A Nurse's Story

by Tilda Shalof

  This is war. This place is a war zone and this man’s body, our battlefield.

  His heart rhythm was stable, so I sat down at one of the small tables on wheels that we keep in the unit. Our patients can’t sit up and eat meals in bed, so we use these portable tables for our charting purposes. I wheeled it over to within an arm’s length of the foot of the patient’s bed.

  “Are you Manjit’s nurse today?” asked a pretty young woman with a mocha complexion. She came from behind me and approached me tentatively, as if not wanting to disturb me. Perhaps she was trying to determine my reaction to her early presence, unannounced and long before the official hospital visiting hours. She probably sensed that not every nurse was friendly to families. Each nurse had his or her quirks. Some kept their distance and wanted space to do their work; others were more relaxed and welcoming. Would I be one to open the way for the family or would I be another obstacle for them to overcome? Would I be one of those nurses who keeps them in the waiting room, closes the curtains, and bars them from the room, or would I be an ally?

  “Come right in,” I said. “I was just going to do my initial assessment, but you’re welcome to visit Manjit. You are his wife?”

  “Yes, I am,” she said with a smile. “My name is Jatinder.” She wore a wrinkled purple T-shirt over black stirrup pants and carried herself with the grace of a dancer.

  “Have you been here all night?” I asked as I recorded Manjit’s vital signs and noted that his fever had spiked to 40.0°C.

  I could plainly see that she had. The dark circles under her eyes told me the whole story of her night in the waiting room on one of the lumpy, narrow couches. I lowered the side rails and beckoned her to move closer to her husband. I drew the curtains around his bed and examined him from head to toe, as I had been taught.

  As I did this, out of the corner of my eye, I watched Jatinder caress Manjit’s sweaty bald head and his swollen face. He was intubated and heavily sedated, so he could not communicate to her in words, but she seemed satisfied merely to be near him. Later that morning, we bathed him together, and she rubbed his back. I began to wonder how a person as sick as Manjit could get better. Perhaps it was simply a limitation of my imagination. Perhaps I was not religious enough to believe in miracles. Perhaps because I had such misgivings, I was not the best nurse to be caring for this patient.

  I turned my focus to his body and noted that he looked pale. He had lost a lot of blood in the operating room where he’d gone to have an abscess removed and he was bleeding from his wound and from sores in his mouth and in his lungs. I logged on to the computer to check his hemoglobin just as Laura poked her head into the room. She said, “Your hemoglobin’s down to 64, so I’ve cross and typed him for two units of packed cells.”

  “Thanks. I’ll call a porter to pick it up.”

  “I sent one already,” she said and was gone.

  THE SECOND DAY that I took care of Manjit, his blood pressure was even lower, and he was on a few additional intravenous blood pressure medications (inotropes) to support it. The ventilator was on even higher settings to take over more of the work of breathing for him.

  I went about performing my various tasks and made notes in the chart. Then I stepped back and let the family administer their homemade medicine of loving words, caresses, and prayers.

  “Keep that heart beating, buddy,” said the brother, Deenpal, into Manjit’s ear. “You’re going to get through this, man.” He picked off some flakes of dried skin from his brother’s fingers, and then held the mottled hand in his warm one. The two hands joined like that looked linke one. Even their stainless steel bracelets, symbols of their faith, seemed to be intertwined.

  In her real life, not this new nightmare life she was living, Jatinder was an aerobics instructor and Manjit was an executive at Canadian Tire.

  “The fall is usually his busiest time. Just before Christmas,” Jatinder explained to me. She showed me a letter from Manjit’s boss at head office:

  Your amazing courage and fortitude will get you through this, big guy. Just as you always give your best to the company and never give up when the going gets rough, you will pull through this.

  At lunchtime the family brought me warm chapattis, eggplant with coriander, and fresh samosas.

  They placed a dagger in a leather sheath in Manjit’s hand by his side.

