The Only Best Place

by Carolyne Aarsen

  “You hearing me, nurse? I got rights. I got medical insurance. I can pay.” His voice rose with each declaration.

  Relax. Don't take it personally. Don't let your emotions intrude on your patient-nurse relationship.

  “I'll get the doctor,” I said with a careful smile.

  As I left, I massaged my temples, trying to push away the pain that had been steadily building since my confrontation with Dan. I couldn't push aside the angry words thrown down between us. What he'd said about my mother, what I'd said about his. What Gloria had said about Dr. John.

  I worked the night shift after our fight, unintentionally underscoring his accusation that I put work before family. But I couldn't be at home with all that tension boiling beneath the quiet facade we kept up for the sake of the kids.

  Once again our lives slipped past each other. I hated it.

  In spite of my pique with her self-righteous gossiping, I set my own pride aside long enough to realize that Gloria was right. I had been edging around dangerous territory, encouraging Dr. John. And I had encouraged him for the wrong reasons. Pride. Selfish gossip. In spite of what Gloria and Wilma had done and said, I had no right to bring down their characters just to prop up my own weaknesses. What had been worse was realizing how easily I had slipped into the same territory where Dan had been. I had come here with a sense of pride and superiority. All lost. Swept away.

  So I created a distance between me and Dr. John. I kept our conversation professional and didn't rise to the bait when he made a comment about Gloria. Thankfully he seemed to get the hint, but I felt as if I had lost my only ally.

  I checked on the woman with the croupy cough beside Mr. Francisco. Thankfully she didn't ask when Dr. John was going to see her. I didn't have an answer.

  As I stepped out of her cubicle, a noise at the front desk caught my attention. My heart sank when I saw the man carrying a child, a woman hurrying behind him. All the beds were full. Mr. Francisco had been triaged to the end of the line and was our last patient. If we had a real emergency, he'd be bumped back to the waiting room, which would make him even more cranky.

  Then the frantic-looking man by the front desk glanced over his shoulder and ice slipped through my veins.

  It was Dan… and he carried Nicholas.

  Wilma was right on his heels.

  Questions skittered through my mind. Why was Wilma here? Kathy was supposed to be taking care of the kids. But right behind those questions a larger one loomed, heavy and threatening.

  What was wrong with Nicholas?

  Go. Now. Hurry. Your baby. Your little boy is in trouble. You should have been at home. You knew he wasn't well. Dan was right. You do put your job first and now Wilma gets to see firsthand.

  Nicholas had been fussing all last night and was a bit feverish that morning, but I had put it down to teething. Had I been so terribly wrong? Me? A nurse?

  Guilty fear tumbled through my mind as I made my rubbery legs hurry to Dan's side.

  “He's burning up, Leslie.” Dan looked to me as if I had an answer. All I had at the moment was a flash of guilt that I hadn't been home to prevent this. Whatever this was.

  “Bring him into the trauma room,” I said, holding back from pulling Nicholas out of his arms myself. I hurried ahead of him, Dan and Wilma right behind me.

  Relax. Assess. Triage. Treat.

  I ran through the litany that always helped me during the harder cases that came into the emergency room in Seattle.

  The words usually calmed me and pulled me back from the emotions of the situation. I had a job to do.

  But I had forgotten about Mr. Francisco glaring at me through narrowed eyes as he sat on the bed we needed for Nicholas. “Where's the doc? I thought he was going to see me next.”

  “We have to move you back to the waiting room,” I said firmly. “We have an emergency.”

  He didn't budge.

  “Please get off the bed.” I couldn't stop the edge in my voice. My son needed that space.

  “I'll sue.”

  “I know a good lawyer. We have a very ill child.” I didn't have time for this. “Now, get off that bed.”

  I didn't know where this fit in nurse-patient procedure, but as I stared at him, he finally moved. I was there in a nanosecond, whipping off the sheets he had been sitting on, replacing them as he stormed out the door. He moved surprisingly fast for someone with severe back pain.

  When Dan and Wilma came in the room, I saw Wilma look from me to the retreating back of Mr. Francisco, then back at me, puzzled. No time to explain.

