The Making of a Nurse (10 page)

“What about talking with patients and listening to their concerns? Isn’t that nursing, too?”

“Of course it is, but too much digging and probing can do more harm than good. Listen, Tilda, a nurse is someone who helps people feel better. End of story.”

That was Hannah’s nursing theory. Well, one thing was for sure, you didn’t have to read between the lines to figure out where you stood with her.

ONE OF THE FIRST
patients admitted to the new unit was a high-ranking army officer named Shaul Dayan. The treatment we had given him for his multiple myeloma was successful, but he still got infections and mouth sores. Even so, he looked virile and handsome. One morning, Ben Cassis told me he wanted to perform a bone marrow biopsy on Shaul and so I began to gather everything he would need for the procedure. I rushed around, setting up as quickly as possible, as I could hear him pacing impatiently outside the door. I had to keep running in and out to retrieve things I’d forgotten and when I came back in, Shaul said, “Listen, don’t let old Ben Cassis put pressure on you. This is what you will need for the procedure.” He made me a list: gauze, sterile drapes, a Jamshidi (a specialized instrument for performing this type of biopsy), a large syringe, and an assortment of glass slides and containers for the samples of his own bone marrow. “Relax,” he told me, handing me the list, “you can do it.” Ben Cassis performed the difficult procedure, which involved puncturing the hip bone with a large needle and extracting a sample of bone marrow. (Most patients screamed during that test, but Shaul smiled.) Assisting with that procedure always upset me because I imagined how excruciating the patient’s pain must be and I knew how much depended on the results. Afterwards, Ben Cassis left the room abruptly, and I stayed behind to tidy up. Shaul saw that I was distraught and put his arm around my waist to comfort me. I couldn’t help but fall in love with him, too. In Shaul’s case, that was a particularly easy thing to do and I was not the only one. Rarely a day or night passed when there was not a beautiful woman at his bedside.

“I am his wife,” said a woman.

“I am his girlfriend,” said one on a separate occasion.

“I am his lover,” said another.

“I am his Commanding Officer,” said yet another.

“I am his wife,” said a different one, and I didn’t ask any questions.

“I am his mother,” said an older woman, and I could see the resemblance.

Boldly, I asked him about them and he grinned. “They all cry
over me but I tell them they are allowed only one to two teardrops per day. But sometimes they exceed their quota.”

On occasion, Shaul told me a little bit about his work in Intelligence for the Israeli Defence Force. “The wars of the seventies exposed some serious weaknesses in our land intelligence systems,” he explained. “Today’s battlefield is more demanding, with more deadly weapons, especially during counter-engagements. The old-fashioned methods of obtaining information through agents and interrogators have low effectiveness, especially when we need immediate, accurate information for the precise identification of targets. Remember Iraq, in 1981?”

“Were you involved in that?” I asked, but he only smiled in answer. “I developed electro-optical devices for remote-piloted vehicles that display targets in real time.”

“I see,” I said, trying to.

Later that day, Ben Cassis showed me the results of Shaul’s bone marrow biopsy. “He’s at his nadir,” he said grimly. “He is vulnerable to infection. We’ll have to put him in protective, reverse isolation.”

Now, we had to approach him in gowns, gloves, and masks. It wasn’t the usual type of isolation procedure where we were protecting ourselves from infection. In this case, we were trying to protect the patient from organisms we might be harbouring. Over the top of my mask, I smiled at Shaul with my eyes and he smiled back with all of him. “Are you cold?” I asked. “Here’s a blanket.”

“Put that down. Sit with me.” He patted the bed beside him. “Here.”

What did he need from me? He had all his army buddies and all those wives, girlfriends, and lovers who lavished attention upon him. And if Aviva caught me sitting, doing nothing, she would think me lazy. “I’d better go,” I said, inching toward the door.

“Don’t leave.” He held me with his eyes. “Don’t avoid me.”

I hadn’t realized I was doing that. His face was thin and pale, but in his eyes I saw his vitality. Suddenly I realized what he did in the army. It was obvious. He was a spy. He could fool anybody he wasn’t going to die.

“Sit down,” he said, “and be with me.”

“Of course.” I sat next to him on his bed. “I’m here. I’m with you.”

