Origin Story by Sarah Banks

Emily reflects on her reasons for becoming a nurse, and searches for meaning in her job.

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I push morphine to pay my mortgage

The thought had bobbed around Emily's mind more than once, but it settled there this morning - the first time it showed enough gumption to stake out its own space. There were two milligrams of morphine in each milliliter of saline, and she pushed the colorless solution directly into patients' veins to chip away at the principle on her thirty-year mortgage.

Resting her chin in the palm of her hand, Emily flipped to the next page of the medication guide. Morphine was designated a high alert medication thirty years ago, a label tagged onto any medication with the potential to cause serious harm when used incorrectly. Insulin was also a high alert medication, but insulin and morphine provided different services. No one ever begged Emily for insulin. They simply accepted the shot as a humdrum part of their daily routine. Morphine was welcomed in, allowed to sit at the table, and invited back. Plenty of people begged her for morphine.

Emily sat back and looked at the bulletin board above her computer, eyeing the paper leaflet - a duplicate of the hospital's patient satisfaction survey - that her manager pinned to the rectangle-shaped foam last week. Question #5 stared back at her: "How well was your pain controlled during your hospital stay?" Higher satisfaction scores yielded higher reimbursement rates from insurance companies. Emily sighed and continued to read the medication guide laid out on the desk.

Morphine, classified as an opiate, interfered with the way the body processed pain. Experiencing pain was similar to picking up a telephone. When a person stubbed their toe, the nerves in the foot dispatched a signal, calling up the brain to relay the throbbing sensation, but morphine interrupted the conversation. The opiate sliced through the communication cord between the peripheral nerves and the brain, so the mind was no longer aware of the body's pain.

She closed the medication guide's worn pages and sat back in her swivel chair.

Did pain exist if the brain never acknowledged its existence?

Emily tapped her pen on the desk and chewed, not for the first time, on the question. She was sure of one fact. Emily knew morphine provided relief. Every person had a different threshold for pain - varying degrees they could and would tolerate. Pain could be sharp, shooting, cramping, throbbing, or heavy, but it was always subjective. No test was capable of proving the presence or intensity of the sensation. High cholesterol registered as a tangible number on a blood test, but pain survived in the mind.

Of course, the desire for relief wasn't always tied to the perception of physical pain.

During a travel assignment, Emily found one of her co-workers, Jim, slumped over his steering wheel after overdosing on several vials of morphine he stole from the controlled medication cabinet. Before a surgery to correct a herniated disc, Jim received a prescription for an oral opiate, and he soon realized that the round, chalky tablets could serve a dual function by providing relief from the grief of a pending divorce and looming custody battle. There was far less real estate between the pain of a hip replacement and the pain of losing your parental rights than one might imagine, and morphine laid claim to the solution for both. The medication was far more effective than it had a right to be. Emily had never taken morphine herself, but she provided its services in exchange for socking money away into her retirement account.

The thought ballooned, lodging itself behind her temples. She dispensed morphine in exchange for a salary and a house in the suburbs.

Emily knew that sounded bad. She knew how bad it sounded, but her actions were fully legal. She had been a nurse for ten years, and she injected morphine into people's veins on a daily basis. Closing her eyes, she considered her role as a middleman in the exchange. She provided a valuable service - more than a bit part - but nursing was not her calling. Emily felt the need to make that clear upfront. She was a nurse, but, when the word fell behind her name, an asterisk sat down beside it.

Plenty of nurses had origin stories - tales of why and how they came to the profession. Her friend Melissa knew she wanted to be a nurse when she was ten years old. After undergoing surgery to remove a ruptured appendix, one of the night nurses brought her ice cream and played board games with her until 4:00am. Melissa knew right then and there that she wanted to be a nurse, but some of Emily's classmates were nudged into nursing on the heels of less miraculous happenings. Her friend Todd moved out of state for college, but with minimal time management skills and no one tapping him on the shoulder, he floundered and eventually lost his scholarship. He returned home to live with his mother who gave him the option of enrolling at the local community college or working full-time to pay her rent. Todd decided to take pre-requisites for nursing school.

