A Nurse's Story

by Tilda Shalof

  The mother sobbed into her son’s bare chest and the father stood on the other side of the bed, holding his son’s hand. He looked at it in sheer amazement. That hand that had gripped a hockey stick hours before, now was lifeless.

  As I went about my work, I made a point of not talking to my patient as I always did. If I spoke, whom would I be addressing? It would be without purpose and confusing for the family. He was dead, after all, despite the apparently normal activity on the monitor, despite his composed, youthful face and good colour, despite the rise and fall of his chest.

  I was the caretaker of their son’s body. The guardian of his vital organs.

  In just a matter of hours, he had gone from a young healthy boy to a critically ill patient, to a dead body, to a treasure trove containing precious gifts. Waiting inside this body were the spoils of an untimely, tragic death. But were we pirates, pillaging and plundering the human body for its booty? Our haste and efficiency made me feel at times as if we were treating a person as a means to an end, but in order for the organs to be viable for transplantation, we had to act fast. Organs did not live long inside cadavers, even less in buckets of preservative fluid. How can we make this experience more respectful and honourable, yet do our work quickly and effectively? I wholeheartedly believed in what we were doing. The boy was dead; he was a body. A casing, a container, a jewellery box containing sapphire lungs, a ruby heart, an emerald liver. To others, now, it might mean a chance at life: as precious as gold, frankincense, and myrrh.

  We three kings of Orient are

  Bearing gifts we traverse afar.

  Field and fountain, moor and mountain following yonder star

  O star of wonder, star of light

  Star with royal beauty bright

  Westward leading, still proceeding, Guide us to thy perfect light.

  The parents’ backs, as they turned and walked out the door, moving farther and farther away from the body of their son, leaving it behind to us, entrusted in our care, was the saddest sight I had ever seen.

  “Their Christmas is fucked, for sure,” said Morty, standing just outside the door.

  Silent Night.

  Holy Night.

  Shepherds quake, at the sight.

  Hell, I was quaking too, but there was no time for that. There was so much work to do.

  Prep the body for the OR. X-ray, echocardiogram, and bronchoscopy – all to verify that the organs were in good condition for transplant. Treat the complications of brain death: the buckets of colourless urine spilling out from his bladder, caused by a type of diabetes due to a hormone disruption from the brain damage. Cooling his body when it suddenly heated up, warming it when his temperature erratically dropped. Levophed up, Levophed down with each swoop and dive of his blood pressure. I thought of Laura’s oft-repeated quip: Levophed? Leave ’em Dead! The brain was no longer in control – we are, or so I was trained to believe. I administered medications for no other reason than to maintain good organ perfusion. Stop, isn’t this too bizarre, too macabre? No, I answered myself back. He’s dead and now his family has given the ultimate gift. Their son’s organs and tissues may save other people’s lives. Focus on that, I told myself. Isn’t it good that something positive might come of this tragedy? Two voices – there were at least two – kept up a dialogue in my mind.

  And all the bells on earth shall ring,

  On Christmas Day in the morning.

  The room was quickly becoming crowded.

  “Have we reached a consensus?” the surgeons asked about each organ. “Are we ready to roll?”

  The thoracic surgeons who wanted the lungs arrived, already in their OR scrubs and rubber clogs, hopeful for an expedient retrieval. The liver team was there, asking me to draw more blood tests.

  The harvest would soon begin. Then a long winter of recovery, then hopefully, new life would spring forth.

  WHAT HAPPENED LATER that Christmas evening, just as we were finishing up that shift and getting ready to leave, makes me tremble to think of it still. And when I do, I reach out to touch my loved one’s hand to make sure he is safe. It makes me pause before I get into my car. It makes me say a prayer – even though it’s not really my way or habit to do so.

  “Everything has already been decided, no matter what you do or don’t do … whether you will arrive safely or make it to your next birthday,” my husband, the cheery existential fatalist, says. “It’s all been decided, but you still have to do the right thing.”

