by Tilda Shalof
Suddenly, I felt impatient with her and eager for my shift to be over. This case was stirring up too many uncomfortable feelings. We had learned in nursing school about being empathetic and non-judgmental but in this situation, I was struggling to do these fundamental things. Did you have to hide all your feelings in order to be a nurse? If so, who out there was so virtuous? And I couldn’t put out of my mind that critically ill young woman in Emerg in fulminant hepatic failure. She desperately needed to come to the ICU and there was a chance we could save her, but we didn’t have a bed for her. We didn’t have a bed for her but here was Sam, with no hope for recovery or real improvement, taking up a bed that she could have. Maybe what Morty had said at breakfast was right, that we couldn’t save everybody. Health care cost a lot of money and we had to make choices. Here was Cindy dictating to us what should be done, possibly just to get her own needs met. It couldn’t be for Sam’s sake that she was doing all of this. She was calling all the shots and we were following her orders.
Cindy continued to smooth out Sam’s sheets. Sam was grunting and farting. His farting heralded a stream of diarrhea that seemed to please Cindy because it gave her something more to do. His head reared back against the pillow. His eyes were open toward the ceiling, but he did not appear to be aware of anything up there, not the ceiling light, nor the room, nor his mother’s constant presence.
On the one hand, what Doris and the other nurses said was mere speculation. It was dangerous and wrong to raise such serious allegations without proof.
On the other hand, what if the rumour were true? I had noticed that Nell, who had been sitting with us at breakfast, had kept quiet. Perhaps she, with all her ludicrous stories and confabulations, was uncomfortable facing a disturbing truth. Anyway, to me it seemed true, or at very least plausible, that Cindy could be having that kind of relationship with her son. The image of it came easily, without effort or strain, full-blown in my mind. It did not require a stretch of the imagination. I thought about how Cindy kissed him on the lips and draped herself across his body. How she wanted him to have children, but said she was too old.
But even if it were true, it seemed to pale compared to the tragedy of Sam himself. His existence in this world was undoubtedly a tragedy. Or was it? Maybe the failing was in those of us who are unable to accept what we are given and find its meaning. Perhaps that was more important than whatever might be going on between him and his mother.
Oh, but when Sam does die one day, how Cindy will suffer! How lonely and bereft she will be without his companionship, such as it is, and without the pleasure he could give her. Sam was everything to her. Yet, did she love him so much that she was prepared to do everything to keep him alive, or did she not love him enough to let him go?
I turned away from the two of them to face the window. I gripped the edge of the sink and looked out at the dark courtyard below and wondered if Ivan might pick up beer and chicken wings for dinner. Barbecue, Ranch, Cajun … I was tired and I wanted to go home. I wanted to see my own baby and make sure he was as normal as I thought he was. As normal as he was when I left him this morning. I wanted to be with Ivan, have fun together, and put all of this out of my mind.
As I prepared Sam’s 1900 hours dose of antibiotic, I fleetingly considered labelling the bag with a medication sticker, but omitting the drug. If he were to miss just one or two doses of antibiotics, the infection could overwhelm him, and he would become septic and that would be that. I pushed the terrible thought out of my mind and gave the medication as ordered.
I looked at the clock, waiting for my shift to be over. The minute hand made one complete revolution. Then another. I turned back to watch Cindy massage Sam’s feet again and see the way she cradled the heel and held his toes in her hand. It was so plain to see – her hand was full of love for the foot, for the whole person who was her son. Cindy brought his foot up to her face and held it against her cheek. She kissed the sole of his foot and closed her eyes, savouring his taste, his smell. She asked for nothing in return from Sam, just to love him. The way Cindy was holding his foot, the way she rubbed it, kissed it, caressed it against her cheek was exactly what I did with my own little baby’s foot. What was the difference? We each had given birth to our sons and loved whatever had come out of us. That my love seemed natural and easy to me, and that hers for Sam seemed impossible, was a failing in me, not in her. If Cindy Jürgens was using her body and Sam’s to communicate that love – and what really was the difference between a foot and a penis, anyway? – and if some of that primal, physical love was transmitted to Sam, and if it was perceived in any way in his primitive brain cells, and if maybe, just maybe, it gave him some pleasure or human connection or alleviation of discomfort – we would never know if he had pain or pleasure – during his stay on the planet earth, then who was I – or anyone – to say it was right or wrong, good or bad? If I started deciding all of that, what kind of nurse would I be? What kind of person would I be if my mind were made up about everything? To be the kind of nurse and person I wanted to be, I would have to break through all my prejudices and get beyond all judgment. I decided to have no opinion about the whole matter. The only rule I would have would be compassion.
