The Night Shift

My last shift at the hospital was….ummmm, interesting. Very interesting.

It started around 2p, when I’m doing my rounds. I go into the room of a post-op patient. He’s struggling a little to breathe, but in his defense, he up moving around. I check his vital sighs and they are out of range. Heart rate elevated, respiratory rate elevated, oxygen sat lower than it should be. Something was off.

I let the nurse know that something was off with this patient and she sort of dismissed my concerns and told me if I was concerned, I could call the surgeon myself.

I went back downstairs and mentioned my findings to Lloyd. He agreed to come look at the patient. We go up together and assess the patient again. He looks worse, but is still up moving around, preparing for discharge.

Lloyd agrees to stay with me as I call the surgeon since its my first time doing it.

I write down what I’m going to say.

“Hi, I’m calling about Patient [Name}. You preformed [type of surgery] yesterday. His vital signs are [vital signs]. I calling because he’s short of breath and diaphoretic in addition to his vital signs.”

I see the RN I reported the vitals to in the background, laughing.

The surgeon replies YELLING–and this is a direct quote–“Who the fuck do you think you are calling me about a patient. I wrote discharge orders on him this morning. Why the fuck is still in the building?”

THE YELLING through the phone can be heard everywhere.

“Aren’t you a fucking nurse? I write the orders and you follow them. And if you can’t do that, then you can get the fuck out of my hospital”

From somewhere deep down inside, I pull up resolve I didn’t know I had. I manage to not break down.

“Actually, I’m not the nurse, but I am a member of the care team. I reported the finding to the patient’s nurse, and she chose not to do anything. Upon reassessment, the patient had decompensated further. And that’s why I called you. And I just wish you would try to throw me out of this hospital when you are clearly in the wrong here.”

And I the schadenfreude I felt when I called her over, “Excuse me, it’s for you”.

MORE YELLING occurred over the phone. The RN furiously scribbled new orders. Her eyes shot daggers in my direction.

I made a beeline for the elevator. Chris joined me.

“Bold move, Cotton.” I don’t know why Chris has started calling me Cotton, but he has. “That surgeon is an asshole. Did you really tell the nurse about everything and she didn’t do anything?

‘I did. And she didn’t”

“Good job. You probably saved his life. Sounds like a pulmonary embolism to me. He’s probably going to call me for ‘medical management’ and I’m going to tell him to go fuck himself. Because I can. He needs to learn he can’t speak to people like that and still get what he wants. That surgeon has lost his damned mind.”

“But you did good” Chris looks at me a little too long. I shifted my eyes and wondered how an elevator that only travels between the ground floor and one level up can take so long.

“Hey. Do you want to go to El Jalisco again for lunch?” Kate asks. We are supposed to be studying gas laws, capillary action, density of air and water, and other science-y stuff when Kate asks me this seeming innocuous question.

“You remember what happened last time?’ I responded without it trying to seems like I’m a party pooper.

Kate’s eyes glinted “yeah.” And I knew she wanted the same thing to happen again.

Last week, Kate, two other classmates, and I went to the local Mexican restaurant for our lunch break between out 3.5 hour class and out 3.5 hour afternoon lab. It’s like this every Tuesday. A full 8.5 hour day starting at 8:30am. And then I stupidly go in to the hospital from 5-11 every other Tuesday. So for me it ends up being about a 15 hour day.

“I have to work at the hospital this evening.”

“You’re just going to see your boyfriend.” She says that word-boyfriend- like a 5 year old would say.

“He’s not my boyfriend.” I snap back, perhaps a little too loud as our instructor looks up at us.

“Not yet, but you want him to be”

OK. I’ll admit it. At to myself. I was attracted to Chris from the moment he crashed into me. I even arranged my schedule to be every other Tuesday because he works every other Tuesday. But the truth is, I know nothing about him. Not really. He’s nice and he’s a hospitalist. That’s all I got. Oh and he doesn’t wear a wedding ring.

Kate wants me to go to the Mexican restaurant because I speak Spanish. And last week, we got a free pitcher of margaritas. And the waiter was flirting with me.

Kate has been married something close to 20 years and she has a teenage son. Her mission is to get me “hooked-up” before we graduate. I don’t think it matters to her who since the top two candidates are Andres, our cute waiter from last week, and Chris-who she’s never met.

We go to the Mexican restaurant again. I order lunch fajitas again, and again, I get the large size. At least I’ll have lunch tonight, I think.

” I think I might be an alcoholic.” Kate blurts out.

“Well, alcoholism, is a self-diagnosed disease so if you think you are, maybe you are.”

Our order arrives along with a free pitcher of margaritas–just like last time. Andres is once again the culprit. We talk about gas laws and other school things. Kate drops another bombshell on me.

