Moments later, the registration clerk came to tell Molly that the man’s family was waiting in the private family room. When Dr. Preston was finished with the other patient, he came to get Molly, wearing his white lab coat. He usually shunned medical coats, but Molly had told him once about a report that people believed doctors wearing white coats were more trustworthy and professional. He had donned the coat for family notification ever since. The moment he left the family room, though, that coat came right off.
When Molly and the doctor opened the door, the family members were seated and crying. “Did he make it?” one of them asked. This was almost always the first thing a family member said. Molly had difficulty avoiding eye contact with the family; she couldn’t let them read her sympathy. She kept her eyes trained on Dr. Preston.
As usual, Dr. Preston started at the beginning. “When EMS picked up your father, he wasn’t breathing and his heart wasn’t beating,” he said matter-of-factly, his bright blue eyes sincere. “So they started CPR and transported him to us. When he got here, he still wasn’t breathing and his heart wasn’t beating. We put in a breathing tube, continued with CPR, and gave him medications to try to restart his heart. I’m sorry to tell you that we weren’t able to do that. Your father has died.”
Dr. Preston offered his condolences. After a few beats of silence—rarely did a family say something right away—it was Molly’s turn. “Do you have any other questions for the doctor? I’m going to stay with you and let you know what happens next.” The man’s widow and her daughter shook their heads. Dr. Preston left the room.
Doctors and nurses told the family together so that after the doctor left, the nurse could deal with the emotional breakdowns and walk the family through the next steps. Many doctors first explained how they tried to save the life, before revealing that they were not able to, because, Molly said later, “It’s easier for them to have that gradual letdown. Once you say, ‘He’s dead,’ they’re not going to hear anything else. We want them to know how hard we tried.” Doctors specifically used the words “dead” or “died” so that loved ones couldn’t misinterpret the message.
Molly’s nursing school had offered no instructions on how to talk to the family; her psychology rotation covered only mental illnesses. The one official rule Molly had learned was that staff first had to notify the next of kin before letting nonrelatives know. When a patient collapsed in the workplace, coworkers often sat in the lobby for hours without knowing the patient was dead, because the ER staff couldn’t tell them before locating the family.
By watching physicians like Dr. Preston, who presented the news well—and, equally as helpful, those who did not—Molly had learned what the bereaved needed to hear at this crossroad. Many nurses hated this task. Molly didn’t mind it, particularly when she was paired with a doctor who was not good at it. She considered it her responsibility to soothe and assist the families, much as she had done with the patient.
Molly sat down next to the widow, who sobbed on her shoulder. Families usually wanted some physical contact with the nurse. Molly typically put her hand on a shoulder and let the person guide her from there. If the family member needed more comforting, she would lean into Molly’s shoulder or reach for a side hug. Molly remained quiet during these interactions. At this point, people didn’t want to hear, “It’s going to be okay.”
When the woman’s cries subsided, Molly spoke gently. “Next, you’ll need to contact a funeral home and let the hospital know which home you’ll be using. Your husband will be in our mortuary until you make that decision. Take all the time you need. Whenever you make that decision, Registration will make the arrangements to have him transferred over there.”
The widow looked up at Molly, still stunned. “Next week he was going to help drive his granddaughter to her first day of college,” she said.
Almost every family told Molly something specific about the deceased, as if subconsciously trying to prolong his life for just a moment longer. Molly always tried to come up with something positive and personal to say, so that the family would know that the hospital staff saw the deceased as a human being rather than a patient. “He must have been so proud that his granddaughter is going to college,” she said.
The widow and the daughter both nodded, smiling through their tears.
As soon as a nurse on the 7:00 a.m. to 7:00 p.m. shift got off work, she was supposed to “give report,” a recitation of her patients’ status for the incoming nurse. Molly already had been working for more than twelve hours without a break. She hadn’t even eaten. Nurses at Pines almost never got time off for lunch. There was rarely a chance to go to the cafeteria, break room, or simply outside for thirty minutes. Only once in the past two years had Molly been able to leave the department for a break. The usual scenario involved eating while working at the nurses station, which was an Occupational Safety and Health Administration (OSHA) violation.
Hospitals were required to give nurses breaks, yet the constantly short-staffed Pines nurses never had time for them. Technically, nurses were prohibited from bringing food or beverages to the nurses station to prevent them from contaminating patient labs and vice versa. Priscilla, the nursing director in charge of supervising every nurse in the ER, let the OSHA rule slide because the odds of getting caught were low. When The Joint Commission—the governing body and accreditation group for hospitals—sent inspectors, they had to check in at the front desk. Immediately, a hospital-wide page would announce, “Pines Memorial would like to welcome the TJC inspectors.” Molly said the announcement meant “Hide your food!” She explained, “After the announcement, we have about ten minutes before the inspectors get to us. It’s so obvious, like, ‘Warning! Mayday! All the stuff that shouldn’t be out—hide it!’”
Priscilla let many rules slide, actually. She seemed to try to look out for the nurses as best she could, which couldn’t have been easy because she also had to enforce the new policies thrust upon them by the Westnorth Corporation, the giant healthcare system that had taken over the hospital six months earlier.
