The Shift

by Theresa Brown

I click the phone off hold. “It’s Theresa.”

  “Yeah, um, we don’t have a blood type yet on Sheila Field. Did the tubes get sent?”

  “Yes, but the hang up might be the third tube.”

  “The third tube?”

  “It’s a rule now that if we’re doing a type and screen on a new patient we have to send two separate samples of blood thirty minutes apart to make sure the right patient is typed. That second sample is the ‘third tube’ of blood sent.”

  “So the second sample wasn’t sent?”

  “No, it was definitely sent, but not that long ago. They may not have finished with it.” I’m not telling him the third tube of blood wasn’t drawn when it was supposed to be. Briefly overdramatizing, I wonder if Sheila will not have her surgery and will die of sepsis because I bent the rule about triple-checking blood samples. But we would never allow something that awful to happen because of a mistake in procedure and the time the blood was drawn doesn’t affect its processing.

  “This worked a lot better when we just had anesthesia do the type and cross,” Peter says, talking to himself more than to me.

  “Yes, well, you know, if a system’s working they decide to make it more complicated.”

  “And the oncologist is saying that FFP would help her, so that’s a couple more hours . . . and we’ll do her tonight.”

  It takes me a minute to understand. Tonight? He will operate on Sheila tonight. He’s irritated, venting about the lab, the oncology attending, and the last-minute decision to give Sheila fresh frozen plasma (FFP), but I want to shout “Yahoo!”

  Instead, “That’s great,” I say, with almost no affect at all, but I’m smiling now, grinning really, like Trace laughing with his dad or Beth after she talked to her daughter. It would have been so hard on Sheila and her family to postpone, possibly even dangerous, although proceeding tonight will not be easy for Peter or his team in the OR.

  “Thank you,” I tell him. Of course he’s not operating tonight to satisfy me, but he is doing it. I feel my hand open up, the infinity of Sheila’s life finally, thankfully released.

  I hang up the phone and that’s it—the shift is over. My ducks are all in a row and I can leave. Candace, Irving, Mr. Hampton, Sheila, and even Dorothy are no longer my patients. I am leaving, leaving, leaving. Another nurse, another good-hearted overworked soul in white will take over: night shift. And then tomorrow morning I’ll be back.

  But for now I do not think about tomorrow. Now is now and I am leaving. I prop my portable phone into one of the chargers at the nurses’ station and am about to toss my papers in the shredder when I remember I may want them tomorrow. Throwing away my notes at the end of the shift always feels definitive, but it also makes me a little regretful. Legal requirements about patient confidentiality demand that my record of a day’s work ends up as thin strips of cheap copy paper, confetti made from the records of four discrete people’s lives.

  Holding my notes, I head to the locker room and run into the owlish intern taking care of Mr. Hampton. He stops in the hall, head slightly bent, shoulders turned inward, exactly how he looked this morning. “He’s doing OK with the Rituxan?” he asks. His voice is low and soft and he blinks at me behind his thick glasses.

  “He’s doing incredibly well,” I tell him, explaining that Mr. Hampton stopped needing the oxygen, that he sat up on his own in bed, his confusion diminished, and enthusiastically took part in conversation. I smile and the intern, his slightly woebegone expression unchanged, focuses on my face as I keep talking. “I was so worried about him, and he did great.”

  “Well,” he says, “If we could know the future our jobs would be a lot easier.” He briefly makes full eye contact and I see again what I first liked about him this morning: underneath the tiredness, the working so hard just to stay afloat, there’s a humaneness that impresses me. It surprises me to realize that I feel a bond with him and I felt it this morning, even though we had only a whisper of acquaintance informed by his workmanlike politeness and the scrupulousness that put him outside Mr. Hampton’s room early in the morning.

  I smile a trace of a smile at him and then scrunch together my eyebrows, thinking, How can someone so young be so wise?

  As is so often the way in the hospital, we barely nod at each other and move on. Nurses and doctors—we come and go from our patients’ lives and each other’s with the anonymity of mail carriers, the efficient intimacy of the guy who reads the gas meter in the basement. That initial impression is what matters. Can I work with this person? Can I trust him?

