Photo from northshorelij.com
By Lauren Fetter
Water droplets from the filter of a broken coffee machine fall steadily into a small plastic dish as they compete with the rhythmic tick-tocking of a metal clock on the wall. These are the only sounds breaking the silence in the small room.
The volume of a flat screen television on one of the shorter pale blue walls is turned off. Four plastic bags sit untouched on the windowsill as their contents spill over the edge onto a ripped, blue faux leather arm chair. The chair’s male inhabitant, a tall and lanky 20-something whose gray sweatpants are riding unbearably low, is unfazed.
Paper goods. Plastic cutlery. Potato chips. Toothpaste. Deodorant. Face wash. Lysol spray. Hand sanitizer. Water bottles. The Stella S. Siben Family Waiting Room in the Intensive Care Unit at Southside Hospital has been turned into a makeshift pantry. Its occupants have seen better days.
“Excuse the mess,” a woman says to the young man in the arm chair, grabbing the bags off the windowsill and passing them to her husband. “We’ve been here since Tuesday.”
The couple, known around the unit only as Mr. and Mrs. Burke, have made the waiting room their home for the last four days and nights — switching their warm and comfortable bed for the cold and dismal surroundings of a hospital.
She hands a bag to her husband and brushes her untamed black curls away from her face. She has not slept since Tuesday, Sept. 22 — the night her world came crashing down.
Home from college for the evening, Mrs. Burke’s teenage son, James, was used to walking everywhere he went, so the five minute walk up the block to the local 7-Eleven would be a piece of cake. Or so he thought.
Just before 10 p.m. while crossing Montauk Highway in East Islip, police said, James was struck by a 2013 Volkswagen, driven by 67-year-old Shermane Coonerty of Babylon. The driver was unscathed. James was anything but.
“We expected him to be on the curb with a broken leg,” Mrs. Burke says, shaking her head in disbelief. “But the cop said it was bad and told us to go right to the hospital.”
Broken ribs. A collapsed lung. Numerous facial and skull fractures. A coma. All combined with an intensifying case of pneumonia. The only thing working in James’ favor was his prior 19-year-old clean bill of health.
It is just a waiting game. Waiting for prayers. Waiting for answers. Waiting for the unknown.
Mr. Burke walks the bags, which are starting to rip, out of the room and into the old elevator to place them in his car. The dark circles under his expressionless eyes show his exhaustion. His half-untucked shirt is wrinkled and stained with coffee. He doesn’t care.
“Ah, the Pope’s in town,” a larger woman sitting on one end of the loveseat along the wall says out loud, looking up from her iPhone 6 while her feet rest on the coffee-ring-stained table in front of her. The bright jewel tones in her scarf radiate off of her dark complexion, the only source of warmth in the frigid room. She looks back down at her phone.
A frail elderly woman next to the creaking door leading into the white-walled, sterile hallway now holds a firmer grip on the rosary beads in her hand than she did before. She rubs one of the smaller crystals between her thumb and pointer finger. A single tear falls from her closed eyes. Then another, then another, as she continues to pray for a loved one in an unrecognizable language.
Mrs. Burke grabs a thin white blanket from her black, oversized tote bag and wraps herself in it, forming a cocoon of sorts. She unties her hot pink Nike sneakers, removes them from her feet and places them ever-so-gently at the foot of the longest couch in the waiting area. Laying her head in her hands, she leans her elbow on the armrest and closes her eyes.
“Just a quick power nap,” she says, yawning. “Just a quick one.”
It will be another two weeks of constant worry, fear and grief before Mr. and Mrs. Burke can breathe a little easier, before they can expect any progress.
“We’re going to have to keep an eye on him,” a nurse says, sighing. “But the good news is that he’s being moved to another floor: Brain Injury.”
* * *
Felicia Breen walks through the now-opening elevator doors on the Brain Injury Unit, known as BIU, while a purple travel mug filled with coffee sloshes in her hand. It is 6:45 a.m., and nurses from the night shift are starting to gather their things and head home. Her day is just beginning.
Moving into the crowded break room, she puts her lunch in the white refrigerator next to the coffee pot percolating on the sand-colored counter top. She hangs her black rain coat on a hook above the break table and places her purse in one of the small tan lockers in the corner of the room. She closes the door and locks it, smiling at the picture taped to the front of it: Her son stands at bat on a baseball diamond when he was 12. His 25th birthday is next week.
