A Nurse's Story

by Tilda Shalof

  Nell had often spoken about a period of her life when she was a hockey mom to five orphan boys in Thunder Bay and how as a child she used to ride a camel to school. It had been given to her family by an itinerant circus troupe. We all remembered her recount the day the camel broke out of his pen and rampaged through the town. It crashed into a strawberry social the ladies of the local church were holding and soon whipped cream, shortcake, and berries were flying everywhere.

  We all knew of times when we were working with her and she had to run out to the Eaton Centre on her lunch hour. If she was a little late getting back, she had a ready explanation for her delay.

  “I had to do CPR on someone who had a cardiac arrest in a shoe store,” she’d say. Or “I got stuck in an elevator and all of a sudden, it cut loose and started plummeting downward. I kept jumping up and down, figuring I’d have a 50 per cent chance of being in the air when it came to a crash landing, and that’s exactly what happened. What luck!”

  Sometimes, if work was slow, I was guilty of prompting her and goading her into recounting stories of her exotic vacations where she always had fantastic adventures and narrow escapes, just like Indiana Jones. There was the time she was walking along a secluded beach in the Galapagos Islands when she was chased and attacked by a pack of wild dogs. She swam far out into the ocean to escape them, but they tore into the water after her. Then one by one, as the dogs plunged in after her and set upon her, snarling and growling, brave Nell had the presence of mind to poke out their eyes and blind them, then drag them under the water, one by one, and drown them.

  The funny thing was that when she did show up to work, Nell was a wonderful nurse. She had a wise, calm presence, vast knowledge, and expert skills. Patients adored Nell, always asked for her and gave her gifts of money, flowers, bottles of fine wine, and job offers for private nursing for astronomical wages.

  We were grateful that Frances had gone to visit her. We were all so comfortable and experienced with diseases of the body – heart attacks, respiratory failure, liver disease – but the mind? No one knew anything about that! If a patient in the ICU ever showed signs of depression or anxiety, we’d call a “psych consult” and they would come in and talk to the patient for a few minutes and then order a cocktail of meds, such as Valium and Prozac, or Haldol and Ativan.

  “I HATE NURSING. I can’t wait to get out of this hell hole.”

  I was horrified to hear Laura saying this to a tall, slim, beautifully coiffed woman in a navy suit who was standing at the nursing station. She had come to visit our ICU to gather data on research she was doing about nurses’ work lives. It also turned out she was one of the new vice-presidents of the hospital who was getting out to meet and greet the “frontline workers.”

  “I hate this job,” Laura added, as if her first statement wasn’t clear enough.

  The woman looked a bit taken aback, but kept her cool. “Do you have any specific concerns?” she inquired, but Laura shrugged her shoulders and turned away.

  “Gotta get back to my patient,” she mumbled discourteously.

  “What good is that?” I asked when I confronted Laura later. “Either articulate your complaints constructively or don’t be such a bitch. It reflects badly on all of us. If you’re not part of the solution, you’re part of the –”

  “Stop lecturing me! I’d like to see that fancy lady put on a pair of scrubs – she did mention she was a nurse, didn’t she? – and pitch in here and give us a hand. She’s probably one of the ones behind the move that’s underfoot to oust us, lay us off – especially us old-fashioned, uneducated, diploma nurses – and hire the cafeteria sandwich makers and housekeeping staff to replace us. She’s the one who wants to institute some new theory of nursing, but hasn’t a clue what nurses really do in practice. I don’t trust her for a minute. She’s going to sell us up the river when the next swing of the pendulum comes around and the government decides there’s too many of us.”

  Morty, freshly revved up from a union meeting and never one to miss out on a good argument, joined in.

