The Making of a Nurse

by Tilda Shalof

  0000: The Missing Minute

  Midnight is 0000 hours in our digital world. Is it the end of the night or the beginning of the next day? Is it today’s date or tomorrow’s? So far, this night is allowing me to consider such imponderables. I listen in on Roberta talking to a family member at home. She’s trying to soften the blow after the doctor called to tell them their eighty-four-year-old father died. (It’s not in her to fabricate by telling people their loved one has “taken a turn for the worse,” even if they have just died so that they won’t drive crazy on the way in like many well-meaning nurses do.) That must have been Casey’s patient, I figure. He had an abdominal aneurysm and was scheduled for surgery the very next day, but the family doesn’t seem shocked by the news. Roberta offers them the opportunity to come see the body, but they decline. “I’m sorry for your loss,” she says.

  0033: The Tools of Our Trade

  I get up to stretch my legs and set off, on the prowl for something sweet or salty to nibble on, out of a vague restlessness. I see the nightly congregation about the nurses’ station has begun. We’re a few steps away from our patients’ rooms and can be there in a jiffy if needed, but for a few moments it is as if we are a world away. It’s our communal campfire and there’s no denying that at times, there’s a festive, party atmosphere that must seem so heartless to anyone passing by. Here we sit with our jellybeans and pretzels and over there are the patients, stretched out with their tube feedings and IV bags. We are chatting and laughing while they are intubated and unconscious. Not for one moment are we oblivious to the fact that they are not exactly having quite as merry a time as we are, but somehow, that brief, frivolous interlude fortifies us to return to our patients. Perhaps at times we do get carried away. I remember a patient on the floor telling me once, “I heard you guys and dolls whoopin’ it up last night. Having a party, were you?” I apologized for keeping him up. “Yeah, but it was also kinda nice hearing your young voices and knowing at least someone is having a good time,” he admitted.

  Tonight we’re worrying about our hands, the tools of our trade. We examine them for cuts, abrasions, contact dermatitis, and rashes. We bemoan the antimicrobial hand lotion we have to constantly use, and how it dries the skin.

  “It’s the powder inside the gloves that irritates them, makes them itchy.”

  “My hands are raw! Worse on the days I work and on my days off, they kind of recover.”

  “All the handwashing we do is rough on the skin.”

  “I can’t stand wearing gloves. It’s not the same, you know, when you touch a patient through vinyl. It’s like wearing a …”

  “Yes, yes, we know, we get it.”

  We moisturize. We debate the merits of glycerine, lanolin, shea butter, and plain old Vaseline. We vote for the most effective barrier cream, the best emollient, and estimate the number of hand scrubs per shift. We keep our hands in good shape, the way a chef cares for his set of knives or a musician tunes his instrument. We were impressed when we heard about a hospital that gave out leather manicure kits for Nurses’ Week – much preferable to the coffee mugs with the hospital’s logo, pizza vouchers, or free doughnuts, we all agreed.

  I greet Chandra, who’s also on tonight. She’s dipping her fingers into an industrial-sized pot of something called “Bag Balm,” working it into her hands. It smells like a barnyard. “Have you seen what it says here?” I read the label. “For veterinary use only. It’s a ‘soothing, penetrating, healing ointment for caked bags, sore teats, and chapped, hard milkers. Apply to udders before the night milking and again before the day milking.’”

  “If it’s good enough for Shania Twain, it’s good enough for me.”

  “She uses it? What’s wrong with her hands?”

  I put to them a question I’d been thinking about. “Could you be a nurse if you were blind?” They ponder a moment then mostly agree. Even in a wheelchair, you could be a nurse, they say. “But what if you didn’t have use of your hands?” Ahh, that’s different, they agree. No, without hands, you couldn’t be a nurse. “That’s what I think. No gadget, device, piece of equipment, or trained monkeys will ever replace the hardworking human hand, for its capacity to soothe,” I say, bringing them around to my foregone conclusion.

  Roberta makes like she’s playing the violin to my sentimental observations.

