the night shift

When the inevitable happened, I was taking an exam. I won’t say that I knew the exact moment, but I had a feeling that it *might* happen. I’d even fought with my aunt the night before.

“You should be here tomorrow. Your father will probably die. You will regret not being here if it happens when you aren’t here”

“I won’t, but thanks for trying to make me feel guilt that I don’t have. He wasn’t there for me in life; why should I be there for him in death”

And with that, I stormed out, not even a glance over the shoulder at the soon to be departed.

I may have been daddy’s little girl when I was 5, but that ship had certainly sailed by 15, and at 25, we were strangers. I’d like to think I’m past the ‘it’s all my parents’ fault, but are we ever really over it?

I sat in the back row of the church during the memorial service. My aunt, my dad’s new wife, my grandmother, and an assorted cast of loose acquaintances fill the pews of the small church that the service was held in. Next to me was my mom, who divorced my dad when I was a 7. Her husband didn’t come. My college roommate, who I hadn’t seen in a couple years, was on the other side of me, and beside her were two of my professors from school.

My cousin, the minister, gave the eulogy. It was all about how my dad was the best uncle to him and his brothers. And how he used to do things with them… how he was like a second father to them. He talked about how his recent marriage was a ‘new chance at life’. He talked about how he was a changed man by letting a dog in his life–and how that dog never left his side. My cousin the minister opined for nearly 20 minutes about the virtues of his uncle. He just forgot to mention that my father had a daughter.

Maybe it’s for the best that he forgot to mention me.

Everyone else did too.

Everclear: Father of Mine

“Did you here about Jeremy?”

I’m once again in the ICU at the large hospital where Jermey works for my clinical day. The absolute last thing I want to hear about in anything Jeremy did or didn’t do.

My patient is unconscious and ventilated. I’m attempting to draw an ABG to assess the ventilation status of our patient, and well, to practice my ABG skills. They are adequate, but I’m not going to lie, I don’t like hurting people. Even if they are unconscious.

My preceptor for the day is one of the ones engaging in the gossip about Jeremy so I can’t help but hear it.

“No, what is it?’ my preceptor asks

“He and that girl from radiology eloped. On April Fools Day.”

“For real? What is her name anyway?”

“Rachel. Isn’t she like 20 or something?”

“I heard they had only been dating a couple of months”

“Wasn’t he dating someone else though, like recently? I never heard that girl’s name, but I’m pretty sure she worked here. You know, the one where his ex tried to kill the girl”

The gossip about Jeremy and Rachel continue, but I hear none of it. I can definitely say that having a needle in someone else’s arm when you hear about your recent ex’s elopement is one of the worst ways to get that news.

At least I was sitting down.

Maybe now people will stop talking about me without really talking about me. But how does one move on so quickly? I’m barely hanging on to my sanity, and Jeremy is marrying some girl from radiology.

I am hating my life right now.

The Who: Won’t Get Fooled Again

I went home with James. His apartment is right across the street from the restaurant so it’s convenient.

I got in the shower and washed all the blood away. Somehow it had gotten in my hair. I got out of the shower and James had given me a t-shirt to wear. Everything else was destroyed anyway.

I came out of the bathroom and James had really stepped things up. He had cooked a meal and poured out a glass of wine. James is older than me, but sexy as hell and clearly knows his way around the kitchen. I cut into the chicken piccata he’d whipped up in the time I was in the shower. It was delicious.

“So that’s the guy you’ve been dating. The one who just stood around while you saved his ex’s life.”

“Yea, I didn’t see that coming. He always seems so sure of himself in the hospital. Like when I code is called, he shows up and takes over, acting like an air traffic controller. I never would have imagine he’d freeze like that”

“You know we will have to press charges against his ex. At minimum, property destruction. I hope it doesn’t cause you any problems.”

“Why should it? *I* didn’t destroy property. Thanks for dinner; it was amazing. I am exhausted”.

“Go sleep in my bed. I’m going to clean up and wind down”

****** *********** ************ *********** ************ **********

My dad is in the hospital. Again. Even more awkward it’s the hospital where Jeremy works and I do my clinicals. It’s awkward telling my instructors that under no circumstances do I want any of my classmates working with him.

It’s even more awkward seeing Jeremy.

A relationship kinda dies when the police get involved. As in there was a restraining order. And a court case. And involuntary commitment to a psychiatric hospital. Not many romances can survive that.

Oh and the fact I saw him with someone else. When he cancelled a date with me.

***** ****** ******* ******** ********* ******** ************

“Are you OK?” Chris asks me.

