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“Just call me David,” he said with a crooked smile, and shook her hand.
“Krissie,” she agreed. She even managed a smile. “Part of the reason I came home was because I don’t want to have to invent medicine anymore.”
He nodded and finally, finally, his face fully relaxed into a pleasant, even attractive, smile. “It can still come up to bite you. Take it from me.”
And there it was. He had been reacting to his own difficult transition and to his expectation she would have the same problem, perhaps even make the same mistakes. And he might be right, she admitted honestly. While time with the VA had helped ease her back, she hadn’t come back all the way, because VA hospitals were woefully underfunded and understaffed. She’d had to “invent medicine” there sometimes, too.
“Okay,” she said. “I’ll take the warning the way it was meant, not the way it was given.”
At that, a chuckle escaped him. “Fair enough,” he agreed. “I was heavy-handed about it, as if you’d already done something wrong.”
“I haven’t had time to mess up yet,” she said on a humorous note.
“And you probably won’t. It’s just that I know how long it takes to come back from all that adrenaline.”
“Meaning?”
“You walk in, you smell the antiseptics, the other things that you identify as hospital, and after years of experience in wartime conditions, the adrenaline automatically kicks in. We’re like Pavlovian dogs in that respect. We go up the instant the smells hit our noses.”
She nodded slowly. “I guess you’re right. But I spent the last year and a half at the VA in Denver.”
“Still stressful, even if it’s not as bad. Anyway, you and I learned trauma medicine under the worst imaginable circumstances. It’s not something you can shuck easily like worn-out clothes.”
“No, it’s not,” she admitted. “I felt it when I first walked in here tonight. I had to remind myself this is different.”
“Exactly. Anyway, I guess I was harsher and more critical than I needed to be by far.”
She pursed her lips. “You might say that.”
He flashed another smile, quickly. “The thing is, like it or not, we become adrenaline junkies after a while. That can affect our judgment. So just watch out for it. I found when I first came here that I had a tendency to magnify every symptom. If you’re not careful, every cold can look like pneumonia or lung cancer or TB. I know that sounds like a stretch, but I’ve run that course. Sometimes still do. Where we’ve been, nothing was ever as simple as it looked at first glance. Now we’re in a place where it most often is that simple.”
“I can see that.”
“I’m sure you can. Just remember, you’ve been conditioned to see things otherwise. Don’t run on automatic. Ever.”
With that, he picked up his charts and walked away, leaving her feeling as if, despite their friendlier conversation, she’d just been scolded again.
He had the most unfortunate manner, she decided. And was probably hypercritical, to judge by the way Julie and Nancy were trying to avoid him.
It was kind of funny, when she thought about it. Dr. David Marcus might have a bark, but at least he had the good grace to realize when he had crossed the line. And there were four other doctors in the joint practice that served the county and the hospital, so it wasn’t as if he was the only one she’d be dealing with.
That was the point at which she realized that peace could have another downside. With only six patients on the ward, she actually had very little to do. There were only so many times she could disturb them by entering their rooms, only so many treatments and checks to be administered, and with a twelve-hour overnight shift yawning in front of her, she would need to make work to occupy herself.
Quite a change. Quite a change indeed. One thing Dr. Marcus had been right about: she was used to being on adrenaline most of the time. The cases on this ward shouldn’t elevate her stress level by so much as a molecule.
A doer by nature, she decided to check the linen closet and supply closet for the routine needs of any hospital ward. She expected to find everything well-stocked, though. She wasn’t the only night shift nurse to have time heavy on her hands.
As she was approaching the linen closet, an orderly emerged from the nearby cleaning closet with a cart, pail and mop. He seemed startled at her approach, then took a wide stance, as if planting himself firmly. A young man with tousled blond hair, a too-thin body and a narrow chin, he watched her approach almost warily. He looked to be fresh out of high school, which would have put him well out of her milieu when growing up, and the kindest word anyone would apply to his appearance was “ordinary.” Poor guy probably had trouble getting dates.
