7 | Years

03:30. The nurses station was illuminated by a few small overhead lights, the darkened hallways quiet. I was kicked back in my computer chair and halfway through explaining something or other to my long-suffering orientee, when my scrub pocket lit up with a call to my spectra-link. 

“Hey.” The voice was the nurse at Station 3. “Do you have a minute to try an IV? He's going to surgery early, and the charge nurse is busy. It's for Room 21.”

I scooted off my chair and forbid the orientee from coming to watch. Stage fright. 

Room 21 was brightly lit and the bed already raised to working height. The remnants of an IV start kit were littered on the edge of the bed. 

"Hi!" I announced. "I'm Kristen, one of the nurses up here. Your nurse asked me to come start an IV for you." 

A spry face framed by white hair and prominent ears tilted up at me. He broke into a grin.

"That's what I like to see, a pretty smile!" He chuckled. "Hello Kristen, very nice to meet you."

I grinned. "You're a good sport. That's not what most people say when I wake them up at 3 in the morning. I'm just gonna put this tourniquet on your arm here and take a look." We made small talk as I tapped and flicked and hunted for a vein.

"...Yeah, my kidney doctor wanted to take out a piece of my kidney, but now this other doctor has to take out part of my colon so the first doc has to wait. I've never even had to stay in a hospital before. I'm 93." He paused and I marveled at his good health, then warned him of a small poke as I slipped the IV catheter into his loose skin. The vein blew a second later and my heart sank. But he had already forgotten about me, staring beyond my shoulder and into the past. 

"93 years. That's a long time, isn't it," he mused as I opened a new kit. "It's gone quick. 17 years already since my wife died." I looked up to see his bright eyes film over with tears. I stopped what I was doing and listened. 

"There at the end she had a special hospital bed at home, and we pulled our beds next to each other. Sometimes during the night I would wake up and reach across to hold her hand." The tears were rolling freely down his face now, unashamed. I felt the familiar tightness of not knowing what to say. 

"I bet it meant a lot to her," I said at last. "I bet she knew how much you loved her." 

"She did." He responded immediately. "She did." I warned him of another small poke, and breathed a silent prayer as the IV went in.

"Please, God." I thought. "Please just let this work for him." The line flushed and gratitude washed over me.

"There you go," I said, stepping back. "It's in. Sorry it took two pokes, but it's working great now." 

He grinned unexpectedly at me. "I knew you could do it."

* * * 

6 | Ghosts

The halls of my unit are a gallery - a gallery of remembered faces and stories on parade each day I spend at work. 35 beds, 35 patients, 35 lives interrupted by surgery. As quickly a as a person is discharged to home, the fax machine whirs with report of another groggy patient in the Recovery Room ready to occupy the vacancy. The rooms are constant-- scuffed laminate floor, bedside table (prone to sudden spills and tipping), recliner chair, temperamental thermostat. But the scenes that play out within those walls are diverse. Sometimes, unexpectedly, a moment or a conversation settles into the back of my mind and engraves itself into memory. These are my ghosts at work.

* * * 

09

It was a rare day- meds were passed, patients were comfortable, care was charted. I dropped by to see if my patient in room 09 needed anything and found him sitting up in his recliner. Two pillows propped between his ankles preserved the precautions necessary after hip replacement surgery. Arms crossed, chin in one hand, he studied the news broadcaster as she delivered a report on a recent shooting. I watched silently with him for a moment and then shook my head. 

"It seems like every time I walk by a TV, they're talking about something terrible that's happened. It never ends."

He considered for a moment. "You know, I used to get discouraged about it. I worked as a Chicago cop for years- I thought I wanted to be that guy busting down doors, breaking up fights. But I kind of got burnt out on it. Then one day I found I had a soft spot for the kids in school who go home to these messed up families, who live surrounded by drugs and shootings and broken relationships. I started going to schools just to build trust and be a safe person for them to talk to. It was amazing: these kids would open up to me- a stranger- and talk about things they hadn't told their parents." He looked over at me. "And that's when I realized that you can't worry about everything bad that happens in the world. You just focus on what's in front of you, help the people you can, and don't worry about the rest of it. There are other people working on those other issues. 

