Going Bareback**

One of the unique aspects of nursing is that you are likely to work side by side with someone who has been practicing vastly longer than you have. Nursing is not a profession where long years of experience automatically translate into management. Many nurses do not want management because it takes them away from the bedside. Instead, they are compensated with other perks of seniority such as first dibs on shifts and holidays, the option of choosing whether or not to interact with problem families, and the license to practicing nursing the way they learned it, no matter how long ago that was.

Now I love working with nurses who have been around forever. They have done everything and they have seen everything and for the most part they are happy to share everything they know with you, so long as you come with an appropriate attitude. This doesn't mean you grovel, but it does mean that your bachelors degree does not trump their diploma and 20 years on the floor. While it is said that nurses eat their young, this had not been my experience…or maybe working 15 years in the software industry with ex-military folks who didn't care about my hurt feelings was good preparation for nursing.

Case in point, my new manager, Kyle. About a month into my first job, I was transferred from the acute care unit to the ventilator unit. I don't know how much input Kyle had into this decision, but it was the Director of Nursing's will that I replace the nurse who was transferring to another facility. I could see immediately that everyone loved April, the nurse who was leaving. Meanwhile Kyle had not acknowledged my presence even after a week of orienting to the unit. I wasn't sure this was going to work out so well. Even after April left, Kyle barely spoke to me. He would talk to the respiratory manager and the lead nursing assistant when he wanted to know what was going on. I said nothing. I was determined not to fail what was clearly some test of my metal.

While the day shift is undoubtedly the lighter of the shifts, I think it is the hardest shift to transition into. If anything weird is going to happen with a patient, it happens between 12am and 7am. There are simply less people in the building to help you if something bad happens, your access to doctors is diminished, you can't get STAT anything. Most 911 calls happen on the 11pm to 7am shift. When you come on for the day shift, you have to catch all the events of the last shift and help finish some of the work. Things like IV dressing changes, catheter changes, certain blood tests get left for the last minute. In order to move the process along, I follow the nurse coming off shift to give her a hand and get report.

On this day, I was following Maggie, a forty year nursing veteran. Maggie is tall and wiry with a whisky voice from too many cigarettes and a tanned hide from too many afternoons on the golf course. She started working the night shift after her husband died. There was something I admired about the candor of her grief. It was raw, but not maudlin. "The wee hours are when I miss him most," she would explain. "By the time I get out of here, it's morning and I have the day ahead of me." She had certainly figured out a way of making the best out of a bad situation.

"Come help me change this catheter on Mrs. Gillian," she said, waving me into the room. "She's just so big, I can't possibly move her on my own." Another thing about Maggie is that she is blunt in a way that we're not anymore. What used to be an "alcoholic" is now a "history of ETOH abuse" and what used to be "an overweight patient that requires two staff to move" is now a "bariatric" patient. There is no mean-ness in Maggie, she's plain-spoken. But it's jarring to hear the forbidden words made flesh. Call it what you will, at five feet and 250lbs, Mrs. Gillian was a big woman.

So I followed Maggie into Mrs. Gillian's room. It's still dark outside and the fluorescent light is on over the sink. This combined with the flickering of the TV makes me feel like we are working clandestinely. Mrs. Gillian, who is conscious, but unable to communicate except by grimacing, sweating profusely and breathing against her ventilator is expressing her displeasure. Her breathing on the ventilator makes a noise similar to a donkey's bray. It is dissonant, patternless, and echoes in my head on nights when I can't sleep. It sounds like pain to me.

"Did she push this thing out?" I ask, starting to feel a little dizzy. Her breathing was so uncomfortable and she was using so many muscles to breath against the ventilator, she expelled the catheter. The golfball sized balloon that would normally keep the catheter in place was still in tact, laying at the foot of the bed. "Oh yes," Maggie responded while pulling a new catheter out of its wrapping. "She does it all the time. I don't know why we keep putting new ones in. She's got to be in agony. But then she has these bed sores, so I guess we keep doing it until the doc says otherwise." Maggie continued unwrapping the catheter. She checked the balloon by inflating it just a little and then she lubed the tip. She cleaned Mrs. Gillian's perineal area with the cleaning swabs that come in every catheter kit. Then I rolled Mrs. Gillian to her side so that Maggie could approach from behind, something they don't teach you in nursing school. It's not the "official way" of inserting a catheter, but it's how you do a big patient on an air mattress when the target area is obscured by folds of skin and legs that are clenched shut.

Just when I think I cannot hold Mrs. Gillian steady anymore, Maggie is done. I roll Mrs. Gillian onto her back and straighten out her bed clothes. Something was wrong. Maggie hadn't been wearing gloves. I know I saw her wash her hands but the pack of sterile gloves was laying on the mattress with the rest of the used kit. No way, I thought, she couldn't have. But she didn't. Maggie was washing her hands again as I cleaned up the rest of the kit. "Thanks for your help," she said as she walked out of the room.

I washed my hands and went out to the nurses station, which was abuzz with the morning's activities. In the background a respiratory therapist was opening a bag of chips. "I brought food!" she announced. Maggie sailed over to the bag. "Thank you so much. I'm starving," she said. She reached into the bag, pulled out a handful of chips and walked away. "No chips for me," I thought to myself.

Just then, Kyle picked up the bag of chips,"Who brought these in?" Kyle asked, enthusiastic about free junk food so early in the morning. He grabbed a paper towel and was about to pour some out when I said "I wouldn't eat those if I were you." Kyle looked at me as though I was the junk food police. "Why not?" he retorted. "A certain someone inserted a catheter bareback this morning then had their hands in that bag you've got there," I stated matter of fact-ly and then turned back to Amy, the desk nurse. "Bareback?" Ken asked? "Yeah," I said, without looking up from Amy, "no gloves." A muffled squeal escaped from Amy, "Ooooh, she did that for you too?"

Kyle held the bag of chips by his fingertips and dropped them into the trash. As he breezed by me on his way to morning meeting, he said, "Bareback…I like that."

Kyle stopped ignoring me after that.

**Names are changed.