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.