Miss Pearl Smith

Pearl Smith did not trust a living soul. “Living” is an important distinction because her one surviving relative was a wicked, degenerate nephew, while her primary confidant was her late third husband with whom she regularly spoke and always consulted when faced with executive decisions. Pearl kept her shades drawn and lights out at every hour so that she might observe the drama of the hallway, as one sits in a theater, as a safe and anonymous spectator. She hid in the recesses of room twenty-four, shielding herself from the world with a single faded sheet that was stamped with a factory bar code and the Vanderbilt hospital logo. She twisted the sheet around and around her tiny frame, bunching the last handful of fabric under her chin with a dainty, polished, and vice-like grip. She would crane her neck up and out of this shell when something piqued her interest, or quickly retreat when spooked or annoyed. This habit, along with a pair of crooked, oversized bifocals, which elevated her eyes like antennae, caused me to always think of her as a cranky garden snail.

As is often the case in my profession, I met Pearl during the most tragic period of her life. Her nephew had manipulated a judge into ruling her senile and incompetent in order to take control of her estate. Once named power of attorney, he sold her home of sixty-five years, pocketed the cash, and abandoned her on the doorsteps of the Emergency Department. The subsequent legal and logistical chaos that ensued is far too convoluted to discuss here, although the fact that she remained in room twenty-four for over two hundred days offers some insight.

She was not ill, except for understandable bouts of nervous stomach, and she was not senile, except that her quirks could faze even the most seasoned of nurses. Therefore, caring for her mainly consisted of waiting with her, in the dark, for answers from the interminable parade of lawyers, risk managers and psychological evaluators who invaded her space each day.

I greeted her warmly on the first morning of our acquaintance, telling her my name and asking if I could bring her anything right away.

“I a’int having no student! Look at that baby face. Get outta here, Child.”

“Oh, I’m not a student, Miss Smith. I’m a registered nurse. Look, see? Here’s my badge.”

“What kind of school lets out such a baby? How old are you?”

“I’m twenty-three. I graduated from the University of Virginia School of Nursing in 2012.”

“Hmm, Charlottesville,” she considered while smacking her dentures. “How long you been workin’ here for?”

“Over two years now.”

“Hmmph, then go on and bring me a black coffee with six sugars! And two stirrers, Baby Nurse. And don’t be brining me none of that dern stuff for the diabetics. I a’int got no diabetes.”

“Yes, ma’am. Right away.”

Sugar is the catalyst for affection with Southern women. I promptly returned with precisely six packs of Domino sugar, two stirrers, and a freshly brewed cup of coffee. Therefore, unlike the many unsuspecting staff members who were fired before me, I had passed the first round of interviewing.

*

A collection of feminine bottles sat on Pearl’s bedside table. They were the focal point of the room, drawing one’s attention away from the stained wallpaper and the precarious, uneven ceiling panels. Periodically, she would reach over and admire the decorative bottle tops, making subtle changes to their arrangement. She kept a bottle of Fracas by Robert Piguet (complete with gold tassel), a curved genie-like bottle filled with lavender oil, the obligatory tub of cold cream, and various colorful eye and neck serums, her “little fountains of youth.” They were the last survivors of her material world, the modest remaining proof of her individuality. Of course, there was also the pleather purse hidden under her pillow, but it did not contain valuables or pictures of smiling relatives. Rather, it held crumbs, peppermint lifesavers and balled-up business cards from the gaggle of lawyers she encountered each day.

On the morning we met, I could hear the bated urgency in her voice when she ordered me to bring her a bath over the call-light system.

It was ten a.m. On this hour, unexpected tasks could alter the course of an entire day, with dire consequences. During this vital window, I could allot precisely ten minutes to each of my acutely ill patients—sixty minutes divided between six rooms. I needed to perform assessments, turn bedridden patients, help the others into their chairs, complete wound care, administer small mountains of medications, and participate in medical rounds for each person. Of course, if a patient’s status became critical, ten o’clock would wait. But, “the ten a.m. pass” was essential for establishing the framework of the day and intercepting disasters, which seemed to lurk around 11:30.

Normally, a bath request would be postponed, but the emotion in her voice reordered my priorities. Underneath the barked order, she begged for a moment of control, for the morning ceremony that once made her a lady, rather than a patient. At 10:32, I brought her two basins filled with warm water and a pile of clean linens.

“What took you so long? I have been calling since 10:02. Y’all forget that healthcare is a service.  Dawdling is not a part of customer service.”

“I’m so sorry, Miss Smith. I was caught up helping a confused man down the hall.”

“I guess that’s something—I could hear someone talkin’ outta his head. It’s that most a’ these nurses, they sit and gossip or go off and smoke their cigarettes. They leave you pressing the call button like a fool.”

“Well, a real nurse should never smoke. And the good ones rarely sit. How’s this water?”

“Oh! Like ice! Ugh!”

“Ok, I’ll dump some and add more hot water. I’m the same way. I like it piping too.”

“It’s gotta have steam coming off it, Child, to kill the bacteria. You should know that spending all your time in a hospital.”

