text: “Hey, Carla” a gravelly voice greets from behind. As she finishes swiping her card through the time clock, Carla turns toward the direction of her name and sees Vicki digging through the bag barely hanging onto her shoulder, her keys jangling wildly, as she stood in the middle of the hallway, blocking Carla’s path toward the elevator. “Shit, I do this every morning” she says as she coughs. “Can’t find your badge?” Carla asks. “Fuck no! Even though it was right here when I tossed the damn bag in the car.” “You don’t think it fell out in your car, do you?” “I don’t fucking know but I don’t have time for this. I’ll walk up with you and go look for my badge after report or something” she says decidedly and hefts her tote bag filled with who-knows-what back on her shoulder. Vicki’s movements from readjusting her work luggage created a nearly imperceptible breeze but Carla catches the sharp whiff of bittersweet aroma that tells her Vicki probably smoked four cigarettes on her way to work. Vicki claims she has to “store up nicotine” because it’s impossible to find time for a decent break after getting to the floor. Carla inhales a little longer before walking past Vicki and pushing the button to call the elevator. As the women cross the threshold, one after the other, Carla holds her badge up to the black square with the blinking light near the numbers. The badge reader beeps and Carla selects “3” before the doors close in order to transport the nurses to the employee entrance for the ICU. Vicki could have ridden the visitors’ elevator up to the ICU but then she would have been required to check in with security since she was without her hospital badge. Here in the capital city, the hospital takes security very seriously, especially the ICU, and she would have had a hard time getting in without her badge. The doors were not even halfway open before Carla and Vicki could hear various cardiac monitors alarming, complaining of some disagreeable heart rhythm or misalignment of connections. Somewhere down the hall, a call bell dinged incessantly; the night shift was ready to go home and the day shift had not yet received report. It was the secretary that finally answered the call bell and told the patient “Your nurse will be right in.” Nearly everyone on the unit could hear the patient’s response as he yelled “THEY’VE BEEN SAYING THAT ALL DAMN NIGHT!” Vicki and Carla step off the elevator and narrowly miss colliding into another nurse walking as fast as he can to not officially be running. “That kind of night, huh?” Carla asked Elijah as she followed him to the main nurse’s station to check her assignment. Looking harried and exhausted, Elijah simultaneously shook his head, rolled his eyes and let out a deep breath. “You don’t even want to know, girlfriend. Thankfully, that piece of work has transfer orders to go upstairs today” he says, waving his arm in the general direction of the bellowing voice. “Well, aren’t you sweet?” Carla winked at him as she picked up the assignment clipboard. The back of her neck tingled when she saw that she had two sedated patients. Immediately she started fidgeting with her left hand: popping her knuckles, twisting her wrist to spin her bracelet around and around, and finally grabbing a pen that she started clicking every two seconds before she noticed Elijah looking at her. “Look, I don’t know how you get yourself going in the morning but if I were your partner and had to listen to all that popping and clicking, I’d shove that pen right through your trachea and give you a new airway” Elijah said without even blinking. “Geez! We know who has decided to chose violence today!” Carla said, laughing it off. “Remind me to request a different nurse if anything ever happens to me, okay?” “Gladly” says Elijah with his best customer service smile. “Now, are you going to make me wait all day or can I give you report so I can get my ass home, drink whiskey in the bathtub and try to sleep a little before coming back to this hell hole for one more night.” “Oh! You have my people? I didn’t even notice! I just assumed you had Mr. Sweet Cheeks down there with how ummm ... good you look this morning!” Carla tried to stop the last few words from coming out of her mouth, as she sat the clipboard down, but was unsuccessful. Thankfully, Elijah didn’t seem to take offense, maybe he had reached the state of exhaustion where he was numb to everything ... except her pen clicking. “Oh, you can thank me later when all you have to do is make sure the med don’t run dry. Both of our lovely ladies decided last night was a good night to buck their sedation, try to pull out their breathing tubes, and the doctors were NOT ready to try them off the ventilator. I mean, I have to stay up working all night so I don’t know why they have a problem bringing in the calvary at dark-thirty a.m. but who am I to judge?” Carla chose to just nod her head in agreement as they walked toward the station nearest beds 3 and 4 where she would be working today. She caught that sharp, bittersweet smell again before she saw Vicki’s bag next to the other computer at her station. “Dear God, doesn’t she know we can smell her from a mile away?” Elijah said as he made a face of disgust. “It’s a hard habit to break” Carla said quietly. “Well, hopefully she airs out a little so you don’t have to smell that all day.” I need to smell it all day , Carla thinks. It keeps me grounded and keeps the other demons away . “Here,” Elijah said as he pulled out a seat at the computers, “None of the families are here yet so let’s just do report at the station and then we’ll go check sedation settings before I sprint out of here.” As Elijah reviewed the admission notes, doctors’ orders, recent blood work, and meds for the patients, Carla felt like the thermostat had been increased by 30 degrees. She was hot, sweating, and knew she was going to leave sweat marks on the chair when she stood up. “Bed 3,” said Elijah “was the worst of them last night. 