  His mother asked for my help to put on his special ritual undergarment, underneath his hospital gown. She placed a small wooden comb on the bedside table.

  They pinned a clear plastic bag containing a small, thick prayer book to the pillowcase under his head.

  His father placed photographs, credit cards, and a few dollar bills in a wallet and put it in his hand.

  “For my son to use in the next life, should his time come to go there,” he explained to me with a slight bow of his turbaned head.

  Jatinder and Deenpal rocked the bed vigorously to stimulate Manjit’s blood pressure and make him know that they were there, at his side.

  “Let’s take a walk,” Jatinder crooned into his ear. “Let’s go away from this place. Please, Manjit, come with me. Deenpal and I are with you. Feel our energy. We are here. Use our energy. Take it. You have given everyone else so much. Keep on going. If anyone can do it, you can. Absorb that oxygen, Manjit. You are so strong. We can feel it. Your body is full of energy.”

  The next day, if it was possible, Manjit’s face was even more misshapen, his neck even more swollen around the endotracheal tube. Jatinder and I wiped away the blood clots that were spilling out of his mouth. Clear fluid dripped out of his nose. The air in the room was stale, unmoving, and at times foul odours came off him. The odours were the vaporized residue from the chemotherapy he had received, combined with the decaying smell that often emanates from bodies that have not been exposed to fresh air for weeks. His skin sloughed off in sheets and the brother collected it and disposed of it.

  “I know you are in there, Manjit.” Deenpal took up Jatinder’s loving litany whenever she faltered. “You’re going into the home stretch, man. All of us are here with you. Don’t worry about anything. Your blood pressure is good. Keep it up. You missed the Santana concert with cousin Suresh, but there will be another. Everything is taken care of at work. Come on now, you’re scaring us. Just get better. Concentrate on the fight. Once this is over, we’ll get out of here together. Here’s cousin Suresh. He came in from Vancouver to see you. We’re going to keep talkin’ your ear off. Get that oxygen into those cells. You do the work on the inside and we’ll do the work on the outside. We’re nowhere else but here with you. Keep fighting. Don’t be tired. Be strong. You’ll rest later. Keep focusing. Remember we set this year aside so that we’ll have the rest of our lives together. Keep beating those odds. Mind over matter. Use this energy to clean out the bad stuff. We’re here, with open arms. Let’s go through this together. We’re brothers for another sixty-seven years together. It is written. We have all the time in the world. Sponge up that oxygen. Don’t be afraid.”

  I fell into a trance from the sound of their loving incantations that was broken only when Dr. Leung came to tell them that she wanted to do a CT scan of Manjit’s head. His pupils were dilated and unresponsive, and she was afraid there might be swelling or even bleeding in his brain.

  As a professional courtesy to Deenpal, who was a doctor, we allowed him to come into the darkened viewing room to see the various views of his brother’s brain on the computer screen. He stood, blinking at the images before him. I could see the twelve pictures reflected in Deenpal’s glasses. He saw what even a first-year medical student could see. Massive hemorrhage with clotted blood blocking the vesicles and passageways. There was no circulation in his brother’s brain, therefore no oxygenation, and no activity.

  “Massive global infarction of the left and right hemispheres” was the radiologist’s diagnosis as he looked over at me. I could read the message in his eyes: Even if he survives, what kind of condition would he be in?

  I kne
w Manjit was going to die. Surely Deenpal, a doctor himself, realized that, too?

  Later, when we returned to Manjit’s room, Jatinder told me that Deenpal felt guilty at having persuaded his brother to undergo the bone marrow transplant.

  “But what option did we have?” she asked as if I had objected, too. “It was that or for certain he would die. But we don’t want to be the instrument of destruction to his next life. We have many bodies. That is our belief.”

