This was my first attempt at fiction in narrative medicine. I submitted it to a journal for consideration but it wasn’t accepted. Disappointing, of course, but there’s so much good material out there for me to learn from, and it was a good exercise.
Based on a true story, many details have of course been changed. When the nurse enters the picture at the end, that’s where I wrote myself into the story, thinking this is the nurse I would like to have the courage to be one day, every day, or even today.
For those who know me personally and might be shocked at my use of profanity in the story, I went back and forth with this but at the end of the day, this is the real world, and this is the expression of really, really strong emotions when things go so far from what everyone had hoped. Even still, in it all, there still remains opportunity for light and for good to enter the picture.
I’m open to feedback in how to tell a story better. Thank you for reading.
Everywhere he walked throughout the hospital, he swore people who weren’t even in his department were looking at him with silent accusation. I heard about what happened. You idiot. What kind of doctor are you? He was sure even the hospital cafeteria staff somehow knew what happened with him and that disastrous chest tube placement last week. He saw it in the glint of distrust in their eyes when he placed his orders. He saw it in the way they laughed with their backs to him while flipping burgers on the grill. How does everyone in this hospital know about that day!? Who the hell is talking about me down here in front of the cafeteria staff, for God’s sake? HIPAA, my ass.
Getting through residency and almost one year of his surgery fellowship was enough time to build a reputation and ego requiring some nurturing and protection. But the humility and wisdom borne from experience, those were still so nascent. This far into his practice, he was fine with the routine chest tube placements, but still found those complicated cases tricky to troubleshoot. I screwed up. No, I didn’t! I don’t know, it happened so fast and I thought I got it in ok. But the kid was screaming and her scoliosis made placement tricky and then the stupid nurse had to go push that code button when I just needed everyone to calm down and let me focus! He was convinced that if the girl had only heeded his pleas to just relax a minute! then she wouldn’t have flinched and his hands wouldn’t have been shaking and the chest tube wouldn’t have gone into the wrong place and this nightmare would not be everyone’s reality. Sterile gloves would not have touched non-sterile fields. The hemorrhage wouldn’t have happened. She developed an infection, which quickly developed into Acute Respiratory Distress Syndrome, and she was once again gasping for air, for life.
This was not how it was supposed to end.
It was supposed to be a routine chest tube placement, one final post-operative step in managing the removal of the cystic hygroma that had been compressing the young girl’s airway in increasing measure over recent years. The chest tube was to help resolve her minor pneumothorax, and overall it was looking so good. Once she got over this final hurdle, she would be on her way towards discharge, towards her new life. God, if she just hadn’t been so damn anxious!
The mother demanded to speak with him a few days after the incident. Her daughter was now on high ventilator settings and heavily sedated. Xeroform and a clean gauze dressing covered the failed chest tube insertion site. If not for the fact that the nurse had just reinforced the outer dressing before he arrived, the serosanguinous drainage persistently saturating the underlying gauze would have accused him as well. My blood is on your hands.
He knew people were calling him an asshole. Fuck them, they don’t know me. They don’t know what I’ve been through to get here. And the thing is, he had promised his wife, pregnant with their first child, that once he got through his fellowship, they could have time together again, work on paying off his medical school loans, and move out of their apartment into a condo, perhaps. He couldn’t risk it all. He had to choose his words judiciously. God it was terrifying.
The girl’s mother rose from her watch at the bedside when she saw him approaching the room. She shrugged her blanket off of her shoulders, tucked her disheveled hair behind her ears, and stepped outside the doors.
“Tell me what happened.” The mother’s tone was controlled, not overly pressing, but also not entirely safe.
“It happens sometimes with chest tube placements. When we realized it was in the wrong place, we managed the issue, got a new chest tube in, and treated her accordingly.” The fellow’s tone was controlled, not overly defensive, but also not entirely apologetic.
