by Tilda Shalof
Tracy and I used to laugh about a plan we had, to cause a scene at a dinner party in which we would reveal the truth about our work. Everyone would stop mid-chew. They’d put their forks down as I would cheerfully tell them about the litre of pus we drained out of one guy’s chest cavity. They’d weep as I would tell them about the tiny smile the semi-comatose man gave when his wife bent down to tell him she loved him. Their jaws would drop after I would tell them about a young man, a ward clerk, who was hit by a car while running out at lunch to register for university courses. In the afternoon he was declared brain-dead and became an organ donor and by that evening, another man dropped down to his knees in gratitude to that unknown donor and to God. Of course we never went through with our devilish plan, but I realized that when you put some things into words, they gain a weight and a power that they hadn’t had when left unspoken or unrecorded.
“I hope you never do that.” Frances was aghast. “It would be too unsettling for people.”
“Hey, Frances,” Laura interjected, never at a loss for a jibe at her. “Did you hear they removed the word gullible from the dictionary?”
“Did they really?” Frances asked. “Now, why would they do that?”
“Because it means the same thing as the word Frances.”
“You’re mean.” She stuck her tongue out at her. “All I’m saying is there are some things you shouldn’t tell people. It’s too shocking. It scares them. Besides, they’d never believe you.”
“You should tell people,” Justine insisted. “The public needs a dose of reality.”
“It’s good Tilda’s out there telling people about nursing,” said Tracy. “Many people don’t know what nurses do. They still think it’s bedpans and helping the doctors.”
“Yes, it should be Tilda, after all, she’s still embedded with the troops, down in the trenches.”
“So, Tilda, what else have you been up to lately?” Justine wanted to know.
I told them that I’d started working on my Master’s degree and about the travelling I’d been doing across the country, meeting with nurses and speaking with them about our work and our stories.
“I hope you’re telling them about all the exciting developments,” said Frances, “like Nurse Practitioners, and clinical nurse specialists. Nurses are now First Assistants in the operating room.”
“What about film studio nurse?” Justine said. “They need nurses on movie sets. I did that once and gave a Tylenol to Denzel Washington. I would have liked to have given him a lot more! Once, I got to airlift a patient to Anchorage, Alaska. What a blast! Oh, and make sure you tell them about the army. The army needs nurses. There are lots of wounded soldiers these days.”
“I met a nurse who runs a sexual assault clinic, collects forensic evidence, and counsels victims,” Tracy said.
“Remember those old Cherry Ames books, Tilda?” Laura was a big second-hand bookstore browser and had recently bought me two, in mint condition: Cherry Ames, Jungle Nurse and Cherry Ames, Army Nurse. “Even Ol’ Cherry Ames would be shocked at what nurses are doing now!”
“What do you tell the student nurses you meet on your travels?” Frances asked.
“I start off by asking them why they chose nursing.”
“I tell you what I’d say,” Laura interjected. “The only choices open to me were teacher, secretary, or nurse. So I ended up being all three.”
“Well, these nursing students say they’ve heard you make a decent salary and that there are good dental and drug benefits and lots of opportunities for advancement. I ask them how many plan to work in patient care when they graduate and they all raise their hands. Then I ask, what about five years from now, how many of you plan to still be at the bedside? You know what?” I took a breath for the clincher, “None raise their hands. They all want to be managers or researchers. Patient care is a stepping stone, an apprenticeship at best.”
“It’s understandable. Nursing takes a lot out of you. Not everyone can stay in it,” said Justine.
“A friend of mine asked if I would advise her daughter to go into nursing,” Tracy said.
“No way!” Laura interrupted again. “I hope you told her to steer clear of that!”
“Why?” I snapped at her. “Has nursing been so bad for you?”
“Listen, Tilda, young people these days want to have a life and can you blame them?”
“So, I told my friend,” Tracy said firmly, to try to diffuse the tension, “I don’t know your daughter, but how about your son? We need him even more. That opened their eyes.”
“Yeah, so do you still think sisterhood is powerful, Tilda?” Laura put to me.
“Yes, I do, but maybe we have too much of a good thing. We need men to balance the mix. Nursing would benefit from the way men think and take action. I’ll tell you one thing though, new nurses these days have no difficulty with computers or any of the technology that we will struggle with.”
“Tell me about it,” said Frances with a huge sigh. “The other day I was having a problem with the monitor in the CT scanner room. I called the technician and he explained to me how to fix it, but I couldn’t get it to work and was getting frazzled. The patient’s IV was going interstitial* and I had to spend all my time with the friggin’ machine and on the phone with this guy. I said to him, please come in and see for yourself what the problem is. ‘Oh no, no, madam. I cannot do that,’ he says. ‘I am speaking to you from Bangladesh.’”
“What did I tell you?” I said. “That wouldn’t faze new nurses these days. They are completely at ease with technology. They know how to find information on the hospital database or the Internet and they think way more globally than we ever did. They’re a lot more confident, too. Way more than I ever was,” I added as an afterthought.
