by Tilda Shalof
THE DOG NEVER came for a visit but I did get an opportunity to offer Marianne another pleasure. After having the breathing tube in her throat for such a long time, she had to learn to swallow again. A speech pathologist worked with her and progress was slow.
“Swallowing is crucial,” she explained to Marianne. “Not just to get food in, but to protect the airway, the passage into the lungs.”
One day, it was decided that we could start with a small ice chip, see how she managed with that. I sat her up in bed and placed the ice chip on Marianne’s tongue. She swallowed it. Then another, and another.
“Let’s take a break, now,” I said.
Later, we tried again. She swallowed the ice chip eagerly, proud of her achievement.
“How was it?” I asked.
“Delicious,” she sighed.
“She’s doing great,” I reported to the team. “I’m going to try a Popsicle.”
“Okay,” agreed Jessica.
“How about a Popsicle, Marianne?” I asked her.
Her eyes opened wide. “Do you think I’m ready? Do you think I can do it?”
I was confident, yet I knew that if she aspirated, it would be a mistake, another setback. I would be blamed; it would be an error of judgment. However, if it worked, what a triumph!
“Let’s give it a try. Shall we?”
“Bring it on!” She pulled herself up to a sitting position.
The kitchen sent up a cherry Popsicle on a paper plate, labelled with Marianne’s name.
I broke it into little pieces, let it soften and mashed it up a bit. My heart was racing.
I placed a chunk, the size of a ruby jewel, into her open mouth and her tongue carried it back.
“That’s …” She closed her eyes.
I had to look away. She deserved privacy to experience this simple pleasure.
“That’s …” She fell back against the pillow.
“Are you okay, Marianne?”
For a moment, I thought she had fainted. I glanced at her oxygen saturations on the monitor. I reached for my stethoscope.
She opened her eyes. She smiled a dreamy smile. “It’s an orgasm.”
16
A DOSE OF PHOTO-REALISM
Oh! The charms, trinkets, icons, objets d’art, knick-knacks, and assorted bric-a-brac I have seen at patients’ bedsides over the years. I have kept a list of what I’d observed:
A filigree guardian angel; a Mario Lemieux bobble-head doll; an unopened bottle of tropical Boochoo juice from the Philippines (to have a sip of it was a dying man’s unrequited last wish); West African juju charm; kirpan – a Sikh dagger – and special wooden comb and stainless steel bracelet; wreath of plastic flowers and a friendship candle (unlit); a laughing jade Buddha; hand-shaped hamsa with a blue-green centre (to ward off the evil eye); a cassette tape of Anne Murray’s greatest hits (“If I ever hear ‘Snowbird’ again, I’ll barf” – Morty’s comment); three oranges and a clay bowl of rice; a discarded dialysis filter still containing a patient’s blood, saved so that it could be buried with her; a battery-operated plastic fish that sang “Don’t Worry, Be Happy;” a pair of deer antlers from a hunting expedition; vials of holy water and miniature plastic Madonnas; laminated prayer cards of assorted saints, especially St. Jude, the saint of extreme causes; a Native Indian dream catcher and a canoe paddle; tiny scrolls in foreign calligraphy; marble rosaries and olivewood crosses; two goldfish (Pebbles and Bam-Bam) swimming in an iv bag of saline; single eagle feather; Buddhist mala beads; small jar of Long Life Rejuvenation Powder with the price tag still on – $395.
Family or friends brought these small objects to the patient’s bedside. Sometimes they were taped to the wall, hung on an iv pole, thumb-tacked to a bulletin board, or pinned to a pillow (and occasionally, accidentally, bundled up and thrown out with the dirty laundry). I regarded them as salutes to the memory of the patient’s former life as a healthy, ordinary person. (It was health that had conferred their ordinariness, in contrast to the extraordinary state they were in now.) These placements at patients’ bedsides were like altars, the focal point for families’ prayers. I marvelled at the sincere and steadfast faith of people in these desperate situations, trying to invoke the healing powers attributed to these objects.
