A Nurse's Story

by Tilda Shalof

  My work is critical care and where I work is the intensive care unit – the ICU. Sometimes, even after all these years, I hear those initials as words – I See You. They remind me of the privilege that nurses have to see deeply into our patients’ lives as we accompany them through some of their most private, difficult, and vulnerable moments. But when I explain to people that my patients are critically ill and that some are likely, or even certain, to die, they often ask me if I find my work upsetting. I tell them that yes, at one time I did and now, I don’t, but I know they find my answer hard to believe. “It must be so depressing,” they say. I struggle to explain why I don’t find my work sad, but they remain unconvinced, because they certainly find it so.

  This book is my attempt to explain why I do not find my work either depressing or distressing – why, in fact, I find it inspiring, challenging, and endlessly fascinating. Nursing has given me the opportunity to master technical skills, achieve a degree of maturity as a person, come to terms with my own emotional vulnerability, and, above all, to work with other women and men, who, in my experience, have been generous and devoted friends and extraordinarily accomplished practitioners of our profession.

  No, I do not find my work upsetting or depressing, yet I believe that many nurses do at times, and I have tried to give voice to their concerns. Not only that, but I know many nurses who are disenchanted and disheartened by what they feel is a lack of recognition or respect from the hospital, the public and politicians. Many nurses are exhausted from the burdens of shift work, impossible workloads, and severe staffing shortages. In addition, there is another, and to my mind, equally serious and pervasive stress: the constant exposure to the suffering and despair that grave illness can bring. Perhaps even more disconcerting is that as nurses deal with these known and familiar stresses, we are now faced with brand-new risks that may put our health – even our lives – in jeopardy. These risks take the form of new and more virulent infectious diseases and hazardous work environments.

  It may not be fashionable to say so, but even after all these years, I still love being a nurse. Sometimes I worry about the future of my profession. Recently, on a summer evening, at a barbecue dinner with friends, I asked the mother of teenagers how she would feel if her kids went into nursing.

  “Not pleased. I’d do everything possible to steer them in a different direction.”

  I asked her fourteen-year-old daughter if she’d ever considered nursing as a career.

  “No way! Why would I go into something that all I hear about it is how difficult it is, like how all nurses hate it, like how the government is cutting back on health care? I’m going to be a stockbroker.”

  I decided to bring my informal survey closer to home and asked my own children. Max, my six-year-old son, said, “No, not a nurse. I am going to be an artist and a doctor.” (I have come to believe that this happens to be an excellent combination.) But perhaps there is a glimmer of hope because when I asked Harry, my eight-year-old son, he answered, “First, I want to play hockey in the NHL, and then I’ll be a nurse.”

  However, this book is intended neither to entice young people to enter this profession nor to dissuade them from doing so. Nursing is not for everyone, but I can honestly say that now I have learned some of its challenging lessons and I am very grateful to have chosen nursing. Nursing has been very good to me.

  A few years ago I attended an old woman’s funeral. The rabbi spoke of her generous nature, how even throughout her long and difficult illness she continually put aside her pains and worries and made time to listen to her children and to play with her grandchildren.

  “She was a woman who conquered herself so that she could serve others,” the rabbi said.

  I sat up suddenly. That sentence set my mind on fire. In a moment I understood what I had been trying throughout my life and career to do. I have had to conquer many personal fears, anxieties, prejudices, and insecurities. I have had to learn basic fundamentals of taking care of myself in order to become the kind of nurse that I aspired to be. I happened to stumble into my profession, but now I walk proudly. I used to wait outside a patient’s door, hesitant and tentative, trying to build up the courage to go in and do something helpful. Somehow, I propelled myself into the room sideways, hoping not to be noticed, to get through my shift without harming anyone. As far as I know, I have never harmed anyone. There were many patients I have cared for over the years that I could have given more to had I been taking better care of myself and had I known what I know now, but it took me a long time to learn all of these things. This is the story of many stories. It is what I’ve learned from my colleagues and my patients over the years. It is my journey of learning to conquer myself so that I could serve others. It is my expression of gratitude to nursing and to the nurses I have known and have had the privilege to work with. They have given me the best of nursing care and it has made all the difference.

  ACKNOWLEDGEMENTS

  Thank you to Douglas Gibson and Jonathan Webb of McClelland & Stewart for believing that a nurse’s story deserved to be told, and to Wendy Thomas, Kong Njo, Elizabeth Kribs, and everyone else who contributed to the editing, design, and production of this book.

