by Tilda Shalof
As if the stopcock wasn’t daunting enough, I also had to deal with the transducer, which connected to the monitor, cables, computer module, and the oscilloscope. Those, together with the electrodes, waveforms, and amplitudes, were just some of the vocabulary of a brand-new language in which I had to become fluent. In addition to all that, I had to add on the lexicon of critical illness, such as multi-system organ failure, congestive heart failure, and hepatic or renal failure. Then there were the shocks: anaphylactic, hypovolemic, cardiogenic, and the worst shock of all: septic shock. All failures and shocks.
I HAVE ALWAYS been a big reader, and as a child I devoured the Cherry Ames stories – Cherry Ames, Cruise Nurse; Cherry Ames, Dude Ranch Nurse; Cherry Ames, Ski Patrol Nurse; and Cherry Ames, Department Store Nurse. I had dreamed of being like her, one of those compassionate, selfless people who did generous things for people in need. The glamour and exotic adventures that nursing seemed to offer were appealing, too. All in all, nursing seemed like a good way to do all that and make a living at it, too.
In some ways, my career choice of nursing felt like a fallback onto something familiar. In my family, I had always been the caregiver. I was one of those little girls who could spot the one person in a crowd who wasn’t feeling well, the one who needed a chair or an arm to lean on. Early on, I figured out that to help someone who is unsteady on their feet, you offer your arm, rather than take theirs in yours. Without anyone telling me, I would run off to fetch an aspirin and a glass of water if someone had a headache or a pain somewhere.
I often wonder if other nurses come from homes where they learned to be the caregiver, where that was the role handed to them or the one they took upon themselves. It was at home, where my parents were older than most, and where there was so much illness, that I first honed my nursing skills. My mother had Parkinson’s disease and manic depression; my father had diabetes and heart disease; and one of my brothers, schizophrenia. Doling out my mother’s pills, monitoring my father’s blood sugar, and coping with my brother’s paranoia and verbal outbursts occupied my free time as a child. To the best of my ability I took care of them all until my parents died and my brother and I lost contact. My two other brothers left home to escape the madness, and who could blame them?
Nursing was a logical, if ironic, choice for me: those very skills that I had developed at home in my family provided the vehicle that transported me away from that house of sadness. They provided my means of escape and became the tools of my trade. However, when I first told my self-educated, working-class father and my uneducated, yet cultured mother my choice of career, it took them aback.
“Jewish girls don’t go into nursing,” my father said when I told him what I was thinking of studying. It was the early eighties and I had just finished high school and was casting about for something to do. There would always be sick people and nurses would always be needed to take care of them, I reasoned. Surely I could do that; I had been doing it for years.
“I never heard of a Jewish nurse, have you, Ellie?” He turned to the couch where my mother lay. My mother knew a lot about opera, but very little about anything else.
“She’ll be Florence Nightingstein,” my mother said in a voice muffled by a giggle and her arm, flung back across her face.
“I wonder why there aren’t many Jewish nurses,” my father mused. The question seemed to interest him, as did most everything. “It is one of the oldest professions, although by no means the oldest one, mind you. We all know what that is, of course, heh, heh. Perhaps it is because the noble vocation of ministering to the sick is, somewhat – how shall I put this?”
“Icky,” offered my mother.
“Well, Ellie, now that you mention it … but it’s not just the menial work, it’s also that nursing is not very, well, it’s not the most –”
“High class and refined. Not at all,” my mother said, with a melodramatic shudder of disapproval behind her arm and her now-closed eyes.
“Surely, Tilda, you could choose a profession that doesn’t involve such selfless, back-breaking labour and long hours for such meagre remuneration. What are your girlfriends going into?”
It was true that none of my friends had even considered nursing. Natalie was off to study social work in New York. Allison was going to do a liberal arts degree at the University of Toronto, but first a year of backpacking through Europe. Stephanie was an aspiring actress.
“Your mother and I always hoped you would go to university,” my father said wistfully. I knew he regretted that he had not had that opportunity when he was my age.
“Maybe I could study nursing at university,” I said, wondering if I’d even be accepted with my ho-hum academic performance in high school.
“I see,” he said slowly. I knew he was trying to come around to supporting me, as he did in most everything else. “Whatever you decide,” he said finally. “In life, it’s not about doing the work you love, it’s about loving the work you do.”
I had no idea what my mother thought. At any rate, she had no further comment, as she had risen from the couch and was busy being Madame Butterfly in the kitchen.
FOR THE NEXT four years I stumbled, bumbled, and fumbled my way through university lectures and clinical assignments in hospitals throughout the city. Somehow I got through it all but I began to have qualms about my choice. There was something about my personality that seemed unsuited to being a nurse. Nurses were by and large practical, sensible people, oozing with confidence and common sense. I was nothing like this. There was also something about my temperament (too mercurial) and my constitution (too sensitive) that made me ill suited to be a nurse. Yet, at the same time, I still felt passionately committed to the noble idea of service to human beings in need. I longed to be a bona fide member of the “helping profession.”
