They told us our daughter was fine, but after talking into the walkie-talkies strapped to their chests the guy, oh so softly, said, “We’re gonna have to take a ride.” Crap. It was nine o’clock at night. I was hoping to avoid the hospital. But, again, I’d been in nursing school long enough that I didn’t argue. If they wanted to take us in, I figured there was a reason.
My daughter and I, she in her footie pajamas because she’d been getting ready for bed, went downstairs to get into the ambulance. Rudyard Kipling’s story “Rikki-Tikki-Tavi” was sitting out and I grabbed it. It was a good pick. Rikki-Tikki is a brave little mongoose. To protect his adopted British colonial family in India he must kill two full size cobras, who are husband and wife, and destroy all their eggs before the new little cobras hatch. He gets some help from other animals, but Rikki-Tikki is the hero of the story, constantly cautioning himself to stay on guard and figure out the best way to win a fight.
The kindly EMT sat in the back of the ambulance with my daughter and me and listened while I read: “This is the story of the great war that Rikki-Tikki-Tavi fought, all by himself . . . .” When we arrived at the hospital it felt too soon; I was only two-thirds of the way through the book. “I’d like to hear what ends up happening to Rikki-Tikki-Tavi,” the EMT said before he lifted my daughter, wrapped in a thin but enormous white blanket, out of the ambulance and deposited her, like a princess on a chair in the waiting room of the emergency department at Pittsburgh Children’s Hospital.
“It is impossible for a mongoose to stay frightened for very long,” I had read, and the EMT seemed to like that idea. Long, long after my daughter got the X-ray showing the nickel wasn’t lodged in her esophagus and the whole event became just another family story, I thought about finding that EMT and giving him his very own copy of “Rikki-Tikki-Tavi,” but I’d never even learned his name.
“Here, I’ll help you,” I tell the EMTs today. “We always like having Irving on the floor.”
Unstrapped, Irving gets himself up off the stretcher and walks over to the chair in the room. It’s not one of the good armchairs, but he sits down in it with an expression of placid contentment. “That’s nice.” His voice is a whisper we can barely hear as he rubs his hands back and forth a few times over the armrests, satisfied in a way that suggests life has lost its ability to disappoint.
“OK, Irving,” one of the EMTs calls out, his voice overly loud but friendly. “We’ll be back to get you when you’re ready to come home.” They pull the stretcher up to waist height, making it easier to push, and head out.
“Is this Irving Mooney?” a young woman in a long white coat looks cautiously through the door. She must be the intern assigned to Irving. She’s petite and her straight black hair ends in a modern stacked cut just at the nape of her neck. She comes into the room, extends her hand to Irving. “I’m Meredith.”
Irving doesn’t seem to see her hand, or else doesn’t understand why she’s holding it out to him, but he nods slowly, looking up.
“And you have a rectal abscess, right?”
“A . . . what?” He cocks his head to one side.
“A rectal abscess. A sore, um, on your bum.”
“Oh, yes. On my backside.” He turns a little, angling his right side out toward Meredith and me. Then he reaches back with his right hand and points to a spot on his lower back just above his waist. “It hurts . . . off and on.”
Meredith frowns. “I’m confused. Your back or your backside? Your back or your rear end?” She says each word distinctly.
“My backside. Here—” He angles the left side of his body away from us and points to his right side again, explaining in that low soft voice, “Here—it’s on my back. Right here.” Then he straightens and sits normally in the chair, his hands folded one over the other in his lap.
Another time when Irving was admitted to the hospital his scrotum was badly swollen, which is unusual but happens more than the average man might like to think. It’s embarrassing and, I’ve heard, pretty uncomfortable. During morning rounds that day Irving told the medical team, “I’ve got this problem with my balls,” in a voice so soothing it surprised me to realize what he’d actually said.
“Meredith!” Another woman, a little older, taller, also wearing a long white coat, comes into Irving’s room. “Is this the rectal abscess?”
“Um, no. He says it’s on his back.”
“His back?”