  “Oh, cry me a river!” says Jenna.

  Theo joins us and we admire his beautiful hands and the elegant gold and sapphire band he’s been wearing on his ring finger since his recent wedding to his partner, Phillip. “Boop-boop-dee-boop,” he sings out, giving a little skip and kick of his heels before plopping himself down onto Roberta’s lap. He has shown me pictures of when he was a drag queen and won the Ms. Gay Halifax Pageant and, I must say, he looked stunning in his pale blue ball gown.

  At the start of every shift, Theo swoops into the ICU and envelops each person he encounters into a huge embrace and plants a kiss on every cheek of each doctor, nurse, hospital assistant, porter, housekeeper, respiratory therapist, ward clerk, family member. “I darn near got a hernia leaning into your bed to give you that kiss,” I once heard him say to a patient. No one is left unhugged or unkissed by Theo, whether they like it or not, and most everyone does. (And if at first they aren’t completely comfortable with such florid demonstrations of affection, they soon get used to it and even begin to crave it.)

  I’ve often wondered why there aren’t more men in nursing. Back when I graduated in 1983 about 2 per cent of nurses were male. Nowadays, they say it’s about 5 per cent – not much progress toward gender balance. I have worked with only a few dozen men over the years, most of them decidedly straight, quite a few openly gay, one (that I knew of) who was transgendered, and a few undecided – but who cares? What difference does it make? What is really mind-boggling is that there are not more men in nursing, still in 2007. I once asked Theo how he chose nursing.

  “It drove my father crazy when I told him,” he said, “but I think he’s come around. I’ve always known I wanted to be a nurse. The guidance counsellor at school spent two hours one day trying to get me to change my mind. He said, ‘Theo, what about medicine or law?’ But I didn’t want to be a doctor and I knew I wasn’t a good enough liar to be a lawyer!”

  “Why aren’t there more men in nursing, Theo?”

  “It’s different for gay men. We don’t feel we have to hide our soft, caring side, but most straight guys are afraid it will make people raise questions about their sexuality.”

  I can feel my own soft, caring side beginning to flag at this time of the night, so I ask Roberta to recite one of her latest poems to perk us all up. Not many know that in addition to her vast store of rock ‘n’ roll trivia, Roberta has another talent. She is secretly a poet. “I tossed this one off this morning, before going to sleep.” She pulls a sheet of paper from her pocket. “It’s called ‘Just One Shock.’”

  I need to see the doctor

  I need to hear the news

  I only want the good stuff

  Don’t be giving me the blues

  I’ll ask one hundred questions

  Then I’ll ask one hundred more, but

  If you don’t give me good news,

  Then I’m heading for the door.

  As soon as you start saying

  That he will not pull through

  That’s the time that I will say

  Don’t call me, I’ll call you

  Let me make this clear to you

  Before I get to my car

  I want you to do everything

  I’ve seen it on ER

  He’s only eighty-eight, you see

  Enough of all this talk

  If his heart should stop tonight

  I expect you to give one more shock.

  How true, we murmured, appreciatively. At least someone has the guts to tell it like it is.

  Theo gets up and stretches his arms over his head. “Tootle-loo, chums. See ya, later.”

  Chandra returns to
her patient so that her partner, Tikki, can get away for a break and Jenna has already left. She seems in a much cheerier mood since her pager went off a few minutes ago and she showed me the text message from her husband, who is a policeman, also working the night shift. “I … LOVE … YOU,” the digital letters spelled out. I don’t think I’ve ever seen anything more romantic.

  I stay behind with Roberta, who is quiet. She has told me about her latest family worry. In addition to one son with autism, her other son was just diagnosed with Tourette’s Syndrome. “I used to call us the A-team, but I guess now, we’ll be the ‘T and A’ team,” she says.

  I want to tell her again that I admire how she deals with her challenges, but it makes her cringe whenever I do. “You gotta do what you gotta do. You’d do the same if you had to,” she’s told me. “It’s like being a nurse. You don’t want to be thought of as a hero or an angel. You’re an ordinary person doing a difficult job with good days and bad days.” She gets up to make her rounds, but before she goes, I can’t resist.