"Like you, for example," he went on. "You're here every day. Think about how many people you come in contact with. That's your margin of impact. I worked with the kids; someone else is working somewhere else. It all adds up." He waved dismissively at the TV. "You can't let yourself worry about all the things out of your control."

* * * 

04

The smell of alcohol hit me like a wall when I opened her door. She startled at the sound and turned from anxiously pulling apart the surgical dressing on her hand: eyes puffy, face streaked, hair straggling down her green hospital gown. Tufts of surgical dressing lay scattered on the floor where she had thrown them. "Degloving," the PACU report stated. She'd had her hand outside the passenger-seat window of the car as it sped down the highway, she and her boyfriend both drunk: all the skin below her wrist had been stripped away as the car rolled down a bank. Now, on the flip side of the O.R., she was detoxing from multiple addictive substances... in strictly medical terminology, she was a hot mess. 

She sobbed into her free hand as I picked up a discarded ACE wrap off the floor. "It's so hard, everything is awful, I don't want to talk about it anymore," she wailed. Her boyfriend's lean frame stooped unsteadily with one arm tucked into a sling.

"I know it's not your thing, and that's cool, but at least you could try to support me! I mean, come ON man, we've talked about this! You know it's always been my dream, you've never even cared that it's important to me, all you would have to do is come with us and help out with some stuff, it wouldn't be for long." There was crazy in his eyes and his gait was anything but steady.

"No, NO!" my patient yelled. "Stop asking me! I don't want to talk about it! I've told you a hundred times, I don't WANT TO! Your band is STUPID!" Her sobs got louder. I surveyed the picture. This was not the first time I had broken up this fruitless discussion tonight. Even after I'd given my patient multiple doses of IV Ativan, the boyfriend still managed to work her into a sobbing frenzy. Frustration made me braver than usual. 

"ALRIGHT, guys." I declared, cutting them both off but directing my attention to the boyfriend. "I have to say again that you need to stop discussing this with [my patient]. You're obviously upsetting her, and right now, she needs to calm down and focus on recovering. She just had surgery. She's in pain. Neither of you are thinking straight and now is not the time to deal with this. I know this has been a difficult night but I am going to have to ask you to leave until you both calm down. There is a family waiting room down the hall where you can go. NOW, please." I pointed to the door. The boyfriend wilted into a tearful mess as he staggered towards the door. "I know, I'm sorry, it's just not fair, I'll leave now, you guys have to do your job, I'm sorry, this is all awful." 

I fully agreed.

It took twenty more minutes to calm down my crying patient and patch together her surgical dressing. By the end of the night, I was hopelessly behind with my other patients, and my charge nurse alone kept me from drowning. Days later, I learned that the boyfriend smuggled a bottle of vodka onto the unit, spiked hospital-standard juice cartons for himself and his girlfriend, and ultimately the happy couple signed out AMA. 

Some days, you just can't win.

* * * 

13

His little frame was tucked neatly into bed-- the sheets arrayed to perfection. His face crinkled into a mischievous smile as I pushed my computer into the room. 

"Ahh, Kris-tina!" He always used the Italian version (the "right" version, he insisted) of my name. "Did you discover the answer to my riddle yet?" I laughed.

"No, I'm afraid I haven't. I wracked my brain but I still have no idea." He chuckled gleefully. 

"Ah, well, keep working on it, in the meantime I will go to I-taly and find you nice Italian boyfriend. Perhaps you would not mind if he has one leg and is 40 years old?" He tilted his head up at me, and I waited expectantly for the punchline.

"...because if you double that, it's ME!" He broke into giggles again, and I couldn't help laughing over how pleased he looked. His chuckles died away into high-pitched wheezes, and suddenly he looked old, frail. He swallowed his pills submissively and settled back into the pillows. 

"I think maybe I will take a nap now."

I turned toward the door, smiling, and began throwing away my isolation gear.

"Sleep well, my friend." 

