‘The Successors’ by Jeremy Mills
jeremy mills, msn, pmhnp-bc placed third in the prose category of the 2022 phm health professions creative medical writing and art contest. read his piece “the successors,” in full below and read more about ysn winners in this contest.
“Okay, so, she shows up for electroconvulsive therapy, right? You know, ECT, right? Her aunt or cousin or someone brings her every few days for, like, two weeks,” Clarice says. “And the treatments work. It’s a miracle. The psychiatrist said he knew it would work all along, so he’s real happy about it. After years—I don’t know, maybe two years—of pretty frank psychosis, she has improved a ton. She’s come back to us. There’s a lot of improvement. And I mean a lot.” Clarice widens her eyes, which she does when she arrives at her favorite part of a story. “And you know what she asks me? You want to know what’s the first thing she wants to know?”
“What’s the first she wants to know?” Marybeth asks, perched on the bench’s edge, dragging on the cigarette she has pinched between two fingers. Since the virus appeared, she’s smoking again. She’s been scolded by the security officers multiple times, but she’s unapologetic.
Clarice blinks twice. “She wants to know why everyone is wearing masks,” she says and raises her eyebrows. She laughs loudly—not at the misfortune of psychosis, she is quick to assert, but at the sheer absurdity of missing the past two years and waking up to a permanently changed world. Clarice is a former smoker, too, and she’s eyeballing the cigarette six feet away, but she is holding strong for now.
“No way that’s true,” Olu says.
“It’s true,” Clarice says briskly.
“Damn,” Olu says. “Missed the whole pandemic so far. Is that a blessing or a curse?”
“Wow,” Janelle says. The four nurse practitioners are outside the hospital, a rare five-minute break where they can all be together. The parking lot off to the side of the emergency room is decidedly a non-smoking zone, but Marybeth makes no effort to hide her cigarette, long and thin, the kind she smoked in high school. The parking lot is full, cars circling around and around, waiting for a spot to open. The hospital is nearly at capacity. Soon, if things don’t turn around, they’ll be treating patients in the emergency room lobby.
Janelle and Olu work the emergency room and sometimes the intensive care unit. Marybeth works for a pulmonary group contracted by the hospital. Clarice is mental health, mostly at the hospital but occasionally at the outpatient clinic. The four women went to nursing school together and grew close over the years.
“I’ve probably got to get back in there,” Marybeth says and unfolds her mask.
“Me, too,” Janelle says.
They all stand and say goodbye. Janelle misses the days when the four of them went to a restaurant or a bar after work. Those days seem both like yesterday and like they happened a million years ago—she can’t remember time ever passing so strangely as it does now.
“Love y’all,” Olu says.
Janelle must keep her distance from the only other prescriber working the night shift in the emergency room, a physician named Dr. Nguyen, because he is sick but well enough to work. So, here he is, treating people with the virus while he has the virus—there’s no other doctor available, and every nearby hospital is short-staffed. It’s something Janelle hears on the news to be more and more frequently occurring across the country, contagious doctors traipsing through the hospital. Her boyfriend is a healthcare recruiter and assures her this is happening everywhere, it’s not just her facility. She pretends she can see viral clouds hissing from the edge of Dr. Nguyen’s fitted mask. She’d rather be at home: it’s her sixth day in a row because there’s no one else to work. She feels tired but not exhausted right now. It’s still early in her shift.
The skin on Janelle’s face stings with pain, red from the tight mask she wears for twelve hours in a row. She’s expecting to see blood every time she readjusts it. The surgical or cloth masks she wears to the grocery store or gas station are tolerable, but the masks at the hospital feel like a kitchen sponge on burned skin after a while.
“I’m so tired of these things,” Janelle says.
“Hmm,” Olu says
Olu is finishing her charting on a nearby computer and giving monosyllabic responses if Janelle says anything. Her shift is technically over, her last of seven in a row, but she is in her second hour of charting. Olu doesn’t seem to be as bothered by the masks. Why can’t I be like that? Janelle asks herself.
“I know I need to get moving, but I just can’t make myself go,” Janelle says. She’s standing in the main nursing station at the back of the emergency room. The emergency room is fuller than it’s ever been, and the nursing station is emptier than it’s ever been.
“Guess I’ll get going,” Janelle says.
“Mmm,” Olu says.
“Have a nice night,” Janelle says. “I’ll see you in the morning.”
