Chapter 10/ 2008
A Holocaust Survivor Survives.
The day before I am to begin orientation for my second part time job, charge nurse at the assisted living facility, the kid is all giggles, babbling about antibiotics and the G tube between snorts of laughter. I ignore him, as he could not possibly be giving antibiotics intravenously. Maybe his spacey RN boyfriend is. Maybe the Cuban is. I know I’m not.
“What’s so funny?” I ask.
“I wanted to see what would happen if I took her off the vent. She become the blue and her saturation crash,” he says.
“Why would you take a a ninety-three year old man with double pneumonia off the vent?” I ask.
More giggles. The kid fingers his rosary and leaves for school.
“He’s saying something is wrong,” the Cuban tells me a half hour later.
I am in the kitchen, thinking of the kid’s double chin as I crush my patient’s pills into a fine dust.
“He can’t talk, he’s trached,” I say.
My carotids vibrate. A drop of pee stains my white Hanes boxers. The man can not talk unless his trach is occluded.
I run into my patient’s room. His oxygen saturation is seventy. Normal is ninety-five. Lips are blue. Skin is cool. Pulse is rapid and thready. He is sweating. The vent refuses to alarm, its screen flashing ominous warnings of a danger more severe than the threat the e-book phenom poses to the publishing world. Blood pressure is 200/110. I have been out of the room for five minutes.
It will go that way sometimes.
I try to suction him through his trach. I can not get in deep enough. It is blocked. I lift him up into a sitting position. I pound on the bone white skin of his back to break the blockage up. I still can not get in. His fingertips and toenails are blue. His pupils are dilated. His blank eyes plead for me to get air into his lungs. My hands have left frantic indentations on his back.
“Pound the chest,” the Cuban says.
“He has a pulse.”
“Pound the chest.”
“There’s no reason to.”
I attach the ambu bag to his trach. His chest does not rise or fall. Saturation is sixty-five. I turn the oxygen up to ten liters. The only way to get air into his lungs is via the trach. He is going to eat it. I try to suction him again. Nothing. I pound his back again. I suction. Nothing. His fingers and toes are ice cold.
“If you don’t pound his chest I will,” the Cuban says.
At least, she is employing the right pronoun.
“If you pound his chest you’re only going to make it worse BECAUSE HE HAS A PULSE!”
I call 911. His sweat has saturated the mattress with fear. His eyes are closed. I open them. Pupils fixed and dilated. I shine a flashlight into them. Nothing. Pressure the same. Saturation drops to sixty. I ambu bag his face. Maybe I can get some air in this way. Nothing. He is going to die. I keep bagging. His chest does not move.
“If you don’t pound his chest, I will,” the Cuban says again.
I run around the bed to where she is standing. I pick her up and carry her into the hall.
“Stay there and let the firemen in,” I say in a remarkably calm voice.
His pulse is one hundred and twenty. Pressure remains elevated. His heart is going to blow. Great. On top of everything else, I am sure he has had a stroke. I can not get the suction catheter in any further. I still can not bag his trach. His saturation has dropped to fifty-five. All I did was leave his room, as I do every morning when I prepare his meds. I have killed him.
The paramedics enter. The Cuban opens her yap to tell them what is going on. Two sentences in, they ask her to leave. She will not budge.
A paramedic, with deep blue eyes and biceps the size of her neck, stares the Cuban down. She retreats to the doorway.
I bag my patient’s face as all three paramedics shoot me the same “What the fuck?” stare. Each is straight out of Central Casting, acting immigrants who have crossed any manner of sexual and ethical borders to reach the City of the Angels, their dreamy eyes and wet lips signaling their willingness to do whatever it takes to crawl out of the vortex of the day player roles their chiseled faces and bodies have sucked their dreams into.
“His trach is blocked. I can’t get anything out,” I say. “I didn’t know what else to do.”
I give the musclebound trio report. The one with the blue eyes tries to ambu bag the trach. If my patient can not dive into the deep healing pools of the Aryan eyes gazing down at him, he is surely lost. Nothing. The blonde scruffy one, his bangs falling over the unlined glow of his tan forehead, pushes Blue Eyes aside and tries to suction through the trach. Nothing. Saturation fifty-three. Pulse races, blood pressure pounds.