At 7:20 p.m., the charge nurse assigned Molly to put a Foley catheter in an obese paralyzed patient, a somewhat time-consuming procedure that required assistance. Molly walked to the nurses station, where five nurses were giving report to the oncoming shift. “Y’all, can I get a little help in Room 3 with the Foley?” she asked. The nurses ignored her. They didn’t even make eye contact with her.
These weren’t generally uncivil nurses; they were just busy. The outgoing nurses were determined to give report and go home, and the incoming nurses didn’t want to be bothered with someone who was not their patient. The nurse Molly would give report to was already working on a trauma patient. Molly knew that if her friend Juliette had been on duty, she would have been at Molly’s side in a heartbeat.
Molly looked over each of the nurses with her piercing green eyes. A tall, striking brunette, she was hard to miss. Five people were ignoring her—and she was not a quiet person. She had hoped that one of them would sense her frustration and offer to assist. But she would not badger them into helping her out.
Typically, many of the nurses at Pines worked well together, giving aid when needed, knowing they were in it together. Erica, for example, was constantly assisting her coworkers at bedside on top of her supervisory duties, as she was today. Ever since the buyout, however, the atmosphere had changed. The morale was as low as Molly had ever seen it. People were just too tired and angry to help each other out. The staff knew why Pines had allowed the buyout: Independent hospitals across the country were having trouble turning a profit because new insurance guidelines made getting reimbursement for medical care more difficult. Westnorth had instituted several changes that angered the nurses, including cutting their weekend overtime pay and slicing vacation accrual in half.
One of the worst new policies forced nurses to pay for parking at the hospital while techs and physicians could still park for f
ree. The nurses who didn’t want to pay for the covered garage would have to park at a satellite garage that was a shuttle bus ride away from the hospital. To catch the bus, nurses would have to get to work thirty minutes before their shift began and wouldn’t get back to their cars until at least thirty minutes after their shift ended, effectively adding an unpaid hour to their workday. What kind of company wants to make money off its employees like that?! Molly had wondered, dismayed.
The hospital takeover had directly and indirectly affected patient care, too, which was evident when Molly ended up struggling to insert the Foley alone. The procedure took longer than it would have if another nurse had helped to lift the obese patient. ER staffing was supposed to be determined by the number of patients who came in. The number had increased drastically enough to justify an additional staff nurse for every shift, but Westnorth had refused to hire anyone. Consequently, waiting time to get into the short-staffed ER had increased from an average of thirty minutes to three hours.
That night, on the drive home, Molly cried with frustration. She was known as being thick-skinned rather than a crier. She was so tough that once while playing pickup basketball, she tripped and broke her arm, but waited hours before going to the hospital because she was having too much fun to stop playing. Now she cried because the once tight-knit hospital no longer seemed to care about the welfare of its nurses, and her usually co- operative coworkers were so worn down that they “acted like I was invisible.”
As Pines Memorial’s treatment of nurses deteriorated under Westnorth, Molly had toyed with the idea of leaving the hospital. Earlier in her career, she’d worked as a nurse for an agency that assigned her shifts at different hospitals. As an agency nurse, she could choose which days she worked, and the pay was slightly higher. To return to the agency, where she was a nurse in good standing, all she had to do was fill out paperwork and send in her latest certifications.
Molly had stayed at Pines because she enjoyed learning from her experienced colleagues. But lately, there had been too many days like today. That night, she called Priscilla and left a voice message about the day’s events. “I have gone home angry and in tears more in the last two months than I have in my whole career. If I leave work angry again, I will not come back.” It may not have been the best way to let her boss know that she was close to quitting, but she was too frustrated to care.
The next morning, Molly, the designated trauma nurse, was able to focus exclusively on her patients without having to deal with politics, or so she thought. A middle-aged woman had multiple injuries from a car accident, and the operating team would have to repair her ruptured spleen. Molly’s job was to keep her stable in the trauma room until the OR was ready. As Molly connected the patient to a monitor, a nurse sitting at a computer called out from the nurses station.
“You’re going to love this one, Molly,” she said. “Now we’re going to have to pay for fancy uniforms!”
Molly froze. “What?” She breathed deeply. She had a patient to take care of. “Just a minute. Let me finish what I’m doing and I’ll come over.”
While Molly continued to work on the patient, the other nurse read aloud the policy, which administrators had posted on the employee website without notifying the ER nurses. All staff would now be required to wear a standard uniform. But only the nurses would have to pay for the uniforms out of pocket.
“What about the doctors and the techs?” Molly asked.
“Nope,” the nurse replied. “They’re covered.”
That was the last straw. It wasn’t the uniform, specifically. It was what the uniform expense represented: Pines didn’t appreciate its nurses. Furthermore, management gave employees little motivation to work hard. Hospital employees weren’t held accountable for their actions, and the supervisors were either too wimpy to enforce important hospital rules (Priscilla) or played favorites (Charlene). Too frequently, certain nurses and techs called in sick, then posted vacation pictures on Facebook. Or they were unprofessional: Lucy, the laziest tech in the unit, had refused to do lab work on patients she deemed too “gross” to touch. As Molly said, “There are no consequences for poor work ethic and no rewards for good work ethic.”
