by Tilda Shalof
“Yeyiyeh tov,” it’ll be good, or “Ha kol besder,” everything’s all right, she said to Israeli patients.
“Insh’allah,” she said to the Arab patients, invoking God’s mercy on their behalf. She would bend down to the little cots where children lay, cradle their faces in her hands and murmur, “Shwaya, shwaya, it’s going to be okay.”
When patients vomited she rubbed their backs and told them, “That’s great! Keep going!” When patients cried in pain, she said, “You’re a hero,” or “You’re so brave.” Even to the sickest patients, patients we knew would likely die, Hannah said, “You’re doing so well.”
What a snow job, I thought. “Why do you say it’s going to be okay for them?” I challenged her one day, “why give them false hope? Shouldn’t we be helping them accept reality?”
Boy, do you have a lot to learn, said the look on Hannah’s face. “There will be time for that. They need hope. Right now, hope is just as important as chemotherapy – maybe even more.”
Patients loved her. “Hannah,” a patient called to her. “I put out three hundred cc of urine. Is it enough?” “Don’t worry,” she answered, “I only put out two hundred cc myself.” Another time, a patient who had been in remission for a year arrived in relapse. “Oh no, not you again!” Hannah said with the perfect lightness of touch to wring a sad smile from him as she pulled him to her in a big hug.
“Damn it,” growled Dr. Ben Cassis whenever he heard that one of his patients had relapsed.
THE BLOOD DRAWING had to be completed by precisely ten o’clock in the morning. If I was running late because I had difficulty finding veins or was conversing with the patients too much, Aviva came over to help me finish up, and I soon found out why. All the doctors, nurses, secretaries, and lab technicians gathered in a cramped office a few doors away from the clinic for breakfast, and it was not to be missed. Breakfast required the team’s full attendance and during that time, the patients seemed to understand that they would have to fend for themselves and each other. Patients might be in the middle of treatments or receiving a blood transfusion, and others throwing up, but at 10:00 a.m. sharp, the team disappeared.
Out of nowhere, a huge spread appeared, laid out by Jamilla, a young girl from the West Bank who was the hired helper. The table was laden with a pot of strong brewed coffee, plates of green olives, soft white cheese, slices of yellow cheese, piles of hot toast, platters of cucumbers, radishes, red peppers, and a salad composed of tomatoes and cucumbers chopped into tiny pieces. As if we didn’t have any pressing work or sick patients a few steps away, we sat down to enjoy a luscious, leisurely meal.
I usually sat perched on the edge of the sink where I could listen in on their loud, heated discussions in Hebrew. I didn’t feel confident enough with the language to be a part of it and weigh in on any of the controversial topics they raised. They all held strong opinions about everything. They spoke about new chemotherapy protocols, the wins or losses of the Tel Aviv soccer team, the rising price of tomatoes, and, of course, politics. (Sometimes the price of tomatoes was a political issue in itself.) They spoke about plans for the soon-to-be-opened bone marrow transplant unit, and about economic cutbacks to health care, and the unrest just starting to brew on the West Bank, called the intifadah.
Hannah had explained to me how our Arab patients came to us. “The hospital bus brings them in the morning from the occupied territories,” she started off, allowing a few extra seconds for that contentious phrase to sink into my brain. “They receive treatments and then the bus returns them to their homes in Gaza or the West Bank.”
Once, I looked out the window of the clinic and saw a circle of Bedouin mothers eating their mid-morning meal of grapes, pita bread, and sunflower seeds. They lifted their veils to spit out the seeds and sat laughing and talking while minding their children who played all around them. A little boy stopped to pee in the sand. I chuckled to myself when I thought about how inadequate was the lecture I’d received on “cross-cultural nursing,” where the professor had suggested we inquire, “Did the patient wear ethnic costume or Western dress?”
