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The Shift
Theresa Brown
Reviewed by Kathy Hare

            For a quick synopsis of “The Shift” you only need to read its subtitle: “One nurse, twelve hours, four patients’ lives.” Few of us experience a 12-hour period packed with endless tasks that must be executed amid a cauldron of emotions. Added to the stress is the knowledge that even an infinitesimal mistake could mean the difference between life and death for those in your care. This is what many in the medical profession face on a daily basis. Clinical nurse/author, Theresa Brown,  is one of them.
          She works on an oncology ward at a teaching hospital in Pittsburg, PA. Before embarking on her nursing career, Brown was an English professor at Tufts University. Combining both careers, she has created an outstanding account of a “day-in-the life” of an oncology nurse. This book is a real eye opener! You’ll gain a whole new respect for those who work tirelessly to improve our heath. But I think “The Shift” should come with its own medical warning label, because I have never read another nonfiction work that filled me with such anxiety. Would her four patients still be alive by the end of day?
          Nurses were once charged with taking care of their patients’ basic needs – not any more. Now they must understand a multitude of laws, be technological wizards, coding experts, psychologists,  and at times, mind readers. But Brown isn’t complaining, she loves her work. What she provides in “The Shift” is a first-person account of how a hospital functions as everyone from medical specialists to the cleaning crew scrambles to extend the lives of their patients.
          Brown’s day begins in the wee hours of the morning, before her children or husband are even out of bed. A brisk bike ride to the hospital “mellows my pre-work unease,” she writes. Once she enters the ward, there’s no room for doubts, she must exude confidence.
          Packing the pockets of her scrubs with the tools of her trade, she then reviews the medical data for the three patients assigned to her, a fourth will be added later in the day. To a lay person, that appears to be an easy caseload, until Brown fills in the details. Throughout the day, she will assist others in medical procedures that may be as simple as double-checking another nurse’s math, or as stressful as resuscitating a patient.
          Today Brown’s patients are Richard Hampton, Dorothy Webb and Shelia Field. Hampton, “a lymphoma patient in his late seventies,” is new to the ward. Webb, a woman in her fifties, is nearing the end of her six-week treatment for leukemia. All the nurses adore Webb because she has a pleasant personality and keeps a well-packed candy bowl on hand to sweeten up the staff. “Shelia Field, my third patient, is a wild card,” Brown writes. Technically, Field doesn’t have cancer. She is plagued by a blood clotting disorder, “antiphospholipid antibody syndrome,” an autoimmune disease.
          Before checking on her patients, Brown glances at the white board located in the nurses’ station. It’s divided into sections, one for each room. Under “Privacy Laws” only the first three letters of a patient’s last name may be listed on this board. Personally, I find that worrisome, especially since my name would be displayed as “HAR,” which could stand for Hare, Hart, Harris, Harrison, etc. Fortunately for Brown, there’s little chance of making a mistake because she works on a ward with nothing but private rooms. But it’s one illustration of how some government regulations might cause more harm than good.
          Next, the board lists the name of the attending physician, who is “ultimately responsible” for the patient. Yet, with the exception of morning rounds, most attending physicians spend little time on the ward. Should a problem arise, medical decisions will be made by “interns, residents, nurse practitioners and physician assistants.” Brown explains the duties performed by each of these; nurse practitioners and physician assistants share many of the responsibilities of full-fledged doctors, while receiving far less compensation. And in Brown’s opinion, “inpatient care would collapse without them.”

First published in The New Falcon Herald
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