by Tilda Shalof
When I went back into the patient’s room, the doctor and the lawyer had left and the girlfriend grabbed my arm. The intensity of her gaze frightened me. Would she attack me? How would I manage to call security for a Code White – a violent patient? Where was Morty now?
“I need his sperm,” she said. “I want you to help me.”
Did she want me to somehow procure it for her?
“It is impossible and against the law,” I said sternly, in imitation of both the doctor and the lawyer. She softened and slumped again over the body in the bed.
What a conundrum: if something is impossible, did it even matter that it was against the law? If it is against the law, did it even matter if it was possible? There was a surgical procedure available, but it would be against the law to perform it, so what did it matter that it was possible?
“What about the old-fashioned way? Would it work?” she asked with a weak smile.
At that moment, Morty turned up again and handed me an urgent report she’d scribbled on a piece of paper.
“Necrophilia!”
“I doubt if ejaculation is still possible when there is brain death,” I said, temporizing after glancing at the note and glaring at Morty to stop. “But I can’t say for sure.” There were certainly a number of questions that were coming up in my practice that had not been covered in the nursing curriculum. “But you heard what the lawyer said. Raoul gave consent to donate his organs, but he didn’t give consent to father children after his death.”
I rejoined Dr. Bristol and the lawyer, who were continuing their discussion just outside the patient’s room. They were talking about electro-ejaculation techniques (I noticed both men wince imperceptibly at the mention of that) and the feasibility of procuring viable sperm after a period of oxygen deprivation. It will certainly make an interesting case study to write up for publication, Dr. Bristol must have been thinking.
After a few minutes, the girlfriend came out of the room. She had a beatific expression on her face. “I got what I wanted,” she said, patting her purse and licking her lips. “You can take what you want.”
We looked at each other in disbelief. Was she bluffing?
We would never know for sure.
IN MOST CASES the organ procurement phase went smoothly, causing little distress or confusion, at least among the nurses. Once the declaration of brain death was made, our work was straightforward and mostly technical, although it was done under the intense pressure of time constraints. However, when it came to allocating those precious and few organs to recipients, it became harder to suppress judgment. Sometimes our reactions were explosive.
“I can’t believe this!” exclaimed Morty one morning on team rounds. “I took care of this patient a few months ago and I had to give him whiskey down his nasogastric tube so he wouldn’t go into the DT s. I remember how the psychiatrist said this is not a detox centre and that we’ll have to address his alcohol abuse in another setting. Now, it’s a mere few months later, and he’s in a hepatic coma and his liver enzymes are sky high, but he promised to stay sober, so they put him at the top of the transplant list. They found him a liver right away and guess whose liver matched? A victim of a drunk driver who ploughed into another car on the 401, a mother of two kids, on New Year’s Day! What guarantee do we have that he won’t go back to drinking and ruin this new liver?” she demanded to know. “Couldn’t they have found a more deserving candidate?”
Silently, we were grateful to her for having the courage to ask the question that was on all our minds.
“Do you believe that a patient suffering from alcoholism warrants different treatment than a patient with a congenital disorder of the liver?” Dr. Bristol challenged her back. “All things being equal, why should there be a bias?”
“But all things aren’t equal and you know it,” Morty said. “The reality is there is an imbalance in supply and demand. There aren’t enough organs for everyone who needs one.”
“What about the overdoses? I sometimes have a problem with them, too,” admitted Tracy. “I realize these patients must be mentally ill to do something so irrational, but what if they go on to a second attempt and destroy their new liver? It’s such a waste.”
“Surely we mustn’t create a hierarchy of diseases so that mental illness or alcoholic cirrhosis have inferior status and fewer rights than a congenital disease such as, say, a biliary tract atresia, or even a contracted disease such as hepatitis. We aren’t here to apportion blame or pass judgment. We’re here to treat patients impartially, based on their medical needs. Why should transplantation be treated any different than any other treatment we offer? Don’t we treat overweight diabetics without compunction? We treat smokers with respiratory diseases, don’t we?” His eyes twinkled with the love of these questions.
“Even if we do regard alcoholism as a disease, why can’t we expect someone to exert some control over themselves, especially if their behaviour is ruining their health and harming their family life?” I asked. “Organs are scarce. Is it too much to ask?”
“What about the cost of all of this in dollars and cents?” asked Morty. “We can’t ignore that any longer.”
“David, you’d offer Osama bin Laden a kidney transplant,” said Laura.
“You’ll have to find him first,” said Morty.
“Well, we would certainly put him on the list. That’s the beauty of Canadian medicine,” said Dr. Bristol, content that questions were being raised and not the least bit perturbed that no answers were found. We all knew there weren’t any, anyway. Although we always argued with great zeal, we all knew that resolution of these perennial questions was never really possible and we just had to live with the uneasiness these situations created.
“Okay, I’ll give you an ethical dilemma,” said Morty. “Let’s just say that Princess Diana had been wearing her seat belt and her organs had been intact after that car crash. Do you think for one minute the Royal Family would have offered them up for donation? I can just see some homeless low-life rubby staggering around the London Underground drinking away his new royal liver! Or even some poor deserving commoner getting her lungs? The blue blood in his veins would be a dead giveaway!”
