In violation of hospital policy, someone who worked the night shift had placed a water bottle on the desk at the nurses’ station. Ava wondered which of her coworkers had broken the rule. She picked up the bottle and studied its blue label. The plastic cylinder held the standard 16.9 ounces of water, nothing out of the ordinary to the visitors walking by the desk, but a citation-worthy offense to the staff of Unit 3B at Kingsley Memorial Hospital.
She held the bottle over the trash can, let it hover there for a moment, then set it back on the desk. Looking at it would make her decision easier.
I can’t wait to quit this job with its silly rules and stupid citations for breaking the silly rules.
Ava smoothed a wrinkle from her indigo scrub pants and sat down at the desk. She pulled her phone from her pocket and read the resignation letter she’d written last week and emailed to herself.
She had started her nursing career at this hospital ten years ago. She still loved caring for patients, but the rules had grown more rigid each year. Add in persistent staffing shortages from the recent pandemic, and Ava needed a break from hospital nursing. After months of searching and interviews, she had accepted a job working from home as a consultant for a company that developed healthcare software. She’d give Tess, her manager, the resignation letter today.
As she reread the final line, a ring jolted her from her thoughts. The call light for room 4510 was beeping at the front desk.
She picked up the phone. “Good morning, Mr. Thompson. It’s Ava. What can I do for you?”
“Morning, Ava. Could you please bring me some pain medicine? My back is starting to hurt again.”
“Yes, sir, I’ll be right down.”
As Ava hung up the phone and rose from her chair, Tess rounded the corner.
“Morning, Ava.”
“Hi, Tess. Hope your morning is going well.”
“It is, but I need—”
“Sorry, but I can’t really talk right now. I need to get one of my patients some pain medicine.”
Tess glanced down the hall at the doors to the patient rooms, then looked back at the nurses’ station. “Is that a water bottle next to the computer?”
Ava followed Tess’s gaze. “Umm… looks like it.”
“You know that’s not supposed to be there.” Tess crossed her arms. “Especially with the GHA coming next month. They’ll cite us if they see food or drinks on the desk.”
“But I…” Ava began to speak, then closed her mouth. She looked down and fidgeted with the wristband on her watch. She didn’t plan to be at Kingsley Memorial when the Group of Hospital Accreditors visited.
GHA visits were a source of stress for the entire hospital. They could issue citations for non-compliance and require corrective action plans, which placed accreditation status at risk. Loss of accreditation threatened insurance reimbursement rates and public trust. Ava knew it was important to maintain quality care, but each year, GHA seemed more merciless.
Last year, an accreditor issued a citation after discovering a blood pressure monitor in the hallway. According to GHA, the machine cluttered the corridor and could pose a hazard if nurses needed to evacuate patients urgently. No one fessed up to the infraction, though Ava felt certain that if she ever needed to move a patient’s bed urgently, she could simply push the machine aside.
During the same visit, a different accreditor cornered a pharmacist and demanded she locate the hospital’s severe weather policy in the online manual. During Ava’s orientation ten years earlier, a hospital educator had shown the orientees where to find the policy and procedures manual. Ava had helped implement those procedures a number of times since then. Still, under pressure, she wasn’t sure how quickly she could locate them on the hospital’s intranet.
She looked at the water bottle and shrugged. “Sorry, it’s not mine. It was sitting there when I got here.” Ava started toward the hallway. “I’ll get rid of it after I give Mr. Thompson his pain medicine.”
Tess continued to talk. “Why didn’t you throw it away? You, out of all my staff, have been here long enough to know better.”
Ava’s cheeks flushed, and she turned to face her. “Sorry, I guess I was just focused on looking up the morning labs.”
Tess furrowed her brow. The two nurses had begun their careers in the same cohort at Kingsley Memorial and quickly became friends. Last year, Tess had been promoted to unit manager—a move that was good for her resume and bank account but that created a distance between them. Now, Ava wondered if they were still friends. Realizing she could no longer roll her eyes with Tess over something as silly as leaving a water bottle on the desk had, no doubt, added to her desire to leave the hospital.
She thought back to the first GHA visit they had ever prepared for together.
“Can you believe Patty gave me a verbal warning for having a saline flush in my pocket?” Tess asked.
“It’s ridiculous,” Ava said. “We’re just trying to cut down on the number of times we have to leave a patient’s room to get supplies.” She crossed her arms. “And it’s not like saline is a medication.”
Tess gave an exaggerated imitation of their manager’s stern expression before breaking into a grin.
Ava cracked a smile and shook her head. “I could never be that nitpicky about the rules.”
“Same,” Tess said.
The memory slipped away as quickly as it had surfaced, leaving Ava in the present, where Tess seemed distant and no longer felt like the person she once knew.
“I guess I just don’t see the logic of not allowing water bottles at the desk,” Ava said. “It seems like a silly rule.”
“It’s about infection control. It’s unsanitary to have drinks out in a hospital with sick patients. All water bottles should be kept in the break room.”
Ava let out a sigh. “I’m not saying it’s all bad. I agree we shouldn’t have water bottles on top of medication carts, but there are no patients at the nurses’ desk.” She looked down the hall. “Or at the computer alcoves where we do our charting. You know I’m either in a patient’s room or at a computer, so it’s hard for me to stop what I’m doing and go to the break room for water.”
