The chronicle of the final voyage of the medical relief ship GSC Nightingale.
Monday, September 20th 2213
Lucy expected the first day of class on the Nightingale to be like her other first days—syllabus review, textbook discussion, and introduction to students and faculty—so when the one hundred nursing students arrived in the simulated hospital on the fourth deck, they were surprised to find only one nursing instructor standing at the doors to meet them.
Nurse Athelstan George towered with arms crossed, watching the students assemble with eyes so dark brown they were almost black. His curly hair was pulled into a bun on the back of his head, and his trimmed beard looked like he could easily let it become wild. His blue-gray scrubs looked too tidy on him, like someone had dressed a gorilla up in a tuxedo.
“Good morning,” he said when the area was full. “Is this everyone?”
The crowd shuffled as everyone looked around. It was impossible to tell how many students had showed up, but it wasn’t hard to believe a hundred people were jammed into the room.
Next to Lucy, Emma clutched a pile of books. Her wide, excited eyes watching Nurse George intently, like a starving child eyeing an unguarded cake.
They had been told they’d only need their Patient Assessment text that first day, so that was all Lucy had brought. She leaned toward Emma and said, “Do you want me to hold some of your books?”
“No,” Emma said. “I’m okay. I usually have more.”
Nurse George wrapped the fingers of one hand around the other fist and cracked his knuckles. He repeated the act on the other hand and then put his hands behind his back.
“This is the hospital,” he said. “Your DEXTER units are inside, waiting. Your doc partners will be here in a couple of hours, and it’s up to you to do the initial triage on the patients.” He rubbed his chin absently. “Your textbooks will outline the procedure. I expect it written up and submitted to me no later than 1800 tonight.”
Lucy suppressed a groan but many around her didn’t.
Nurse George grinned. “Yeah, yeah,” he said. “Get used to the papers. You’re gonna write a lot of them.” He kicked the hospital’s double doors open and waved them inside. “I’ll be around if you have questions.”
Emma was the first student to dash inside. Lucy tried to keep up with her, but the flood of students into the hospital separated them.
A hallway fed the students into an intake area with an unmanned desk in the middle. Like spokes of a wheel, five halls spiraled out from the intake area. Every hall displayed a placard at the mouth with room numbers on them. The placard posted at the hall on the left said ROOMS 4101-4120; the hall on the far right said ROOMS 4501-4520.
Clipboards lined the desk, stacked several high. Upon closer inspection, the students discovered that each clipboard featured a student’s name on the screen.
Everyone went to work finding his or her clipboard. When Lucy finally released hers from the pile of them, she retreated to a far wall before she looked at it. The top page listed her name. She flipped to the next page, dragging her finger up the screen, and saw Otto’s name and a room number: 4317.
She found the middle hallway with the placard ROOMS 4301-4320. Her room was nearly at the end, and the door stood open. She stepped inside and smiled at Otto, who slumped on the hospital bed.
“Hi Otto,” Lucy said.
He squinted at her and frowned. “Hi.” He wasn’t the happy-go-lucky unit she had spent time with since Thursday. He clenched the sheets on the bed and grumbled, “Where’s the doctor?”
“Uh, he’ll be here soon,” Lucy said. She nudged the door shut and fiddled with her textbook and clipboard for a moment. She crossed to the sink in the corner and set the textbook there, then turned to Otto with the clipboard. She pulled a stylus from her pocket and licked her lips. “So, um… why are you… I mean, what brings you in today?”
Otto glared up at her, scowling as he rolled his eyes. “Are you even old enough to be a nurse?”
Lucy’s heart pounded. “Yes.”
Otto rolled his eyes again and said, “I get chest pain sometimes.”
“Okay.” Lucy scrolled through the clipboard more, searching for a page to record information on. She finally came upon one, organized to get Otto’s medical and social history.
“I need to ask some questions,” Lucy said, activating the page to record and assimilate information. “Is that okay?”
“Fine.” Otto scratched his cheek. “When’s the doctor going to be here?”
“I’m not sure.”
