by Tilda Shalof
Praise for A Nurse’s Story
“In a post-SARS world where nurses are finally being recognized for the heroes they always were, A Nurse’s Story is the best-seller no one can put down.”
– Montreal Gazette
“There are genuinely heart-rending, disturbing and thought-provoking stories to be found in the pages of A Nurse’s Story. If this book doesn’t give you pause, you’re made of stone.”
– Edmonton Journal
“Tilda Shalof’s A Nurse’s Story is the first time the work of nurses has been documented in print in Canada in such an honest, no-holds-barred account. … Shalof has seen it all, and writes about it, too.”
– Calgary Herald
“[Shalof’s] book isn’t a doom-and-gloom account of overworked nurses. Interspersed with tales of tragedy are accounts of the funny, often bizarre events that transpire in an ICU.”
– Canadian Press
“[A Nurse’s Story is] difficult to put down, so compelling and beautifully written are these stories. … Shalof’s colleagues point out during one of their ongoing discussions about the value of their work, that eventually everyone needs a nurse. And for that reason alone, A Nurse’s Story would be worth reading, in order to understand where it is most of us will end up sooner or later, what it is that might be visited upon us and just who it is that will be looking after us.”
– Winnipeg Free Press
“Readers may approach this book with the hope of reading dramatic tales such as those seen on television shows such as ER. While such readers are not likely to be disappointed, they are likely to discover more than they had hoped.”
– Brandon This Week
“A cracking good read. … I hope it’s not the only story Shalof has to tell.”
– Quill & Quire
CONTENTS
Preface
1. Home Remedies
2. Watergate Diagnosis
3. Theorizing, Conceptualizing, and Catheterizing
4. Ice Cream Days
5. Harder, Faster
6. Thinking Like a Nurse
7. Hockey Mom, RN
8. Your Mother, Your Father
9. The Proper Use of the F-Word
10. Comfort Measures
11. A Night in the Life
12. Nightmares
13. Chess Moves
14. Inhospitable Hospitals
15. Nursezilla
16. Off-Duty
17. Dangerous Assignments
18. Nursing Confidential
Acknowledgements
PREFACE
There are many wonderful things about writing a book, but the best, by far, is having readers and being in contact with many of them. Since the publication in 2004 of A Nurse’s Story, I have heard from people all over the world. Many are nurses themselves who, despite a diversity of experiences and cultures, and the wide variety of roles, settings, and specialties in which they work, tell me that my nursing stories resonate strongly with theirs. In turn, these new conversations and connections have furthered my thinking about the journey of becoming a nurse and what it means to be a caregiver. Thus, The Making of a Nurse is both the story behind A Nurse’s Story, as well as an up-to-the-minute follow-up of what nursing is like for me, still in it after twenty-five years. It is also my response to the many readers who have asked me to explain what I meant when I said I had to learn “to conquer myself in order to be of service to others.” It was a phrase I had heard in a eulogy delivered at the funeral of a woman who had been a grandmother, a wife, a friend to many, and an active volunteer in the community. That phrase caught my attention because it seemed to sum up what I had been trying to accomplish both in my personal life and in my professional career.
During my childhood, both of my parents had serious, chronic illnesses. For years, I was their nurse, but as a teenager, I began to grow resentful of the care-giving responsibilities expected of me. I longed to escape what felt like an onerous burden. Then, of all things, I decided to study nursing. I remember the day I received my degree and my licence to practise and thought that was that: I was a nurse. Hardly. I had to be made into one. The patients I have cared for and the nurses I have worked with helped me become the nurse I aspired to be. (There are times when it still feels like a work in progress.)
