A Nurse's Story

by Tilda Shalof

  Our work was stressful, but I believed that many of us thrived on the stress. It energized and exhilarated us. We craved the stress of challenging cases, of solving complicated problems, and putting our knowledge and expertise to good use. Stress was the price of doing work that was fascinating, challenging, and invigorating.

  Often, if I stopped a nurse in the middle of a busy day or night, when he or she was caring for a sick or “crashing” patient, and asked how it was going, the answer would be something like “I’m having a great day. Gosh, look what time it is! The day is flying by so fast.”

  The work made us feel vital, needed, and alive, alive, oh!

  I remember coming into Nicole’s room one day to give her a hand. I knew she was busy. The crash cart was in there, off to the side, most likely put there because she believed she would need it soon. She had even gone ahead and attached external pacemaker pads to her patient’s chest, just in case, because she had noted an occasional ominous heartbeat on the monitor that sometimes foreshadowed a lethal arrhythmia. I drew her blood work for her, looked up lab results, prepared and hung an antibiotic while she gave me an update on her patient.

  “Pressure’s in his boots,” she said, nodding at the monitor. She was mixing up more dopamine, the powerful vasoconstrictor drug to elevate the blood pressure. The problem was that her patient needed that drug, but it could also dangerously speed up his heart rate. Nicole narrowed the high and low alarm parameters so that she would be warned even sooner in the event of a problem.

  “He’s just had a seizure and has been going in and out of a tachy rhythm with lots of irregular beats. He’s pretty sick, but thanks for the help, Til, I’m cool now.”

  I looked at her. Nicole was flushed with excitement. She was doing five different things at the same time, planning ahead for another five. She was totally focused, in her element, in control, completely at home with the chaos. There was a huge smile on her face.

  Nurses like to fix things. If they can.

  I COULD ONLY hear one side of the telephone conversation, but it stopped me in my tracks.

  The organ transplant coordinator was sitting at the nursing station making phone calls. A cup of cold coffee sat on the counter beside her and at her feet was an oversized red plastic picnic cooler that I knew contained some newly dead person’s body parts. She leaned forward as she spoke into the phone.

  “How soon can you get him to the hospital? … Yes, a pair of lungs … it’s a very good match….” She smiled, sharing the excitement with the person at the other end. “He’s waited a long time for this call … over a year, I know … yes, it’s for real! Now, I don’t want you to rush, but we do need you here as soon as possible … don’t forget that there’s always a chance that once we’re in the OR, the lungs might not be satisfactory. Sometimes there is some reason that we cannot go through with the transplant. If that happens, we’ll have to wake him up and he’ll go back on to the list…. We’re here waiting for you. Drive safely.”

  We smiled at each other as she hung up the phone. I clicked my pen at her. It was one of the ones she had given out to all of us – key chains, too – that bore the slogan “Don’t take your organs to heaven. Heaven knows we need them here.”

  We weren’t supposed to know which organs went to which recipients, but often we had a pretty good idea. It had happened to all of us more than once that we would care for the brain-dead donor, send the body off to the OR for organ retrieval, and then come in the next shift and take care of the recipient. At first it seemed ghoulish, but I got used to it and soon it became what it still seems to me now: incredible. Awesome in the true meaning of the word: I was full of awe.

  WE TRIED TO keep Margot’s body going until the fetus was at least twenty-four weeks’ gestation. That was the decision the husband made, to try to save the baby. The mother would not live, but maybe the baby could have a chance if the mother was kept alive for as long as possible. All the nurses cared for her, some of us with nagging qualms.

  A small group of nurses spent extra time in the room, playing soothing music to the fetus, talking to it, and holding gatherings in the med room to pray for divine intervention on its behalf.

  I hung back, along with the other secular or merely skeptical nurses who didn’t believe such disproportionate efforts should be made for a fetus. All our efforts and resources, both human and financial, should be directed toward the living, we believed. Margot was dead, merely hatching a life that was tenuous at best. With each day that passed, her organs become more vulnerable, more exposed to deterioration and infection and therefore less suitable for transplantation to someone else. After a few days, the matter was decided for us when Margot’s body became too unstable and the doctors had to deliver the baby at twenty-two weeks and disconnect Margot from life support. The baby was stillborn.

