The Making of a Nurse

by Tilda Shalof

  Had she always been so wise or had illness turned her into a Buddha overnight?

  “I let him get it all out and I listened. Daniel and I are very close, you know. Then he lay his head down on the kitchen table and wept while I read poetry to him.”

  “What did you read?” That, I had to know.

  “Leonard Cohen.”

  Of course, or else John Keats, “Beauty is truth and truth is beauty.”

  “Especially now, more than ever, I am committed to optimism. I refuse to entertain any dire thoughts. My father always used to say, ‘accentuate the positive.’”

  If Daphne was afraid of what lay ahead, she was doing a fantastic job of hiding it. I couldn’t imagine having cancer and being so serene. She seemed pleased with the way things were going and didn’t appear to wish things were otherwise.

  “The doctors told me my body is already responding to the chemo. They say I’m doing great.” She opened her notebook.

  As always, for Daphne, eating and talking were only preliminaries to writing. I doubted that even now there would be any disruption to her routine. I was certain she would continue her daily free-flowing “morning pages,” her walks and weekly artist’s dates with herself, according to the instructions in her bible, The Artist’s Way, a book by Julia Cameron. In all the years we had written together, Daphne had never cancelled a writing session and had considered my occasional excuses flimsy. A migraine, the flu, even giving birth – bring the baby along! – none were legitimate reasons not to show up at the writing table. “If you want to be a writer, don’t let anything stand in your way,” she would say. She herself accepted the sacrifices necessary to create art and if forbidden love affairs, travels to exotic locales, long-distance relationships, or intense communion with other artists served her muse, so be it. She did whatever was required to nurture her artistic soul. Her duty was to herself as an artist.

  My duty was to myself as a nurse – at least during “office” hours. When I was on, I was on, and when I was off, I made a point of being off. Outside of the hospital, I was a mother, a secret writer, and a big-time daydreamer. I didn’t always welcome opportunities to be a nurse, off-duty. But as I grow older, there is less and less of a separation between my professional self and my personal self. More and more, being a nurse is part of everything I do, both at work and away from it.

  But there were times when I wanted a break from the caregiver role. Once I almost ran away from being a nurse. I was standing in line at a grocery store and recognized the cashier as the wife of a man who died in the icu. I wanted to abandon my shopping cart, turn and run, before she noticed me, but it was too late. She had been smiling broadly at other customers but when she saw me, her smile vanished. Buxom and short with blunt-cut blond hair, she had big, blue eyes that instantly filled with tears. “It’s been years, and still I cry.”

  “Seeing me brings it back,” I said. It was all coming back to me, too.

  She nodded and kept up her work, scanning my eggs, cat food, and orange juice, but I could tell she was back with her husband in the icu, when I was his nurse. “I think about him every day.”

  “Of course you do, Genya.” How did I even remember her name after so many years? I also remembered her husband’s name. It was Vladimir and he had been in his early forties, perfectly healthy and strong, before becoming terribly sick and weak almost overnight. He and Genya had a daughter, Tanya, who at the time was a teenager in a pink sweater, jeans, and running shoes.

  “Will my Dad be okay?” Tanya had asked me the night he was admitted to the icu.

  I hadn’t worked there long, but already I knew to choose my words carefully, both the ones I said and the ones I didn’t. I knew that my words, tone, facial expression, and gestures would be observed and analyzed. I took a deep breath. “Your father is very sick. We are doing everything we can for him. The next twenty-four hours will be crucial.”

  My yogurt and carrots sailed along on the conveyor belt. “I live for my Tanya,” Genya sobbed.

  I remembered even more. Vladimir made it through that night and the next. Genya and Tanya stayed by his bedside, speaking softly to one another in Russian. Later, they fell asleep, their heads resting on either side of him in bed. I was also there the day he died and they threw themselves on top of his body, wailing and shrieking, trying to pull him back to life, calling his name, begging him not to leave them. For years I’ve tried to put it out of my mind – there had been so many patients in between – but when Genya saw me, it all came back for both of us. I wanted to offer consoling advice, but the only thing I came up with was what Ivan always says, and though it sounds trite, it is the truest thing. “Life goes on, doesn’t it?” Life did have a maddening habit of going on even after your world is shaken. You have to make a conscious choice to go forward – or not.