While most practising nurses have expressed a familiarity with my stories, and indeed express a sense of affirmation to see many of them for the first time in print, other readers tell me that they have provided a window into a world they had never known about nor had the opportunity to enter. There is indeed a motherlode of nursing stories, however, and few have been recorded. I wanted to tell mine, but I had to find a way to do so that would ensure the utmost protection of patient privacy and confidentiality. So, once again, in The Making of a Nurse, I changed names (with the exceptions of my family, Pearl Bernard, Dr. Margaret Herridge, and nurse Janet Hale) and all unique and identifying details, and in a few cases created character composites, in order to ensure the complete anonymity of all patients and colleagues. My objective is to explore themes and issues that are not exclusive or particular to any individual patient, situation, or person, rather than to document specific character portraits.
To be honest, something else motivated me to write this book. I am worried. Some of the best nurses I know have left the profession, disillusioned and disheartened (there are lots of things that can wear you down!), and so many nurses actively discourage their own children from choosing nursing. At the same time, people in hospitals and in their own homes are in desperate need of more nursing care. There is a growing, worldwide shortage of nurses. If this trend continues, it will have an impact on each and every one of us: we will all need a nurse at some point in our lives. We are going to have to take very good care of ourselves so that we can take care of each other. Perhaps knowing what nursing is really like, at least from one nurse’s perspective, will help people make a more informed choice about the profession. I hope this book contributes to that understanding.
I often wonder: Who would want to be a nurse, especially if they knew what it really entails? Who chooses nursing these days and why? I ask these questions honestly and open-mindedly, not rhetorically or cynically. Nursing is not a career you can advise or persuade someone to choose and it is a hard path to champion if you have not personally experienced its many satisfactions. I’m quite sure that the vast majority choose it because of a genuine desire to help others, but one nursing student told me nursing attracted him because “the salary is decent and it’s steady work.” Another told me she really wanted medicine, but didn’t get in and nursing was her fallback. I’m afraid these motivations aren’t going to cut it when those nurses enter a patient’s room and are faced with raw human suffering. Nursing is dirty, gritty, messy, grinding, brutal, rough, and heartbreaking. It is also inspiring, sophisticated, challenging, fun, comforting, and at times, exhilarating.
I recall one day, years ago, sitting at the back of a hot, stuffy classroom, learning theories and abstract concepts about nursing, and the professor saying blithely, “Nursing is about Life,” and then pausing to add, “and Life is about Nursing.” How trite, how inane, I thought, jotting down that line in my notebook anyway, just in case I might be tested on it. I was only half paying attention, mostly daydreaming, wondering if I had what it took to be a nurse. Recalling that comment today, I think, how true, how insightful. Yet, how hard won that understanding has been.
My friend Joy says every reader will find something to cry about in this book. It is my sincere hope that every reader will also find lots to laugh about, as well. After all, if Life and Nursing have taught me anything, it is that the two go hand in hand.
Tilda Shalof
March 2007
1
HOME REMEDIES
My patient’s name is Joe, or so he says, and I am his nurse. His chart states his name as Zbigniew Zwiezynskow and under place of residence, there is merely a sad trio of letters: NFA – “no fixed address.” He’s in his mid-forties, admitted last night to the Intensive Care Unit, the ICU, with pneumonia. He’s feverish, delirious, and so violent that he may try to kill me if I decide to release him from the restraints we’ve placed on his arms and legs. But medically, his condition is improving – no small thing here in the ICU, where all of the patients have life-threatening, catastrophic illnesses. We’re full; each of our twenty-two beds is occupied. Attached to every patient are monitors, machines, and equipment and in every room there are sickening odours and horrific sights, but I hardly notice these things any more. I have learned how to go beyond it all, to see through it, push it gently aside and go straight to the person lying there in the bed.
Today, all day, Joe is my patient. His heartbeats, urine output, breaths, cough, skin, dirty fingernails, and wild, greasy hair are all my concern. I will enter his world and for the next twelve hours, minute by minute, I will dwell with him there.
It’s taken me such a long time to get here.
