THE NIGHTINGALE JOURNALS
A/N: Aceipey allowed me to borrow her son, Spike, for this chapter. He is all kinds of cute and I simply had to incorporate him into the story.
Things I own: A pair of z-coil work shoes that put a spring in my step. Literally. They also make me a few inches taller, which is a bonus, being that I'm 5' tall.
Things I don't own: Anything Twilight. It all belongs to Stephenie Meyer.
Thanks to my beta, Trinity/TFX, who gives me spanks for encouragement. ILY, bb.
CHAPTER ONE: THE NEW RESIDENTS
BPOV
It's the beginning of July, and our new residents are starting today. We only get second and third year residents in the PICU; first years aren't yet skilled enough to care for our more complex patients. To be honest, some second and third years aren't either, but that's beside the point. The bottom line is that the clock is reset every July, and the first few rounds of residents tend to be really conservative and careful. It's like pulling teeth to get a fucking dose of morphine. For your patient, that is. Suffice it to say, most of us hate the month of July, and we all try to take vacation during that time. Since I've only been here for five years, I'm lower in seniority and never get the vacation I ask for.
Residents cycle through the PICU in four-week stints. They rotate through the PICU twice during their residency—once during their second year, and once during their third year. A different resident is on call every night; when they're on call, they're responsible for all of our patients for twenty-four hours. There are four residents for each rotation, so they're on call every fourth night. During the day shift, all the various doctors are on duty: residents, fellows, attendings, surgeons, and specialists. The attendings run the show. They are full-fledged physicians who have been hired to cover the PICU patients. They're also responsible for training the residents.
The PICU pecking order is as follows, in terms of who ultimately gets to call the shots:
Attendings
Specialty physicians/surgeons
Fellows
Residents
Med school students
Well, they call the shots, but it's the bedside nurses—led by the charge nurse—who really run the show. We're the ones who are with the patients for a twelve-hour stretch, so we get to know them far better than the docs do. Our input and feedback has a direct impact on patient outcomes. In fact, any good doctor will tell you that the nurse's perspective is the most important piece of data out there. Personally, I make it my mission to help new residents learn and understand this very important tenet of ICU care, because it will serve them well to learn this early in their career. I sigh deeply to myself, acknowledging that I'm going to need a great deal of patience over the next 6 weeks as we get the new residents broken in.
From across the hallway, I hear laughter and a deep, familiar voice, which draws me from my thoughts. It is a voice so distinctive, I would know it anywhere. It is gentle, lilting, and silky smooth. The accent is British. The profile of Dr. Cullen flashes in my head, his beautiful blonde hair streaked with subtle grey coloring. His clear blue eyes. His perfect skin. Some of the older nurses talk about when he was younger, how hot he was. Never mind the "was" part of the equation—he's still absolutely beautiful, and a kind, generous soul on top of it.
I direct my attention back to my patient, and in a few minutes, the voice is directly behind me.
"Good morning, Nurse Swan."
"Dr. Cullen, you know you're the only one who can get away with calling me that…and only because you say it in that lovely accent of yours. What are you doing here so early? I usually don't get the privilege of seeing you before my shift is over."
He laughs heartily at my comment. I turn around to face him, and suddenly, it's as though I was hit by a cement block.
Edward Cullen? The fuckhot son of the fuckhot daddy!
"To answer your question, I'm making the rounds this morning in lieu of Dr. McCarty to introduce our new PICU Fellow, Dr. Cullen, to everyone on the floor."
"Oh, that's right. I heard something about the new Fellow starting this week." I have to act ignorant, because otherwise I might let it slip out just how fuckhot I find Edward Cullen to be.
God, I remember him as a resident. His biceps always showed so nicely, poking out of his sleeves. His hair was always just schmexed. Even then, I wanted him, as inappropriate as that would have been. Time has been very, very good to you both, Drs. Cullen.
Edward Cullen looks me straight in the eyes and I feel lightheaded. He's impossibly good looking, and he flashes this killer grin at me. I remember it perfectly, he lifts one side of his mouth into a smile, so it's all crooked, and it is equal parts playful and smoldering.
Damn, those eyes. I forgot how green they are. Perfect and rare, just like every last bit of him.
"Now, it was important to me to introduce Dr. Cullen myself, to fend off any rumors of nepotism. There was a selection process that we used, and blindly rated the candidates. It just so happens that my son came up with the highest score, and thus he was offered the job."