The third paramedic, a dark Latino with a shaved head and a red snake tattoo circling his lower neck, reviews my patient’s meds with me. We go over his medical history. I show all three the document spelling out, in no uncertain terms, the full code status of the ice cold man on the sweat dampened bed jammed into this tiny room. The three shoot me the stare again. My inadequacy has made me wet under my arms and between my legs. I stare into the blue eyes. He has to bring my patient back. What is the point of having all those muscles and angular cheekbones if you can not resuscitate a sweet old man who smiles when Debbie Reynolds dances?
My patient is on the gurney. Without breaking a sweat, the three sets of pumped up arms have tilted the gurney to an angle perpendicular to the buffed hardwood floor. We are in the elevator. I hold my patient’s cold hand. He should not be up so late. It must be two in the morning. The bright light of 10 AM hits my eyes, momentarily allowing me to see the veins and capillaries running across my corneas, as the blue sky beats down on the wailing ambulance before us. The trio lifts my patient into the ambulance with the grace of Cher’s Vegas backup dancers. Branches sway in the wind. I do not feel anything.
Except the cold fear telling me I have killed my patient.
“You don’t see many of these anymore,” the Latino says.
We are both looking at the numbers on my patient’s arm. The hairless hands and neatly manicured fingernails of the paramedics hold on to leather straps as the sirens roar from somewhere deep inside the speeding vehicle. Cars move to the right to let us pass. The weight of killing my patient is so heavy on me I do not sway to the left when we round the corner to the emergency room. We reach the hospital in three minutes.
They will never revive him. I have let a Holocaust survivor die.
Everyone in the ER knows my patient. He has coded here many times before. The ER nurse gives him an aerosol treatment. Suctions out a huge mucous plug. Moving him around and the swerving of the ambulance have dislodged it. His saturation begins to rise. His airway is open. His chest rises and falls again.
I call the kid. He is at school. He shows up in ten minutes. I assume today’s class was held at an undisclosed location in the bowels of the hospital. The kid performs another of his mad woman Tennessee Williams flavored monologues for the ER doc. Elizabeth Taylor can flawlessly deliver these heartfelt musings of desperation and loss with a sense of truth, not a kid who can not get his pronouns straight. Doc looks at the kid without blinking and instructs me to call the family. Even though our patient is breathing again, this morning has been a terrible blow to his frail body. Most likely, he has stroked out. There is nothing else the doctor can do. My patient is going to die, probably in the next few hours.
“Jake did what she can…everything is good…the ER will bring her back,” the kid tells the family.
The doctor shakes his head. He pats my shoulder. I can not talk.
“Take your time…not to do the worry,” the kid says.
The kid turns his dead black eyes on me.
“I’m hungry,” he says. “Have you had the lunch yet?”
An hour later, my patient opens his eyes. Drugs have lowered his blood pressure and slowed his pulse. Saturation is ninety-five on three liters of oxygen. The faintest hue of pink has returned to his lips and nail beds. He is transferred to the Coronary Care Unit. A parade of doctors enters and leaves. The kid dissembles to anyone who will listen. No one does. They know the kid. When they are not snickering, the eyes of the nurses and respiratory staff shoot arrows at me. I sit at my patient’s bedside. I have sweat through to my bones. The skin on the bottom of feet feels like it has been peeled off by the Gods of Nursing, who passed their morning sitting in judgement as I scurried and stumbled to save the sleeping man whose head now rests on two plastic pillows encased in cheap linen pillowcases. I write my nurse’s notes. I review the paramedics’ documentation. They arrived four minutes after I called. I thought it was, at minimum, a half hour.
The family enters. They do not ask me what happened. The kid holds court. The eyes of the family shine. Their heads move slowly up and down. They cup their chins with the palms of their hands. They think they are getting their money’s worth. The head doc comes in. I ask him about Troponin levels. A kindred spirit, he tells me about atelectasis and white blood cell counts. He ignores the kid. The doc looked out the window when the kid told him he took our patient off the vent to, you know, see what would happen. The doc squeezes my cheeks with his chubby white fingers. The teenage granddaughters and their mothers stop texting.
“Good job,” the doc says. “You’ve done all your mitzvahs for the month.”
“We’ll keep him here a few weeks, until he’s stable,” the doc tells the family. “You’re lucky a good nurse was with him today.”
The family stares at me for a moment before they resume texting.
I work for them for a few more weeks. They never thank me.
“You’re a nurse?” the respiratory therapist asks me the next week.
“Slave to the sick for thirty years.”
“Did you start as a teenager? How old are you?”
“Fifty-six in a few months.”
