Nights

After a weekend at home celebrating the 4th of July, I am back to work, and for the most part happy about it. Or content. Or perchance resigned. I believe in the training I am receiving, which appears to be in critical care nursing, but in my opinion is really just further exploration into the human condition.

Today my patient has vast metastases of what started as colon cancer five years ago. Surgery this afternoon removed part of his liver. In the midst of all this, he is also bright eyed, 44, and a married father of four.

When I meet him and his tragic story, what keeps me from sorrow is the long list of duties I have to accomplish throughout the night as his nurse. Here and there he gives me a look that communicates a total understanding of his plight. I pause and take in his gaze, and try to look back in kind. What an honor to be the person receiving these communications at this point in his life.

I keep eying his monitor, and eying him, and he seems at rest. Nothing makes me happier, since sleeping is an unfortunate rarity in the ICU. He even seems to sleep through the hourly finger-sticks I am forced to do, one of my most unsavory tasks. I know that pain inevitably exists on many levels for my patients, but for some reason the idea of poking their finger every hour seems like adding insult to injury. I for one think that finger-sticks hurt like hell, but tonight, my man snores right through, bless his heart.

Since moving to nights, many friends and family have asked me what it's like, and how I handle the schedule. I say the same thing to everyone: the actual work and shift is not a problem. The stress comes on my days off, when I sleep all day and wake up with only a couple hours of daylight in which to re-connect with people on conventional schedules. Then I am reminded of how "off" my schedule makes me to the rest of the world, and then I am reminded of how few people I even know in this new city of mine. Here enter the blues, and I find myself on my couch, doomed to looming infomercials and replays of daytime baseball games.

I go back into my patient's room to hang a new medication, to do another finger-stick, to adjust his insulin pump, to make sure his reflexes are intact, to check on the rate of his epidural anesthesia, to listen to his breath sounds, to flush his arterial line, to empty the urine from the collection bag of his catheter, and he wakes and watches me. He has big, brown eyes and they are full of questions. I try to be quiet, hoping he'll close said eyes and go back to sleep to get much needed rest, but I know he is awake and wants to say something. "How am I?" he asks. I stop working with the pump and look at him. "How are you?" I say, unsure of his question. "Yes," he replies. "You know more than I do about how I am doing. How am I doing?"

And here's where the time equilibrium betrays me; where my knowledge of his prognosis and probable outcome haunt me; where I have to be conscious about how much I say, but yet hold myself to some modicum of truth. So I talk about now, this shift, this immediate period of time we're sharing. I tell him his vital signs are stable, the surgery he had that day went well, that he is not bleeding, and that together we are managing his pain. I comment that he's been resting so well that I can hear him snoring from the nurse's desk. He smirks.

I crouch down to empty the catheter bag, and he again watches me, peering over the edge of the bed.

"Miss Suzanne?" he asks, "What if I have to pee?"

I smile from my squatted position and explain to him that he has a catheter, and that if he feels he has to pee, he should just go ahead.

"You sure?"

I hold up the bag, saying, "See all this urine here?"

"Yeah," he replies.

I point at him and nod.

"That's mine?!" he exclaims.

"Well, it's not MINE!" I quickly reply with raised eyebrows. He gifts me with a chuckle and turns his head in mild embarrassment.

I go over to the toilet and dump what's been collected, take off my gloves, wash my hands, put on a new pair of gloves, and set about my final task (which I've put off until last), the finger-stick.

I approach his bed and take his big, calloused hand, picking a new finger and noting the tan lines from his rings.

He's watching me.

"Suzanne, do you believe in God?"

I jab the tip of his middle left finger.

"Sure," I say as I squeeze the drop of blood onto the test strip and put gauze and pressure onto the little wound I just inflicted. "Why do you ask?"

Without a flinch he tells me, "Because I have been praying for you tonight. I've been praying for God to grant you wisdom, and intelligence, and courage. I pray that through your wisdom, and your intelligence, and courage, that God will be able to cure me. And I know already that God has blessed you with these things. And I thank you."

The glucometer beeps out a reading, I take the gauze off his finger and give it a quick, soft rub to make sure there is no bleeding, and take his hand in mine for a moment.

"Thank you for praying for me," I say. "You are a blessing."

He smiles at me and squeezes my hand. "God bless you, Suzanne."

"And God bless you. Now get some sleep."

I take off my gloves, wash my hands, adjust the insulin infusion, and leave his room in order to document his blood sugar and carry on with the next task. Later I document in my nurse's notes, "Patient rousable, alert, conversational, oriented to person, place, time."

Nurse's notes are painfully dry. Such documentation communicates little of the greater narrative at work. And so, from the bleary-eyed perspective of a somewhat reticent night nurse, I'll continue to tell the story.