Ernesto Barbieri is a registered nurse in the Boston area whose writing has appeared in The Believer, Iowa Review, Midway Journal, Fourteen Hills, Berkeley Fiction Review, and elsewhere. A graduate of Hunter College’s MFA fiction program, he is at work on a novel and a graphic memoir.
Jess Ruliffson is a graphic journalist based in Boston. She teaches at Boston University and The Sequential Artists Workshop. See her work and connect at https://www.patreon.com/jessruliffson and www.jessruliffson.com.
Editors: Jim Dao, Marjorie Pritchard,
Amy MacKinnon, and Heather Hopp-Bruce
Animation and project management: Heather Hopp-Bruce
Digital editor: Rami Abou-Sabe
Developer: Andrew Nguyen
Copy editor: Jessie Tremmel
STOP ANIMATION
PLAY ANIMATION
BED ALARM
In the ICU every patient is a fall risk. Sensors alert nurses to a patient getting out of bed without help. It rings in the room and outside the room.
VISITOR ALERT
Anyone entering the unit must first "buzz in." An intercom at the nurses’ station along with a security monitor helps nurses enforce the "two at a time" rule for families.
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CHAIR ALARM
A synthesized voice of reason, telling the patient to sit back down.
ARRHYTHMIA
ICU patients often go into weird arrhythmias, caused by infection, agitation, fluid overload, and many other factors. Prompt response is crucial.
IV PUMP LOUD BEEP
Kinked IV. Usually from a patient bending their arm. But sometimes drugs will interact and "crystallize" inside the line, ruining the IV’s patency.
IV PUMP SLOW BEEP
Low on batteries, needs programming, delayed for too long, or medication is done infusing.
RAPID RESPONSE
A code for a person in distress is called over the PA system. Can be anyone in the hospital: a patient who can’t breathe, a visitor who’s found unresponsive, a nurse with low blood sugar.
LAB TUBE
Pneumatic tube system that traffics blood between the lab and ICU.
MEDICATION SCANNER
A rover a device resembling a cellphone is used to scan a patient’s wristband. Ensures the right person gets the right meds.
ARTERIAL LINE
A special IV that keeps continuous track of your blood pressure. If the line is dislodged or the patient goes hypotensive an alarm sounds.
Click each to listen
STOP ALL
PLAY ALL
WHEN
ACCIDENTS
HAPPEN
True stories from an ICU
Written by Ernesto Barbieri
Illustrated by Jess Ruliffson
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Series
The patient is a woman in her 80s who fell out of her wheelchair.
Shattered her pelvis. Whisked off to surgery for a stable fixation.
But something went wrong.
That’s the thing about medicine — and human bodies — something always goes wrong.
“Hi, this is Judy in the OR,” says a nurse on the phone. “We need two units, stat.”
“She’s not typed,” says the person on the other line.
“Huh?”
“We don’t know her blood type.”
By the time she gets to the ICU, she’s in low-grade kidney failure.
(Low-grade kidney failure is caused by a sharp decrease in circulating blood volume. The kidneys hoard sodium and water to preserve the body’s fluids. Blood is diverted to the heart and brain, depriving vital organs of oxygen and leading to shock.)
“She looks terrible,” says one of the nurses.
“She needs blood. They never typed her,” says Ernesto, also a nurse.
“What?!” says a third nurse
“OK, let’s give her fluids,” says a doctor.
We get the woman X-rayed, and it’s remarkable — the murky gray of her anatomy against the bright white lines of our hardware.
I lift the sheet to check the incision: a scattering of red dots and dashes conceal the screws, pins, and plates underneath.
ONE HOUR LATER, IN THE RECOVERY ROOM
“When can she eat?” says a woman visiting the patient.
“Not for a little while,” says Ernesto
“Can she have water?” asks a man visiting the patient.
“Ice chips for now,” says Ernesto.
My answers are a digest of half-truths, half-promises. They satisfy no one.
Meanwhile, bed five has bugs: Candida, RSV, C. diff. She’s caught in a doom loop of
diarrhea and pneumonia.
“You have lovely hair,” says Marek, also an ICU nurse.
Marek keeps a stash of beauty supplies in the pantry.
Beard trimmers, scented lip balm, loofahs, and Lady Speed Stick…
He creates mirages of calm.
But the noise is relentless.
(The background is filled with the word “beep” flashing over and over again)
“Doing OK?” Marek asks Ernesto, who is walking past in the hall.
“Yeah,” replies Ernesto.
You breathe wrong, it trips an alarm.
Everything blurts peril.
Everything radiates color.
It’s like the hospital is a clearinghouse for down-market gadgets that were resold
as medical equipment.
You got any Tylenol? I have a headache,” Ernesto asks Marek.
“I have peppermint oil,” Marek responds.
RAPID RESPONSE, SIXTH FLOOR. RAPID RESPONSE…”
The patient is a man in his 50s, complaining of chest pain. In the ER, they gave him aspirin. Hooked him up to an EKG and found his heart to be in A-fib.
