The Making of a Nurse

by Tilda Shalof

  “No, I’ve seen him on the street, panhandling. Maybe around Yonge and Bloor.”

  It impressed me that she saw him as an individual, not as an anonymous street person. I, however, was not so noble. On the other hand, she didn’t have to get as close to him as I did. She wasn’t in his face as I had to be, breathing his air, smelling his pollution, hearing his grunts and obscenities. I was close enough to sense his thoughts, read his life story, and feel a bit of his pain.

  When it was my turn to speak, I raised the question of whether he still needed the breathing tube. Initially he had required maximum support, but today he was more awake. Although his blood gases showed poor oxygenation, and he had a lot of thick, infected secretions, if we did a lot of deep breathing exercises and chest physio, he might be able to improve on his own. I suggested we extubate him and see if he would “fly.” If he didn’t do well, he would have to be re-intubated, but if that happened, then he could be sedated and allowed to get the rest he needed.

  The staff doctor agreed. “It’s worth a try.”

  The respiratory therapist removed the tube and I sat my patient up in bed and helped him cough out his secretions. He looked around, bewildered. “I need a drink,” he muttered.

  “Not yet,” I said. “Easy does it.” I put my hand on his shoulder.

  We placed an oxygen mask on his face, but he ripped it off and threw it down on the floor.

  Carmel popped in to ask me if I wanted to go for coffee with her. She must have been feeling guilty about her switcheroo, but it was karma: I was meant to have this patient.

  “No, maybe later,” I told her and sat down to think. I hadn’t thought much about my own similarly dismal period in years, but now, taking care of this man who had nothing – no home, no family or friends – brought it all back to me. Eventually, I had decided I didn’t want to live that way any more and faced the daunting task of taking up my life in my arms. The first thing I had to do was find a place to put myself, a shelter of some sort. “Home” seemed like an impossibility. I took the first place I saw.

  “Donna! Get the screwdriver!” the landlord of Regal Mansions hollered down the hall to his wife. “The hacksaw, too!” Clearly, there were some loose screws, but I had no idea what this man was planning with the hacksaw. He led me down a dark, narrow hallway that smelled of cigarette smoke, cooking, and the bodies of the many lives living in the rooms behind the doors. It was dimly lit with shaded lights and sand-filled spittoons at the elevator. We stopped at the bachelor apartment for rent on the second floor. It was at the back of a three-storey building overlooking a parking lot. It didn’t have a kitchen, only a tiny refrigerator and a hotplate in the corner of the room. There was only one rule at Regal Mansions, the landlord informed me: no pianos.

  Drugs and guns are welcome, I suppose. “That won’t be a problem.”

  It was in a rundown building in a seedy neighbourhood. “Toronto’s twenty-fifth homicide of the year happened right around the corner,” he boasted. The apartment was dirty and the walls were crumbling and needed paint. “It ain’t the Taj Mahal, but if you get bored, you can go across the street to the church and watch the weddings.”

  Joy didn’t hesitate to offer her opinion. “Don’t even consider this dump, Tilda. Come stay at my apartment until you get yourself sorted out. I have a futon.”

  “I kind of like this place. It’s growing on me.”

  “Yeah, it grows on you all right. Like a fungus.”

  I called the landlord to say I’d take it. I hired a painter, a Russian man who promised to do “special job for young lady.” I handed up a cup of coffee and a doughnut in a paper bag to the top of the ladder and stood back to gaze around at my new periwinkle blue walls. It was the colour of dusk and dreams; of in between, of day turning into night and night turning into day. It was a becoming colour, I thought, pleased with the paint and my pun.

  “Let me ask you something.” The painter rested the roller on the can of paint. “What’s nice girl like you living in dump like this? You should live with parents until wedding. What boy want girl who lives in bachelor apartment? A parscutzveh we call this type.”

  “I hear you,” I sang out. “Thanks for the advice.”