“It might seem stringent, but if we allow drinks at the nurses’ station and the computer alcoves, pretty soon, nurses will be leaving them on the medication carts. Besides, upper management is doing surprise audits of floors later this week to prep for GHA’s visit.”
Avoiding a surprise audit was all the more reason to turn her resignation in as quickly as possible.
“I understand,” said Ava. “I’ll throw it away.”
Tess uncrossed her arms. “I’ve got it this time.” She grabbed the bottle and tossed it into the trash. “Thanks for understanding. I know you want our unit to be the best it can.”
“I do.” Ava’s response was automatic.
Despite her decision to leave, Ava still cared about the unit. She felt a tightening in her throat. When she and Tess had worked side by side, this floor felt like home. Back then, she’d been certain she would never leave.
She looked up at Tess. Their eyes met in a brief moment before Ava spoke.
“Are you free this afternoon? I need to talk about something.”
“Tomorrow. I have meetings with my boss and the other managers all day.” Tess turned to walk into her office, then stopped and turned back. “Oh, and don’t forget to update the whiteboards in your patients’ rooms. Make sure you write your name, the room number, doctor’s name, discharge plan, all of that. Upper management is going to pay special attention to those when they do the audits.”
Tess shut the door to her office.
Ava fished around in her pocket for a dry-erase marker. Last year, during the accreditation visit, GHA encouraged the hospital to develop methods to improve communication between nurses and patients, so Kingsley Memorial retooled the whiteboards already hanging in patient rooms. Now, nurses were required to update them at the start of each shift.
Before she could walk down the hall, the call light for room 4510 rang again, and Ava reached over the counter to grab the receiver.
“I’m so sorry, Mr. Thompson. I’ll be there in a few minutes.”
“Thanks, Ava. Sorry to bother you again, but I’m really hurting.”
“Absolutely. I’m on the way.”
#
Mr. Thompson’s room was dark when Ava walked through the door. She could make out the outline of a man slumped in bed, the sheets wrapped around his feet. She turned on the light over the sink, and the oxygen tubing in his nares came into view. Diagnosed with lung cancer five years earlier, Mr. Thompson was admitted to the hospital several times a year and had become a frequent patient of Ava’s.
“It looks like you had a rough night, Mr. Thompson. I’ve got your ice and pain medication.” She signed into the computer in the room and scanned his armband. “Can you rate your pain level?”
“It’s about a six now.”
Ava filled his pitcher with ice before pouring some water from a bottle into it. She placed the pill into a plastic cup and handed it to him. He swallowed the medication before speaking.
“Thank you for always responding as quickly as you can. I know you’re busy.”
Ava’s gaze drifted to the floor, and she shifted her feet. “Absolutely. It’s no problem at all.”
When she looked back up, he was staring out the window. The sky was beginning to lighten to the soft blue of early morning. On the table next to the bed, a basket of lilies sat beside him.
“These flowers are really pretty.” Ava ran her fingers along the edges of the fiery orange petals, speckled with tiny black flecks. “My mom planted purple lilies around our mailbox, and they’d bloom each spring.”
“Claire brought those when she visited last night. She’ll come up here later when she gets off work.”
Claire was Mr. Thompson’s daughter. Ava rarely saw her because she worked a full-time job as an accountant during the day and had a son, Jeremy, who played basketball at his high school.
“She’s planning a trip to North Carolina, so I can see the mountains in the summer. She wants all three of us—me, her, and Jeremy—to go, but I’ve been so tired lately. I’m not sure I can hold up to that kind of trip anymore.”
Ava looked up at the bag of fluids and electrolytes dripping into his veins. “We’ll do everything we can to get you there.”
Even though the cancer had spread to his bones last year, Ava hoped Mr. Thompson still had more quality time ahead of him. In nursing school, she had been drawn to oncology because it gave her an opportunity to develop long-standing relationships with patients. She knew she would miss those relationships after she left Kingsley Memorial.
She sat down on the couch next to his bed. Mr. Thompson looked down and began to fidget with the fabric of his gown. Ava’s gaze wandered past his bed toward the whiteboard on the wall. The lines were still blank—no doctor, nurse, or discharge plan. She started to stand, but when Mr. Thompson spoke, she sat back down.
“The doctor rounded really early this morning.” He stared down at his hands. “He told me the chemo isn’t working anymore.”
Ava felt a weight settle in her chest. “I’m so sorry, Mr. Thompson.”
“There’s some kind of trial I can get into. Something about trying immunotherapy, but I’d have to qualify for it.”
“I’ve had a lot of patients who benefited from drug trials.”
“I’d have to move to Houston for a few months.”
“Have you talked to Claire about it?”
He shook his head. “I don’t want to worry her right now. It’s tax season, so she’ll be really busy with work for the next few months.” He pulled the blanket up over his shoulders. “She would have to move with me.”
“How do you think she’d feel about that?”
He looked over at the lilies. “Oh, she’d do it. She’s my daughter, and to tell you the truth, I’m not sure she’s ever been able to accept that I’m going to die at the end of all this.”
