Who's Gonna Notice Anyway: Er Nurse Manager Deals with Aids

By Rita M. Grady

A career woman, proud and successful, a Nursing supervisor, wants things her way. She gets life on her terms until she deals with AIDS in her professional and personal life.

Emergency Department supervisor, Mary , fights a budget and changing health care finances. She deals with an employees alcoholic wife; a nurse with a needle stick exposure to AIDS and a challenging black orderly. "Only in the Emergency Room" incidents fill her days.

AIDS patients are causing the hospital to lose money. The crusty mouth sores, diarrhea, fevers, dementia and suffering take an emotional as well as financial toll on the nurses. Mary and another RN Manager overcome local resistance and seek support to open a halfway house for persons with AIDS in the capitol city of Sacramento, California.

Nights are lonely for Mary. Are there any decent men out there? She meets and falls in love with an Engineer. Is AIDS in his background? Are marriage to this man and childbirth a realistic choice for a smugly independent business woman? Is a career focused life what she wants? Will she run away from AIDS? Can she? And, whos gonna notice anyway?

• Language: English
• Publisher: Xlibris US
• Release date: Jul 28, 2000
• ISBN: 9781462827879

Rita M. Grady

Dear Reader, As a staff nurse, supervisor, educator and department manager, I have had the privilege to be a Registered Nurse in California. Ive loved all of it-particularly my experiences in the Emergency Department. A wife, mother, grandmother, adjunct faculty at Cosumnes River College and, American Red Cross Volunteer Nurse, Im trying to figure out how to handle retirement. Enjoy this novel, Rita M. Grady, RN, BVE, MSHCA

Book preview

WHO’S

GONNA

NOTICE

ANYWAY

ER Nurse Manager

Deals With AIDS

Rita M. Grady

Copyright © 2000 by Rita M. Grady.

All rights reserved. No part of this book may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, recording, or by any information storage and retrieval system, without permission in writing from the copyright owner.

This is a work of fiction. Names, characters, places and incidents either are the product of the author’s imagination or are used fictitiously, and any resemblance to any actual persons, living or dead, events, or locales is entirely coincidental.

This book was printed in the United States of America.

To order additional copies of this book, contact:

Xlibris Corporation

1-888-7-XLIBRIS

www.Xlibris.com

[e-mail]

Contents

PREFACE

1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

Bob Grady, my husband, who has put up with five rewrites.

Ellene Rifas and Becky Morris, nurse cohorts.

Eileen Grady Hitchcock and Harris Photography

Catherine Grady Sterk, Rx coach

Myriads of friend and relatives

PREFACE

Who’s gonna Notice anyway? is a fiction. These people and situations could have existed, or might now exist. Real time events, such as the San Francisco Earthquake of 1989 actually occurred. The American Red Cross established temporary Disaster shelters there for the persons displaced by the earthquake. These events have been dramatized to fit the story. Characterizations of healthcare providers, Person with AIDS or other patients and their significant others, reflect my decades as a Registered Nurse with multiple hospital assignments.

The idea for this story came out of my experiences with the disease AIDS when it first raised it’s ugly head in our communities about 1986. The story takes us from 1988 through the year 1992. Much in the treatments of AIDS has changed since then but the need for education about the disease and it’s prevention continue.

1

So I was wrong! Wrong, I can handle, but I hate looking ignorant. Nurses shouldn’t be stupid when it comes to a new disease. I honestly thought it was an urban anti-gay myth! A great sleazy black cloud pulled by maggots dogging my footsteps.

She pauses at the mirror as she descends the stairs. Taking down the upswept hairdo she releases the wavy light brown, gold streaked hair to the shoulder. It doesn’t make sense to wear an up do when you are driving in California with the sunroof open. The image in the mirror, with the demure camel colored silk blouse and tailored suit, does not camouflage the Dolly Parton figure. Her honest gray eyes with their drooping lids form the ceiling for a grimace of distaste coupled with sadness.

These eyes that seem to freeze open when looking directly at you with a snide remark or reprimand. Or, can squint in great good humor forming a fantastic smile. This smile can lock onto your heart with warmth. The warmth of spirit that can make even the youngest baby or saddest grump smile back.

"Can it really be" she is saying to herself, that a virus has surfaced that lives for years in the blood without producing any symptoms? Sabotages the human body’s defense against disease, the T-cells, putting a person at risk for dying from everyday infections? A disease called AIDS—Auto Immune Deficiency Syndrome?’ How do we health care providers fight something like that?

Preoccupied with thinking about the horror of such an epidemic she stuffs her business cards into her purse. Mary Marxton, RN, MBA—Administrative Nurse Manager—Emergency Department Manager—Metropolitan Hospital—Sacramento, California.