“I am not even remotely OK. In span of a month, my now ex’s ex girlfriend tried to kill me, I broke up with the guy I’ve been dating for a year because he chose just go date someone else without telling me.. My dad is dying and I can’t do anything about it. I’m fucking my boss at the restaurant just to have someone to hold me when I fall apart. I can’t deal with everything alone, yet, I keep pushing people away.”

“I’m still here.”

“I mean not really. I see you two days every other week.. If that. I don’t have your number. You don’t have mine. If I didn’t show up, you’d never know what happened. Unless you listened to the rumor mill-which you say you don’t, but you still seemed to know an awful lot about Jeremy. And how that went up in flames.. You knew how my dad was doing before I even said anything. I literally had someone try to kill me and you never…”

“I know. And I’m sorry. I didn’t know how. Or what to say. I still don’t.”

“yea, well, no one else does either. My dad is dying. Slowly. School is dragging on. I spend every waking moment in a hospital either working in one, going to school in one, or visiting in one. I’m literally sleeping on the floor in waiting rooms. I’m exhausted all the time. I barely have time to eat. I hear people whispering about me here, Main, and the restaurant. People who don’t even know me are talking about me. IN FRONT OF ME.

‘Even at the restaurant, I’ll have people say ‘Were you working here when that incident occurred?’ The incident! Someone who I didn’t even know existed literally tried to murder me, and it’s gossip. For the whole town. I even tried to save the one that tried to kill me. You can’t imagine what I’ve heard. What people have said when they didn’t know they were talking to me.

‘It’s literal hell on Earth, and every day I don’t know how I get through the day, and I do only to do it all again the next day. I’m up for ICU rounds at 6a, then I either go to class or change clothes and learn in the same ICU that my dad is a patient in. Then I study a little and go to work either here or at the restaurant. If I’m at the restaurant, then I sleep at James’s place. Only to get up and do it all over again. With the locations reversed. And no one asks how I am. Or offers to help. Or anything. But something is always wrong. And I don’t know how much more I can handle before I become the knife wielding protagonist in someone else’s story.”

And with that I walked away.

Chris had nothing to say anyway.

Toad the Wet Sprocket: Something’s Always Wrong

I’m in my last 6 month of school. Sometimes it’s stressful. We are almost always in one of the ICUs or sometimes the ER so our patients are never really ‘well’. I still pick up shifts at the satellite hospital where Chris works. That pace is a lot slower, but I’m also a lot more independent there.

I’ve never really mentioned my other job, but I’ve been working at the restaurant since before I started school. I’m a hostess/bartender and train new employees. It’s a fun job and I get heavily discounted food and bartending is fun. It definitely puts into things into perspective because at the end of a stressful night at the restaurant everyone is always still alive.

A couple shifts ago, Jeremy’s ex showed up to the restaurant. She was yelling! YELLING at me, saying that she was going to commit suicide because she has nothing to live for now that I’ve taken Jeremy away from her. Y’all, I didn’t know this woman existed and she shows up at my job calling me every sort of insult one could come up with. It got so bad the General Manager came out and told the woman that if she didn’t calm down, he would call the police on her.

Meanwhile, I texted Jeremy to tell him his crazy ex was at the restaurant and that I wasn’t going to put up with this treatment. James had me go to the back of the house to help diffuse the tension, but to no avail. Susan kept yelling. And threatening me.

About 5 minutes later, Jeremy shows up, and tries to calm Susan down. She continued to hurl threats at me, and starts to pick up food and plates off of diners’ table and throw them at the glass window. People started yelling. I’m sure someone called the cops.

Susan picked up a steak knife off of one of the tables and slashed her own throat. People screamed. I ran out from behind the window, grabbing cloth napkins on my way to her. I get to her and hold pressure at her neck. She’s fighting me the whole time. Jeremy is standing around being completely useless. The cops arrive and call for an ambulance. They help subdue Susan. Meanwhile, I’m still holding pressure. The ambulance arrives, takes over and wheels Susan out. I look down and realize I’m covered in blood. It’s 8p on a Saturday night. The restaurant should be packed; meanwhile, we are having to close because it’s an active crime scene.

The police question me. And Jeremy. And some of the dinner guests. By 10p, I am exhausted. And covered in blood. Jeremy is a mess; mentally and physically. The the police finally let us go they turn to me and say, “do you have anywhere you can stay tonight. I don’t think you should be alone. “

James tells them that I am staying with him and can be reached at his number. Jeremy says nothing,

I walk out with James’ jacket over my shoulders wondering what the fuck just happened and feeling quite certain that everything with Jeremy has exploded like a powder keg on the 4th of July.