Otto made a loud noise of frustration. “I didn’t come here to see a nurse. I came for a doctor!”
Lucy tried to remember what she’d read in the text, but could only recall bits and pieces. Her nervousness sucked most of her memory out of her.
“I… sir, I need to get—”
“You need to get the doctor, is what you need to get.”
“I need to get your medical history so—”
“Why?” Otto asked. “It’s none of your business.”
Lucy didn’t know how to continue. She stood, speechless, until someone knocked on the door.
“That better be the doctor,” Otto grumped.
Lucy opened the door. Natalie stood on the other side, grinning. “How’s it going?”
Lucy brought the clipboard up to block her face from Otto as she muttered to Natalie, “Why did you guys make him so mean?”
Natalie laughed. “It’s random. Sorry.”
“I don’t know how to handle this,” Lucy said.
“It’s your first day.” Natalie stepped into the room and shut the door. “Hey Otto.”
Otto glared at her. “Are you the doctor?”
“No, bitch, I’m a nurse.”
He slammed his fists against the bed. “Where is the doctor?”
Natalie smiled. “Otto, cool it.”
And, incredibly, Otto did. The petulant expression vanished from his face and he stared at the floor with blank eyes. He didn’t speak again.
Natalie inspected a fingernail as she said, “Patients like these are hard. There are three principles of nursing. Did you read your textbook?”
“Yes,” Lucy said. “But I just… I can’t remember it.”
“Relax,” Natalie said. “Just think. What are three things you think are important to being a good nurse?”
Lucy didn’t answer right away. She thought about why she wanted to be a nurse, and why she had sacrificed so much to get to the Nightingale. Her father’s funeral was the first thing into her mind—and probably always would be—followed by the air raid sirens, the evacuations, and the sleepless nights spent in caves away from the towns and the lights that made them good targets.
She realized she’d been quiet for too long, so she cleared her throat and said, “Empathy.”
Natalie nodded; the look in her eyes told Lucy she knew something deeper had gone into that answer. She didn’t press the issue or Lucy’s pause, just said, “Good. What else?”
“Respect,” Lucy said after a minute.
“Yes.” Natalie smiled. “One more thing.”
Lucy clenched her teeth and grimaced as she tried to wring a final answer from her mind. She couldn’t think of anything definitive, so she said, “Communication?”
Natalie scrunched her nose. “What kind of communication?”
“Clear?” Lucy tried. When Natalie shook her head, she said, “Concise?”
“Confrontational,” Natalie said. She held up her hand and ticked three fingers. “Empathy. Respect. Confrontation.”
Lucy pursed her lips. “Confrontation?”
“Hell yeah.” Natalie pointed at the still-subdued Otto on the bed. “When you’ve got someone like that all in your face, you’ve got to confront them about it. Say, ‘yeah I’m the nurse and I’m a professional and I’m here to help you, so tell me what I want to know or shut the hell up’. Or if the patient is nice, you still have to confront their issue. Or you might have to confront doctors or other nurses. You can’t be a wilting daisy. You’ve got to be ready to kick balls and own your practice.”
The energy and fire in Natalie’s explanation lit a flame of Lucy’s own. She wasn’t going to let patients or doctors or anyone else walk on her. She could kick balls. She could own her practice. She could do all that and more!
Natalie grinned. “So, you going to let this dick yell at you anymore?”
“No way,” Lucy said. Her stomach felt a little unsure but she was ready to face mean Otto again. “I’m going to figure out what’s wrong with him and solve it.”
“Good,” Natalie said. “Otto, activate.”
He straightened at her words, sitting up and blinking a few times before his face pulled into its previous irritated countenance. “If you’re not the doctor, I don’t want to have anything to do with you!”
Lucy licked her lips and stepped toward Otto. In her most authoritative voice, she said, “Sir, I need to get some information from you for the doctor. Please answer my questions as best you can.”
Otto turned his head toward her, scowled, and said, “I don’t have to listen to you. You’re just the nurse.”
