The Making of a Nurse

by Tilda Shalof

  What else is there, I wondered? “Mmm …” I murmured as if I understood.

  “Colleen’s the type that if she worked in a supermarket she’d prefer to handle the cash and bag groceries rather than deal with customers, you know what I mean? Anyway, relax, girlfriend, we’ll manage.” He passed me the box of doughnuts. “Here, have a ‘tractor wheel.’” It was what he called the sugary, ridged crullers. “Or, a Boston Cream, if it doesn’t make you think of draining an abscess.”

  I chose a plain glazed one. It was a wonder I ever even had an appetite at the hospital, but I usually did. Anyway, there was no more time to chat because I had just gotten word from the resident on call that we were receiving a new admission from the Emergency department. “Scott, you’d better get started with the vitals and the baths. After I finish transcribing the orders, I’ll go around and do the IVS, dressing changes, the meds, and the peritoneal dialysis.”

  “Sounds like a plan. Don’t worry, Tilda. There are only two patients who are PBS tonight and one guy coming in now who’s HIBGIA.” I waited for him to fill me in and he complied. “C’mon, girlfriend, get with the program. ‘Pretty Bad Shape’ and ‘Had It Before, Got It Again.’”

  “You’ll have to keep a close eye on this new admission,” the resident said, wheeling a stretcher into the ward. “He’s a seventy-something homeless man with asthma and congestive heart failure.”

  Until I called Medical Records, I didn’t even know his name was Mr. Fred Olsen. His chart was so heavy and in so many volumes that the porter brought it up from downstairs in a wheelchair. I went to see him and stood looking down at a poor, dirty person sprawled in the bed. His breathing was noisy and laboured and when I placed an oxygen saturation monitor on his finger to get a sense of his tissue perfusion, I got an abnormally low reading of 75 per cent, so I cranked up the oxygen concentration.

  “If he deteriorates during the night,” the resident said almost hopefully, “we’ll be able to transfer him out to the ICU.” The doctor’s beeper rang and he had to run off, but I stayed behind with the patient. His oxygen mask hung loosely on his thin face and scraggly beard and I tightened it to fit better. I saw that he had soiled himself and so I went to get a basin of water, clean sheets, and a fresh gown. I got to work bathing him, all the while thinking about the multitude of equally pressing things that needed attending to. A man peeked into the room and asked to see the doctor. “He was just called away, but he’ll be back in a few minutes. Is there a problem? Can I help you?” I came out into the hallway to talk to him.

  “No offence, but you’re just the …”

  Yes, what am I? I dare you to say it. He changed his tack.

  “How is my mother doing?” he asked politely. “She seems confused.”

  Which one was she? I ran through my notes to refresh my memory. Luckily, I had read her chart. “Confusion is common after a stroke. It may improve with time. It’s still too early to say.”

  “What? Mother had a stroke? Why didn’t anyone tell us?”

  The man followed after me as I went to the nurses’ station and reviewed her chart, but there was nothing much to tell him about his mother as the doctor hadn’t yet examined her. The CT scan done in the Emergency department showed she had suffered a stroke and that lots of blood work had been drawn and other tests performed, but the results were still pending. Since I had nothing more to tell him and about twenty other places I had to be at that moment, I turned away from his anxious face and whizzed past him. I couldn’t spare a moment even to help him prop his mother up in bed so that she could sip a cup of tea. Colleen was nowhere to be found and Scott needed help with a patient, a forty-year-old man who that afternoon had swallowed paint thinner in a suicide attempt and was now vomiting blood. I showed Scott how to irrigate the patient’s naso-gastric tube with saline and left him with that and went out to the large group of family members waiting outside the door. “How was Salim before this happened?” I asked them. There was so little information in the chart and a considerable language barrier between us.

  “He was good, very good, thank you, miss.” They bowed slightly, grateful for my concern.

  “Was he unhappy about something?”

  “Oh, no, nurse, he wasn’t unhappy. Salim is such a very happy person.”

  “What led him to do such a thing?”

  “Well, he lost his job at the paint factory and his wife left him and took the kids back to India.”

