Bringing It Home

by Tilda Shalof

  The crisis of care of our growing senior population is all over the zeitgeist: the “ticking time bombs,” “the Grey Tsunami,” “Baby Boomerangst.” In my own online research, I’ve read articles that Judith has written on this subject and she has a different take. She believes that seniors are being demonized, blamed for the out-of-control spending in health care. “That’s a myth,” she says, calling it “senior bashing” and “ageism” and writes, “One would think that seniors are going to singlehandedly destroy the world as we know it – or, at least, bankrupt the healthcare system.” She argues that caring for our aging population is only a modest health care cost driver, accounting for a mere 1 per cent increase in health care spending; that can’t explain skyrocketing health care costs. Spending on seniors isn’t growing at a faster rate than spending for the population at large. Judith argues that health care costs are rising due to expectations from the public to receive more and more services – including new drugs, expensive hospital care, and the latest technological advances – and especially due to the relatively new financial burden created by the increase in chronic illnesses.

  As soon as the Jewish holidays were over, I finally snagged a meeting with Judith, again in her home, this time on a Sunday afternoon. I was hoping to talk with her about these serious issues. So, we’re back in her front living room, by a large window that looks onto a quiet street, sitting side by side in the comfortable chairs. I suppressed a little giggle, imagining us as two pundits sitting on a panel, squaring off on a current events TV show like Agenda or Meet the Press. The little table between us was once again stacked with books and journals, different ones than on my last visit. Sneaking a peek while she took a phone call, I saw an issue of the Harvard Business Review, a biography of Barbra Streisand, and, again, the heavy Hebrew bible with the blue silk ribbon bookmark trailing out resting on top of the pile.

  There’s something reassuring, even appealing – at least to me – about a leader keeping a religious book so close at hand. Even though I’m not a believer, I like that she is. If taken to heart, the moral teachings and words of wisdom could keep a leader true to good values.

  Judith turned off her phone, placed it on the table, and gave me her full attention. Wasting no time, I launched into my rant about the crisis in home care, its disorganization and inadequacy, the neglect of seniors, the shortage of long-term beds, the overwhelmed caregivers.

  At first, Judith listened closely, but when I paused, she spoke.

  “It is painful to witness human suffering.” She looked out the window onto the quiet street for a few moments. “Let’s go out for a bite to eat,” she said unexpectedly.

  Deflated, I wondered if she’d heard me. (I am also beginning to wonder if Judith cooks. On Undercover Boss, disguised as a home care worker, she acted inept, bumbling around in the client’s kitchen. She didn’t even know how to make toast. Was she playing a role, or was that really her? I don’t exactly smell any chicken soup with matzah balls simmering on the stove or chocolate chip cookies baking in the oven when I visit her home.) We got into my car and drove to nearby Dr. Laffa, a kosher middle-eastern “meat” restaurant, a designation that differentiates it from a “dairy” restaurant. According to the rules of keeping kosher, meat and dairy products are not to come in contact with one another.

  As we waited to be served, I got back to my concerns.

  I told her about visiting Magda in the hospital and the problems I witnessed there – seniors jamming up the ER, sent home to unsafe situations, “crisis placement,” “caregiver fatigue,” readmissions after hospitalization, et cetera (lots of et ceteras).

  Suddenly, I realized that, again, Judith was not listening to me. Her mind was far away. I was getting exasperated. I started to think about how I might weasel my way out of this frustrating assignment, when suddenly, it dawned on me. Judith is working on these problems from a completely different angle. In fact, she knows them so well, and is so deeply concerned about them, that she’s chosen to focus on their solutions. I’m in the past, still weaning myself off old ways of thinking, trying to grasp new ones; she’s fully engaged in bringing about that old, long-predicted titanic paradigm shift that has been talked about for so long – turning the focus to wellness, primary care, and home care.

  I always feel a few steps behind her, straining to keep up with her fast mind and boundless energy. I can almost feel the force field of her brain, the heat of her bristling intelligence, pulsing like a living thing around her.