Later that morning, Priscilla gathered the ER nurses to tell them about the new uniform policy. While the group splintered into side conversations, Priscilla brushed her dark bangs off her face and put a hand on Molly’s arm. “I got your message,” she said.
“This place is coming apart at the seams,” Molly told her.
“I know.”
“I’m holding to my word on my message yesterday.”
Priscilla nodded, placating.
“I’m not changing my mind,” Molly said. “I’m giving you one month’s notice. The uniform is just the last straw.” She could call the agency tonight, start the re-registering process, and begin orientation within weeks. She was giving Pines Memorial ample notice because she didn’t want to leave her coworkers even more shorthanded.
Throughout the rest of the day, nurses complained about the policy. “They’re kicking us when we’re down,” they said. “The changes are making things worse.” They looked at Molly because she was one of the most outspoken nurses.
“Doesn’t matter to me,” she said. “I just quit.” Her coworkers laughed dismissively. “No, I actually did, y’all. I gave notice.”
Generally, Pines Memorial’s schedules were flexible and fair, and Molly had come to value the nurses’ intelligence and ability to stay cool under pressure. But, she thought, I can’t be angry at work every single day.
Molly had originally decided to make the career switch from occupational therapy to nursing after her mother had passed away. While in mourning, Molly received several letters from her mothers’ coworkers. The letters “talked about her being the best nurse they had ever known, how much fun she made work, and how much the patients and her coworkers respected her,” Molly remembered. Inspired, Molly became a nurse, too, at the age of 27—ten years ago. “I’m not that touchy-feely, but I truly love nursing. It’s a meaningful career, I’m good at it, and it’s flexible,” she said. “You can find work any time of day, any day of the year, which makes it mom-friendly.”
Molly had wanted to be a mom for as long as she could remember. After three years of trying to conceive with her police officer husband, Trey, she had finally scheduled an appointment at a fertility clinic. As an agency nurse, she would be able to arrange her schedule around her clinic appointments.
More experienced colleagues kept telling Molly that once she worked at several other hospitals, she would realize that Pines wasn’t that bad. “Will I find out from working at other places that that was really as good as it gets?” she wondered. Experiencing hospital life at various institutions was the best way Molly could discover whether anybody was treating both nurses and patients right.
She gave herself a year to find out.
LARA SOUTH GENERAL HOSPITAL, August
On her way to the staff locker room, Lara stopped in her tracks. The half-used vial of Dilaudid, a narcotic five to ten times more powerful than morphine, lay on a counter. It seemed to shimmer with energy and promise. You deserve it, coaxed a voice she remembered well. You’ve been working fourteen-hour days. Your mom just died. She died in your arms. It will make you feel better. It’s sitting right there. No one will know. You want it. Take it.
Lara had been a drug addict. It had started so innocently. Nine years ago, as a single 26-year-old nurse, Lara was chatting with the other nurses on the night shift about paying off school loans, when one of them said, “Did you know you can get four thousand dollars per egg if you donate them? We should all go together.”
“That’s kind of cool,” Lara had said. “I’m young, I’m healthy, and it’s easy money.”
The next morning, the four nurses went to a clinic for the screening process. Lara, with her blonde ringlets and fair skin, was the on
ly donor selected. After the multi-week process of egg retrieval, the doctor handed her a check and a prescription for Percocet.
The pill was the first narcotic she had ever taken. Within minutes, she was simultaneously giddy and calm, suffused with warm happiness, the world’s best buzz. She couldn’t stop giggling. Nothing bugged her. Her insecurities—about her dating life and her skinny boy’s body, which was never fit enough for her standards—dissolved. The next day, she took another pill. She didn’t think twice about it. It was her prescription, it energized her, and there were no side effects.
At work she was chattier and also more mellow than usual, and she managed to stay cheerful even while dealing with ungrateful patients and tedious charting. She skipped lunch breaks. When she finished the pills, a girlfriend who didn’t need her prescription anymore offered the pills to Lara. Why not? Lara thought. That week, she took three pills at a time.
A few days after the bottle emptied, Lara started to feel sick. That afternoon at work, she remembered that she had morphine in her pocket, 1 milligram left over from a patient. Back then, hospitals weren’t as vigilant about counting the “waste”—the surplus drugs left over from patients’ prescribed doses. Nurses went home, shrugged off their scrubs, and dumped their pocket contents into the trash.
She fingered the vial, running her thumb along the smooth, cool glass. If the Percocet made me feel that good, maybe morphine will, too, she thought. She returned it to her pocket to use at home. There was no inner voice asking her what she was doing, no angel on her shoulder imploring for restraint. It was just a little shot in the arm to take the edge off the day. She would never actually take narcotics at work, she told herself.
The Nurses: A Year of Secrets, Drama, and Miracles with the Heroes of the Hospital Page 2
