“Thank God for the food truck,” said the charge nurse to no one in particular.
It hadn’t been a great morning at the no-name hospital in Upstate New York. They were short-staffed to begin with, and a nurse had called in sick. Her staff was used to working with bad ratios, but today was worse than usual. Everyone and their mother had decided to come to the ER. She knew not to bother calling her manager. He was a well-dressed guy, but his ideas were a bit wonky. His solution had always been to just shorten treatments.
She knew better, though—he had never worked in the industry. A few shortened treatments could fix a day, but the price would be paid in oxygen—as in respiratory distress. Or cardiac arrest. Like the one they had that morning. The patient had been full of fluid for a week, but they hadn’t been able to offer an extra treatment. In fact, per the manager’s advice, they had turned her usual three-and-a-half hours into three flat. That kept the overtime charges down.
When she showed up that morning, she couldn’t breathe. Then she lost her pulse. It never came back. Just another day in the dialysis unit. Except for the trainee. It was new to her, and she broke down crying. The charge nurse tried to comfort her for a minute, but the overtime rules … Back to work.
The doctor, like he always did, soaked it all in. He knew what was up, but he had been muzzled long ago. When things started eroding, he had set up meetings with the manager. But he kept getting the same word: budget. He would counter with his own word: quality. But his word didn’t carry the same weight. When he tried a new one—rationing—he was reprimanded.
Human resources came down hard. They said he was harassing the manager. He quieted down. A family. A visa. His options were limited. It was this or back home. The manager knew that. The charge nurse knew it too. That’s why she had stopped asking the doctor to speak the truth. They worked together in silence. Two unsettled souls, just trying to keep things average. They could sleep with average. Below that is where insomnia kicked in.
But despite the problems, the charge nurse knew that, deep down, the administration cared. No amount of staffing issues, budgetary constraints, cardiac arrests, or human resource reports could overshadow the love coming from the boardroom. Because on that day, in the beautiful asphalt parking lot, there was a food truck.
Amol Shrikhande is a nephrologist.