Ozzy Osbourne: Crazy Train

We had clinic at the big city hospital the other day. I’d say about 75% of our clinical experiences are at this hospital.. it’s the hospital where Jeremy works. It’s always good to see him.

Anyway

I was working in surgical ICU on this particular day. Surgical ICU is a good place for students because there’s a lot of activity. The primary goal is to get people off the ventilator as soon after surgery as possible so there is a lot of ventilator weaning, adjusting settings, drawing ABGs, spontaneous breathing trials, and extubations. Sometimes there’s setting up BiPAP; other times it’s just oxygen for a few hours. Regardless, SICU is a busy place.

Sometimes, things don’t go as planned and a patient has cardiac and/or respiratory failure. They may have to go back on the ventilator for a while. Such was the case with my patient. The patient was alert and oriented and had borderline passed the weaning tests. The MD said “pull the tube. Sometimes we gotta see what they can do”

And so I did.

And things were fine. For about an hour. Then monitors started beeping and a flurry of activity commenced.

Now as a student we are not fully certified in ACLS or PALS, but we are in BLS. So I grabbed the Ambu bag and started ventilating the patient. The RN began chest compressions.. For what seemed like an eternity, but in reality probably less than 30 seconds, it was just the two of us..

Reinforcements arrived quickly and I backed out of the way while more experienced people took over.

I backed myself into a corner; right up against Jeremy. He put his hand on the small of my back— a decidedly intimate gesture. I froze.

“What does he mean by this” popped in my head.

The patient was re-intubated and placed back on minimal settings. Everyone disbursed and I headed towards the restroom. Jeremy followed.

“Hey, you did really well in there. You kept really calm in a high pressure situation.”

“I’ve got to pee” I replied as I entered the stairwell.

Jeremy followed. He caught up to me in about three steps. He grabbed my wrist and pulled me close to him, and kissed me squarely on the mouth.

To be fair, I kissed him back

“What the hell is that about?” I blurted after our lips separated.

“Go out with me.”

“Are you insane? I work two jobs. And I’m in school”

“Everybody’s gotta eat at some point. Besides, I can help you study.”

Not really knowing how to extricate myself from this situation, I agreed.

What the hell was i thinking. Dating should be the last thing on my mind, and besides if I were going to date anyone, it would be Chris. Shy, sweet Chris. But alas, I find myself agreeing to a date with Jeremy after he kissed me in the stairwell. Why couldn’t Chris have been the one to kiss me in the stairwell?

I fear this might get complicated.

Pearl Jam: Jeremy

We’ve been having a lot of rain lately per usual, but for whatever reason, it seems to have a little more intensity behind it this spring. We have clinical scheduled on Thursdays and our class is split up and assigned various practice sites. One of our classmates jokingly asked if clinical ever got ‘rained out’. You know, like a baseball game, he said.

Our instructor took this opportunity to go on a tirade about how healthcare is a 24/7 job and if thought we didn’t have to show up because of a little rain, then now was the time to choose another career. The tirade went on for quite some time.

24 hours later

I’m at one of the two large hospitals in our area. There are 6 of us total; 3 in one ICU and 3 in another ICU. About 11AM we get an overhead page telling us to report to a specific area. Our instructor tells us rain has cause one of the back-up generators to fail, and there is the potential for the others to fail as well. Until further notice, we are to hang out in ICU and wait for impending power failure. We are briefed on what will happen when (note when not if) the generators fail. All ventilators and other life saving equipment will stop. Our job as students is to take the Ambu bag and manually breathe for the patient for as long as necessary.

20 minutes later the power goes out. All 4 back-up generators fail and the hospital is dark. And quiet. I mean it’s daytime so there’s some light coming in and it’s full of people so there is that kind of noise, but none of the associated beeping one associates with an ICU. For two solid hours, us students manually breathe for these patients. The actual RTs are doing two at a time.

Disaster relief is trying to figure out how water got in the building and caused the generators to fail. Meanwhile my hand is developing cramps. We switch off and I get a little break, but the hospital is a complete disaster.

Our clinical ends at 3p, but no one can go anywhere. The area around the hospital is flooded and besides, and perhaps more importantly, there still isn’t power to power the generators. Around 5p, 3 of the 4 back-up generators are functioning we enough. The rain outside has slacked up, but the water is still everywhere. No one is going anywhere any time soon.

The job at the hospital is understanding when I explain the situation and how I’m stuck at another hospital. Thankfully, it’s summer so it’s still daylight when we are finally able to leave the building. The water is receding, but damage has been done. To the hospital and to all the housing around it.

Class is still scheduled for the following day because ‘hey, it’s just a little water, right?

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.