by Tilda Shalof
Tracy’s father was okay, but Tracy was a mess. Her eyes were bloodshot from staying up all night with him. She had not left his side for a minute. However, the biggest hurdle for her had been just getting into the hospital. With a second wave of SARS threatening to spread like an epidemic, even stricter control measures had been put back into effect throughout the entire hospital. No one other than staff giving direct patient care was allowed into the hospital. Somehow, Tracy had managed to sneak in and get to her dad. He was lucky; all the other patients were on their own, with no visitors to keep them company or give their loved one that special attention.
Tracy’s dad had been kept in the holding area of the Emergency department, lying on a stretcher, for two days, waiting for a bed. Finally they found one for him on Cardiology and he was being transferred there, just as we arrived. He was in stable condition, but would be kept for a few days more until a heart catheterization could be done to determine if he had any blockages in his coronary arteries and see if bypass surgery was an option.
Frances had helped him wash himself, gave him a shave, and then went down to the drugstore to buy him a toothbrush and toothpaste.
Laura had joined us, took one look at him, and marched off to find a resident and point out to him that Mr. Smyth’s right leg was swollen and painful, possibly indicating a deep vein thrombosis – and “how could you have missed that?” I heard her accosting him. She also managed to convince the doctor to increase his dosage of pain medication as he was clearly in discomfort but was the stoic type who never complained.
“The patient under-complains, the doctor under-prescribes, and the nurse under-administers – it all adds up to pain control worth diddly-squat,” she said to us, as if all the responsibilities of the world had come to rest on her shoulders. “Do they really believe that patients in pain are at risk of becoming drug addicts? Is that what they’re afraid of? Honestly! How many times have you guys ever seen a case of over-shooting pain medication?”
Nicole had helped Tracy’s father to change into a fresh hospital gown. I told Tracy to step out for a minute so she didn’t have to help put the urine bottle in place so that her father could pee.
“Get out of here for a sec, Tracy. Just be a daughter now, not a nurse.”
I knew the difference. How well I knew how hard it is to be both. Better to be one at a time. I pulled up a chair and sat beside Mr. Smyth’s bed and asked him what he thought about the war against Iraq.
“I’ve seen a lot of war,” he said, “and I’ve been thinking about my grandchildren. War isn’t good for children, you know.”
He told me about his experience in the British Navy. He had been a submarine gunner off the coast of Normandy during World War ii.
“You girls are angels,” he said, looking not quite as grisly as before Frances’s beauty treatment.
“No, we’re not,” said Justine, shaking her head vigorously.
“Speak for yourself,” said Laura, who was leaning up against a low-lying window ledge. “You may be a devil, Justine, but I’m an angel.”
“No, nurses are ordinary human beings, professionals doing a demanding job. All we’re asking for is fair working conditions, a decent wage –”
“That’s enough, Justine.” I poked her. “This isn’t the time.”
“If anybody is to be praised,” she continued in a calmer vein, “it’s these nurses who work on the floors. You haven’t seen a nurse yet, Mr. Smyth, because your nurse has eight other patients who are in worse shape than you. The entire hospital has become one big intensive care unit. The typical hospital patient is being sent home now to be cared for by whoever is available and willing. Patients who are now in the ICU are ones that not too long ago were unsalvageable altogether. Hospitals have to change.”
She hardly stopped to take a breath and continued.
“Can you imagine working here on this floor, running around all day, never feeling that you can master the work, never feeling in control over your time, or the demands made on you? Never feeling like you can do a satisfactory day’s work? You know exactly what the patient needs, but your hands are tied. The institution takes away all our creativity, initiative, and power and turns nurses into stones.”
Tracy’s dad was listening closely. “You gals deserve more respect.”
“No,” Justine railed on, “nurses have to respect themselves first. We can’t expect respect from anyone else until we have it for ourselves and we have a long way to go on that score.”
I had been watching the nurses on that floor. I saw them rushing around, answering phones, setting up lunch trays, taking a blood pressure, and dashing off every so often to record everything in the charts. All the while, with this new and frightening virus, nurses were having to don masks, gloves, gowns, and goggles, and change out of all that and scrub their hands, and then put on a new set of everything all over again before going to the next patient.
“You know what’s the hardest thing about these masks?” said Frances, pulling hers down briefly for a gulp of air.
“Breathing?” I asked.
“I don’t know, but they’re playing havoc with my makeup,” said Nicole. “I have to keep reapplying my lipstick!”
“That, too,” Frances said. “The worst thing is you can’t read patients’ facial expressions. And you can’t smile at them.”
“Only with your eyes,” I said, making mine smile at her.
“Can you imagine how patients are feeling these days, being isolated, only occasionally seeing a nurse appear at their door? Two eyes over the top of a mask?” Frances asked.
“You’ve all been so good to me,” said Mr. Smyth. “How can I ever thank you gals?”
“It’s nothing,” Frances told him, eager to relieve his sense of obligation. “I give 100 per cent to my patients. Why wouldn’t I give 110 per cent to one of our own?”
