Nightshifted es-1

  Nightshifted

  ( Edie Spence - 1 )

  Cassie Alexander

  From debut author Cassie Alexander comes a spectacular new urban fantasy series where working the nightshift can be a real nightmare. Nothing compares to being Nightshifted.

  Nursing school prepared Edie Spence for a lot of things. Burn victims? No problem. Severed limbs? Piece of cake. Vampires? No way in hell. But as the newest nurse on Y4, the secret ward hidden in the bowels of County Hospital, Edie has her hands full with every paranormal patient you can imagine—from vamps and were-things to zombies and beyond…

  Edie’s just trying to learn the ropes so she can get through her latest shift unscathed. But when a vampire servant turns to dust under her watch, all hell breaks loose. Now she’s haunted by the man’s dying words—Save Anna—and before she knows it, she’s on a mission to rescue some poor girl from the undead. Which involves crashing a vampire den, falling for a zombie, and fighting for her soul. Grey’s Anatomy was never like this…

  Cassie Alexander

  Nightshifted

  For anyone who ever got paid a little extra to stay up very late.

  Acknowledgments

  This book would not have been possible were it not for the efforts of many other people, only some of whom I’ll get to recognize here. Firstly, my husband, Paul, for understanding completely what I’m trying to do; my agent, Michelle Brower, for believing in this crazy book; and my editor; Rose Hilliard, for buying it and her excellent input afterwards. I am forever in the debt of my alpha reader, Daniel Starr, who played an incalculable role in making me the writer I am today. I will always appreciate my beta readers, Tina Connelly, Anna Eley, Patrick Weekes, and Julia Reynolds, for letting me borrow their brains and time. I promise to return their brains soon. My parents for not always getting this, but being supportive anyway. My writing friends Rachel Swirsky, Blake Charlton, David Moles, and Barry Deutsch for getting it, and still being supportive, even though being on the publishing inside they knew everything that that would entail. Thanks to Matt Bellizzi for showing me how to shoot a gun, Vera Nazarian for help with Russian, and my girlfriends V, C, M, and J in real life, for listening and making me occasionally leave my house.

  Any mistakes in this book are mine. No part of this book constitutes actual medical advice. Not all doctors are bad, just some of them can be annoying.

  Last, but not in any way least, I want to thank the girls on my work weekend for keeping me out of trouble. Thanks for not letting me accidentally kill anyone. I appreciate that most of all.

  Chapter One

  “How can your liver be this good?” I stood outside Mr. November’s room, watching him stir restlessly. Normal people couldn’t get 20,000 micrograms of fentanyl and 80 milligrams of Versed an hour and live, much less still be attempting another slow-motion escape from their hospital bed.

  But I knew Mr. November wasn’t normal. From my assessment, when I’d seen his chipped yellow fangs around his titanium-tipped endotracheal tube, and from the way he was restrained in bed—six soft cuffs, two on each arm, one on each leg, a Posey vest wrapped around his chest and tied beneath the bedframe—and from the fact that he was here on Floor Y4 to begin with. No one here was normal, except for me. I was human and looked it: average brown hair, average blue eyes, average hips. My patients here? Let’s just say “average” was not the first adjective you’d pick for them if you saw them on the streets. Or the twentieth.

  Mr. November continued to squirm. I wondered which cheerful member of our daytime staff I’d be giving a report to come seven A.M. with him crawling out of bed behind me. I could almost feel them judging me now.

  His IV pump beeped empty and his cuffed right hand made rabbit-punching jabs. Crap.

  “Hey, you!” I shouted and leaned into his room to try to attract his glazed attention. “Stay still!” I commanded through the door. Sometimes with agitated patients the voice of nursing authority buys time. I dashed to the supply room, unlocked the narcotics drawer, grabbed a bag of fentanyl, and made it back to his room as he started to thrash his head from side to side.

  “Stop that!” I hauled on my isolation gear as fast as I could. If he managed to knock his endotracheal—ET—tube loose, that’d be the end of his ventilator-assisted breathing, which’d be the end of him. I put my gloves on, snatched the bag, and rushed inside. When I silenced the pump alarm’s beeping he visibly calmed.

