The Making of a Nurse

by Tilda Shalof

  I was quiet, brooding over what the doctor had said.

  “Are you worried about missing school, Tilda?”

  I nodded. That too.

  “Some experiences in life are more educational than school.” He studied me intently for a moment. “You really are so grown up.”

  That had always been my claim to fame.

  I often wondered where the mythical truant officer lurked, the one who prowled the streets on the lookout for children playing hooky. I prayed he would find me and send me back to school. The principal and teachers knew there were problems at home and never questioned my frequent absences. My friend Joy thought I was lucky to miss so much school.

  My father jangled his keys in his pocket as we stood on the subway platform waiting for the northbound train to take us home. “See, Tilda, that was one doctor’s opinion. We’ll go to other doctors and get more opinions. We’ll make our own inquiries, come to our own conclusions.”

  I was busy thinking about the twelve ways of looking at the heart. My father was loving, oh yes, and good-hearted, and kind, and bossy, and I was afraid he was going to die.

  MY TELEVISION TRAINING with Dr. Ben Casey, the neurosurgeon, turned out to be good preparation for my starring role accompanying my parents to doctor’s appointments, especially my mother, to hers with Dr. DeGroot, Chief of Neurology at Toronto General Hospital. I went along to help with buttons, zippers, belts and boots, chairs, stairs, escalators, and furniture. The doctor was tall and severe-looking. She had the same serious expression and wore similar, drab clothes at each visit: a brown tweed skirt, a plain white blouse buttoned to the neck, a white lab coat with a slender silver reflex hammer sticking out of a pocket, and sturdy black oxfords. Her manner was stern and brusque, just like Dr. Ben Casey’s, and she didn’t waste anyone’s time, especially her own.

  “I think Willie DeGroot prefers the company of women, if you know what I mean,” Dad told my mother with a wink, after the first appointment.

  My mother put her trust in her. “I’ll do whatever she says. She’s the one who will help me.”

  “You can’t do better than Chief of Neurology at a world-class horse pistol. Dr. DeGroot is the head honcho! Now, I’m all for Women’s Lib, but it does take some getting used to.”

  Sometimes I took my mother to her appointments by myself. We went through the same routine at each visit. First, I would hand over to Dr. DeGroot the clipboard with all the charts my father had set up for me to log my observations of my mother’s condition. The doctor would glance at them while my mother smiled at her coyly, as if by ingratiating herself she would be rewarded with a better diagnosis. Then I was expected to stand back and let her struggle solo through the rest of the exam. I felt like a traitor, as if I were letting her down. I was used to covering for her but now, in front of the doctor, her infirmity was exposed. From time to time, I lurched forward to offer my arm, but Dr. DeGroot waved me away. At the doctor’s request, my mother took ten steps forward, ten backward, tried to hop on one leg, swung her arms over her head, scissored them at her sides, clapped her hands, one, two, three, sat down in a chair and then attempted to get up out of the chair by herself. She performed these actions with weak and faltering motions as if moving against resistance, like she was pulling her limbs through water.

  Once, Dr. DeGroot brought in medical students to observe this interesting case. “Now, I will demonstrate the Babinski reflex,” Dr. DeGroot said. She used a key to gently scratch the soles of my mother’s bare feet. “Can you feel that, Mrs. Shalof?”

  “I’m not dead yet.” She rolled her eyes and smiled at the students, who appreciated her joke.

  Dr. DeGroot went on to check her reflexes, her handgrips, tongue muscles, eyebrow movements, and her ability to identify samples of peppermint, lemon, and vanilla. “Testing the twelve cranial nerves is an essential part of a complete neurological examination,” the doctor explained.

  I thought of offering them the useful mnemonic my father had taught me to help remember those cranial nerves: “On Old Olympus Tiny Tops, a Finn and German Viewed Some Hops,” for olfactory, optic, oculomotor, trochlear, trigeminal, abducens, facial, acoustic, glossopharyngeal, vagus, spinal, and hypoglossal. (He told me a racy version, too: “Oh, Oh, Oh, to Touch and Feel a Girl’s Vagina, Such Heaven!”)

