Thursday, February 24, 2011
"Where's my CAP, Millie." or Lorane, RN (Part II)
We were being thrown to the 'lions' you may recall (although I dare say our representative Millie, here - even yellowed with age - has something of a ;kitten quality; about her). And 'Red Riding Hood' was straightening her cap and some things out. I barely heard Clara's droning account of the night shift so RIVETED was my focus on the room. There were monitors, respirators, tubes, tubes, tubes. They sprang from noses, curled out of urethras, burst from chest walls, drifted into veins and out of arteries. Seven lives were "in here." Eight, counting me. Clara exited, on, "No aide today, sweetie."
I made solo, solemn bedside chart-rounds. Four of the five UNCONSCIOUS patients had been in this "unit" for months, monitored and maintained after sustaining irreversible brain damage. Leaning over the first of them, I took Mr. Goldberg's cold hand into mine and whispered dire ctly into his ear. "I'm Miss Clarke. I'll be taking care of you today (and who will take care of ME tomorrow?) and make you as comfortable as possible. This litany was repeated with the other three, while checking the artificially regular heart and breathing rates keeping time in their waltzing chests. Pupils stolidly fixed, finally dilated. That they could not respond was obvious. But I believed they could perceive. No one had proven otherwise.
Next up (or not), Frank Ryan. "Mr. Ryan, you were sleeping when I came in. I'm Miss Clarke." He looked like Stan Laurel, frail body resting on a Stryker Frame - special bed; rotated 180 degrees so you could flip the paralyzed body, sandwiched between two stretchers, then remove the top one from the back once landing-on-the-abdomen was safely completed. Frank's buttocks were now two gangrenous cavities - testimony to a time when he was NOT being turned. I assured him his dressing change/wound treatment would be the FIRST thing I did after completing 'rounds'. From his gaunt, stubbled face, his eyes shined. "Miss Clarke, I'm 'Frank'."
"Frank it is. would you like to stay on your back for a while this morning, look around?"
"Oh, how nice. . . .if you have the time," he added apologetically.
Joe Kazinski was next to Frank. No tubes. No machines. Just smiling at me from under his sheet - which was tied to the bed at all four corners. A broad forehead and black, handlebar mustache made his dark, good looks seem aristocratic.
"Clarke, " he said. "Nursie Clarke." Then as if to introduce himselt, he said, "I'm FINE!" And he winked. Skimming his admit notes, I learned he was initially treated for a concussion - subsequent to a fall. Currently, his diagnosis was "Rule out Organic Brain Syndrome." Apparently, he'd remained confused, disoriented LONG after his injuries healed. This "chronic" degenerative brain disease was being entertained. There were orders for restraints and sedation but he demonstrated no need for "critical" care, as I understood the term.
"Mr. Kazinski, have you been in the hospitalk. . ."
"Joe. Call me Joe. Or Zhivago. The supervisor calls me DOCtor."
"Joe, who is the President of the United States?" He lifted his head and squinted around the room.
"He's not in HERE. Nope. You must've missed him."
"I'll help you with your tray when it comes up, Joe."
"NEver eat before a game. But I'll be glad to help you." He was taking orders, now. "What'll it be? Just juice and coffee? We got HOT danish, today, boys."
Turning to check on the newest admission, I noticed the policeman, sprawled on a low lounge chair wedged between the bed and the wall. Arms folded across his dark blue, wrinkled uniform, hat covering his face, with head back, he slept. I thought "How did I miss THIS?" The patient's chart had a pink sticker on the front announcing, "Twenty-four-hour surveillance - N.Y.P.D" Above it, his ID: Warburton, Michael; Age: 18; Dx: Multiple Trauma/Cerebral Hemorrhage. As with his fellow unconscious patients, Michael was only alive because of the respirator. However, in this case, the admitting doctor's notes indicated his losses were "temporary."