Ava shifted on the couch.
“It’s hard to accept that a parent won’t be here anymore.” Ava’s own mother had died last year, a fact that still felt unreal when she woke each morning.
“I think a lot about how Claire will handle things when I’m gone.” He paused, then let out a sigh. “Sometimes, I wonder if it’s worth it anymore. Even before the chemo stopped working, I was sick all the time. I haven’t been able to go on my daily walks for the past month or meet my church group during the week.”
“Have you told Claire how you feel?”
He shook his head, and they sat in silence again, both looking out the window. Ava stared at the pink haze spreading across the skyline until the weight in her chest eased. Mr. Thompson’s words finally broke the quiet.
“Thanks for sitting here with me, but you should go ahead and get your day started.”
“I’m always up for talking.” She smiled and reached for his hand, giving it a gentle squeeze. His hand was warm against her cold fingers. “Especially with one of my favorite patients.”
As she turned to leave, Ava glanced at the whiteboard. She checked her watch. If she didn’t hurry, she’d be late for the morning medication pass. She would update the whiteboard later.
#
The next day, during Ava’s lunch break, she knocked on Tess’s office door.
“Come in.”
Ava opened the door to see Tess sitting at her desk, facing her computer. A framed picture of Tess and her daughter, Chloe, rested next to the computer. She looked up from the screen and motioned for Ava to sit in the chair across from her.
“Ava, I’m glad you’re here. I wanted to talk to you about something.”
Ava stifled a sigh. Her lunch break lasted only thirty minutes. She didn’t have time for small talk before telling Tess she planned to resign.
“Okay, sure.” Ava forced a smile.
Tess shuffled through a pile of papers, pulled one free, and handed it to Ava. It was a printout of Mr. Thompson’s medication administration record from the previous day. Tess pushed her glasses up onto her head and leaned forward.
“You gave Mr. Thompson pain medication at 7:35 am yesterday.”
“Yes.”
What was this about?
“But you never followed up on his pain,” Tess said. “You didn’t document a reassessment.”
“I did follow up,” Ava said quickly. “I went back into his room around 8:30. His pain was a zero. I was just busy with med pass and rounds, so I didn’t document it right then. I must have forgotten to do it later.”
“Well, it doesn’t count if you didn’t document it.”
“But I did control his pain.” Ava crossed her arms and met Tess’s gaze.
“Not according to our accrediting agency.” Tess slid the paper back into the stack. “You know we need this documented correctly to maintain accreditation.”
Ava’s eyes drifted to Tess’s desk. A half-empty water bottle sat beside the computer. Heat crept up her neck, and she thought of the resignation speech she had rehearsed that morning.
“Does it count if I charted it but didn’t do it?” Ava asked. “If I document that his pain was a zero, but I never actually went back into his room?”
Tess sighed and rubbed her temples. “You know you need to do both. Pain reassessment should be charted exactly one hour from the time you administered the medication. We need ninety percent compliance to keep our accreditation.”
“But sometimes it’s not realistic,” Ava said. “What if I’m in another patient’s room? What if I’m five minutes early or five minutes late?”
“Try not to be,” Tess countered.
“You know I can’t control that!” Ava snapped back. Tess had worked with her on the floor for years. Had she forgotten what it was like?
Tess raised her eyebrows. “We’ve been friends a long time, but you need to be mindful of how you’re speaking to me. I’m your manager now.”
Ava sank back into the chair.
“I know you’re doing all the right things,” Tess said, her voice softening. “But if the reassessment isn’t documented exactly one hour after, it gets flagged by upper management.”
“I’m not saying I don’t see your point,” she added. “But they’ve really been on me with accreditation coming up.”
Her gaze wandered to the picture of her daughter, and for the first time, Ava noticed faint circles under Tess’s eyes. A few stray hairs escaped her ponytail, and wrinkles creased the front of her blouse. She rubbed at her eyes.
Ava remembered the day Tess told her she was applying for the management position. She had spoken of how difficult it was, as a single mother with one income, to pay for Chloe’s college tuition. Ava knew Tess didn’t want her daughter burdened with student loans for the next decade, the way she had been.
“I don’t want you to think I don’t appreciate you,” Tess said. “We’ve had so much staff turnover this past year, but I can always count on you to steady the floor.”
The words brought a pang of guilt to Ava’s chest, but she pushed it down. She glanced at her watch. Twenty minutes left. She opened her mouth, but Tess spoke again.
“I do have one more thing.” Tess reached into her drawer, pulled out an envelope, and placed it on the desk. “A patient’s family sent you a card.”
Ava picked it up. Her name and the hospital’s address were written neatly across the front. Inside was a card from Mrs. Blake’s family, thanking Ava for taking care of their mother. Ava had been Mrs. Blake’s nurse several times over the past year. The week before she died, Ava had helped discharge her to hospice.
“You get more cards than any of my other nurses,” Tess said with a small smile.
Ava traced the handwriting with her eyes, thinking of her last conversation with Mr. Thompson.
“That makes me happy,” she said, her voice catching slightly. She took a slow breath.
