Authors: Tilda Shalof
We move quickly from the bagels and banter, from the gossip and girl talk, to our never-ending inquiry into our work, what it means, how we can do it better. We never tire of talking about where nursing takes us, what we see there, and what we are privileged to be able to do for people in need.
In her quiet, understated manner, Jasna tells us about her night on the Rapid Respond Team.
“I was called to consult on the floor. It was a woman, two days post-op. I assessed her and she was dry, so I gave her fluids and did blood work – little things – maybe it was just the close attention – but she really perked up. I love when patients get better,” Jasna says with a sigh that makes it obvious she’s thinking of the others. “Then I went to see another patient I was concerned about and ended up spending most of the rest of the night with him. When I got there, he was lying in bed, vomiting coffee grounds, blood-streaked bile. He was confused, mumbling to his wife in Serbian, but I could understand him because it’s my background, too.”
“What did you do?” I asked.
“I sat him up, cleaned him, got an order for an X-ray, drew some blood work – blood cultures, too, because he had a very high temp, started a bigger
IV
, gave him fluid and he perked right up. I spoke to him in Croatian and he responded appropriately.”
“But how did he understand you?” I ask.
“It’s the same language, silly,” she says, grinning at me for not knowing that and without meaning to, unintentionally reminding me how little we know about cultures other than our own. “Anyway, technically, I could have signed off on him because his condition had improved, but I was still worried because he was slightly restless and his vitals weren’t rock solid – subtle things that could easily get missed on the floor. I spoke with the doctor about whether we should bring him to the
ICU
. We decided to monitor him closely on the floor today and I’ll follow up on him when I’m back tonight.” She looks satisfied with her night’s work and returns to the scarf she’s knitting.
Jasna is as accomplished a knitter as the others but hasn’t mastered the knack of knitting and talking at the same time like the other two. Stephanie is busy with her usual pair of colourful socks, and Janet has another baby blanket on the go, this one in soft, pistachio-coloured yarn.
“How do you know so many babies?” I used to tease her as I watched her produce blanket after blanket. That was before I found out that she donates them to orphanages or gives them to single mothers on welfare who in all likelihood don’t knit for their babies.
“I like to know the gender before I get started on the blanket,” she says. “Ultrasounds are so detailed, believe me, they know, but the patient I had last night, his daughter who is pregnant and completely on her own – the Baby Daddy left her – three weeks away from delivery – wouldn’t tell me. Her mother died a few years ago and her father is having a bone marrow transplant. It’s been a rough go for all of them, so this one is for the new baby.”
“It’s a beautiful blanket,” I say, fingering the lacy pattern. “Doesn’t it bother you that the baby is going to pee on it, spit up on it?”
“Life is for living. We should use our treasures, not save them.” Her fingers fly over the silky wool, making the blanket blossom like a living thing, filling her lap under the table, growing minute by minute as we sit here talking.
I ask them more about the Rapid Response Team because it fascinates me so much and because knowing expert nurses were there, waiting in the wings if something had gone wrong with me, was one of the things that reassured me the most. They all say they are enjoying this new path their career has taken and find it exciting and satisfying. They plan to stay with it, but only as an adjunct to their regular shifts in the
ICU
. They are proud to be adding to the growing bank of worldwide data that proves that rapid response teams are saving lives and reducing
ICU
admissions. But the role does involve huge additional responsibilities for nurses, and offers only marginally more pay and little recognition.
“Nursing is not an easy sport,” Janet says. “It’s for the young. Maybe
we bees
in the wrong business. One day I’m going to open a yarn and fabric store for knitters and quilters. I’ll serve tea and of course bagels, too.”
“I’m staying,” Stephanie says.
“I’s
happy being a worker bee. I like where I am.” She’s entertained the idea of moving from bedside nursing into teaching or a job with more normal hours but so far hasn’t strayed from the
ICU
. The Rapid Response Team keeps her busy along with a new mission she’s taken on of spearheading initiatives to make our
ICU
more “green,” reminding everyone to turn off lights and finding ways to reduce waste and recycle supplies. Stephanie is not one to sit much, except when knitting.