  “You have to stay still, sir. You’ve got pneumonia and you’re in the hospital.” I switched out the bags and reset the pump. I inhaled to say more, but I saw Meaty, my charge nurse, rise up like a moon behind the nursing station outside, holding one thick hand up in the shape of a phone. It was the international nursing gesture for, “Call the doctor?”

  I nodded. “More sedation. Now. Please.”

  Mr. November’s hands spasmed again. I didn’t know if he was reaching for me with a purpose, if he just wanted to be free, or if he didn’t understand what was happening—not unlikely, with all the meds he was getting—but I grabbed his nearest hand in both my own. “You’ve got to rest now, okay?” His grip tensed and so did I—most of the training videos I’d watched before starting this job had emphasized the “minimal patient contact” rule, for vastly good reasons—but then he relaxed, letting me go.

  I stepped back from the bed, took off my gown and gloves, washed my hands, and went outside.

  “You okay there, Edie?” Meaty asked as I returned to sit behind my desk, just outside Mr. November’s door. I grunted a response and flipped open Mr. November’s flowsheet to hide behind. Meaty didn’t check in on Gina or Charles unless they called for help. But I was new here. Just when I was starting to feel like I knew how to be a nurse at my last job, only a year out of nursing school, my brother overdosed. On heroin. For the third time.

  An unknown “friend” (read: dealer) had been kind enough to leave Jake on a curb and call 911, which’d brought him here. By the time I got to the emergency department they were on his second dose of Narcan. They’d put an IV line into his neck because he had too many tracks on his arms to find a vein. Only some cruel miracle had stopped him from getting infected this far. If he kept it up, I knew his luck wouldn’t hold.

  I wanted to touch him and I didn’t want to touch him, because it didn’t take being a nurse to know all the diseases he might have. And so, as I was finding some gloves to wear to hold his fucking dumbass junkie hand, a man came by and said, “Wouldn’t you like to see your brother clean?”

  I thought he was going to tell me about Jesus, and I was getting ready to tell him where to shove himself, when he offered me a job.

  Chapter Two

  Before, when I’d worked in a nice private hospital, if someone had done something particularly boneheaded, or exhibited poor nursing judgment, they’d have been asked, “Hey, where do you think you work at, County Hospital?” or, “Looks like you did a County job to me.”

  But what if no one called 911 the next time around? Or Jake ignored a septic sore? Working at County seemed preferable to watching him die, knowing I could have done something to prevent it. I didn’t understand what I was signing away exactly, only that they promised to keep him straight—and unlike all the rehab programs my mom had scrounged to send him to, it’d worked.

  So now I really was at County. Only worse. Floor Y4 was for the daytime servants of vampires, sanctioned donors, werewolves, zombies, you name it—and purgatory for us, their staff. We were in the bowels of County, off the records and off the charts. I signed forty things in triplicate, got special badge access to the special elevator, and when I took the special ride down, I found myself in an ominous hallway where my badge opened just two doors. One led to our locker rooms and bathroom. The sec
ond went here to Y4, an eight-bed intensive care ward with an institutionalized appearance: exposed ducts, dim lights, and where everything could use a fresh coat of a lighter shade of paint.

  Peeking over my flowsheet and into the room, I saw Mr. November at it again, this time kicking himself off the bottom bedrail. “Be still!” I scolded. Reminded anew, he relaxed. That’s the hassle with Versed. It’s an amnesiac. On the plus side, it helps patients forget the horror of having an ET tube sit in their lungs and a ventilator helping them breathe. On the downside, it means that every time you warn them they have Tubes in That They Should Not Pull On, that warning has a half-life of about thirty seconds before they forget and try pulling again.

  “Meaty, any word?” I asked, as Mr. November switched gears and tried to reach his ET tube, one millimeter at a time.