  “Lay him on the bed,” I said to Dan. “Take off his shirt and coat.”

  My heart stuttered in my chest as Dan undressed him, handing the clothes to my mother-in-law. I pulled the crash cart close, clipped a new cover on the thermometer, and checked his temperature. Sky-high. His breathing was fast, pulse erratic.

  “Dr. John Brouwer!” I called out, knowing he was somewhere on the ward. “I need you now.” Again, no time for niceties. This case now had priority.

  Nicholas's chest was clear.

  In spite of my training and my previous experience, I couldn't pull back far enough from this case. This body, burning with fever, lying so still on the bed, was my son. My baby boy. I called to Arlene to get a lab tech down here.

  “What happened?” I asked as I started a chart.

  My mind clicked through the possibilities as a faint whisper of a memory teased the back of my mind. The mother who had come in the other day talking about a suspected case of meningitis at the day care. We hadn't treated the child here, so I never thought of it again. Until now.

  “Kathy said Nicholas was cranky when you left for work,” Wilma said. “Then he started shivering a couple of hours later and he threw up. She called Dan, who called me, and we met at Kathy's place. When we picked Nicholas up, we noticed that he was all stiff.”

  Febrile convulsion?

  Habit and training pushed away the emotions for the moment as I scribbled rough notes on the chart. I would translate later. I hooked him up to the vital-signs monitor, slipped the oxygen mask on, snapped a tourniquet on his arm, and swabbed the spot where I would start the IV. I was pushing things. O2 and IV were not on the standing orders for a young child presenting with a fever. But I couldn't get rid of the doubt scratching repeatedly at the back of my mind.

  Why was that cannula shaking so much? Why couldn't I hold it still? I swallowed and tried to relax.

  Oh, God.

  I took in another breath.

  Oh, God.

  The expression had always been simply that. An expression. A cry to a deity that I had conveniently sidelined, only to call Him out when things went wrong. God's name was an expression of fear, a cry for help.

  It was only in the extreme situations of my job that I used His name. But now, as I gently pierced my own son's soft skin with a needle, I felt as if I mentally whispered to Him. Drawing on His power and strength.

  “When he got drowsy on the way here, I knew something was really wrong,” Wilma was saying.

  Nicholas's eyes fluttered open. I didn't want to make eye contact. He was a patient. If I saw his eyes, if I saw tears or pain, he would cease to be a patient and suddenly become my son.

  Check oxygen levels. Increase saturation. What would the doctor order from the lab? I started a requisition form.

  Where was Dr. John?

  I checked the vital-signs monitor, my mind still flipping through possibilities.

  Chills. Fever.

  Treat the fever.

  I slipped him to his side and gave him a Tylenol suppository, then noticed how his legs were drawn up. That puzzled me as the whisper in my mind amplified.

  Mother panic clawed at my nurse persona. I couldn't separate them. My little boy lay on the table, deathly ill.

  Where was that lab tech?

  I glanced at the clock again and made a snap decision. I couldn't wait another second. I wrapped a tourniquet around his other arm, tightened it,
and once again slipped a needle into my son's soft skin so I could draw blood. A faint gasp from Wilma pierced my concentration but I couldn't lose focus. Every second counted to my fevered brain. Once the vials were full, I carefully set them onto the crash cart.

  “What's wrong with him, Leslie?” Dan asked, weariness and concern edging his voice. “Why did you take his blood?”

  I looked across the bed at him and eked out a reassuring smile as I pulled off the latex gloves. “The lab will need to run some tests.”

  I looked down at Nicholas and ran my finger down his soft cheek. He held his head funny. The whisper gained volume. I was about to extend his knee to check my suspicions as Dr. John swept into the cubicle. Dan's eyes narrowed when he saw John and I thought, Please, no time for this, Dan. No time.

  “What do we have here?” Dr. John asked.

  “High fever. Did up the blood work.” I listed symptoms, turning my son's pain into something clinical. Detached. Simply another patient.

  Just as I spoke, a tech came into the room.

