By Matt Eversmann
With Chris Mooney
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“The compassion, the work ethic, and the selflessness of nurses … are given the respect they deserve and captured beautifully here.”
–Sanjay Gupta, MD, neurosurgeon and chief medical correspondent, CNN
"James Patterson's account of the twilight world between life and death that nurses inhabit is one of the most moving things I have ever read.”
–Sebastian Junger, author of Freedom and The Perfect Storm
Around the clock, across the country, these highly skilled and compassionate men and women sacrifice and struggle for us and our families.
You have never heard their true stories. Not like this. From big-city and small-town hospitals. From behind the scenes. From the heart.
This book will make you laugh, make you cry, make you understand.
When we’re at our worst, E.R. nurses are at their best.
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Angela was born in New York City and grew up in Virginia Beach. After graduating from nursing school, she did an externship at a cardiovascular ICU. Angela is a traveling nurse and currently lives in California.
I don't think I'm cut out to be a nurse.
Growing up, I watched my mother take good care of my extended family, especially my grandmother. My interest in becoming a professional caregiver sparked, I toyed with the idea of becoming a doctor—until I shadowed one and found out how little time doctors spend with patients.
And I want the human interactions, so I chose nursing.
But nursing school, I'm finding, is hard. I'm struggling with the dual responsibilities of attending class during the day and working as a nursing assistant at night.
The hospital job is important because it's a front-row seat to the reality of nursing. The nurses here run around at a hundred miles a minute, all the while projecting to everyone that they are cool, calm, and collected.
I admire their composure, because I'm an empath. I'm highly sensitive to what other people are thinking and feeling. I take on their emotions, their pain. A lot of the nurses here share that trait. They have more heart than they let on.
And then there's death. It comes in waves, and lately we've had a lot. When someone dies, it really affects me, and it really affects the other nurses too because, deep down, like me, they're nurturers. But they can't show it. They have to be rational, steady, fully in control of their emotions.
There's no way I can do this for a career, I think as a nurse delivers a new patient to one of the open rooms on our floor.
His name is Brian. His wife is with him. They both look shell-shocked.
"I came into the hospital tonight because I'm not feeling well," Brian explains as the nurse and I get him settled. "I was holding a lot of fluid in my stomach, and I wanted to see what's what. They ran a couple of tests, and it's…I have pancreatic cancer."
Brian is a professor at one of the colleges. He's a super-nice guy, former navy, and really, really accomplished. He's so kind to the staff—so thankful. The staff love him. I love him. We gravitate toward him because of his demeanor, how he handles himself as he tries to fight the disease.
One night, as I'm talking with Brian, I share my struggles with him.
"You can do this," he tells me. "Going to school during the day, working nights—I know it's hard. It's supposed to be. Remember, nothing that's worthwhile in life comes easy."
I come from a family of nurses and doctors. They've essentially given me the same advice—to hang in there, be resilient. They're supportive because they're my family. But the conviction in Brian's words and the confident way he says them leaves an indelible impression on me.
In the two months he's with us, I watch his physical abilities decline. He can no longer walk, can't even stand up or roll over in bed.
"We've been married for forty-five years," his wife tells me. "I don't know what I'm going to do without him—I don't even know who I'll be without him."
Brian's death hits me hard. I cling to his words as I continue my struggle through nursing school. I think of him when I graduate.
At twenty-five years old, I'm a traveling nurse. Every three months, I get to pick where I'd like to work. I've decided to finish up my stint in Colorado Springs, take a month off, then move to New York City. My family spent many summers there when I was young, and I enjoyed those times, but I've never been there as an adult.
I arrive in early March of 2020. The first two weeks are fun. I work three days a week and explore the city on my days off.
I'm aware of COVID. It's on my radar, but it hasn't hit NYC yet.
The travel company I'm working for calls me and says, "The hospital is going to transition you into overflow."
During cold and flu season, hospitals can get overcrowded, so they often have designated areas to deal with a high volume of sick patients. On top of that, my hospital is also expecting an influx of COVID patients.
"Be prepared to work forty-eight to seventy-two hours each week."
"Okay," I say, wondering if I'm going to get an N95 mask and proper protective equipment. "Will do."
