Page 7 of Alarm Fatigue

Cramped into the ICU office, Mark and I review the patients list for the night. He has hardly made eye contact with me and is staring down at his paper as we review the case of each patient we need to look after. The air feels charged between us, and for my part, I cannot seem to stop fidgeting.

“Next one. Forty-eight-year-old female, witnessed falling down two flights of stairs while intoxicated; hospital day 1, now known to have a stable SAH per the most recent CT scan. Neurosurgery team is following and they want us to keep the systolic BP less than 150, hence the nicardipine drip.”

“Got it, systolic blood pressure under 150, anything else?”

After a beat, I realize that either he does not seem to hear me or else he has lost the power of speech. He really is avoiding eye contact. Well, to be fair, so am I. The tension is this room is about a mile past subtle. To hell with this. “Mark?”

He glances at me, briefly. “What’s up?”

One of us has to be a grown up, I think. “Do we need to talk about the cafe thing? Because I do not want to have awkwardness between us. Not any more than usual, anyway. “

“Nope, nope not at all.” He quickly looks away from me, his lips pressed together in a thin line.

“Okay.” I look at him as he suddenly looks up and stares back at me, “Are you sure? Because it seems like there is something maybe on your mind that you want to get off your chest?“

He nearly interrupts me, “Lazarus, why don’t you just go start your rounds and page me if you get into trouble, okay?”

Oh, right, he is an asshole, now I remember. “I doubt I will need you, but thanks for the offer,” I say. “Page me if we get any new admissions. As always, I am happy to help.” I flash him a smile that is as icy as I can muster, hoping I indicate non-verbally exactly how unhappy I would be to be useful to him in any capacity.

“Sure,” he says, his eyes are now intently on his computer screen rather than on me. As I walk past him, however, I cannot help but notice he is just staring at the hospital’s home page, and unless he has forgotten the hospital name and address, he cannot be actually looking at anything of significance on the monitor. Weird.

What a disaster. At least no one is sharing this office with us. If this new increased tension between Mark and me was picked up by the gossip mill in the hospital, this would become even more uncomfortable, which is almost hard to imagine. After putting my bag in the locker room adjacent to the ICU office, I grab my notes, hang my stethoscope around my neck and head down the stairs to start rounding on the Neuro ICU patients.

Walking through the doors of the unit, I see some of my favorite nurses gathered around the monitors. Smiling at them each in turn I pull up a chair. “Hey, team, we ready to have a…night?” My work mates often tease me for what they see as a contradiction—that I can be simultaneously religiously observant and superstitious—but experience is my teacher. Once a medical provider has lived through the effects of someone announcing it is a “quiet night” enough times, you will learn that there are some things you just do not say in a hospital. If you say quiet night, it will be unbearably busy. If you say “easy night,” it will be complex. These are well-established facts.

“We are ready, Rachel. Where do you want to start?” Rose, one the best ICU nurses is in charge tonight. Thank God. I needed a win. “Let’s start in room 10 and work our way around.”

Hours go by and it occurs to me that Mark would probably rather grow a third arm out of his chest wall than ask me to help him out tonight. That must be why I have not heard anything from him since that first encounter. It is at that moment when I hear a critical event paged overhead. Still no message from the good doctor. The next one I hear announced I will just show up without an invitation. Why not? He is just being stubborn for no good reason. Can we not just be adults about this?

Of course, it could be that he actually just does not need my help. I have not needed his, so why am I assuming he is intentionally avoiding me. How long before this all blows over between us and we go back to our less tense and more casual mutual dislike? Up until now, I had arranged everything in my life in an attempt to grasp at, as well as maintain emotional stability. From my color-coordinated closet and drawers to my pristine collection of matching food storage containers labeled clearly for meals containing either meat or dairy, I thrive on approaching life with a sense of external order, dimly hoping for a sense of inner order.

My phone pings with a text from none other than Dr. Mark Levy.

Mark: meet me in the lounge

would you?

Hesitating before I reply with an ‘okay’, I grab my lunch to head downstairs. Now that I am faced with it, I wish I had kept my mouth shut about clearing the air. Too late now, I realize grimly. I am certain that we will be uncomfortable whether we talk about what happened or whether we don’t try to discuss anything. It is all just messy, that is the truth of it.

As I swipe my badge outside the door and enter the lounge, he looks up at the sound of my entrance. I glance around and take in that we are, in fact, alone. At this time of night it is not surprising. It is only those of us with truly bizarre life choices that keep these strange hours and eating habits.

“I seemed to remember you take your dinner about now.” He says softly.

“Lunch. I call it lunch.” I argue for no reason. Why is he speaking so gently to me? Him talking to me with a soothing quality to his voice is more unnerving than anything I have ever heard out of his mouth. Just when I thought this could not get any trickier.

“Okay, lunch then.” He seems to be contemplating the meal I start to unpack before me. “I thought we could clear the air while we eat.” And there it is, one emotional hand grenade, lobbed to my side of the table.

My stomach feels as though it has dropped into my feet as I sit opposite him and continue to lay out my food. I look over at his meal and smile to myself. It is a good thing he loves to go to the gym all the time because he seems to eat takeout every time he works.

Mark does not keep kosher as I do. I do not know him well enough to know if this was how he grew up, or if he is in some type of rebellion, or just simply cannot be bothered. It is a very personal choice and I am not one who believes that just because someone is Jewish, they need to be Jewish in a certain way. I personally have maintained a sense of spiritual connection to certain traditions that I continue to live by. At one time in my life I would have categorized myself as a modern orthodox Jewish person but I am not so sure anymore. I keep kosher and since Eli died my prayer life is a whole thing. I say traditional prayers every day, but not multiple times a day anymore—usually just when I wake. I do not consider myself particularly frum, but more spiritual. Honestly it is a rarely occurrence for me to go to shul anymore. Not that there is anything wrong with it, I just usually sleep right through the opportunity.

The truth is most of these habits were formed from following the lead of my mother. That was true until I started to make a point of doing things with intention and for my own reasons, because I found a particular practice had value to me. My mother, as a fallen away Irish-American Catholic who had converted to the Jewish religion in order to marry my father, was very sensitive to the image she felt she needed to maintain to remain a ‘legitimate Jewish person.’ Shortly before she died, in a rare demonstration of self-honesty, she spoke at length with me about this motivation to keep up appearances. She really believed her membership to the tribe could be revoked at any time by a concerned rabbi if she wore a pair of pants or showed any of her hair to anyone other than her husband. I think she also tended to be strict about her own observance because she desired a sense of belonging and spiritual connection to her practice.

As someone born Jewish, I have exercised some of the privileges that she never felt she had. I elect to wear scrubs that seemed more practical for my profession which happen to be pants rather than the more traditional choice of a skirt. When I married, I only I partially covered my hair with a small kerchief rather than having my natural hair shorn and my head completely covered. At the same time I completely respect other people’s choices to do or not do what they find meaningful—even if they are just following the letter of the law because it is the correct thing to do. I just have never felt the need to judge where anyone else is coming from. Maybe in part because I always felt badly that my mother felt pressure when she just wanted to feel loved and be seen.

Of course being married to my father did not help her to feel loved or be seen.

“So what are we having tonight?” Mark asks.

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