by Tilda Shalof
“Going up?” I would say if I saw him waiting for an elevator.
“I hope so and I will see you there, too!”
We also had serious discussions about many things, such as the assassination of Yitzchak Rabin, the prime minister of Israel, budget cuts to health care, the choice of soups that day in the cafeteria, and our sweet-tooth indulgences.
“I realize I should eat less, swim more. My joints are getting creaky. That’s the problem, we realize these things, but we don’t do them, God, please forgive us.”
Once I called him during the night to administer the last rites for a patient.
“I’ll be right there, my dear.”
Within fifteen minutes, he was.
“Is he conscious? Is he still able to hear me?” Father Szigetti asked me as he took the patient’s hand in his and bent down close to his face.
“He’s not conscious, but he may very well hear you. We have no way of knowing for sure. We always talk to patients anyway, just in case. You never know what they take in.”
“Well, my dear, I will pray for his soul and sit with the family, but I can’t administer the sacrament of the sick or the last rites to an unconscious man. There has to be a conscious will in order to accept the blessing. It can’t be done without the patient’s participation.”
I wondered if I should hold back the morphine that was keeping the patient comfortable, but drowsy, in order that he might be more awake to participate in these rituals. Which need took priority, the body or the soul?
“But isn’t prayer supposed to be a consolation?” I asked, annoyed with him that he was being such a stickler, withholding something that might comfort the family. Why did a prayer come with conditions? I pressed further. “I don’t understand, Father. A man is dying. Wouldn’t he want it said? Besides, maybe he can hear you. Why don’t you take that chance?”
“I’m sorry, my dear, but if this unfortunate gentleman can’t participate in acceptance of the sacrament, it cannot be administered. I can bless him with the holy water. That I can do. The edicts of the Padre must prevail.” He dipped his pinky finger into a little silver vessel that he carried with him and made the sign of the cross on the patient’s forehead. He closed his eyes, and whatever the prayers were that he was saying, I stood there and joined him.
“How do you deal with all the suffering that you see in the hospital, especially in the ICU?” I asked him sometime shortly after that meeting with Rosemary in her office.
“Death and sickness are a part of life,” he said quietly. “None of it surprises me, nor does it sadden me. I accept it as God gives it to us. Sometimes I wonder what will happen if modern medicine and science manage to eradicate illness altogether. How will we learn the important lessons of humility, faith, hope, gratitude, and compassion, that these mortal conditions teach us?” Father Szigetti gave a nod toward Mrs. Zaiken’s room. “By the way, she’s one of yours, I think,” he said with mock solemnity.
“That’s true. I’ll look after her,” I said and smiled.
“Speaking of which,” said Rosemary, tapping me on the shoulder, “Tilda, could you give us a hand with Mrs. Zaiken? Bruno is her nurse, but there’s a problem you might be able to help us sort out. I’ll stay here with your patient and cover for you.”
The family were Orthodox Jews and didn’t want their mother taken care of by a male nurse.
“Bruno is an outstanding nurse,” I said and put my arm lightly around him. He was looking a bit crushed. “He’s a complete gentleman and will respect your mother’s modesty. Not only that, but Bruno is a mensch.”
“Isn’t there a female nurse available who could look after our mother instead?” a black-suited, black-hatted man inquired, keeping his gaze on the clock on the wall beside the door where I stood. I recalled that even eye contact with a woman was prohibited.
“We’ll try to keep your request in mind from now on,” I said.
A man was sitting in the corner of the room, rocking backwards and forwards vigorously and loudly chanting Hebrew psalms.
“By the way,” I asked, my curiosity, as usual, getting the best of me, “what are you praying for?” I glanced down at Mrs. Zaiken’s chart: Alzheimer’s disease. Ovarian cancer. Kidney failure and coronary artery disease. Seventy-four years old, living in a nursing home.
“That the Lord might see fit to grant her more days,” the spokesman answered.
“I see,” I said.
