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And other tales from the night shift at a hospital near you

Illustrations by Bill Koeb

My shift starts at 7 p.m. Tonight, at least, I know all of my patients already. It could be worse—and often is. I go room to room, making the rounds to reintroduce myself. Knowing all my patients at the start of a shift usually means I know what to do for them—and good ways to do it. Today, there are four. Ms. Henderson* and Mr. Smith are easy patients, with stable health and uncomplicated needs. Mr. Johnson is a little more trouble, and Ms. Rice—well, her day-shift nurse just told me, “That bitch asks for pain medicine and won’t take no for an answer.”

If the patients were new to me, I’d need to find out how sick or out-of-it they were. But whether I know them or not, the first thing I do is calculate how many are likely to shit or pee in their beds and how often. Then I go to the supply room and collect linen accordingly. A hospital nurse spends 30 percent to 70 percent of her time managing human waste. Clean linen goes fast, so you learn to get it into your patients’ rooms as soon as possible. Tonight, I add extra linen to my calculations. I bring it into Room 31. That would be Mr. Johnson’s room.

“He ain’t here yet,” Mr. Johnson tells me. He means the devil. Using the linen I have brought, I am going to try to swaddle Mr. Johnson to prevent Satan from sodomizing him. I put extra pillowcases, a draw sheet, rolls of gauze, and a roll of tape down on the chair.

“I never see anyone but hospital people and your friend in this room.” Never works, but I try it, just in case.

“You can’t see him,” he explains.

The devil has been visiting Mr. Johnson regularly ever since the “Root Woman” cast a spell on him. He says she also is responsible for destroying his kidneys. A dialysis machine now removes waste products and excess fluids from his blood three times a week. To make this process possible, surgeons connected an artery to a vein in his arm. The dialysis nurses insert needles into this “graft” to attach him to the machine. The graft has become infected, and that’s what has put Mr. Johnson in the hospital.

I ask if he wants me to fix him up now. He nods, grabs a bed rail, and starts shifting himself onto one side. I pick up my extra pillowcases and start. I pull one pillowcase between his legs, stretch it to cover his anus and his genitals. Then I wrap gauze around the pillowcase, over his lower abdomen and between his legs, and wrap tape over the gauze. I repeat the procedure at least two more times. Then I cover these layers with the draw sheet. I repeat the steps with gauze and tape. I would be very reluctant to do this for someone who was both incontinent, as Mr. Johnson is, and able to produce urine, which he isn’t. The linen is meant as a shield, not a diaper. Mr. Johnson has episodic hallucinations that he is being raped by the devil. By wrapping his privates, I am providing him with a measure of security—and perhaps, maybe, a little peace of mind for me as I make my way through another shift.

In addition to Mr. Johnson, tonight I tend an elderly lady with a serious bloodstream infection (Ms. Henderson), a fairly young man with AIDS and active tuberculosis (Mr. Smith), and a young female heroin addict (Ms. Rice) who is recovering from endocarditis, an infection of the lining of her heart, most likely caused by sticking nonsterile needles into her veins.

As I am working on Mr. Johnson, I hear a man cursing out in the hall. “Motherfucker!” he yells for the second time. Mr. Johnson looks up and asks me what the noise is, worried perhaps that the Dark One has arrived. I tell him that it’s probably another patient. We have two people going through DTs.

The shouting stops. I finish wrapping Mr. Johnson. A loud fly buzzes into the room. As the fly closes in on me, I see why it’s so loud. It’s huge.

I work on an acute medical unit in a large District of Columbia hospital. The patients we get enter the hospital with problems for which no surgical intervention is planned—diabetes, high blood pressure, stroke, more diabetes, AIDS, liver cirrhosis, diabetes augmented by longstanding alcoholism, sometimes asthma aggravated by crack, often IV heroin and/or cocaine somewhere in the background. Did I mention diabetes? Usually these people are elderly, but booze and dope can age others onto our ward with ferocious speed. Regardless of their age, all of these people have no money. That’s why they wind up here, on this floor, with me.

The hospital added a spiffy modern wing some time ago. The new wing houses specialties the hospital is very proud of. Patient rooms in the new wing are spacious, with private showers. They are intelligently planned, with ample storage space for supplies nurses frequently use. Patient rooms in the old wing—my wing—barely have room for two beds. Maneuvering a stretcher or a portable X-ray machine in and out of one requires spatial skills that I lack. We don’t have much storage space, but then again, we don’t need it, because we never have enough supplies. Our unit looks poor, with peeling, stained wallpaper and a stench to match. Emergency room patients come up through the new wing before they come to us. One night, a woman who was wheeled to a bed on my unit asked me if the part of the hospital she had passed through was the part where people with money stayed.

