A Nurse's Story

by Tilda Shalof

  His grief at the death of his baby was instantly doubled – if the laws of mathematics apply to such emotions. His anguish expanded to fill the room as he began to howl. He twisted and writhed on the floor. The cousins, aunts, and uncles surrounded him, and each one pulled up on his arms and legs to get him to his feet – even the policeman came in to help. But he fought against them; he did not want to be brought to his feet. He wanted to stay down there on the floor and die as his wife had. I saw what it meant to be beside oneself with grief. I thought fleetingly of joining him.

  The ward clerk moved in swiftly. The patient’s name band had to be changed, as well as the health insurance number and the information in the computer. She had to let Admitting know about this mix-up, right away.

  I couldn’t sit. I couldn’t stand. I couldn’t summarize the notes in the chart or tally the in’s and the out’s on the fluid balance sheet. I couldn’t even find it in myself to be happy that at least we had saved someone and a young person, at that. I felt myself shutting down, until I felt nothing. I felt my heart closing off to save myself. It was too much for me.

  Rosemary told me, “Tilda, go take a break in the lounge. Give yourself time to pull yourself together. Maybe you would like to leave early?”

  I was a failure.

  Leave early, Rosemary had said. Did she mean for the rest of the day or for the rest of the year? Leave the ICU altogether?

  She came to check on me and then sent me home in a taxi, and another nurse took over for me.

  6

  SISTERS OF THE AIR

  I took a few weeks off work, but moped around at home and thought of little else than work. How could I strengthen myself enough to do this work, keep enough of a separation that the sadness didn’t affect me so much, yet stay emotionally connected to my patients and their suffering? I wanted to be efficient and empathetic, compassionate and capable. Competent was not enough. But more than these concerns, I missed the work – and my friends.

  “You had fun at work,” Ivan commented, one evening over dinner.

  It wasn’t meant as a criticism, but I took it that way. Enough to set down my fork and face the imagined attack.

  “How could anyone do this work if they didn’t have a few laughs now and again? It’s perfectly harmless. We never do it in front of the patients. Laughing is our coping mechanism.”

  “You don’t have to give it a fancy name. You’re allowed to have a good time. There’s nothing wrong with having fun.” He chuckled at my indignation. “I was merely making an observation.”

  He knew what he was talking about. I considered him somewhat of an expert on fun, and I knew I had a lot to learn about the subject. In my family, when I was growing up, I never even thought about fun. Having fun was taboo. How inconsiderate it would have been to be light-hearted when there was my poor mother, lying on the couch, always sad and disappointed by life. How could I have fun when she could not?

  It was Ivan who introduced me to the concept of fun, but it was the nurses of the ICU who taught me its practice. I was thinking about all this when the phone rang. It was Justine.

  “Yo, Tilda! Listen, since you’ve gone incommunicado, I’m calling to tell you the latest news. The hospital has a new mascot. She’s this huge woman who sits outside the front entrance every day in a wheelchair, calling out to everyone who walks by. I swear, she’s the world’s ugliest woman. Her legs are wrapped in drippy bandages and she’s holding her iv pole with one hand like it’s an umbrella and smoking a cigarette with the other. She gets people to collect cigarette butts off the lawn and then she stuffs them all into one butt and has a free smoke! Then she chatters away all day about how she used to be in show business, but the doctors took out her ribs and shocked her and now she can’t shovel snow any more. She keeps calling out that they’re using her as a guinea pig, a scapegoat, and a miner’s canary – all because of the bomb that was dropped on Hiroshima. Get the picture? Then at the end of the day, the Wheel-Trans bus comes and – what that poor driver has to put up with – takes her away!”

  Of course, I burst out laughing, but tried to stifle it. It wasn’t right to laugh.

  “Thanks for that information, Justine. I can hardly wait to meet her,” I said.

  “So, Til, when are you coming back to work?”

  “Let me talk to her,” I heard Laura say and could just picture her grabbing the phone from Justine. “Get your butt back in here, Oh Sensitive One. We need you. Do you know how short-staffed we are? We have two doubles and a sick call – one of them Nell Mason, of course – and I’ve been on the phone all morning calling for overtime. Some team player you are!”

