November 18. Central Virginia, USA. 12:18 a.m.

Most residents in this rural community are asleep at this time. But beyond the banks of Polecat Creek and on the outskirts of the cemetery, someone is creeping through the dense fog, calculating every step and listening out for every sound.

Her name is Jordan and she has masterminded her plan for the drop down to the tiniest detail. She feels the kudzu vines wrapping around her ankles like hands reaching up from beneath the ground dragging her six feet under, but she persists. If she makes it up the hill and past the old lantern posts draped in kudzu, she is in the clear. Only a few steps away. A branch snaps and she hears a splash. Jordan ducks down into the vines waiting until she thinks it’s safe to proceed.

Except it wasn’t safe to proceed, and at 12:46 a.m., she heard the piercing crack of a high-powered rifle.

I'm Leslie, and this is Vaso & Vibes: A Nursing Thriller Podcast. In the shadows of critical care, where life and death meet every day, you'll find stories that are haunting, heartbreaking, and sometimes beautifully absurd. Welcome to the underbelly of nursing. Now, back to this case.

As you know by now, this podcast straddles the line between ‘this could actually happen in real life’ and ‘science tells us theoretically this could happen’ so let’s explore what happens when it does’. However, this episode has kernels of my own lived experiences, as all of them do. But what makes this episode different, is that it hits very close to home. Episode one explored how rural residents are medically disadvantaged, and this episode examines that as well. However, this episode takes things to a deeper, darker, level because this case explores that component of real life. For many living in rural communities, daily life is the most unsettling horror story of them all, and I think it’s important to highlight that. So as you listen to this episode, think about how each of our subjects approached problems in their everyday lives, and justified their solutions for solving them. Would you have acted any differently? What choices would you have made? Have you experienced these very scenarios?

Bringing a little empathy with your listening ears will help you unpack this case to determine who was really right, and who was really wrong.

Now, back to this case.

Jordan instantly jumps, and hears the auditory pattern of footsteps racing through the woods. Deer hunting this late at night is illegal in Virginia; then again so is what she’s doing. In a rural small community, mutually assured destruction is just standard operating procedure; it’s how business gets done because justice is simply whatever it takes to get stuff done. Those boys weren’t supposed to be hunting and she’s been not supposed to be doing her…services.

But here we must ask ourselves: do we really know who fired the gun? Jordan assumes it’s hunters but she saw no hunting trucks or men crouching in camouflage. Furthermore, Jordan’s own movement—albeit quiet and calculated—would’ve been more than enough noise to scare away any alleged deer. So that leaves us with two possibilities: either whoever pulled the trigger was genuinely shooting at what they believed to be deer or were intentionally shooting at a person.

Jordan has been taking this backwoods midnight hike to the old slave cemetery for years ever since her father—was gone, and this was the closest she ever came to meeting her ancestors buried in it.

Now let’s examine the cemetery.

The old slave cemetery sits deep within the woods in a small rural area in central Virginia. To the south of the cemetery lay Polecat Creek, and about a fifth of a mile or so past the junction of the gravel and dirt road was the old plantation. Anthropologists and archeologists conducted exhaustive research in this area and discovered artifacts indicating that former slaves escaped the plantation by following the river north, through the cemetery and past the tobacco fields into the neighboring counties. The researchers uncovered clandestine codes and directions hidden within secret markings on the tombstones. Legend has it that there was a safe house somewhere near Augusta County as well as a vein of the Underground Railroad.

But Jordan was not a slave; at least, not in the historical sense, though she leverages their navigational knowledge to guide her through the backwoods…and in life.

She felt something thick and wet beneath her feet and began sliding down. She caught her grip. The clay earth meant she had reached Polecat Creek. Across the north bank of Polecat Creek and just over a small hill lay the cemetery.

For Jordan, the cemetery was her third place. By day, she was a nurse at the one high school in town. By night, she worked two shifts a week at the children’s hospital in the emergency department. And once a month, she did the pickups and drops.

But the cemetery was where she could process it all. Her great-great-great grandmother’s remains lay there. Hattie was her name. She would sit by Hattie’s grave, her ancestor’s headstone the backrest for her earthen lounge chair. Jordan would talk with her, ask her for advice, and update her on her life. She knew the deceased woman couldn’t possibly know she exists but somewhere in her gut she felt like her talks mattered. Showing up mattered. Her presence mattered, even when no one was watching.

At 12:58 a.m., Jordan reaches the cemetery. She spends a few minutes talking with Hattie’s grave, then does her pickup and drop, and proceeds to turn around and get out of there.

By 1:35 a.m.,

Jordan is back at the plantation house and on her way home. Jordan doesn’t realize, though, there was someone else out there. Someone else watching her every calculated move.

Someone waiting for the right opportunity to make their presence known. Let’s put a pin in that; we’ll talk about what Jordan saw after she left the cemetery in a moment.

By this point, you’re probably thinking, “why doesn’t she just take a main road? Surely there has to be a road to the cemetery,” but here’s why that’s not her best option.

There is a main road to the cemetery which technically sits on the north perimeter of the old plantation estate, but the problem with taking it is it lands her a greater chance of getting caught. You see, the road is only a dirt path, and she risks getting her tires stuck in the mud and clay when it gets soggy after rains. Getting stuck in the mud would mean needing to call for help, in an area so remote no cell phone gets a signal. So effectively it meant the possibility of getting stranded. She would be a sitting duck.

So let’s talk about the other house, that sits on the other side of the cemetery, because discussing the house and its inhabitants may explain more about potential persons of interest connected with the shooting.

About a quarter of a mile near the cemetery entrance, nestled behind a cluster of white pines sits an historic antebellum architectural goddess in brick form. The structure was a relic of the Confederacy somehow still standing, thriving and carrying a darkness within it wanting to break free. The house has been in the same family since it was built and every iteration of it is seemingly a rejection of what the house truly wants to be. It does not want to be a museum because many of the artifacts were stolen. It does not want to be a wedding venue because the last wedding party to get married there was caught in a barn fire when the rusted over outer latch got stuck, trapping everyone inside. There were only four survivors; none of whom were the bride or groom. The house quickly became the subject of local lore. Local legend tells us that the house is inhabited by a dark spirit that roams the halls seeking retribution for slavery.

One morning a student came to get his blood sugar checked at her office and started talking about how he and his older brother had visited that house on a dare. The two siblings were playing a game called “Ding Dong Ditch”, where someone runs up to a house, rings the front door, then sneaks off to hide quickly before the occupant opens the door. The student rang the doorbell and ran to hide behind the rose bushes with his brother.

Neither brother was prepared for what happened next.

They watched as the front door slowly peered open. Then the screen door creaked open. Behind the screen, appeared a lanky lugubrious shadow darker than shadows should ever be. It was wearing a long black robe and the figure reached out with long twisted claws to push open the door. Something was off about the figure.

As the shadow with gnarly, long, claw like fingers reached to push open the screen, it never actually stepped out of the house and onto the veranda. It didn’t say anything just faced forward towards the driveway.

The boys continued hiding behind the rosebush, refraining from any movement whatsoever, including breathing. They silently prayed that the impish figure wouldn’t see them.

Then suddenly, as if it heard their thoughts, the cloaked shadow figure turned in their direction. Beneath the cover of the hood a pair of glowing eyes met their gaze and tore through their soul like radiation.

The boys bolted from the bushes, down the gravel road and into the older brother’s car at the end of the driveway. They flew down the dirt road, past the old slave cemetery and ten miles back to their apartment.

“We saw the Devil that day, J Banks” the student said.

Okay I’m going to butt in here for a moment because I want to offer a possible theory for what could be going on with this person.

Derived from the Greek words “agora”, meaning “open space”, and “phobia”, meaning fear, agoraphobia is condition that is beyond simply being afraid to be in open spaces. It is an intense, excessive anxiety or fear of being in situations and environments from which escape can be difficult or embarrassing, and where it may be impossible to get adequate help. So trying to control this fear and anxiety drives the person with agoraphobia to confine themselves, often avoiding going outside, traveling, being alone, or being on a bridge or in an elevator. The condition is debilitating and can cause persons with the condition to forego vital medical care, like doctor’s appointments and annual screenings.

Agoraphobia can develop in people who survived traumatic childhood experiences, such as a plane crash, or perhaps…being trapped in a barn fire.

Jaundice is a condition wherein bilirubin becomes concentrated within the bloodstream, giving the mucous membranes, skin, and eyes a bright greenish-yellow appearance. Jaundice can be caused by numerous conditions, ranging from certain cancers to alcoholism, hepatitis, or bile duct obstruction—like what can happen with gallstones. For those not in healthcare, the appearance of jaundice in a person may be quite unsettling.

But let’s rewind here a bit, go back to Jordan in the cemetery and look at the details of the pickup and drop.

Jordan is in the cemetery, she sits back, and is talking into the nocturnal void to the spirits of the ancestors buried in the cemetery.

After a few moments of solitude, she removes the crumpled paper fast food takeout bag from her messenger bag. With a hand trowel, she digs a shallow grave over the grave of her three times great grandmother.

Another successful drop.

Within the bag were the letters, drawings, cards, and photos from students—and even teachers—from the high school where she works. Collectively, they were a way for the families on the outside to remain tethered, if only loosely, to their loved ones inside.

She moves on to another headstone, the front of which bore the dates 1886-1902.

A child, not much older than the students she cares for everyday. A life ended far too soon…a tragedy but in a heavy realist way…a blessing for that life spared the darkness and indignities of being born into the wrong place at the wrong time.

“Ohh sweet angel,” Jordan whisperers and sighs.

There is a bulge in the dirt below the epitaph, and Jordan claws away at it with her trowel. She retrieves a crumpled brown paper bag, brushes the dirt off, and opened it to reveal folded pieces of paper, origami figurines made from torn out pages of the Holy Bible, a few necklaces crafted from woven washcloth strands, and other trinkets made from found and reclaimed discard from the commissary.

The pickup.

She returns the items to the paper bag and places the bag in her messenger satchel. She fixes the soil to look as though nothing were ever there, then begins her journey back across the cemetery, through Polecat Creek, beyond the No Trespassing sign and past the plantation house.

As she creeps past the plantation house, she sees a candlelight’s glow shining through one of the windows. She hears the laughter of a couple and what sounds like playful banter.

But something isn’t right—no one occupies the house. We know this because Town Council voted to restore the facility and designate it as an historic preservation site, meaning essentially it will not be zoned for private residence. In other words, outside of business hours, no one should be in the house.

Jordan knows this, and thinks to herself, “No one’s supposed to be here.”

No cars are on the property; no bikes, scooters or any other form of transportation.

“Who is that?!” She wonders as she leaves the premises.

November 19, 9:30 a.m.

It is the next day at school, and Jordan’s nurse’s office is bustling. Students take turns passing off hall passes, all eager to see what goodies our “Secret Santa” has for them.

Jordan removes the bag of presents and letters from her satchel and dumps its contents all over her desk. She separates the items, each labeled appropriately with an identifier, like a hospital wrist band, with the names of their intended recipients.

Let’s look closer at one of the items, because it might give us a glimpse of what’s going on.

“To Lacey, love Pop Pop,” a folded letter reads.

More about Lacey.

So Lacey comes every day to take her ADHD medication and on “Christmases”, she gets her letter from her grandfather serving fifteen years for armed robbery.

Lacey was born in her grandfather’s laundry room, on a pile of warm sheets and towels. Her mother was only eighteen when she gave birth and without prenatal care, had no idea when she was due. So her mother, Lacey’s grandmother, stepped in as her unofficial midwife. This far deep into rural Virginia, specialty care came from the most competent person in an adjacent trade. Farmer’s wives became midwives; decades of helping deliver foals, calves, and puppies taught them a thing or two about the stages of labor.

Lacey’s mother worked at one of the fast food joints and couldn’t afford to take care of her newborn on her own, so she leaned heavily into her parents for financial support. Pop Pop worked long hours as a supervisor at the dog food plant, but his meager salary could only be stretched so far. So on his days off, he robbed banks in nearby towns. He got away with it twice, but third time’s a charm. The police had caught onto his strategy and met him, guns drawn, at his safe house. New technology caught up with him: the teller had placed a tracking device in the money bag; so authorities new precisely where he hid the money before going to the safe house. He was sentenced to twenty years, but with good behavior, he’d be out just in time to surprise Lacey at her high school graduation.

Now we know, though you’ve probably assumed by now, that these pickups and drops are related to prison inmates and their families and this is an unconventional way of psychosocial connection. So let’s look more into this…what a typical lifestyle of communication for these inmates and their loved ones might look like:

One phone call a day; visitation on Thursdays, and Christmas once a month in between. “Christmas” was the code name the students had given the day after pickup. Everyone in the school system and even the prison system “knew” about the pickups and drops, but too many benefited from them to cause trouble for them. Even some of the teachers and custodial staff had loved ones on the inside and participated.

We see that Jordan’s system functioned much like the old slave cemetery did as her third place: it fulfilled a need caused by the institutional status quo. The prison needed Jordan’s courier service because it kept the inmates in line; it maintained order and gave them something to live for…a reason to keep doing the right thing everyday under impossible circumstances. The school system needed Jordan’s system because it fulfilled a psychosocial need for the students and gave them something to not only keep them motivated to study and work hard—and to provide them a little discipline when they step out of line.

“Listen…I ain’t tryna get jammed up, J Banks, what, so my Pops can reach through the jail phone and smack me at visitation? Nah, I’m good,” Jordan recalled one of her students saying.

Let’s stop for a second because this is really important—you’re probably wondering how she got the nickname J Banks. Well, let’s get into it. You may think it was one of the students that started this trend but it wasn’t. It was actually one of the custodians who dubbed her J Banks; he too was one of the users of the backwoods courier service. His son was locked up for trying to rob a liquor store. He said she reminded him of all those people during slavery times that used the Underground Railroad and sang about the River Jordan. The River Jordan was a powerful representation of freedom, liberation, and became a code for several key moments in life: for slaves, finally achieving freedom could be referenced as “crossing over the River Jordan”, and the reference is so potent and culturally rooted that it has even gained mainstream reference in hip-hop culture and contemporary Christian music.

“River Jordan” was also a reference to one’s own impending death…and finally being free.

Having gone to nursing school myself and recently graduated, I know that nursing school teaches a lot— but it doesn’t teach everything, and some of the most valuable lessons learned are gained from working the profession after graduation.

Many, like myself, go to nursing school because we have a high threshold for gore tolerance and we want to help people.

But what was Jordan’s motive? Examining her true motive may shine light on her rationale for starting this system in the first place, because you see—Jordan didn’t go to nursing school to ‘save lives’ or ‘help people’—she went for a completely different, selfish reason. More on that later.

So it’s 9:30 a.m. and she is sorting the mail into piles: students, teachers, and staff. She puts one letter aside, addressed to Principal Langston. She will hand-deliver that one later; she too can’t risk getting caught.

Mutually assured destruction.

She reaches down and grabs one letter in particular, and whispered aloud:

“To Jordan, from Daddy.”

And that was the real reason Jordan went to nursing school. You’ll recall, I said in the previous case “Bryan and Ryan in the Ambulance Bay” (Episode 4, Parts One and Two—go check it out next if you haven’t heard it), but I said to always remember: there is NO true objective reality. There is my reality, your reality, and a void in between in which everything exists, and sometimes it feels like we’re screaming into that void, doesn’t it? Without possibly being able to understand what is really going on in someone’s head…

But here, we learn that every story has…a backstory, and we are now learning about Jordan’s. You see, when Jordan was in high school, her mother was diagnosed with a terminal cancer. The news rocked their family of three. Her mother slowly lost her strength, ability to function, and her appetite. Jordan helped her with activities of daily living, and her father’s job kept the bills paid and food on the table. Her mother was in immense pain and emotional distress, worsened by her cachexia. Her father worked for a highway construction contracting company, and while that paid the bills, it didn’t help with his wife’s pain and appetite. So he started purchasing cannabis from one of their neighbors. This was before decriminalization of cannabis in the commonwealth, so everything was done under the table. Another hidden system filling in the cracks. But, it helped…a lot.

Then one night while at his dealer’s house, the police showed up for a bust. A raid was conducted that turned up over seven hundred thousand dollars in cash, one hundred kilos of marijuana, scales, baggies, and even crack cocaine clearly intended for distribution. Her dad claimed he was never engaged in the business side of things, but his public defender couldn’t prove otherwise. Her father missed her mother’s funeral and her graduation. Jordan went to nursing school so that she could become a corrections nurse, hoping to work in the prison where her father was incarcerated. However, she was not allowed to work there because of the conflict of interest and became the school nurse instead. Through nursing, Jordan realized there were so many people suffering because of circumstances, situations, and the consequences of rural poverty and if she was suffering, she could only imagine how many of her friends, neighbors, and relatives were also suffering.

It all started with one birthday card.

During one of the visitations, her father informed her that he would be allowed to work on the cemetery clean up detail, and would be working in the old slave graveyard in their town.

“Man it sure would be nice to see you in the flesh, not just through this window,” her father says and smiles. “But knowing I’ll be closer to you—on my birthday even—is the greatest gift a dad could ask for.”