  “You were a good nurse. I remember.”

  I thanked her but silently vowed not to return to that grocery store for some time.

  Yet, on another occasion, I was thrilled to be recognized as a nurse. I was walking through a crowded shopping mall, eating an ice cream cone, when I heard someone calling, “Yoo-hoo, Nurse!” A woman rushed up and plunged right into me, grabbing my arm. “You were my nurse when I was in the ICU! It was you.” I thought about denying the allegation since I had absolutely no recollection of her, even after she told me her name. “I’ll never forget you,” she said. “You were there when I woke up after my surgery. I was so embarrassed to, you know, and you helped me with the bedpan.” She got really choked up. “I’ll never forget it.” Both my ice cream and I melted.

  THAT SAME FALL when Daphne fell ill, there were many people around me who needed a nurse. A neighbour called to tell me she’d found a lump in her breast. I rushed a close friend’s mother to the emergency department after she collapsed at home. A girlfriend was having anxiety attacks or perhaps indigestion, or gall bladder or heart problems – the doctors didn’t know for sure. Another neighbour, an elderly man, had a stroke and I visited him in the hospital and fed him soup. Jenna lost her baby in the sixth month and ended up having a hysterectomy, putting an end to any hope of bearing a child. We all visited her at home while she was still on long-term disability leave.

  By that winter, Daphne lost her hair, eyelashes, and lots of weight from her already ballerina-slim body, but she was finding new ways to be glamorous. She was excited to have been chosen to model for a poster at the local community centre of members using and enjoying the facilities. She felt certain her hair would be grown in by the time of the photo shoot that spring. The day I visited her at home, she was getting ready to go to a party despite her nausea.

  “I’m hoping the dry heaves will ease up by tonight,” she said.

  “You have the energy to go to a party after a week of chemo?” I asked in amazement.

  “I’ve always been taught that it is wrong to closet yourself away.”

  Daphne was doing well. She didn’t need much from me, but I had a feeling the time would come when she would, and I tried to prepare myself.

  “DO YOU EVER GET called on by friends and family – even strangers – when they hear you’re a nurse?” I asked the others at work and then regaled them with a funny story about what happened to me on a flight with Ivan and the kids to visit family in South Africa. “Is there a doctor on board the plane?” the captain announced somewhere over Namibia. A few minutes later, he called out again, this time for anyone with a medical background or any knowledge of first aid. I got up and made my way down to First Class. There, I found a drunken man in an orange and black dashiki, hopping around on one foot, yowling in pain from a toothpick that was sticking into the sole of his foot. I yanked it out, splashed on some alcohol (the rubbing, not the drinking kind), bandaged it up, told him to see a doctor when he got home, and that was that.

  Roberta didn’t say anything, but I knew she had taken care of her father when he was ill and how she worked tirelessly with her two children who had severe developmental probl
ems. However, she did tell us what happened on a recent vacation in the Maritimes. “We were on the Catamaran in Prince Edward Island and a woman heard me mention I was a nurse so she came over and asked me to change her dressing on an incision from a recent surgery. So, I went into the washroom with her and did it,” she said with a shrug. “It was nothing.”

  I understood. Nurses are familiar strangers.

  Noreen told me about her sister-in-law who lived alone and spent her days drinking beer and smoking cigarettes, barely moving off the couch. Noreen brought her a meal and when she was there noticed a strange growth on her face and that her belly was hugely swollen. She took her to the doctor who drained twelve litres of fluid from her abdomen and removed what turned out to be a benign tumour.

  “Twelve litres!” I looked at the garbage can next to the sink. Twelve litres would almost fill it to the brim. It was an incredible story, but I had seen bizarre cases like that.

