The Night Shift

Clinical is usually pretty boring. To be fair, I’m not sure how I’ll feel about a bunch of neophytes working under my license– once I get it. Most clinicals involve doing very mundane tasks under watchful supervision. It’s rare that something exciting happens. And if it does, I’m usually pushed aside for the more experienced people. Also, to be fair, I’d rather have an experienced therapist working on me than a student, if something interesting happens.

I was talking to Chris about this and he said “you never want to be an interesting patient.” At first, I didn’t quite understand the statement, but now, I get it. If one is sick enough to require an attending physician or a specialist, then one is quite sick. If one’s condition can be solved by a student, it’s not that serious. Besides, students get excited about attending’s mundane

I digress.

The other day, we were wrapping up for the day, and I was walking back to our meeting point when I heard someone coughing. Not like run of the mill coughing, but like end of times coughing. I poked my head in and asked if the patient needed anything, tissues? trash can? The patient motioned for me to bring the trash can over. So I did. Not two seconds later, the patient coughed, and produced massive quantities of blood. More than I’ve ever seen at one time. More than a trauma. A lot of blood.

And I just stood there.

The patient’s nurse came in as I was standing there. She hesitated for a half of second before going to the patient’s bed. She held the patient’s hand while simultaneously pressing the call button. A few moments passed until a few others filtered in the room. Time of death was called. I walked out of the room in a state of shock.

The physician took me aside and said, ‘the patient was a no code. There was nothing that could be done.”

I replied “But there was so much blood.”

“The patient most likely ruptured their bronchial artery coughing. You can do this until you retire, and you’ll probably never see this again.”

I met up with the group, still a little shocked by what I saw.

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.”

From somewhere deep down inside, 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 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.

We have this classmate. Since her last name is McDaniel and mine is Montgomery ,we are ofter placed in the same group. In every class someone has to be first and someone has to be last. Kate, our other friend Amanda, and I are first. As of now, all three of us are straight A students; McDaniel is…. decidedly NOT. 

On clinical days, we have to be at the hospital at the ungodly hour of 06:30, and student parking is like a mile away from the actual clinical site so we have to arrive by 6:15 to be on time. I live about an hour away from the clinical hospital so I have to leave my house at like 5am. See? Ungodly. Anyway… I digress… 

I’ve gone out with one of the hospital RTs a few time. His name is Jeremy, and he’s one of the ‘lead’ RTs… Not exactly a manager, but not a floor staff RT either. I haven’t told Kate or anyone really. Anyway, we’re gone out a few times, and last night was one of those times. Jeremy let me stay at his place last night since he lives so close to the hospital. There is a point to this, I promise.

Jeremy and I get to the hospital about 6:15. Since I’m early, I go to the unit I know I’ll be on. I strike up a conversation with the night shift therapist since she isn’t busy. You know the usual, how was your night? Anything significant happen? Which patient would be a good one for me, as a student, to work with?

I get the details and meet up with the rest of the class. McDaniel and Montgomery are once again ‘partners’ and assigned to the Cardiac ICU. I choose the two that was suggested to me and McDaniel gets one vent patient and one recently extubated patient.

After sfhit report, I go about assessing my assigned patients. About 7:30 I hear the computerized “Code Blue- Cardiac ICU”. That’s strange; that’s the unit we’re on. I pause my assessment and stick my head out into the hall. McDaniel is over by a room in the corner excitedly waving everyone over.

“I went in and did my first assessment. Came back out to get the meds, and went back to the patient’s room and they were unresponsive. So I called a code,” McDaniel reported.

“Did you check the chart for their code status?” someone asked.

“I couldn’t find it,” said McDaniel.

“What the hell?” Ah, yes, the therapist I’m working with has returned from getting breakfast. “What the hell is going on?” she repeated.

“This patient went unresponsive when I left the room to get their meds so I called a code,” McDaniel excitedly explained.

“Did you bother to check vital signs before declaring them [air quotes] unresponsive? the therapist asked becoming more and more exasperated.

“Yes” and McDaniel rattled off some numbers.

“That’s strange’, the therapist mused aloud. “This patient was pronounced dead at 5:45 this morning. We waiting for the morgue to let us take the patient down.”

McDaniel looked crestfallen. She stammered out ‘but I heard breath sounds. I felt a pulse.’

The therapist replied ‘well you must be a fucking miracle worker because you raised the dead– and then killed them again.”

Snickering broke out among the code team. Some even laughed outright. McDaniel looked like she wished the floor would swallow her whole.

I meandered back to my side of the ICU, and I overheard someone say “Imagine being so incompetent, that you imagined hearing breath sound and feeling a pulse.” and someone else chimed in “Fucking students. They’re all idiots.”

I do my best to not be an idiot, but when your classmates are assessing dead people and saying they hear breath sounds, it’s hard not to agree with them

“Hey. Are 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.

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, and I ponder the events of today.

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.

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, 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.

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;m 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.

“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.

DMB “Crash into Me”