The log she almost quit

The first time Dana Ruiz quit the log, she did it properly. She dropped it in the kitchen trash on a Sunday afternoon in February, on top of that morning's coffee grounds, and put the lid down.

It was a green spiral notebook, small enough to ride in the side pocket of her work bag between her stethoscope and a granola bar she never ate. Four months of pages. After every shift she sat in her car on the third level of the parking garage and wrote the same four lines: hours slept, shift or off, the stairs from one to five, and one word for the day. On days off she wrote them at the kitchen counter.

For seven weeks, ever since she had started doing anything differently, the word for her second day off had been sand. Sometimes wet sand. Once, underlined twice, cement.

She stood there with her hand on the lid and thought that a record saying the same thing for seven weeks wasn't a record. It was a complaint with dates on it.

Then she pictured what she would say to a new grad who threw out a patient's flowsheet because the numbers were boring. She lifted the lid and fished the notebook out. The cover kept a brown ring from the filter, and for the rest of its life it smelled faintly of dark roast.

Fix the sleep first

By February she had done the careful part. Months of reading. The list on the back of a shift schedule. The one vendor out of five whose support person wrote back by name and answered the question she had actually asked. The Monday tax had been running her life for a year, and she approached ending it the way she approached a new order from a doctor she'd never met: skeptically, and with a pen.

Her own doctor had listened without making the face Dana had braced for. She asked what Dana was reading and where she was getting it, wrote some of it down, and then said two things. Fix the sleep first. And write down the bad days, not only the good ones, because people remember the good days when they want something to have worked.

Dana had said a version of that to patients for eleven years. It is a different sentence when it's pointed at you.

So, the sleep. For years she had done what half the night staff did: home by eight, asleep by nine, awake at three, and then on the first day off, stay up until four in the morning trying to turn back into a day person by force. Now she picked a window and kept it, work night or not. Box fan on. Phone charging in the kitchen, face down. An alarm on days off, set for noon, which sounded like a luxury until the first time she wanted to throw it across the room. It was the least interesting thing she had ever done for her health, and the hardest.

Nurses watch the line, not the single reading. Her line was flat, and flat is boring, and boring at 7:30 in the morning after twelve hours on a cardiac floor feels a lot like failing.

The landing

The second time she nearly quit was in March.

The overhead page came a little after four: a code on the fourth floor. Dana was in that room for most of the next hour, and it did not go the way anyone in it wanted. Afterward there was a family in the hallway, a daughter still wearing the lanyard from her own job, and Dana walked them to the small consult room with the tissues and the painting of a lighthouse. She brought water in paper cups. She stayed longer than she had in her. Then there were two hours of charting and report, and a man in the next room who needed his call light answered as if nothing had happened, because for him nothing had.

She took the garage stairs at 7:40. Between the second and third levels she stopped on the landing and held the rail, long enough that a tech from radiology asked if she was okay.

In the car she opened the notebook to write the four lines. Instead she wrote nothing is different, in capital letters, pressing hard enough that it came through on the next three pages.

Then she drove home and went to bed at her usual time, because that was the other thing she was learning to do, and because the box fan didn't care what kind of night she'd had.

Damp

Denise had been a charge nurse on nights for twenty-six years and ate one hard-boiled egg at three every morning, peeled over a paper towel. The next night she walked into the break room and found Dana writing in the green notebook.

"What are you charting?"

"Me," Dana said. "It's not going well."

Denise held out her hand, the way she did for anything she intended to read whether or not you offered it. She turned the pages slowly. She reached the capital letters and didn't say a word about them, and Dana liked her more for that than for anything else in six years. Then she flipped back a few weeks and put her finger on a line.

"When did you start writing damp?"

Dana leaned over. There it was, three weeks earlier, under a second day off. Damp. And again eight days after that. She had no memory of writing either one.

She read down the page the way she would read a telemetry strip, the whole run at once instead of one beat. Sand, sand, cement, sand, sand, damp, sand, damp. The stairs column had drifted from a row of twos into twos and threes. None of it was anything she would have noticed if she hadn't written it down at 7:30 in the morning, when she was too tired to lie to a notebook.

"Two damps isn't a trend," Dana said.

"No," Denise agreed, and handed it back. "It's two damps." She returned to her egg.

Dana didn't decide anything in that break room. She had seen too many good nights followed by bad ones to call a drying day a dry one, and she was still careful about what she'd let herself credit: the sleep, the stubbornness, the thing she had researched and checked. But she stopped reading the log one entry at a time, looking for a miracle. She started reading it the way she read a chart at the start of a shift, a whole page at once, looking for the direction.

April was still mostly sand. There was more damp in it.

Near the end of the month she came off her third night, took the garage stairs, and already had her keys out at the car before she realized she hadn't stopped on the landing. She had to think back to find it at all. She sat with the notebook open against the steering wheel, her thumb over the coffee ring, and wrote a four.