Shift Change

Karen was married twice: to Stephen, the first love who widowed her when she was 26, and then, to her job.

She had only recently become an LVN and was on the floor the night they brought Stephen in. She wasn’t even originally on the schedule, but at the last minute, Nancy Anders came down with the flu and Karen agreed to cover her shift. She would be forever grateful for that. The idea that she was almost not there when Stephen passed could still drive the bile up into her throat if she dwelled on it for too long. No one should have to die in front of strangers.

After that, she went on to become an RN and the kind of nurse who knew that she would one day die on her feet. (Nurses think about their feet a lot). In a happy, hopeful way, Karen looked forward to that day. Sometimes she imagined something as simple as a massive coronary in the middle of her shift; other times, she imagined a massive coronary (it was always a massive coronary) while exerting herself in some complicated acrobatics to save someone else’s life. She hoped it would be a child, or a pregnant woman, or a priest. It gave her a little smile. Stephen would be so proud.

Though, she knew he was already proud of her. He told her almost every day. Back when she was taking nursing classes at the technical college and she’d think about quitting because it was so hard, he promised her that if she stuck to it and became a nurse, he would listen to her stories and rub her feet every night.

“I’m sorry I couldn’t keep that promise completely,” he told her three days after he died. “But I can still listen to your stories every night.”

And he did. She loved him for it. She let her friends think whatever they wanted to think about why she had no interest in remarrying.

Karen’s hospital, Our Lady of Mercy, which was definitely not the one in the Bronx, served a handful of rural counties at least 200 miles away from anything resembling an even somewhat large city. The modest building housed all the services one might need in an emergency or for general well-being, but it wasn’t the best option for long-term survival. Thus, it was affectionately known as Our Lady of The Sticks. At one time or another and at multiple times, Karen had performed every kind of nursing duty in every kind of context. Of course, the most exciting duties where those in which she stood at the margins of life and death: someone coming into the world and someone going out.

While she liked obstetrics alright, she didn’t prefer it. It wasn’t that there wasn’t enough drama in birth, but that she felt less needed in that situation. The baby and its mother were usually surrounded by cheerleading family members. And if they weren’t, at least they had each other. Instead, Karen enjoyed those high-intensity situations pregnant with panic. She wanted to be the calm voice, the eyes to look into, the hand to squeeze. That’s when she felt she was at her best.

Mostly, she got on well with her coworkers; but, like most nurses, she had little patience for doctors with poor bedside manners. In particular, Dr. Sorenson irked Karen. She hated the way that he never looked up from his clipboard when he was talking to a patient. He never addressed them by their names. He was dismissive of their concerns and questions. He was unmoved by their gratitude. Sorenson was callous and dispassionate, and that was to say nothing of how he treated staff.

“It’s not healthy to learn their names, Sharon,” Sorenson would snap while deliberately calling her by the wrong name. “If you had gone to medical school, they would have taught you properly not to get too attached. They’re patients. We’re doctors. It’s just our job. Boundaries.” The last word was his favorite and he always hammered it with grave finality.

While Karen loathed his company, she didn’t mind her shifts with him because she felt she could balance out the patient’s experience. The more he ignored a patient, the more Karen fussed over them.

Karen was the only one by his side when Sorenson, 52, died. Sepsis following an emergency gallbladder surgery. She wasn’t his nurse that day, but she was on duty. She went to his room, mopped his forehead and pulled a chair up by his bed. She watched as his eyes searched for understanding, darting around the room, looking for anything. So, she let him stare into her blue eyes and squeeze her thin hand. He let out a long sigh and his panic evaporated.

“That was so kind of you,” Stephen said that night. “You didn’t have to do that. He didn’t really deserve it.”

“I know,” she said, “But everyone deserves a good death. And he was alone.”

One spring night, when the rivers were flooding, Mr. Schafer, 73, was nearing his last breath and he understood it. Undiagnosed lung cancer mistaken for pneumonia. In his eyes, Karen didn’t see fear, but remorse and longing.

“My daughter,” he repeated again and again among other delirious ramblings.

While the doctors focused on palliative care, Karen grasped at every resource to reach his daughter and summon her. It took several hours to connect with Natalie Schafer-Smith and it would be several more before the daughter could make it through the floodwaters to the hospital.

When Mr. Schafer’s rattling breath finally stopped, Karen, in defiance of an order to not attempt CPR, resuscitated Mr. Schafer so that he could survive just long enough for his daughter to arrive. She was not reprimanded because the doctor never found out.