I slap the fly out of Mr. Johnson’s room with a towel. The fly follows me to Ms. Henderson’s room, drawn, perhaps, by the smell. She is alone, although there’s another bed in the room. Her roommates don’t last long, because she screams during dressing changes and they can’t stand the fumes coming off her wound. This woman is in her late 70s and nearly immobile as the result of a stroke. An ambulance brought her here from one of the city’s public housing projects. When she was wheeled up to the unit, her eyes were open, but she was unresponsive, critically ill. She was so dehydrated that her skin stayed in position after it was pinched and her eyeballs were sunk into her skull. Her blood pressure was almost inaudible, her urine the consistency of Jell-O.

The fly is probably looking for the wound on her right hip. The only other people who have ever seen anything like this wound are combat medics, and then probably only if they’ve stumbled upon an injured soldier (dead or alive) who has lain partly submerged in a swamp for some time. By wound, I mean shredded or excised muscle over a large area, with exposed bone.

Not only did Ms. Henderson smell like rotting flesh when she came up from the emergency room, she also smelled like urine and shit. She had layers of dried black feces up and down her back and legs. Almost every elderly patient we get from her particular housing project looks something like this.

She stops shrieking when I enter the room with juice and a pill. She looks interested. She calls me Mama. Sometimes she recites nursery rhymes. I raise the head of her bed and encourage her to drink some juice. This is her first drink since she came in; she received fluids intravenously while she remained unresponsive. She sucks up juice vigorously through the straw, swallows easily, doesn’t cough, passes the test. She can have plenty more.

We can take out her IV once her antibiotics are finished. That will save her from the misery of people digging for veins to restart IV lines she will then pull out again. After she finishes drinking, she looks me in the eye and smiles again: “Thank you.” Very impressive. I put the paper cup with the pill in it to her mouth.

I tell her it’s medicine. One pill.

She asks if she needs it. “Yes.”

The pill goes down, too. She can swallow fluids and meds easily, a fact that makes me happy—and angry. All anybody had to do was hold food and water up to her mouth and she never would have ended up like this. There was a young woman who accompanied Ms. Henderson to the hospital in the ambulance. She wrote two phone numbers on a piece of notebook paper. They’re both disconnected.

Ms. Henderson screams and fights during her three daily dressing changes. I don’t want her to hurt, and I don’t want her to fight. The best pain medicine I’ve managed to get her is one Percocet every six hours—an oral narcotic. (I was shooting for intravenous or intramuscular Dilaudid or morphine, but the interns wouldn’t go for it.) Now I’ll go do other stuff, wait about an hour for the Percocet to take maximal effect, to reduce her pain and—I hope—her combativeness.

I go down the list. Mr. Smith doesn’t need anything. Ms. Rice is sulking because her pain shot is not due for another hour and a half. I’m running right on time.

The loud man, the shouting man, comes shuffling down the hall, slightly out of breath. Mr. Frederick’s been here a long time now, long enough to have become a “placement problem.” He’s now speaking more calmly, smiling and following Jill, his nurse. “Don’t worry. I got plenty of money,” Jill is telling him dismissively. “You got some honey, too,” he says. He stares at her ass as he says this.

As Jill nears me, I walk up to her and stage-whisper, “He’s staring at your ass.”

She says she knows. He’s been doing that. She turns to the man: “Quit looking at my ass!” She orders him back to his room, telling him that when she gets the machine to test his blood sugar, she’ll come to him. He turns obediently and shuffles away.

He will be staring at our butts for the foreseeable future. Mr. Frederick was brought in by an ambulance that was called by a young woman, “obviously inebriated,” according to the emergency medical technician’s report. He was conscious, but confused and lethargic when the ambulance arrived. (He remains confused. Nobody is sure if this is a recent phenomenon or a more longstanding problem.) The EMTs stuck him for a blood-glucose reading and got a level too high to read. One subsequent call to the house was answered by the same young woman, who identified herself as his daughter. She stated that she “thought” he had diabetes, that she remembered him taking “pills or something” for it.

