The Making of a Nurse (29 page)

“Life Is a Highway,” I sing out to her.

“Tom Cochrane, and I’m going to be driving it for a long while,” she sighs.

Trina flies past us at the nurses’ station. “Yo, you vanilla girls, get your butts in my room,” she, a chocolate girl, says. “I need your muscles to turn my patient and change the sheets again.”

Roberta goes to help her and I return to my own patient. It’s about time I got back to work.

When time permits and all is quiet, we take turns and steal away for a break. Jenna is carrying a blanket, in search of a place to nap. “That one is haunted,” she says, rejecting a particular room.
“There’s a ghost. Remember that young boy who died? Well, I’m not going in there,” she says, superstition overriding her fatigue.

I pay a short visit to Tikki, ostensibly to say hello, but my hidden agenda is to check up on her and she knows it. When she started in the
ICU
a few months ago, I was her preceptor. She came to us straight from her university studies where she achieved top marks. She’s now qualified to “fly solo,” but a few of us have an uneasy feeling about her and I always try to be nearby, especially if she has a really
busy
patient. There is no question that Tikki has improved, but to be honest, the thing that changes most noticeably about her is her hair. She started out with a spiky, black Goth style to a fancy up-do with purple streaks, to her current style of long, multi-coloured dreadlocks. In addition to her many tattoos she’s shown us, she’s got lots of body piercings – tongue and ears are what’s visible, but she claims there’s more. (Funny, I saw her once with her mother in the supermarket wearing a girly, puffy ski jacket and a lavender Dora the Explorer track suit. Go figure.) She’s now a Wiccan and a devotee of hypnotic techno music. She has a new tattoo she wants to show me and informs me that her diamond nose ring is actually an engagement ring. I’m just about to offer congratulations when I notice two long cords dangling from her ears, snaking into her scrubs.
She’s listening to music?
“Tikki, is that an iPod?” I am aghast. She is moving to the beat of the music in her ears and doesn’t hear me so I tug on one of the strings. “Tikki, you won’t hear the alarms! You can’t concentrate properly!” I stop. There are more reasons than I could possibly enumerate. “Take it off!”

“Hey, Tikki can you give me a hand with my patient’s dressing change?” Chandra, on the other side of the room, calls out to her.

“I’ll be there in a minute. I have a bid on eBay in five minutes for a vintage Barbie, okay?”

Chandra and I lock eyes in irritation. “No, Tikki, it’s not okay. I need your help now.” Tikki turns off her music and logs off her computer.

I quell the terrible feeling I have at what I have just seen and return to my own patient. I sit at the desk and open a file in
which I’ve been making notes and collecting data for the past few weeks. I add Tikki’s newest tattoo. It’s a green-blue serpent on her ankle. I keep watch over my patient and review my findings.

It seems Jenna’s patient’s six-year-old daughter was indeed left alone when her father suddenly took ill and was brought to the Emergency department. Fortunately, a neighbour took her in and she’s being cared for by Children’s Aid Services until her father gets back on his feet. How easily Jenna and Roberta could have let that go, passed the buck, or overlooked it altogether. How easily they could have said, I’m tired, or it’s not my concern, it’s beyond our scope. “Good call, Roberta,” I say, but she shrugs it off.

“Good friends, neighbours – isn’t that what people need more than anything?”

“Tonight’s the Night,” I put to her.

“Rod Stewart. Hey, what research are you up to?” She pointed at my stack of notes and I smile an inscrutable smile. “You’re So Vain,” I tease her with Carly Simon.

Of thirty-eight subjects, between the ages of twenty-five and fifty-five, including nurses, respiratory therapists, doctors, and one hospital attendant, 68 per cent have at least one tattoo. Here is a representative sampling:

A dolphin on a hip, a ring of roses around an ankle, Woody Woodpecker on an inner thigh, a green Celtic symbol behind an ear; a Brazilian wax,
*
numerous butterflies, the names Tom and Terry, a Toronto Maple Leafs logo; yin and yang; the Mona Lisa, a marijuana leaf, and an @ sign, a dragon, a cross, a Nike swoosh (the ultimate branding), a sword, Chinese characters, and a skull and crossbones.

