A Nurse's Story

by Tilda Shalof

  “Can’t think of anybody, offhand,” she said. “Yeah, Liam Neeson. Now that’s an Irish hunk!”

  “Yeah, Darryl is an excellent doctor. He’s very smart,” said Frances, “but he’s too touchy-feely. And his rounds go on all day. I can’t get my work done because he drones on and on. I know if I go into a family meeting with him, it’ll be hours until I get out. I feel like saying, get to the point!”

  “Yeah, just like you do, Jabber Jaws,” said Laura.

  And as usual, we ended the evening in high spirits from the pleasure of one another’s company.

  ONE DAY I was taking care of a post-op lung transplant patient who was crashing. His blood pressure was falling and his blood gases showed a dangerously low level of oxygen. Quickly, the room filled with people – the surgeon and his residents who had just performed the surgery; other nurses who’d come in to help me; the respiratory therapists; and Dr. Jessica Leung, the senior medical fellow. Darryl Price stood at the foot of the patient’s bed, quietly surveying the scene before him.

  “We’ve increased his oxygen,” I told him. “I’ve already called X-ray for a stat chest. I drew a set of ’lytes and a troponin and I have a chest tube all ready in case he’s blown a pneumo. I just did an electrocardiogram. Here it is.”

  Darryl’s gaze didn’t leave the patient before him, and he pursed his lips in consternation. Clearly, he was seeing something that none of us were seeing.

  “Have I forgotten something?” I asked.

  He cleared his throat. “The family. We have to speak with the family.”

  The family? I hadn’t given them a thought. Who was out there, even? I looked at the chart. A wife, some kids, two, I thought.

  “But what can we tell them? He’s crashing and we don’t know what’s going to happen.”

  “That’s exactly what we have to tell them. Look, there are enough people here to take care of this situation now. I have a feeling it’s just a mucous plug or fluid overload and they’ll be able to fix it. Tilda, I want you to come with me.”

  Together we walked through the long corridor toward the elevators that would take us to the waiting room. Massive renovations were being undertaken throughout the hospital to merge units and consolidate departments, and the waiting room had been permanently relocated far away from the ICU to another floor altogether. The nurses had written a letter of protest, explaining the necessity for families to be in close physical proximity to their loved one and the difficulty many elderly visitors had in walking so far to the ICU, but to no avail.

  In the elevator, Darryl and I exchanged a few words. He was reading Robertson Davies and listening to Emmylou Harris’s melancholy Wrecking Ball; I was reading whatever Oprah had chosen that month and rediscovering the Chopin nocturnes of my youth.

  “You must read Thomas Mann’s The Magic Mountain,” he said. “If you haven’t read it already. That’s the best book to help you understand the experience of illness from the patient’s point of view.”

  I took it like a prescription.

  In the waiting room, Darryl introduced us to the family. They were easy to spot. It could be no one else but the huddled group sitting around the Thermos of coffee, some still slumped on couches that had taken on the shapes of many other haggard bodies before theirs. All eyes turned to ours, trying to read the news.

  Usually whenever I entered the waiting room, I tried to keep my face still and expressionless. I think of my husband at the poker table and how I can never tell when I walk by the game at our dining room table if he’s got good cards or bad ones, if he’s up or down.

  Their eyes were trained on us, first on the doctor, then on me, back and forth. What is the news? Will he make it?

  Darryl took a seat with them on one of the couches and I joined him. He put his arm around the patient’s wife. He looked directly at her and then at the grown children. He did not avert his eyes as I usually did in these situations.

  “It is terribly frightening for you and for all of your family out here, waiting. Waiting and wondering is very hard. Your husband’s transplant went very well. He received a good set of new lungs. I know the surgeons have already told you about that. However, here in the ICU he has developed some complications. I think we can sort them out. But I want you to prepare yourselves for setbacks such as this. They are very common. We’ll keep you informed every step of the way. We’re busy with him right now, trying to help his breathing and bring his oxygen levels up by making adjustments to the settings on the breathing machine. Right now would not be the best time for you to visit unless you feel you absolutely must.”