I went over to Cindy and Sam. She was applying peppermint-scented oil to his feet and moving her hands up his legs.
“Cindy, I’m going to go out to help another nurse who has a busy patient. Sam is stable and the monitor alarms are on. Come and get me if you need me. You and Sam need some privacy.”
She looked up, surprised. She had not been alone with him even one minute since he’d come to the hospital. At home he belonged to her, but the hospital had a way of taking claim. We don’t own other people, certainly not our children, but Sam belonged to her more than he belonged to the hospital or to any of us. She deserved some time alone with him.
I closed the curtain around them. I shut the door. Then I turned my back on the two of them and gave her time and space to love him however she chose.
13
SHH! IT HAPPENS
I had been a critical care nurse for twelve years. During that time I had written articles about nursing, spoken at conferences, been a mentor to new nurses, and even conducted a research project. However, no matter what foray I made into related pursuits, I always wanted to return to the bedside. For me, it was where I found the greatest challenges and satisfactions. It still is.
Other than two maternity leaves, I had only one extended hiatus from working in the ICU and it was the result of a ridiculous escapade. I had to call work to let them know I would be out of commission for a few weeks.
“Laura, is that you?”
“Tillie! What’s up? Why did you call in sick? You sound pretty healthy to me.”
“I’ve had a little … mishap.”
“Are you okay?”
“Yes, but I broke my ankle.”
“What happened?”
I had to tell her. I knew they would never let me live it down. They still remind me of it, whenever the circus comes to town.
“I … just hope … you had …” Laura could hardly speak. She was choking on tears of laughter. “A pink parasol!”
A long-ago pledge I had made to myself to be a “fun” mother when I had my own kids prompted me to do something reckless and foolish. Since my own mother had been an invalid, lying motionless on a couch for days at a time, only to rise up more tired and weak than before, I promised myself I would be different. At a children’s birthday party with a circus theme, I watched the kids swinging merrily on the trapeze. I giggled at the clown and even made a few tentative jumps on the trampoline. I decided to ask for permission to try the tightrope.
“Sure,” said Boris, the Russian ringleader, with a chuckle. “Go ahead.”
It was only a few feet across, four feet off the ground, and surrounded by soft mats. I stepped onto the tightrope and inched along, as graceful and lissome as an acrobat. I executed my aerial stunt beautifully, but upon my clumsy dismount, the lou
d sound of crack was easy enough for anyone to diagnose.
A six-year-old girl looked down at me where I lay on the mat. “Did you break your foot?”
EIGHT WEEKS OFF work with my foot in a cast gave me an opportunity to step away from the bedside and reflect on my profession. It had become a particularly exciting time. The hospital had appointed a new director of nursing who was a brilliant and inspiring leader. She gave dynamic and invigorating lectures about nursing. She believed in the value of the work we did. Not only that, but we knew she would be a formidable presence on our behalf at the corporate table.
When she first arrived, she held a series of informal meetings, open to all staff nurses, and since I had so much free time on my hands, I came to listen to what she had to say.
It was a glorious afternoon in late September. The sun was streaming through tall windows in the auditorium where the meeting was to be held. Our new director would speak and then open up the discussion to all of us to raise whatever issues or concerns were on our minds. No topic was off limits, she assured us. Confidentiality was ensured. Tea and biscuits were served.
