by Tilda Shalof
How does she get away with it? I wondered. But whenever I looked in, I saw that both Mrs. Powell and Morty were having a jolly old time, making fun of each other.
Perhaps humour was the best way to deal with a situation like this and the uncomfortable feelings it brought. If only I could find this same lightness in myself.
I FIRST MET Gabrielle Mendoza during one of her admissions to the hospital, early on in the course of her illness. During a lunch break at work, I went up to the Oncology floor to pay her a visit at the request of the family, who were neighbours of mine. Gabrielle was a thirty-three-year-old woman who had breast cancer. When I met her, she had just completed a course of chemotherapy that had left her feverish and weak. But at that moment, when I first met Gabrielle, more than anything, she was distressed at not being able to take a shower.
“I can’t stand not being clean,” she said softly.
I looked around. It wasn’t that there were nurses sitting around at the nursing station doing nothing. There was no one there. I knew how short-staffed that floor was – in fact, I didn’t see any nurses, anywhere. Surely they were there, busy in the rooms? It was easy for me to wheel Gabrielle into the shower and help her out. I soaped her up, washed her back, shampooed her hair, dried her off, and then eased her down on to clean sheets. I was proud at how efficiently and smoothly I did everything, talking with her all the while, distracting her with light-hearted conversation during those moments.
One afternoon at home, a number of months later, I received a phone call. Would I come over to help Gabrielle? She wasn’t feeling well, her father told me, and he couldn’t reach her husband at work. I had heard about the brutal chemo treatments and radiation therapy she had endured and their failure to bring her into remission. Most of all, I had heard of her valiant attempts to continue being a wife and a mother to her two young sons.
When I got that call from her father to come to Gabrielle at home, I said, “I’ll be right over.” I wondered what I should bring. What did a dying woman need? A stethoscope? A hot water bottle? Herbal tea? I had nothing useful and decided to go with empty hands.
I met her father at the door. He was just returning from the drugstore, carrying a little paper bag. “I bought some milk of magnesia. I think Gabrielle’s having a touch of constipation,” he explained in his genteel manner.
Gabrielle was lying on top of a rumpled bedspread. She looked pale and weak. A sparkly pink scarf was askew on her head, inadequately covering her baldness. In a jean miniskirt, she still had an admirable figure. Somehow, life must have gone on in that household because there were a few golf balls at the ready beside her husband’s electric putting-practice machine in the corner and a scattering of her sons’ hockey card collection on the floor beside her bed.
“I have to go to the bathroom,” Gabrielle said when she saw me.
With her leaning on us, her father and I guided her to the bathroom and she and I went in together.
“It feels like it’s there, but I can’t push it out,” Gabrielle said in between gasps. “I don’t have the strength. I can’t do it.”
I told her to lean forward against me, so that I could take a look. When I looked down, I saw the biggest, baddest mass of black stool I’d ever seen. It was stretching and widening the opening beyond what I thought was physically possible. That huge mass was causing her shortness of breath. It was why even walking that short distance had been so painful for her and why her abdomen was so distended.
I had no gloves, no instruments, and no one to help me. I knew that I had to do two things: first, get that obstacle out of her and second, ensure that this experience would be one of relief and ease for Gabrielle, with no shame or embarrassment. I desperately wanted something to protect my hands, but there was nothing. I eased my fingers in there and probed around the stool, trying to loosen it up. I held on, tugged just a little and Gabrielle yelped in pain. With my other hand supporting her and holding her upright, I massaged her abdomen.
“Come on, Gabrielle, you can do it,” I said as I dug deeper with my fingers and tugged again. She almost fainted with pain as it moved along her rectum. And then it emerged, inching its enormous length out slowly. It splashed into the toilet. She stood up, straightened her shoulders, and shivered with relief. So great was her release from pain that it seemed like a type of pleasure, I think.
The smell filled the room. I tried not to wrinkle my nose. I did not want to take that smell into my lungs, but I forced myself to take deep, neutral breaths, so that Gabrielle would feel my acceptance and respect for what we had accomplished.
