I slipped the darkblue jacket off, tucked it into the narrow locker and snapped the latch shut. The staff room smelled of cheap washing powder and a hint of bleach drifting in from the next bathroom. My night shift was scheduled to start at nine, but I arrived a little early so I could change without hurrying and sip a strong black tea from my thermos. The bitter aftertaste told me the night would be long. I smoothed my white sweater under the gown, slipped a pair of rubber gloves into my pocket and stepped out into the corridor of the highdependency ward.
The corridor was lit by a dull glow from the ceiling lights, the soft clatter of a porter pushing an empty trolley echoing off the walls. Beyond the long window pane lay the lateautumn darkness; a few street lamps in the courtyard offered a weak wash over the crust of frozen snow. I nodded to the dayshift sister, who handed me a folder of orders, the oncall anaesthetists contact details and an old pager. Three patients for the night, all critical: check blood pressure, inspect the drips, listen to the lungs and, above all, keep anyone from slipping away.
In Bay6 lay Albert Edward Pavlov, seventyeight, with terminal stomach cancer, an opioid pump humming at his side, his face waxen. The monitor tracked a fragile pulse, oxygen saturation hovering around eightyfour percent. I dampened the old mans lips, adjusted his pillow and verified the timing of his next morphine dose his pain needed to stay under control even through the night. His breaths grew softer, though a harsh wheeze still rattled between his ribs.
A door down the hall flickered with the cardiac monitor of a younger patient Nick Prudenko, twentyfive, who had been rushed in after a roadtraffic collision. He suffered a fractured pelvis, a bruised lung and internal fixation. A catheter was linked to a drain, colloids sat on the bedside table. I made sure his urine bag wasnt overfull and heard him whisper:
How long have I been here?
Two days now. Everythings going as planned, just keep breathing easy, I replied evenly. He closed his eyes and the nightshift sister moved on to the next bay.
Rosie Turner, fortythree, had just survived a suicide attempt a bottle of sleeping pills and a deep despair. Her stomach was washed out, her mind cloudy, fresh pink bruises marked her wrists. She squirmed under the blanket, trying to pull it off.
Rosie, Im right here. Your mouth might be dry, let me moisten your lips, I said, handing her a watersoaked cotton ball. Her glassy stare fixed on the ceiling; the nurse observed how much pain it takes to drive someone to the pills.
It was twentythree past fifteen. The first entries: temperature, blood pressure, drip rate. From the old mans bay a rising cough drifted out. I lifted the headboard, connected an aspirator, then placed oxygen spectacles. The rattles eased, but his fingers remained cold and bluish.
Before I could step out, Nicks monitor shrieked: saturation at seventynine, blood pressure dropping. He had rolled onto his side and snagged the oxygen tube; the drain had tugged, leaving a dark stain on the sheet. I repositioned him, pressed gauze to the leak, swapped the fluid bottle and entered new parameters. The frontline staff were weary, the hallway quiet.
Midnight found me reviewing Rosies chart: two children, a divorce in August, no previous attempts. She asked to use the bathroom and then wept quietly. I helped her, administered diazepam and dimmed the lights. The deep phase of the shift began thoughts stretched, my legs felt as heavy as lead.
At one oclock the radiators sighed with a thin metallic hum, frost edging the window frame. The nightshift sister again made her rounds old man, trauma, suicide changing urine bags, moisturizing lips, checking dosages. The oncall doctor descended once, glanced at the charts and went back up: a stroke on another floor. The ward hung on the green lines of the monitors and the last sip of cooling tea.
Three fortytwo. Simultaneously: Rosies hoarse cry, a VTAC alarm for Nick, a prolonged moan from Albert. I hit the general call button, the pager buzzed to life. Time narrowed to a thin slit that had to hold three lives at once.
Rushing to Nick, I saw a pulse of onehundredforty and a falling pressure. Defibrillation was on standby, but I chose medication first. A cupboard in the corridor gave way as Rosies fixation slipped. Alberts wheeze grew rarer. I slammed the red emergency button, raising a bright signal across the ward, and, clutching the keycard to the drug cupboard, realised there was no going back to the calm before.
The warning light still flickered when two members of the resuscitation team the anaesthetist and a paramedic with a trolley sprinted to my station. I gave a brief rundown and followed them to Nick, already drawing a dopamine ampoule.
Inside, the monitor danced red and green, but the rhythm held together. While the paramedic placed an additional catheter, I pressed gauze on the leak and handed the doctor a syringe. Onefifty on forty, I reported. Within a minute the squiggles on the screen evened out. He would pull through.
The pager vibrated: the porter was struggling with Rosie. I handed the observation to the paramedic and hurried to the third bay. The woman stood barefoot by the window, clutching a bottle of saline.
Rosie, look at me. Youre safe here, no ones judging you, I said, moving in slowly, without sudden gestures. The plastic bottle clattered onto the linoleum, and Rosie broke down. I helped her lie down, applied fresh soft dressings, gave a minimal dose of diazepam and telephoned the oncall psychiatrist: an inperson assessment in the morning and roundtheclock observation.
Only then did I return to Albert. His rattles thickened, saturation fell to sixtythree. The morphine still lingered, but the furrow between his brows spoke of lingering pain. I gave a bolus, perched on a stool and took his cold hand. The corridor siren had already hushed, replaced by whispered commands, and the ward settled into near silence. Albert took two shallow breaths and then was still. Time of death: four zero five. I switched off the oxygen and tucked the sheet up to his chin.
The paramedic entered, helped disconnect the equipment and left to complete the paperwork. Patient stabilised, patient maintained, patient passed without a scream, I thought, ticking off the nights tally in my mind.
Just before five, pale dawn filtered through the grimy window, a blue hint of sunrise breaking. I collected used gloves, flushed Nicks drain, changed the bloodstained sheet. He was breathing more evenly.
Stable. Well get a scan in the morning and, if all looks good, move him to the general ward, I said. He gave a faint nod.
Rosies breathing steadied. I placed a folding chair by her bedside the porter would stay on watch. In her chart I wrote: High risk of repeat selfharm, 24hour observation, psychologist referral, safety plan.
Half past six, the oncall doctor came down again, this time unhurried. I handed over the verbal report and the procedure log. He checked the deathtime entry, nodded and signed the forms.
At eight the dayshift sister and the hospital cleaner arrived. I showed them the fresh bandages on Nick, the analgesic schedule, the observation protocol for Rosie. Then they cleared Alberts bay, closed his eyes and prepared the body for transfer.
The computer logged the final entries with trembling fingers: Rosie Turner conscious, denies suicidal thoughts; Nick Prudenko haemodynamics stabilised; Albert E. Pavlov death, pain controlled. I added, Nursing surveillance fully provided, and pressed Save.
The staff room still smelled of that cheap powder, but now it buzzed with earlymorning chatter. The sister slipped off her gown, buttoned her jacket neatly and placed the pager on its charger a long beep sounded like a farewell.
Outside, a thin dusting of snow filled the gaps between the paving stones. I inhaled the crisp air, feeling the breath steam from my lungs, and smiled despite the nights grind. A spare tea bag rustled in my pocket for the next shift. Cars hurried past, and I allowed myself a halfminute of peace before heading to the bus stop. The night was over, and I had made it through.
