical done within three days and is it on the chart? Have her belongings been safely stowed? That last question doesn’t seem so important. Sheila could die on the table. Does it matter where her clothes end up? But of course it does. Even in the midst of calamity ordinary details must be attended to. It reminds us that life goes on.
One of the odder experiences I had in the hospital also revolved around a patient’s property, though property of a more personal nature. I walked into a patient’s room at 8 a.m., start of shift, having never met her or any m
ember of her family before. A tall thin woman with a very short haircut held out a denture cup to me, with the plastic lid on, and said, “These are not her teeth!”
I try to always be patient in the hospital but sometimes I get my hackles up when people are rude, and this was one of those times. I arched my eyebrows. “These are not her teeth!” the woman said again, thrusting the denture cup toward me.
“Excuse me?”
“She went down to a CT scan, returned to this room, and these are not her teeth!”
She’d said it three times now. “And you are?”
“Her daughter.”
The woman standing next to her, heavier and shorter, spoke up. “I’m her daughter, too, and these are definitely not her teeth!” Just then the rounding medical team came in, all six of them. I hadn’t gotten much information in report, but as the medical team started talking it became clear that the patient, a woman in her eighties, did not have long to live. She was also barely conscious.
So I put the dentures out of my mind. The patient would not be needing them. And then I got busy, just like any normal day, except a little busier than usual: phone ringing constantly, a string of time-consuming miscommunications, hands in need of holding, medications to be given, and, if I’m totally honest, lives with more promise to be tended.
At some later point in the day the daughter found me to relay a precise description of how the dentures in the cup differed from her mother’s. The canines were too long, the incisors too short, or maybe it was the other way around. I took a minute, called CT, asked if they had any misplaced dentures forgotten on a counter. They reacted as if I was insane. Plus, the scan had been done the day before, when the staff at CT had been completely different. No one there now had seen the patient the day before. Learning this and thinking about it made me wonder why the night-shift nurse had not been asked about the mixed-up dentures. Maybe by the time the patient returned to the floor following the test, the family had already left for the night.
The Shift Page 17