  “Now, Mrs. Shalof, I want you to write something for us.” She handed her a pen and paper.

  “What shall I write? A sonnet? An epistle? My last will and testament?”

  “Anything will do. Why don’t you make a list of your daily activities?”

  The way my mother picked up the pen and positioned herself on the chair I saw immediately that she had become Tatiana, composing the letter to Eugene Onegin in Tchaikovsky’s opera. Dr. DeGroot took a look at the page and passed it to the students, who nodded. “Micrographia,” she said gravely.

  Bingo! A point scored in the diagnosis game!

  Dr. DeGroot explained to the students the complex process of examining the mind. “First, establish the patient’s level of consciousness. It is the most sensitive indicator of neurological status. Then, observe whether the patient is alert, drowsy, confused, stuporous, or comatose. In a true coma, if you lift the eyelid it will gradually cover the eye. In a hysterical coma, the eye rapidly closes.”

  My mother blinked a few times to demonstrate that she was experiencing neither type of coma.

  “Now, we will perform the functional inquiry to examine cognitive function. In other words, speak to the patient.” She turned to the subject at hand. “How are you today, Mrs. Shalof?”

  “Ever so much the better for your asking, Dr. DeGroot.”

  “Mrs. Shalof, can you please tell us in which direction the sun sets?”

  I saw how desperately she wanted to give the correct answer, but was either confused or simply didn’t know. She looked at me helplessly. Behind the doctor’s lab-coated back, I mouthed the answer, but she had looked away.

  “I always tell my children, don’t let the sun set on your anger. Resolve your differences before the day is done.” She saw from the doctor’s frown that that wasn’t the desired response.

  How could she not know that the sun sets in the west? She knew every word of La forza del destino and could name every aria that Renata Scotto had sung at her La Scala debut. Sometimes I wondered if she was playing a game. Perhaps the joke was on us?

  “Please count backwards from one hundred by threes, Mrs. Shalof.”

  “Higher mathematics has never been my strong suit.”

  Dr. DeGroot went on to check “expressive functions” by asking her to use words in a sentence, first apple and donkey, and then microscope and guillotine. When she got to chattel and amanuensis, my mother’s energy flagged and her voice began to fade. We could hardly hear her.

  “Now, I will test the patient’s abstract reasoning,” the doctor explained. “Mrs. Shalof, what does ‘people who live in glass houses shouldn’t throw stones’ mean?”

  Despite her fatigue, she sat up tall and tried her best. “It is a parable about resolving conflicts peacefully. It is never necessary to resort to violence.”

  “What about ‘a rolling stone gathers no moss’?”

  “Oh, the Rolling Stones! I can’t stand their moaning and caterwauling. They are ruining their vocal cords. Oh, let’s see. It’s about discipline. Stay true to your dreams and you will succeed.” She looked up hopefully into Dr. DeGroot’s stern gaze. “Perhaps this is all a dream and there’s nothing wrong with me. Is that possible?”

  “You most definitely have a degenerative neurological condition.” Dr. DeGroot washed her hands at a little sink and ushered us to the door. On the way out, I glanced back to see what my mother had written.

  THERE WAS ANOTHER occasion when my father asked me to go with my mother to her appointment because he had a business meeting. Again, Dr. DeGroot put my mother through her paces. Afterwards, the doctor stood washing her hands and looked back at us in the little mirror over the s
ink and said, “You may get dressed now, Mrs. Shalof. I have arrived at a diagnosis. Please wait outside until I call you back in.”

  My mother turned to me to dress her. For the examination she had worn a paper gown that flapped open at the back and a pair of floppy paper slippers. As I put her clothes on her and zipped and buttoned everything, I pretended she was a doll and we were playing dress-up. We went out to the waiting room, where there was a television on that no one was watching. The Watergate investigation was underway and it was on all the time, for weeks now, non-stop. “Let’s stay here and watch this. It takes my mind off my own problems.” She pulled at my sweater to bring me down to sit beside her. “Those guys are in worse trouble than I am.” We sat watching and after a few minutes, Dr. DeGroot called us back in. I offered my hand to help my mother out of the chair, but she wouldn’t budge. I tried to pull her up. Her body was a tug of war between us.

