Open Mic Night

Contemplating presenting something at open mic night about an experience in the hospital

The Nurse

It was Tuesday, July 12th. The iced coffee in her hand draws condensation from the humid air and drips it onto her blue scrub pants. She is too numb from little sleep to notice the water spot. In her other hand she grips her phone, scrolling through morning health news - pharmaceutical companies bumping up drug prices by 300% overnight, old mice aging backward through a blood transfusion from youthful mice, the opioid addiction crisis plaguing spinal injury patients (among others). She clicks off the device and instead watches the brownstones lining the streets and the orange sun rising over the driveways. Her eyes water, whether from lack of sleep or stress or the brightness she can’t say. 

It’s another hectic day at work. The unit is short staffed yet again so each nurse takes on one additional patient. While in one room tending to a particularly deep wound, edges soggy with purulent yellow drainage, the nurse wonders if she will have time later today to eat her ham sandwich. Management has already sent the staff a curt message ‘Rounds at 11:00’ meaning less time to accomplish all the tasks lined up in a twelve hour shift. She tapes the date and time on the wound, so she can see if other nurses are changing the dressings daily as ordered. She ensures the patient is comfortably arranged on his side, relieving pressure on the sacrum, so blood can flow to the tissue and heal it. She lowers the bed, cleans up the trash, and hands the patient his call bell so he can ring the phone hooked to her scrub pocket should he need anything. A ventilator alarm goes off in the hallway, so she hurries out to see if it is her patient who is in respiratory distress. 

Management points to the power point, indicating ‘clients’ pain management ratings from April to May to June. 

“See, in May we did a good job managing pain, but we are slipping now in June - remember we should be assessing clients’ pain at least every four hours because the Joint Commission determines hospital reimbursement based on HCAPS scores of pain management as rated by clients.”

The nurse thinks again about the article she read on the way into work, about the spinal injury patients hooked on opioids. Due to staffing shortages, as well as a need to use what is easy instead of what is right, this hospital fully endorses treating self-reported pain with opioids. As if throwing drugs at the problem will resolve it. One of her patients today had his oxycodone dose ratcheted up over weeks and months as he grew tolerant to the medication, until he developed a bowel obstruction, threw up fecal matter, and was placed on bowel rest with an NG tube dangling down his esophagus to suck out the backed up food matter. He receives nightly enemas to soften the hard stool packing his intestine and creating an impasse. She shakes her head, as he had refused stool softeners for days beforehand even though opioids are known to slow gastric motility and cause constipation. She is happy her coffee keeps her regular. Her coworker bumps her foot suddenly. She looks around, confused. 

“Hey there Stacy, glad to have you back in the conversation” her manager chirps smartly “we just got a call from tele that your patient in room 28 is off the monitor.”

Oh good, she thinks, an excuse to leave the meeting. She hops to her feet, glad to be back up and moving again. The best way to make a day go by quickly is to make it a busy day. At the nurses station, she grabs a strip of electrodes so she can refit the wires to her patient’s chest and the heart monitor tech can continue to watch her patient’s heartbeat on a screen in a different part of the hospital. He will notify the nurse of any irregular rhythms so she can obtain orders from the doctor to address the issue if necessary. 

She strolls in the room and past the curtain dividing the two beds. Her patient is sprawled across the bed, the heart monitor thrown to the floor next to her. The nurse strides quickly to the bedside, grabbing the woman’s hands - they are ice cold. She lays a hand at her throat, and feels no throb of life at the carotid artery. Reaching forward, she smacks the code blue button at the head of the bed and, now bracing her laced fingers and locked arms against the woman’s sternum, begins rapidly compressing her chest and counting - One. Two. Three. Four. Five. Six. Seven… her watch reads 11:47. At least seven more hours of work until this shift will be over. 

Beyond the whoosh of adrenaline, her own blood pounding in her ears, she hears the roommate questioning rapid fire as nurses, doctors, vital signs machine and crash cart all roll into the room. “What’s happening? Is she alright? Is she dead?”  each query rising in pitch and volume until someone says “Get her out of here!” Thirty. The nurse pauses while another healthcare provider at the head of the bed bags the patient, watching for the chest rise to indicate the oxygen is being delivered. She attaches electrodes to the chest and turns on the defibrillator - no electrical rhythm. Back to chest compressions. The doctor shouts out orders according to ACLS protocols - 1 mg of epinephrine IV push, two minutes of chest compressions, analyze for shockable rhythm and rotate, here’s the ENT doc let’s go ahead and intubate, okay and now she’s back let’s transfer to the ICU. The nurse looks at her patient’s wristband - 7/12/46. It is her seventieth birthday today. 

At 13:18 the nurse walks back onto the unit after helping to transfer the woman to the ICU and giving the nurse there her report on the patient’s health history and body systems. During this exchange the patient is reduced to a few abbreviations of chronic conditions and organ systems. The nurse realizes her phone is dinging in her pocket and answers.

“This is Stacy, how may I help you?” 

“I need my pain pill, it’s been three and a half hours since my last dose and I’m supposed to get one every three.”

The nurse sighs and walks over to the med room. 

At 19:37 the bus rolls up to the hospital stop. She walks to the very back, lays down in the seat, crosses her arms over her face, and lets out a few choked sobs, her teeth gritted and her eyes squeezed shut. After a deep, shuddering breath she sits up and looks out the window at the orange sun setting between the brownstones in the driveways. She takes her ham sandwich from her bag and numbly takes a few bites. She doesn’t notice the mustard that drips onto her scrub pants. She thinks about the woman’s roommate, whom she had comforted in the hallway as environmental services cleaned out the semi private room, bleaching away the smell and residue of her patient.