“Thank you,” Natalie sobbed into Karen’s shoulder when her father’s struggle was over.

“That was risky,” Stephen beamed. “But you’re an angel.”

Karen drifted off into a warm slumber, dreaming of the massive coronary that would reunite her with her truest love. She always hoped it would be a heart attack because she thought it was the quickest, most merciful way to go – and she had seen so many ways to go.

Jacob Warren was 27 when he overdosed on opiates outside an all-night diner. Karen was 61. He was indigent. They guessed he must have run away from home a long time ago. They searched vainly for the next-of-kin while the gentle hum of the ventilator kept him on this side of life. As Karen tended to him, she was overwhelmed by the churn of emotions that threatened to drown her. The man, a child in her eyes, looked just like Stephen had looked 35 years ago. He could have been the son they never had together. She wanted to hold him, but she knew it was wrong. She wanted both to mother him and to kiss him lightly on the lips in an unmotherly way. A part of her wanted to walk away from him. But when it became increasingly unlikely he would survive, she couldn’t bear the thought of leaving him alone.

At shift change, she refused to go home. Jacob Warren lingered, and so did she.

Soon, the search for family members would be declared over and decisions would be made.

It was now her “weekend,” a Wednesday, but she sat vigil. She could hear the whispers in the hallway and she knew they weren’t for Jacob. Dr. Jenkins, the psychologist, drew her into the hall to ask her if she had gone home or if she had slept. She asked her if there was anything she’d like to talk about. Karen shrugged her away and Dr. Jenkins scurried back to the chorus well-meaning whispers from her co-workers. Karen knew she’d be ordered home, and she couldn’t not be there when Jacob died. He would need someone. She had to act quickly.

She collected herself and splashed some water on her face from one of the many nearby sinks and hurried after Dr. Jenkins.

“I’m sorry,” she said. “You’re right. I need to go home. Jacob, err, the patient, reminded me of someone I care about and I’ve been pulling long shifts recently, so I’m not thinking straight. I’m fine. Just distracted.”

Dr. Jenkins relaxed and concern lifted from her brows. “Glad to hear it. Go enjoy your weekend.”

When Dr. Jenkins was out of sight and when the crowd of onlookers had gone back to their duties, Karen, charge nurse, went back to Jacob. She disabled the alerts on his monitors. She held his hand and brushed back his sandy hair. She kissed him lightly on the cheek. She turned off the ventilator.

Jacob Warren opened his eyes for the first and last time. In that space between a heartbeat and one that never came, he stared icily into Karen’s blue eyes. It filled her with a grotesque coldness she couldn’t understand.

She recovered quickly enough to cycle on the machine and reset the alerts. She darted out of the room before she could be discovered and the Code Blue was sounded. She ran to the restroom and vomited. Icy sweat pricked at her skin.

That night, Stephen did not come to visit her, but someone else did.

As she wept quietly, Jacob, now looking less like Stephen and more like a wraith, appeared at the edge of her bed.

“I had been waiting for you for a long time,” The Wraith rasped.

“Where’s Stephen?”

“Stephen can’t see you anymore. After tonight, he has finally reached the other side. But he wants you to know that he is thankful for the journey. He wanted me to tell you goodbye.”

“I will go to him.” She held back her breath and tried to will her heart to stop.

The Wraith shook his head.

“No. You’ll not step foot on those banks for a very, very long time. You’re too good at your job.”

“Not anymore. I did something horrible. I can’t. I can’t go back there.”

“You won’t. You’ll move on to the job you were meant to do from the beginning. It’s your calling.”

Confusion and anger rose like a tide overtaking Karen. She braced herself. “Let this be the moment!’ she screamed in her mind. “This is the moment I want to die.”

The Wraith, reading her thoughts, solemnly shook his head.

“No one should die alone, Karen. So, you won’t. I’m sorry. I’m so, so sorry. You were the kindest kind of woman. You helped so many people cross over to me and then I helped them with the last crossing. And finally, you helped me cross. I’ve been waiting for you to free me for so very long. It’s your turn, now. I’m sorry to repay your kindness this way. But your kindness does come at a price.”

“What?”

“This.”

The Wraith leaned over her and brushed back her dark hair. She was astonished at the touch. Stephen had never been able to touch her all those years. He picked up her thin hand in his own and when he did, it turned to bone. He squeezed her hand tightly.

When he let go, her hand held two gold coins and her own wedding ring.

“Goodbye, Karen,” he smiled.