Nurse’S Notes: A Novel

By Barbara Alexander

Nurses` Notes looks into the life of a nurse in a small community
hospital.
For Barb Alexander a large part of her life is defined by her duties as
a critical care nurse. Saving lives, especially those on the verge of death
gives her a sense of purpose.
Whenever on duty, Alexander`s patients become her main concern
and she welcomes them as a significant part of her world.
As a part of the hospital staff, she is also subjected to the conflicts and
issues taking place behind closed doors. But when the hospital drama
starts affecting her personal life, Alexander is caught in a predicament
regarding her main concerns- her profession and her personal life.

• Language: English
• Publisher: Xlibris US
• Release date: May 20, 2011
• ISBN: 9781462850495

Barbara Alexander

Barbara Alexander has worked in a small community hospital for 25 years. She has a Bachelors Degree from the University of North Carolina at Charlotte. She lives with her family in Richmond, Virginia. The artist is Barbara von Luderitz, a freelance artist that has exhibited her work in various places in North Carolina. She lives in Hickory North Carolina with her family.

Book preview

Copyright © 2011 by Barbara Alexander.

Library of Congress Control Number:       2011905394

ISBN:         Hardcover                               978-1-4628-5048-8

                   Softcover                                 978-1-4628-5047-1

                   Ebook                                      978-1-4628-5049-5

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

1-888-795-4274

www.Xlibris.com

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93453

Contents

CHAPTER 1

CHAPTER 2

CHAPTER 3

CHAPTER 4

CHAPTER 5

CHAPTER 6

CHAPTER 7

CHAPTER 8

CHAPTER 9

CHAPTER 10

CHAPTER 11

CHAPTER 12

CHAPTER 1

orange sunset chapter 2.JPG

The Newspapers were full of the incident, front page at that: a nurse is suspected to have killed a patient! Luckily it was not in our hospital, but in a hospital within an hour’s drive.

Some patients will be placed on ventilators, knowing that with proper treatment that they will come off again. Then there are those, a few patients that will never get rid of that machine that breathes for them. It could be that their C1 and C2 the first and second vertebrae, respectively, in their neck were broken in a wreck or they are paralyzed by a creeping crippling disease like Myasthenia Gravis or Guillain-Barre’ syndrome where the muscles in the chest get so weak, that one just cannot breathe.

Nurses usually have a big heart, the females more so then the males, and these cases evoke a great deal of sympathy in us. Personally, I try to spend more time with these patients or at least find their favorite TV shows. Their brains are often still active, and most of them communicate by mouthing words, often soundless or an eerie whisper.

They are not the brain-dead, ones,—the ones they call vegetables—a strange and unfit name to a foreigner like me—what? A potato, a cucumber or a tomato that is full of life, full of nutrients?

Anyway, these patients have their full brain capacity, although some cannot feel their body parts. They are incontinent of stool and urine, they have catheters to drain their excrements in to bags that often expose them to germs, urinary tract infections develop and if it is unnoticed too long, they will die of sepsis, the usual cause of death. It can take a long time, it can make the families grow weary, and most patients are extremely depressed. It can take years before death brings an end to these hopeless situations. But the brain, yes the brain, is still there, very depressed, but there.

We nurses take care of them, skillfully and faithfully clear them of their secretions, feed them through their stomach tubes, and clean their bedsores which can be deep like craters, deep enough to expose the tendons. Usually they live in special nursing homes that are licensed to keep ventilators, but the infections bring them to any community hospital.

It is a sad life and until GOD or death intervenes. There is a helplessness that surrounds these patients and the antidepressants should be handed out to the nurses as well. This helplessness must have been the conversation one night at this other hospital, sixty miles away. What are we doing this for ? Is it right for the families to decide the end of care? The body parts of the patients are rotting off, but the social security check or the disability check still comes in. It is a bleak conversation, there are no answers. There is nothing one can do about it.

Yes, there is says Shirley, a mousy little nurse.

Like what? Asks Paula, another longtime night—nurse in the ICU.

Shirley just smiles. Her patient’s oxygen saturation just at that very moment drops to the sixties, not a healthy number. Paula calls a code; I can imagine a whole team of doctors, nurses and respiratory therapists rushing to the unit. Shirley would give them a brief update and the history of the patient. It is obvious the quality of this life is less then optimal. Still, an effort is made and the code goes on for fifteen minutes. Despite suctioning and 100 percent oxygen and first—line drugs the efforts failed. When the oxygen level drops further and further, the heart rate beats slower and slower until asystole, a straight line is on the EKG monitor. The code would be called off and the patient pronounced dead.

Apparently this kind of incident was repeated again, a Kevorkian comment yes, we can do something about these dismal, sad situations followed by a code and then another dead patient. Shirley was always humming Another One Bites The Dust and Paula was growing more and more suspicious of the macabre response and finally went to her nurse manager. Mercy killing? No, just killing!! The coincidence of always Shirley’s patients coding was too obvious. What are the chances? Some patients were NO CODES, and no resuscitation was even attempted.

After much convincing, the family of the last dead patient agreed to an autopsy to find out the actual cause of death. The report of what they found was unbelievably shocking: small gauze occluded the tracheostomy, the small plastic tube that should let the air flow to the lungs was totally obstructed.

The criminal investigation was started and Shirley was arrested and held in custody. Accidental or unintentional mistake were quickly ruled out and after short interrogations, mousy little Shirley admitted to the last murder.

This brought up another logical question: what about the other patients that died in her care? The other poor families also read the story in the newspapers and in total shock agreed to exhume the caskets. Most of North Carolina’s newspapers picked up the story, the poor families!! ! To believe your loved one is well taken care of only to find out they have been murdered.

Unlike Kevorkian, who had an agreement with his patients, Shirley did not. That would have been different, but still murder. Seeing her picture on the front page, I thought she looked somewhat familiar—have I seen her before? I contemplate my whole profession, wonder about burn out, and ask myself why anyone would go into nursing, if not wanting to help people. As the sun sets I have no answers.

At 4:30 am, it is still dark and the soft ocean waves from the alarm clock awaken me. Even so I know I am closer to the mountains, in what I call now my hometown. The coffeemaker hisses in protest but obliges to make that dark smooth liquid that keeps me going all day. I sit on the porch to absorb a bit of nature before being close up inside with monitors, computers and very sick people clinging desperately to life, or not. The crescent moon remains in the early morning sky. Vega shines brightly, because dawn has not yet come. Watch out young girls; the moon is lying on its back, and it’s easy to get pregnant. The Petunias fill the air with their sweet peculiar smell.

No one else is up in the neighborhood yet. I love the silence. A soft wind caresses my face, like a lover when he first meets you. I pray, Thank you GOD for the beautiful moment, thank you for the abundance of life around me. Soon I will be around critically ill patients who are hanging on by a thread. Life is not always more powerful than death. I go inside to listen to my meditation CD to prepare me for the day: I commit from within to be an even greater space of love to all that I know and to the ones I do not yet know.

The drive to work takes forty-five minutes. A glorious sunrise awaits me on this day. The lush green trees of North Carolina are still slightly shrouded in a cool mist. Steven Curtis Chapman sings I am Speechless. The sky changes from a dark purplish