[The following stories are true except for the parts I exaggerated. If it seems wildly inappropriate to be laughing, I promise you it is far better than the alternative.]
It’s the middle of the night, which seems like a pretty good time for a joke when you have to be awake anyway. I’m in the middle of my six-month preceptorship as a newly graduated nurse in the children’s intensive care unit in Salt Lake City, Utah. The year is 2004, and I like the nurse I am at this moment.
I have a light load tonight with two patients who require monitoring and assistance, a few medications, perhaps a lab draw, and advocacy as needed, but not the kind of complex, critical, and constant interventions that have you on your feet for 12 hours with hardly a scrap to eat or a chance to pee.
“I dare you to tell the doctor about this kid’s urine output.”
My preceptor (trainer) is Beau Penton, an easygoing and playful but very adept male nurse. I say male because I have known a girl named Beau. And because a few people out there may equate nurse with the female gender.
The column in my charting where I record urine output remains empty hour after hour. His fluid intake indicates that he ought to have something coming out by now. Not wanting to cause extra stress on his heart or lungs, wanting to keep his blood pressure within a normal range, and mostly just wanting my numbers to “look good” by morning, I agree that it is time to tell the doctor.
Only Beau and I already know why this kid hasn’t peed–he has no functional kidneys.
But the brand new medical resident who is on his first rotation through the Pediatric ICU–he might not know that. The poor guy has probably been up for 20 hours and dealt with at least as many patients.
Dr. First-Year stops in for a quick update before hopefully nabbing a couple hours of sleep. I unfold my tryptic charting and bite my lip hard to keep a straight face.
“Dr. First-Year, I’m sorry to bother you, but so-and-so here in room such-and-such has had no urine output for several hours. I keep checking his diaper, but it’s dry.”
As he reads over the chart I’ve handed him, his eyebrows furrow. Then they shoot up in alarm when he sees that this boy hadn’t made any urine all day either.
“Oh, wow. Yeah, let’s see if we can get him a diuretic. We need to pull some of that fluid off. Let’s see here…”
His words trail off as he opens his drug guide to calculate the weight-specific dose. He reaches down for the order sheet to request medication from the pharmacy when he suddenly straightens up.
“Wait a second.” He looks again at the name on the chart and pulls a little summary out of his scrub top. Before he can even find his chicken scratch notes about my patient, he looks up to see my face contorting with suppressed laughter.
He nods his head with a grin on his face.
He tilts his head to one side as he slowly shakes a finger at me and chuckles out, “You almost got me there.” He sets the chart down and walks away with, “They warned me about you, Beau Penton.”
Beau has bowled over with laughter and then leans back, points at me, tries to speak, shakes his head at the futility, and laughs for a few more seconds.
“Ahhh hahaha” he says, and wipes his eyes. A couple last chuckles bounce his shoulders up and down, and then he gets his words out. “You pulled that off perfectly. They’re never going to let me train another nurse after this.”
I share this with you because a few days ago I began viewing my whole life through a new lens, one that might require me to rewrite the narrative I’ve carried around with me for so long. You see, when I look back on being a nurse, I easily recall the many times I flipped out and couldn’t handle myself amidst all the demands placed on me. I remember the mistakes I made and didn’t seem to learn from. I remember the baffling actions I took, some of which resulted in scary situations or could very easily have led to devastating consequences. I even decided that the moments I had infused with humor and little pranks were perhaps a sign of impulsivity and my inability to cope with stress. Even the moments when I let myself be “me,” I now wonder if I may have just been manifesting ADHD.
But when I try to throw my sense of humor into that bad lot, my mind hears a gentle plea.
“Don’t do that. You didn’t do anything wrong. Remember–laughter is the best medicine.”
I reluctantly allow my sense of humor to stay on as my personal assistant, but only on a trial basis. My sense of humor is sure to lead to trouble soon enough.
Fortunately, my husband’s sense of humor can keep us both afloat. I teased him when me met a couple years into my career that I had already spent many nights with another man. With this same man I eventually co-chaired our department’s quality council as well. My husband married me knowing that the other man would remain in my life for the foreseeable future.
He took it like a real man and asked, “Does he make you laugh?” I didn’t have the heart to tell him just how much my co-worker and I laughed together, so I answered with the line he had cued from Ocean’s Eleven: “He doesn’t make me cry.”
That was true until today.
When a person takes their life, they take all the answers with them too. Why did you do it? What made life that unbearable for you? Was your final decision something I could have dissuaded you from? Should I have done more when we last interacted?
So I spent the day reflecting on many of our memorable moments as nurses.