Room to room to room, Janelle settles into a routine. Check the chart for the rundown (the registered nurses are far too busy wrangling the chaos to give her a verbal report), knock on the door, see the patient, deliver the news, comfort the patient, write the orders. Then, repeat.
Room eleven. A mechanic in his work clothes with malaise and elevated blood pressure, complaining of irritation at the IV site. He’s positive. Room fifteen. An elderly woman on oxygen. She is very sick but managed to drive herself to the hospital, holding a garbage bag of clothes because she says she knew. She’s positive. Room eight. A mother with two children who keep taking their masks off despite constant reprimands. The kids shouldn’t be there, it’s not safe, but there was no one to watch them when their mother couldn’t breathe. She’s positive. Room six. A college student in a sweatshirt with his school’s name on it, smiling thinly whenever he sees someone but admitting to be short of breath. He’s positive. Room eight. It’s been empty for ten minutes. Janelle doesn’t know what happened to the patient, but she doesn’t have time to ask anyone. Room fourteen. Positive but well enough to go home soon. Room twelve. Positive. Room one. Positive.
“Damn it,” Janelle says.
The liquor store is the busiest place Janelle has seen all week. There are more people in the wine aisles than she saw shopping for produce at the grocery store. Two people are looking at vodkas when no one was looking at bread. Three people are looking at pinot noirs and malbecs, one person was looking at carrots.
Janelle looks up and down the racks of white wine. She picks up a bottle with a lemon-yellow label. Underneath the logo sits a bright red poppy, so it’s brightly colored and eye-catching, like the packaging of children’s candy. It’s 13% alcohol. This is the one. She thinks for a moment and takes a second bottle.
“You don’t have to wear a mask in here,” the man behind the counter says as she checks out.
“I’m okay,” Janelle replies, “but thank you.”
The storeowner looks at her. “It’s really okay,” he asserts.
“I work in the emergency room,” Janelle says. “I think you might want me to wear my mask.”
He puts her bottles of wine in a tall paper bag. “That’ll be forty-two eighty-three,” he says flatly, looking at her.
In the parking lot, Janelle fumbles for her ringing phone. “Hello?” she says.
“I’m leaving,” Marybeth announces.
“You’re what?” Janelle asks. She feels her stomach shrinking.
“I’m leaving,” she says again. “I’m doing the travel nursing thing.”
Janelle puts the wine in the backseat of her car and gets behind the wheel. “You’re going through with it, huh?” They’d had a heated conversation in the cafeteria about this earlier in the week.
“I had to tell you first, girl,” Marybeth says. “I wanted you to know first.”
Janelle doesn’t say anything.
“Come on,” Marybeth says.
“I’m happy for you.”
“This is a gamechanger for me. A real life changer,” Marybeth goes on. “I’m going to be making nearly double what I make now, working as a registered nurse, not even as a nurse practitioner. That’s going to change my kids’ lives, Janie. You can’t pass that kind of thing up.”
“I’m happy for you,” Janelle repeats, knowing it sounds insufficient.
“You should come with me. You could do it, too,” Marybeth says. “They’re recruiting from all over. They need help everywhere. Then maybe you could come back to the hospital when all this pandemic stuff settles down.”
“When do you leave?”
“A month or so, I guess,” Marybeth says. “I’m going to turn in a month notice tomorrow.”
Janelle takes a breath. They’ll never get another nurse practitioner hired and pushed through orientation in such a short time. She and Marybeth are the last two full-time nurse practitioners working the ER.
“Janie,” Marybeth says and pauses. “You know I don’t want to leave you.”
“I know you don’t,” Janelle says.
Explosions of color are periodically shooting through the nighttime sky, originating from a place where a small triangle of light reveals the existence of a bonfire—it’s the day after Halloween, but someone is shooting off fireworks, and Janelle doesn’t know why. She is standing on the balcony of her apartment and can hear excited screams and laughs come from the faraway gathering, slivers of sound traveling through the wooded hills. She hasn’t heard a party like this for over a year, and in a way, it’s nice. Firecrackers pop in the distant darkness.
A lone streetlight casts a yellow glow over the apartment building, its light partially obstructed by fading fall foliage. She looks at the remnants of the holiday below: skeletons and pumpkins and black cats litter the yard, the paper coverings wet and disintegrating in places from the weather. The residents of the building are generally careful about litter and are rarely noisy, but the first Halloween in two years had been a big to-do. She smiles when she thinks of all the kids wearing masks for fun rather than necessity.