The sheer math astounds me. Since becoming a nurse in 1983, I have put in thousands of twelve-hour shifts at many different hospitals. I have worked with thousands of nurses and hundreds of doctors and other professionals. I have taken care of tens of thousands of patients ranging in age from eight to 104 who have had a multitude of diseases, illnesses, and injuries, and have administered to them a sea of intravenous fluids, rivers of syrups, suspensions, injectable medications, and at least a million pills, capsules, and tablets. Researchers study large populations, searching for patterns and trends, but the only way I know how to practise as a nurse is one patient at a time, seeing each individual in my care through illness, loss, pain, grief, or the prospect of death. For me, each time, the numbers all come down to one. As a nurse, there is the patient I am caring for and together, we proceed, one on one, side by side.
It wasn’t always like this. Even though I was practically born a nurse, with strong instincts to help others, I was raw and unskilled; I had to be made into one. But long before it became my livelihood, taking care of others was my way of life. You could say I practised as an amateur for many years before going professional. My mother was my first patient and I cannot recall a time when I did not know it was my job to be her nurse. I was six years old when she first became ill, but as my father always said, I was very mature for my age.
WHENEVER SHE STARTED SHRIEKING, I went running. With her arms outstretched and her head flung back, crashing waves of sound poured out of her wide-open mouth. Her voice engulfed me. I was drowning, but I dove in to save her. “Please stop!” I screamed at her.
“I sing for you,” she warbled.
“Don’t!” I closed her lips with my fingers, but they exploded open again. Her voice filled the house. There was nowhere to hide. Low and rumbling one minute, it would suddenly screech up to a piercing high note. As soon as I was trapped by her voice, she would pause to recount one of her fables.
“When I was your age, I sang to the birds in the trees and they sang back to me.” She returned to Vissi d’arte, then paused again. “I don’t merely sing Tosca, I am Tosca.” She gave a little laugh. “I am so Tosca, it’s not funny. Like her, I live, and am prepared to die – for my art.”
Yes, she was so Tosca, it made my head ache!
“Tosca brings me to the brink of madness.” Her eyes shone. “Just to the brink, mind you.”
Oh no, never further than that!
“And the secret to life, Tilda,” she leaned forward to impart her wisdom, “is perfect breath control and deep diaphragmatic breathing.”
Her life lessons were often interrupted by my three older brothers, especially when they trooped in together, always hungry, after school. “What’s for dinner?” they’d ask. Tall high-school basketball star David was from my father’s first marriage. Aloof, ambitious Stephen and angry, brooding Robbie were from my mother’s first marriage.
“ Vichyssoise and bouillabaisse,” she sang, to the tune of L’elisir d’amore. On other nights it might be Chicken Cacciatore to Le nozze di Figaro or Bratwurst and Sauerkraut to Der Rosenkavalier. Her singing voice was like a signal to my brothers to vamoose. They scattered in different directions to their rooms, but I stayed close by her side.
She sang wherever and whenever the impulse struck her, even in the grocery store or at the bank. Big, cartoon blasts of Italian arias, French chansons, German Lieder ballooned out of her mouth. I flushed with shame. It was so annoying, so unnecessary. What would make her stop? Poison? A bullet? A dagger? I could do nothing but wait it out. She sang until she dropped down onto the couch in exhaustion. What a relief that was – like when the dentist stopped drilling. I wished she would stop altogether. Singing, I mean. She sang for friends at salon evenings in our home hosted by my father. It was at one such gathering that they each made an important announcement.
After her final encore, their friends called out, “Bravo, bravo!”
“Brava, brava,” my father shouted, loudest of all, to correct them. He stood beside my mother at the piano and faced the guests. “What a set of pipes on that gal!” he crowed. “Unfortunately, Elinor hasn’t been her best lately. The top medicos in the city are running a battery of tests, but I say all she needs is rest. She’s wearing herself out taking care of the kids. They’re a handful, especially Robbie. He’s been acting up lately, nothing serious mind you, just normal teenage hijinks. David, what an athlete, and Stephen, what an outstanding scholar, and of course, Tilda is our little nurse. She’s an angel. I don’t know how we would manage without her.” He put one arm around me and the other around my mother. “But Dr. Wilhemina DeGroot, the brilliant and renowned Chief of Neurology at Toronto General Hospital, is working on this most perplexing case. I feel certain she will come up with a magic pill.”