  Frances was next. “Howya doin’, Tillie? Oh, we miss you so much. Come back already. You’re not going to quit, are you? We’re all going out for drinks this week, it’s Justine’s birthday. Can you join us? Work has been so interesting lately. We’ve done lots of transplants – lung and liver – and we even did something new – a combined kidney, pancreas, plus liver and intestinal transplant on a young boy who had a rare idiopathic coagulopathy. He’s doing really well for a guy that was so sick when he came in, with clots throughout his abdomen and pelvis, one of them obstructing his –”

  “Time’s up, Jabber Jaws,” I could hear Laura tell her. It sounded like Laura was trying to yank the phone away.

  “Old Bossy Boots here won’t let me talk any more. You come back, soon,” Frances managed to call into the phone as Nicole got on the line to tell me she was dating someone new – a nephrology resident, Oliver, who had rotated through our ICU and was very well liked – and she was very happy. “This might be the one,” she said.

  Then Tracy came on the line to tell me quietly – she wasn’t ready to tell the others – that she was pregnant. She was a few weeks along, but she and Ron had been trying for a long time and were ecstatic.

  I called Rosemary the next morning and told her I was ready to return.

  IT HAD TAKEN me only two weeks away from my work to recover from that disturbing mix-up with the smoke inhalation patient, plus the residue of sadness I couldn’t seem to shake off after caring for the Sikh family and their son. During that time I came to the paradoxical realization that I loved being a critical care nurse and wouldn’t want to work anywhere else. I had worked so hard to master the skills; I couldn’t give up now. How could I ever have thought otherwise? In fact, at times I even felt a little sorry for people who didn’t have work as fascinating as mine.

  On the evening before I returned to work, the group of us, along with boyfriends and husbands, met at a pool hall in Little Italy to celebrate Justine’s thirtieth birthday. She announced that she was going to university part-time to work on her degree and then mentioned in passing that she and her boyfriend of only a few months, Tom, were engaged and we toasted all of those things. I noticed that everyone was calling her by a new nickname and I asked why.

  “It’s because of what happened the other night at work,” said Nicole. “Tell Tilda about it.”

  Justine needed no prodding.

  “Some lab technician calls to tell me that my patient’s potassium is 3.1 mmols. This guy hardly speaks a word of English – ‘verry creetee-cull reee-sult,’ he’s saying. I say to him, okay, it’s 3.1, gotcha. Goodbye. But then he asks my name. What right does he have to ask my name? Why do you need my name? I ask. Some new policy about verification. Okey-dokey. I say, ‘My name is Pippi. Pippi Longstocking.’ A minute later his supervisor calls back to ask my real name. It’s his job, he says. This is serious business and he has no time for games. I say, ‘Pippi’ – and slam the phone down.”

  “Did she ever!” said Nicole.

  “So the guy calls back and I say, okay, you’re right, I was kidding about Pippi. My name is Morticia. Morticia Addams. And he buys that!”

  “We laughed about it all night,” said Tracy.

  The name stuck. She became Morty.

  The next night there was a sequel.

  Never one to leave a prank wel
l enough alone, Justine rummaged around in the refrigerator, which was always cluttered with Tupperware containers of old food and plastic bags filled with abandoned lunches. She found a Thermos with some sort of slimy substance in it and slapped a big yellow sticker on it, labelled “Biohazardous Material: Handle With Caution” and sent it off to the Microbiology lab, along with a requisition to identify the contents!

  WE STAYED OUT late that night and had a few drinks – I drank a watermelon wine cooler and endured incessant teasing for it – but we all had to leave by midnight, because we had to get up early the next morning for work.

  It seemed like no time at all passed between the moment my head hit the pillow and the ringing of my alarm clock at 6:00. I jumped out of bed and hustled off to work.