“What if I paid a little visit? You know, the cemetery isn’t far from that old plantation house they’re about to renovate…I’m sure I can park there during the day; not like anyone lives there.”

“Girl shut yo mouth, you can’t be saying stuff like that! They listen to these calls!” her father said.

Jordan looks up and sees a guard walk by looking over her father’s shoulder. He looks down at Jordan’s father with a stern expression, then smiles, laughs, and makes a joke.

“Now y’all ain’t planning some big getaway are you?” the guard says.

“No sir, not at all sir,” her father says and lightens his tense demeanor.

“Good, ‘cause I sure need you on work release duty at that cemetery so don’t try to leave just yet,” the guard says, then pats her dad on the back and leans over and clicks his knuckles against the desk where Jordan’s dad is sitting. His wedding ring makes a ‘clank’ sound against the surface. He stands back up, nods, and walks away.

“Who dat, Daddy?” Jordan inquires.

“Oh, that’s just Peters. He’s good people. He’s actually one of the good ones; let’s us keep contraband—you know, nothing serious—like extra writing paper or stuff from the commissary. He’s cool, and his wife’s real sweet. One day she even baked a bunch of pies and had the kitchen pass them out for errbody. Nice lady; but a fiery red so you gotta watch out for her! Haha. He’s lucky though. But no forreal, there are some here that aren’t so nice so you need to learn to talk in code like your ancestors” her dad says.

He motions with his eyes and a gentle nod to another guard standing by the door; a big burly man with a stern expression. Evidently he is not one of the good ones, and likes to make trouble for people.

“I would love that but…you know what they say about the River Jordan…I looked over Jordan, and what did I see/ Coming for to carry me home?/ A band of angels coming after me/ Coming for to carry me home,” her father sang, using the lyrics of “Swing Low, Sweet Chariot”, an old Negro spiritual to warn her of the dangers of making plans with inmates.

Old Negro spirituals were songs slaves used to communicate messages—warnings, directions for escaping, and promises of hope and a better life—with others slaves, leaving their owners none the wiser. She realized what her father was telling her: ‘a band of angels’ didn’t mean a heavenly host of good fortune…it meant she could potentially get arrested too, or worse, if she got too close to her father on work release.

“Okay, well two can play at that game,” Jordan says.

The guard announces that visitation is over. Before hanging up the jailhouse phone, Jordan says to her father:
”Oh, and Grandma Hattie said…happy birthday.”

She winks.

And so it began.

Several months of pickups, drops, and visitations passed.

During one visitation, Jordan was telling her father about the mysterious candlelight she saw in the plantation house.

Her father gave her a long silent glare through the plexiglass.

“Girl don’t go lookin’ for snakes or you might get bit,” he warns ominously.

“Wait—wha—you know about it?! How?!” She asks.

“The walls here have ears, baby girl,” he says, then lowers his voice as he continues.

He wouldn’t say who those people were in the window of the plantation house, or even how he knew they were there or even why they were there. But his ominous warning both intrigued and terrified Jordan.

Soon though; very soon…Jordan would find out.

One night, as she packed her satchel for her midnight courier delivery, a feeling of dread washed over Jordan. She tried to block it out of her mind and pushed on; she needed to make that delivery. This month, Lacey had a birthday card to deliver, in addition to the other letters and gifts in the paper fast food bag. She packed her hand trowel, a can of pepper spray, and a flower to leave at Hattie’s grave. As she began her hike, the dread feeling kept getting heavier and heavier. The dread soon turned to panic and anxiety—for what, she wasn’t sure, but it was becoming increasingly difficult to shake.

She pushed on, and reached the plantation house. Once again she saw the candelight in the window flickering. She heard a man’s voice, and a woman’s voice but couldn’t distinguish what they were saying. She cowered and crept past the house, making sure not to rustle any leaves or step on any twigs; anything that could make a sound. She kept walking, and then Jordan heard a sudden sound so terrifying, it stopped her in her tracks.

It was silence. Deafening silence.

The candlelight was no longer shining in the window. The laughter and banter of the couple in the upper room of the house was gone.

After a few moments, Jordan picked up her courage from the ground and kept walking. She walked past the No Trespassing sign. As she approached the north end of the property and Polecat Creek, Jordan heard it.

The shot.

Part one ends here, with Jordan falling to the ground, her face hitting the boggy clay soil of the banks of Polecat Creek. Under the full moon’s light, Jordan looks over, in horror, and sees a plume of blood curl through the murky dark water.

Who got shot? Was the shooting related to the people in the window? What caused the people in the window laughing and bantering, to suddenly go silent? Perhaps most importantly, what did Jordan’s father know and why didn’t he tell her? In Part Two, we’ll examine each of these questions and look closely at each subject to uncover what’s really going on with this case.

Join me next time, for Part Two.

For access to the exclusive content related to this case, along with deeper dives into the pathology behind each of these clinical manifestations, connect with our private community of Vaso & Vibes sleuths by joining us on Patreon. Link is in the show notes, or go to Patreon.com/vasoandvibes.

Disclaimer: This podcast is for informational and entertainment purposes only and does not constitute medical, psychological, or legal advice. The stories, characters, and scenarios discussed are creative, synthesized composites and do not reflect actual patient cases. The views and opinions expressed in this podcast are entirely the host’s own and do not represent the views of any employer, hospital, or healthcare institution.

Sources, credits, and episode transcripts can be found at the Vaso & Vibes Substack.

Join the conversation on Patreon for the Vaso & Vibes: Night Shift.

For more information, visit: www.vasoandvibes.com

Credits:

Theme Song:

Game Day by JMHBM is licensed under a Attribution 4.0 International License.

Intro:

Tense and Rising by Free The Muses is licensed under aAttribution 4.0 International License. (CC by)

Other Music:

Ex by Nctrnm is licensed under a Attribution 4.0 International License.

Sources:

Halter, M. J. (2021). Varcarolis’ Foundations of Psychiatric-Mental Health Nursing, 9th Edition. [VitalSource Bookshelf 10.5.3]. Retrieved from vbk://9780323697095.

Hinkle, J. L., Cheever, K. H., Overbaugh, K. (2021). Lippincott CoursePoint Enhanced for Brunner & Suddarth’s Textbook of Medical-Surgical Nursing, 15th Edition. [VitalSource Bookshelf 10.5.3]. Retrieved from vbk://9781975186722

“You mean the thing with the bikes when they were children? Yes, Ryan told me,” she said.

“And you’re aware of what Ryan did for retaliation? His little ‘long game’? How he lured Bryan into—”

“Yes, I’m aware. May I leave now?” Tamesha interrupted.

She was not aware of what the detective was referring to, but again, it was none of her business. But she would always wonder.

Disclaimer: This podcast is for informational and entertainment purposes only and does not constitute medical, psychological, or legal advice. The stories, characters, and scenarios discussed are creative, synthesized composites and do not reflect actual patient cases. The views and opinions expressed in this podcast are entirely the host’s own and do not represent the views of any employer, hospital, or healthcare institution.

Sources, credits, and episode transcripts can be found at the Vaso & Vibes Substack.

I am excited to announce: there is now a place for you to join me in the…after hours…discussion about this episode—and all episodes— and that is at the Vaso & Vibes Patreon account. It gives breakroom conversation; you know, the nitty gritty fun that doesn’t happen out on the unit floor. In my hospital, I work the night shift, and I absolutely love the vibes that come with it. Chill, low-fi, and—honestly, a little spooky—where all the magic happens and that’s precisely the ambiance I wanted to create for my podcast fan club community.

Join the conversation on Patreon for the Vaso & Vibes: Night Shift.

In Part I, we discussed the dynamics between college-aged twins Bryan and Ryan who work as Emergency Medical Technicians at a local fire and rescue station. They are taking prerequisites for nursing school; the two dream of becoming flight nurses. They work alongside paramedics Keith and Tamesha. We also learn that Tamesha is partnered on an ambulance rig with Ryan, and Keith with Bryan. There is something romantic blossoming between Ryan and Tamesha, who are the same age and have similar personality temperaments. Not much is said about the dynamic between Keith and Bryan, but we’ll dive into that soon in the second half of this case.

On Monday, December 23, 2002, two days before Christmas and hours before the incident in question, twins Bryan and Ryan got into an argument that erupted into a physical fight, but they were able to, oddly enough, set aside their differences and collaborate on assignments for their Developmental Psychology class. We then learn that, at 6:02 am, two calls were dispatched to the station; both were presumably for patients experiencing heart attacks. Tamesha and Ryan are assigned to a rig and Keith and Bryan are assigned to the second rig. Both rigs leave the station and go to their respective calls at exactly 6:04 am. It is later revealed, though, that communication was lost with Bryan and Keith, and they never made it to the patient’s address. We learn from Ryan that the address to which they were dispatched—twelve twenty-two Grenadine Court—is nonexistent. Tamesha and Ryan had set off to find the missing ambulance, but their search came up short.

We ended things with Tamesha and Ryan sitting in Ryan’s truck and with Tamesha asking Ryan what he knows about what really is going on. And that’s where things pick up in Part II: Ryan is hesitating to open up to Tamesha, the woman who he obviously has a crush on and is interested in pursuing a romantic partnership with.

In this episode, we’ll explore this more: can Ryan trust Tamesha with the deepest, darkest secrets of his relationship with his brother? How much is too much to reveal, and what information is necessary to find Bryan? We’ll then discuss the relationship between rig partners Bryan and Keith…is there something there to help find where they might be? We’ll examine the leading theories authorities have explored to explain the whereabouts of the duo. As you listen to this episode, keep two things in mind: first, reality is an illusion; there IS no objective reality. There is my reality, your reality, and a void of unknowing in between in which everything exists. Secondly, keep in mind that, according to physics, time and space exist in such a relationship that moving really fast can theoretically make time go slower compared to someone who is not moving; compared to someone who is stagnant.

This is Leslie, a CVICU nurse and urban planner at heart, and you’re listening to the Vaso & Vibes podcast. From the underbelly of critical care nursing: dark stories with a beautiful twist. Brilliantly absurd. Shockingly effective.

Ryan is sitting in his truck with Tamesha in an empty gravel parking lot. The engine is running, keeping them warm from the winter weather outside. Tamesha puts her hand on Ryan’s shoulder and meets his gaze.

“Go on,” she says quietly.

Ryan takes a deep breath.

“See that’s the thing,” he begins. “Nothing was different. I don’t think I know anything, honestly.”

He tells her about how he did vehicle inspections, equipment checks, and all of the usual shift safety and compliance checks, and everything was ready to go for both vehicles. The GPS units seemed to be working. Nothing was different or seemed off.

“Everything seemed fine; this makes no sense,” Ryan says.

Ryan looks back down at his phone. He tries one more chance to text his brother; they were on the same network so text messaging was available. The giant brick Nokia weighed heavily in his hand, and he knew the weather was probably making reception worse.

Still no response.

He tried calling. It rang, then went to voicemail.

“We could try retracing the ambulance tracks—we got off when we tried going to Grenadine,” Tamesha suggests.

Ryan shakes his head, and motions his upturned palms to the windshield.

“Look out there! Those tracks are covered by now,” he snaps.

Tamesha with draws her hand from his shoulder.

Ryan realized he overreacted.

“Look, sorry, but there’s a lot you don’t know about my family..and about me.”

Water is a simple compound but powerful and necessary to the healthy functioning of biological systems. Comprised of just two hydrogens and one oxygen molecule, water is dutifully loyal to other water molecules and repels other molecules (like oil). Molecular polarity explains a lot of things; in a way, it can even explain why some people simply get along better than others.

The thing about water is that it, quite literally, goes with the flow and with enough time, that flow caused rifts. Cavernous rifts; like the Grand Canyon or Luray Caverns in the United States.

Water is flavorless, odorless and notoriously takes on the flavor of whatever it is surrounded by. Without it, life is not possible. With too much of it, death is inevitable.

Though ten years apart, Bryan and Keith had very similar personalities. They met at the fire and rescue station and quickly became best friends. It were as if they were twins. On days they worked, they ran a rig together and on their days off, when Bryan wasn’t in class or studying with Ryan, he could be found with Keith. If Ryan was his biological extension, then Keith was his psychosocial other half. Bryan and Ryan had their own place together, but Bryan spent most of his time at Keith’s townhouse. At the apartment he shared with his brother , Bryan was required to maintain a strict cleaning regimen; the place was spotless. But at Keith’s, he was allowed to occupy space true to the college bachelor he was.

This caused a growing tension between the trio: Keith watched on the sidelines as his best friend had every aspect of his life controlled by his older twin brother. Ryan watched as his twin brother replaced him with a total stranger. And Bryan was existing somewhere in the middle.

If Bryan and Keith were water, Ryan was oil, and if Ryan was salt, then Bryan was water.

It was this tension that formed the powder keg that exploded into a fistfight on December 23, 2002.

Ryan rests his head on the back of the headrest reclines his chair and crosses his arms behind his head. He begins to open up.

“As you now know, my brother has an explosive temper. It has gotten him into a lot of messed throughout our lives, and unfortunately, it has been up to me to clean them up.”

“What kind of messes, Ryan?” Tamesha asks and stares at him, fearing the answer.

“Do you want the truth or do you want me to tell you what you want to hear?” he quizzes.

“I want you to tell me whatever won’t make me get subpoenaed one day. I know your dad is a prosecutor,” she retorts.

There is radio silence.

Outside, the snow continues to fall. By now, the sun has risen. Ryan drives Tamesha to her mother’s townhouse where she still lives. She invites him in, but he declines. She insists, offering her kitchen table as an impromptu investigation and planning space. He complies.

Ryan has met Tamesha’s family on several occasions. The two family dynamics could not be any more different. Ryan grew up in a multimillion-dollar house with more rooms than people to occupy them. He played ice hockey at his private Catholic high school. His parents owned a vacation house in Maine where they “summered”. When they turned seventeen, the twins were gifted matching trucks-new. Tamesha’s mom, younger sister, and herself lived in a split-level townhouse in the downtown area of the same suburb. Their back yard was smaller than the master bedroom of the house. They couldn’t afford a lot of the enhancements of life that Ryan and Bryan’s family enjoyed, but what they lacked in money they made up for in love. There is a warmth in their dynamic that lacked in his, and he was magnetically drawn to it.

Ryan was especially fond of Tamesha’s younger sister. She didn’t talk much and avoided most social settings. She locked into a strict routine with a rigidity he respected. Yet she observed everything, and was hauntingly intuitive to an almost supernatural degree. Her neurodivergence was a superpower and she used it to benefit everyone in her inner circle.

“I figured we could get my sister to help, she’s great with figuring out puzzles and mysteries,” Tamesha says.

Tamesha’s sister is sitting at the table sipping a glass of water. She takes one look at Ryan, then quickly looks away to avoid awkward eye contact. She then takes a sip of water, looks down at the floor, and says:

“There’s no use searching for people who don’t want to be found.”

It is now late afternoon.

Back at the station, a full investigation has begun. Police and members of the press are swarming the old Cathedral-turned-station. They are interviewing fire and rescue staff, and searching top to bottom for clues that could reveal the whereabouts of the missing ambulance and its inhabitants.

Among the press staff on site is Kat, Bryan’s mom, who herself is also being interrogated. She tells authorities that she last saw her son yesterday (Sunday) at mass and for family brunch immediately thereafter. Everything seemed fine, according to her. Keith had joined them for brunch. Nothing was off between them.

Except—she did recall—Keith said something jokingly to Bryan at the brunch table, and Bryan splashed a glass of ice water in his face and stormed off, leaving the restaurant.

“Other than that, it was a normal Sunday brunch,” she said. “Boys will be boys.”

She maintained that this was her last interaction with her son before he and Keith disappeared.

The police extended their investigation to include an inquiry into the patient for whom the dispatch was directed. The patient was admitted to the Catholic hospital and after undergoing stent placement, was recovering and awaiting a room. According to the patient’s wife, she became upset that a rescue team hadn’t arrived but assumed the inclement weather was the reason for the delay. She and her son loaded the patient into the son’s sport utility vehicle and transported the patient to the E.D. At no point did they ever speak with or interact with Bryan and Keith.

Police questioned Ryan and Tamesha separately, at the police station.

The inquired about Tamesha’s relationships with Ryan, Bryan, and Keith and asked about her knowledge of the dynamics between Keith and Bryan. She disclosed everything she knew, which wasn’t much. She told them about how Bryan and Keith were “thick as thieves”, but they did have their arguments. She told them about how Keith had an on-again-off-again girlfriend, but it was mostly “off”, and that Keith had a suspicion that something was forming between his girlfriend and his best friend. But that was the extent of the knowledge regarding the alleged lover’s triangle—if one would even call it that. Tamesha regarded them all as ambitionless townies, and figured their drama was largely due to their stagnation in life. They had nothing better to focus on; to strive for, and according to Tamesha, that was the root of their problem. She maintained a comfortable buffer zone between herself and the personal lives of her coworkers, except Ryan. Tamesha spent most of her time focused on her prerequisite courses for med school, and meddling in the affairs of her coworkers was too much of a distraction. Her purpose was singular: get the experience, and leave. She would be taking the MCAT exam in a year; nothing was going to stop her.