Minutes pass with more fireworks. Leaning on the wooden railing, Janelle is watching a bottle rolling down the sidewalk, pushed by the breeze. She is spending the weekend alone, a rare two days off, and though it’s chilly, she is enjoying standing outside, doing nothing in the last hour before sleep.
The ringing of her phone startles her, and she picks it up from the balcony’s table.
“Hello, Dr. Nguyen,” she says. “I knew it was you without looking. It’s nearly midnight, you know.”
“How’d you know it was me? Am I the only person who would be calling you this late?” he asks. “That’s just depressing.”
“It is,” she agrees.
“Can you come in tomorrow? We really need your help.”
Janelle thinks for a minute. “What’s going on?”
“No one to work. We really need you.”
“I worked all week.”
“I worked all week.”
“Can you be here before sunrise? If you get in bed now, you can still get a solid six hours of sleep,” he says.
The far side of the ICU, the wall of rooms furthest from the main entrance, is a dark and still place. All visitors have been banned for months, and the halls are empty. In contrast, every room is full. Ms. Cooper is a patient on a ventilator in ICU room forty-two. She is eighty years old and weighs ninety-eight pounds. No family members or visitors are allowed in the ICU, so she lies in her bed alone all day. Initially, they tried to do a video call on an iPad a couple of times, but the cacophony of the machines and monitors and alarms made it impossible to really hear what the heads on the screen were saying. Ms. Cooper seems more agitated afterward, the nurses report, so no more attempts have been made recently.
Janelle isn’t sure why she chooses Ms. Cooper’s room, but she goes in and stands for a few minutes when she’s on ICU rounds and needs to have a moment of stillness. In the completely full ICU of ventilators and IV pumps and alarms and codes, there isn’t really any silence, but there is stillness if one seeks it out.
She’s seen dozens of patients today, and she’s tired. The nurse practitioner scheduled to take over for Janelle has called in sick, so Janelle is in no hurry. She’ll have to stay and work while the hospital scrambles to find someone who can come in and work. She flips on the television and sits beside Mrs. Cooper, who hasn’t been consistently awake for days. After staring at—not quite watching—the local news for a few minutes, she combs Mrs. Cooper’s hair and adjusts the IV tubing and smooths the blanket and sheets.
Janelle’s work phone buzzes. It’s a message stating that they can’t find someone to work any sooner than an hour before midnight. Janelle will be at the hospital for at least four more hours.
The smell of warm beer makes Janelle think of hungover Sunday mornings in college. She smells warm beer now because she hasn’t finished the first bottle of pale ale she bought when she arrived. She’s at a nearly empty bar with Clarice, a rare moment of unmasked conversation between two adults. Some workplaces are maskless now, but not the hospital.
Clarice doesn’t come to the hospital anymore, now only working at the outpatient center due to personnel shortages. The outpatient office’s staff evaporated in the pandemic’s second year, she’s been explaining: five front desk employees became two, eight therapists became three, six nurse practitioners became four. Everyone’s quitting or taking a break or going to private practice or just disappearing.
The bar’s atmosphere is a nice change from the hospital, but it doesn’t take long for the topic of work to come up.
“Do you ever think of quitting?” Clarice asks.
“Not really. I mean, yes, of course I do,” Janelle says, “but it’s not like there’s anyone waiting around to replace me.”
Clarice peers into her glass and flicks the speared olives bobbing in the drink. “I’m just burned out, Janie.”
Janelle puts her lips together and touches Clarice’s hand.
“You know, I always think back to what my first boss said,” Clarice says, “I was a new grad, just out of school, a new nurse practitioner, and he was my first supervising physician. Great guy, really loved him. And he told me, there’s a sixty-forty rule with your patients, right? Sixty percent, forty percent. Basically, on any given day in psychiatry, sixty percent of your patients are going to need some help, and forty percent are going to be doing just fine. I mean, of course you want everyone doing well, but that’s just not reality all the time.”
“Yeah,” Janelle says. “Of course.”
“And that is what allows mental health providers to get through their day, about half of their folks doing well. Maybe not perfect, but okay. Mental health providers need that to handle all the pain released in their presence, you know, to persevere and be strong for the people who need them to be strong. That way, they have the resources for the patients who need them, and they have the victories with the patients who just need to pop in and be like, hey, I’m doing all right.” Clarice sips her drink. “And, you know, we don’t have that right now. We just don’t have that right now.”