  “It’s obvious she can’t take care of herself any more.” Noreen pulled a face. “But I told Bill, your sister has got to move in with us. She can’t live on her own.”

  Patricia is a nurse who has the caring gene in a big way, but she’s not relying on heredity alone to pass on the tradition to her own children. She teaches them lessons in caring even though her oldest is not even eight years old. “I always say to my kids,” she told me. “If you hear someone crying, stop and find out why. Find out how you can help. Life is not about the almighty dollar, buying another car or a bigger house. You are in this world to help others.”

  EXACTLY ONE YEAR LATER, Daphne’s cancer came back. This time she had to return to the hospital and have a colostomy. All those years of working out, standing in her spot in the aerobics studio in front of the huge mirror, she had always taken pride in her flat, toned abdomen, where now there would be a hole and a bag hanging down. A Clinical Nurse Specialist came to teach her how to attach the bag and empty it, how to feel clean, and how to manage swimming, bathing, and having sex. “You’d be surprised at how many people are walking around with hidden scars, blemishes, holes, tubes, and appliances. People you may even know,” she said with a smile that put Daphne at ease.

  Two weeks later, I visited her again. “Daphne,” I said when I saw her, trying to hide the shock I felt at seeing her swollen face, bloated belly, and grey complexion. I had seen patients like this but never a friend. “You … you look … you look …” Terrible, was the truth. I am a bad liar, inept and unconvincing. “You look … different from last time.” Fortunately, at that precise awkward moment, I recalled advice that Renata, a nurse who had worked in this cancer hospital, once told me: Rejoice in the smallest details. There’s always something positive to say.

  Daphne was wearing a luxurious, cream-coloured terrycloth robe edged in black silk and lace. I complimented her on it and added, “It’s good to see you sitting up in bed.” Her face brightened.

  Praise any achievement, however small.

  “And,” I said, looking her over, “I see you’re wearing your watch.”

  She said she was feeling nauseous and asked me to give her her medication. She must have forgotten that I wasn’t on-duty, nor was I her nurse. I handed her the call bell and told her to call her nurse, but she was reluctant to do so. She said she didn’t want to bother them. I knew she felt more comfortable with me and probably felt she had to be economical in her quota of requests. Most patients feel that there is a limit to what they can request of their nurse. We probably make them feel this way because there is a limit to what we can give, but there is no limit to what they need. It’s understandable, but what I couldn’t understand was my reluctance to become Daphne’s nurse. I wanted only to spend time with her and concentrate on memorizing her because I was starting to fear that I might one day be in the position of only having memories of her.

  After the nurse came and gave her an injection, I sat with Daphne until it took effect. At the same moment, we both heard the sounds coming from inside her robe. Her bag was gurgling. It needed emptying and she looked to me. She didn’t want to call the nurse back. I understand, I said, and emptied her bag quickly and efficiently. I had never smelled anything from Daphne other than possibly a whiff of French perfume – and now, this.

  Then she told me that her nurses were too busy to take her to the atrium courtyard to get some fresh air, and she desperately needed her daily walk. Would I help her?

  I do not want to be your nurse. I clenched my teeth and kept my eyes down as I got her slippers from under the bedside table and pulled back the covers. We looked at her feet. Her long, slender feet that had always been turned out in perfect ballet position as she stood in her spot in the aerobics studio were now pudgy, bloated balloons, swollen with fluid.

  “A nurse told me they wouldn’t ever return to normal,” she said with dismay. “I’m trying not to take in her words.”

  “Well, she doesn’t know you, does she? She doesn’t know that you’re not the average patient.”

  Daphne loved that response. She excelled at being special. Being called upon to be special brought out the best in her. But there was an unmistakable change in her that day, I realized as I helped her to the bathroom, pushing the IV pole alongside her. She had become a patient.