“But before you leave, I do have an additional question. Two, actually. You are aware of the incident that happened between the twins when they were young?" The detective asked.

“You mean the thing with the bikes when they were children? Yes, Ryan told me,” she said.

“And you’re aware of what Ryan did for retaliation? His little ‘long game’? How he lured Bryan into—”

“Yes, I’m aware. May I leave now?” Tamesha interrupted.

She was not aware of what the detective was referring to, but again, it was none of her business. But she would always wonder.

Christmas came and passed, as did New Years. The months, and years passed by. Though parts of the ambulance turned up in scrap yards and the case was reopened, it quickly went cold as leads dried up. No trace of Bryan or Keith was ever found. Ryan completed nursing school, landed a job in the Cardiovascular Intensive Care Unit, or CVICU, and worked for several years before becoming a flight nurse. Tamesha got into medical school, passed her boards, and completed her residency in Emergency Medicine.

Ryan and Tamesha ended up dating and got married shortly after her medical school graduation. The two had a child—a daughter. They named her Bryana, a tribute to Ryan’s twin flame. One Christmas Day, they were all sitting around the massive living room of Ryan’s parents’ home, sipping egg nog and opening presents. There were two presents left unwrapped under the tree: one for Bryan and the other for Keith.

Kat, the twins’ mom, sighs and looks under the tree. She clutches the gold pendant of Saint Anthony of Padua that adorns her neck.

“Mom, they’re dead. We need to move on,” Ryan says matter-of-factly as he lifts Bryana to his shoulder to burp her.

“Don’t say that. You don’t know that. For all we know, they are somewhere still in that ambulance, waiting to be rescued. We have no way of knowing whether they are dead or alive, and until we have evidence of otherwise, I know Saint Anthony watches over them,” Kat cries.

“You’re not alone. Every year on the other side of this cul-de-sac, children that look like me and Tamesha go missing and their cases go cold. And for you to be the wife of a former prosecutor and journalist yourself, its important for you to recognize this. Every year mothers like you cling to a Schrödinger-esque hope that their children—not proven dead, are therefore alive,” says Tamesha’s younger sister.

Tamesha’s sister leans on her husband’s shoulder and he holds her tight. The two met at their school for neurodivergent youth and fell in love; it was a slow burn but the flame was bright. The two went to school; her husband became a counselor and works with underprivileged neurodivergent youth in the community, and Tamesha’s sister applies her innate spiritual and intuitive gifts as a Human Resources manager for the public school system. Her talents have prevented several predatory candidates from ever setting foot near a classroom.

Dissociative amnesia is a condition where patients experience the lack of ability to recall key autobiographical memories. It is considered when all other neurological or medical conditions are ruled out. Patients with prefronto-temporo-limbic network dysfunction are at an increased risk for severe cognitive and memory deficits, unpredictable behaviors, and reduced inhibition. These patients may be at risk for developing dissociative amnesia after a traumatic event or even after conduct unbecoming or committing egregious acts.

A fugue state is a rare subtype of dissociative amnesia that involves the patient traveling or wandering away from their environment and losing any sense of personal identity or sense of self with an accompanying loss of autobiographical memory. These phenomena are still not fully understood within the medical and psychiatric communities.

Another ten years has passed since the disappearance of Bryan and Keith. The story has skipped an entire generation, fading into the annals of history for their suburban town. Kat was much obliged to the sage advice of Tamesha’s younger sister. She published a best-seller about her experiences and started a podcast; an outlet for therapeutically sharing her own experiences and a platform to exercise her privilege and power of the pen as a journalist to amplify the voices of disenfranchised missing and exploited persons. She interviews the mothers, families, and friends of those still existing on a Shrödinger plane of reality. Ryan and Bryan’s father passed away tragically from a heart attack on New Years’ Eve three years prior. Ryan was on a flight responding to a mulit-vehicle accident when it happened and was unable to save him. Ryan, Tamesha, and Bryana moved into the family home with Kat. When she is not busy podcasting and doing book tours, she babysits for Ryan and Tamesha.

The old gothic Cathedral-turned-fire station was condemned and demolished two years ago, and a new, modern and minimalist-chic coworking space was established in its place. The weeping beech tree still remains; its blowing leaves now rustle whispers of Bryan, Keith, and the other souls unable to find refuge in the church that once stood.

One Spring morning, Tamesha joins her not-so-little sister for tea and a pastry at the vegan bakery that is behind what used to be the fire and rescue station. It had become their tradition; they meet for coffee or tea on the one day of the week they both happen to have off from work; today it was a Monday. Her sister is eight months pregnant; her and her husband are expecting their first child and Tamesha is helping her sister plan the nursery and color scheme for the birth announcement.

“Sage is perfect for you, and that little soothsayer you’re cooking,” Tamesha jokes.

They share a giggle, then Tamesha’s sister gets quiet and looks down. She takes a swollen finger and swirls the tea leaves in her cup, then looks up with a grave expression. Her sister meets her gaze.

The sister’s eyes pierce with the sharpness of an eagle’s talon. She is looking through Tamesha and into some plane of existence that exists beyond either of their realities. Tamesha waves her hand to get her sister’s attention. The sister blinks, then returns her attention to the present conversation.

“What do you think of libraries?” the sister asks Tamesha.

“Uhm, okay, random much?” Tamesha says with bewilderment.

“You know the funny thing about books—you can pick them up, read them a little while, then put them back on the shelf. You can forget about it, but that book remains on the shelf, even as life passes you by. It remains unchanged, unweathered by age and the sands of time. Maybe its ready to be read again.”

A few weeks later, a man walks into one of the dive pubs downtown. He is wearing a flannel shirt and ripped jeans—the ones that look slovenly but are intentionally and ironically exorbitant. He is wearing shoes that were popular twenty years ago, but looked new. Probably expensive limited edition vintages. Nothing about this guy says broke college kid, though he had the energy and demeanor of one. He sits down, and the bartender asks what he wants to drink. The man requests a pint of whatever IPA is on draft. He sits and stares at the game on the television. Hockey playoffs. He smiles.

He captures the gaze of the bartender.

“Wouldn’t it be really cool to be a pro hockey player?"

The bartender looks at the man; he couldn’t be any older than twenty-one. He looks familiar, in the way that an old high school classmate from years ago would. She ponders for a minute, thinking he reminded her of one of the guys that used to play ice hockey at her former Catholic high school, but shakes this idea out of her mind. She is forty-one; this kid is twenty years her junior. It would be chronologically impossible for them to have gone to high school together.

The guy finishes his drink and says he has to leave.

“See you tomorrow,” he nods.

He puts a weathered, aged ten dollar bill on the counter and walks out. It was one of the old prints; she hadn’t seen one of those in, gosh, a few decades. It was so old and almost foreign that she took the inking marker from the register to check it. It was legit; just an old ten dollar bill.

As she adds the change to the register, an iced jolt rushes down her spine, giving her goosebumps. She pauses and looks up.

“There’s no way…could it be….really? Him? All these years?”

The next day, as promised, the man returns to the bar. He is wearing yet another vintage-chic outfit. He smiles as he greets the bartender. She returns the smile and immediately asks for the man’s identification. He removes his wallet and hands her a horizontally-oriented card that was not expired.

She takes his ID and immediately drops it on the floor in shock.

Like a book, this story ends here, though so many questions linger. Who was the man at the bar, and what name was on the ID card he presented? And if it was actually Bryan, why did he look as if he hadn’t aged? Assuming it was Bryan, what happened to Keith? Assuming it wasn’t Bryan, what really happened after the incident with the bicycles? Did Tamesha ever learn this dark secret? Perhaps most importantly—what exactly did Tamesha’s sister know, and why was she never interrogated by the police?

Unfortunately, this story leaves us with more questions than answers, but I encourage you all to solve this case. For access to the exclusive content related to this case, along with deeper dives into the pathology behind each of these clinical manifestations, join our private community of Vaso & Vibe sleuths by joining us on Patreon. Link is in the show notes, or go to Patreon.com/vasoandvibes.

Disclaimer: This podcast is for informational and entertainment purposes only and does not constitute medical, psychological, or legal advice. The stories, characters, and scenarios discussed are creative, synthesized composites and do not reflect actual patient cases. The views and opinions expressed in this podcast are entirely the host’s own and do not represent the views of any employer, hospital, or healthcare institution.

Join the conversation on Patreon for the Vaso & Vibes: Night Shift.

For more information, visit: www.vasoandvibes.com

Credits:

Theme Song:

“Game Day” by JMHBM, from the Free Music Archive

Intro:

“Carnival of Souls” by HoliznaCCO, from the Free Music Archive; no changes were made to the original track.

Outro:

”Lofi Soul Hip Hop Mix 3” by Ketsa from the Free Music Archive; no changes were made to the original track.

Other Music:

“Tense and Rising” by Free the Muses, from the Free Music Archive

“Ephemeral III (Lilith)” by Le Chaos Entre 2 Chaises, from the Free Music Archive

Sources

Bergman, I. (Director). (1968). Vargtimmen (Hour of the wolf) [Film]. Svensk Filmindustri.

de Arriba-Pérez, F., Sánchez-Piedra, C., Díaz, J., & Carmona, R. (2025). Association between air pollution and Monday peak mortality from acute myocardial infarcion. Journal of the American College of Cardiology. Advance online publication. https://pmc.ncbi.nlm.nih.gov/articles/PMC12869875/

Elliot W. J. (2001). Cyclic and circadian variations in cardiovascular events. American journal of hypertension, 14(9 Pt 2), 291S–295S. https://doi.org/10.1016/s0895-7061(01)02174-4

Grondin, C. (n.d.). The significance of 3 a.m. Catholic Answers. https://www.catholic.com/qa/the-significance-of-3-am

Taïb, S., Yrondi, A., Lemesle, B., Péran, P., & Pariente, J. (2023). What are the neural correlates of dissociative amnesia? A systematic review of the functional neuroimaging literature. Frontiers in psychiatry, 14, 1092826. https://doi.org/10.3389/fpsyt.2023.1092826

Tonelo, D., Providência, R., & Gonçalves, L. (2013). Holiday heart syndrome revisited after 34 years. Arquivos Brasilerios de Cardiologia, 101(2), 183-189. https://doi.org/10.5935/abc.20130153

Only one of them would arrive at the hospital.

Disclaimer: This podcast is for informational and entertainment purposes only and does not constitute medical, psychological, or legal advice. The stories, characters, and scenarios discussed are creative, synthesized composites and do not reflect actual patient cases. The views and opinions expressed in this podcast are entirely the host’s own and do not represent the views of any employer, hospital, or healthcare institution.

Sources, credits, and episode transcripts can be found at the Vaso & Vibes Substack.

I am excited to announce: there is now a place for you to join me in the…after hours…discussion about this episode—and all episodes— and that is at the Vaso & Vibes Patreon account. It gives breakroom conversation; you know, the nitty gritty fun that doesn’t happen out on the unit floor. In my hospital, I work the night shift, and I absolutely love the vibes that come with it. Chill, low-fi, and—honestly, a little spooky—where all the magic happens and that’s precisely the ambiance I wanted to create for my podcast fan club community.

Join the conversation on Patreon for the Vaso & Vibes: Night Shift.

Most heart attacks happen between 6:00am and noon, when there is an increased risk of a grave cardiovascular event. Bryan and Ryan were there for it. The twins did everything together. They played ice hockey in high school together, and even had the same 3.9 grade point average. So when they decided they wanted to become flight nurses, they first became EMTs (Emergency Medical Techs) while taking prerequisite courses at the community college for nursing school. On Monday, December 23, 2002 at exactly 6:02 am, two calls came into the station; both for people presumably having heart attacks. Bryan, Ryan, and their respective partners took the calls. It was settled: Bryan and Keith, his partner, would go on one call; Ryan and Tamesha, his partner, would go on the other. Loaded up and ready to go, each ambulance with their respective partnerships departed the squad bay at the exact same time.

Only one of them would arrive at the hospital.

I’m Leslie, a CVICU nurse and urban planner at heart, and this is the Vaso & Vibes: A Nursing Thriller podcast. From the underbelly of critical care nursing: dark stories with a beautiful twist. Brilliantly absurd. Shockingly effective.

Bryan and Ryan were born twelve minutes apart; Ryan was the oldest. They were born in a suburban Catholic hospital in their hometown. The boys enjoyed a typical New England lifestyle: they spent winters playing ice hockey and ice skating, and summers vacationing with their parents out of state in Bar Harbor. Ryan was the responsible one, always taking the lead and looking out for Bryan. Other than each other, the two boys had no other siblings. Their mother, Katrina (“Kat” for short), was a journalist for the local newspaper and their father, Jean-Paul, was a commonwealth’s attorney. They attended mass every Sunday, except when traveling for hockey tournaments. The duo was inseparable.

In biochemistry, salt follows water: Bryan was water, and Ryan was salty.

The more rambunctious of the two, Bryan was less of the ambitious go-getter and more of the rule-breaker. Though he followed his older twin’s lead on nearly everything, deep down inside, he resented being seen as Ryan’s shadow. Of the two, Bryan was more likely to get into trouble and had a checkered disciplinary record. At their Catholic high school, Bryan was frequently reprimanded for dress code violations; his uniform simply didn’t suit his personality, so he repeatedly altered it. He hated tucked shirts and frequently ditched his tie after getting dropped off by his parents. Much to his brother’s chagrin, Bryan was seen as less like a catalyst for positive change and scholastic achievement, and more like an inhibitor.

Secretly, he felt like Bryan was holding him back.

As we would expect, it was Ryan’s suggestion that the two pursue careers as flight nurses. They realized soon enough their dream of being professional hockey players was washing down the pipe; they needed a fail-safe career that would leave them with multiple options. The two were semi-interested in medicine, but the idea of going to school for ten-plus years only to stay confined to a hospital didn’t appeal to them. Flight nursing sounded exciting, unpredictable, and even dangerous. They could achieve the same ends—save lives—and get the same adrenaline rush as playing on the ice. Also, if all else failed, they could go back to being Cardiovascular Intensive Care Nurses and be assistant coaches for their former high school ice hockey team. It was a solid plan.

The twins enrolled and began taking their prerequisite courses. They became Emergency Medical Technicians, or EMTs to gain hands-on emergent patient care experience and improve their chances of getting into the local university nursing school’s next cohort. They worked nights and weekends at the local rescue squad and attended classes during the day. They would occasionally play recreational ice hockey at the local rink, if time allowed…and if Ryan let them.

At the station, Bryan and Ryan were surprisingly never partners on a truck; their personality dynamics were better suited to save lives in alternate pairings. Ryan paired up with Tamesha, a paramedic with dreams of going to med school. Bryan paired up with Keith, and their bromance was undeniable.

Keith was a paramedic and U.S. Navy veteran. He served for two enlistments, and used his G.I. bill to complete a fast-track paramedic program. He lived a simple townie life triangulated around three points: the gym, the bar, and the station. For Keith, the idyllic life of the wife, the house with a garage, the 2.5 kids and a dog wasn’t in his cards. If he could live everyday doing whatever made him happy in the moment—saving lives by day and using his harrowing tales of life as a paramedic to entice women at the bar at night—he would die a happy man.

And thats precisely how he lived up until the day he vanished.

On the other hand, Tamesha, Ryan’s partner, was a stereotypical Type-A individual. She was President of every organization she participated in at public high school. She did not come from a background of privilege, but clawed her way to becoming valedictorian, member of the honor society, and first string violinist for the District Orchestra. To perfect her craft, she spent two summers in Italy, paid for solely by scholarships; her mother could not afford it. Her mother raised Tamesha and her sister in a two-bedroom apartment in the town center. A widow shortly after Tamesha’s younger sister was born, the mother of two was determined to make the best of a tragic situation and lived life empowered by the ambitions of their ancestral lineage. Her mother worked two jobs to fund Tamesha’s scholastic pursuits and Tamesha’s younger sister’s private school for children on the autism spectrum.

Her sister was her anchor, and she relied on her ‘special set of skills’ to hold her down whenever she needed advice from a perspective beyond anything any of her neurotypical associations could offer. More on that in later.

The resemblance between Ryan and Tamesha was striking. Their seamless partnership behind the wheel of an ambulance offered what seemed to many to be a foreshadowing of a future dynamic later down the road. Tamesha had ambitions to become an Emergency Room physician. Unlike with Keith, becoming a paramedic was merely a stepping stone to her ultimate career goal; it was a mere means to an end.

For Keith, it was the end.

Before I get into the details of what happened that December morning, let’s discuss the events leading up to it. The station where Bryan, Ryan, Tamesha, and Keith worked was located in a suburban community about a thirty-minute drive from the larger metropolitan center. It was tucked away on a side street, across from a nondenominational church and behind a vegan bakery. The three-story facility was originally a Roman Catholic cathedral built in the mid-1800s but closed after, ironically, a fire destroyed much of its interior. Since the “bones” of the building were good, however, the facility was not torn down. Instead, a multimillion-dollar renovation in the early 1950s converted the facility into a fire and rescue station. The Victorian Gothic facade elements remain, and the eerie glow of the fire engine lights before every dispatch reflect through its large windows. Three of the original stained glass panels remain. One of which is a series of panels of Saint Anthony of Padua holding the holy infant Jesus and a lily. Saint Anthony is the patron saint of lost things, a hauntingly foreboding harbinger of the events that lay ahead. On that morning, the candles placed in the windows of the station glowed with a spectral glow through the patron saint. By this window is a towering weeping beech tree, whose lugubrious branches mourn for the sinners’ souls that never made it to confessional before the Great Fire.

