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A Profound Abysm
By Judith D. Andrade
AuthorHouseCopyright © 2013 Judith D. Andrade
All rights reserved.
Rosanna quickened her pace down the dark corridor as the pager beeped again. The eerie sound echoed off the walls. 'I'm coming' she muttered to no one in particular. Despite her overall diminutive stature, long legs quickly ate up the distance. The aging downtown hospital had not been designed for easy access between units.. 'A golf cart would have been handy,' she thought, hating the aching calves which seemed to reach maximum discomfort in the early hours of the morning.
Unafraid, despite numerous stories of ghost sightings, the young night supervisor chose the basement corridor as the fastest route. Ahead of her, she could see the shadows of the low level night lights beaming down. Rosanna climbed the short two flights of stairs and pushed open the double doors separating the Paediatric unit from the Obstetrical suite. She was greeted by a frazzled looking night nurse.
'Thank God you're on tonight. It just seems like one crisis after another. Things sure ain't getting any better.' It was clear the night charge nurse was stressed. Rosanna observed her carefully, noting that her hands were swift and sure, checking names and dosages against the medication record sheet. Mentally, Rosanna tried to sort through the numerous tasks which would be needing attention on the busy unit.
'Give me a quick rundown of what needs to be done, Margaret.' The experienced supervisor used an economy of words hoping not to increase the obvious tension emanating from the nurse.
'What doesn't need to be done? I am behind on my meds already and that one over there ... is all over my case because I can't run to assist him the minute he comes in. Does he think he's the only one who has work to do?'
Rosanna's eyes followed the direction of the head tilt. The partially glass encased resuscitation room was located at the far end of the unit. A unidentifiable care provider, dressed in green scrubs, was observing a baby, who was lying immobile on an over-bed warmer. He seemed more intent on the tiny patient than harassing the night nurses. Rosanna did not make any rejoinder. Tension between nurses and medical staff was a long standing issue. She turned away from the tall figure before trying again to get a sense of where she could help.
'What's your major concern right now? I'm not able to do your medications but maybe something else?'
'Cory in 203 was screaming so much his stitches popped. The resident is working with Lou to stop the bleeding. He'll be going to the OR as soon as the surgeon comes in. Ping is specialing a post op gastric insertion tube. Just as we got that sorted out, ..uh ... the baby over there, suddenly had an increase in his respiratory distress. It was a good thing ... he came up but, he's oh..sooo, demanding. I can't be everywhere.'
The young nurse, simmering with anger or resentment, increased her tempo, quickly pulling vials from the cupboard, drawing up injections for her patients, labelling and sorting them into different piles for distribution. She still had not gotten to the point. The night supervisor, on a tight schedule of her own, was beginning to feel some of that frustration.
'Do you want me to help him?' Rosanna asked quietly inclining her head in the direction of the tall figure.
'Would you Ms. Amadeo? You are really great you know. None of the....'
'Just tell me what I need, and then you can get back to your meds.'
'Since you are not wearing a uniform, you'll have to cap, gown and mask after you scrub up over there. Dr. Howard will have a tray at the bedside with everything on it if he needs to intubate. Are you're ok with that?' Margaret, a fiery red head, with a legendary temper looked up then realizing that the procedure may not be familiar to supervisory staff working in the office.
'Sure. I'm fine assisting with the procedure.'
Rosanna hurried over to a nearby sink to quickly prepare herself. She removed her lab coat, tucked her shoulder length, raven hair in a soft OR cap, and slipped on a mask. She put on the protective gown and washed her hands. As night supervisor, she wasn't required to wear a uniform but all too often she found it necessary to help out on the busy wards. She knew most of her colleagues would probably have looked for another nurse on a less busy ward, but the staff resented being moved from one place to another mid shift. Sometimes, the RN would lack the speciality skills required on other units despite being competent on their own. Rosanna wasted little time in getting ready. Her own work would have to wait.
'What can I do to help?' she whispered softly approaching the bed. Rosanna could tell at a quick glance that the little boy, struggling for breath, was in serious trouble. The Doctor bending over him was trying to fill the baby's tortured lungs with air. He was using a bag and mask attached to an oxygen outlet and pressure gauge. His long fingers wrapped easily around the little body with all the gentleness in the world.
'Look Mrs. DaSilva, your son is having some difficulty breathing right now. I know you're worried but it would be better if you waited outside. A nurse will be along in a minute.' His voice was soothing and very reassuring. Rosanna was impressed but quickly made her own position clear.
'I'm not the boy's mother. I'm here to ...'
'I don't care why you're here,' he interrupted rudely. 'I need a nurse. If you want to help, then see what's keeping her or the Respiratory Therapist. This child's condition is not improving. I am going to have to intubate him before he can be transferred to Paediatric ICU. If no one is available on the unit, call a code pink!'