WE MADE A point of meeting once a month, our group, Laura’s Line. We went out for lunch or dinner and a movie or just drinks, but wherever we went, we stipulated that we would not talk about work.
“But who else can we talk to about work? Sometimes I need to go over this stuff to get it settled in my mind,” I wailed. “I can’t tell Ivan or any of my friends. They tell me it’s depressing to hear about my work. It upsets them so I never can talk about it.”
“Go see a shrink,” said Laura.
“I can’t tell anyone, either,” said Nicole.
Perhaps Tracy was the wisest. She kept quiet, listening to us and keeping her own counsel. How I envied her self-containment.
“I tell people what I do, but no one believes me. Can you imagine if people knew what we really do?” asked Morty. “I mean the truth? No one would believe it. Hey, Tilda, no drinky-poo for you tonight. You’re still feeling the effects from that silly Kool-Aid drink you had last time.”
“No one could even describe some of the things we do,” said Laura with an involuntary shudder. “No one has seen what we’ve seen. Did you see that cavity in Mrs. Claggett’s chest after they removed her lung? You could get lost in there. I had to shove my arm in up to my elbow to pack the wound and they hadn’t even ordered any pain medication for her, ’cause it dropped her blood pressure. I feel like a member of Hitler’s army when I do that dressing.”
“Enough!” we yelled out in a group mutiny.
“There’s more to life than work!” Nicole said.
“I agree,” said Tracy, who was sipping ginger ale. She still wasn’t ready to tell them her news.
Frances also wanted to change the subject. “Let’s talk about something else, shall we? How are the Leafs doing in the playoffs? Nicole, what about that new guy, Tiger Woods, do you think he’ll win the Masters? Not only that, but there’s a war going on in the Middle East. Bosnia, Ireland, and Zimbabwe, too. What about all of that?”
Of course.
“I wonder if my patient got a liver transplant in the end,” I murmured. I was thinking about the Cree women, those two sisters of the air.
“Tilda!”
7
GIFTS AND DONATIONS
’T was the day before the night before Christmas, and all through the hospital lobby joyful music rang out!
I made sure of that.
My loathsome childhood piano lessons turned out to be worth it, after all: I approached the hospital administration with the proposition that the flagging morale (the place had been abuzz lately with ominous rumours about layoffs and cutbacks) of the staff and patients could be lifted by an infusion of Christmas spirit. How better to do this than with the glorious music of the season? However, certain objections were raised. We live in a city of multicultural diversity. We have to be sensitive to the needs of all groups. If Christmas is celebrated, others will feel marginalized. They will not feel that their voices are heard; they will feel excluded. Why not embrace them all, I asked. Have an African group come in and sing the melodies of Kwanzaa, a choir of children from a synagogue, and so on. They would look into it, they said. Maybe call a meeting, form a committee, strike a task force …
Meanwhile, I managed to convince them that this year at least, Christmas wouldn’t be Christmas without carols! I opened the keyboard and started off the morning by launching straight into
Joy to the World!
It was in a high-pitched key and I didn’t know how to transpose it down a notch, but luckily, some soprano cleaning staff showed up by 0730 hours and helpe
d me carry the tune.
With all my heart and soul I
Let Heaven and Nature Sing!
The lobby did look festive, in a restrained sort of way. A few tired-looking green and red tinsel streamers had been draped here and there. The electric lights on a forlorn artificial Christmas tree that was a permanent fixture, all year round, were turned on for the week. “Seasons Greetings to All” announced the banner that was strung across the entrance to the lobby.
I sat at the piano, which was positioned near the information booth at the main entrance, under a sign written in the green and black colours of the hospital that read, “Taking Care of You is a Corporate Priority.”
Even at that early hour, the hospital was already bustling. A trolley with an industrial-sized urn of hot apple cider was set out and people helped themselves. The secretaries from radiology and the kitchen staff, a staff pathologist, a few social workers, and the chief librarian were all there, clustered around the piano. The lady who gave out the uniforms (known throughout the hospital for her surly manner and her habit of handing out lab coats with buttons missing) was positively ebullient. Even she joined me in song.