“I’s
staying put, too,” Janet concedes. “The youngsters need us old farts. That’s what I love – passing the torch to the young ones. They need us. They’re still hassled by doctors who don’t listen to them. Sometimes the young’uns themselves don’t have the
confidence or the knowledge to speak up in the first place. The other night a nurse on the floor paged me about a patient whose blood pressure was low. I asked her what she was planning to do about it. ‘I don’t know,’ she says, ‘but I’m writing it down in the patient’s chart.’ What good is that? So, I went for a look-see and assessed the situation myself. He was an eighty-five-year-old man with multiple medical problems, who’d been in and out – mostly in – of the hospital for over a year. He had made his choices, even gone to the trouble of documenting them, and was adamant that he didn’t want life support or to be in the
ICU
, but his kids didn’t agree. They wouldn’t let him go in peace. When I got to him, he was in the throngs of dying and–”
“The ‘throes,’ ” I interrupt her.
“What?”
“It’s the throes of dying. Go on.”
“Well anyways, his sons insisted that everything be done – a full code – and the wife was persuaded by them to go along, so we resuscitated him. We brought him down to the
ICU
, intubated him, and he’s hanging in there, alive – for now, anyway.”
“It’s reassuring to hear that nothing has changed in my absence,” I comment dryly but don’t allow myself to go to that contentious subject that usually preoccupies me so much. Instead, I return to the more upbeat topic of the young, upcoming generation of nurses. I asked about Shauna, one of the newer ones I’m particularly fond of. They tell me she’s become an amazing nurse. She impressed me, too, on one of the last shifts I worked. A doctor wrote a hemodialysis order that she didn’t agree with. Her patient’s blood pressure was low and unstable, so she thought that a different modality, called
SLED
,
*
which removes waste products at a slower, more gradual rate, would be preferable for this particular patient.
“So, I went down to the floor to talk to the resident,” Shauna told me. “At first he wouldn’t even listen to me, but then he realized that I knew what I was talking about and that he needed to know what I was telling him so that he could tell me what I needed to do,” she said in obvious frustration at this conundrum. “In the end, I spelled out the order for him and made arrangements for the change of plan. All he had to do was sign off on it.”
I see the good ol’ doctor-nurse game plays on …
Nurses often know more than they let on or are allowed to put to use. In fact, many are so well educated that their scope of practice could be safely expanded, only to the benefit of patient care. Why can’t nurses order a blood test or an X-ray if they have reason to believe they’re indicated, or choose a laxative or pain medication for their patient? After all, what’s important is not who writes the order but that the right things get ordered and properly done.
“How about you, Jazzy? Any plans to leave?” Janet asks.
“I’m not going anywhere,” she says simply. Jasna, a caregiver around the clock, is like many nurses I know: rarely off-duty.
“How is Simone doing? Is she still in the
ICU
, hanging in there?” I ask them about the young nurse I worked with on my last shift in the
ICU
.
“Yup, she’s doing great,” Janet says. “We all assumed she was going to be one of these gung-ho types, you know, the ones who’ve been a nurse for all of two and a half minutes and are already planning to go back to school to do their master’s degree. It makes you wonder who’s going to stick around to take care of patients. But Simone says she likes the
ICU
and that she still has a lot to learn.”
She’s got that right. We all do
.
“Simone was overwhelmed,” Jasna says. “All she needed was a little guidance.”
“We’ve taken her under our wing,” Janet assures me, looking
even more mother-hen-ish than ever. I can picture her protective wings spread out over her baby nurse birds, watching over them and nurturing them until they’re ready to fly on their own.
I wish I had been more supportive on that last shift when I worked with Simone, but I am secretly comforted when I hear that a newbie is nervous. In time, they will overcome their fear, but it’s a good sign, at least at first. It means they realize what they’re taking on. It’s like the Hebrew word for “awe,” which also means “fear,” as the Rabbi explained at Rosh Hashanah services. This awe/fear combination is the awareness of the potential of our actions for good or harm. There’s a popular slogan: “Nursing – making a difference.” Yes, but bad nursing makes a difference, too. Harming someone does, too;
killing
someone makes a huge difference.
