Narc Nurse

One of the nurses on shift is a narcotics thief. It's not a secret. Five weeks ago, IT had finally managed to synchronize the logs between the medication dispensary and the patient charts. They uncovered months of irregularities between drugs pulled versus administered.

Someone was taking pain killers out under the patient names, but those same patients, many who denied ever complaining of pain, never received them.

And it isn't camaraderie shielding the perpetrator from justice. No, our team, once the only thing that made this job doable, has dwindled into the same painful stiltedness that used to define my childhood. Hours spent in the cafeteria after school waiting on my parents, putting together old, flaking puzzles and playing hand-me-down board games from 20 years ago. Silence as claustrophobic as the flannel sheets and down comforters that stayed on my bed well into summer because there hadn't been time to find a new house cleaner when the other left mid spring. It's now equally miserable at the nurses' station where we used to raid the candy drawer, finding each other's favorites, and placing them at the computer each Reese's lover, Kit Kat enthusiast, or M&M fan had claimed for the night.

We don't even have a candy drawer anymore. No one wants to buy chocolate for someone who might be a drug thief. So, it's not our allegiance to one another protecting the thief. It's only because of corner cutting that management can't pinpoint the culprit. Too many nurses relied on the auto-logout function of the Pyxis, leaving their accounts wide open for the withdrawal of large quantities of controlled substances. Oxycodone, Hydrocodone, Morphine, Dilaudid.

The few nurses who had no ambiguity surrounding their Pyxis withdrawal records were made into narc nurses. Their exclusive role on the unit now the maintenance of scheduled drug regimens.

I'm one of them, thanks to having the flu and being on sick leave during a significant uptick in the disappearance of medications from the system. And now, after the buzz of the news and buoyancy of management's vote of confidence, it's lonely. The reasons for coming back each night are getting harder to come by. Money seems to be the only one left. But despite my seven-year plan for my student loans, despite the fact that Prime Day is coming and I want a new e-reader, that the rent on my apartment is supposed to go up again in accordance with housing inflation, it's not enough.

And it's sure as shit not the joy of medicating the entire unit. Without even trying to fake a smile for customer's service's sake, I hand a cup with a half-moon Oxy to Room 23. Room 23 is a frequent flyer whose visits mean wound care and strict pain regimens until we discharge her back to the streets, where she immediately returns to injecting meth with dirty needles. It doesn't matter how much I like her, it's still frustrating to see her name on the assignment sheets every few months.

Nathan, her nurse tonight, has no qualms about showing annoyance. His resting bitch face is even more aggressive than usual. "Show your tongue," he says, making sure 23 didn't pocket the pill. She cheeked her meds the last admission, then overdosed, coding halfway through wound care.

"You all good in here?" I ask him.

"Do you have time to grab her antibiotics for me?"

I dig my clogs into the laminate flooring, rocking back as I glance at the clock. "Umm." I could probably grab them before medicating 11 again, but I don't want to give Nathan the option of one of his famous disappearing acts.

He sighs. As if he's the only put upon nurse in this entire establishment. "Thanks for the help." The sarcasm practically drips, and I roll my eyes, readying for his usual follow-up about women. Or even better, straight to estrogen complaints. As if his testosterone has made him any more efficient or capable.

We're saved from toeing that human-resources line by my work phone.

"I need to get this," I say. And, because I can't help myself: "Good thing it's only narcotics you can't pull."

I angle myself toward 23. "I'll be back with your IV pain meds soon."

She nods, picking at the edges of one of the marshmallow gauze mounds on her arm. Her specialty air mattress purrs as it waffles her from side-to-side, maintaining oxygen flow to dying skin.

Brushing the privacy curtain back, opening and closing the door, sanitizing on the way out, I answer my still ringing phone.

"Where are you?" Anita's voice grates, the huskiness always worse when she's stressed.

"Just finishing up in 23."

"11's losing his ever-loving mind. I need you in here now."

I power walk to the med room, elbows swinging. The hallway is a flurry of last-minute evening medication passes, vital sign carts clacking loudly against the faux wood as nurses drag them from their depot into rooms. The bladder scanner's bum wheel squeaks in frantic circles as the floater tech talks into her work phone.