A social worker called back several days later, intending to notify the family that Mr. Frederick was ready for discharge and to find out if someone was going to pick him up. This time, a man answered the phone, told the social worker that the patient had no daughter living with him, refused to identify himself, but made it very clear that there would be no one at the house to take care of the “old man.” The social worker notified the city’s Adult Protective Services Division. A visit to the home by a city worker weeks later found several men reclining in a filthy living room, pipes and other drug paraphernalia in plain view, and an odor in the air. For the time being, looking after Mr. Frederick was our responsibility.

Last year, a nursing administrator met with each shift.

We’ve had several recent incidents that concern me, she said. One patient had called the patient advocacy hot line two weeks earlier to report her nurse because that nurse was not “acting like her friend anymore.” The nurse in question had been concentrating on another patient in imminent danger of respiratory arrest.

She also mentioned an occasion on which a patient had removed a needle from a sharps container, drawn HIV-positive blood from his own vein, and threatened to stick staff members if he did not get his methadone that second. She said she hoped we recognized that such a situation was an emergency and merited a call to security. I made a mental note to call 911 instead.

For many of our patients, a hospital visit turns into a hospital stay for reasons that have nothing to do with their health. Mr. Wilson was one such patient. He remained with us for months after his mother refused to take him home with her. Actually, she told the social worker that she’d take him if the hospital would pay for his food. He had become a paraplegic after suffering several gunshot wounds in different shootings and had recently been released from the D.C. Jail.

Mr. Wilson had come in for pain control or some other vague diagnosis. He loved pain medication and (inexplicably) oxygen. The doctors ordered it. At his request, he was identified under a female pseudonym on our board and on computerized patient lists. He told us he had enemies looking for him. With administrative approval, he had us change his room once, from a semi-private to a private room, after he told us he’d received a death threat over the telephone.

He ought to have known what one sounded like. He was constantly threatening to kill or maim staff for “disrespecting” him. Requests to change his dressing or bed linen and attempts to deliver or remove his meal trays at times he considered inconvenient were all disrespectful acts. Requests that he turn down the volume of his television were disrespectful. Requests that he refrain from yelling into the telephone or from yelling at us were disrespectful. Our disrespectful acts would usually lead to his dialing a number on the phone and ordering up a hit. He’d tell someone that we weren’t treating him right, to get here as soon as possible. We’d call security, tell them that we’d gotten a threat and that they should look for some guys coming to kill us. Just some guys, we’d say, we don’t know who.

We take turns assigning patients and empty beds to nurses. We also rotate as “charge nurse,” a powerless position that theoretically requires the titleholder to trouble-shoot the whole unit. It’s impossible to trouble-shoot a 35-bed unit while taking care of your own seven or eight patients. This evening, I’m thankfully not charge nurse and have been assigned a relatively light patient load by the person who is. But I am slated for the first admission.

Admissions involve a lot of paperwork and make nurses uneasy. We know nothing in advance about the new patients. Most come from the emergency room, a department we have little respect for. Sometimes, the ER people send a very sick person up with no warning. Even when we get a report ahead of the patient, we don’t usually believe it. They don’t seem to like to take a lot of pulses or other vital signs. They don’t always check the results of tests they run, or they don’t order any. They don’t seem to like to feed people or clean them up or make sure their IVs are running. I guess they’re too busy saving lives to engage in the routine activities that ensure that lives stay saved.

We complain at least monthly about the care patients receive in the ER. We also complain about what we consider poor assessment, poor planning. We frequently get patients we believe should go elsewhere, such as an intensive care unit or the operating room.

Like Mr. Calhoun. The emergency room nurse calls me some time after my shift begins to tell me she’s sending him up. Blood pressure of 60 over 20 to 30, breathing at a rate of 60 breaths a minute, pulse at 160 beats per minute. He’s almost dead, I suggest. No, she says, he’s not that close. He’s oxygenating well, has an oxygen saturation level of 95 percent. He’s talking. He came to the emergency room, she says, with complaints of dizziness. He’s very thin, is 24 years old, suffers from AIDS, shot heroin intravenously as recently as yesterday. Doesn’t know what his T-cell count is. “He’s dying,” I repeat. Yeah, but he’s a DNR (do not resuscitate), she explains. Dying is what he wants. The doctor discussed it with him. He’s talking. He’s alert and oriented.

I want her to keep him. The “talking” part is supposed to convince me he’s OK. I’m not buying. I protest that with his pressure and everything else, he might die in the elevator or the hall. No, she thinks, he probably won’t; he’s OK for now. He’s awake. He’s talking. He’s coming up.

