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Cooked: An Inner City Nursing Memoir
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Cooked: An Inner City Nursing Memoir

by Carol Karels
In May 1971, Look magazine featured an article entitled "Chicago's cook county Hospital: A Terrible Place." The article provided an in-depth look at the largest public hospital in the country, one located on Chicago's dangerous gang-controlled and drug-infested West Side. Months later, the author, the a na�ve suburban teen, and one hundred other nursing


In May 1971, Look magazine featured an article entitled "Chicago's cook county Hospital: A Terrible Place." The article provided an in-depth look at the largest public hospital in the country, one located on Chicago's dangerous gang-controlled and drug-infested West Side. Months later, the author, the a na�ve suburban teen, and one hundred other nursing students, began their training there, despite newspaper articles that warned that the hospital might close any day. At 'the County,' where nurse duties included swatting flies in the OR and delousing patients, both nurses and doctors were expected to provide care under the most desperate of circumstances. cooked provides aaan inside look at the 2,000-bed ghetto hospital, often referred to as a "19th-centruy sick house," that provided health care to millions of Chicago's poor.

Editorial Reviews

American Association for the History of Nursing Bulletin
"This delightful little book chronicles the journey into the world of nursing. She brings to life the day-to-day rigors of a student nurse, while facing the challenges in this large institution with a variety of colorful characters. This is a stunning read with few limitations. Seasoned nurses will love this book and younger nurses can experience a world before their time. The reader is left wanting more."
AORN Journal
"This book reads like a novel. The author takes readers not only back in time but-for those who never darkened the doors of a huge, urban teaching hospital-to a strange place. Her descriptions of the sights, sounds, and smells are so good that readers can get lost in this foreign environment."
"The main character in her book is really �The County�, the hospital on which the television show ER is loosely based. For years, The County has had a reputation as a hospital "war zone" whose staff draws respect from peers who work in more civil environments. The County was the last-chance refuge for hundreds of patients turned away from other hospitals because of race or poverty."
Nursing Education Perspectives
"Set in Chicago, her story underscores the commitment many have made to the nursing profession while bringing to the forefront the turbulence of an era marked by political and medical activism. She shows us nurses at their best, true patient advocates with great collegial relationships."
Nursing Spectrum Magazine
"This is a memoir about a hospital disrupted by chaos and held together by dedicated health care workers. Karels both honors these individuals and critiques the health care and political environments in which they practiced. Cooked is a reflection on how far we�ve come and a tribute to the efforts of those who struggled to provide adequate health care under the most trying circumstances. "

Product Details

Arcania Press
Publication date:
Product dimensions:
5.40(w) x 8.30(h) x 0.60(d)

Read an Excerpt

I continued to report to work as a clerk on the busy admitting floor three evenings a week. I prepared a chart for each patient as they arrived from the Emergency Room. Once on the admitting floor, Ward 35, patients were thoroughly examined by a doctor, and had laboratory and other diagnostic procedures performed. Once they were stabilized, they were sent to their ward.

Patients on Ward 35 were acutely ill, and had multiple problems. Typical complaints were swollen feet, severe shortness of breath, chest pain, seizures, paralysis, coughing of blood, or urinating blood. A number were unconscious or too drunk to cooperate.

Most of the words I wrote on the charts each evening had been foreign to me a few weeks earlier. But I was getting better at matching the diagnosis with the patient. Patients with yellow skin and tight, swollen bellies had hepatitis or cirrhosis of the liver. Most of them were alcoholics. Emaciated men with hollow eyes, sunken Adam’s apples, gray skin, and a hacking cough had tuberculosis. Heavy set men and women suffering from shortness of breath and swollen feet had congestive heart failure (CHF). Those that arrived from the ER attached to a portable oxygen unit usually had myocardial infarction (MI) written in the diagnosis box, a fancy word for heart attack. Patients with swollen faces who smelled like ammonia usually had some kind of kidney problem, or chronic renal failure (CRF).

