Kayla E. Cushner

The Juice

I couldn’t look at you as you walked by. I was scared. You had become more than I could handle. I didn’t want you to see me as you stumbled out of the room, sweatshirt half-on, hair stringy and disheveled. But when you opened the door and walked into the hallway, with the three men in their navy blue uniforms ready to “escort” you off the unit, you kept your head down. You didn’t want to see me either.

Each night, every 3 hours on the dot, you called out with pain, demanding your meds, a hazy cocktail of Dilaudid, Ativan, and Benadryl. A dutiful new nurse, a novice, I stood by the Pixis machine checking and double-checking the orders on the computer screen, filling each syringe, twisting the needles on and off, packing my pockets full of alcohol wipes.
You had poisoned yourself with enough alcohol that all the cells in your body were now demanding more, screaming for something they could not have. You were a complete stranger to me, and when I walked onto the unit that night it had become my responsibility to keep you calm. It had become my job to attach each syringe to your IV and inject your veins with Dilaudid. And Ativan. And Benadryl.

We had already spent 2 nights together, dancing around the harsh reality of it all – stuck in our roles, testing each other. I entered carefully as I opened your door each time, tiptoeing around the landmines - addiction, trust, judgment, truth – afraid of an explosion. I was assigned to be your nurse probably because I was the newbie. Or maybe it was because you were “an interesting case” or “a good experience.” Nurses deal with all kinds of crazy, and I’m sure they deemed your particular flavor to be “good practice.” You were needy and unpredictable. Frankly, they thought you were mean.

But you weren’t mean to me. Not tainted by years of having to take care of “that kind of patient,” I was bubbly and trusting and I was nice to you.  Perhaps I was naïve. You told me that this was your first baby. “He’s a miracle baby,” you said in your groggy haze, “And the doctors told me I would never be able to get pregnant! Can you believe it!” Your chart said you had 2 children, both of whom were no longer in your custody. I thought of this as I sat on the end of your bed, listening and smiling while you told me about your story.

You were growing a baby inside a cesspool of drugs and alcohol, vodka and narcotics coursing through him as his organs began to take shape. Heart, brain, kidneys, liver – all poisoned from the start. Training to become a midwife, I care for pregnant women every day, advising them to eat leafy green vegetables, to exercise, to take their prenatal vitamin daily. I thought about the pregnant moms in the prenatal yoga classes, ingesting the perfect combination of Folic Acid and Omega-3 Fatty Acids. And there I was pushing medications into your body that I knew would most likely cause your newborn baby to detox after birth, to experience drug and alcohol withdrawal in the intensive care nursery, filling his first few days of life with a kind of pain that most people never have to experience.

Your reputation loomed outside your door in the cold, fluorescent hallway. “Did you know that guy in there is actually her boyfriend’s father and the father of this baby? That poor baby.” The stories swirled around me each night as I filled your syringes and tried to paste on a look of calm as I opened your door.

I knelt down next to your bed and I felt him standing over me, mesmerized as I pushed the medicine from the syringe, through your IV, into your veins. He just stood there, blank stare, mouth hanging open, watching, retreating into your bathroom every few minutes.
The flickering TV sent blue strobe lighting, filling your dark room. You were watching some reality show about people who hoard antiques in their attics. “These people are crazy,” you said.

I first saw the water bottle on one of my middle-of-the-night ventures into your cave, armed and ready with your 3-hour cocktail. I asked. “It’s cranberry juice,” you said, “mixed with apple juice.” I wanted to believe you. I walked out of the room, carrying the heaviness of your lies in my gut. The suspicion ignited chatter at the nurses’ station, a 2 a.m. drama. “Ask her to smell it,” they said. I knew I had catalyzed the troops. Something big was about to begin. I felt relieved that he had left to go home for the night.

I walked back in, ready to execute my brilliant plan of asking if I could smell the juice sitting on your bedside table. But I couldn’t do it. You had trusted me because I had trusted you. I could feel myself pressed against my limit, and as much as I wanted to push through to the other side, it wasn’t the night. I couldn’t do it. So I clumsily walked to the other side of the bed, getting myself close to “the juice,” and pretended to fiddle with the settings on your IV.
When I came out, the resident had been called to the nurses’ station. She was standing there, hesitantly ready to intervene. She entered your room, pillow marks on her face after being woken in the middle of the night to deal with the juice on your bedside table. She came out with a sample in a small plastic cup, reporting, “There’s vodka in here.”

The smell of booze is not proof enough that you were, in fact, drinking a water bottle full of cranberry and vodka, an additional cocktail you had prescribed yourself as I was simultaneously injecting Dilaudid, Ativan, and Benadryl through your bloodstream and into the body of your unborn baby.

Another nurse entered your room with a butterfly needle and vials, informing you that the doctor needed us to draw blood. “No,” you told her. “I know what you’re trying to do. You can’t have my blood.” And you were right. You didn’t want your baby to be taken from you. You were trying to protect him. I watched as the nurse came out into the hallway empty-handed.

You called out again, asking for a nurse. I just sat there at the nurses’ station, now firmly planted on the sidelines, glued to the chair by the immobilizing fear that comes with inexperience. I watched the scene as the other nurses stepped in, calmly facilitating the process with ease – they had seen it all before and I had not. But I was your nurse. I should have confronted you myself. I should have had the courage.

A nurse stepped out of your room and told me your declaration: “I’m signing out AMA,” you said. You wanted to leave against medical advice, a term you had become all too familiar as you checked yourself in and out of hospitals over the past few months. Again, the resident went in, now with the attending at her side, and they explained to you why this was all a bad idea. “We’re worried that you will go home and get so intoxicated that you will not be able to know when you are in labor.”

Thinking about the births I had seen, it was hard to fathom the amount of alcohol a woman would have to ingest not to know that she was in labor. I thought about the eager pregnant moms with their hospital bags packed – pajamas, Chapstick, coconut water, their favorite iTunes playlists – all set and ready to go weeks in advance. I thought about the pregnant women who call at 3 a.m., the questions they ask, the pains they feel. And then I thought about you, anesthetized by your addiction, unknowingly ready to birth your baby.
As you walked out, you kept your head down, angry, quiet, leaving with your worn-in sweatshirt and your water bottle full of “cranberry juice mixed with apple juice.” I watched you go, knowing our paths would never cross again, knowing that your baby would be born in just a few short weeks, wondering how you would care for him, wondering if he would stay with you. Your face towards the floor, mine hidden behind my computer screen, we went our separate ways. I entered your room after you left. It was eerily quiet, eerily still, the aftermath of exploded landmines scattered across the floor.

Kayla E. Cushner

Kayla E. Cushner graduated Cum Laude from Kenyon College with a Bachelor of Arts in English in 2010. She is a cellist, childbirth educator, and doula. While at Kenyon, she conducted an independent study on “Birth in America.” Kayla is currently an RN working on the Maternal Special Care Unit at Yale-New Haven Hospital. She is in her second year at YSN and will graduate in 2013 as a Certified Nurse Midwife.