  By lunchtime, it felt like I’d never left. In fact, I was reminded it was lunchtime by Navreen, the travelling Roti Lady, whose real job was in the hospital laundry service. She stuck her head into the opening of the curtains in my patient’s room to ask if I wanted to buy either a spicy chicken or vegetarian roti – that was all she had left.

  I could hear Laura arguing with someone on the phone.

  “The order is in the computer, you say? … It says I’m supposed to bring the patient down for an ultrasound at 1300 hours? I see…. Maybe, just maybe, I’ll take an order from a doctor, but from a computer? Never!”

  Frances had been tied up in the quiet room for over an hour with a distraught family, participating in a drawn-out family meeting conducted by the Irish doctor, Darryl Price. He did tend to go on and on.

  Tracy and Nicole came to get me for lunch.

  For some reason, Justine was patrolling the refrigerator, still looking for something.

  “Who stole my can of Diet Pepsi?” she yelled into its depths as she rummaged around. “I was just getting ready to drink it.”

  I didn’t think it belonged to anyone. It had been in there for weeks. I must have looked guilty, because she looked right at me.

  She pointed her finger at me. “You?” She made the motions of chugging back a drink.

  I nodded. “I was thirsty. Here, go get yourself another.” I tossed her a loonie. “My treat,” I added graciously.

  “Thirsty? Thirsty, you say? I don’t care if your mouth is as parched as the Sahara Desert. Don’t steal my stuff,” she grumbled.

  “You don’t scare me,” I laughed and the others joined me.

  Later that day, Rosemary came over to Justine, who was working beside me that day. She had a puzzled expression and held out a lab report to Justine. “Is this for you, by any chance?” she asked.

  It was addressed to Morticia Addams, Staff Nurse, Medical-Surgical ICU.

  Microbiology Report

  Identification of Thermos contents: Ravioli.

  MY PATIENT ON the day that I returned to work was a thirty-year-old Cree woman from a reserve near Manitoulin Island who had swallowed paint thinner and antifreeze. She had a history of drug and alcohol abuse, but whether she had gone on a desperate binge or made a deliberate suicide attempt was not clear. However, this time her actions had put her into a hepatic coma that had so badly disrupted her body’s clotting mechanism that she was bleeding from both her mouth and rectum, as well as internally, because of her destroyed liver. She was in a deep stupor, but roused from time to time and uttered incomprehensible sounds. As the day wore on, we had to insert a huge tube into her stomach to stem the bleeding and a breathing tube into her lungs to protect her airway from aspiration. I knew that only a brand-new healthy liver could save her life, but these weren’t so readily available.

  “I hope she’s a candidate for a liver transplant,” I said during rounds.

  “Of course she is. She’s right at the top of the transplant list,” said Dr. Bristol. “Is there any reason you can think of that she wouldn’t be a suitable transplant candidate?”

  I drew a blank at this test question and luckily he turned it over to the entire team to consider.

  “I want to know if she’s made a commitment to taking better care of herself, if she’s going to abstain from drinking and taking drugs so that she doesn’t ruin her new liver,” one of the nurses said.

  “Something as precious and rare as a liver isn’t to be taken lightly,” someone else commented.

  “Isn’t it her right to live her life as she chooses?” asked Dr. Bristol. “What if she isn’t completely rational? Do you believe that receiving an organ transplant confers a moral obligation?”

  Some of us nodded.

  “What if this unfortunate woman is mentally ill and unable to keep such good intentions? Is living a healthy lifestyle something that can be legislated? Even if it could, should it? What if her home environment, social conditions, personality – whatever – predispose her to make decisions that might jeopardize her new liver? Let me put something else to all of you. Would you put a death-row prisoner on the transplant list to receive a new liver? Should our criteria be strictly medical need or do lifestyle choices figure into the mix? I want you all to think carefully about these things before you’re so quick to pass judgment. Once we make medical decisions based on our emotional reactions, we set a very dangerous –”

  Just then Justine – now known by all as Morty – sauntered over to the team, carrying a large metal basin filled with murky grey water that was sloshing from side to side.