  After our walk to the atrium, we turned around and headed back to her room. The minute we got there, I couldn’t wait to escape. I got up to go and pretended not to see the many other things that needed taking care of by a nurse, things that every nurse would jump up to fix. I was off-duty. She said she felt like she was going to vomit. I said goodbye. On my way out I told a nurse that Daphne needed her and rushed past the nurses’ station before she noticed from my uniform that I was a nurse myself.

  “I JUST GOT HOME from the hospital,” Daphne sang into the phone, a few weeks later. She was back to her daily workouts at the gym, back to teaching her English literature courses. She sent me an invitation to the launch of her second book of poetry that was written in and inspired by the Moonbeam Café – the coffee house where we wrote together many times. She had inscribed it, “To Tilda – My great, great friend on the writer’s path.”

  Another year passed and the photo gallery of gym members was unveiled. One of them was a full-length, life-size picture of Daphne with her new hair grown in, thick and wavy, wearing a black leotard and purple tank top. She looked even more lithe and gamine, with her long neck and large, wide-set eyes. In the photo, she had struck an irrepressibly exuberant pose with her left, writing arm flung high into the air.

  One cold, snowy March day last year, when every cell in my body was telling me to stay put, stretch out, and read a good book, for some reason, I grabbed my gym bag and went. It was mid-morning by the time I arrived, and Daphne had already completed her workout and was at her locker getting ready to shower. She used to enjoy being naked in the locker room but now she had a towel wrapped tightly around herself to keep her colostomy bag out of sight. I waved hello but didn’t stop to talk. As I stood at my locker contemplating the merits of the Stairmaster versus a few laps around the running track, Daphne came over to me, bent down, and whispered, “I can’t stop vomiting. Nothing is staying down. Do you think it could be something serious?”

  I sank down to the bench. Here it is. It likely meant one very serious thing, but I asked, “How long has this been going on?” Stalling, keeping my face perfectly blank, I prayed to be wrong.

  “Two days. Even a sip of water comes right up.”

  I wished it were something she had eaten. If only it was a pesky case of gastritis or upset stomach, but I doubted it. “Is anything draining from the bag, either solid or liquid?”

  “No.”

  “Nothing? Not even gas?”

  “No, not a thing.”

  For years, we had talked of poetry and prose, roses, wine, and lace. Never did I dream that one day we’d be talking about shit. “Daphne, it could be …” an obstruction due to a tumour. “Perhaps you should see your doctor.”

  “Do y
ou think so, Tilda?”

  “Shall I drive you?” I answered, changing back into my clothes. Daphne was a reluctant driver, even at the best of times. That afternoon the doctor sent her for a CT scan. It showed her abdomen was full of tumours. He told her he could not offer more surgery, only another dose of gruelling chemotherapy. He admitted her and a nurse came to start an IV.

  “Please put it here.” Daphne made a graceful arabesque with her right arm to proffer it to the nurse while keeping her left one close to her body, hidden under the covers. Of course. It was her writing hand. “I have a belief that my pages will see me through,” she said to me. “No matter what happens, somehow I will find the strength to write myself through it.” She continued to set daily goals: her morning pages, first thing, and then three laps around the nurses’ station, and meditation for one hour.

  “You always were so disciplined,” I said, noting immediately her displeasure at my verb tense and nostalgic tone. “I mean, you are so disciplined.”

  “I try to keep the dire thoughts at bay,” she said to me once again.

  “How do you do that?” I asked her, needing her to explain the seemingly simple precepts once more.

  “I take in the positive energy everyone sends my way and flood my body and my mind with it. I pray a lot. Tilda, would you pray with me?”

  Okay, I said, and did my best. Of course praying helps, I thought. At least it helps while she’s still alive, but why was I such a skeptic? Why didn’t I hold out for miracles? “What did the doctor say?” I asked, bringing the prayer session to an end.

  “He said ninety-nine per cent of patients die after a second relapse such as this.”

  I pulled my chair closer even though it was already touching her bed. “He’s given you a very big assignment.” We sat and thought about the work ahead of her. I wondered if she would still be the star pupil, the exceptional one, the valedictorian standing first in her cancer class?