First, she showed us a beautiful photograph she had taken on a trip she had made to the south of France. It was a picture of an arched stone bridge and she referred to this structure as a “hermeneutic channel.” She spoke about the symbolism of the image, its simple beauty and its union of function and aesthetics. Somehow, she gracefully segued into an entreaty to all nurses to end our long-standing tradition of passive silence in the face of client suffering and injustices in the health-care system. She expressed her belief that nurses are the new “knowledge workers” in the health-care system of the twenty-first century. She called upon each of us to seize and cherish the opportunity to make a difference in our patients’ lives. Standing tall before us in a dark suit upon which a jewelled brooch glinted in the sun, she threw her arms open wide with the vastness of her vision of our profession’s glorious future.
The nurses sat in pink, white, or blue uniforms, or baggy green scrubs, listening and munching cookies. I was sitting way at the back, wearing my street clothes, having come in from home for the meeting, hobbling in late, still learning how to use my crutches.
I was thrilled that we had a leader with such an exciting vision for our profession. Finally, here was someone at the helm who believed in the value of nursing, and from what I could see, she would fight for the things we deserved – recognition and respect. But still, for me, something was missing. It had nothing to do with our salaries, working conditions, or gruelling schedules. It was something that was never raised publicly. It was something that seemed at odds with her lofty vision of our roles, yet I knew it was an important part of our work.
What I wanted to raise was too wild and too crude for that gentle assembly. It wouldn’t sit well with these nice refreshments we were enjoying. I didn’t have the courage to raise it. It was an important aspect of our work, yet we hardly ever talked about it, even among ourselves, except to joke about it. It was the underbelly of nursing life.
Many nurses couldn’t cope with the dirty work of nursing. Those nurses often chose to work somewhere other than in the hospital with patients, certainly elsewhere than the ICU, where patients and their bodies were the most vulnerable. Some nurses sought cleaner, easier places to work, or took refuge in computers, paperwork, or teaching. Who needs a university degree to give a bedpan? they said.
In fact, so frequently did I hear that bedpan remark that I grew to expect it, like a slogan or a motto of some kind. I had heard it from so many different nurses, in all the hospitals that I had ever worked at. It reminded me of a breed of chimpanzee that I had read about who all have the same habit of wiping their faces with banyan leaves. Who knew how this same behaviour got so widely propagated among unrelated members of the same species who inhabited different continents?
I was dismayed at how nurses reduced our profession to a toilet. They made bedpans our emblem, like the stethoscope symbolized the doctor, and a gavel, the judge. Yet, if we did want to stay at the bedside taking care of patients, this personal, intimate care was an essential part of our job. Sometimes it made us feel unclean and demeaned. We knew that patients who lost control of these functions of their body surely must feel embarrassed and ashamed, but so did we at times, for doing this work.
When I had to clean blood, urine, sputum, vomit, or feces (there was a secret hierarchy), I tried to focus on the person, not the bedpan or the basin. I wanted to help my patients keep their dignity, but the trouble was that in those moments, I was struggling to hold on to my own.
Perhaps it was the juxtaposition of hearing those lofty, philosophical thoughts put forth by our new director of nursing, coupled with the opportunity I had around that same time to perform an act of hands-on care for a dying woman in her home that made me reflect on the significance of nursing’s dirty secret. I decided that one day I would break through this frontier and expose the scariest, messiest taboo of all.
THANKS TO TV shows like ER, it is generally well known that “Code Blue” denotes an emergency – likely a cardiac arrest – somewhere in the hospital (and something of a badge of honour for those chosen to run to attend to it).
“Code Red” is the signal for a fire alarm.
“Code White” means a violent patient, sometimes from the psych ward, who requires the muscles of the security guards.
“Code Green” warns of a toxic spill.
“Code Yellow” is a patient on the loose – someone MIA or gone AWOL.
We nurses coined “Code Brown” for our own purposes. It was our cri de coeur, our SOS signal for help – STAT – with a clean-up job.