  In the locker room I take off my nurse shoes, put unused alcohol wipes and wrapped saline syringes back into my locker, toss in my notes from today with my pen clipped to the top, and pull out my tights for biking, along with my jacket and wraps. I’m making a reverse transformation from nurse back to ordinary person.

  It’s all women working tonight, so I dress quickly in the locker room instead of changing in the bathroom—it’s one less step before I leave. I flatter myself that my black biking clothes peg me as a ninja, but I know I’m leaving the real action behind at the hospital. Besides, my bright yellow jacket completely ruins the ninja effect.

  I run my ID card through the time clock and the computer asks me if I took a thirty-minute lunch break. I think we’re supposed to hesitate before punching “no.” It probably makes managers look bad if too many nurses say we didn’t get lunch, whether we got our thirty minutes or not. I punch “no.” The law’s the law.

  Slinging my bag over my shoulder, I jab the down button outside the elevator and then, unwilling to wait, take the stairs. I’m impatient, but the stairwell is also quiet. There are no speakers here so the overhead pages don’t penetrate: no urgent calls for anesthesia, warnings about lost patients, or yet another fire drill will intrude. Down I go, down, down, down. The metal banister is cool under my hand and the cleats on my bike shoes make a gentle clicking noise on the stairs.

  Halting briefly I glance out the window in the stairwell door and see a sign pointing right for the Medical ICU. Mr. King, I think. I slide my hand around the railing, stick my foot out to keep going down the stairs, then stop, turn and open the stairwell door and go through it, back into the hospital hallway.

  I look again at the sign for the MICU and walk that way. ICU is a hard place for me since it’s often the last stop for our sickest patients. We oncology nurses and the ICU RNs don’t always get along so well, either. For some of us, the onc. patients are “ours” whether they’re in the ICU or not and we can be critical of the care they receive there. ICU nurses feel we send them patients almost dead from treatment and expect miracles.

  I push through the double doors, retrieve my name tag from my bag to show that I’m official, and try to look open and friendly. “We’re all colleagues,” I remind myself.

  A nurse at the desk looks up questioningly at me and I hold up my name tag. “I’m Theresa, here from medical oncology, wanting to see Frank King.”

  “He’s, um, over there,” she gestures, then returns to her charting.

  “Who’s his nurse?”

  She looks up again, quickly, and reads down the whiteboard behind her. “Lemme see—it was Tim, but now it’s . . . Eva.”

  “Cool. Thanks.” She ignores me and continues working.

  I walk by several rooms on my way to Mr. King’s, seeing patients on ventilators, with multitudes of tubes and drips running in and out of them. The rooms are small and they beep and chirp from a variety of monitors and pumps.

  I reach Mr. King’s room, set down my bag, and look inside. There’s a nurse with pale blond hair pulled back into a loose French braid standing by his bed.

  “Are you Eva?”

  She looks up, neutral. I show her my name tag. “Theresa, from upstairs,” I point with my index finger. “I wanted to see how he’s doing.”

  “He’s awake,” she says. “He just can’t talk ’cause he’s on the vent.”

  “He’s awake? That’s great.” I step into
the room and make eye contact, give a big smile. “Hi, Frank.”

  He blinks his eyes at me even though they’re almost concealed by the breathing apparatus coming out of his mouth. He looks very frail, but at least blood’s no longer dripping down his chin.

  “Yeah, and his wife was in here earlier telling us this story about how she bought a dog for herself, but then the dog just fell in love with Frank and followed him everywhere and ignored her.”

  “Really?” I had never heard that story. I look right into his eyes. “Well, obviously, Frank, that dog knew quality.”

  Eva laughs and Frank’s eyes crinkle together.

  I take hold of his hand where it’s lying on the sheet. “Listen, buddy—we all want what’s best for you. You’ve been at this a long time.” He blinks again.

  “And everyone upstairs misses you.” I squeeze his hand, but he gives no pressure back.

  An X-ray tech comes to the door and I see his machine parked in the hallway outside. “Portable chest,” he says. “You’re gonna have to give me some room in here.”

