Revenge Begins

I was just coming off of my shift when Louise Grace, my manager, came in bright and early to call me into her office.

“Hope, can you stop in my office on your way out,” she asked, her tone was friendly and welcoming but her eyes narrow and brow furrowed. I didn’t trust her one bit.

My knees got weak as my heart sunk within my chest. Only a couple of weeks off of orientation and you’re already in the manager’s office. Nice job, I thought as I nodded my head and swallowed down the big lump that developed in the back of my throat.

I only had one night off, but had spent nearly the whole time worrying about the repercussions of the Dr. Evangelist episode. I had not known if he went to Louise as he had threatened but it was now apparent that he had. In hindsight, it was one of those situations where one doctor preferred to be called while another doctor preferred not. At this stage of the game I only had the more senior nurses to rely upon for advise and if I couldn’t rely on them I was really screwed. These situations could be so confusing, especially to a new grad like me. There was no way to ever get it straight, which doctor to call when, so it left nurses in a damned if you do, damned if you don’t situation.

I knocked softly on Louise’s door, the door opened slightly so I stuck my head in. She nodded and waved me in. She was on the phone so while she finished, I sat quietly in the chair closest to the door. I could feel my heart beating in my chest and came to realize that that seemed to happen quite frequently since I had become a nurse.

“I will be sure to take care of it,” Louise said as she hung up the phone. “So Hope,” she leaned forward on her desk directing her attention to me, her eye brows coming to a v on her forehead. “I got a visit from a not so happy Dr. Evangelist.”

“I know he was mad. He was very rude to me on the phone. My patient went into A-fib but by the time I came back he was out of it. I wasn’t sure what to do so I asked another nurse,” I replied, the words coming out a mile a minute.

“Well, it seemed pretty simple to me Hope. You work on a telemetry unit. If a patient has a change in rhythm, you call the physician,” her eyebrows now rose on her forehead. “I think this is a pretty serious matter and I ensured Dr. Evangelist that I would take care of the matter and promised him it would not happen again.”

The situation was being blown way out of proportion but I could tell from the way the conversation was going that Louise was not going to ask for my side of the story nor was she going to address the fact that Dr. Evangelist was out of line in the way that he spoke to me.

“Hope, I hope you realize the gravity of this situation. What concerns me the most was that when Dr. Evangelist asked you about the patient you didn’t know anything about the patient,” Louise continued.

“That’s not entirely true,” I tried to defend myself but Louise continued. “Dr. Evangelist was truly concerned about the safety of his patient and you as the nurse are fully responsible.”

“But Louise, I was off…”

“Hope, I don’t want to hear any excuses!” she said interrupting me again. “Here is what I am going to do.” She leaned back in her chair and folded her arms across her chest, “I am just going to put this in your file as a warning. I believe that you’ve learned from this situation and it will not happen again.”

“Y-Yes, it won’t happen again,” I stammered.

“Good. Now go home and get some sleep,” Louise ended the conversation and I left her office.

Walking out to the parking lot, I pushed back the tears that welled in my eyes and swallowed the lump that I couldn’t seem to get out of my throat. The more I thought about the conversation the angrier I got. By the time I reached my car, it took everything out of me to resist the overwhelming urge to punch the window. I would not, could not, let them get the better of me. I couldn’t believe Louise. I thought she would be more supportive but she was so condescending. She didn’t even give me a chance to tell my side of the story. It was obvious she listened to Dr. Evangelist but when I spoke, my words fell on deaf ears.

Driving home my anger kept me awake and burned at my brain. It kept me so distracted I didn’t see the light change from yellow to red until I was nearly on top of the car in front of me. I slammed on my brakes, causing them to lock up. My car came to a screeching stop, just inches from the other car. As the smell of burned rubber entered my nose, I let out a deep breath; the lump in my throat was replaced by the pounding of my heart. My white knuckles glared at me from the steering wheel in front of me. Only then did I realize how tense my body was. “Don’t get mad Hope, get even,” I heard the words as if my mom was sitting next to me. Suddenly, I felt better. My body began to relax and a smile crept up the corners of my mouth. There wasn’t much I could do about Louise Grace but if Dr. Evangelist wanted to be called about his patients that is exactly what I would do. I giggled to myself thinking about the sleep he was about to miss out on.