I drifted along in my first two years of university in a state of dreamy distraction. Then, during my third year, my father died suddenly. I barely had time to register the shock, so busy was I caring for my mother, who was in the advanced stages of her disease and overcome with grief and depression. It was just before my final exams and my professors advised me to drop out and defer my studies for a year, until things settled down. But I was in so much of a hurry to get out and be free that I didn’t take their advice. Somehow I managed to finish that year and then the next, all the while counting the days until I could escape my home and family, and most of all, myself. Somehow I got through it all. I managed to graduate with a Bachelor’s degree of Science in Nursing and a Certificate of Competence to practise nursing. I was familiar with abstract theories and had read lots of research studies, but the rigorous discipline and practical skills of basic nursing practice eluded me.
The dean of the Faculty of Nursing shook her head sadly at me on graduation day. Prim and starched as Florence Nightingale herself, she wore a dove-grey suit with a white blouse and the requisite coral cameo at her throat. I had scraped by with a 66 per cent average. Who would want a nurse who knew only 66 per cent of the material? I knew I was a liability out there, but I promised myself I would be very careful, double-check everything, and try to stay out of the way of patients.
“You do have potential, dear. If only you had applied yourself, you could have made the Dean’s List,” said the dean herself. “Maybe you should go into research or administration. If you repeat courses and improve your marks, you could apply to graduate school. Have you considered that?”
I had thought about it, briefly, then quickly put the idea out of my mind. I was too impatient to get away from home – and to work, to travel, and to have fun and adventures – to pay much attention to her suggestion.
“She’s a good nurse,” I heard the dean telling the other professors afterwards at the graduation party. “Competent, but a bit scatter-brained.”
UPON MY GRADUATION, full-time nursing positions were scarce. That didn’t particularly perturb me, as I was not ready to settle down in one job, anyway. I joined a nursing agency and took on a variety
of placements, such as private-duty nursing for imperious, rich old ladies recovering from hip replacements in their homes. Over the next few years, I did freelance medical writing for a pharmaceutical company; computer work for a doctor; and lots of part-time gigs in hospitals around town, never going more than a few times to the same place. I thought of myself as a “freelance” nurse.
In my travels, I discovered that many nurses were suspicious of degree nurses. Sure, they know lots of theories and research, they said, but can they cope with the demands of the job? In my case, they had reason to be concerned.
I recall one of my first days on a general medical ward. The doctor ordered a naso-gastric tube to be inserted into my patient’s stomach after surgery.
“There’s the clean utility room,” said the nurse in charge, waving in one direction and running in another to receive a fresh post-op patient who was coming off the elevator on a stretcher. Over her shoulder she called out instructions. “Get a size 10 or 12 tube, a large syringe, and a basin of ice. Make sure you auscultate the gastric bubble to check for proper placement. Once you get it started, connect it straight drainage – no, better make that low Gomco – and replace the hourly losses with saline. While you’re at it, his potassium is low, so you’d better change the IV to 20 millequivalents of KCl per litre and run it at 100 cc per hour. When you’re done that, insert a Foley catheter and measure his hourly urine output. If this is your first time, you lucked out, ’cause males are a lot easier to catheterize than females. Got all that?”
I had read about these things, even seen one or two, but had never actually done any of them before.
“Oh, you university grads!” she said when she saw me floundering. “We need real nurses around here.”
The littlest things could trip me up. One day, on a postpartum ward, I was assigned to take care of five new mothers and their babies. One new mother, exhausted and in discomfort after a Caesarian delivery, needed my assistance with a bed bath, but something was wrong with the curtains around her bed. I tugged and pulled, but they were stuck and didn’t slide along the rails on the ceiling. I yanked at the curtains but they wouldn’t budge. I went off to find the nurse in charge to report the curtain problem. I advocated for the client’s right to privacy. Patients needed personal space within the vast public territory of the institution that they can call their own, I argued, recalling a lecture I had once heard on the subject. Patients have an inalienable right to autonomy, and with their permission, we may enter their domain.
“Call housekeeping,” the nurse said, pushing the laundry cart into a patient’s room. “Probably just needs some more rods and hooks. That and a spritz of WD-40 should do the trick.”
“You’re right,” I conceded. A few rods and hooks, not a paradigm shift. I went back to work.
Even though the agency sent me to different hospitals around the city, and I rarely returned to the same ward twice, after just a few months, wherever I went, they considered me “senior staff” on the team. But “team nursing” was beginning to be considered old-fashioned and on the way out. Nursing theorists were promoting the virtues of “primary nursing.” In primary nursing, nurses were responsible for all aspects of the care of a small group of patients to whom they were assigned. Whereas in team nursing, the work was divided and each nurse focused on a few tasks – say, vital signs or dressing changes – and did those tasks for all the patients in that ward, sometimes up to as many as forty patients.
From the patients’ point of view, team nursing was “off-the-rack” shopping and primary nursing was personalized service; it was assembly-line production versus a made-to-measure, custom job. As so-called “senior staff,” working with a team, I might be the one to administer the meds for all the patients in the ward or pair up with an orderly and make rounds turning patients in bed, giving baths, changing the iv bags. It was a big responsibility, but my role was clear and straightforward.
