by Tilda Shalof
As we walk along the boulevard, Justin talks on the phone to a public health nurse about the safety of giving two live immunizations at the same time. He’s going to see a child this afternoon who needs her vaccines. “Yes … okay, so it’s safe to give two live viruses on the same day,” he says over the roar of the passing traffic. “But if I give only one, I have to give the second a month later.” He gets off the phone. “In the community, you’ve got to communicate with others – doctors, pharmacists, social workers, whoever has the information you need.”
“It should be like that in the hospital, too, but we’re not always team players.”
We walk a few blocks to the apartment building of the next client and, since the door is open, we walk right in. Instantly, I’m in shock. Justin forgot to prepare me for the sight before my eyes. From the door to the walls, from floor to ceiling, on all the walls, in every space and crevice, upon every surface, there’s stuff. Lucy, his client, calls out to us from where she lies in her bedroom, on her bed in the midst of more stuff. Her bed is so loaded up there’s only a narrow strip for her to sleep. (As for the kitchen table, there’s neither a kitchen nor a table.)
Justin and I wade and weave through a tangle of electrical cords and TV cables and scattered hillocks of clothes to get to her. With each step, it’s impossible not to tread on something. Lucy’s bedroom is dark with the curtains drawn, and the bed is so overloaded with objects that I have to look twice to make out Lucy herself. She’s a thin, wispy woman in her fifties and has numerous oozing ulcers all over her body; to me, it looks like she’s scratched herself and made sores that have become infected. They are so painfully sensitive that even the edges of the gauze press and chafe.
“Don’t fold the bandages,” she barks at Justin. “They feel like tourniquets. I want to rip them off. Last night, I was ready to take a scissors to your hard work.”
While Justin does his work, Lucy watches Say Yes to the Dress on the TV. A bride gazes at herself in the mirror and appraises what she sees with hopeful eyes. Her tummy bulges and breasts spill out over the top. “I’m not sure this dress is for me,” she says.
“I assure you, it’s not, you idiot,” Lucy says, with a snort of derision.
Luckily, she has her TV show to distract her somewhat, because the dressing change is tedious and uncomfortable. Then Justin has to start a new IV in her arm, which she finds most disagreeable, too. Justin runs an antibiotic into the new line, and chats with Lucy.
As we wait for the IV infusion to finish, I can’t take my eyes off a jumble of Christmas decorations (china angels that meld into faded wreaths, scented candles in dusty glasses, a blow-up Santa doll, unopened bags of potpourri, rolls of gift wrap), jars of springs, screws, and keys, ancient TV converters, stacks of wire hangers, a pile of plastic purses, a rusted bird cage, a tennis racquet missing strings with TV bunny ears poking through it. There’s nowhere to sit, so I stand outside her bedroom door and gaze at a mountain of hats, bags full of bags, mounds of wrinkled clothes, scattered piles of compact discs and VHS tapes, a laundry basket full of old shoes, a Donald Duck plush toy …
There’s so much to look at! Clear Rubbermaid tubs filled with ribbons, string, and acrylic paint bottles; strewn fabric swatches; a typewriter on the floor, keys missing and a spool of ribbon unravelling out of it; a beat-up red-and-white striped, circus-type popcorn maker whose popping days are long gone; a colourful swirl of scarves; a bundle of empty toilet paper rolls; and a lineup of empty Mason jars with no lids … I peel my eyes away, if only to give them a rest from this visual onslaught.
Lucy had a urinary catheter and frequent bladder infections, which have led to a problem with incontinence. Justin reminds her about the exercises he’s taught her to retrain her bladder. Though she loves coffee, it exacerbates her condition, but Justin promises to bring her one, as a treat – from the Smiling Goat, of course – on his next visit.
I have to wonder: given the fact that Lucy has poor balance, limited mobility, almost no movement in her legs, and weakness in her arms and hands, what are the logistics of collecting and storing such a stash? I’m just being pragmatic. How does she scavenge and dumpster dive from a wheelchair? That could really impair your ability to carry out your compulsions. How do you get your fix for this addiction? Do you have to enlist help? I can feel how this stuff – what most would charitably refer to as “junk” – is companionship and comfort to Lucy. Perhaps she’s attached to these things like others are attached to their family or to their pets.