“The side of his back.” She walks over to Irving and points to the right side of his back.
“So, not a rectal abscess at all?”
Meredith shakes her head no. It’s one of those moments when the hospital is like that childhood game, Telephone. I always wondered if some kid passing on the whispered message deliberately changed it to make sure the game worked and was funny, but I’ve seen it happen often enough in the hospital: the side of the back becomes the backside, which becomes the rear end, which somehow becomes the rectum. Good thing we don’t need a scan to find out the truth for Irving; all we have to do is look.
“Mr. Mooney, I’m Eileen, the resident on this case. I’m working with Meredith and we need to see the abscess—the sore—on your back. Is that OK with you?” She’s friendlier than when she first came into the room and I wonder if she’s relieved to be dealing with an infected lesion in a much less intimate location.
“Fine, fine.” Irving seems to be confirming something for himself more than talking to Eileen, but she doesn’t slow down.
“Good! Because the sooner we see it, the sooner we’ll know what we’re dealing with.” She turns to me. “Are you his nurse?”
I look at my watch. “Only for about forty more minutes.”
“You can go. We’ve got this.” I look at her. You can go. Am I being dismissed or given a breather? She doesn’t seem rude, just purposeful, not unlike my behavior toward the EMTs who dropped Irving off.
I nod at the two of them. “Call me if you need anything—if he needs anything.”
“Sure,” Eileen says. Turning back to Irving: “Now if you can lie on the bed, Mr. Mooney.”
Chuckling to myself about the “rectal abscess” mix-up, I close the door on my way out. Candace’s call light is on in the hallway, but so is Mr. Hampton’s. I step into his room first.
“Everything OK in here?”
Trace’s head is thrown back in a laugh and I see that even his teeth are perfect. “The call light’s on. Did you need me?” I step into the room and shut the door. That way I don’t hear the ring accompanying Candace’s call light and I won’t see it. Out of sight, out of mind. If she were really in trouble her cousin would probably have burst out of the room yelling for help, or that’s what I tell myself.
Trace collects himself, looks up at the light flashing on the wall. “Oh, no, we’re fine. It must have been an accident.”
I walk over to the bed and fish out the remote from under Mr. Hampton’s knee.
Mr. Hampton shakes his head. “Mistake,” he says.
“Hey—sorry,” Trace tells me.
“No problem. Like I said, I’d rather come in and have it be nothing than walk into an emergency because you didn’t call.” I reach behind the bed to turn off the alarm. “I’ll be leaving soon; it’s the end of shift. Can I get anyone anything before I go?”
“Oh. No. Nothing,” Trace says. “But thanks for everything.” He gives me a sincere look, without the movie-star smile.
I’m ready to brush off his gratitude, to say I’m only doing my job, when I bite my tongue. “You are very welcome,” I say, taking all three of them in with a glance.
Candace’s call light is off once I get back in the hallway. The aide must have answered it. That’s a relief, I think, and then I remember the chair. Sheila’s comfy armchair, the one her brother-in-law spent all day sitting in; I was going to give it to Candace as a kind of peace offering and because it would be a nice thing to do.
I think over what else I have to get done. I recorded report on Mr. Hampton once
it was clear he would do OK with the Rituxan. Candace doesn’t have much going on and Irving just got here, so report for him will be easy. No need to do voice care on Sheila, because even if they don’t operate tonight she’ll almost definitely go to ICU instead of returning here, and Dorothy is long gone. I’ll give face-to-face reports—what we call “verbals”—for Candace and Irving. We’re supposed to always record change of shift information for the oncoming nurse, but with new admissions we often don’t. It’s easier just to talk to the nurse taking over.
It’s 6:55 p.m. I need to be in the conference room in five minutes. Moving fast, I grab some Clorox wipes out of the dispenser on the wall and go into Sheila’s room to wipe down the chair. Candace will wipe it down again of course but I don’t want to offend her by introducing a dirty chair into her clean room.
The chairs are big and look solid but they’re actually very light. Disinfection accomplished, I push the chair out of Sheila’s room to Candace’s door. I knock.