  She pulled out a picture of their wedding ceremony to show me what a handsome man her husband had been. I could allow myself only a fleeting glance at it, out of politeness, and then had to look away. I knew that if I looked at it, I’d be drawn in too deep. I glanced sideways at the photograph of the beautiful couple, Manjit, handsome as a king in a black tunic, Queen Jatinder in a red gown, and elegant Prince Deenpal at their sides. I couldn’t reconcile that image with what I saw before me, the grieving young woman, the distraught family, the unconscious, bleeding man in the bed.

  “I wish you could have met him,” she said, “and got to know him as he really is.”

  I pulled out a roll of surgical tape from my lab coat pocket and took the photograph from her hand. “I’ll put it up on the wall, for everyone to see.”

  “Thank you.” Palms together, she bowed slightly to me. “How can we ever repay you?”

  When they left the room for a short break and fresh air, I tried to keep up the one-sided conversation with Manjit, as I had learned from Frances. I tried to always make it part of my practice to talk to unconscious patients, but at times I found it awkward. It was like leaving a message on a telephone answering machine; you’re not sure if it will be received, but you go ahead and speak, anyway, on faith.

  “You have a lovely family, Manjit. They’re all rooting for you. I’m with you now. I’m Tilda, your nurse, today,” I said. “Tomorrow, too,” I added, a little tentatively.

  My words were sincere but came out tersely. Somehow I couldn’t carry on with the healing chorus that the family was providing. I held myself back from entering their loving circle. It was more than I could bear.

  LATER THAT NIGHT, at home, I couldn’t sleep. I wanted to call the ICU to find out from the nurse in charge how Manjit was doing. I knew it wasn’t a good idea. I probably should make that break, keep more distance.

  I picked up the phone and called.

  “How’s Manjit doing?” I asked.

  “Hanging in there,” the in-charge nurse said, “but the family is losing it. You back tomorrow?”

  “Yes.”

  “Do you want to go back in there or do you need a break from them?”

  “Put me back in there, please.”

  “Oh, I see here that Rosemary left a note saying she thought you should have a change of assignment. She thinks you’re getting too emotionally involved. Are you?”

  “Of course not.”

  I LAY ON my bed and thought about them until late into the night. If such a tragedy could strike such a loving, close family, what hope was there for anybody in this world? I imagined having to resuscitate Manjit with Deenpal standing by, watching to make sure I was doing everything correctly. I fantasized that when Manjit died, as it seemed inevitable he would, Jatinder could marry the equally handsome older brother, Deenpal. That way there could still be a happy ending. I worried how Jatinder would go on and how the mother and father would cope with their loss.

  “Death is not the end,” the father had whispered to me, but I wasn’t convinced.

  I stared up at the ceiling, at my alarm clock, at my wristwatch that lit up in the dark at the touch of a button. I mulled over all the sadness and suffering at work and couldn’t wait to get back in there.

  THE NEXT MORNING, when I walked in, the family members were dressed in long white gowns, the men with white turbans on their heads, even Deenpal and cousin Suresh, from Vancouver. They were immersed in their Olympic marathon of devotion. Their hands swarmed all over Manjit’s body in frenzied caresses.

  The mother massaged his bladder to try to push out a drop or two of urine, but his kidneys had shut down.

  The cousins kneaded his limbs to stimulate his circulation.

  The father stumbled around the room, chanting his prayers, but in a daze.

  Deenpal told his brother off-colour jokes to try to rile him up. Then he poured forth relentless commands into his brother’s ears.

  “Kick their butts, Manjit! Break the door down! This is our last fight. I’m going with you all the way, my brother, my baby. C’mon. Hang tough. Get that oxygen into the blood. Think about Umma, how much she needs you. Think about Jatinder, how much she loves you. It’s Deen, your only brother. Your right-hand man. No time to relax now. Keep running like an athlete and don’t think about the finish line yet. You are going to do that MBA, you hear me?”

  It seemed to me that their words were medicine, just as important as the Vancomycin, ceftazidime, and Levophed that I was injecting. The family’s voices, the dagger at his side, and their offerings to their God were just as effective – perhaps in this case, even more so – than the treatments I was giving or the procedures I was performing.

