The Making of a Nurse

by Tilda Shalof

  Suddenly, I gagged. I ran out of the room and made it to a garbage can and vomited. When I came back I saw the patient had managed to dispose of the dirty bandages and had cleaned her wound and covered it with clean sterile gauze by herself. “I’m so sorry,” I said.

  Finally, I went to Buddy. “How are you feeling today?”

  “Better than dead! You’re the one who looks stressed.” He settled back into his pillows. “Hey, Miss Tilda, have you seen my rash?”

  “Rash?” I searched my notes. “Where do you have a rash?”

  “On my skin. That’s the best place for a rash!”

  Iris and I exchanged exasperated looks. “That’s bad, Buddy. Really bad,” she said.

  “What’s for lunch, dearie?” he chirped when I brought him his tray. He lifted the cover and made a face. “Back home, at midday, I always have two poached eggs, side by each.” He turned to Iris. “You know what we’ll do, dearie? We’ll take Tilda home with us, screech her in, and make her kiss the codfish.* Then we’ll prepare her a Jiggs’ dinner.”

  “What’s that?” I sat down on a chair beside his bed, wishing I could stay there all day.

  “Salt beef, carrots, turnips, potatoes, sometimes an old rubber boot.”

  “Buddy puts a bit of salt beef in, on Sunday, for sure. Moose, if we can get it.”

  “Horse, if we can’t. And guests. See, if we runs out of horse, then we use the guests!”

  “Don’t mind Buddy.” Iris shook her head.

  “Are you okay, Buddy?” I asked when he suddenly winced. “Are you having pain?” He rubbed his back and his chest. “Oh, it’s pain, all right,” he said. “It’s good pain. Real good pain.”

  “The pain is good?”

  “Yes, it’s shocking good pain.”

  I ran to get him a painkiller and even before I gave it, he grinned at me. “Works like a charm,” he said. “You’re an angel.”

  Later that day, I had no choice but to face Miss Wilson, again, the woman who called me Maggie. She wasn’t in her room when I went in to restart her IV, which had become displaced from her vein. I was just about to leave when I noticed a stack of loose sheets of paper on her bedside table. I HATE MY NURSE, she’d written in big letters. On another piece, in capital letters, FAT WHITE ASS and THERE’S A NURSE IN THIS HOSPITAL THAT I HATE. On another sheet, she’d written, SHE HAS IT IN FOR ME. SHE’S TRYING TO KILL ME. As I left her room, I twisted around to take a look at myself. Was it really that fat?

  I came back later and tried to win her over. “How about a back rub?” I offered, but she said I was too rough. “Get me a Coke. I’m the captain and you’re the skipper. Don’t forget that.”

  “I have to restart your IV. It’s gone interstitial, which means it’s not in the vein properly.” I could hear the anger mounting in my voice.

  “You’re talking too loudly. I’m not deaf.” She glared at me. “I want another nurse to do it.”

  Why does she hate me? It was so unfair and unfounded! Did she hate me because I’m white? It was prejudice! She didn’t give me a chance. Later, I went back to try again. Surely, we could work out our differences, whatever they were? I waited a few moments in her room. When she emerged from the bathroom, she came toward me carrying a measuring cup of urine she had drained from her catheter. I saw what she was about to do. “Don’t even think about it,” I warned her. “Don’t you dare!”

  “Oh, I dare!” she laughed, and flung the urine at me. I jumped out of the way just in time to have it splash on my pants and shoes. “That’s for reading my private notes, you bitch.”

  Worse than urine, I was covered in humiliation. I wanted to flee to the locker room to shower and change my uniform but just then I heard an announcement that stopped me in my tracks. “Code Blue, Code Blue.” A cardiac arrest right here on this floor! I knew who it was. Buddy’s aneurysm must have blown or else he had gone into cardiac arrest. I ran into his room, following after the doctor and the respiratory therapist. A nurse had already gotten there and was on his bed doing chest compressions. Another nurse was pushing an IV medication right into Buddy’s vein and another was setting up the defibrillator to shock his heart. I stepped back to let the more experienced nurses take over and ran to get them things they needed. The arrest continued on and I went out to the hall where Iris was waiting. She tugged at my sleeve. “What’s happening?”