And some noteworthy narrative comments:

“Have You Lost That Lovin’ Feelin’?” I ask Roberta as she rushes past me.

“No! The Righteous Brothers. What makes you think that?”

“Having any ‘Saturday Night Fever’?” I ask her, pretending to be concerned.

“The Brothers Gibb,” she says without pausing. “I’m busy. I’ve got to help Casey admit the new patient.” Casey has indeed put aside her sewing and salami and is back to her usual efficient and capable self, busy with the young woman who overdosed on Tylenol and her distraught parents. I go over to help, but as chaotic as it is in there, Casey has everything under control. The room is filled with lots of doctors, nurses, and respiratory therapists, and they don’t need another pair of hands, so I head back to my patient. I can’t help but remember similar situations in the past with Laura, who would be right in the midst of this crisis, taking control of the emergency, but afterward felt compelled to make some caustic remark like, “I’m going to give a seminar called, ‘Suicide: Get It Right the First Time.’” Laura had a problem with these patients. “They botch themselves up and make life worse,”
she’d pretend to complain, for she couldn’t reconcile that we were fighting to save lives and they were trying to destroy theirs, but as usual, expressed her sadness as outrage.

A chaplain, looking just as distraught as the family, stands outside the patient’s room, consoling them. The mother, through her sobs, tells the doctor and Casey what happened. “She had a terrible fight with her boyfriend. He was cheating on her and she went home and swallowed a bottle of Tylenol, chased down with alcohol. There was no note.”

I shiver, suddenly feeling cold, and return to my patient’s room, where I’m supposed to be, anyway. It’s not my particular assigned portion of tragedy tonight.

No matter how many years of working nights, I still feel a chill and an overwhelming urge to lie down about now. Night shift doesn’t feel healthy. It’s not normal and it’s getting harder as I get older. You don’t sleep the same way during the day as you do at night. How much longer can I keep this up? From time to time, someone brings in an article about higher rates of migraines, depression, breast cancer, stomach problems, infertility, and heart disease in night shift workers. We worry. I make a list of things I’ve got to do on my day off. It’s time for the second wind to kick in. Where is it?

We move from bed to bed, drawing samples of blood from our patients’ arteries and veins. We need some results right away to treat any abnormal values and others to have ready to review by morning rounds. Luckily, we don’t have to wake our patients and can do it silently, drawing our samples from lines already in place. Bone-weary, cement-footed, dragged down, my vision is blurred, my mind is foggy, and my thoughts are muddled.
I’m getting too old for this
. I get up and walk around, splash cold water on my face at the sink. I will myself awake with whatever mental powers I can summon. The second wind must be right around the corner,
any minute now it’ll come. How short the night feels when you’re sleeping in your bed at home and how long it feels when you are up all night at work. I skulk around the unit, eavesdropping, guarding, gossiping, and watching.

Three o’clock in the morning feels like the middle of the night, but there are only four more hours to go. Monica has returned from her “break,” looking flushed and more energized than anyone has a right to at this hour of the night. She is shocked when I tell her about Tikki’s iPod and bad attitude and asks me what I am going to do about it. She tells me I’d better keep my eye on her and document the problems with her work. “If you see something wrong, it’s your duty to do something about it,” she reminds me and I know she’s right.

Tikki is not too pleased when I show at her side once again. I hate policing people, but when I take one look at her patient’s flow sheet, I immediately see a problem that could be serious. “Tikki, did you notice your patient’s cardiac output?”

“Yes, I did,” she says slowly. “It’s 2.3 litres per minute.”

“What did you do about it?”

“I mentioned to the doctor it was low,” Tikki said defensively, “but she didn’t react.”

“You have to recognize the significance, make a fuss, and follow through,” I say, trying to goad some reaction out of her, but she only looks wounded and starts to explain herself. Suddenly, across the room, there’s a scream and a moan.