On one particularly busy evening, the head nurse said she needed my help in the back. I had never even taken a temperature before! Seeing the alarmed look on my face, she said, "Don’t worry. I’ll show you what to do." I followed her to the bedside of an unconscious man. A doctor was standing behind his head, squeezing a black rubber bellows. The bellows was attached to a tube that went down the man’s throat, into his lungs. The tube was attached to a portable oxygen unit.

"Watch what the doctor’s doing," said the nurse. "The patient can’t breathe on his own. He should be on a ventilator, but there aren’t any to spare anywhere in the hospital. So we have to breathe for him manually. You just have to squeeze the ambu bag eighteen to twenty times a minute. Do you think you can handle that?"

Did I have a choice? It was clear the man would die if somebody didn’t do it. I took my place on the stool and began squeezing the bag. I watched the clock on the wall and counted my squeezes out loud for the first fifteen minutes, intensely concentrating on my task. For the next hour, I counted to myself and continued squeezing, but found myself distracted by all the chaos. My hands really hurt and beads of sweat rolled down my face. But I couldn’t stop squeezing.

From my stool, I had a direct view of the drug overdose room, packed to overflowing. That night, they were mostly heroin ODs. To my right, patients who had been rushed in with heart attacks and strokes just hours earlier occupied the four cardiac care beds. An old woman in the corner slept peacefully, in a diabetic coma. I remembered trying to pry her shoes off earlier. They were too-small shoes that seemed glued to her swollen feet that were pocked with smelly lesions. Her comatose state kept her from noticing the nauseous look on my face as I peeled off her socks.

As I counted and squeezed, counted and squeezed, I caught glimpses of the patients in the isolation rooms, both with suspected TB. Earlier in the evening I had to wear a mask when I checked their clothes--a protection against the stench as well as the disease. I had decided to send their excrement-caked clothes to the incinerator. New patients kept being wheeled in, on stretchers and in wooden wheelchairs. All needed a bed, even though there was ‘no room at the inn.’ Any other hospital would have hung a ‘No Vacancy’ sign up, but Cook County Hospital couldn’t turn these patients away. County was the last stop.

My shift ended at 11 p.m. Would I get relief? I wondered. Or would I just stop squeezing, return to my room, and finish my homework? Perhaps one of the ventilator patients in the hospital would die in the next two hours, freeing the machine for this man. I didn’t even know his diagnosis. Who was this man? Did he have a family? Or did he roam the streets, one of the legions of homeless who passed through the County?

I would never find out. At 10:30 p.m., the beeping noises coming from the cardiac monitor stopped. A doctor pushed me aside. The medical team took emergency action. For over thirty minutes, I stood with my back to the wall, watching in horror as they performed CPR. They squirted jelly on his chest, shocked him with paddles, then injected medicine directly into his heart with the longest needle I’d ever seen. Their heroic efforts were unsuccessful and they covered his face with a sheet. Standing against the wall, I wondered what I’d done wrong. Had I missed a beat? Had I squeezed too fast? Had I been too distracted? This man’s life had been left in my hands and I’d let him down. I had seen my first death, and I felt responsible.

As I shakily packed my things to leave, the head nurse, Mrs. Sanchez, ran over to me and asked to speak to me privately. I thought she was going to fire me on the spot. Instead, she asked if I would be interested in working in the back with the nurses from now on, as a student assistant instead of a clerk. She said I had been a great help that evening. I told her I still hadn’t learned how to take a pulse or a blood pressure. I was just taking Chemistry and Microbiology courses all day—no nursing courses. She said she’d talk with an in-service instructor the next day to arrange some special hands-on training for me.

As I walked back to my room through the musty tunnel, I felt so confused. A man had just died under my watch and I was being ‘promoted.’ Or was I just being ‘promoted’ because they were so overworked that any pair of hands could help. I thought about Mrs. Sanchez’s offer. Learning a clerk’s job was one thing, but learning how to be a nursing assistant in two days was positively frightening.