That night, I started assessments on my patients and when Ms. Angeles asked for a sleeping pill and I saw her physician was Dr. Evangelist, I told her I would be glad to call him. It’s only 12:01am not too late.

“Dr. Evangelist,” I said in an overly happy tone. “This is Hope calling about Ms. Angeles. She is having trouble sleeping and asking for a sleeping pill.”

“Restoril 15mg may repeat once,” he replied in his deep muffled voice barely getting the once out before he hung up. Asshole I thought as the dial tone rung in my ear.

I continued my assessments and while listening to Ms. Smith’s heart she complained of a headache.

“Well, Ms. Smith you are on a nitroglycerin drip. While it opens up your arteries to increase the blood supply to your heart one of its main side effects is a headache. Let me see if you have something ordered for it.”

“Oh no,” Ms. Smith declined. “I don’t want to be a bother.”

“Oh yes,” I insisted knowing she didn’t have anything ordered. “There is no reason for you lye in bed with a headache when there is Tylenol out there.”

“Well okay,” Ms. Smith agreed.

I went out to my MAR and double-checked her med list. “Oh darn I have to call Dr. Evangelist again,” I said to no one in particular. I glanced up at the clock 12:32. He probably just fell back to sleep again. I grinned to myself.

“Hi, Dr. Evangelist. This is Hope. I’m sorry to bother you again,” I began, again in my overly cheery voice. “I’m taking care of Ms. Smith and she is on a nitro drip and complaining of a headache.”

“Tylenol two tabs every six,” again he hung up abruptly. Hearing the dial tone, I stuck my tongue out at the phone.

I completed my assessments and went about my night happily. Lucky for Dr. Evangelist none of my patients needed anything for the rest of the night.

The following night, while getting report from Stacey, Wanda burst into the report room, “Hope, you are getting a patient from the emergency room.” She dropped a piece of paper in front of me with a patient name and huffed off as if she was actually busy doing something. Wanda was one of those nurses that no matter what patient assignment she had, she always had time to sit on her ass and read. I was beginning to develop my own opinion about Louise Grace as a manager and the decision to put Wanda in charge was not making my opinion any better.

I was just finishing putting supplies in the room and getting it ready for the patient when I saw the gurney coming down the hall. My heart nearly stopped and then speed up again when I saw the tech pushing the gurney. Oh be still my heart for once in the past two years my heart is racing for a reason other than nerves about my job! Behind the gurney was an ER tech that I hadn’t met yet. He was about 5’8” and his ER t-shirt was rolled up at the sleeves showing his bulky biceps. He had a big smile on his face and instantly I was drawn to his energetic personality. He rolled the patient into the room and following him in I took inventory from behind. Jean was in the room waiting. From behind Sam, I raised my eyebrows at her several times and pointed to his behind.

“Well, well, Jean, look what the cat dragged in!” I said pretending to be talking about the patient. “This is Mr. Mr.,” I stammered as I forgot the patient’s name.

“Grange,” the ER tech said finishing my introduction. While he assisted him to the bed he also introduced us to him, “Mr. Grange, these nurses are the best in hospital they are going to take great care of you.” He looked up and winked at me, “This is Jean,” he said pointing at Jean then looking at his ER sheet and pointing to me he continued, “and this is Hope. She is going to be your wonderful nurse tonight,” he smiled at me.

“I don’t know Mr. Grange if I’ll meet your expectations if I’m held to,” I paused as I glanced at the tech’s ID badge. “Sam’s standard!” I said teasingly.

“Oh yes you will,” Sam continued. “You will be even better.”

“Oh you have all been so great,” Mr. Grange said. “I’ve had the best care already.”

We tucked Mr. Grange into the bed and I started my assessment. “So tell me, what brought you here to the hospital,” I asked.

“I was out playing golf with my buddies when I developed some chest discomfort,” he answered. “I feel so stupid. I’m sure it is just some indigestion.”