I page the nursing supervisor (she trouble-shoots half of the hospital) and wait by the phone for her call. She responds quickly.

“Listen to what the emergency room’s sending us.” I give her blood pressure, pulse, and respiratory rate numbers, tell her they say he’s still talking. How the hell can he still be talking? The emergency room has lied to us before. I tell her that even though he’s a DNR, I don’t think he should come up here. He could die on his way up. Why does he have to die on a stretcher while being wheeled through the halls? She says she’ll go down there and see what’s up.

Calling the supervisor usually doesn’t work, though not because she doesn’t try. It just doesn’t work. I hope to hell that we are not out of oxygen equipment. I realize that his arrival could be quickly followed by a trip to the hospital morgue. I think about how I hate the morgue. The morgue’s refrigeration began to break down frequently two years ago. I heard that around the same time, the survivors of a long unidentified and unclaimed deceased individual sued the hospital for turning the body over to the city morgue, where he was cremated. So the hospital now keeps dead John Does forever, or almost forever. Occasionally, orderlies are asked to train as many fans as possible on the bodies, in lieu of refrigeration.

With a guy coming up on 100 percent oxygen, breathing at 60 a minute, I first rummage through a drawer trying to get equipment together. I look for an oxygen meter plus tubing. I can get him sedated, ease his “air hunger,” but that might put him to sleep for good—I think about the morgue again. I mentally run through a list of other items I might need: extra linen, absorbent pads in case he’s incontinent or has seeping wounds, an IV pole, extra needles, tape, a basin, maybe a water pitcher.

And here he comes already. They are in a hurry all right, rolling down the hall on a well-equipped stretcher, oxygen tank hanging from a bed rail, IV fluid running into an arm, a blue plastic bag of belongings riding the stretcher next to him. I see that he’s a big man—make that a very thin big man—with muscle-wasting evident even on his face. His two yellowed and calloused heels extend off the end of the stretcher’s mattress for several inches. A transparent green oxygen mask obscures his face. He’s in a room before I catch up with him.

I tell the orderly to wait a minute, that I want to pad the bed. I drop my supplies in the chair inside the room. I rip open the packet of bed pads, center two on the mattress, cover them with a draw sheet, and then repeat the process. “I’m going to be your nurse tonight,” I tell the young man. I introduce myself. He whispers his first name. So the ER wasn’t lying about the talking.

The orderly pushes the stretcher back up against the bed. He and I link gloved hands under Mr. Calhoun and lift him from the stretcher to the bed. I screw an oxygen meter to the wall. The orderly disconnects the tubing from the tank on the stretcher rail and passes it to me. I attach it to the meter on the wall and turn the dial all the way up. Mr. Calhoun breathes very quickly, but without much effort. The orderly hands me a chart, pushes the stretcher out of the room, and leaves. I take the rest of Mr. Calhoun’s vitals. His pulse is still in the 160s. Blood pressure is 70 over 30 after the move to the bed, a process that probably raised it.

I have to make the floor intern aware, even if we aren’t going to resuscitate this man. I hand Mr. Calhoun the nurse-call bell. Tell him I’m leaving, that he can push the red button if he needs me. Or feels worse. Anything. He takes the bell and nods.

In the hall, I see my supervisor. She apologizes. She made it down there, and then a code (a patient in full cardiopulmonary arrest) came in and she started helping, and they sent Mr. Calhoun up before she could see him. I tell her he made it up here, but his pressure is 70 over 30. That he’s got a DNR order written, but I’m going to let the intern know. She asks if he’s really talking. Yes. Unbelievable. She heads toward the room, and I go in the direction of the nurse’s station. Ted, the intern, is sitting there talking to the resident who supervises him.

Lydia, the unit secretary, looks up from the phone and covers the mouthpiece. She asks me if I’m taking the new admission? It’s a family member.

I tell her I’ll take it even though I hate these calls. I write the vital signs I just got on a scrap piece of paper and put the ER chart in front of the two doctors. I sit down in another chair. I pick up a phone and say my name. A woman identifies herself as Mr. Calhoun’s mother. She sounds very young. I also hear a small child crying in the background. His baby brother or sister? His child? Is this a girlfriend? “Shut up!” she yells at the crying child. “It’s the hospital!” She tells me that she’s trying to find out about Mr. Calhoun.