The next day, Mrs. Sanchez told me that my in-service training had been scheduled on a ‘quieter’ floor, Ward 28. Ward 28 was located on the second floor of the four-story B Building, the former psychiatric hospital. Bars still covered the windows. Each ward had about 150 patients. The building was now filled with those suffering from alcohol withdrawal (DT’s), hepatitis, ascites of the liver, and drug overdoses. I met the in-service instructor at the nurse’s station and she gave me a brief tour of the ward. The beds were lined up parallel to each other, separated only by faded green curtains. Each bed had a little nightstand for essentials. ‘Luxuries’ such as radios, telephones, and televisions were forbidden, she told me. In the sunroom at the end of the ward, patients could watch television and use the pay phone. The patients, some looking half dead, lined up in their wooden wheelchairs for that phone.

"Mr. Smith!" barked a nurse to an elderly man in a wheelchair. The phone was cradled against his stubbled chin with one hand. His other hand was clutching his crotch. "You’re on strict bedrest!" yelled the nurse. "Who let you out of bed?"

"I’m just talkin’ to my sugar," he protested. "No crime in that. Gimme another minute." Turning away from the nurse, he continued his phone conversation. The nurse shook her head and muttered under her breath. Then she directed the closest aide to wheel Mr. Smith back to bed.

"Din’t I just say I was gettin’ off the phone ?" argued the irate patient, when the nurse’s aide tried to pry the phone from his hands. "Well, I mean to, soon as I’m done here." He thrashed his arms, causing the IV tubing swing wildly against his chair.

"Nurse!" yelled a patient halfway down the ward. "I need a nurse!" Thinking there was an emergency, my instructor ran down the hall to see what was wrong. I followed her.

"I’m done with the bedpan," said the patient, a grossly overweight man with bulging, bloodshot eyes. Beads of perspiration rolled down his dark face. A large piece of white tape with the words "BEDREST" scrawled in black magic marker had been affixed to the foot of his bed. My instructor reached under the sheet and grabbed the full, foul-smelling bedpan. She emptied its contents in the utility room. She then told the nurse that the patient in Bed Twelve had produced a "large amount of soft putty-colored stool."

"Is he on hepatitis precautions?" my instructor asked, alerted by the light color of his stool. The floor nurse nodded. "Then how come a ‘Hepatitis Hazard’ warning hadn’t been taped to the end of the bed," she asked, looking irate. The nurse just shrugged and continued her chores.

"OK, time to get serious," my instructor said to me, after returning the bedpan. "Have you ever taken a rectal temperature?" she asked, as she led me to the bed of an emaciated, comatose man. The blood vessels on his tight black forehead protruded like earthworms. I didn’t have to say anything; the look on my face told her the answer. "An alcoholic with liver failure," she noted, after quickly scanning his chart. His palms and soles glowed luminescent yellow, a common skin color on this floor. My eyes met those of the other patients--all yellow-tinged. So many men with tight swollen bellies under their white hospital gowns waddled up and down the corridor that Ward 28 resembled a male maternity floor.

The thought of taking a rectal temperature on a stranger filled me with anxiety. I pulled the green curtain around his bed and stood on one side, waiting for guidance. My instructor rolled his body, pure dead weight, toward her. She told me to pull down the top sheet. My anxiety turned to revulsion when I discovered a pool of diarrhea under him. I reeled back and pointed to the sheets, hoping she’d say, "Sorry about that. We’ll find another patient."

Instead, she seemed delighted at this unexpected bonus and urged me to proceed. She asked if I’d ever made a bed around a comatose patient. I told her I’d never made any hospital bed before. I didn’t tell her that I rarely had made my bed at home. And now that we had Sophie the maid, I never made my bed in the nurse’s residence either.

"What a perfect opportunity!" her smug smile seemed to say. So, I spent the next half hour bathing the man, changing the bed, and finally taking the rectal temperature. His unconscious state spared him my embarrassment.

My instructor then showed me how to record urinary output, how to put a bedpan under a patient, and how to remove it. She explained how to take special precautions with hepatitis patients. She also explained the behavior of a number of patients who were talking to themselves. They asked us to remove the bugs from their sheets, or to swat the creatures on the walls.

"They’re in DT’s," she said. "Alcohol withdrawal." Dinner break came as a welcome relief.

When I returned after dinner, the sun had already set. Within a few minutes, all the lights went out on the ward, with one flick of the switch. "How do you see anything back here without lights?" I asked.