  “Who shall live and who shall die?” the rabbi said each year during the solemn Yom Kippur service, the prayers for the Day of Atonement. “Yet, whether it has been decided or not does not absolve you of the responsibility to do the righteous thing,” he made sure to add.

  Frances told me just a few of the details that she knew as she admitted her patient and rushed around trying to get as much done as she could before the end of her shift. My “donor” patient had gone to the OR for organ retrieval. I could have gone home a few minutes early, but I stayed to help her.

  From the little she told me, from what I heard from the paramedics, and from what I knew about these situations, I could easily imagine the details.

  There must have been a patch of black ice, undetectable, unavoidable to the driver of a car that was on the way to visit grandparents for the holidays. Margot Heinz, a twenty-seven-year-old woman was sitting beside Steve, her husband, their two children in the back seat. Steve swerved to avoid an oncoming driver who had wandered crazily into their lane.

  “That guy must have had a few too –” he must have started to say, when suddenly, the tires couldn’t find purchase on the road and the car went into a skid. Steve slammed on the brakes, the car spun around, flipped over into the ditch. They were found, a few moments later, the horn blowing, the children crying, and Steve, sitting, motionless, his eyes glazed. Margot, slumped forward; not a sound from her.

  Ambulances raced to the scene and paramedics began resuscitation efforts. They called ahead to the hospital to let them know what they’d found. Two small children in shock, but vss – vital signs stable. One thirty-something white male, multiple fractures, contusions, possible concussion. Young white female, appears to be pregnant, VSA – vital signs absent. Letters are faster than words. The driver races to the hospital with the siren screaming, but takes the time to put in another call, this one to the provincial trauma centre, to alert them about a possibly brain-dead victim, a potential organ donor.

  A pager goes off in the jeans pocket of a young woman working late at the hospital. It’s Christmas Eve, but she’s on call for the entire province, ready for just this sort of eventuality, which unfortunately, with drinking and festive merry-making, is statistically speaking more likely to happen at this time of year than at any other. She is responsible for all the lungs, hearts, livers, and kidneys that become available for distribution to transplant centres. It will be a long night ahead, and as tired as she is, and as disappointed as she is to be missing Christmas with her family, she hopes that some good may come of each tragedy. She loves her work.

  The ICU is dangerously short-staffed. Casey is in charge on the night shift.

  “Belinda,” she’ll say as she enacts an impromptu skit of how she’ll call one of our nurses who managed to get Christmas off, at home: “We interrupt this Midnight Mass and the ho, ho, ho, opening of your presents. Don’t bother taking down your stocking! Dump your eggnog down the sink and turn off the oven with the undercooked turkey – who cares about salmonella? – and come to work in the ICU. We’re working with a skeleton staff, but we can’t afford to lose an organ!”

  I could see the grandparents, the stricken look on their faces as they waited for their children and grandchildren to arrive. It is late and dinner is getting cold.

  “Where are they?” I can hear them saying.

  “Now, don’t fret, dear. They’re on their way. There must be traffic or they got delayed somewhere.”

  “It’s not like them to be late.” She stand
s at the window, waiting for a sign.

  I picture the police car pulling up to the front of the house and see the grandmother falling in a faint to the floor. Two officers get out and begin their slow solemn walk up the driveway. Margot’s father knows without being told. One of the police officers, perhaps a young woman, near Margot’s age, will hold his hand and sit with him. She may also be wishing she were home with her family for Christmas dinner, but it was her turn to work.

  “WHEW!” SAYS CASEY, glancing at me. “We could use more Jewish nurses. We can always count on them to work on Christmas.” Rosemary is getting ready to go home, but comes to tell us that if we are desperately short-staffed, she will come in and help out if necessary.