“Oh, I agree. My grandma says the same thing. She worked in one of the Catholic hospitals in New York before she got married. The nuns were so strict back then! The rooms had to be ice cold and the bath water had to be steaming.”

“I bet she wore a nice white uniform. That’s what y’all are missing nowadays is discipline. This fool came in here yesterday claiming he’s a medical doctor. He was wearing a university jacket! I said ‘you wouldn’t wear that to your mother’s dinner table, what makes you think you can wear it while you put your hands on me!’”

“That’s just terrible.”

“They’re all boys these day. The men are gone—You married?”

“No, not yet.”

“You best be looking. This is no place for a young lady.”

“I am. Just looking for the right one.”

“Well don’t get any fatter. That’s important. Make sure you eat lots of fruit, ’specially watermelon. It pulls off the fat when it passes through the system.”

“Oh, that’s good advice, and I like watermelon. All right, this should be the correct temperature now. Can I help you with your gown?”

“Do I look like a cripple to you? I can take off my own clothes. Go on and give out the rest of those pills to all ’em sick people. I’ll call you when I’m through. Here, put these on the window ’fore you go.” She whipped off her wig and popped out her dentures. I set down a clean towel and laid them carefully on the windowsill.

“Alright, just call when you’re through. I’ll be right in this area.”

“Well, go on!”

“Yes, ma’am.”

I looked back over my shoulder as I left the room. She opened the lavender oil and closed her eyes to breathe in the scent. She then poured sparing drops over her hands, forearms, and into the bath water. She turned the water round and round, mixing in the sweet smell, and allowing the steam to rise up onto her face. I made sure to shut the door after myself, muffling the hall sounds, and closing off her private world.

*

Days turned into weeks and months, but they were measured in seconds and minutes for Pearl because the large digital clock over the nurse’s station hung in her direct line of vision. The scenes that unfolded beneath it were her only source of entertainment. She decided to call her program, “The Days of Y’all’s Lives!” and then laughed at her cleverness.

One morning, I stood near the left side of the nurse’s station to listen to report on my group of patients. Peter, a night shift nurse, gave report on his patients near the right side of the station. When I had completed my notes, I collected Miss Smith’s coffee and the package of watermelon I had brought her (daily peace offerings were no longer required, but had become an excuse to start the day off with the kooky conversations that I had begun looking forward to).

“I saw that.”

“What’s that, Miss Smith?”

“I saw you and Blue Eyes over there.”

“Oh, Blue Eyes?” I knew what she meant.

“You and that Sinatra lookin’ boy. Don’t blush, child. He looked right back when you turned away.”

“Oh, Peter? No, he’s just a . . .”

Mr. Wilson, who was taking his breakfast in the hall, completed my thought, “STRANGER IN THE NIGHT! EXCHANGING GLANCES! WONDERIN’ IN THE NIGHT! WHAT WERE THE CHANCES?”

“Mr. Wilson, no! He’ll hear you.”

“Quiet, you!

“Pearl’s got you, Baby. I’ll take care of it.”

“Miss Smith—”

“He’s young! You’re young! What’s the problem? Leave the watermelon and get on with your business.”

*

She wasted no time. Later that morning, her team crowded into the narrow room for rounds. Dr. Vadas, the attending physician and head of our department assumed his central position at the foot of her bed. His Hungarian directness contrasted sharply with the Tennessee way of taking meandering strolls around the point. Family members often interpreted this as arrogance, but our female patients tended to forgive his bedside manner with remarks like, “Oh, he is such an intelligent man.” His commanding manner and large shoulders had an uncanny flustering effect on them, causing one woman to require a Xanax each morning in anticipation of rounds. Of course, no one could fluster Miss Smith, although the fact that he would habitually turn on the lights irritated her to no end.

“Turn off the dern lights! There’s no consideration with these doctors! It’s all about them.”

“How am I supposed to perform an assessment with the lights off?”

“You’re the only one around here who’s got a problem with it.”

“I have no problem.”

The last members of the team squeezed together so the door could close. As the primary nurse, I stood at my workstation by the head of her bed. Once the hum of conversations quieted, I began presenting her clinical overview.

“This is Miss Smith. She is currently awaiting placement in the community. She has a history of hypertension—”

“Ey! Smartass! Keep your eyes up where they belong. She’s being set up with the Sinatra boy.”

Dumbstruck, I looked up from my papers, searching the room for an explanation. My audience collectively held its breath. Dear Lord, please let the smartass be anyone but the married head of our department.

“She’s too good for you anyway.” Oh God.

“We are all listening to the report, Miss Smith. Nurse Rose, please continue.”

I finished my report with scarlet cheeks and did not breathe again until the team left. Fortunately, we were a group of professionals highly practiced in the art of responding to awkward outbursts. In fact, the only time someone conceded discomfort was the morning Mrs. Katz arbitrarily called Dr. Weisler a Nazi and fired him on the spot. In this case, business carried on without a hitch as the group discussed possible long-term living facilities for Miss Smith’s placement.