"You must be really proud. He'll be following in your footsteps, starting in the PICU just like you did!"
"Indeed I am, Bellar," he slides my name out with his adorable accent. "But don't let him off easily; I expect you to challenge him, like you do to everyone else."
"I promise that I will make his life interminably difficult, just for you, Dr. Cullen."
"Good! He needs to learn from the best nurses we have!"
"Carlisle Cullen, you are so full of BS! I'm sure you use that accent of yours to get whatever you want!"
"I can speak from experience; he is especially slippery when it comes to convincing my mother to do his bidding."
"You know, Edward, I could stop introducing you at any time."
"All right, Dad. Point taken. It was nice to meet you, Nurse Swan."
"Oh god, not you, too! It's Bella! I don't want to have to get violent with you, now!"
He just smiles and gives me his signature smirk, and the two of them get on their way.
Shit, I'm going to be in big trouble with that hot piece of ass hanging around here. How the fuck am I supposed to ignore that?
~xXx~
There are several kinds of official code designations within the hospital. There is code red, which is used in the event of a fire. Code pink is used when a child is abducted. Code orange is used for natural disasters. Code blue is the worst, used whenever a patient stops breathing. The very, very worst? CODE BROWN.
"Swan! There's poop everywhere! Can you please give me a hand?" Jasper begs. He is an incredibly good nurse, extremely empathetic with patients, until they poop. I'm convinced the previous charge nurse put him in that room deliberately, knowing he would be unable to change assignments. He's in the room with Spike, the Rotavirus kid. Rotavirus is a very, very nasty illness that results in constant poo, and it has this sickly sweet, distinctive odor. It's awful, and Jasper is in there gagging constantly.
"Oh come on, Jasper. You're a man—a little poop never hurt anyone. Just take a deep breath of that lovely, sickly sweet odor. Kind of makes you a little disappointed we see Rotavirus so rarely, hmm? Plus, look at that kid, he's so adorable! How can you resist his messy red hair or those green eyes? He smiles at you even while pooing, and you can see those two teeth on the bottom row; how can you not love that face? His hair is almost messier than Cullen's. Seriously, Spike is a major league adorable patient."
Jasper is unable to answer because he's making gurgling, hacking noises. I'm not sure where the idea comes from, but suddenly, I know exactly how we're going to initiate Dr. Cullen to the PICU. I quickly explain my plan to Jasper, then get the secretary to page Cullen. It will only be heard in the PICU, not anywhere else in the hospital.
Paging Dr. Cullen, Dr. Edward Cullen. Code brown in room five-oh-one. Code brown, room five-oh-one.
Cullen comes peeling out of the Doc's room towards room 501. He quickly walks over to the room, stethoscope around his neck, serious business written all over his face.
I follow him into the room, where Jasper is in the midst of Spike's diaper change. Spike uses that moment to sit up and smile at Edward.
"Wha? I thought—is this the wrong room? Where is the code?" Edward asks, his face a study in confusion.
Jasper and I start cracking up. Dr. McCarty walks in to see what we're up to.
I attempt to clarify for Edward what is happening. "Did you listen to your page carefully, Dr. Cullen?"
"Yes, I did!" He says adamantly. "A code was called for room 501, but this patient is just fine. Look, he's smiling at me for god's sake!"
Dr. McCarty pats Edward on the back. "They pulled a code brown on you, Cullen. As in, poop. You just got PICU punked, dude!"
McCarty leaves the room, shaking his head and laughing. The three of us direct our attention back to Spike, only to find that he has Cullen's cell phone in his hands. Hands that, just moments previously, had been all over his messy diaper. I'm now certain I'm going to pee in my pants due to the look on Edward's face. I don a pair of gloves, grab the germicidal wipes that can kill any microorganism, and clean off Dr. Cullen's phone for him, demonstrating that we are good sports in the end.
"You're going to be absolutely dangerous, aren't you Swan?"
"You're a very smart boy, Cullen. You'll have no trouble fitting in here. Consider yourself initiated."
~xXx~
It isn't long before we have a real code, because we are a PICU, after all. It's a fairly common occurrence. For all the drama and intensity a code has when it is shown on TV, the real thing is a far different kind of beast. There is still drama and intensity, but it is so controlled in comparison.
