Chapter 9
2 p.m.
Bill woke up wondering where he was. That’s the problem with being a travel nurse, you find yourself in so many cities, sometimes it takes a few minutes to remember where you are.
“Oh. Yeah. Shit.”
Reaching for the remote, he shut off the TV to give his brain a break. Straightening his legs, he realized his knees were getting too old for sleeping curled up on a couch, dorm-style. Stumbling toward the bathroom, his dry mouth and aching brain wrestled for attention. A half-gallon of ice water and a gram of Motrin later, he was headed home from Troy’s house.
6 p.m.
Heading south on Rainbow, his headache mostly in check, Bill resigned himself to the shift ahead. East on Charleston, Del Taco and the requisite pre-shift chicken burrito loomed ahead. State Health Department and narcotic diversion were, at least temporarily, non-issues. Time to focus on surviving the next 12 hours.
6:45 p.m.
Sitting in the staging area, also known as the break room, waiting for assignments, nurses and techs filed in one or two at a time. The TV on the wall was tuned to CNN, and remnants of day shift lunches still littered the conference table. An occasional doctor, PA, or X-ray tech wandered in to make a deposit or withdrawal from the staff fridge.
Fourteen RNs, four techs, and a charge nurse now filled the room, getting their game faces on. Conversations shifted from mall sales and Vegas shows to who was working in which area that night. A couple of brief administrative announcements, a few grumbles about assignments, and a five-minute in-service from a pharmaceutical rep on the latest admixture system and they were off.
Or maybe the pharma rep was talking about bowling scores, it was hard for Bill to tell. He hadn’t been listening.
7:10 p.m.
Taking report from day shift. Bill drew a CHF exacerbation, two asthma exacerbations, and a new chest pain workup. All the IVs were already in, blood sent to the lab, and meds given for all four patients. The CHF patient was waiting for a bed upstairs, the asthmas would likely go home, and the cardiac workup hadn’t been seen by a doc yet.
A better-than-usual start. Nothing to do but sit and wait, though that also meant the potential for three beds to open at the same time, triggering three new workups simultaneously.
Spinning around in one of the half-dozen chairs inside the nurse’s station, Bill asked aloud if anyone needed help. No response.
“Okay, I wasn’t really gonna help anyway.”
The other nurses were running around with blinders on, trying to get up to speed.
7:20 p.m.
The charge nurse rolled one of Bill’s asthma patients out to the hallway and hooked him up to portable oxygen to make room for a code 3 ambulance arrival.
After a quick room cleanup and pulling on large powder-free nitrile gloves, Bill took a deep breath—ready.
The X-ray tech rolled in with the portable machine. Respiratory therapist—just “RT” to everyone—followed with a portable vent.
A doc, the charge nurse, and a couple of other RNs who could spare a few minutes also wandered over, pulling on gloves. The report: 47-year-old male coming from a quick care clinic across town. He’d walked in complaining of shortness of breath. EKG showed SVT—supraventricular tachycardia. He was now in and out of consciousness, blood pressure dropping like a rock, diaphoretic as hell in the ambulance.
("Diaphoresis" being one of those words healthcare folks throw around to feel like they speak a second language.)
7:30 p.m.
The ambulance crew hustled down the hallway, eager to offload before they lost the guy. They hadn’t intubated but had started an 18-gauge IV in the left hand and given 6 mg of Adenosine. It hadn’t broken the rate of 190. The first liter of blood pressure-supporting fluids—normal saline—was already half in.
Transfer complete. EMS out of the way. Bill went for a second IV and blood draw in the right arm—needed a bigger, more reliable vein than one in the hand.
7:34 p.m.
Second liter of saline running wide open. Bill flushed the new IV site after drawing labs.
Triage nurse had the patient’s clothes off and monitor leads on.
X-ray tech shot a chest film.
The doc called for 12 mg of Adenosine, which was already drawn up.
Bill picked it up and slammed it into the IV site, followed immediately by a saline flush. Adenosine has a half-life of seconds.
The patient’s heart stopped—for what felt like five minutes but was really just a few seconds. Everyone stared at the monitor.
150. 180. 200.
“Shit,” muttered the doc. “Hit him again.”
Another 12 mg, injected by Bill.
More waiting. Flatline.
Fifteen seconds later: 150... 180...
He converted—straight into V-Tach.