  To the patients and families I have cared for, I will always feel honoured that they have entrusted me with their lives.

  Faced with the impossible challenge of acknowledging all the nurses who inspired this book, I have had to compromise with this short list. My apologies to those I’ve unavoidably missed: Lesley Barrans, Georgia Barrett, Dawn Barretto, Stephanie Bedford, Karen Bennett, Polly Ann Boldt, Patricia Bone, Allyson Booth, Richard Bowen, Bryan Boyachuk, Judy Brooks, Stacey Burns, Christine Caissie, Anita Chakungal, Paula Chen, Suzanne Chiasson, Dallas Christian, Sherrill Collings, Sharon Cudek, Ingrid Daley, Penny and Helen Damilatis, Blonie Deza, Belle Dhillon, Maureen Falkenstein, Barbara Farrell, Debbie Finn, Marcia Fletcher, Jo-Ann Ford, Gary Frazer, Roberto Fuerté, Catherine Gadd, Cheryl Geen-Smith, Elizabeth Gordon, Dorota Gutkowski, Janet Hale, Kathy Haley, Lynda Hattin, Rosie Healy, Helena Hildebrandt, Claire Holland, Grace Ho-Young, Linda Hunter, Tammy Hutchings, Anita Jennings, Isabel Jordão, Lori Karlstedt, Chris Kebbel, Sandi Keough, Anisa Khan, Nydia Khargie, Meera Kissondath, Connie Kwan, Cathy Landry, Kwai Lau, Edna Lee, Marianne Leitch, Murry MacDonald, Shona Mackenzie, Isabella MacLeod, Kate Matthews, James Mazgalis, Bridgette McCaig, Kathleen McCully, Margaret McGrath-Chong, Robert McGregor, Moira McNeill, Carolyn McPhee, Julie Millar, Amanda Moorhead, Sue Morningstar, Denise Morris, Kerrie Murphy, Sue Nash, Cecilia Neto, Patricia Nunes De-Sousa, Linda Nusdorfer, Carol Oyerzabal, Janet Patterson, Kate Pettapiece, Winsome Plummer, Jennifer Post, Jonathan Pridham, Sharon Raby, Wendy Radovanovic, Cheryl Ramsden-Lee, Juliet Ramsay, John Remington, Katie Reposa, Terri Ritter, Karyn Robinson, Theresa Robitaille, Karen Roche, Elizabeth Romano, Les Rusland, Carla Samuels, Maureen Samuels, Kathleen Saunders, Jackie Spandel, Paula Spensieri, Rosemarie Stangl, Janice Stanley, Marilyn Steinberg, Adrella Suban, Kelly Sundarsingh, Oliver Tadeo, Claire Thomas, Jasna Tomé, Stacey Toulouse, Angela Tozer, Brenda Twa, Amber Verdoni, Jenny Vian, Sue Wegenest, Paulette Weir, Tanya White, Theresa Zamora, Denise Zanus, Mugs Zweerman, and the late Jane Jackson, who deserves a book of her own.

  There are many other dedicated professionals who are a part of this book. To name but a few: Jimmy Arciaga, Trisha Barnes, Carolyn Brunette, Laurie Campoverde, Gary Corney, Roger D’Amours, Hanwar Dilmohammed, Sister Teresa Forma, Mary Georgousis, Fernanda Gomez, Gail Henry, Billal Jehangeer, Ludwika Juchniewicz, Brenda Kisic, Urszula Kolomycew, Wade Morey, Cyndy Rahm, Cecilia Reblora, Rosa Ricciardi, Sandy Rothberg, Loretta Savage, Roman Schyngera, Lola Troper, Gary Wong, and Zeinul Velji.

  I feel enormous gratitude to these dear friends who are also colleagues, for nurturing me and my dreams, with love and patience over the years: Judith Allan-Kyrinis, Karen Calverley, Ann Flett, Cecilia Fulton, Lisa Huntington, Mary Malone-Ryan, Linda McCaughey, Julia Piercey, and Sharon Reynolds.

  Thank you to Marlene Medaglia fo
r mentoring me and for being the kind of nurse I am still striving to be and to Maude Foss, whose unwavering support has been invaluable.

  With appreciation to these fine physicians from whom I have learned so much: Richard Cooper, Wilfred De Majo, John Granton, Laura Hawryluck, Margaret Herridge, Brian Kavanagh, Neil Lazar, John Marshall, Janet Maurer, Joanne Myer, Tim Winton, and the late Bill Mahon.