  “First I’ll read a psalm,” said Father Szigetti as he laid out the doll-sized body on a sterile green towel on the countertop in Margot’s room. It looked like a strawberry jelly-baby candy spit out from a child’s mouth, still glistening and wet. “Then we will pray for the soul of this baby.”

  “Can you offer the last rites to the mother or the baby?” requested one of the Catholic nurses.

  “We do not anoint the dead,” Father Szigetti reminded her firmly and gave her a look that told her she should know better. He did offer what comfort he could to the nurses.

  Margot’s lungs were still usable, but unfortunately not soon enough for Alice Heidebrecht, the Mennonite farmer’s wife with pulmonary hypertension. Her condition had deteriorated rapidly, and she became too unstable to undergo a transplant. She was cared for at home and died there.

  I didn’t know for sure, but I suspected that Margot’s lungs went to my patient, the one I cared for a few days later. Jeremy was an eighteen-year-old boy who had cystic fibrosis. He hadn’t had a day of his life when breathing hadn’t been an effort. In order to replace missing enzymes in his body, he had to swallow over two hundred capsules a day.

  “I realize a lung transplant won’t cure his CF,” said his mother, “but whatever help it can give his breathing, we would be so grateful. He’s struggled all his young life.”

  Clearly, she had too, along with him.

  Jeremy did well. Within a few hours after the surgery, he was awake and weaning off the ventilator. His vital signs were stable and by the end of the day, we removed the breathing tube. The look of astonishment on his face, his expression of pure amazement that he could breathe with ease, probably for the first time in his life, moved me to tears.

  Jeremy looked around and simply breathed. In and out, and we watched.

  “It’s so quiet,” his mother said, sobbing in my arms. “I never heard him not coughing. I can’t believe it!”

  “Ma, I’ll need an alarm clock, now,” he said with a grin.

  “He had never needed one before,” she explained. “His coughing woke him up every morning.”

  SYLVIE HAD BEEN waiting for lungs for almost two years. She also had CF, but had never been as sick as Jeremy. Now she was. Only seventeen years old, her lungs were shot through with holes, from mucous plugs and recurring infections.

  I came over to help Tracy, who was her nurse, and we stood on either side of her bed and watched Sylvie gasping for breath. We had her on an oxygen mask at 100 per cent and even though each breath was a struggle, she used what little energy she had to mouth words.

  “Mommy, help me…. I can’t breathe.”

  Her mother was holding her hand. “Do something, please,” she pleaded with us, standing by.

  There was nothing we could do. We couldn’t give her any sedation because that would make it likely she might not breathe enough to meet her oxygen requirements. That, in turn, would make it more likely that she would need to have an endotracheal tube inserted and then a ventilator to take over her work of breathing. All these events would be a setback and would cause Sylvie to be removed from the transplant list.

  It was a hear
tbreaking situation. None of us could bear to watch, so we stepped outside the room and kept an eye on her from there.

  “What’s going on in there?” asked Laura, from across the hall.

  “Sylvie needs sedation and intubation,” Tracy explained, “but if we do that, they’ll take her off the transplant list.”

  “If she gets intubated, it will be a one-way ticket out of here,” said a medical resident passing by. “They’ll downgrade her or take her off the list, for sure, and right now, she’s at the top of the list in Ontario.”

  “I think she would tolerate a smidgen of sedation,” said Tracy. “I think she could handle it. It would lessen her anxiety and would help her to breathe.” I watched Tracy thinking it through. She was calculating Sylvie’s height and weight, deciding which drug would be best and at what dosage. She was taking into account all the other drugs that Sylvie was on and the various effects and interacting effects they might have on Sylvie’s rate of breathing, blood pressure, heart rhythm, and emotional state. She was thinking back to previous times when she had taken care of Sylvie and recalling her reaction to sedation, to analgesic, to anti-anxiety medications. She was putting the whole picture together and adding in her instinct and kindness to come up with her plan of action.