  “Come on, Dr. DeGroot wants to see you again.” I yanked on her arm. “Come on! Get up!”

  “You go. Come back afterward and tell me what she said.”

  “Where is your father today?” the doctor asked when I returned to her office.

  “He couldn’t make it. He had a meeting.”

  “Well, you seem very grown up for your age. What are you, about thirteen, fourteen?”

  “Twelve.”

  “You have a very close relationship with your mother, I can see that.” She looked sad, which seemed her way of being kind. “Your mother is a fascinating case. Sit down, Tilda.” She pointed to a chair. “She has a serious brain disorder that is uncommon in a woman in her mid-forties. It is likely a sequela of an infective encephalopathic process that manifests in Parkinson’s disease. In addition, she exhibits a number of concomitant components of motor neuron disease and cognitive and psychiatric derangement.”

  It sounded bad, though not nearly as bleak as when Dr. Ben Casey closed the patient’s chart and sadly walked away. “Is it contagious?” I asked. It felt like it was.

  “Of course not, but her condition is unusual. I will be publishing an account of her case history in the Annals of Neurology. Your father can read it in the next issue. Now, she’s not too far gone yet, but she will get much worse. There is no cure, but there are medications for the symptoms and promising new developments on the horizon. Now, go out there and tell your mother what I’ve just told you and if she has any questions, bring her back.”

  What could I make of that mumbo-jumbo? At least it wasn’t like when Dr. Ben Casey dropped a bombshell of “subarachnoid hemorrhage” or “astrocytoma, malignant, inoperable” and from his hard-set expression and dark eyes, you knew it was game over.

  I went back out to the waiting room. The television flickered and the investigation droned on. The sad, grim faces of the Watergate men loomed large on the screen, reflecting the miserable faces of the patients sitting around the room, also worried about their fates. My mother was staring at the screen, still sitting in the chair where I had left her, her elbows cradled in her hands, held close like someone might take them from her. I thought about turning around and running away, never to return. What if I leave her here? She’s too much for me. I can’t handle this! I went over to her. Her eyes stayed fixed on the TV set as I repeated the doctor’s words, but with a more upbeat delivery. She turned away and it looked as if she was crying, but there were no sounds or tears. “Are you okay?”

  She shook her head, part yes, part no. “Dr. DeGroot said that with certain conditions, patients are not able to produce tears. I must have one of those.” She wiped her face of tears that weren’t there. “But believe me, it doesn’t mean they don’t cry. You can cry without tears. I can vouch for that.” I sat down with her to watch the defendants with their shamed faces getting grilled about their devious activities. We laughed at the earnest men, their implausible alibis, and their circuitous explanations for obvious wrongdoings.

  “And I thought I had problems,” my mother said, and we laughed even more.

  We sat in the waiting room until the Commission broke for lunch. I helped her up out of the chair, and she leaned into me. “My nerves are shot,” she said softly. We walked slow, tiny steps to the subway station, my mother clinging to me every inch of the way. As the train roared into the station, she held on even tighter. Suddenly, she swayed forward and I reached out to pull her back from the edge. “Don’t worry, I won’t jump. I can’t even whip myself up into enough of a frenzy to commit suicide.” She sank into the nearest seat on the train and pulled me down beside her.

  “We’ll be home soon,” I told her. Please wait until we get there before falling apart!

  She cuddled my arm and stroked it like it was a kitten. As soon as we got home she was seized by a bolt of energy. She pushed me aside and marched ahead, still in her coat and boots. She went into the den where there was a hi-fi stereo and a metal rack filled with record albums. She flipped through them and grabbed Maria Callas singing Norma and Leontyne Price’s Aïda. She pulled each album out and cracked it over her knee. The brittle seventy-eights broke easily, but the flexible LPs required more force. She looked odd, standing on one leg, the other bent up high, like a flamingo.

  “Don’t break your records!” I pulled the pieces from her hands.

  “Life is nothing to me if I can’t sing.”

  “But Dr. DeGroot didn’t say you wouldn’t be able to sing.”