“Breathe,” he said, and we sat quietly for a few minutes. He handed me a pair of earphones and he put on his and plugged both into his tape recorder. “Listen to this.”

“It’s magnificent,” I said, still breathing for him.

“Of course it is.” He grinned. “It’s Bach’s
Magnificat.”
He lowered the volume. “Tilda, when two people listen to music together, it is an act more intimate than sex. Music is direct experience, the only one that two people can feel at the same time. Even during love making each person is inside their own orgasm, experiencing their private pleasure. Only music can be felt simultaneously.”

I was loath to change the subject but I had to ask him something. “Shaul, are you afraid?”

He thought a moment. “Not of death,” he said, “only of pain.” He had started to suffer terrible bone pain and could no longer be as stoic as he had been for the biopsy. Once, his pain was so bad that I gave him a large injection of morphine very quickly. His eyes rolled back and he went limp. I was afraid I’d given too much, too fast. “Shaul,” I shouted at him. “Are you there?”

“Don’t worry, sweetheart,” he answered with his eyes closed. “I feel fantastic. I love you.”

IN THOSE DAYS
, I had the ability to block everything out of my mind on my days off. I had some mental switch that allowed me to disconnect from any thoughts of my patients and their problems. I put it all out of my mind and escaped into fabulous adventures with the new friends I was making. We went camping in the desert, scuba diving in the Red Sea, had mud packs in the Dead Sea, went skinny-dipping in the Sea of Galilee, and went horseback riding through the Golan Heights. We threw parties and sang, drank, and danced all night. On many occasions, I went up to Jerusalem with them and we visited the holy sites there. Once, while standing in the
shuk
, the outdoor market where vendors had overflowing displays of vegetables, fruits, nuts, seeds, and spices, all bursting with colour and
flavour (I never knew there were so many varieties of olives, dates, pecans, and pomegranates), I thought about my father and burst into tears. He would have loved that panoply and to have tasted each item, so I did, as many as I could, in his stead.

Every month, I called my mother and tried to have a conversation, but it was impossible to hear her and what I heard I could not understand. Just as my frustration was about to spill over into anger, Pearl came on at the right moment and helped me say goodbye and hang up.

THERE WERE FIVE
single-patient rooms in the bone marrow transplant unit; two nurses worked on days and one nurse at night when it was usually quieter. Since I was the most junior, I ended up being assigned to more night shifts than the others. At first I was worried about working alone, but Hannah assured me I could call her at home if I had any questions and the doctors and nurses in the main ward, Barrack Thirty-six, were always available to help if needed.

One evening Ayelet, the day nurse, gave me her report as I came in to start my night shift. Shaul was now in remission and had gone home a few days ago. In his bed was Talia Bar-Lev, who was six days post-bone marrow transplant. She was doing well, except for persistent high fevers, which could indicate lingering infection, but tonight they had abated. Abdullah, a twelve-year-old boy from Gaza, was to be discharged the next day. His mother watched over him and nodded at me when I checked in on him. Yuri was there that night, too. He was to get a bone marrow transplant in a few days, but seemed relaxed, sitting up and watching
TV
when I peeked in on him. In the fourth bed was Samuel Abulafia with his wife sleeping in a chair beside his bed. He had been admitted that morning in pulmonary edema, a buildup of fluid in his lungs, but for now, he seemed comfortable and was breathing easily.

“Only four patients?” I looked at the fifth room. An empty bed might not stay that way.

“I haven’t heard about anyone who needs it.” Ayelet got up to leave. “I know it’s a nurse’s superstition, but I’ll say it, anyway. It’s been a slow day. I’m pretty sure you’ll have a quiet night.”