Lucy’s eyes darted to Natalie, who lifted her eyebrows in a gesture of Go on, let him have it! Lucy steeled herself and said to Otto, “Sir, I’m just as qualified as the doctor is to perform this assessment. I’m a professional and I’m not going to let you treat me like—”
“Like what?” Otto interrupted, yelling. “Like an ignorant little girl who doesn’t know anything about anything? Listen, honey, go get the doctor so we men can have a conversation with some substance. Okay?”
With huge, surprised eyes, Lucy looked at Natalie. Natalie gaped at Otto, then met Lucy’s gaze. “Holy shit.”
Otto yelled, “How did I get stuck with two worthless wenches?”
Natalie’s alarm melted off her face and she laughed. As she opened the door, she said, “Someone programmed him a little too hard for a first day. Sorry.” She jerked her head toward the door, indicating that Lucy should follow.
Lucy did. In the hall, Nurse George’s disembodied voice issued out of speakers in the ceiling: “Your patients are powered down. Please come into the hallway.”
Lucy watched as doors opened and nineteen other nursing students escaped from their rooms. They all gathered around Natalie, who said, “So, how’s it going?”
“Great!” someone said.
“Awful!” someone else said.
A chuckle passed through the crowd of students. Lucy spotted Stacy a second before he said, “My patient won’t say anything to me.”
“Sometimes they won’t,” Natalie said. “And sometimes you love your patients, and sometimes you hate them. But it’s important to remember one chief thing: treat them all the same. No matter how you feel, your patients get the same level of care across the board. Right?”
Natalie grinned. “Well, are you all ready to handle another patient? Because your DEXTER units have been reset with another personality. When you walk into that room, you’re dealing with a brand new patient. Save your current assessments and start a new one. See if you can get more information this time!”
She lifted her hands in the air and splayed her fingers. “Go, my minions. Go forth and nurse!”
Another chuckle from the students, and then they all dispersed back to their rooms. Lucy took a deep breath and knocked on the door, peering in a moment later.
“Hello,” she said to Otto.
He lifted his face toward her, tears staining his skin, and he said, “Whuh-whuh-why does it h-hurt so b-bad?”
Lucy stepped into the room, clutching the clipboard to her chest, and began her assessment of him: blood pressure, pulse, respirations, and blood glucose. Ten minutes later, another personality switch happened, and Lucy took vital signs on that one. Another switch came ten minutes later, and on and on.
After Otto had gone through a dozen personality swings, Lucy was rescued from her personality roller coaster by a knock at the door. The door opened, and Daryush poked his head in. He smiled at Otto and then at Lucy. To Otto he said, “Hi there. I’m Daryush. I’ll be your doctor today.”
Otto clapped his hands a little. Daryush had gotten lucky and walked in during one of Otto’s happy phases. “Oh good!”
Daryush entered the room all the way and shut the door behind him. He stood beside Lucy and said, “What’s the problem today?”
“I’ve got tingly feet,” Otto said, indicating the offending body parts. “And I’ve just got no energy. I try to exercise but I can’t. I went for a walk the other day and I had to sit down right in the middle of it.”
Daryush nodded, and Lucy watched his clipboard record what Otto was saying and allocate the information out into a preset format.
A few minutes of questioning later, Daryush smiled and said, “Okay Otto, I think I’ve got enough information. Nurse Lucy and I are going to go get to work on a diagnosis for you, okay?”
“Oh, thank you!” Otto said. “Thank you so much!”
Daryush opened the door and said, “We’ll see you later, Otto.” Then he and Lucy stepped out.
Daryush beamed at her. “Well, he’s just a nice robot, isn’t he?”
“No.” Lucy snorted. “You should have seen him the morning. He was downright mean.”
“That’s crazy,” Daryush said. “Well, let’s not go in again, so he doesn’t have a chance to cycle back to meanness.”
“Aren’t you going to give him his diagnosis?” Lucy asked.
Daryush shook his head. “I don’t know what’s wrong with him. Tingling toes and fatigue? It could be a million things. I need tests and stuff, which I don’t have. This was just an assessment exercise, I think. We’re supposed to figure it out later.”
