The Making of a Nurse

T
here are many wonderful things about writing a book, but the best, by far, is having readers and being in contact with many of them. Since the publication in 2004 of
A Nurse’s Story
, I have heard from people all over the world. Many are nurses themselves who, despite a diversity of experiences and cultures, and the wide variety of roles, settings, and specialties in which they work, tell me that my nursing stories resonate strongly with theirs. In turn, these new conversations and connections have furthered my thinking about the journey of becoming a nurse and what it means to be a caregiver. Thus,
The Making of a Nurse
is both the story behind
A Nurse’s Story
, as well as an up-to-the-minute follow-up of what nursing is like for me, still in it after twenty-five years. It is also my response to the many readers who have asked me to explain what I meant when I said I had to learn “to conquer myself in order to be of service to others.” It was a phrase I had heard in a eulogy delivered at the funeral of a woman who had been a grandmother, a wife, a friend to many, and an active volunteer in the community. That phrase caught my attention because
it seemed to sum up what I had been trying to accomplish both in my personal life and in my professional career.

During my childhood, both of my parents had serious, chronic illnesses. For years, I was their nurse, but as a teenager, I began to grow resentful of the care-giving responsibilities expected of me. I longed to escape what felt like an onerous burden. Then, of all things, I decided to study nursing. I remember the day I received my degree and my licence to practise and thought that was that: I was a nurse.
Hardly
. I had to be
made
into one. The patients I have cared for and the nurses I have worked with helped me become the nurse I aspired to be. (There are times when it still feels like a work in progress.)

While most practising nurses have expressed a familiarity with my stories, and indeed express a sense of affirmation to see many of them for the first time in print, other readers tell me that they have provided a window into a world they had never known about nor had the opportunity to enter. There is indeed a motherlode of nursing stories, however, and few have been recorded. I wanted to tell mine, but I had to find a way to do so that would ensure the utmost protection of patient privacy and confidentiality. So, once again, in
The Making of a Nurse
, I changed names (with the exceptions of my family, Pearl Bernard, Dr. Margaret Herridge, and nurse Janet Hale) and all unique and identifying details, and in a few cases created character composites, in order to ensure the complete anonymity of all patients and colleagues. My objective is to explore themes and issues that are not exclusive or particular to any individual patient, situation, or person, rather than to document specific character portraits.

To be honest, something else motivated me to write this book. I am worried. Some of the best nurses I know have left the profession, disillusioned and disheartened (there are lots of things that can wear you down!), and so many nurses actively discourage their own children from choosing nursing. At the same time, people in hospitals and in their own homes are in desperate need of more nursing care. There is a growing, worldwide shortage of nurses. If this trend continues, it will have an impact on each and every one of us: we will all need a nurse at some point in our lives. We are
going to have to take very good care of ourselves so that we can take care of each other. Perhaps knowing what nursing is really like, at least from one nurse’s perspective, will help people make a more informed choice about the profession. I hope this book contributes to that understanding.

I often wonder: Who would want to be a nurse, especially if they knew what it really entails? Who chooses nursing these days and why? I ask these questions honestly and open-mindedly, not rhetorically or cynically. Nursing is not a career you can advise or persuade someone to choose and it is a hard path to champion if you have not personally experienced its many satisfactions. I’m quite sure that the vast majority choose it because of a genuine desire to help others, but one nursing student told me nursing attracted him because “the salary is decent and it’s steady work.” Another told me she really wanted medicine, but didn’t get in and nursing was her fallback. I’m afraid these motivations aren’t going to cut it when those nurses enter a patient’s room and are faced with raw human suffering. Nursing is dirty, gritty, messy, grinding, brutal, rough, and heartbreaking. It is also inspiring, sophisticated, challenging, fun, comforting, and at times, exhilarating.

I recall one day, years ago, sitting at the back of a hot, stuffy classroom, learning theories and abstract concepts about nursing, and the professor saying blithely, “Nursing is about Life,” and then pausing to add, “and Life is about Nursing.”
How trite, how inane
, I thought, jotting down that line in my notebook anyway, just in case I might be tested on it. I was only half paying attention, mostly daydreaming, wondering if I had what it took to be a nurse. Recalling that comment today, I think,
how true, how insightful
. Yet, how hard won that understanding has been.

My friend Joy says every reader will find something to cry about in this book. It is my sincere hope that every reader will also find lots to laugh about, as well. After all, if Life and Nursing have taught me anything, it is that the two go hand in hand.

Tilda Shalof 
March 2007

M
y patient’s name is Joe, or so he says, and I am his nurse. His chart states his name as Zbigniew Zwiezynskow and under place of residence, there is merely a sad trio of letters:
NFA
– “no fixed address.” He’s in his mid-forties, admitted last night to the Intensive Care Unit, the
ICU
, with pneumonia. He’s feverish, delirious, and so violent that he may try to kill me if I decide to release him from the restraints we’ve placed on his arms and legs. But medically, his condition is improving – no small thing here in the
ICU
, where all of the patients have life-threatening, catastrophic illnesses. We’re full; each of our twenty-two beds is occupied. Attached to every patient are monitors, machines, and equipment and in every room there are sickening odours and horrific sights, but I hardly notice these things any more. I have learned how to go beyond it all, to see through it, push it gently aside and go straight to the person lying there in the bed.

Today, all day, Joe is my patient. His heartbeats, urine output, breaths, cough, skin, dirty fingernails, and wild, greasy hair are all my concern. I will enter his world and for the next twelve hours, minute by minute, I will dwell with him there.

It’s taken me such a long time to get here
.

The sheer math astounds me. Since becoming a nurse in 1983, I have put in thousands of twelve-hour shifts at many different hospitals. I have worked with thousands of nurses and hundreds of doctors and other professionals. I have taken care of tens of thousands of patients ranging in age from eight to 104 who have had a multitude of diseases, illnesses, and injuries, and have administered to them a sea of intravenous fluids, rivers of syrups, suspensions, injectable medications, and at least a million pills, capsules, and tablets. Researchers study large populations, searching for patterns and trends, but the only way I know how to practise as a nurse is one patient at a time, seeing each individual in my care through illness, loss, pain, grief, or the prospect of death. For me, each time, the numbers all come down to one. As a nurse, there is the patient I am caring for and together, we proceed, one on one, side by side.

It wasn’t always like this. Even though I was practically born a nurse, with strong instincts to help others, I was raw and unskilled; I had to be
made
into one. But long before it became my livelihood, taking care of others was my way of life. You could say I practised as an amateur for many years before going professional. My mother was my first patient and I cannot recall a time when I did not know it was my job to be her nurse. I was six years old when she first became ill, but as my father always said, I was very mature for my age.

WHENEVER SHE STARTED SHRIEKING
, I went running. With her arms outstretched and her head flung back, crashing waves of sound poured out of her wide-open mouth. Her voice engulfed me. I was drowning, but I dove in to save her. “Please stop!” I screamed at her.

“I sing for you,” she warbled.

“Don’t!” I closed her lips with my fingers, but they exploded open again. Her voice filled the house. There was nowhere to hide. Low and rumbling one minute, it would suddenly screech up to a piercing high note. As soon as I was trapped by her voice, she would pause to recount one of her fables.

“When I was your age, I sang to the birds in the trees and they sang back to me.” She returned to
Vissi d’arte
, then paused again. “I don’t merely sing Tosca, I
am
Tosca.” She gave a little laugh. “I am so Tosca, it’s not funny. Like her, I live, and am prepared to die – for my art.”