They're Still Talking About This One

They’re Still Talking About This One

“Wait, no I wasn’t blaming her for his death! I didn’t mean to say that. I’ve said too much!” I was embarrassed and appalled that what I thought of as innocent gossip had now erupted into a major scandal at work.

Here’s how it started.

There’s a nurse; let’s call her Rachel. She’s been working on our unit for almost a year. And sure, she didn’t quite fit in with all of us. But it was more than that. She didn’t take the best care of her patients. And we all knew it.

“Did you see that Rachel’s patient has his light on every few minutes? I guess I’ll go check on him myself.” I know I’ve said that before. But then, each one of us has.

“Rachel passed her meds late again tonight. I swear she just isn’t organized. Or focused.”

“Geez, why can’t Rachel get her work finished before rounds? It’s not like her load is any different than mine.”

So that’s the way we all felt on 3B. We work on the busiest surgical floor in the hospital, in the city’s busiest hospital. I’m the most senior nurse, having lasted five years at Memorial. The usual burnout rate is two years or less. But there’s a group of us that have been together for 3 years now, the A team. We work ourselves half to death. Night shift is the worst. So short-staffed. But then dayshift is so busy with testing, doctors’ rounds, and all the bullshit that goes on during “normal” hours. I wouldn’t work days again. They rarely have time for patient care. It’s all they can do to give drugs within a two-hour window and get labs drawn, tests ordered, answer phones, walk patients. It’s crazy. And the family complaints, geez. I couldn’t and wouldn’t want that.

That’s why I work night shifts. More time for quality patient care for the ones that need it. And surgical patients generally get better each day, so eventually, they need little help by the time they are close to discharge. It’s a perfect mix because there’s more time for the more complex patients and new post-ops.

But Rachel has struggled to fit in from her very first day. We all see it. It’s not just me. I oriented her when she first started. Well, I really am the best one to get them started, especially the new nurses. And Rachel? She was green. Right out of nursing school and had just passed boards. They throw her on nights! And by THEY, you know I mean administration, the bean counters, no formal experience with actually doing patient care. A nurse is a nurse, in their minds. Just fill the spots. Or don’t. Most of the time we are still short at least one nurse each night. So, we each take more patients. Tell me how we’re supposed to give good care.

All of us talked about Rachel. It wasn’t just me. She couldn’t get her work done on time, which always created more work for those of us who care, like me.

So last month, one of Rachel’s patients goes and dies. I know people think that patients die all the time in a hospital, like every shift all day long. But that’s actually not true. But the code was chaos; too many staff responded, filling the room with unnecessary people, and you could hardly get to the patient. I arrived as quickly as possible; everyone on the unit responded to codes, and Rachel’s patient had been down too long. I could tell immediately. His skin was mottled, grey, cold, and stiff. This just doesn’t happen right away. So, he had to have been gone for too long before she found him.

I’m just saying. I didn’t blame her for the death. In passing, I might have mentioned that Rachel probably hadn’t checked on him in a while. Whoever overheard me should have just kept their mouth shut. I was just saying what everyone felt.

There was this time Rachel even came out to the landing outside of the stairwell, where we would sneak out for a smoke; oh, come on, you know we do that. Everyone does. But Rachel didn’t smoke, and she came out there looking for help bathing a patient too large to turn over. I just rolled my eyes and told her to wash his hands and face and check it off.

“We don’t have time to give baths tonight. Dayshift has aides; they can do it.” I looked at the other nurses as Rachel went back inside. “I can’t believe she left the unit unattended. What is she thinking?”

And passing meds! I would see her standing, looking up things on her med cart. Always had some small handbook checking something she should just know.

I was hoping she would eventually get used to the pace here. Only the best make it on 3B. Don’t look at me like that! I mean the nurses, of course. Not the patients.

So, the night of the death? Sure, I can tell you about it. But I wasn’t saying Rachel killed the guy. But her lack of attention meant she wasn’t on top of it.

Do you mind if I smoke? Oh, ok, I can wait.

So, Mr. Chalkley had been in the hospital for six days. Major surgery, aortic valve replacement. He had transferred from ICU three days before and was recovering slower than average. But then he was 81. You know who should be looked at? The doc that would do that surgery on an 81-year-old.

But anyway, Rachel. Chalkley might have been too much for her to handle. He had numerous meds through the night; he needed help to even turn over. I know during his code, his IV had infiltrated into his arm, so he hadn’t been getting his fluids or IV meds—basic nursing care to check that.

But then, this one night, almost a week post op by that time, the alarm started blaring and the hospital operator, just following protocol, starts announcing, “Code Blue room 320, Code Blue room 320.”

I was in the break room and immediately went to 320. There must have been a dozen people there by then. Respiratory care, the lab, a pharmacy tech with another emergency cart, nurses, aides, a supervisor. Overnight visitors were peeking out of the other patient rooms. And there’s Rachel, literally kneeling on the edge of the bed and doing compressions. She’s tiny, so I guess she couldn’t reach him.

I told one of the male nurses in the room to take over compressions and told Rachel to step down. Her efforts were ineffective anyway. He had a monitor on; being a step-down unit, almost all of our patients have them. I could see right away that her resuscitation was useless.

Everything was done for him, but nothing was gonna bring him back. I saw that right away. He didn’t have a shockable rhythm, and like I said, he didn’t have a bit of warmth, even on his torso, and almost all of his body was blotched with blue and purple mottling. His skin was paper thin, so his arm tore open and didn’t hardly bleed. Nothing circulating. I had to tell Rachel every drug to give during the code.

Well, yes, of course, someone runs the code. And it was me. Well yes, that’s one of the responsibilities, to assess what drugs need to be given and the timing between. Someone else is the scribe taking the times down. I guess it isn’t unusual that I was barking the orders of the drugs; it was a code. That’s how it runs.

Well, I just meant that Rachel gave the drugs and waited for me to tell her what’s next. I got the sense that she didn’t know what to give next. Well sure, I was directing the code. But he couldn’t be saved at that point.

The blood we drew was a deep shade of ruborish gel. Not oxygenated. So he had been gone for too long, and our efforts to restart his heart or even to just circulate for awhile, didn’t work. It was his time to pass.

Well, I DIDN’T say she killed him. I said that it wouldn’t surprise me if she had not checked on him all night. Something like that.

What? What’s that? No, Chalkley was Rachel’s patient. No, he wasn’t mine.

No, you’re wrong. If he had been my patient, I would have checked on him constantly. I wouldn’t have let him die and be found so cold.

Well, yes, I make the shift assignments. But I also take patients because, again, we are chronically understaffed.

Let me see. Yes, that’s my writing. That’s the team assignments for that night.

What? Yes, the block of rooms for Rachel was 301-308. Mine? Let me look again. Mine were 315-322. And, um, and. wait, this can’t be that night? Not the night Chalkley died. This isn’t making sense to me.

No, no, I wouldn’t have missed a patient. Who said that? What do you mean? I couldn’t have mixed that up. I wouldn’t miss a patient.

How could there be no patient notes for that night? That means Rachel didn’t even chart on him. It wasn’t me. I couldn’t have. I wouldn’t.

I’m done talking. I’ve said too much. I didn’t mean anything about blaming Rachel, but she probably never saw him the entire shift. It looks like Chalkley missed all his meds, which would certainly contribute to his cardiac arrest.

Well, I explain it by saying the assignment sheet you have is wrong. I never went in his room, because he wasn’t my patient.