Ah, summer. Sunshine and humidity. Ninety degrees and mercury still rising – what a perfect time for the air conditioners to go out at The Hospital’s extended-care nursing home. And, if they don’t get the AC fixed in the next 38 minutes, a fleet of ambulances will bring us more than 90 new patients this afternoon.

We’ve kicked into disaster mode, and all the mass-casualty plans and formulas that have been gathering dust since we reviewed them on September 12, 2001 have been brought to the light. There’s an emergency call center established in admitting, extra nurses being booked and brought in, one division being emptied to make way for the old folks…we’ve mobilized our own little war on terror.

There are still endless questions that the plans and papers fail to address. In the event of a terrorist attack or natural disaster, everyone becomes our patient. However, The Hospital admin tells us that there are not our patients – they’re just “hanging out” while the AC is getting fixed. Do we have to pass meds? Do assessments? Document incidentals? Who the heck knows? But we’ll make it work. At The Hospital, we always do.

I know that 90 degrees is nothing to mess with when you’re an octogenarian, and I have to give a snap to The Hospital for its quick response to this predicament, but as the countdown to transport continues, I find myself questioning the report that the air conditioner repair people are working hard at fixing the problem. I wonder if they’re even there yet, or if they’ve promised to arrive sometimes between nine and three next Monday.

Recent events pertaining to death and general freaked-outedness (story of my week) have led me on a trip down memory lane, to that sunny afternoon four years ago when, for the first time, one of my patients died.

I was only a few weeks out of orientation, working as a unit secretary on a surgery floor that deals primarily with cancer patients. Not a lot of people actually die on that floor; if they are terminal, they know they’re terminal and they go home so they can die in peace, without us jabbing them with needles and force-feeding them green jello. Usually, the people who actually die on that floor are the ones who surprise us.

Mr. Patient wasn’t a surprise – we knew he was going, he knew he was going, and the plans were in place to discharge him the next morning with hospice. He just jumped the gun a bit. When his son came up to the desk an hour after my shift started and asked if he could see the doctor, I told him the doctors would be in soon on rounds. I had been taught from Day One that one does not interrupt the doctors in a discussion (as they were at that very moment, right behind me where Mr. Patient’s son could see them but thankfully not hear them, since they were talking about golf). He said again that he really needed the doctor to come to the room, and I explained again that the doctors would be in very soon, it was almost time for rounds, and could I get the nurse to bring him anything in the meantime?

He leaned across the desk and scowled at me. “Well,” he said loudly, “my dad just DIED and I think I need the DOCTOR to come in and pronounce him.”

The golf conversation screeched to a halt and I sat down, speechless as the doctors clamored around and looked at papers and asked questions and finally went to see the patient’s family. I knew there was something I was supposed to be doing… ah yes, there, in the back of my orientation manual was the Expiration Checklist. Okay…notify physician, that’s done, call spiritual care, will do, call expiration tech…

“What’s an expiration tech?” I wondered aloud.

“He’s the dude with the body bags,” said the CNA, passing by my desk with a cup of juice for one of our live patients. “Bags and tags.”

What a job, I thought. I called spiritual care, the expiration tech, the nursing office, the clinical manager, everyone on the list – check, check, check. Spiritual care came and consoled the family, a social worker appeared to suggest funeral arrangements – it all went on around me in a blur as I went back to the daily grind of answering the phones, processing orders and scheduling exams.

About half an hour later, admitting called. “We have a patient for room 25,” the girl said.

“Um, 25 is still…occupied.”

“You discharged Mr. Patient thirty minutes ago.”

“He died. He’s still in there. The family needed some time and the expiration tech–”

“Well, I’ve got a patient in the Emergency Department who needs a bed on your unit now, and that’s the only one open. You guys need to move that guy out of there, NOW.”

Click.

I told the charge nurse, and miraculously, the family cleared out and went into a meeting room with the chaplain and the social worker while the expiration tech bagged and tagged. Or so we thought.

The orderlies rolled Mr. Patient by my desk on a stretcher with a sheet pulled over the raised rails so the outline of his body was obscured from view. Away they went on the service elevator, just as a housekeeper showed up to clean the room. The expiration tech filled out some forms for the chart, handed them to me and left as the patient from Emergency rolled past my desk and into room 25. It was perfect timing.

