First Flight

After six weeks, my wings were clipped and I was left to fly on my own. As with any first flight, the plunge was deep and frightening but as I learned to spread my wings the flight slowly became smoother and smoother. Unlike a bird that inherently knows flight patterns and navigation, I quickly had to learn how to juggle seven patients. I created my own flight pattern. I started at 11pm and got report on all of the patients. After report I checked the medication record to see who had medications due. Then I would check the orders and make sure no orders were missed. Last, I would check the heart rhythms on the monitors and sigh in relief knowing my patients were all ticking.

Using Michelle’s lesson, I would see patients that had problems with their ABCs first and then patients who needed medications. I ended each shift the same way I started by checking the heart rhythms on the monitor and sighing in relief that they were all still ticking.

The fear of killing a patient was overwhelming. It nagged and nagged on my brain and when I slept, it took over my dreams. In one dream I entered my patient’s room to find her lying on the floor in a pool of blood. I ran down the corridor to get help but the corridor just became longer and longer and when I finally came to the end where the nurses’ station should have been, it was a dead end. I turned yelling for help but no one came or heard. I ran back to the patient’s room to find the code team doing chest compressions on her. As I walked into the room I heard a nurse say, “no one knows where the nurse has been all night.” The physician turned to me, “Hope! What kind of nurse are you? You left the patient lying in her own blood. You did nothing to try to save her. You should have stopped the bleeding, Hope!”

In another dream, I was so good at taking care of my patients. I was happy and confident. My patient’s loved me and I loved them. I had one of the best nights ever. It was morning and I was giving report when one of the nurses asked, “Who had room 24 last night?” “Not me.” I replied. When the charge nurse checked the assignment sheet she said, “Hope, you had 24 last night.” I thought hard. “No, I didn’t have her.” I was sure of it. I checked my report sheet from the night before and as I brought it up to show the charge nurse, my heart stopped. There at the top of the page written in small letters, in my own handwriting, was Room 24 Mrs. Meyers. My heart began to beat again. In fact it raced, as I looked at all of the medications that the patient didn’t get. And her groin! Her groin was not assessed. I got up and ran to her room. I could tell upon entering, her face pale and white as a ghost, and blood dripping from her bed, that she was dead. She hemorrhaged out from her femoral artery where they had poked her for her angiogram. As I turned around, all of the nurses were behind me glaring at me and whispering, how short of time I had my nursing license before it was revoked because of neglect.

My alarm clock also became many types of bells and whistles in my dreams. One night I couldn’t get my meds passed in enough time because my call lights kept going off. I was being pulled in several directions at once. I couldn’t quite organize my night and I had become way behind. Three of my patients had their lights on at once I couldn’t get to them fast enough. I was headed to the third light when I heard a scream followed by the emergency light. My pace quickened and the alarm inside me went on. Hope, your patient needs help. Each room I went into the patient was tucked nicely in bed. Room after room I couldn’t find the one with the emergency light on. Then I heard my name, “HOPE!” Startled I opened my eyes. It took a moment to adjust but there was my Mom in my doorway and my alarm blaring annoyingly.

“Hope, you want to get up? Your alarm has been going off for 15 minutes?” My mom asked.

I looked over to the clock. It was 1:16. “Oh, Yes.” I said.

“I’ll make you a cup of coffee, “ my Mom offered.

“That would be great!” I replied wiping the crust from my eyes. I sat for a moment and wondered, would these dreams ever go away? Would I ever be able to leave my job and not worry that I forgot to do something?

I pondered my previous night. There is one misconception about working nights that I learned right off the bat. I wasn’t the only one not sleeping. Patients did not sleep at night. I can’t tell you how many times I’ve heard, “Working nights can’t be that bad. At least, all of your patients are asleep.” My first week working, I learned that was a crock of bologna.

It was about midnight, I went around and checked in on all of my patients and passed my meds. All was quiet on the floor and as I sat down to get my charting done I looked over at Wanda who had her charting done and was reading a book. I peaked at the title, Runaway Jury by John Grisham.

“Has it been this quiet all night?” I asked Wanda as she flipped the page.

“Oh no you didn’t,” Wanda started, looking up at me from behind her glasses.

“Didn’t what?” I asked confused.

“Didn’t just say the word.”

“What word? I just asked if it has been this quiet?” I replied.

“Uh, Yeah! That word. The quiet word! I might as well put my book away now, Hope. And when this night goes to hell, remember it is all your fault.” Wanda got up and sauntered away as if she was pissed. I was left standing there still unsure exactly what I did wrong.

I pulled out my first chart and after signing off all of the orders for the day, I turned to the nursing progress notes section and began writing my note. Jean walked up with a stack of charts in her arms. Jean was in nursing orientation with me but we didn’t realize we would be working on the same floor. She was a few years older than me but was also a new grad and this was her first job too. She was always smiling and talking. After working several nights with her, I realized that she didn’t ever really shut up.