Justin is not the only one caring for Lucy. An occupational therapist visits and works to help her part with items, one at a time. A physical therapist assists her to strengthen her upper body for using the wheelchair. A speech language therapist helps her speak more audibly and clearly. A public guardian handles her money because Lucy is a compulsive shopper and would blow through it all and be broke in no time.
Back in Justin’s car he does his charting and makes a few phone calls. I keep quiet to allow him to concentrate, but after a few minutes, he looks up from his notes, looks out the windshield, and says simply, “I love home care.”
“I feel that way about the ICU.”
“Here’s what I like about home care. The independence. Relying on yourself. Personalizing care to each individual. Using all of your skills. Our scope of practice is expanding all the time. What RNs used to do now we do.”
(Long ago on this journey, I abandoned the prejudice against practical nurses that a lot of hospital nurses still harbour. To them, only RNs are real nurses. To them, I say, meet Justin Bragg, a registered practical nurse and a real nurse by anyone’s standards.)
“Another thing is that out here in the community, everyone inside the client’s circle of care works with each other. There’s true collaboration, real teamwork.”
“In the hospital, there are still hierarchies, and we’re not great at collaborating with other services and departments. Sometimes the right hand doesn’t know what the left is doing.”
Something else occurs to me, and though it’s a weird observation, I go ahead and ask anyway. “I’m curious, Justin. Was it just a coincidence that all your clients today were female?”
“Yes, just a coincidence,” he says, “but with one slight exception. There are times when Lucy is ‘Eddie,’ an eight-year-old boy, and he’s very mischievous, always getting in trouble at school.” In addition to Eddie, Lucy has three more distinct people inside herself, each with their own personalities, behaviours, likes and dislikes. Justin knows them all and interacts with each one as they make their appearance. “I know I’m speaking to Eddie when Lucy refers to her pills as ‘my treats for being a good boy,’ calls an outing ‘recess,’ or when she stays indoors on a rainy day and calls it ‘a time-out for being a bad boy.’ Another of her personalities comes out only in the third person. ‘She’s scared,’ Lucy will say. This personality – Loretta – is the one that will express what scares Lucy.”
Wow, Justin knows his clients well – all of them.
“Oh, and something else I just thought of,” Justin says, still answering my question. “You’re right, the clients today were all women, but Marnie was born male. She still has a penis and testicles, but she’s been out for many years as a woman and dresses as one. She even managed to pass as a woman back in the day, during her stewardess years, when there was a lot of pressure to be attractive to men and keep the pilots happy.”
Occasionally, for different reasons, female hospital patients request to have no male nurses assigned to their care. I think they’d feel differently if they met Justin. Justin is the nurse anyone – no, everyone – would want.
Tomorrow morning, I fly home. I need to get back, regroup, become reacquainted with my husband and family, and do a few shifts in the ICU so I don’t lose my job. I don’t know how Judith juggles so many different things – running VON, leading the nursing profession, and tirelessly traversing the world on behalf of global health. Her stamina is incredible; she’s
indefatigable. I’m exhausted after these few stops and can’t wait to get home. I crash in my room at my lovely hotel, which is situated on the deliciously named Chocolate Lake. The employees all have nicknames like Snickers, Kit-Kat, and Twix. The hotel mascot is Cocoa, a chocolate lab, of course, who’s snoozing in the lobby, stretched out in front of the fireplace. He belongs to everyone. The hotel staff take turns walking him around the lake and taking him home for the night. Cocoa is a communal dog; they share his care.
MOTHER OF MOTHERS
“IT’S YOUR CHOICE. La langue de votre choix,” it says on the airport welcome sign.
It’s true. C’est vrai.
I’ve quickly discovered you can greet anyone here with either “hello” or “bonjour.” And while Quebec is French and the rest of Canada is English, from what I can tell, New Brunswick is truly bilingual. Anyone here takes your lead and carries on in either language. And right off the plane, the people here are warm and welcoming.