Emily thought back to her own reasons for applying to nursing school. On the first day of class, her instructor asked each student the same question: "Why do you want to become a nurse?"

She was certain of her answer, but when Emily stood to face the class, she fumbled around with the tie on her jacket and mumbled something about always wanting to help people. Of course, that was a lie. After her divorce, she felt called to become a nurse because she needed health insurance and a downpayment for a house. She never felt guilty about her motivation, but she wondered what her patients would think. How would they judge a nurse who administered medication so she could discharge her students loans?

What would Mr. Jones in room 1015 think?

Emily clicked on the computer screen and scrolled through a list of patients until she landed on his name. She reviewed the vital signs she had charted earlier: blood pressure, heart rate, respirations, and temperature. She clicked on the box next to Mr. Jones' name and recorded his pain level as a "6." Emily's documentation was meticulous - an exact account of the patient's day - relaying a narrative to the next shift. She read the social worker's update before her gaze wandered down to the worn magnetic strip on her name badge. It would need replacing soon.

Pushing up from the desk, she walked down the hall and placed her hand on the doorknob of Mr. Jones' room. Knocking lightly, she peeked inside to catch a muffled invitation.

"Come in."

A crumpled-up man was lying in bed with his arms propped up on pillows. He pulled a grey blanket over the standard-issue hospital gown, a light green color with a white tie at the neck. His brown eyes looked ahead as Emily closed the door behind her.

A basket of zinnias sat on the table next to the closet, their stalks bent over the edge of a wicker enclosure. They looked like yellow pinwheels, and Emily tamped down the urge to flick one - a dare - to see if it would spin. She wagered they had been duped into service - cleaved from their roots, removed from soil and sunshine, and packed into a basket to sit with a dying man. Emily straightened their stalks, but the lemon buttons immediately fell back over.

She walked to his bed, speaking her next words from the formulary.

"Mr. Jones, your morphine isn't due for another hour. Is there anything else I can get you right now?"

She tensed, hoping he would decline. Emily felt remorseful for her wish, but Mr. Jones was focused on the window. Yesterday evening, he had asked - or rather, insisted - that Emily leave his curtains open. He watched now as dawn nudged blue into the atmosphere.

Mr. Jones furrowed his brow and turned to survey Emily. "I'm not sure what I need." He looked down and began fidgeting with the blanket as she proceeded on script.

"Well, I do need to check on a few things before you go to hospice. Is your daughter meeting you there?"

"I hope so," he answered. "I haven't told her the time yet."

"Would you like me to call her?"

He shook his head. "No, thank you. I can tell her."

Emily had never met Mr. Jones' daughter, but he always sounded content when he mentioned her. While she had met his son on several occasions, his daughter, Scarlett, remained a name typed in the chart. Emily considered calling her, but she didn't want to disrupt Mr. Jones' plans. She would have to trust that Scarlett planned on meeting her father at the hospice facility tomorrow.

Mr. Jones had been Emily's patient for five years, the length of time following his diagnosis of heart failure. Like any chronic illness, heart failure ambled along to a rhythm of remissions and exacerbations. Before the heart went completely kaput, it could beat along for years with the aid of diuretics, but over time, the lull of remissions shortened to reach the disease's certain endgame - a pitch where the heart could no longer pump blood through the body at an adequate pace. Initial access to care may be unequal, but everyone eventually met age and illness on an uneven playing field.

Because patients with heart failure bounced in and out of the hospital, the diagnosis allowed Emily the opportunity to become more than a passerby in their lives. Typically, Emily had hurried transactions with her patients. Perhaps she registered as a ping in their life stories. But Mr. Jones had become a regular at the hospital, and she realized that their interactions were a bright spot amid her often tedious shifts. She felt a melancholy at this recognition. Mr. Jones would have no more admissions. There would be no more conversations to punctuate the drudgery of her day.