"You have to use flashlights," she explained.

"What if a patient wants to read?" I asked. She looked at me as if I were crazy to have asked that question. With the onset of darkness, it seemed that more patients began hallucinating. The place seemed like a mental hospital, with all the screaming and howling.

I told my instructor about a few of the drug overdoses I’d seen on Ward 35, and how frightening they had been to observe. Most of our admissions had OD’d on heroin or PCP, an animal tranquilizer also known as angel dust. One fellow high on angel dust hyperventilated as if he were a train, choo-chooing slowly at first, then escalating his breathing to a feverish pace until his face was bright red and his muscles were so tense that the blood ran up his IV tubing. Then he’d pass out and go for minutes without breathing. Then, the choo-chooing would start all over.

There weren’t any detox programs for the drug OD’s, the in-service instructor told me. Once they recovered, they were just sent home, or back on the streets.

Those two evenings of intensive instruction were eye-openers. Yet, as much as I’d seen and done, I still felt totally unprepared for the challenges of Ward 35.

My first night back on Ward 35, Mrs. Sanchez asked me to assist the nursing staff and doctors wherever I was needed. Assist how? I wanted to ask. Someone was always yelling for help and there never seemed to be enough. Even so, the evening nursing staff on Ward 35 provided top-notch care. They included four RNs, three LPN’s, and three nurse’s aides. Occasionally, there were student assistants as well.

The nurses, Miss Nixon, Miss Collins, and Miss Johnson, raced non-stop all evening, handling each emergency like a pro. Their hands were always filled with supplies or medications, as they carried on simultaneous conversations with several doctors, nurse’s aides, and technicians. All seemed to have eyes in the back of their heads, knowing who was climbing out of bed, having a seizure, pulling out an IV, or choking on saliva.

All four nurses were outspoken patient advocates. It was they who determined the moral code on the floor when it came to doctor/patient relationships. If a med student or intern flubbed a procedure, they insisted his superior do it. If they felt a procedure or a medication was uncalled for, they’d speak to the doctor quietly outside the room. And the doctors listened. They knew these nurses dealt with the same emergencies every night. If anyone knew what to do, it was the nurses.

Soon after I had arrived, I heard one of the Indian doctors yell from behind a curtain, "I need a nurse in Room 3."

"What for, Dr. Shah?" asked Mrs. Sanchez in her sing-song accent.

"A shpinal tap," he said. The doctor had a tray set up in the room to do the spinal tap. His hands were already gloved.

"Carol will help you," she replied, and she called me over to room three. Outside the room, she said "All you have to do is hold the patient in position. The doctor is going to numb the patient’s back, then insert a needle to remove the spinal fluid. Come get me if he sticks the patient more than three times. Three times and you’re out. That’s our rule."

"OK, sir, put your knees up to your chin, as far as they will go," the doctor told the patient, an old grizzled man who looked confused but nevertheless did his best to follow the doctor’s heavily accented instructions. "Now, sir, tuck in your chin--try to touch your knees. Good, good. Now, just hold him in that position, Nurse."

The doctor must have known I wasn’t a real nurse, in my pink frock. But I stood on the side of the bed and held the patient in the position, for what seemed like an eternity. I watched as the doctor probed the man’s spine with his long fingers, then injected a medicine to numb the pain. A few minutes later, he inserted a foot-long needle into the man’s spine, wiggled it around, pulled it back, pushed it back in, then finally withdrew it completely. I exhaled, relieved that the procedure was over.

But it wasn’t. The doctor’s fingers continued to palpate the man’s spine. A moment later, after saying, "One more little shtick," he inserted the needle again. The patient endured the procedure with grace, flinching as the needle entered his spine, but not questioning anything the doctor did to him. After a moment, and an angry shake of his head, the doctor withdrew the needle again. I remembered what Mrs. Sanchez had said, "Three strikes and you’re out." What would I do if the third stick didn’t produce the desired spinal fluid? Fortunately, the third stick was a bulls-eye, and the doctor withdrew two tubes of clear fluid.