  I am deeply grateful to Dr. Mark Bernstein for his encouragement, generosity, and for throwing open the door.

  Thank you to Rabbi Elyse Goldstein for her wise counsel.

  Thanks for the steadfast and enthusiastic support from the families of Tony and Daneen Di Tosto, Desmond and Michelle Hirson, and Alan and Rivi Horwitz. Thank you to Larissa Ber, Méira Cook, Elise Dintsman, Vanessa Herman-Landau, Mara Koven, Annie Levitan, Ella Shapiro, Dawn Sheppard, Anne Werker, Rhea Wolfowich, Bob and Marcie Young, and David Zitzerman for friendship and advice. Thank you to Joy Friedman-Bali, my sister of the earth, and to Robyn Sheppard, my sister of the air.

  A huge debt of gratitude to Barbara Turner-Vesselago, friend and teacher who gave me the courage to write and taught me to go “fearward” and mine the vein. I thank fellow free-fall writers for reading my early drafts and sharing their writing with me: Karen Alison, Malca Litovitz, Ann McLurg, Faith Moffat, Sue Reynolds, Monique Shebbeare, Cathy Shilton, and Susan Zimmerman.

  I am grateful that I had the good fortune to have many parents. First, my own, the late Harry and Elinor Shalof. Also, Alec and Leah Lewis; Jerry and Bernice Friedman, Dr. Shlomo Katz and the late Dr. Shirra Katz, Dr. Robert and Norah Sheppard; Florence and Richard Weiner, and Rita Young. Thanks to Robert and Stephen Grant, and Tex and Bonnie Shalof for being my brothers and sister.

  Thank you to Harry, Max and Ivan Lewis – especially, Ivan. Although he’s never read a word I’ve written, without him I couldn’t have written even one.

  I

  TREATING THE NUMBERS

  It’s night shift. I jot down a series of numbers onto my patient’s twenty-four-hour flow sheet and then prepare to read them out loud to the medical resident who is standing with me at the patient’s bedside, waiting to hear them.

  “Everything is out of whack,” I say: “7.26, 68, 76, 14.”

  That’s a losing lottery ticket. No one can survive such a deranged acid-base balance, sky-high carbon dioxide levels, and plummeting oxygenation and bicarbonate ions.

  “Those numbers are not compatible with life,” the resident says.

  “Not life on this planet, anyway,” says Lynne, the nurse who’s kneeling by the door, packing up her knapsack, getting ready to leave. She was on the day shift and is the only one in the room who’s smiling: she’s going home. “I’m outta here. I’m going home to have sex with my husband.” Lynne has finished giving me report on Mr. DeWitt, all the facts and the numbers, what’s high, what’s low, what’s rising, and what’s falling. Now it’s up to me to carry on throughout the night.

  “Have fun,” I say as I’m thinking about something else. “You know what, Lynne? I think we should call a family meeting. Does his wife know how bad the situation is? Has anyone told her? I’m going to call her. I think she needs to come in.”

  “She just went home,” says Lynne. “She’s been here all day and was exhausted when she left. What makes you think he might not make it through the night? He’s been spiralling downward for weeks. You could probably get him through the night.”

  Together we stand there, Lynne just outside the door, me just inside, surveying the body of the middle-aged man stretched out in the bed, surrounded by machines and monitors, tubes and wires, bags and drains that expose all the secret fluids of the body.

  “I see your point, though,” Lynne says. “When you take a minute to step back and really look at it all, you do start to wonder sometimes. But do you really think it’s going to be tonight?”

  “I have a feeling.” I have learned to trust my feelings.

  I consult with the medical resident and together we decide that I should call Mrs. DeWitt and ask her to come in. I tell her that unfortunately, her husband is not doing well. His blood pressure is very low, I say. It is dropping, I add, as gently as possible. He is on powerful intravenous medications for his blood pressure, inotropes we call them, but we have had to add another drug because of the serious heart irregularities that he developed today. Another problem is that his urine output is dropping off. Perhaps she would like to return to the hospital and we can talk about it further? Is there someone who could drive her?

  “FAMILY MEETING” is the term we use to gather all the people closest to the patient to provide them with an update on the patient’s condition. Sometimes we call a family meeting to discuss the death and how we will let it happen. A family meeting is rarely called if the patient is improving.