On the twelfth day of Christmas
My true love sent to me…
My heart was about to burst with jubilation – how I loved this music! My fingers flew recklessly over the keys. I flubbed a few sharps or flats here and there, but I didn’t let that stop me. I’m the kind of pianist who can’t play “Mary Had a Little Lamb” without a full score of sheet music in front of me, yet with notes up there, I can play anything.
Then, after playing “Rudolph, the Red-Nosed Reindeer,” I had to take a brief pause to dry my eyes and blow my nose. I was such a sentimental fool! The part when the other reindeers make fun of him and don’t let him in on their reindeer games really got to me.
Dr. Bristol rushed by with a wave, but didn’t stop. “I don’t sing,” he said by way of greeting.
At mid-morning, I took a break and came up to the ICU to visit my friends. The unit looked magical. Laura and Nicole had taken charge of the decorations and had chosen a Disney theme. They plastered photographs of each of the staff doctors, plus a few senior residents, onto the faces of each of the seven dwarves. Rosemary was Snow White.
“No nativity scenes allowed. Nix on that,” Laura said in mock admonition, making an x with her index fingers. “Christmas isn’t politically correct. I’m surprised you got away with playing Christmas carols, Tilda. Soon even that will be outlawed. Everything has to be watered down to accommodate Chanukah.” She bowed in my direction. “And Kwanzaa, thank you, Althea and Belinda,” she said and nodded at two of our Jamaican nurses. “When the hell are Diwali and Ramadan, with all due respect to any of us around here that celebrate those holidays?”
Morty harrumphed in agreement and shook her head, making her little dangling mistletoe earrings swing vigorously. “I want to know why there was never any mention of Kwanzaa when we were kids. I think it’s a made-up holiday, invented by Toys R Us. There’s a conspiracy going on against Christmas.”
Althea and Belinda looked bemused. No one could be offended by Laura, who was mad at the world, nor by Morty, who insulted us all equally.
The red, white, and gold lights on the tree twinkled on and off as we sat around the nursing station admiring Laura and Nicole’s hard work. Nicole was waiting for the arrival of her patient, who was coming in from her home on a farm near the town of St. Jacobs. She was to be admitted to the ICU for only a few hours in order for us to perform specialized tests of her lung and heart function, something that could be done safely only in the ICU. Dr. Bristol had told us about her in rounds that morning.
Alice Heidebrecht was a twenty-five-year-old woman with no previous medical history. She’d been symptomatic for a few weeks with an as yet undiagnosed problem – shortness of breath upon exertion and even sometimes at rest. It was “idiopathic,” meaning no known cause – but the slightest bit of activity made her weak and dizzy. She had even fainted a few times at home.
“They’re Mennonites,” said Nicole, who had reviewed the patient’s chart, which had been sent ahead. “She can’t do any of her farm chores or take care of her three children, who are all under the age of four.”
“Check out if they’re bringing in any pies,” said Morty, “or quilts.”
“Where will they park the horse and buggy? Special rate for livestock, don’t you know,” said Laura, in a mock Maritime accent to poke fun at Frances, who prided herself on her familiarity with rural customs.
Rosemary had kept me as extra in case of a new admission, which left me free for my carol-playing duties, as well as floating around the unit and helping the others.
Nicole admitted Mrs. Heidebrecht in a room at the end of the hall, partly because we thought she might prefer the privacy, and also because it was farthest away from the TV lounge where The Grinch Who Stole Christmas was playing at top volume to the delight of some children we’d put in there while their parents were visiting a sick relative.
“That’s my favourite movie,” said Nicole, one of the most un-Grinch-like people I’d ever met.
“Go take a break, Nicky, watch it with them,” I said, “I’ll admit her for you.”