IT SHOULDN’T HAVE been easier or more pleasant to take care of the grateful, “nice” patients, but for most nurses, it was. We tried to be above such bias and never let it affect our care, but a card we received from a woman we’d cared for following serious complications after abdominal surgery did make us feel very appreciated.
Even though the odds were stacked against me, the care and dedication of the staff and God’s hand have saved me. I have been given the opportunity to once again enjoy the love of my children and grandchildren. I thank you with all of my heart for being so aggressive in my treatment. My memory of my ICU stay is limited, which may be a good thing, but everyone filled me in on just how incredibly relentless and compassionate all the doctors and nurses were and I thank you.
With love and gratitude.
“I prefer a card like that to the chocolate bunny with the bitten-off ears that we got last Easter from some family. Do you remember that?” said Laura with a snort. “Some gratitude!”
“How about the bottle of rotten cherry kirsch?” I added.
Then a letter came that put us all in our place:
I know I was difficult during my stay with you, and I want to apologize to those to whom I may have lashed out at in my frustration. Being in the ICU was the most harrowing, terrifying experience of my life and I am still plagued with nightmares from my ordeal. However, my thanks go out to all of you. You saved my life.
THERE WASN’T ALWAYS the luxury on days to socialize or to discuss the cases that troubled us, but during the long night shifts that we worked together, there was time to talk about everything, and we did. It was cold in the hospital late at night, or maybe it just felt that way because our bodies were slowed down. If all was quiet with the patients, we sat out in the hall, flannel blankets draped over our shoulders, at v
arious, odd distances from one another, so that we could keep an eye on our patients and the machines, and spring into action if necessary. We propped our feet up on little stools that we normally used for standing on at the bedside of patients while doing CPR chest compressions.
Of all of us, Morty found night shifts the hardest, for she slept poorly on days. “When I work nights,” she moaned dramatically, “I feel sick. It runs my metabolism down to a slug’s or maybe a two-day-old cadaver’s.”
Nights were a hardship for most nurses, but some nurses chose to work nights exclusively.
“I don’t like working days,” said Pamela. “I used to do them, but no way. I’d never go back to days.”
“Is it because of your kids?” I asked.
“Hell, no,” she said. “My kids are little and I sleep when they nap. No, I can’t stand the politics and all those doctors hanging around on days. And there’s so much commotion with the families. Nights are usually quieter, and you’re more in control of your work at night.”
“I don’t like when you tell people you’re going to night shift they give you such a pitying look, like what a loser you are, especially if it’s a weekend and everyone’s out having fun and you’re going off to work,” said Tracy, getting up slowly to do her vital signs and then do mine for me, while she was at it.
I must have looked like I was about to nod off because she asked, “How’re ya doing, Tillie? Hangin’ in there?” She gave me a little shove.
“Just barely,” I muttered.
When Tracy came back, she added, “I don’t like when people call it the graveyard shift. It’s so demeaning. We do this for a living. We’re professionals around the clock.”
I sat up to make myself be more awake and to add a complaint of my own. “I can’t stand going to bed when the sun is up and going to work when it’s dark. Whole days can go by when you don’t see any sunlight because you have to waste the day sleeping. It makes me feel out of kilter with the rest of the world.” I yawned just thinking about it. “It feels abnormal and unhealthy.”
From time to time we worried about the effect on our health of working the night shift. Someone would bring in a newspaper or magazine article that reported on research that showed that shift work could take years off our lives, make us more prone to depression, diabetes, and heart disease.
“At this rate, I’ll be a hundred before I’m thirty,” said Laura.
Sometime, during every night shift, a wave of exhaustion came over me, so powerfully that I felt like I would collapse. There were moments when I envied – even slightly begrudged – the patients their beds. There came a time, a moment I could pinpoint every night shift I worked, when I ran out of energy. I was afraid I couldn’t go on. I temporarily lost faith that I would be able to carry on. It was usually between 3:00 and 4:00, sometimes 4:30. Sometimes my eyelids closed and opened again like a blink. I had to glance at my watch to be sure that it wasn’t more than a blink. A few more of those micro sleeps somehow helped me make my passage on to the reliable gift of the second wind. Luckily, almost always, at some point, the second-wind phenomenon kicked in.
Occasionally, and only when it was quiet and safe to do so, we took turns covering for one another during breaks and took short naps. The doctors certainly did, and we knew we would be able to function better and more safely if we could lie down for even a few minutes. A storage room with mattresses piled high worked well for our purposes or an empty patient bed would do in a pinch, if we were desperate. (There was some disagreement among the nurses about the minimum “cooling-off period” required between a patient’s death and subsequent removal to the morgue, and the bed’s use for napping. How much time was enough for the bed to slough off its residue of death in order for a nurse to feel comfortable to curl up on its clean sheets? For me, as soon as the hard gurney rolled down the hall, away from the unit, with its load under a white sheet, the bed was immediately fresh once again, its karma newly minted.)