  The wife shook her head. “We can wait.”

  He smiled. “His nurses know everything and will keep you informed. As soon as he stabilizes, we will call you and you can come down to visit him. Is that okay?”

  She nodded.

  “These must be the worst days of your life.”

  She nodded.

  “We understand what you’re going through.” He reached over to take her hands in his. “We are with you.”

  OVER THE YEAR that Darryl Price spent in our ICU completing his fellowship in critical care medicine, I had many opportunities to observe his unique way of using the simplest, most truthful words to convey complicated, painful news to families in the kindest way possible. I recall working with him once and before the shift had even started, I received a strong premonition that a powerful, almost mystical, transformation was about to take place. It was, in fact, brought about in large part by Darryl’s words, gestures, and caring soul.

  It was night shift. As I stood for a few minutes in the med room staring into my coffee cup before going to start the long night ahead, I could feel powerful swirling, churning waves of energy emanating from my patient’s room. Of course I didn’t mention this to the others. They already had enough reasons to tease me.

  Darryl Price was standing outside the door of the patient’s room, in quiet consultation with one of the vascular surgeons. I knew the situation must be serious for him to be here so late at night. Staff doctors had usually gone home by now and left the running of the ICU to the resident on call, who would contact the staff at home if there was a problem.

  I lingered in the medication room a few more minutes, delaying entering the world I would inhabit for the long night ahead. At the centre of this world were my patient and his family, each one confronting this crisis in his or her own way. The situation would demand my complete attention and my ability to give myself over to meeting their needs. Over the night ahead, there would be hundreds of facts, details, and numbers to absorb and interpret. At the same time, I would have to remain flexible enough to change as the situation evolved. I thought of the moody piece of music that I loved by Arthur Schoenberg, all dark and dissonant, called “Transfigured Night.”

  I was ready. I dumped my coffee in the sink, rinsed out my mug, and filled it with spring water from the cooler. I walked over to my room, drinking slowly.

  “I’m glad you’re on tonight, Tilda,” Darryl said. “But it will likely be a busy night for you. We have to talk with the family about what to do in the event of a cardiac arrest. I’ve reviewed the case thoroughly and I think a ‘do not resuscitate’ order would be appropriate given the patient’s extremely poor prognosis. What do you think?”

  I was thinking about how unusual it was to talk about these things before a crisis occurred and how helpful it would be to talk with the family before it was too late.

  “Are you in bad form, Tilda?” he asked, peering at me closely. “You look tired.”

  “Oh, I’m fine,” I said, snapping myself out of my reverie.

  He looked tired, too, and I told him so.

  “It’s my son’s sixth birthday today,” he told me. “I’ve still got ten more patients here in the unit to see and another few on the floor. I know I won’t get home until he’s long gone to bed. Anyway, please page me when the family comes in.”

  The nurse from the day shift had finished tidying
up the room as a courtesy to me and stood there, waiting. Of course, I remembered, she’s been here over twelve hours. She wants to go home. Me, I’ve got the whole night ahead. We sat down together at the table on wheels in the patient’s room and she brought me up to date on the patient’s condition.

  Mr. Eagleton, seventy-one years old, had been in our ICU for a week and we all knew his history well. He had been transferred to us from Midland Huronia hospital for repair of a ruptured aortic aneurysm. He had had to return to the OR today for ten hours and was still bleeding internally. His blood pressure was low and his heart rate was fast. Even more troubling was that he was showing no signs of waking up.

  “He’s not doing very well,” the nurse said to conclude her report. She appeared to be finished and stood up to go.

  “Is that it?” I asked.

  “That’s about all I can think of.”

  “How’s the family coping?”

  “Oh yeah, I almost forgot. There’s a wife and some grown-up kids, but I’ve been too busy to let them in. You know how it is. I think they’re still in the waiting room.”