  “They’re working on him. They will try to resuscitate him and then will probably take him straight to the operating room.”

  “Thank God. Does that mean he’s getting better?”

  I put my arm around her in answer.

  As I was leaving to go home that evening, the nurse who had given me the heads-up about that nasty wound called out to me. “Hey, you okay?” she asked.

  “Fine,” I said, hurrying off. “No problem,” I called back.

  Riding home on the subway, I found a seat by myself and let the tears flow. Yes, I was sad about Buddy, but I was crying about my father, my mother, my family, and myself. I had my own problems. Why did the patients always get all the sympathy?

  BECAUSE I WORKED FREELANCE, for an agency, I was never in one hospital long enough to learn how things worked. Nights were particularly difficult as I had to figure things out for myself, such as when to call the doctor at home and when not to. Late one evening, I needed a laxative for one of my patients and I decided to page the doctor. She didn’t answer and after an hour, I paged again. Finally, she called back. “You’re calling me now for that? You couldn’t think of it earlier? I hate to think what you’d do in a Code Blue.”

  “Okay, I’ll just chart ‘MD notified.’”

  “Oh, how you nurses love that phrase so you can pass the buck! Calling me about some trivial thing you could have figured out for yourself or planned for ahead of time.”

  She was right. It was one of the oldest tricks in the book. Fobbing off my responsibility instead of merely speaking up for what my patient needed. But in most hospitals, a nurse couldn’t even administer a laxative or a single Tylenol without a doctor’s order. I went to my patient, but by then he was sound asleep and I wasn’t about to wake him to give him milk of magnesia. There were so many situations like that, where nurses’ hands were tied. But most times, the stakes were a great deal higher than a laxative. Once, near the end of my shift with a mountain of charting still to complete, a call bell rang. It wasn’t one of my patients, so I let it ring. Let someone else go, I thought. But it kept ringing. I got up and went to answer it.

  A man stood beside his bed, clutching his chest, his face crunched in agony. “Oh, I’ve never had such terrible pain,” he groaned. I placed an oxygen mask over his face and called for help.

  “I’ll get you a painkiller.” I eased him down onto the bed.

  “Don’t leave me.” He clutched at my arm. “I’m dying. Get my wife.”

  I felt his pulse. It was rapid and strong. “I’ll be right back,” I said and ran for the electrocardiogram machine. I pushed it straight out ahead of me like a grocery cart and I was off on a madcap shopping spree. Running past the nurses’ station, I called out for someone to bring morphine and an aspirin because I thought he might be having an acute coronary event – a heart attack.

  “The doctor hasn’t ordered it,” the nurse in charge said, looking up over her glasses at me. “He’s in emerge right now, seeing a patient. Wait till he gets here.”

  But if I waited, it might be too late. I was not authorized to give a medication that wasn’t ordered, nor administer oxygen without a doctor’s order, or even perform an ECG without an order, but this was an emergency and I went ahead and did all of those things.

  Later, when the doctor finally arrived and the patient was feeling much better, he was furious. “I didn’t order this ECG,“ he yelled at me and ripped it up. “Who do you think you are? If I report you, you’ll lose your licence.”

  It turned out the patient had suffered a mild heart attack as I had suspected, but it was hardly reason to feel vin
dicated. It was a serious setback for the patient, but what seemed to concern the doctor much more was a nurse threatening his authority. It was an old, unspoken, unwritten “doctor-nurse game” you had to play and the rules stipulated that even if you, the nurse, knew something, you weren’t supposed to let on. Diplomacy and tact were needed. Suggestions or hints were okay, but taking action and making decisions was far too bold. Even the nurse in charge backed up the doctor. “You are going to get yourself in trouble,” she warned, but did concede, “You may actually have saved that guy’s life. Maybe you really want to be a doctor?”

  “No, I want to be a nurse,” I mumbled. But I did want to be able to use my knowledge, skills, and judgment. I hated knowing what to do and being unable to do it; seeing things, but being unable to take action. The worst was feeling invisible and unheard.