“These days,” Clarice says, “it’s more like ninety percent, ten percent. Every single person I meet now is doing sopoorly. Because we’re all doing poorly. So many of us have lost the sense that things are going to be okay. We’ve lost time, we’ve lost money, we’ve lost people. And it’s just all this pain that I can’t fix, all day long.” She looks at Janelle and smiles sadly. “In fifteen years working in mental health, I’ve never seen it like this.”
“I’m sorry,” Janelle says.
“We’re going to be okay, though,” Clarice says. “We really are going to be okay.”
Janelle had planned to tell Clarice that the hospital was chaos, that they also have staff shortages, that Marybeth is leaving, that nothing feels certain any longer, but she can’t now. “I’ll always be here for you,” Janelle says, squeezing Clarice’s hands softly.
“I think you need to come check on Mrs. Cooper,” a voice says. Janelle turns around, and it’s a woman in turquoise scrubs, the lone CNA working the night shift.
“Where’s the nurse?” Janelle asks, her fingers hovering over the keyboard. She is in the middle of writing orders and documenting patient encounters. She has hundreds of unfinished charts.
“You’re a nurse,” the CNA says.
Janelle twitches. “Yes, I know, but, I mean the—”
The CNA looks worried.
Janelle stands up. “Okay, I’ll go see her.”
It’s a long hallway, a turn to the left, and another long hallway. Janelle enters the room and looks around. There’s nothing new since she checked on Mrs. Coopers earlier in the evening. The television is still off. The nutrition bag has finished its infusion. The random items on the sink counter and bedside table are unmoved.
Under the ventilator mask, Mrs. Cooper isn’t breathing right. For all the terminology seared into her neurons, Janelle still thinks this way—she ain’t breathing right. Mrs. Cooper has shallow breaths and little chest movement upon inhalation, and her oxygen saturation is down. The monitors are whistling but not in full alarm mode yet. Janelle stands and looks at the woman in the bed, listens to the hiss of the ventilator. The CNA hasn’t followed her into the room, and it’s just the two of them.
It doesn’t happen often, maybe only a few times in her career so far, but it happens then: Janelle is looking right at Mrs. Cooper when she stops breathing. There’s an instance of startled motionlessness, a special kind of muscle tension in the chest that happens to even the most battle-hardened veterans of the ICU, a dread that occurs in only this circumstance, when someone is floating away right in front of you. When you can still reach out and grab them.
Janelle leans in with a clinched fist and pulls down the neckline of the faded green gown and gives Mrs. Cooper a strong sternal rub. “Come back this way,” Janelle says in a low voice. She rubs harder.
There are seconds now before the monitors catch up with the patient, before the waveforms on the screens change, before it gets a lot louder in the dark room. The skin on Mrs. Cooper’s chest is red and irritated, like a knee scrapping summertime pavement, but Janelle is clinching her fist even more tightly.
I need to call a code, she thinks.
There’s a sudden intake of air. Mrs. Cooper’s chest rises as her lungs inflate.
“That’s my girl,” Janelle says. She feels adrenaline at the top of her head and in the toes of her feet.
When Janelle goes home the next morning, Mrs. Cooper is still in her undisturbed room, breathing silently.
The cafeteria is empty, a contrast to the full ICU three halls away. The room has two walls of windows, and the world outside is darkening during the final moments of sunlight, snow falling and collecting on the sidewalks and trees and benches. From here, the parking lot isn’t visible, and it’s so cold outside no one is milling about. Here, in this moment, the planet seems deserted, a pocket of space on the other side of the veil, separated from the real world by a thin but tangible membrane. Someone has turned off the lights, and the cafeteria feels abandoned, a scene from a movie where everyone has permanently gone away and no one is ever coming back. There are long and bare tables with dim and receding light cast upon them. For days, Janelle has worked alone. Olu has the virus and is too sick to work, Marybeth is smoking somewhere in the Midwest, Clarice is just gone.