A long, muscular youth, his body was curled into a fetal position. Head shaved, a small dressing denoted the point at which the surgeon had drilled into his skull to stop the bleeding. His bruised, swollen face was contorted, set in a grimace - one that reflected the grotesque images of the cold nightmare he was enduring, of the scenes. . . . and the I realized I was just STANDING THERE, STARING, with everything I had to DO! Pulling back his sheets, I saw that he was tied to the bed at wrists and ankle and had a wide canvas strap securing his motionlessbody to the bed. "Michael," I began, "You're in the hospital. Thesere was an accident. You MUST WAKE UP!"
Then I gently extended his arm. It immediately sprang into a flex that slammed his fist into my neck. He was refexively combative.
"Shouldn't get too close," the cop spat. I had finished what had to be done to Michael and walked around the bed to confront his 'keeper'.
"WHY is Michael under surveillance?" He looked at Michael, at me, at his shoes. Then, with disgust coloring his rsponse, "Warburton's a hit-and-run. Ran a stop sign and hit someone." He paused, awaiting an answer. Getting silence, he continued,
"Hit a NURSE. She's CRITICAL!" "I see," I said dismissively while turning away. "And hope YOU see you could have had TWO 'critical' nurses if his neck chop hadn't been blunted by my quick movement away. And YOU just sat there!"
"He-is-a-CRIMINAL. And I get paid ONLY to make sure he ain't goin' nowhere."
Enough. I got to work - quickly, efficiently, against the predictable backdrop of machinery cacaphony. Monitors beeped 70 to 90 heart squeezes per minute. I knew what 60 or 100 would sound like. And the respirators - hiss/click, hiss/click, hiss/click - 5 variations on THAT theme and I didn't even have to look up to know that the right amount of breathing was going on. An orchestra conducted electrically. A band that performed while nobody played.
After bathing, changeing & turning Frank, "Both areas look angry now, Frank. But I think with regular care and turning, we'll get you back into a real bed before long."
"Miss Clarke, do you know who's playing in the World Series?" I bent to put his bath things away. "But I'll find out." Now standing, "And I'll see what I can do to get a barber up here." But Frank was fast asleep.
Joe ate unassisted while I got the morning care of the others going. I was starting to panic as "morning" duties were becoming "afternoon" chores. (Their dead weight was hard to maneuver alone.) Visiting hours were from 2 to 4 and I wanted time to spend with what I thought would be a desponded group. Finally, I GOT TO Joe, who'd been observing my rushed ministrations all morning.
"Here, Nursie. Let me help you turn George." "Thanks, Joe. I'm fine. . . .Uh, Joe, will you be able to stay in bed if I don't tie ALL 4 cxorners of your sheet?" (I had really struggled to undo the knots in his sheets,)
"Well, of course. Unless I'm going out. If I'm going out, I have to get out of the bed." Actually, I'd been told the measure was taken to prevent his falling OUT of bed, Probably from a time when he was more heavily sedated, weaker. Siderails will be sufficient, I mentally decided.
"Joe, you just tell me if you want to get out of bed."
"Sure. Sure, I'll tell you. You know I LOVE to play in the World Series. Frank is right, Nursie Clarke. I mean we SHOULD DO something."
Hiss/click, hiss/click. COMMUNICATE; REACH THE PATIENT. RESPECT HIS INDIVIDUALITY. HA! IT'S 2:30 AND WHAT HAVE I DONE? Hiss/click. EVERYONE IS CLEAN, HAD THEIR MEDS, TREATMENTS, WERE FED BY MOUTH OR TUBE. AND EXCEPT FOR FRANK, AND POSSIBLY JOE, THEY DON'T EVEN KNOW IT. I'M CHECKING VITAL SIGNS BUT THERE ARE VERY FEW SIGNS OF VITALITY. Hiss/click. Hiss/click. I HAVE TO BE BETTER ORGANIZED, THAT'S IT. TOMORROW. . . .
