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I’ve been working at the hospital for eight years now; the last four in TICU – Trauma Intensive Care Unit. Haven’t been able to get off the night shift yet, but I’m glad to have a job. It’s tough these days with all the cut-backs and cost-containment measures. The bottom line of my check register is dangerously close to being in the red -- and I’ve got four more days until payday -- but I’ll make it. I’m tough. I can make it on my own.
Stamping snow off my boots like I’m doing some kind of country western line dance, I’m coming through the staff door with a handful of other stragglers all bundled up in winter survival gear. We night shifters all have that haggard, sleep-starved look on our faces. There was talk awhile back of implementing a retinal scan for identification, but it was too costly. We still scan our badges against the barcode reader, just like the old days. It’s kind of like airport security -- a worthless procedure but I guess it makes people feel safe. There are so many ways for Killer Joe to get inside this complex – I mean, a hospital is a public building, right? And with so many employees, who’s to say one of us isn’t crazy? Our pharmacy has been robbed twice in the past year, at gunpoint. Both were inside jobs. One of the thieves, a maintenance worker, didn’t want narcotics; she wanted anti-rejection meds for her brother who lost his job – and his medical insurance – six months after his transplant. He couldn’t afford the medication, rejected the kidney she had given him and had to go back on dialysis. Which, ironically, the government pays for -- even though it’s far more expensive and way less effective than a transplant. When people are desperate, there’s no telling what they’ll do.
Walking down the hall, breathing in that good old hospital smell, that mixture of antiseptic, cafeteria food and humanity. Those of us just coming on duty are waiting for the elevators, the snow from our boots and coats melting into little puddles. We don’t all know each other but we know we’re part of the pack. We share comments about the road conditions, the weather forecast, the upcoming Super Bowl as we’re waiting for the steel box which seems to be stopping at every single floor.
Ding! The elevator finally lands, empties it’s load and we crowd in, like holocaust victims. Somebody presses the button and the doors close. We all call out our floor numbers and the self-appointed operator pushes the buttons. The numbers of the floors light up and the steel cage rattles and squeaks, stopping on the second floor to let off one nurse and pick up two lab techs. We’re all dressed pretty much the same, in worker’s uniforms; proletariat scrub suits of various colors and patterns. Some wear white lab coats over top of scrubs. Those are usually the house staff, the baby docs. The lab techs wear white coats too, but you always know the lab techs because they carry Easter baskets -- plastic caddies filled with goodies like needles, syringes and little glass tubes with colorful tops, lavender, red and blue. But Easter is a long way off.
We all squeeze in a little tighter to make room for the new arrivals. The doors close, we go up, but not very quickly -- and with a lot of creaking and groaning. I imagine a bunch of miners in the basement toiling away with shovels and picks. They’ve harnessed a little burro to a capstan; he’s plodding round and round and round, hauling the elevator up like a cart of rocks. Those miners don’t know if it’s day or night down there in the bowels of the earth but I’ll bet they’re getting tired, and that poor little burro too. They all just want to go home.
Sometimes I wish I had the miner’s job instead of the nurse’s job. Surely there wouldn’t be as much documentation to drudge over. I wouldn’t have to worry about accidentally offing anybody by pushing the wrong drug, or misinterpreting a heart monitor, or fucking up a cardiac output measurement.
It never ceases to amaze me, the power of life and death in my hands. Anyone can make a mistake, especially late at night if you didn’t get enough sleep that day and you’ve got other things on your mind. Maybe that’s why I drink too much coffee and carry a few extra pounds. I need that caffeine and sugar rush to keep me awake. I’ve started smoking again, just to keep me alert. I’m a good nurse, I know I am, but no one is perfect and life is so unpredictable. You can’t possibly prepare for everything, can you? Just do your damn best, that’s all you can do.
I get off on the fifth floor and turn left. Above the double doors, Trauma Intensive Care. A small sign next to the door says All visitors please check in with the receptionist and take a seat in the waiting room. But on night shift there is no receptionist, are you kidding me? We nurses decide who gets to enter the hallowed gates. At night we call all the shots.
Stepping inside I hear the sighs of the ventilators. Oooh paah, ooh paah. I hear the beeping of a disgruntled intravenous pump and the whining electric motor of the portable x-ray machine as Duke, the rad-tech, pushes it down the hall. Over-laid on the background of electronic sounds is the bright chatter of human voices. It’s a busy unit, Trauma Intensive Care. People coming and going at all hours, excitement in the air like the smell of popcorn. It’s kind of like a carnival, a three-ring circus, a Wild West show complete with Buffalo Bill and Annie Oakley. We’re usually oversold and you’re guaranteed to see amazing feats of life-saving derring-do and some fancy roping to boot. Maybe even a miracle or two.
Intensive Care Units are always brightly lit; we’re the land of the midnight sun. Studies have shown the ill effects of continuous light on the body’s circadian rhythm; it jacks with the pineal gland, it leads to disorientation, confusion, and slower healing times. People need darkness, we need rest. We need to dream. But this is no country for old men – or old nurses. Sleep must wait. If you’re in Intensive Care it’s because your life is on the edge and you are dangling by a thread. Your vital signs, your heart rhythm, your arterial pressures, your pulmonary pressures, your intracranial pressures – we make them our business. Here, there is no privacy. We watch you closely; we invade your every drug-induced dream. But we keep you alive. And if you’re well enough to complain, you’re ready for discharge, you’re outta here, sucker.
Coat and backpack in the locker, now I’m sitting in the conference room trying to warm my hands, holding a cup of bitter black sludge that passes for coffee. Listening to a taped report by the off-going shift along with my co-workers: Tim, Marty, Chris, Melanie, Jeff, Morgan, Russell, Jane, Cid. We’ve got a good posse on tonight. As nurses we all depend on one another, we work as a team. We’ve each got our own patients but we watch each other’s back, we keep an eye out for all the patients on the unit. And we’ve got to be ready to respond to a code.
There are different codes for various emergencies. If a fire breaks out you call the operator and the operator pages “Mr. Gallagher” -- our code word for fire. Imagine the pandemonium if the operator used the F word!
If a patient crashes -- if their heart stops or they go into V-fib -- you push the magic red button. Doing that alerts the operator to announce “COR ZERO,” along with the floor and the room number. When you press the magic red button you’re calling the Mission Impossible team to come help you. You’re calling the resident docs, the interns, the nursing supervisor. You’re calling nurses who are expert in starting IV lines, respiratory therapists who can set up a ventilator and intubate, if the doc can’t. You’re summoning lab techs and runners. It’s like giving a big party and having all your best friends show up -- a little out of breath, gifts in hand, expectant looks on their faces.