So, where am I now? Moncton, New Brunswick, population 110,000. What a blast this is, touring the country on VON’s tab. But I’m here on business, I remind myself, to meet teen moms and their babies. Nurse Educator Maria DesRoches has arranged a meeting in the office with Chantal, the mother of six-year-old Mimi, who sits quietly beside her on a couch, ping-ponging between colouring with crayons and playing a video game on her mother’s phone. Chantal’s wavy chestnut hair, parted down the centre, is like a curtain drawn to either side to reveal her dark eyes and gentle face – a look mirrored in a smaller replica by her daughter.
Mimi was a newborn and Chantal only seventeen when she was miserably married to a World of Warcraft–gamer husband for whom the virtual world was better than the real one.
“I tried to get into it, too,” Chantal recalls, “I even created my own avatar, but he pushed me away. Financially, it was tough. He sold my engagement ring. He didn’t work, but at seven exactly, supper had to be on the table. Then he’d be on the computer until two or three in the morning. He didn’t even care about the baby’s first kick. He never showed interest in her.”
Mimi interrupts her mom politely to ask for a snack and squeals with delight at what she finds in Mom’s purse. “Les poisson d’or! Les poisson d’or!” Noticing me, she translates for my benefit, “Goldfish!” She shows me a picture of her dog on the phone. “Il s’appelle Pitou and he ran into moi and il fait du boo boo.” She points to a sore knee. “Sometimes I manqué just in time.”
Chantal picks up her story. “Fortunately, I found Rock & Talk. It’s a support group for teen moms. It’s where I met Maria.” Chantal smiles at Maria gratefully. “We talked about making a budget, getting back in shape, dealing with stress, nutrition, and our relationships. My mom told me my life was over by having a baby and dropping out of high school. She said she wouldn’t support me if I was going to throw my life away. Maria became my second mom during that time. It was a bad time.” Chantal covers her face and Mimi jumps up from the couch to put her arm around her. Chantal wipes her eyes and continues. “Meeting other girls with similar problems helped me, but it was a terrible time. I was not in a good place. One day this other girl was speaking about her bad situation – Maria called it psychological abuse – and I realized that’s what it was for me, too. He wouldn’t let me out of the house, told me I was fat and ugly and I’d always be alone if I left him, no one else would want me. He said he’d get custody of Mimi because I was a bad mother. One day he was furious about how I’d parked the car. I went out to move it but he got in before me and tried to run me over. Mimi was crying but he wouldn’t let me go to her. That was it. ‘I need to get out,’ I told my parents. They came over one day when he was at work. I was so scared I was sick – dizzy, throwing up, headache. We packed my things. I left him a note. Told him the truth, with a bit of water added to the wine.”
At the same moment, Maria and I look over to see how Mimi is reacting. She appears to be totally engrossed in the video game, her imperious little index finger commanding a rocket to fly into outer space. I have no doubt she is listening. Chantal realizes what we’re thinking.
“I don’t hide anything from Mimi. She’s seen everything. There are no secrets between us. Once, he – her father – grabbed me by the throat and she was right there. Another time –” she stops short. She doesn’t want to talk about that time.
Chantal went back to finish high school and then applied to college to study to become a laboratory technologist. She worked at Tim Hortons, in a grocery store, as a waitress and a dog walker, and at a retirement home. Her mother eventually became more supportive and helped with babysitting. Chantal was a diligent student until a setback at school that first year.
“I wrote an exam. I was so nervous that as soon as I got into the exam room, in pencil, I jotted down the order of the tubes for drawing blood, you know, blue, red, green, lavender, EDTA, heparinized – on the desk top. I got 98 per cent on the exam but the next day, I got a call from the dean. He accused me of cheating. Incroyable, I thought. ‘What are you talking about?’ He showed me a picture of my writing on the desk. It was an honest mistake, but they took away my 98 and gave me a 51, so I’d pass, but just barely. It made me want to quit college and I almost did, but …” She looks at Maria, to show what made her stay. “I decided I’d show them. On my next exam, I got 100 per cent, actually 102 per cent with the bonus questions. The next year, I made the honour roll, with perfect attendance.”
