Eight nurses are working day shift in the unit today, seven on evening shift, and five or six at night. The unit is in the shape of an elongated U, with the nurses’ station near the center. Neill’s mother, born at this very hospital, also is a nurse. “She told me candidly what to expect. She was a pediatric nurse, and after years it became really physically demanding and exhausting. She was on her feet a lot,” says Neill. “One nurse here was doing Weight Watchers and she bought one of those clickers to see how much she walked. By the end of her shift, she had walked three miles.”

After checking her patients’ charts, Neill stocks up on the medications she will distribute this morning–aspirin, cefuroxine, Colace, Pepcid, heparin. She takes patients’ vital signs every four hours, makes printouts of the EKG readings to attach to their charts, does wound care and dressing changes, replaces empty intravenous fluid bags with full ones. Neill follows doctors’ orders for care, but monitors patients carefully. “I have questioned dosages,” she says. “A lot of the medications and dosages we use are routine, so if I see a dosage I’m not familiar with, I’ll ask a charge nurse.”

Neill feels there is mutual respect among the nurses, surgeons, and other staff she works with on the unit. “I pretty much know our doctors, although we probably work more closely with the physician’s assistants,” she says. “My mom was there when you stood up for doctors when they came into the room. There’s much more recognition now that our role is a vital one, that it’s a symbiotic relationship.”

She checks on the patient recovering from heart surgery, who has four chest tubes, an IV, and an epidural for pain. Even with all of the tubing attached to his body, he is sitting in a chair watching the wall-mounted TV. Heart and lung patients often retain fluid so they are encouraged to get out of bed and breathe deeply to prevent pneumonia.

Neill greets the man warmly. “You didn’t eat much off that breakfast tray,” she says.

“I had two bowls of Jell-O. But I’m feeling a little nauseous.”

Neill checks his vital signs–blood pressure, pulse, temperature, heart rate, respiration–then goes to the medstation to get a dose of anti-nausea medication. She must punch in an ID number and put her finger on a scanner before a computer-operated door slides out with the proper prescription. Medications, many of which are controlled substances such as synthetic morphine, are rigorously monitored.

She returns to the patient’s room and injects two vials of Droperidol into his IV, which leads from a central line into the jugular vein in his neck. “This is the same medication you had last night,” she says. “Did it help?”

Her patient nods.

Neill helps him back into bed, changes the linens on the chair, switches out his chest drains. Once she gets the tubes leading to the Pleurovac drainage machine untangled, she uses hemostats to regulate the suction on each side of the Y-tube, a tedious and frustrating process.

“There’s a lot you learn on the job, that you don’t in the classroom,” she says, “from the technical stuff to the emotional aspects of the patient and their family.”

Neill removes her gloves, then washes her hands with green antibacterial soap in the sink beside the bed. “It really dries your hands out washing them every five minutes,” she says. Even in this high-tech era, however, there is no better safeguard to prevent the spread of infection.

Neill enjoys most aspects of her job–working with patients and colleagues, applying what she’s learned in school, educating someone who wants a healthier lifestyle, even the adrenaline-pumping moments when she’s attending a patient in crisis. Her least favorite task: the paperwork. “It’s really easy to get behind. There’s hours of it each day,” she says, after returning to the nurses’ station to log her patient’s vital signs into his chart.

Just past noon, Neill makes sure her patients’ lunch trays have been distributed. She leaves a note on the tray of the man with diabetes and kidney disease, who is still in dialysis, so workers won’t take his tray away before he returns.

Neill gets a half-hour for her own lunch, which she usually brings from home and eats in the unit’s cramped conference room in case she’s paged. Today, it’s a turkey sandwich on whole wheat, a large bunch of green grapes, and pretzels. During her twelve-hour shifts, she eats at mid-afternoon. “That’s the one thing that’s kind of hard,” Neill says. “My friends all have regular, business-hour-type schedules, and they’re always talking about going out to eat lunch in restaurants.”

Since she was in high school, though, Neill never wavered in her career choice. Even as a child, she dressed as a nurse every Halloween. “My mom would bring home supplies, and I would play doctor on my little brother,” she says.

By 3 p.m., Neill has already put in a hectic eight-hour work day. She’s sat down just three times–twice to update charts, once for lunch. And she still has four hours to go. “Sometimes, I think the public’s image of nurses is as bedpan pushers who wear white shirts and little hats . . . a pretty archaic view,” she says. “My friends are amazed when I tell them about pulling out chest tubes and some of the other pretty involved stuff we do.”

The nurses of Unit 21, however, clearly have a devoted fan club. Hand-written notes, cards, and drawings line the walls and fill the bulletin boards. They read: “The family wishes to thank you, all the good nurses on the second floor, for being so nice and thoughtful while my grandpa was in for heart surgery,” and “Dear Unit 21 nurses, Thank you for taking such good care of my mommy. I’m her youngest daughter. I’m glad she’s home.”