How many people can say that about the way they do their work? How many nurses can say that about their practice, that they give 100 per cent? How many nurses can say it and have it be as true it was as in Frances’s case? Was I a giver like that? Had I managed to conquer myself to that extent? Not quite, I knew, but I was still in it, with no plans to go anywhere else.
It used to be that I gave what I could, yet at times had felt so depleted, resentful, and bereft. Now, I know what it is that I give and I have learned to value it. I’ve learned how to take care of myself and know now that I can find compassion for other people’s pain only when I’ve first found room in my heart for my own.
THERE WERE MORE reasons to celebrate that night.
Justine had just graduated with her degree in nursing and as the class valedictorian, she had given a thought-provoking speech about the perilous, but promising future of nursing. She delivered it with the new, more sober attitude she’d adopted lately. Still, she managed to keep the crowd entertained and, at times, had them laughing uproariously.
“If you ever want a break from nursing,” I joked, “you’d have a bright future in stand-up comedy.”
“Funny you should mention that,” she said. “I’ve decided to leave nursing.”
“What?” I gasped, thinking for a moment that my comment had jinxed her, but as soon as she said, “I’ve applied to law school,” in a flash, I realized what sense that made.
“Maybe through legal channels or politics, I can make a contribution to nursing. Let’s face it, my strength isn’t patient care.”
It was big of her to admit that, but I didn’t entirely agree. She had kept many patients in stitches and wasn’t laughter the best medicine? She intimidated some families, but they all respected her intelligence and knew her heart was in the right place.
“Everything changed for me that night that I was totally out of line. I lost control of myself and was lucky I didn’t get caught and that no one reported me.”
The incident she was referring to had happened a few weeks ago and I had been in charge. Justine was caring for an elderly woman. When I came in on
rounds I saw that there were ten iv pumps running and six iv lines in various parts of her body, and tubes and drains everywhere. The ventilator was on maximum settings and the patient was thrashing in the bed so wildly that we had to restrain her hands in order to do what we were doing, which naturally made her even more upset. But what was the alternative? We still didn’t know. Our response when the family kept asking for “everything to be done” was to try to impress on them that “everything was being done.” For them, it was not enough. There was nothing more we could offer, but they wanted nothing short of a miracle.
But there, in the meanwhile, lay Justine’s patient, a helpless old woman, straining at the tube in her mouth and grimacing with every single thing we did to her. For me, the worst part was seeing the terror in her eyes. What could I do but look away? But not Justine. Not that night. She chose to see everything.
The family had left for the day and suddenly Justine jumped up.
“I’m going to call them,” she said, “I’ve had enough of this.”
“What are you going to say to them?” I trailed after her toward the telephone. There was no stopping her – I didn’t even try – and soon I heard her talking to the patient’s son.
“Look here, this is your mother’s nurse, Justine Fraser. What? … Is everything all right? No, everything is not all right….
You’d better get in here right away. We’ve got the ventilator going full blast and your mother is on every known drug, running at industrial-strength doses. Unfortunately, we cannot cure old age! If your mother arrests tonight, I want you to be here to watch me pound on her chest and crack her ribs to try to get her heart started up again! You guys are not thinking clearly. This is cruel. You’re doing it for yourselves, to put your minds at ease. It’s not for your mother.”
Unbelievably, from what we could gather, they were thanking her over the phone.
“I was way out of line,” Justine now admitted, “and I know it. But that night I decided to be guided by what I believed was right for the patient. The place finally got to me. It pushed me right over the edge! I’m ashamed of the way I behaved. The way I spoke to the family was wrong. They could have reported me, but they didn’t.”
Shaken by Justine’s harsh words, the family had rushed in and faced the realization that there was no point in continuing treatment. Perhaps Justine had made them see the situation differently and that helped them to make different choices. Or maybe they had felt coerced or shocked by her words. Perhaps they were relieved that someone had made some of these fateful decisions and they didn’t have to bear any of these onerous responsibilities. At any rate, they came in, and we gradually, slowly, brought the battery of machines and drugs to a grinding halt. We pulled out the tube and stripped away the equipment and listened to the room becoming quiet, except for the deep, rasping, irregular sounds of the mother’s last breaths and the family’s sobbing. We pulled up chairs alongside the bed and stayed with the patient and the family until the end.
I watched the straight backs, the outstretched arms, the kind, attentive faces of the nurses around me, as we did this sacred work. I looked around at their faces and their eyes met mine. I think I had an inkling that night that it might be the last time we would all work together as nurses.
WE HADN’T SEEN much of Tracy lately, who was still taking university courses to complete her degree in nursing, and was busy with her young family and taking care of her father who was recuperating at home. She had switched to permanent nights and weekends and that was apparently taking its toll, too.
“My neighbour says to me ‘have a nice weekend’ and I’m thinking what weekend? My weekend is Wednesday and Thursday. I don’t know how much longer I’m going to be able to keep this up,” she said with a weary sigh. “It’s too hard on my family. I overheard my kids talking the other day,” she continued. “Matthew was saying to Jake, ‘Stay away from Mom. She’s crabby when she works nights.’”
MY HEART WAS sinking. They were dropping like flies.
I looked over at Frances.
“Don’t worry, Tilda,” she reassured me. “I’m not going anywhere.”