Gathering her long black hair on the top of her head, she secures it with a clip before examining the discharge and admissions board by the nurses’ station.
The white erase board is filled with colors detailing patient-to-nurse assignments, the last names of each patient on the floor — women in red and men in blue — and their bed location in each room: window or door. With 23 patients divided between three registered nurses on staff, any calm Sunday will be a hellish one.
But Felicia’s workdays have not always been this way — at least not the ones before she became a nurse more than 20 years ago.
Her first career lent itself to her own office in a New York City highrise. Wearing dress clothes and heels to work every day, Felicia was an editor in publishing for Sports Illustrated until her and her husband wanted to start a family.
After the birth of her only child, Richie, she made the tough decision to leave the job she loved in Manhattan, believing a new career closer to home would be the best choice for them. An interest in healthcare and a love for learning made Felicia’s next career move an easy one: Nursing was the way to go.
The 58-year-old nurse doesn’t regret her decision to switch jobs. “I’m reduced to scrubs and abuse sometimes,” she says while laughing. “But I like it and I’m glad I chose to do this.” But when the patient-to-nurse ratio is as high as it is today, she says it’s not always easy to get a full understanding of the patients she is taking care of.
“You don’t really get to know them, or always get a good assessment.”
It’s 10 a.m. and Felicia has delegated nurses aides to patient rooms and assigned lunch breaks for everyone working on the floor, though most of the nurses work through them. Their own needs are not a priority. The patients are.
Felicia is the nurse in charge today, which makes her job a little bit more intense than most. After giving out morning medications, she takes a seat at the computer next to the window in the nurses’ station and logs onto the new hospital system to begin charting patients’ vital signs, meal intake and general patient condition. It is the first time she has had the opportunity to sit down since she arrived, and it will be a few more hours before it happens again. But she’s used to it.
The Brain Injury Unit at Southside Hospital is considered a Regional Center for Brain Injury Rehabilitation, and is one of three brain injury units on Long Island. The hospital’s outpatient physical rehabilitation program is connected to the unit. It is designed to help patients with traumatic brain injuries recover through intensive physical, occupational and speech therapy programs. Many patients have fully recovered from their injuries through rehabilitation. Others have not been as fortunate.
The nurses’ station is quiet now, except for the sounds of mouse clicks and keyboard strokes. Felicia adjusts her white scrub top and pushes her glasses onto the top of her head. Dr. Enisa Goljo sits across from her and flips through a binder of loose paperwork while two residents discuss the debt they have accumulated from medical school. One of them owes more than $700,000 in student loans — something not unheard of in this profession.
A patient’s granddaughter asks Dana, a nurse’s aide, where she can find some water for her and her family. The young aide with a bright burgundy bob pulls up the waistband of her too-long green scrub pants and walks the girl to the dining room to locate a water pitcher.
“Felicia, one of your patients wants Tylenol,” Francine Castellino, a registered nurse, says as she takes a seat at a free computer to begin charting. Though she’s been a nurse since 1986, she’s only been back at Southside since 2012. Francine took time off to raise her children and handle her own health issues, and she is still getting back into the groove of things.
“Okay, I’m on it,” Felicia says, getting up from her chair. She grabs a packet of Tylenol from the medicine cart and walks over to a WOW — workstation on wheels — to bring with her to the patient’s room so she can chart their pain.
“That one’s mine, Feef,” Sue Renz, the third nurse working today, says while laughing. She points at the large font on the mobile computer screen. “Can’t you see it’s for the reading impaired?”
Working at Southside since 1984, Sue has been on BIU for just over 17 years. Felicia has worked with her for 16. Neither of them see retirement in the near future.
* * *
Sue makes her rounds to six patients, greeting them and their families, letting them know that if they need her, she is just a button away. Her seventh and final patient assignment for the day is 19-year-old James Burke. Today is Nov. 22. It has been exactly two months since he was admitted to the hospital, and his condition has changed drastically.
“Hi, Sue,” James says, waving at her as she begins to write down the nurses that are scheduled to care for him, as well as the name of the medical doctor working on the floor.
