I thought this would be an interesting article for all of you: http://www.boston.com/news/specials/.../whole_series/

Julia Zelixon pulled back the crisp green blanket covering Helen, her patient, and suppressed a gasp.

“I’ve never seen anything like this,” she whispered to another nurse, standing nearby. “Never.”

Julia had read about necrotizing fasciitis — better known as flesh-eating bacteria — in nursing school, but this ravaged abdomen was beyond any textbook description. From just below the ribs down to the left hip, an enormous patch of Helen’s flesh had been surgically removed to block the fast-moving infection. Only a white layer of gauze covered her crimson muscles, and black magic marker lines, drawn by nurses across Helen’s thighs, mapped the bacteria’s continued spread.

Julia, a first-year nurse, carefully cut the sutures that held one of Helen’s monitoring lines in place. She revealed nothing of the thoughts racing through her mind to the 55-year-old patient, who was staring straight up and trembling slightly.

“I’m sorry dear,” Julia said softly, her accent redolent of her native Russia. “Does it hurt?”

The other nurse in the room, Michele Jerard Pender, had seen too much in 20 years of nursing at Massachusetts General Hospital to be unnerved by Helen’s wounds. She didn’t miss a beat in her stream of advice about removing the monitoring line from a major artery: Be sure to block the opening with gauze and “hold it real solid for five minutes” to prevent a gusher of blood. It was a lesson M.J., as she is universally known, had learned the hard way, long ago.

M.J. and Julia had been thrown together for an extraordinary crash course in the ways of the Intensive Care Unit — Mass. General’s answer to the national shortage of veteran nurses. M.J. had just eight months to turn a trainee fresh out of school into a nurse ready to care for the most gravely ill patients at one of the nation’s leading hospitals.

Eager and ambitious and, at 35, more tested by life than most of her peers, Julia was, from the start, utterly sure she would succeed.

M.J. believed in her, too, but also knew how hard the road ahead would be.

M.J. watched carefully as Julia continued preparing Helen to “travel,” an oddly cheery nursing term, considering where the patient was about to go: Doctors wanted a CT scan of the advanced ovarian cancer that surgeons had discovered as they battled the infection. Helen hadn’t been told yet, but she was in danger of dying from two diseases at once.

As with many intensive care patients, Helen’s problems were a devastating mix of bad luck and bad choices. The reclusive woman had noticed a lump in her groin months earlier, but had not sought medical help until the infection was rampant. She also had stopped chemotherapy for ovarian cancer against her oncologist’s advice. Surgeons at a suburban hospital discovered the consequences of both decisions, and promptly put her in an ambulance bound for Boston.

Now she was in the hands of Julia and M.J. in the surgical intensive care unit, or SICU. Nurses in the cluster of 20 small, starkly lit rooms on the fourth floor of Mass. General’s Ellison Building jokingly call the ambience “cavelike,” because most of the windows look out on a brick wall a few feet away. But they pride themselves on caring for the most difficult caseload among the six intensive care units in this 875-bed teaching hospital of Harvard Medical School. Its patients run the gamut from gunshot victims to some of the most severely burned patients from the 2003 fire at the Station night club in Rhode Island.

The SICU is a place of inescapable intensity, where staff members converse in a clipped shorthand that is both urgent and sometimes vulgar; where the loudspeaker can summon a stampede of white coats and blue scrubs to the bedside of a “crashing” patient; and where, lest anyone for a moment forget how fragile their patients are, electronic bulletin boards in the halls flash a stream of warnings in red — 434 APNEA ..... 406 TACHY ..... 428 VNT ALARM — whenever a patient’s vital signs drift beyond safe levels.

“You’re at Mass. General now; do you know that?” M.J. loudly asked Helen about an hour after she arrived on a frigid January afternoon, nervous and disoriented. The patient shook her head. M.J. told Helen that she had taken care of her two years earlier, when she was in for cancer surgery, but Helen didn’t seem to comprehend that, either.

“You might want to see if she’s anxious,” M.J. said, turning to Julia. “You’ve got that order for Ativan.” Minutes later, Julia injected a clear syringe of the fast-acting sedative into a tube that drained into Helen’s central vein. Soon, the patient closed her eyes, looking almost serene.