  “Our health care system does not need more money,” she said. “It requires something more difficult – imagination and creative vision, attention to basic human needs, and courage. Courage is needed to do things differently and lead the way.”

  Sheepishly, I put aside the folder of articles I’d clipped from newspapers to prove my points. Luckily, the food arrived and I was instantly distracted by the luscious, flaky laffa bread, slightly smoky from the wood-burning oven, and the rich, creamy, lemony hummus, crispy falafel balls, and smoky eggplant salad. I tried to pay attention to what Judith was saying.

  “From your travels, you are just beginning to scratch the surface of the problems, the inequities, the unmet needs, the results of a system overly focused on sickness and hospital care. Spending more on hospitals will not make us healthier. Health has little to do with hospitals or medical intervention. At VON, we say, ‘Health Starts at Home,’ but many people do not even have a home.”

  She gave me a few moments to take all that in while she served me – a hefty portion of stewed mushrooms and spicy grilled chicken – then herself. “People are living longer, but with more chronic illnesses. But what if a person with diabetes receives good primary care? They’d be less likely to later need dialysis, amputation, or hospitalization.”

  In the ICU I have cared for many people with diabetes and its complications; they are at the end-stage of these problems. What Judith was describing was the other end of the spectrum – preventing these problems altogether.

  I must have looked as discouraged as I felt because she threw me a bone. “We have to roll up our sleeves and get to work, especially when these problems are all fixable.”

  After we finished eating, we sat back. Judith was in a mood to reminisce.

  “My life has been about building relationships, connecting with people. I have colleagues and friends around the world.” Of all her many achievements, that seemed to be the one of which she’s most proud. By now, I know her bio pretty well. Born in Hungary, a child of Holocaust survivors who escaped to Israel; English is her third language. She studied nursing in Jerusalem, married, came to Canada at twenty-five, worked as a nurse at the Jewish General in Montreal, got a master’s degree, then a Ph.D., became Chief Nurse of Canada, then president of the Canadian Nurses’ Association, and is now running for president of the International Council of Nurses (ICN), the largest worldwide organization of nurses.

  She is passionate about our socialized health care system. She told me about her time in Ottawa at the Office of Nursing Policy. “My small apartment there had a view of the flag on the top of the Peace Tower. It served as a daily reminder of my commitment to do everything I can to advocate for sustaining our health care system for the future.”

  On the personal side, I asked her about any mentors she’d had along the way. Her first was her director of nursing, a woman named Mary Barrett.

  “Mary was prim and proper,” Judith said. “A real lady, with every hair in place. There I was, a new nurse, an immigrant straight off the boat, a staff nurse with little experience who could barely speak English. She must have seen something in me because she made me a manager. Years later, I asked her why she hired me. ‘I needed a “troublemaker,”‘ she said, ‘someone to stir the pot, and I knew that was you.’ ”

  The reason I asked her about mentors is because the topic has been on my mind a lot lately. I receive many emails from young nurses who say they want to find a mentor but have had no luck; the nurses they encounte
r are either too busy or too burnt-out to offer them any guidance. Just the week before, I had received this email.

  Dear Nurse Tilda,

  I recently graduated from university and am now starting out on my nursing career. I don’t have a job yet, but I’m looking for a mentor. How do I find one? Do you know anyone willing to mentor me? Can you help me?

  Sincerely, New Nurse

  Apparently, mentors are in short supply. My advice? Keep on the lookout; they are out there, but know what you’re getting into. A mentor doesn’t make life easier; a good mentor will raise the bar and challenge you. The mentor’s job is not to hold your hand or stroke your back, but to light a fire under you and kick your ass. Take it from me – Beware, and be wary, of the mentor. Life is definitely easier without one. Be honest with yourself: if it’s encouragement you are looking for – and everyone needs some of that when starting out – find a cheerleader, a life coach, a good friend (or a bad therapist).