“Hi,” she said as she approached. “I’m Kristin Tate, the new night nurse.” Something about him looked familiar, but then darn near everyone in the county looked familiar, even after all her time away.
“I recognize you,” he said. Then, as if making a decision he added, “Charlie Waters. You probably don’t remember me. We only talked a couple of times.”
She smiled. “Sorry, I’m still getting to know everyone again. Nice to meet you. I was just wondering what I’m going to do all night. Any suggestions?”
A shy smile lit his face. “I play cards.”
“Now that’s an idea. Maybe the four of us can play.”
“After I finish,” he agreed.
“Do you have a deck of cards?”
He looked down at his scrubs as if to say, “Where would I be hiding them?”
“Good point,” she said in response to his gesture. “I’ll look through the drawers at the nurses’ station. We can’t be the only folks who have wondered how to get through a quiet night.”
“Probably not,” he agreed. “But I have a lot of work to do. Bathrooms and floors before the patients go to sleep. After that?”
“It’s a date.”
Julie and Nancy joined Krissie in her tallying of the supply closets, then returned to the nurses’ station with her. No call lights, no monitor warnings. All the patients were happily watching TV or sleeping and, for the moment at least, experiencing no problems.
“It’s awfully quiet tonight,” Julie remarked.
Krissie perked at that. “You mean it’s not usually like this?”
“Absolutely not,” Nancy said. “We usually have a few more patients than this. More injuries, for one thing. And in August it’s strange to have only one dehydration case.”
“I’m not complaining,” Julie remarked. “When the ward is full, we hardly get a breather.”
“True that,” Nancy agreed in the slang of the young.
Julie hesitated, then said, “I heard Dr. Marcus riding you. Not what he said but…just so you know, he can be hard to get along with sometimes.”
Krissie wasn’t quite sure how to respond. There were certain rules of professional etiquette, and while she’d seen them broken countless times when some doctor or nurse was a pain the rear, she didn’t think she should encourage it her first night on the job.
But she didn’t have to say a thing. Nancy chimed in. “I try to stay out of his way, because you never know when some little thing will annoy him. But mostly he’s okay. I don’t think he means to be edgy.”
“I don’t think so, either,” Julie agreed. “Because he can be really nice sometimes. But other times, there’s this look on his face, and you know he’s uptight about something. So I just duck.” She gave a little laugh. “If he’s mad about something I did, he has to find me.”
Krissie couldn’t contain her smile. “Sometimes that works.”
“Yeah, you can’t really hide, being the charge nurse. Anyway, you’ll find he’s here a lot. The other docs all have families, so Dr. Marcus is on call most of the time.” Julie scrunched her face a little. “Sometimes I think he doesn’t sleep.”
Or maybe, Krissie thought, he has trouble sleeping. She certainly did, even after all this time. Nightmares seemed ready to pounce, and were one of the reasons she preferred the night shift. When she had a nightmare while sleeping during the day, she only had to open her eyes to see sunlight, and she had learned it dispelled those images quickly. At least most of the time.
“Anyway,” Nancy said, “it’s probably the war.”
Her comment was laden with the knowledgeable tone of someone who thought they knew. Krissie didn’t think Nancy could imagine the half of it.
They did find a deck of cards, however, and after ten, when the patients had all been checked on, medicated and settled, Charlie joined them. He remained shy, but Julie seemed to have taken a shine to him, making him blush with alarming regularity.
Charlie left at midnight, his shift over, and Krissie sent Julie and Nancy to take a break. They announced they were going to the cafeteria to meet up with some friends from other wings and would be back in half an hour.
Krissie was amazed to discover how relieved she was to be left alone for a little while. The ward was quiet, the call board remained silent, Hester Alexander’s heart monitor continued its steady rhythms.
One by one, she checked on her patients, moving soundlessly as she opened doors and looked in. Mr. Hedley was going to need a new IV bag of antibiotics in about an hour. Other than that, everyone seemed to be resting comfortably and sleeping deeply. Mrs. Alexander opened her watery blue eyes just briefly, then returned to sleep. Krissie silenced the monitor in her room. It was enough that she could keep an eye on it from the nurses’ station; no need to disturb Mrs. Alexander’s sleep.