* * * 

21 

The squeaky wheel of a bed rolling down the hallway told me that my patient had returned from surgery. I hopped up and around the nurses' station and met him by the door to room 21. This was my patient's second surgery since admission, and nearly my second week of caring for him. I was relieved to skip the "hi-my-name-is-Kristen-and-I'll-be-your-nurse" speech. I leaned against the bed and evaluated my patient's tight-lipped, pain-drawn face. 

"Welcome back, stranger. I hope you didn't have too much fun without us downstairs."

My patient's eyes stayed shut against the light, but he turned slightly in the direction of my voice. "Oh, absolutely. We had quite a party, they have all the pain med candy. You quite missed out. Speaking of which..." he squinted one eye open. "Where is my Puff the Magic Dragon?" 

I placed his PCA pain button back into his hand. "Same deal as before. Dilaudid. You can push your button and get a dose every 6 minutes if you need to. Let's get you settled and we'll go over Dr O's orders, okay?" 

He nodded. The PCT and I helped the transporter maneuver the bed back into the room.

"One more day in paradise," I grinned. My patient made a face and pressed his pain button. 

* * * 

5 | Weakness

"So you'll be taking care of this lady, huh? Good luck."

Exhibit A: something you don't want to hear from the day shift nurse before she leaves you with the patient in question.

"...I guess she basically screamed at the night nurse. She was okay for me, but I think she can sense if you're insecure. Just don't show your weakness and you should be fine." 

My weakness. 

As a green nurse in my first year of acute care, weakness is a constant companion. I doubt myself. I question my judgments. I ask questions until I stretch everyone's patience, and after that I fly by the seat of my scrubs. I come perilously close to making it up sometimes.  How on earth am I supposed to hide my weakness? Is it even safe to do that?

I draw in a breath as we enter the room, turning broadside to face the woman enthroned on her chair and holding court with a tired-looking family member. I give her a genuine smile. 

"We're doing shift change, I'm Kristen, and I'll be your nurse until 11 tonight. How are you feeling?"

She sizes me up. 

Hit me with your best shot. I've got my game face on. 

* * *

IVs have an uncanny ability to sense shift change. They work complacently all through the day, but the minute they smell shift change, they go bananas and start leaking, beeping, infiltrating, and bleeding their merry little hearts out. They really can be villains. 

I had actually hit it off to a good start with my patient. I liked her dry humor, she liked my Chuck Taylors, and the day shift nurse helpfully talked me up with nonsense about how patients love me. But five minutes later, I got a call from my tech. 

"Hey, can you come in here for a minute? Her arm's swelled up. I think the IV blew."

Of course it did. It's shift change. 

I briefly consider asking my charge nurse to restart the IV. She could do it effortlessly, and I wouldn't have to risk face with my patient over a messy IV attempt. But I will never improve if I don't try. So I pile my IV start equipment on the bedside table and chat nonchalantly to keep her mind off the needle. Or maybe it's to keep my mind off the needle. 

"So." she nods in the direction of my supplies. "Are you any good?" 

Shot through the heart. I never know how to respond to this. 

"Oh, don't worry. We do this a lot up here. Everyone needs an IV or five." She laughs at this. Good. I don't mention that I missed my last three IV sticks.

"Deep breath for me, little pinch..." I slide the IV into her left antecubital vein. Instant blood flash. Easy stage over: I flick the catheter gently with my fingertip to advance it and recognize that I've already resigned myself to blowing this one. 

My catheter meets resistance. I shift the angle slightly and nudge again. Resistance. Another degree. Resistance. I'm painfully aware of how many seconds have passed: another nurse would have finished this by now. 

Suddenly, the blissful release of catheter sliding into vein. It's in. I throw on a J-loop and flush the line; it works like a dream. I mask my relief with a business-as-usual expression and compliment her on her cooperative vein. 

"It's in?" She looks as surprised as I feel. "Wow, I barely felt it. You're good."

Cue theme song. 

* * * 

The high from that small success gave me the audacity to try an IV that my charge nurse missed. Miraculously, that one went in too. The cranky 83-year-old lady with dementia didn't pull her hand away, so I don't think I hurt her badly, either. 

Maybe in twenty years I won't fear IVs. Maybe I'll be a veteran who throws in hard sticks without hesitating.

But I have a lot of IVs to blow before then.