He stands toward the head of the bed as I do a head-to-toe assessment of my older adolescent patient. She is ventilated through a breathing tube and has all sorts of medications feeding directly into her veins to keep her heart pumping and her vital organs in prime condition. But they are not for her. In the morning she will give a final gift to a neighbor down the hall, a girl whose heart is barely keeping her alive.
I had seen the girl weakly pushing herself to a sitting position, writing in her journal, and looking nearly as white as her crisp hospital sheets. She knows nothing about her neighbor. I wonder how often she reassures herself by saying, “For now I will stay alive.”
As I close my assessment and fill out the “Skin and Integument” section, I ask Beau what all the marks are on her upper thighs. White, jagged lines, hatch marks on a tree trunk.
“That’s where she would cut herself. She’d been doing that for the last couple years, ever since an older boy raped her. Eventually the pain was too much, and she killed herself.”
He tries to say more, but his throat catches. He looks away before managing the rest:
“He should be in this bed instead of her.”
I stare down at her and vow to honor her body that night in every way a nurse can.
In the morning, as Beau and I wheel her bed toward the surgical suite, we reach an intersection where another bed pauses so that we can cross first. Donor and recipient pass within inches of each other.
Beau and I exchange a meaningful look. After we hand her over to the surgery team, he asks if I got the chills too. I can only nod.
Fast forward a few years. I now independently care for critically ill patients. Much of the time I manage my work pretty well. But I am pregnant, depressed, miserable from months of morning sickness, and terrified because I have been working with a patient the last few days whose treatment methods exceed my training.
On a recent night I nearly cause irreparable lung damage in this little boy because after asking his respiratory therapist to hang a new bag of fluid to keep his lungs moistened while he is therapeutically paralyzed and ventilated, I forget to follow up. The attending physician, a force of nature I’ll call Dr. Energizer Battery and who intimidates the hell out of me, has discovered the error, firmly warns me of what could have happened, and corrects the situation before the bag runs dry.
I feel like a pile of BM for my mistake and shift the blame to my charge nurse, who is expecting too much of me. I accepted the assignment because I know how short-staffed we are, and I know all her other options are even less qualified than I am. But that didn’t make me feel any less like a giant liability.
One of the last times I see Beau while working as a bedside nurse, I slam around the break room, crying and swearing and telling the medical resident exactly what I think of her boss, Dr. Battery. Beau watches me, stunned.
Before lunch, I had watched as this same patient, who very likely would never recover, deteriorated. The heavy conversations that had taken place recently between the parents, the attending, and the primary nurse led only to an insistence that we continue to try everything.
But I can’t do it. I can’t make my own brain and body do all the work necessary to increase our efforts and monitor the minutia in case some sign of improvement can be found. When I receive a litany of orders and a “Get it done yesterday!” from Dr. Battery, my blood begins pounding through me with indignation: Why are we doing this? Why do I have to be in here busting my body when we know it isn’t going to help?
The charge nurse comes to help out and relieve me for lunch. I fume as I slam sterile packages into her hands and tell her where to attach them for our latest insane intervention. We have worked together for years, but she now looks at a stranger.
As Beau watches me in the break room, he catches up to my stride by agreeing a little about Dr. Battery. Then he helps slow me down and collect myself by asking fairly neutral, objective questions. The resident assures me that she will explain my predicament to the attending, who, as I recall, comes and apologizes. She sympathizes about how hard it is to go to all these lengths since it likely won’t make a difference.
When I opt a year later to stay home with my daughter rather than risk the lives of someone else’s children, I see my manager breathe a sigh of relief, perhaps because now she won’t have to suggest it herself.
And yet, it is in that last year when I am pregnant and working full time that I also receive top ratings in my annual review. Such is the life of the inconsistent ADHDer. Shines like a star here, collapses into a black hole there, and learns she cannot trust herself anywhere.
Beau, I don’t know what happened. I don’t know why you stopped your future from coming and left us all with an incomplete picture of the Beau we all loved. But when I was with you, I trusted myself to be me and not have it lead to catastrophe. Thank you for believing in me. Thank you for your understanding, like that time I sat down for our council meeting, and I turned green because you opened up your to-go breakfast of sausage and eggs. Your mouth dropped open and you asked, “Are you preggers?” To my sickish nod, you replied, “Then this can wait,” and you closed up your breakfast until I left. You’re the first co-worker I told, and you gave me permission to experience it just as it came even though I was scared by how quickly motherhood was affecting my whole world. You cried with the rest of our council when we were the first in our staff to learn that our co-worker’s husband had taken his life. I guess no one is immune, so I’m going to let you experience death as it came to you. For some reason, that is how you chose to go. I won’t wait until you’ve sent back these details from beyond for me to honor your memory and goodness.
Thank you for the laughter, Beau. And the tears. Goodbye.