“If we could know the future our jobs would be a lot easier.”
A detailed and exhausting account of one nurse’s twelve-hour shift on a hospital’s hematology/oncology floor. Medical memoirs are a favorite genre of mine and I enjoyed it!
If I sound the alarm and the patient is OK, then I over-reacted and have untrustworthy clinical judgment. If I don’t call in the calvary when it’s needed, then I’m negligent and unsafe for patients. You don’t always know because what goes on inside human bodies can be hidden and subtle. This job would be easier if there weren’t such a narrow divide between being the canary in the coal mine and Chicken Little.
Over the twelve-hour shift, Brown is responsible for four patients. Four patients don’t sound like many at first, but the stakes are high and there are multiple tasks to juggle per patient. Her patients are immunocompromised, so a number of extra precautions have to be taken during each task to keep them safe from invisible dangers. We spend time with these four patients:
• Dorothy – A woman in her 50s with a positive attitude. She is being treated for leukemia and is waiting for her lab work to return to normal so she can be discharged after a six-week stay.
• Richard – A fragile lymphoma patient in his late 70s, who has just been prescribed an extremely toxic chemo drug that demands constant supervision while being administered.
• Sheila – A woman in her mid-40s with antiphospholipid antibody syndrome, a blood clotting disorder. She is experiencing mysterious abdominal pain.
• Candace – A difficult (or empowered, depending on your perspective) cancer patient in her early-40s, who is scheduled to receive a transplant of her own cells.
In the book’s disclaimer the author notes that while these stories are true, specific details have been changed to protect patient and staff confidentiality. In some cases, composites are used. While she is unable to give us updates on patients after they leave the hospital, we do get enough of a conclusion for the aforementioned patients.
I watch the intern walk down the hall, slightly stopped, as if he bears the weight of the world on his shoulders. But it is I who will give Mr. Hampton his Rituxan, who will monitor him for serious changes in blood pressure, heart rate, and breathing, who will need to call this intern, or his replacement, if the treatment intended to heal ends up hurting instead. The intern doesn’t know this drug as well as I do. The intern won’t be the person hooking it up to Mr. Hampton’s IV, watching it run down the plastic tubing directly into his vein, knowing that if things go badly, it will be result of the work of my own hands.
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The more patients an individual nurse cares for, the smaller amount of TLC per patient. More significantly, research on staffing levels has made it pretty clear that the more patients a nurse has above a certain number (the number itself depends on the patient population and how sick the patients are), the larger the likelihood a patient will die who wouldn’t have otherwise. In other words, nurse-to-patient ratios aren’t just about patients feeling cared for; they’re also about fragile people staying alive.
Besides the patients, my favorite parts were Theresa Brown’s insights into problems with the way care is managed at hospitals. I wish there was more time spent on these topics. Theresa airs her frustrations with a system that doesn’t allow her to spend as much time with a patient as she would like. She always wanted to do more for them, but time constraints and the hospital’s bottom line didn’t allow it most of the time. She addresses the lack of emotional care for patients, hospital hierarchy, practitioner fatigue, the overcomplicating of processes in the name of safety and excessive workload. Though she gets frustrated, Brown loves her job and shows remarkable empathy for her patients and colleagues. In one chapter, she notices that she treats the escort in a way that she complained about a doctor treating her earlier. She realizes that everyone has a lot to do and maybe they are all doing the best they can to get through the day and keep their patients alive.
As force from the syringe makes blood swirl into the saline I stop and watch it billow like silk. Red. Beautiful. I never gave blood too much though before I took this job, but now I revere it. Blood is the liquid of life. Red cells give oxygen, platelets form clots, and white cells protect us from infection. Without healthy blood humans cannot live.
Because the author was an English major before changing careers, the language occasionally becomes poetic. This leads to some distracting figurative language and excessive literary references. (“Changing the bandages on his dying toes caused a shadow of pain to fall over his face, like the moon covering the sun during an eclipse.”) While it did make the work feel more human, it was jarring to shift from routine, “day-in-the-life” language to emotional language.
I had doubts that the author could maintain my interest with such a tight focus, but I enjoyed the whole book. We are all likely to be patients at some point, so this is a useful read for everyone. “There will come a time when each of us will need a clean, well lighted place that stays open all day and night, offering shelter from life’s storms.” It certainly will make me more patient! If you liked this book, you might also like The Real Doctor Will See You Shortly: A Physician’s First Year.
In all the hurly-burly, I’d forgotten, but now I remember: The most important thing of all is that everyone’s alive at the end of the day.