“Well, it’s better to be safe than sorry,” I replied. “The plan for tonight is we will be drawing a series of blood tests called cardiac enzymes that will tell us if there is any injury to your heart. If your blood tests come back negative, then you are probably right, it is probably indigestion. However, if there is an area of your heart that is damaged or what we call ischemic, from a narrowing of your artery, then this blood test will come back elevated. In the meantime, I have an order for morphine for your pain. Are you having any chest pain right now?”

“Yes. It’s right here,” Mr. Grange pointed to the middle of his chest.

“Okay, if you had to rate it on a scale of 1 to 10, 10 being the most severe pain you could ever imagine, how would you rate it?” I asked.

“Oh probably a 3 or 4,” he said.

“Can you describe it for me,” I probed.

“It’s just a discomfort like a little burning sensation,” he replied.

“Does it move or get worse when you take a deep breath,” I asked.

Mr. Grange took in a couple of deep breaths. “No,” he replied shaking his head at the same time.

Upon completing my assessment I went out to the nurses’ station to give the admitting physician a call. A bit of glee went through me when I saw it was Dr. Evangelist. I prepared all the information I needed and sent out a page.

When the phone rang, I answered in my usual, very cheery, almost annoying tone, “This is Hope. How can I help you?”

He answered in his usual short, rude, definitely annoying tone, “Dr. Evangelist.” He was so pompous I could feel my hatred for him run through my veins. It was starting to become difficult to even pretend to be happy.

“I just admitted Mr. Grange to room one. He was playing golf when he developed chest pain…”

As usual he cut me off, “I know Mr. Grange, the ER called me. Continue his meds from home. Gi…”

This time I cut him off, “Mr. Grange is having 4 out of 10 chest pain right now. I gave him Morphine but it didn’t relieve his pain.”

“I really don’t believe his chest pain is cardiac related. If you looked at his lab results you would see that his first set of cardiac enzymes were negative,” Duh, I thought. “and with his age of 42 it’s probably just indigestion. Give him a GI cocktail,” the line went dead followed by the dial tone. I gave the phone my middle finger.

“God he is such an ass. Jean, what’s in a GI cocktail?” I asked.

“It’s a mixture of Maalox, Belladonna, and Viscous Lidocaine,” she answered.

“Can I just write GI cocktail in my orders or do I have to write each one out?”

“Just write 30cc GI cocktail and pharmacy will mix it up,” she replied.

“Okay, thanks.”

About 15 minutes later I entered Mr. Grange’s room to give him his GI cocktail.

“How would you rate your pain now?” I asked as I handed him the concoction.

“It’s about a 7,” he replied holding his chest.

“Take this and give it about 15 minutes and see if it works. It should kick in pretty quickly. In the meantime, I’m just going to recheck your blood pressure again.”

“Sure,” he said holding his arm out so I could put the blood pressure cuff on him again. His blood pressure displayed 125/89. His bottom number was only about 5 points higher otherwise his blood pressure was the same.

“Well it still looks good. I’ll check back with you in a few minutes,” I said as I left the room. I went to the monitor and checked his rhythm but there was no change there either. Ten minutes later I checked on him again.

“So how is your pain now,” I asked as I walked into the room.

“It’s a bit better. It’s probably down to a 2,” he replied.

I felt a little better. His pain was down, his blood pressure was good and there was no change that I could see from his cardiac rhythm but I still couldn’t shake the nagging worry that something more than indigestion was going on. I also worried that the GI cocktail could be masking his chest pain, as that was a caution that I read about in my drug handbook. I checked his labs to see when his next set of cardiac enzymes was due – 03:15. I looked up at the clock and it was just after midnight. I still had a few more hours.

Thirty minutes later Mr. Grange rang his call button. “Hey Mr. Grange. How can I help you?” I said as I entered the room. He was sitting in his bed leaning forward with his hands gripping his chest.

“Oh! My pain is worse again. It’s back up to a 7 or 8,” he said.

“Okay. I think what I am going to do is have them draw your labs again now. Someone will also come up to do a 12 lead EKG. Changes in your EKG could also indicate heart muscle damage that can be caused from a heart attack.”

I hurried out to the nurses’ station to call lab and EKG and let them know I needed these tests done stat and I changed them in the computer. I went back into Mr. Grange’s room and took a set of vital signs. Again there was no change but I continued to worry about him. The lab tech arrived first but was followed shortly by the EKG tech.