A few minutes later, the service elevator opened and a confused-looking orderly pushed the stretcher-with-a-sheet-over-it back in front of my desk. Mr. Patient had returned.

“Why are you here?” I asked him. “Why is HE here?”

“Uhhh,” he mumbled. “They said the tags was wrong and to bring ‘im up, so I brung him.”

He shoved a crumpled transport log in my face. I ignored it. “Who said the tags were wrong?” I demanded, looking around desperately for a charge nurse, any nurse, anyone who had been here more than three months and was better-equipped than I to deal with a dead body in the hallway.

“The guy in the morgue. Could you sign this? I got another trip to do.”

“You can’t just leave him here!” I wailed.

“I’ll put ‘im back in the room,” the orderly said, kicking the brake off and starting toward room 25.

“There’s a patient in there now.”

“Where’s your empty rooms?”

“We don’t have any. Please, just wait while I call the morgue and straighten this out and then you can take him–”

“I’ll put ‘im here,” he said, pushing the stretcher into a corner by the elevators. He grabbed the transport log from me, not caring that I hadn’t signed it, and disappeared.

Breathe, I told myself. Call the morgue and tell them that the idiot orderly just left a dead man by the elevator.

“His tag was wrong,” the man in the morgue said when I called.

“What tag?”

“His toe tag. He has the wrong tag on his toe. That one goes on the bag and there’s no tag on the bag so you have to do them over before we can take him. Go look at it.”

“I am NOT looking at it.”

“Better call the expiration tech.”

Click.

So I called the expiration tech. I explained the situation frantically. “You’ll come up and fix it right away?” I pleaded. “He’s in the hallway, we have no rooms–”

“Those tags are right, it’s that guy in the morgue who’s all backwards,” the tech grumbled. “Go look at the body, there’s a white tag on the toe and blue tag on the bag, right?”

“I AM NOT LOOKING AT IT!” I said again. I couldn’t, physically could not go look at Mr. Patient’s toe. I’m the newbie, the secretary for chrissake, why should I have to go look at the toe? I looked again for a nurse – WHERE were my nurses?

“Call the guy in the morgue back, tell him–”

I mustered all my meager courage. “No, YOU come up here, YOU look at the tags, and YOU call the morgue back since YOU are the expiration tech and there is a dead body in MY hallway.”

I slammed down the phone and a nurse finally appeared. “I need to take Mrs. Brown to CT. Is anyone using that stretcher?” she asked, pointing to the corner by the elevators.

“Mr. Patient is,” I said wearily.

“But he–”

“Came back,” I finished. “The morgue sent him back and said his tags were wrong and there was no empty room to put him in and he’s there and I called the guy and he wanted me to look at the toe but I couldn’t go look, I really couldn’t and so I told him–” I was gasping for breath and trying hard not to cry. “And Mr. Patient’s family is still in the meeting room and if they come out they’re gonna see him and I told the guy and he wanted me to look at the toe, but I couldn’t because I’ve never seen a dead body before and I couldn’t go look at the toe and–”

The nurse was wide-eyed and furious, but as she opened her mouth to curse the expiration tech to the seventh circle of hell, the elevator pinged and he reappeared. Blind to our hysteria, the tech trotted over to the stretcher, unzipped the bag and placed a white tag on the toe and a blue tag on the bag. We watched, mouths agape, as he silently pushed the stretcher onto the elevator and he and Mr. Patient disappeared down to the morgue just as the red-eyed family emerged from the meeting room.

Once again, it was perfect timing. The nurse and I could do nothing but shut our mouths and tend to the living.
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Today I Feel: better
Now Playing: “Midnight Train to Georgia”
Gladys Knight and the Pips

Gail’s eyes were red and they spoke volumes. I knew before she said anything that the decision had been made and it had to happen today, perhaps was already happening even as I stood there and watched tears flowing silently down her cheeks.

“Two o’clock,” she said, in response to my unasked question. “They’re getting the recipients to pre-op now.”