  “Laura’s right, Tilda. Nurses make up the vast majority of the hospital workforce – over 95 per cent – and we’re the only ones who are at patients’ bedsides twenty-four hours a day. We’re the ones out there risking our lives, exposing ourselves to infectious diseases – hepatitis, tuberculosis, HIV, and now these new super-bugs, these drug-resistant bacteria that every other patient seems to get these days. Not to mention the hazardous working conditions, the radiation exposure, the toxic chemotherapy spills on the countertops – I had a fingernail melt away from some of that stuff. There’s Aspergillus fungus blowing in at us from the ceiling vents and Acinetobacter in the plumbing. And believe me, girls – and boys,” she added with a nod to Bruno and Charles, who had come over to listen in, “it’s way worse on the floors. You wouldn’t believe their workload or the conditions they have to put up with. We’ve got it made here in the ICU, especially with a nurse manager like Rosemary – we couldn’t have a better one – but I bet you they’ll give her the axe one day, too.”

  “See what I mean, Tilda?” Laura felt vindicated. “You’re incredibly naïve. So what’s the point of talking to this new corporate nurse person? And what’s the incentive to stay here – all these hassles, no respect, stressful work environment, fighting politics with the doctors, abusive patients, and angry families? Oh, yeah, and an extra fifteen cents an hour for the additional responsibility of being in charge. Your turn is coming up soon! You better get ready. You’ll see, the additional $1.80 you make will just barely cover the cost of the extra coffee you’ll need to keep you going.”

  “What’s the incentive?” I stammered. “What’s the incentive? What about all the reasons you went into nursing in the first place?”

  “I do this job because I like to think that there will be someone there to care for me when I get sick one day,” Laura said.

  “How do you know –?”

  “We’re all going to get sick of one thing or another. Get real, Tilda. We’re all going to need a nurse one day. We’re all potential patients. I just hope there’s a good nurse there for me when it happens. Maybe that’s why I do this work. Superstition or hope or wishful thinking that if I do my part, someone else will do theirs.”

  “I’m not listening to you any more,” I told Laura later that day. “I’m not listening to you complain all the time unless you can come up with some constructive plans to improve things. You say what’s the incentive? I’ll tell you – doing work that’s interesting and challenging. Helping people. Having the opportunity every day to make a difference in people’s lives. Having the skills to relieve pain, comfort an anxious family member, assess a wound and know exactly what’s needed to heal it. I don’t believe these things aren’t satisfying to you, because you’re one of the nurses around here who do those things best. I don’t believe you, anyway. If you hated nursing that much you wouldn’t be as good a nurse as you are. Besides, if you really hate nursing, as you claim you do, what are your plans to change careers? If you’re really planning to leave this job, have you updated your resumé or taken any courses?”

  “Booze and cheap drugs, that’s my escape from this place … and chocolate,” she said.

  “Very good, keep it up. You’ll be here forever.”

  I simply didn’t believe her. I stood watching her warm her patient’s cold hands in hers. I watched the steadiness in her arm that guided the crying family from the quiet room. I watched her titrate the dose of Levophed with the dips and surges of her patient’s erratic blood pressure. She was brilliant. I would let her do open-heart surgery on me. Yet her bitterness was a poison I wanted to expunge from her heart – for her own sake and because I was afraid it would infect too many others.

  “Tell me, what’s the real reason you take the longest route to the cafeteria?” I asked her.

  “There you go again,” she said with a sigh. “I need the exercise, okay?”

  “You claim I’m the one who’
s so sensitive … I’m not so sure.”

  “I have never, ever cried over a patient,” she said, “and I never will.”

  NICOLE LONGED TO be married and have a houseful of kids. She wanted to have a boy and a girl and a Sharpei, named Liam, Sophie, and Chin-Chin, respectively. Things were going well with Oliver, but it was still too soon to say for sure. Nicole knew, as the others did, that she’d better start taking courses toward her degree, even if only part-time. The problem was, another world pulled her in a different direction. She was a scratch golfer and once had dreams of trying out for the professional circuit. She had taken a year off work and golf training in order to care for her dying mother. We knew she was still working toward paying off her student loan and was in no position to take on the cost of tuition. Apparently her game hadn’t suffered too much from the time off, however. When Daniel Huizinga and David Bristol challenged her to a round of golf, she trounced them – to our delight.