“Are you okay?” Tess asked.
“I’m good.”
A wave of grief rose unexpectedly. It happened sometimes at the hospital, but she’d gotten good at pushing it down. This time, though, tears threatened to form. She looked at the floor.
They hadn’t talked about her mother since the funeral, and at some point, it had become an unspoken rule between them to avoid the conversation. They sat in silence for several seconds, the hum of the computer monitor the only sound filling the room.
“How’s your dad?” Tess asked.
Ava froze. Her fingers tightened around the arm of the chair.
“He’s doing okay,” she said quietly. “As okay as he can, I guess. It’s… different for him without my mom, but he’s managing.”
“And you?” Tess asked. “Are you managing?”
The air in the room felt thick. Heat flushed across Ava’s face and neck. She inhaled slowly and turned toward the window. The sky was clear, a bright blue. She focused on a single cloud, steadying her breathing, before looking back at Tess.
“I’m managing.” She loosened her grip on the chair. “I don’t know if I ever told you how much it meant to me that you came to the funeral.”
“I wouldn’t have missed it.” Tess held her gaze. For a moment, the lines around her eyes seemed to soften. “I know things are…” her voice trailed off. “Different now that I’m your manager. But you can always talk to me if you need to.”
Ava’s eyes began to mist over. The room felt smaller, heavier. She needed to leave. She’d give Tess the resignation letter tomorrow.
She stood.
“So what was it you wanted to tell me?” Tess asked.
“I—” Ava hesitated. “Just that I switched a shift with Jennifer next week. She needed to take her son to a doctor’s appointment, so I’m covering Tuesday. She’ll take my Saturday.”
Tess nodded. “That’s nice of you. Just make sure both of you request the swap in the computer.”
“I will.”
“And one more thing.” Tess picked up the half-empty water bottle and took a sip. “You updated your whiteboards, right? I’m checking those tomorrow morning before the audit.”
“Sure,” she said, the lie slipping out before she could stop it. She’d never gotten around to updating the whiteboards. “You don’t need to worry about that.”
#
Ava studied the whiteboard in Mr. Thompson’s room. Blank spaces, more than she cared to count, stared back at her. Date. Room number. Phone number. Nurse. Nursing assistant. Nurse Manager. Social worker. Doctor. Tests. Lab results. Diet. Activity level. Consultations. Treatment Goal. Discharge Plan.
She stifled a sigh. Next, the hospital would add a space for the patient’s favorite TV show.
Ava remembered when the whiteboards were simple, with only a few blanks to convey the most vital information. Now, they felt burdensome, like time-consuming puzzles that pulled her away from patient care, and she wondered if patients even understood what some of the words meant.
Still, she pressed the tip of her dry-erase marker to the board and worked quickly. When she reached Treatment Goal, she hesitated, lifting the marker away. She chewed on her bottom lip before writing Healing.
“You have very neat handwriting.” Mr. Thompson’s voice came from the bed behind her.
“Thanks.” She turned to face him. “I’d stopped updating these boards for the past few months. I get so busy taking care of patients. Sometimes, it’s the last thing on my mind.”
“I understand.” He studied the board. “It could be helpful, though. I was thinking you could write when my pain medication is due in the blank space at the bottom. That way, I won’t buzz you at the wrong time.”
Ava turned back to the board. “That’s not a bad idea.” She wrote “Pain med due at 3:00 pm” in the blank space, and in the final blank labeled “Nurse,” she added her name.
Mr. Thompson chuckled. “But I’m pretty sure I know your name by now.”
Ava smiled. Out of the corner of her eye, she noticed the lilies on the windowsill. Someone must have moved them. Her lips straightened into a thin line. It was against policy to keep anything there. The window needed to remain clear in case of evacuation during a fire.
“Who moved your flowers?”
“Oh, I asked Claire to put them there last night. I can see them better on the windowsill.”
“They do look pretty in the light.” Ava stepped over and touched the soil. It was slightly damp, just enough to keep the plant nourished for a few more days. Some of the blossoms were opened, splayed like orange faces, while others remained closed, the buds perched like clenched fists. “This plant still has a lot of buds. If it stays watered, it’ll keep flowering.”
“Huh,” Mr. Thompson murmured.
“It could bloom next summer, too… if you want to keep it over the winter,” Ava spoke more to herself than to him. Her mother, an experienced gardener, had taught Ava everything she knew. Since her death, Ava hadn’t found the motivation to tend her plants beyond basic watering and fertilizing.
She shook her head and refocused on Mr. Thompson. The IV fluids dripped into his veins, and the oxygen prongs rested beneath his nose. His skin looked paler than yesterday, even after the blood transfusion. His collarbones seemed more pronounced, too. Had they been that visible before, or had she just not noticed?
Ava glanced at the pulse oximeter reading on the wall-mounted monitor. His oxygen saturation had drifted down to 89 percent. She reached over and bumped his oxygen up by one liter. Maybe he would qualify for the immunotherapy trial.
“How was your visit with Claire last night?” she asked.
The sparkle in his green eyes dimmed, and the corners of his mouth turned downward. “It was okay. We talked about the trip to North Carolina. She’s disappointed, but she’s starting to understand why I can’t go.”
