Alexandra Robbins - The Nurses: A Year of Secrets, Drama, and Miracles with the Heroes of the Hospital

THE NURSES

A YEAR OF SECRETS, DRAMA, AND MIRACLES WITH THE HEROES OF THE HOSPITAL

ALEXANDRA ROBBINS

WORKMAN PUBLISHING

NEW YORK

To my family, past and present, with love

CONTENTS

PROLOGUE

Four hospitals stand within a fifty-mile radius of a major American city. On the surface, they are as different from one another as fairy-tale sisters.

Pines Memorial Hospital is a pleasant-looking cream-colored building with a sixteen-story tower and broad, welcoming windows overlooking a quiet tree-lined suburban avenue. After decades of independence, the neighborhoods favorite hospital was bought out by Westnorth, a large healthcare corporation, which is slowly diluting the local flavor. With 190 beds, Pines Memorial serves a highly educated, wealthy population with a large percentage of academics, retirees, and nursing home residents. Because it is close to a major highway, Pines emergency room, which has approximately 60,000 visits per year, often treats victims of major-impact car accidents. Nurses joke that the hospital should be called Highway Memorial, because the risks of the highway are far more relevant to the medical staff than the quiet red pine forests outside of town.

Several miles away, South General Hospital occupies a mostly gray edifice curved away from the road, as if to shield its inhabitants from the gang violence that occurs frequently nearby. The Level-1 trauma center
designated as such because it has the resources to treat every stage of injury, from prevention through rehabilitationhas 300 beds to serve one of the most indigent areas outside the city. South Generals ER sees 95,000 ER patients annually. The reputation of The South is like that of the proverbial kid from the wrong side of the tracks, hoping to keep up with her peers, but unable to overcome the disadvantages of living on the poverty-stricken south side of town.

Forty-five minutes west, in a peaceful corner of the city, Academy Hospital, proud and prestigious, inhabits several white-pillared, brick structures that wind around courtyards and patios, reflecting the storied architecture of its surrounding university campus. With approximately 425 beds, Academy treats a ritzy demographic of young and middle-aged residents in the nearby million-dollar homes and the students at the elite university. The Academy ER treats fewer than 45,000 patients per year, partly because it simply does not have the building space to expand its emergency department walls.

And Citycenter Medical, a longtime teaching hospital, is split between two dusty beige high-rises, perhaps representative of its dual personalities: a stalwart institution with top-notch doctors and an ER so poorly managed it is considered dangerous by many of its own staff. A 390-bed Level-1 trauma center, Citycenter has an emergency department that is crumbling beneath the weight of the 85,000 annual patients it does not have enough nursing staff to treat properly. While Pines Memorial treats more blunt force, multisystem traumas because of the car accidents, Citycenters traumas are typically isolated injuries, such as gunshot wounds. Easily reached by public transportation and in the heart of a densely populated city, Citycenter is a destination of choice for homeless people, drug-seeking addicts, and the uninsured.

In each of these disparate institutions, pale blue curtains shroud pods of frightened people. In each, seasoned healers perform routine procedures and medical feats behind bleached sterile walls. And in each, tracking invisible undercurrents through hallway mazes, nurses connect doctors to patients, carrying out copious orders in synchronized steps, entwining themselves intimately in convalescents lives.

CHAPTER 1

WHAT ITS REALLY LIKE TO BE A NURSE:
The Joy and Heartbreak of the Secret Club

Emergency nurses practice in an environment that has been called permanent whitewater, where constant change, challenge, and crisis are the reality. Amazing stories occur each day and some of these stories may never be acknowledged or written.

E MERGENCY N URSES A SSOCIATION, A WARD R ECOGNITION P ROGRAM

In the hospital, were truly a family and we have fun together. ER nurses have the raunchiest jokes, foulest mouths, and grossest stories. Because were working in such close proximity there are always inappropriate jokes, comments, and teasing. Occasionally it escalates to a one-night stand between a nurse and doc, but mostly that happens off hospital grounds.

AN E AST C OAST TRAVEL NURSE

Its like high school, except for the dying people.

S AM, A NEW ER NURSE

MOLLY PINES MEMORIAL, August

Molly raced toward the nurses station, dodging other fast-walking staff, weaving through stretchers lining the corridors. Traffic was stopped ahead; another nurse pushing a patient bed had gotten stuck because the halls were barely wide enough for two stretchers to pass each other. Molly had no time for this. No one did. The Pines Memorial ER was overloaded with patients, many of them moaning in pain or calling for the nurses who scurried through the brightly lit department.

After ten years as a nurse, three of them at Pines, Molly had learned to tune out the voices, and the cacophony of constant monitor chirps, high-pitched call-bell dings, and low-toned beeps of alarms from patients not her own. She didnt even notice the smell anymore, a blend of cleaning spray, urine, and, depending on the number of intoxicated patients, alcohol.

Molly ducked under a stretcher, scooted in front of the traffic jam, and helped the nurse lift the bed slightly to extricate the wheels. When the nurse smiled gratefully, Molly flashed a thumbs-up and hustled to the station.

There, Erica, the senior charge nurse, caught her eye. Ive been trying to call a Code Purple for hours, but Charlene wont budge! Erica said. Friendly and smart, Erica struck just the right balance for a manager: She was firm but fair, and the nurses respected her. It was unusual for her to be rattled like this. A Code Purpleclosing the ER to ambulances and rerouting patients to other hospitalsmeant less profit for Pines Memorial, which would explain the administrations resistance. But the ER desperately needed relief.

Charlene, the nursing supervisor, stomped into the nurses station. Erica urgently called out to her. Charlene! We need to call a Code Purple.

No way, Charlene said, shaking her long blonde hair.

Every room is full. Everyone has more than the usual number of patients. Even the hallway is full. We dont have beds to move these people to, Erica insisted. Where are we going to put any other ambo patients who come in?

Ill get back to you. Charlene left the room.

Erica shot a worried look at Molly.

The medic phone rang. Medic phones, which kept Emergency Medical Services in touch with hospitals, resembled walkie-talkies attached to police scanners. As Molly pressed the radio button, the other nurses nearby groaned. Whats this one going to be? one nurse sighed.

Molly answered the call. Pines. Go ahead.

A medics voice crackled over the speaker. Were bringing in a seventy-two-year-old male. Working code. Five-minute ETA.

Crap, Molly muttered after she released the button. No time to waste. A working code meant that CPR was in progress.

We have to make room for a code, yall, Molly said, in her unmistakably Southern drawl. Erica didnt have time to reply before the phone rang again.

Molly reached over and hit the button. Pines.

Medic forty-two en route to your location with a fifty-eight-year-old female in respiratory distress. We have her on BiPAP. Bilevel positive airway pressure was a method of assisted breathing. The patient probably would have to be intubated.

Whats your ETA? Molly asked.

Ten minutes.

Erica summoned Charlene again. Charlene! Were getting two working codes.