“What’s up with Wanda?” She asked.

“I don’t know. She’s pissed at me because I asked her if it’s been quiet all night,” I explained. “She stomped off mumbling something about the night going to hell now.”

“Great job Hope. You’ve gone and done it now.” Jean said in her high-pitched voice, giggling as she plopped into the chair next to me and dropped the charts on the desk simultaneously.

The clock turned 2:37 just as I was finishing up with my last chart. I was struggling to keep my eyes open when I saw something move out of the corner of my eye. I turned in the direction of the movement to catch a glimpse of a grey haired man rounding the corner.

“Quick Jean! I think one of our patients just fled.”

Jean and I turned the corner and sure enough there was an old grey haired man prowling through the corridor with nothing on but his green hospital no slip booties. From our point of view all we could see was his behind, a saggy, skinny, old butt with a mission to get away.

“Is that your patient Jean?” I asked.

“No, he’s not mine,” she replied.

“HEY, SIR!” I yelled. “Maybe he’s Wanda’s,” I mumbled to myself.

The patient turned toward us and grabbing his 80 year-old penis yelled, “Catch this!” and started to run.

Jean and I ran after the man and when the corridor ended, requiring badge access to open the door, the man was trapped.

“Sir, where are you going?” I asked.

“I’m getting out of here,” he yelled. “You can’t keep me hostage anymore. I know what you are up to. I know what you are trying to do.”

“Sir, My name is Hope and this Jean. We are nurses. You are in the hospital.”

“AHW, Bullshit!” The patient said. “This is all just a cover. You are in on it too. You should be ashamed!”

“Sir, what’s your name,” Jean asked.

“That is of no concern to you,” the patient responded.

I glanced over to his name band and got a glimpse of his last name, Bonner. Bonner, that name was familiar. He was my patient. I didn’t recognize him without his green gown on.

“Mr. Bonner why don’t you let us take you back to your room,” I suggested but at the sound of his name Mr. Bonner’s eyes widened as if in shock and his facial expression changed from one of wariness to fear. He had transformed like a kitten cowering in the corner one minute to a cat with his hair standing up ready to pounce the next. I wasn’t prepared for what happened next. With all of his might Mr. Bonner punched me in the face and kicked Jean in the shin. In our brief moment of confusion he ran.

We ran after him, following him back down the corridor and toward the telemetry floor. Just as Mr. Bonner reached the end of the hall the elevator doors opened and Wanda came out with her lunch in hand. Mr. Bonner jumped in and Jean and I followed. As the doors were closing I yelled to Wanda, “Call security!” I knew Wanda was probably laughing to herself right now and I prayed that she heard me.

I turned to Mr. Bonner who was in the corner of the elevator. By now he had taken out his telemetry pack which is a 6”X4”X2” plastic box that monitored his heart rhythm. He decided to use it as a weapon. After getting wacked a few times in the face with the thing I finally managed to get a hold of it. Jean moved in and tried to grab one of his arms but instead he grabbed her hand and bit it. Jean screamed in pain. Finally, I looked at the 100-pound 80-year old man and thought to myself, enough!

“Okay Jean on the count of three we’re taking him down.” Jean must have thought the same thing. With a look and a nod she indicated that she was ready.

“One, two” and on three I went for his left shoulder and Jean went for his right and the two of us overpowered Mr. Bonner and had him pinned on the floor. At that moment I heard the ding of the elevator and the doors opened. To my relief three security guards dressed in blue waited on the other side of the doors.

Once we got him in the room and restrained, I ran to get some haldol to subdue him. I could hear Mr. Bonner from the med room, “HELP! GET ME OUT OF HERE!” he yelled at the top of his lungs.

“POLICE! SOMEONE GET THE POLICE!” he seemed to yell even louder.

I tried to draw up the med as fast as I could so he wouldn’t wake up the other patients. I hurried out of the med room, and saw Wanda sitting at the desk with her book smirking at me. “Lazy Bitch,” I thought to myself as I hurried down the hall.

Jean held Mr. Bonner’s leg and he screamed to high heaven as I plunged the syringe into one of his quadricep muscles and injected the medication. When Mr. Bonner finally calmed down, I walked back out to the nurses’ station and sat down. I grabbed the chart to document the events that occurred. Jean handed me an icepack for my face. Until this moment I had completely forgotten about my face, which had not only been punched but had been hit with the telemetry pak multiple times. Now that I brought my attention to it, I realized that it hurt, my right temple was a bit swollen and I could feel the teeth indentation in my cheek from the punch.

“Thanks Jean. How’s the bite on your hand?” I asked. Before she could answer the phone rang.

“Telemetry, this is Jean.”