For Julia, who only a few months earlier had been a nursing student at the University of Massachusetts at Lowell, Helen would be the first highly unstable patient she would transport out of her room, a carefully orchestrated undertaking that requires a nurse to leave behind the built-in monitors, breathing equipment, and racks of medicine in a patient’s room for portable versions of the same. Every ICU nurse has a healthy respect for the challenge of what sounds like a simple chore — pushing a very sick patient’s bed down the hall. “You don’t want to be stuck in the elevator with a dead [oxygen] tank,” M.J. said.

Julia set about moving Helen with single-minded zeal, stretching on tiptoes to the farthest corner of the bed to disconnect tubes and unplug wires, laughing when M.J. compared her to an octopus. She got the monitoring line out of Helen’s artery and held gauze over the wound, just the way M.J. had suggested. She attached Helen’s IV medicines and fluids to a “tram,” a rack that hooks to the bed. She put a green canister of oxygen on the bed and connected it to a purple “ambu bag” with a facemask to manually inflate and deflate Helen’s lungs. She placed a portable vital-sign monitor in its rack at the foot of the bed, plugged Helen in, and headed off for the scan.

“You’re remembering everything today. You’re getting an A-plus,” exclaimed M.J.

Julia’s very presence in an ICU at New England’s largest hospital is a measure of the upheaval in nursing, one of the most demanding but least glamorized professions in medicine. Although television shows such as “ER” make it seem as if doctors do just about everything in hospitals, nurses actually provide nearly 90 percent of intensive care, usually with no doctors in sight. Nurses sometimes feel like second-class citizens, but they are the backbone of the ICU, and hospitals struggle to recruit and train enough of them.

Until four years ago, Mass. General required nurses to have one to three years of hospital experience before they could work in the ICU, giving them more on-the-job training than most residents, the recent medical school graduates who are the frontline doctors in teaching hospitals. As residents rotate through, seasoned nurses provide continuity of care and a practiced eye for the telltale blood pressure drop, raspy breathing, or other signs that a patient is failing.

But the nationwide shortage of nurses — 6.7 percent of nursing positions in Massachusetts are vacant — has forced even prestigious hospitals to take once unthinkable steps to recruit the next generation, including signing bonuses of up to $5,000.

In 2001, Mass. General began its intensive care program for new nurses willing and able to work under near-constant stress. A patient in the SICU typically requires 20 hours of nursing care daily, 13 percent more than in 1999, as medicine gets better at keeping the sickest of the sick alive. Patients here routinely require a dozen or more intravenous medicines and up to six feeding and monitoring tubes.

“The patients that ICU nurses are taking care of would have died 30 years ago,” said Jeanette Ives Erickson, Mass. General’s nursing chief.

Some senior nurses are uneasy about the growing number of first-year nurses in the ICU, believing they lack the judgment to make life-and-death decisions. But the idea is catching on: Nearly one-fifth of Julia’s graduating class went directly into intensive care or emergency room positions.

For Julia and the other fledgling nurses, the months of training would be exhausting. In short order they had to master how to administer scores of drugs; carry out complex procedures; help families cope in their darkest hour; and, most important, head off crises that can take a patient swiftly from critical care to the morgue. “There were times when I would come home and couldn’t keep my eyes open past 8 p.m.,” recalled one former ICU trainee less than fondly. Senior nurses like M.J. decide whether trainees have the aptitude and grit for this work. And while the teachers are supportive, they pounce quickly on mistakes, especially those that may jeopardize patient safety.

“Some days you’re going to get hammered,” M.J. said one day, summarizing what she expects of trainees. “But you know what? Take it to heart, learn from it, and tomorrow’s another day.”

Not everyone makes it: Four of the 17 nurses in Julia’s class would not graduate, a higher dropout rate than basic training for the Marines. For those who survive, the prize is considerable: a job with lots of autonomy at a world-famous teaching hospital, where senior nurses make more than $100,000 a year. For Julia, whose training was observed firsthand by a Globe reporter and photographer, graduating from the ICU program would mean something more: regaining her sense of direction after tragedy knocked her life off course.