by Tilda Shalof
“Nicky, for God’s sake, put on gloves!” we’d shout at her.
“That’s gross, Nick,” said Tracy.
“Dangerous, too. What about AIDS, hepatitis? The yuck factor?” I asked with an involuntary shudder and tossed her a pair of disposable gloves.
“I prefer to touch patients with my hands,” she explained. “I can’t feel anything with gloves on. Anyway, I cleaned my own mother when she was dying of cancer and the nurses there used to say the same thing. They were afraid that I’d absorb some radioactive isotopes or traces of her chemo, but I wasn’t worried.”
Some things we left alone.
MY GANG HAD an annoying habit of commenting on what we brought for lunch when we sat together in the lounge. I hid in a corner to try to keep my meals to myself.
“What have you got there, today, Tillie?” Frances inquired. The others looked up.
I might have had a Tupperware container of leftover stir-fry or a slice of cold pizza, but whatever it was, I didn’t wish to discuss it or share with anyone.
“What is that?” Laura asked, peering down into my bowl one day. “Your soup looks like what’s draining out of my patient’s rectal tube.”
“Thanks, Laura.” I pushed away my lunch, but couldn’t push away the thought.
Nicole was known for bringing in huge lunches, sometimes an entire head of iceberg lettuce and a long English cucumber. She proceeded to prepare a salad like some perky demonstrator in a department store, using various gadgets for cutting, dicing, and slicing. She brought in an entire bottle of French dressing that she poured over it all in a huge container that Morty nicknamed the “Jethro Bowl” after the TV show The Beverly Hillbillies.
“You could bathe a patient in that bowl,” said Tracy.
“Are you going on a safari?” Laura asked her when she saw Nicole’s grocery bags.
I had hang-ups about food and I didn’t always want to discuss with them what I was eating. My weight was always up and down, then steady, then up again. It was always related to various emotional states. Food was my bugaboo.
“How do you stay so slim?” I once asked Clara, a Polish nurse who had come to Canada to work in our ICU. She spoke a halting, but correct English.
“Zees is vhat I doo.” She gave a weary shrug, as if dealing with a slow child. “Eeet’s simple. I eat ven I am hungry and I stop ven I am fool.”
Imagine. As simple as that.
I WAS FERRETING about among plastic bins in the supply room, searching for a specimen bottle. It was a special one that contained growth medium for testing stool for Cryptosporidium, and for Clostridium difficile, and for whatever other mysteries might be growing in the waste products shooting out of my patient’s rectal tube.
“What’ya need?” asked Laura, appearing in the doorway.
“I’m looking for a container to collect stool.”
“It’s commonly called a toilet, dontcha know?”
I shot her a withering glance. “You know what I mean, a specimen bottle.”
“Come on, Tilda, surely you can find a better hobby than collecting stool. How ’bout stamps? Or coins?”
“Laura!”
She went right to the drawer, slid it open, and tossed me the bottle. “Here, Tilda. Get a life.”
WE CALLED HIM our “tiny dancer,” after the Elton John song. He was a diminutive AIDS patient who was a former ballet dancer, originally from France. Now he was unconscious and dying from the fatal pneumonia that these patients so often got. He had constant diarrhea and in order to keep him clean, we inserted a rectal tube. But one alone did not contain it. We inserted another, then another. It took five large rectal tubes to seal his stretched anus. We stood around his bed, shaking our heads, trying to find a better, less invasive solution. It was undignified, crude, disrespectful, probably uncomfortable, but what was the alternative? How else could we keep him clean and his skin dry?
THERE WAS A patient who looked like Jesus. He stretched out his long, thin arms with his hands drooping down. He even had a long beard and soulful, heavenward-looking eyes. He had pancreatitis related to alcoholism and had to have emergency surgery, but remained septic for weeks afterwards. The sclera of his eyes were stark white, his pupils bright blue, like a husky dog. Frances tried innumerable times to convince him to let her shave his scraggly beard. No matter how we positioned his emaciated body, or tried to make him comfortable, he always resumed the pose of the crucifixion.