Life is good now. Chantal credits her success to the Rock & Talk group and Maria’s support. “She taught me how to be a mother. I didn’t have a clue how to take care of a baby, or that you even needed a car seat. I was so down after I had Mimi. Here was this beautiful thing, but I felt no love for her. Luckily, in time, it came. Now, I’m a peer support to other teen moms.”
“When we see someone like Chantal, who has many strengths, we knew it would help her to help others,” Maria says. “We hired her for a few hours a week to help run the program.”
“I’ve received so much. Now, it’s my turn to help others.” She gathers up Mimi and her toys and is about to leave when she stops and turns back. She wants to tell me what happened, the other time. “It happened a few months ago.” She starts tentatively. “I was buying my house and I had to meet with him to get my name off the old house we had together. He wasn’t making payments and it was giving me a bad credit rating. He had remarried and his wife was nine months’ pregnant. She was cowering in the corner and looked just like me when I lived with him. Mimi was petrified, sobbing hysterically. He came up to my face to show me who’s boss, but I stood up to him. ‘You got another girl pregnant, but you ain’t no father.’ He shoved me up against the wall. I hit him with my purse. Then I had a panic attack. I was taken to the hospital. They gave me three shots of Ativan.” She pounds her fist into her leg, one arm, then the other. “Boom, boom, boom.” When I told the nurses what happened, they called the cops, but they didn’t press charges because there were no marks on me. There was no evidence and because I had swung my purse at him, they said I’d started the altercation. So they opened a file on me!”
Chantal now has a full-time job with the Red Cross as a phlebotomist. Recently, she met a man online and they’re Skype-dating. “Sometimes it’s easier to talk to strangers than people you know, but for now, I’m by myself. People think I’m the nanny because there’s no ring on my finger. Beyoncé is right – if he likes it, he’s gotta put a ring on it – but even though I’m a single mom, I feel proud.”
To get to the next stop in my itinerary, Maria drives us an hour north of Moncton along the scenic Northumberland Strait to the quaint little village of Bouctouche. I see town names along the way, like Shediac and Miramichi, that come from the Mi’kmaq First Nations people.
It’s easy to talk with Maria. There’s a calm openness about her that puts one at ease and makes you feel as if she has all the time in the world to discuss whatever’s on your mind. She’s like a beatific Madonna with her graceful hands
, kind, soulful eyes, and serene demeanour. Yet, she’s also a petite firebrand who knows who she is and confidently rocks a chic look in silk harem pants, a billowy paisley blouse, and open-toed shoes showing pink toenails.
Her title may be “nurse educator,” but what Maria is is a professional nurturer, a mother who mothers mothers, a parent who parents parents. Apparently. (I couldn’t resist.)
“Nurturing? Yes, I am, bien sûr, but I also give the firm message that these girls have to step up and get their act together for the new life they’ve brought into the world.”
In a church basement, we attend a session of Bosom Buddies, where mothers are blissfully breast-feeding their little ones. Annik’s first baby, petite Manon, was premature, at twenty-five weeks, and weighed just under two pounds. “I went from ‘I hope I can breastfeed’ to ‘I hope my baby survives.’ Manon was so weak I had to teach her how to suck. I pumped and pumped and she had only my milk,” Annik says. “Then I developed mastitis. The pain was unbelievable. I would scream, but still, I breast-fed her.” She was paired with a mom who’d been through similar difficulties, and who offered telephone supports and home visits.
“Mothers helping mothers is not a new invention. It’s the way it always used to be,” Maria says, “only now it has to be organized, because it doesn’t happen naturally among the women of a village.” She tells me about an annual event she helps organize where the school gymnasium is filled with breast-feeding mothers. “It’s become as popular as a basketball game.”
When I was at home, breast-feeding each of my two sons, I once calculated that, time- and energy-wise, it amounted to the equivalent of a full-time job with mandatory overtime. For me, it wasn’t exactly a blissful experience, at least not at first, but I had a lot of support from girlfriends, and that kept me going. Had I been isolated or alone, I doubt I’d have stuck with it. I know the value of these groups.