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Yet Julia did not feel as if she was on her own. Not at all. After 20 years in nursing, M.J.'s ability to rapidly size up a patient's care and condition bordered on a sixth sense, and every time she popped into Phyllis's room to check on Julia that morning, she rattled off a litany of concerns: The IV blood isn't dripping fast enough. . . . Did you ask her pain level? . . . Empty your urine bag, or you're going to have a flood.

''I'm so ready to be out of orientation," Julia grumbled to herself.

Julia knew that, with each critique, her freedom hung in the balance. The head nurse had instructed M.J. not to let Julia out of training unless she could safely care for the full range of patients, in the everyday workload of the ICU. M.J. and Julia's other teacher, Jeanne Rufo-Huckins, had already extended her training by two weeks because they felt she wasn't ready. If they extended her time again, Julia said, ''I would be totally pissed, and they would know it."

But by noon M.J. was feeling less confident about her student's progress. Phyllis wasn't doing well, clutching her stomach in agony and complaining that she was freezing. When M.J. checked in, Phyllis's blood pressure had dropped so low it set off a flashing red alarm on the vital-sign monitor, and M.J. was puzzled that Julia didn't recognize the obvious: The treatment plan she had discussed with the doctors at morning rounds wasn't working.

M.J. had stressed time and again the importance of getting a doctor when the patient takes a serious turn for the worse. Yet after all these months, M.J. felt that Julia was still stubbornly inclined to rely on her own judgment.

''She's fully off your plan, basically," M.J. said. ''What should you do?"

''Get the resident," answered Julia, giving the answer she knew her teacher wanted to hear.

''Absolutely," M.J. replied. ''You've got to do something. You can't just look at it."

After so many shifts working side by side, Julia and M.J. had grown increasingly blunt and testy with each other. The two women considered themselves friends with much in common, but in some ways they may have had too much

in common. Smart, opinionated, and strong-willed, both are accustomed to being in charge at home and at work, and neither finds it easy to hold back if they see a better way.

And Julia's self-confidence had grown tremendously since she reported for ICU training straight out of nursing school the previous August. She had believed from the start that she would be a very good intensive care nurse. Now she had come to believe something else: that her teacher wasn't always right.

In fact, she knew it. Ten days earlier, Julia had prevailed when M.J. questioned her judgment. The patient, a diabetic, had come to the hospital for what he thought would be a routine checkup and ended up with a diagnosis of advanced gangrene in his right leg, which required amputation at the knee. Julia wanted to turn off the blood-thinning drug the patient was receiving to prevent dangerous blood clots. M.J. thought otherwise, but the doctor assigned to the case agreed with Julia that the drug was causing internal bleeding and damaging the patient's liver. ''I'm happy," she beamed afterward.

But the glow from such moments didn't last. M.J.'s running commentary was a constant, grating reminder to Julia she was still a student.

''I've had it up to here," Julia said, holding her right hand to her eyebrows.

M.J. was tiring of the tension, too. Of all the nurses M.J. had trained, Julia was among the brightest and, at 35, brought the most life experience to the job. But she had comparatively little hospital experience, the practical bedside seasoning that could temper her textbook smarts and instinctive self-reliance.

Sometimes, M.J. said, she felt Julia was trying to win a debate that experience -- M.J.'s experience -- should decide. ''Everybody else I've [taught], when you say, 'There's a better way to do something,' they would listen to me, and they may not do it exactly, but they will incorporate it into their practice."

Julia, M.J. complained, always had to be convinced, and even then, ''she would do things her way."

Photo gallery | Printer friendly | E-mail to a friend | Other Special Reports
  [1]  [2]  [3]  [4]  [5]  | This series:  [Part one]  [Part two]  [Part three]  [ Part four ]