1. Grady, Allison MSN, RN, PPNP-BC


A clinical instructor finds herself haunted by disquieting impressions.


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Tap-tap-tap. As I walk with characteristic speed to my car after an eight-hour shift with my students, I can still hear the singsong chime of the seizure alarm. It must have gone off at least 15 times during our shift. Although I'm not a new nurse, this particular unit was new to me. During the first few weeks, I would snap to attention at each alarm. If the nurses looked concerned, I would mirror their expression and follow behind to make sure that my students were present and acting within their limited scope of practice.

Figure. Illustration... - Click to enlarge in new windowFigure. Illustration by Janet Hamlin.

Now when I hear an alarm, I simply glance over to see which room it is coming from, sometimes even taking the initiative to answer the light myself. But often I am not at the desk. I am walking around the unit, finding students who have not kept up with their charting, answering questions about treatment decisions, and challenging their clinical decision making. After we leave the unit, we spend two more hours talking about our experiences-the emotions, physical tasks, pathophysiology, what qualified as a success and what felt like failure-lending support to each other in this new environment.


Yet now as I climb into my car, free of the shift's sensory overload, I immediately turn on a podcast, the radio, or the Yankees game for the 20-minute drive home. And even though I hear all of the political shenanigans of the day, the runs being scored against a helpless bullpen, or the bass line of "Seven Nation Army," my mind keeps drifting to the baby covered in bruises.


I read his admission note early in the shift but had to reread it multiple times because I kept getting interrupted. Bite marks. Healing fractures. Broken bones. Subdural hematoma. No visitors allowed. Age: eight weeks. My students had questions about the logistics of child abuse and about caring for such a patient in a hospital setting; I had questions about the people entrusted with his care who left him so branded and bruised.


As I drive home, my thoughts drift back to the bottle he eagerly drank from me. He later fell asleep on my chest. The callus I have developed through years of nursing practice felt a little soft around the edges tonight. I wanted to weep, to yell about this evil. I wanted to impart some deep meaning and lesson to my students. "Stay in the room," I told my student. "He needs the time and attention." Stay in the room, I wanted to tell my student, you need to bear witness to what happens to the most vulnerable in our communities. Instead, we reviewed the feeding and changing schedule and how to conduct a physical exam.


5-7-8-2. I type in the code to my back door, hear the familiar chime when I turn the lock and pushed the door open. The smell of chicken and tomatoes greets me. The card game UNO is open on the coffee table.


Upstairs, my husband and son are asleep, needing to be up in less than eight hours.


The silence of the house feels almost painful to my ears, which are still full of the sounds of my shift. I slip off my shoes and tiptoe upstairs. I creak open my son's door and whisper "Good night." My voice is scratchy from hours of talking in the dry hospital. He stirs, bringing his stuffed monkey closer to his nose and pulling up the blanket. His skin is damp, and he smells like baby shampoo. His breath is deep and even. He has no bite marks. No healing fractures. No subdural hematoma.


I repeat this ritual with my husband, who stirs a little more. I shed my scrubs and wash my hands and face. I settle in with a book as I wind down my day.


But in that silence, I can hear every alarm that I did not answer. I can hear the girl calling out down the hall, "I just want to leave. Just let me go. Let me out of here." I can hear the giggles of the cousins visiting a patient in the playroom, the child crying after his flu shot. I can smell the tube feedings that another patient vomited after his afternoon walk, the glue used to place electrodes on the head of the patient admitted just before we left the unit. I thought of the eight-week-old. Swaddled and sleeping in his room. Healing. Waiting. Alone. I can hear his IV fluids mechanically drip into his veins.


I slip on a pair of headphones. I can no longer sleep in the silence.