  At night, I heard babies crying, people screaming, cats yowling, a dog’s toenails clicking on bare floors in the upstairs apartment. Vibrations of Bob Marley and the Wailers thrummed through the wall and floorboards along with the earthy whiff of dope, when I left the windows open. I lay down on the bare floor so I could feel the warm throb of Jamaica in my bones. The smell of hot, steamed fish and fragrant jasmine rice permeated the hallway each evening as I trudged down the hall after spending the day with my mother. A Vietnamese family lived across the hall. There were about twenty pairs of plastic sandals and slippers outside their apartment, beside the front door. Once, when the door was open, I saw the family squatting on the floor in a circle, their rice bowls cupped in one hand, chopsticks in the other. I left the window wide open and one night a squirrel scurried in. I tossed him a few kernels of popcorn, grateful for his undemanding companionship. We were all looking for places to call home.

  I bought a little travel alarm clock with green hands and numbers that told the time in Tokyo, São Paulo, and London. I took my parents’ stuff out of storage and donated my father’s clothes to a home for alcoholic and homeless men. I imagined the bums at the Silver Dollar Tavern on Spadina Avenue sporting my father’s lime green polyester shirts, black beret, and paisley cravats. There wasn’t anything useful like furniture or kitchen utensils, but there was a foot-long sign with my father’s credo, THINK, in bold letters and his Underwood typewriter with the keys that stuck. A bunch of dried up ballpoint pens from dry cleaning plants and a stack of library cards from every small town he’d passed through. There was his Ponderosa Steakhouse discount card and a catalogue from a medical supply store featuring raised toilet seats and bathtub bars.

  Joy came for a visit. “How’s your new place?” She stepped gingerly over the threshold. “I’m so glad you’re back. I missed you. We have so much to talk about,” she said like old times, like we were fourteen again. She handed me a plant in a pot as a house-warming gift. I didn’t want something I would have to take care of and she read my thoughts.

  “It’s a cactus, you goof. Put it on the windowsill and give it a few drops of water every other month. You can handle it. Cocooning is what you have to do now.”

  I had no curtains so I cut up green garbage bags and before taping them over the windows I caught a glimpse of a pretty garden in someone’s back yard. It seemed unimaginable that I would ever sit in a garden like that with civilized people. Even with my garbage bag curtains in place, the sunlight filtered through along the sides, like shafts of light slicing through an aquarium. I slept on a mattress on the floor and didn’t bother with sheets or blankets, just pulled my jacket over myself like I did when I slept in the park. Home, I kept trying out the word before I fell asleep.

  One morning, I got up and went to the refrigerator. It was empty from the top shelf to the bottom. It was entirely up to me to make this place a home. I was coming to the bitter realization that the mother/nurse I yearned for was going to have to be me. It was up to me to fix myself – or not. I was tired of always being homesick. I had been yearning for a home for so long, even when I was at home. I got to work. That day, I scrubbed and scoured that place until it shone. In the evening I went out to buy bubble bath. The options promised were “revitalizing,” “rejuvenating,” and “soothing,” but since I had no idea which remedy I needed, I settled on “moisturizing.” I realized that the time had also come to buy a few groceries.

  I HELPED MY PATIENT out of bed, eased him down onto a comfortable chair, and went back out to my desk and computer. As I sat there, I returned to the question I’ve asked myself every day of my life as a nurse. Do I love my patient? Some would say love is a lot – too much – to ask; only skilled caring and basic respect are necessary. Many would claim that
love is not a requirement for the job. Nonetheless, it’s what I’ve come to expect of myself. Because, after all, what is prejudice if not a failing of the ability to love? And if I couldn’t manage love, at least I wanted to offer loving kindness.

  I went back into his room and pulled up a chair and sat down beside him.

  “What’s your name?” I asked. “I mean how do you pronounce it?”

  “Whaddya need to know for?” His voice was hoarse from the tube.

  “What should I call you?”

  “Nothing.”

  “Who are you?”

  “Nobody.”

  I waited.

  “Okay. Call me Joe.” He picked his nose.

  “How are you feeling?” I waited. “Joe?”

  “How the hell do you think?” His skinny legs were splayed open and he scratched at them.

  “Your legs must be itchy,” I said, and he grunted. “I’ll get you some cream for those bites.”

  “I’m thirsty. I could use a drink.”

  “How about some juice?”

  “Got a beer?”

  I handed him a cup of orange juice. He took it, looked at it, and hesitated.

  “What’s wrong?”