Only good nursing makes things better
.
Then there are the calls to arms to “rally the troops” and “recruit” and “retain” more nurses. Why the military jargon? It smacks of coercion yet is in widespread use in nursing circles. Who wants to be recruited (like a soldier?) or retained (what – against our will?) to a profession as difficult as this? Why not
attract
people,
support
them in this challenging career, and
keep
them in it by creating healthy workplaces? Sounds radical.
“Yes, Tilda, Simone is coming along. We’re working with her. Haven’t sent her off the show in tears, yet. She’s still a contender,” Stephanie says.
Janet’s got an insider scoop and moves closer. “I found out she was having boyfriend problems and I told her to dump the guy because in my humble opinion–”
“There she goes again,” Stephanie says.
“He’s a bum,” Janet gets in her two cents, then proceeds to put me on notice. “So you see, Tilda, you’re not the only one who has problems. Everybody’s got their shit to deal with.”
“Dr. Phyllis
has spoken,” I shoot back.
I look around the table. It’s true. Everyone has something or someone they’re worried about. Jasna’s son’s seizures are getting worse, more frequent. What must it be like for her and her husband to see their child suffer like that, day in, day out? She is like so many nurses: caring is the reality of their public lives and their private ones, too.
Stephanie is doing well, capably raising two splendid teenaged daughters on her own. She’s now well recovered from her own health scare that has made her even more grateful for her good fortune and aware of taking care of her health.
“Goin’ for the squeeze next week,” she says cheerfully.
She’s been diligent about her yearly mammograms ever since her mother died of breast cancer. She’s in training for a two-day walk – The Weekend to End Women’s Cancers – she does every year to honour the memory of her mother and to raise thousands of dollars for cancer treatment and research. Janet joins her, as captain of the medical team, organizing first-aid stations.
“Easy for you to say,” says buxom Janet about our skinny-minny friend. “You’ve got two fried eggs. Imagine me having to cram my shelf into that machine. Well, there’s one good thing about being well endowed – I’ll never fall on my face!”
“So, Tilda, when do you think you’ll come back to work?” Jasna asks.
“Soon,” I say evasively, though not meaning to be. I really don’t know.
“Are you ready?” Janet asks, looking me over, sizing up my readiness.
“Almost,” I say cautiously. I’ve been away from work for six months now, since before the start of the summer. Fall has come and gone, now it’s winter, but suddenly I feel nervous about
returning to the
ICU
. Not as bad as when I started out, years ago, but whenever I’ve been away from it, like after each of my ten-month maternity leaves, or even after a long vacation, I get this uneasy feeling, worrying about whether I still have that edge, if I am up to its challenges. It’s that fear and awe combo.
“When you get there, you’ll get your mojo back,” Jasna assures me.
A wave of bagel customers just came in and Eric introduces us, the nurses after night shift. They see us and must think,
Knitting nurses. How sweet
.
I watch my friends’ graceful, swiftly moving hands and think of all the lives they’ve saved with those very same hands that are now occupied with this seemingly trivial, decorative hobby. Those onlookers have no idea the mighty battles these hands have waged. I bet they don’t even know that it is nurses like these who would save their lives. If they should be unlucky to land in the hospital, they’d be very lucky to fall into these hands. How do we save this species of nursing from extinction? How to grow more nurses like these and ensure there are enough of them to meet the needs of everyone who needs them, which is everyone, one day?
All I know is, what strengthens me the most is being a nurse.
Robyn had told me that as I was being wheeled into the operating room, I gave her a thumbs-up. “It made me so emotional when you did that,” she said. “There you were, taking care of me even at that very moment.”
“I don’t remember, but that was nice of me. It’s what friends do.”
“But you weren’t just being my friend,” she continued. “It was more than that. You were taking care of me, as a nurse would, up to the very last minute that you were able.”