I made a list of calls to make after report: Joe, Frank and Michael should have physical therapy; (muscles waste from lack of activity); Dietician for Frank - things he can safely eat in a prone position; the barber; Social Services. (WHY had there been no visitors?) housekeeping - Joe could use an armchair. I just then looked up and through the glass partition of the nurses' station & saw Joe talking to Mulvehill. (Well THAT'S one call I won't have to make. You're not getting out of here today without promising me an aide!) Then I finished report notes.
"You seem to have everything under control." Mulvehill's porcine bulk filled the doorway. She'd startled me but I started my pitch.
"I was just jotting down some thins I . . ."
"You're not having any trouble with Kazinski, are you?" I thought he must be a pet. And she was leaving! Panicked, I shouted her name, started an approach and stumbled. She stared at me which gave me the time/nerve to regain balance/sense of reason, for
"I MUST have an aide tomorrow."
"I'll see what I can do," she threw back over her meaty, cold shoulder.
It was 5 o'clock when I was finally ready to leave. I'd given report at 3 to a wary and disinterested LPN. Then I made detailed notes in each patient's chart and my calls. Only the evening dietician could be reached. She referred me to the day staff. Thoroughly frustrated, I went home. My frustration sank into depression, spiced by fatigue. After a hot bath and boullion, I sat in bed with a legal pad, mapping out the next day's strategy. It was a sterling Nursing Plan. Damn-it! I'll be lucky to get one third of it done! Critical care? Come come. How about "custodial" or, worse, "criminal" care. And then I spid a framed needlepoint Connie had made for me. "Those whom the gods would destroy, they first make mad." I laughed. And scouredstorage boxes until I found an old trasistor radio. "This is for you, Frank. I'll be damned if I'll let your mind rot along with your ass!"
The gods smiled the next day. I had an aide, Mattie. We did the baths and linen changes together, brisquely. Mattie sulked. I ignored her. When we'd finished with Frank, I sent her on a ten-minute break. The woman had seemed nervous - especially around Joe. "Apparently, his charm is eluding you, my dear" I thought. I poured the sugar and Gantrisin mix into the holes on Frank's buttocks and left him using his urinal (which was strapped to the under-side of his stretcher - listening to his radio.
Then on to Michael - who had to be turned. Officer Heeley had made it clear that he had NO intention/obligstion to assist me, so I stood on the arm of his cushy chair, having let the siderails crash merallically down, and boosted myself to a kneeling position from which - now ON Michael's level - I could lean over to roll him toward me. Then. A moan. I looked up, listening. Hiss/click times 5 and, yes, Frank was moaning. Mattie had turned the crank, flipping his body & thus flooding his body with the contents of his urinal. I was there in seconds. Too many to prevent Frank's getting a mouthful.
"Get OUT!" Mattie fled. I helped Frank with some oral cleansing. Then we heard chuckling. Joe, sitting in the lotus position on his pillow, observed, "You're pissed off. Frank'
s pissed on!" Finally, Frank grinned back and I somehow allowed myself to relax.
"Joe, I don't know what we'd do without you."
(Indeed, having learned that the supervisor called him "doctor", I'd asked Jack the origin of THIS sobriquet. Jack just laughed, He was remembering that day when the barber,mhired by the city, was bored and feeling naughty - and had recently seen the hit movie "Dr. Zhivago" - decided Joe needed an Omar Sariff mustache. The resemblance was SO stunning, folks began calling Joe Dr. Z, then just "doctor." Guess Joe thought it MORE than appropriate and started accompanyi ng the attendings and residents when the 'rounded'in the "Unit". Jack said you'd hear, What doe Dr. Zhivago think we should do? and Joe ALWAYS HAD a serious suggestion. It really was hard NOT to like Joe.)
"Would you like to sit in your chair and listen to the radio with Frank?"
"Sure. Sure, I love to listen to Frank. When I'm not busy."