  He turned meek, unsure. “Do you have apple instead?”

  I stopped in my tracks. He’d found my soft spot. I preferred apple, too. We weren’t apples and oranges. We were both apples.

  “God, I need a fucking drink in the afternoon. I mean a real one.”

  “I know how you feel.” I craved something in the afternoon, too. For me it was coffee or chocolate, or both, but wasn’t it the same thing as booze or drugs? Both were cravings to fill the same emptiness. We each had our own drugs of choice.

  “I’d like a smoke, too.”

  “Can’t help you there. I’m sorry.”

  Perhaps this was compassion. It wasn’t being upset with someone else and it wasn’t fixing people’s problems. It wasn’t feeling what they were feeling. It was simply bearing witness to another person’s predicament. For years I hadn’t known how to give and always either gave too much and felt overwhelmed, or else gave too little and felt inadequate. So often, I turned away in the face of things that shamed or disgusted me, things that scared or saddened or enraged me. To be the kind of nurse I wanted to be I had to get beyond these barriers. This way of compassion empowered me. It felt healthy and helpful. For years I had been a caretaker and now I was a caregiver. Caring was no longer a burden. It was my life’s work, the work I was meant to do. My emotions no longer felt like a liability. I was able to do this work because I care as much as I do, not in spite of it.

  Joe and I sat together. There were questions I wanted to ask, advice I thought of offering, maybe even a pep talk. Instead, I sat quietly, giving him the space to speak if he wanted to, hoping my presence was some comfort. I wanted to tell him I had once been just as lost, but had found my way back. Should I have told him? Probably not. There was no need to say or do anything.

  My shift was almost over. I asked someone to cover for me and raced to the bank machine and withdrew five twenty-dollar bills. As I slipped them into his worn, empty wallet, I knew my small gesture was a token, more for me than him. I said goodbye and went out to hand him back over to George, who arrived back for night shift. He would likely be transferred to the floor the next morning and eventually discharged back onto the streets to a men’s shelter or detox centre. Like so many of our patients, once they go out the door we lose contact. Maybe he will get a dog or find someone to love. Love can bring about miraculous cures. I know this from personal experience.

  18

  NURSING CONFIDENTIAL

  “Is it true?” Laura asked. “I heard you left the ICU. Have you finally come to your senses?”

  “No, I didn’t leave. I merely took some time off,” I said, a touch defensively.

  “After all these years, it’s getting to you, isn’t it? Face it, Tilda, it’s time to make a change. Even Tracy’s had enough. She left.”

  It was true. After completing her degree in nursing, working full-time in the ICU, and being a full-time hockey mom, Tracy resigned from the ICU and took a position as a public health nurse. I’ve been encouraging her to go on and do a Master’s or become a Nurse Practitioner,* but she looks at me like I’m crazy. She’s got a student loan to pay off, a mortgage, and kids going off to university next year. Her career has taken a different course. She’s teaching mothers how to breastfeed and care for their babies and told me she’s enjoying the new challenges.

  Every few months Laura’s Line gets together. If more time goes by, I pine for them. I need to see them, be near them, and hear the interplay of their voices. Recently, one Saturday evening, we were sitting outside on a restaurant patio sipping drinks. We meet on weekends now that all of them, except me, work weekdays, nine to five. I asked Tracy about her new job.

  “It feels strange going into people’s homes. It’s their territory. The other day I asked a mother how her baby was doing and she told me he’d gained two pounds since my visit the week before. I took one look at the baby and I was horrified. He had a bony, triangular face. I picked him up. There was no way that baby had gained weight! What could I say to the mother that wouldn’t freak her out or make her lose trust in me? I asked her if I could watch him feed. I wanted to see the baby latch onto her breast and how he sucked. How many poos, pees, I asked her? She said she’d just fed him and she was putting him to sleep. But I had a terrible feeling. Something was wrong. Your baby needs to be weighed, I told her. I made her promise she would get him weighed that day. She said she would, but I worried. I called her on my day off. She ended up taking the baby to emerge and he had to be hospitalized. He had lost nearly three pounds, and finally she saw how serious it was.”

  We sat taking that in. Only then did we realize what this meant. Tracy saved that baby’s life.