  We convene in a shabby, cramped room called the “quiet room.” It is a tiny room with buzzing fluorescent lights, no windows – I would never take anyone in there if they suffered from claustrophobia. It has the feel of a bunker in a war zone, but aesthetics aside, it seems to be the only room in this huge, bustling, overcrowded, downtown hospital that could be made available for this purpose. The quiet room! It is probably the most disquieting place in the whole hospital. Bombs are detonated in here.

  We turn our attention to Mrs. DeWitt. She is the one who knows Edgar DeWitt best. She is the person who will speak on his behalf, as he is no longer conscious and cannot tell us himself what he wants us to do. She perches on the chair, frail, but tensed up. She knows why we’re gathered here.

  “What would Mr. DeWitt have wanted?” the doctor asks his wife.

  “To live! That’s what he would have wanted.” She sobs into her hands.

  Of course. Isn’t it obvious? Isn’t that what anyone would want?

  “We understand,” the doctor says, “but, given his deteriorating condition and his irreversible medical problems, if we continue with the life-support measures that we have in place, we are merely prolonging the inevitable.”

  I watch Mrs. DeWitt and I can see that in her panicked state, she finds comfort in the simple fact that the doctor is talking, because all the time the doctor is talking, her husband is still alive.

  “We do not believe that we can reverse his medical problems. Perhaps the time has come, that we should very gently, slowly, when you are ready, of course, remove the ventilator, all the life supports, and let nature take its course?”

  She sits weeping into the cave of her two hands. I offer her a new box of tissues and pull out the first one to get it started.

  “Did you ever discuss this situation with him?” I press gently. “Do you think he would want all this to be done?” My words are like sticks, poking at a fire, making it flare.

  “Who would want all this done?” she asks.

  The doctor and I smile at her response, so true and honest.

  “I don’t know what to do,” Mrs. DeWitt says. “Whenever we had a big decision to make, Ed and I always made it together.”

  “There’s no need to decide anything this minute,” I say, “but his condition is very critical. Anything could happen tonight.”

  Whatever happens, it will be a long night for all of us.

  The family meeting is over and we return to Mr. DeWitt’s room.

  Frances peeks her head in the door and whispers, “Do you want to order in food, Tilda?”

  Frances is one of my pals – we’ve worked together for years. Tonight she’s the nurse in charge and her duties include organizing transfers in and out of the hospital and discharges and admissions to and from the ICU, making rounds with the doctor to check on how the patients are doing, and finding out if any of the nurses or doctors want to order snacks or meals from the sheaf of menus we keep on hand – Greek, Thai, pizza. It never sits well to eat this heavy food late at night – it’s already 9 p.m., or 2100 hours, according to the twenty-four-hour clock we use – but we often do because we’re always hungry. I order a veggie sub with hot pepper
s and a bottle of Grape Beyond juice and return to my patients, who are, in equal measure, Mr. and Mrs. DeWitt.

  Mrs. DeWitt smiles at her neighbours from the street she lives on; they have joined her at her husband’s bedside. They stand there, looking uncomfortable. These helpful people drove her back to the hospital when she received my phone call. Mrs. DeWitt’s smile reflects the required gratitude of someone who has no relatives or true, trusted friends to call upon and must rely on favours from acquaintances. Friends you choose, family you’re born into, but neighbours are random and have no obligation whatsoever. What they offer is truly a gift.

  “I don’t want my husband to die on March 5,” Mrs. DeWitt says.

  It’s not like booking an airline ticket. Or is it? I look up at the clock on the wall near the door and note that it is 2200 hours on March 5, 2004. In two hours it won’t be March 5 any more. Can we keep him going until then? Anything can happen. There are no guarantees. Of course I’m curious to know why she’s made this request, but I’ve heard stranger ones. I wait for her to tell me, if she wishes.

  “It’s Greta’s birthday,” she says, pointing to her neighbour, and this gesture brings a tear to Greta’s eye. “I don’t want Ed’s death to ruin her birthday. Good neighbours are hard to find.”

  We all stand around Mr. DeWitt’s bed and I do my work of measuring and monitoring, watching and waiting. Together we keep the vigil.

  I am instilling drops of lubricating fluid, called artificial tears, into Mr. DeWitt’s swollen, bulging eyes. The medical term for this condition is scleral edema, but sometimes, among ourselves, we refer to them as “jelly eyes.” We see eyes like this all the time in the ICU.