For a quick synopsis of ìThe Shiftî you only need to read its subtitle: ìOne nurse, twelve hours, four patientsí lives.î Few of us experience a 12-hour period packed with endless tasks that must be executed amid a cauldron of emotions. Added to the stress is the knowledge that even an infinitesimal mistake could mean the difference between life and death for those in your care. This is what many in the medical profession face on a daily basis. Clinical nurse/author, Theresa Brown, is one of them. She works on an oncology ward at a teaching hospital in Pittsburg, Pennsylvania. Before embarking on her nursing career, Brown was an English professor at Tufts University. Combining both careers, she has created an outstanding account of a ìday-in-the-lifeî of an oncology nurse. This book is a real eye opener! Youíll gain a whole new respect for those who work tirelessly to improve our health. But I think ìThe Shiftî should come with its own medical warning label, because I have never read another nonfiction work that filled me with such anxiety. Would her four patients still be alive by the end of day? Nurses were once charged with taking care of their patientsí basic needs ñ- not any more. Now, they must understand a multitude of laws, be technological wizards, coding experts, psychologists; and, at times, mind readers. But Brown isnít complaining; she loves her work. What she provides in ìThe Shiftî is a first-person account of how a hospital functions, as everyone from medical specialists to the cleaning crew scrambles to extend the lives of their patients. Brownís day begins in the wee hours of the morning, before her children or husband are even out of bed. A brisk bike ride to the hospital ìmellows my pre-work unease,î she writes. Once she enters the ward, there is no room for doubts — she must exude confidence. Packing the pockets of her scrubs with the tools of her trade, she then reviews the medical data for the three patients assigned to her — a fourth will be added later in the day. To a lay person, that appears to be an easy caseload, until Brown fills in the details. Throughout the day, she will assist others in medical procedures that may be as simple as double-checking another nurseís math, or as stressful as resuscitating a patient. Today, Brownís patients are Richard Hampton, Dorothy Webb and Shelia Field. Hampton, ìa lymphoma patient in his late seventies,î is new to the ward. Webb, a woman in her 50s, is nearing the end of her six-week treatment for leukemia. All the nurses adore Webb because she has a pleasant personality and keeps a well-packed candy bowl on hand to sweeten up the staff. ìShelia Field, my third patient, is a wild card,î Brown writes. Technically, Field doesnít have cancer. She is plagued by a blood clotting disorder, ìantiphospholipid antibody syndrome,î an autoimmune disease. Before checking on her patients, Brown glances at the white board located in the nursesí station. It is divided into sections, one for each room. Under ìPrivacy Laws,î only the first three letters of a patientís last name may be listed on this board. Personally, I find that worrisome, especially since my name would be displayed as ìHAR,î which could stand for Hare, Hart, Harris, Harrison, etc. Fortunately for Brown, there is little chance of making a mistake because she works on a ward with nothing but private rooms. But it is one illustration of how some government regulations might cause more harm than good. Next, the board lists the name of the attending physician, who is ìultimately responsibleî for the patient. Yet, with the exception of morning rounds, most attending physicians spend little time on the ward. Should a problem arise, medical decisions will be made by ìinterns, residents, nurse practitioners and physician assistants.î Brown explains the duties performed by each of these; nurse practitioners and physician assistants share many of the responsibilities of full-fledged doctors, while receiving far less compensation. And, in Brownís opinion, ìinpatient care would collapse without them.î Brown spends about 90 minutes checking laboratory results and doctorsí orders before actually seeing a patient. While viewing the data, an intern informs her that Mr. Hampton will be receiving ìRituxan today.î She finds the news disturbing because of Hamptonís age and frailty. The drug activates a patientís immune system, but also contains a ìBlack Boxî warning that includes death as a side effect. Yet, it is Brownís responsibility to administer the drug and closely monitor Hamptonís vital signs every 15 minutes in case anything goes wrong. She wonders, ìWill I kill this patient today or heal him?î This is not an uncommon question when treating those with lethal diseases, because the individual response to a potentially toxic treatment is unknowable. As she enters Hamptonís room, Brownís fears increase. He is ìold, frail, short of breathî and barely conscious. Leaving him to sleep, she responds to a call for help from Fieldís room. ìSheís having abdominal pain,î Brown tells Yong Sun, ìan MD specializing in cancer.î He appears baffled, so Brown ìhelps outî by suggesting a pain medication. However, both doctor and nurse miss a vital clue associated with Fieldís pain that will complicate her future recovery. At the same time, Webbís call button is chiming. She is upset because she didnít received her Prilosec before her breakfast tray arrived. Supplying heartburn medication is not a top priority for the medical staff, but it is to Webb. The Rituxan drip for Hampton has now been started; so far so good. But Fieldís condition has deteriorated; she needs a CT scan — STAT! Moving a patient in extreme pain requires time, meaning Brown doesnít get to monitor Hamptonís vitals as often as she should. While all this is going on, Brownís fourth patient, Candace Moore, is admitted. She will be receiving ìan intravenous infusion of her own (cancer-free) cells,î to combat leukemia. While this procedure is safer than receiving donated stem cells, it isnít risk-free. Moore is known throughout the oncology ward for being the ìpatient from hell.î She is a nit-picking, germophobic woman, who has a low opinion of the staff. She enters the hospital with her own Clorox wipes and a team of relatives to help disinfect her room. Immediately, she is demanding a new shower curtain, and the replacement of an IV line she ìbelievesî isnít properly functioning. Webbís and Mooreís needs seem petty in comparison to Brownís other patients, but each must be addressed. Read the authorís comments about Mooreís behavior. While the staff understands her concern about germs, they just wish she could be a little nicer. None of the patientsí conditions will be resolved by the end of Brownís shift, but she does provide an update in the last chapter, ìKnowing the Future.î An oncology nurseís favorite phrase is, ìI hope I never see you here again.î These are dedicated professionals who make the sacrifices necessary in order to keep us alive. Read ìThe Shift.î Then go out and hug a nurse!