  “Oh, I see.” Now I had too much information. I smiled at their old granny who was blowing kisses to me. She was hobbling around with a cane and looked like she’d just flown in from the streets of Calcutta with her black teeth, dusty feet in sandals, wearing a flowing brown sari with a veil that trailed down her back and nose ring in the shape of a daisy. She smiled at me, put her palms together, and bowed. I bowed to her in return and then went to find her a wheelchair. Since I couldn’t find one, I put her on a swivel chair from the nurses’ station and she blew more kisses at me as her grandchildren gave her rides, wheeling her up and down the halls. Just then I heard Colleen call out, “Come quick!” and I rushed into the room and saw a mini-geyser of blood spurting out of her patient’s groin. He had undergone an angiogram that day and the site where a huge needle had been placed was gushing. I grabbed a pile of sterile gauze, reached down into the folds of his belly and slapped it on the spot. I pressed my full weight upon it to staunch the blood. I put Colleen in place to keep pressure on the spot until the bleeding stopped and I went off to page the surgeon.

  I spent the entire night running from crisis to crisis. In between, I was answering the telephone, speaking with families, ordering drugs from the pharmacy, filling out forms, paging doctors, ordering trays from the kitchen, restocking cupboards, cleaning rooms. It was well after four o’clock in the morning and I had yet to begin to make a dent in my charting, but I decided to check on the homeless man one more time. I turned the light away so as not to wake the other patient in the room who was snoring lightly. At first I thought Mr. Olsen was asleep, too, but upon closer examination, I saw that he was dead. Now, there would be a slew of paperwork, a call to the morgue, and, once his bed was vacated, the possibility to get a new admission in his place. “Well, at least it’s one less to worry about,” the resident said, coming up to stand beside me at the patient’s bedside, and I hate to admit it but I had just had the exact same thought.

  It’s almost over, I told myself as the day shift began to arrive. This is my last shift, my last night as a nurse. I was throwing in the towel. (I would have thrown in my cap, too, if I wore one in the first place.) I sat down to collect my scattered thoughts as I prepared to hand over to the oncoming charge nurse. I went through them one by one. “Mr. X … wound still inflamed, spiked a temp last night … Mrs. Y, slept well, good pain control … Mr. Z … less nausea but urine output still low.” Then I came to a report about a patient I couldn’t recall. “Mr. Henderson,” I said, reading the note slowly. “Low blood pressure. Cerebral hemorrhage, unconscious, neck fracture …” Who was this? How could I not know about a patient, especially one this sick? I saw Colleen snickering and whispering to her day shift friends, who looked over at me and laughed. She had set me up! Some jokes are meant to provoke laughter and others to provoke embarrassment and this was of the latter type. But hadn’t I been warned? Nurses eat their young. Unfortunately, I had never learned how you avoided becoming someone’s live bait.*

  Just as I was leaving, the nurse manager came over to ask me to stay for a few hours of overtime. “We’re dangerously short-staffed. How ’bout it, Tilda?”

  “Sorry. No can do,” I told her curtly without even offering a reason. Let me outta here. Let me put an end to this nightmare. But still, it was not to be. As I tried to leave again, a nurse shouted from the medication room. “Call the Mounties! The narcotics count is off.” She’d said it like a joke, but it was a serious situation and no one could leave until we reconciled the count. The morphine tallied, as did the Codeine and th
e Dilaudid, but two vials of Demerol were missing. As the nurse in charge, I was held responsible and had to fill out an incident report. Unaccounted-for narcotics was never taken lightly and I knew this report would become a permanent part of my record. Again, I saw Colleen smirking as she left. I didn’t know if she had had anything to do with it – whether she was a possible user or simply a troublemaker – and I didn’t even care at that point.

  “Rough night?” said the nurse manager, coming back over to me.

  I shot her a murderous glance but my rudeness didn’t dissuade her from reaching out to me.

  “Come to my office. Let’s have a chat.”