  A resident came over and took a look at Sylvie from the door of the room. “If you snow her, she won’t breathe, and we’ll have to tube her and that’ll end her chance for a transplant. She’s small, and even a pediatric dose of sedation might be too powerful for her. I wouldn’t take the chance.”

  “But you’re not in there with her,” Tracy said. You haven’t stood watching the terror in Sylvie’s eyes, her struggle, the mother’s helplessness, I thought. Overall, it was a small thing, but it was a big thing to Sylvie and her mother. It had the potential to be a big thing, in the long run. I could see in her eyes that Tracy was going to take a chance.

  “I’ve had asthma all my life,” Tracy said, revealing something that none of us knew. “I know how terrifying it is when you can’t breathe. There’s nothing scarier. I know it’s a fine line, but I think a touch of morphine would ease her anxiety and open up her airways. I can’t bear to see her like this.”

  The resident shook his head. “I disagree. It’s not worth the risk.”

  “I’m going to page Dr. Bristol,” Tracy said, knowing the repercussions that might ensue by trumping the resident and going over his head, and more importantly, by possibly jeopardizing Sylvie’s chance for a lung transplant.

  “He’s not going to like it,” the resident called out.

  Tracy came back in tears. “He said, ‘Do what you have to do. You know I don’t approve,’ and slammed down the phone. I’m going to give it anyway.”

  She knew he wouldn’t back her up if the plan backfired. But we would.

  Tracy went back into the room to talk to Sylvie and her mother. Bruno joined them and offered Sylvie a soothing massage until the drug arrived. I retrieved the narcotic keys and went to the locked cupboard to get the morphine. I think I saw Tracy’s hands trembling as she injected the drug.

  “Just the tiniest dose,” Tracy assured the mother.

  All those things – the nurses’ words, touch, and positive intentions, along with the morphine – helped ease Sylvie’s breathing. It was something only a nurse could know. You had to be right there to judge that delicate balance. Tracy had a finely tuned intuition and a tough analytical mind. She knew a lot, but didn’t even know she knew it or how she knew it.

  Sylvie’s mother smoothed her daughter’s hair. “You look better, dear, don’t worry about anything. Your brother is back home taking caring of the cats. I’ll call Papa and tell him you’re doing better. Now, don’t try to talk. Just rest.”

  AS FRANCES AND I got on the elevator the next morning, Sylvie’s mother was just getting off.

  “I’m goin’ out for a quick smoke. I’ve gotta get right back ’cause Sylvie’s going to the OR. They found lungs for her last night!”

  We smiled automatically in response to the mother’s smile and tried not to show the trepidation we felt. We couldn’t bring ourselves to rejoice as she did. We knew that in Sylvie’s case the recovery would be long and difficult and likely complicated, if she even made it off the operating room table. She had deteriorated so quickly over the past day before going into the OR; she would be a high-risk case.

  Thank you not only for your expertise, but also your generous and caring hearts.

  Most of the nurses were comfortable with the idea of organ transplants. For the most part, we believed in what we were doing. We knew that many people were out there in the community, living each day by the phone, praying for that call that might save their lives. Even when families refused organ donation, everyone respected their decision. We understood that either grief or certain moral or religious beliefs might preclude a family from agreeing to organ donation. However, sometimes there were occasions when a person had signed the donor card on their driver’s licence, but the family overrode that decision at the time of death. Those occasions made many of us feel disappointed, even affronted, on behalf of the dead person. Their wishes had not been carried out.

  “We don’t own our bodies – or anything for that matter – once we are dead,” explained Dr. Bristol. “The law is very clear about this point,” he added.

  But there was one case that wasn’t so clear-cut. It left us all flummoxed. I still wonder about it, now, from time to time. That night I learned a new word.

  “I put you in with the donorcycle,” said Casey, the nurse in charge on days.