ALICE HEIDEBRECHT LOOKED up from where she lay in the bed and gave me a wide smile when I came into the room and introduced myself. Her broad, round, sturdy face was wan, and she was breathing heavily from the effort of having got up onto the bed. Her pale skin was exactly the colour and texture of one of those pies, still raw and unbaked, that Morty had mentioned. Wire-rimmed glasses magnified her eyes, making her look startled, which she probably was. Her husband, Jakob, was at her side, holding her hand.
She had draped her long dark dress, black bonnet, and undergarments over the chair beside her bed, and I noticed the handmade stitches in the garments, the buttons fashioned from wood chips.
Under the sheet, which she’d pulled up to her chin, I could see that she was naked, as if in total submission. Perhaps that was what she thought a hospital in a big city expected of her.
The room had become suffused with their combined earthy smells, smells that I was unused to but that were not unpleasant. It was the natural smell of bodies accustomed to a life of manual labour, the smells we usually wash away.
I placed an oxygen mask on her face to ease her breathing and helped her into a blue hospital gown. I took her vital signs, started an iv in her arm, and then sat down with both of them and explained the complicated tests for pulmonary hypertension, the disease that Dr. Bristol suspected she suffered from. A nurse would be with her, I assured her, during every moment. The tests were not painful, but were definitely uncomfortable. There would be times during the testing when she would be administered different drugs, and we would be monitoring her closely for side effects.
She listened to me, but was more focused on her husband’s watchful gaze, as if she heard what I was saying only when it was filtered first through his ears.
The moment I stepped away from them to record my notes in the chart, they instantly became oblivious both of me and the hospital around them. He turned to her and spoke in hushed tones in the German dialect that they shared. Then he bent down low over her body and drew back the sheet. He lifted the blue hospital gown and placed his ruddy, chapped lips on her pale pink ones. He cupped her small breasts in his large, rough farmer’s hands – hands that bulged with the circulation of the hard physical life that he lived.
I watched them for a few minutes. I wanted to keep on watching them and not disturb those intimate moments, but David Bristol arrived and wanted to begin. I made some rustling noises with the curtain to let them know we were ready. With that, Jakob Heidebrecht stood up beside his wife, pulled up the covers, picked up his wide-brimmed black hat that he had laid on the bed, and went out the door.
With Mrs. Heidebrecht under mild sedation, we inserted a deep catheter into the right internal jugular vein in her neck and threaded it down into her super
ior vena cava, right atrium, and into her right ventricle. Then we floated a tiny, air-filled balloon until it reached the pulmonary artery. With that balloon, I measured pressures in the chambers of her heart at the same time that I was administering various potent drugs – pure oxygen, a beta blocker, nitroglycerin, nifedipine, and nitric oxide – and then new experimental drugs that hadn’t yet been proven to be useful in this condition. We were hoping to see if any of them would alleviate her symptoms. If they didn’t, there was only one option: a lung transplant.
Throughout the day, the carols stayed with me, coming and going in my mind, both the stirring words and the glorious music, both when I was at the piano and when I was away.
Angels we have heard on high, sweetly singing over the plains
Each one, as I played it or sang it to myself, was my favourite at that moment.
NICOLE JOINED ME and together with the doctor, we reviewed the patient’s numbers and trends and tried to find helpful correlations between the drugs given and the patient’s reactions.
We called Mr. Heidebrecht back in and immediately understood the conclusion that Dr. Bristol had drawn when he handed Mr. Heidebrecht a beeper. He explained that either he or Mrs. Heidebrecht would have to carry it with them at all times so that they could be reached if lungs became available. This was the only option, he explained. A social worker would be in touch with them to go over the details, but in the meanwhile, they must carry this beeper and remain within an hour’s drive of Toronto.
Mr. Heidebrecht looked at it and shook his head.
I imagined it was how an Orthodox Jew might regard a pork chop: not as much with distaste, but rather, with disinterest. Anyway, he explained, with a shrug of his shoulders, they didn’t have a telephone in their farmhouse.
Dr. Bristol tried to impress on them the importance of being available every day, twenty-four hours a day. Only a lung transplant could possibly save her life.