“You were one of the worst cases I’ve ever seen,” said Laura. “You spent your first few weeks in the ICU running to the bathroom.”
“There’s something wrong with a nurse who isn’t terrified at first,” said Frances. “It’s a good sign.” She smiled at me. “It means the nurse is motivated and wants to be safe. It means she realizes the enormity of the responsibilities we’re taking on.”
I looked at Frances’s kind face and around the table at each of them. Did they even know how much I had learned from them and how much they had given me, not just as colleagues, but as friends, especially during a difficult period of my life? How could I ever tell them all of that or thank them or tell them what I really felt which was that I loved them?
“But it can’t be easy for them, Tilda. The hospital is still a shock to most people,” Frances said.
That’s true, I thought, remembering Sandy’s horrified face on her first day in the icu. For most young nurses today, the hospital is still the place where they are confronted for the first time in their lives with people who are frail or hysterical, confused and combative, or lying in bed unconscious. They are expected to take care of bodies that ooze and leak, and that sigh and cry. “I feel for these new nurses. They start off with the best of intentions, but unfortunately, things happen along the way that wear them down,” I said. “Generally speaking, people who choose nursing want to help others. By and large they are good, moral people.”
“Things are improving,” Frances said. “Nursing has come a long way. Back home in the Maritimes, when I did my training, a nurse had to get up to give her seat to a doctor. Now, nurses are diagnosing and prescribing. I heard a nurse on the radio speaking about organ donation after cardio-pulmonary arrest. And look at the nurses in the ICU rapid response team!”
“Nothing’s changed,” Laura grumbled. “Hospitals are dinosaurs. They’re dying institutions.”
I agreed with both of them. We did still need new ways to care for people in hospitals and in their homes. “We’re stuck in the old tired way of doing things. The new ways aren’t yet in place.”
“I wonder what hospitals of the future will look like,” I mused. “Do you think they’ll ever really be patient-centr
ed as everyone says they should be?”
“They won’t be patient-centred until they stop being so doctor-centred,” Laura said. “In fact, if they were nurse-centred, everything would improve because nursing is about patient care.”
“Yeah, doctors should lobby for more nurses. What they want for their patients will only be achieved if they work with us,” said Justine. “I’m afraid to admit it, Laura, but I agree with you.”
“I’m actually very easy to get along with.” Laura leaned back and sipped her drink. “Once you people learn to see it my way.”
Typical Laura.
I WAS INVITED TO SPEAK to a class of first-year nursing students. I stood at the front of the room and looked around at the young, mostly interested, a few bored, faces. It was still a sea of women’s, mostly white, faces, but I’ve heard the trend is changing. Their pens were poised, ready to take notes. I got up there and introduced myself. I told them, yes, I’m a nurse, working at the bedside, caring for patients for more than twenty years. Their jaws dropped. I heard a collective gasp in the room.
Twenty years goes by a lot faster than you’d imagine it would. I stood before them, the old, sage, withered crone nurse they imagined me to be. They were eager to ask questions of a real, live working nurse.
“What if you disagree with a doctor’s orders? Do you still have to do it?”
“No!” I practically shouted. “If you disagree with something, speak up, but be able to express your rationale and work out your differences.”
“What happens if you make a mistake? Will you get fired?”
“Do everything you can to prevent mistakes by asking lots of questions and double-checking yourself and with a colleague if there’s anything you’re unsure of. If you make a mistake, own up to it by disclosing it fully. Learn from it and make sure you don’t do it again.”
“What do you say if a patient asks if he is going to die?”
I told them that once I walked by a patient’s room and I saw Nicky with her ear down low, next to her patient’s mouth as he lay in bed. I moved in closer to listen in. “Am I dying?” I heard the patient ask. Nicky paused and said, so tenderly, “Yes, dear, you are.” I could see the connection between them that Nicky knew that was the right thing to say to that person at that moment. For other patients it would not have been appropriate. The hardest thing about patients dying is that it makes us face our own discomforts on the subject. “Work on yourselves to develop the sensitivity and wisdom to know what to say and do in each very different situation,” I advised.
“What is it like when a patient dies?”
“At first, it may frighten you. It may bring up disquieting feelings about your own loved ones. In time, you’ll learn to deal with those feelings. A patient’s death may be a sad or joyful event or it may be peaceful or conflicted, but as a nurse there is so much you can do to make dying comfortable and dignified for the person and the family.” One day you may even grow to appreciate how lucky you are to be with people during these precious moments.
“What do you do if a patient doesn’t like you? Has that ever happened to you?”
“Never!” I joked, thinking back almost twenty years to Mrs. Wilson, stage name: L’il Roxy, and how I did everything I could think of to win her over and never did. “It’s hard when patients are angry or hostile, but you will learn in time that, usually, it has nothing whatsoever to do with you. They take out their emotions on the safest and closest person – you, the nurse. You will learn how to set clear limitations and boundaries so you don’t get hurt.”
