3. The Primordial Spark
The Primordial Spark
NORA
In astrology, the sign that launches the twelve-sign cycle and marks the beginning of a new season is Aries. A fire sign. Some astrologers call it the primordial spark because it represents the first burst of energy that sets everything in motion.
The sign that comes before Aries, at the tail end of the cycle, is Pisces, the sign of dissolution and chaos, which I've always found interesting, because the concept of creation and new beginnings coming after chaos is not unique to astrology.
In creation theories, whether posited by science or religion, creation is almost always preceded by some type of chaos.
In the Big Bang theory, the universe begins as an infinitely dense, volatile point of energy expanding into everything.
In the creation story, the earth is all darkness and chaos until God puts everything in order.
In Greek mythology, the very first thing that exists is Chaos itself, and from it emerges the earth, the sky, and everything that follows.
It's also directly observable in nature.
Stars are born inside collapsing clouds of gas and dust, all that disorder crushing inward until something at the center ignites.
Aries season starts in spring, right when the earth wakes up from winter, months of cold and dormancy and bare branches, and then the world comes back to life.
There's something profoundly beautiful in the thought that across different traditions, separated by centuries and oceans and everything else, we've arrived at the same answer: there will always be new beginnings at the end of chaos—
"You're still reading that?"
Kip was leaning in the doorway with his coffee.
"Excuse me for wanting a little whimsy in my life, Kip."
He dropped into the chair across from me. "What does it say for me today?"
I scrolled with exaggerated concentration. "Let's see. It says... try not to be an annoying coworker today."
"Me?" He put a hand on his chest. "Annoying? Everyone loves me."
To be fair, they did. Kip could make the whole station laugh during a twelve-hour shift and still have every chart done before handoff. He'd been at CCMC longer than most of us and wore it lightly, like the job had never managed to make him heavy. Some people just moved through the ER that way.
"Morning!" Lori came through the door with her bag over one shoulder.
"Morning, Lori."
"What are you guys talking about?"
"Today's horoscope," I said, still scrolling through the list for the day.
Liz came through the doorway with Jen right behind her. They arrived together most shifts, coffee already in hand, already mid-conversation about something.
"You don't actually believe in that stuff, do you?" Liz said.
Liz had a way of walking into a room like she was resuming it. Jen was quieter about it, but she watched everything.
I put my phone away. "It's just for fun."
Gracelyn wasn't on today. I'd checked the schedule the night before, the way I always did.
It shouldn't have mattered. The bays filled the same either way, and I'd done it plenty of times without her.
But there was something about shifts without Gracelyn that made me feel like I had to be more careful.
"Morning."
Josie had the board already printed. She pinned it to the wall and turned around.
"Twenty-two in the department, three boarders waiting on beds upstairs, eight in the waiting room. We're starting behind." She looked at the board. "Liz, bays one through four. Nora, six through nine. Lori, ten through thirteen. Jen, fourteen through seventeen. Kip, fast track."
She ran through the high-acuity patients. A chest pain in bay eight waiting on a second troponin. A sepsis watch in bay two, antibiotics started on nights, lactate pending. A fall in bay ten, elderly, altered, CT ordered but not yet done.
"Dr. Sullivan is our attending today."
I wrote my assignments on my forearm. Cliff Sullivan was a good doctor, but he ran the floor like every minute you spent talking to him was a minute he didn't have.
Under Harlan, the ER felt like everything was going to be alright.
He answered questions like he wanted you to learn, and he trusted the nurses to do their jobs.
With Sullivan, questions got short answers.
Clarifications got a look. You learned fast to have everything ready before you approached him, and if you didn't, you only made that mistake once.
"One more thing." Josie set the marker down and turned to face the room. "I got an email from administration last night. They're tightening up on error tracking. They've seen a rise in incident reports department-wide, and they want numbers down."
She looked around the room. "This isn't new. This is the job. But I'm telling you now because I don't want anyone caught off guard. Do your checks. Read your orders back. If something doesn't look right, flag it before it becomes a problem. We don't cut corners in this department."
Nobody said anything. Kip tapped his coffee cup twice against his knee. Liz looked at Jen.
"Let's go."
Las Vegas doesn't sleep, and neither does its ER.
CCMC is the only Level 1 trauma center in the state of Nevada.
