"The Woman in Room 248," by Elizabeth Naranjo

The Woman in Room 248

The woman in room 248 won’t live through the day. That’s what Shirley, the night nurse, tells us in her report to oncoming staff. Shirley is a tank of a woman who manages to look as though she’s sprouted a chair. The chair is on rollers, and during report she shuffles her huge feet to roll from one end of the desk to the other when she’s looking for something. She delivers her prediction like she’s forecasting the weather. 

The woman in room 248 has end-stage multiple sclerosis. As a student I’m assigned only one patient at a time, so I get to know them well. She was diagnosed at twenty-five, four years after marrying her high school sweetheart and six months after the birth of their son. Until then, she had been in perfect health, according to the history and physical in her chart. She had, in fact, been a nurse’s assistant, working days and attending school in the evenings to earn her nursing degree. I imagine she spent nights curled around her baby, making up for lost time, whispering promises of a future that was not meant to be. But I digress. My imagination tends to unfurl at times. It complicates things.

The disease struck hard and fast; within a year, the former nursing student was confined to bed, unable to move her limbs or control her bowels. Her breathing is done for her by a ventilator attached to a pale-blue accordion tube attached to a mask that floats over the plastic jammed through her throat. Another tube, thin and snakelike, coils across her abdomen and into her stomach, delivering a steady flow of liquid food. She is prone to frequent spasms. 

Here is how you glean clear, objective data from subjective observations for the purpose of charting, taken from my notes (in bold) last week:

Beside the ventilator tubing, the smooth brown skin of her neck slopes to a gentle curve and in this hollow, above the strike of collarbone, her mother often cups her head, pressing a cheek to the reassuring pulse of her daughter’s carotid artery. Skin around trach site clean, dry, and intact. Family at bedside.

When I lift her thin, damp gown to observe the gastrostomy tube, her muscles seize and she thrusts violently several times before a more rhythmic twitching ripples over her frame, releasing the taut mound of flesh above her pubis. G-tube intact, abdomen soft, non-tender, increased spasms noted.

The mother, a relentlessly jovial woman with steel-gray hair, looks up from her magazine and strokes a washcloth down her daughter’s hairline where the black kinky curls burst with beads of sweat. Below this, bright eyes stare dully at the mounted television screen, reflecting an intact unparalyzed mind. She doesn’t look at the boy, now six, slumped in a corner playing on his grandmother’s phone, and he doesn’t look at her either. Patient alert, diaphoretic, with 0 signs of pain. 

I’m thinking about the mother when she appears at the nurses' desk. Her hair is pulled back into a severe bun, accentuating the puffed face, the red eyes. Two unbroken streams of tears trail down; to her, the gathering of nurses behind the desk must look like a kaleidoscope. She fixes on Shirley and begins to speak. “I just wondered—“

“Ma'am, we’re in the middle of shift change,” Shirley says curtly. “Someone will be right with you.” The woman stares for a moment then nods faintly and wanders off. Shirley rubs her forehead and heaves a great sigh. “I know the woman’s upset,” she mutters, “but I have forty other patients and she’s been up here every fifteen minutes. I can’t get anything done.” She rolls backward and snatches up a telephone, tells the caller she’ll be a minute, rolls back. “Okay, where were we? 248. Obviously this pneumonia’s taking her down. Family switched her code status to DNR, comfort measures only. Again, I doubt she’ll make it through your shift, but maybe she’ll hold on for evenings. The paperwork’s a bitch and they’ve got nothing better to do anyway.” One of the nurses laughs, one glances impatiently at the clock. “Let’s see…251.” Rolling across the aisle for the vitals sheet. “Bobby Carter. He’s fine. Had a good night. Stable, no complaints. Room 252—“

“You mean she,” I say. Everyone turns and stares. “Bobby’s a she. Fifty-seven-year-old, right hip fracture? Admitted on Tuesday?” No one says anything. The air is thick with resentment. Who the fuck does she think she is? A second-year nursing student correcting a seasoned veteran. They look at each other knowingly, huddle closer, and continue report in muted voices.

***

My grandmother’s skin is a weathered map, her hair a cloud of silver. I am a junior in high school standing over her bed, bobby pins between my teeth, combing the fine threads. The air is spiced with ammonia. A man shuffles down the hall, his robin-blue gaze an empty shell.

“Mary.” My grandmother turns over the paper in her hands—the day’s menu—over, over. “Mary. What are you doing here? With this old woman. Look, I can’t even open my letter. It’s from the president of the United States, and I’m shaking so bad I can’t open it.”

“I’ll open it, Grandma.”

“Why are you here, child? You should be outside. Somewhere else.”