Whenever a Code Blue is called, we have staff from the PICU travel to help resuscitate the patient. When it occurs in our own home, there is a special button we push that calls the code team to our bedside. To the untrained ear, it is a fairly innocuous sound. To PICU staff, however, it is a call to arms. Anyone who is able stops wheat they are doing and travels quickly to the center of action. A code cart is wheeled to the patient's room, which contains everything we need: code drugs, like epinephrine and atropine; syringes, IVs; equipment; and a defibrillator, among other things.
For the first code I attended, I was shocked. I expected screaming, upset people, disarray and confusion. What I experienced was a calm, quiet attitude, wholly focused on keeping the patient alive. Everyone had a role, and it was defined within a split second. It was amazing to me, watching my colleagues in action. They never once stopped to think about what they were doing—it was as if it was hardcoded into their brains. I never expected to do enough codes to get that comfortable with it myself, but a sad fact of my job is that I could easily code someone with cool efficiency after waking up from a deep sleep.
Dr. Edward Cullen's first code is a sight to behold. It feels wrong to put it in such terms, but he is such a different breed from the Fellows we've had in the past. He is supremely confident, but not cocky; compassionate, but tough; calculating, but human. It's almost as if he was born to do this job, much like I feel I was born to do mine. I'm surprised that someone this young has so much poise, but the same could be said for the elder Dr. Cullen. The man is a legend. I cannot imagine how difficult it must be for Edward to try to follow in Carlisle's footsteps. He has the brains, the physique, the looks, and the personality to do anything he wanted to in life. The fact that he chose to do what his father does, knowing up front the reputation and respect that man has earned, says a great deal about Edward Cullen's character. He never takes the easy way out. He is committed, determined, and driven. It makes me wonder what he might be like outside of work. Could he possibly be that…perfect?
The patient happens to be tiny, so I am doing chest compressions by placing my hands around the chest, essentially squeezing it with every compression. My fingers are on the patient's back, and my thumbs are over the sternum. There is a Respiratory Therapist opposite me, delivering breaths to the patient with an ambubag, the oxygen cranked up to 100%. There is no Attending on site, so Edward is in complete charge of this code.
Like any good, experienced doc, he is constantly asking questions to ensure he has the best data available with which to make decisions.
"What was the heart rate when you started compressions, Swan?"
"The lowest rate I saw on the monitor was 54." In general, when pediatric heart rates are 60 beats per minute or less, you start chest compressions.
"What time did you start?"
"I pushed the code button and immediately started compressions. It has been about five minutes."
"Give point one of epi per kilo. What is the patient's dry weight?"
"He's four kilos."
"Okay, do it. Give the epi."
"Epi's in, Dr. Cullen."
"Stop compressions for a second." I see him watch for a rhythm on the monitor, but it is still erratic.
"Okay, start compressions again."
There are a lot of things you don't think about when you are an observer of a code. One of them is how hard it is to do CPR, even on a baby. It's exhausting, because you use a set of muscles that you don't frequently use otherwise. In this case, the muscles below my thumbs, at the base of my palms, were killing me. They start to cramp up after a surprisingly short amount of time. Sweat starts to pour down your face, and because you need to keep your gloves clean, you have to simply let it run down into your eyes. We trade positions with other nurses, but it is an intense, focused mission that you're on, and sometimes you forget the simple things, like switching positions.
The code continues for about ten minutes. We're able to get the heart restarted and beating at a normal sinus rhythm. As we start to clean up, I watch Edward assessing the patient. He has a look of absolute concern and focus. Even though the patient is stabilized, he still isn't finished. He looks over to me, and asks if the latest lab results are back. They are, so I read them off to him. He tweaks the patient's ventilator support and asks me to send follow up labs in thirty minutes.
He takes one more listen with his stethoscope, then he surprises me. He puts his thumb in the patient's small hand, and says something softly to him. I can't hear the words, but the meaning is clear. He's asking the little guy to rally and hang in there. I've never seen a doc exhibit such obvious compassion, at least not so overtly. Don't get me wrong; the docs care deeply about saving the lives of children, or they wouldn't do what they do. The difference is that they all remain relatively detached. It's usually the nurses who aren't afraid to show the patients love and care. To see such a gesture from Edward is unexpected. It also makes me hope, for his sake, that he doesn't have a problem with the patients haunting him in the hours he isn't at work.
I see in his face genuine compassion. Unlike so many physicians, this isn't about playing God to him, or stroking his ego. It is about the patients. About making their lives better. His entire approach, his comportment, speaks to his care for the child. I'm surprised to see him in that light because, as I said before, it is so unexpected.