(A-fib is a quivering of the heart’s upper chambers. Impaired pumping can lead to blood clots in the heart, which may travel to other parts of the body. Heparin is infused until the patient can be “bridged” to an oral anticoagulant.)
They started a heparin drip, which caused him to bleed into his stomach. They stopped the anticoagulants.
Now he’s got blood clots in his lungs.
“The good news is, you’re in a hospital,” says the doctor.
“OK,” says the patient.
“You’re going to get the absolute best treatment,” says the doctor.
“Thank you,” says the patient.
“W’ere going to choose the best drug for your condition,” says the doctor.
“OK,” says the patient. “Which drug?”
“We don’t know yet,” says the doctor.
“Then how do you know it’s the best,” says the patient.
The doctors have this unbound energy.
Medicine for them is about more than just pills, more than just science.
“Medicine” is a cipher for unlocking the mysteries and sacraments of a supposedly random universe.
“What about my liver?” asks the patient.
“Oh, your liver is terrible,” says the doctor.
“Really?”
“Your liver, pancreas, all bad.”
“Jesus.”
“But it’s treatable. All of this is treatable.”
I sometimes think a hospital is an engine of chaos…
...a noisy apparatus that converts suffering into money.
Other days it feels like a casino, with its countless opportunities to lose — and slim odds to win.
“It’s like there’s a man with a gun standing behind you, OK?” says the doctor, to the patient with heart issues. “And there’s a man with a knife behind him.”
“Blood’s here,” says a nurse at the door.
“Finally,” says Ernesto.
And we recruit more gadgets to the scene.
Verify the Patient
(Ernesto’s handheld scanner beeps as he scans the arm band of the woman who fractured her hip.)
Check the unit number, the blood type.
(beep, beep)
Barcodes on people. Whose bright idea was that? They ought to be shocked With 200 joules.
Every step is just another opportunity for a mistake.
You’re juggling all these devices, listening for alarms, watching for signs of a hemolytic reaction, and trying to hold it all in your head.
(Hemolytic reaction: If it’s the wrong blood type, the immune system will rip apart the red blood cells and the kidneys will fail. Iron in red blood cells is toxic — it destroys the liver and lungs.)
Everything you do, there’s a barcode to scan, a dozen buttons to push.
Your eyes are everywhere but on the human in front of you.
“Can she have soup?” asks the man visiting the patient.
“Not until the blood’s finished,” says Ernesto.
“What about a salad?” asks the womman visiting the patient.
You hear these stories…
A nurse in Tennessee accidentally injects vecuronium — a chemical paralytic — into a woman waiting for an MRI.
A neurosurgeon drills a hole into the wrong side of someone’s head.
And you think: How does that happen?
Didn’t something go bloop, bloop, bloop?
We’ve had two falls this year.
The last one was Marek’s.
I was the charge nurse.
CRASH
“What was that?” asks Ernesto.
PLEASE DON’T GET UP blasts an alarm.
“I left the room for two seconds,” says Marek.
“Was it a head strike?” asks Ernesto.
“What do you think?” replies Marek.
Ernesto is in the hall talking to a nurse in pink scrubs. She is wearing large hoop earrings.
“Was the bed alarm on?” she asks.
“Yes, it was,” says Ernesto.
“Why isn’t the sign posted?” she asks.
“What sign?”
“The fall risk sign.”
“We have fall risk signs?” asks Ernesto.
“Yes, look,” she says, pointing to a sign on the wall.
“That’s the Red Sox logo,” he says.’
“No, those are non-slip socks. See the white treads?”
“It’s literally the logo of the Boston Red Sox.”
“In this hospital it means: FALL RISK.”
“Hook-Kay,” says Ernesto.
But everyone here is a fall risk.
When you take a sick person and rob them of sleep, wire them up to a dozen machines, and pump them full of strange drugs, they are going to fall.
No nursing error is required. Gravity will take care of it.
When the blood’s done transfusing, the kitchen is long closed.
Ernesto stands at the bedside of the woman with the hip fracture.
“She didn’t get the dinner tray,” says the woman visiting the patient.
“Let me see what I can do,” says Ernesto.
A bubble of leftover lettuce — I take out the white parts…
The hard parts that no one likes.
A selection of dressings from our private fridge.
Apple slices from my uneaten lunch.
Crumbled saltines — they’re kind of like croutons.
A forbidden dose of ice cream.
I bring it all to her on a plate.
Not a foam tray. No plastic dome.
A solid object — that’s what sells it.
Has weight.
Might break.
The sisters
ICU stories 4:
Recovery and decline
ICU stories 3:
Tenderness and brutality
ICU stories 1:
The sisters
ICU stories 4:
Recovery and decline
ICU stories 3:
Tenderness and brutality
ICU stories 1:
Recovery
and decline
ICU stories 3:
The sisters
ICU stories 4:
Tenderness
and brutality
ICU stories 1:
Although the events in this story are real, names have been changed to protect identities.