  Margot is declared brain dead. Steve, who has stabilized in ER, is notified, and although he is beside himself with grief, he believes that even though Margot hadn’t signed the donor card attached to her driver’s licence, she would have wanted to donate her organs. Her life was lost, but maybe others will be given the opportunity for life. That is the kind of person – that was the kind of person, he corrects himself (how cruel the rules of grammar can be) – that Margot was.

  The surgeons on call are paged. The ophthalmologist will want those clear, young corneas. Someone will harvest the kidneys and the pancreas together, along with a few metres of bowel. A thoracic surgeon will procure the lungs and a cardiovascular surgeon, the heart. One hopes the organs are in good condition, but they may be used anyway, even if there are deficiencies. The potential recipients for these organs are desperate and will take any chance at life. Even imperfect or iffy organs – a bruised liver or smoker’s lungs (after one transplant, the nurses swore they got a whiff of smoker’s stale cigarette smoke every time they came near the patient) – may be put to use.

  Margot’s liver was severely lacerated in the accident, but her other organs are in excellent shape and will go to those whose need is greatest and who mostly closely match the donor. However, the most pressing question still needs to be addressed. What about the twenty-two-week fetus inside Margot? Is it still viable and if not, who should be saved? Whose life takes precedence? Should the body of the mother be sustained on life support until the fetus can be safely delivered, even though such a delay puts her precious organs in jeopardy? Or should one life, a precarious one at best, be discontinued so that others might be given a chance? Are we doing the right thing, this tampering with life, this tinkering with death? Pretending to play with the stars, as if we even could? Have we gone too far? Perhaps it all has been decided already, but that does not exempt us from trying to do the right thing.

  God and sinners reconciled.

  It was time to go home. It was already late, and Ivan and I were invited to friends’ to share in their Christmas Eve celebration. It was also Chanukah, so I would bring the menorah and light the candles and we would have carols and songs together, plum pudding and latkes.

  I lingered for a few more minutes in the lobby and because the piano was still there, the open keyboard was an invitation I couldn’t resist.

  Bearing gifts we’ve traversed afar Field

  and fountain, moor and mountain,

  Following yonder star

  It was the most Jewish of all the carols. It was as sombre as any of the Hebrew songs I knew, even the so-called cheerful ones. Its minor key echoed with the melancholy in my heart. How can such joy and such sadness co-exist simultaneously within me and in the world around me? Yet they always have.

  Westward leading, still proceeding

  Guide us to thy perfect light

  But I couldn’t bear to end the day on such a mournful tone.

  Hark the Herald Angels Sing!

  Glory to the Newborn King!

  Joyful, all ye nations rise,

  Join the triumph of the skies

  I sang along with a few other people who gathered, just as they were leaving the hospital. My hands stretched out vigorously past the octaves, using more muscle than was really required and let my heart soar along with the words and music. Yes, that’s it, we have to give glory. Glory to our good health, to our friends, family, and yes – I’ll dare to say it, though quietly to myself – to God.

  8

  GRATITUDE

  As I was transferring a patient to the floor, she asked me to make a stop by the pay phone. She was an elderly woman who had suffered a severe bout of pneumonia related to her chronic lung disease, but now had improved and would likely be sent home in a few days. She asked me to put the quarter she had saved for this purpose into the phone and called out the phone number from a little folded piece of paper. It was the number of a local funeral home. She took the receiver from me and proceeded to make arrangements to purchase a burial plot. She held up her credit card for me to read off the numbers, which she then repeated into the phone.

  “No, I’m not dead yet,” she explained to the person at the other end, “but I may be shortly.”

  ON ANOTHER OCCASION, we admitted a Mr. Tom Kettle, and as I was inputting his name in the computer chart, he said, “That’s T. Kettle, for short.”

  I looked up and met Laura’s eyes, then Frances’s eyes. Such tiny jokes didn’t warrant the uproarious laughter with which we all erupted, but it seemed to, at the time.

  “Mr. T. Kettle.” I paused to wipe tears from my eyes when we were still laughing about it later, in the lounge. “That reminds me. Remember that British patient whose first words when we extubated her were ‘May I please have a cuppa tea, luv?’”