  Eva looks up at me. She mouths, “Sorry,” but I shake my head. “Is Opal here? His wife?”

  “I think she went out to get something to eat.” Eva shrugs, giving me a slight frown.

  “This Xray was STAT,” the technician says, walking into the room trailed by an assistant holding a flat sheet of film. “I need it now.”

  “Got it,” I say. I squeeze Frank’s hand one last time. “See you.”

  In the hallway I pull Eva aside. “What’s the plan for him?”

  She lowers her voice. “Family meeting tomorrow. His son can’t get here until then and they want to make the decision about hospice together.”

  “Right. Well, thanks. He’s a nice guy. We’ve taken care of him for a long time.”

  An alarm sounds in another room. “Eva, that’s you,” a voice calls out.

  “Gotta go,” she says, swirling around, her pale hair shining like light behind her.

  I grab my bag from the floor and retrace my steps back to the stairwell. It’s over for Mr. King, I think, and feel a lump forming in my throat. I shake my head, cough—it’s not time to grieve; it’s time to go home.

  A few more flights down and at the first floor I open the heavy door slowly and walk out into an almost empty hallway. A couple of nurses are also leaving and a few visitors come and go. The cafeteria barely buzzes; they’ll soon be closing up for the night. I can see why Opal would want to get food somewhere else.

  The double glass doors whoosh open for me and, buttressed by a wall of indoor heated air, the evening’s cold doesn’t hit me until I take a few steps into it. After I’ve spent twelve hours in a hermetically sealed world, including a brief stop in the ICU, fresh air is enlivening. I breathe in, then feel the sting on my cheeks and pull my neck scarf up and over most of my face.

  I unlock my bike, put on my helmet, snap the strap of my bag across my chest, and pull on my gloves. By the time I get home I’ll be sweating, but right now I want to be comfortable, so I start out completely covered up. My bike lights are on and I zip straight out of the parking lot, happy that riding my bike makes parking free for me.

  I push into traffic and the first real turn of the pedals is a release. The streets are dark and it’s a weeknight, so there’s very little traffic. My mind wanders to Dorothy. A few weeks before, she told me about her love of the Girl Scouts. It came up because she was trying to order a special Girl Scout hat and they kept messing up the order. I wonder how hard it would be to order one of those hats. How much might it cost? Could I surprise her with it? Pie in the sky—it’ll never happen. For one thing, I can’t afford to buy my patients gifts. But I’d like to get Dorothy the hat she wants if I could. Does that matter? My mother loves to say that the road to hell is paved with good intentions, but sometimes that’s all we have in the hospital.

  Pedal, breathe. I go slowly because I’m tired. I think about the owlish intern and his comment that knowing the future would make our jobs a lot easier.

  Before I started this work I thought I would never be able to leave a patient at the hospital at the end of shift, never walk out when this trying chapter in someone’s life story wasn’t yet fully told. In nursing school, though, they teach us how to leave.

  Clinical groups meet on the floor together at the start of shift and leave together at the end. We don’t call the hospital after we’ve left to ask how so-and-so did. We give our all while we’re there and then we go. This isn’t indifference but practicality. Nurses are the hospital’s mechanics, its sprockets and gears. The idea is, from one shift to another, a seamless blanket of nursing care is provided to every patient. For that model to work we have to make what happened that day—the good and the bad—as separate from ourselves as the uniforms we take off at shift’s end.

  And sometimes we don’t know how a patient’s story ends. People are “lost to follow up,” move, get treatment elsewhere, never again come to the hospital because they’re transferred to outpatient care. I often don’t know what happens to patients I’ve laughed with, cried with, gone toe-to-toe with a doc for, or talked at length with family members about.

  Pedal, breathe. I’m going uphill now over a short stretch of road paved with stones. Bumpity, bumpity. My hands shake on the handlebars but I go this way to avoid the smoothly paved but very steep road one block over.

  Now Mr. Hampton’s surprising, inexplicable recovery comes back to me. What if it continued? What if, after his dose of Rituxan is complete, he is completely healthy?