“No way. You’ve had work done? It’s very subtle. I’m loving that your grey hair matches your glasses.”
“I bought these when I had money. They’re the last Alain Mikli frames I’ll ever own. I can barely buy groceries.”
“This is my second job, dawg. I work it to pay my bills down.”
We smile and nod our heads. He is short, dark, his guns as rounded and hard as the paramedics’. The kid could look like him if he laid off the potato chips and ice cream. The therapist has a tattoo, one of those tribal chains wrapped around the arm deals. I never had a thing for tattoos. I like his. He asks me about the kid. I tell him about the babbling, the mimicking, the nurse lover, the fake school. The therapist grimaces, rolls his eyes and crosses himself.
“I’m from a real different island than that one,” the therapist says. “Last year, we couldn’t figure out why your patient had so many infections. We cultured his trach…there was stool in it.”
My stomach wakes up and growls. A sliver of pain flashes through my balls. I look at the chain slinking around his dark skin. I tell him about the no gloves, not washing hands, not cleaning equipment, the bare feet, the medication faux pas.
“Stool in his fucking trach, dawg…stool in his trach,” he says.
“I bet his daughters have to take an Xanax before they wipe their asses,” I tell him.
The kid calls an hour later. He has lost his wallet. He will not be in on time.
“I’m not staying late tonight…I have something to do.”
“I lost my wallet in the bad place.”
“I’m not staying late tonight.”
“It was in the dirty place.”
“Did you shove it up your ass?”
The kid does not answer.
“I’ll give report to the staff and you can read my nurse’s notes,” I tell him.
“It was in the bar on the Santa Monica Street.”
“I’m not staying late tonight.”
“Don’t tell her wife’s caretaker I was in that place.”
“I’m not staying late tonight.”
During the three weeks my patient is in this hospital, the kid is never in his room when I arrive on duty or leave for home. I do not miss him. The family thinks he is sleeping at the bedside, on a green vinyl chair which folds out into a cot. I keep our patient clean, hydrated and comfortable. He smiles at me when he wakes up, then quickly drifts off to sleep. He closes his eyes whenever the doctor discusses sending him home. The staff put their bows and arrows down. They ask me to work on their unit. The respiratory therapist has sung my praises. A real job. A steady income. For ten minutes, I breathe in a new life.
Word around the hospital is that it is about to go bankrupt.
“I don’t use the air conditioning in my car, dawg,” the therapist tells me on the last shift we work together. “I’m trying to save on gas, but it’s weird, I drive with my windows open and I can’t feel the air.”
“I haven’t felt the air for months,” I tell him.
The next morning, the hospital goes bust. It shuts its doors that afternoon. The staff loses every cent in their 401Ks and their accumulated sick and vacation time. They are not paid for their last two weeks.
The airless days are hotter than I ever remember. The nights are chilly. Is it summer? I do not know.
My patient is transfered to another hospital. Every Monday, the kid calls the agency to change my days. And every Tuesday. My orientation days at the assisted living facility are set in stone. I can not change my schedule to accommodate the kid’s bullshit.
“I don’t want you taking care of that old man anymore, even in the hospital,” the boyfriend says.
“It’s between rent or food if I don’t go in,” I tell him.
“That punk is playing you like you’re from an enemy village.”
The boyfriend is funny since his fiancee hocked her engagement ring and gave him the heave-ho. We joke about him dropping in on the kid at the hospital. We will dress him up in tight jeans and a shirt, unbuttoned just so. He will fix his baby blues on the kid and tell him he is looking for me, then make with his sexy squint and inform the kid to stop messing with my schedule. The kid will lose a lot more than his wallet.
“My New York attitude is rubbing off on you,” I tell him.
“You can wait around for me to call, but only me.”
The boyfriend gives me a check for the rent.
“You’re my call boy,” he says. “You’re not to work for that man. You can’t see what it’s doing to you.”
I do not know why the boyfriend is so nice to me. Nor how he plows through his days, calling people and taking them out to lunch, trying to find work. He has not booked an event in months. He let his administrative assistant go the month before. His savings are close to zero. He has tapped into his 401K. Not that it is worth much anymore. He says things will turn around soon.
“I’ll come in and answer phones for you,” I tell him. “Do some computer stuff.”
“No one is calling me,” he answers.
At night, my cat and his dog sleep side by side on the chair at the foot of my bed. The boyfriend and I hold each other tight under the heavy down covers.
The City of the Angels is colder than either of us ever remembers.