  According to David’s sheepish report, “Nicky double bogied at the opening hole, then strung 17 pars in a row.”

  What a pleasure finally to see the personal side of him.

  “She was amazing,” he added, in awe. “We didn’t even bother to add up our score!”

  JUSTINE CLAIMED SHE wanted to get into politics or acting and keep nursing as a sideline. Nonetheless, she kept working hard toward her degree and had aspirations for further education. Her love of centre stage found opportunities in local theatre where she had played Bloody Mary in an amateur production of South Pacific in Scarborough and a role in the chorus line of Grease. She also claimed it was a good place to meet guys, something she was very successful at, anyway. In addition to these activities, Justine also took her duties as our union rep very seriously and spent a lot of her spare time attending meetings, rallies, and dealing with grievances, which was just as well, because she was the first to admit that her forte was not patient care.

  FRANCES CLAIMED SHE was happy. It was strange to hear someone say that. I hadn’t ever heard it said before.

  “I love being a nurse,” she said simply.

  Even stranger.

  “HAVE YOU THOUGHT about going back to school to get your Master’s degree?” Rosemary asked me. She was working on one herself, taking evening courses.

  “I’m not ready to go back to school,” I said. “I still have a lot to learn about patient care. I want to continue doing what I’m doing.”

  It was late afternoon on that first day back at work, after my brief leave of absence. I sat with Rosemary in her messy office. Schubert’s exuberant Trout Symphony played softly from her computer and I caught a whiff of her vanilla-scented cologne from the Body Shop: she smelled like cookies. She wanted to know how work was going and did I plan to stay on after my year was up, in a month’s time? She didn’t mean to pressure me, she explained, but she needed to know, as full-time positions were becoming scarce once again.

  “The trend keeps repeating itself,” she said. “The need for nurses stays the same. What changes is each government’s willingness to pay for them. Now the pressure is on us to move our staff toward part-time and casual positions and bring in agency nurses as needed.” The tense expression on her face made me realize she wasn’t pleased about these changes. She explained the administration’s position. “It’s a cost-saving measure so the hospital can avoid paying nurses benefits or offer any assurance of job stability. Ultimately, we’re trying to avoid layoffs.” She smiled at me. “As for your work, Tilda, it’s quite satisfactory,” she said. “You give safe care.”

  My heart sank. I wanted to do much more than that.

  “You are competent, but very emotional. I worry about you. There might be other departments in the hospital where –”

  “No, I want to stay here, Rosemary. I want to get over my emotions.”

  “I understand,” she said and paused, to consider her reply. “It’s like this. Certain patient emotions, for example, anxiety, can be contagious. Patients’ emotions belong to them. Your ability to be helpful to patients and families will be impaired if you share their feelings – fear, anxiety, anger, despair – whatever. The nursing literature on this subject calls it ‘emotional contagion’ and it’s like an infectious disease itself. It’s hard to stay immune to it. It’s very easily spread and difficult to treat. Some nurses vaccinate themselves with emotional disconnection and apathy, both of which lead to burnout and attrition. However, on the other hand, over-identifying with the patient can prevent a nurse from functioning as a professional. The course of action I suggest is this: prevention. Take good care of yourself so that you are in a position to take care of others. Eat properly, get exercise, do yoga or meditation, whatever it takes to be healthy. Take mental health breaks from this work, as you wisely did. Make sure you have good support systems outside of work, develop hobbies – I love gourmet cooking, for example, and my husband and I breed Jack Russell terriers. Find a balance between your work and your personal life. It’s important to ensure that your own life is healthy, especially when you’re in the profession of taking care of others. All those who wish to serve others have these same challenges.”

  “Sometimes, when I’m not at work, I think a lot about the patients and wonder how they’re doing. Certain cases really get me down,” I said glumly. “Sometimes the situations we deal with are really –”

  “Hopeless?”