“How do you keep up your ideals?”
“I don’t know … but they are stronger than ever.” They waited for me to come up with a more useful sound byte. I dug deeper inside. “Sometimes you may need to step back from nursing and reconnect with the reasons you chose it. If you are in it for the pay cheque or the job opportunities, those things won’t sustain you in the long run.”
“Why don’t nurses get more respect?”
“The onus is on us. We get as much respect as we show toward ourselves and our profession. Only when we acknowledge what we know and can offer our patients, when we conduct ourselves as professionals and use our voices to advocate for patients and speak out against injustices, will we get the respect we deserve. Our voices will be heard, but only when we speak up.”
“What is the secret to being a successful nurse?”
“Find ways to enjoy it and make sure you have fun. Help your colleagues and accept help from them! Take good care of yourselves so that you can take care of others.” I knew what awaited them, how frightening the hospital world can be, for patients, to be sure, but also for nurses. I owed it to these young, well-educated nurses to tell the truth.
“What advice would you have given to those students?” I asked Laura’s Line that evening.
Frances started. “Don’t try to be perfect. You can’t fix everything. Do the best you can.”
“Never eat pizza on night shift.” For once, Laura wasn’t sarcastic. “You’ll regret it afterward.”
“Have some laughs,” said Tracy, and we had one remembering a night shift years ago when the song “Gloria” came on the radio that sat on top of the refrigerator and how Tracy suddenly jumped up, began to sing and boogie around the nurses’ station like it was a disco, and how the rest of that night flew by.
“All very amusing, but I hope you told them the most important thing is that nurses have to get political,” said Justine. “That’s the only way we are ever going to improve things for our patients.” Way back when I was still trying to figure out the difference between a vein and an artery, Justine was attending rallies and negotiating labour relations to improve our working conditions. “Think of the numbers,” she went on. “There’s a quarter of a million nurses in Canada alone. If only we were organized and stood together, our power to make changes could be immense.” Then she turned to me. “How about you, Tilda? Isn’t it time you moved on to bigger and better things?”
I knew what I wanted. “I’m happy where I am.”
“Well, I hope you’re telling people they’d better be nice to us,” Laura warned. “Soon there’s going to be another disaster, maybe sister of SARS or avian flu or bioterrorism, and who do you think will be taking care of the victims?” She surprised me with her next comment. “You won’t catch me going to work when the next pandemic rolls along. I’m running for Algonquin Park, to wait there until it’s over.”
“I don’t believe you,” I said. “During SARS, you led the way! You were the first one brave enough to go into the patients’ rooms.” I can still picture Laura, covered from head to toe in protective gear and how she managed to reassure her patients with her eyes over the top of her mask. She looked like she had just stepped out of a spaceship on Mars. I can still see the curve in her back as she leaned closer to bridge the space between them. Her body said I’m here with you. I’m not going anywhere. I have all the time in the world for you. Laura had also managed to reassure the rest of us who were terrified to go in. SARS was lethal. It killed many people, including doctors and nurses, but Laura insisted that with the right protection, we would be safe. We are nurses, we have to take this risk, she’d said. We know how to go in safely. Now, she claims she’ll run away? I don’t believe her.
“Yeah, I’m tired of being a hero,” she insisted. “I didn’t sign up for danger duty and I have a feeling that SARS was just a practice in disaster. A dress rehearsal before the big one.”
What had changed in her or was she bluffing? If the time came, I believed she would be there, as she was before. Nursing is in her blood. She’s got a bad case of it.
“We’ll see” was all she’d concede.
“What about you, Justine?” I threw back at her.
I’d never seen Justine so wistful as she looked at that moment. “When the tsunami hit South East Asia, and the hurricane New Orleans, I was envious of the nurses who went there to treat shock victims, set up health centres, give vaccin
ations and medications. That’s what nursing is about.”
I don’t think we’ve ever gotten together without mentioning Nell. We still couldn’t forgive ourselves for not recognizing her cries for help. “When Nell went to the hospital,” recalled Frances, who had tried the hardest to reach out to her, “she wouldn’t let me come with her, even though she said on the phone she was coughing up black sputum. She did tend to exaggerate at times.”
“Yeah, just a bit,” we chuckled.
Frances continued. “She told me that when she got to the ER and saw how busy it was, she jumped off the stretcher and got to work, starting ivs and giving out meds until she eventually collapsed, but not before starting her own iv and giving herself an antibiotic, of course. I wouldn’t have put it past her. She was an incredible nurse. That was the last time I heard from her.”
I reached into my bag and pulled out my surprise dessert. It was a rare, limited signature-edition bottle of ice wine. The waiter uncorked it and poured for us. That afternoon I had heard a wine connoisseur on the radio praising this superb harvest and its peach nectar silkiness. I knew it would be the perfect complement to our summer-sweet friendship. The expert also said something that made me think of nursing. He praised the winery and explained how they employed the latest technology in the service of preserving traditional values of winemaking. Nursing must do that, too, I thought.