The hospital gives us each a simple surgical mask. Because of the limited supply, the mask when not in use is to be stored in a brown paper bag and then reused until it's soiled. Because I'll be working in the COVID unit and the COVID ICU, I can wear my gown multiple times. When it's soiled, I'll be given another one.
We're each given a respirator (a mask with a filter) in a bag labeled with our name. Respirators are designed to be used once and for no longer than one hour. But now, as long as they're not soiled, we're to reuse them until they fall apart.
COVID hits New York fast and hard. The hospital insists we wear our masks continuously throughout our twelve-hour shifts. The constant wear causes blisters on my nose and my cheeks. My skin breaks down. One day after work, when I take off my mask, the skin peels off my nose. It just rips right off.
During a thirteen- to fourteen-hour day, carbon dioxide builds up inside the masks. The gas is unsafe in high concentration. A couple of nurses on my floor pass out from inhaling too much CO2.
I use the respirator I'm given for three weeks.
By April, the COVID cases have risen alarmingly. One day, we have close to eleven thousand cases.
If I don't have COVID now, I think, I'm going to get it.
The majority of our patients who need to be intubated don't ever make it out of the hospital.
Some days, instead of working in the COVID ICU, I'm floated to other floors with COVID patients who need lower levels of care. It's there I get word that one of my ICU COVID patients has been taken off the ventilator and is breathing on his own. He's being transferred to me.
His voice is really raspy, and he's still very weak and very, very sick. He shouldn't be alive—I was sure he was going to die. He may very well still die.
This guy not only survives, but in a couple of weeks he's up and walking. Healthy. When he leaves our hospital, people line up in the hallways to cheer him on. He's the first patient who's gotten off the vent and made it out of here.
One day I have five patients, all young guys. Four of them die.
It's one of the most horrific things I've ever seen. I've never had so many patients die in one day. It's the worst thing emotionally that's ever happened to me. When I leave the hospital at nine p.m., I'm physically and mentally exhausted. I've got nothing left.
I live a mile away and walk home every night. This area was, not that long ago, very busy and had high foot traffic. Now it's completely empty except for homeless people. And rats, which are at an all-time high. They're everywhere you look.
The emptiness of the streets…it's such an eerie feeling. Stores are open, their lights on, but there are only a few people around. When they see me dressed in my scrubs, they turn away or move to the opposite side of the street because they know I work at the hospital and they think I'm probably infected with COVID.
Usually, I feel proud to be a nurse. Now I feel like a leper.
When I get home, the stress I've been under these past six weeks—waking up at four every day to go to work, the long, grueling hours, the deaths, the suffering and trauma—all of it finally takes its toll. I call my mom and tell her what's happening.
"Are you okay?" she asks.
"This is so much harder than I expected." Then I lose it. I start crying hysterically. "I don't think I can do this. All of my patients are dying—I can't handle it anymore, Mom. If I catch COVID and I'm on a vent, please just let me go."
My mom listens patiently and does her best to console me.
"A lot of nurses are just up and leaving New York," I tell her. "They don't even show up for work. Today, I was supposed to be working with a guy named Paul. I couldn't find him, and when I asked where he was, I was told, 'Oh, he's not coming in. He's on a plane right now going back to wherever he's from.'"
"Can they actually do that? Isn't that—what do you call it again?"
"Abandonment. In any other time, yes, it would be reported to the board of nursing. But this is COVID, so they're ignoring it because when someone leaves, the hospital has another warm body who is willing to fill that spot almost instantly. There are so many nurses flooding into the city to help."
"Do you want to leave? Come home?"
A part of me does. Of course a part of me does. Who wouldn't want to get away from this stress, exhaustion, and death?
Then I recall Brian's words: I know it's hard. It's supposed to be. Remember, nothing that's worthwhile in life comes easy.
I'm doing something others can't. I'm still here, and I'm able to hold my head high because I know who I am, and I'm not a quitter. Running away isn't an option.
My years in nursing have taught me resiliency. I've stayed the course through uncomfortable situations that had me questioning who I was, doubting my skills as a nurse. Each time, I emerged on the other side stronger from my experience—stronger mentally, physically, and emotionally.
I will handle this pandemic because I can handle more than I give myself credit for. I'm a nurse. I can handle anything.
Katie Quick lives in Virginia. She worked on the medical-surgical floors and in the ICU before becoming an emergency department nurse.
