By Claire Nightingale (@PotsCooking)
It’s 2 AM and the phone is ringing, but I am not asleep. 2 AM is my 2 PM, being a night shift nurse, so I am busily fussing about the house, cleaning and organizing. I look at my phone. My friend is calling. My father says that nothing good ever happens after midnight, and as a general rule he is correct.
“How much will it take?” my friend keeps repeating, between sobs.
How much will it take – how much will what take? What is she talking about – money? Does she need money? I ask for clarification.
“How much will it take to kill her.”
My friend has been taking care of her ailing grandmother for the past few months, and now the end is near. My friend is not a nurse, but she has become accustomed to certain tasks – cleaning up urine, inserting suppositories, feeding someone that is too tired or ill to have any appetite. But death is an entirely different story.
“This black goo keeps coming out of her mouth and nose. I can’t get it to stop. She screams whenever I touch her. She won’t let me clean her up. She keeps begging me for this to be over. I need to know how much oxycodone I can give her to put a stop to all this.”
I spoke in hypotheticals, as giving someone such advice would cost any health practitioner his or her license. “Hypothetically, around [x] milligrams would do it. Hypothetically, you would want to put a bag over her head after she passes out to make sure she actually stops breathing. Hypothetically you will need to check her pulse every five minutes to make sure she’s actually dead.”
“Great, thanks.” And then she abruptly hung up.
I do not know what my friend ended up doing. I do know that two days later, her grandmother did finally pass away, rotting and emaciated – your typical stage IV cancer patient. The first thing she said to me at the funeral was, “Fuck, it’s not like it is in the movies.”
The glittering, glass behemoth of a building looms over me in the dark. I am walking into the hospital. It is 7 PM, and my night shift is about to begin. I straighten my nurse’s dress, adjust my stockings, pull back my hair into a ponytail, and check to see that my white shoes are clean. My makeup is soft and smooth, my nails are a delicate pink. Looking like this makes my patients feel at ease.
I am in love with the night. Nights are for quiet, and for healing. There are no high-heeled, pursed-lip administrators wielding clipboards with audit forms. There are fewer family members, fewer doctors, fewer people in general. It is me and the patient. It is our time together.
I have been a nurse for many years. I have only worked in critical environments – the various intensive care units, and the emergency room (ER). Now I am a float nurse, which means I go to whichever unit is hurting the most for staff. Tonight I have been sent to the ER. When I walk in, two patients are actively dying (we call this “coding”), and resuscitation efforts are in effect. There is total chaos. I go into the first code. All I can tell is that the patient is an elderly woman – much like my friend’s grandmother. She is so fragile and so thin, lying there naked on the silver ER table. She must weigh only around 80 pounds. The paramedic doing CPR on her is large and muscular, and I can hear her ribs cracking with every compression. Her clothes have been cut off with giant scissors, and lay in tatters on the floor. A breathing tube is jutting out of her throat, and the nurse keeps trying to put a feeding tube down her nose but there is too much blood.
“Fuck! She must be on blood thinners, I can’t get this fucking tube past all this shit!” The nurse is getting frustrated.
“Stop for a pulse check,” the doctor hollers out.
The paramedic stops compressions, so that a nurse can check and see if we’ve successfully revived her. The paramedic is sweating. He looks at me and gives me a wink. He is always asking me out on dates.
“Hell, just call it,” the physician sighs. “She was dead when they rolled her in anyway.”
“Who’s gonna help me clean her up? She must’ve shit herself on the way in – it’s everywhere,” the nurse asks. “I’ll help you,” I offer.
We begin the process of making her look presentable for her family. Her ribs are now broken, and large bruises have formed over her chest where the paramedic was pushing. There is blood everywhere, from the messy intubation and from attempts at starting IVs. Her dentures are not in place, so her mouth is caved in. Her skin is somewhere between gray and green. There is a single curler in her hair that is still hanging on, leftover from her last time sitting in front of her mirror at home. I try to make her look as nice as possible, but that is difficult.
I go and get the family. The daughter stops at the door.
“That’s not my mother. That can’t be my mother. Is that my mother?”
I check the armband. Yes, it is her mother. We have simply violated her beyond all recognition. This 90 year old woman, who should have died at home peacefully with her family, now lies dead on a cold, silver table, naked in front of a cadre of strangers who are hungry from a missed lunch break and tired from already working 50 hours this week. There is no time for compassion. This patient is just a number, one of many passing through our emergency room tonight. Time to get the body out, so someone else can be shuffled into the room.
The code next door is still going on. As soon as I am finished helping the one nurse clean up her dead patient, I run into the adjacent room. This code has been going on for nearly two hours. It is a young, white man – a boy more like the looks of it. His skin is as white as marble, and his lips are blue. Someone at the halfway house where he was staying found him in the bathtub, lying in cold water with a needle jutting out of his arm. Heroin. His “friend” dumped his body in front of the hospital and then drove quickly off, probably frightened of getting involved or having to answer any questions.