My deepest apologies to the owners of those veins to come. I will give you my best and sometimes that won't be good enough. I'm a human, and humans learn through experience... which looks a lot like practice. I'll try to make it up to you. 

All I can promise is to be better than I was yesterday. 

4 | Life is beautiful

(Another memory from the student days, when every experience is seen through new eyes.)

* * *

She was nervous. I couldn't blame her.

Terse replies met my efforts at small talk: her face was taut, expressionless.

Those moments of waiting have tortured humanity since the invention of the first rudimentary surgical instrument. Mortality never looms so large as in the quiet before submitting one's body to the operating table, trusting another person's skill with a scalpel. The idea of having one's insides opened to the world has never been a pleasant one. 

"Okay then! I think we're ready." The OR nurse deposited an armful of IV bags & tubing into my waiting hands. "Make sure you keep the piggyback higher than the primary; I've got a sterile pump in the room," she said in my direction. 

We helped the woman to her feet and waited a moment while she smoothed back disheveled blonde hair. The OR nurse led the procession with routine briskness, winding her way through the hallways connecting to the operating room. The patient followed heavily and I took up the rear, holding the IV bags at shoulder height & keeping the train of tubing off the floor. 

Her urgent surgery had been docked for 08:00: a glance at the clock showed that we were 30 minutes behind schedule. Despite the delay, the mass of foreign tissue growing below her diaphragm would be removed, the incision neatly sutured, and the whole ordeal over before she knew it. But no reassurance can shorten the moments before the plunge.

Inside the operating room every surface glinted in sterile perfection. Scalpels were arrayed with mathematical precision, gauze neatly stacked, suction equipment hooked up & tested. Sterile blue drapes had been spread over the table, ready to receive the patient. We helped the woman into place. 

"And, the surgeon is here!" announced the circulating nurse. "Michelle, you want to get him ready?" The scrub nurse nodded & began unfolding a sterile gown as the surgeon strode into the room. Following in his wake was the woman's husband-- who looked just about ready to faint. While they scrubbed in, the anesthesiologist struck up small talk with the patient.

"So. How're you feeling?" he asked after a few moments. The woman laughed shakily.

"You know that part on a roller coaster, when you're going up and all you can hear is 'click...click...click...?' That's what this part feels like." 

"Alright!" announced the surgeon a few minutes later. "We're a go." The light glanced off the first scalpel as it went in. 

Blood. Blood trickling down a swollen abdomen. The smell of burnt flesh as cautery meets blood vessel. The surgeon opened the skin with a smooth draw & burned back the yellow fat beneath. I moved to get a better view.

There: I could see it. The abdominal muscles separated and the mass was bared to the world. It was smooth, taupe, tangled with a complex and beautiful pattern of blood vessels just beneath its surface. It was larger than I had imagined. The surgeon made a few more incisions, reached in deep, & pulled. As he lifted, a foreign body came free in his hands.

The surgeon held up 8 pounds, 3 ounces of tissue. And as he raised it towards the light, it kicked him.

The room launched into motion. Nurses closed in, transferring the now-wriggling mass to a table. The table disappeared from view as blue scrubs bent over to perform a well-practiced dance.

"Heart rate 150."

"BP 67 over 35."

"O2 sats?"

"68 and rising."

"Looking good!" announced the pediatrician, laying aside his tiny stethoscope. A nurse gathered up the bundle and brought it over to the woman & her husband-- who was furiously rubbing away tears of joy.

"Here you go," said the nurse with a smile. "Congratulations; she is beautiful."

3 | ER

Throwback to the student days, to one of the first times I participated in a code. 

* * * 

The ambulance theme song catches my attention from across the nurse’s station. I close my charting and jog over just as Kate, my preceptor, picks up the receiver. “This is Northwest Base, go ahead.”

“Northwest, this is Palatine 25. how do you copy?”

“Loud and clear, Palatine. Go ahead.”