  Meaty gave a negating grunt. While Meaty was likely not Meaty’s actual name, he or she was Y4’s charge nurse, which meant they were the resident expert on all nursing-related chores, the general patient coordinator, and our physician liaison. With an androgynous face and an abdominal drape that almost reached the floor, Meaty brought scrubs from home to accommodate his or herself, the bathroom in the locker room wasn’t sexed, and I hadn’t had the balls yet, metaphorically, to ask.

  Frustrating as it was, it wasn’t Meaty’s fault the doctor hadn’t called back. They probably wouldn’t ever call back, and Mr. November would be squirrelly all night.

  “Damn.” I flipped through the nursing chart to write another note on the restraint form, choosing “restless” and “continually pulling” for Mr. November’s past hour of activities. Too bad there wasn’t a form for my opinion on the state of things—I would have written “bleak” and “undersupported by other hospital staff.” I hoped the call had woken the doctor up.

  Even though he’d been here for a few days, Mr. November’s chart was mostly empty, except for his tox screen. The emergency department here surreptitiously checks people for various conditions—such as “porphyric hemophilia” (likely vampire-exposed), “leprosy” (likely zombies), “rabies” (likely were), and “sisters of junkies who were suckers” (me). Everything else, all of our plans, treatments, and patient response, was unofficial. But surely some actual records were kept somewhere, if only for accounting’s sake. The drugs we used alone must cost a fortune. And even if my fellow nurses were getting paid just as poorly as I was, someone was footing our bill. The only thing in other charts that gave me any clues was the patient information page saying patients belonged to a health insurance group I’d never heard of before, the Consortium.

  But not Mr. November—we didn’t even have his real name. Hence being named for the month. He’d been found outside, dehydrated, with a kicking case of pneumonia, too run-down to move. He looked eighty. Thin white skin hung in empty folds around his sharp features, like ice melt off a glacier, so thin that lifting tape wrong would tear it. During my assessment I could smell the bad breath of a body going metabolically awry. He had a central line going into the femoral vein on his thigh, channeling in medications and, of course, blood.

  Not because he’d bled out—but because technically he’s almost a vampire. Not a full one, but a “vampire-exposed human,” some real vampire’s daytimer.

  Despite all the legends about instantaneous infection, it usually takes repeated exposure to vampire blood for it to change you—assuming you weren’t allergic and didn’t just die instantly from anaphylactic shock.

  Mr. November had been exposed to a lot of vampire blood at some time. His fanglike canine teeth, which I could see now as he tried to work his ET tube out with his tongue, meant he had to have come close to changing. I wondered why nobody had ever finished the job and wished they had; it would have saved me this night of work. Because now, even though he was probably three hundred and twelve, vampire blood having life-extending properties, he could still die on my watch. People who’ve been exposed live long, but they aren’t full vampires, and they don’t get to live forever. As if fighting this fact, Mr. November started leaning forward in bed again.

  I went back in the chart to see what medications I could give him. He was maxed for now, but come four A.M. if Dr. Turnas hadn’t called back, I planned to reintroduce him to my friends lorazepam and oxycodone in a big, big way.

  Charles walked over from his side of the ward. His patients were asleep or quietly watching TV. “Need any help, new kid?”

  I was fairly sure Charles knew my name by now, and just as sure that it wasn’t worth letting it get to me. “Not unless you’re hiding an extra bag of fentanyl,” I said. He laughed. Charles was my height and older, with brown hair turning gray. I’d noticed that no matter how hectic the night felt to me, Charles never let it show. I was jealous of his ability to keep his act together, but I’d like him more if he didn’t pretend I was twelve.

  “You’ll be fine, new kid,” Charles said, but he wasn’t looking at me. I followed his gaze to see Mr. November making plucking gestures with his right hand. I thought Mr. November was reaching for his IV despite the pillow I’d placed in his way, until all but one of his fingers curled inward, leaving only his pointer out. He started to move it deliberately. Spelling things. I groaned.

  “Stay out,” Charles advised. Mr. November didn’t stop.

  “He’s trying to communicate,” I said.

  “Just because he’s trying to doesn’t mean he can.”