“My husband is an asshole. He told me he thinks you are cute.” I had gone over to Kate’s house to study. We were supposed to be alone, when her husband and son interrupted our study session by barging into the kitchen. “What’s really concerning is Bryan also thinks you’re hot.” Bryan is her 16 year-old son.

I began to think that Kate might really be suffering from alcoholism, because these are not confessions one makes sober.

And later that day…

Later….at the hospital, Chris stops by the office. Lloyd is somewhere in the building being the social butterfly that he is, and I’m studying and manning the phones.

“So what did you learn in class today,” Chris asks.

“Gas laws and alcohol… as in alcoholism. I think my friend Kate drinks too much–Oh and her 40 something year old husband and teenage son think I’m hot.”

“We’ll I’ll split the difference and say this 30-something year old agrees with them.”

I AM SPEECHLESS.

FLOORED.

The phone rings. They need me for a nebulizer treatment in the ER.

I laugh. Or I think I laugh. “Saved by the bell. Duty calls. I’m needed in the ER.”

When’s your next shift?” Chris asks.

“Thursday,” I reply.

“Great, I’ll see you then”. Chris and I head in opposite directions.

As I head home and get ready for beda I ponder the events of today. It feels like one of those nights I won’t be sleeping.

ElizaMarie, future RT

ElizaMarie, student RT’

Ummm hey, My name is ElizaMarie.

All three are variations of an introduction I’ve use at the hospital just this week. I have a hard time speaking up when it’s needed. Idk why I’m like this but it’s been an issue my entire life.

There are so many people to meet. There are the hospitalists. So far, I count 4. There are the ER physicians–I’ve met 7 so far. And so on. There are the ICU RNs, the ER RNs, and the floor RNs. There are a million a one PCTs, a few unit secretaries, X-ray techs, and the chefs. For such a small hospital, there are a lot of people here.

I notice most people are polite and welcoming. Some of the ER staff in particular get annoyed when I say ‘I can’t do *that’ (whatever *that is varies from time to time, but it’s most assuredly something I have yet to learn or be checked-off on). So I try to explain that I’m a student, a helper of sorts, with the added bonus of learning while getting paid. They don’t understand. I get it. It’s been a long time since Respiratory Student techs were even allowed in the hospitals so most have never come across one. Sometime I try to say I’m the respiratory version of a PCT, but even that gets people confused. PCTs have specific job duties. I do not.

But it’s exhausting–not only having to introduce myself to everyone and remember who they are in turn, but also, trying to explain my not-so-clear even to me role. Chris has been most helpful in introducing me when I work on his shift. He’s a nice guy, that one.

So allow me to give a proper introduction:

Hi My name is… ElizaMarie Montgomery. I’m 24 years old and a 2nd semester RT student. If things go according to plan, I’ll graduate next year and will be a Registered Respiratory Therapist, but for now, I’m here to learn and help out in any way I can.

I don’t like rules and I don’t always follow them but call it what you want to and  sometimes RULES are just RULES, and these are the rules. 

The Rules

1. The Night Shift is a work of fiction. Realistic fiction. Fiction so real you may think it’s real. But fiction nonetheless. Even the main character, RT ElizaMarie is fiction. All the other people–also fiction, but just in case they aren’t–names have been changed to protect the innocent. Or the guilty.

2. You don’t know me. Even if you do, pretend you don’t. Anonymity is never guaranteed on the interwebs, but I’ll do my best to convince you that you don’t me.

3. You don’t know the person I am talking about. Because it’s almost a 100% chance that the person I am talking about is an amalgam of more than one person. And even if it’s not, you still don’t know that person. See rule #2

4. Nothing or no one is as it appears. [See rules 1, 2, 3, 5 & 6 for explanations]

5. HIPAA is for real. [I don’t want to lose my license before I get it or get kicked out of school before I finish]

6 I make things up…like names, details, and locations. [once again, see rule 4 for explanation]

7. The institution is the place most of the stories occur. The actual institution changes as new opportunities present themselves.

8. Any resemblance to persons living or dead is coincidental, and speaks to universal issues in healthcare. And love. And life.

9. Once again, The Night Shift is a work of fiction. Nothing mentioned should be construed as medical advice. If you need medical advice, you should probably seek advice from an actual medical professional, or call 9-1-1 in a true emergency.

10. The Night Shift is for entertainment purposes only.But it’s not a bedtime story you’d want to read to children. Or impressionable young adults.

11. Since some of these chapters take place during education events, absolutely all policies of related educational institutions were followed. Or they would be. If any of this were real.

12. Sometimes life imitates art and sometimes art imitates life. Sometimes we never know which is which.

13. I couldn’t think of any other rules or disclaimers,, but I like round numbers. Numbers divisible by 3, 5, and 10 are also acceptable. The only prime number that is acceptable is 13. It’s been my jersey number since I started T-ball at age 5.  Before Taylor Swift was even born so I absolutely did not conscript that from her. Unlike every single chapter name in this story. 