“Let’s go outside together. You need to get up. Bring your letter; I’ll read it to you.”

“What letter? This? This is my menu! Beef stroganoff, scrambled eggs. You need new glasses, girl.”

I sweep the last pin over her temple and lightly pinch her earlobe. “You can tell me a story, then.”

She’d been eleven when her family migrated west, their former lives swallowed in dust. She had lost one brother to famine and another to the war that ended the famine—a poor tradeoff, she would say. She didn’t like being fussed over and preferred the company of men. “Always,” my mother said bitterly. “She’s always preferred your uncles.” She indulged in excess only with words, a stream-of-consciousness novel with no resolution. I loved her stories. Spun with threads of Alzheimer’s dementia—memory, dream and fancy—they made her appear sometimes vulnerable, sometimes dignified, and forever mysterious. Years later, in Medical Terminology, I will learn the prefix and root word for dementia mean “without mind.” I will take issue with this meaning, perusing the Latin dictionary for words like “complex” and “transcendent” and “ethereal” to attach to “mind.” 

I grip the loose flesh draped over the bones of her arms, steadying her as she pivots to her wheelchair and sinks into the cushion with a sigh. I attach the metal poles of her footrests and swivel the platforms for her feet, cup each slippered foot and gently raise her legs so the calves rest against the padded bumpers. She’s telling me a story about the nurse who works at night, a tall boy with earrings, she says, and eyes for the red-haired housekeeper. “They whisper to each other in the dark,” she says. “They use the bed next to mine, pull the curtain closed. They think I don’t know.” 

I blush as I wheel her past the desk. “Shh, Grandma, not so loud.”

“Think I’m a crazy old woman.”

“No one thinks that.” 

I take her outside to the courtyard and finish my homework while she dozes in the shade of a sycamore tree. “You should be a nurse,” the employees say. “You’re good at taking care of people. You have a good heart. A nurse, or a social worker.” 

I begin volunteering at the nursing home, changing bedpans and bringing ice water to the residents. I enroll in nurse’s aide courses in my senior year. But that’s the year my grandmother dies, and I can’t be in nursing homes after that. I go with my mother to collect her things, which include a recent card from the White House, congratulating her on her ninetieth birthday.

***

Room 248 is empty this morning. Despite Shirley’s prediction, the patient held on another day, and then another evening, passing away at one in the morning and leaving Shirley to deal with the paperwork. On my way to the break room for coffee, I pass the desk where she’s hunched over, one hand scribbling madly and the other thrust in her short spiky hair. 

A night aide shuffles in with bleary eyes. “How did it go?” I ask her.

She blinks. “Last night? Okay, I guess.”

“No, with the patient passing away.”

She shrugs, grabs a bag from the coat rack and slings it over her shoulder. “The family stayed forever. Nurses were freaking out. Body has to be gone in four hours, you know. Hospital policy.” She motions to the table on her way out. “The mom left some stuff.” 

I stare after her, then walk over to the table. There’s a jumbo-size thank you card addressed to the “Staff of Station 2” and a plate of homemade banana nut muffins. I read the card. “Thank you to all of you who helped make this a home for my daughter, Regina. Thank you to all of the nurses and nurse aides who cared for her these five years. You are truly God’s angels.”

God’s angels. I watch them—the day shift assembling for morning report. Shirley takes a bite of her muffin and brushes crumbs off the chart in front of her. I think about walking away. I told my husband last night, in bed, that I think about walking away. He’d spent the evening replacing a fuel injector, and I’d alternated between writing my care plan and taking refuge in the garage. It’s fascinating to watch him—he’s so at home in his work. His body and mind built for untangling the mass of wires and thick cables, the conglomeration of metal shapes fused together in a twisted jumble. His muscles flex and glide in rhythm when he turns a wrench or adjusts valves, wearing a smooth sheen of oil and the flaring scent of gasoline. He belongs there.

“I need a beer,” he said, wiping the sleeve of his shirt across his forehead. 

“I’ll get you one.”

“Let’s both go. I could use a break.”

“Okay.”

I settled at the kitchen table while he washed his hands. “How’s it coming?” he asked.

“Pretty good.” Papers scattered, textbook a rainbow of notes, dog-eared pages of PowerPoint.

He dried his hands, cracked his beer. He walked over and squeezed my shoulder, then sat, waiting for me to say more. The way I did months ago, when nursing school was still exciting, a path to healing, a way to make a difference. Disease processes neatly printed in ink, and answers in multiple choice format. He waited for me to talk the way I did before clinicals—the hours spent in actual hospitals, on the floor, practicing skills and observing the reality of nursing: stinging cynicism and petty competition and numbed hearts. 

