*demographic details altered in order to preserve privacy
"Patient is a seventy five year old Caucasian man with hypertension, diabetes type two, and history of stroke in 2017. He presented to the ED last night and arrived at the ICU around two hours ago. Cause of hospitalization is COVID-19 complications with oxygen saturation down to the mid seventies --"
"Stop," the receiving nurse interrupts me, "what do I need to know now -- what is wrong with him?"
I can hardly blame her for being sharp. I know from earlier conversations during the shift that this particular nurse is slated to be "tripled" this evening, an ICU nurse colloquialism where instead of working within the usual parameters of one nurse to one or two critically ill patients, the nurse will work with three. Each of those patients, having been assigned a nurse out of ratio, will now experience an increased chance of mortality during their hospital stay of about 7% -- a figure that compounds with each shift that they are in an imbalanced assignment. Hospitals are aware of this figure, but with a shortage of nurses and an abundance of patients, they are left with two choices: 1) have the nurses work out of ratio or 2) close hospital beds. Between these options, hospitals more often choose the former, which keeps patients happy and money flowing -- at least in the immediate term. In an attempt to preserve nurse well being, management does their best to group patients with lower acuity together; however, in the critical care unit, patient stability is rarely a given, and a patient can deteriorate quickly.
While I'm unsure of which other patients this nurse is assigned, I know that this delirious man was assigned to her as one of the easier charges. Right now, he is looking anything but. It doesn't matter that fifteen minutes ago the man was freshly bathed and looking pristine, at the moment, the patient is a mess. He is tangled in cables, his hands are grasping at nothing, and the sheets are balled up and hanging off the edge of the bed. His gown is pulled up such that his genitalia are exposed, and his glasses are askew. He is moaning, and we are talking over the din of fans, alarms, and sounds of human distress. "He needs to be cathed," I say. "I was going to do it before I left," I say, lamely waving the catheter kit in my hand. She crosses her arms, looks at me, and gestures for me to carry on.
I am silent as I set up a sterile field. She's an old timer nurse, known for edging on rude to new graduates under the guise of education. She's not very nice, but she's one of the best nurses on the floor, and one of the only with more than five years of experience. She's one of the best, and that's why she's tripled; she's safe, skilled, and jaded. Perhaps the only thing more offensive to her than cocky new nurses is cocky new admin -- and I am new admin. Young at that. She sighs behind me, and the back of my neck prickles. I am eventually able to forget her presence and muscle memory guides me through the task. Task finished, I go to gather the trash, and as I look up from gathering the used supplies, I catch a glimpse of my coworker.
She stands there with her arms no longer tightly crossed but hanging loosely, like she'd forgotten their defensive stance and indeed their existence at all. Her head is tilted to the side, her face blank, and her eyes unfocused. In those few seconds preceding her noticing that I've noticed her, I see myself mirrored in her stance: physically present yet mentally detached, dissociating to maintain a sense of sanity but really just ensuring functional capability. "It's done," I mutter, breaking the spell. She snaps back to reality.
"Great," she gruffly replies, dismissing me with her turned back. "See you tomorrow."
Her face haunts me all the way home.