I tell her that he just came up from the emergency room a minute ago. He’s awake and he was just talking to me, but his blood pressure is very low. We are giving him IV fluids to try and bring it up. She asks if his pressure is “real” low. “Real” convinces me that Mr. Calhoun has been sick for a long time and that she knows he has AIDS. I tell her that he’s really sick. The supervisor walks back into the nurse’s station, walks up to the doctors, and starts reading over their shoulders. Mr. Calhoun’s mother asks me if he’s going to make it.

I chicken out. I ask her if she wants to talk to the doctor. I put her on hold, wave to the intern, say: “Family member of the guy who just came up,” and transfer the call to the phone near him. I go back to Mr. Calhoun and tell him his mother called and is talking to the doctor. This seems to stimulate him. He pulls the oxygen mask away from his face. “I want them to put that tube in me,” he says. “What tube?” He explains that he wants to be put on that machine. Is he talking about a ventilator? “The machine that breathes for you?”

He doesn’t want to die, after all. He pants, trying to catch the breath he lost talking.

“OK.” I let him relax, take his vital signs again: 60 over 30. I tell him that I’ll tell the doctor. It’s unusual for a DNR to change his mind, but he is young. When old people say they want to die, they don’t often change their minds. I hurry back to the nurse’s station and announce that Mr. Calhoun is a full code now. He wants to be a full code. The intern asks why. I see Lydia already drawing a line through the DNR order on Mr. Calhoun’s brand-new chart. “Oh”—the intern looks away—”OK.”

Two things have to be done right away if we are going to try to save this man’s life. His blood pressure has to rise. There are intravenous drugs that can do that. And a ventilator has to take over the mechanics of breathing for him. To be placed on a ventilator, he has to have a tube inserted into his trachea. The people from the anesthesia department have to insert the tube.

Mr. Calhoun’s resuscitation takes forever. We try a pager number and two extensions before we reach Anesthesia. Not only do we have to stick a plastic tube down his trachea while he’s still completely able to feel it, it turns out there are no free ventilators. A respiratory therapist attaches a bag to the tube once it’s down his throat and he’s finished gagging. She and I take turns squeezing the bag to force 100 percent oxygen into Mr. Calhoun’s lungs. Every time I ask him if he’s OK, Mr. Calhoun shakes his head no. He can’t speak anymore because of the tube. When it’s not my turn to squeeze the bag, I hold his hand. The supervisor adds a drug to his IV to raise his blood pressure, but it doesn’t come up much. Finally, another respiratory therapist finds a ventilator, and three of us push Mr. Calhoun’s bed up to the floor with the ventilator. I say goodbye. I know he’s going to die.

A long time ago, I went to public schools here in D.C. Few people believe I went to public schools, except occasional former classmates who come in as patients. They remember someone like me from some class we had together, even though it was a huge school. I stuck out in high school and I stick out now, because I’m white. Nobody white goes to D.C. public schools. And nobody white becomes a nurse in D.C. anymore. Or, rather, those who do rarely work in a hospital like this one, on a floor like this one.

I don’t see many African-American nurses, either. Instead, in this city, on this kind of floor, nursing care is provided largely by women who came here from the Caribbean: from Trinidad and Tobago, the Virgin Islands, Haiti, the Dominican Republic, and, above all, Jamaica. As a result, I order from the menus of the Jamaican restaurants in my neighborhood and know what I’m getting. I know the yellow pepper shaped like a turban. I know how to avoid getting gang-raped in Ocho Rios. Patients refer to me as “the White Nurse.” My colleagues, on the other hand, are often known collectively as “the Nurse With the Accent.”

I walk back on the floor after pushing Mr. Calhoun’s bed, and Lydia tells me that the devil’s back. She points down the hall to Room 31. I don’t hear Mr. Johnson screaming as I hurry toward his room, so I have reason to hope that we aren’t in for too much drama.

I push open the door. He starts again. His hands fly up to his wild-eyed face. He tells me, “I thought you was the Beast.” The Beast was just in the room, but he left.

Almost all my patients have pills or IV medications scheduled for 10 o’clock, and it’s going on 11 now. I haven’t talked to or seen Mr. Smith or Ms. Rice since Mr. Calhoun was brought to the floor.

I don’t have time to grapple with Satan. I pull back Mr. Johnson’s covers and point out that he’s still all wrapped up. He tells me that he knows.