  I shook my head because I knew if I spoke, I would cry, and if I cried, I would lose it altogether. “I’ll come,” I told her, “but I have nothing to say.” Yet the moment she sat down opposite me and gave me her undivided attention, I spilled my guts and told her everything. Not just about that horrific night and the homeless man who had died alone and the bleeding groin and Colleen, but about Buddy, too, and about the suppurating wound, and the patient who called me Maggie and about how impossible, frustrating, and soul-destroying it was to be a nurse. She listened to me, nodding her head from time to time. I expected her to tell me to toughen up and get better at my skills and at organizing myself, but she said none of that. What she did say surprised me. “You have to learn how to get in and how to get out.” You have to care, she explained, but not too much, or it will interfere with your ability to be effective. “Fix what you can and leave the rest. Some things you can’t make better.” I must have looked dubious. “I know it sounds harsh,” she said, “but it’s the kindest thing. The most helpful.”

  “I may be having a nervous breakdown,” I warned her, holding my head in my hands.

  “You’re exhausted,” she said kindly.

  Yes, there are times when sleep is the only solution.

  * Here’s a simplified version: One has to be sick enough to require a liver transplant, but not too sick that it would be overly risky. Of course, there has to be an organ donor, too.

  * Stands for Computerized Tomography (in full, Computerized Axial Tomography, or CAT). It’s a scan that has the capacity to look deeply into the body.

  * A screech-in is a Newfoundland hospitality rite de passage to initiate newcomers to the province, which involves dipping a foot in the ocean and literally kissing a cod.

  * However, it did make me recall my father’s old joke about the cannibal who was eating a clown and stopped to complain that something, “tasted funny.”

  6

  THINKING LIKE A NURSE

  The “All-Day-Breakfast” must have been invented for people who work at night because nothing tastes better than poached eggs, buttered toast, and hot coffee in a greasy spoon diner, in the late afternoon after an entire day lost to sleep. That horrible night shift, I had intended to call it quits, but with sleep and food so fine, my outlook improved. I decided to stay, after all. Besides, I needed nursing more than nursing needed me. Fortunately, around that time – it was 1988 – there was a sea change in the job market and hospital officials decided that instead of layoffs, more nurses were, in fact, needed. Headhunters went scouting, offering incentives of sign-on bonuses and education subsidies. Opportunities abounded. “Recruitment and retention” suddenly became the new buzzwords, making it sound like a military operation.

  But before I had a chance to apply for any of those jobs, my mother’s condition worsened and I was faced with a difficult decision. Her doctor in the hospital called me to come in. We walked together down the corridor. “Your mother has pneumonia,” he said gently. “Her condition has been severely debilitated for some time. Did she ever discuss her wishes with you?”

  My mother had told me exactly what she wanted, but I never really believed I would be in a position to have to carry it out. “I don’t know,” I lied.

  “The burden of treatment must be weighed against possible benefits so as to avoid unnecessary suffering,” he said in a kind but formal way.

  “What are the choices?”

  “To withhold further treatments, discontinue feeding, and wait and see. Or …” He paused before option number two. “To transfer her to the icu, institute life support measures, and then wait and see.”

  I told him I would think it over. I hung up the phone and went into the cafeteria. Even though I wasn’t the least bit hungry, I bought a butterscotch sundae in a small plastic cup that had a tiny wooden paddle for a spoon. I thought about using that little oar to push off from shore and row out into the high seas in order to get as far away from all of this as I could. I understood the choices before me, and I wondered how I would feel after each fateful one. Do me in, she’d told me. Find a way. From the age of six, I knew my mother’s wishes, but now would I have the courage to carry them out?

  I went back up to her room. She had a fever and I sat beside her and placed a cool cloth on her forehead. A medical student came in to take blood. He poked at her arms that were covered in bruises from previous needle attempts, but soon gave up and left. My mother was in her fifties, but she looked eighty. She no longer responded to the music on the radio I played for her and now, barely spoke.

  A nurse came in and took her vital signs but there was nothing vital about my mother’s grey pallor or her raspy breathing. When the nurse left, I leaned down close to my mother to hear if there was any last message, but her breath had an unpleasant, medicinal smell that made me pull away. She looked at me but I don’t think she saw me.