“And how do you feel about missing it?”
He took a few slow breaths before answering. “I’m sad I can’t go, but I hate that she’s disappointed more than anything. She mentioned another trip in the future.” He paused again. “I just don’t see how I’ll be any better by then.”
He turned his gaze to the window. The sky had settled into a vivid blue, thin cirrus clouds feathered across it. It seemed too bright for what he’d just said.
Ava understood Claire’s disappointment. Admitting her father couldn’t go on the trip made it real—that his illness had changed what he could do, that his death might be closer than she wanted to believe.
Ava wasn’t religious. She didn’t know if consciousness persisted after death, but after her mother died, she found herself hoping it did. It felt impossible that the person who created her could one day stop existing.
“Sometimes, I think it would be better if I went ahead and died,” said Mr. Thompson. “That way, Claire would be forced to accept it. Right now, she’s stuck in limbo. I tried to mention changing my status to DNR, but I could tell it upset her, so I dropped it.”
Again, Ava thought of her own mother’s battle with ovarian cancer. Even after the cancer had spread to her bowels, and the oncologist told her she likely had a year left to live, Ava was hopeful. She’d wanted to believe her mother would respond differently to chemotherapy or that the doctor would find a new drug trial. She supported her mother’s decision to become a Do Not Resuscitate but refused to discuss the type of flowers and music she wanted at her funeral. After she died, Ava couldn’t deny that it had taken the loss to force her into acceptance.
“I’d never wish for someone’s parent to die, but I can see what you mean,” Ava said. “Maybe she just needs more time to come to terms with your diagnosis. Or maybe she’s hoping you’ll have success with the immunotherapy trial.”
“If I don’t go through with the trial, I need to discuss becoming a DNR with the doctor.” He looked at the lilies. “I don’t know how you do it, Ava—seeing the suffering and watching people die.” His voice lowered to a near whisper. “Claire couldn’t do what you do.”
Ava thought about the job with the software company. Most nurses who took those types of jobs needed a break from the emotional demands of patient care, but Ava had never felt burdened by her work. She was frustrated with the hospital’s red tape, the rules that interfered with her ability to provide care, but she would miss patients like Mr. Thompson.
“To be honest, Mr. Thompson, I can’t really explain it. When I did my oncology rotation in nursing school… something just clicked.” She paused. “It felt meaningful in a way that nothing else had before.”
She glanced at the bed and saw that his eyes were closed. Before leaving the room, she looked back at the lilies. The orange flowers stood out against the blue of the sky.
#
The next day, after finishing morning rounds, Ava settled at the nurses’ station. If she wanted to avoid the on-site accreditation next month, she needed to turn in her resignation today. But each time she thought about talking to Tess, a nagging doubt flickered in the back of her mind.
She was reviewing morning lab results when a voice broke through her thoughts.
“Morning, Ava,” Tess said.
“Morning.”
“I have a list of things I’m auditing today. Do you have time to go over it before you start passing meds?” She slid a sheet of paper across the counter.
Ava glanced down at the page, a list of bullet points under each heading, and felt her mouth tighten. Before she could respond, a call light sounded. She picked up the receiver.
“Hi, Mr. Thompson, I’ll be right down. Can I bring you anything?”
“No, I just need to talk to you.”
His voice was weaker than it had been yesterday. He’d been dozing during her morning rounds, so she hadn’t disturbed him.
“Sure, I’ll be right down.” She looked at Tess. “He sounds a little different. Do you mind coming with me?”
Tess glanced down at her copy of the list, then back up at Ava. They had worked together long enough for Tess to trust Ava’s instincts. “Sure, let’s go.”
The room was dim when they stepped inside. Mr. Thompson sat slumped in bed.
“Do you mind if I turn on the light?” asked Ava.
“I’d rather you didn’t. They’re too bright. Maybe just open the blinds?”
Ava crossed to the window, where the basket of lilies still rested on the sill. As she pulled the blinds open, she studied his face. His skin was paler than it had been yesterday, his lips tinged a faint purple.
Ava looked up at Tess, but her manager’s attention had drifted to the lilies, studying the orange petals. Tess opened her mouth to speak, hesitated, then closed it.
She turned back to Mr. Thompson and slipped the pulse oximeter onto his finger. The number blinked on the screen—85 percent, even with the nasal cannula in place. She increased his oxygen by two liters, bringing it to a maximum of six.
“Mr. Thompson, why don’t I check your blood pressure?” Ava said gently.
She applied the cuff to his left arm and pressed the green button. The machine whirred, then fell silent. Two flat lines appeared on the screen.
“Let’s try the other arm,” Tess said.
Ava moved the cuff to his right arm and pressed the button again. The machine hummed for a few minutes before displaying the same result.
“It may be too low for the machine to detect,” Ava said. “I’ll grab a stethoscope and take it manually.”
She had just turned toward the door when Mr. Thompson’s voice stopped her.
“No… don’t do that,” he whispered. “I don’t want y’all going to any more trouble.”
“It’s no trouble, Mr. Thompson,” Ava said, stepping back to the bedside. “We just want to make sure you’re okay.”