Hannah lit up a cigarette. “They know their child is sick and can’t get proper medical treatment in their villages, but they don’t like to come to us.” She shook her head sadly and took a deep drag on her cigarette. “Slowly, they are gaining confidence in us, but if their village is put under curfew or they’re hassled at the border after a terrorist attack, all is lost. Once, we sent an ambulance in to pick up kids for chemo treatments. At first, the mothers were scared when the soldiers came to get their kids, but then they understood what they were doing and kissed them. Have you noticed how blood tests make them very nervous? They’re scared we’ll take too much and they don’t like getting Jewish blood, but they are relieved we don’t ask for a blood donation in return. All in all, they’re grateful but would rather not be dependent on us. Maybe one day, we’ll all realize that disease is the enemy, not one another.”
Aviva saw the situation differently. One morning at breakfast, she spoke about an Israeli soldier who was killed in a terrorist attack on the northern border. One of his kidneys had been transplanted into a ten-year-old Arab boy in renal failure, and she wasn’t pleased about that. “Don’t you think we should take care of our own, first?” she asked me, fuming.
“We must put all personal feelings aside,” said Dr. Ben Cassis, coming into the room and pouring himself a cup of coffee. He was a dark-skinned Moroccan Jew who dressed for work formally in a suit and tie that he removed the moment he walked out the door at the end of each day. He was brilliant, but stern and unapproachable. “What we do here is pure, untainted by politics. That’s the beauty of medicine.”
It was unlike him to speak about the beauty of anything and it stirred me to hear him say that. I began to take more of an interest in him, though he was married and had teenaged kids. But not for one moment was it lost on me, the similarity of his name with my old television love interest, Dr. Ben Casey.
“Have you heard? There’s been another devaluation of the currency,” said Aviva, changing to her other favourite subject, numbers and facts, checks and balances. “Yesterday one thousand shekels was worth one thousand shekels. Today, it’s the same, but tomorrow, one thousand shekels will equal one shekel. It’s not just shifting a decimal point. Soon, our money will be worthless.”
“It’s because of the Lebanon campaign. We can’t continue bombing Beirut,” said Ben Cassis wearily. He seemed weary not just of the endless war or the politics, or the economic woes of the country. He was weary of treating cancer patients and losing so many of them. He was weary of life itself. “And the West Bank and Gaza Strip, too. It’s time to pull out of there altogether.”
“Last month, I earned three hundred and twenty dollars,” Aviva continued. “It makes more sense to go into overdraft than to forgo something, ’cause the price will surely double by next month.”
“If we even make it to next month,” said Ben Cassis.
“Oh, shut the hell up,” said Hannah good-naturedly, and we all had a good laugh.
I decided to plunge into the conversation and tell them about the drastic cutbacks in health care also taking place in Canada. It was so severe, I said, that there were no jobs for nurses. It seemed like health care was in crisis everywhere, I went on, but no one was paying the least bit of attention to what I was saying because they were all doubled over, howling with laughter. Aviva explained the joke to me. “The word for economic cutbacks is ketzitzot, not ketzitzim. You said there were drastic ‘meatballs,’ not ‘cutbacks’ in health care spending!” I laughed too, but hoped they weren’t going to bring up the other grammatical blooper I’d made the day I left Hannah a note asking her to order more blankets. By accidentally substituting one letter in the word, I’d ended up asking her to order more “happiness” instead.
Hannah and Dr. Ben Cassis were always the positive and negative charge, the mother and the father of the unit. But there were times that not eve
n the fun and banter of those communal morning meals made Ben Cassis lighten up.
“Yuri, Yuri,” he said about the patient who had relapsed. “Damn it,” he said, pounding his fist on the tabletop. He closed his eyes. “Oh, Yuri,” he said sadly to himself.
“He’s a Russian tragedy,” said Hannah, pointing at Ben Cassis with her cigarette. “Yosef, did you examine Khalid today? He’s looking better. He’s even got a smidgen of colour in his cheeks.”