  Mrs. Eagleton looked like the kind of woman who, most other times, would be impeccably groomed and well dressed. This night she had thrown on a pair of jogging pants and her husband’s bulky old homemade wool sweater before rushing to the hospital. I saw that she had two watches on her wrist and two rings on her finger – her own and her husband’s. I took her by the hand and guided her to the ICU. I lowered the side rail a bit so that she could hold his hand, and I encouraged her to talk to him.

  “The sound of your voice will be a comfort to him,” I said.

  She spoke quietly to him and then began to cry when she got no response. “We had our fiftieth anniversary party the other night, the day before he went into the hospital,” she told me. “I said to him, ‘Alfred, should we go ahead with the party if you’re not feeling well?’ He’d been working on the boat all day at the cottage and maybe he overdid it. He had a funny look on his face. I gave him two Tylenol, but they didn’t seem to help. He said, ‘Yes, dear, go ahead with the party, I’ll be fine.’ And now this.”

  I couldn’t tell if Mr. Eagleton had any pain because he was deeply unconscious and did not respond in any way. We’ll never really know if he has pain, I thought, because he will probably die. Even if he did survive this crisis and lingered longer, he probably would not remember. Research showed that most patients report they can’t remember the ICU experience. I decided to go ahead and give him more narcotic in case he was having pain even though it would drop his blood pressure further and then I would have to increase the blood pressure medication. I would have to watch him very closely tonight.

  I brought chairs for the wife and children and gave them privacy, but hovered quietly in the background. I put in a page to Darryl and returned to do my work. Within minutes he was there. We brought the chairs just outside the patient’s door and held the family meeting there. “Mrs. Eagleton,” Darryl said to her. He addressed her primarily, but from time to time looked over at the two daughters and the son. “What have you been told about your husband’s illness?”

  “Our family doctor in Midland said he had to come to Toronto right away for surgery. That was last week. He was nothing like this. Alfred never complained about anything. He just wanted me to ask you to please not put the intravenous in his right arm because he plays the violin. He loves his music. Tell me, doctor, is it very serious?”

  Darryl sighed, and then took a deep breath. He pulled his chair closer to Mrs. Eagleton and placed it not so that he faced her, but so that he was sitting alongside her, as if they were going to discuss this case together as colleagues. They could have been two people sitting side by side on a bench on a boardwalk, looking out at the vast ocean. Two friends discussing a shared problem. He placed his hand lightly on the sleeve of her woollen sweater.

  “What we have to do tonight is to think of the person inside the body of Mr. Alfred Eagleton. We must think of the things that are important to him as a person and as a man. The brain problem is the main thing, to our way of thinking. He does not have any quality of life and is unlikely ever to have one again. We are all very worried about him. We are capable of doing all of these things, but we don’t think these are the right things to do for him, because we don’t feel we can bring him back to the good quality of life he had before. We are very disturbed to use these treatments when we don’t believe that he can get better. We feel very disturbed when we use these machines and drugs when they are not to the patient’s benefit. Yes, it makes us feel we are very clever, fixing all these things, but it’s not good for the patient. Good medical treatment, in our opinion, is that we not start any new treatments or add any more artificial means of life support, other than what is already in place. It’s okay to lose a bit of dignity for a while, if we can expect a benefit, but I believe, in this case, it’s degrading. What can we now do to make his life dignified and comfortable for him? There are many medical things we can do. That part is easy. What is really hard for all the doctors and nurses is that there is no chance of improving his condition.”

  He let all that sink in and sat there with them for many long moments. Then he continued.

  “It is very sad for everyone here, for us, and for you, that your husband is dying. In fact, without these machines and drugs chugging along, he would be dead already. No matter what we do now, the outcome is going to be the same. He will not improve and there is no chance that he will recover from this.”

  No one could fail to hear the kindness in these harsh words.