The thought perked up, climbing to a perch, and sat there - Mr. Jones' time in the hospital, the days when he was sickest, were the days Emily enjoyed coming to work. The realization startled her, and she paused by Mr. Jones' bed before stepping toward the closet.

"Mr. Jones, have you decided which shirt you want to wear today?" She rustled around in the familiar suitcase before pulling out a green flannel shirt.

"How about this one?" She asked, holding up the shirt, but Mr. Jones ignored her and continued to examine his blanket.

Finally, he peered up at Emily. "Do you remember my first admission to the hospital? I had just been diagnosed with heart failure, and I thought my life was over."

His reaction sounded familiar. She'd never met a patient who reacted well to the fresh label in their medical chart. Some physicians dropped the diagnosis off in matter-of-fact wrapping, and some couched the two words in more palatable terms - explaining that the pumper wasn't quite as strong as it used to be - but, either way, heart failure was a life-altering diagnosis. Emily had cared for hundreds of patients with heart failure, and, while their reactions to the diagnosis were predictable, she remained curious about the diverse lives they had led. She wondered who they were and what made them tick before they morphed into a cog in the healthcare system, understood against oxygen tubing and beeping pumps. Before the healthcare system defined them as a room number and a diagnosis.

She canvassed her brain for the synapses that preserved the memory of Mr. Jones' first hospital admission.

"I remember asking you for a contact person, and you gave me your son's name."

He smiled at her statement. "You have a sharp memory."

Turning to the bedside table, Mr. Jones rustled around inside the drawer to find his wallet. Opening the worn leather, he shuffled it contents, finally pulling out an old photograph. It was bent and crumpled around the edges, but a young couple smiled back from inside the margins.

Emily grinned. "You showed me that picture - your wedding day - right after I finished your first admission assessment. You were married for forty years. Your anniversary is May 10th." Her ability to call up such details surprised her.

He studied the picture as he fingered its edges. "I'll leave this one to my son. He always liked it."

Emily sat down on the couch next to the window. "It's been ten years since your wife died from ovarian cancer."

"I told you that on the first day we met."

Emily smiled at his choice of words to describe his first admission - as if two strangers bumped into one another on the sidewalk.

He looked ahead and drew in a deep breath, the rise of his chest eliciting a slight wince. Emily glanced at her watch - fifty minutes until she could remove his morphine from the medication cabinet. Mr. Jones sat back and exhaled, continuing to study the picture. He seemed to be handling the discomfort.

They sat in silence until he looked up, his gaze drawn towards the window where he watched the sun kindle under the horizon. Pink and gold flickered at the margins of a light blue expanse. Turning to her, Mr. Jones spoke.

"Did you know that animals aren't aware of their own mortality?"

Emily raised her eyebrows before he continued.

"They understand danger, threat, and injury, but they don't understand that they'll die. They see death as something that only happens to other animals." He paused before pressing on. "Well, at least that's what I read in a magazine. I guess there's no way to know for sure."

He sat up straight in bed, willing himself to continue.

"Of course, I always knew I would die. We all do. But I didn't understand it...if that makes any sense." He scrunched his eyebrows before proceeding. "Heart failure is a terminal disease. You can look that up online. I didn't understand that when I was first diagnosed - when I was admitted to the hospital because I couldn't breathe - but I eventually accepted it. The statistics - you can look those up on the internet, too - but they're not great. I watched a video of blood flowing through the heart to understand it. But processing that it's happening to you... being sent somewhere to die..."

Emily wondered if she should speak, but he began talking again before she could press her thoughts into a meaningful sentence.

"I feel at peace with my decision to go to hospice, but I don't want to die. The longer I live, the more attached I get to this world."

His brown eyes looked straight at her.

"I just want someone to know I was here. To know that I existed."

Emily tried to form words, but the zinnias pulled her gaze across the room. The yellow pinwheels had tipped down further over the side of the basket.

