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The mother of 5-year-old Haley and 7-year-old Colin, M.J. seldom completely leaves her family life behind during her 12-hour shifts, fielding calls from the sitter, her husband Greg, and the children, and carrying an oversize calendar to track their first communions, swim meets, school barbecues, and other activities. During one lull in the ICU last winter, M.J. grabbed a few minutes to read a magazine article on how to get children to pick up their toys and coached her husband by phone on where to find one of Haley’s favorite outfits.

At work, as at home, M.J. is accustomed to making decisions. Residents often glance in her direction during morning rounds and ask, “Isn’t that right, M.J.?” Everything about her seems practical and purposeful — from her choice of words to the clogs she wears for the extra inch of height she needs to reach IV bags.

M.J. knew from the age of 5 that she wanted to be a nurse. “My dolls always had broken arms, and I had to fix them,” she recalled. “I just never wanted to be a doctor. I saw them as being really busy and spending a lot of time on the bookwork of medicine and not really spending a whole lot of time with the patient.”

As a teenager she worked as a candy striper at the local hospital, then went to nursing school at the University of Vermont, landing at Mass. General right after graduation in 1984. Unlike Julia, however, M.J. spent three years on regular wards before she switched to intensive care.

“I would never even have considered going into an ICU right out of nursing school,” M.J. said. “It was something, stresswise, I wasn’t going to put myself through.”

As Julia’s ICU training began to involve more nights, longer hours, and sicker patients, she began to see the wisdom in M.J.’s words — though she never doubted her decision to go straight from school to the ICU.

“When I came there, I had a lot of confidence because of my life experiences,” Julia said over tea one February morning. “It surprised me that there were a lot of things I wasn’t ready for.”

Julia held her patient’s right index finger reassuringly and leaned in close to his pillow while a resident peeled back the large bandage above Frank’s left knee. Gray foam concealed a deep, six-inch-long opening where surgeons had inserted steel pins to hold his thigh together.

“Are you all right?” Julia whispered sweetly, and Frank squeezed his eyes shut so tightly she knew the answer was no.

A generation ago, Frank probably would have died in the crash that landed him at Mass. General. Another driver, allegedly high on marijuana and painkillers, had smashed head-on into his car as Frank drove home from a birthday party. The impact nearly split Frank’s pelvis and shattered his left leg, so that he practically bled to death before firefighters could get him on the med-evac helicopter. Little more than an hour after the accident on a rural highway, the helicopter delivered Frank to Mass. General, where high-speed pumps kept him alive with transfusions equal to the entire blood supply of 10 adults.

Now, five weeks later, Frank was alive, but a challenging patient for a new nurse to manage. He was conscious enough to notice the picture of his nephew taped to the wall, but also to suffer as an orthopedist examined the gash in his leg for signs of infection. His heart was so fragile, it had stopped twice the previous weekend. And he had to be fitted with a device with five attachments running into his chest to monitor the strength of each beat and to stimulate his heart if it slowed. Julia had never cared for a patient with what’s called a pulmonary artery line, but she had a mantra for moments like these: “If it’s easy for you at this point, it should be scary.”

M.J. tried to make it sound simple: Just inflate the tiny balloon at the tip and slide the line along the blood vessel near his heart until it can’t advance any more. Of course, she had to warn that Julia could kill her patient if she moved the line beyond the vessel and into Frank’s heart. “You can put the patient into v-tac or v-fib,” M.J. said, using shorthand for rapid and irregular heartbeats. “It can be lethal.”

As she spoke, M.J. realized that Frank was watching them. A doctor himself, Frank couldn’t speak because of the breathing tube in his trachea, though he moved his lips wordlessly. Still, the nurses knew Frank understood much more about what was happening to him than the average patient. He knew, certainly, that his life was, up to a point, in the hands of an ICU rookie.

“He knows everything,” M.J. said. “He’s listening to me teach Julia and thinking, ‘Oh, my God.’.”

Part two: As a patient’s needs multiply, the lessons become intense

Scott Allen can be reached at allen@globe.com.