  “You have a difficult decision to make,” the doctor said when he came back into the room. “Your mother is critically ill. Again, the choices are to transfer her to the ICU and put her on life support or keep her here and focus on her comfort. Did she ever discuss the matter with you?”

  “Yes, she did,” I told him. “She told me many years ago, and again on many occasions.” I said I knew she wouldn’t want to go to the ICU because whatever they might be able to offer her there, she would never again be able to sing and that was all she really wanted. The doctor agreed that a palliative approach was wise, but we decided to continue with antibiotics and feeding. I guess I wasn’t entirely ready to let go yet.

  The nurses kept her clean and comfortable. They talked to her and caressed her and stayed even closer by her side, offering her the loving kindness that I hadn’t been able to for years. I couldn’t bear to visit her. A few days later, a nurse called to tell me the news. “Your mother has improved. Her fever is down.” The doctor was also impressed. “Given her premorbid condition, I didn’t expect a recovery, but her superb pulmonary function pulled her through. She’s got the respiratory reserve of an athlete with huge tidal volumes. It is extraordinary how she sings little tunes for the nurses at a moderate volume but her speech remains barely audible.”

  “She always said breathing was the most important thing.”

  “Now that your mother has recovered,” the doctor said, “we will have to fill out the papers for her to be placed in a chronic care facility.”

  But her recovery was shortlived. Within a few weeks, the pneumonia returned and this time ravaged her even more. One afternoon Pearl met me at the nurses’ station, her face glistening with tears. “She’s gone.” She wiped her eyes with her fingers and hugged me. “And I say, good for her! Praise the Lord!”

  I could hardly believe it had finally happened. She had been dying for years but this time it was for real. “Why do you say that, Pearl?”

  “She’s in the arms of the Lord. Her suffering is over.”

  “Her life was sad,” I lamented.

  “Yes, but she was saved,” Pearl exclaimed. “She took the Lord Jesus into her heart just in time, before she died. Read Psalms: ‘Alas for those who cannot sing, but die with all their music in them.’”

  “Who was she, Pearl? Did you ever get to know her?”

  “I did! I loved that woman. I do! I loved her like my chile.”

  I loved her that way, too, even when
I was a child myself. She was my first patient and a gentle soul who adored beautiful music but cried when she heard it. She adored elegant clothes, but rarely wore them. She admired great books, but never read them. I had missed her all my life and now that she was dead, suddenly, I no longer missed her.

  My three brothers were at the funeral, but we didn’t speak much. I could see that Robbie was mentally not well. “I made you take care of me,” he said. “I was very disturbed. Do not underestimate the very-ness of that disturbed.” I tried to put my arm around him, but he pulled away. My other two brothers seemed happy. They would be okay.

  “I’m sorry for your loss,” the Rabbi said to us. “We can only hope she’s in a better place now.”

  “It couldn’t be much worse,” said Stephen under his breath.

  The Rabbi spoke of her magnificent voice and her thwarted career as an opera singer. He told of her dignity and the courage with which she met her challenges. I sat there, squelching my memories of all the harsh things I’d said, the rough way I’d handled her at times, and the promises I’d broken. I thought of the tender nursing care I’d given to other people, yet the only patient for whom I couldn’t muster sufficient compassion was my mother. I sat there and tried hard not to think about the one long black velvet glove with pearl buttons that she wore when she sang. I had found it among her belongings and had searched all night for the mate.

  I was in my late twenties and grief seemed familiar to me now, this second time around, mourning my other parent’s death. I knew that the sharp pain would eventually subside, that it would always be lodged inside me, more bearable with time. For a few days I was tempted to follow my old escape route, underground into the subway, but a newer, stronger core within me was developing and I made the decision to go forward with my life. I decided to accept a position at Toronto General Hospital in the Intensive Care Unit. It was the same hospital where I had gone with my mother to her appointments with the neurologist Dr. DeGroot, and to my father’s various doctors. It was the hospital where I had first worked as a candystriper and then in the patients’ lending library, distributing novels and magazines. Now, its Department of Nursing was offering a critical care course and upon its successful completion, a staff position in the icu. It had only ten beds at that time but there were plans to expand.