I looked for some indication of changes in his EKG and thought I saw some slight changes that could indicate he was having a heart attack. Waiting for his cardiac enzymes to come back seemed to take a decade but when the printer arose and started spitting out papers. I ran to look at them. My eyes skimmed down the paper and then stopped. Unknowingly, I gasped when I saw the results and muttered under my breath, “I knew it!” My response actually caught Wanda’s attention.

“What’s up?” she asked.

“Oh! Just Mr. Grange has been having a heart attack since he got here and Dr. Evangelist has been having me give him GI cocktails. Thank God I had his labs drawn early! Can you page Dr. Evangelist for me, please? I am going to give Mr. Grange some Nitroglycerin,” I said as I ran off.

“Okay Mr. Grange. Your labs came back elevated so it looks like your pain is indeed from your heart. I have a page out to the cardiologist but I want you to put this nitroglycerin under your tongue. The nitro will open up your vessels and increase the blood flow to your heart. By doing so your chest pain should subside a bit. If it doesn’t improve in 5 minutes I will give you another one. Right now our goal is to reduce your chest pain as much as possible. In the meantime, I will be monitoring your blood pressure and we’ll need to give you some oxygen.” I applied a nasal cannula and cranked up the oxygen to 4 Liters. Just as I finished setting up the blood pressure cuff I heard the phone ring.

“I’ll be right back I think that’s probably the doctor calling me back,” I said as I headed to the door.

Stepping out to the station I picked up the phone, “this is Hope.”

“Hope. Evangelist” he said snidely.

“Dr. Evangelist, Mr. Grange continues to have pa…”

“Hope, I thought I made it clear that Mr. Grange’s pain is related to indigestion,” he said.

“Yes you did,” I said.

“Then WHY are you calling me?” he asked.

I resisted the urge to say, “I couldn’t shake the feeling that you, Yeah You, Dr. Evangelist, were wrong!” Instead I said, “Well, I couldn’t shake the feeling that it was more, and when Mr. Grange’s pain continued, even after the GI cocktails that you ordered, I had his cardiac enzymes drawn a bit early and they came back elevated. His CK is 780 and MB 26,” I realized that I was talking too fast, trying to get it all out before he would interrupt me.

“Get a 12 lead EKG and start a Nitroglycerin drip. Titrate for chest pain,” I wrote the orders as he spoke.

“I already got a 12 lead. It looks like there are slight changes,” I replied proud that I was on top of it.

“Fax it to me. I’ll call you back,” he ordered and hung up the phone.

Yolanda, our secretary sat with a bag of Doritos in front of her. I asked her to fax the EKG while I ran to the med room to prime the nitro drip. I could hear her sigh in protest but I ignored her.

Within minutes I entered Mr. Grange’s room with an IV pole and pump in tow. “Okay, how is your pain now?” I asked upon entering.

“It’s still the same, Hope. Maybe even worse,” he replied still clutching his chest. “It’s a… It’s at least an eight,” he said between breaths.

While hanging the nitro drip, I assessed Mr. Grange’s ABCs. His breathing was definitely faster. While connecting the IV tubing, I touched his arm to assess his circulation. His skin had become cool and clammy, even his face had become paler, almost grayish. I wondered if my eyes were playing a trick on me. I listened to his heart not sure who’s was beating faster his or mine. I looked him in the eyes, his fear mirrored my own. I only hoped that mine wasn’t as apparent.

“I started the nitro drip. You should start to feel some relief. I am going to monitor your blood pressure frequently. Your EKG was faxed to Dr. Evangelist. He should be reviewing it right now. He will be calling me back,” his blood pressure 99/43 flashed on the screen. Nitro would increase blood flow to his heart muscle, which would reduce his chest pain but it would also reduce his blood pressure. If his blood pressure fell below 90 his heart wouldn’t get the blood flow that it needed leaving me in a sticky situation.

His nitro was started at 10 mcg per minute. Increasing it 10 mcg at a time, I had the drip up to 60 mcg per minute but Mr. Grange’s pain was still at a five and his blood pressure was down to 88/42. I never thought I would ever wish for Dr. Evangelist to call me but I silently prayed for his call my worry maximizing the adrenaline running through my veins.

