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I trudged into the nursing station. The phone sat on an empty desk. Mary, the stocky, dark-haired charge nurse, faced the chart rack at the other end of the room. I avoided acknowledging her presence, keeping my eyes on the floor. Any word from her might shake my resolve. I stood by the desk and picked up the receiver with a trembling hand. I dialed the operator. When she answered I said, “Please page Doctor J. I’ll hold.”

From the corner of my eye, I watched Mary’s head bend in my direction as she leafed though one of the patient records. My body jerked when I heard a gruff voice say, “Dr. J here.”

I took a long breath and plunged in. “I’m Marianna Crane, one of the staff nurses on 2 West. You just left your patient, Ms. O, telling her she could go home today.” My heart drummed so loud in my ears that I barely heard the words coming out of my mouth. “I just want you to know that her lungs sound full of fluid. She has a productive cough, two plus pedal edema and is having problems urinating. I obtained 300 cc’s when I cathed her.” I gulped and raced on. “I don’t think she’s ready for discharge.”

Even though I had only glanced at his large frame as he exited Ms. O’s hospital room, I visualized his face turning crimson with anger at the audacity of a nurse questioning his judgment. An ominous silence planted itself at the other the end of the phone. The fact that my words couldn’t be taken back set my skin on fire. Was he still on the line? Finally, his voice pounded into my ear: “I’ll send the resident up to check her.” Click.

I stood with the phone pressed to my head. Then the realization hit. He had listened to me. I had accomplished what I wanted. I didn’t feel elated as much as relieved. Ms. O would get the work-up she needed. I hung up the phone.

Mary turned to face me. “Wow,” she said.

“The resident will come up to check on Ms. O,” I told her. I didn’t plan to stick around to discuss what had just happened. I marched out of the nurses’ station and up and down the hall twice until my heart no longer galloped. I barely talked to Ms. O while I gave her a bed bath. I feared I would blurt out that I had initiated a course of action that might delay her discharge.

While I was taking care of my other patients, the resident sauntered into her room and later an attendant whisked her down to radiology. I left before Ms. O returned to the floor. Before she received a diuretic to get rid of the fluid in her legs and lungs. Before the insertion of a Foley catheter to keep her bladder draining. And before the discharge order was cancelled.

When I returned to work three days later, Ms. O, dressed in a polyester pantsuit, sat at the side of the bed finishing her breakfast. She had taken the time to rouge her cheeks and apply a rosy lipstick. She smiled in recognition when she saw me. “I’m going home today,” she said with a chuckle that didn’t this time produce a paroxysm of coughing. She took the last bite of sausage and drained her coffee cup. Pushing the empty tray away, she shimmied off the bed on trim ankles. Her step, although slow, was steady. She settled into the wheelchair.

I pushed Ms. O through the hospital exit. The summer sun had yet to heat up the asphalt parking lot. A cab waited at the curb. I held her arm as she carefully stepped out of the wheelchair. She tried to press a couple of dollar bills in my palm. “Oh no.” I said, “Nurses are not allowed to take tips.” I stressed the word nurse.

To Ms. O I was just another hospital worker. As far as I knew, she had never asked why the resident appeared, examined her and delayed her discharge. She was unaware of my concern or the part I, a nurse, played in her recovery. And why would she know? I never told her. And surely her doctor hadn’t.

 

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