I badge into the med room, but just as the lock light switches from red to green, Lauren opens the door from the inside. Normally, I'd give her my best, isn't-this-place-a-clusterfuck look, maybe talk some shit about Nathan if she has the extra minute. But her look of concentration stops me. "Everything okay?"

Lauren's workout band is in its usual place at the top of her forehead, her blonde braid as beautiful as ever. But her eyes are narrowed, her jaw tight. She's the one we all turn to when we need help. She oriented me when I was a new grad, becoming the sun to my every rotation around this unit. And it's as if she's blinked out. I feel the creep of darkness, as dark as the ride home from school each night when another pickup deadline was missed, and like I'm that lonely, confused kid all over again, I want to curl up and cry.

We can't go on like this.

"Are you here again tomorrow night? Want to go out for a drink after work?" I ask. That's one easy step toward finding a way back to what we had. When's the last time we did our last shift cheers? To drinking and not sinking.

"This is one of three. Sorry," Lauren says, double checking the medications she has in her hand against her to-do list.

I try another tactic. "I'm helping with 11, but then I should have a minute. You need something?"

"Only if you can take one of my patients." Lauren fake laughs. "I'm at seven."

"I wish I could."

"Sorry girl," says Lauren, motioning me past her to the Pyxis. "I've gotta run. I'm trying to get everyone else taken care of because 20 is a ticking time bomb. We've had a Rapid Response already, and he's one bad breath away from a code."

"Let me know what I can do."

She slips from view as I begin typing my username into the machine.

Minutes later, his medications in hand, I reach for the hand sanitizer beside Eleven's door and pump it twice before remembering whose room I'm entering. I flap my hands, encouraging it to dry so he won't smell the alcohol. His withdrawal is one of the worst I've seen, and any hint or whiff is liable to tip him over the edge. Voices raise inside. Hoping enough time has passed for the smell to evaporate, I enter the room.

It smells of urine and body order. To limit stimuli, the blinds are closed and the television is off, an anomaly in a hospital where the first thing a patient does is click on the local news or reality shows. A crucifix is anchored to the wall next to the clock, whose silent sliding secondhand is a reminder to all hospital workers that there aren't enough minutes in a shift. And they're slipping away.

11 stands tremulously at the bedside, Anita within arm's length of him.

"Sir—" she says, her voice more exasperated than frightened, "I need you to get back into bed." She glances from him to me, her glasses winking in the half light and short grey hair purpling in the near-dark.

11's body shakes. "I told you—" He steps past that line of appropriate personal space until he's nose-to-nose with Anita. "—to leave me alone."

"That's not an option." Anita doesn't flinch, her barrel-chest, straight-backed posture like that of a standing punching bag. She's always been one to take risks, fudging her charting to suit the situation and meeting the patients' aggression with her own, pushing back when shoved.

It's not best practice, but it's real. And goddam if it doesn't highlight just how far we all are from the lantern-holding, full-skirted nighttime prowls of old Florence. I'm just one more in a long line of people who joined the scrubbed ranks believing her lie about the holiness of wiping asses.

If we could ditch that solitary propaganda, get the team back together, just go out together again, all of us, as a unit—hell, I'd even invite Nathan at this point—we could laugh about it. The farts in faces while wiping. The burst ostomy bag. The patient who won't drink his juice until he's twirled it with his dick. The misery becomes somehow fun when unpacked later at the bar. With the people who just get it.

Anita's immune to my look of longing, which might register like sexual interest if she were to suddenly catch the way I'm watching her. That's how powerfully I need to feel like part of a team again—the desire is strong enough, it's becoming akin to horniness. I'd kill for an Anita swaddle right now, when it's nearly shift change and our eyes ache from exhaustion and she drapes warm blankets over our shoulders to help us chart our progress notes.

Anita doesn't spare me a single glance. She's focused on 11 still, who doesn't go in for the hit but instead, crumples into the older woman, as if she's his post and he, the exhausted boxer. "You can do this," she says, patting his back. "You've got to do it for those beautiful girls of yours. They need you to get off the booze."

I pull the computer desk down from the wall and begin to log the Ativan, a benzo used to limit the risks of alcohol withdrawal. "Scan him for me, please?" I hand Anita the scanner.