If it's bad enough, it comes to us. Stabbings, gunshot wounds, car accidents on the I-15 at two in the morning.
But it's also chest pains and broken hips and a tourist who passed out on the Strip because she forgot to drink water.
The city runs twenty-four hours a day, and so does the ER, and you never know which version of Las Vegas is going to walk through those doors next.
Sullivan came through on rounds midmorning. He stopped at bay eight and looked at the chart.
"Troponin back?"
The man in bay eight had come in overnight with chest pain. We'd drawn his blood twice to see if his heart was in trouble, and the second result still wasn't back.
"Pending. I called the lab ten minutes ago. They said twenty more."
"Follow up in fifteen. If it's elevated, I want cardiology on the phone before you page me."
"Got it."
He was already at bay ten, where Lori was adjusting an IV line on an elderly woman who'd come in after a fall. The CT had ruled out a brain bleed, but she was still confused and not fully oriented, which meant something else was going on.
"Did neuro see her?"
"I paged them," Lori said. "They haven't come down yet."
"Page them again. If they're not here in twenty minutes, call me and I'll do it myself."
Lori nodded and made a note. Sullivan moved on. That was how he worked. Question, answer, order, gone.
Jen's patient in bay fourteen discharged. The man had come in for a reaction to a new medication, and before they'd gotten it under control, he'd thrown up across the bed, the floor, and most of the side rail. He was fine now. The bay was not.
Lori was walking past when she saw it. "Do you need a hand with that?"
"Oh my God, would you?" Jen said. "I have to finish charting on fifteen. You're a lifesaver."
Lori put on gloves and went in. I would have stayed to help, but bay eight's labs were back and Sullivan wasn't going to wait. I went back to my patients.
Every time I passed the station, I checked. Lori was still in fourteen. Stripping the bed, wiping down the rails, mopping the floor. The smell carried into the hallway. And every time I looked over at Jen, she was at the nurses' station with her coffee, scrolling through her phone.
By the time Lori came out, she'd restocked the bay by herself. Jen hadn't gone back once. Not to check, not to help with the last of it, not even to say thank you.
I didn't say anything in front of Jen. I waited until Lori passed my bays and pulled her aside.
"Hey. That was nice of you to help. But don't let them do that to you."
Lori looked at me. "She said she had to chart."
"She didn't come back, Lori. She let you clean her bay by yourself. And she'll keep doing it if you let her."
Lori was quiet for a second. Then she nodded.
Two months on this floor had taught me how it worked. There were nurses who helped you and nurses who used you. Liz and Jen were the second kind. They'd done the same thing to me when I started, and after a while, I'd stopped offering.
"Thanks for looking out for me."
"Of course."
Kip came around the corner with two coffees and handed one to Lori without breaking stride. "You look like you need this more than I do."
Lori took it. "How did you know?"
"I know everything that happens on this floor." He winked and kept walking.
The shift ended at seven thirty. I finished my charting, gave bedside report to the night nurse taking my bays, and went to the locker room.
Lori was already there, changing out of her scrub top. She looked up when I came in.
"Longest shift of my life."
"They're all the longest shift of your life when Sullivan's on." I opened my locker and pulled out my bag. "What are you doing with your days off?"
"Sleeping. Then maybe sleeping some more." She pulled her jacket on. "You?"
"Same. Ian has school, so it's just me and the house for most of the day. I'll probably do laundry and pretend that counts as productivity."
"That absolutely counts."
The door opened. Liz and Jen came in mid-conversation, laughing about something.
"I'll see you Wednesday, Nora."
"See you Wednesday."
Lori picked up her bag and walked out. She didn't look at Liz or Jen. She didn't say goodbye. The door closed behind her.
Liz watched her go. "What's her problem?"
I didn't answer. I opened my locker and took my time.
I always did at the end of a shift. Changed out of my scrub top, pulled on my T-shirt, swapped my work shoes for my sneakers.
Ran a brush through my hair, checked my face in the small mirror on the inside of the locker door.
Twelve hours under fluorescent lights did something to a person.
I was just going home, but I wasn't going to walk out looking like the shift had beaten me.
I tried to tune Liz and Jen out, but they were too loud to ignore.
"So. Did you hear about Andy Walsh?"