TENDING LIVES - Nurses on the Medical Front by Echo Heron, RN, Fawcett Columbine, New York, 1998, 341 pp, $25 ISBN: 0-449-91076-8

Echo Heron, RN, ICU nurse, has enlightened and entertained us with Intensive Care (Ballantine 1988) and Condition Critical (Fawcett Columbine/Ballantine 1994). In both works she show-cased her life as a nurse and allowed us a glimpse into the frustrating world of hospital politics, bureaucratic idiocy, everyday under staffing, and difficult doctors. In Tending Lives--Nurses on the Medical Front, Heron presents a more intimate look at nursing as she draws on the varied experiences of her colleagues.

Getting nurses to contribute their stories, the stories that they freely swap with one another was a difficult task. Heron resorted to asking nurses to post ads in the nurse's lounge of every unit, ward, and medical floor of every hospital, clinic, and nursing registry in their area. Heron found out that often within 20 minutes, hospital management had torn down many of the ads, warning that any nurses who responded to "that ad" would be suspended.

The stories, however, were eventually submitted to Heron--they have a "from the front" urgency. Laura, a critical care nurse, works out of a Seattle-based nursing registry, dividing her time between nursing, photography, and counseling women at a battered-women's shelter. She has no difficulty handling a 22-year-old neuro patient, the ICU tragedy of the month, whose subdural was evacuated 10 hours after his injury from being in the wrong crowd--a hopeless situation. The problem, however, was dealing with the walking, wounded--the other half of any tragedy--family members, the girlfriend, all in serious denial, even after being told many times exactly what the score is.

Carol, a 41-year-old nurse, was inspired to become a nurse by her grandmother, an army nurse in WWII. She relates a riveting story about a psychotic prisoner who came in during the night, having murdered two cops and three members of a drug dealer's family. After a wild chase and struggles with the police, he was placed under Carol's care for treatment of a concussion. As she prepared to go into his room to give him a Haldol injection, she hoped to inject his six-foot-five, 340-pound body without waking him as he was locked in leather wrist and ankle cuffs, a canvas restraining jacket, leather leg and torso straps, and around-the-clock sedation from three different medications. But as she entered the room, she saw the prisoner perched in a hole where a window used to be, his gown opened in the back, arguing with enemies Carol couldn't see. The resolution of this story is an amazing tribute to the ingenuity of a seasoned nurse. This chapter alone is worth the price of the book.

Linda, an ER nurse in a small town in West Virginia, thought violence only happened to nurses in big cities. But one night after her shift, just 100 feet short of her car, she heard steps and felt cold steel at the back of her skull. Throwing out her purse with 53 in it didn't deter her assailant. Money wasn't his objective. He marched Linda to the dumpster where a 15-year-old girl lay unconscious and where Linda noticed another assailant. Immediately, she whipped out her stethoscope and found a slow heart rate and shallow breathing. The pair wouldn't let her take the girl inside to the ER. She finally persuaded them to let her go in, get a syringe of Narcan, and help. When she returned, all three were gone. Since this incident, Linda has married, given birth to a daughter, rid herself of her implants, and lost her mother. Though she can't remember who her boyfriend was then, she thinks daily about what happened to that 15-year-old girl. Each time she relates this story, she still agonizes over whether she did the right thing.

Heron believes that nursing is a calling and that patient care transcends the present workday shift, which usually lasts longer than the 8 or 10 hours that a paycheck covers. She has done her profession (and ours) a great service by giving us a blow-by-blow account of what nursing is really about--much more than trays, bedpans, shots, and IVs. After reading these forty stories of caring nurses in a variety of fields, all tending to the lives of their patients (who are really our responsibility), we realize that we need our nursing colleagues to care for our mutual patients. If I'm ever critically ill, I want one of Echo's nurses to help me challenge the grim reaper.

Del Meyer, MD