  Judith repositioned her chair sideways, so she was sitting parallel to the table and pushed her glasses up to the top of her head. As she did, I noticed her beautifully manicured hands, a tiny daisy painted on each pinky finger. This babe has a fun side – I hope I can get to know it. Judith put her palms together and gazed out, beyond the other diners and the waiters carrying plates of food in this busy restaurant. “Mine is a Cinderella story. Imagine, a new Canadian like me running this great organization that’s so much a part of our history. But it makes sense. VON is a complete expression of my personal values. If you want to see chesed and tzedek, they live at VON.” She didn’t translate for me; she trusted I knew these Hebrew words meaning “loving-kindness” and “justice.”

  “The most important thing is to be true to who you are and to your own values. I am not afraid to be a Jew in the world. As a Jew and as a nurse, I have an obligation to pursue g’milut chasidim – social justice. For me, being a Jew is inseparable from being a nurse, from being a CEO, from being a Canadian, from being a global citizen, from being a grandmother. All of these things encompass who I am.”

  She confided that her bid to become president of ICN has become a demanding and time-consuming campaign. She must travel constantly and work hard to become intimately familiar with the health care issues in each of the 135 countries that ICN represents. I would have thought she’d be a shoo-in, but apparently, the competition is fierce. “Taiwan has a very strong candidate,” she says, “and Colombia, too.”

  Whatever it is that Judith does in the upper echelons of the United Nations and the World Health Organization remains invisible to me. It strains my imagination, so I do what I always do when I’m feeling out of my depth: I make a joke.

  “Just think, if you become the ICN president, you’d be Nurse of the Universe,” I teased her, not sure how she’d take it. “Hey,” I forged on bravely, “that’s even better than Miss Universe ’cause there’s no swim-suit competition. And I bet you’ll have an answer ready when they ask how you’d put an end to world hunger. But you’ll still have to balance that heavy crystal crown as you walk down the runway.”

  She didn’t laugh, only smiled politely. She probably doesn’t waste her time with silly pop culture, especially something as frivolous as a beauty pageant. Does she even watch TV? I can’t imagine there’d be anything on TV that would interest her.

  There’s something else on her mind. “There are certain countries who do not want me to hold this position, the highest nursing office in the world. Privately, they tell me it’s not possible. We won’t let you in.”

  I asked her if it’s anti-Semitism, but she waves off that suggestion. “I have no enemies.”

  I was glad my suspicion was unfounded, but I’m quite sure that if she encountered prejudice of any kind, toward herself or others, Judith wouldn’t hesitate to call it out. “I do not shy from debate,” she said. “I’m comfortable with conflict.”

  “At this stage of my life, my focus is global health, but there are great needs close to home, on our very doorsteps. That’s why I’m sending you on this journey. Next week you’ll go to Nova Scotia, Newfoundland, New Brunswick, and Ottawa. I’m sending you to VON sites all over Ontario, then out to western Canada to see first-hand the incredible work of the street nurses of Vancouver, where there is the highest incidence of substance abuse in the country. You’ll meet a VON nurse who runs a detox unit. You’ll spend time with Morag in Edmonton who works in a shelter with women who’ve experienced domestic violence. Morag is doing research on women who’ve been strangled during intercourse. You met her at the AGM, right?”

  The East Coast! The Rockies! The Prairies! Here I come.

  “I want you to visit a First Nations’ reserve where the rate of diabetes is five times the national average, where there is the highest rate of cardiac disease, mental illness, suicides, and substance abuse in the entire country. Living conditions are so deplorable there that the people are forced to drink soda pop because it’s safer than the water. It is a crisis. You will see all of that when I send you to northern Ontario – Sudbury, North Bay, and Thunder Bay.

  Ah, the allure of Thunder Bay. At last, I’ll get there.

  I leaned back, full of anticipation, excitement, and good food.

  I can hardly wait for my adventures to continue, but for now, I return to the present moment. My patient has shown small signs of improvement since the start of my shift this morning. He’s more alert, and I’ve been able to wean down his sedation and a few of the ventilator parameters.