“Oh, no. Everything is okay.” I watched as Jean nodded her head as she spoke. “No we do not need the police. I assure you everything is okay. We just had a confused patient that was yelling.”

“Okay. Thanks for checking we will check on the patient.” Jean hung up the phone and looked up at the assignment board. “Uh, Wanda. Your patient in room fifteen called 911. She told them to send the police right away that a man is in trouble and she is frightened.”

Wanda glared at me and with a big huff, she moseyed her fat ass to room fifteen.

“Thank God. I think if my patient was calling 911 I would have lost it,” I said to Jean.

“Well serves her right… That Wanda. She’s been reading her book all night and hasn’t even offered to help us. She’s so lazy. She probably should have checked on fifteen anyway since her room is right next to Mr. Bonner’s.”

“That would require her to actually get up, Jean,” I said sarcastically.

“Yeah, I know.”

I looked up at the clock – 3:33. I couldn’t believe only an hour had gone by. I was documenting in Mr. Bonners chart and the drop in adrenaline left me dozing off as I wrote. My writing had started so neat but as I dozed my script had started to drift up the page. A lady’s scream startled me awake again.

“What was that?” I asked Jean.

“I don’t know. Maybe Wanda’s patient choked her,” she replied.

I chuckled as I ran down the hall toward the direction of the scream. I found Mrs. Hurley from room twelve lying on the hallway floor with blood running down her cheek. When I asked her questions, her responses were barely comprehendible. It was as if she was still sleeping. I had given her a sleeping pill just after midnight and a known side effect is sleepwalking. It looked like she slept walked her cheek right into the doorframe. I helped her back into bed and just got back to the nurses’ station to call the physician when the monitor tech announced that the patient in room ten was off his leads. I sighed as that was my patient as well and headed down the hall to check on him.

The door was closed and I was wary of what I might find behind it. Visions of Mr. Sandor on the floor pulseless and breathless went through my head. I called his name first as I pushed the door. I heard a sound come from behind the door but it would not open as something was blocking it from behind.

“Mr. Sandor?” I called again. I heard a grunt and the door opened a bit more. I was able to stick my head through the crack. Mr. Sandor was lying behind the door. I let out a sigh of relief. He was moving therefore not dead.

“Mr. Sandor, are you okay?” He looked up at me and replied, “Oh Yes. I’m okay. I heard a woman cry out so I got up to see if she was ok but I forgot I have these thing-a-ma-gigs on my legs and I tripped.”

Mr. Sandor had a coronary artery bypass graft a couple of days earlier so at night he wore sequential compression devices that wrapped around his calves and intermittently compressed his legs. The compression motion improved the circulation and prevented blood clots from forming. The SCDs, as we called them, were connected to a machine that pumped the air into the devices. Mr. Sandor had about 4 feet of hose length before he tripped.

“Are you able to move away from the door a bit so I can open it a little further and squeeze in? Then I can help you get up.”

“Yes, I think I can do that.”

I helped Mr. Sandor back to bed. “Now did you hit anything when you fell? Are you sure you are okay.”

“Oh yes, I am just fine. But Hope what about the woman?” Mr. Sandor looked at me with worry in his eyes. “Is everything okay out there. I heard a man yelling earlier but when I heard the woman scream. I had to make sure she was okay. He didn’t hurt her did he?”

“Oh No! She is fine. Thank you for checking, that was so kind of you. She is okay. Everything is okay.” I reassured him.

Finally at 4:45 AM, I spoke to both of the patients’ physicians and reported the falls, filled out the appropriate paperwork, and documented in both of their charts. I still had to take Mrs. Hurley down for a CT scan of her head just to make sure she didn’t have a bleed from her fall and I had to prepare my 5am medications. I quickly browsed my medication list and was relieved that only four of my seven patients had morning meds.

The next thirty minutes were spent taking Mrs. Hurley down for her CT scan. When I got back up to the floor. Wanda came up to me. “Hope, when you were off the floor. Mr. Sandor went into Atrial Fibrillation. I checked him and he was okay but now he is back in sinus rhythm.”

“Thanks Wanda. Do you think I should call the doctor about it?” I knew that atrial fibrillation is common after heart surgery. Many people have it. In a normal heart beat the atrium contracts and then the ventricle contracts. When people have atrial fibrillation the atrium contracts at a much faster rate and the ventricular response is variable. It creates an irregular heart beat.

“I said he is in sinus rhythm again. No I wouldn’t call,” Wanda replied condescendingly. I chose to ignore her attitude and since she had many years of experience, I decided not to call the cardiologist and hurried on to pass my medications.

At five to seven day shift started trickling in. Boy was I ever relieved. I passed my last medication and heard my name over head. “Hope, Dr. Evangelist on line one. Hope, line one.”