21-year-old female admitted as the driver of a single car accident, ejected from the vehicle, unresponsive at the scene, and, on top of everything being broken, her drug screen lit up like a Christmas tree.” They reviewed the lab results together and Carla saw that this patient was positive for nearly everything on the toxicology screen except marijuana. “I guess they haven’t figured out how to inject marijuana yet so” Elijah trailed off with a shrug. He continued to review the current orders for the patient’s sedation meds, ventilator settings, the last time the patient had been bathed, turned and whatever else he said ... Carla couldn’t hear him. As she glanced at the patient’s name, Carla felt her heart jump into her throat, momentarily suffocating her, and threatening to make her vomit her very life source right there onto the nurse’s station. Destiny Williams. It can’t be , Carla thought. “Okay?” she finally heard Elijah say. “Yeah, sure” Carla nodded and shook her head, coming back to the conversation. “Our other friend is an 84-year-old grandma, with a history of smoking about ten packs a day. Ms. Ethel decided to just sit around when she had the flu last month which then turned into pneumonia and now, she’s lucky enough to have a machine breathing for her” Elijah reported. “She got agitated last night and started pulling at her tubes but we caught her before she extubated herself. We gave her a little more ‘sleepy juice’ to keep her happy ass still until they can give ‘er a chance to show off her breathing skills on her own.” “Got it” Carla said as she watched Elijah click through the orders screen, the lab results and the plan of care, just like he did with Destiny’s chart. But all she could think about was Destiny. “So, you said the families have been by?” she asked. “Oh, well, just Ms. Ethel’s. This other one hasn’t had any visitors yet.” “How long has she been here?” “I think 2 nights” he said as he clicked back on Destiny’s chart to find her date of admission. “Yeah, 2 nights” Carla confirmed as she pointed to the screen. Carla knows they walked into the patients’ rooms. She knows Elijah showed her the settings on the pumps that were controlling the medication delivery to each patient. She also knows that they looked at the ventilator settings together and all of the mouth care supplies. But, as she said goodbye to Elijah and watched him walk away, she couldn’t recall any of the numbers for the various settings nor which side of the bed the vents were set up on. All she saw was Destiny. The unit was quiet now. Carla couldn’t hear any of the cardiac alarms. Mr. Sweet Cheeks was apparently satisfied (or did somebody already transfer him? No, it was too early for transfers.) And the last few night shift nurses were congregated around the elevator to ride to freedom together. Carla had to know. She slipped back into room 3 where she appraised Destiny not as a patient. What Carla saw as she looked at Destiny was somebody’s daughter, somebody’s dream, somebody’s reason to get clean. But had somebody failed her? What caused Destiny to have track marks up and down both arms? What led to Destiny thinking it was a good idea to combine so many drugs at once and then get behind the wheel of a car!? What happened to her mom? Where was Amanda? Knowing she had a little time before Vicki started looking for her, Carla sat on the edge of Destiny’s bed and held Destiny’s hand. Destiny didn’t move when Carla touched her. She couldn’t move. Destiny was sedated and paralyzed in order to keep her safe while she had a breathing tube down her throat, the machine breathing for her, because she was unable to effectively oxygenate on her own. As Carla felt Destiny’s limp hand in her own, she was transported back to the night that she and Amanda promised each other they would get clean. They would pursue better lives for themselves because they were too young to die but, mostly, because of the secret Amanda shared with Carla that night. “I’m pregnant.” Carla had barely heard Amanda’s whispered confession. “Are you sure” Carla asked. “I bought 5 tests from the Dollar Store the other day and they all came back positive.” “Oh, Amanda” Carla said as she pulled her friend in for a hug. “And before you ask, no, I don’t know who the daddy is but I don’t care. I’m keeping this baby and I’m going to get clean so she can have a better life than the one I’ve been livin’ out here on the streets.” “Okay! I’m here for you and we’ll do it together” Carla exclaimed. “See ...” Amanda stalled “that’s the thing.” She looked away, not able to make eye contact as she continued “I’ve been talking to some social workers and they said there’s rehab facilities or somethin’ like that for pregnant women like me who want to get clean