  His serious, tight-lipped wife perches at his bedside. There will be many long months of recovery ahead. What will life be like for him at home? She will be his caregiver. What will it be like for her? How will she manage? What supports does she have in place? I try to open a discussion about any concerns she might have, but she shuts it down with a terse, “I’m fine.” Perhaps she fears that if she opens up she might break down altogether. I get that. Here, we take care of the most urgent needs. We do today’s work today, minute by minute; we don’t think about tomorrow. Besides, why would she open up to me? Why invest in a relationship with me? I’m the nurse du jour; tomorrow will bring a different one.

  My friends want to know when I’ll be returning to my regular ICU shifts. “You are coming back, aren’t you? After you’ve finished this home care thing? Right?”

  Of course I’m coming back, I say, but now, for the first time ever, I’m not so sure.

  “There’s much to do and we’re each responsible for our part,” Judith had said after lunch, after I drove her back home and just before she got out of my car.

  Her words stayed with me, reverberating like a modern echo of an ancient Talmudic saying: The day is short and the hours are long.… You are not obligated to complete the work, but neither are you free to abandon it.

  Each time I see Judith, I get contemplative about being Jewish. As I drove home after that yummy lunch, I flirted briefly with the possibility of taking my religious observance up a notch. Maybe I’d start going to synagogue more frequently. It couldn’t hurt. But definitely not any of the hard-core stuff like refraining from work on the Sabbath or keeping kosher. Yet, what I’ve always valued even more than the rules carried out to the letter of the law is the moral teachings and the words of wisdom. Judith’s beliefs about home care, caregiving, and volunteering reminded me of a passage in the prayer book that I used to hear recited in synagogue when I went with my father.

  As soon as I got home, I made a beeline to an old prayer book to look it up. It’s called Eilu D’varim or “These Are the Things.” Reading it again after all these years, I realized that it is not a prayer, but rather a mundane checklist of the basics of human interaction. Honouring elders, welcoming guests, caring for the sick, providing for the needy, celebrating with the bride and groom, comforting the mourner, and being a peacemaker. These are the things that connect us to one another, that create community. After all, life is with people. And the benefit of following these things (the payback)? They are beyond
all measure. (Priceless.)

  FRIED HALIBUT AND RAPPIE PIE

  TWENTY-EIGHT YEARS AT VON and you get the feeling she’s loved every moment of it.

  “I started at the age of ten,” Suzanne jokes.

  We’re sitting in the VON office in Yarmouth, Nova Scotia – the workplace of nurse manager Suzanne D’Entremont, whom I met back in Windsor at the AGM. With her rosy cheeks and a wide, easy smile, she has none of the tense worry lines that I see on the faces of the hospital managers I know. Elegant in a navy suit with a cream-coloured shell and a string of pearls, she’s radiant, bubbling over with enthusiasm for her work and for VON.

  “This organization helped me grow. When I saw a need for a ‘symptom relief kit’ to alleviate the discomfort of people dying at home, they gave me the time and resources to develop it. When I had safety concerns about central IV lines, they funded my research. VON has supported my passions – foot health, palliative care, and bereavement support, among others.”

  Suzanne has organized my itinerary here, a list of clients who receive home care or community supports. She’s also arranged for a driver to take me to each place, some of them remote or difficult to find. My driver is Darin Perry, who turns out to be the husband of Janet, the fun-loving executive I met at the AGM who landed in a wheelchair with a sprained ankle after a late night of partying. In fact, Maritimers have a reputation for knowing how to have fun, so it should be an enjoyable trip.

  Just as we’re about to set out, I ask Suzanne, “I figure about fifteen minutes per visit, right?”

  She raises an eyebrow. “I booked you two hours per visit. Stories take time.”

  We laugh because we both know what it’s like in the hospital. There’s no time to sit and talk for more than a minute or two with patients. It’s more like shoot, get to the point, cut to the chase, I gotta run. You’ll just get behind in your work and neglect your other patients, or at least they’ll feel that way.