“It’s leftover hemoglobin from the three units of blood he got last week. He’s not producing his own. Soon, when the Bleomycin we gave him destroys his lungs, we’ll be visiting him in the Intensive Care Unit. He’ll have to be on a ventilator. I’m sure he’ll appreciate us then.”
“How about Geula? She’s improving.”
“Geula?” Ben Cassis repeated. “None of her four children is a bone marrow match, and I have that news to tell her today.”
“But she has more energy,” said Hannah. “She’s in good spirits.”
“Her diarrhea is lessening,” I offered.
“So, she’ll die without diarrhea, so what? We give them a drug for the leukemia, but it destroys their liver. Another drug damages their kidneys. They get mouth sores, skin rashes, ulcers, and pain. The only question is will they die from the disease or from the treatment we’re giving them?”
“We have to believe in what we are doing,” Hannah said, trying to lighten the tone. “I gave chemo to my neighbour’s dog and he’s cured of leukemia. I believe in our treatments. It’s all we have.”
Ben Cassis sighed heavily. “I don’t believe in anything. I certainly don’t believe Geula will make it. She looks worse every single day.”
“You are an unbearable human being.” Hannah squinted at him through her cigarette smoke.
“The only thing that might help Geula is a blessing from the Rabbi,” he said sarcastically.
“Isn’t it enough that you are a man of no faith? What do you care if she goes to the Rabbi for a blessing?”
“Ceremony and ritual are abracadabra nonsense, but the laws of God and the laws of Science are one and the same.”
“The family is praying every day,” Hannah said.
“So am I. So am I,” he said with a nasty laugh.
“Yosef, you’re impossible.” Hannah stubbed out her cigarette. “Well, Geula may die, but she will be happier getting there if she prays along the way. Let me ask, do you believe in anything?”
“Yes,” he said, “in science.”
“Hannah, I need you,” a patient called out.
“Turn off the toaster,” she said to Jamilla, and to the rest of us, “let’s get back to work.”
I could feel myself becoming dangerously attracted to Dr. Ben Cassis, but at times, his detached, rational approach put me off, and sometimes put off his patients, too. Once, I was assisting him with an examination and when he finished, as I helped the patient up off the table, she asked him when she should come back to see him again.
“In two weeks,” he answered curtly.
She looked scared. “What if I don’t make it till then?”
“In that case, you won’t have to come back.” He closed the chart, stood up, and walked to the door. The patient and I looked at each other. She turned to Ben Cassis in reproach, but he was gone, on to the next case. But I think we both understood that he hadn’t meant to be cruel, merely logical.
A FEW MONTHS AFTER I began working in the clinic, the new bone marrow transplant unit was almost ready to be opened and Shoshana Zamir, as the Nursing Director, called a meeting of the entire team to discuss its organization and management. “Hannah Shalev will be the head nurse and Aviva Shofet her assistant,” Shoshana announced.
“No, no, no,” interrupted Hannah. She had no patience for titles or accolades. Her dangling earrings tinkled as she shook her head. “Aviva and I will share the head nurse position.”
“There can never be two captains of a ship,” Dr. Ben Cassis said, “never two generals of an army. There has to be a Chief-of-Staff and a second-in-command.”
Hannah was older, wiser, and more experienced, but Aviva was much more ambitious, taking night courses at the university toward her nursing degree to get ahead. When Shoshana chose Hannah, Aviva tried to hide her disappointment, but I felt relieved. Although Aviva was helpful to me, she was also bossy and critical and always finding fault.
Shoshana Zamir had asked me to prepare some information on the nursing care of bone marrow transplant patients so that I could assist the other nurses with our new educational needs.
“Ahh, our little professor,” said Hannah, blowing away a puff of smoke, as if to clear the way for me to make my presentation. “Why are you studying all the time?” she often asked me. Sure enough, at that meeting, she joked, “Nursing theories? What good are they? All bluff and blah-blah.” My scalp tingled as I blushed in embarrassment. “Forgive me, Tilda, but I have no pretensions about what it is to be a nurse. I have no use for academics and philosophers who have forgotten that if they want to call themselves nurses, they should take care of patients. Nurses must never forget that their work is with patients, wiping their noses or their asses or whatever needs to be wiped. That’s what nursing is about!”