  Which was true. Most times patients would scribble off the page and onto themselves, if they had enough reach. But then again, a few could tell you if they were cold, or hot, if they wanted the lights on or the TV off. You’d be surprised what people can obsess on when they’re doped up and have nothing else to do. Once a guy told me in Spanish that he wasn’t getting enough aire. I did a blood gas to check, and he’d been right.

  My patient, my call. I grabbed paper from the copier, a Sharpie, and a clipboard, and suited up to see.

  Because working on Y4 is like being in a hybrid ward for biohazards, trauma, and psych, isolation gear carts sit outside each room. They’re equipped with gowns, face masks, hair nets, and gloves, just like every other isolation cart you’d find in County, until you get to the CO-propelled tranquilizer rifles loaded with suxamethonium chloride darts in their top drawer. During training when I asked why we didn’t have garlic and crosses, I was told that garlic doesn’t work, and the Consortium doesn’t allow vampire-specific discrimination.

  I pulled my gloves on and gave Charles what I hoped was a sorry-for-ignoring-you shrug before walking in.

  The same badge that granted access to the elevator and locker rooms triggers the light set over Mr. November’s door, so Meaty will know where I am if there’s a lockdown. Charles knows where I am too, and is unimpressed, leaning on the doorway behind me.

  “Okay, sir. Do me proud.” I removed both the restraints on Mr. November’s right hand, positioned the pen in it, then braced the clipboard upright for him against the pillow. “Are you in pain?”

  I couldn’t imagine that he was, but he was still awake. He ignored my prompt, and began working on a laborious capital A.

  “Do you need to have a bowel movement? Want the TV on? Lights off?” I ran through my routine, while he made three—no, four—n’s in a row. Typical intubated patient. I sighed. I glanced over my shoulder and saw Charles smirking.

  I launched into my stock speech number three.

  “It’s two A.M. in the morning on Sunday, November twenty-ninth.” And I’d been working straight through since Thanksgiving, courtesy of being the newest nurse and having a desperate need for holiday pay. “I know it’s frustrating when you can’t communicate, but you’re in the hospital. We’re taking good care of you.” I reached out and patted his arm. “Save your strength and rest.”

  He finished another letter, a lowercase a. I took the clipboard from him.

  “Annnna … Anna?” I sounded out aloud, and he nodded, tubes and all. A small triumph, potentially imaginary. “I’ll see if w
e can contact her for you.” The light of human connection—or whatever passed for it here—flashed in his eyes and his lips curved into a smile. If I didn’t know he had fangs and was getting a rhino-killing dose of narcotics, he’d look like any other elderly patient. I took the pen from his hand and his eyes closed.

  Then the Versed pump started beeping. I hit the alarm silence button, and looked imploringly out to Charles.

  He rolled his eyes at me. He would have never gowned up to come into a patient’s room and not brought in the medication they were almost sure to run out of next. “I’m on it.”

  “Thanks,” I said, and gave him a winning smile hidden by my mask. I hit the alarm silence button a few more times and when Charles brought me the Versed, I hung it as quickly as possible before sneaking back out of the room.

  * * *

  “So, Meaty—” I held Mr. November’s clipboard out over the nursing station desk like it was proof of something. “This guy—no word on him yet?”

  Meaty shook a large hand in an indeterminate fashion. “Sorry, Edie. We sent his photo out to all the Thrones.”

  I looked at the clipboard and sighed. At least with patients at my last job I could make assumptions. I used to know that when someone had too high a drug tolerance, or too low a pain tolerance, that maybe they’d been a user back in the day. Here at Y4—maybe they’re a werewolf? Or weretiger. Or weremanatee. I snorted. Gina down the hall was a vet and an RN, in charge of the were-corrals in rooms one and two. I knew someone was in one now, because they were howling. Last night was the full moon. We kept track of that here.

  Mr. November might be completely new to town, since the local vampire Thrones hadn’t jumped to claim him. It’d take longer to figure out which Throne he belonged to the farther he was afield. Maybe vampires only put out missing vampire bulletins at night.