“Hope,” I turned to Jean at the doorway. “Dr. Evangelist is on the phone.”

I let my breath out in a long sigh not even realizing that I was holding it. “Thanks Jean. Hey, can you stay with him and monitor his blood pressure while I talk to Dr. Evangelist?”

“Yes of course,” she said taking my place at the bedside.

Before answering the phone I looked at the rhythm on the monitor. His heart rate had picked up its pace to 124 beats per minute. “Hey, it’s Hope,” I answered relieved.

“Is the nitro up,” Dr. Evangelist asked.

“Yes. I have the drip up to 60 mcg but he still rates his pain a five. He is cool and clammy and I can’t increase his nitro any further ‘cause his blood pressure is 88/42.”

“Start him on a heparin drip and call the cath lab team in. I’m on my way in,” my ear and the dial tone had become good friends.

Scanning the nurses’ station, I didn’t see Wanda. I calculated the loading dose, hurried to the med room to get the drip, and brought it and another IV pump into the room.

“Jean, I need the cath lab team called in but I can’t find Wanda. Do you know how to call them in,” I asked desperately.

“No but I’ll go find out,” Jean ran out of the room.

“Mr. Grange, I just talked to Dr. Evangelist and we’re going to start you on a heparin drip to help thin your blood and reduce the blockage in your heart. In the meantime, Dr. Evangelist is on his way in and will be taking you to the cath lab to perform an angiogram. He will put a catheter into your groin that leads up to your heart and try to push the plaque up against your arteries to open them up,” my words came out slow and steady as I tried spare Mr. Grange from the fear and panic that I felt inside.

“Okay,” Mr. Grangea said. His breathing had slowed up a bit but his coloring still looked off. Every time I looked at him I thought he looked worse but I couldn’t tell if he really did look worse or if my eyes were playing tricks on me. Sometimes when people are close to dying they have an overwhelming feeling of impending doom. At this moment, I thought I knew exactly how that felt. Jean came in with some papers.

“The cath lab team was called in. I just called the operator and they said they would take care of it. I couldn’t find Wanda. Here’s the consent form and paperwork,” Jean handed me the forms. I had just finished filling them out and getting the consent signed when Dr. Evangelist came in.

Once he walked in the situation turned into a whirlwind. I followed his orders, starting IVs, giving him IV fluid, calling his family and before I knew it he was being wheeled down the hall to the cath lab.

I finally took a deep breath and sat down at the nurses’ station. My feet were aching and now that the adrenaline rush was gone exhaustion was taking over. I was finishing my documentation when Wanda approached me.

“Hope, I just heard Mr. Grange went to the cath lab. Why didn’t you tell me,” she snarled.

“I would have if I could have found you,” I replied looking up at her challenging her to say more. She trudged off down the hall her thighs rubbing together made a swish, swish sound as she walked away.

After giving report, I found Jean standing at the elevator waiting for me.
“Jean, thanks for waiting for me,” I said as I approached her.

“No problem but don’t make this a habit, okay!” she said as we entered the elevator.

“Believe me I hope this is not going to be a pattern. But once again thank you for your help. As usual Wanda was useless and I couldn’t have done it without you,” I said.

The elevator stopped on the third floor and my heart skipped a few beats as Sam entered the elevator.

“Hey, Ladies!” he said as he entered. I stood with my mouth gapping open.

Jean spoke first, “Don’t mind Hope, Sam. She has had a crazy night and her synapses aren’t firing as quickly as they should.”

“Oh no. Did everything turn out okay?” he asked me.

I finally came out of my daze, “Yes. It was Mr. Grange. The man you brought up to me. He ended up having a heart attack and I sent him to the cath lab.”

“Well good thing for him he had an excellent nurse. You probably saved his life, Hope,” he said as he got out of the elevator. We followed him out but at the end of the hall he waved good-bye as he headed back to the emergency department.

I watched his backside until he turned down another hall. Walking out his words ran through my head, “he had an excellent nurse. You probably saved his life” and a smile came to my lips when for the first time in my nursing career I actually believed it. I was an excellent nurse and I did save his life.