  I angled my chin toward the crash cart. “You drew blood already?” She frowned and Dr. John picked up on that.

  “That's not part of standing orders,” he said as he checked the chart.

  “I couldn't wait,” I replied, keeping my focus on my son. “I think this is serious.”

  “I know you may have done things differently in Seattle, but here we follow policy and procedure.” Dr. John snapped on a pair of gloves and waited a moment, as if to let his words sink in. I realized what he was doing and I felt another flicker of panic, followed by anger. We had so often been warned about doctor-nurse relationships. I understood the full implications of it now.

  “We don't have time for this,” I said. “I'm suspecting meningitis.”

  Too late I realized what I had done. I had not only criticized Dr. John in front of other people, I had also stepped way out of the bounds of my job and delivered a premature diagnosis.

  “I think you might be overreacting,” he said quietly, his voice telling me more than either Dan or Wilma could pick up. He reached for the otoscope and checked Nicholas's ears himself.

  I bit my lip and imagined myself grabbing the front of his lab coat and giving him a shake. Why was he dawdling? Every moment counted.

  Keep your mouth shut, Leslie. Don't say anything.

  “His ears are red. He might have an ear infection,” Dr. John said, ignoring me and giving Dan a patronizing smile.

  I couldn't stay quiet. I threw away any shred of pride I had and looked him directly in the eye, pleading with him. “Please, John. This is my son. I know he has more than an ear infection.”

  Dr. John frowned again. “Is this going to be a problem, Leslie?”

  “I think we should do a lumbar puncture.”

  Dr. John's eyes narrowed. “Last time I checked, that was my call to make, Leslie.”

  I had already gently rebuffed advances from him that I knew I had unwittingly encouraged. Now I had chosen to go toe-to-toe with him. If he wanted, he could fire me on the spot, could reduce my hours, could make my life here at the hospital miserable. But I was now nurse and mother.

  “I know my son. He has never thrown up. He has an elevated heart rate. Nicholas is not teething, doesn't have an ear infection, and doesn't simply have a cold.”

  Down,girl. Keep your voice down. You're exhibiting classic signs of an hysterical parent who wants the entire health-care system to fix her child.

  But it was my son who lay on the table, not my pride or my job. And I knew how quickly we had to act.

  Then, with a sigh as if to show he was still in charge, he turned back to Nicholas and lifted his head.

  It barely moved. Nuchal rigidity, I thought as my heart skittered like slippery shoes on ice.

  Then Nicholas screamed, took a breath, and vomited all over the doctor.

  “We'll need to do a lumbar puncture,” Dr. John said. “If positive, we'll have to call an air ambulance.”

  “Lumbar. That's the back, isn't it?” Dan asked, panic in his voice. I didn't like to hear that. I wanted Dan the way he always was. Calm and in control.

  “We need to drain some spinal fluid to confirm the diagnosis of meningitis.” I could barely speak the words as I reached for the LP kit. This was my little boy they were going to do this procedure to. My chubby little Nicholas. Dan's wild gaze snagged mine, and I tried to give him a reassuring smile even though I knew, more than he did, what the potential complications for Nicholas were.

  The next few moments were a flurry of busyness as I unwrapped the LP kit and laid it out, the lab tech returned to collect the fluid, and Dr. John prepped the site. A wave of fear pressed relentlessly against the thin wall of resolve I had erected. I couldn't let it get in. Couldn't let it wash over me.

  Dr. John inserted the needle into his spine and as the fluid came out, the wave grew. Cloudy.

  Dr. John called to Arlene to order in the air ambulance, ordered intravenous antibiotics. My hands weren't shaking as much as before, but even so I found myself concentrating fiercely on my job and then, while we waited, writing everything carefully down on the chart as if writing down the pre cise time and exact measurements would make all the difference for my son.

  Son.

  I looked down at Nicholas with his one arm strapped against the bar, his leg immobilized, the IV cannula sticking out like an obscenity.

  As a father has compassion on his children… The Bible passage slowly filtered past the flickers of fear, eased them away. God loved Nicholas. I had to cling to that.