Station personnel operated on a 12-hour shift system. For Bryan, Ryan, Keith, and Tamesha, they worked overnights, with their shifts ending at 7:00 in the morning. The hours between 7pm and midnight were generally mundane—though anything could happen at anytime—but for the most part, the long initial stretch comprised of patient transports, paperwork, and other routine tasks. This was the opportunity to catch up on homework, when possible, goof around, and keep the station in order.

Then came the wolf hour and the witching hour.

The hour of the wolf, popularized by Ingmar Bergman’s film that translates to the same name, refers to the time between midnight and sunrise. Johan Borg calls it “the hour when most people die, when most children are born. Now is when nightmares come to us. And if we are awake…we’re afraid.”

At the pinnacle of wolf hour, falls witching hour. The witching hour falls between 3:00 am and 4:00 am, a time when dark forces manifest and the pious are awakened by the Communion of Saints to pray, according to folklore. In healthcare spaces, the witching hour is a time of increased agitation, unrest, and a sense of impending chaos before the next shift arrives.

There is something else important we need to explore, and that is that the week between Christmas and New Year’s sees some of the highest rates of heart attacks the entire year, and, as mentioned earlier, most heart attacks happen during early morning hours. Researchers believe this end-of-year cardiac surge is likely related to a combination of factors meshing in a perfect storm. Increased stress during the holidays, combined with cold weather, overindulgence in food and drink, missed medications, travel fatigue, delayed medical care, and altered circadian rhythms all precipitate irregular heart rhythms. This is further exacerbated by binge drinking and holiday seasonal behaviors, thus creating the unfortunate opportunity for atrial fibrillation in persons with no known heart disease. You may be familiar with this concept: “Holiday heart syndrome”. People may feel a fluttering sensation in their chest, dizziness, shortness of breath, or a racing heartbeat. What’s more—heart attacks frequently occur most often on Mondays, the beginning of the work week, likely due to circadian rhythm disturbances and stress levels.

So in the early morning hours of Monday, December 23, 2002, as Bryan, Ryan, Keith, and Tamesha sit in the station awaiting their next call, it could be argued that the cards were stacked against them.

It was a typical snowy winter early morning in New England. There was already an accumulation of six inches with more coming down. It was two days before Christmas, and the holiday lights illuminated the block surrounding the station, which only reflected the gloomy glow of candles in the stained glass windows and the shadows of an all-white-and-tinsel Christmas tree in one of the back station corners. The building was poorly insulated, so an ever-present iciness hung in the atmosphere of the place, delivering occasional jolts of chill down the spines of the squad. The overall vibe of the building was cold, dark, gothic and gloomy, but the closeness of the crew helped defrost the place.

Bryan was sitting by the computer desk, searching online for last-minute Christmas gifts. Ryan had already purchased, wrapped, and hid his gifts for everyone; so had Tamesha. The two were standing by the Christmas tree, chatting over hot drinking chocolate. As Tamesha laughed, the reflection of the white lights and tinsel gleamed on Tamesha’s rich, espresso skin and sparkled in her hazel-colored eyes.

Ryan couldn’t stop staring at her; he was entranced. She asked him about his gift for his mom, Kat, but he didn’t hear the question.

Ryan had purchased a Christmas gift for his partner: a Littmann stethoscope. She had already given him his Christmas present, and its all he had wanted, really: a kiss under the mistletoe hung in the archway of what used to be the vestibule of the Cathedral that is now their station. It was Bryan who hung it for his older brother, hoping it would help him get a lucky kiss from the paramedic. His plan worked.

It was 3:04 am.

Ryan walked over to his brother, who was finalizing his purchases. The gifts would arrive one week after Christmas.

“You always do this, you wait until the very last second to do something because you can’t be bothered to think about others before yourself,” Ryan scolded him.

“And once again, you’re sticking your neck in my business. Fall back,” Bryan said.

The two continued to argue, and the argument escalated into a hockey-style brawl. The two were rolling around on the floor, punching each other and exchanging blows. Keith and Tamesha ran over to break them up; Keith slammed Bryan against the stained glass of Mother Mary.

“Dude, quit. This ain’t home and you know he don’t stand a chance,” Keith said to his partner, with a sly grin.

Ryan and Bryan continued to glare at each other, both out of breath, ready for Round Two.

Ryan spit out a mouthful of blood; lucky for him, it was a busted lip and not a broken tooth.

“Sleep with your eyes open,” Ryan warned his brother.

Though their GPAs were identical, Ryan was branded the brains of the duo, and Bryan the brawn. Ryan has never actually ‘won’ a fight against his younger brother, who has often stepped in to defend Ryan against other peers. Ryan, though, has other ways of getting back at those who scorn him. Unconventional ways.

Tamesha wrapped her arm around Ryan’s shoulder and escorted him away to clean and dress his wounds.

“You two are thick as thieves—you guys gotta work this out,” she said with a motherly undertone.

“You know, everyone thinks we’re inseparable, and everything’s all good,” Ryan lowered his voice. “But no one knows what goes down behind closed walls and front doors,” Ryan said.

Ryan told Tamesha about how Bryan had a terrible, uncontrollable temper. Seemingly little things would set him off. When the two were young boys, they were racing bicycles around their cul-de-sac. Ryan won and jumped off his bike to celebrate. His taunting enraged his younger brother, who immediately got off his bike, threw it to the ground, then proceeded to slam his brother’s head against the asphalt. Ryan suffered a concussion with an open head wound and required stitches and an overnight stay in the hospital. The boys’ parents shrugged it off.

“Boys will be boys,” their father said and scoffed.

Kat, their mother, wanted to believe him, but deep down inside knew something about her youngest son was unsettling. Something dark was a matter with Bryan.

It was 3:46.

The twins did not apologize to each other, choosing instead to continue life, business as usual, like nothing happened. In fact, they even started working on their homework for Developmental Psychology together.

It was as if the fight never happened, though a dense fog of darkness loomed in the atmosphere in the station.

At around 4:30, Tamesha started planning the menu for the station’s holiday potluck dinner in three days. Keith agreed to bring sodas and plates (not surprising), Ryan would bring a turkey, and Tamesha would provide side dishes.

Bryan signed up to bring a honey-cured ham. He had no way of knowing…that he wouldn’t be attending. Neither did Keith.

At 6:02 am, two calls came into the station; both for people presumably having heart attacks. Bryan, Ryan, and their respective partners took the calls. It was settled: Bryan and Keith, his partner, would go on one call; Ryan and Tamesha, his partner, would go on the other. Loaded up and ready to go, each ambulance with their respective partnerships departed the squad bay at the exact same time.

They geared up and loaded onto their rigs. At 6:04, they each pulled out of the station, sirens blaring.

At 6:10 am, Ryan and Tamesha arrived at the scene. A 56-year old male was having chest pains that hadn’t been relieved with sequential doses of nitroglycerin under his tongue. Nothing about the scenario was concerning or daunting for them; they knew precisely how to address these situations. They provided oxygen and gave the patient aspirin en route to the Catholic hospital. The patient’s heart didn’t stop, and the E.D. was ready and waiting for their arrival.

At 6:42 am, they arrived at the Emergency Department.

There was no communication from Bryan or Keith, and the last time they were seen was at 6:04 when they departed the ambulance bay.

At 6:56 am, dispatch contacted the station to find out the whereabouts of the rig, because the patient’s family ended up driving the critical patient to the hospital when the ambulance never showed.

They radioed Ryan when Bryan and Keith went radio silent. Ryan tried to call, then text, his brother, but his phone went straight to voicemail. He tried again. Nothing.

It was 7:10 when Ryan and Tamesha returned to the station. Time to clock out and go home. Ryan was going nowhere. He clocked out, but tensely paced the station, anxiously awaiting communication from his brother and Keith. He decided to get in his truck and retrace the route of the ambulance to the site of the call, thinking he would find the rig. Perhaps there was an accident; it was a snowy day. The roads, though scraped and salted, were still icy. Wanting to support he partner and having nowhere pressing to be until later, she offered to accompany Ryan.

Salt is a powerful compound; powerful enough to prevent water from freezing on roads. Technically, it’s called freezing point depression. The thing about salt, is that it is essentially any neutral ionic compound made of positively-charged cations and negatively-charged anions and are often produced by neutralization reactions between an acid and a base. Salts are three-dimensional, their structure comprised of intricate crystal lattice patterns. In the body, sodium is extremely important. It maintains fluid balance, regulates blood pressure, and is highly involved in neuromuscular function. Sodium is the driving force for how fluid is handled in the body. It is necessary; vital. However, too much of a vital thing is not a good thing, and too much sodium leads to increased fluid retention, and increased fluid retention drives up pressures in the body. When the body reaches its breaking point, things can go awry.

A person who is “salty” is said to be bitter, or angry. A person might be described as being salty after being resentful over losing or receiving criticism.

Ryan and Tamesha leave the station in Ryan’s truck. They see two sets of ambulance tire tracks in the snow: one was from Ryan and Tamesha’s rig and the other was from Bryan and Keith’s. They pass the vegan bakery, approach the intersection at the end of the block, and continue heading in the direction of the call.

“Twelve twenty-two Grenadine Court,” Tamesha recalls.

Ryan puts the address into his GPS.

No such address is found.

“That can’t be right, he says. Are you sure?”

“Yes,” Tamesha confirms, “the dispatch was for twelve twenty-two Grenadine Court.”

“It says no such court exists,” Ryan says, with an expression of both agitation and bewilderment washing over his face. He glares at Tamesha.

“How dare she question him,” he thought.

Ryan has an idea, he thinks that the person taking the call mistook Grenadine for Glendale, and decides to drive to Glendale Court. Twenty minutes later, they arrive at Glendale Court, but there is no Twelve twenty-two. At a loss, he sighs, slams his arms against the steering wheel, and peels off and parks in an empty gravel lot. He says nothing, closes his eyes, and lets out a deep sigh.

“Okay, you know something. Spill it,” Tamesha says.

Ryan looks at her, and hesitates before talking. He doesn’t know how much of what he knows is relevant to the situation at hand.

(Outro music)

In next week’s episode, we’ll unpack what Ryan knows, more about their brotherly bond, and what authorities believe may have happened to the missing ambulance. Join me next Friday, for Episode 4, Part II of the Vaso & Vibes podcast.

Disclaimer: This podcast is for informational and entertainment purposes only and does not constitute medical, psychological, or legal advice. The stories, characters, and scenarios discussed are creative, synthesized composites and do not reflect actual patient cases. The views and opinions expressed in this podcast are entirely the host’s own and do not represent the views of any employer, hospital, or healthcare institution.

Sources, credits, and episode transcripts can be found at the Vaso & Vibes Substack.

I am excited to announce: there is now a place for you to join me in the…after hours…discussion about this episode—and all episodes— and that is at the Vaso & Vibes Patreon account. It gives breakroom conversation; you know, the nitty gritty fun that doesn’t happen out on the unit floor. In my hospital, I work the night shift, and I absolutely love the vibes that come with it. Chill, low-fi, and—honestly, a little spooky—where all the magic happens and that’s precisely the ambiance I wanted to create for my podcast fan club community.

Join the conversation on Patreon for the Vaso & Vibes: Night Shift.

For more information, visit: www.vasoandvibes.com

Credits:

Theme Song:

“Game Day” by JMHBM, from the Free Music Archive

Intro:

“Golden” by Little Glass Men, from the Free Music Archive; no changes were made to the original track.

Outro:

”Quiet Outro” by ROZOL, from the Free Music Archive; no changes were made to the original track.

Other Music:

“Tense and Rising” by Free the Muses, from the Free Music Archive

Sources

Bergman, I. (Director). (1968). Vargtimmen (Hour of the wolf) [Film]. Svensk Filmindustri.

de Arriba-Pérez, F., Sánchez-Piedra, C., Díaz, J., & Carmona, R. (2025). Association between air pollution and Monday peak mortality from acute myocardial infarcion. Journal of the American College of Cardiology. Advance online publication. https://pmc.ncbi.nlm.nih.gov/articles/PMC12869875/

Elliot W. J. (2001). Cyclic and circadian variations in cardiovascular events. American journal of hypertension, 14(9 Pt 2), 291S–295S. https://doi.org/10.1016/s0895-7061(01)02174-4

Grondin, C. (n.d.). The significance of 3 a.m. Catholic Answers. https://www.catholic.com/qa/the-significance-of-3-am

Tonelo, D., Providência, R., & Gonçalves, L. (2013). Holiday heart syndrome revisited after 34 years. Arquivos Brasilerios de Cardiologia, 101(2), 183-189. https://doi.org/10.5935/abc.20130153

Show notes, sources, & transcripts: subscribe to Vaso & Vibes on

Substack.

Disclaimer: This podcast is for informational and entertainment purposes only and does not constitute medical, psychological, or legal advice. The stories, characters, and scenarios discussed are creative, synthesized composites and do not reflect actual patient cases. The views and opinions expressed in this podcast are entirely the host’s own and do not represent the views of any employer, hospital, or healthcare institution.

For more information, visit: www.vasoandvibes.com

Credits:

Theme Song:

“Game Day” by JMHBM, from the Free Music Archive

Intro:
“Golden” by Little Glass Men, from the Free Music Archive; no changes were made to the original track.

Outro:
”Lofi Soul Hip Hop Mix 3” by Ketsa from the Free Music Archive; no changes were made to the original track.

Other Music:

"Terror Drome" by Mark Wilson X from the Free Music Archive; no changes were made to the original track.

“Tense and Rising” by Free the Muses, from the Free Music Archive

Viktoria sees the love and closeness of the family, and wishes she had that. She also realizes: the only way to keep her nursing license in tact—and her life—is to leave.

I’m Leslie, a CVICU nurse and urban planner at heart, and this is the Vaso & Vibes podcast. From the underbelly of critical care nursing: dark stories with a beautiful twist. Brilliantly absurd. Shockingly effective.

In Part I, we learned about the family dynamics of Viktoria, a nursing school student and operator of a backdoor clinic in her grandfather’s business. She ran this clinic with her cousin and best friend Sofia, though neither of them were authorized to conduct medical assessments, provide wound care, or deliver patient education. Their grandfather, Dedushka, was the head of the household and was an accountant, though had never been to college or earned any certification. His two “assistants” were his grandsons—Viktoria’s older brothers. Together, they operated an accounting firm in the street-level office in the building below their apartment. This building opens up to a back alley teeming with life and the adventures of inhabitants of their Russian enclave.

As you heard in Part I, Babushka, the grandfather’s wife and the family matriarch, worked dutifully in the background to maintain the operations of the household: the cooking, cleaning, and overall mess-cleanup tasks. She was a one-person clean-up crew. Depending on what you believe, Babushka is an innocent bystander to the chaos that ensued, or an active accomplice in the family drama—we’ll explore that more later. Viktoria is torn about taking a position at the hospital unit she has grown to love and was precepting on—the intensive care unit—but a recent experience left her questioning that desire. Sofia seemed to be steering her away from that direction, reminding her of their pact to graduate, pass the boards, then work for the family business. Loyalty to family over everything—or else, she implied. After leaving a disturbing clinical shift, Viktoria arrived home and was greeted with terrible news.

Viktoria collapsed to the floor, the weight of her upper body succumbing to the numbness of her legs. She has no words, but a million questions. What happened? How? What if she had been there to save him? Several questions looped around in her head. If she had not been in that stupid clinical, she would have been here, taking care of her community…of the one person who needed her most. She began to ruminate on this reality.

She went to nursing school to save her people…yet she couldn’t save her people…because of nursing school. The irony was not lost on her.

She later learned that one of Dedushka’s clients had asked to meet him early this morning—before everyone else awoke but after Viktoria left for clinical, so she didn’t see him—and beat him in the back alley so badly it caused his blood to back up and his heart to stop pumping. He lay there, face down in the cold dark alley until her two brothers found him. Though they weren’t initially going to call for emergency medical services, Mama insisted and threatened to do so if they wouldn’t. He was taken to the hospital, where he was pronounced dead.

They were fully satisfied with getting justice on the streets without the legal system, and knew a few fighters at the gym that would gladly help them.

Viktoria, who barely ate lunch at the hospital, definitely didn’t feel like eating dinner. She showered and went to bed; she had yet another clinical shift at the hospital tomorrow. Something wasn’t sitting right with Viktoria, and she lay awake in bed, drafting her plan, until she eventually fell asleep.