“Help! I need help!”

It’s Chandra. I leap over in two bounds. In moments, Roberta rushes in. Theo arrives, pushing the crash cart ahead of him, Jenna, Trina, and others right behind him. Chandra is slumped over the side rails of her patient’s bed, practically lying on top of her patient, her hands covering her face. “Shit, shit. I’ve made a terrible mistake.” She pulls herself upright and quells her terror long enough to tell us exactly what happened. “I hung what I thought was the antibiotic, but it was a bag of insulin – fifty units in a fifty
cc bag. I got them mixed up. Instead of the antibiotic, I ran in the entire bag of insulin in twenty minutes. It was supposed to go in over twenty-four hours.”

She’s barely finished getting this story out and Roberta has already run to fetch the glucose analyzer to check the blood sugar and I am pushing two large syringes of Dextrose 50 per cent – D50 – a concentrated sugar solution, into the patient’s central intravenous line. Someone pages the doctor. We work fast. Chandra is in shock, stunned by what she’s done. Normally a self-possessed, take-charge sort of person who prefers to do everything herself, she’s backed right off and lets us take over, as if she’s forfeited her right to be a nurse.

Theo examines the patient, assessing his level of consciousness. He shines a light into his eyes and sees that the pupils are responding briskly, as they should. Someone draws blood to check electrolytes. As I place the electrodes on the patient’s limbs and chest for a twelve-lead
ECG
, I catch sight of Tikki, watching and looking smug. Surely she recognizes that this is an emergency? “He looks okay to me,” she says with a shrug of her shoulders and goes back to her own work.

“He may not be shortly,” I snap at her, glancing at the blood sugar result of 3.0 mmol/L.
*
Anything below 4.0 is dangerously low.
Don’t you realize if we don’t take immediate action to rescue him, he will have a seizure, go into a coma, and have a cardiac arrest in a matter of minutes?
I draw up a syringe of midazolam, the treatment for a sudden seizure, to have at the ready. The patient stirs in his sleep and we jump. Is it due to the commotion in the room or the sudden plummeting of blood sugar? Theo tries to shake him awake, but can’t rouse him. Whether it’s from insulin shock or from the sedation he’s already on, we can’t tell. I push in another – now the third ampoule of D50 and Roberta retests the patient’s blood sugar. It’s now 2.5 and could still drop further. “Is the doctor on her way?” I ask.

“She can’t come right now,” Roberta says. She’s starting a Dextrose 10 per cent solution and I push in another amp of D50,
figuring that even if I overshoot, a high sugar level is less dangerous than a low one, and set my eyes on the cardiac monitor, on the lookout for arrhythmias. “She’s in emerge examining a patient who may have to come here and the young woman with the Tylenol overdose is crashing, so she has to go to her first, but she says we’re doing all the correct things.”

“How could I be so stupid?” Chandra moans. She paces the room, wringing her hands. “I wasn’t tired. I wasn’t overly busy. I wasn’t stressed out.” She stops in front of the
IV
pump, picks up the empty bag of insulin in her hand, stares at it, and shakes her head as she searches for clues to understand her mistake. I can imagine her desperate wish to take back those few moments of inattention, to return to the blissful, innocent time of “just before.”

“He’ll be okay,” I say, taking another reading, and see that the blood sugar is down to 1.6. I push in two more amps of D50.
I think he will, anyway
.

We’ve managed to get the patient’s blood sugar back to a normal range and so far, he does not seem to be experiencing any adverse effects from the mistake. I put my arm around Chandra, who is devastated. She pulls away and I understand her reaction. What I do not understand is Tikki’s.

The doctor arrives and says, “You saved her,” and doesn’t harp on the fact that one of us almost killed her. She is pleased we took control and agrees with everything we’ve done. She examines the patient, finds no abnormalities, and is satisfied that the mistake has been completely rectified. She and Chandra fill in an incident report that outlines all the details. In the morning, they will inform the manager and staff doctor, who will call the family to let them know what happened.