  “Life Is a Highway,” I sing out to her.

  “Tom Cochrane, and I’m going to be driving it for a long while,” she sighs.

  Trina flies past us at the nurses’ station. “Yo, you vanilla girls, get your butts in my room,” she, a chocolate girl, says. “I need your muscles to turn my patient and change the sheets again.”

  Roberta goes to help her and I return to my own patient. It’s about time I got back to work.

  0100: Priority Setting

  When time permits and all is quiet, we take turns and steal away for a break. Jenna is carrying a blanket, in search of a place to nap. “That one is haunted,” she says, rejecting a particular room. “There’s a ghost. Remember that young boy who died? Well, I’m not going in there,” she says, superstition overriding her fatigue.

  I pay a short visit to Tikki, ostensibly to say hello, but my hidden agenda is to check up on her and she knows it. When she started in the ICU a few months ago, I was her preceptor. She came to us straight from her university studies where she achieved top marks. She’s now qualified to “fly solo,” but a few of us have an uneasy feeling about her and I always try to be nearby, especially if she has a really busy patient. There is no question that Tikki has improved, but to be honest, the thing that changes most noticeably about her is her hair. She started out with a spiky, black Goth style to a fancy up-do with purple streaks, to her current style of long, multi-coloured dreadlocks. In addition to her many tattoos she’s shown us, she’s got lots of body piercings – tongue and ears are what’s visible, but she claims there’s more. (Funny, I saw her once with her mother in the supermarket wearing a girly, puffy ski jacket and a lavender Dora the Explorer track suit. Go figure.) She’s now a Wiccan and a devotee of hypnotic techno music. She has a new tattoo she wants to show me and informs me that her diamond nose ring is actually an engagement ring. I’m just about to offer congratulations when I notice two long cords dangling from her ears, snaking into her scrubs. She’s listening to music? “Tikki, is that an iPod?” I am aghast. She is moving to the beat of the music in her ears and doesn’t hear me so I tug on one of the strings. “Tikki, you won’t hear the alarms! You can’t concentrate properly!” I stop. There are more reasons than I could possibly enumerate. “Take it off!”

  “Hey, Tikki can you give me a hand with my patient’s dressing change?” Chandra, on the other side of the room, calls out to her.

  “I’ll be there in a minute. I have a bid on eBay in five minutes for a vintage Barbie, okay?”

  Chandra and I lock eyes in irritation. “No, Tikki, it’s not okay. I need your help now.” Tikki turns off her music and logs off her computer.

  I quell the terrible feeling I have at what I have just seen and return to my own patient. I sit at the desk and open a file in which I’ve been making notes and collecting data for the past few weeks. I add Tikki’s newest tattoo. It’s a green-blue serpent on her ankle. I keep watch over my patient and review my findings.

  0115: Home Alone

  It seems Jenna’s patient’s six-year-old daughter was indeed left alone when her father suddenly took ill and was brought to the Emergency department. Fortunately, a neighbour took her in and she’s being cared for by Children’s Aid Services until her father gets back on his feet. How easily Jenna and Roberta could have let that go, passed the buck, or overlooked it altogether. How easily they could have said, I’m tired, or it’s not my concern, it’s beyond our scope. “Good call, Roberta,” I say, but she shrugs it off.

  “Good friends, neighbours – isn’t that what people need more than anything?”

  “Tonight’s the Night,” I put to her.

  “Rod Stewart. Hey, what research are you up to?” She pointed at my stack of notes and I smile an inscrutable smile. “You’re So Vain,” I tease her with Carly Simon.

  0130: Research That Gets Under Their Skin

  Of thirty-eight subjects, between the ages of twenty-five and fifty-five, including nurses, respiratory therapists, doctors, and one hospital attendant, 68 per cent have at least one tattoo. Here is a representative sampling:

  A dolphin on a hip, a ring of roses around an ankle, Woody Woodpecker on an inner thigh, a green Celtic symbol behind an ear; a Brazilian wax,* numerous butterflies, the names Tom and Terry, a Toronto Maple Leafs logo; yin and yang; the Mona Lisa, a marijuana leaf, and an @ sign, a dragon, a cross, a Nike swoosh (the ultimate branding), a sword, Chinese characters, and a skull and crossbones.