One night his intestines were so full of infection that they bulged out of his belly, broke open his suture line, and spilled out into the bed. The surgeon came and coiled them back, loop by loop. I helped by pushing the two sides of his wound together like a bulging, overstuffed suitcase, so that it would stay closed. For a time, we had to keep a sterile green towel in place to catch his intestines, in case they popped out again.
He was with us for many months and we all took care of him, but I wasn’t aware that he had developed any special bond with me until one day he made a request and it seemed that it was something only I could fulfil.
“Nurse Tilda, clean me out!” he called out.
Frances was his nurse that day and I heard her say, “Tilda has another patient today. I’ll do it for you.”
“No, I only want Nurse Tilda.”
He was chronically constipated and needed frequent manual disimpactions of feces that were jammed up there like hardened clay. With long, extended fingers (double-gloved), we relieved his discomfort.
But what could have been special about the way I did it? Besides, it wasn’t what I wanted to be known for!
I CAN STILL see the way the overhead fluorescent light glinted off the shiny metal bedpan that Laura held as she came out of the washroom where she’d gone to retrieve it for her patient.
“This man is going to die,” she pronounced about her newly admitted patient.
“Shh. No, you’re not,” I came over to his side to tell him. “Don’t listen to her. You’re doing very well.”
I don’t think he heard Laura anyway, or me for that matter, because moments ago, she had given him morphine for chest pain after a heart attack and he was becoming quite drowsy.
“Why did you say that?” I asked her when we sat down to do our charting. “He’s stable, now. He’s got a decent blood pressure and is in normal sinus rhythm.”
“Whenever they have an acute coronary event and then all of a sudden ask for the bed pan, it’s a tipoff. It’s usually a vasovagal reaction from a disturbance to their parasympathetic nervous system. I betcha anything this guy’s had an anterior infarction,” she said, studying his 12-lead ECG.
A few minutes later, something made her glance up at the monitor, seconds before the patient’s heart went into a rapid, uncontrolled rhythm. It was a few seconds more until the alarm went off, but by then, Laura had got the crash cart, which she had thought to place just outside the patient’s door, and was pushing it ahead of her into the room. We flew into action and there wasn’t even time for Laura to say, “What did I tell you?”
“MULTI-SYSTEM ORGAN FAILURE is the highest cause of mortality in ICU patients.” Dr. Daniel Huizinga was speaking in the lecture hall, refreshments provided once again. He was usually the absent-minded professor, distracted and whimsical with patients or medical students, or brash and boyish with nurses, but on stage he came to life as a distinguished and commanding speaker.
“In fact, multi-system organ failure is a lot like pornography,” he said. “You don’t know how to describe it, or define it, but you know it when you see it.”
He went on to talk about “stool enemas.” It was a new idea in critical care medicine and he wanted to study the benefits of it. The theory was that by returning the patient’s own diarrhea to the patient via the rectum, bowel flora that had been eradicated by broad-spectrum antibiotics would be restored. Something new to try. He was enthusiastic about this distasteful plan and eager as a child mucking around with mud pies to try it with patients. “Of course,” he added,
“I’m counting on the nurses to assist me with this research.”
“Thus the coffee and doughnuts,” said Morty, looking around at all of us. “Don’t touch them. It’s a bribe. He thinks if he feeds us he can get us to do his dirty work. Don’t we have enough work to do already, without being the doctor’s research assistants, too?
Believe me, you’re not going to be getting any credit for his research if you help him with this scheme!”
“Some doctors have a very high disgust tolerance,” I said, wrinkling my nose at the thought of this procedure and feeling queasy from the doughnut I’d already eaten.
“Daniel?” Morty waved her hand. “Could you please review the connection between multi-system organ failure and pornography?”
“WHO WAS YOUR most memorable patient?” I once asked Tracy, who knew so much, yet said so little.