He sits upright in his bed, clicking through the television channels on the remote attached to his bedside. His dark brown hair is shaved on the left-hand side of his head, marking the spot fluid was drained from. His pajama pants, covered from top to bottom in the New York Giants logo, come up short around his ankles. He sets his gaze on the captions moving across the bottom of the television screen while his mother wipes off a dry-erase board with a tissue.
“Your uncle called while you were sleeping to see how you were,” she says.
He gives her a confused look. Mrs. Burke has gotten used to this. She smiles at him while she begins to write the same phrase she said aloud on the board in red marker.
Though James has made significant progress since he came to the BIU, including regaining the ability to talk, walk and eat on his own, he still has trouble understanding people when they speak to him. In order to compensate for the deficit he is experiencing, his family members and nurses write down what they say on a whiteboard to help him comprehend. So far it has been working.
Mrs. Burke holds up the dry-erase board as James begins to read it out loud. He understands and nods.
“I’m sorry, I’m sorry,” James says afterwards, scratching the back of his neck and shaking his head. “I’ll get it.” A smile sweeps across his face as he laughs, but his eyes hold a look of disappointment with himself.
“Don’t worry, we’ll work on it,” Mrs. Burke says, wiping off the board again.
She is just happy he is alive.
* * *
“You got a headache, honey?” Felicia asks the patient who requested Tylenol. Her thick Brooklyn accent makes him smile. She asks him to categorize the pain on a scale from one to ten before she hands him the Tylenol tablet and fills out the patient chart accordingly. It is 1:15 p.m.
As she gets ready to leave the room, an unrecognizable voice yells down the hallway: “Felicia we need you. We’ve got a rapid response.”
A rapid response is a change in patient condition that signifies a shift in vital signs or deterioration in patient health. When a rapid response is called, health care providers must assess and treat a patient at bedside to prevent respiratory or cardiac arrest, a transfer to the Intensive Care Unit and, in a worst-case scenario, death.
Struggling to maneuver the WOW out of the room, she pulls the cart, which appears to weigh more than she does, behind her down the hallway, leaving it outside. The light above the door frame alternates between blue and red as the defibrillator in the nurses’ station is rolled into the hospital room. Dressed in navy blue scrubs and white jackets, a group of physicians assistants, doctors, critical care nurses and residents on call rush down the hallway to join Felicia and the other nurses.
Patients on the unit, both young and old, have sustained head injuries from strokes, car accidents, falls and other scenarios. Many of them go through surgery or come from other floors before they are placed in BIU, which makes rehabilitation harder as most are doing things like walking and talking for the first time since their injuries. In some cases, patient condition worsens over time, despite the constant care.
Now the rapid response team wheels the patient out of the room and into the hallway as they wait for an elevator. The patient will undergo testing, though her vital signs have been brought back up to normal. The elevator doors open.
* * *
After dinner, patients continue to sit and talk with visiting family members, though most are wheeled back to their rooms for the evening. Some patients must be constantly watched because they are not stable enough to remain in a room by themselves. They sit in wheelchairs along the cream-colored walls by the nurses’ station where aides and nurses alike can care for them.
Felicia, Sue and Francine have all given out required medication to their patients and continue filling out any unfinished charts before the night shift clocks in.
It’s 8 p.m., a time that usually comes and goes before they get to clock out, when Felicia and the other nurses have completed their work. They say goodnight to their patients for the evening, though the most bittersweet moment comes with a hug from James Burke.
Tomorrow morning, James will be discharged from Southside at 4:30 and taken to Stony Brook University Hospital to undergo an angiogram, a test that uses a special dye and camera to take pictures of the blood flow in the body. For James, this will reveal the blood flow in his brain. From there he is expected to receive outpatient rehabilitation to bring him as close to fully-functioning as possible.
“Every patient is different. They might be coming in doing nothing,” Felicia says, referring to the patients who are unable to perform basic functions on their own as “clap-outs,” much like James himself was when he first arrived. “But you get to see people progress, and that’s the best part.”
Felicia puts on her coat and slings her purse over her shoulder. Her purple travel mug is back in hand, though its contents have been gone for quite some time now. She waves to the night shift nurses and wishes them luck, though more often than not the overnights are calmer.
The look of exhaustion on her face cannot be hidden for much longer when the elevator arrives on the floor. The doors open and she steps inside. Her day is finally over.
But tomorrow morning she will be back for more.