"Be careful," she said. "They're suing the hospital."

I thanked her neutrally for the heads-up and glanced in the half-open door, where I saw a woman in her 80s, curled up on her side, asleep.

I wasn't sure how to work more carefully than I did ordinarily. I had seen nurses tape over their last names on their hospital identification so that they couldn't be named in a lawsuit. I had seen nurses refuse to care for certain people. I had seen doctors hand over patients to colleagues when they had reached their limit. I decided to just be particularly nice and friendly. And when I met the patient's two daughters, they were so pleasant and helpful that I wondered whether the night nurse had been mistaken. They helped me bathe their mother; they carried laundry to the carts outside. They even emptied water basins and trash cans. They stayed with their mother all day, combing her hair, talking with her, rubbing lotion on her. What on earth, I wondered, could have made these devoted daughters so angry that they had consulted a lawyer?

I never learned what Mrs. Evans' lawsuit was about; I don't even recall why she was originally hospitalized. What I remember, above all, is the anger of the other nurses on the floor at the family's decision to sue, which manifested itself in avoidance of and neglect of the patient. If I was not around, for example, no one answered her call light.

"I don't want to go in there. She might sue me," they would tell each other, laughing but only half-joking.

And after a couple of days assigned to Mrs. Evans, during which time each nurse in turn told me that she had previously injured her back lifting the woman, I could no longer obtain assistance in transferring my 90-pound patient from her bed to the wheelchair. Every single nurse flatly refused to help me, and the charge nurse allowed this.

I don't know what eventually happened to this patient or to her lawsuit. I do know that she spent weeks on the floor after her family had submitted their lawsuit, suffering the retribution of a staff angry, hurt and afraid of her. I know that the nurses had never bothered to learn the names of the two daughters keeping vigil at their mother's bedside. And I know that the rage and frustration that had sent them to a lawyer in the first place could only have been compounded by the icy treatment their mother received. A mountain of distrust and anger had grown between the patient's family and the staff (the patient herself, a good-natured and somewhat forgetful woman, seemed oblivious to all this), and the hospital's responses, self-protective though they may have been, only caused this mountain to grow.

I was reminded of a fairy tale I read when I was a child, in which a princess is imprisoned by her father atop a glass mountain. Suitor after suitor comes courting, charging the mountain on horseback and then tumbling down, unable to gain purchase on the slick surface. The princes and princess could see each other, even talk to each other, nearly touch. But the glass mountain, so clear it was barely visible, kept them apart. In the end, one resourceful prince manufactured a homemade pair of wings and clumsily flapped his way to the top.

I have many friends who are nurses. We spend a great deal of time together talking about work: the difficult I.V. we could (or couldn't) start, sad and funny stories heard at the bedside, the patient sent home too soon, the $50 instrument our hospital refuses to buy, the way we would do things if we ran the hospital, or the department of public health or the country. We don't talk much about liability. We don't mention malpractice, except in whispers or jokes. But it's always there, in the back of our minds, even if we're only half-aware of it.

"Lawsuit" is the word underlying the way I was taught to chart in nursing school, the way we were all taught. I have written countless notes that read something like this: "Patient has apical pulse of 125. MD notified. No new orders." Behind the bland words is the unspoken premise that if my patient has an arrhythmia that is missed -- well, at least I notified the doctor. At least I did my part and cannot be blamed. One nursing school instructor told me that as I chart, I should imagine how my words would sound read aloud in a courtroom. Solid advice, no doubt, but certainly disturbing.

The implicit threat of liability not only colors the way we chart but the way we look at patients, talk to them, care for them. When I take a report at the start of shift, more than once a patient has been described to me as "an attorney," or as having "a son who's an attorney," as if this were a medical diagnosis. Do I act differently around patients who are attorneys? I try to treat all patients with equal care and respect, but I doubt I succeed entirely.

And how much do we alter our behavior when we feel particularly scrutinized? Several years ago, the unit where I worked discharged a patient to a long-term-care facility about 25 miles from the hospital and across a bridge. The patient, a woman with advanced AIDS, was near death and had no nearby family. She was only semiconscious when the ambulance picked her up in the morning.

Not an hour later, we received a call from the driver: The nursing home had changed its mind. It refused to receive Flora, and the ambulance was compelled to reverse directions in the middle of the bridge and return the unfortunate woman to us. As we lifted Flora into the same bed she had vacated an hour earlier I remember that, along with the outrage and sadness I felt, was a tiny spark of relief that there was no family beside me, witnessing this treatment of a dying woman, and that Flora herself was not really cognizant of where she was or what was happening.

Suppose Flora had been an attorney, or had had a family member who was a politician or a hospital trustee? Would we have transferred her out at all when it was evident she did not have long to live? Or would we have moved her into the spacious, sunny corner room, known to staff as the "VIP Room," furnished with couch, refrigerator, table and chairs, with plenty of room for family to spend the night? I don't think we would have given Flora more gentle and conscientious nursing care than we did, but perhaps, with more eyes on us, that aborted ambulance journey would have never taken place.

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