“Huh! My most memorable patients are usually the ones I try to forget!” She paused, then said, “Mrs. Powell, without a doubt, but I can’t say I was too fond of her.”
I appreciated her honesty because it wasn’t something most nurses would admit, especially ones as conscientious as Tracy.
“I don’t know why,” she mused, “but Mrs. Powell couldn’t – or maybe wouldn’t – control her bowels. It seemed like she enjoyed making a mess. She didn’t care if she was dirty or that she smelled bad, no matter how many times we bathed her. She enjoyed offending us and that disgusted me. We couldn’t help her preserve her dignity, because she didn’t have any to begin with.”
We all remembered Mrs. Powell, but Frances remembered something else.
“Once I saw her terribly frightened. It was when David Bristol told her there was nothing more we could do for her. Only that softened me to her. She was the only patient that I had difficulty feeling empathy for.”
I also remembered how, quietly, among ourselves, we privately called Mrs. Powell something that rhymed with that name.
She had chronic breathing problems from years of smoking, and was also obese and diabetic. Her weaning from the ventilator was slow, with many setbacks. Her main interests were eating and sitting on the bedpan. In fact, rather than choose between these two activities, she preferred to do them both at the same time.
She had many habits that revolted us. But we were professionals, or so we kept trying to convince ourselves. We could rise above it, not allow our personal feelings – even ones of abhorrence, distaste, and disgust – affect the care we gave.
She liked to poke about in her own feces and identify remnants of foods she had eaten a few hours earlier. She picked it out and showed us, whole and intact, a long noodle or piece of banana.
Once I actually found a single pea lying underneath her. It fell out when I turned her to change the sheets. The princess and the pea, I thought. Not.
“She’s a human food processor,” said Morty in disgust.
“I can’t take it,” said Nicole.
Tracy kept her thoughts to herself, gritted her teeth, and bore it bravely when her turn came.
Mrs. Powell managed to time her farts for whenever we came near her bed to give nursing care. She opened her legs wide, to show us her labia and hemorrhoids flapping with each expulsion of gas. She curled her long bony toes, which were thin and splayed apart like fingers. They made me think of the roots of a fibrous tuber. She delighted in her depravity.
The problem wasn’t hers, it was ours. By exposing us, by aiming at us, so to speak, her behaviour spilled all over us. It humiliated us. We felt shamed.
“Isn’t this the most disgusting job in the whole world?” asked Laura, who kept threatening to leave nursing altogether, to pack it all in and move to a remote part of northern Ontario or open a bed and breakfast in the Maritimes, or move to New York to write jokes for David Letterman. Or, at the very least, she was going to work in the Cardiovascular ICU, a place that was cleaner and where people actually, usually, got better.
We equalized the burden of caring for Mrs. Powell by sharing her on a rotating basis.
Her husband, Jim, came to visit every day wearing what looked like the same pair of grimy overalls. He stood at the foot of the bed, hands tucked inside on his chest, under the bib.
“You got lots of gizmos, here, Mother. All the bells and whistles,” he said. “Wow, this place is flashing like a casino.” He stood there, admiring the ventilator. “Well, Mother, I couldn’t make it in any sooner today cuz we had to load the dunkey onto the back of the truck, but he wouldn’t move. So I says to Barney, get me a plank of plywood and a pudayto.”
“What was the plywood for?” I asked, listening in. I assumed the potato was to tempt the donkey to move forward, but I wanted to steel myself if there was going to be any mention of cruelty to animals.
“That’s to jam in between his hind legs so he don’t kick you – you know. And then I give ’em the pudayto to coax him on to the truck, but he won’t budge. Barney says, hell, no, shove it up his arse. So we did that – shoved it in good, and, boy, did that dunkey take off! Then we had to figure out how we were gonna get that pudayto out of his rear end. So I stuck my hand way up there.” He demonstrated the shoving and thrusting motions he’d used. “But what wuz we gonna do with the shitty pudayto? We gave it to the dunkey to eat. He don’t care. He’s a dunkey.”