I loved making beds, especially an “occupied bed,” when we turned the patient from side to side and did everything for the person who lay there helpless. As we went from room to room, I worked with a nursing assistant and we moved together wordlessly in concert with the sheets and blankets, making corners and pulling up the linen, folding it down, and making it smooth all over. Presto: the finished product, so crisp and inviting. Those beds we made would be a gift to any feverish patient.
Team nursing also gave me a fleeting sense of belonging to a group, even though I never stayed anywhere for long. Team nursing assuaged my loneliness and gave me a sense of family, something I craved, but then wanted to escape from. From the nurses’ point of view, team nursing was an efficient way to work. It even occasionally allowed for time at the end of the shift to sit and drink coffee together at the nursing station while we finished up our charting. Although team nursing was convenient for nurses, I could see that for patients it fragmented the care they received into separate tasks performed by different people coming and going at various times. However, at that stage in my career, patients were the least of my concerns.
In those days of adjusting to the realities of my profession, one of the hardest things for me was waking up each morning for work. The luminous green numbers on the face of my alarm clock glowed in the darkness when I woke up long before it rang, after a night of broken, restless sleep. During those nights before work, I couldn’t afford to abandon myself to the deep sleep that allowed for dreaming. The hours of the night were a countdown. My alarm clock was set for 5:00, but bells were ringing in my head at midnight, around 1:30, at 2:00, again at 3:14, around 4:00, at 4:33, until I finally shut it off at 5:00, before it had its chance to do its job. I lay there in disbelief that it was so early and that there was so much ahead of me that day. Would this be the day that would break me? I wanted to go back to sleep, not because I was tired, but because I was afraid. Duty propelled me forward. I put on a tape of Glenn Gould performing the Bach Concerto in E Major. His deliberate and forthright interpretation helped drown out my apprehension. The music fortified me to go on.
At 6:00 I left the house and rushed through the deserted streets to the subway. At that time of the morning, the moon is still out, as well as the bright headlights on the few cars in the city streets. When I reached the hospital, I entered the chrome-walled elevator and rode it to whatever floor I was assigned to that day. I strode through dark, disinfectant-smelling corridors, opened the heavy door of the ward or department du jour and reported for duty like a soldier.
The work was hard and I was busy every minute of each twelve-hour shift. Mostly I was running, fetching, pushing, hauling, lifting, carrying, and pulling. There were lots of opportunities to use my mind, but there was little time for it; the work required a Trojan’s stamina and stopping to think only deterred me from completing all the tasks that were required. I was beginning to realize that the best way I could excel as a nurse would be to invest in a good pair of running shoes and a gym membership. I had to get in top physical shape for this line of work.
Nursing also required close attention to detail, quicksilver problem-solving abilities, and strict time management. Often, I fell short. Once, I increased the rate of a patient’s IV, not even noticing that it was not properly connected, and fluid and medication had dripped into her slippers. On another occasion, on an ophthalmology floor, I reported that my patient’s pupils were wide and unresponsive to light. Could he be having a stroke? Should I call for a neurology consult? When the nurses gathered at the nursing station stopped laughing, they told me that the patient’s widened pupils were due to the drops the doctors instilled to dilate the pupils, a standard procedure prior to an eye examination.
At least I always tried to be empathetic. I had been taught that empathy was the most important quality a nurse had to offer. In fact, it was the hallmark of the professional nurse. However, in my case, some common sense and maturity would have helped, too.
One evening on an Oncology floor, a man with advanced stages of cancer silently ate his
dinner. The news was on the TV, but he paid it no notice. The room was filled with flowers and boxes of unopened candy, but there was no family at his side. His disease was progressing rapidly, and at times he endured excruciating pain.
He pushed away his half-eaten dinner, leaned back against the pillows, and sighed deeply. I noted his “flat affect” and reminded myself to document that later in his chart in the “emotional/psychosocial” category. “Oh,” he let out a long sigh. “What will be?” He shook his head and covered his face with his hands. “What will be?”
Finally, my chance to be empathetic had arrived. I pulled up a chair to his bedside.
“Tell me how you are feeling, sir. Are you perhaps worried that the cancer has spread?”
He looked up and noticed me. “No, my dear.” He patted my arm. “This Mulroney government is ruining everything. Oh, for the Trudeau days. Now there was a leader!”
I HAD A tendency to take patients’ reactions too personally. Toward the end of a busy evening on a Cardiology ward, I brought a plastic med cup of pills to a patient. I gave her the pills along with a glass of water with a bent straw in it.
“Which pills are these?” She sat up in bed to examine them.
“Please don’t sit up yet, Mrs. Jones.” I put my hand gently on her shoulder. “You have to lie down and keep that sand bag on your groin. You’re at risk for bleeding after your angiogram.”
“These aren’t my pills.” She took her glasses from the bedside table, shook them out, and put them on to examine what I was offering.