Mr. Jones' next words broke through her thoughts. "My parents had me later in life. My mother wasn't sure she could have any more children, but I surprised her."

Emily felt the urge to interrupt. "You were born on August 5th, 1946." Again, her ability to recall such detail - this time from his medical chart - startled her.

He raised his eyebrows and nodded, showing he was impressed with a small smile. "The hottest month in Mississippi... the time of the year when we have to remind ourselves that we don't shovel snow off of our driveways in January," he chuckled. "Does anyone in Mississippi have a child in August on purpose?"

Emily smiled. She had grown up under the same Mississippi sun that tracked her days each summer.

"I was born in Pinola, at the county hospital. My parents and my brother were born there too." He looked somber as he continued. "The hospital closed a few years ago. Budget cuts, they said."

Emily thought about the role of small county hospitals - their mission somewhat different than that of hospitals in larger population centers. The aged buildings played a vital role, serving rural communities as a point of entry into the healthcare system. Many county hospitals shuttered their doors in the face of financial difficulties, and she wondered where they had stored their medical records. Had the hard copies, the old paper charts, been converted to a digital form - as the electronic medical records that now populated health care? Or were the papers shredded, blotting the stories from the official record? Did the documentation - evidence of birth, illness, and death - still exist?

While she was thinking, Mr. Jones began flipping through his wallet, landing on a different photo. He studied the picture before holding the snapshot, a family of four, up to Emily. Inside the edges, Mr. Jones' father stood next to a teenager while Mr. Jones' mother held an infant wearing a white gown. The baby's eyes smiled back at Emily.

"That's me with my family - my father, mother, and brother - on the day of my baptism at the United Methodist church."

The infant in the photograph shared the same eyes as the man in the bed, the same brown eyes as the child's mother, and Emily wondered about Mr. Jones' children. Did they share their father's brown eyes?

"I'm still a member of that church, but I haven't been in years. They actually called a few years back to make sure I wanted to stay a member... or to make sure I hadn't died," he laughed, giving Emily permission to smile at the idea of his childhood church calling members to note which ones were still living. She wondered about the names on church rolls - the active, the somewhat active, the active on Easter and Christmas, and the deceased. She bet the church would still have a record of Mr. Jones' baptism.

His next words surprised her. "I want you to have this photo."

On instinct, Emily opened her hand and took the picture, but when she looked at the smiles on the faces of Mr. Jones' family, she felt a tug of regret. She couldn't take the photo from him. This picture belonged to one of his children. Besides, what would she do with it? Frame it and put it on the mantle above her fireplace?

"Mr. Jones, I can't. Don't your children want this picture?"

He waved her words away. "They have plenty of photographs. I want you to have this one."

Emily wavered for a few seconds but didn't want to refuse him - not when he was dying. She considered his request as she looked out the window. The sun hovered on the horizon as an orange semi-circle. The thought from that morning prickled at the back of her mind, and she rose from the couch, clutching the photo and placing it into her pocket.

"I'll put this in my wallet later."

Mr. Jones lay back in bed, content with the agreement. She was turning towards the door when he spoke.

"Emily, do you work tomorrow?"

"No, I'm off tomorrow."

"Well, I'm supposed to get there at 3:00."

She pivoted to face him.

"To the hospice? Yes, I know. You're supposed to arrive at 3:00. You're going to tell your daughter what time you'll be there so she can meet you."

He nodded, then paused, looking into her eyes before continuing, "I just wanted to make sure I told you what time I was supposed to get there."

"Okay, thanks. I..." Emily's voice trailed off, and she met his eyes again in a brief moment before he turned towards the window. She put her hands in her pockets and stared out the same window to watch the sun continue its climb. The globe-shaped star looked electric as it pulsed orange to reset the day. Pink and gold flushed up to fuse with a cerulean spread that would stash the clouds behind blue for the day. After the sun passed through the horizon, Mr. Jones glanced back at Emily.

"Thank you for telling me," she said. "I'll bring your morphine before I begin the paperwork."