“I’m just not getting any sense from you that you feel sorry about any of this.” She didn’t tear up. She didn’t raise her voice. But her eyebrows furrowed, just for a second, just enough to betray her efforts at suppressing the terribly conflicted mess of forgiveness and fury rising from her gut. She swallowed hard and held the vomit at bay. She wanted him to feel so many things, but right now, she just needed him to feel as though he could talk to her.
“Of course…I’m not happy with how things have turned out. But we managed the issues appropriately.” He did not, he would not avert his gaze from hers. This was all he would offer.
She took a sharp breath as one final great protest threatened to unleash against all of her hell. He steeled himself. She could not say if it was sheer fatigue, self-restraint, or resignation that stopped her, but she found her lips frozen in an overwhelmed silence.
She had so many questions.
How can I get you to tell me what happened in any straightforward way?
Just how sure were you of what you were doing?
Why wasn’t it an option for you to ask for help before things got so bad? What were you trying to prove?
Were we just an unfortunate stepping stone in your training? A necessary casualty to boost your resume? Will there be more screw-ups for you to MANAGE APPROPRIATELY?
Why is it SO FUCKING HARD for you to say to me, “I’m sorry”?!
She found herself unable to do anything but stare at this man with the inscrutable poker face. Who could say if he secretly possessed the king of hearts or all the jokers in the deck. He had been such a welcome sight when he first entered her daughter’s room that fateful day, another key player in moving her daughter forward towards her new life. He was warm, personable, professional. By the time he had left, his role had plunged from the heights of heroism to the depths of the unredeemable. She closed her eyes, exhaled slowly through pursed lips, turned her back to him, and returned to her daughter’s side. He turned to the exit, passed the nursing station, and went to his next case in the OR. He couldn’t explain the dull hollowness eclipsing his relief.
He was back in the cafeteria the next day, holding his ground against all his silent accusers serving him food.
He took his tray to a table and had just sat down when an unfamiliar nurse approached him. Then he remembered the distinctive blond streak in her otherwise dark brunette hair that had caught his eye at the nursing station on his way out from yesterday’s dreadful confrontation.
“Hi,” she ventured gently.
She had only been a nurse for a few years. She was still learning to navigate communication with the physicians. Their place, her place, their voice, her voice.
“I don’t know you, but my name is Christina. I was Jeanette’s nurse yesterday. I know her course of events, and, well, I overheard your conversation with her mom yesterday.”
Shit, leave me alone. The last thing I need is a lecture from a self-righteous nurse who wasn’t even there the day everything happened. I bet those cafeteria guys are watching and just eating this up.
“Honestly, I don’t know what happened that day. I can’t imagine this has been easy for you. I just want to tell you –”
His face was impossible to read. For a moment, she hesitated and her face flushed as she felt her naiveté. But this wasn’t about what she had learned in a nursing school classroom. It was about what drove her into nursing, what was formed in her through all those long days and nights in the hospital with her very ill little brother, watching staff come and go, discerning roles, discerning hearts. This doctor didn’t need to know her story. She knew, and it was enough. And so, though she felt small, she found her place, found her voice, and she pressed on.
“ –I’ve gotten to know Jeanette’s mom. She’s more reasonable than you think. She’s losing her daughter and she knows it. She doesn’t want a big lawsuit. She just wants to grieve without this …question hanging over her.”
He spoke in a slow, deliberate monotone. “I already told the mom what happened that day.”
“No, not that question. She saw what happened. She can’t change it and she’s accepted that. She just wants to know if it matters to you. Right now, and for your future practice. She just wants to know if it really matters to you.”
He was quiet. Christina fidgeted with her fingers, but held his gaze.
“That’s all. I hope…you’re doing ok. Thanks for hearing me out.” She walked away.
He ate a few bites of his lunch, but for the most part, he pushed the food around on his plate, wondering what things would look like if he moved one piece one way, then another.
He stood up, straightened out his clothes, and headed up to Jeanette’s room.