But I sensed reservation in her voice.
“At least not for now,” she added.
I searched her face for clues, for assurances she’d stay, but she wouldn’t commit.
“Promise me you’re not going anywhere, Frances.”
She kept quiet.
“C’mon, Jabber Jaws,” said Laura. “You’ll be here forever. You’ll never leave this place.”
“I can’t go on without you guys,” I said.
“This is not the Titanic going down, Tilda. I’m sure you’ll survive,” said Frances sternly. “The manager of the OR called me and asked if I’d like to work there. He promised to send me on the course next month, but when I took a look at the textbook, I had my doubts. It’s all about retractors, ratchets, and forceps. The advantage is it’s straight days, and just the occasional on-call duty for nights or weekends.”
I looked at her in dismay. “How could you?” I guilt-tripped her.
“I’m turning forty-four this year, Tilda. How much longer can I keep doing all these nights and weekends? Christmas, New Year’s?
Nursing is for the young. Besides, all the suffering and death – it chips at you after a while, the sadness of the work we do.”
“But Frances, you always said you could handle the emotional demands. Remember how you told me you believed that our work was good, that we helped people and that was what always kept your mind at ease?”
“Yeah, I still feel that way, but being around so much sadness is making me sad, too. It creates more sadness than there was in the first place. I’ll give you an example of when it really hit me. Do you guys remember that young girl, only twenty-four? ‘It’s not fatal, is it?’ the mother asked me, but I was too busy to talk to her, her daughter was so sick. But even when I finally got things under control, I found myself putting off going out to the waiting room to face the mother. I never used to do that.
“They were East Indian; I remember the mother’s red sari and the gold bracelets along her arm. Surely they had been told how serious pulmonary fibrosis could be. She had cared for her daughter for years, and now she had to turn her over to us and stand by and watch. We were the mothers, now. Later when I was on lunch, I could hear someone calling for the arrest cart and I thought to myself, Just stay put and eat your lunch, Frances. It’s your break. Other people can take care of the situation. But I couldn’t sit there and eat my lunch while my patient was arresting and so I went back to her room. There was a crowd in there. They didn’t need an extra pair of hands in there right then, but I knew where I was needed. I went out to the waiting room. I didn’t even have to say a word. She saw my face and I had to practically carry her like a newborn baby down to the ICU. Anyway, the daughter was arresting and they were still working on her and the mother kept asking me what was happening and all I could say was ‘It doesn’t look good.’ I didn’t say much more but she couldn’t have taken much more right then, anyway. She collapsed onto the floor. Belinda, Ellen, Pang-Mei, and Bruno were all on that day and they helped me carry her into the resident’s on-call room where we tried to lay her down on the bed. But she didn’t want to go on the bed. She threw herself back onto the floor and started writhing around. I sent someone to get a crash cart for the mother, just in case. Belinda thought she’d fainted, Pamela thought for sure it was a seizure, but I could see it wasn’t that. Someone else thought we should give her Valium. I gave her oxygen and took her vitals. Her blood pressure was okay, but meanwhile she had lost consciousness, so I slipped in a bite block to protect her airway. Someone brought her a blanket from the warming cupboard, and we stretched her out on the carpeted floor and covered her. Everyone was speculating about the problem and what could be the cause. Then I figured it out. I knew the diagnosis. Grief. That’s what it looks like and that’s what it was. There was no other diagnosis and the only treatment was nursing c
are. I have always prided myself on giving that kind of care, but it sure takes its toll at times. Now, I don’t know any more if I want to spend all my time around such sadness.”
“Yeah, it’s not only that, it’s the politics, too,” said Laura. “The last straw for me came about a month ago. I was in charge and I had to double up nurses in two different rooms and it was very unsafe because both patients were very unstable. To top it off, I was short-staffed for the next shift and had to spend every spare moment on the phone trying to call in overtime. I didn’t have enough nurses, so we had to close the ICU and we ended up turning down a lung transplant and the ruptured aortic aneurysm had to go somewhere else. The lungs went somewhere else and I hope to God the aneurysm made it. I had to bed-space another patient in the recovery room, but they were stretched to the limit over there so I had to leave the unit, go over and take care of the patient myself, for a few hours. That morning, I said to myself, ‘That’s it. I’ve had enough.’”
So now Laura and Justine were leaving nursing and Tracy and Frances were having second thoughts.
It was no surprise to us that Nicole was leaving. We had known about it for some time. She was moving to Atlanta, Georgia, for just a few years only – she’d be back, she insisted – with her husband, Andrew, who was now a thoracic surgeon, and they had a baby on the way, too. Andrew had been offered a staff position at a big medical centre. Nicole had been looking so classy lately in the pearl necklace he’d given her – she’d taken to wearing it with her green scrubs.
“Lots of great golf courses down there,” she said. “You’ll all have to come and visit. Right, y’all? You come on down, you hear?” she added, practising her Southern accent.
“Andrew is looking forward to not having to wait weeks for his patients to get their CT scans and MRIS. He won’t have to scramble to book procedures and OR time for his patients and won’t have to scrounge around for research money. It’ll be a nice break for him and I’m sure we’ll be back one day.”