The idea of spending time later figuring out a diagnosis with Daryush made Lucy’s heart beat faster. “So, we’ll meet up after lunch, then?”
He smiled slowly, like he was just now realizing that Lucy’s presence was an option. “Yeah. Yeah we can. Or we can have lunch together.” He scratched his head. “Or not.”
Lucy didn’t get to accept his lunch offer. Sarah stormed out of a nearby exam room, face red. Stacy strolled out after her, stifling a laugh.
When Sarah saw Lucy and Daryush, she grunted angrily and continued her retreat. Stacy approached Daryush and Lucy, grinning when he got close.
“What’s the matter?” Daryush asked, indicating Sarah.
“She’s pissed,” Stacy said.
Lucy exhaled hard out her nose. “Obviously. Why?”
Stacy laughed. “Patient wouldn’t stop crying. It was hilarious.”
“The patient crying was hilarious?” Lucy was alarmed at his callousness.
He shook his head. “No. Sarah’s reaction to the patient crying was hilarious. She didn’t know what to do. She just stood there with her clipboard and kept telling her to stop crying, and that made her cry more.” He chuckled.
“I guess we got lucky,” Lucy said. “Otto’s pretty nice now.”
“I think Sarah would be just as weird with a nice patient. I don’t think she knows how to interact with lesser humans,” Stacy said. He tapped Lucy on the arm with a fist. “Hey, later do you want to get together to do some homework?”
Lucy was surprised and let that emotion show on her face. She pulled it back as quickly as she could, trying to sound nonchalant when she said, “Why would you want to do homework with me?”
He shrugged. “We’re going to be roommates for a year, right? Might as well get to know each other. No sense in making this an unpleasant arrangement.”
“Okay.” Lucy smiled. “That sounds like a plan.”
“Great,” Stacy said. “See you later.” He waved as he walked off, and Lucy dared to believe that at least four people were interacting with her without mentioning her being from a war zone.
Maybe everyone back home was wrong. Maybe you were just being paranoid about it. Maybe no one cares.
That thought made her smile until Daryush said, “So you’re going to be busy with him?”
She didn’t catch onto what he was saying at first. “Yeah, I guess we’ll do homework. That ought to be fun.”
Daryush nodded. “Okay. Well, I can get this diagnosis done on my own. I’ve got a class to get to, so I’ll see you tomorrow.” He walked away before Lucy could process what he had said. Only after he was halfway down the hall did she realize he thought she had ditched him for Stacy.
“Daryush!” she called, but he kept going. She didn’t know if he couldn’t hear her or if he was ignoring her. She muttered, “Shit.”
From inside the room, Otto called, “Are you out there, nurse? I need a glass of water!”
Lucy rolled her eyes and was about to pretend like she hadn’t heard him, but halfway down the hall, she found a water machine and got a cup for Otto.
Lucy looked for Daryush for the rest of the day but never saw him. Stacy found her at lunch and suggested they work on their papers immediately afterward, to which Lucy agreed.
They had the common area to themselves. Stacy reclined back on the couch with his feet up, assessment text in one hand. He tapped the screen, highlighting parts and making notes, and then he said out loud to Lucy, “Do you even understand what the hell a nursing diagnosis is?”
“Kind of,” Lucy said. “It’s more about the patient than the illness. I don’t know exactly yet.”
The main door opened with a whoosh and Jack strode in. He paused when he saw Stacy and Lucy, and lifted a hand in greeting. “Afternoon.”
“Hey Jack,” Stacy said, sitting up.
Perking up, Lucy observed.
“Hey.” Jack lingered for a moment, and then kept heading to his room.
Lucy said, “Jack, do you want to do homework with us?”
He smiled. “Yeah, sure. I mean, I don’t want to slow you down or anything…”
Stacy waved his hand dismissively. “I don’t think anything could slow us down about now. We may, in fact, be going backwards.”
Jack laughed. “Okay. Let me grab my notes.” He disappeared into his room.
While they waited for Jack’s return, Lucy observed Stacy. He furtively groomed himself: smoothing his hair and shirt, drawing fingers along his eyebrows, even testing his breath a little. Lucy managed to hold in a laugh, but just barely.