  “The what?”

  “A daredevil. He was in a motorcycle club doing a stunt. Anyway, he’s brain dead and a potential donor, but there’s a catch.” She smiled and said, “I thought you’d have the tact to handle it, Tilda. That’s why I put you in there.”

  Dr. Bristol and the hospital’s lawyer were already in the room. I tried to listen in, but Morty kept talking loudly over them.

  “It’s like The People’s Court,” Morty said, referring to the afternoon TV show. “The case you are about to witness is real. The participants are not actors. They are actual litigants with a case pending in the California Supreme Court.”

  “Hush,” I said. “I want to hear what’s going on.”

  “The victim did in fact sign his organ donor card on his driver’s licence, but the common-law girlfriend – she’s the next of kin, there’s no one else – states she’ll overrule if we don’t allow for retrieval of sperm for posthumous fatherhood,” the lawyer was saying.

  “Sperm retrieval would be impossible in the conventional manner,” explained Dr. Bristol to the lawyer, “technological advancements notwithstanding.” The two exchanged boyish grins. “The patient is brain dead and sperm retrieval would be possible only by way of an invasive procedure. At any rate, more importantly, does the next of kin agree to organ donation?”

  “Yes, but only on condition of receiving … the other. In hand, so to speak. It has been explained to her that sperm retrieval is not allowed in this case. There must be clear, prior intent on the part of the deceased to put his post-mortem sperm toward such a purpose.”

  What other purpose is there for the stuff, I wondered.

  “He’s my fiancé,” a distraught and pretty woman standing at the bedside said. “We’ve already set the date, Valentine’s Day!”

  “You can understand why this matter must be sorted out most expeditiously,” said Dr. Bristol to the lawyer. “If there is any chance he is still to be an organ donor, that is.”

  “I won’t agree to anything if I can’t have his sperm,” she said.

  “It gives new meaning to the term dead-beat dad,” said Morty, who was trying to whisper, but was probably incapable of it.

  “Shhh,” I hushed her.

  Dr. Bristol came up with a creative suggestion.

  “Could the sperm be obtained, then quarantined in a cryogenic storage facility? That would allow the proxy – and the courts �
�� the time to make a more considered decision.”

  “I want his baby!” The woman began to wail and threw herself across the husky, extensively tattooed body in the bed and sobbed into his broad chest. “He wanted me to have his baby,” she said, amending herself.

  Dr. Bristol addressed her. “It is doubtful, or at best uncertain, if Raoul would have wanted to be a father after his death.” He spoke slowly and carefully.

  “If you call that being a father!” said Morty under her breath, but just barely under.

  “At any rate, we will never know his wishes in this regard. Did you ever talk with him about having a child?”

  “Of course. We talked about it many times.”

  “Did you ever talk about having a child, even in the event of death?”

  “Of course not,” she cried in exasperation. “He never thought he was going to die! Why would he? He’s only twenty-five. He doesn’t even have a will.”

  The lawyer drew Dr. Bristol and me to the side of the room and Morty included herself.

  “Her motive must be determined. Is it truly her desire to have his child, or is there possibly a financial incentive, for example, inheritance of his estate? What if in the ensuing year, she finds a new partner, what is to be done with the, er, sample?”

  “That’s going too far! I’m not prepared to probe into her psyche or her love life,” exclaimed Dr. Bristol. “I doubt whether she is even in a rational state of mind at this moment to discuss any of this.”

  “She doesn’t seem to have even registered the loss,” I noted.

  A surgeon walked by and beckoned me to join him out in the hall.

  “What’s the holdup?” he asked with a glance at his watch. “We’ve been ready and waiting for him in the OR for over an hour.”

  “There’s a bit of a hitch … I mean a glitch.” I stifled a giggle.

  He was tired and wanted to know if he could grab a nap before the long night ahead, or if there was even going to be a long night ahead. I understood all of that but sometimes in their eagerness for the “harvest,” the surgeons acted more like hunters than farmers.