My mother tugged on my father’s sleeve, to indicate she wanted to say something. First, she thanked the guests, as she always did, but that night added something new. “This will be my last performance. If it were not for you, dear friends, I would not have the courage to go on.”
“Of course you would, Ellie,” my father interrupted. “You can beat this thing.” The guests’ voices rose up again and the tinkling of wineglasses merged with their conversation and laughter.
The next morning, I sat at the kitchen table with my brothers, each one barricaded behind their own cereal box, eating breakfast and planning for prizes they were going to send off for. My father had already left early to go to work. My mother appeared at the door, wanting to join us, but frozen in place. Her dark, wavy hair was tousled from sleep and she still had on her bright red lipstick and dark eyeliner from last night’s performance and her black silk “Madama Butterfly” robe with pink blossoms swirling all over it. I jumped up and went to her. She leaned on me to make her way to the table, and when we got there, I eased her down onto a chair.
“Today,” she announced, “I feel normal.” No one was listening. “Well, nearly normal.” From the pocket of her kimono she took out a small tin of blackcurrant lozenges and popped one into her mouth. She kept those purple “pastilles” close at hand to keep her lubricated so she could break into song whenever necessary. She cleared her throat. “I may have to cancel performances. I must shepherd my vocal resources.” She glanced at the clock on the stove. “Aren’t you kids late for school?”
Why didn’t she know it was summer vacation?
Suddenly, she turned around in the chair as if someone was calling her. Was it a chorus of merry villagers? Don Giovanni asking for her hand in marriage? She stared at the chart on the stove and began to sing, “Beef, boeuf, 375 degrees; chicken, poulet, 375 degrees; ham, jambon, 375 degrees; veal, veau, 375 degrees; la, la la.”
Robbie turned on the radio and strummed his
index fingers in an agitated drumbeat to accompany the Rolling Stones, making it perfectly clear that Mick Jagger was not the only one around who could get no satisfaction. “What do you think of his voice?” he asked our mother.
His question broke her reverie. “Voice? You call that a voice? He has no voice. Singers nowadays can’t make a sound without their moog synthesizers and microphones. They don’t know the first thing about proper breathing. Who can understand a word he’s wailing? His diphthongs are atrocious.”
We could barely hear her. Her batteries were running low. “Why are you whispering?” I asked.
“I have to protect my vocal cords. I am not a piano or a violin. You can’t press my keys or pluck my strings. My voice is my instrument and I have to keep it in good working order.”
I knew all about her voice, how it required hydration, lubrication, and nutrients and how smoke, cool drafts, and spicy foods were to be avoided. She clutched onto the kitchen table to pull herself up and out of the chair. “Now if you children will excuse me, I must prepare for my concert.”
“What concert?” Stephen asked with suspicion. We never knew what to believe.
“A benefit concert for the Institute for the Blind.”
“How ’bout for the deaf?” Stephen muttered, making Robbie and David chuckle.
My mother slowly made her way to the living room, gripping each piece of furniture as she went, and I followed closely behind. At the piano there was a bouquet of red roses given to her by her friends, but they were wilted because no one had thought to put them in water. “I’ll do some light numbers to cheer up those poor blind folk,” she told me. “Nothing too serious.” She rifled through stacks of sheet music. “Perhaps ‘Smoke Gets in Your Eyes’? Or, what about ‘On a Clear Day You Can See Forever’?” She loved her joke so much that she started laughing hysterically and within moments, tears streamed down her face. She could go from zero to flat-out howling laughter in seconds! I loved it when she laughed. When she finally caught her breath, she looked around at the room, as if seeing it in a new way. “It’s a fairyland!” she exclaimed, suddenly seeing a world that was enchanted and hopeful. She wiped her eyes with the sash from her kimono. “Laugh and the world laughs with you, cry and you cry alone,” she said, putting a damper on all the fun. “I’ll do ‘Ah, Sweet Mystery of Life’ and Schubert, of course.”