In this stolen moment, I acknowledge to myself how striking Dr. Edward Cullen is. I'm not the kind of woman who is on the hunt for a doctor. I find the cliché of the doctor-nurse pairing both condescending and outdated. That is one of the main reasons I've eschewed dating doctors; I have no desire to spend the rest of my life answering the withering glances I would undoubtedly receive. Still, looking at his caring, beautiful face, I have to rethink my hard limits. For Edward Cullen, I might just make an exception to my rule.
~xXx~
"So, Alice, I decided to officially start this blog I've been talking about. I decided to call it 'The Nightingale Journals' and my blogger name is going to be BellaLuna. Isn't that perfect? For night nurses?"
"Are you going to write about real things that you experience? I mean, how are you going to keep it HIPAA-approved?"
"You can make it generic enough to remove certain details, like the patient's name and gender. The reader will still be able to the gist of the significance of the case."
"I think it's a great idea, Bella. I can't wait to read it! Think of all the funny work stories you'll finally be able to spill!"
"I know, right? Since I can't get Dr. Napoleon back without being fired, I can at least harp about it in my blog. That does give me a small sense of satisfaction."
I decide my debut blog will be an introduction into why I chose to be a nurse. It will do a good job to set the tone of the blog.
WEDNESDAY, FEBRUARY 17, 2010
The Nightingale Journals Begin
I can remember the exact moment when I decided to become a nurse. I was 14, and my mom was recovering from her first surgery for Stage III breast cancer. I was scared as hell, worried about losing my mom, and grossed out by all the tubes and crap that were coming out of her body. I was pretty squeamish as a kid. My dad sat in the chair next to her bed, holding her hand and speaking quietly to her. My mom had two nurses caring for her—one worked during the day shift, and one worked overnight.
Her night nurse was kind and gentle, treating my mom with such respect and dignity. She did whatever she could to make my dad and me feel welcome. The day nurse was another matter entirely. It almost seemed like she hated being there. In that respect, I totally understood, because working with cancer victims had to be draining. She was terrible to us, though, and wasn't nice to my mom. That, to me, even as a 14 year old, was unacceptable.
The defining moment came to me when my mom complained about her bladder feeling full. The nurse said to her, "Oh don't be ridiculous, Renee! You have a foley catheter in so you don't need to urinate!"
My mom quieted down, but she kept whimpering because of the pain. The nurse came to give her some morphine to stop her whimpering, and my mom was able to get some sleep. When her night nurse came in, one of the first things she noticed was that my mom's catheter was kinked, which didn't allow for any urine to flow out of her bladder. When the nurse unkinked it, nearly a liter of urine poured out. Her nurse was absolutely disgusted when we told her the story of the other nurse, and she reported the incident.
I vowed at the moment that I would become a nurse, so that other people wouldn't have to suffer the way my mom did, and that there would be one more compassionate nurse out there in the world, who truly wanted to help others. I never once wavered from my goal from that moment forward. If anything, my mom's death from cancer made me more steadfast than ever.
I've been a nurse for five years now, and I absolutely love what I do for a living. 95% of the time, I leave work feeling fulfilled and satisfied, like I've contributed a small amount of good to the world. It's an incredibly hard job both physically and mentally, but it's worth every sore muscle, tired foot, and headache it causes. The fact that I can give love, encouragement, and compassionate care to a patient for twelve hours is all I need to keep me going. It's a beautiful thing to love what you do.
POSTED BY BELLALUNA AT 8:02 AM 0 COMMENTS
~xXx
EPOV
Dr. McCarty stops by to review a couple of patients with me, in order to prep me for the upcoming night shift. He lets me know that Bella Swan will be my charge nurse this weekend, so I'll be in good hands. I take a huge amount of satisfaction knowing that Bella's colleagues all think so highly of her. It just proves that my attraction is absolutely warranted. When McCarty spills that Bella started a nursing blog, however, my curiosity is far more than piqued. I feel as though I've just been given a window to peer into her psyche and get to know her from the inside out. I get the website address for her blog, and make it a point to bookmark it.
Bella Swan, you and I are about to become intimately acquainted, and you don't even realize it.
My plans to make Bella Swan mine have just zoomed ahead of schedule.
A/N: If you need a good website for searching any of the medical terminology I mention in this chapter, I find www (dot) emedicinehealth (dot) com. Or you can simply google it. Like adrenaline rush.