Cassie Alexander - Nightshifted

For anyone who ever got paid a little extra to stay up very late.

This book would not have been possible were it not for the efforts of many other people, only some of whom Ill get to recognize here. Firstly, my husband, Paul, for understanding completely what Im trying to do; my agent, Michelle Brower, for believing in this crazy book; and my editor; Rose Hilliard, for buying it and her excellent input afterwards. I am forever in the debt of my alpha reader, Daniel Starr, who played an incalculable role in making me the writer I am today. I will always appreciate my beta readers, Tina Connelly, Anna Eley, Patrick Weekes, and Julia Reynolds, for letting me borrow their brains and time. I promise to return their brains soon. My parents for not always getting this, but being supportive anyway. My writing friends Rachel Swirsky, Blake Charlton, David Moles, and Barry Deutsch for getting it, and still being supportive, even though being on the publishing inside they knew everything that that would entail. Thanks to Matt Bellizzi for showing me how to shoot a gun, Vera Nazarian for help with Russian, and my girlfriends V, C, M, and J in real life, for listening and making me occasionally leave my house.

Any mistakes in this book are mine. No part of this book constitutes actual medical advice. Not all doctors are bad, just some of them can be annoying.

Last, but not in any way least, I want to thank the girls on my work weekend for keeping me out of trouble. Thanks for not letting me accidentally kill anyone. I appreciate that most of all.

How can your liver be this good? I stood outside Mr. Novembers room, watching him stir restlessly. Normal people couldnt get 20,000 micrograms of fentanyl and 80 milligrams of Versed an hour and live, much less still be attempting another slow-motion escape from their hospital bed.

But I knew Mr. November wasnt normal. From my assessment, when Id seen his chipped yellow fangs around his titanium-tipped endotracheal tube, and from the way he was restrained in bedsix soft cuffs, two on each arm, one on each leg, a Posey vest wrapped around his chest and tied beneath the bedframeand from the fact that he was here on Floor Y4 to begin with. No one here was normal, except for me. I was human and looked it: average brown hair, average blue eyes, average hips. My patients here? Lets just say average was not the first adjective youd pick for them if you saw them on the streets. Or the twentieth.

Mr. November continued to squirm. I wondered which cheerful member of our daytime staff Id be giving a report to come seven A.M. with him crawling out of bed behind me. I could almost feel them judging me now.

His IV pump beeped empty and his cuffed right hand made rabbit-punching jabs. Crap.

Hey, you! I shouted and leaned into his room to try to attract his glazed attention. Stay still! I commanded through the door. Sometimes with agitated patients the voice of nursing authority buys time. I dashed to the supply room, unlocked the narcotics drawer, grabbed a bag of fentanyl, and made it back to his room as he started to thrash his head from side to side.

Stop that! I hauled on my isolation gear as fast as I could. If he managed to knock his endotrachealETtube loose, thatd be the end of his ventilator-assisted breathing, whichd be the end of him. I put my gloves on, snatched the bag, and rushed inside. When I silenced the pump alarms beeping he visibly calmed.

You have to stay still, sir. Youve got pneumonia and youre in the hospital. I switched out the bags and reset the pump. I inhaled to say more, but I saw Meaty, my charge nurse, rise up like a moon behind the nursing station outside, holding one thick hand up in the shape of a phone. It was the international nursing gesture for, Call the doctor?

I nodded. More sedation. Now. Please.

Mr. Novembers hands spasmed again. I didnt know if he was reaching for me with a purpose, if he just wanted to be free, or if he didnt understand what was happeningnot unlikely, with all the meds he was gettingbut I grabbed his nearest hand in both my own. Youve got to rest now, okay? His grip tensed and so did Imost of the training videos Id watched before starting this job had emphasized the minimal patient contact rule, for vastly good reasonsbut then he relaxed, letting me go.

I stepped back from the bed, took off my gown and gloves, washed my hands, and went outside.

You okay there, Edie? Meaty asked as I returned to sit behind my desk, just outside Mr. Novembers door. I grunted a response and flipped open Mr. Novembers flowsheet to hide behind. Meaty didnt check in on Gina or Charles unless they called for help. But I was new here. Just when I was starting to feel like I knew how to be a nurse at my last job, only a year out of nursing school, my brother overdosed. On heroin. For the third time.

An unknown friend (read: dealer) had been kind enough to leave Jake on a curb and call 911, whichd brought him here. By the time I got to the emergency department they were on his second dose of Narcan. Theyd put an IV line into his neck because he had too many tracks on his arms to find a vein. Only some cruel miracle had stopped him from getting infected this far. If he kept it up, I knew his luck wouldnt hold.

I wanted to touch him and I didnt want to touch him, because it didnt take being a nurse to know all the diseases he might have. And so, as I was finding some gloves to wear to hold his fucking dumbass junkie hand, a man came by and said, Wouldnt you like to see your brother clean?

I thought he was going to tell me about Jesus, and I was getting ready to tell him where to shove himself, when he offered me a job.

Before, when Id worked in a nice private hospital, if someone had done something particularly boneheaded, or exhibited poor nursing judgment, theyd have been asked, Hey, where do you think you work at, County Hospital? or, Looks like you did a County job to me.

But what if no one called 911 the next time around? Or Jake ignored a septic sore? Working at County seemed preferable to watching him die, knowing I could have done something to prevent it. I didnt understand what I was signing away exactly, only that they promised to keep him straightand unlike all the rehab programs my mom had scrounged to send him to, itd worked.

So now I really was at County. Only worse. Floor Y4 was for the daytime servants of vampires, sanctioned donors, werewolves, zombies, you name itand purgatory for us, their staff. We were in the bowels of County, off the records and off the charts. I signed forty things in triplicate, got special badge access to the special elevator, and when I took the special ride down, I found myself in an ominous hallway where my badge opened just two doors. One led to our locker rooms and bathroom. The second went here to Y4, an eight-bed intensive care ward with an institutionalized appearance: exposed ducts, dim lights, and where everything could use a fresh coat of a lighter shade of paint.

Peeking over my flowsheet and into the room, I saw Mr. November at it again, this time kicking himself off the bottom bedrail. Be still! I scolded. Reminded anew, he relaxed. Thats the hassle with Versed. Its an amnesiac. On the plus side, it helps patients forget the horror of having an ET tube sit in their lungs and a ventilator helping them breathe. On the downside, it means that every time you warn them they have Tubes in That They Should Not Pull On, that warning has a half-life of about thirty seconds before they forget and try pulling again.

Meaty, any word? I asked, as Mr. November switched gears and tried to reach his ET tube, one millimeter at a time.