I tell him he has to let me go see my other patients, because I had a bad emergency and I’m running way behind now. I’ll come back as soon as I can. He tells me to go ahead. I know he’s not going to take his eyes off that door.

Mr. Johnson tries to be agreeable, and he almost always is. He’s not irrational. I’ve let him sign his own consent forms for the procedures he’s had done on him, because I don’t believe he’s incompetent. Satan and the episodes of sodomy are the only passing hallucinations he experiences. I suspect that the hallucinated experience of repeated rape takes its toll on him, though. He’s often reluctant to consent to treatments that are very likely to help him and pose little risk. When this happens, someone contacts his friend Ms. Bethea, a wonderful, sweet person, who comes in and convinces him to sign. Satan never appears while she is present. She helps him and us.

Mr. Smith is right next door. When I apologize for my neglect and offer the explanation—the Mr. Calhoun emergency story with names omitted—he smiles and waves it away. He points at his TV. If I’ve got a minute, he tells me I’d probably like this show. I make minutes for Mr. Smith, but his TV has nothing to do with it. I like to look at him.

He’s gorgeous: thick, wavy blond hair, brown eyes, lots of muscle definition now that he’s lost so much weight. He wears very little clothing. He’s also kind. He can’t believe how hard we work. He gives away cookies and other stuff. His boyfriend brings all kinds of stuff in just to give away. Once, the boyfriend grabbed a fire extinguisher from the wall outside the room and put out a mattress a psychotic guy two doors down had set on fire. He smelled the smoke before we did.

That episode led to a visit from an administrator. Why didn’t we know the guy had matches? We just didn’t. We don’t frisk patients. We’re not cops. But you knew he was psychotic. Well, he never lit a match, or took a match out, or even tried to smoke a cigarette. And if he was psychotic, why didn’t the hospital pay a nurse’s aide to sit with him if he had to be on a medical floor? We asked for one. She didn’t answer. Bitch. Administrative meetings are one reason I work nights. They occur less frequently on the night shift.

I decide to go ahead with the dressing change on Ms. Henderson even though the pain medication may be starting to wear off. She needs three changes a day, and she’s had only one so far. Back in her room, I announce that I have to change

the dressing on her hip. “What?” I repeat that I have to take the old dressing off and put on a new one. Remember?

She never remembers. She’s lying on her right hip. No matter how she’s positioned, pillows propping her onto her left hip or back, she always wiggles onto her right hip, the one with the bloody crater. I put on two pairs of gloves. I raise the bed to my waist level and slide my hands under her to shift her onto the other hip. She’s not small, but not immense, either—worth a try at doing by myself.

I find it difficult to get another nurse to help me. A few will come any time you ask, unless they are busy with their own patients. Some are always too busy. Some are always taking a break. And I hate to be asked for help, too.

I pull her onto her left hip. She asks me what I’m doing. This time I hear the anxious quality to her voice. She probably remembers now that changing the dressing hurts like hell. I start pulling the tape from the edges. “Oh, Lord!” She remembers for sure now. The tape is loosened all the way around. I pour some saline solution under the cover dressing, because I know the gauze underneath will be stuck to the wound tissue.

“Stop!” she screams.

I have to work very fast now. I try to keep an eye on her right hand. She can tear off a fresh dressing or scratch healing muscle tissue or hit me. I pour saline onto a length of dry sterile gauze. I unwrap a cover dressing and get it ready. I stick four measured pieces of tape to the rail next to me. Then I work the old dressing off while she screams and shakes the bed rail. Her right hand stays on the bed rail. This is an ugly, ugly wound, and I am essentially just putting a large Band-Aid on it—what she really needs is for the surgeon to come back and excise more of this black, dead tissue. I lay the new, moist gauze in place, unwrap a sterile cotton swab, and—as quickly as I can, because this is the worst part for her—push the moist gauze into the deeper areas of the wound. I also push it up under her skin in the parts where I know there is tunneling of the wound. She screams and screams. Endlessly.

“I’m finished! I’m finished!” I shout, trying to let her know that she can stop screaming. I tape the new cover dressing on with the pieces of tape from the rail. I tell her again that it’s over. I put a clean diaper under her backside. I prop the pillows under her to try and keep her on her left side. I give her 10 o’clock pills, with juice. I empty the urine, now clear, from her catheter bag. I lower the lights and leave.