"You lie flat now," he told the patient, "or you’ll get a headache. Stay flat for an hour. Don’t sit up for anything, not even to pass water."

If you didn’t count the belligerent drunks and the severely disoriented, the patients we admitted to Ward 35 were exceptionally polite and cooperative. They expressed gratitude for any care they received, even under the most stressful of conditions. Most were older black men and women who had lived through Jim Crow laws, and who still spoke in deference to whites. They accepted treatments without protest, most quietly nodding and saying, "You do what you have to do, Doctor. I have faith in you, jest as I have faith in the County."

Even after being stuck multiple times--for blood work, for a spinal tap, or for an IV--they seemed to take it all in stride. When success was finally achieved, they’d whisper, "Thank the Lord. Thank you, Doctor. I’m feeling better already." It didn’t take me long to realize that many of the patient’s problems were the result of not understanding their disease. Or failure to take the proper dosage of the prescribed medicines.

"Have you been taking your medicine?" the doctors would ask.

"It ran out, doctor," they’d apologize, "My grandkids been sick and I couldn’t find the time to see the doctor to get another perscription."

Or, "I was feeling better, so I stopped taking my pressure pills." Or, "I was feeling bad so I took two pills a day instead of one. That’s why I ran out." Or, "I thought I was cured of the diabetes (or the TB)." From what the doctors said, there was very little patient teaching going on in the clinics, and this was a concern of many on Ward 35.

Miss Nixon poked her head in the room shortly after I finished labeling the test tubes with the spinal fluid. Cradled in her arms were two glass IV bottles and tubing. "We need you in the overdose room, Carol," she said. "Dr. Patel needs help with a physical. The guy’s drunk and his speech is really slurred, and Patel can’t understand a word he’s saying. And vice versa, I might add."

Entering the room, I heard Dr. Patel ask the patient for a urine specimen. "Please pass your warter into the receptacle," he said, handing the patient a small urine cup.

"Say what, man?" responded the patient.

"Here, he wants you to pee in the bottle," I said, giving him the larger urinal.

"Why dint he say so in the first place?" asked the patient, angrily pulling his penis out from under the sheet to comply with the doctor’s request. I turned my head while he filled the urinal. I continued ‘translating’ for the rest of the physical.

Next, the nurse told me Dr. Johnson needed help in Room 1 with a GI bleeder. "He’ll need an NG tube and some iced saline for lavage," she told me.

Say what? Now I needed a translator. NG, GI, and lavage were not in my vocabulary yet. But I went into Room 1 and asked the intern, a lanky American with red hair and a scraggly red beard, if he needed any help.

"Sure. Go get a basin of ice and a bottle of saline. When you get back, I’ll show you what to do." So, for the next half hour, I performed what the nurse had called gastric lavage. I filled a turkey baster with iced saline, then squirted the saline into an orange tube that connected the patient’s nostril to his stomach. Then I released the pressure on the bulb to allow the stomach contents to flow back into the bulb. I then squirted the stomach fluid into a metal basin, grimacing the entire time. I kept doing that until the stomach contents were clear.

"Good job," said the doctor. "You can stop now. I’ll hook him up to the GOMCO, a suction machine. I have to draw some more blood here." I left Room 1 and stood in the hall for a few minutes, my own stomach in knots. I noticed that several new patients were lined up in wheelchairs in the hall, none with paperwork. I ran into the clerk’s office and offered to do one of the charts. The only clerks on duty that night were Mrs. Anderson and a new one named Fitz.

"Have a seat," said Mrs. Anderson. "We be missing you tonight. I be glad for the help." I had started working on a chart when Miss Collins walked into the clerk’s office.

"What are you doing in here, Carol?" she asked.

"They’re really backed up and they’re short tonight," I explained, thinking I was doing the right thing. "I just came in to help."

"You can’t do both," she said, in a stern voice. "You’re either a clerk or a student assistant. But you can’t be both." I apologized to Miss Collins.

"Sorry," I whispered to Mrs. Anderson.

"It’s OK," she grinned. "Be glad they need you more. You’ll become a nurse faster working with them than you will with me. Someday, you might even be my nurse. And I want you to be a good one."

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