The older man lying in the ICU bed is dying. I don't think he's even aware that he's surrounded by his family—his wife and two adult sons.
"Is there anything I can do for you?" I ask them. "For him?"
The wife dabs her face with a tissue. "All he'd want is his dog."
"Go home and get him."
The family turns to me.
"What?" the wife asks.
"Go home and bring the dog here."
I'm pretty new in my ICU career, and though I suspect bringing a dog here is against hospital policy, I don't care. If my dad were dying, he would want his dog. (This was long before therapy animals became an actual thing.)
The sons return with the dog—a golden retriever. It's three o'clock in the morning. I sneak the dog up the back hallway. Because the man's bed is pretty high, I help lift the retriever up. The dog snuggles up to the man and rests its head under the guy's arm.
The dog stays with him all night long.
The hospital administrators aren't pleased. I get called on the carpet, but I don't care. The patient was dying. The family said he needed his dog, and I made sure that happened.
My most memorable moment in the ICU involves a married couple.
The man is pretty young—in his forties—and he's a home-hospice patient dying of cancer. Home-hospice patients have a team in place that helps them deal with pain, anxiety, and malnutrition, and death is usually imminent.
Once a hospice patient calls 911 or comes into the ED, he or she becomes a patient seeking treatment. The man's wife said she wanted his code status reversed, which means we have to do whatever we can to keep him alive.
"I just couldn't let him die at home," the wife tells me. "We have two young kids."
Her husband is not verbally responsive at this point. His blood pressure is very low, so we've put him on IV medication. He's also on oxygen because he needs a lot of respiratory support.
There's no question he's going to die. It's just a matter of when.
My mother refused to take her kids to funerals because she didn't want to expose us to that level of sadness. There's no escaping it in the ICU—and that's not the only place you find it.
My last semester of nursing school, I did a clinical rotation in a nursing home where you're assigned one patient and you spend the whole day with them. I took one lady to her activity, then brought her back, got her cleaned up, put her in bed, and went to my noon conference. When I checked on her afterward, I discovered that she had passed.
I cried and cried—I could not get it together. The family had to console me. They rubbed my back and told me, "It's okay, honey. We knew she was going to pass."
I was twenty years old and hadn't had any experience with death and dying.
I went home that night thinking, If I can't deal with a ninety-year-old dying, there is no way I can work with sick babies in the neonatal ICU. I decided to reroute my career and went to work on a medical-surgical floor—with a large elderly population.
I've got to get a handle on the experience of death, I told myself. I have to figure out how to better help families going through the transition of their loved ones.
And I want to help this woman deal with her husband's eventual death in the ICU. I can tell she's at her wit's end even before she says, "I'm not ready for this."
I understand how she feels.
When I was a new ICU nurse, my brother-in-law was in a horrible motorcycle accident and had to be flown to a trauma center. The medevac providers couldn't do much, but they kept him alive, and what they gave me and my family was time. Time to sit with him, time to be with him and love him until a priest gave him the last rites. I got to be there with all of them to make sure he was treated with dignity and to watch him pass.
I'm about to speak when her husband soils himself.
In a situation like this, I typically tell the family member to step outside, go to the cafeteria. But for some reason, I say, "I'm going to clean him up. Do you want to help?"
She looks at me with the most incredulous expression, one that says, Are you serious?
"He's your husband," I say. "You can help me if you want, or you can leave the room."
She starts crying. "I've been his caretaker, giving him his medications and tube feedings, but I haven't seen him naked in six months. He's been afraid to show me his body because he's so skinny."
"Let me get everything we'll need, and we'll do it together."
As we wash and clean her husband, it's clear how physically and emotionally spent she is. We talk about all sorts of stuff, and as she rubs his back and then massages his feet, she confesses she hasn't had sex with him for over a year and a half. Washing him and cleaning his bottom is the most intimate she's been with him since he got sick.
Looking at her face, I can see just how much in love she is with her husband, even under the gross and cruel circumstances.
After I clean up and take out the trash, I say, "I want your husband to rest right now. How about you? Do you need to rest?"
I put his bedrail down and pull back his covers. "Would you like to take a nap with him?"
She starts crying and crying and crying.
"Can I?" she asks.
"Of course. He's your husband."
"We haven't slept in the same bed for six months."