Ms. Rice hasn’t called me back yet for pain medicine. I’m grateful but also uneasy. I go to her room. Television on, empty bed, no Ms. Rice. Her roommate tells me she put on a robe and went out. Ms. Rice does this. I don’t mind, but Ms. Rice’s antibiotic is due soon. If she misses two doses, her stay will be extended one day. If she misses many more than that, she might have to start all over again with a different antibiotic. Ms. Rice makes friends with other junkies and visits their rooms or brings them back to hers. She buys food. Goes to services in the chapel. Gets high. She probably leaves the hospital sometimes.

Another nurse, Veronica, is looking for me. We run into each other in the hallway. She asks me to guess what.

I don’t have to answer. The screaming starts up. Veronica comes with me into Mr. Johnson’s room. He’s on his back, the head of his bed slightly raised, eyes staring straight ahead, the covers crumpled at the foot of his bed. “Get back! Get back!” he screams. I tell him it’s just us, nurses. We move toward his bed.

“Lord, stop it!” he shouts.

Veronica tries to soothe. She tells him there’s nobody in the room but us nurses. She takes one of his hands. I walk around her and take the other one.

Mr. Johnson keeps invoking the name of God and yelling at Satan to “get back.”

Once again, I repeat that there’s nobody in the room but him, me, and another nurse.

He reminds me that I can’t see the Beast: “He don’t let you see him!”

I think of giving him a sleeping pill. I tell him I’m going to give him something to make him relax and sleep.

I run and get his pills. Veronica’s gone when I get back. Mr. Johnson is staring straight ahead but not yelling. He swallows the pills I put in his mouth. He looks very serious. I cover him back up with his blanket and slip out of his room.

“Girl, it’s snowing outside!” Ms. Rice is back and standing over me in the nurse’s station. “Snowing?” I say, fear creeping into my voice.

She tells us to look out the window. Lydia and I go to the window. We see the snow, all right.

I tell Ms. Rice not to go anywhere. Her antibiotic is late, and I have to hang it right now to get her back on schedule.

Deep snow imprisons hospital workers, especially nurses. The last time we had a major snowfall in D.C., I spent four days at this hospital. I worked for 16 hours the first night and 12 the other three. I tried to sleep during the days on an army cot the hospital provided. They did not provide food for us, not free food at least. By the time I was allowed to leave, I was running out of money. By the last day, I’d given up sleeping—it was impossible. I asked around for a shower. Some nurses were taking turns in empty patient rooms, one nurse guarding the door while the other washed at the sink.

The last time it snowed, I took care of a woman who thanked her lucky stars on every flake. Seeing as we were trapped together, I spent a lot of time in her room. She told me she was so glad she was in the hospital. “Why?” Because if she were home, she’d be freezing. “You don’t have heat?” She did have heat when her sons paid the bill, but even when they paid the bill, they often left the door open, even in winter. I asked her why.

Turned out they sold drugs, and a lot of times, they were high and didn’t know the door was open.

“How do you feel about a nursing home?” I suggested.

She wouldn’t mind.

I told her that with her permission, I would write exactly what she had told me in her chart and make a formal referral to a hospital social worker to get her in a nursing home. She was eager. But once the roads were passable and it was time for her to go, a social worker arranged for an ambulance to take her home, not to a nursing home.

I take the bagged antibiotic solution back to Ms. Rice’s room, hang the bag on her IV pole, and wait for her to pull the plastic intravenous catheter out from under her nightgown. People who need long-term administration of intravenous medication have large-bore catheters inserted through the chest wall into a deep vein, or into an atrium of the heart itself. Not fun, but once it’s done, the patient avoids getting stuck repeatedly to find new veins. These catheters are also ideal for recreational IV drug use. For this reason, any patients with a history of IV drug abuse stay in the hospital for the entire course of treatment. I think administrators are afraid patients will overdose with a built-in mainline at their disposal.

Ms. Rice’s head nods while I pierce the catheter port and tape the needle in place. She looks high. I don’t mention pain medicine.

Mr. Smith asks for a sleeping pill. He swallows it and says good night. Ms. Henderson’s asleep. So is Mr. Johnson.

Admissions are rolling in for other nurses, but I’m finished with mine. I’m back where I started. It’s 1 a.m. Work slows from now ’til 5 a.m. I read charts and write in them, check lab and radiology results, eat, read books and magazines. Every hour, I look in on everyone. I answer my patients’ calls when they push the button. Every two hours, I change Ms. Henderson’s position to keep her wound from growing. Ms. Rice gets a shot. Lydia does crossword puzzles. Sometimes she asks me for a word. The radio plays Caribbean music. My eyes sometimes close.