She angles it at 11's wristband and clicks. The room flashes with a red echo of the barcode read.

"Now, you're going to sit yourself back down." She guides 11 onto the bed. "And behave."

A moist sheen visible above her top lip, her hand shaking slightly, gives me pause. She's probably going through withdrawals herself. I know she's back to smoking again.

She holds a hand out, palm up. "I can give that to him if you're busy. It's no problem."

A lingering pause follows, then flares into something else. Engaging the doubt inside all of us that keeps us from putting the radio on after midnight, singing along to the current Top 100 hits and laughing at Anita when she complains about that rap garbage. Ribbing her with the lewder lyrics as we pass by in the hallway during 4:00 AM vitals.

I swallow. "I'm here. I'll do it."

Anita purses her lips and moves from the head of the bed to the bottom, where she resets the alarm that will trigger if 11 gets up.

As I approach the patient, she says, "You don't seriously think I'm the one, do you?"

I don't know. What I do know is we need to find whoever it is so we can go back to the way things were. "Of course, I don't think it's you."

Anita taps her foot, and I administer the Ativan, wondering what made someone decide to try this. What led to the thefts?

11's still shaking all over, but after I disengage the syringe, his face relaxes.

"That bought us maybe ten minutes," Anita says. Her own tremors seem more marked, and I think not for the first time the line between nurse and patient is precariously murky. We all begin to match each other after a while.

Ten minutes later, I'm not sure how 11's doing. Screams beckon me further down the hallway after I've gotten 23's IV pain killers ready. Nathan stands outside the room with his arms crossed, watch centered on his wrist and angled up as he switches from glaring at it to me. As if I'm the problem.

I'm not. But I'm going to find the solution. I pull up my scrub pants from where my stethoscope is dragging them down and jut my chin. "I got caught up in 11."

"I don't give a rat's ass about Room 11." Nathan uncrosses his arms and points to the door. "Do you hear her in there? If she doesn't let me get her wound care done, you're doing it. I've got five other patients, and I don't have time for this."

I reach for the hand-sanitizer. "Don't have time for your job? That's funny." This isn't helpful, but at least it's familiar. We've always been like this with each other.

Cupping the hand sanitizer in my palm, I brush past him, walking into the room alone. He doesn't follow me, so he's probably run off to wherever he goes when he stops answering his phone and no one can find him.

"I'm so, so sorry," I say, making a show of grabbing for the computer desk. Sanitizer leaves a slick sheen across the keyboard, and I mop at it, doing my best to hurry. "I know I'm late, but I'm here now. I've got your meds."

"The Dilaudid?" 23's voice cracks as she rocks in the bed, worrying at her nose, red from running all day and night.

"Of course," I say in my most soothing tone.

23 scrapes at her cheeks. "Hurry. You don't know how bad it hurts. It hurts so freaking bad."

"I'm sure it does," I say. I feel like I know something about pain these days—the acute, edging on chronic just like hers. My chest hurts anytime I think about work, and nothing seems to be making it better. Finding the thief is my best solution—but how? If management hasn't accomplished it yet, with undistracted time and IT at their disposal to scan through all the records and logs, how am I going to catch the person?

Once I've emptied the syringe, 23 lowers her hands, her head drifting back onto the pillow, muscles unclenching.

I didn't hear Nathan enter, so when I see him, I jump, straightening at the bedside. Not for the first time, I wonder if the fact that he's always sneaking around, gone for random amounts of time, and a total prick about it when questioned, isn't proof he's the narc thief. I hope it's him.

"Sorry to scare you," he mutters. The way the light hits his face accentuates every feature, the deep grooves of his smile lines. He has been looking more stressed lately. We all have—Lauren's coldness earlier pops back into mind, Anita's tremor—but Nathan doesn't care about anybody, so there's no reason for him to be any more unhappy than usual. Nothing has changed for him—except he can't give narcotics anymore. Or, steal them.

"Good luck with the dressing change," I say, stalling to try and turn the conversation in a way that might make him reveal something.

He shakes his head. "What a waste of everybody's time."

"But how are things anyhow?" I ask, feigning interest after years of shooting him the bird whenever I thought he wasn't looking—and sometimes when I knew he was.