She climbs in. I turn down the lights and put on some soft music.
Some of my older coworkers aren't happy about what I've done. One nurse begins to approach me.
I've lost count of the number of times a nurse or doctor has said, "Put the family in the waiting room." I want to scream, Bullshit. Instead, I go get the family members, bring them to the bedside, and say, "Look at that monitor. See that right there? That's a heartbeat. There's life, so take this moment and take this time."
The nurse looks at me sternly now. "Katie, family members are not supposed to be in the bed with the patients."
"I didn't read that policy."
She's not happy with my flippant response. I don't care. I'm not like most nurses. I tell it like it is. Not everyone can be compassionate. It's not their fault. They're just programmed differently. Some people just aren't as sensitive as others. Some people aren't as emotional. As my mother told us growing up, some people need love the most when they least deserve it.
"He's her husband, and he's dying," I tell the older nurse. "Just leave them be."
The couple naps for four hours.
Her husband passes that night.
I truly believe I gave that woman the most amazing experience, one that she will always cherish. It's not something I signed up to do; I did it because it was right. I don't think people realize the fight that goes on in nurses' hearts—sticking to a hospital's legal policy versus acting on humanitarian impulses.
I will stand there with you and cry with you. I will print off a strip from the monitor that shows your loved one's heart was still beating while you were there, talking, holding a hand, giving a kiss.
Amber Richardson lives in Dallas, Texas, and works in an emergency department.
Nurses are at the center of it all.
Nurses are the first ones to see a patient. We take your vitals, assess the situation, and initiate the orders—start your IV, your labs—before you see the doctor. And you see the doctor for only a few minutes; a nurse is constantly monitoring you. When a doctor orders the wrong medication or the wrong dose, we're the ones who catch the errors. I don't think the general public knows just how much nurses do.
The Hispanic man who comes into the ER is young, in his mid-thirties, and somewhat overweight. His name is Daniel, and around his neck he's wearing a rosary with a crucifix. He says he's having abdominal pain that's radiating to his back.
I ask him about his medical history. He says he doesn't have one.
"I don't ever need to go to the doctor," Daniel says.
Which doesn't surprise me. I've learned from experience that most Hispanic men rarely, if ever, get yearly checkups. They also rarely complain when they're hurting. They're workaholics, driven to provide for their families. When a Hispanic man comes into the ER and says he's in pain, we tend to take him seriously.
The man's wife and nine-year-old son accompany him to the exam room. The other nurses and I hook Daniel up to the monitor and, because he's dehydrated, get an IV started.
I have this weird feeling that something's not right. I order a CT scan.
Daniel's family stays in the room while I take him up to get the scan. When we return, they're gone. I get a call from the radiologist, who confirms my suspicions about Daniel.
"Your patient has an abdominal aortic aneurysm that's about to rupture. He needs to go to surgery right now."
Because if it ruptures, he could die.
As I explain this to Daniel and let him know what will happen next, my gut tells me that I need to find his family and bring them back here before he goes into surgery because it might be the last time his wife and son will see him alive. His family needs to be here to say goodbye.
I find out they went to the cafeteria. I run down there, get them, and bring them back to the room. A doctor is there. He explains why Daniel needs emergency surgery.
The wife is visibly struggling as she realizes the severity of her husband's condition. Tears are flowing down her face, and the nine-year-old, who's standing there watching and listening, is absolutely terrified.
"Okay," I tell Daniel, "you need to give your family a hug. We've got to take you to surgery."
Daniel slowly takes off his rosary beads and places them around his son's neck. We wheel him away to surgery.
It doesn't go well. Daniel codes. He's brought to the ICU. A few days later, he dies.
While the outcome hurts, I find some solace in the fact that I made sure Daniel saw his family. Daniel being able to hand over the rosary to his son—that will be the boy's last memory of his father.
Working in the ER, you see people die all the time. You learn the ideal way you want to die. One patient I have is a man in his sixties. He has terminal cancer and a host of medical complications, and when he comes into the ER, he's barely coherent.
He's surrounded by his three daughters, all grown women in their forties. They've decided not to allow any further treatment or CPR if he codes. They want their father to pass peacefully.
I bring in chairs so they can sit with him.
