The Making of a Nurse

by Tilda Shalof

  “How do I know you’re not trying to poison me?” she asked with a demure smile.

  Could she read my mind? If so, she would know that I wasn’t planning to kill her, but I would have preferred her dead instead of my father. I hated myself for my wicked thoughts. As I eased her down onto the toilet seat and handed her a wad of paper, I prayed she would wipe herself. She sat giggling. “It won’t come out.”

  I looked away to give her privacy. At my tragic clown face in the mirror, I burst out laughing, a vicious, pathetic laughter. How could my father do this to me? I was furious, but cackled with laughter even more. I went to put away my mother’s clothes and turn down her covers, but when I came back, she was gone again. “Where are you?” I dashed from room to room and noticed the open front door. I ran outside and found her sitting behind the wheel of the car in the driveway. She turned the key in the ignition and the engine started up. “Mother, please come inside. It’s late. It’s cold.” She shifted into reverse. I opened the car door, but with surprising force she pulled it shut and released the hand brake. “Let me come with you.” I dashed around to the passenger side, climbed in, and just before she drove off I lunged for the keys and turned off the ignition. “Come back into the house,” I begged.

  “Your father is at the subway station. I have to pick him up.”

  “Mother,” I said, taking her hand, “I’m sorry to have to tell you, but he died.”

  “Don’t you do re mi me, like all the rest.”

  “Come back into the house. It’s time for bed.”

  “Do you have any understanding of what’s going on?” She leaned on me as we walked back in.

  “Very little,” I admitted.

  “You know what?” She brightened with a plan. “I’m going to do what I’m going to do and afterwards, I’ll tell you what I’ve done.”

  “Good idea.” I trudged up the stairs, guiding her up in front of me. I couldn’t wait to get into bed and escape behind my closed eyes. But sometime during the night she stood over me, shaking me awake. “Where’s the conductor? Who’s keeping the beat? The soloist is waiting.”

  “What are you talking about?” I mumbled.

  “I need to see samples of organisms. I have certain stipulations.”

  “Go back to sleep, it’s too early to get up.” I rolled over but somewhere between sleep and morning, I heard her say, “I called the fire department and the police.” Next thing I knew, sirens wailed down the street toward our house.

  I TRIED TO GET back to my classes at the university, but I noticed that wherever I left my mother in the morning was where I usually found her when I returned home at the end of the day. One evening she pointed in an agitated manner at an empty chair and said, “Does that man come here every day?”

  “Who are you talking to?” I barked at her, like a policeman to a suspected criminal.

  “Salut!” She clinked an imaginary glass at her imaginary companion. “Leave us alone.”

  “Mother, do you know where you are?” I said wearily.

  “Pay the driver and give me my change!”

  Suddenly, I could see what was about to happen and I rushed over to her but it was too late. A dark wet puddle was spreading around her on the velvet chair, dripping down and onto the carpet. I pulled her out of the chair, dragged her along to her bedroom, put a diaper on her, and we both fell asleep.

  “Severe cognitive impairment can occur after a psychological shock such as a sudden loss,” Dr. DeGroot explained when I called to tell her what was happening. “It’s a mild psychosis or a traumatic disorientation. It sounds like she’s pleasantly confused. How’s she managing with her ADL?“

  Oh, those darn Activities of Daily Living! The very things that had always been so difficult for her: walking, talking, bathing, eating, and getting dressed. “With my help …,” I told the doctor and as I got off the phone, I sat there considering my own ADL of late: mulling, pondering, worrying, stewing, and wondering. I longed to lie in bed and sob for hours, but it was a luxury I couldn’t afford. I got up, got myself dressed, then my mother, poured cornflakes into a bowl, lifted spoonfuls to her mouth, eased her in and out of chairs, and then sat down to contemplate my life of servitude. I saw everything through a soft, fuzzy film of tears that I didn’t even wipe away. Why bother? More came. Tiny pulses of energy kept me going, but at times I gave up and joined my mother as we sat in our nightgowns watching game shows and evangelical healers on the television.

  “What have you been up to?” Joy called to ask. “My mother is very worried about you.”

  “We get up. We watch The Friendly Giant and The Price Is Right.”

  Joy’s mother, Bunny, got on the phone. “Tilda dear, you have to get some help. Ask your brothers if you can afford to hire someone to help you.”

  “I promised her I’d always take care of her.” But that was a long time ago, wasn’t it? It’s a promise I can no longer keep.

  “It’s too much for you on your own,” Bunny insisted.

  My brother Stephen had taken over managing the finances and had been giving me money for groceries and medications. He told me that there were sufficient funds to hire a caregiver for my mother and so I called the Loving Care Agency (because of the name) and hired a Personal Support Worker. I had to avert my eyes from my mother’s accusatory glare when Pearl Bernard arrived, but Pearl soon won her over. And when she put her strong arms around me, I shivered at her warm touch. “You must have loved your dear father,” she said. Tears sprung to my eyes. Yes, I did, but only now that he was gone did I realize just how much. Yes, I loved him, but I hadn’t shown it and had never told him. Too often, I had been irritated and impatient at his corny jokes. I had refused his exotic meals and hadn’t played along with his word games or puzzles.