Could this disease turn out to be a world wide plague worse than polio? Shuddering, she straps herself into the new white 1987 Starion, opens the sunroof to make it easy for the sun to put gold streaks in her hair and puts on a sun visor. She envisions a skeleton named AIDS sitting next to her as she speeds toward the hospital with her clicking and blinking turn signal pulling her up the freeway on-ramp. Just as well put clothes on him. Actually, nice clothes. This is supposed to be a disease of gay men. They generally pay attention to their wardrobe. I better add a straw hat, pith helmet or baseball cap. I don’t want him to get sunburned. She smiles at the thought.

The skeleton, if his name is AIDS Virus, has chosen a formidable enemy. If his name is PWA, a Person With AIDS, he has chosen a strong champion. On the professional side she has studied health and disease and served many hours as an Emergency Department nurse. As a manager she has the experience, education, good mentors and plenty of hard knocks that have prepared her to be a good administrator. She knows how to obtain and manage money. To play the game and squeeze every dollar to fund her projects.

Managing money and independence are her strong points and she openly disdains women who are financially dependent upon men.

On the personal side, her passion for nursing her fellowman has been described as co-dependency, being a pushover, or, too nurturing and smothering. Some consider her a control freak who finds likely victims in her health care services staff and clients.

On this day, any professional peer, a friend or observer would describe her as a crackerjack Emergency Room Nurse, a fair and understanding boss; a strong staff advocate who also respects the Administrative folks dealing with the scrutiny and fiscal constraints of health care 1989 style. All agree she ought to find someone and get laid.

In her mind she reviews the previous evening shift, a three-bell night, with the confusion of three ambulances backing into the dock with their bells ringing. Mary wonders if one of those patients could have been infected with this new retro-virus that is so clever in tricking the T-cells into reproducing the virus rather than another T-cell . . . all this while the disease lives merrily away in the persons blood and semen. Should she worry about the Orderly washing the blood off the backboard, the general MASH atmosphere where blood on the green scrubs is a sign of a cool Emergency Department nurse? At least the staff are not likely to get the virus from sex in the ED but there is plenty of blood around.

Shifting down to pass the slow driver, the new 1987 Starion slides into the left lane to dash from the rolling hills of Roseville, California for the direct fifteen miles shot down Highway 80 to the hospital. With the sunroof back she will be able to hear the California Highway Patrol plane if it is cruising for a speed trap. She spends a lot of time on the road and has a hobby interpreting vanity license plates. WIF4LIF, wife for life, Cute!

Her elbow rests on the window. With her ringless left hand she is twirling a strand of hair behind her left ear. This is the only sign of her nervousness. A big red B for budget on the calendar next to her is the only appointment for today. Justifying her expenditures is not her favorite thing.

The camel colored suit with the ivory blouse has the obligatory tie but it is lace. This is her ‘business’ look. The earrings are pearl studs. No dangling earrings in the ED for babies or delirious patients to wrench out of her ears. Tall, 5 ft.8 inches she wears expensive pumps. Her skin is flawless with a slight tan and a scattering of freckles. A goddess of womankind, she has been told.

Traffic is light, she is going into town two hours late. No commuter crunch at 09:30. At 07:30 she had checked in with Juan, her Charge Nurse, to tell him she still needed to do some work on the budget and would be in late. At that time it had been quiet with only five patients in the ED. Probably folks who had suffered their chest pains all night but were too frightened to try to make it through the day at work. Now, they felt the need to see a doctor. Probably other persons who had stroked out during the night and were found lying in bed paralyzed and unable to speak when their significant others woke up in the morning.

It is unlikely that there would be an overdose at that early hour. I have always disliked caring for an overdose patient. Dealing with the shattered loved ones, spouses, acquaintance whoever. The patients who had been given Syrup of Ipecac and kept vomiting on you! The stomach washing, trying to put the antidote, powdered charcoal, down someone who is fighting your every move. Meanwhile you monitor their heart and breathing. Working with the docs trying to keep the patient alive. No fun.

Some of the other patients were probably a few almost-well folks coming in to get a doctor’s slip to return to work. Strange that you need a doctor’s slip when you are born, work, marry or die. I reckon the Medicine Man still holds power over the village. This routine stuff is the dull side of Emergency Room nursing.

Good old John Denver, sometimes a diamond, sometimes a stone. Better turn down the radio as I come up to the traffic booth. I don’t want that nice Security Officer to ask me out again. We don’t have too much in common. As the gate comes down behind the Starion she drives to the space marked Supervisor. She hears the bell of one ambulance backing up and sees a second already in place.