  “What does that numbskull know about music?” She plunged her face into her hands. “I can’t bear to listen to great voices and be reminded that I can no longer produce my best. What is more pathetic than the artist who can no longer perform? I might as well be dead. Will you find a way to kill me?”

  I took her hand, like Dr. Ben Casey’s Nurse Wills did with a patient after surgery. It might be “curtains” for the patient, but the nurse always stayed at the patient’s side, even after the doctor left the scene. I put my mother to bed, imagining myself as part of a long tradition of noble caregivers who kept vigils at the bedsides of the infirm. I was Jo March from Little Women, who waited all night for Beth’s fever to break, but by morning Beth was gone.

  “I feel better when you’re with me.” She snuggled up close. “Don’t go to school. Stay here. I need you more than that silly old school.”

  “What do you mean? Not go back? Quit school?”

  “Why not?”

  “It’s against the law for one thing. I have to go back. I’ll never catch up. I’m missing everything!” The only other kid I knew of who didn’t go to school was Pippi Longstocking. I turned the TV on to keep my mother company and went downstairs to wait for my father to come home.

  SLEEP USUALLY CAME so easily to me, but that night I lay there stewing until long after Johnny Carson’s lead-in theme song and monologue. When it was over, my father got up and signed off, just like his favourite broadcaster, Walter Cronkite: “And that’s the way it is, February 19, 1972.” My mother came into my room and I pretended to be asleep.

  “You awake?” she whispered. She slipped off her shoes and sunk down onto my bed. The darkness seemed to give her even more licence to nestle in close and seek comfort in my arms. I hated how she used my body to make hers feel better, the way one huddles around a fire for warmth. “If only I could be a better mother to you,” she murmured.

  Aha! Now, we were getting somewhere! I sat up eagerly. “What would you do?”

  “I would give you the sun, the moon, and the stars.”

  But my wishes were so much more modest than that!

  “Tilda, what would I do without you? Promise you’ll never leave me. That you’ll always take care of me.” I nodded. “Will you make sure that nothing bad ever happens to me?”

  “Yes,” I pledged. “Of course.” I saw no reason why not.

  “I am embarking on a difficult course. It may be the fight of my life, but I am prepared to give everything so that I may sing again. I will need your help.” She brought her lips to my ear. “And another thing,” she whispered. “When
the time comes, I want you to pull the plug.”

  “What plug?”

  “Now, I’ll sing you my favourite song.”

  A silent rage was boiling inside me. I wanted to push her over onto the floor. I wanted to hurt her. I had been feeling this anger for some time. It was what made me dig my nails into her as I pulled her along, or grab her arm too roughly, or drop her down into a chair with more force than I should have. Sometimes I even thought about not catching her when she stumbled and letting her fall to the ground. As she sang her sad song, my heart heaved with resentment. Who could be angry at a sick mother? I could. To make up for my shameful thoughts, I pretended to listen to her. For now at least, pledging promises and pulling plugs were momentarily set aside for singing songs. Suddenly, she grabbed my hands. “My life is over,” she cried.

  “Dr. DeGroot didn’t say you were going to die.” I pulled away and flopped onto my side, my back to her.

  “Tilda, if I get very bad I want you to do me in,” she implored and then looked up at the ceiling as if to beseech the heavens above. “When the time comes, please kill me. It’s the only kind thing to do.” I looked away and pretended not to hear. “Find a way,” she said, and I pretended not to understand.

  IT WAS LESS THAN one year later when I came home from school one prematurely dark afternoon to an empty and silent house. The streetlights hummed with electricity in the blue twilight and Christmas lights blinked on the neighbours’ trees. I entered the house and moved from room to room, turning on lights as I went. When I got to the kitchen and flicked on the light switch, I found my mother at the table, staring out with blank eyes. I ignored her strange behaviour, opened the refrigerator and stood staring into its depths. “Where’s Dad?” I asked casually, mid-bite into an apple.

  “In his ivory tower.” Then, of all things, she broke into song. “Spesso vibra per suo gioco, il bendato pargoletto, strali d’oro in umil petto, stral di ferro in nobil seno. Questo manca …”