Janelle comes here at least once every shift and stands in the low light. There’s a melancholy here that feels right to her. The grief of a place with good memories, now bathed in the first signs of deepening night. A feeling of being left behind—she has been left behind. A feeling of being the last in line—she is the last in line. An awareness of an unconquerable task before her with a sense of duty that she will at least try. Staring at the falling snow, allowing this feeling to swell in her chest, is melodramatic, and she knows this. She is going to look silly to the people of the future when they invent a way to look back at every moment in time. But she can take a breath here and feel sorry for herself and no one has to know it. She thinks a sorrow is better than an anger.
Another moment, another scan of the vacant room, another leaf edge disappearing underneath snow, and then it’s back to work.
It’s the middle of the night, and the vestibule is empty. After an unusual shift, 2:00 PM to 2:00 AM, Janelle walks through the front doors of the hospital, still in her lab coat, practicing legerdemain with her car keys, crunching ice in her rubber shoe covers. For the first time in perhaps years, the hospital has no nurse practitioner when Janelle leaves, and there won’t be another until Janelle comes back tomorrow. Bright lights over the entrance illuminate only a small stretch of pavement, anything more distant consumed by the snow dancing in the air. It’s cold. Janelle starts when she hears a voice behind her. “Oh, wait a moment. Over here.”
Janelle turns around. An unmasked woman in a long coat with a cigarette—someone Janelle has seen before but isn’t sure where—is emerging from the darkness, coming toward her.
“Please wait,” the woman says.
“Yes?” Janelle says.
“Ms. Hardesty, the nurse practitioner. That’s you,” the woman says, nervously pulling her coat strings more tightly around her trunk. “I thought that might be you coming through the—”
“Is everything okay?” Janelle asks, “it’s very late, and—”
“I had to thank you,” the woman says. “Ms. Hardesty, when you helped me talk to Donald the other day—Donald, room twenty-three, I’m sure you remember—I can’t tell you how much that meant to me. I can’t believe I have to talk to him through a screen, but it was so good to see him.”
“I do remember, and I—”
“Thank you so much for being so patient. I’ve never talked on a screen like that before, but it was so good to see him and talk to him.”
“You shouldn’t be out here this late,” Janelle says. “You’ll freeze to death.”
“I can’t go home yet.”
“It’s freezing out here. It’s late. It’s two in the morning.”
“But they won’t let me inside.”
“Yes, yes, I know that. But it’s only going to get colder. You need to be inside your home.”
“I think he’ll die tonight, don’t you?” the woman asked.
Janelle pauses and looks at the woman. The wind hurts her face.
“It don’t feel right to be at home if he’s going to die here,” the woman says.
Janelle thinks for a minute. “I don’t think he’s going to pass away tonight,” she says. A wave of anxiety washes over her immediately. If that statement turns out to be untrue, this might be an exchange the woman will never forget, the night she left when her instincts told her to stay. She has seconds to take it back or to commit. She commits. “I think he’s going to be okay.”
The woman says, “If it wasn’t for people like you—” She doesn’t finish her thought and drops her cigarette, which disappears in the whiteness at her feet.
Janelle puts her hand up and waves it. She shakes her head.
“What you did for me,” the woman says, her voice and hands trembling together, “I can’t—”
Janelle does the only thing she can think of, and that’s reach out her arms and hold a stranger in the snow.
ICU room forty-two is unlit and unhurried. Janelle is looking at the flowers that appeared overnight beside Mrs. Cooper’s bed. Lantanas, zinnias, vincas. There’s no vase or ribbon or card, just an oversized mason jar and water. Mrs. Cooper hasn’t seen the flowers yet. Janelle doesn’t know if Mrs. Cooper will see the flowers. Every shift, six days in a row, Janelle has stopped by to check on Mrs. Cooper, even if she’s working elsewhere in the hospital. There aren’t many days left. Soon the ventilator will be stopped if the patient isn’t improving.
Not everything was bad today, Janelle thinks. The ICU isn’t full anymore, and the breaking news is the third floor in the tower is returning to general stepdown patients—it’s not going to be a special ward for the virus any longer. A new nurse practitioner is going through orientation and will be working shifts with her soon. The doctors seem in better spirits. They’re going to allow visitors again soon, during daytime hours.
Janelle walks to the sink and runs hot water over her hands for a couple of minutes. Her hands are always freezing these days. Afterward, she dries them off. Not everything was bad today, she says to herself again.
Janelle turns around. Mrs. Cooper’s eyes are open. She’s looking at Janelle.
“Welcome back,” Janelle says, tearful, smiling.