  WORKING FOR THAT AGENCY, I really got around. I worked in medical wards such as Neurology, Nephrology, or Cardiology, where patients had chronic problems such as diabetes, asthma, congestive heart failure, kidney problems, and in many cases a few, or all, of the above. Those wards were usually separate from other specialties like Orthopedics, General Surgery, or Gynecology. There, patients were recovering from their surgeries and in some cases from the complications caused by, or that ensued after, those surgeries. Usually the medical and surgical specialties were kept apart, but administrators found that by merging them, they could amalgamate services and reduce duplication. However, that sometimes made for an uneasy juxtaposition of incompatible philosophies and personalities. The Medical approach involved subtleties such as the alchemy of cheicals and the passage of time. They discussed both the “big picture” and the minutiae of details and ideas and used delightful words and phrases, such as “angry rash,” “integrity of the skin,” “cardiac embarrassment,” an injury to the heart muscle, or “defervescence,” which referred to an overall deterioration in the patient’s condition. The Medical docs were in it for the long haul, were satisfied with small gains and took the inevitable setbacks in stride. They knew they couldn’t fix everything, but it was a darned interesting process to try a little of this and a little of that and see what happened.

  On the other hand, surgeons were focused on the bottom line, in “cutting” to the chase, and in outcomes. They looked for opportunities to excise and resect (remove and chop) or suture and anastomize (sew and glue) and liked to fix the things they could and quickly became disinterested in the things they couldn’t. Many had favourite nurses and flirted with them, whether they were attractive or not. There were always a few who lived up to their stereotype, like the surgeon who showed up one busy morning, needing help with a procedure he wanted to perform on my patient. “Hey, I’m putting a chest tube in Mr. Kanji,” he said in an offhand manner. “He’s got a pneumothorax and I may need a hand.”

  “And you would be … ?” I asked as I continued preparing my medications.

  “Hi, I’m Vince, from Thoracic Surgery.” He extended his hand.

  “Hi, I’m Tilda, from Nursing,” I said, mocking him ever so slightly. “I’ll help you with that procedure as soon as I give the patient something for pain first.”

  “Oh, he won’t be needing it. The way I work doesn’t hurt a bit.”

  “But he’s already in a lot of discomfort from his surgery.”

  “Don’t worry, he’ll be fine. I’m very fast.”

  I bet you are. “But, even so …” I recalled having read somewhere that “Pain is usually under-reported, under-ordered, under-administered, and thus under-treated.” I couldn’t bear to think of doing that procedure – which involved making a deep cut into the chest in between his ribs, inserting a large, thick plastic tube into his deflated lung, and applying strong suction pressure once it was in place – without local anaesthetic and a painkiller first.

  “He won’t need it,” Vince said cheerfully, looking at his watch. “Can we get started?”

  Oh, I get it. You don’t want to wait while I get the keys and go to the narcotics cupboard for the drug. Then you’ll have to wait a few minutes more for me to give it and for it to take effect.

  “Don’t worry,” he cajoled. “I have superb technique.” He patted me on the back. “None of my patients ever complain.”

  “That’s because most of your patients are under general anaesthetic.”

  “Aren’t there any nice nurses around any more?” he teased, and I glared back at him.

  Was it possible that he could really do such a smooth job that it wouldn’t make a difference to the patient? Was I being over-conscientious? We stood on either side of the patient’s bed and looked down at the man’s emaciated and bony body. I decided not to be on my side or the doctor’s, just the patient’s. I tried to fly inside his mind, so I would know what to do.

  “Hey, is this guy even conscious?” Vince asked.

  The patient had grunted and moaned a few times while we stood there but didn’t seem aware of us, of our conversation or its meaning. “Anyone can see he’s in discomfort,” I said, and it was true.

  “Okay, go ahead, give him something if it’ll make you feel better.”

  I ran out and came back quickly with the drug. “Until this takes effect, there’s the sink,” I teased him. He hadn’t even washed his hands.

  “You’re a pretty tough cookie, aren’t you?” he grinned, donning a sterile cap and gown.

  I hung a small bag of saline with two milligrams of morphine injected into it, but he didn’t like this slow method. “Push it in, fast,” he ordered, but I told him no. “I have to give it this way.”