I was a bit preoccupied. Preoccupied with what I was going to say. Preoccupied with not getting lost. Getting lost. That was the hard one. Left. Turn right at the first hallway. The right at the last door. It’s easy.

It was not easy. 

I have never been great at finding my way. Whether on a hiking trail. Or in life. And particularly, some random doorway down a long corridor where the rest of my life was waiting.

Not to be dramatic or anything.

Bam!

A literal crash of two humans.

“I amm so sorry.” I stammered out. 

“You crashed into me”

“I’m sorry. I’m looking for the RT department. Is this the way? I ask, ignoring the fact that I almost knocked a grown adult male, quite possible a physician, to the ground in my preoccupation.

“Hi. I’m Chris.”

“I’m lost. Is this the right way?” Where were my manners, I thought much to late to correct.

“It is. Let me show you”

Chris chatted on, but I heard none of it. Fate. Future. All those thoughts were running through my head.

“Here you are. Good Luck”

“ummm, thanks for the escort”

I had never been one to have concrete goals or plans. I am a person that blows which ever the way the wind blows me. A tumbleweed. Do they even have those in the South? Random thoughts. That’s how my brain works. Jumping from here to there. Focus. I need focus. For my interview. For my life. This was a chance to begin life again.

“So why respiratory therapy?”

“To be honest, I went to the career fair, and that and x-ray tech were the only two programs still accepting students for the fall. So I enrolled. I’d never even heard of RT, had no idea what they did, or anything.”

Should I be this honest? In an interview? Well, it’s too late to stop…. I thought as I heard myself talking with the department manager, a grizzled old guy named Gus.

“I enrolled. Did well, and found myself actually enjoying learning about the heart and lungs. And clinicals were amazing. ICUs in the first semester”

“We’re no level 1 trauma center” Gus mentioned. “Things aren’t always exciting around here”

“That’s OK. I’m still in school. I can use the downtime to talk to people” Whaaaa- why did I say that? I’m an introvert. I hate talking to people..

“Well, the pay’s not great, and there are no benefits, but I’ll do what I can. We haven’t hired a student in years, but I think you’ll fit in OK around here. The job is yours if you want it.”

“OK. Thanks. I’ll get back to you and we can iron out the details”

Who was this person and what was coming out of her mouth?

“Sounds good. Here’s a card with my direct line on it. You can find your way back to the front of the building can’t you?

‘Yes, Thank you”

With no Chris to guide me, I meandered my way to the front door of my new place of employment.

 

Dear Reader:

Hi. My name is Eliza Marie Montgomery, and this is my story. It’s been said that one’s co-workers determine job satisfaction. Especially in healthcare. To some degree, I believe that’s true. After all, these are the people I spend the most waking time around. And even not on a 12 hour shift, these are the people that can still make your day ‘good’ or ‘bad’.

Co-workers can become friends over time. After all, who else can you trauma bond with during a traumatic shift. Who else can literally save your life during a violent patient encounter? Co-workers can also become more than friends. After all, as a single person, where else are you going to find someone to date? While it seems good in theory, this is almost always a bad idea. It’s hard to maintain a collegial relationship with someone who has seen you naked. There’s always a little bit of truth to shows like Grey’s Anatomy. The Night Shift is my story and these are my people. Some I like better that others.

Cast of Characters

• Gus–> a grizzled old veteran, the boss, just trying to make it to retirement
• Mitzi–> ditzy, blonde, know-it-all, tries to make my life hell. I try to avoid her
• Lloyd–>30+ years on the job; knows how to do everything
• Ike–>another old timer; night shift, sleeps most of the shift
• Sandy–>does yoga when she thinks no one is around; also night shift
• Dr. Chris–>physician, hospitalist, the nicest and most approachable of the hosptialists
• Dr Greg–> ER physician, knows his stuff, no nonsense, hilarious
• Nurse Liz–>my favorite ER nurse
• Kate–>my classmate and friend, has the same job as me starting out but at the larger intuition

__________________ ______________________ _____________

Additional characters occurring later

• Nurse DJ–>fun, knowledgable, RN, around my age
• Justin–>I dated a hockey player; it was fun for a minute, but Canada, in winter–no thank you
• Nurse Margaret–>the human embodiment of the energizer bunny, fund of knowledge only gained by being a RN for >50 years
• Charlotte–> another BFF at the institution
• Christy–>my partner in crime at the institution
• Nurse Maria–>my nurse BFF at the. latest institution
• Jeremy–>a mid-level manager type at the large institution. I dated him; it went badly
• James–> my restaurant boss; I dated him too. You can imagine how that went
• Jeff–>You’d think I’d learn that dating co-worker is the worst idea ever.
• Taylor–> my co-resident. I guess you can probably figure out what happened there.