He looked up at her, lips parting as if to speak, but his eyelids fluttered, then slowly closed.
Tess placed a hand on his arm. “Mr. Thompson, can you hear me?”
He didn’t respond. His chest still rose beneath the thin hospital gown, but slower now. The monitor dropped to 80 percent.
Ava pressed her fingers to his wrist. “His pulse is really thready,” she said, glancing up at Tess.
“Is he a DNR?”
“He hasn’t decided yet. We have to do everything.” Ava reached for the phone on the nightstand. “I’m calling a rapid response.”
She dialed the operator.
“Go grab the manual cuff,” Ava added. “And bring a face mask from the supply room. I’m going to increase his IV fluids.”
While Tess left to get the blood pressure cuff and oxygen mask, Ava adjusted the IV pump to increase the fluids. When Tess returned, she secured the mask over Mr. Thompson’s face, but his lips remained purple. His oxygen saturation hovered at 80 percent.
“Give it some time,” Ava said.
Tess adjusted the pulse oximeter on his finger and wrapped the manual cuff around his other arm, pumping it up. Aside from the steady hum of the IV pump pushing fluids into his veins, the room was silent.
“80/45,” said Tess, offering a faint smile. “Better than nothing. Maybe the fluids are working.”
Ava nodded. “I hope someone gets here soon.”
Mr. Thompson’s chest continued its labored rise and fall. Gradually, his lips began to pinken, and his oxygen saturation climbed to 90 percent. Ava rubbed his sternum in a circular motion. His eyes fluttered open, and he looked at her.
“Mr. Thompson, how are you feeling?”
“Weak,” he tried to smile, but his lips fell flat.
“You’ll feel better in a few minutes.” Ava patted his shoulder and pulled the hospital gown up around his neck.
“Who are you?” he asked, his breath fogging the mask as he glanced at Tess. “Are you a nurse on this floor?”
“I’m the —”
“She’s a nurse,” Ava said, meeting Tess’s eyes. “She’s worked with me for a long time.”
At that moment, the rapid response team and Dr. Patterson, the oncologist, entered the room. Dr. Patterson nodded at Tess. “What happened? Who’s his nurse today?”
“Me,” said Ava. “He became very weak, and we couldn’t get a blood pressure reading. His oxygen was low, so we placed a mask on him.”
The doctor checked the monitor. “Let’s give more fluids.” He turned to a respiratory therapist. “Increase his oxygen slightly.”
“I’ll get more fluids,” Tess said, but before she could leave, Mr. Thompson spoke.
“Wait,” he whispered. “Don’t hang any more fluids… and don’t turn the oxygen up.” He reached for the mask straps.
Ava frowned. “What do you mean?”
“I mean, I don’t want any more treatment.” He lifted his head slightly. “I’ve thought more about the immunotherapy trial, and I don’t want to do it.”
The room fell silent.
“Are you sure?” Dr. Patterson asked. “Did you talk to Claire about it? Yesterday, when we discussed what would happen if you stopped breathing, you said you hadn’t.”
“I’m sure,” Mr. Thompson said. He looked at Ava. “Don’t call Claire.”
“But…” Ava stammered. “Don’t you want her to be here?”
He shook his head.
Ava thought back to her own mother’s death. In the middle of chemotherapy treatments, she had developed a bowel obstruction and was admitted to the ICU at Kingsley Memorial. When her kidneys began to fail, the doctor said they wouldn’t recover enough to continue treatment.
She was transferred to 3B, Ava’s unit, to await hospice placement, so the family could be at her bedside without the machines and visitation restrictions of the ICU. During those weeks, Ava had taken off work to be with her. One morning, she went home to shower when Tess called.
“Ava…” Tess’s voice softened. “I’m so sorry. I wish I didn’t have to tell you this… but your mom died about an hour ago.”
“Wait—what? But I wasn’t there,” Ava felt her lower lip tremble.
“Your dad was here.” Tess paused. “I was here, too.”
“But I wanted to be there. I didn’t think it would happen that fast.” She slipped on her shoes. “I need to get up there.”
“Of course. Take your time. Your dad is in the room, and I’ve already called the funeral home.”
Ava sat back down on the bed and took a deep breath.
“Are you okay?” Tess asked. “Do you need someone to drive you? I can come get you.”
“I’m…,” Ava faltered. Until this moment, she hadn’t believed her mother would actually die. How could she have been away when it happened?
“Are you okay?” The question came again—this time from the other side of Mr. Thompson’s bed.
Ava blinked.
A flash of orange caught her eye. The lilies sat on the windowsill, their petals fanned open, bright against the sky.
Tess stood across from her, on the other side of Mr. Thompson’s bed. The monitor beeped steadily.
Ava tightened her grip on the bed rail. “Yeah,” she shook her head and rubbed her eyes.
Ava looked at Mr. Thompson, then at Dr. Patterson, then at Tess.
Mr. Thompson glanced at the lilies, then back at Ava. “I don’t want her to have a memory of me dying, and I don’t want her to be in limbo anymore. Would you stop the IV fluids and remove my oxygen mask?”