I broke up the stool with the toilet plunger so it wouldn’t clog the pipes. I washed my hands, then held her up in the shower, then eased her down into a warm bath. The calm smile on her face was my reward.
Gabrielle died at home, a few days later, and I hoped it was in comfort and peace.
14
TIRED, HUNGRY
“Her! That’s the one! I don’t want that nurse taking care of my husband ever again!”
It was me, standing at the end of the wagging, accusing finger of Brenda Laurence, the ex-wife of Dr. Irving Laurence, who was a patient in our ICU. She was speaking to Sydney Hamilton, our manager – who happened to have stepped out from her office at that very moment – to single me out: a bad nurse. Sydney took it in stride.
“Tilda is an excellent nurse. However, if you have any specific concerns, would you care to discuss them privately with me?”
What happened with the family of Dr. Laurence was that I did something a nurse should never do: I took a dislike to them. Despite my best efforts to conceal my feeling, the family must have sensed it. Apparently, it was mutual.
Dr. Laurence was a seventy-five-year-old man with cancer, diabetes, peripheral vascular disease, COPD*, kidney failure, and coronary artery disease. He was also hugely obese, which exacerbated all of his other problems, especially his diabetes. It had made him so susceptible to infections that only a few months ago his right foot had to be amputated. We all knew him well from his numerous previous admissions to the ICU. On this particular admission, his main problem was breathing. He was so sleepy that he was difficult to rouse. He was in a deep torpor, snoring loudly and breathing hardly at all. He was not getting enough oxygen and it looked to me like he would need to be intubated soon.
I had already met his ex-wife, Brenda Laurence, that night I had been in charge, and had got to know him and his family well during his many subsequent hospitalizations.
His live-in companion and chauffeur, Howie, brought him to the hospital whenever the naturopathic and homeopathic remedies, along with the puffers and oxygen tank they kept on hand at home, weren’t helping him. With his advanced age and many medical problems, the chances were slim that Dr. Laurence would ever fully recover. His will to continue seemed to be weakening with each hospitalization.
I admitted him, and Morty came over like a welcoming committee.
“Hi, Dr. Laurence! You’ve been picking up a lot of frequent flyer points with us lately, haven’t you?” She gave him an affectionate nudge on the arm. He roused briefly to give her a weak smile and then fell back into a snoring stupor.
Laura came over to have a look. “I bet this guy’s carbon dioxide level is almost 100,” she said. She held a hand over his chest, closed her eyes, and like a wizard, pronounced her diagnosis: “It’s 94, I’d say. His baseline normal runs fairly high, but I think he’s in hypercapnic respiratory failure.”
As far as I knew, Laura’s low-tech, old-fashioned diagnostic skills of observing, listening, touching, sensing, and thinking had always proven correct.
“I bet you anything this guy has Pickwick Syndrome,” she said, continuing with her own workup. “It’s named after a character in a Dickens novel. When I worked in Emerg I saw a patient like this once. It was a hot summer day and this morbidly obese lady came in, hardly breathing – just the occasional grunt – impossible to rouse, just like him. When I got her up on the bed, a grilled ch
eese sandwich fell out from under her breasts. ‘Oh, that’s where it went,’ she mumbled and took a bite. Pickwick has a very bad prognosis. I swear to you, if he gets intubated, we’ll never be able to get him off the ventilator. These patients are impossible to wean.”
Daniel Huizinga was the staff doctor on that week, and he came in to talk with the patient in order to ascertain whether he wanted the breathing tube again this time. But by then, Dr. Laurence was so oxygen-deprived and confused that he was in no condition to participate in this discussion.
“Do you want us to put the breathing tube in?” Daniel shouted loudly into his ear.
Dr. Laurence must have heard because he nodded in assent, too taxed to answer in words. Of course he wanted it then, at that frightening moment, but to me, it didn’t seem like the best time to put such a question to a person.
