The Making of a Nurse (41 page)

“No.”

“Nothing? Not even gas?”

“No, not a thing.”

For years, we had talked of poetry and prose, roses, wine, and lace. Never did I dream that one day we’d be talking about shit. “Daphne, it could
be …” an obstruction due to a tumour
. “Perhaps you should see your doctor.”

“Do you think so, Tilda?”

“Shall I drive you?” I answered, changing back into my clothes. Daphne was a reluctant driver, even at the best of times. That afternoon the doctor sent her for a
CT
scan. It showed her abdomen was full of tumours. He told her he could not offer more surgery, only another dose of gruelling chemotherapy. He admitted her and a nurse came to start an
IV
.

“Please put it here.” Daphne made a graceful arabesque with her right arm to proffer it to the nurse while keeping her left one close to her body, hidden under the covers. Of course. It was her writing hand. “I have a belief that my pages will see me through,”
she said to me. “No matter what happens, somehow I will find the strength to write myself through it.” She continued to set daily goals: her morning pages, first thing, and then three laps around the nurses’ station, and meditation for one hour.

“You always were so disciplined,” I said, noting immediately her displeasure at my verb tense and nostalgic tone. “I mean, you
are
so disciplined.”

“I try to keep the dire thoughts at bay,” she said to me once again.

“How do you do that?” I asked her, needing her to explain the seemingly simple precepts once more.

“I take in the positive energy everyone sends my way and flood my body and my mind with it. I pray a lot. Tilda, would you pray with me?”

Okay, I said, and did my best. Of course praying helps, I thought. At least it helps while she’s still alive, but why was I such a skeptic? Why didn’t I hold out for miracles? “What did the doctor say?” I asked, bringing the prayer session to an end.

“He said ninety-nine per cent of patients die after a second relapse such as this.”

I pulled my chair closer even though it was already touching her bed. “He’s given you a very big assignment.” We sat and thought about the work ahead of her. I wondered if she would still be the star pupil, the exceptional one, the valedictorian standing first in her cancer class?

“What do you think, Tilda? Do you think I can beat this thing? Do you think I’ll make it?” She closed her eyes to take a deep breath, then opened them to receive my response.

I had never been asked a harder question. I couldn’t look her in the eye because if I did she would see that I thought she was going to die. Still, that question hung in the air between us. I wanted to give the best, kindest response, but also the truest. I looked at her expectant face. How cruel it would be to say anything that might dash her hopes.

To Daphne, giving up was the worst possible choice, but wasn’t there a peace to be found in surrender? I am committed to look at life as truthfully as I can, but I had to respect her way. As a nurse
and as a friend I try to treat others as
they
wish to be treated, not how
I
would wish to be treated. It’s like giving a present: you don’t give what you would like to receive; you try to imagine what the other person would want. I had to find a way to tell the truth, but which truth and how to tell it? I delved deep into the well of all that I have learned as a nurse and said, finally, “If there is anyone who can beat this, Daphne, it would be you.”

She leaned back against the couch, pleased to receive the gift I’d offered.

A FEW WEEKS LATER
, the hospital sent her home and the doctors told her they had nothing more to offer her except palliative care, but she was angry at the very suggestion. I went to visit her and her husband, Ken, told me that the tumours were wrapped around her entire intestinal tract, cutting off the circulation. She was receiving nutrition at night through an intravenous line called
TPN
*
that he managed quite capably. Their living room had been transformed into a mini hospital suite.

“I wrote only one line today,” Daphne said when she saw me. “Nothing feels like a poem.”

Ken asked about the drain in her abdomen. “Sometimes it flows well, but other times it seems blocked.” He was an engineer and needed to visualize the internal structures in order to understand their function. I drew a diagram of the anatomy of the organs and how the tumours obstructed the outflow of fluid. By positioning Daphne on her side, gravity would ease the pressure. We talked about the laws of motion and the impedance of flow, until he said he understood. I sat down on the bed beside Daphne, feeling proud of my small but useful contribution.