I shuffled out after them but made a detour to the linen closet where I could take deep, cleansing breaths and compose myself.

My good friend, Bobby jumped up from the desk to follow behind me.

“Hiding?”

“Miss Smith.”

“Tequila? Oh sorry, all we have is Red Jell-O. Red Jell-O?”

“Thanks.”

“Red Jell-O to match your cheeks, Rosie.”

“Oh no.”

“I had no idea Dr. Vadas was such a playboy. Think he’d look my way?”

“You heard that, huh?”

“Highlight of my day.”

“Did Muriel hear?”

“Mouth o’ the South? No, the damage was contained.”

“Well, at least there’s that.”

Our pagers sounded simultaneously, “Doesn’t Patsy know we’re hiding?”

Stop Hiding. Rm 13: Nausea. Rm 20: Wound Care. Rm 30: Family Q’s.

“I’ll get started. Finish your snack, Sugar.”

*

That night Peter just happened to be assigned to each of my patients. At the end of my shift, we would need to sit together for a length of time to exchange reports. This would have been a lucky coincidence, had it not been for the unflattering trail of bile splattered across my scrub top. I had also been spat on, had skipped lunch and was shaky from too much caffeine.

I finished my final task at 6:38 p.m., two minutes before shift change. Two whole minutes! Enough time to eat a Snickers and wash my face. I made a bee-line towards my locker, arriving inches away from glorious snacks. However, the sudden cacophony of crashing metal and screams caused me to turn back immediately. A man weighing over five hundred pounds had gone into cardiac arrest while walking with his physical therapist. The fact that he had collapsed in the hall complicated the situation gravely. The entire staff gathered around and worked together to heave him up onto a stretcher.

Our department had many flaws: miserable funding, obscure location, apathetic management, dilapidated equipment. But at the end of the day, we leaned on each other and stood by each other. Not one of us would leave the scene until it had been resolved, for better or worse. We sprang into action; each assuming a task or responsibility that required attention, and which, on a typical unit, would likely fall to one nurse. Many hands make light work and spare precious milliseconds that determine life or death. With vigorous chest compressions, oxygenation, and numerous anti-arrhythmic drugs, the patient returned to us after spending seven minutes on the other side.  However, a full hour passed before he was stable enough for us to safely cheer and welcome the poor disoriented soul back to earth.

He would need to be transported to the Intensive Care Unit for monitoring over night. The ICU was located over a mile away (a unit feature that often required us to execute scenes such as this without support from physicians or modern equipment). Therefore, an unhappy pair would have to volunteer to make the long journey.

“Rose, Peter, transport! Give report in the tunnel,” commanded Bruce, our ex-military charge nurse.

The rest of the staff had already dispersed, hitting the ground running to make up for the late start. The disrupted schedule meant that there would be no sleep for the patients and dangerous work ahead for the nurses: we were already short-staffed and over-crowded with delirium, traumatic brain injury and detox patients who become most agitated after dark.

“It’s a full moon tonight,” said Peter as he unlocked the bed and took hold of the heavier end.

“I should have known! It’s been bedlam since sundown.” It is a truth demonstrated time and again in hospitals the world over: Full moons bring pandemonium.

We stood waiting outside of the elevator with IV poles and monitoring equipment in tow. I rested the bulky chart on my hip while watching the floor numbers change above the door. I should have been more attentive because a sweet granny by day had become a creature of the night and had crept up behind me. She smacked the chart to the floor and grabbed me by the wrist.

“I’ll cut you! I’ll cut you right here!”

“I see what you mean—Mrs. Roberts, you’re at Vanderbilt Hospital. Here, let go of Nurse Rose and hold on to me. You’re safe. I’m going to bring you to your room, alright?”

I held the elevator open much to the chagrin of the hurried cardiologists on board. He returned, and we made the long, winding trip with patient, bed, and equipment through the underground tunnels leading to the main hospital. I could hardly form a sentence due to exhaustion by the time we completed the hand-off.

It was almost nine p.m. when we reached the elevator passage beneath our building. I fought heavy eyelids while he read over his report notes.

“Hey, this might help you cross the finish line.”

He tapped my shoulder with something cold. He had produced an icy carton of chocolate milk from one of his oversized scrub pockets.

“Chocolate milk! Where’d this come from?”

“I stole it. From the ICU.”

“You stole chocolate milk just for me? Thank you!”

“You’re welcome.”

We rode up to the unit in silence, except for my milk carton noises. The doors finally opened and we began to part ways.

“Ok, have a good night. Thanks for the chocolate milk!”

“No problem—Oh, by the way, ah, some of us are getting dinner—I mean breakfast at Noshville tonight—I mean tomorrow morning. You should come if you’re not working again.”

“Oh, sure. That sounds fun.”

“Alright. Good. Well, I’ll see you then.”

As I collected my coat from the closet behind the nurse’s station, I could hear one voice above all the others, “Mhhmm, Pearl knows! Pearl’s got ya, Baby.”