Every day, Jim managed to keep his wife amused with his stories, but at times he fretted over her.
“She’s not herself, today,” he said when he thought she was having a setback and not eating as much as usual. (People often said this about their loved ones, but I always thought that in some ways, illness made people more like themselves than ever.)
“She’s quiet today,” he said on another occasion. “She’s becoming a snob. Too good for us, now that she’s in the big city. When I married her, she was white trash just like me, now look at her, all hoity-toity.”
Some days she refused to try to wean from the ventilator and begged us to place a lit cigarette at her trach hole so that she could take a few puffs. Jim pleaded with us to let her do it, too.
Morty was the only one to handle the situation with aplomb.
“We’ve taken care of you all these months when you were so sick and unable to do anything for yourself. You’re better now and it’s time for you to take care of yourself.”
Mrs. Powell motioned that she wanted ice chips and snapped her fingers at Morty as if to say, “Right away!”
“There’s no ‘right away’ around here, Betty! What’s happened to your manners? Just because you’re sick doesn’t mean you can forget all about please and thank you.”
If ever I asked Mr. Powell to leave for a few minutes when I had to clean up his wife, he said he preferred to stay and watch.
“That’s marriage!” he told me one day. “You start off with a frying pan and end up with a bed pan.”
He enjoyed chatting with whichever nurse took care of his wife that day. He bragged about his days as a firefighter and all the heroic rescues he’d made.
“You must have been in a lot of dangerous situations,” I said.
“Yeah, they used to say that the rats are leaving and now we’re going in.”
He warned me one day as he was going home, “Now you take care of my pretty girl there, missy, or this’ll be one angry cowboy for you to answer to.”
If, for some reason, he couldn’t make it in, he’d call and ask about her. If she was eating well (and how!), if she was shitting well (yes sir!), and how was her heart – “Was it doing any of those funny little things?” Had she had one of those “heart o’grams” that day and what in the dickens did those quacks think was wrong with her, anyway?
“You take her today, Morty. You haven’t had her for weeks,” Nicole said one morning before we started our shifts.
“No way. I’m looking for an unconscious, intubated patient, thank you very much.” Morty scanned the patient list board to choose something nice and easy. “Besides, I didn’t bring my gas mask. I don’t want to breathe in any toxic fumes.
”
“No, it’s your turn. You’re the perfect nurse for her ’cause you’re such a shit disturber, anyway,” said Laura.
“Tilda should take her. She won’t mind.”
“No, I had her yesterday, and last week, too. I’ve done my duty,” I countered, smug and safe.
“How about Frances? She’s got allergies. She won’t smell a thing.”
“Frances has the fresh lung transplant. She’s received report already.”
“What about –” She looked at Tracy.
“No way, I’m carrying on with the same patient I had yesterday. Ever hear of something called continuity of care, Morty? She’s all yours! Remember to double-glove.”
Morty stormed off but she was never really mad and never for very long.
I heard her later that morning, her voice booming out.
“Three bowel movements already, Betty? It’s only ten in the morning. Were you saving it all for me? Well, that’s enough poos for you. You’ve reached your quota for the day. Now, you have to hold it in.”
And later in the day: “I’m going to make you a fart chart, Betty. We’ll keep track of them. We’ll classify them: musical, tooting, ripping, silent but deadly – then the smells – rank, swampy, musty, cheesy, funky, and so on.”
Later in the day, Morty pulled a chair out to the hallway and called out to Mrs. Powell, “I’d love to join you in there, Betty, but I’m overcome by your vapours.”
Mrs. Powell couldn’t speak because she was still on the positive pressure ventilation. I had never heard a patient with a tracheostomy laugh, but I am sure that’s what she was doing.
“I’m not going to waste my time trying to help you get better if all you want to do is eat and shit,” Morty called out to her. “I’m going out tonight after work and I want to wash my hair.” She grabbed a few towels from the linen rack, stuck her head under the faucet in the sink in Mrs. Powell’s room, and started to lather her hair with chlorhexidene scrub.