The Shift: One Nurse, Twelve Hours, Four Patients' Lives by Theresa Brown

yelling intensified my concern for the wife, as it should have, but when we confirmed the wife’s bowels were working fine, at least as far as the CT could show, I made that experience my baseline without thinking it through. In that situation there was lots of yelling and no perf. Therefore, a real perf would evince more moaning and writhing and even louder yelling.
    A psychologist would call that a reaction formation: my outsize anxiety about a non-existent abdominal perforation led me to believe that if an actual perf occurs the patient will have a lot of pain and be very agitated. This, I now know, is wrong.
    If there’s one thing I should have learned in the hospital, it’s how little control—of the good or the bad—we really have. Dorothy is cured and going home. Mr. Hampton is getting Rituxan and I am worried that it will hurt him more than help, or at the very least land him in intensive care. Candace is a hard patient to manage, but of course I want her transplant to go well. And now Sheila, my learning opportunity, turns out to be a slow-motion medical emergency.
    My phone rings. “Medical Oncology. Theresa.”
    It’s the intern. She’s already heard from the anxious radiologist. “Stop the Argatroban,” she tells me. She sounds scared or maybe, like me, she feels guilty for having no premonition about the perf. It’s not rational that some of us who work in health care expect ourselves to be omniscient.
    “If we stop the Argatroban now it will take several hours to clear her body. They can’t operate until then.” She hangs up.
    I slide my phone back into my pocket and wonder who’s going to tell Sheila this terrible news? Me? I would, but without any kind of plan in place I’d unnerve her without being able to list her options. I know very little about the surgery she will need.
    My phone rings again. “Hey, it’s Peter. Are you taking care of Sheila Fields?”
    “Yes,” I tell him. Click, another switch goes through; my mind is now mostly on track with Sheila’s perf. Peter is Peter Coyne, an attending surgeon who is also a friend. The most common thing people say about Peter is, “I love Peter Coyne.” He puts the lie to the common stereotype of surgeons as arrogant. He’s sweet and a huge fan of bad puns and even worse jokes that I always laugh at despite myself. Whoever put in the consult for Peter to become Sheila’s surgeon did a good thing for her.
    We met a couple of years ago over the phone. He’d surgically placed a permanent intravenous line, a triple lumen Hickman catheter, in one of my patients and I needed to know if the line could be used. I was a new nurse and not as clued into the hospital hierarchy as I would eventually become. I called around to find out about my patient’s IV line and someone told me to just page Dr. Coyne so I did.
    My straightforward question, crisply delivered, “Is this newly-placed Hickman OK to use?” somehow devolved into a joke that made no sense but struck me as very funny.
    “Well, I don’t know,” Peter said, “Are we placing Hickman catheters today or pumpkin catheters? If no one told you whether that line is safe to use I may just have to start handing out demerits.”
    The unexpectedness of his answer surprised me and I couldn’t stop laughing. Then Peter got serious and told me the line was good and he would put an order to that effect in the computer.
    “We’ll be up soon, but I need to talk to her doctor,” Peter tells me now. “Do you have the name?”
    “I have the intern’s name.”
    He laughs, but it’s strained. “This isn’t a case for the intern; I need to talk to the attending.”
    This is unusual. Attendings may talk to each other at meetings, or socially, I suppose, but on the floors they seem to only talk to each other through go-betweens such as interns or nurses or through scribbled notes that often don’t even get read.
    Attending to attending confirms my worries about Sheila. But Peter is on the case,