“Here?” I asked, incredulous. It made sense for clinical reasons, but emotionally it felt all wrong.

“It was what her husband said she would have wanted. Here. With her friends.”

Susie had been a nurse in the DMH Cardiothoracic ICU for more years than she cared to admit – twentysomething, she’d say with a smile when anyone asked. When she received the Excellence in Professional Nursing award just four weeks ago – a prestigious honor for lifetime achievement – the emcee lauded her “twentysomething” years of service to DMH, to the ICU, and to her patients. Who was really counting, anyway? We all are now – because it was exactly four weeks ago that we gathered to honor her, and today we have gathered to mourn.

She wasn’t even old. Her youngest is only seventeen, an awkward boy whose spindly height doesn’t quite distract from the fact that he hasn’t grown into his feet yet. She was strong and creative, a brilliant mentor to everyone she worked with, a thoughtful and compassionate nurse with clinical skills beyond compare… and yet she fell. After a friend’s barbecue in her neighborhood, she left to walk home. They found her hours later, crumpled up on the ground, unresponsive and completely brain-dead but alive.

It wasn’t assault, which was everyone’s first assumption. I’ve found myself thinking that if she HAD been assaulted, she could have kicked the dude’s tail and she could have lived. She was that tough. Susie lived and breathed for the daily battering she got in the CTICU. The sickest patients, the neediest families, the craziest doctors – she handled it, all of it, anything you could throw at her from the outside. But it was an inside job, an aneurysm, that quickly and quietly brought her down.

It’s two o’clock now. Despite the fact that every bed is full and monitors are beeping in every direction, the CTICU seems deathly quiet today save for the sound of tissues being pulled from cardboard boxes and nurses trying desperately to disguise sniffles as coughs and frequent throat-clearings. The atmosphere is one of disbelief – not just because their best and brightest has been taken from them, but because at this very moment, we know that her organs are being harvested and prepared for transplant into patients that Susie’s own friends will have to care for. One of the patients who comes in here tonight will have Susie’s lungs. One will have her heart.

Susie lived out of town, and after she was found, EMS took her to the closest hospital. They knew right away that there was no chance, no hope of recovery. That other hospital was where they made the brain-death diagnosis and her family made the decision to pull the plug after three days of goodbyes. But her organs are coming here to DMH for the transplants – here, to her own division where her heart beat and her lungs breathed every day for twentysomething years. It makes some sense, as I said, because we’ve got some of the best transplant teams in the country… but how can we bear to let her come back to us in pieces? How can her friends check breath sounds and respiratory rate on Susie’s lungs in someone else’s body? How can they monitor her heart rate when it’s not her heart anymore?

The anonymity of the donor system wasn’t even considered today – we all know who’s getting Susie’s organs. Her life-support removal was scheduled so that her harvesting could be scheduled and the transplants could be scheduled (as transplants rarely are), so everyone knows. The clinical director made the decision to tell the recipients’ families as well. I think this move was partially to explain why all the nurses will be crying when they care for these patients, but more than that I believe that it shows the families that their loved ones will be receiving the best possible care because Susie, the nurse who taught everyone in that unit everything they know, will be guiding them one more time. That’s why her husband wanted BGH doctors to do the transplants and Susie’s friends to care for the patients – so we would have one more chance to make Susie proud. It was so we would have the chance that we were denied on Saturday night – the chance to save her, the chance to help her live and continue giving hope to us and to others.

“Here with her friends,” Gail repeats quietly. “It’s what she would have wanted.”

Fighting back tears, I am inclined to agree.

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Today I Feel: a little lost
Now Playing: “Heaven is a Place on Earth”
Belinda Carlisle
(I really was listening to that.)

Well, this is interesting.

According to Newsweek, I, a college-educated woman with a quarter-century of candles on my cake, have a 50% chance of getting married. Ever. Five years ago, when I was but a lass of twenty and actually engaged to a a nice boy who I didn’t marry after all, I had a 75% chance. In a mere five years, 25% of my prospects are gone.

It sounds a little depressing, doesn’t it? 50% isn’t great. A 50% chance is never a good prognosis for a patient, and even for me – unsure at the moment whether I really want marriage any time soon if at all – statistics like that make me wonder if I’m just laying here, watching my levo drip run dry.