She rocked herself back and forth. Suddenly, she lurched forward for the plastic basin into which she vomited in an almost graceful way. Ken rubbed her shoulders as she heaved into the basin and then hurried off to empty it and rinse it out. I wondered if he felt any of that resentment that used to sweep over me when I had been home
alone taking care of my mother, but he seemed wholehearted in his new role as his wife’s caregiver. He had a few more questions and for those, he took me aside.

“They won’t admit Daphne to the palliative care unit, because she wants to have the night time nutrition. I see their point of view,” he said. “Why feed someone who is only going to …”

“Hospitals can’t tolerate too much ambiguity or contradiction,” I explained. “They can’t work at cross-purposes. If Daphne wants to be fed, she doesn’t by their definition qualify for palliative care.”

“To her, palliative care means it’s the end.”

“Yes, and it also means comfort.”

“What should I do if I can’t manage with her at home?”

“Has she expressed a wish to die at home?”

He shook his head. “She doesn’t believe she is going to die.”

“Bring her to the hospital when she is ready or when you are.”

I went back to sit beside Daphne.

“It’s hard, Tilda,” she said, shuddering as she reached for the plastic kidney basin. “My poems are from my old self and I am still giving voice to my new being.”

I was leaving the next day for a family vacation and I wanted to say goodbye to her, but she wouldn’t have accepted it. I believed it would be the last time I’d see her, but when I got up to leave, she smiled and said she’d see me soon. I saw that she was not afraid of dying because she did not think it possible. It was her ingenious way of keeping fear at bay. But it was only a few days later, during that vacation, that a mutual friend called to tell me that Daphne had been admitted to the hospital and had died there, that morning.

It’s the Jewish custom to rush to burial in the belief that mourning cannot properly begin until the person is in the ground. I was too far away to attend the funeral, but I wanted to know the end.

“I went to see her yesterday,” the friend said. “I asked her how she felt. She said ‘grand,’ and then a minute later she died. That was Daphne, elegant to the end.”

EVERYONE HAS SOMEONE
they are worried about. Everyone needs a nurse, or will at some time. And once you become a nurse, or choose to act like one, you’ve signed on for life. Can you ever be off-duty? Once you know what you know and once you have chosen to care, can you ever look away and not respond when needed? Is it possible to turn off that awareness of others’ needs, especially if you have the skills or knowledge to mitigate another person’s suffering? It is, but you don’t. For most nurses, their profession defines who they are. They are nurses everywhere, all the time. There’s no turning back.
Nurse
is noun, verb, and adjective. It’s a job, but it’s also a way of being in the world, on-duty and off, at work and away.

M
y day was not getting off to a good start. Usually, I leave myself enough time so that I can sit for a few minutes before work in the underground mall opposite the hospital. I like to take the time to pause and locate my calm centre that I vow to maintain in the face of the possible things in the day ahead that might threaten to disrupt it. That morning, I guess I hit the alarm clock snooze button a few too many times, and had to scramble to get dressed and then rush off to work.

Outside the front doors of the hospital, there was the daily gathering of die-hard smokers clutching their
IV
poles (urine bags dangling off the bottom) with one hand, their lit cigarettes in the other. (It’s the only place they can go because smoking is banned inside.) As I was about to get onto the elevator, two men, their fat bellies pushing out under their flapping hospital gowns elbowed their way forward, cigarette packs in hand, eager to get outside for their smoke. “I’m on thinners,” one was saying to the other. “How ’bout you?”

“Me too,” his partner said. “Man, they do a number on your heart.”

Riding up in the elevator, I was subjected to more snippets of dreary conversations.

“Our health-care system is falling apart … gone to rack and ruin.”

“Forecast calls for rain,” a voice said.

“What a dull morning,” someone else said. “Not a bit of sunshine.”

Maybe it’s time to look for a new job. Why do I still work in this depressing place?