Two voices call out, “Come in.”
Opening the door I see Candace and her cousin eating pizza. When did that pizza get here? It must have been when I was in Irving’s room. I catch a whiff of the pepperoni and cheese and I feel a twinge in my stomach. No surprise.
“Hey. I thought you might like one of our primo armchairs.” I gesture toward it. “I just cleaned it. Another patient had it but she’s gone to the OR and won’t be coming back.”
Candace stands up to look at the big brown chair. I can’t tell what she’s thinking. “I’ve got a chair in the room right now.”
“I know, but this one’s a lot more comfortable and I can trade yours. We move furniture around all the time.”
“Can it be cleaned with bleach?”
“Uh-huh. Just like all the others.”
She stands there for a minute longer, saying nothing. “OK. That’s great. But we can do it.” Following some unspoken command, Candace’s cousin hops up and starts moving the smaller armchair out of Candace’s room while Candace takes the comfy chair and maneuvers it inside the door. “We’ll have to wipe it down,” she says aggressively. Then she stops pushing and looks at me. “Thank you.”
“You bet,” I tell her, taking the old chair from her cousin so that I can put it in Sheila’s room.
In the conference room the nurse taking over for me has her papers and is sitting down to listen to voice care. I tell her she’ll be getting verbals for my two admissions and she nods, punching in the right codes to hear report on Mr. Hampton.
Maya the aide, who’s heading into a double shift, is eating a piece of pizza. Each pepperoni has an opalescent drop of grease inside it, but looking at it makes my mouth water.
“Where’d you get that?” I try to sound nonchalant.
“Candace,” she says while chewing, and for a minute I feel bad they didn’t offer me a slice when I went in.
“She said she would have given you some, but you must not have heard the call light.”
“Oh.” I feel my face fall. I’m suddenly that hungry.
“So I asked for a piece for you anyway.” She holds up another plate, covered with an unfolded napkin, and underneath the napkin is a second piece of pepperoni pizza, also shiny with grease. I don’t even really like pepperoni, but the happiness I feel about this cold oily piece of pizza blooms like a tea flower dropped in hot water.
“You are wonderful.” I take the plate from her, lean up against the computer table in the conference room and start eating. The pizza hits me like a drug as I chew and swallow, barely pausing.
“Did she need anything?”
“Nah!” Maya says. She takes an index finger and circles it around in the air next to her temple—the universal symbol for crazy. “She’s batshit.”
I laugh. I ought to tell her she’s wrong, that Candace has been through a lot, that any of us might react to being hospitalized the way she has. But I don’t. I just eat.
The nurse taking over for me finishes report on Mr. Hampton and clicks off her phone. “So he’s getting Rituxan until two in the morning?” she snaps. The thought of taking several sets of vital signs during the night must be annoying.
I raise my hands, palms up, a placating gesture. “He’s doing fine with it.”
She sighs. “Rituxan, Candace Moore, an admission who just got here, Beth’s patient up front who can’t walk and needs to pee constantly and whatever other train wreck comes our way tonight since I’ll get the next admission, too.”
“Candace is content right now and nothing starts for her until tomorrow. She came early because she was worried about her central line—which is fine—so no worries there. Irving should need only IV antibiotics and fluids.” More placating. “And I’m here tomorrow,” I tell her, which makes giving report in the morning easier since we usually get our previous patients back.
“I just don’t want to be here,” she says, “It’s my fifth twelve this week.”
“Your fifth nightshift this week!”
“Well, we’re short because they haven’t approved a new hire for nights and the truth is, I can use the money. Our furnace is on its last legs.”
Now I get it. She’s exhausted and broke.
I give quick verbal reports on Candace and Irving and she takes notes. The storm of her frustration has passed and she doesn’t even jump on me when she sees the list of new orders for Irving, which are more or less the standard package for his particular problem: insert an IV, administer evening medications, treat his abscess with two different intravenous antibiotics, but also consult infectious disease to make sure we’re not missing anything, take vital signs every four hours, record his fluid intake and output, infuse normal saline at 150 ml/hour, and serve him a “regular” diet. Since Irving is stable, there’s no urgency.