“Alright, we have a 73-year-old man found non-responsive at home after a suspected heart attack. He was PEA on the monitor when we got to him, but since then we’ve been able to feel a carotid a few times. Pulse is gone now. We started compressions, put in a King airway, & got a line in him. Bringing him in now, ETA 6 minutes…”

Someone scrambles to call a Cardiac Alert for room Bravo-2. We pour into the room with a crash cart, clearing the floor, piling equipment and priming bags of fluid. We are ready when the paramedics burst in with the wheeled stretcher, delivering chest compressions as they approach.

A paramedic gives report amidst the flurried activity. “We’ve given him 5 doses of epinephrine but haven’t gotten a pulse back. He’s gone into V-fib a few times, but mostly he’s flat-lining.”

I catch sight of a tech about to draw blood; in a burst of courage, I stop him.

“Hey, I’ll start an IV and draw blood from that instead.” He nods and pushes the tubes and tourniquet in my direction. I jump in without letting myself think twice.

The patient’s arm feels like cold wax beneath my fingers; dead weight. There is no twitch when I slide the needle into his vein, no exclamation of pain. His arm jerks rhythmically as someone delivers chest compressions. I calm my breathing and search for the blood flash. Bang; got it. The IV is in. I hang a bag of fluid wide open and step back.

“I need a med nurse!” Someone calls. I don’t even hesitate this time. The adrenaline has hit.

“Got it! What do you want?”

The doctor considers. “Epi. Let’s try it again.”

I have never set up an epinephrine cartridge before. Once, after a simulation, my instructor passed a cartridge around and explained how it works. “You pull off the yellow tab, twist the two parts together, and you’re set.” Now, staring at the pieces as I dump them out of the box, it seems more complicated. I jam the cartridge into the injector and double-check with a nurse standing next to me.

“Hey, did I do that right?”

He nods. “You’re good to go.”

“Kate!” I call as I scrub an IV port. “First dose of epi is going in... now.” She nods and records the time.

Thump, thump, thump. The room is still except for the tech delivering chest compressions. We’re holding our breath, willing the epi to take effect.

Flat line.

10 minutes of compressions and 2 doses of epi later, the doctor uses an ultrasound to check for heart activity.

“I got nothing. Anyone object if I declare it?”

No one speaks. We know there’s nothing else to be done; 7 doses of epi should kick-start a stone.

“Alright,” says the doctor. “I’m calling it at 4:33. You can stop compressions.” The tech steps down from his stool and drags a shaking arm across his forehead. Compressions are a workout by anyone’s standard.

“I’ll send the family to the viewing room. Go ahead and get the body ready.”

Suddenly, the room is quiet. It’s just me, Kate, and a tech. Kate is filling out her time-keeping page, so I turn towards the bed.

The white body lies bare, glaringly pale in the fluorescent light. His chest is extended as though with a deep breath; our artificial ventilations left air in his lungs. I stare for a moment, half-expecting an exhale to relieve the tension. But he lies rigid.

“Hey, would you mind…?” The tech points towards the man’s eyes, and I realize I’m the only person still wearing my gloves. I step over and gently press the man’s eyes closed, but not before I see the vast emptiness staring up at the ceiling.

“The family is here; I’ll take him over,” announces someone in the doorway. With that, we are alone in the room, left to clean up papers, plastic packaging, and EKG stickers off the floor. To prepare the room for the next patient.

Life is a thread. Take a moment today to look around you at the people you love. Notice each one. Because pages turn, & you will never return to this one.

2 | Immortal

Humans.

How can we describe them? 

Flawed. Brave enough to face fear. Weak enough to fail daily. Vulnerable, easily broken, resilient. Having the capacity for fierce love, for scorn, for idiotic laughter, for searing joy through tears. 

Humanity intrigues me. 

* * *

She stormed out of room 22 with thunderclouds in her eyes.

“Who took his heat packs?!” She demanded. Her eyes roved across the nurses’ station & seized upon me. I shifted up from my charting and pulled out my best how-can-I-help-you face.

“Heat packs?” I probed. I had no idea who this woman was. 22 was not my patient. 

"That's what I said! He had three heat packs, THREE, they were in his room half an hour ago, I just went downstairs to get a coke, and when I came back they were GONE." She glared at me. 

Do I look like someone who routinely steals heat packs out of patients’ rooms?