“Wake up, wake up, Irv,” shrieked Brenda, when she came in later that day. The breathing tube was in and he had been mildly sedated, for comfort.
“Open your eyes, Irv, and look at me.” She glanced at me in exasperation and then gazed back at him sweetly. “Oh, why aren’t you doing it, you stubborn thing?”
“I’m sure he would if he could,” I couldn’t help but interject.
She glared at me. “Irv, you can do it. Open your eyes and talk to me.” She slapped his cheeks hard, once, then again. She gave a few tugs on his urinary catheter and I jumped up to stop her. “Wake up, Irving, right now! I want to show you the dress I bought in New York to wear to your grandson Mitchell’s wedding. Come on, open those gorgeous green eyes.”
He opened his eyes, saw her, then closed them, and turned away.
“He’s not being stubborn,” I explained on his behalf. “He’s unable to respond to you.”
“Nonsense,” she said. “Irving is a very strong man. He never gives up. You don’t realize whom you are dealing with.”
“He doesn’t seem as motivated as usual,” I said.
“If you can’t have a positive attitude around him, I don’t want you taking care of him,” Brenda said to me.
I refrained from telling her what the other nurses had been saying.
“He’s trying to tell us something,” others who knew him better than I were saying. “He’s had enough and he’s turning away from the family. How much can a man of his age take?”
I kept quiet. Later in the afternoon, for a few brief moments, Dr. Laurence became more alert, and I propped him up so that he could scratch out a note to me in wobbly handwriting on a sheet of paper attached to a clipboard.
“Is this necessary? Do I have any choice in the matter?”
I seized the opportunity.
“Dr. Laurence, do you understand that the breathing tube is keeping you alive right now?”
He nodded.
“Do you realize that if we take the tube out, you will die?”
He nodded.
“Is that what you want?”
He clasped his hands together in prayer, his eyes heavenward. His message couldn’t have been clearer, his intention more resolute. Yet, when his family came in later, he closed his eyes and turned away from them. He chose not to express his wishes to them, at least not as unequivocally as he had to me.
We knew from previous admissions that Dr. Laurence and his wife had been separated for many years, but had remained on good terms. She had come in from New York, where she now lived and their son, Sidney, had flown in from California, where he now lived. Dr. Laurence lived with Howie in a huge mansion in the exclusive Bridle Path. On previous admissions, he had been able to tell us something of the travels he had made around the world with Howie. However, it seemed that whenever he needed health care, he was decidedly Canadian. His medical records from our hospital alone took up over five volumes.
Back in the forties, starting with only a dollar in his pocket, Irving Laurence built a vast fortune in the garment industry, manufacturing women’s clothing. He later went on to develop a chain of drop-off and drive-through dry cleaning outlets. As it turned out, he wasn’t a medical doctor at all. He had donated money for a wing of a medical school in Denver, Colorado. In appreciation for that gift, the university had bestowed on him an honorary doctorate and accepted his older grandson to their medical school. We heard about his father’s many achievements, from Sidney, who made frequent references to the family’s vast wealth and his father’s generosity, often managing to slip in a proud mention of his son, Adam, the one who was slaving away at medical school.
“Is he specializing in moguls or après-ski?” Morty had asked without compunction.
Sid was a filmmaker, a screenwriter, a music stylist, and a movie producer – the story often varied – who lived in Los Angeles. During this admission, Sidney and his mother visited Irving Laurence daily, but always managed to avoid arriving when the other was there. They hadn’t been on speaking terms for many years, still keeping alive some old family squabble.
One thing they did have in common was that neither of them believed that the hospital visiting hours applied to them. Neither did they believe in calling in first from the waiting room before they entered the ICU, as we requested all visitors to do. They walked right in whenever they pleased, day or night.
Brenda came in first, early the next morning.
“Sidney probably won’t even come today,” she said, draping her coat over the computer in the room. “Has my son even been here yet? Did he get here before me?” Then she turned to her mission: she was hell-bent on getting a response from Dr. Laurence.