My nursing practice had evolved in such a way that the technical tasks and skills I had worked so hard to master had long since become second nature to me. My goal had become to perform those tasks in such a way as to convey the loving kindness I felt for my patients. I wanted to minister to their mind, spirit, and emotions as thoroughly as I did to their bodies. Over the years, I have managed to create positive and healing relationships with many patients and families. However, in order to do this, it has always been imperative to me to know at least something of my patients as the people they truly are.
I have become somewhat of a detective, always prowling or sleuthing for the hints and keys that could help me solve the mysteries. In many cases, those precious objects were all that I had to go on to help me in my quest. As I looked at those mementos and held them in my hand, I pondered their meaning to the patient. I examined them for clues to the identity and personality of my patient – a person who often remained hidden, obscured and unknown. Those little objects connected me to the patient and family. They spoke to me when the patient could not. And if the patient was conscious enough to be at all aware of the surroundings, then these objects had another purpose: perhaps even a glimpse of these familiar talismans was a comfort. Maybe they would serve as an encouraging beacon or signpost along the way to the patients’ desired destination: home.
However, as fascinating and poignant as I found these personal items and as much as I was touched by them, nothing affected me nearly as much as when a family member brought in a photograph. It was only then, gazing at that photograph, that I began to learn the story I longed to know. A missing puzzle piece was suddenly slipped into place.
Photographs, placed lovingly, wistfully, but above all, with great hope, at patients’ bedsides always stopped me in my tracks. It was usually a picture of the person before becoming a patient, enjoying a characteristic activity. A father at a family cottage, standing on a Georgian Bay dock, holding up his big catch; a young woman glancing up from a telephone conversation to smile at the photographer; a joyful wedding day, family all around. Often, there was a picture of a grandchild or a beloved pet.
Families told me that they put those pictures there as a goad, to motivate the patient. I could also see that sometimes they served as a kind of mnemonic device to jog a patient’s confused or clouded mind. Whereas the personal mementos brought to the patient’s bedside were intended for the patients, I believe that the photographs were placed there for us – the nurses, doctors, and all the people caring for that person – to see. In one sense, it seemed a family’s way to put us on notice: to let us know that their expectation was a return of their loved one to the previous robust state preserved in that image. Additionally, the photograph was placed there to remind us that the patient we saw in the bed looked nothing like the person they really are. “This is who they really are,” the photograph was put in place to announce.
A stew was beginning to simmer in my mind. The meat, potatoes, onions, and carrots were incidents collected over the years in the ICU:
I LED A man to his daughter’s bed. She had just returned from the OR after emergency surgery for a perforated ulcer that caused stomach contents to leak into her abdomen. She was swollen with sepsis, intubated and strapped down with all our trappings. I guided him with my arm around his shoulder.
“This is not Kelly,” he said, visibly relieved that this horrible sight, whoever this was laid out in the bed that I had mistakenly brought him to see, was not his daughter.
“Yes,” I said as gently as possible. “It is.”
“But she’s so bloated. That’s not her. Kelly is slim and beautiful.”
“It’s called edema, or third-spacing. The tissues fill up with fluids
when there is this amount of infection. It will go away in time.”
“It can’t be,” he said, turning to leave. “It’s impossible.”
I showed him her hands, her fingers, and then her name band.
“Kelly,” I called. “Your dad’s here.”
Only when she squeezed his hand did he recognize her.
COLLEEN LOOKED TERRIBLE. Emaciated and yellow, her skin was sloughing off in sheets. She was in kidney and liver failure and was so weak that she couldn’t even lift her arm up off the bed. Worst of all, she’d suffered strokes that made her unable to express herself. She looked at us with helpless, frustrated eyes. We’d pulled her through pneumonia and many subsequent complications, but had mixed feelings about our “success.” We’d brought her through to this?