  Their heads were bent over him, their arms clasped in prayer. The mother was prostrate over his body. I feared she might faint, collapse in her grief.

  Deenpal pulled me outside into the hallway. “Tell me. How do you think he’s doing?”

  I looked at him, a little surprised. He’s a doctor, surely he knows the score?

  “Prepare yourselves for the worst.”

  “Do you think so?” he asked, just like a brother.

  “It must be hard being a doctor and a brother,” I said.

  UNBELIEVABLY, MANJIT HUNG on for another few days.

  “It takes a lot longer for the young ones to die,” said Frances. “Their hearts are strong.”

  When Manjit died, the mother collapsed. Frances gave her oxygen and Tracy called for a stretcher. The mother’s wailing could be heard throughout the intensive care unit.

  The father shook his head in disapproval at the mother’s keening. “The soul never dies,” he told me, “so there is no mourning.”

  “You’ve been a wonderful Umma,” Deenpal called out to her as they carried the mother away. Then he turned to his brother’s body, looked over at me and I thought he was going to smash something. Only Jatinder was peaceful.

  “It is God’s will,” she said, closing her eyes. “Once his mind was gone, I knew it was over. I don’t want his body if I can’t have his mind, his smiling eyes, his incredible personality.”

  Frances came in to help me and together we removed the tubes and wires, and pushed to the side the heavy machines that surrounded his bed like ugly, hulking monsters. She went out to invite the family to come back in to see him, if they wished to do so. Only Deenpal and the cousins came back. I was glad at least they got the chance to see Manjit, who looked so much better dead than alive, so much more like himself without our trappings. In his face at rest, one could see something of that proud handsome groom on his wedding day.

  The other nurses congregated in the room to comfort first the family, and then me, too. Frances and Nicole put their arms around me.

  “Are you okay?” Justine asked. “You’re shaking.”

  “No, I am not. Shaking, I mean.”

  “Well, you don’t look too good.”

  Rosemary told me to “take some time off, Tilda. You need a rest from work.”

  In the locker room, Laura, Frances, Nicole, Tracy, and Justine pulled me toward the door.

  “C’mon,” said Justine. “We’re taking you out for a drink.”

  5

  DECOMPRESSION

  I was beginning to wonder if it was all too much for me: the suffering, the death and dying. Even getting up so early in the morning at times seemed like an inordinate burden. Who needed it? Surely I could find work that was less demanding, that took place during normal hours, that wasn’t so full of misery? I had been a nurse for
a few years and was finally able to see beyond my own personal problems and begin to appreciate the pain of others. However, my emotions threatened to overwhelm me. My patients’ suffering was becoming mine.

  One morning when I drove to work, I listened to a radio talk show on which callers described their jobs. A young woman gushed about working at Disney World and how she loved “making children happy.” A florist rhapsodized about creating beautiful bouquets for brides and other people in love. Even the description the computer programmer gave of sitting day after day in his quiet office moving a mouse around and staring at a blue screen sounded appealing.

  I knew I might make a good librarian, but the old-fashioned kind who advised people what to read and stayed hidden among shelves of dusty books. I could give piano lessons to children, but didn’t think I could make a living from that. Being a lifeguard at a pool was another option. I was a strong swimmer and could gaze into the water most of the day and just jump in when needed.

  Yet I did want to do something that helped people, and as sad, and at times disturbing, as my work in the ICU was, it was also fascinating and exhilarating, and I remained determined to master it.

  On days off from work, I lay in bed after I woke up, stared up at the ceiling and relived whole scenes from the hospital, as if I were watching a movie. Then, over the next day or two, I began to prepare myself to face it all over again.

  Ivan and I were planning to get married, but for the time being, it seemed just as well that I lived alone. I wasn’t too much fun to be with and most people tended to recoil when they heard about my work. I tried not to impose it on others.