The next morning, Viktoria awakened an hour early to prepare for clinical—she had work to do. Under normal circumstances, her and Sofia would walk together to the bus stop for the hospital. They would arrange to take lunch together, and after their shifts were done, they would walk to catch the bus home. Yesterday evening, Sofia stayed behind to watch a procedure, so she found out the news late that night about Dedushka. This morning, Sofia would find herself alone at the bus stop; Viktoria had work to do. Arriving early at the hospital but dressed in her clinical attire, Viktoria takes the elevator down to the basement floor where the morgue is located. She takes the knotted Orthodox prayer rope from her scrub pocket and kisses it. Dedushka should still be in the morgue; she doesn’t think the funeral home has come for the body yet. It will be her last few moments with the man she loved and admired most; he was like a father to her. He was there for her best and worst moments. She just needed…one more time with him, to say goodbye. She opens the cooler door, walks in, and looks for the patient ID labels on the body bags. There were seven bodies in the walk-in.

None of them were Dedushka’s.

Puzzled, she returns the prayer rope to her scrub pocket, exits the morgue, and takes the elevator up to the second floor for her ICU preceptorship clinical. She sees Sofia, who gives her a long, cold stare but does not come over to greet her. Instead, her preceptor comes to her, asks to have a chat, and walks with her to the breakroom. She apologizes for her ignorance and insensitivity and asks for her forgiveness. Though never one to hold a grudge, Viktoria doesn’t trust it—but acknowledges the apology. The shift continues unremarkably, and at lunch time, Viktoria goes to get Sofia. The two go to their little corner in the cafeteria on the first floor.

“Where were you this morning?” Sofia asks. “Do I want to know?”

“I went to say goodbye to Dedushka but he was…gone. Not only that, there was no record of his patient label in the logbook,” Viktoria said.

Sofia gave her a long stare.

“Viktoria, don’t mail yourself packages you’ll regret opening later. Leave it alone. He is gone. We will go to the funeral and move on,” Sofia said stoicly.

Viktoria found the remark off-putting, but knew when to leave well enough alone.

The funeral.

Dedushka’s memorial service was held at the Russian Orthodox Church, three blocks away from the back alley. Interestingly enough, Dedushka traveled thousands of miles when he was younger—only to live and die within the same 3-block radius for the remaining 40 years of his life. The church was a place of peace amongst violence and chaos; a reprieve from the brutality of the everyday grind. It was ornamental beauty among the concrete dilapidation that was culturally home. The smell of incense was a nice contrast to the smell of cigarettes and dumpsters in the back alley.

She finally pays her respects and the days of mourning commence. During the service, the brothers flank her in the pew and one whispers to her a phrase in Russian that loosely translates to: “Grief gets in the way. His business —our business—is yours now. Tomorrow, get to work.”

Viktoria had no time to mourn. Her brothers throw her feet first into the business, into her grandfather’s old shoes. She knows loyalty to family is what comes first; it has to, it always does. She will run the business and she is learning—things weren’t what they seemed. She realizes just how powerful she is now. She also realizes she doesn’t need a degree to be an accountant; at least, the type of accountant her grandfather was.

A few months pass by. She is the first woman “accountant” in her family’s history, and the only female accountant in their entire Russian enclave. She worked twice as hard to get half as far, but ruling with an iron fist earned her the respect of associates twice her age and triple her size. Yet she has the feminine energy of the divine, infusing a sense of empathy in her work…if only a razor thin amount.

She doesn’t know how or why she is so good at things—it’s almost as if her grandfather never left. She has been having several dreams about him lately; conversations with him, during her slumber. It feels both comforting and disturbing, but maybe its her mind’s way of getting the closure she was robbed of.

Graduation day has arrived, and everyone in Viktoria and Sofias’ cohort has been hired into their desired specialties. For Viktoria and Sofia, it was a major accomplishment. They were both offered full-time nursing positions on the ICU; Sofia declined. Viktoria, though, was undecided. For now, she will continue running the family business; her new life as an accountant already started. It is a grave conflict of interest; at work, she now causes the wounds she once used to heal. Sofia had already taken over the backdoor clinic operations; for her, this is business as usual.

The Thursday night tradition continues. One random Thursday, the office is closed and the doors are locked. In the break room area, one of her brothers fills the shot glasses with the chilled pepper vodka from the freezer. He passes around the shots and a Mason jar of pickles and each person takes one. They toast.

Viktoria notices hers is a little more full than the others. She shrugs.

She tells them that she’s decided to step down from the business and will be choosing which brother to hand things over to. She will go work at the ICU full time and for the other four days a week she will run the back door clinic with Sofia. “Love it or leave it,” she tells them. It’s how it’s going to be.

Flunitrazepam is a powerful central nervous system depressant. A benzodiazepine, it is seven times more potent than Valium. It causes profound drowsiness, altered coordination, and extreme relaxation. What’s interesting about this drug, is that it causes the brain to cease creating memories while a person is under the influence of it; in other words, it causes a form of amnesia and the person is none the wiser of their actions and activities while on it.

You may have heard of this drug by another name: Rohypnol.

Everyone has left the table and Viktoria pours another shot of vodka to sip, sits, and thinks. Which brother will be best to fill her shoes? She hears footsteps getting louder. How could anyone have gotten in? Did someone leave the doors unlocked?

“We’re closed,” she slurs. She cuts her self off; a woman mustn’t overindulge in her line of work; it’s not safe. She must stay sharp and ever vigilant.

She sees a shadow appear in the direction of the break room doorway. A tall, heavyset man appears, only his eyes and mouth visible in the shadow cast by the break room light.

“Dedushka! But..,how?! You’re dead?!”

It’s as if two years haven’t gone by; he still looks the same. “I’ve missed you.” He says he’s missed her too and they embrace. He grabs a double shot glass, and sits at the table directly across from her. She slides the vodka across the table to him. He fills the glass, takes a sip, sets the glass down. Leaning in, he rests his elbows on the table and folds his hands and cracks his knuckles. “Now, Petitchka, my little birdie, fill me in on what I missed while I was gone.”

They had a wonderful conversation; he was so proud of her and impressed by her stories of the ICU. She even told him how he died— how the baseball bat hit his chest, causing fluid and blood to fill the space around his heart and that caused the cardiac tamponade. She started crying, apologising. If only she knew then what she knows now, she could’ve given him a fighting chance to survive. He reassured her that there was nothing she could’ve done. He asked about his funeral and how Babushka was doing after he died. He took the handkerchief out of his breast pocket and wiped the tears from her face and eyes...

The next day, Viktoria awoke in her bed, groggier than usual.

It was another of her lucid dreams.

She was still in her clothes from the day before; she must’ve had a little too much pepper vodka. It happens from time to time. She lay in bed thinking about the previous evening, and how sweet it was to catch up with her grandfather one last time.

“Many girls would kill for one last day with their grandfather,” she thought. “How lucky am I.”

She takes off her clothes and tossed them into the laundry pile. She looks down and notices a vintage Burberry handkerchief in her pocket. It was her grandfather’s. Puzzled, she shrugged and goes to shower, get dressed, and get ready for work.

She has accepted a full time position at the ICU but is awaiting onboarding instructions from the recruiter. She will go to the backdoor clinic and help Sofia with their clients.

Three weeks pass by, still nothing from the recruiter about onboarding for the ICU position.

One Friday afternoon, a client shows up to the business entrance to the accounting office, with a duffel bag and slams it on the desk. With the numbness of a thousand death blows, he stares into Viktoria’s soul. His double black eyes are hollow. She looks down and sees blood-soaked gauze wrapped around both kneecaps.

“Now give me my daughter,” the man says.

Ice flows through Viktoria’s spine.

“I…what? I’m sorry…I think you are confused,” she says. She hesitates.

Where has she seen this man before?

She opens the oversized duffel bag to reveal stacks of hundred dollar bills. There is at least $250 thousand—if not more. She is confused, but excuses herself to secure the duffel bag in the safe and find out more about his daughter. She goes to Sofia’s backdoor clinic, and asks if she provided care for a man with bloody kneecaps.

Sofia stares at Viktoria, and choosing her words carefully, replies.

“Yes…why?”

”He is asking about his missing daughter? What is he talking about? I think he may be mistaken,” Viktoria says.

“I can’t say anything. HIPAA violation,” Sofia clipped.

“Saying that tells me you know something, and if a child is missing and you had something to do with it, we could BOTH lose our licenses!” Viktoria said. She was always the more maternal of the two.

“What do you mean, I had something to do with it? I didn’t do anything. The image in that mirror of guilt…is you,” Sofia said, then returned to bandaging a patient’s knee cap.

Stunned, Viktoria goes back to the man. She asked for his name and number so she can find out more information and get back with him.

“What—you don’t know my name? You knew everything about me last night! You and your old man. If my daughter’s not back home when I get there, I’m going to the police. I’ve got nothing to lose,” the man says with desperation then walks out, slamming the front door.

Stunned, Viktoria decides to close shop early and go upstairs. She had been nauseous all day, and had a splitting headache she couldn’t shake with strong coffee. Too much pepper vodka, she assumed. She heads upstairs.

She deposits her dirty clothes in the laundry bin in Babushka’s room; she does all the laundry in the household. She starts to leave and hears what sounds like a faint, muffled whimpering. Almost like a puppy, but there are no dogs in the family. She follows the sound. She creeps closer to Babushka’s closet, and the sound gets louder…

In Russian folklore, there is a mysterious, supernatural ogress masking as an older grandmother figure, described as having iron teeth and a complex personality. She cannot be defined by the terms good or evil, and is mostly misunderstood—but the crux of the misunderstanding is enough to warrant apprehension. She is Baba Yaga. The Baba Yaga is told to be a source of guidance for weary, lost travelers roaming the woods wherein she lives. She is also rumored to capture and eat little children that happen to cross her path.

Back at the clinic, Sofia finishes up with her last client, a pregnant teenager who’s parents’ don’t know she’s expecting. She hands the girl a bottle of prenatal pills that she has started stocking in the backdoor clinic. As the girl leaves, her two cousins walk in—Viktoria’s brothers. They all exchange glances.

“I think she knows,” Sofia says, “but the money is in the safe, so can we just let the girl go?”

The two brothers look at each other, then look at Sofia.

“If he’s good for a quarter of a million, then he’s good for half a million. Let’s pay him another visit tonight.”

Sofia is torn. On the one hand, Viktoria is her best friend; her cousin—more than that, she is emotionally her sibling. On the other hand, business is business.

“You guys should just—let her leave. She isn’t happy. You can’t keep this up much longer—it’s not healthy. Safe. Just let her go…let BOTH of them go,” Sofia quivers.

“Never. She’s too good. She know’s too much,” one of the brothers said.

“Technically—she shouldn’t remember anything...even though she did everything.”

Upstairs, Viktoria goes to open the closet door. It is the master closet; a walk-in space large enough to hold a poker table. It is disproportionately large to the size of the master bedroom that shares a space with it. Babushka walks by and notices Viktoria reaching to open the closet door. A woman of few words, she now, surprisingly, has a lot to say.

“Viktoria! How is the business? Do you love accounting? Help me finish dinner—let’s talk.”

Though Viktoria thought this was odd, she turned back and looked at the closet door, then shrugged and followed Babushka to the kitchen. After dinner, Babushka cleared the table and began washing the dishes. Viktoria went back into her grandmother’s room, and opened the closet door.

She was not prepared for what she found.

She silently gasped — she saw a girl—maybe eight? Nine?—curled up in a ball with her feet bound and her mouth gagged.

Viktoria quickly shut the door behind her and turned on the closet light. She asked the girl her name, where she lived, and who put her in there.

“Baba Yaga! Baba Yaga!” the girl screams and Viktoria quickly covers the girl’s mouth with her left hand and motions for her to remain silent with her right finger.

She looks at the girl, and says confidently, “I’m going to get you out of here…but you have to be quiet and follow my lead.”

Viktoria closes the closet door back, leaving the girl still inside. She scans the hallway to make sure no one is moving about. Babushka is still in the kitchen, finding something to clean. Mama is watching television with Viktoria’s younger brother.

She returns to the closet, and gets the little girl out. They creep into the hall, and out the door, downstairs, and out through the backdoor clinic and into the alley. As they run through the alley, the yellow glow of the streetlights washes over them, giving them angelic wings and halos.

The little girl trips, tumbling to cobblestone. Her knee is bleeding.

“She needs saline, antibiotic ointment, and a nonstick,” the nurse within her thinks.

She turns around. The backdoor clinic is within eyesight. She wants to take her to mend it, but she cannot—she must not. At this point, the clinic, the business, and the back alley are in her rearview mirror. Instinctively, Viktoria hugs her and wants to tell her, ‘everything will be alright’, but she learned in school—no false promises. Nothing is certain. The truth is—it very well may NOT be alright.

She continues to stare at the backdoor clinic, then realizes she’s standing in the exact spot where her grandfather’s body fell. She then realizes—she doesn’t think she’s ever actually seen his body...

But she has no time to think, or question, she must act. She must run.

They run—fast—to the little girl’s house, where her father greets her with open arms; the little girl’s mother let’s out an ear-piercing screech of joy. Her baby was home. Safe.

Viktoria sees the love and closeness of the family, and wishes she had that. She also realizes: the only way to keep her nursing license in tact—and her life—is to leave. Though its only a few miles away, the hospital is outside of the enclave. It is away from the back alley.

She takes out her phone, and calls her preceptor.

In this episode, we explored the sticky ethical issues that can happen when professional life intersects reality--and the one constant theme explored in this podcast, has been the fluidity and subjectivity OF reality. In the next episode, we'll explore that fluidity in more detail because, as we know by now, things aren’t always as they seem. Join me next Friday, for Episode 4, Part I of the Vaso & Vibes Nursing Psychological Thriller podcast. This episode was researched and written by Leslie Okhirkhian, for the Vaso & Vibes podcast. Thank you for listening. For show notes, audio credits, sources, and transcripts, visit the Vaso & Vibes Substack.

Disclaimer: This podcast is for informational and entertainment purposes only and does not constitute medical, psychological, or legal advice. The stories, characters, and scenarios discussed are creative, synthesized composites and do not reflect actual patient cases. The views and opinions expressed in this podcast are entirely the host’s own and do not represent the views of any employer, hospital, or healthcare institution.

For more information, visit: www.vasoandvibes.com

Credits:

Theme Song:

“Game Day” by JMHBM, from the Free Music Archive

Intro:

“Golden” by Little Glass Men, from the Free Music Archive; no changes were made to the original track.

Outro:

”Lofi Soul Hip Hop Mix 3” by Ketsa from the Free Music Archive; no changes were made to the original track.

Other Music:

“Tense and Rising” by Free the Muses, from the Free Music Archive

Each of these establishments opened up to the back alley.

Show notes, sources, & transcripts: subscribe to Vaso & Vibes on Substack

Disclaimer: This podcast is for informational and entertainment purposes only and does not constitute medical, psychological, or legal advice. The stories, characters, and scenarios discussed are creative, synthesized composites and do not reflect actual patient cases. The views and opinions expressed in this podcast are entirely the host’s own and do not represent the views of any employer, hospital, or healthcare institution.

For more information, visit: www.vasoandvibes.com

Credits:

Theme Song:

“Game Day” by JMHBM, from the Free Music Archive

Intro:
”Ephemeral III" (Lilith”” by Le Chaos Enter 2 Chaises, from the Free Music Archive; no changes were made to the original track

“Golden” by Little Glass Men, from the Free Music Archive; no changes were made to the original track.

Outro:
”Lofi Soul Hip Hop Mix 3” by Ketsa from the Free Music Archive; no changes were made to the original track.

Other Music:

“Tense and Rising” by Free the Muses, from the Free Music Archive

In a crowded loft apartment over an accounting office lived three generations of Viktoria’s family: Dedushka (her grandfather), Babushka (her grandmother), her two older brothers, her mother, and her younger brother. Dedushka, an accountant, owns the building; it is his office downstairs. Next door, Viktoria’s uncle, Dada Dima, owned the European store and lived above it with his family: his wife and his daughter Sofia. On the same block was the boxing gym also owned by the family.

Each of these establishments opened up to the back alley.

I’m Leslie, a CVICU nurse and urban planner at heart, and this is the Vaso & Vibes podcast. From the underbelly of critical care nursing: dark stories with a beautiful twist. Brilliantly absurd. Shockingly effective.

In the back alley, Viktoria and Sofia would play and dance with Viktoria’s younger brother while the adults smoked cigarettes and made bets on UFC fights. Sofia was her best friend. Clothes, secrets, and one time—even a boyfriend; they shared everything. More than cousins, they were as close as sisters.

The back alley was where the magic happened. The gray cobblestone provided just enough resistance to keep wrong-turn traffic out and the smell of fermenting dumpster refuse meant even the City didn’t want to deal with whatever dumped it. The alley had a special way of keeping the wrong people out and only the right ones in. It was as loyal as the inhabitants that occupied it.

On Friday and Saturday nights, Babushka would serve bowls of borscht with fresh cilantro and parsley, topped with healthy dollops of sour cream to the men gathering in the alley. A lot of their neighbors and even some friendlies from the Armenian community several blocks over came to make bets at Dada Dima’s store. They would place their bets and buy drinks, then sit in the folding chairs, eat borscht, and stream the fights on someone’s laptop computer, paying a few bucks a pop. On any given Friday and Saturday night, for about ten bucks, a man could get a drink, a bowl of borscht, and a front-row folding seat to the show. The streetlights offered the perfect yellowed afterglow to everything caught under their spell. For Viktoria, the back alley was an extension of home. A few years prior, the City built a park a block away to clean up the riffraff in the alleys, but it sits abandoned; the swing hinges are rusted over from infrequent use. Who needs a park when there are perfect alleyways to laugh, play, and be merry and be social? What the city sees as riffraff, they see as home…or the closest to it they’ll ever get outside of the former Soviet states.