The next couple of hours passed smoothly enough, and finally Krissie decided to take her own break, a half hour in the break room with her bagged lunch and another cup of coffee from the coffeemaker on the counter.
She had eaten only half of her turkey sandwich when her pager sounded. Julie. Dropping her sandwich on the waxed paper, she took off for the ward at a fast walk, just as the PA system announced a code and a room number.
She arrived a few seconds later on the ward to see Nancy waving at her from the door to Mrs. Alexander’s room. From the nurses’ station she heard the unmistakable warning from the cardiac monitor. Ignoring it, she began to jog down the hall, even though you were never supposed to run in a hospital.
“Cardiac arrest,” Nancy said quietly. Inside the room, Julie was hovering over the patient looking helpless. Damn it, an LPN should know better.
“CPR, Julie. Did you call the doctor?”
Nancy nodded. “Yes. He answered the page.”
“Julie, I’ll take over. Where’s the crash cart?”
“Getting it.” Nancy fled.
Flatline. It was a sight a nurse saw too often, but never wanted to see. She joined Julie at the bed and motioned to her to take the breathing bag, while she herself climbed on the bed, straddled the patient and took over the chest compressions. Each compression registered on the monitor, but nothing else.
Dr. Marcus and the crash cart arrived together, along with a crash team assembled from all over the hospital. The high whine of the charging defibrillator filled the room along with business-like chatter as the team acted.
“Intubate.”
Krissie paused in the compressions to allow the doctor to insert an endotracheal tube in the esophagus. He worked swiftly, and moments later the breathing bag was attached to it, again worked by Julie.
“Two hundred,” the doctor said, then to Krissie, “Off the bed.” He was holding the paddles and Krissie quickly jumped down. “Clear!” he said, and applied the paddles.
Mrs. Alexander’s body jumped, but the flatline remained.
“Push 20 ccs of sodium bicarb.”
Another nurse stepped forward with a syringe. “Pushing.”
“Give me three hundred.”
A jolt of three hundred volts was applied, lifting the patient half off the bed. Still a flatline.
Krissie climbed back on the bed and continued compressions, counting automatically until Dr. Marcus said, “Clear.”
She jumped down again and another shock was applied. Nothing.
“Epinephrine.”
A large syringe was slapped into his hand, and Krissie watched as he stabbed the needle directly into the old lady’s heart.
“Clear!”
Snap!
Nothing.
“Clear.”
Snap!
Still that awful straight line…
“Compressions,” Dr. Marcus said.
Krissie started to climb on the bed, but a male nurse beat her to it, giving her a break. Her arms were shaking. Her stomach turned upside down.
They called time of death at 3:31 a.m.
Chapter Two (#u23b2ebd0-5109-5469-a66a-27cc6ca7daa3)
David Marcus evidently had no desire to leave medical matters until morning. He sat at the nurses’ station while orderlies worked in Mrs. Alexander’s room, cleaning up the inevitable detritus of the code. In those moments where every second counted, items such as syringes and swabs went flying, along with their packaging. Mrs. Alexander herself lay carefully arranged beneath a sheet, awaiting whichever came first: a visit from immediate family or the trip to the morgue.
From moments of intense activity to absolute stillness. Krissie sat on a chair, staring at nothing. It didn’t matter how many times she saw this, every time felt like a personal failure.
“There wasn’t any warning?” David asked.
“I was in the break room eating my lunch when I got the page. The code was called right after that. You’ll have to check the monitor.”
“Wasn’t anyone watching it?”
“Julie or Nancy, I thought. But you can check and see if there was any warning.”
His face tightened and he looked off into distant space. “She was getting better.”
“That’s how it looked.”
“I guess we’ll find out from the autopsy. But damn.”
She managed a nod. “Why’d you push the bicarb?”
“Because she was on a potassium-sparing diuretic. There was a possibility that her kidneys hadn’t cleared enough of it so it was one of the first things I thought of.”
“I can see that.”
“Except that tests didn’t show anything wrong with her kidneys.”