“Come on, Irving, you can do it!” She slapped him on the cheek. “You look stunning today! C’mon, Irv, you sexy thing. Talk to me!” She flicked her finger on the inside of his thigh. “He needs his glasses,” she told me. “Why haven’t you put them on him?”
I did as she requested and he closed his eyes behind them.
“You’ve drugged him!” she cried. “That’s why he’s like this.”
“Your husband has not received any sedation today, nor during the night,” I replied.
“He wasn’t like this when Ingrid took care of him yesterday. He was better with her.”
I looked back in the nursing notes and read that the patient had been unresponsive for over a week.
After an hour of unsuccessful attempts to elicit any response from him, Brenda fled the room, saying she had a luncheon date.
Howie came in later that morning and stayed all day. He was living in the Laurence mansion, taking care of the plants and pets. He wore a cowboy hat and boots and a beautiful shirt, the exact colour of the inside of a cucumber. As soon as he arrived, he put his take-out coffee cup on top of the ventilator and leaned down to kiss Popsi, as he called him, on the cheek. Then he sprayed him all over with Eau d’Homme cologne and gave him a manicure and pedicure. After these ministrations, he sat on the edge of the bed, sipped his coffee, and munched on a chocolate croissant, the flakes dropping all over the bedsheets. Dr. Laurence opened his eyes at the sight of that tempting food. The hunger, the frustration, and the disappointment in the old man’s eyes, to which Howie was apparently oblivious, made me unbearably sad.
Howie had other things on his mind, and he shared them with me. He was afraid that his tireless devotion would go unrewarded. He was worried that the family would shaft him when it came to distribution of the estate.
“They’re so mean,” he complained, “and after all I’ve done for Popsi over the years! Not only that, but now I’ll miss out on those yearly vacations at the villa in the Cayman Islands.” He nodded over at the huddle of doctors viewing X-rays on the computer. “What do the big chiefs say? Do you think they’re going to pull the plug?”
I looked over at Dr. Laurence to see if he was taking any of this in, but thankfully, his eyes were closed again and either he was sleeping or had completely tuned us out.
I accidentally bumped into the bed as I went over to change an iv bag.
“That’s just your clumsy nurse, Popsi.” Howie glared at me. “Don’t
worry, Irv, you’re okay. I’ll look out for you.”
“Has my mother been here?” Sid stood at the door. “Has she been here yet? How long did she stay?” I didn’t like spying for them.
I STEPPED OUT for a few moments to stock up on supplies from the clean utility room and when I came back, I found Brenda had replaced Sid once again and was busy going through the chart.
“That’s not allowed,” I said, hating to play the role of an enforcer. I put my hand out for the chart.
“I have the right to read my husband’s chart,” Brenda said in a huff. “How am I supposed to know what’s going on? No one tells me anything around here. Irv always shares everything with me.”
“I’d be happy to answer any questions you have or bring a doctor in to speak with you.” I knew that there were sensitive bits of information in that chart that Dr. Laurence may not have wanted her to know. He had been treated by a psychiatrist for depression, took Viagra on occasion, and had had numerous homosexual relationships over the years, and not only with Howie, his current companion.
“Your husband’s chart is private and unless he gives you permission to read it –”
“But he can’t give me permission,” Brenda said. “He won’t wake up!”
“Well, then.”
I took away the chart, feeling like a child refusing to share her toys.
THE NEXT DAY, in the race to show his devotion to his father, Sid got there first.
“How’s Pop doing?”
“Stable,” I said. I couldn’t say much to these people without getting in trouble.
“Stables are for horses!”
“He’s having a good day,” I expanded.
“Every day above the grass is a good day!”
“He hasn’t changed overnight,” I tried.
“Tell him to change already!”
“Heh, heh,” I murmured and put on a false smile. His vaudeville act made me bristle. Sid, as a person, made me recoil.
“Say, nurse, do you know how to read all those numbers?” He pointed at the monitor.