The boy is lucky. The ice water that he was submerged in acted as a preserver. This is actually a standard practice now in medicine in post arrest patients, cleverly nicknamed “Dr. Ice.” You drop the patient’s body temperature to around 33 degrees Celsius, and then slowly rewarm them. It actually has a remarkable success rate.
The boy is alive. It’s only been two hours, but he is already awake and looking around. We pull out the breathing tube that was only recently inserted. He gasps as he takes his first real breath.
“Hey buddy, you with us? Can you hear me? Can you give me a thumbs up?”
The boy looks dazed and confused. His eyes are red rimmed. Then he starts to look scared.
“We are not the police. We won’t call the police. We’re just here to make sure you’re ok.”
The doctor, who also happens to be my father, is reassuring. He always takes his time with these patients. He offers to bring him water and a sandwich. This is usually a nurse’s job, but my father takes a special interest in the overdose patients.
“Do you have anyone you want me to call?” I gently ask him.
There is still chaos encircling us. There is medical trash all over the floor – empty flush syringes, IV tubing, defibrillation pads. “No,” he whispers. I ask him to repeat, as I couldn’t hear his voice, which is weak after having the breathing tube down his throat.
“No, there’s no one to call.”
He looks up at me. There are large, fat tears rolling down his cheek.
“When’s the last time you had something to eat?” my father asks. He has returned with a sandwich.
“I… I can’t remember.”
“Clair, go to the doctor’s cafeteria. Take my badge. Get him a hot plate. This is garbage anyway,” my father instructs me, chucking the sandwich into the garbage can. I come back with a steaming plate, piled high with food. The boy’s eyes widen into saucers. “Don’t eat too fast or you’ll get sick,” I warn him.
The last time I look at him, he is digging into the plate eagerly with his fork. He looks up at me and smiles. He is missing a few of his front teeth.
This boy will not be our last OD for the week. At the end of last December, we had six overdoses all within one week. Six. All of them died. All were young men under 30. There are no old heroin addicts to advise the young. It is a drug hell bent on putting the user into an early grave, and it is usually successful. We did not not use to see such things, even 10 years ago when I started. What has happened to this generation of men to cause such hopelessness? To the point where they will plunge a needle in their arm over, and over again, each time knowing it could be their last, but frankly not caring?
I decide to go up to triage to see if I can help there. This is where patients are initially assessed and prioritized, and the basic tasks are completed – lab work, EKGs, and the like. Two young black men are screaming at one another. One of them cocks his fist back, ready to throw a punch. Michael, my favorite security guard, swoops in and puts a stop to everything. He comes over to me and gives me a long, tight hug. “How you doin’, little miss?” This is what he always calls me. “Living the dream,” is always what I say back.
I hear screaming coming from the ambulance bay. It is high-pitched – a woman’s. Then a slew of curse words.
“Get your fucking hands off me, you cocksucker!”
It is a young white girl, in her early twenties. The picture of modern womanhood. Her short black dress is in shambles, and part of the sequin lining has been torn off. She is missing one high heel. Her black eye makeup is running down her face, and has merged with the vomit smeared across her cheek. She is very, very drunk.
“Who’s this peach?” the male nurse cracks a joke. Male nurses are good to have around when these types of patients arrive. Young, drunk women cause the most trouble.
“She fell in her dorm. The RA found her at the bottom of the stairs in her own vomit.”
“Hey sweetheart, can you tell me what happened? Do you know where you are right now?”
“Sweetheart!? You fucking cunt, you want me to suck your dick? Yeah fucking right! Don’t you know who my dad… my dad is?” She is slurring her words. She hiccups and vomit dribbles down her chin.
We begin cutting her clothes off. She’s fallen down a flight of stairs and has sustained a broken wrist and her body is covered in scrapes and abrasions. She glares up at me, eyes unfocused but full of malice.
“You want to see my cunt, you fucking lesbian!? You wanna? Look at it! LOOK!” She begins thrusting her pelvis up into the air. Michael has shown up, and is standing next to me. She hocks a loogie and spits it at him. It hits him square in the chest and oozes into his shirt. “No way for a lady to act, mmm mmm mmm.” He shakes his head, wiping off his shirt.
“This ain’t no lady,” the paramedic begins to laugh. He winks at me again.
“You’re laughing at me?? At me?! Don’t you know who my daddy is?” she screams again.
“No,” I say flatly. She looks at me again.
“My school tuition is your fucking salary, you bitch.”
“What a peach!” the male nurse says again.
We end up having to put her in leather restraints. She continues to scream, scratch, and claw at the air. She is frightening the other patients and their families. I walk out and close the door, but can still hear her yelling. Two nurses are standing at the nurses’ station outside the room.
“I fucked both of them… both! In the same night! Poor Jeremy got sloppy seconds.”
They begin to laugh. I decide not to join the conversation, and instead go back up to triage. There’s a new patient waiting to be seen.
Two paramedics are lazily leaning up against the wall. One yawns, the other is fiddling on his phone. The former’s shirt is messily un-tucked from his trousers, and a half-eaten Snickers bar protrudes from his pocket. The latter looks up from his phone only to look at the ass of the nurse passing by.