This is one major problem with systems: though dysfunctional, there is some element to them that works, and that is why they are sustained. Often institutions (such as governments, planning commissions, and the housing authorities) feel the need to “clean up” (in other words—gentrify) or disrupt the system to make it fit into the neat little boxes they want it to for their theoretical or academically-pleasing principles. In so doing, they create the very marginalization they seek to resolve.

For the City, the back alley was problematic. Blightful. Unsightly.

For the Soviet diaspora, the back alley was familiarity, comfort, and safety.

Except for that one night.

Babushka tends the house. On Sundays after Liturgy she makes blinchkis (thin pancakes) with big bowls of spiced ground meat seasoned with fennel, ginger, and onions. The smell of the sautéing seasonings branches into the halls, penetrates the walls, and wafts through the back alley. Everyone answers the call. The extended family gathers around the table, laughing, talking, and enjoying the delicious meal. For Babushka, it is serious work; she takes it just as seriously as any nine-to-five desk job. Maintaining the home is her calling; she only leaves it to go to the store, to the Orthodox church, or to serve borscht in the back alley.

Babushka is a complex individual. She is quiet, but her words speak volumes. She is the matriarch, yet knows her place at the base of the family. She is submissive to her husband, yet he wouldn’t dare betray her. Babushka moves in silence, and to some this may seem intimidating—unnerving, even. Her stoic precision in executing her life’s work robotically gives, to some, uncanny valley. She wears many hats; she is the chef, housekeeper, laundry service, and the cleaner of all messes.

Indeed, in this life, there is no mess Babushka cannot fix.

Not even death.

On any given day, Babushka wakes up before the sun rises to tidy the house and prepare breakfast. The family eats together, Mama walks to work, and Dedushka and the two brothers walk downstairs to the office. Dedushka is an accountant and Viktoria’s two brothers are his associates. Or so they tell her. Mama works at the European day spa one street over, though its backdoors open up to the the alley way.

Not much is said about Mama; she flies under the radar, and this is a skill that took years to develop. Like white rice, Mama is bland and easily dismissed yet perfectly accompanies any and everything. She goes to work, comes home, plays with her young son, and goes to bed. She asks no questions, volunteers no extra information, and this is how she has survived for decades. She knows nothing about her father’s business and never question’s her mother’s routines. She only knows what people tell her because she chooses not to think for herself. Thinking is dangerous. Thinking makes people disappear. She has seen many people disappear through the years. There is safety in being easily forgotten. People who fly too close to the sun get burned and Mama clipped her wings long ago. She is worried about Viktoria; she knows her daughter is different. Her daughter is a phoenix, and she’s afraid her thinking lately is going to get her burned yet again in life.

Viktoria and Sofia recently graduated from high school and are studying to enroll in nursing school. Despite Dedushka being an accountant, Viktoria and Sofia will be the first persons in the family to go to college.

Dedushka is busy all year, not just tax season. For the Russian enclave, everyday seems like tax season, because everyday Dedushka sends his two grandsons to collect. Sometimes—a lot of times—accidents happen and people get hurt.

“Probably the cobblestone; its so unsafe,” Viktoria figured.

When bloody, disheveled clients show up in the back alley behind the office, they give two knocks on the back door. The two-knock calling card means Dedushka has sent someone to get cleaned up. Viktoria and Sofia would clean and dress their wounds and make sure they were hydrated. If they were hungry, they would offer them leftovers from Babushka’s dinner the night before. It happened so frequently, the two girls converted the back storage room in the office into a small health clinic, equipped with medical supplies like saline, antibiotic ointment, gauze, splints, and bandages. They mostly saw the same injuries: blackened eyes, contusions, and busted kneecaps. They became highly skilled in caring for these precise wounds. For a client seriously injured, they would stretch out a small cot and allow the man to rest until he were ready to get back out to work. This inspired their passion to go to nursing school, so they could take care of their people—their grandfather’s clients. He does so much for them, he is a good business man. It is a shame they find themselves hurt so often.

For the majority of them, going to the hospital wasn’t an option. They make a pact: they will go to nursing school so they can care for their friends, families and neighbors. The American healthcare system isn’t prepared to handle the…nuanced…needs of their community. Some of the boxers are Dedushka’s clients and asked the girls to extend their services to fighters at the gym. They obliged. The gym operators agreed to pay them cash to do minor wound care and nurse the amateur fighters. This would be their job to earn money for school.

There are several specialties of care that fall under the umbrella term of nursing. Licensed Practical Nurses, or LPNs and Associates Degree of Nursing, or ADN nurses have a wide scope of work that falls within their responsibilities of care, and Unauthorized Assistive Personnel, or UAPs, answer to them both. Nursing aides or nursing assistants fall into this category. Furthermore, nurses trained at the Baccalaureate level hold the widest scope of authority for nursing outside of advanced degree practice, and can delegate tasks to LPNs, ADNs, or UAPs. It is considered out of line for UAPs to perform patient assessments, administer medications, provide advanced wound care, or deliver patient education.

It is absolutely prohibited for UAPs to open clinics and independently manage patient care.

Viktoria and Sofia are accepted into a baccalaureate nursing program. The family celebrates. The community celebrates. Dada Dima donates bottles of his pepper-infused potato vodka distilled in the back kitchen area of his store, and jars of his wife’s homemade pickled vegetables. He infuses the bootleg vodka with chili peppers over months, giving it a dry, crisp, satisfying burn and sells it to the Slavic enclaves; his customers swear its better than anything in the package stores. Neighbors bring instruments and play live folk music. Children dance and play in the streets as the adults clap to the rhythm. Meats sizzle and crackle in their own fat on the grills.

The alley teems with the joy masquerading the tragedies yet to come.

The girls begin school and soon lock into a routine that in and of itself becomes comforting: they wake up, eat breakfast, go to school, then go to their clinic to perform client wound care. They study at night, and attend school and work by day. After work on Thursdays, Dedushka would gather his personnel to celebrate the business wins for the week. They would sit around the conference table, and one of Viktoria’s brothers would bring a tray of Dada Dima’s vodka shots from the breakroom freezer. He would hand one to each person; they would toast, then sit around laughing, venting, and reflecting on the week thus far. Afterwards they would go home for Babushka’s home-cooked dinner. Viktoria and Sofia would always join them for the Thursday Night Tradition.

One Thursday evening deviated from this norm.

The office had closed. Dedushka sent Viktoria’s two brothers away but stayed to catch up on “paperwork.” There would be no pepper vodka tonight. Sofia left a couple of hours earlier; she had a Canvas Discussion Board post due for school and dismissed herself after the last client left. Viktoria remained to check inventory and prepare a purchase order for her grandfather. More bandages…definitely. Non-sticks were fine; but saline was quickly running low. She finalized her list and placed it on his desk. He stands up, removes his reading glasses, and places them on the desk atop the purchase order.

“Spacibo, y dobray noche,” he says as he nods. “Thank you and good night.”

Viktoria nods. They gather their coats, turn off the lights, lock the doors, and head upstairs to the apartment. Dedushka pauses and turns around.

“Forgot something,” he says hesitantly. “Go on, I’ll be up in a few.”
Viktoria turns to continue walking upstairs when she feels a hand grab her elbow. A gentle hand, a familiar hand...

(Dramatic pause; suspense music plays.)

…it was Dedushka. He spins her around.

“I love you. I’m proud of you. Remember that.”

Puzzled, she half grins and nods, continuing to walk upstairs. Little does she realize: this was possibly the last time she would see Dedushka alive.

In nursing school, Sofia and Viktoria conduct immersive clinical experiences on the intensive care unit at the local hospital. It is their favorite rotation. They are fascinated by the drips, the pumps, and seeing patients at the brink of death being slowly brought back to life…in some cases. Their preceptors are knowledgeable, patient. Eager to be molding the next generation of critical care nurses. Teaching with the left hand, and recruiting with the right. The supposed nursing shortage has the unit eyeing their best students for career placements, and Viktoria knows this.

“What would you think about coming to work here when you’re done with school?” her preceptor asks her.

Viktoria pauses.

“I would absolutely love to come work on this unit, and would give my left kidney to do so,” she screams internally, but remains outwardly stoic.

“It would be nice, but I can’t. I must help run my family’s clinic,” she sighs.

Viktoria has been torn between two fates: leaving the family business and building a real, stable career in the hospital ICU…or remaining loyal to the only institution that has had her back. Where will her preceptor be—her fellow students, and the school even—when she gets jumped in the back alley for turning her back on her community…or worse?

She has no choice.

She sits in the hospital food court with her cousin Sofia; she hasn’t eaten in eight hours yet somehow feels full…the weight of her conflict satisfying her appetite. She stirs her spoon around her soup, tracing a figure eight repeatedly.

“Shto takoe?” Sofia asks. “What is it, what’s up?”

“What if we worked here when we graduate? This place gives us a shot at really shaking things up at home. We could actually make a difference, you know.”
Sofia stares silently at Viktoria.

“That can never happen. We are here for one reason: get the degree and go home to help our people. No one has their back. No one gets them like we do.”

They finish their meal in silence and return to the unit. The lunch table was the only place they could speak their language comfortably, express themselves honestly, and set aside the pressures of school and clinicals…even if only for thirty minutes. They return to the unit, and Viktoria’s preceptor tells her they’re getting a new admit.

“Forty-one year old male, up from the E.D. with Diabetic Ketoacidosis. He doesn’t speak much English, so you’ll have to get the mobile translator,” her preceptor says.

“What language does he speak?” Viktoria asks.

“I dunna, something Slavic probably, his name is Mikhail Romanovskidomichovich-something-whatever,” the preceptor says with the crass douchebaggery of someone bearing a very punchable face.

“So he speaks Russian…”

“Ooops my bad I forgot you were one of them!” the preceptor says.

Viktoria cuts her a cold look, searing through the preceptor’s soul like a knife through Swiss cheese. She enters the patient’s room, sanitizes her hands, and walks to the bed. She greets him in Russian and asks for his name.

She learns that he recently moved to this country from Moscow. He was a powerful immigration attorney, with a prominent practice. He sold his business and moved to the United States because his daughter was born with a rare medical condition for which the most advanced treatments were in this country. So they packed up everything and came here. He sacrificed it all —including his insulin—to afford the treatments she needed. In providing everything for her, he left nothing for himself. She is thriving, and he was dying.

He speaks to her in perfect English. No translation service was needed.

“Sir, your blood sugar bad. You in ICU. You need fluid and insulin. We help,” the preceptor says rudely in broken English.

Both the patient and Viktoria look at the precepting nurse with consternation.

“He speaks perfect English,” Viktoria said.

“You know, I’m not stupid. Just sick. Please don’t talk to me this way,” the patient asks politely.

“Izvenitye, Pozhaluysta,” Viktoria says and nods to the patient. “Excuse me, please.”

She motions for the nurse to follow her out of the room. In the hallway, the nurse looks at Viktoria with reprimand in her eyes.

“Highly inappropriate, Viktoria,” the preceptor says.

“No, what you did was insulting. He is right—you treated him with disrespect. Did you even listen to why he is here in the first place? How you treated him makes me wonder what you really think of me. You know I can’t wear fancy scrubs or buy those expensive water bottles. I pack the same soup everyday because I can’t afford a burger in the food court. Not only am I working for free but I’m being insulted in the process. And you know what? When I leave here? I have to go take care of my people in my community—people just like that patient, because they don’t trust people like you—and now I see why. When this clinical is over, take your job and shove it.”

That evening, Viktoria rushes home. Eager to be with her family after the traumatic experience at the hospital earlier, she resents having missed breakfast for what amounted to a day of unexpected chaos and disappointment. She arrives and finds yellow crime scene tape surrounding the back alley, and a detective speaking with her brothers through a Russian language translator. She runs upstairs to the apartment, and finds Babushka, Mama, Dada Dima, and her brother seated around the kitchen table.

No Dedushka. Her heart sinks.

Mama gets up and runs over to Viktoria, and holds her daughter tight against her chest, rubbing her back in that comforting way all mothers do.

“I’m so sorry, baby. Dedushka’s….dead.”

To find out what happened and what Viktoria does about it, join me next week for Part 2. This episode was researched and written by Leslie Okhirkhian, for the Vaso & Vibes podcast. Thank you for listening. For show notes, audio credits, sources, and transcripts, visit the Vaso & Vibes Substack.

Disclaimer: This podcast is for informational and entertainment purposes only and does not constitute medical, psychological, or legal advice. The stories, characters, and scenarios discussed are creative, synthesized composites and do not reflect actual patient cases. The views and opinions expressed in this podcast are entirely the host’s own and do not represent the views of any employer, hospital, or healthcare institution.

For more information, visit: www.vasoandvibes.com

Credits:

Theme Song:

“Game Day” by JMHBM, from the Free Music Archive

Intro:
”Ephemeral III" (Lilith”” by Le Chaos Enter 2 Chaises, from the Free Music Archive; no changes were made to the original track

“Golden” by Little Glass Men, from the Free Music Archive; no changes were made to the original track.

Outro:

”Lofi Soul Hip Hop Mix 3” by Ketsa from the Free Music Archive; no changes were made to the original track.

Other Music:

“Tense and Rising” by Free the Muses, from the Free Music Archive

Monday morning is when Millie comes to C23; she always does. She brings colored pencils—freshly sharpened—coloring books, and masking tape. Claudia loves the fractal sheets. Swirling geometric patterns of leaves and nautilus shells.

“Everything spirals eventually in nature; it is no less beautiful,” she says.

I’m Leslie, a CVICU nurse and urban planner at heart, and this is the Vaso & Vibes podcast. From the underbelly of critical care nursing: dark stories with a beautiful twist. Brilliantly absurd. Shockingly effective.

Millie tells Claudia about her decorating adventures for her new apartment, and how she’d rather live a life of bare bones simplicity and cheap IKEA furniture than break down and get a roommate. Always the happy loner, she’d have it no other way. Though she’s been checking the thrift stores within a few-block radius, nothing ever quite seems just right. Perhaps that’s why she and Claudia got along so well: they were very clear about how they wanted things to be. Their way or the highway.

“You should blend the yellow and orange in your sunset with the grapefruit color—make that scene come to life!” Claudia told her.

Claudia never hesitates to offer her opinions on all things beautiful and colorful. This was their routine for the last six months. Millie would drop by, complain about her boyfriend du jour or discuss her latest purchase for that “college chic” loft apartment she never shut up about. Claudia would listen and interject with blunt objectivity, delivering searing advice Millie knew she needed to hear but felt painfully sweet to sensitive ears. Likewise, Millie would listen as Claudia ranted and raved about her next door neighbor.

“He’s always asking me out to a movie. I don’t have time for that.” Claudia said…with unintentional irony.

Mondays came, and passed. They laughed, talked, and colored. Each week when it was time for Millie to go home, she hugged and said, “take care.”

The week passed, and Millie and Claudia lived parallel lives. Claudia, now retired, spent her days with Lexi watching soap operas and tinkering around the place, and her evenings letting herself be annoyed with Mr. Clemmons’s untoward advances. Lexi was her hired help. She came by on days when Millie wasn’t there, helping Claudia take care of things around the place. Millie thinks she’s seen her in passing a couple of times; a short girl, around Millie’s age. Long curly, bushy hair. A martini glass tattooed on her wrist; probably an ode to a past bartending life.

In the right lighting, the two could pass for twins.

Millie on Mondays, Mr. Clemmons at night, and Lexi in between. It was a perfect system.

But dysfunctional systems were ment to be broken.

(Pause, dramatic music.)

Millie spent her week working—she was a copywriter for a luxury hotel brand, yet lived in a cheap but swanky downtown loft apartment over the Twenty-Sixth Street Bodega. She worked from home, leaving only for the gym, to pick up groceries, shop for more art supplies…and on Mondays to see Claudia.

This Monday, March 14, was different.

To appreciate how this Monday was different, let’s rewind to simpler times. Since she was ten, Millie spent summers at Claudia’s house, climbing the big oak tree in the front yard, catching lightning bugs in Mason jars with big holes poked in them, and playing in the Dead End street with Tonya and Katrina until the streetlights came on.

Claudia’s house was magic. Large, hand-stretched canvases draped her walls with abstract hues of violet, midnight black, and cerulean; colors dripping with intentional spontaneity. On others, shades of crimson and green swirled like bellydancer hips to the beat of their own drum. In the corners were towering statues and artifacts from her worldly travels.

Claudia always found beauty in spirals.