Three-thirty a.m., and the station phone rings. Lydia answers, then listens. “What?” she says. She waves to me, gives me a quizzical look. She covers the mouthpiece. “What?” I say. She can’t believe what the man is saying! She hits the speaker-phone button. She thinks he’s talking about his butt.

There’s a jumbled male voice muttering, then “Help! Police!”

Lydia asks him who he is.

It’s Mr. Johnson, calling from right down the hall. He’s almost out of breath. Lydia asks why he’s using the telephone. He says his call button fell on the floor.

What’s wrong? “Somebody’s messing with my butt, I tell you!” Shit! I hurry to Mr. Johnson’s room.

Mr. Johnson sits up, pressing his back against the raised head of his bed as if he’s trying to escape through it. I call his name.

He screams for help.

He’s uncovered. The layers of linen and gauze and tape I wrapped him in lie scattered on the bed and floor. I usually have to cut him out of them every morning—if I forget, the day-shift nurse gets pissed. How did he pull all that off? I see Lydia standing at the door, shaking her head. “Get back! In the name of God, get back! I invoke the name of God!” Mr. Johnson cries.

I try and take his hand, but he won’t let me.

“Call the police!” He’s never asked for the police before.

I tell him I’ll go find a policeman and leave the room. Ms. Rice stands in her doorway. She asks what’s going on. I don’t answer her. Someone from the lab is standing at the station counter holding printouts to deliver to us. She needs a signature on her clipboard.

Ms. Rice calls after me, asking if she can get another pain shot.

I feel hopeful when I realize I know this tech. I sign the clipboard. I ask her to do me a favor. I put the clipboard down on the counter.

I ask her to take off her lab coat and pretend to be a policewoman. I give her a brief explanation. Her eyes light up a little as she removes the coat.

Two other nurses are now in Mr. Johnson’s room. He doesn’t seem to see anyone, though. His eyes bulge, and he keeps on screaming, and saliva is flying out of his mouth with each syllable.

One nurse tries to rub his back. He recoils and stares at her.

I call his name and tell him I’ve got a policewoman. The tech steps forward.

“You ain’t no policewoman! You ain’t wearing no uniform!”

She replies that she’s a plainclothes police officer.

He doesn’t buy it.

“All right!” I yell. “She’s not a policewoman, and there is no goddamn devil in this room! It is 4 o’clock in the morning and I’m tired! I’m tired of this shit!”

He apologizes, but tells me, “The devil is in that corner!” He points.

“No, he is not!” I do turn and look, though.

I leave the room again.

I call the intern. Plead with him to help me out with Mr. Johnson. I describe the history of devil hallucinations. In the background, Mr. Johnson continues to scream. I tell him I’ve tried taping pillowcases to Mr. Johnson’s ass.

He asks if they’re still on. No, they are not.

He next asks if Mr. Johnson tore them off himself. I can’t believe I am having this conversation. I didn’t see who tore them off. I pause. I want to try Thorazine or something like that, I tell him.

He OKs 50 milligrams. Then I ask if he’ll let Mr. Johnson’s team know that I think he needs a psych consult. He assures me that he will. So I run two floors down and three wings over to the pharmacy and bring back one tiny brown pill.

Back in Mr. Johnson’s room, I manage to slip the pill in his mouth between screams. He doesn’t notice. I fill a paper cup with water and hold it to his lips. Another nurse grabs his hands.

I yell at him to swallow as I pour a small amount of water in his mouth. The pill goes down. I look at the nurse who held his hands, tell her I’ll sit with him for a while, but I want to get his chart. She nods. I go out into the nurse’s station to get the chart. The hall is empty now, and he’s still screaming.

In Mr. Johnson’s room, I talk to him, tell him I’m in there with him, remind him who I am. He stares as if he’s looking through me and resumes screaming. On a sheet of paper, addressing the team of doctors assigned to Mr. Johnson, I write: “Please see nursing documentation. I feel Mr. Johnson could benefit from a psychiatric consult.” I’ll tape this paper to the front of his chart, just in case the intern forgets to tell Mr. Johnson’s team. At around 6 o’clock I’ll try and call Ms. Bethea. I know from experience she’s an early riser. CP

Art accompanying story in the printed newspaper is not available in this archive: Illustrations by Bill Koeb.