  “I THINK YOU have a crush on Darryl Price.” Morty was teasing me again. “I saw you send him a card in the hospital mail delivery. Was it a fan letter?”

  “It was a St. Patrick’s Day card that said ‘mazel tov’ on it. He’ll know who it’s from and no, I do not have a crush on him. I am a very happily married –”

  “Yes, you do. I’m going to call Ivan and tell him.”

  “I do not. I admire Darryl.” I said it in such a way as to show them that yes, I was hot, but only under the collar. “Okay, you’re right, I have a crush on him. I’m attracted to his mind.”

  “Oh, so that’s it.” Morty smiled knowingly.

  “Yes, I like the way he thinks and the way he talks to families.”

  “Are you sure?”

  “Yes, I love his words.”

  “That all?”

  “No, there’s more. His courage.”

  12

  THE DIFFERENCE BETWEEN A FOOT AND A PENIS

  Nicole pulled me outside the room, well out of earshot of the patient’s mother, to give me a whispered report. I gasped after hearing the first few details.

  “You’re kidding … it’s not possible … I never had such a patient,” I said.

  I had just returned to work after a long maternity leave. Ivan and I had a baby boy, whom we named Harry, and I was as happy as could be. That first day back, I was thrilled to see all my old friends and catch up on the gossip. However, what awaited me in my patient’s bed that day gave me a shock for which nothing in my ten years of nursing had prepared me.

  I think about them still, my patient, Samuel Jürgens, and his mother, Cindy. It makes me wonder if all stories should be told. I’m not sure about this one, but it haunts me, still.

  In my patient’s chart was a long list. Two whole pages outlined his medical problems, most of which he’d been born with, nineteen years ago. Samuel had a genetic disorder that resulted in severe mental retardation, kidney problems, diabetes, a seizure disorder, major heart malformations (for which he’d undergone numerous corrective surgeries), and severe physical deformities such as a tiny misshapen head with a prominent forehead, misplaced eyes, a severe cleft palate, and webbed fingers and toes.

  “But what’s he in the ICU for?” I asked, for as serious as his problems were, none was life threatening.

  “Pneumonia,” Nicole said. “He’s here for intravenous antibiotics and mechanical
ventilation through his permanent tracheostomy. The mother does just about everything for him. You’ll have an easy day. She’s moved in with him here and brought in an air mattress that she uses to sleep on the floor beside his bed. His mother does everything for him – and I mean everything. Absolutely everything you can think of.”

  After hearing all that, the first thing I did was wave at the mother sitting in the chair beside her son in the bed and call out to her that I would be with them shortly. The next thing I did was go to the nurse in charge and notify her that for my next shift, I would like a different patient assignment. One day caring for this particular patient would be enough for me. No siree, it’s too much to ask. We are a team and we have to share the really difficult cases. They should be assigned on a rotating basis. She agreed and made note of my request. Other nurses nodded in agreement. They didn’t like to be in there very much themselves. Take care of him today and you won’t have to go in again for a long time, they assured me.

  The patient’s mother must have sensed my apprehension because she beckoned me over.

  “Come on in, Sam won’t bite.”

  I approached them. In the big hospital bed lay a huge, strapping nineteen-year-old body with a tiny, baby brain encased in a distorted, mangled head. From what I understood from the chart, there was something wrong with almost every single part of Sam.

  “He functions at the level of a three-month-old infant,” said Cindy. She sounded as proud as other mothers I knew who claimed their child was gifted.

  I thought of my own son, who was just ten months old. I recalled how at three months, crying, feeding, and sleeping had been the extent of his activities, and at the time I loved every minute of it. But now, at ten months, his repertoire of skills had expanded to sitting up, playing peek-a-boo, and smiling at me in recognition. How much more gratifying and fun was each day that he could do more and more wonderful things! What joy – and relief – we felt as he reached each milestone. Would I love him as much if he couldn’t do these things? I hoped I’d never have to find out.