  “But it will take too long to take effect if you do it like that.”

  “Even so …” Every patient reacted differently to narcotics – to all painkillers, in fact. For some, a small dose was enough to treat severe pain. For others with milder pain, a larger dose had little effect. Soon, the morphine eased our patient and the procedure went smoothly, and just before Vince left he asked me out. But I turned him down because first of all, he was a jerk and second of all, it was around that time that I had reconnected with an old boyfriend I’d met in Israel. His name was Ivan Lewis and things were getting pretty serious between us.

  UNFORTUNATELY, I DIDN’T ALWAYS speak up as assertively as I did that day. Once, after spending more than an hour on a complicated abdominal dressing that required rigorous sterile technique and deep internal packing, I had moved on to care for another patient when suddenly I heard an angry voice in the hall outside the previous patient’s room.

  “Where’s a nurse? I need a nurse in here right away!”

  I ran back to find one of the staff surgeons tearing away at the bandages I had just spent so much time putting in place. “I need to have a look at this incision,” he barked, ripping away at the tape and gauze pads and leaving the wound exposed. “Who did this dressing?” he growled. I swore under my breath as I stood watching him make a mess of my work. The patient seemed a bit bewildered but pleased to have his doctor there. “Would someone bring me a fucking pair of scissors?” the doctor shouted, right in front of the patient, and then glared at me, clearly the someone he had in mind. I scurried off to hunt some down. It wasn’t an easy thing to do as each hospital kept supplies in a different place and I was always going on a scavenger hunt.

  “Grin and bear it.” A nurse passing me in the hall saw I was upset. “We’re nurses, aren’t we?”

  “Why do we have to take it?” I fumed.

  “Don’t let him get to you,” she advised. “He makes everyone uptight, but he’s a surgeon, you know. They get away with murder.”

  That remark made me giggle as I rushed back into the room, scissors in hand. But by then, the doctor was gone. He’d managed to remove the rest of the bandage by himself. The dirty gauze littered the bed and floor. The wound was left wide open. The patient’s covers were thrown back and his gown was askew.

  “How am I doing, nurse?” the patient looked up at me. “The doctor didn’t mention.”

  “Your
incision is healing nicely.” I was steaming mad as I repacked the wound with sterile gauze and then cleaned up the mess. On the bedside table, beside the chart, I found a fancy pen the doctor had left behind. He’d used it to write in the chart. It had gold-coloured letters spelling out the name of a drug company. I did what anyone would do in that situation. I stole his pen.

  THEN THERE CAME A NIGHT so crazy and chaotic, so stressful and upsetting, that by the end of that shift, I was ready to call it quits – being a nurse, I mean. I was sent to a medical surgical ward where I’d worked before, but this time, they put me in charge. In short order, I had to know everything about the medical condition of all of the thirty-two patients and be the one ultimately responsible for their nursing care. Luckily, Scott, the RPN, was on that night, and I knew from experience that I could count on him. However, Colleen, another RN, was also on and I knew from experience that I could not count on her. Skinny and low-energy and often in a bad mood, Colleen looked particularly disgruntled when she showed up late that night. She didn’t greet me, but I caught up with her and re-introduced myself.

  “Hi,” I said with a fake smile. “I’m new,” I added nervously.

  “Hi, New. I noticed someone put you in charge.”

  “I mean, my name is Tilda. I’m from an agency, so it makes more sense for you to be in charge as you’re staff here,” I said. “You know the patients better than I do.”

  “Who said I wanted to be in charge? They obviously figure a university nurse is better for the job. Anyway, you’re welcome to it. Enjoy!” She showed me a doctor’s note. “Just to let you know. I hurt my back. I can’t do any heavy lifting.”

  No lifting? Lifting was easy. The uplifting was the hard part.

  Colleen went off to prepare medications for her patients and I sat down at the nurses’ station beside Scott at a table covered with patient charts. “Colleen’s got a chip on her shoulder,” he explained, opening the box of doughnuts he’d brought in, “but she’s a good nurse. Problem is, sometimes she’s just not that into patient care.”