"The fuck do you care?" he asks. 23's soft snores accompany his harsh tone.

"Just worried about you," I say, knowing I botched my first investigative interview already. "Things have been tough lately. And—I know I'm a narc nurse, but I'm no narc. You can trust me if you ever need to talk."

Nathan snorts, but before he can say anything else, my phone chirps and he gives me a death look, pointing to the sleeping 23. "Get your loud ass phone out of here. I gotta get this done while she sleeps." He holds up the gauze packages and then bats them at me, forcing me out the door.

I pick up as soon as the door's clicked shut and I'm in the hallway.

"Hey, come find me at the front when you get a chance, please?" The charge nurse's voice crackles from line static.

If I'd heard this a month ago, I'd have steeled myself for a new admission, maybe an ICU transfer. But now, I'm good for nothing but medicating. That's it.

The dimmed lighting along the corridors and lobbies encourages a sense of urgency instead of relaxation. I can feel the pulse of the place up-ticking. Staff members hurry past me without looking up from their to-do lists, maybe trying to remember if they switched the rate on the antiarrhythmic drip, or if they should call to blood bank to check whether that first unit of blood is ready yet. Lauren sits by the phone next to the med room door, probably on hold with the lab.

I push one of the chairs into the desk on the outskirts of the main nurses' station and walk up to the charge nurse. "What's up?" I ask her.

"Don't hate me." The charge drops the corded desk phone from her ear to her shoulder, biting her lower lip and trying hard for puppy eyes. "It's just one patient. An admission literally no one else can take. And the emergency room is already maxed, even all the hallway stretchers are full—non-psych patients are chilling in the halls down there."

"I thought as the narc nurse, I'm not supposed to have—" The sentence isn't worth finishing. When had the rules ever meant a damn when paired with cashflow? More patients, more money. I look at the clock on the wall. "It's already time to medicate Room 11 again. He's maxing the protocol, needing the full dose every half hour if not sooner. I've had to call pharmacy to restock twice this shift already."

The charge sighs. Hers is the most thankless job of them all. "I know you can handle this. I wouldn't ask if I weren't desperate. There's no one else."

"Fine." My shoulders feel tight, and a headache is beginning to form, pushing behind my eyes. "I'll get the room set up as soon as I'm done in 11."

I walk past the desk where Lauren had been sitting and round the corner to get to the med room. After badging in, I'm fully prepared for Anita to be standing there, rubbing the inside of her middle finger with her thumb, angry I'm not going to be early with 11's meds.

I stop short. Past the Pyxis, at the far side of the small room is Lauren. Hovering over the sink, her eyes wide.

"I just threw up," she says, straightening and wiping her mouth. "I knew I was sick." She shivers.

"Oh, God." The right thing to do is to tell her to go home. But supportive coworker be damned, nobody tells a sick nurse to go home. That would mean six or seven more patients to distribute. I grab a box of tissues from one of the supply shelves lining the opposite wall and set it beside her.

Lauren stoops over the sink and pours some water, cupping her hand to catch it. Drinking from her palm and then gargling. "I'll manage. We're short enough as it is."

I want to argue, but I don't. Behind me, the click of the door unlocking precedes the heavy shoosh of its opening.

"Come on then," Anita's voice barks. "Let's get this show on the road. I swear he's about to break his neck in there, jumping out of bed and shakin' about like he's doing the damn jitterbug." She coughs, throaty and wet. "He needs a drip."

"Have you told the charge?" Lauren asks, using a tissue to mop the area around the sink. She's always been a problem solver, consistently the person everybody turns to for help or advice.

Anita snorts. "With the ICU full, what's the charge going to do?"

Nothing. Because there's nothing any of us can do around here except somehow pull a miracle out of our ass by skipping breaks, forgetting to pee, cutting corners, and making sure that despite the UTI and impending heart problems for all us staff members, the care plan is actioned shift after shift.

A bed alarm sounds, muffled by the thick med room door and insulating supply shelves. Out in the hallway, it wails like a passing ambulance. A flashing light blinks above 11's doorway.

Medication in hand, I jog toward it, Anita's footsteps a power walker's lub-dub close behind. We bypass the hand sanitizer, running directly into the room where 11 searches his closet.

