AT four o'clock on a Friday afternoon the hematology-oncology clinic at Boston's Beth Israel Hospital is quiet. Paddy Connelly and Frances Kiel, two of the eleven nurses who work in the unit, sit at the nurses' station -- an island consisting of two long desks equipped with phones, which ring constantly, and computers. They are encircled by thirteen blue-leather reclining chairs, in which patients may spend only a brief time, for a short chemotherapy infusion, or an entire afternoon, to receive more complicated chemotherapy or blood products. At one of the chairs Nancy Rumplik is starting to administer chemotherapy to a man in his mid-fifties who has colon cancer.
Rumplik is forty-two and has been a nurse on the unit for seven years. She stands next to the wan-looking man and begins to hang the intravenous drugs that will treat his cancer. As the solution drips through the tubing and into his vein, she sits by his side, watching to make sure that he has no adverse reaction.
Today she is acting as triage nurse -- the person responsible for patients who walk in without an appointment, for patients who call with a problem but can't reach their primary nurse, for the smooth functioning of the unit, and, of course, for responding to any emergencies. Rumplik's eyes thus constantly sweep the room to check on the other patients. She focuses for a moment on a heavy-set African-American woman in her mid-forties, dressed in a pair of navy slacks and a brightly colored shirt, who is sitting in the opposite corner. Her sister, who is younger and heavier, is by her side. The patient seems fine, so Rumplik returns her attention to the man next to her. Several minutes later she looks up again, checks the woman, and stiffens. There is now a look of anxiety on the woman's face. Rumplik, leaning forward in her chair, stares at her.
"What's she getting?" she mouths to Kiel.
Looking at the patient's chart, Frances Kiel names a drug that has been known to cause severe allergic reactions. In that brief moment, as the two nurses confer, the woman suddenly clasps her chest. Her look of anxiety turns to terror. Her mouth opens and shuts in silent panic. Rumplik leaps up from her chair, as do Kiel and Connelly, and sprints across the room.
"I can't breathe," the woman sputters when Rumplik is at her side. Her eyes bulging, she grasps Rumplik's hand tightly; her eyes roll back as her head slips to the side. Realizing that the patient is having an anaphylactic reaction (her airway is swelling and closing), Rumplik immediately turns a small spigot on the IV tubing to shut off the drip. At the same instant Kiel calls a physician and the emergency-response team. By this time the woman is struggling for breath.
Kiel slips an oxygen mask over the woman's head and wraps a blood-pressure cuff around her arm. Connelly administers an antihistamine to stop the allergic reaction, and cortisone to decrease the inflammation blocking her airway. The physician, an oncology fellow, arrives within minutes. He assesses the situation and then notices the woman's sister standing paralyzed, watching the scene. "Get out of here!" he commands sharply. The woman moves away as if she had been slapped.
Just as the emergency team arrives, the woman's breathing returns to normal and the look of terror fades from her face. Taking Rumplik's hand again, she looks up and says, "I couldn't breathe. I just couldn't breathe." Rumplik gently explains that she has had an allergic reaction to a drug and reassures her that it has stopped.
After a few minutes, when the physician is certain that the patient is stable, he and the emergency-response team walk out of the treatment area, but the nurses continue to comfort the shaken woman. Rumplik then crosses the room to talk with her male patient, who is ashen-faced at this reminder of the potentially lethal effects of the medication that he and others are receiving. Responding to his unspoken fears, Rumplik says quietly, "It's frightening to see something like that. But it's under control."
He nods silently, closes his eyes, and leans his head back against the chair. Rumplik goes over to the desk where Connelly and Kiel are breathing a joint sigh of relief. One of the nurses comments on the physician's treatment of the patient's sister. "Did you hear him? He just told her to get out."
Wincing with distress, Rumplik looks around for the sister. She goes into the waiting room, where the woman is sitting in a corner, looking bereft and frightened. Rumplik sits down next to her, explains what happened, and suggests that the patient could probably benefit from some overnight company. Then she adds, "I'm sorry the doctor talked to you like that. You know, it's a very anxious time for all of us."
At this gesture of respect and recognition the woman, who has every strike -- race, class, and sex -- against her when dealing with elite white professionals in this downtown hospital, smiles solemnly. "I understand. Thank you."
Nancy Rumplik returns to her patient.