  I nodded.

  “It is hopeless only if you see death as a failure, if you see death as the worst possible outcome. Many doctors see death as a personal failure, but nurses have the chance to make a valuable contribution in these cases. We can do everything we are able to do to save a patient, but then we have to let go and recognize our limitations. Besides, not everyone here dies, but it’s human nature to dwell on the catastrophic cases. However, I believe that there is always something to hope for, even if a full recovery isn’t possible. These are the things that are at the heart of nursing’s domain. I’ve heard you say it yourself. It’s all that you learned at school and from the examples of your colleagues. I must say, you have chosen to make friends with quite a wild bunch, but I have a lot of respect for each of them. If you focus on those things that are at the heart of nursing – comfort, dignity, nourishment, promoting well-being – you’ll find that you’ll alleviate some of the suffering, and you’ll always have hope.”

  After I left Rosemary’s office, I thought about what she had said and also about a conversation I’d had that very morning with Tracy. She was telling me about the liver transplant patient she’d taken care of last week who had done so well. Within twenty-four hours of his surgery, new liver intact and working, he was transferred out of the ICU to a general floor, smiling, talking, and rejoicing with his family. She told me about him, because the patient had suddenly deteriorated that morning and needed to return first to the operating room and then to our ICU. He was in shock, still bleeding internally, and his room was swarming with people.

  “It’s a zoo in there,” said Tracy, standing just outside the door, looking in.

  “Why didn’t you ask to be his nurse so you could follow up with him? You knew him and his family so well.”

  “I got pretty close to them,” she admitted. “They were so glad to see me the other day on the elevator and told me how well he was doing on the floor. Even so, I think it’s better if someone else takes care of him today.”

  It’s probably better for you, too, I realized in that moment.

  To do this work properly, I was going to have to keep something back. I would have to learn to create and nurture that peaceful harbour within myself that Rosemary described. Otherwise, how could I go on opening my heart and having it broken again and again? But if I closed it altogether, what kind of nurse would I become?

  ANOTHER FRIENDLY FACE on staff in the ICU was that of Father Vincent Szigetti. Because he wore casual blazers and no clerical collar, I didn’t realize at first that he was a priest. He had the rotund belly of a sensual man who enjoyed h
is food and drink a little too much, and because he confided in me, I knew those things to be true. He visited us often, both the nurses as well as the patients and families, and regaled us with hysterical jokes and fascinating stories about his missionary work in Africa and his travels through war-torn Bosnia.

  “When you went to Nigeria, did you take the wife and kids?” I once asked him.

  “Oh no, my dear, I’m a priest. I’m married to the church.” He looked at me with mock seriousness and twinkling eyes. “Many of us don’t wear the collar any more. Not us modern ones, anyway. But we follow the tenets of the Vatican, just the same. Now, don’t forget, I’m the R.C. chaplain.”

  “Oh,” I said and giggled. “Now, don’t you forget, I’m the J. nurse!”

  “I thought so, my dear.”

  “Would you ever take confession from a Jew?”

  “From you, anytime, my dear! But surely you don’t have anything to confess!”

  “You’d be surprised,” I said and left it at that.

  I often helped him figure out from the patients’ names whether they were Roman Catholic and therefore might be in need of his services – confession or communion, the sacrament of the sick or last rites. Sometimes, when things were going badly and I asked the family if I should call the priest, it sounded like a line from a movie.

  “Is it that bad?” they would ask. “Is he that far gone?”

  “You deserve a commission from all the referrals you’ve made to me,” Father Szigetti joked.

  “I’d be rich,” I said. “But everyone could use your services, not just Catholics.”

  “You’d be surprised!” he said. “Now, dear, if you ever need to speak with me about anything that’s troubling you, please come by my office or have me paged.”

  I often shared with him things that troubled me, as well as many hearty laughs about silly things. For example, if he wanted to know about a patient who had been discharged from the ICU, he would ask, “Discharged upward?” with a heavenward glance.