"Back into bed," Anita demands. "This instant."

"Fuck off lady." 11 steadies himself on the side of the closet with one hand, the other still sifting with jerky imprecision through the giant plastic bag of belongings.

Tiredness claws at the space between my eyebrows, and I make the mistake of clicking my tongue. Anita tenses beside me.

11 half turns, doing his best to straighten to full standing but shaking so badly. It appears we're going to have a night of withdrawal induced seizures despite the Ativan.

"I've had it with you, cunts," he says. His belt slithers from the plastic bag like a snake from its hiding place, buckle glinting in the dim light.

Anita dodges before I'm even sure what's going on. "Move," she shouts as the first crack rattles the ceiling tiles against their checkerboard bracing.

And maybe it's just the new role, or maybe it's that the entire unit has been unrecognizable for the last month, but I can't find the adrenaline to act. Instead, I'm frozen. Stuck inside my body, like all I'm capable of is the narration of my life. Not participation.

Room 11 gathers the belt back to his chest and lifts it again, whipping outward. Still, I'm too numb to react. I take it in the shoulder. An instant lance of pain. A burn radiating all the way down to my wrist.

Anita shouts into the hallway for help. She needs to call the operator—I need to call the operator—and initiate a Code Strong Man. She runs off. Probably because she forgot her handheld. She'll be rushing to find a wall mounted phone like she did for most of her career. 11 drops his belt and bends, nearly biffing it as he tries to pick it up.

"Why?" is what I ask when I should be getting the hell out of here. I'm just so fucking alone and tired, I can't make myself move.

Instead, I just want to ask "why" again. I have enough self-awareness to know the question isn't even for Room 11, who raises the belt above his head once more. I've simply become that dumbass new nurse who goes deer-in-the-headlights when confronted with disaster.

Anita runs back into the room, shouting my name. She grabs my hand and pulls me. I'm tripping. Too wrapped up in feeling grateful she's simply here to keep track of my feet or what's going on. I stumble as she yanks me to the doorway. 11 roars. A snap and more pain lances down my hip.

From the hallway, footsteps pound. As we back out of the room, security, a stampede of blue-suited, heavy-breathing bodies, moves in. Two of the guards rush the patient, catching him under the armpits and dragging him forward until they can push him back without smacking his head into the closet, two more joining to grasp him by the ankles. Not until they have a firm hold of him do Anita and I edge back into the room from the doorway.

11 screams, twisting himself in security's grip to try and bite. They carry him to the bed, locking his wrists and ankles in heavy, black, behavioral restraints.

"He still got an IV, miss?" The man at the right hand asks.

"Left forearm," I say, beginning to come back to myself. Agency is slipping through the cracks in the wall around my consciousness that had me immobile and useless before.

"You okay, honey?" Anita asks, squeezing my arm.

I lean into that touch for a second before grabbing the Ativan from my pocket.

As soon as the syringe has emptied, Room 11 still bucking and fighting the restraints, making his bed bounce into the wall, heavy thwacks of plastic on drywall, the ringing in my ears begins to fade.

"One of you needs to take Bethany to the emergency room," Anita says to the security guards. "I'll get the restraints charted, honey."

"No." My voice is hoarse and sounds funny to me—like I've been sick or something, and my shoulder throbs. There's no time to nurse it, though. Emergency will be calling to give report on the new admission any minute, and four other patients also have pain medications coming due. "It's nothing, really."

Anita scoffs. "You just got whipped with a belt. You need to be seen."

"I'm the only narc nurse tonight." I try to muster a smile, but it only serves to make my chin quiver. I desperately want to leave. Before, Anita would have been bear-hugging me despite the patient riding the bed like a bronco—Lauren sprinting from across the unit to see if we needed help with anything. Now, even with Anita's kinder tone, the fact that she came back for me, I still just feel alone. And so damn tired. For the first time, I do want to take the easy road and go downstairs to the ER to hide from the remainder of the shift.

"This fucking place," a security guard mumbles, handing Anita the key to the restraints. Room 11 writhes on the bed, unchanged by the Ativan.

"You got that right," Anita says. "Go on," she says to me. "I'll chart this." She reaches for the empty syringe.

