Chapter 4

I don’t see Dr. Keller for the rest of the day. From bits of conversation here and there, I know he’s busy in the OR with a case. Thankfully, it seems like Kim didn’t mention the issue between Dr. Keller and me to anyone. Since it happened in the treatment room, no one else knows about it except Mr. Greg and a few doctors who witnessed his yelling.

I return to work the next day, hoping it’ll be better, and it actually is. Dr. Keller is in for rounds around 8 in the morning. He sees his patients, speaks briefly to some nurses and to Kim, but he never even looks at me. It feels like he’s erasing my existence, and honestly, that comes as a relief. Maybe Kim’s instructions to leave me alone are working.

The unit is fully staffed today, and for the first time, I get the chance to learn the routine properly.

Doctors’ rounds happen in the morning, starting between seven and eight. Dr. Lewis, who looks to be in his sixties, is the physician in charge of the floor. He mostly keeps to his own work and doesn’t interfere with nursing tasks. Dr. Keller, on the other hand, is deeply involved in the day-to-day running of the floor since most of the patients are under his care. His leadership skills and younger age seem to work in his favour.

Kim attends doctors’ rounds for all residents unless two doctors arrive at the same time. The assigned nurse is still expected to attend rounds even if Kim is present. Any new orders are discussed during rounds. Before rounds, most morning medications are given to the patients. CNAs check vitals and help with personal care like hygiene and toileting. Some days, there aren’t enough CNAs, so nurses have to step in and cover everything. If you’re lucky, you might get a few minutes to take a break in between.

After rounds, the main responsibility of nurses is to process the orders given during rounds. Once that’s done, it’s time for the second medication pass, followed by documentation and preparation for handover. This is an eight-hour shift, starting at 6. I’ve always preferred twelve-hour shifts. I hear they’re slowly implementing them, starting with med-surg, but nothing’s finalized yet.

In rooms with four beds, there’s one nurse and one CNA assigned. In single rooms, you end up caring for six to ten patients, depending on staffing. There’s also a float nurse who helps when needed. It’s busy, but manageable; nothing I can’t handle.

Today, I’m paired with Marty, one of the nurses who’s been on this floor for three years. She explains everything clearly and makes me feel at ease. Around noon, one of her patients’ urinary catheters stops draining. She tries flushing it, but feels resistance, so she removes it. She gathers supplies to insert a new one, then looks at me.

“Do you want to try?”

I never turn down an opportunity to learn, especially when someone’s supervising. “Sure, I will,” I say, genuinely happy.

Mrs. Jane is very cooperative. I explain the procedure and prepare everything. Marty assists by opening the dressing tray and guiding me step by step. I follow her instructions and ask a few questions along the way. Once I clean Mrs. Jane’s perineal area, I ask for the catheter. Marty checks the package, then frowns.

“Oops. This is size fourteen. I need sixteen French,” she says. She sets it down and adds, “I’ll be back in a minute,” before stepping outside the curtain.

“Sorry, Mrs. Jane. We got the wrong catheter. Marty’ll be back shortly with the right one,” I say.

“That’s okay, dear,” Mrs. Jane replies. “How long have you been a nurse?”

“Not long. Almost eight months.”

“That’s good. You got a hospital job without much experience. You must be very smart.”

I smile. I don’t tell her how hard it was to get this job, how many applications I sent, or how many follow-ups went unanswered. “I think I was lucky,” I say.

“These days it’s hard to find a job. You’re really lucky,” she adds.

I hear the curtain move and turn, expecting Marty. “Well, Marty’s here. Let’s cont-”

I stop mid-sentence as Dr. Keller steps in.

“What’s going on here?” he asks, his eyes moving from the exposed Mrs. Jane to me.

“Mrs. Jane’s catheter was blocked, so we’re changing it,” I reply.

“Who gave you the authority to change my patient’s catheter without an order?” he asks.

I stare at him, caught off guard. In my previous workplace, nurses were allowed to change a blocked catheter. I glance past him through the narrow opening in the curtain, hoping Marty will return. She doesn’t.

“Who gave you the authority to change my patient’s catheter?” he repeats, his voice louder.

Before I can answer, Mrs. Jane tries to speak. “Marty is my nurse, she-”

“Shh,” he says, lifting a finger to his lips. “I asked her.”

“Marty asked me to do it,” I say. “Mrs. Jane is her patient.”

“So if someone asks you to do something for a patient, you do it without checking for orders?” he says. “You don’t verify anything?”

“As far as I know, changing a catheter can be a nursing intervention in certain situations,” I say quietly.

“Oh, now you’re teaching me,” he says with a short, mocking laugh. “Why don’t you go to the OR and do surgeries too, since you seem so capable?”

“I’m not teaching anyone. I’m just answering your questions,” I say, keeping my voice low.

“This is her post op day one,” he snaps. “There’s a reason urine may not be draining, and you decide to take matters into your own hands.”

“I didn’t,” I say. “The assigned nurse flushed it first. It didn’t work, so…”

“Then where is the assigned nurse?” he asks, scanning the room.

“She went to get the catheter.”

He laughs. “Best joke of the year. You expose the resident,” he gestures toward Mrs. Jane, “leave everything open,” then points at the tray, “risk contamination, and walk away to get supplies. Where do you come up with this nonsense?”

“We had the catheter, but it was the wrong size,” I say, my voice barely there.

“Listen carefully,” he says, his tone turning cold. “Unless I tell you otherwise, stay away from my patients. I bring them here to treat and save their lives, not to kill them. And tell Marty to call me before doing anything.”

With that, he steps out from behind the curtain.

I stand there, looking at Mrs. Jane, forcing a weak laugh while my hands shake uncontrollably.