"Oh, sorry," I ventured. "Were they the little red-and-white plastic ones? Those usually only stay warm for about 20 minutes... it's possible that someone might've thrown them away if they had gone cold." 

“You don’t understand: the doctor gave them to us herself. HERSELF. This is totally unacceptable. I can’t believe someone took them. I won’t put up with this! THIS IS RIDICULOUS!!!” 

It was quickly becoming a scene. A patient peeked out of a nearby room to see what the commotion was about. A quick assessment concluded that the woman before me was a  smoker, near-sighted, likely had a history of substance abuse from her haggard face and iconic emaciated frame. Stringy hair trailed down from a ponytail. And right now, she looked ready to do murder over a disposable heat pack. I eased my voice to calm, apologetic tones.

“I’m sorry about the other heat packs, let me grab a few more and see if they’ll do the trick. Just a second.” I scooted into the supply room and returned with three of the offending item. She snatched them from me and whirled back towards the room. As a parting blow, she turned over her shoulder and shouted, “I’ve cared for him for 30 years. I AM NOT GOING TO LET HIM DIE.” The door slammed behind her and left me, stunned. 

* * *

I’ll be honest: I chose to go into healthcare mainly for the buzz. I love the rush of chest compressions, life-and-death stakes, being called upon to use knowledge and judgment under pressure, at a moment’s notice, with a human life in the balance. I’m amazed by the intricate design and resiliency of the body: the skill of science to manipulate and heal, and its immense shortcomings and inability to ultimately control outcomes. And frankly, I think people are interesting.

In small doses.

Are those good enough reasons? Would it frighten you to know that your nurse is driven by some kind of adrenaline addiction instead of Ghandi-like love for humanity? But it is more than that. I believe right down to my toes that every person is a reflection of their Creator, a soul wrapped up in flesh. There is a kind of reverent wonder in caring for an immortal being… even if it is dressed in a tattered black hoodie and smells of stale cigarette smoke.

* * *

The door to 22 opened slowly and the woman’s skinny frame slipped out. The fight was gone from her eyes. She leaned against the nurses’ station and shifted her weight a few times, tongue passing over her teeth. Hesitating.

“I don’t know how you guys do it, every day, here. Helping people. I couldn’t do it. I’m sorry I yelled. It’s just…” Her eyes were suddenly docile. Pleading. “He’s been my life-partner for 30 years. He’s everything.” I broke into a small, lop-sided smile. One of my real ones.

“It’s not a problem. Really. You’re under a lot of pressure. It’s rough, being in a hospital where things happen out of your control. I’m glad the heat packs helped.”

She smiled gratefully and turned back towards the room. 

"There are no ordinary people. You have never talked to a mere mortal. Nations, cultures, arts, civilizations - these are mortal, and their life is to ours as the life of a gnat. But it is immortals whom we joke with, work with, marry, snub and exploit - immortal horrors or everlasting splendors." | C.S. Lewis, The Weight of Glory 

1 | Beginnings

Someone asked whether being a nurse is what I expected it would be. I am discovering that ‪being a nurse‬ means a cookie eaten at 1 A.M. on the way out to the parking garage can count as both lunch & dinner. 

It's her face when she lights up & says, "Oh, I'm so glad you're my nurse today! I was just telling my husband that you were my favorite." 

It means feeling 2 inches tall when you don't know the answer to the Infectious Disease doctor's question.

It's the tears that come an hour after your shift when you finally unwind enough to realize how overwhelmed you were. 

It's the joy of discovering that your patient is also your brother in Christ. 

It's the uncertainty, triumphs, failures, & continual blessings that come rapid-fire in just 8 hours.

It's the coworkers alongside you. 

It's laughing until your sides hurt... about things normal people will never understand.

It's feeling more fallible than you ever imagined, & more thankful than you thought possible. 

It's feeling privileged to share a small part in so many stories.  

It's being amazed by the intricate design & resiliency of the human body. 

...and at the end of the day, it's the comfort of your own pillow at 3:00 A.M. when you can't sleep because you physically hear hospital alarms echoing in your ears. 

Being a nurse means ‪being human‬. I wouldn't trade it for the world.