  Finally, as if just now remembering that she was here, I looked at Wilma. She stood at the bedside, her eyes firmly on Nicholas, her fingers resting lightly on his leg. His grandmother.

  “So, what now?” Dan asked, panic edging his voice.

  “We wait for the air ambulance.”

  “That's it? That's all we can do?”

  I nodded.

  Waiting was an agony for parents, and even for nurses. As long as we had a task, as long as we were intervening, we felt as if we were pulling the person toward life. I needed a job to do. Something so I could feel like I was keeping my son alive. Keeping him healthy.

  “If it's okay with you, I'd like to pray,” Wilma said quietly.

  I glanced at Dan looking down at our son, his hand clutching Nicholas's. Dan nodded slowly and closed his eyes.

  I guessed praying was doing something, so I closed my eyes.

  “Dear Lord, we know that You are a Father and that You loved Your Son,” Wilma said, her voice surprisingly calm. “We know how deep Your love is, that You know if even a hair falls from our head. Lord, we plead with You for this child. Be with the doctors who will take care of him. The nurses…” Her voice wavered, which almost made me lose it. She loved my son as well, I thought. And she loved God. She was a worthy intercessor.

  Wilma cleared her throat and continued. “Keep him in Your care, Lord, we pray. Keep him healthy. Let us enjoy him again. Amen.”

  I took a long slow breath, my eyes on Nicholas. He still looked flushed, still lay deathly still.

  Nothing had changed, no bright lights accompanied by stirring music, angels singing. No miracle. Yet I felt a whisper of peace sifting around the edge of my fear. Nicholas had family around him, interceding.

  Then Nicholas stiffened and vomit spewed out of his tiny mouth. And the peace exploded violently out of the moment.

  Chapter Seventeen

  No answer at all?” My sweat-slicked hand clutched the headset of the phone in the parents' room of the hospital.

  Where are you,Terra? I need you.

  “I'm sorry, ma'am.” The disembodied voice gave standard-issue condolences. I whispered an equally fake thanks and dropped the phone into the cradle.

  I had dragged myself here after spending most of last night standing guard over my son, keeping death at bay. I fell asleep on the couch and had just woken up. My first thought was a desperate need to connect with my siste
r. But nothing. Had she moved already?

  “Hey, there.”

  I jumped, then felt a hand on my shoulder. Dan crouched down beside me.

  “Hey, yourself.” I wiped my tired eyes.

  Images of last night scurried through my mind. The flashing lights of the helicopter, and then it was gone into the air, taking our son away. Then the mad dash to Helena in the night and the long vigil by Nicholas's bed in the pediatric ICU.

  Dan had left toward morning while I stayed behind. Finally, one of the ward nurses practically pushed me to the parents' room. The last thing I remembered was wondering if I could sleep while my son lay in critical condition in Pediatric Intensive Care.

  “Have you seen Nicholas?”

  “I just checked on him. He's sleeping.” To my disappointment, Dan didn't come and sit beside me. Anneke had slipped in and found the toys. I called her name, and she got to her feet and slowly walked over.

  I must look a wreck, I thought, pushing at my hair, which now nested around my face. I quickly finger-combed it, then held out my arms to my little girl. When she finally came, I pulled her into my arms, clinging tightly. Then I pulled away and looked her over, almost hungrily.

  If it wasn't so pathetic, I would laugh.

  She looked like a little refugee. She wore her favorite polka-dotted skirt—the one that was far too large for her—a plaid coat over a stained T-shirt, and rubber boots. Her hair was pulled into some semblance of a ponytail, and I saw a smear of jam on one corner of her mouth and dirt under her fingernails.

  I cleaned the jam with a dab of Magic Mommy Spit but was helpless about the rest of her new look.

  She had obviously dressed herself and Dan obviously didn't care.

  Obviously, because his ensemble was hardly GQ material. Oblong oil stains decorated his pants, and his shirt had a darker spot on the chest where a pocket had once been and had since been ripped off.

  If my family looked like this after two days away from me, I couldn't imagine what my house looked like. Dan and neat were not two words that dovetailed.

  “How are you doing?” Dan sat beside me but kept his distance.