Ava looked at Dr. Patterson. He gave a single nod. She unhooked the IV from Mr. Thompson’s arm and gently lifted the oxygen mask from his face.
“Could you do something for me, Ava?”
“Of course. Whatever you need.”
“Could you hold my hand?”
Ava took his hand. His skin was already cold, blood pulling inward as his body sacrificed its extremities to preserve the core.
“Your hand is warm,” he said. For a moment, there was a flicker in his hazel eyes.
“Do you want me to stay?” Tess asked Ava.
“No, I’ll be okay, but could you keep an eye on my other patients?”
“Of course.”
The rapid response team gathered their equipment and stepped out of the room. Dr. Patterson gave a final nod before slipping out, and Tess followed him into the hall, gently closing the door behind her. Ava turned off the monitor.
She pulled up a chair and sat beside him, his hand in hers. She stayed through the next hour as his respirations slowed—brief breaths followed by longer pauses, until his chest no longer rose and his lips took on a deep, fixed blue. She squeezed his hand one last time before releasing it and drawing the blanket up over his shoulders.
As she stood to leave, her eyes caught the whiteboard. The word Healing still sat beside the line for Treatment Goal, and for a moment, something eased in her chest.
Her gaze lifted. Yesterday’s date was written at the top with her dry-erase marker. She hadn’t had time to update it. Irritation rippled through her. The resignation letter flashed through her mind, but when she looked back over at Mr. Thompson, the pang of doubt returned.
Not today. She didn’t have anything left for a decision like that.
She had the weekend off. It would have to wait until Monday.
#
Ava looked at the orange lilies sitting on the shelf in Tess’s office. Though the buds had opened into flowers, their leaves drooped over the side of the pot.
“I asked Mr. Thompson’s daughter if she wanted those, but she said she didn’t have a green thumb,” said Tess.
“Gardening is definitely a lot more work than it seems,” said Ava.
She reached out and ran her thumb along the edge of one of the petals. The blooms remained soft despite the leaves beginning to crinkle at the edges.
Ava had been thankful for the weekend off. Though the break had given her time to reconsider her decision to leave the hospital, she found herself still wavering. Maybe she could take the job at the software company and stay part-time at the hospital, picking up some weekend shifts. Maybe, after accreditation, Tess could convince upper management to relax some rules.
She drew her hand back from the lily and looked at Tess. “So what did you want to see me about?”
Tess fidgeted with her pen, clicking it rapidly against the desk before pushing her hair behind her ears. “You know how upper management was planning to do audits on all the floors this week?”
“Yes. Are they still happening?”
Tess cleared her throat. “They actually did surprise audits last week.”
“Really? I didn’t see anyone.”
“They sent someone dressed in street clothes.”
Ava rolled her eyes. “They really will do anything to catch people breaking the rules.”
Tess didn’t smile.
“The thing is, they came the day Mr. Thompson died—after the funeral home picked up his body. They went into his room before housekeeping had a chance to clean it.” Tess hesitated. “They want me to cite you for the basket of lilies on the windowsill. They also had issues with the whiteboard. The date wasn’t correct, and they didn’t like that you chose ‘healing’ for his treatment goal. They’re looking for something more specific.”
Ava narrowed her eyes. “You’re not going to actually cite me, are you?”
“I don’t have much of a choice,” Tess said, glancing down at her desk before meeting Ava’s gaze again. Her voice softened. “Not if I want to keep my job.”
Ava remained silent, her lips pressed together.
“Look, I know you don’t deserve this,” Tess continued, “and I know what happened. But it’s a formality.”
The room was quiet for a moment.
“I understand,” said Ava.
The words surprised her. So did the calm. She felt no anger, only resignation—a certainty that she couldn’t change the system. She could only stay and work within it, accept it for what it was.
She had built this moment up, avoided it. Now, the words came easily. “I’ll sign your sheet.”
Tess exhaled, some of the tension leaving her shoulders. “I’m so glad. I—”
“But I won’t be back next month.”
Tess blinked. “You want to take some vacation? I can understand that after what happened.”
“No.” Ava shook her head. “I mean, I won’t be back at all. I’ll email you my resignation to make it official, and I’ll work out my schedule for the next two weeks. But consider this my notice.”
“But the accreditors will be here next month. I need you for that.” Tess’s composure slipped. “Besides… where will you go?”
“I got a job working from home for a software company.” Ava felt a flare of anger rise—brief, sharp—before she pushed it back down. “Somewhere I can put my water bottle on the table.”
Tess’s eyes widened.
Ava shifted in her seat. “I’m not mad at you, Tess. I just can’t do this anymore.”
“I know the rules can be strict—”
Ava shook her head. “I don’t think the rules are all bad. It matters that patients know their nurse’s name. It helps to write when pain medication is due.” She paused, choosing her words carefully. “But the whiteboards aren’t a substitute for meaningful communication. And there has to be some room for judgment.”
She let out a slow breath.
“I held a man’s hand while he was dying because he didn’t want his daughter there. In that moment, I’m not going to prioritize updating a whiteboard.”
Tess didn’t respond.
The image returned to Ava—Mr. Thompson’s hand in hers, the skin cooling, the color draining as his body shut down. His eyes, once sharp, gone still.