But one night I walked past a locked room and noticed a note taped to the door.
“Do not disturb. Nurse sleeping.”
Now that was going too far.
ONE NIGHT I was working beside Bruno. We loved working together and joked that we were like brother and sister. We moved our tables out into the hall because we kept the patients’ room dark and we needed the hall lights for charting, conversing, and sharing a bag of microwave popcorn. It was just around that desperate time of waiting for the arrival of the second wind, praying it would come – sleep would be so easy, it was so close – when I looked up to see five men in dark three-piece suits enter the heavy double door of the ICU, stride toward us down the hall, in a tight formation like a phalanx of troops. Visitors at this hour? Who was so sick that visitors showed up in the middle of the night? I looked at Bruno and he mouthed the answer to me.
“It’s the mob.”
He got up to meet them and then ushered them to the room of the patient they had come to visit. “Come right this way, gentlemen,” he said graciously, like the mâitre d’ of a fine dining establishment, leading customers to their reserved table. I wondered what would happen next because it was Pamela’s patient and she didn’t tolerate unannounced visitors at the best of times.
“Should I warn her, so she doesn’t throw them out?” He chuckled. “There may be repercussions. They may give her an offer –”
“– she can’t refuse! Yes, you better,” I advised.
But it was too late by the time he got down the hall to Pamela’s room.
“Sorry sirs, visiting hours are long over,” I heard her say. “Come back in the morning. Our patients need to sleep. Next time, call in first on the intercom in the waiting room, to see if it’s a good time for you to visit.”
I couldn’t hear their response, but Bruno was standing outside the door, out of their line of vision, motioning “pow, pow,” with his fingers as a gun, but Pamela wasn’t getting the hint. Fleetingly, I wondered how he might pantomime a bloody horse in a bed.
“Are you people family or friends? Are your names in the chart? I only give out information about patients to family members. Oh, you’re family? Ahhh … I see.” She must have noticed Bruno’s signals. “Oh. In that case, here are some chairs. Have a seat. Stay as long as you like.”
It took the Mafia to keep Pamela in line.
IT MUST HAVE been a month or two later when a tall young man carrying an artist’s portfolio and a petite woman wearing black bicycle shorts arrived at the ward clerk’s desk. I heard my name called over the loudspeaker, requesting me to come to the nursing station. There was someone to see me.
“Remember me?” The young man smiled. I didn’t recognize him, but knew I should.
“It’s Jeremy,” he said.
“Jeremy!”
“Yes, it’s me!” He beamed and stood tall to show off our shared accomplishment, his health. “Look, I can breathe!” He took in a deep breath to demonstrate. “Sylvie’s here too, of course.” He put his arm around her waist.
Here they were, the two of them, yet I sensed the eerie presence of four. The two lives that were lost and the supreme gifts they had given, so that these two young people could breathe. Here they were that day, members of this exclusive club. They had joint membership in a lung fraternity, their friendship cemented by the rare experience they shared.
Jeremy had returned to graphic arts school and Sylvie to living her life however she chose.
“What do you remember of your stay in the ICU, Jeremy?”
“To be honest, I try to block it out. I look around at all these other cyborgs stretched out in the beds and attached to machines and I think, I was just like you, man, but I made it. It doesn’t make me feel great though, ’cause I know that some of these dudes won’t make it out of here.”
“But do you remember anything specific?” I asked. “Did you have pain? Did we manage to keep you comfortable?”
“I didn’t have any pain, but I had nightmares. Stuff about the doctor
s and nurses being Nazis, doing experiments on me. I know it’s not true, but the mind plays tricks on you. Oh, I know. I dreamt some hockey players came to visit me.”
“That actually happened, Jeremy. Mats Sundin and Tie Domi from the Leafs came to visit you. You must have been too sedated to take it in.”
“Wow. Now that I know about it, it makes my day. Nah, I don’t remember too much about those guys coming in – I think my mom told me about it – but I remember you.”
“How do you remember me? There were so many nurses who took care of you.”
“You took care of me right after my transplant when I got back from the OR and you seemed to know just what I was thinking. It seemed like you were right inside my head all the time. You knew I wanted to see my parents right away and then the next big thing on my mind was getting that damn tube out. You were with me every step of the way. You were me until I could be me, again.”
“That’s better than a Timbit,” said Laura, passing by and helping herself to one from the box on the nursing station counter.
“I’ll say.”
Jeremy grinned and I watched him breathe. Mostly unconscious while in your tender loving care, but I remember well the soft, reassuring voices of comfort in the surrounding space. With gratitude.
9
CELESTIAL HOUSEKEEPING
Rosemary, our nurse manager, had a firm policy. She insisted that every nurse take a turn at being in charge of the ICU. At the end of my first year of working there, my turn came. Although I had resisted taking on the role, I came to enjoy the challenges it offered. That slight remove from the bedside helped me understand some of the bigger issues in the hospital and in the health-care system.
“Busy day?” I asked Casey, who had been in charge on the day shift, as I came on to the night shift to take on the role for the first time.