  And some noteworthy narrative comments:

  An obstetrician passing by, eager to be included in my “study,” told me about her first delivery. “I lifted the patient’s gown and right there, on her pubic area, was …” She stopped to laugh at the memory, “Tweety-Bird! Well, what could I say but, ‘I tot I taw a puddy-tat?’ The staff doc bent down to take a look and he’s normally a very uptight sort of guy, but he said with a perfectly straight face, ‘I did, I did! I did see a puddy-tat!’”

  A hospital attendant reported that he once worked in a tattoo parlour. “It was near a church and you wouldn’t believe how many priests – and nuns, too – came in to have religious symbols – as well as some kinkier things – put on under their clothes where they’ll never be seen.”

  Only one day by your nurse, I thought. We’ll see everything.

  0140: No Rest for the Weary

  “Have You Lost That Lovin’ Feelin’?” I ask Roberta as she rushes past me.

  “No! The Righteous Brothers. What makes you think that?”

  “Having any ‘Saturday Night Fever’?” I ask her, pretending to be concerned.

  “The Brothers Gibb,” she says without pausing. “I’m busy. I’ve got to help Casey admit the new patient.” Casey has indeed put aside her sewing and salami and is back to her usual efficient and capable self, busy with the young woman who overdosed on Tylenol and her distraught parents. I go over to help, but as chaotic as it is in there, Casey has everything under control. The room is filled with lots of doctors, nurses, and respiratory therapists, and they don’t need another pair of hands, so I head back to my patient. I can’t help but remember similar situations in the past with Laura, who would be right in the midst of this crisis, taking control of the emergency, but afterward felt compelled to make some caustic remark like, “I’m going to give a seminar called, ‘Suicide: Get It Right the First Time.’” Laura had a problem with these patients. “They botch themselves up and make life worse,” she’d pretend to complain, for she couldn’t reconcile that we were fighting to save lives and they were trying to destroy theirs, but as usual, expressed her sadness as outrage.

  A chaplain, looking just as distraught as the family, stands outside the patient’s room, consoling them. The mother, through her sobs, tells the doctor and Casey what happened. “She had a terrible fight with her boyfriend. He was cheating on her and she went home and swallowed a bottle of Tylenol, chased down with alcohol. There was no note.”

  I shiver, suddenly feel
ing cold, and return to my patient’s room, where I’m supposed to be, anyway. It’s not my particular assigned portion of tragedy tonight.

  0150 or So: Low Tide

  No matter how many years of working nights, I still feel a chill and an overwhelming urge to lie down about now. Night shift doesn’t feel healthy. It’s not normal and it’s getting harder as I get older. You don’t sleep the same way during the day as you do at night. How much longer can I keep this up? From time to time, someone brings in an article about higher rates of migraines, depression, breast cancer, stomach problems, infertility, and heart disease in night shift workers. We worry. I make a list of things I’ve got to do on my day off. It’s time for the second wind to kick in. Where is it?

  0200: Vampires

  We move from bed to bed, drawing samples of blood from our patients’ arteries and veins. We need some results right away to treat any abnormal values and others to have ready to review by morning rounds. Luckily, we don’t have to wake our patients and can do it silently, drawing our samples from lines already in place. Bone-weary, cement-footed, dragged down, my vision is blurred, my mind is foggy, and my thoughts are muddled. I’m getting too old for this. I get up and walk around, splash cold water on my face at the sink. I will myself awake with whatever mental powers I can summon. The second wind must be right around the corner, any minute now it’ll come. How short the night feels when you’re sleeping in your bed at home and how long it feels when you are up all night at work. I skulk around the unit, eavesdropping, guarding, gossiping, and watching.

  0300: The Witching Hour