Over her bed were pictures of her three children and one in which she was wearing a mini-skirt, skipping rope with them in front of their house.
“It was taken just last year,” said her husband. “That’s what Colleen really looks like. Not that.” He looked over at the shrunken, drooling woman in the bed and made an involuntary shudder.
SOME NURSES SHARED with me their experiences with patient photographs.
“Remember the young man with the pancreatic cancer and that picture of him in his chef’s hat working in that fancy restaurant?”
“How ’bout that wrinkled old lady who kept a picture – a fairly recent one, too – of herself in a sexy halter top and a pair of Calvin Klein jeans?”
“I’ll never forget a patient so disfigured by a skin disease that she pinned a picture of her former self to her hospital gown. ‘I was not always as you see me now,’ she told me quietly.”
“When I worked on the floor, I had a patient who kept a photograph taped to her hospital gown. It was a picture of her son who died over twenty years ago. He was wearing an Afro and bell-bottoms and a jean vest. ‘She must have kissed that picture a million times,’ her husband told me.”
THE MEDICAL RESIDENT presented a case during rounds. “Mrs. Tanaka is a twenty-five-year-old woman, previously healthy, gave birth last night, full term, C-section delivery. Had a cardiac arrest, was resuscitated, is now in septic shock.”
I stepped forward. “She’s been improving overnight … vital signs are normal, good pain control, but oxygenation is still a problem.”
“Let’s review her X-ray,” said Dr. Leung.
We discussed the details at length. Then, just as we were about to move on to the next patient, something caught my eye. A passport-sized photograph taped to the cardiac monitor. It was a petite woman in a kimono and geisha makeup, holding a pink sunshade over her shoulder with clasped white-gloved hands. Could this be her? I looked back and forth between picture and patient, patient and picture, trying all the while to picture the person.
“What did she have, boy or girl?” I asked. “Girl,” the resident said. “A healthy baby girl.”
“REMEMBER THAT CHINESE mother who made us give those twigs and sticks and desiccated reptile organs to her son? We had to grind it all up with a mortar and pestle like in some medieval apothecary!” said Laura.
“What I can’t understand,” said Tracy over whom common sense always ruled, “is why people don’t realize that even something natural can have side effects and drug interactions. How can we give these things, without knowing what’s in them?”
“Remember how some of us refused to give the mystery mixtures and she gave the concoctions to her son, herself, down his nasogastric tube?” Laura went on. “And when he got better she believed it was because of her medicine, not ours! Can you believe it? Thousands of dollars of drugs and equipment and she thinks she cured his meningitis with her potions of eye of newt and ox balls!”
“Let her think that, what do you care?” I asked.
Morty remembered that case, too. “Daniel Huizinga told me to go ahead and give it but use lots of water to dilute it. I told him that considering all the chemicals in Lake Ontario, I’d need a prescription for that water!”
“WE HAVE TO help Ellen,” said Laura, pulling me along. “She’s having a meltdown.”
Ellen was not a new nurse but she hadn’t been there as long as we had.
We found her leaning against the counter in her patient’s room, sobbing. Other nurses had taken over the care of her patient. Cardiac and thoracic surgeons had appeared out of nowhere and were swarming the room. Like high-tech carpenters, they carried with them all the instruments they needed to do the job, which in this case was open-heart surgery, right there in the patient’s room. Every second counted and there weren’t enough seconds available to transfer the patient to the operating room.
“Christopher learned sign language in preparation for his lung transplant,” Ellen said through her tears, “so he could communicate while he was intubated. He kept signing ‘thirsty,’ ‘thirsty,’ but I couldn’t give him anything to drink. Then he started it again.” She showed us the “t” and “h” with her fingers. “I said to him, ‘Yeah, yeah, I know you’re thirsty, Chris, but you can’t have anything to drink right now.’ I was too busy to even talk to him. But it turned out he was going ‘th’ for ‘thank you’ and it just about broke my heart!”