  Pearl prepared hearty foods like Callaloo soup, salt fish, and mashed plantains, and my mother quickly regained her appetite. I went shopping for a pair of orthopedic shoes, a raised toilet seat and railing, and finally, with Pearl’s gentle persuasion, the wheelchair my mother had resisted for so long. Grief had brought me to a standstill. My life had been shutting down, but Pearl got us all going again. I even returned to my classes, and the professors and other students all helped me ease back in. Thanks to Pearl, a nurse in her own right, I managed to finish my third year at university.

  In my fourth and final year, we had lots of clinical work in the hospital with real patients, always under the supervision of a registered nurse. Most RNs didn’t mind and a few actually welcomed it, but there were always one or two who didn’t like it at all.

  “It’s not an option. It’s part of your job description,” I heard the manager tell Joan, one of the nurses assigned to supervise me and who didn’t look too happy about it. She was heavy-set and wore clunky white Swedish clogs and made a face as soon as she saw the knapsack I was lugging around, practically split open from the heavy textbooks I was carrying. (I had taken pains to ensure that the university insignia emblazoned on it was hidden from view as I had begun to sense that this was a point of contention.)

  “What’ve you got in there?” she asked.

  “Books,” I muttered.

  “Well, you won’t be needing any of those around here. You become an RN, a Real Nurse, on the job, taking care of patients. Not from reading books.”

  I apologized and trotted after her down the hall. “Tilda? What kind of name is that? Is it short for something?” Joan asked, not looking back. “Where’d you get a name like that?”

  “My parents had a sense of humour.”

  Joan was gruff and a bit rough around the edges, but she was gentle and kind toward patients and I learned a lot from her. She inspired confidence by the smooth way she did technical tasks, all the while comforting her patients with a kind word or touch of her hand. We had six patients to take care of that day, but the first priority was an elderly lady whose fluid balance was uncertain. “Let’s see you go in there and put a catheter in this lady,” she said, standing outside the
patient’s room. “Her urine output has dropped off and we need to follow her fluid balance more closely.” She handed me an armful of supplies. I stood there contemplating the task at hand and realized that although I knew how to theorize and conceptualize, I did not know how to catheterize. Joan took one look at me and chuckled as she took back the supplies. “Come on,” she said kindly, “watch me.” She led the way and I followed in after her. First, Joan explained to the patient what we were going to do. “I’m going to clean you down there,” she said to her as she closed the curtains around the bed and gently uncovered her naked white thighs. Joan ended up letting me do the procedure with her close guidance. It was tricky, as you had to keep a strictly sterile field in order to prevent introducing bacteria, but I managed it successfully. When I told Joy about it later, she thought it a strange thing to take pleasure in, but my fellow nursing students understood exactly how incredibly satisfying it was to see the stream of urine fill the tube once I had positioned it correctly and secured it in the patient’s bladder.

  We were busy that day. Joan and I discharged two patients and received two more from the ICU. I thought I was doing pretty well under Joan’s close watch, but later that day, in the nurses’ station, as I stood behind a floor-to-ceiling rack of patient charts, I was mortified to hear her and another nurse on the other side of the rack complaining and making fun of the students. I heard Joan’s voice first.

  “The patient has Alzheimer’s but she didn’t seem to pick up on that. I found the two of them in the lounge, watching an old Beverly Hillbillies rerun.”

  That would be me. It was the episode where Ellie Mae Clampitt’s pet chicken and a rooster stood at a miniature grand piano, pecking out a duet. Who could resist that one?

  “… they were sitting there, laughing their heads off and my student didn’t even notice the patient’s nasal prongs had slipped out of her nose and she wasn’t getting her oxygen.”

  “You think your student is bad,” the other nurse said with a sigh. “Mine gave her patient’s meds through the naso-gastric tube and then reconnected it to the drainage system so it all drained out – can you believe it? Then she set up a basin for her patient’s morning care with only an inch of lukewarm water in it. What are they teaching these university students?”

  “Mine’s useless, too.” Another nurse must have joined the conversation. “She accidentally threw a patient’s bathrobe into the dirty laundry bin, so I sent her down to the basement to go through all the dirty linen to find it.”

  “And have you seen how these university nurses make a bed?” Joan asked. “When I was training, the head nurse stood at the door and checked that the fold of the sheets was facing out, not the open edges. Those were the days of real nursing. I’m telling you, I don’t know what’s wrong with this generation of nurses. They haven’t a clue.”

  Our professors had warned us about bully nurses who “eat their young.” Nurses were part of an “oppressed group,” they had explained, and as such, often resorted to “lateral aggression” in order to raise their status in the hospital hierarchy. Of all those nursing theories I had studied, I was beginning to sense that what I would need most to survive as a nurse was Darwin’s Theory of Evolution – “survival of the fittest”! This was part of the initiation rites, to be sure, but I couldn’t disagree with what they were saying. I would be scared to have me for a nurse. But I suppose I was a good enough nurse.