He picked up the foam cup from his bedside table and took a sip of water before shaking his head.

"I'm okay right now." He placed his hand on the novel sitting on his bedside table. "I want to stay awake a little while longer, but I'll let you know if I need anything later."

Emily delivered a slow nod as she turned once more towards the door. Before reaching for the doorknob, she pushed the zinnias up for a second time, and the stalks remained standing. Green stems mounted bursts of yellow.

Mr. Jones piped up. "You should take those flowers."

Emily looked at the lemon-colored blooms then back at Mr. Jones. "You don't want to keep them?"

He shook his head. "I don't really need them. They'd be better off at the nurse's desk."

She ran her finger across a yellow petal and nodded. "They'll definitely brighten up the front desk."

Emily scooped the wicker basket up from the table. Stepping outside of Mr. Jones' room, she made a beeline for the nurse's desk and placed the zinnias down on the counter. The soil in the basket secured the stalks in an upright position, and the blooms perked up, popping open like yellow parasols.

Emily smiled as she headed down the hall to the computer room. She paused as she passed the controlled medication cabinet. Behind a glass panel, several vials of morphine sat stacked on top of one another, placed there by the pharmacist for easy access.

She sat down in the swivel chair and tapped her badge on the computer screen to access Mr. Jones' medical record. She looked down at the face on the plastic rectangle - a photo from her hire date - and studied the smile and the blonde curls she wore ten years ago. It was definitely time for a new badge. She scanned through the list of names on-screen until she found Mr. Jones. Emily placed the cursor on the blank box next to pain level and typed "0" onto the line. She clicked on the green arrow at the top left of the screen to save the information before toggling to a different screen to record Mr. Jones' physical assessment. The computer monitor hummed as Emily typed.


  1. The phrase, “ the first time it showed enough gumption to stake out its own space,” speaking of the idea of administering morphine for money, is characteristic of the crispness and imagination of the narrative. The thoughts of the nurse were piercing and colorful. The pathos of the patient was moving. Their intersection is very meaningful. His physical pain is at a zero, but she tended to his emotional needs. This is a fantastic piece of writing. .. literary writing. Thank you!

    1. Thank you so much for the nice comments. I'm glad you enjoyed my work.

  2. A beautiful, moving story. Emily questions her motivations for administering morphine. In the end, it is the nurse with the most self doubt who is the most humane. Wonderful, Sarah!

    1. Thank you! I'm so glad you enjoyed my story.

  3. I love the juxtaposition of how she treats pain with opioids in the first half of the story, then - whether she is aware of it or not - treats pain with compassion and connection in the second half.

    (In the 90’s, the drug companies that manufactured opioids made a big push in the US to get “pain” included as the “5th” vital sign. A subjective assessment vs. objective physical observation (for the first four). They gave away so many free lunches to us residents, free travel, fancy hotels and conferences, so much bling, gifts, etc. They wanted us to diagnose and treat the “epidemic of under-treated pain” with their opioids... ...well, those of us in the US, we all know how that ended in the 00’s and beyond…)

    1. Thank you for your kind comments.

  4. “Origin Story” is a gentle tale of a nurse’s uncertainty whether she embarked on her career for the right reasons. At the beginning of the story she appears to have reduced many opiate users to erstwhile dopers, who’ll take morphine for any or no reason – to get high. But the humanity of one patient of long-standing touches her and she appears to revise her opinion. When the patient, Mr. Jones, refuses his morphine, the MC types a “0” next to “pain level” and by this act appeared to vindicate the lives of both Jones and herself. A very thoughtful story, Sarah; are you a nurse? I ask because you seem to have such a profound insight into your characters.

    1. Thank you for taking the time to read my story. I appreciate your comments and thoughts into my work.

  5. A beautifully told story rendered in perfect prose and not afraid to tackle the biggest issues in life (and death). I found this story bold, moving, sad, but compassionate, redeeming and a joy to read.

    1. Thank you so much! I love when people find something in my words that is moving. That is the best compliment.