I hurried to the phone. “Hello, this is Hope.”

“Hope. Dr. Evangelist,” his voice was deep and slightly muffled.

“Hi.”

“How’s Mr. Sandor?”

“I’m sorry, which physician are you?” I was still getting used to all of the physicians and wasn’t familiar with Dr. Evangelist’s name. The conversation took a turn.

“I’m the cardiologist. Were you not taking care of Mr. Sandor last night?” he asked irritably.

“Uh, Well yes, I was,” I replied stuttering nervously.

“So you took care of a patient all night long on a telemetry unit without having a clue who the cardiologist is?” he demanded.

“I’m sorry Dr. Evangelist. I am new here and am still getting familiar with physician names. How can I help you?” I tried to divert this conversation.

“Like I asked before, how did Mr. Sandor do last night?” he asked again.

I felt my cheeks burn as I spoke, “He did pretty good. He fell on his SCDs last night but was not injured. His vital signs are stable. He did go into afib but he came out of it and is back in sinus rhythm now,” I reported.

“How long was he in it.” I felt a sinking in my chest. I hadn’t even asked Wanda that and had gotten so busy passing my meds that I never had a chance to look at the monitor or investigate how long he was in it.

“Uh, I’m not sure,” I replied.

“What do you mean you are not sure? Are you an RN?”

“Uh, yes.”

“Well maybe you need to go back to school to get some basics. How was his blood pressure?”

I realized I didn’t know that either. Why hadn’t I asked these questions? “I’m not sure how long he was in it because I was off the floor at the time. The nurse that was watching my patient said he went into it and came out of it and that he was okay so I think his blood pressure was okay.”

“You think his blood pressure was okay?” Dr. Evangelist’s was angry and his voice was escalating on the other end. “I don’t care who was watching the patient or where you were when this happened. You are the primary nurse for this patient and it is your responsibility to know what is going on with the patient. You know, Hope, what I really have a problem with is the nurse who has taken care of my patient all night long after having major cardiac surgery has no fuckin’ clue about a major change in rhythm and never called the physician about it either.”

“I, Uh, I’m sorry Dr. Evangelist.” I knew he was right. I should have asked these questions but I let everything else that was going on affect my judgment. I continued with my explanation, “I wasn’t sure if I should call and I asked a nurse with much more experience than me and she told me not to,” my voice started to crack and I could feel my arms shaking.

“What the fuck is going on around there? What idiot nurse told you not to call me?” he yelled.

As pissed as I was at Wanda I was not going to bring her into this and at this point Dr. Evangelist was being such a prick that he was making Wanda look like a saint. I steadied my voice as I held back tears, “Dr. Evangelist, it was my decision not to call you. I don’t feel comfortable naming someone else for a decision that I made.”

“That’s fine. I’m on my way in right now and your manager is going to be my first stop,” he threatened. “Now, how much Metoprolol is he on?”

“He get’s 25 mg twice a day,” I replied, relieved that I finally had an answer.

“Give him 50 mg this morning and increase his dose to 50 mg twice a day.” Then I heard a click on the other end. Dr. Evangelist hung up the phone without even a good bye.

Nurses were multiplying at the station so I hurried to give Mr. Sandor his additional 25 mg of Metoprolol. “Mr. Sandor. I have another 25 mg of Metoprolol. Dr. Evangelist wants your dose increased to prevent your heart from going into that irregular rhythm again.”

He swallowed the pill down and after taking a few deep breaths, I felt a bit better. I refused to let this physician make me cry and after the night that I had I knew I could easily break down. I wondered where all the handsome, flirty physicians were that I always saw on TV. They sure weren’t here at this hospital.

I was just finishing up with report when Jean came to check on me. “Hope, are you okay? Do you need any help with anything?”

“No, I’m good. I’m almost done here.”

“Okay, I’ll wait and walk out with you,” Jean grabbed her backpack and headed toward the elevator to wait.

“Thank you so much for your help last night, Jean,” I said as I caught up to her at the elevator.

“Oh it was nothing.”

“No really, it meant everything. I would never be getting out right now if it weren’t for you. You didn’t even get a lunch break.”

“Well neither did you!” Jean replied.

“I know and I’m starving,” I said as I realized my stomach was empty and gurgling. “How ‘bout I treat you to breakfast?”

“That sounds wonderful, but please not here let’s get outta here.”

“For sure,” I said.

As Jean and I exited the building, the sun was just starting to come up behind us but straight ahead of us was the moon – huge and completely full, it had not quite set to the horizon yet.

“Wow, Jean. Look at the moon!” I exclaimed.

“Holy cow! No wonder it was such a crazy night,” Jean replied. “It was a full moon.”

A full moon, I thought to myself, as I sipped the coffee that my mom had made me. I wondered when the next full moon was and reminded myself to make sure I was off.