In a way, I was pleased. Joe's response to the situation, all things considered, had beenappropriate and timely. Might even be worth mentioning it to the 'other' doctors. Having fallen hopelessly behind schedule after righting Frank's wrongs, I went back to Michael, mounting the bed more vigorously this time, pulling him onto his back. With the sudden movement, Michael's knee swung up forcefully into my abdomen. I collapsed on top of him, his freed arm locked around my neck. Heeley just WATCHED and my hatred of him gave me strength. I struggled free & used Michael's body to push myself off the bed.
"Don't tell me what your job is, Heeley. You restrain his arm ior I'll report your . . . ."
A new and cold emotion gripped me - FEAR. SOMETHING, what is it? MISSING? DOESN'T BELONG? Hiss/click, Hiss/click times . . .4? I distinctly heard FOUR respirators - and now a low buzz - that terrifying buzz of a straight line going across an ascilliscope. I SCANNED THE ROOM. THAT'S IMPOSSIBLE. THEY'RE ALL ON AUTOMATIC TRIGGER. THEY DON'T TURN OFF! And then I saw Joe - he saluted, proud, teacher's pet. And to his right - Mr. Goldberg and silence.
"I fixed it, Nursie. You see - I just pulled this plug here. . . .and that noise stopped. My pleasure, Nursie." Running to Mr. Goldberg, I fought a violent shaking.
"No! Mr. Goldberg. No. How long. . . When did he. . .?" Thrusting the plug back into its socket, I heard, Hiss/click, click, click, click. The lungs were rigid, resisting the pressurized gas. I thumped his chest vigorously a few times. Then I was on the bed, straddling him, doing - what I knew was futile - massage. Hiss/ click, click, click, click. Finally, someone's hands were around my waist. Heeley set me down and silently walked back to his chair.
"Mr. Goldberg has expired. It was the frosty voice of Mulvehill as she disconnected the respirator plug - again.
I sank down on Joe's bed beside him. "It's okay, Nursie. I'm always happy to help. . . ."
"No. Joe, Mr. Godberg expired because. . ." and I was being force-led to the Nurses' Station bt Mulvehill as she spoke through a nauseating, clenched grin, "Dob;t you think we should talk while phoning in our report?"
Once seated, the supervisor smiled briefly, unctuously through the glass at Joe and then addressed me, tutorially, impersonally,
"Not everyone ARRESTS, Ms. Clarke. "People die." She began to smooth stray hairs back from my brow.
"Mr. Goldberg is better off. You mustn't upset yourself." I raised my eyes and saw Joe - grinning at the face that was above and behind mine. He held his fist with his thumb pointing toward the ceiling in a winning gesture. I heard,
"You must learn to handle these things, dear." and I saw, reflected in the glass, the fat face nodding approval to Joe.
My GOD! This is daemonic! I shoved the chair back into Mulvehill's belly, standing to confront her. She never budged. I searched the sober moonface for some sign of emotion - fear, anger, shame - anything that might alter the sinister possibility - inchoate and repulsive - that was emerging from my messy thoughts. There were none. I forced myself to demand,
:Has Joe ever done this before?"
Undaunted, she calmly said, "I'll finish up in there. Mattie and I can give report. You had better. . . "
"Is THAT why Joe is IN there?"
"You may be interested to know there's been an opening in Critical Care. . ."
"And then again," I countered fiercely, "I may NOT be interested." I spun, walked out feeling relief, sorrow, hope and - most of all - the THRILL of averting a VERY close call - and headed for Frank. "Good luck, Ms. Clarke." and I squeezed his hand. Then I looked at Joe. He smiled broadly.
"Goodbye, Joe." He put his head down and smiled sheepishly,
I stared at him for a few seconds, "God HELP you! There is NOTHING I can do here." Going down in the elevator, I realized my cap had fallen off during the commotion.
"I'll get a new one. And I'll practice nursing in a place where they practice Medicine!"