  At times, I struggled with what it meant to be a nurse. Sometimes you had to take charge of situations or impose your will on patients, and I found that difficult. For example, if a patient refused to get up out of bed right after surgery, I didn’t like having to nag them about it, even though it was necessary for their breathing and circulation. If they didn’t do what we said or wouldn’t take their meds, we were supposed to record that they were uncooperative or non-compliant. Many aspects of being a nurse involved policing and enforcement, and I was uncomfortable in that role. And so often, a nurse had to inflict discomfort in order to be of help. I flinched more than my patients did when I gave an injection or pulled off the tape around an IV. There was so much to do, so many important details to remember, and everything was to be documented because it was drilled into us that “not charted, not done.”

  But there was so much I did like, especially wearing my uniform and being part of the team. I liked to fill my pockets with what I saw real nurses carry: different types of tape, bandage scissors, a clamp, and medication labels. I liked caring for fresh post-operative patients. They were cool and clammy with an anaesthetic-induced grey pallor, and when I put warmed flannel sheets on them, they woke up grateful, not only to have survived the operation, but for my being their nurse. I liked bathing patients and I didn’t mind emptying bedpans of urine, though I couldn’t bring myself to touch people’s slimy false teeth without gagging. And I liked how the nurse’s presence was constant and sustained, whereas the doctors’ visits were brief and intermittent. Nurses talked in a casual, familiar way to patients, especially compared to the formal, reserved manner in which the doctors spoke. They had no airs or pretensions and I liked that.

  AS GRADUATION NEARED, everyone was excited about landing jobs and getting started on our careers. We had a lot to live up to. High goals had been set for us. We were warned that we might at first experience a temporary period of “reality shock” when we actually entered the work world, but not to worry, in no time at all, we would adjust. We had to adjust. After all, we were to be the “change agents” of the future, they told us, the ones who would bring nursing into the twenty-first century and save the health-care system. I wanted to do all of that, of course, but in the meantime, I was just praying that I wouldn’t give someone the wrong pills or miss a serious sign that indicated danger.

  “MOTHER,” I SAID to her one evening, on Pearl’s day off, “let’s go out, you and me. I want to talk with you about something.”

  “I don’t want to go anywhere. I want to go somewhere,” she said in her muddled way, but I got her into the car and drove to Fran’s Restaurant, where they were having a “Festival of Raisins”: Raisin Pie, Raisin Cake, and Raisin Pudding. Raison d’être was what I needed. “Mother, I have something important to tell you.”

  “How thrilling,” she said, rolling her eyes.

  “When I graduate in June, I want to go to Israel. I’ve heard they need nurses there and I want to see the country and travel. Pearl will take care of you.”

  “In my heyday, you were a mere essence.” She giggled. “I’m getting a surge of Genevieve.”

  Frustration rose up at the back of my throat, tasting of acid. How could she segue in and out of insanity? “Are you trying to drive me crazy?” I stood up to go.

  “Go practise your part in the play,” she muttered and beat a retreat behind her eyes.

  When we got home, she exploded with a secret source of energy just like that day when she destroyed her records. She began frantically rummaging through drawers and closets looking for something. She bent down to pluck at invisible objects on the floor. “Something about you disturbs me,” she fretted. “You have an abnormal mental make-up and smell like polka dots. Your words come from a garbage can and those men you brought home damaged Pearl. I won’t stand for it.”

  “What men?”

  “Switch over your switches and you’ll see them!” She grabbed my sleeve and dropped to her sotto voce, hushed, yet powerful enough for the audience in the back row. Suddenly, something frightened her. “Listen!” she cried, “Pearl is having a seizure! Go help her.” Pearl, back from her day off, was singing “Abide With Me” as she ran my mother’s bath. “Pearl’s fine, don’t worry,” I said. “You’re torturing my central nervous system,” she said as I handed her over to Pearl. I picked up the phone to buy a ticket to Tel Aviv.

  THE DAY BEFORE my flight, I sat down for one last run-through of the “reality orientation” exercises Dr. DeGroot had taught me. “Mother, listen up.” I pulled her chin to face me. “You are Eli
nor Shalof. It is 1983. You live in Toronto. Pearl is taking care of you. I’m sorry to have to tell you, but your husband, my father, unfortunately –”

  “There, there,” Pearl cut in.

  “That’s your version.” My mother sat still, smug with her truth.

  “Well, what’s yours?”

  “Oranges and lemons.”

  “Sometimes she get mixed up, but she know what’s what. She do!” Pearl said as she smoothed my mother’s dark, wavy hair and wiped her mouth. She had a knack for making her look glamorous. “She good enough, man. Good enough, I say!”

  “She’s going downhill,” I grumbled.

  “Maybe, but oh Lord, what a voice she have! She open the mouth and out it comes. Glorious! Some voices you have to listen for a while until you hear them. This voice you hear right away. I would do anything for that woman!”

  The next morning, my mother stood in front of the door, frozen and rooted in place. Her nylon stockings drooped, and she gripped the floor with her toes for balance. “Don’t go,” she said, and tried to stamp her foot. Pearl explained it to me. “Your mother, she want what’s best for you. She do. Put your questions to God. Place your faith in Him. Ask Him for a sign.”