  “Wasn’t that when Morty brought a pot of tea to her room wearing the tea cozy on her head? When the patient saw her coming in with that, she lost her dentures in the bed from laughing so hard!” said Nicole.

  Of course, all this silliness set us off again.

  PEOPLE WHO ASKED about my work always raised the same questions. How did I manage to keep my emotional distance? Why was I so drawn to such catastrophic illness? Wasn’t it depressing? Why didn’t I choose a happier place to work, where more people got better? Whatever I answered did not satisfy them.

  I began to suspect that people asked these questions because hearing about my work raised uncomfortable feelings and new questions in them. It disturbed them and made them feel squeamish. It provoked them to think about their own safety and their mortality. It made them wonder if such devastating things could ever happen to them or their family. It made them feel unsafe.

  Frances told me how she dealt with this reaction from her friends and family.

  “I tell them that I love being a nurse, especially here in the ICU. You get to solve problems and know that it’s all up to you. You have your patient’s life in your trust for these hours and you can really help people. Sometimes you get to bring people back from the brink. I wouldn’t work anywhere else.”

  Nicole explained her position. “Taking care of people who may or may not make it is not depressing when it’s not your own family member in the bed. Even if you get very involved with them and care a lot for them, at the end of your shift, you leave.” But then something occurred to her. “But if it happens to be your own family member, then that’s different.”

  I didn’t ask Laura, but she overheard and told me anyway.

  “It’s not the work that depresses me, it’s the doctors. We do all the work and the doctors get all the credit. We’re the ones who really know what’s going on with the patient, but the family rushes in and asks, where’s the doctor? What does the doctor say? People don’t realize that it’s nurses who make people better.”

  Sometimes I responded to inquiries about my work by giving the example of the Cresswell family. I accompanied them into the ICU when they arrived for the first time, explained everything to them, helped them get used to the scary machines, demystified the alarms, encouraged them to ask all the questions that were on their minds, allowed them to visit their father whenever they wished, and, in the end, ensured that he was pain-free and comfortable.

  “But how did he do? Did he get better?”
my friends asked. Of course, everyone wants a happy ending.

  “Well, no. The treatment was unsuccessful. He had serious illness and a lot of complications. But he had a good death.”

  Even we nurses could sometimes get fixated on death and dying and forget about the success stories that we’d had a part in. There were many lives we saved and people we fixed and cured and sent on their merry way. If they came back to visit us, what a bonus! But we never expected it. In fact, we were a little surprised whenever former patients walked in the door. Why would they want to revisit the scene of such horrors? Even with the most compassionate and gentlest of nursing care, so many ICU experiences were unpleasant: the IVS, the drugs, the intubation, the ventilator, and the noise. Surely they wanted to forget about us and put the whole experience out of their minds? Nevertheless, from time to time, a patient would walk in the door and want to shake the hands of those who cared for him. They made a point of thanking us one by one and often placed a box of doughnuts or a big green plant on the nursing station counter. We waved them off and did all we could to limit or relieve them altogether of any sense of obligation. We did want to be appreciated, but we didn’t want gratitude. We wanted acknowledgement, but not indebtedness. There’s a big difference.

  Those cases – those success stories – were the reasons that we went in to nursing in the first place. But even when our patients didn’t get better, if we believed we were helping in some way, we could do our work with a clear conscience. So long as we believed that the pain of the treatments was worth enduring for a reasonable chance of improvement, we loved our work in the ICU and did it wholeheartedly. Most of us wouldn’t have worked anywhere else. Those nurses who left often ended up coming back. Occasionally, we received a card or letter of thanks.

  We would like to acknowledge with grateful hearts the care you provided to a woman who was very special to all of us. Although we gave her up to God, we are so appreciative of the skilful and loving care you gave her during her time with you. Thank you to all of you.