Mary Markston, Registered Nurse, proudly plays the role of an educated woman with Masters degrees in both Nursing and Business Administration. She quickly swings her briefcase out of the car and briskly walks into the back door of the Emergency Department. One glance tells her they are busy. She is well aware that her suit and silk blouse won’t impress her staff members. They value real nurses who handle the patient care, she resists the urge to tell them how important it is to present a business image at the budget meetings. She decides to change her jacket to look more like a real nurse.

Unlocking the office, she hangs the jacket over her chair, kicks the high heels into the corner, rolls and pins her hair to the top of her head and whips on the long white lab coat. Only the supervisors and doctors wear the long coats at this facility. A quick look in the mirror shows her the coat is buttoned straight. Dumb 36-D, who needs them anyway? The plain flat running shoes are quickly tied and she emerges as Mighty Max. Although the staff do not call her that to her face, she smiles to herself, it certainly beats the M&M she was called in high-school.

Cordial and precise, she smiles as she walks through the department. The ambulance ‘jockeys’ flirt with her as they are taking equipment from her cupboard to replace their own stuff which is being left on the patient. They know she will have their jobs if they are caught taking extras and skewing her costs. Mary tries to remember the recent news article about ambulance drivers initiating resuscitation measures on every call often to excessively pad the bill. How human are human services anyway?

Everything is under control. She checks the board which lists each room, the diagnosis and the progress of the patient as he goes through treatment. She thanks her stars they are so competent. Pat yourself on the back, Mary, you hired them her Dad would say to bolster her ego. Handling a staff of 118 with a total personnel and operational budget of nearly $6 million for this 24 hour operation, with all of the legal and regulatory guidelines, for a ten bed Emergency Department was no cinch.

Sometimes she day dreams of a ballet where the kind and efficient moves of the ED staff are shown. A graceful passing of a bloody sponge; the pirouette to the head of the bed to initiate the Oxygen flow; the plie’ to avoid getting slugged by a belligerent drunk; the graceful bow to swab an arm and start an IV. Put that in the budget! Are Nurses the only managers in town who run the risk of hiring incompetent people who can accidentally kill someone if they are less than skilled, informed, careful and drug free?

That patient looks bad. Cold, clammy, afraid to breathe or turn. Juan has everything under control before the Surgeon even sees the guy. Looks like a tearing aneurysm says the Senior Resident who is moonlighting in ED.

Juan has already put Harold on the phone to the Operating Room asking the OR Nurses to look at the schedule and see which elective surgery they can move to fit this big case into the schedule. An operating room is being cleared and the case cart is being sterilized by the time the Surgeon sees the patient. This game of anticipation—out guessing what the doctor will do—is the fun part of nursing.

Juan is dead on his feet and rubbing his eyes. His copper skin no longer shows the effects of his childhood in the fields. In fact, he almost looks pale as he strokes his prominent Aztec nose. He is an excellent nurse—due in part to the training and experience he gained as a Corpsman in the military. He persevered and excelled in his studies while getting a degree in nursing. Men, especially Hispanic men, were few and far between in nursing. His ability to speak Spanish was a godsend in Sacramento, and he helps Mary make her EEO/AA percentage.

He probably spent the night looking in the bars for his alcoholic wife. Thank God she works at Brand-X hospital and not for me. I wonder if her employer has anything in the works to help her. Maybe I should be looking into his co-dependency. Maybe I should mind my own business.

What a mess in Rm.#8. It should be clean and ready for patients. Where is that orderly? The minor cases, the cuts, bruises, burns and sprained ankles have not started to come in as yet. Wait until the doctors offices close around noon. Fewer patients? This is probably evidence of the impact of the Doc in The Box walk-in clinic next door. The Urgent Care clinic was opened three months ago by two of our doctors. They are skimming off all the walk-ins that formerly brought patients into the ED. When you consider that the ED is actually a loss leader by itself, it enhances the money making capabilities of the other departments by bringing patients. Better check the statistics that might add fuel to the budget for developing and marketing our own Triage Yourself Urgent Care Annex. We are losing patients to the walk-in clinic.

Look at that poor girl shivering, covering her face, in fetal position. Mary notes the setup is for a Menstrual Extraction. Early abortion by any other name. I wonder who is with her? There doesn’t seem to be anyone around. Mary pats her hand. Have you ever been in our hospital before?

I was born here. Sobbing, she rubs her red eyes. Mary is careful not to phrase the question, have you had this procedure before because that might look like a judgement or moral query about repeat abortions. At this time Mary does not have an interest in coaching someone on her lifestyle. She sees her job as giving emotional support to a sister in distress. She gives her a warm blanket from the blanket warmer and tells her what to expect during and after the procedure. All of this has probably already been explained by the Physician, but sometimes people don’t hear anything we tell them at this point . . .

A pale emaciated young man lies in Rm.#6. He looks like a recently released