It takes effort to be positive. It doesn’t come naturally to me. At times, it requires courage and imagination, neither of which I could muster during a recent period of disenchantment with my hospital world. I wasn’t burnt out as much as tuned out. Coasting along, floating mindlessly, going through the motions, I gave safe and satisfactory care, but my thoughts were elsewhere, my heart empty; the zing was gone. I worked to pay my bills, no more, no less. Then a patient startled me awake. He was a nameless, homeless man in his forties who came in with a terrible diagnosis. It’s the condition that causes the greatest suffering, requires the most painful treatment, and has the bleakest prognosis. To me, it’s the worst possible diagnosis because it’s the one I once had. I knew this man’s problem so personally that I never believed a time would come when someone like me could offer anything to a person like him, much less the other way around.

“YOU LOOK TIRED
, Tilda. Coming off nights?” someone asked in the locker room as I changed into my scrubs.

“I’m coming on now.” I glared back at her. “Day shift.”
Do I look that bad?

“Ouch. Excuse me.”

Since I was running late, I hustled off to the
ICU
, checked my assignment at the nurses’ station, and headed straight to my patient’s room. “How was your night, George?”

He leaned back in his swivel chair. “I worked all night to save this guy, even though I’m not sure we’re doing him a favour. But he’s finally coming around. Say, how are your muscles?” He playfully
squeezed my biceps. “This dude’s rambunctious. You may have to call a Code White for the security guards or else snow him with sedation.” Then George dropped down to the more serious story of our patient. A street nurse found him collapsed in an alley, cold, emaciated, and hardly breathing. She brought him in her van to our hospital where he was intubated and ventilated. During the night, he kicked and punched everyone who came near him. He had pneumonia, but the medical notes stated the more dire diagnosis: Failure to Thrive.

The physical causes of failure to thrive, such as poor nutrition and dehydration, are easy to treat, but when failure to thrive is due to a loss of will or lack of hope, that’s a case of pure despair, and what’s the cure for that? I had a feeling that’s what we were dealing with here. In the place of “Name” read “John Doe.” “Home address” was blank. He was an alcoholic, iv drug abuser, and out on bail for assault. He had been attending a methadone clinic but had lapsed back onto heroin, cocaine, and crystal meth use – in short, whatever he could lay his hands on. Then he’d developed an untreated upper respiratory infection that in his debilitated state quickly led to pneumonia and brought him to us in the icu.

I looked into the room. He was sitting up in bed, peering out to see who would be his nurse just as I was peering in to see who would be my patient. I didn’t like what I saw. He was thrashing about and had a nasty look in his bleary eyes. His ribs stuck out as he leaned forward, tugging his hands against the restraints pinning him down. He whipped his head from side to side, as if trying to escape the tube that was sticking straight out of his mouth. He was trying to kick his legs, but they were held down tight. Despite the restraints, he was managing to create quite a commotion. George finished giving me report and stood up to leave.

“Good night,” I said with a fake smile.

“Good luck,” he said with a sympathetic one.

I paused to consider my options. No one would want to switch patients with me and it was far too late to secretly pencil in a different nurse’s name beside this patient. If I had gotten to work earlier, I could have made the change and no one would have been
the wiser. Another more energetic and motivated nurse could deal better with this patient than I. I’ve done my time with difficult patients and the younger ones need this experience, I reasoned. Since I could see on the monitor that his vital signs were stable, I didn’t go to him immediately. I sat outside his room, perusing the chart, and wasting time before I had to go in. Carmel, a nurse I’d worked with occasionally, came by with a guilty look on her face. “Hey, Tilda.” She touched my arm. “I have a confession.” She took up the seat beside me. “I got here early and saw they’d put me with this patient and I made a switch. I put you here instead. Have you noticed how they usually give the dangerous assignments to the black nurses?”

No, I hadn’t noticed, but other nurses have told me this. Perhaps it’s true, but what makes one assignment more unpalatable or difficult, or even more hazardous, than another? Caring for this patient was frightening for me for reasons no one could possibly know. It was my secret. The dangers here weren’t only that this man was filthy, infected, and violent. I felt confident I could capably protect myself from those risks. I was far more susceptible to catching a lethal dose of his despair. I swallowed hard. “Carmel, if you feel you’re being discriminated against, why don’t you say something to the nurse who made up the assignment?”