Chuck Klosterman’s view in Sex, Drugs and Cocoa Puffs: A Low Culture Manifesto, makes me wonder about 50%. Klosterman eschews statistical evidence and instead focuses on probabilities, which he insists are the same no matter how many variables you have or the statistical likelihood of this outcome or that. Either something will happen, or it won’t. What are the odds that I will roll a die and come up with a three? 50-50. Either I will roll a three or I will not. Klosterman pitches the whole one-in-six idea out the window by noting that numbers have no memory. What are the odds that I will get run over by a metro bus when I am walking out to my car today after work? 50-50. Either I will, or I won’t.

In another five years, Newsweek tells me that I will have a 30% chance of ever getting married. Where will my other 20% go, I wonder? Won’t it still be a game of probability in five years? I should, by rights, still have the 50% until the day I die alone in my spinster bed. Either I will get married, or I won’t.

Once I reach 40, if I am still not legally bound to someone, I am more likely to be killed by a terrorist than I am to ever walk down the aisle in Vegas. 2.5% – that’s 25 of every 1000 single women who will get married over the age of forty. But why, statistically speaking, should that be any indication of my personal chances? Either I will or I won’t. 50-50.

I was raised with a generation of women who were taught that we could do, have and be whatever we wanted – and if I WANT to get married, if the rest of the 25-year old college-educated women out there WANTED to get married, we could hit the Elvis Chapel en masse and turn those Newsweek graphs upside down. If all the 40-year old single women in the world just WANTED to get married, they could do it. They’d just have to marry the wrong people – but they could do it. And maybe they will… or they won’t.

Newsweek cites all sorts of reasons – mainly career focus – as the force behind the later-in-life marriage trend. They also note a changing demographic (13% of men in my marriagable age range are gay, compared to about 3% of women who are lesbians) as a hurdle to overcome when husband-hunting. Modern women are also picky, demanding, narcissistic, megalomaniacal and fiercely protective of our independence. And why should we WANT to give all that up to get married anyway? As the great philosopher Miranda Hobbes says, men are being phased out. Not only do women no longer need to depend on men (daddy-then-hubby) for financial support, they don’t need husbands – or even live-in-honeys – to have kids with… just a trip to the friendly neighborhood sperm bank, and the American Dream can be yours, ladies! Hire a nice Mexican boy to mow the lawn and water the flowers near the white picket fence you paid for, pay an Eastern European housekeeper-slash-nanny to diaper the kiddies and have dinner on the table by six.

It’s not that I don’t want to get married or that I disagree with people who do (well, some of them, but that’s a whole ‘nother can of soup), but for anyone to skew the social irrelevance of the modern husband into a statistic about a woman’s “chances” is just absurd. These aren’t chances, they’re choices. And if we’ve become pickier and less likely to settle for that which is not our idea of total perfection, that’s a CHOICE, not an impending doom. Women used to get married because husbands provided financial security and children. Love was a perk. But now that women can pay their own bills (including the fees for artificial insemination or adoption), all we have left to look for is love… and maybe that’s what the Newsweek article should have been about. Love is the real trick.

Anyone can get married – especially now that Bush is cracking down on the illegals, I bet there are a lot of Mexican men who’d marry a nice American girl to keep from being deported. If for some reason (up to and including reality TV) I absolutely HAD to get married in 12 months, I bet I could do it. I bet lots of women could, and we could beat the so-called “odds” if we had a really good reason to do so. But I’ve chosen to turn off the alarm on my biological clock because quite frankly, I don’t think that’s what marriage is all about when all is said and done. And neither is love.

Love is an abstract noun (kind of like terrorism). The Man cannot quantify it with bar graphs and scales and statistics. But it’s a possibility – and a probability. Either I will, or I won’t.

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Today I Feel: quizzical
Now Playing: “Danger Zone”
Gwen Stefani, Love. Angel. Music. Baby. 2005

You know it’s going to be a good Monday when you attempt to open your office door with your car key and wonder why you’re not going anywhere.

Not that this has ever happened to me.