After I got everyone settled for bed, I did a final check. The patients were comfortable and stable. Talia had been started on a new medication and her fever was now down. Yuri’s
TV
was on softly, but I knew he’d leave it on all night. He had told me once how he dreaded falling asleep, afraid he might not wake up. I stood in the doorway, chatting with him for a few moments and told him I was close by if he needed anything. Then I lowered the lights in the hall and at the nurses’ station. Abdullah’s mother had spread out a mat on the floor and was reciting her night prayers outside her son’s room. When she finished she came and stood observing me over the counter, smiling at me from behind her black veil. Each time I caught her watching me, she giggled and looked away. I was writing in my journal, where I recorded my private thoughts every day. I felt her watching my pen move across the page. She opened a picnic basket and offered me a banana. It was two in the morning. The long night stretched ahead of us. We both yawned at the same moment. I handed her a stack of lab reports and a rubber stamp, and she was pleased to help me while I prepared medications for the morning. Then she sat down on a chair beside me. There we were, the two of us, unable to speak to one another, but understanding each other perfectly. Soon we fell asleep, leaning heavily into each other, our heads resting on the tabletop. A sharp knock at the back door startled me awake. It was 3:00 a.m. Geula’s husband stood on the doorstep with his wife in his arms.

“She’s vomiting blood,” he cried. I saw the trail behind him. “Bring her in,” I said. “Put her in the bed.” I pointed to the empty room.

Although he hadn’t predicted this crisis would happen so soon, Ben Cassis had spoken about this very possibility yesterday on rounds. Geula had received a bone marrow transplant from an unknown donor. The match was good, but not perfect, and he’d seen ominous signs of “graft versus host” syndrome. It is the opposite of what occurs in organ transplants where the person, the “host,” may reject the organ, the “graft.” In
GVH
, the transplanted bone marrow is seen as a foreign body and is rejected by the recipient.

Luckily, Ben Cassis had left explicit orders in the case of this eventuality and I got to work. I quickly inserted a naso-gastric tube
down her nose and into her stomach to drain the blood. Then I started an
IV
for fluids, another for antibiotics and steroids, and another for blood and platelet transfusions. I hung the first unit of blood. As I waited until the tubing blushed, pinked up, became crimson, and then deepened to scarlet, I searched Geula’s face for signs of life being revived within her. I had seen blood have fast, almost magical effects, but Geula lay there, limp and pale, barely conscious. Her four daughters gathered around her bed, chanting prayers and a song with a haunting melody:

The youngest daughter, Sarah, who was only nine years old, nestled into the curve of her mother’s bent legs. The older girls dabbed at her forehead and lips with water that had been blessed by the Chief Rabbi of Israel. I recalled Geula’s last admission, just after her bone marrow transplant and how the family had moved into the same room she was in now. In no time it became full of puzzle books, homework notes and textbooks, and a row of their sandals lined up along the wall by the door. I had a feeling that during this admission there would be no time to set up camp as before.

I recalled meeting Geula and her family in the out-patient clinic. I had asked Tikva, the eldest daughter, a question that opened the floodgates: “Tell me about your mother before she got sick.”

“My mother is a successful business woman. She owns a textile factory. She knew from the start how serious her situation was, yet she always said she would beat this thing. Even after each chemo treatment she got up and went to work. We aren’t close, but she’s my mother, you know?”

I nodded.
Yes, I knew about mothers
.

Tikva usually spoke for the family and approached me now. “Nurse Teelda, please don’t give my mom any sedation. We want her to be with us the whole time, even if tonight is the end.”

“Even if she is in pain?” I asked.

“Well, maybe then,” she conceded, “but we want her to know we are with her.”

This was a matter for a longer discussion, but I had to check on Abdullah and Talia. Both were sleeping quietly. Suddenly, I heard Samuel start coughing violently. I ran to him and found him struggling to sit up in bed, spitting frothy blood into a linen handkerchief. He gasped for air. I raised the head of his bed, gave him an oxygen mask, and administered Lasix that had been ordered for him if this happened. It would increase his urine output and thereby reduce the excess fluid load on his heart and lungs.

“I’m sorry it’s taking so long,” he whispered.

What, to die? He’s sorry it’s taking so long?

“I’m ready,” he said, gasping for air. “It’s my time.”

I knew he had decided on no more treatment, but I had to make him more comfortable. I gave him a small injection of morphine and stood beside him waiting. Would the sparrows still come to him in the morning if he were too weak to sing for them, I wondered? That very morning, they had heard his calls and had flown right into his room in the barrack. His wife held his hand and I smoothed his brow and watched his breathing start to ease.
Blessed morphine
, I thought.