Rosanna inwardly bristled at the tone, but kept her irritation to a minimum. Awareness of the situation was weighing heavily on her. 'I am a nurse, I know CPR, and I'm here to help.'
'Why didn't you say so? Grab this bag, air pressures at 7. I am just going to get things ready, then insert the tracheal tube.' His voice was as crisp and precise as his actions.
Rosanna did little more than nod. It had been awhile since she was needed to help with such a small infant. She watched intently as he prepared the instruments. This was no novice Doctor. His hands moved over the tray with speed and accuracy, picking out the essential equipment.
'Two weeks old, readmission, septic, decreasing oxygen saturation, poor air entry. 'When I am ready to insert, I want you to stand by with the ventilator attachments. I have already preset the machine. He's poorly oxygenated. Seconds count. Keep an eye on the monitor and read out his heart rate if it drops below 90.
Rosanna's hand was steady. She had worked in a neonatal unit for almost two years at another large tertiary hospital. She knew what to expect. The doctor had twenty seconds to get the tube in.
'OK now.... let's go!'
'Heart rate 88!'
'Damn!' His expletive was a clear indicator of a rough start. 'Pass the forceps!'
'Heart rate 84!'
'Light, Suction, tube,' The hands moved quickly.
'Heart rate 78!'
'Come on little one. Easy, easy son, we'll be done in a second.'
It was hard to believe the softly spoken words came from the same man.
'Heart rate 74!'
'Heart rate 68.'
'That's it ... ventilator quickly.'
Rosanna breathed a sigh of relief. She was impressed by the doctor's speed. It was always harrowing to insert an airway tube on a very ill baby. The procedure was so stressful. It didn't take long for some colour to come back into the blue tinged lips. The heart rate began a steady climb upwards. She observed every action taken by the doctor and admitted to herself that he was exceptionally skilled, at least when handling this crisis. His hands and voice had been soft, almost tender.
'I'm just going to give him a mild sedative. He was getting very restless from the lack of oxygen.' Sure hands quickly drew up a drug from the medication cart and injected it into an IV line.
'Give me the name and the dosage of the medications you've given so I can chart the information for the staff.'
He halted his activity for a brief second before changing tone again. 'Aren't you staff? I thought you said you were a nurse?'
'Of course I am but ... I..' She turned away to place the used instruments on the tray.
'Wait a minute. You're not wearing a uniform. What's going on here?' The long fingers held the tube in place as he looked up briefly. It was just enough time for him to see Rosanna's street clothes at the open back of her gown. He put tape in place to secure the tracheal tube and straightened up.
'I am going to report this to the nursing authority. We can't have just anyone assisting with highly technical patient care.'
'Report what you like. My name is Ms. Amadeo and I am a nurse. I told you that already. Now, if you will tell me the name of the drug you are giving, I will pass it on to Margaret who seems to be on her way over with the RT.'
Rosanna quickly wrote the name and dosage on a piece of paper before passing it to the nurse.
'He has intubated the baby and given this medication. Is everything alright with the other little boy Margaret?' Rosanna's tone was tight.
'Yes, he's gone to the OR. Lou's back and Jorge will help me take this little guy up to PICU. If you could just write a short note on the chart, we should be fine now. Thanks a lot Ms. Amadeo. I'll page again if we need more help.'
Rosanna did her charting and left the unit, head held high. Margaret easily picked up the tension at the bedside. Her 'I told you so' look wasn't missed. None the less, Rosanna refused to acknowledge it. She was fuming as she hurried down the hall. There were several more units to check and her night reports to complete before she went off duty.
* * *
'Why didn't you take that emergency call on pediatrics Colleen?' Rosanna asked wearily dropping into the wooden chair behind the aging oak desk.
'You were closer weren't you?'
'Yes, I might have been.... but you are much more familiar with the ward than I am."
'Those girls don't seem to be able to manage. In my day, we had more patients and less staff. We didn't have supervisors to call every minute to help. They should learn to pace themselves better. Every little emergency flusters them.' The words weren't harsh, just coldly matter of fact but there was an element of thinly veiled disgust.
'This was a major.... no..... two emergencies.'
'Then you were the best person to be there. That's what this modern training is all about; learning to delegate, not learning to be a good nurse.'
Rosanna sighed and stood up. 'My feet really hurt. Is there any coffee left?'
'Can't bear to hear the truth, eh little girl?'
Colleen's tone was gruffly affectionate but Rosanna chose to ignore the jibe as she poured some lukewarm, barely recognizable, beverage in a cup before resuming her seat. She had been working with the senior supervisor for over two years. Most nights there was a major or minor point of conflict between them. It was always the same old vs. new in nursing. Rosanna was sick and tired of the recurring theme and said so, with increasing frequency.
