by Tilda Shalof
The ultrasound technologist comes out, wheeling his machine ahead of him.
“Hey, Gary. How’re you doing?” I greet him.
“Good,” he says cheerfully, “as long as I stay on this side of the bedrails.”
As if he knew!
On my way back to the ICU, I run into Janet making her rounds, “checking on my babies,” as she says. “Gotta make sure everyone’s hunky-dory.” We stop to chat. “Are you bagelling with us this morning, Tillie?” she asks, rushing away when her beeper goes off.
“I’m in,” I call out, though I’m in no mood for the jovial cream cheese chatter.
I’ve been gone about twenty minutes and it’s time to get back to my patient. As I’m rushing through the halls back to the ICU, stopping occasionally to catch my breath, I hear, “Code Blue, Code Blue.” I wonder if it was the patient that Janet was on her way to see. The person may need to come to the ICU, I think. It’s not my problem. I’m going home, I remind myself.
Soon Ramona, the day-shift nurse, arrives back and now our situation is reversed. I know everything about our shared patient and she’s starting all over again. I rush through my report and hurry off. George is sleeping so there’s no opportunity to say good-bye. I would have liked to be there when he’s extubated and hear his voice, but it’s time to go. So often it’s like this. We get to read only one page in a chapter of a person’s life and don’t get to hear how the story turns out.
“Thanks for your help, Tilda,” Simone calls out. “You were awesome.”
Before leaving the ICU, I slip a note under the office door of Denise, our manager, to let her know I’ll be off on an extended sick leave, much longer than the two weeks I’d booked off for camp. Will call to explain.
I walk out and don’t look back.
After most of my friends from Laura’s Line left the ICU, I joined a new group: The Bagel Club. There’s Janet, a.k.a. the Grand Poo-Bah; Stephanie, a.k.a. Shorty; and Jasna, a.k.a. Jazzy. They call me Tillie. Every second Sunday morning after night shift we go bagelling. It’s not a legit Yiddish word (though it sounds like it could be), just another of Janet’s spoonerisms. Eric Bailis, the owner of St. Urbain’s Bagels on Bathurst Street, greets us. “Lose anyone last night?” he always asks, though we never tell him if we did. The place is steamy, fragrant with coffee and hot bagels. It’s hopping with regulars who fill brown paper bags with bagels and pastries, then stop by our table to say hi and joke, “Save any lives?” and then seek advice about a skin condition, a knee problem, a mother who has Alzheimer’s.
When we first started coming to this suburban Jewish enclave in Thornhill, the Sunday-morning tradition and the friendly but argumentative clientele was a new experience for these friends. I took it as my duty to explain the incessant kibitzing and shmoozing (gossiping and kidding around), the frequent kvetching (whining and complaining), and constant fressing and noshing (snacking and nibbling). I filled them in on the age-old rivalries between fans of Montreal-style bagels (chewy, dense, slightly sweet) versus Toronto-style (fluffier, heavier, saltier) along with bagel etiquette, such as not toasting a fresh bagel and discouraging ersatz varieties such as sun-dried tomato or chocolate chip. They are amused whenever I recount the corny, nutshell version of Jewish history: “They tried to kill us, we survived, now let’s eat!”
“Is this what they learn you in the sin-ee-gogue?” Janet asks. With her baby blue eyes, brilliantly blonde hair (which she comes by naturally, I know she’d want me to add), and mock hillbilly voice, she likes to act like a white trash hick chick but she’s actually a sophisticated culture vulture. A huge reader, her taste is classic and high-brow (favourites are Jane Austen and Thomas Hardy), plus she’s a world traveller who’s been to France, Italy, and Denmark. With her gregarious and playful personality, curvaceous figure, and robust good looks, Janet stands out in any group. She’s always bursting with life and has a full-of-beans personality – such fun to be around! – and though she may look cherubic, there is a permanent mischievous twinkle in those baby blues. She sits, sipping a hot chocolate, proudly wearing an oversized T-shirt emblazoned with one of the many charities for which she’s the volunteer captain of the medical team. Today it’s bright yellow Ride to Conquer Cancer, and with the event, a bike ride from Toronto to Niagara Falls, coming up soon, she’s recruiting additional volunteers. I turn it down but can’t bring myself to tell her why.
After a shift, we always are dress in our casual, comfy clothes, having thrown our used uniforms into the hospital laundry or brought them home for laundering. (Wearing scrubs outside of work is strictly taboo due to infection control concerns and the unprofessional image it projects, despite the fact that you’ll see this infraction around town in grocery stores or coffee shops. All I can say about that is: Yuck.)
Jasna sips on a chamomile tea. Her quieter, even-tempered presence is a calming flava to our group. Always dressed down and understated, Jasna is implacable and gentle, though she occasionally gives a sly smile and surprises us with an insightful zinger. Modest to a fault, Jasna seriously contemplated being a no-show at a recent award ceremony in honour of her outstanding nursing care.
Then there’s Stephanie, a petite, sassy ball of pure energy. She often says she’s tired but never looks it or acts it and always gives her all to every patient in her care. She’s arguably the best dresser among us in her faded jeans, leather bomber jacket, and kick-ass boots – finds from second-hand clothing shops and bargain basements that she sources out as much for economical reasons as environmental ones.