Beth walks by the conference room and gives a small wave. “Almost done,” she says, smiling.
“Hey, I’m gonna go see Ray,” I tell my replacement. “I’ll be in his room if you need me.” She’s in work mode now and waves the suggestion away. “I’ll be fine,” she tells me.
Ray’s alone in his room, reading No Country for Old Men by Cormac McCarthy and I ask him if it’s a good book. I’ve never read anything by Cormac McCarthy despite how much I like the repeating hard “c’s” in his cowboy-Irish name.
Ray says the book is good, then asks me if I saw the movie version, which won Best Picture in 2008.
“No. The previews made me think it would upset me.” That sounds so lame. I’m an oncology nurse; I should be tougher. But to me the movie looked nihilistic—lots of violence with no point or moral behind it. I can read about such things, but seeing them, even in movies that I know aren’t true, disturbs me. I guess I want to believe that at our core humans are always moral and caring.
“The movie was good,” he says, “but try the book. All his books are good.” He speaks deliberately, as if he has all the time in the world, as if we’re back in that coffee shop where we met only a few weeks ago. So often with patients I talk with them only about their illness because I think that’s what they need. But it seems like Ray wants to talk about books and movies instead of leukemia.
“I’ll buy it,” I tell him. “Then I’ll let you know how it is.”
“Well, I’ll be here,” he says, leaning back into the bed, running his clasped hands over his hair.
“Hey, where’s Liz? Is everything OK at her job?”
“She’s out getting dinner. She hates the food here.” He pauses for a second to think. “Me, too, but it’s free.” He looks rueful and turns his eyes away from me. Then he re-collects his calm and answers my question.
“Liz’s job is cool. They needed her to come in and plan for the next few weeks. You know, patient schedules, who’s covering whom.”
“So she’s not going to be fired for being here with you?”
“Nah. Nothing like that. Not even close.” He looks away again and I’m not sure what to think. If there were work issues this morning I guess they
’ve been resolved, which is good. I would hate to be confronted with a choice between my husband and my job.
Ray’s work has been unbelievably generous to him and Liz. It’s a tradition among firefighters, at least in Pittsburgh, to cover for members who get sick. Individual volunteers from different crews around the city signed up for each of Ray’s twenty-four-hour shifts. They worked, but Ray got the money, so his leukemia diagnosis didn’t also lead to a sudden loss of income or health insurance.
Ray himself admitted that reading philosophy and postmodern novels on shift made him an oddball, but looking out for each other was integral to the culture of the job. His crew, some of whom might not have related to him that much, contributed further by buying dinner for every volunteer who took one of Ray’s shifts and Ray found out about the free dinners only after he was back at work. No one from his crew or another department ever said Ray owed him anything.
While the firefighters protected Ray’s livelihood, his fellow punk rockers looked after his and Liz’s two kids. Their son was finishing elementary school and their daughter middle school. Liz made a schedule: every day someone would be at the house to meet the kids after school, make dinner, help with homework, hustle them into bed on time, stay the night if needed, and then send the kids off to school the next morning. Night after night after night, so that if Liz had to be in the hospital with Ray she could be. An organized rotation of self-acknowledged social misfits with piercings, blue hair, tattoos, fishnet stockings and motorcycle boots kept their family life intact.
I don’t ask Ray how he feels about the relapse, if he’s afraid. He must be afraid. Who wouldn’t be? Afraid of getting the transplant and of not getting it. Maybe talking about Cormac McCarthy is enough. Maybe, like Sheila walking to the stretcher, Ray needs a dose of normal tonight.
Leaving his room I think I’m going home when the nurse taking over for me calls out to me at the nurses’ station. “Peter Coyne is on the phone,” she says, looking anxious. I wonder what’s wrong. Will Sheila not get operated on tonight? Perhaps her blood still takes too long to clot.
The Shift Page 19