On rainy days and muggy nights, Claudia would escort Millie to her downstairs studio, with architectural desks and easels, each illuminated by the glow of their own 50-watt incandescent star. Claudia helped Millie hone her craft. When she first began painting, Claudia taught little Millie how to use her tremors to her advantage: for painting water ripples in sea scapes and pine needles on evergreens. Her disability was her greatest artistic asset. Claudia taught little Millie to use her dominant left hand for fine motor brush strokes, and the essential tremor in her right fingers for elements requiring a little more abstract, creative liberty.

A now retired Art and Photography professor, Claudia spent the better half of three decades teaching young adults the fundamentals of painting, and for each summer during those years, Millie came to Claudia’s house to play and paint. Through the years, Millie and Claudia would find new places to visit, favorite businesses to frequent, and one stop they loved most was the bodega on Twenty-Sixth Street. The bottled horchata was smooth and delightfully refreshing. The bodega on Twenty-Sixth Street became their new favorite third place—it wasn’t home, or the Dead End Street—it was some place they both could find common ground.

So when in early September Millie signed a lease for the loft apartment over the Twenty-Sixth Street bodega, she HAD to go to Claudia’s to celebrate.

(Pause. Draumatic Music.)

Millie picked up two bottles of horchata from the bodega, greeted Hector, the owner who always had kind words of advice and a sweet prayer for them, and hurried over to Claudia’s house.

When she arrived, she rang the doorbell. No one came.

She tried calling; no answer.

“She must be painting in the basement,” she deduced, and walked around back to the basement door.

Still no Claudia.

(Pause. Transition music.)

Amyotrophic lateral sclerosis, or ALS, is a neurodegenerative disease that slowly and progressively wittles away the neural scaffolding of the body. It robs patients of their ability to walk, move, and eventually, talk and breathe. ALS is a cruel, cruel disease with a one hundred percent death rate. There is no known cure.

Many find the slow decline of ALS to be intolerable, watching as their life fades away.

For patients with ALS, effective nursing care is essential and often shares a fence with ethical and moral dilemmas. Nurses must first assess their own values and beliefs about death and dying, what that looks like, and who ought to determine what exactly a ‘good death’ means.

What does a good death look like? Does it mean beating on a person’s chest and cracking ribs, only to prolong more suffering? Does it look like paralyzing the chest muscles and shoving tubes down a throat to keep oxygen flowing to the heart and brain? Does it look like a million drips, constant pump alarms, and escalating interventions each time the body possibly indicates it has had enough? Does it mean bitter pain and suffering right to the moment of expiration?

They may sound cruel, but each of these questions addresses a key component of life-saving interventions used in critical care settings. Cardiopulmonary Resuscitation, or CPR, provides manual tissue perfusion through forced external heart pumping. Intubation allows a way for oxygen to be forced into the body. Vasoactive drips, like vasopressin (think: the “Vaso” in Vaso & Vibes), forces the blood away from the extremities and back up to the core and vital organs when blood pressure tanks. It must be titrated, or increased and decreased, based on how the patient’s body is responding to these interventions.

Most people think about these questions in do-or-die situations, when they absolutely must be answered. That is the absolutely wrong time to think about these questions.

Millie grabbed a loose concrete pathway paver with both hands and hurled it through the slit window of the basement door. She reached in to unlock the door from the inside, cutting an inch-long gash on her non-dominant forearm. She looked through the cracked glass and saw Claudia sprawled out on the concrete basement floor, a large boar-bristle paint brush still in her hand.

Millie gasped in disbelief and grabbed her cell phone out of her back pocket, getting blood all over her khakis.

“NANA!” she screamed, with an ear-piercing shrill.

She called 911. Minutes later, paramedics arrived and Millie and her grandmother were en route to the Level 1 Trauma Center downtown, not far from the bodega and her new loft apartment.

The paramedic looked at Millie’s arm.

“You’re bleeding. Let me get that for you,” he said.

Millie outstretched her arm, revealing a bilateral asymmetry she could teach a Master Class on concealing.

“What happened?” the paramedic inquired.

“Shoulder dystocia when I was a baby.”

“Wow…well it doesn’t look like its stopping you, good for you!” the paramedic said.

“Nothing stops me from doing anything I really want to do. Nothing.” Millie said defiantly and a tad overdramatically.

At the hospital, Millie, who also needed stitches, waited in a separate emergency department bay, holding the her arm around the bloody rapid-fire wound care setup the paramedic dressed in the ambulance.

Several hours later, Claudia was admitted upstairs to the Neurological Intensive Care Unit. Several hours after that, she pieced together what happened.

“I don’t know what happened to me, my legs gave out on me. I mean I’ve had some twitches and shakes for a few weeks now, but nothing like this,” she told the physician, who nodded, took a deep breath, and paused before cautiously choosing his next words.

“I believe I know what’s going on, but I want to run some tests first to be sure.”

Several days later, Claudia had a diagnosis.

Claudia sank back into the hospital bed, her new life started.

For the next few weeks, the world was not the same place anymore. The sky seemed gray—charcoal even. Life was dark. The canvases in the basement remained bare.

On a Monday, Millie came over to Claudia’s home. She was sitting in the rocking chair, watching soap operas, staring blankly at the television. Her eyes were open, but no one was home.

“Okay, Nana, no more of this. Nothing is stopping you. What do you want to do? We’re gonna do it.” Millie said, her voice shaky and cracky, yet somehow confident. Typical Gemini contradiction.

With coaxing, Millie transferred Claudia to the wheelchair, and together, they journeyed to the bodega on Twenty-Sixth Street for horchata. Seeing them wheeling up, Hector, the owner, raced over to open the door and wheel Claudia in. He greeted them with a smile and two horchatas.

“Ayyye, nice wheels Mrs. Claudia!” Hector smiled.

“It’s been a while, Hector. Great to see you. We have a lot to talk about.”

They chatted for what seemed hours, talking about the incident in the basement, the ALS diagnosis, and what life had been like for the last few weeks. Claudia struggled to realize nothing had changed…but everything had changed. She no longer trusted herself to walk. What if she dropped hot coffee on her lap? What if she could no longer paint? For the past few weeks, Claudia had been grieving the life that her future self thought she would have. Life seemed infinite, like a fractal. Now she had an expiration date, like horchata.

“No, Señora, none of this. I have just the friend for you! Life is just getting started!” Hector smiled, gave a hopeful laugh, and took out his phone. Claudia and Millie looked at each other with the curiosity of a head-cocked puppy at something jumping in the grass.

“Mija! I found the perfect job for you!”

Systems approaches often evaluate phenomena by looking at three key anchoring elements: boundaries, interrelationships, and perspectives; the problem with perspectives, though, is they’re based on someone else’s reality.

There is no objective reality; there is my reality, your reality, and the space that occupies us both. This explains why death is viewed differently in different systems. After funeral services in the heavily-influenced Cajun and Creole New Orleans, some families coordinate jazz processions that travel from the service to the site of burial, playing somber hymns. Once the deceased is interred, the celebration begins and the jazz band plays uplifting, upbeat songs that encourage celebration for the life that has lived, loved, and made an impact on those spirits left behind.

One aspect of the death space and environment, is how care for the dying person ought to be managed and navigated. The time of transition is highly personal and individual to each person walking through it, but there are consistent themes worth understanding for persons with terminal illness. Once a patient receives a formal diagnosis with a provider-anticipated six month or less prognosis, the plan of care shifts. A curable course is not followed, and patient comfort is prioritized and quality of life drives therapeutic interventions. Hospice services include preparation for death on social, spiritual, emotional, practical, and financial levels; it is a steady hand navigating patients and families—embracing all of their realities—at this point in their lives.

Hospice care can take place in the dying person’s home or hospitals, to a certain extent.

(Pause.)

Even in dedicated assisted living facilities.

(Pause.)

A month of Mondays passes by, with Millie dutifully dropping by for coloring and conversation with Claudia. She knocks, then opens Claudia’s front door. She removes the colored pencils and the fractal coloring book from her handbag and asks Claudia what colors she wants to use.

“Turquizz n black for stuurters,” Claudia slurs. Her speech has worsened lately. She can no longer sip horchata like they used to. She is fully wheelchair-dependent, and requires substantial assistance with daily care activities. She gently tapes the turquoise pencil to her right hand, and the black to her left…just like Claudia used to do for Millie decades ago.

“Now remember, Nana…shading and abstract with the right; fine motor detailing with the left. You got this!” Millie encourages her.

As they sit and talk, there’s a sudden knock on the door.

“Prrly Lessi,” Claudia says.

Millie opens the door. A tall, slender older man with a kyphotic hunch stands before her, and cocks his head in confusion.

“Jess Ann! Hey Jess Ann, you sly fox! You comin’ to movie night?!" the man asks forcefully but with the mack and game of a seventies pimp. Clearly, he was quite the ladies’ man in his day.

Confused, Millie turns to ask Claudia about the matter but before she could open her mouth, a petite blond-haired woman in scrubs with the patience of a patron saint slips behind him, gently grabs his hand, and guides him away.

“Mr. Clemmons, that’s Not Jess Ann! Jess Ann is not here, its time for your dinner! Let’s go to the dining hall, to eat and watch a movie. Mrs. Doubtfire is on tonight!” she says, and redirects him. He walks away.

“So sorry about that! Mr. Clemmons lives in Hospice C22 next door. His dementia gets worse this time of day. Jess Ann was his wife, but she’s long been passed. Anyways, how is Mrs. Claudia? Is…is it a good day for her today?”

Stunned, Millie starts to speak.

“I— but—nevermind. She’s fine.”

Another few weeks pass, and on the next Monday, Millie comes. March 14.

Millie takes out the colored pencils and coloring books, and as she reaches for the masking tape, Claudia feebly tries to shoo away Millie’s hand.

“Not tday. No more. I’m dn. Plss. Its been fun…but I’m dn,” Claudia says, saliva dribbling down her face.

She’s been having a lot of secretions lately, making it difficult for her to talk and swallow. Millie knows what this means.

She looks at Claudia, who can barely turn to make eye contact, and sighs. Over the past few months, Millie witnessed Claudia’s coloring art progress from neat shading with deliberate strokes within the lines, to messier, angrier, impressionist pencil strokes that barely filled in the objects on the page…to random, abstract squiggles and curves. She saw the pages go from neat, to slightly crumpled, to ripped in places and waterlogged from drool stains.

“Yes, Nana. It’s time.”

Millie planned the party.

She ordered balloons and streamers, a cake for the guests. She called Claudia’s friends (the ones still alive), and invited them to come over. She looked through Claudia’s phone, but couldn’t find Lexi’s number. She shrugged.

“I hope she can make it…”

She stopped by the bodega, looked at Hector, and with a lonely tear in her eye, whispered:

“It’s time.”

Hector understood the assignment. He walked around the corner with an empty liquor box and filled it with bottles of horchata.

“On me, Señorita. See you Monday.”

On Monday, everyone arrived at Hospice Residence C23. Even Mr. Clemmons, there to wish the lady in his reality a happy something-or-other. Though broken, the system gave everyone something to live for based on their own perception of whatever reality was supposed to be. They laughed, drank horchata, sang, and Hector wheeled Claudia to the center of the room. He turned up the music, it was Carlos Santana’s “Maria, Maria”. He spun her around, back and forth, and took a bow.

Claudia’s long flowing hair swirled through the air as he turned her around and around, back and forth, in her chair. The sunlight glowed down on her face from the big window. Millie had dressed her in her favorite pleated skirt, and a blur of red and purple swirled as she turned. There, on the dance floor, years melted away as she spiraled. The young girl who saw the world in technicolor and dreamed of becoming an artist. The young girl who told her parents she would be a professor and teach art to the masses. The young girl who traveled the world to experience the world’s palette. The young girl who believed nothing could stop her…not even death.

“One last dance with m’lady!” Hector smiled.

There was no sadness in the building.

That Friday, Millie walked into the bodega before heading upstairs to her apartment. Hector was there, pleasant and prayerful, as usual.

“Hey Hector, I wanted to say thank you for connecting Lexi with my Nana, she really helped her get through the tough times these last few months. She’s an amazing nurse.”

Hector furrowed his brow in a display of perplexity.

“Lexi?! Who is Lexi?!”

“Your niece? The nurse you said you were going to connect to my Nana…remember? You called her that day when we were all here in the store, right after she got the news,” Millie clarified.

“No Señorita, I think you’re confused…I called my niece OLIVIA, to try to connect her with your grandmother, but her agency wouldn’t accept the type of insurance your grandmother had. So it fell through. I felt so bad…I swear…the system is so broken.”

Puzzled, she walked up to her apartment and opened the door. She plopped her bags down, grabbed a horchata from the fridge, and looked around at the beautiful place she called home. It was filled with the large paintings from Claudia’s old house. In the corners were the statues from her worldly adventures. She was pleased.

She walked over the shag rug—was it Mjuk? Yes, that was the IKEA name for it—and let its fluffy tendrils sink into her feet and between her toes. She sipped the horchata and sighed pleasantly.

“Aaahhh, this is peace.”

She opened the sliding glass balcony door, and stepped out to see the sky. It was exceptionally brilliant that afternoon. There was a perfect ombre of yellow and orange, with—grapefruit?!—in between. She sat on the balcony, and sipped her horchata.

She called the Hospice Residency.

“Hi, this is Millie, the family for Claudia in C23. Could I please speak with Lexi?”

“Oh, hi Millie! Lexi? I’m …I’m sorry…we don’t have any nurses by that name,” the front desk lady said.

“No, I think you’re wrong…she is petite, has long, curly, bushy hair like me…I think she has a martini glass tattoo on her wrist? ” Millie insisted.

“Miss Millie, we don’t have anyone by that name or description that works here. We don’t have any Lexis, Alexises, AlexUSes, Alexandrias, Lexingtons…nothing, I’m sorry, ma’am. We don’t have any nurses that fit that description.”

“Okay but—who’s been taking care of Claudia when I’m not there?”

“Miss Millie, we have two around-the-clock staff nurses making sure medication passes are completed and that patients are comfortable. But they always noted that Mrs. Claudia is so well taken care of and loved by family; your sister does a great job of taking care of her…even with her broken arm.”

“I don’t have any sisters,” Millie said. “I’m her only family.”

Join me next time. This episode was researched and written by Leslie Okhirkhian, for the Vaso & Vibes podcast. Thank you for listening. For show notes, audio credits, sources, and transcripts, visit the Vaso & Vibes Substack.

For more information, visit: www.vasoandvibes.com

Credits:

Theme Song:

“Game Day” by JMHBM, from the Free Music Archive

Intro:
"Golden” by Little Glass Men, from the Free Music Archive; no changes were made to the original track.

Outro:
”Lofi Soul Hip Hop Mix 3” by Ketsa from the Free Music Archive; no changes were made to the original track.

Other Music:

“Tense and Rising” by Free the Muses, from the Free Music Archive

Disclaimer: This podcast is for informational and entertainment purposes only and does not constitute medical, psychological, or legal advice. The stories, characters, and scenarios discussed are creative, synthesized composites and do not reflect actual patient cases. The views and opinions expressed in this podcast are entirely the host’s own and do not represent the views of any employer, hospital, or healthcare institution.

“Everything spirals eventually in nature; it is no less beautiful,” she says.

Credits:

Theme Song:

“Game Day” by JMHBM, from the Free Music Archive

Intro:
"Golden” by Little Glass Men, from the Free Music Archive; no changes were made to the original track. 

Outro:
”Lofi Soul Hip Hop Mix 3” by Ketsa from the Free Music Archive; no changes were made to the original track.

Other Music:

“Tense and Rising” by Free the Muses, from the Free Music Archive

Disclaimer: This podcast is for informational and entertainment purposes only and does not constitute medical, psychological, or legal advice. The stories, characters, and scenarios discussed are creative, synthesized composites and do not reflect actual patient cases. The views and opinions expressed in this podcast are entirely the host’s own and do not represent the views of any employer, hospital, or healthcare institution.

For episode sources, visit: Vaso & Vibes Substack

Credits: 

Theme Song:  

“Game Day” by JMHBM, from the Free Music Archive

Intro: “Carnival of Souls” by HoliznaCCO, from the Free Music Archive

Other music:

“Ex” by Nctrnm, from the Free Music Archive

“Tense and Rising” by

 Free the Muses, from the Free Music Archive

Disclaimer: This podcast is for informational and entertainment purposes only and does not constitute medical, psychological, or legal advice. The stories, characters, and scenarios discussed are creative, synthesized composites and do not reflect actual patient cases. The views and opinions expressed in this podcast are entirely the host’s own and do not represent the views of any employer, hospital, or healthcare institution.

Its a balmy Saturday afternoon. A heavyset, seventy-eight year-old man walks into the general store. No stranger to this place, its his lifeline for morning essentials: diet cola, a “dollar scratcher”, and a bacon, egg, and cheese biscuit with a “touch” of mayo. He hobbles to the counter with a limp twenty years in the making; it gets worse when it rains. Reaching into his pocket, he pulls out a wad of crumpled dollar bills and exactly thirty-seven cents. With burly hands tough enough to pull tobacco but tender enough to rock six grandkids to sleep, the man reaches over and hands his due to the petite cashier behind the register. She goes to the local high school, and on the weekends she helps run her parent’s general store. She studies in short bursts between handling customer transactions.