We called ourselves the Poop Patrol, the Bowel Brigade, the Shit Shovellers, because, at times, that’s how we saw ourselves. We all had memorable stories on this subject, and looking back now, here are a few of mine.
One day, Rodney, the hospital assistant, was nowhere to be found, and I urgently needed his help to transfer my patient to the floor. I was under pressure to move this patient out because there was a very sick patient on another floor who had just arrested and needed to come to the ICU right away.
“Okay, Tilda,” said Laura, who was in charge that day, “I don’t know where Rodney is. You and I will transfer your patient up to the floor ourselves and then swing by the other floor to pick up the arrest patient. I guess we’re porters, movers, secretaries, housekeepers, and maids. Whatever. C’mon, let’s go.”
My patient was all ready. His personal belongings had been returned to him in a big white plastic bag and his meds were sorted into small clear bags. He had recovered from abdominal surgery that had been complicated by a post-op pneumonia, but he had recovered completely. Soon, up on the floor, he would graduate to “DAT” (diet as tolerated) and “AAT” (activity as tolerated) orders.
Laura released the brake of the bed and went to the head to pull and I went to the foot to push. We were barely out of the door when another call came from the floor.
“When are you coming for this patient? He needs to come down to the ICU right away,” the ward clerk called out.
“Tell them we’re on our way,” Laura shouted back.
But just as we were wheeling my patient down the hallway, a dark cloud passed over his face. It was plain to see. Something was bothering him. He clutched at his stomach.
“What’s wrong?” I asked.
“I need to, er … use the bedpan. Please take me back to my room.”
“Wait till we get you to the floor. We’re almost there,” said Laura, forging ahead toward the elevator. “They may even let you use the toilet, if you behave yourself.”
“No, nurse, I need it now. I can’t wait.”
Laura and I looked at each other.
The insistence in his voice made us turn around and wheel him back to his ICU room. I gave him the bedpan and closed the curtain. Moments later we returned to remove the bedpan and resume our trek to the floor. But something stopped us in our trac
ks. Laura and I gazed down in the pan, astounded. It was the most massive quantity of feces all in one deposit that we had ever seen. We could see the entire, fully intact imprint of his intestines, sculpted in a multi-layered, coiled mound. We could see the duodenum, the small and large bowels, the cecum, and the rectum. It was finished off with a satisfying (for him, presumably) swirl on the top. We stared at each other. It was a sobering sight. It gave us pause. It was unbelievable that so much stuff could be lodged inside a human’s body. But it made us feel small and worthless, too, because of this work we did. For moral support, we carried the bedpan together and while I dumped it into the toilet, Laura flushed.
“I wonder what the Royal Family is doing right now,” she grumbled.
“You must feel great now,” I said to the patient as I came out and washed my hands at the sink.
“Never felt better!” he sang out.
Like a soldier recounting a war story, or a fisherman boasting about the size of a catch, Laura couldn’t help but telling what we had seen to, of all people, Nell, who wasn’t the least bit impressed. Handily, she topped our tale.
“Once, when I worked as an outpost nurse in the Australian Outback, I had a patient who pushed out a snake. A live, hissing snake.”
“A cobra, I’m sure,” scoffed Laura. “Or was it the Great Green Mumbo, by any chance?” She was determined to catch Nell in one of her fabrications, one day.
“Maybe it was a worm. Maybe the patient had a parasite and you thought it was a snake,” I suggested.
“If anything, it would be a garter snake,” said Frances, who was even more gullible than I, if that was possible.
“Tilda, if you write about this, I swear I’ll kill you,” said Laura. “But, on second thought, if you do, why don’t you start out, ‘Dear Diarrhea’ …” She cackled away at her cleverness.
FOR SOME REASON that none of us could fathom, Nicole never wore gloves when taking care of patients. She thought nothing of plunging her hands into a basin of brown water while cleaning her patient after a bout of diarrhea. She’d even clean up vomit or change an infected, oozing tracheostomy dressing, glove-free.