  “A new nurse wouldn’t know that,” said Frances finally. “It takes experience and intuition.”

  Or a good teacher to guide her, I thought, looking across the table at Frances.

  I’d been teaching, too. Back in the icu, I had taken Sandy under my wing. (Her real name is Sankofa, she told me.) She’s from Eritrea and has big blue eyes, mocha skin, frizzy hair framing her face, and a huge, beautiful smile. She is new to Canada, but is an experienced nurse who has worked in many countries – it seems that highly skilled nurses are in demand all over the world. She was paired with me in the ICU for a day and we were caring for a liver transplant patient, four days post-op. The new liver was not yet working optimally and there were complications. The patient’s husband stayed by her side all day and the children were in the waiting room. Sandy and I ran the entire day, giving her blood transfusions, platelets, plasma, and medications. Later, her blood pressure dropped and her blood-clotting factors were so depleted that she started vomiting blood. Still, there was reason to believe her liver would recover with the whopping doses of steroids we were giving her. In short, it was an ordinary day in the icu.

  It was even becoming ordinary for her husband. “I’ve finally realized that every day is a completely different day here. It’s a strange state of mind you have to wrap your head around,” he said, nodding, “hoping and praying she’s going to get better and preparing myself for the worst.”

  Yes, that about sums it up, I thought, looking at him. Sandy and I were on opposite sides of the bed. We lifted the patient up to place the X-ray plate behind her back and found a large pool of blood seeping out underneath her. We cleaned her up as best we could and I glanced over at the husband. He seemed to be coping, but Sandy looked horrified. It clearly wasn’t an ordinary day for her.

  “I could never work here,” she said later, on a coffee break. “It’s a scary place.”

  “You’re right,” I agreed.

  “How do you cope with this work?”

  “There is so much you can do to help people.”

  “Have you worked in the ICU long?”

 
“Twenty years.”

  “Wow,” she said, looking at me. “You don’t look that old.”

  “I don’t feel old, but I started in my twenties and now I’m in my forties. Believe me, it happens fast.”

  The prospect scared her. I’ve seen this same surprised look in the eyes of younger nurses when they consider the possibility that such a thing might happen to them, too.

  “Your real name, Sankofa,” I asked, “I mean your African name. What does it mean?”

  She smiled shyly. “It is difficult to explain. It may sound strange to you, but it means one who reclaims the past in order to move forward.”

  THE OTHER DAY I was about to get onto the elevator and I almost bumped into a very energetic elderly woman from Volunteer Services who was getting off. She was pushing a rickety cart out in front of her and it was the exact same size and shape as the one I used to fill with books and take all over the hospital. Near the bottom, underneath the patina of the thick, cream-coloured coat of shiny paint, there was a scratch and I could see a chip of the old bright blue paint. It was the same cart I used to push all around the hospital, thirty years ago! Now, it was loaded with Italian, Korean, and Chinese newspapers. No one in hospitals these days is well enough to read novels. If they’re there, it’s because they are sick and if you happen to catch one reading a book, it’s time to send them home!

  SOMETIMES MORE THAN a few months slip by between get-togethers with my gang, but we keep tabs on one another by phone and e-mail. Everyone’s well, taking good care of themselves, despite a few aches and pains that have started creeping in. Last year, Tracy’s mother died suddenly and she worries about her father now, left on his own. Frances took care of her older sister, who was ill for many years until she died a few months ago. As usual, we talk about work, the good old days, and new topics such as varicose veins, menopause, and kids.

  “What did we used to talk about?” I lamented.

  “Boys!” we laughed.

  Frances and Laura never married and seem perfectly happy on their own. Laura did date a few guys, but stopped because, as she said, “They’re all either looking for a purse or a nurse!” Life is good for all of us, but back then we had some of the best times of our lives. To be sure, we saw the worst things, but also the best. We helped people return to their lives, mothers to their children, husbands to their wives. We delivered good news with jubilation or bad news with gentleness. We used morphine to relieve pain and later discovered how we could bring about comfort with our touch, our words, and our presence. We saw things so raw and real we could speak about them only to one another. We exchanged wisdom, some of it practical and basic, some of it instinctive and complicated, some of it modern and sophisticated, and some of it timeless and ancient.