1. Reishtein, Judith L. PhD, RN


A patient emergency alters the dynamic of a less-than-nurturing relationship.


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"Manage your day," she told me, not for the first time, as if it had been my fault that one patient crashed yesterday just as my second one returned from surgery with a new set of orders. I could not be in two places at once, keeping track of two critical patients, making sure each one received the care she needed at the moment she needed it.

Figure. Illustration... - Click to enlarge in new windowFigure. Illustration by McClain Moore

"Maybe you just don't belong in critical care," Doris continued. "You missed all your 10 o'clock medications and[horizontal ellipsis]"


I interrupted her. "At 10, I was at CT scan with Mrs. Smith-Janet promised she'd take care of Mrs. Ferrucci."


"She was your responsibility-you should have checked on her as soon as you returned to the unit."


My preceptor was supposed to help me adjust to the fast pace of critical care and guide me in the management of complex problems. But all she ever did was tell me the things I did inefficiently or wrong, that I could not keep up the pace, her tone implying that I was a disgrace to nursing.


She had been my preceptor since I started on the unit two months earlier, and as an experienced critical care nurse she had much to teach me. But she was a better nurse than teacher. Usually I just stood there, taking it all in, wishing I'd chosen another career, something less important, less vital, like growing petunias or polishing floors. But, perhaps inspired by the previous night's meeting at the high school about bullying, I fought back.


"I can't manage a day and neither can you," I said, a little too loudly. "No one can-we can only manage how we use the time we have. And I've done a better job with my patients and families this week than you have!"


I barely registered the shock on her face as I continued. "Both my patients required level 5 care, and despite that, I made time to talk to their families about what happened and why and what we're doing about it. How many families have ever thanked you when their loved ones died?" I had seen how annoyed she had been when Ed Smith thanked me for my thoughtfulness and support after we told him his mother had not survived her fifth cardiac arrest of the day.


"I'm doing my job," I pressed on, "and I'm doing it well, despite all your attempts to sabotage me. And if you'd just[horizontal ellipsis] "


My rant was interrupted by the alarm on the ventilator in Mrs. Ferrucci's room. We both raced in to see her husband standing by the bed, holding her hand, looking almost as panicked as she did as she struggled to breathe. "Sir, please leave," Doris commanded. "You're in our way."


He stood rooted to the floor, staring as the face of his wife of 63 years slowly turned from blue to gray. I squeezed his shoulder as I pushed past him and grabbed the Ambu bag from the wall. Tossing a suction kit to Doris, I said, "He can stay. He's not in my way."


Doris didn't say a word as she grimly tore the kit open. The noise was oppressive-now the heart monitor alarm had begun screaming, but I was too busy trying to force oxygen into Mrs. Ferrucci to reach over to the silence buttons. I couldn't compress the Ambu bag; her airway was completely blocked. Doris tried three times to insert the catheter and hit the blockage each time, but on the fourth try she managed to force through it.


And then, through all the alarm noise, we heard the thin squeak of air entering a partially cleared airway.


I reattached the Ambu bag and pushed a few breaths into her oxygen-starved lungs, and then Doris cleared more of the blockage. Both of us relaxed when we reattached the now silent ventilator.


Tears streamed down Mr. Ferrucci's face as his wife's face slowly regained its normal pale color. We straightened her in bed in silence, and then I turned to her husband before we left. "Can I bring you a cup of coffee?"


He looked up at me. "Yes, that would be good. And thank you," he said. He turned and looked across the bed at Doris. "Thank you both."


Doris accompanied me to the utility room and watched as I carefully poured his coffee and added two teaspoons of sugar and half an individual serving container of cream, the way I knew he liked it. As I picked up the cup, Doris spoke.


"You can react quickly when it's necessary," she said. "You did well in there. You'll be a good nurse someday." And she left the room.


I stared after her, repeating her words to myself. I'll be a good nurse someday. From Doris, those words meant the world.