“University is your ticket outta here,” her English teacher told her, so she works hard to make it count. Her English teacher is the man’s daughter. One of them; he has five.

The cashier has known the man since she was old enough to have memories. Old Man Jim, a farmer with eighty acres down the road, stopped in every morning for the past twenty years to get his bacon biscuit, soda, and scratchers like clockwork. Old Man Jim maintained a precise routine. He drove into town (50 miles away) on Mondays to stock up, went to church on Sundays, and tended his crops on weekdays in between.

But every morning, he went to the country store.

“Hey young lady, how’s life treating you today?” he asked the cashier.

“Same as it always is, I guess. How’re you?”

“Better than blessed! Have a good one young lady!” he responded cheerfully.

“Thanks! See you tomorrow!” the cashier responded, fully intending to see him again tomorrow morning.

(Pause, transition music.)

Old Man Jim started his truck, took a bite of his biscuit, and headed down the dirt road to his tobacco crops. He turned into the driveway, killed the engine, and sat back to savor two more bites of his bacon biscuit. He looked out the window, watching a brown thrasher quarrel with a sparrow over something trivial. Probably a nightcrawler. He grinned as he watched the altercation; it reminded him of the twins—his grandkids—fighting over a toy from Christmas past.

He finished the sandwich, took a swig of the diet cola, and shut the truck door. He grabbed his shovel from the truck bed (it was mainly to threaten ratsnakes that snuck up on him from time to time) and walked towards the crops.

Fifty minutes later, he was dead.

(Transition to theme music.)

I’m Leslie, a CVICU nurse and urban planner at heart, and this is the Vaso & Vibes podcast. From the underbelly of critical care nursing: dark stories with a beautiful twist. Brilliantly absurd. Shockingly effective.

While most of you listening are in the healthcare space, there are others unfamiliar with many of the terms I use in this podcast. Sooo, let’s get into it. “Vaso” is an abbreviation for vasopressin, which is a drug we use in the ICU to help get a patient’s blood pressure up when its dangerously low. It is a coded term familiar to those in critical care environments. “ICU” stands for intensive care unit.

What Old Man Jim likely experienced was cardiac arrest caused by cardiovascular disease, obesity, and other factors, many of which were out of his control. Cardiac arrest is when the heart stops beating. Blood ceases to flow, and tissues stop getting oxygen. Cardiac arrest is a medical emergency.

Nearly 90% of cardiac arrests that happen out of the hospital are deadly, and only about 9% of adults experiencing out-of-hospital cardiac arrests who actually receive timely emergency medical care and MAKE IT to the hospital survive to discharge. For rural areas like Old Man Jim’s town? The statistics are…much worse.

To help you wrap your mind around just how deadly medical deserts can be, let’s examine an experience from Old Man Jim’s past. Twenty years before Jim drew his last breath in that tobacco field, his wife woke up at 4:00 AM to braid her hair and make the biscuits…

(Pause, transition music.)

Hazel, Old Man Jim’s wife, was a lunch lady at Baileyville Elementary. She was short and stout, like a tea kettle and just as loud and steamy. Every weekday morning, she awoke at 4:00 am to get dressed and french braid her hair into a bun updo secured tightly with a paisley-printed duckbill clip to keep it all tucked in. She would hobble to the kitchen, gather all of her ingredients, and get to work making buttermilk biscuits and frying bacon for her and Old Man Jim. He would awaken to the sweet smell of maple bacon dancing in the cast iron skillet. They would eat their breakfast, sopping up every bit of the currant jelly and the moment together; a silent, sacred meditation in each other’s presence. After breakfast, she would sit on their back deck and enjoy a Virginia Slim cigarette while watching the birds quarrel over the near-empty bird feeder. Those brown thrashers were always picking fights.

“Just like the twins,” she thought.

She extinguished her cigarette butt on the ceramic ashtray Baby Judy, her daughter, made for her one day in high school Art class. It was pink, with yellow morning glories and the words “I love you, Mama” painted in the equivalent of hand-scripted Comic Sans. But Baby Judy wasn’t a baby anymore; she was now grown with two kids of her own; the ashtray the only remnant of a creative childhood streak tainted by the realities of life in rural poverty.

Hazel grabbed her apron, drove to work, and made the buttermilk biscuits for the entire Baileyville Elementary student body.

This was Hazel’s routine for most of her adult life.

One chilly Autumn morning, Hazel woke up, made the biscuits and bacon, and sat down with Old Man Jim for their morning ritual. When they were done, she got up, cleared the table, grabbed her cardigan from the coatrack, her Virginia Slims, and stepped onto the back deck. It was her “me” time. Self-care before the day’s chaos begins.

“Chilly out,” she mumbled, a cigarette pursed between two lips, bopping with each syllable. She lit the cigarette and sat down with her coffee mug to watch the brown thrashers quarrel…

An hour later and now dressed in his farming overalls, Old Man Jim walks to the front door and grabs his truck keys. He looks out the picture window and notices Hazel’s blue Toyota Corolla still parked in the driveway.

”Hmm,” he thought, “must be havin’ car trouble.”

But in his gut, he knew something wasn’t right. The sun was shining eerily bright…too bright for such a deceptively cold day. He looks out the back porch window, and sees a ray of sunlight washing out Hazel’s French braid-bun. At this angle, he can only see her head.

“Probably dropped a cigarette,” he thought. He didn’t really believe that.

“HAZEL,” he yells out.

“Hey Darlin’ you got car trouble?”

No response.

He walks through the kitchen, picking up speed as he passes the China closet and barrels through the back door. He steps onto the back porch, and forces himself through the storm door and onto the deck.

Hazel is still slumped over, coffee cup spilled all over her lap. Her cigarette butt still smoldering, smoke rising over the words “I love you” in the ceramic ashtray. A haunting chill comes over Old Man Jim. He lifts his clubby, weathered hands and gently stroked Hazel’s cheek with an ironic tenderness. A true “Beauty and the Beast” moment, Southern Living edition.

“Hazel! Don’t leave me! Hazel! Hazel!”

He slides his hand to her neck, checking for a pulse but doesn’t know exactly what he’s checking for.

“Hazel! Lawd, thy will be done…"

Hazel died “old and gray”, which isn’t saying much for the South. The county coroner ruled the Cause of Death to be Sudden Cardiac Death resulting from cessation of cerebral blood flow and global tissue hypoxia. Her heart stopped due to a complete blockage in the Left Anterior Descending artery. Blood and oxygen weren’t flowing to her heart, so eventually blood stopped flowing through her heart, to her brain, and the rest of her body.

So what causes this? Let’s examine Hazel’s life.

Studies of rural-urban disparities have consistently found that, in cases of ischemic heart disease, rural patients tend to be older, female, White, and smokers.

Hazel lived a life in poverty but beautiful in its simplicity. Each day was beautiful, lived in dutiful devotion to her spouse, her work, and…in that moment of solitude with a cigarette and coffee on her porch…to herself. And she lived out that simple, beautiful life each day until it killed her.

Chronic smoking is a risk factor for Sudden Cardiac Death. Hazel was a chronic smoker.

Obesity is a risk factor for Sudden Cardiac Death. Hazel was obese.

A diet high in animal fat is a risk factor for Sudden Cardiac Death. Hazel ate buttermilk biscuits and bacon everyday of her adult life, and that was only for breakfast.

Nothing could have been done differently in that moment to save Hazel’s life, but if something COULD be done—let’s think hypothetical, for a moment—what would that something be, and what would be the outcome?

Let’s play the tape all the way to the end.

Hazel is sitting on her porch, smoking her cigarette. Suddenly the jaw pain she’s been feeling for days now is worse, and there’s a severe pain in her chest. An 'elephant-sitting-on-her-bosom’ level of pain.

Now let’s say Old Man Jim is sitting on the deck with her. Now he doesn’t smoke, but he does love a hot cup of Sanka and a good bird fight. Let’s say he’s sitting on the deck, sees her body jerk and double over and her grabbing her chest. Let’s say he’s good and well-versed on emergency medical response, and instantly runs over, taps her shoulders, asks if she’s okay, then yells for someone to call 911.

But someone isn’t there. No one is there to call.

So he calls 911, drags her heavy body from the deck chair to the hard deck floor surface.

The dispatcher says it will take twenty-one minutes for a volunteer rescue squad to arrive, and tells Old Man Jim, “stay with me.” He guides the desperate husband through Cardiopulmonary Resuscitation, or CPR.

Let’s say Old Man Jim achieves what’s called ROSC, or Return of Spontaneous Circulation. ROSC means that Hazel now has a palpable pulse—and Old Man Jim actually knows what that feels like—and is getting circulation through her body.

Now Hazel is suddenly breathing, coughing.

The next biggest hurdle? How long will that ROSC sustain?

But, this is a hypothetical thought experiment, so let’s assume Hazel sustains ROSC for the-now fifteen minutes it takes for the ambulance to arrive. So the ambulance arrives, Hazel is loaded onto the stretcher, and the EMTs (Emergency Medical Technician) and paramedic do everything possible to keep Hazel alive for the FIFTY minute drive to the closest hospital, which is not even a Level-1 Trauma Center. It is the rural hospital in the closest town to Hazel and Old Man Jim. It is where he drives every Monday to get groceries for the week.

(Pause.)

It is scheduled to close in six months, and here’s why.

Over 180 rural hospitals have shuttered their doors since 2005. Hundreds more are at risk. Hospitals cost a LOT of money to run, and they depend on large patient volumes and reimbursement from insurance companies to cover those costs. With the average small town rural household making approximately $61-$66,000 per year, and with a low-density population served, rural hospitals struggle to bring in enough money from out-of-pocket payments to cover their bills. What’s more: Medicare and Medicaid services, on which a large chunk of the aggregate in Old Man Jim’s community depend on, reimburse based on structures that end up disenfranchising the vulnerable populations they’re intended to help.

Rural hospitals provide vital emergency, inpatient, and outpatient care, and here’s why that matters: rural residents are at the highest risk of suffering poor health outcomes due to hospital closures, because these hospitals are often the only point of access for emergency care.

These are only part of the systemic barriers that marginalize people in rural spaces, and why the intersections of nursing and planning are so critical to improving critical care.

But back to Hazel. The hospital does have a cath lab, though, and that’s a very very good thing for Hazel. When the ambulance arrives at the hospital, its go time. Nursing staff get Hazel transferred onto a bed, start the electrocardiogram testing, and administered morphine. Blood is drawn for labs. She is given oxygen and wheeled off to the cath lab. Nitroglycerin and Aspirin were taken care of on the ambulance ride over. Old Man Jim, who was there for the ride, learns “MONA” doesn’t mean the Mona Lisa. In the Cath lab, or to be technical, the “Coronary Catheterization Lab”, a tube is inserted into Hazel’s leg and fed to her heart. Dye is injected. The blockage is found. From here, things can go one of two ways: the provider inflates a balloon to open the artery and places a stent, or emergency CABG surgery follows. If stenting fails or if multi-vessel disease is found, CABG is the plan.

CABG, or Coronary Artery Bypass Graft, requires providers remove part of a blood vessel (usually the Great Saphenous vein in the leg), and use it to reroute blood around the blockage, restoring coronary circulation. This allows the heart to keep getting oxygen so that it can keep supplying oxygen to the body.

After the cath lab, the patient goes to the intensive care unit. If at a larger hospital with multiple specialty ICUs, the patient goes to a Cardiac ICU. For the first day or so, the patient is closely observed for further cardiovascular pathology. After the ICU, the patient goes to the step-down unit, and if stable, is then eventually discharged to cardiac rehabilitation.

While this is only a general overview presented through a hypothetical lens, it helps to understand the bigger picture of what happens after the heart attack and why. Know that patients experience fear, apprehension, and pain—though well managed—the entire time. Nurses treat their patients while they navigate the disease process, making their journey as comfortable as possible. Nurses are there, with the patient, by their side. Providers come and go, techs run tests and leave, visitors drop in and out, but nurses…nurses are by their side through it all.

Old Man Jim was not so lucky; there were no rescue squads or cath labs in his tobacco field. No morphine. No nitro.

Now that we know what happened to Old Man Jim, let’s examine WHY it happened. If cardiac arrest is the what, isolation is the why.

There are factors that explain why some people are more likely to die sooner or later than others, and from specific disease processes.

Zip code is the largest predictor.

A zip code can tell us a lot about where you live, what resources are near you (like grocery stores and hospitals), and even close estimations to how much money you make. Zip codes are so powerful, they are essentially a seven-digit crystal ball, fortune-telling our possible fates. Old Man Jim lived in geographic isolation, away from advanced medical care. He was 50-miles from the closest urban area; as he lay there dying, in his tobacco field, he stood very little chance.

Old Man Jim depended on sausage biscuits and diet sodas as his dietary staple, only going to town one day a week to buy groceries. Rural communities are often food deserts, or places with limited access to affordable, fresh, and nutritious whole foods. Poor nutrition meant Old Man Jim lacked the variety and sustenance in his diet to maintain cardiovascular health, and over time, this restricted diet of processed foods likely contributed to a hardening of his arteries (arteriosclerosis) and a buildup of plaque within them (atherosclerosis).

Though he had a large family, Jim was alone when he died; a common phenomenon for older adults. As of 2019, it was estimated that around 32% of persons aged 65 and older live alone. Socioculturally, Western populations place value on independence and self-reliance, often living in single-occupant living arrangements as opposed to the communal dwelling norms of eastern European, African, and Asian populations. Social isolation contributed to Jim’s death, simply because no one was around to help him when he died.

Everyday, people living in rural spaces wake up and drive to work, show up for varsity football practice, or go to church services, navigating their built environments as best they know how. And like Old Man Jim, many of them fully expect to show up tomorrow…but some of them will never make it.

Systems establish borders that create marginalization, foster isolation, disrupt interpersonal connections that could otherwise be life-saving, and shift perspectives, making people think this is all very normal and “just the way it is”. Thus a culture is formed around morbidity and mortality, leaving many rural folk to believe its just “God’s will” or “the way things are”.

That afternoon, Old Man Jim never came home. He wasn’t there to meet the twins when they got off the bus. The bus driver rang the school, who rang Old Man Jim’s daughter—the teacher— who raced to get her kids from the bus stop. (Randy, the bus driver, is a good man. Patient and kind. He waited there, with the boys until Old Man Jim’s daughter got to the bus stop.) She dropped the boys off at the house and followed the winding dirt road past the country store and through the gate at the tobacco field. Immediately, she found his body lying peacefully atop a bushy entanglement of thigh-high tobacco leaves.

Hazel awoken and donned her house coat. She brushed through her long but thinning gray hair; the split ends giving her locs their own gnarly curl pattern at the tips. She let it hang. There would be no buttermilk biscuits and bacon. No sacred silence and sopping of currant jelly.

The sympathy calls and random drop bys were getting fewer and farther between.

Its been twenty years since Old Man Jim passed. She was alone; the isolation has been maddening.

She grabbed her cardigan from the coat rack, her Virginia Slims, and coffee mug, and waddled through the kitchen and out onto the deck.

“Chilly out,” she said, the cigarette dangling from her lips.

She sat down, looked up, and smiled into the sun, the golden rays saturating her soul.

“God’s will be done!” She sat back in the deck chair, and took one last drag from the cigarette.

There were no brown thrashers today.

(Pause. Transition music.)

While there is an element of beauty to Old Man Jim dying doing the thing he loved most: tending to his land after eating his favorite meal, it raises the question: what does a good death look like? If he had access to life-saving interventions…would he have wanted it any other way?

In the next episode, we’ll examine that question.

Join me next time. This episode was researched and written by Leslie Okhirkhian, for the Vaso & Vibes podcast; sources for each episode are at vasoandvibes.com. Thank you for listening.

For more episodes, visit: www.vasoandvibes.com

Credits:

Theme Song:

“Game Day” by JMHBM, from the Free Music Archive

Intro:
“Carnival of Souls” by HoliznaCCO, from the Free Music Archive

Other music:

“Ex” by Nctrnm, from the Free Music Archive

“Tense and Rising” by

Free the Muses, from the Free Music Archive

Disclaimer: This podcast is for informational and entertainment purposes only and does not constitute medical, psychological, or legal advice. The stories, characters, and scenarios discussed are creative, synthesized composites and do not reflect actual patient cases. The views and opinions expressed in this podcast are entirely the host’s own and do not represent the views of any employer, hospital, or healthcare institution.

Sources:

Abell, J. & Steptoe, A. (2019). Living alone and mortality: More complicated than it seems. European Heart Journal, 5(3). 187-188. https://doi.org/10.1093/ehjqcco/qcz014

Arefin, S., Alluri, A. A., Barua, M., Patel, T. M., & Kandhalu, S. K. (2024). Evaluation of Mortality Rate Disparities for Cardiac Arrest Between Urban and Rural Cohorts in the United States Using the Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research (CDC WONDER) Database. Cureus, 16(9), e68803. https://doi.org/10.7759/cureus.68803

Graham, W. (2016). Dream cities: Seven urban ideas that shaped the world. HarperCollins.

U.S. Department of Agriculture, Economic Research Service. (n.d.). https://www.ers.usda.gov/data-products/charts-of-note/chart-detail?chartId=84389