Because it's empty, but more so, because I'm done with trying to find the balancing act to surviving this place, I hand it over. Anita can scan it, document, then drop the empty syringe into the sharps container with all the other old vials and needles. I don't care anymore—not about the checklist of items needing doing, and not about who might be the narc thief.

"You go prep for your admission," Anita says.

Cradling my hurt shoulder, I leave 11 and push myself onward. I wish I'd brought something for the pain with me. Usually, I keep Ibuprofen in my locker, but I ran out weeks ago and keep forgetting to buy a new bottle. If it gets bad enough, I'll grab some from the Pyxis. It's not allowed—but getting whipped on the job shouldn't be allowed, either.

Nathan's walking toward me from the opposite direction down the hall. He raises an energy drink, his self-proclaimed addiction, in mock salute. "Lookin' a little worse for the wear, aren't you?"

"Don't let the joint commission see that drink," I say sarcastically, our rhythm easy to remember even when everything else feels fuzzy.

Nathan stops. "What's the matter with you?"

Anita comes out of room 11. "She just got assaulted by this one." She elbows the door whose occupant is still shouting, his obscenities a part of the ambiance at this point. She looks at her watch. "I'm taking five minutes for a smoke. Somebody, anybody—" She looks to Nathan. "Watch my patients."

He laughs and chugs the energy drink. We're all drowning.

In the supply closet, I get all the fixings for my new admit. Stuffing my pockets with the pre-made baggie of toiletries, hooking a urinal onto my pant leg pocket where I keep my stethoscope, pressing oxygen tubing into the crook of my arm. A new gown drapes my now-bad shoulder.

I'll drop this stuff off, then go medicate the others who are overdue.

Call lights sound like fog horns in the hallway. The air stale, smelling of disinfectant and stress. A package of yellow, over-scrub gowns has dropped from the handrail outside a room, spilling onto the floor.

Fatigue continues to make this underwater sensation worsen, and I nearly pass my new admission's room. I swat at the handle, opening the door as the thought registers it's strange it's even closed. We always keep empty rooms open.

The privacy curtain isn't pulled, so as soon as I'm through the doorway, I'm as paralyzed as I was back in 11. Lauren stands on a chair, leaning over the sharps container with a long tendril of tape attached to a tongue depressor. The sticky, white line is sunk into the plastic, red opening of the container.

"What—" I don't finish. My nervous system floors the gas. My heart pounding hard, my tongue thickening, pushing against my throat.

"It's not what it looks like," says Lauren.

It's exactly what it looks like. A nurse fishing in the sharps for drugs.

I step back, listening for any voices in the hallway. For anyone who might pass by and see us from the now open doorway.

Lauren steps off the chair. "I accidentally sharpsed some Metoprolol. Total accident. I was just trying to get it back. I swear."

Metoprolol isn't monitored. Nobody cares if the blood pressure medication is wasted and another dose pulled. I shake my head.

"Please." Lauren fidgets with her sweat band and takes a step forward. "It's not what you think. I promise. But I need to go. 20 is about to code. He's been spiraling all night. I just needed—" She looks to the ceiling, the lights revealing the sweat dewing her face. Her phone begins to ring.

A bed alarm sounds in the hallway at the same time as the intercom crackles to life, calling a code blue in room 20. The telemetry team must have initiated it for Lauren when she didn't answer her phone. Somewhere, someone on the unit is dying. And somewhere else, someone is potentially falling.

"We have to go to that," she says.

There's at least two emergencies calling us away.

But there's one here, too. I look to the code button in this room, aware if I were to press it, a group of people would be forced to run here as well—to help decide what to do with Lauren. And if I run out to room 20 to start compressions, if I walk out to rush to that bed alarm to prevent a fall, if I let Lauren leave this room, I won't be able to report her. The number of wrongs this night are piled so high, her thieving feels like the removal of the stopper finger from the dam rather than the original leak. None of this is Lauren's fault, though she may be the one to finally release the flood waters.

I make my decision amidst the background noise of the intercom, running staff members, curses, and screams. I take one second to brace myself, and in my peripheral vision, the code light leers, cyanotic blue. Blinking on and off. On and off, above the dock-like bed.