"Your dad isn't really aware of what's going on, but he can hear you," I tell them. "The thing he would want most right now would be for y'all to share stories from when you were kids and to just laugh and have fun with that."
As I make my rounds, I hear these women laughing and telling these amazing stories, and it makes me smile. I want to stop working and go in there and join them.
I truly believe this father knows his girls are with him. Being surrounded by my children as they laugh and giggle and tell stories and share fond memories from their childhood—that, for me, would be the best way to die.
Andrea Perry followed her mom and her aunt into nursing. She is a staff nurse in an emergency department on the West Coast.
An ER tech is pushing a young woman in a wheelchair. The patient is completely unresponsive, barely breathing. I move to the wheelchair, locate the portable monitor the tech has placed her on, and lean in to look at the readings.
The woman's heart rate is high, her oxygen dangerously low.
"Boyfriend thinks she accidentally overdosed on some pain medication," the tech tells me. "She recently underwent plastic surgery—breast augmentation."
"How old is she?"
Oh my God, this girl is a year younger than me.
"The boyfriend kept waiting for her to wake up. Two hours passed, and when she didn't come out of it, Mr. Wonderful thought it would be a fantastic idea to drive her here instead of calling 911."
We exchange a look, both of us thinking the same thing: Something fishy is going on. Maybe the two of them were into some shady stuff and he didn't want the police to find out.
That's not my problem. My focus is on saving this woman's life.
Normally, I'd bring a patient in critical condition to the area we call the front wall—one of our larger rooms that holds one to two patients. Those beds are currently full, but I have an open treatment room. It will be tight quarters, but we don't have a choice.
Our ER doctor and nurses swarm over this young woman, whose name is Cindy. We quickly strip off her clothes and intubate her. I have someone call the pharmacy.
"Where's the boyfriend?" I ask, searching for a vein on the woman's arm to start an IV. "The waiting room?"
"He's gone," the tech replies. "He didn't stick around."
The collection area inside the breathing tube, I notice, has pink, frothy sputum, an indication that fluid has collected inside her lungs.
My thoughts turn to ARDS, or acute respiratory distress syndrome. Right now, her body is shutting down because the fluid in her lungs is preventing oxygen from getting into her bloodstream.
"Call RT!" I shout. Respiratory therapy needs to suction the woman's breathing tube.
- “As a trauma neurosurgeon, I have witnessed the compassion, the work ethic, and the selflessness of our nurses in countless situations. They save our lives every day and represent the true life blood of any hospital. Their stories are given the respect they deserve and are captured beautifully in E.R. Nurses.”—Sanjay Gupta, MD, neurosurgeon and chief medical correspondent, CNN
- "James Patterson's account of the twilight world between life and death that nurses inhabit is one of the most moving things I have ever read. In their own bullet-straight words, these heroes describe the pain, the love, and the brutally hard work of trying to save people's lives. I could not stop reading it and when I was done I felt like I was changed forever." —Sebastian Junger, author of Freedom, Tribe, War, Fire, and The Perfect Storm
- “E.R. Nurses captures the beating heart of nursing: the lives lost and saved, the hard tragedies and unbelievable miracles, and how every day nurses show up, give their all for patients, and then do it over and over and over again, all while holding onto their empathy and humanity. Readers will be stunned and moved by this no-holds-barred portrait of nurses' essential and deeply meaningful work.”—Theresa Brown, PhD, RN, author of the New York Times bestseller The Shift: One Nurse, Twelve Hours, Four Patients' Lives
- “These readable bite-sized snippets represent a significant caregiver demographic of women and men who exhibit the labor-intensive focus, compassion, dedication, and passion necessary to be an emergency nurse. From the heartfelt to the tragic, this book displays the nursing profession in all its unsung glory. A timely tribute to the modern-day heroes of medicine, conveyed in their own words.”—Kirkus
- “Thriller legend James Patterson has compiled hundreds of interviews for his poignant and timely nonfiction recounting of the dramatic, dangerous, and professional lives of America’s nurses.”—Parade
- "James Patterson and Matt Eversmann have captured the essence and drama of what it takes to be a nurse. Sometimes heartbreaking and sometimes frightening, give this book to someone who is thinking of being a nurse or is one already."—The Florida-Times Union
- On Sale
- Oct 24, 2023
- Page Count
- 320 pages
- Grand Central Publishing