  What if Mr. Hampton, his son Trace, and Trace’s friend, Stephen, decide to begin a new life somewhere else? Where would that be? Spin the globe. Find some place warm, cheap. Could be an island, but the important thing is to be safe, hidden from disease and out of reach of modern medicine because he won’t be needing it. It’s my fantasy, creating for Mr. Hampton a new clean, well-lighted place.

  The paving stones give way to asphalt and I turn right onto the last long climb to my house. The hill doesn’t look that tough but it’s a deceptively steady rise. This is where I start to sweat despite the winter’s cold, give up on the idea of cadence, and just push slowly, breathing hard.

  I let myself imagine Mr. Hampton and his family in the rain forest. They would build a house on a raised platform, fish for food, watch butterflies, listen to multi-colored birds squawk and scold, and laugh together. It will be warm but not too humid. If rain comes, it will be gentle. Time will stop.

  And then I’m home. I go in through the basement so I can put away my bike. The dog comes down to greet me, sniffing and wagging her tail. Her dark coat shines in the basement’s bare bulb lights. Upstairs I hear the clink of silverware, some news program on the radio. My husband will be finishing cooking dinner as he mulls current events or thinks about physics. The days I work, they wait on dinner so we all eat together.

  I take off my helmet, gloves, unzip my Gore-tex. Home. I’m home again. The steps feel steeper than they did this morning, or maybe there are more of them. Finally at the top I reach up, pulling on the basement door, the old metal knob that’s loose and rattly the way basement doorknobs should be.

  Light hits me first and then more sounds. Not the bright fluorescent light of the hospital, but the soft incandescent lights of home. And not the beeps and rings and dings of the floor, but “Mom’s home! Let’s eat!” and the sound of my son practicing his violin.

  “Do we need knives?” My daughters are setting the table.

  “You made it,” my husband says, looking up from the stove, as if I have come a long way just to get home for dinner. And maybe I have.

  I turn off the radio and we eat: black beans, white rice, orange cheddar cheese, green broccoli, a glass of red wine. The meal is good and the wine gives me a start on feeling peaceful, but I’m not quite there yet.

  The kids talk about school and I have no idea what they’re saying. I’m thinking about Sheila. Sheila meeting with anesthesia. Sheila heading into
the OR.

  My husband plops a clear plastic container of mini peanut-butter cups on the table when we’re done and I think of Dorothy’s glass candy dish. I love that William Carlos Williams poem “So much depends / upon / a red wheel / barrow / glazed with rain / water / beside the white / chickens.” A few of my fellow PhD students in graduate school derided that poem as a minimalist pretension to art written by a doctor pretending he was a poet. But those people never knew Dorothy or her candy dish, the pull it exerted on the staff, the way it told us something important about who she really was: a mother, generous, kind, with a determination to get what she wanted out of life.

  After dinner I wash away memories in the shower, throw my dirty scrubs down the laundry chute, put on my pajamas. The shift is over. I settle into the threadbare couch in our family room and do the New York Times crossword puzzle in pen. Using ink is not about pride but aesthetics. Pencils scratch on newsprint and it’s hard to see the traces of lead against the gray of the paper. The pen, in contrast, feels smooth and the strong capital letters I make stand out in the grid of squares.

  The puzzle soothes me. I read a clue, “How knights roam,” then fill in “ERRANTLY.” Clever. Ordered. I may not be able to finish the whole thing, but that’s only because some tricky logic, an extravagant pun, or the name of a European river or a small Oklahoma town eludes me. There is no fundamental deficiency in me that leads to failure to complete the grid, no lack of vigilance, or empathy, or efficiency, or ability to know that someone’s belly hurts because part of her gut is torn, ripped open. No one will suffer if I never finish another crossword puzzle, if I Google all the answers and then lie about it, if I toss it into the recycling half done, without a backward glance.

  I look up from the puzzle and my daughters are standing in front of me. Freshly showered themselves, with wet hair they refuse to brush, they call out to me, “Good night, Mom.”

  “Wait! Wait!” I say, startled out of my preoccupation with the puzzle and the day. “I have to hug you.” It’s almost exactly what I said to Sheila and I’m relieved that here with my own children there’s so much less at stake.