“I could feel her spirit leave her body.” she wailed, clutching the nurse’s wrists in her arthritic hands. “Her spirit passed by me on the way out the door.” The woman’s white sclera circled her irises, her pupils dilating and her lips quivering. The nurse remembers wondering what to say. All she could think was “It’s not your fault. It’s not your fault. It’s not your fault.”

Her phone buzzes in her pocket, and she takes it out. ‘Pizza for dinner tonight, see you soon!’ Water drips from her eyes onto the screen, blurring the message. ‘Great!’ she sends back.

He greets her at the door, pulling her in for a tight hug, holding for longer than usual. “Mmm,” she manages “smells delicious.” He looks down at her, noticing the pinkness around her eyes, her glazed look over his shoulder at the wall behind him. “How was work today?” he asks. “Fine, you know the usual craziness” she retorts. They eat dinner in silence, CNN playing videos of terrorists blowing up things in far away countries, their country blowing up things in return. 

That night, she reaches out in the darkness to place her fingertips against his throat, feeling for his pulse. He turns to her, and moves his arm behind her head to turn on the bedside lamp. “Stacy, what is it?” he asks. She touches his face, runs her hands down to the hem of his shirt, and pulls it off. His skin is so radiant in the lamplight, so warm. She lightly brushes her fingers over the tattoo inked above his heart, in all capital letters.

DO NOT RESUSCITATE

“Oh, you know, just a bad day at work is all.” He snorts his assent, as an EMT he has had his fair share of bad days. He pulls her close and she lays her head against his chest, listening to his heart thud reassuringly.

The Author’s inner thoughts

I glance up from my notebook and around at the park. To my left are a pack of middle aged men and women jamming out to some house music blasting from portable speakers, and to my right a man stands with a giant sign spray-painted to say ‘PURPLE POWER’ which I know nothing about. In front of me DC sprawls out, no building too tall, so I can clearly see the Washington Monument in the distance. I think that my story is way too trite to be of any use to anybody. Maybe a poem would better serve me for this open mic I’m planning to attend on Tuesday. I turn to a fresh page and begin again, although still inspired by the same subject matter. This time I cut the romance bullshit and get straight down into the nitty gritty, using google supplements as needed so my point is well enforced by fact.  

The Nurse: second attempt

It all started with my patient
Her cold hand cupped in mine
I squeeze, hopeful for a sign
Cold empty eyes stare blankly upward
No evidence of what she's suffered
Within a few hours - heart attack,
Hypoxia, brain damage, intubation
Now a machine breathes for her in syncopation
It's horrific
To witness a soul snuffed out
What really is the worth of a heartbeat without
What makes us human
It made me sick
To see her gone
But still forced to hold on
Herself forgone
This vent beeping on
Forcing each breath through her chest
Without it she'd be still - or at rest
In 1950 the mechanical ventilator was invented
It's ability to provide life saving breathes unprecedented
In 1943 the kidney Dialyzer
Blood filtration and electrolyte equalizer
In 1980 the percutaneous endoscopic gastrostomy (or PEG)
Force feeding those unable to eat - or beg
To be left to starve
Okay... So am I recommending the alternative, death?
To let nature run its course and leave loved ones bereft?
No.
But I beg of you to please ask yourself
What makes the people you love themselves?
Is it a heartbeat alone?
One single kidney?
A digestive tract, a hipbone?
What is it?
When modern medicine is full of lifesaving miracles
When lives can be extended by weeks months and years until
They're a shell of themselves, vent supported,
Bed bound, unable to eat, riddled with sores, and purported-ly braindead
Is that body still full of the person you loved
Or just an amalgamation of the body systems above
When we can keep organs alive forever
Shouldn't the goal be to never withhold care, ever?
And I've seen it, I know
Once they've been brought to this point saying no
Means a sure death sentence
One that you had to bestow
And oh god the guilt to bring down that gavel
You may as well have thrown gravel
On their grave
But truly you were their saving grace
Imagine being trapped in a body wired to machines
You can only grimace, can't let out a scream
Your body's covered in bed sores
You're constantly poked and prodded
Liquid supplements through a tube
Dressing change, nurse forgot Dilaudid
It's like a f*****g horror movie but with no escape
I hope these gruesome images are starting to take shape
Into something you'll remember
And when you tell the doc 'do everything'
This is where your loved one might end up.
It's quality not quantity that makes a life worth living
When you compromise to extend days think of what you're giving
Up, and when you force the voiceless to hang on
When what makes them human is already gone
Don't worry, I'm holding their hand tonight
The machines are still beeping
But something about that flat, unresponsive face isn't right
Is it really worth keeping her here.

The Author throws in the towel

Dark. Very dark. Perhaps too dark. I don’t even know what I hope to accomplish by throwing everyone off their fun-and-games Guitar Hero style 'Wonderwall' entertainment and into the hellscape that is the hospital. I acknowledge to myself that maybe the average American has little to no interest in what is going on behind the brick walls of their local institution, and who am I to go and shove it down their throats? Hi everyone, great to meet you, here you go - just a little nightmare fuel to make you feel guilty that you’re able to walk down the street when you want and complain about your small paycheck or something even more mundane like how you gained five pounds last month. Perspective. I just want to give the general populace some perspective, something new and fresh and raw to crack open their world view like cracking open an oyster shell and revealing that ugly raw pink inside, and maybe if you’re lucky you’ll also get a pearl of wisdom out of it. At the end I decided not to go to the open mic at all, because I felt sure that the audience would just be stalking their acquaintances on Facebook and not hear me anyway.

Reviews

[augustus]

I make no excuses for shouting out loud.That story illustrates just what our nursing staff have to put up with when on shift especially during this pandemic. They are our every day and night heroes. THANK GOD YOU ARE THERE FOR US!