  “Here’s a real ethical dilemma,” she said. “Who volunteers to drink a medicine cup full of my patient’s dirty bathwater for a million dollars?”

  Just the thought made us scatter back to our patients’ rooms.

  Rounds were over.

  “FLORA KNOWS EVERYTHING about living in the bush,” the young woman at my patient’s bedside said proudly. She wore a filthy plaid jacket and her hair was scraggly.

  “Who is to be contacted in case of an emergency?” I asked.

  I had to complete the form in the chart but I knew that the emergency had already arrived. This was it.

  “That’d be me. Flora’s my sister and I’m her sister. We’re sisters of the air. She knows everything about me. I know everything about her, even though we don’t live nowhere together no more.” She took off her jacket and folded it at the foot of her sister’s bed. “Flora’s on the Rez and works in a factory, but we don’t need to talk. If she’s there, then she’s there and if she’s not there, she’s still there. She’s with me wherever I am, all the time. I call her my sister of the air. How’s she doing, anyway?”

  “She’s …” I looked at this young woman before me and did my best to ignore her dishevelled appearance and unwashed smells of the back alleys of the city, where she likely lived. I looked over at Flora, stretched out in the bed, bleeding and unconscious, then back at her sister of the air. “She’s very sick.”

  “But she’ll make it, won’t she? Isn’t she going to get a new liver? That’s what the doctor said. One of those transplanetations?”

  “We hope so,” I said. “If she can hang in until a liver becomes available.”

  “I guess she can’t eat nuthin’ yet, huh?”

  “No, not yet.”

  The sister shook her head and let out a sigh between her teeth.

  FRANCES CALLED ME one day at home.

  “Listen, I’m planning to pay a visit to Nell Mason. She told me not to come but she’s been off sick for weeks and I’m worried about her.”

  For a number of years, it had been Nell’s pattern to work a few days, then call in sick, just at the last moment before the shift started, often leaving us in the lurch. One year Nell had accumulated more sick days than days at work. However, she invariably offered a variety of creative excuses.

  “Yeah, like the Ebola virus,” Nicole recalled one day while we were shooting the breeze in the cafeteria. “Remember when Nell called in sick because she thought she had the Ebola virus?”

  “Yeah, the only problem was that although we had that suspected Ebola patient in the unit, she hadn’t had contact with him. She must be a hyp
ochondriac,” said Laura.

  “How about when she called in with Chinese Food Syndrome?” said Nicole.

  “What the hell is that?” asked Justine.

  “You know that funny throbbing feeling you can get from eating MSG?”

  “How ’bout when Nell called in to say she couldn’t make it in to work because her best friend was dying and she had to help her plan her funeral, choose the music, and everything? Do you remember when she called to say she couldn’t come to work because her mother was just diagnosed with a brain tumour and then Morty, without missing a beat, asked her, is this the same mother who died two years ago and last year was in a fatal car crash?” someone else recalled.

  “How ’bout when she called to say she couldn’t come to work because she had ringing in her ears?” Laura said. “I was in charge and when she told me that I said, perfect, then of course you can come to work. There are bells and whistles ringing here all the time!”

  We knew Nell well, as we did most of the other nurses, but she was not part of our circle. Nell had no group. As it turned out, she was more alone than any of us realized.

  After her call to me, Frances went alone to see Nell and in the cafeteria the next day she told us about the visit.

  “Nell sat on a low window ledge in her empty apartment – she hardly had any furniture – and just stared at me. This was not the Nell we know. She was silent. Didn’t say a word.”

  “Probably couldn’t get a word in edgewise, with you there, Jabber Jaws,” I heard Laura mutter.

  Frances continued. “Her silence was the strangest thing. I tried to get her talking, but she didn’t answer me. No adventures or tall tales. None.” Frances ended the story sadly. “But she says she’ll be back at work, soon.”

  “I loved her story about the night when she took care of Glenn Gould after he had a massive cerebral hemorrhage,” I said. “I could just picture it when she told me how she propped up his arms and hands on pillows and his fingers began to play ‘The Moonlight Sonata,’ or so she claimed.”