“Do you really think Mr. Thompson’s care was negatively impacted because I didn’t update the whiteboard?” Ava asked.
“Of course not, but…” Tess’s voice trailed off. Her lips pressed into a thin line. The only sound left was the hum of the computer.
Ava glanced back at the lilies.
“You know,” she said. “I never asked you about my mom. About the day she died.”
Tess’s expression softened. “It was peaceful. Very quick.”
Ava nodded slowly. “I’ve felt so guilty about not being there.”
“You can’t control that,” Tess said gently. “We both know that. We’ve seen that with patients.”
“I know.” Ava let out a quiet breath. “But it’s different when it’s your family. I didn’t realize how different.” She paused, then exhaled, surprised she hadn’t teared up. “Do you think a patient can control when they die?”
Tess considered her words. “I think… maybe it’s possible. Maybe your mom was trying to spare you from having that memory in the place where you work.”
Ava swallowed. Her throat felt tight. “Maybe.”
There was no way to know. But the silence that had lingered around her mother’s death felt different now—less heavy, something she no longer needed to avoid.
She stood and stepped toward the lilies.
“Can I take these with me?”
Tess nodded. “Sure. They’ll probably die here anyway.” She narrowed her eyes, as if just noticing the drooping petals. “I’m not exactly good with plants.”
Ava smiled. “I’ll come back and get them before I leave for the day.”
#
Ava looked down at the brown sugar latte, swirling the ice with her straw and watching the cubes clink together. The condensation that had gathered on the side of the cup dampened her fingers, and she wiped them on her linen pants. It was May, and the air still held a trace of morning coolness, though she knew the afternoon warmth would settle in and linger.
Tess sat across from her, holding an iced chai topped with pistachio cold foam. She always ordered the same drink, and watching the familiar way she first sipped the cold foam with a straw eased the tightness in Ava’s stomach.
The energy between them was awkward. Tess spoke first.
“I wasn’t sure you’d agree to meet me.”
Ava glanced up, surprised. “I was never mad at you, Tess.” She took a sip of her coffee. “But it was time for me to leave. I needed to get away from the hospital after my mom died.”
It no longer felt strange to say out loud.
“I want to apologize.” Tess paused. “I wasn’t always the best manager. And I didn’t know how to balance our friendship with my new role.”
Ava turned the cup between her hands. Looking back, neither of them had been prepared for the shift.
“It’s okay,” Ava said. “I didn’t know how to handle it either. And I know you were doing it for Chloe.”
“I know a lot has happened,” Tess said, her voice soft, “but I hope we haven’t lost our friendship for good.”
Ava met her eyes and smiled. “We haven’t.”
The tension in Tess’s face eased.
“So,” she said, leaning back slightly. “How have you liked your job with the software company?”
“There’s a lot I enjoy about it.” Ava tucked a loose strand of hair behind her ear. “I wasn’t sure I would like working from home, but it’s given me more time with my dad.”
“Good.” Tess nodded. “This past year has been different without you, but I’m glad you’re happy.” She took a sip of her chai, then set it down, her fingers lingering on the cup.
“I have something else to tell you.”
Ava’s eyebrows lifted. “What?”
“I took a travel nursing job in Maine for the summer, maybe into the fall. I leave next week.”
“Wow… I have to say, I’m surprised.” Ava let out a small laugh, though her eyebrows stayed raised. “I thought you liked management.”
“It was okay at first. The money was nice,” Tess admitted, “but I missed patient care.”
“You were a great nurse.”
Tess smiled. “We were a great duo.”
For a moment, they sat in silence, sipping their drinks.
“Hey,” Tess said, tilting her head. “What did you end up doing with those lilies from Mr. Thompson’s room?”
Ava’s mind shifted to the small patch of earth where the lilies now grew. They had taken root more easily than she expected.
“They’re in the flowerbed around my mailbox. I kept them in their pot over the winter, then planted them this spring.” She let out a soft breath. “I wasn’t sure they’d grow after being transplanted, but they’re doing fine.”
“You were always good with plants.”
“Having more time to garden has been one of the other perks of working from home.”
A breeze drifted through, stirring the edge of the napkin. Ava pressed it down, then looked back at Tess.
“So Maine, huh? When do you leave?”
“Next week.”
Ava nodded. “I should come visit you this summer.”
Tess’s face lit up. “You should. I’m bringing Chloe with me for part of the contract. It’s been a while since you’ve seen her.”
“I’d love that.”
They sat there talking a while longer. The earlier tension between them had faded, and when they finally stood to leave, Ava pulled Tess into a hug.
As she drove away, her thoughts turned to her mother. Some of the memories had become hazy over the past year, but she could still picture her in the garden, hose in hand, watering her lilies.
After parking under the garage, Ava walked to the mailbox and paused at the flower bed. The lilies stood upright, their leaves a deep green. Their orange blossoms splayed open like trumpets, the sunlight glinting off them.
She lifted her gaze to the empty beds along the fence. There was more space than she’d noticed before. If the lilies thrived, she could divide the bulbs in a few years and plant them by the fence, as well. In time, maybe she’d add purple ones, like her mother’s.