“What about talking with patients and listening to their concerns? Isn’t that nursing, too?”
“Of course it is, but too much digging and probing can do more harm than good. Listen, Tilda, a nurse is someone who helps people feel better. End of story.”
That was Hannah’s nursing theory. Well, one thing was for sure, you didn’t have to read between the lines to figure out where you stood with her.
ONE OF THE FIRST patients admitted to the new unit was a high-ranking army officer named Shaul Dayan. The treatment we had given him for his multiple myeloma was successful, but he still got infections and mouth sores. Even so, he looked virile and handsome. One morning, Ben Cassis told me he wanted to perform a bone marrow biopsy on Shaul and so I began to gather everything he would need for the procedure. I rushed around, setting up as quickly as possible, as I could hear him pacing impatiently outside the door. I had to keep running in and out to retrieve things I’d forgotten and when I came back in, Shaul said, “Listen, don’t let old Ben Cassis put pressure on you. This is what you will need for the procedure.” He made me a list: gauze, sterile drapes, a Jamshidi (a specialized instrument for performing this type of biopsy), a large syringe, and an assortment of glass slides and containers for the samples of his own bone marrow. “Relax,” he told me, handing me the list, “you can do it.” Ben Cassis performed the difficult procedure, which involved puncturing the hip bone with a large needle and extracting a sample of bone marrow. (Most patients screamed during that test, but Shaul smiled.) Assisting with that procedure always upset me because I imagined how excruciating the patient’s pain must be and I knew how much depended on the results. Afterwards, Ben Cassis left the room abruptly, and I stayed behind to tidy up. Shaul saw that I was distraught and put his arm around my waist to comfort me. I couldn’t help but fall in love with him, too. In Shaul’s case, that was a particularly easy thing to do and I was not the only one. Rarely a day or night passed when there was not a beautiful woman at his bedside.
“I am his wife,” said a woman.
“I am his girlfriend,” said one on a separate occasion.
“I am his lover,” said another.
“I am his Commanding Officer,” said yet another.
“I am his wife,” said a different one, and I didn’t ask any questions.
“I am his mother,” said an older woman, and I could see the resemblance.
Boldly, I asked him about them and he grinned. “They all cry over me but I tell them they are allowed only one to two teardrops per day. But sometimes they exceed their quota.”
On occasion, Shaul told me a little bit about his work in Intelligence for the Israeli Defence Force. “The wars of the seventies exposed some serious weaknesses in our land intelligence s
ystems,” he explained. “Today’s battlefield is more demanding, with more deadly weapons, especially during counter-engagements. The old-fashioned methods of obtaining information through agents and interrogators have low effectiveness, especially when we need immediate, accurate information for the precise identification of targets. Remember Iraq, in 1981?”
“Were you involved in that?” I asked, but he only smiled in answer. “I developed electro-optical devices for remote-piloted vehicles that display targets in real time.”
“I see,” I said, trying to.
Later that day, Ben Cassis showed me the results of Shaul’s bone marrow biopsy. “He’s at his nadir,” he said grimly. “He is vulnerable to infection. We’ll have to put him in protective, reverse isolation.”
Now, we had to approach him in gowns, gloves, and masks. It wasn’t the usual type of isolation procedure where we were protecting ourselves from infection. In this case, we were trying to protect the patient from organisms we might be harbouring. Over the top of my mask, I smiled at Shaul with my eyes and he smiled back with all of him. “Are you cold?” I asked. “Here’s a blanket.”
“Put that down. Sit with me.” He patted the bed beside him. “Here.”
What did he need from me? He had all his army buddies and all those wives, girlfriends, and lovers who lavished attention upon him. And if Aviva caught me sitting, doing nothing, she would think me lazy. “I’d better go,” I said, inching toward the door.