When Jack returned, texts in hand, Stacy scooted toward Lucy to give Jack room to sit.
“Cheers,” Jack said as he sat. He flipped his text open and tapped the screen to get into the book. “What page are you guys looking at?”
“We were discussing diagnoses,” Lucy said. “Page forty-seven.”
Jack scrolled to the appropriate page and scanned it for a few moments. Then he said, “What about them?”
“How to put them together,” Stacy said. “It’s confusing.”
“Nah, it’s easy.” Jack leaned toward Stacy and pointed to where the Australian had been taking notes. “If you think of it as a three-part question: what, how, why? What the problem is, how they got it, and why you think that.” He paused. “Make sense?”
Stacy and Jack were close—at the movies sharing popcorn close. Lucy said nothing, just watched them interact. Stacy nodded like he understood, and then smiled, embarrassed. “No, it doesn’t make sense.”
“Okay.” Jack stroked the stubble on his chin and cheeks as he thought. “Well, say you’ve got a patient who was in a car accident. What do you think a major problem he’d have would be?”
“I dunno,” Stacy said. “Pain, probably.”
“Okay, good,” Jack said. “Pain because of what?”
“Because… of… the car accident?” Stacy guessed.
Jack nodded. “So we’ve got pain caused by a car accident. How can you determine a patient is in pain? Why do you think the patient is hurting?”
Stacy sighed, using that movement to settle a little closer to Jack. “You can ask them. Pain scale, and all that.” When Jack nodded, Stacy continued. “And people in pain make faces. They grimace, or they guard what hurts, and stuff.”
“Yeah,” Jack said. He reached around Stacy and tapped out in his notes: “So, pain related to a car accident as evidenced by pain scale report of… I dunno, six out of ten, patient grimacing, patient guarding abdomen, et cetera. Does that make it any more obvious?”
Stacy nodded and shifted his eyes up toward Jack. They smiled at each other, and Lucy thought she might laugh out loud at their silly flirting when the main door whooshed open.
A dark cloud seemed to precede Sarah wherever she went, dampening the mood of any room. She swept through the door like an evil sorceress, glowering at the three on the couches. Her gaze lingered on Stacy and Jack for an extra moment, and then she disappeared into her room without saying so much as hello.
Lucy left Jack and Stacy out on the couches. She finished writing the paper for Nurse George and turned it in. As soon as she crawled into bed, Stacy arrived. Lucy waited a few moments before saying, “Did you guys kiss?”
Stacy laughed. “What?”
Lucy rolled over so she could look down at him. “Please, Stacy. You guys are so into each other.”
A little smile twitched up the corners of his mouth. “You think he’s into me?”
Lucy nodded. “Completely.”
“Well we didn’t kiss,” Stacy said. “I’m not gonna give it up so easily.”
Lucy laughed and rolled back over, drifting to sleep not long thereafter.
The next morning Lucy got up before Stacy did and made it into the shower earlier. As she was toweling off, she realized she’d forgotten her bra out in the room.
Who cares, though? He’s gay. He won’t care about your boobs.
She pushed the door open, scrubs pants on, topless. The feeling was liberating; she’d never gone topless around non-family members before. For the first time, she was actually glad to have Stacy as a roommate.
Stacy, who had been waiting on his desk chair, stood when the door opened and started toward the bathroom. He paused at the sight of Lucy’s bare chest, looking between her face and her breasts with a confused then appreciative look on his face.
Lucy laughed. “Are these the first boobs you’ve ever seen, Stacy?”
“No, Lucy,” Stacy said. “No they’re not.”
“What, your sisters or something?” Lucy asked.
Stacy smiled and shook his head. “My girlfriends.”
Lucy felt the color drain out of her face. She was too alarmed even to cover up her exposure. “But… you’re… I mean, Jack…”
Stacy stepped past Lucy, pausing for a moment to say, “I’m not gay. You have very nice tits.”
And then he was gone into the bathroom, sliding the door shut while Lucy stood still in the room, boobs still out, too humiliated to move.