'You young people are always tired. If you ever knew what we had to do without all the fancy equipment that you have now. Well, it doesn't bear thinking about.' Without an immediate response to her baiting, Colleen continued. 'What would you know about the old ways anyhow?'
'I've lived with it all my life. When my father came to this country he made a new life for himself, found a job and started a family. It wasn't easy but he hung on fiercely to his old Sicilian values as a stabilizing factor in a strange and often unfriendly new culture.'
'That's your dad Annie, not you!' Colleen interjected before continuing. 'You have a Masters degree. That makes you very much a woman of today.'
Rosanna wasn't daunted by the finality of the words or the implied criticism of being highly educated in a profession which also required exceptional practical skills.
'It didn't come easily. Papa felt that educating a woman was a waste of time. Even though I was a straight A student, I had to fight all the time for the right to attend University, yet he sent my older brother willingly ... and....' she paused to take a deep breath, emotion making her words defiant, '.....and even though he finally gave in, nursing was the only program he would allow me to take at McMaster.'
'I suppose that you are going to tell me he wanted you barefoot and pregnant?' The sarcasm was biting and painful.
'If I were to tell you the truth, the answer would be yes, but only to a successful Sicilian business man. He would expect my husband to give me a million dollar home in Halton Hills. In return, I would have lots of healthy bambinos.' Responding with her own self mockery decreased the tremor which threatened to derail her defiance. It still hurt that her father refused to acknowledge the academic successes of her life.
'That's still your personal life. We are talking about nursing here. These girls today don't know one end of a bed pan from the other.' The disgust was back in Colleen's voice.
'There's more to nursing than bedpans. I certainly honed a lot of my practical skills when I studied midwifery in England, but new technology and education have enabled nurses to spend less time on practical unskilled tasks and more time on observation of patients, planning and continuity of care.'
'Too much time, if you ask me. Too much time is spent watching beeping machines instead of really seeing to patient care.'
'Oh Colleen that's not fair and you know it. We've had this argument before, one way or another and neither of us wins.' Rosanna's throat hurt. She had not shared her family story before tonight with her working partner. She loved her father deeply but it was clear that night work was taking its toll on her. 'Look Colleen, you and I combine our best skills and work for the benefit of everyone.'
'You are too smart for me Annie.'
'Not smarter, just different! You are the senior here.' she softened her tone, hoping to avoid escalating the ongoing discussion. 'I've learned a lot from you.'
'Sure, sure but it took me 30 plus years to get here. It took you less than ten years, Annie.'
'I worked hard to get here too.' Rosanna tried to keep her tone light but failed miserably.
'Ach, you're too touchy girl!'
The younger woman bent her head in frustration. Try as she might, she could not get past her partner's resentment of anything new in nursing. She knew that her Master's degree stood like a rock between them. Anger flared up in defiance then died out just as quickly. She genuinely liked the older woman and did not want to hurt Colleen. Rosanna had a tendency to let her flighty tongue run away without its common sense, intellectual partner. Quite often, she was unable to put the brakes on in time, to stop herself saying the wrong thing. She took a deep breath before continuing.
'I don't want to argue with you either. I left home to avoid just this type of endless argument, over similar issues. With my father, it's all about my continued single status. I refuse to replace him with you.'
Despite her wish to be cordial, the tone was sharp.
'Don't know what's got into you Annie. Maybe you do need to get married. Your father could be right.'
'He's not and quit calling me Annie. My name is Rosanna.'
Colleen knew she had gone too far. She subsided in her wooden chair. Since their desks faced forward, it was hard to ignore each other but they were both tired. The pile of paperwork seemed to grow in proportion to their fatigue. The change of shift loomed. The reports had to be completed.
Rosanna sighed and closed her eyes. She took another deep breath. 'Whoever hired me knew exactly what they were doing' she thought indignantly. Colleen could be very difficult at times but most nights, Rosanna allowed things to pass in order to maintain unity. Too many shifts in a row seemed to have taken their toll.
'Why am I sitting here trying to soothe this poor lady's ego at five o'clock in the morning? Maybe she and Papa are right. I should be home in bed, curled up with a husband, while my two kids are sound asleep in their room.'
Not having a current boyfriend to fill in the face of the imaginary husband, she was dismayed to find that the partially masked face of Dr. Howard came unwanted into the picture of her make believe family. Still seething over his attitude towards her during their work on the little baby, she returned to the papers littered on her desk firmly quashing the scarecrow-like features from her consciousness.
Excerpted from Suspect, Love by Judith D. Andrade. Copyright © 2013 by Judith D. Andrade. Excerpted by permission of AuthorHouse.
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