Doctor's Orders

2. Onset

It was a bit overwhelming, to be honest. I hoped that the other rooms would stay empty, but I knew it was probably a silly wish, especially in Downtown Chicago. I just wanted the chance to shine on my first shift and luckily, so far, the cases were fairly straightforward. Hopefully I wouldn't face anything too complicated tonight.

"Hello, Mr. Reynaldo," I said cheerfully to the homeless man as I entered his room, pumping sanitizer into my hands.

The homeless man looked at me with sad, weary eyes. "Who are you?" He asked.

"I'm your nurse, Ellie. Remember? You just met me a few minutes ago. Tammy is still here to make sure I get familiar with the way things work here."

His voice was weak as he asked, "Am I dying?"

The question startled me, although we'd been taught in nursing school to expect it from time to time. I gave him my most encouraging smile and said, "Let me take a look at your file," I said, clicking on his name in the computer. The doctor had ordered an aspirin and a pain reliever, as well as an EKG to be done stat.

"Mr. Reynaldo," I said, "It looks like the doctor has tests ordered and I bet they'll get to the bottom of this quickly. Your color is good, so that's encouraging. Once your doctor figures out what's going on, you'll have the right treatment to get you fixed up."

He still looked anxious. I wrapped the blood pressure cuff around his arm while I spoke in a soothing voice. "Now you just relax and focus on getting better, all right? We'll do everything we can to make sure walk out of here as soon as possible."

After I was done with his vitals, I squeezed his hand and made sure he had the call button in his other hand. "You press that red button if you need anything, okay?" I smiled brightly. He managed a little smile in return and his eyes lightened.

I felt more confident after that first interchange. The next two patients, the pregnant mom and the toddler, seemed fine and were quite easy to care for. It was likely the mother-to-be was having "practice" labor pains, called Braxton-Hicks contractions. The young boy who had swallowed the vitamins didn't get enough iron to poison him, so both patients were awaiting some final testing before they were released.

The moment I set foot in the next room, my phone rang, "Ellie, your patient in Room 7 would like to see you." Room 7 was Mr. Reynaldo. I checked in on the teen who most likely had a broken collar bone. I assured him that he would be taken to X-ray soon. His mother stopped me with a dozen questions about internal bleeding and head trauma, although none of his symptoms seemed to indicate such injuries.

When I finally left the room, I headed to check on Mr. Reynaldo. When I walked in, he asked me, "Who are you?"

I glanced at Tammy and she shrugged."I'm your nurse, Ellie," I gently reminded him. "You pressed your call button and asked for me."

"Oh, I guess I did," he said. "And who's that?" He asked, pointing to Tammy.

"Tammy. She was your nurse, too." I decided to ask him a few more questions. "Mr. Reynaldo, can you tell me how old you are, followed by your date of birth." He responded appropriately. "Can you tell me what year it is? And where are you?" He gave the correct answers.

He must have been confused because of his current state and level of anxiety. Over the next several hours, he paged me numerous times. Each time he asked who I was, and each time, I gave him the same response and asked him the same questions in response.

The paranoid woman was a bit challenging. She had schizophrenia and she was a regular here. Apparently, she had trouble taking her medication consistently, which resulted in episodes like this one. Nevertheless, every time I went to check on her, I resolved to be supportive to her in her perceived fears. She begged me to get the IV needle out of her arm because she was certain that the KGB was stealing her blood. "Mrs. Kaston, this is a high-tech facility. We've made sure this area is secure, so you're safe from the KGB here, I promise." It wasn't relevant that the KGB, the main security agency for the Soviet Union, didn't even exist anymore.

On the way out of the room, Tammy patted my arm and said, "Good idea. I think she believed you. Even if she forgets what you said."

After being paged by Mr. Reynaldo the fifteenth time, one of the other nurses said to me, "You poor thing! Mr. Reynaldo is in here all the time. He's the biggest time-waster we have."

I felt a pang of sadness for him, as well as for Mrs. Kaston. Mr. Reynaldo was homeless, probably all alone, and obviously struggling with confusion. Maybe he came to the hospital regularly because it was the only place where people cared about him. I made a decision to be cheerful and friendly to him every time he paged me.

I crossed paths with Dr. Styles several times, of course, because he was the attending for the night. I was dying for the chance to speak two words to him that weren't related to medicine. But the opportunity never came. We were rarely in the same room together, and if we were, our conversation was always about the patient, naturally. 

I finished my shift with a sigh of relief – all of my patients had survived, including several newcomers during the shift. All were in good hands now that I'd introduced them to the day nurse, Loretta.

I felt good as I headed to the locker room. I'd gotten a few pats on the back from Elaine, and Tammy was nothing but positive about my performance. I told myself not to become overly confident because I knew I'd eventually make some mistakes. It was inevitable; I just hoped they wouldn't be serious.

I changed out of my scrubs and I was exiting the staff lounge when Dr. Styles approached.

"Ms. Jansen, did you tell Mrs. Clairmont that she wasn't really in labor?" He said, his tone somewhat accusatory.

"No, sir, I never said anything like that," I replied, shaking my head. "I just told her that it didn't look like she was in labor, according to her chart. And then I told her that you would order all the right tests to be absolutely sure before sending her home."

"She claims that you told her that she was only having Braxton-Hicks contractions. She was understandably upset when I sent her to have an emergency delivery because she was indeed in labor, and the baby was in distress."

"That happened in the last fifteen minutes?" I asked, not believing that her condition changed so rapidly. "I apologize, Dr. Styles. I mentioned that sometimes early contractions can be Braxton-Hicks, but I never told her that's what was happening for certain. The resident who saw her even marked in her chart that the contractions appeared to be Braxton-Hicks. I just wanted her to relax until we had answers."

"I  have the answers," he corrected me with an edge in his voice. "Not you, Ms. Jansen."

How was I supposed to give patients some peace if I couldn't even talk to them? "I know, Dr. Styles; I was trying to tell her only what I already knew. I promise you that I didn't speculate at all about her condition."

His face relaxed, but he still showed no sign of a smile. "It's all right. Just be careful how you word things. Patients will tend to glean hope from anything you say, so if you don't know for sure, be very straightforward about that."

"I understand," I said, breathing a small sigh of relief that he wasn't angry with me. "Thank you for that reminder. I think it will be helpful."

He nodded and hurried away, probably hoping to get out on time since his shift had ended, too.

I wished I'd gotten at least a little smile from him, or a congratulations on my first shift, but all I had gotten was a misunderstanding.

Still, I was happy with myself for an ideal first day on the job.

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