Tears dripped down her cheeks, and she stared at me blankly. She was in shock. I put a blanket around her shoulders and Frances brought her a cup of juice.
What made an experienced nurse suddenly seize up and react as if it were her first time dealing with a tragedy? Ellen was an excellent nurse but she prided herself on never getting emotionally involved with patients.
We heard the buzz of the electric saw and looked over as the surgeon cut into the sternum and then heard the resounding crack as they pulled apart the rib cage. The bed was drenched in red.
“I was having a conversation with this guy an hour ago and now, look! They’re opening his heart!” she cried. We looked closer and got a glimpse of the pulsating heart amid the sterile green towels that covered the rest of his body.
“My own brother is the same age, twenty-four,” Ellen went on, needing to tell the whole story. “This young guy is a math whiz. He’d been doing so well after his surgery. His dad came in earlier this evening and showed me photographs of him. One was of Chris playing with his dog, and another was of his graduation from university. When I saw those photographs, something changed in me. For some reason, this time, I decided to make a new decision: I would open my heart to it all.”
Ellen shivered, took a sip of juice, and continued. “Chris was weaning off the ventilator but around midnight, his pressure started dropping. His father had gone home and I didn’t want to call him back, yet. But by 0230 hours Chris’ pressure was in his boots and he was in bad shape. By 0245 hours I called the parents to tell them to come back. At 0300 he arrested. All I could think of was those damn pictures! My heart ached for the patient and his parents. Actually it felt like my heart was being ripped out of my chest. I’m telling you, I nursed this guy with my whole heart. I crossed over the protective walls that I’d always put up. Suddenly I reversed that decision and when I knew that this poor, great guy, someone’s son and someone’s boyfriend – I kept seeing those images in the photographs – was so sick, that he might even die, I couldn’t handle it. The room was suddenly black and spinning. Thank God Tracy and Laura showed up to help me.”
I was on to something. It was something I wanted to understand better. I wanted to explore, measure, test, and describe it.
“That sounds like research,” said Sydney, our manager, eagerly.
“DO YOU GUYS ever take a look at some of the things people keep by their bedsides? What about the photographs the families bring in – do you notice them?” I asked my friends.
“I swear, the more paraphernalia the family hauls in, the worse the prognosis,” pronounced Laura. “That’s the research you should do, Tilda. Figure out the relationship between the amount of stuff they bring in and the patient’s mortality rate.”
She kicked a defective cardiac mo
nitor stashed under the counter at the nursing station, ready to be sent out for repairs. “This place is really getting to me. I hate this hell hole. This place is the House of Horrors.”
“Why are you still so negative? Your attitude is like poison.” I rose up against her in sudden anger. “Why do this work if you hate it so much? I don’t believe you, anyway. Someone who’s as good a nurse as you are can’t possibly hate it.”
“That’s what you say,” she retorted. She was busy making a stuffed voodoo doll of Dr. Bristol. As he walked by she asked him, “How’s your back feeling, David?” and she jabbed in a pin and chortled in a maniacal way. “Having any strange aches or pains, lately?”
He looked at her, bemused.
She’d been busy with more and more bizarre antics lately. Going from room to room, she put Hannibal Lector or Jack Nicholson’s face from The Shining on everyone’s computer as a screensaver. She filled Sydney Hamilton’s leather briefcase with laxative pellets, just as she once threatened she would do. She ordered a party-size pizza with ten toppings and had it sent to Dr. Huizinga’s house. She stuffed our knapsacks with items that took us by surprise when we opened them at home: a Foley catheter, an enema bag, or a rectal tube (all unused!). She plastered the walls of the residents on-call room with pictures cut out from a calendar called “Cutesy Kitty Cats”: a white Persian with a pink bow, a fluffy calico in a basket, a tabby kitten playing with a ball of yarn. Over the years, it seemed as if her imagination was carrying her farther and farther away from us.
“You’re going through a second childhood,” I said.
“I’m reacting sanely to a mad, mad world,” she cackled.