My husband slid me a glass of iced tea and his brown eyes were warm and keenly aware. I realized that he knew something was wrong and had probably known it for a long time. If I spoke, he would listen patiently. If I didn’t speak, he'd go back to fixing the truck. I envy him this quality—that he can care but not be burdened.

I closed my eyes and took a sip of tea. The melting ice cubes clinked together and I let one slide down my throat, feeling the shock of cold mingle with the spread of heat as I began to cry.

Later, he would tell me not to quit. That I could reconcile my idealized vision with reality, and strike a balance. We made love, and his trust was both bitter and sweet. He was the only one who was not surprised when, three years after my grandmother died, I went back to school. I let him hold me until he fell asleep, and then I slipped away to finish my care plan, remembering that first definition I’d highlighted in neon pink:

From Intro to Nursing: Nurse: a person trained to provide services that promote and maintain optimal health and well-being by employing the standards of care.

“What the fuck does that mean?” I asked the empty kitchen.

What the fuck am I doing here? I think in the break room. I swirl cream into my coffee and then choose a muffin, picking out the walnuts and eating them one by one.

“Code Blue, room 256.”

The drawl of voices at the desk cuts off and everyone jumps up.

“Code Blue, room 256.” Shirley’s chair flies back and she barks orders on her way to the crash cart. 

“Code Blue, room 256.” My mouth is numb, my arm burning where the coffee splashed on my skin. I step out of the break room and smack into a respiratory therapist; he spins and keeps running. The nurse who laughed yesterday at Shirley’s crude joke is on the telephone, a chart flung open before her, feeding information to a 911 operator. 

“Yes, they’re doing chest compressions now. She’s trach to aerosol, 35 %, IV Primaxin for Pseudomonas, looks like she’s fifty-seven…wait, fifty-eight, okay, right, on Bryce Street, 131, second floor, station two.”

“Hey, rookie, come on and learn something.” A male nurse in puppy dog scrubs grabs my arm and drags me toward the room, where a mass of people hovers in the doorway.

Another nurse is at the crash cart, glaring and shooing at the crowd. “We have plenty of help, people, go find something else to do.”

“Don’t mind her,” the male nurse says, tightening his grip on my arm. “Hey, I’ve got your student,” he says as he pushes his way inside. 

Shirley’s standing at the bedside, her meaty arms locked and pulsing down on the patient’s chest. She glances up disdainfully, then looks at the respiratory therapist squeezing the Ambu bag. “Okay?” she says. 

“Okay. You tired? Broke some ribs there.” 

“I’m good.” The words are spoken separately, between breaths. An IV nurse is crouched at the patient’s opposite side, securing a catheter. Someone else holds a bag of saline. I stand useless, my legs frozen, trying to remember anything I’ve learned.

“Still no pulse,” the IV nurse says, and circles around to Shirley, whose face is flushed alarmingly and sheened in sweat. “Shirley,” he says. “I’ll take over.” She jerks her head no, eyes wide and fixed, arms still pumping.

“I’m not asking,” he says, laying a hand on her shoulder. “You’re getting tired.”

Shirley looks at him, startled, and then her expression peels away in rapid layers—anger, resolve, doubt, defeat. She steps aside and for a moment doesn’t seem to know what to do with her hands. Then she places them on the bed and balls the sheet into her fists. 

“Go wait for the paramedics,” she says to no one in particular, and I turn and walk out of the room. I walk swiftly, ignoring the stares of patients poking out of their doorways, their curiosity searing my cheeks.

I’m perfect for greeting the paramedics because I can tell them everything about this patient:

Room 256: Sixty-two-year-old white female, status post motor vehicle accident approximately six months ago. Patient is in a vegetative state, has a #6 Shiley tracheostomy tube, replaced yesterday with minimal bleeding. She was sideswiped by a texting driver and flung into oncoming traffic. Her mother died of heart failure at sixty-five. Patient has a history of coronary artery disease, hypertension, obesity, diabetes. Married forty-two years, spouse supportive, visits on weekends. Home medications include Synthroid 100 micrograms q.d. for hypothyroidism and Lisinopril 10 mg q.d. for blood pressure. Two pregnancies, no children. Has a 16 French 10 cc Foley catheter for neurogenic bladder and hospital-acquired stage III pressure ulcer to sacrum, being treated with Maxorb. Ran a successful catering business, specialized in wedding receptions. Has a few broken ribs.

At the doorway, I watch the fire truck roll to a stop. Beefy men and one pony-tailed woman saunter out, snap down a bariatric stretcher and make their way up the path. The burn in my cheeks grows hotter; I can tell them so many things, but there’s not enough time, and I don’t know which ones matter anymore.