The Premonition

     In which the author was notified in a dream about an alarming situation…

     Several years ago I rather impulsively took a job in another county working in what can briefly be described as an orphanage for special needs children.  The grounds were bucolic, some of the buildings were pre-war and people said a ghost haunted it. So of course I had to work there.  As an outgoing nurse oriented me she warned me that the institution had a deeply ingrained culture, and not to waste my time trying to change anything. I assured her I had no “steam- roller” intentions, I was going to be a worker, not a manager or supervisor. I was all about Nursing 101, nothing revolutionary. I was soon to find out that I had entered, as Jerry Seinfeld once said: “ bizarro world.”

     The nurses’ office had 3 desks and one was occupied by a giant stuffed Tweety Bird.  When I suggested a better use of that space at least two people started crying and said we could never, ever get rid of Tweety Bird. Okay, I knew what I was in for and from the first day tried to tread very carefully.

     Soon we had a new admission, a 12 year old girl with cerebral palsy whose foster mom could no longer physically lift her. She tearfully gave her to us and we assured her she would be safe. “ Ariana” had limited speech and needed to be fed through a stomach tube. That was a process that could not be rushed and someone had to be with her the whole time as she had uncontrolled movements and might dislodge the tube. We often sang songs during the feeding and tried to pass the time as pleasantly as possible. Ariana adapted quickly and became one of my favorites.

     The staff was a very disparate group, many stole food and clothes meant for the kids and an equal number brought in quality food and clothes. Some had college degrees and others  were functionally illiterate. A new part time night nurse joined the staff and I had never met a nurse like her before.  Her main, day job was in a prison.

     In nursing lore we make generalizations about our colleagues such as  emergency nurses are quick thinkers and like excitement; hospice nurses can tend to be spiritual; and some psych nurses, with their deep empathy, almost seem to absorb their patients’ depression.  I had never known a prison nurse.

     “Margaret” (and I give her that name because I know she would hate it), was casually foul mouthed and borderline hostile.  I thought maybe she was like that because of her usual clientele, maybe it was a form of self defense. Some people don’t like others to know they care and put up a front, we call them: “rough, tough cream puffs.”

     I started noticing that it appeared she was not giving the kids their prescribed medications. The pills were on a punch card and I kept a careful inventory of all of them.  When “Shari” began seizing more often I questioned Margaret directly about it. She said that tegretal was not a controlled substance (needing to be officially counted every shift) and that I was mistaken.  I tried to give her the benefit of the doubt as I knew that Shari had been on many different anti-seizure drugs but her brain was determined to have electrical storms no matter what. But Margaret knew I was watching and her hostility became overt.

     Once I tried explaining that certain timed released meds could not be crushed as it was akin to giving someone a drug overdose.  It was suggested that I take my “ hospital R.N. attitude” and hit the road. Another time I tried to implement, as diplomatically as possible, a policy of not giving some cold medications to kids on particular anti-seizure meds due to a harmful interaction and this, too met with great resistance.

     This was a place where staff meetings often had people screaming, crying, and slamming doors. This was a place where, if you had a special way with the kids and they listened to you, you might be accused of using voodoo on them. This was a place unlike anything I had ever seen.

     I was cautioned that I might be physically attacked if I wrote anyone up.  I only did that once.  An aide had left a young lady resident naked on her bed while a construction crew was outside her window.  When I told the aide that  this was wrong her reply was, “ She’s blind, she doesn’t know what’s going on.”  If you have to explain to someone why this is wrong, clearly they do not belong in that profession.

     Finally my mind was made up for me about Margaret.  I spent one long night dreaming that nobody was feeding Ariana.  I showed up at work exhausted and told my fellow nurses of my nightmares.  Margaret spoke up saying: “ I never feed that girl, she scares me.” That was it for me, I reported her to administration and she was fired.

     Many people were furious with me, but I knew Margaret had a good, full time, civil service job.  Eventually a new nurse manager was hired and was able to make some meaningful changes such as more staff accountability, especially with the medications. Tweety Bird was moved, but still retained a place of honor. The funny thing was that nobody knew his origin or exactly what he meant, only that they were deeply attached.   And I, like LeBron James, decided to “take my talents” elsewhere.