“What’d you boys bring in for us tonight?” I ask.
“Same old shit. Nursing home. Trach/peg. GI bleed. Looks like death.”
I walk into the room, and breathe out a sad sigh. The person that lays before me is, unfortunately, a very common sight. She is a black woman in her mid 60s. She is missing both of her legs, likely from poor management of diabetes (which leads to vascular insufficiency requiring amputation). She has a PEG tube jutting out of her stomach. PEGs are placed in people who’ve had strokes are no longer able to swallow food by mouth. She has an AV fistula in her right arm, which is a long term access site used for dialysis. She has a tracheostomy, which is a permanent tube inserted into your trachea for people who can no longer breathe without supplemental support. She has a pacemaker implanted, which is a permanent device placed in the thoracic cavity that delivers electric shocks when the heart “misfires.” Every organ system – cardiac, pulmonary, gastrointestinal, renal – relies on external support. She has had a large stroke in the past – not large enough to have killed her, but large enough to where she is no longer “there.” She is unable to communicate at all, either verbally or written. She stares blankly at the wall behind me. The only noise she can make are croaks and squawks, usually a response of displeasure from being moved or touched. She is currently lying in a pool of her own diarrhea, which is maroon in color due to the massive amount of blood. She is probably on a medication that thins the blood (prescribed for certain cardiac conditions), which has caused something within her gastrointestinal tract to rupture, thus resulting in what’s called a “lower GI bleed.” The smell is beyond foul.
“Ooh, nice! I’ll bet you five bucks she aspirated.” The male nurse has followed me into the room.
“No deal,” I respond. I already know he’s right.
“God, it smells like death – must be a GI bleed.” He starts dry heaving.
What happens to patients like these is that they are left to languish in nursing homes – somewhere halfway between life and death. They are alive, by medical standards at least. A machine breathes for them through their tracheostomy. Liquid feeds, with appetizing names such as Renal Source 5000, are pumped into their stomach three to four times a day. In many cases, like with this patient, they aspirate (choke) on their tube feeding, which results from being laid flat in the bed after receiving a feeding. They lie in bed, and maybe are turned by the overworked staff once or twice a shift, so they develop large, rotting decubitus ulcers over the bony parts of their bodies – their shoulder blades, their sacrum, their elbows. They urinate and defecate on themselves, and are usually left to soak in their own mess, mainly due to the poor staffing of nursing homes, but sometimes due to simple apathy or negligence.
“Hey, I’ll handle this shit show if you go up to the front and help check in the COPD patient.”
I agree, so I walk into the triage station. There is an old man sitting in a chair, his home oxygen tank at his side. He is wheezing as he sits there filling out paperwork.
“I’m going to get an EKG on you, is that alright?” I ask him. “Oh sure, yes, ok.”
I begin to put the EKG leads across his chest. He stops writing, and closes his eyes. A smile spreads across his face.
“That feels nice.”
He looks up at me sheepishly. I am confused – what feels nice?
“That, what you’re doing there,” he clarifies.
I’m still confused – I’m just applying EKG leads, but my other hand is placed gently on his back. “I don’t really get to see very many people,” he says as he drops his head.
“Do you live alone?” I ask.
“Anybody ever come to visit you?”
“Any family around?”
A brother, but he lives far away.
As it turns out, this man has not had a normal conversation with a fellow human in years. He has not been touched by another human in years either – almost 5 years. He is isolated, he is alone. I am the first person to ask him such questions.
What I see at the hospital, night after night, is a perfect microcosm of our societal woes. The elderly and terminally ill are kept alive via fluids and liquid feeds, with no consideration given to their dignity or even their humanity. We go to such ends to keep these patients alive that often their physical bodies, when they do finally die, are unrecognizable to their loved ones. We seek to hide the reality of death. And so patients die not at home, but in sterile, cold rooms among strangers who know them by their medical record number, not their name, with a 60 inch TV blaring infomercials in the background.
Liberal nihilism has saturated our culture. Young people have nothing going for them – nothing to look forward to, no greater purpose to live for. Men, in isolation, turn to drugs; women, in loneliness, become whores. Both lose themselves in pointless television and internet drama. While I witness a young wife puking into a garbage can after I’ve had to tell her husband died despite all of our efforts, the extremely online tear each other to virtual shreds over the topic du jour.
Our elderly citizens have been abandoned. They sit in front of televisions, day in day out. They swallow their pills. They look out the window. They look at the phone. No one is calling to check on them. The neighborhood they live in used to be nice; but things are different now. Doors must be locked. There are no community events. No one brings over any food.
Everyone is isolated – working in boxes, driving in boxes, eating in boxes, sleeping in boxes. No one knows their neighbors’ names. No one comes around to check on the elderly man down the street, whose wife died a few years back and has been left to fend for himself.
Television has replaced reality, with characters replacing friends. Fast food has replaced home-cooked meals. Pills have replaced emotions. Community is forgotten, and everyone is alone.
Everyone is sick now.