but, unless you plan to go get knocked up, they don’t have no room for anybody on their own.” “That’s ridiculous! They won’t turn me away.” Shaking her head, Amanda said, “I don’t know, Babe. The lady said they make you pee in a cup every week to make sure you’re still pregnant and ain’t been sneakin’ no drugs. As long as I stay clean, they help make sure I get to the doctor visits and everything.” Trying to be happy for her friend, Carla put on her best smile, grabbed Amanda’s other hand, looked her in the eye and said “It sounds like a good chance for you and your baby. I’m happy for you, the both of you, Amanda.” The two women looked at each other a little longer, wrapped in the embrace of the familiar darkness, before Carla broke the silence saying “You better not forget about me” as she gave Amanda’s hands a squeeze to punctuate each word. Throwing her arms around her friend’s neck, Amanda whispered “Never.” That was nearly 26 years ago. Amanda stayed clean throughout her pregnancy and delivered a healthy baby girl that she named Destiny. Carla had eaten humble pie and moved back in with her parents where she went through a painful detox alone and refused to go out of the house if the sun was about to set. The darkness was her demise and she knew that she was too weak to avoid the corners and houses that used to feed her habits or help her make the money to afford them. To scratch the itch of stopping the drugs she used to do cold turkey (never as heavy as Amanda’s vices), Carla took up smoking. On days she was particularly pining for a bump, Carla would make a game with herself to see how slowly she could smoke a cigarette, sometimes just lighting one and not even putting it to her lips. When she and Amanda met up after the birth of Destiny, Amanda told her “You can’t be smokin’ around my baby. I’ve been doin’ real good not putting her around any of that old mess we used to do.” So, Carla would leave the cigarettes in her car and not even bring them around her friend. One day, when Destiny was about 4 years old, they met at the park and Carla looked at Amanda before blurting out “I’m thinking about doing something crazy.” “Crazier than stopping drugs cold turkey and having a baby on your own?” “Well,” Carla chuckled, “You might have me there but it’s a close second.” “Hit me with it” Amanda said as she playfully met her friend’s shoulder with a closed fist. “I’m thinking about going to nursing school.” As serious as a heart attack, Amanda returned the same genuine excitement and support that Carla had shared with her five years before. “Carla! You go girl! You’ve always been such a good friend. You’ll be the best nurse.” “I have to take a few classes before I can apply but my parents said I could live with them as long as I have a plan to better myself. I figured being a nurse could help me afford to eventually live on my own.” “Hell, we’ll come live with you” Amanda exclaimed before she thought better of it. Both women’s faces grew solemn as they understood, without having to discuss it together, that it was too risky for them to live together again. “But, for real, Carla, I’m proud of you. Just like you believed in me, I believe in you” Amanda recovered. Classes started for Carla two months later. It took her three years to get her prerequisites completed since she had to space out classes enough to allow her to carry a job without working any night shifts or taking evening classes. Once in nursing school, Carla focused on her studies and clinical rotations and finally finished her associates degree 2 years later without having to repeat any semesters. She passed the licensing exam on the first try and found a job that allowed her to work in exchange for tuition reimbursement as she pursued her bachelor’s degree and finished that in another 2.5 years. During the pursuit of her dream to become a nurse, Carla lost touch with Amanda and had no idea how to get back in contact with her. She often thought of her friend from so many years ago when they had patients come in with the most devastating stories, preceded by drug use and decisions made while impaired. Carla was so thankful that she and Amanda found their reasons to get and stay clean so many years ago and always sent up a silent petition on Amanda’s behalf that she was still doing well, too. But, today, as she looked at the daughter of a friend she hadn’t heard from in over a decade, Carla’s heart shattered just like Destiny’s body. Yes, Carla maintained a healthy fear and respect of the drugs she used to encounter on the street, specifically the Fentanyl they used to help sedate their patients. But seeing Destiny’s bruised and battered body, hearing the machine’s rhythmic breathing for her, and steady beeping as the heart monitor provided feedback for Destiny’s pulse, Carla couldn’t hear the drugs calling her name. She heard Amanda’s voice telling Carla she believes in her. Though the situation appeared dire and Destiny had a long road ahead of her, Carla knew this wasn’t the end for Destiny. As she had so many other days, Carla renewed her vow to stay clean and help nurse Amanda’s daughter back to health. Vicki poked her head in and said she was going to look for her badge in her car. Carla gave Destiny’s hand one more squeeze before standing up and getting to work, continuing to fulfill the dream she strove to achieve each and every day.