CONDITION CRITICAL By Echo Heron, R.N., Fawcett, 1994, 414 pp, $22

Review by Del Meyer, MD.

Heron, a Marin County coronary care nurse, wrote the 1987 best-seller, INTENSIVE CARE, in which she gave us an emotional and frustrating world from student nurse to ICU nurse. In CONDITION CRITICAL, the sequel, she continues to describe for us the experiences, thoughts, and feelings of a critical care nurse. She borrows from true incidents and real life events as she has experienced them, some vicariously, in Redwoods Memorial Hospital. This 247 bed hospital has eight designated-parking areas. The doctors' parking lots 1 & 2 are well-lit and 20 yards from the hospital entrance. Lots 7 & 8 are referred to by the female staff as Rapist Haven and Killer's Cove. These are a long dark hike from the hospital. They are reserved for the nursing staff, which is 97% women. The majority of these women either walk to or from their cars in the dark. Alone. Heron quit using these lots shortly after two nurses were attacked and killed on the way to their cars. The medical staff, which is 97% men, are generally into their well lit cars by 8 PM.

Heron vividly describes a typical ICU day with 9 of 17 patients having been admitted since 11 AM. She details the struggles of trying to get the best five transferred out--if they could only contact their doctors for the order. Chaos erupts when in the middle of all this a doctor raises his voice and blasts out expletives to get a nurse to come running. And then a patient enunciates very slowly with annoyance, "I want a nurse! I want a CCU nurse and I want one now." And Heron replies, "Hey Joe, I've told you a million times--talk to management. Until you can get them to staff us adequately, which I estimate will be a cold day in hell, you'll have to make do with what you've got--just like the rest of us."

She describes an assessment on a large man brought in, who fills the bed top to bottom and side to side. As she completes the exam on this unresponsive patient, she asks out loud to herself as she looks at his head, "Is no one at home in there?"

Once, while working at the nursing station, Heron looked out the window and saw people jogging and others roller skating and she remarked. "These were Normal People. Normal People had nothing to do with the frailties and infirmities of the human body. Normal People weren't required to put in a ten-hour day but get paid for eight, or to work every other weekend plus holidays. In short, Normal People would never, ever feel comfortable discussing blood, feces, and mucus over dinner."

Heron worked the swing shift which she felt had the best of all worlds. "Although a person's social life could be ruined, nobody's biorhythm got upset, and the main traumas of the day shift--constant exposure to the doctors' moods and attitudes--were over for the most part before the shift began."

Heron's sequence on the emergency room with the ER doc du jour, reminds us why those of us that interned in city or county hospitals feel more colleagually towards nurses. As we literally went from bed to gurney trying to save lives it was a real team effort between intern and nurse, with the latter frequently teaching the former, as some lives slipped away. With ambulances bringing in victims, bodies, and body bags, we saw life in the raw together. The doctors in this private hospital didn't quite see it that way.

Heron in over 400 pages of nursing vignettes gives us a perspective to understand and appreciate nurses. As nurses are responsible for increasing number of patients per shift, how long will they be expected to complete their tasks even if it takes an extra two or three hours for eight hours of pay? Employers are trading on the nursing code of ethics and will trade on ours.

Heron states, "That intimate stranger at your bedside is not only your nurse, she is your sister, your mother, your confessor, and your healer. It is not the medicine or the treatment that cures your ills; it is her care that heals." Nurses are able to do what they do because they are rich in the gifts of healing, compassion, and love. As the "doctor de jour" stated, "I don't believe your name is Echo," I would add, "Heron is the Echo of nurses everywhere."