Ventricular tachycardia. Worse than SVT.
O2 saturation dropping. BP dropping.
A 47-year-old father of two was dying in front of them.
No one even knew his name.
His wife, 40. Daughter, 7. Son, 9.
Last they saw of him, he was stepping into the ambulance, apologizing for making them miss dinner.
7:37 p.m.
The charge nurse drew, and Bill slammed 20 mg of Etomidate into the IV, following Versed.
The RT had already prepped the airway setup.
The doc opened the patient’s mouth with a curved metal blade attached to a light and guided the plastic tube into the trachea.
His lips were already blue.
Triage nurse slapped pacer pads on the chest and fired up the defibrillator.
The doc forced air in with an Ambu bag. RT took over bagging.
“Go straight to 360,” said the doc.
“Charging 360,” the nurse called out.
“CLEAR.”
She checked to make sure no one was touching the patient or the stretcher.
The shock jolted him. Barely. Nothing like in the movies.
A moment of garbage rhythms, then a weak but survivable sinus at 115.
7:44 p.m.
Vent running. Diprivan infusing to keep the patient sedated.
Saline still wide open with a pressure bag trying to raise the BP from 79/32.
New EKG underway.
Doc scribbling ICU orders.
Alone with the patient now, Bill slid a Foley into the man’s bladder, then cleaned up the room and covered him with a sheet before the doc brought the family back.
She was crying.
Bed 9 was stable. For now.
Still didn’t know the guy’s name. Not that it really mattered.
7:55 p.m.
Miracle of all miracles: an ICU bed was available.
Bill looked at the slip. “Yeehaw,” he muttered.
No babysitting a critical heart all night.
8:05 p.m.
Report given, transport underway with Bill and RT.
“Damn, Frank. Let’s hope that’s our only excitement tonight.”
Bill felt a familiar numbness settle in as the elevator doors closed.
4:30 a.m.
Sitting at the desk, watching monitors, listening to small talk.
Caught up on labs, IV starts, documentation, and the other 57 steps of a standard workup.
He had, maybe, an hour before the next orders.
Most of the shift had been simple stuff—asthma, negative chest pain workups, homeless folks inventing symptoms for a sandwich and warm bed in an air conditioned room. Miscellaneous bullshit.
5:00 a.m.
EMS crews rarely called in unless it was serious. When they did, everyone listened.
This was the real thing.
“Female. Unknown age. Second and third-degree burns over 75% of the body. BP 95/52. HR 120. Not intubated.”
Bill frowned. Facial burns meant they should’ve intubated already.
Either the medic wasn’t qualified or was too rattled.
She was coming down the hall. Bill went to help—like others had helped him earlier.
5:06 a.m.
Controlled chaos.
Six RNs removing smoldering clothes, starting IVs, inserting a Foley, hooking up leads, infusing warmed Lactated Ringers.
She looked mid-30s but had no ID.
The doc had the tube down and was bagging. RT was setting up the vent.
They held off on Diprivan—didn’t want to tank her pressure.
Nothing ruins your day like a BP of zero.
One nurse left the room after realizing he was holding her entire right foot’s skin like a glove. “Degloving.”
He later swore never to take socks off a burn patient again.
Both legs looked like overcooked hot dogs.
Official count: 85% BSA burned.
Bill felt a wave of nausea. She looked like an ex-girlfriend.
What were the odds—in a city this size?
She was entered as Jane Doe. No one knew her name.
Still, the resemblance shook him.
When things settled, Bill hunted down the EMS crew.
Found them outside, re-lining their stretcher.
“Where’d you pick her up? What happened? Who called it in?” he asked, firing off questions.
They stared for a beat, then answered.
“Metro PD called us. Tent fire in a homeless camp. Homemade setup caught, she couldn’t get out. Might’ve been arson.”
Bill exhaled.
She was homeless—not his ex.
“Thanks, guys.”
Walking back toward his area, shaking his head, fighting tears, he figured her chances at slim to none.
And if she lived? Months of agony. Skin grafts. Infections. Hell.
He was relieved it wasn’t someone he knew, but she must’ve been someone to someone.
Someone with dreams. Doubts. Plans.
In that moment, euthanasia didn’t sound like such a bad thing.
7:00 a.m.
Day shift nurses came bubbling in like life didn’t suck.
Bill gave report and added, “I’ll be at the bar if you have any questions.”
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