There is so much I admire about these women, but as nurses what I love the most is how they always do what’s right for their patients and will fight for them, if necessary.
“Do we have a quorum?” Stephanie starts off, as if it’s a formal meeting.
Now that they’ve finished their bagels, they wipe their hands and reach into their bags for balls of yarn and knitting needles. An hour ago in the hospital, they wielded another type of needle, and their handiwork was patient care. Janet is knitting a soft, custard yellow baby blanket; Jasna, fingerless gloves for driving; and Stephanie, a pair of socks. (She says she only knits socks, claiming she doesn’t have patience for the sweater I’ve been begging her to make me.) Their knitting is the cue to pull out my tools: a pen and paper, but last night before work, in my distracted state, I forgot to throw my notebook into my knapsack. Ever helpful, Jasna flattens open the empty paper bag from the bagels and hands it to me, along with a pen.
“Be careful what you say.” Stephanie gives a sideways glance at me. “She writes down everything. You might end up in a book.”
“Is that what you think?” I say, faking indignation. “That I only come here for material?”
She considers this. “No, you like the bagels.”
My pending surgery is weighing heavily on my mind and I feel guilty about letting them think I’m only going to be off work for the next two weeks. Even though we’ve talked openly about everything (kids, husbands, even our sex lives), I can’t bring myself to share my secret with them – not yet. Besides, they each have their own worries. Stephanie’s a single mom raising teenagers alone. She had her own health scare recently, but thankfully everything is okay. Jasna has three sons, one of whom is severely developmentally delayed. At sixteen, he is non-verbal, wears diapers, and has frequent, daily seizures. Ten seizures is a good day. Janet is tackling health issues and a weight problem and has recently lost sixty pounds. “I was facing diabetes, high blood pressure, the whole kit and caboodle,” she told me privately. “I took myself in hand and did something about it.”
Yes, we share a lot, but today I keep quiet.
So we turn to what we always do, what we need to do, which is review the night. In order to put it all behind us, we must first go over it in detail, taking care to lower our voices and never mention patients’ real names.
“I can’t stay long,” Stephanie warns us, as she usually does, before we begin. “I’m exhausted.”
“I mean it this time. And I have to take my kids to their music lessons before I go to sleep. Tilda, you’re going to have to write fast.”
I start off by telling them about Simone. “She’s stressed out and doesn’t seem to be coping. I hope she stays – we could work with her – but she has a lot to learn.”
“I hope she sees it that way,” Janet says with a chuckle. “Not all of the young’uns take to our direction. Some of them act like they know it all.”
Janet’s words might seem harsh, if you didn’t know that she’s a fabulous nurse and generous mentor. And the younger nurses would likely be horrified at our critiques of their work, our strictly-in-jest, off-the-record American Idol–type reviews, complete with thumbs-up or -down. There’s only a few we’d like to “send off the show,” but even with those, we vow to help them improve their performance. We take turns being the various judges, like the dismissive critic; “That was a horrendous! Give it up, you have no talent” or more the gentle adviser: “You’re not ready, dude.” We lavish praise on the deserving ones: “I gotta give you major props, dog, cuz you know who you are. You’re ready for the big time.” We encourage those who show promise: “I see you’re trying, sweetie, but you have a lot of work to do. Learn to sing first.” But we revel in coming across the real deal where we can say, “That was a fabulous performance. You’re going to Hollywood!”
Despite our behind-the-scenes grandstanding, we actually take a great deal of pride in nurturing new nurses and watching them blossom under our guidance. Nurses have a reputation for being hard on our young, and though they may feel like we’re picking on them, we do it because we know how important it is to get everything right.
Janet is itching to tell us about her night. “It was quiet until about three, then my beeper went off. A nurse from the general surgery floor called, not sounding too concerned, but a little birdie told me I’d better go up there and have a look-see. Well, it turned out to be a good call. A middle-aged lady two days post-op bowel surgery was decompensating but fast. She was on 80 per cent O2 but her sats were meh – so-so. I wasn’t happy. She was having difficulty breathing and her pressure was in her boots, heart rate, 150. ‘We already gave her a litre of fluid,’ the floor nurse told me. ‘Yeah, but it’s not doing anything,’ I said. ‘You have to see if what you tried had any effect.’
“How long had her pressure been low?” Jasna asks, concern in her voice.
Low blood pressure is a huge miss.
“According to the chart, four o’clock yesterday afternoon, but no one did anything about it, only now they call me,” Janet grumbles as if annoyed, but I know she’s pleased she could help, maybe even save the day. “ ‘Why didn’t you call us sooner?’ I ask her. ‘We thought it would get better on its own,’ she says. Meanwhile, the patient was confused, with a decreased level of consciousness …” Janet’s voice trails off so that we can think through the situation ourselves and imagine what each of us would do. All the while, her fingers continue to fly, the needles clicking and clacking over the soft yarn. “I was thinking maybe she’d gotten too much sedation,” Janet continues the story. “I was wondering if she needed an anti-dope, like Narcan.”
I’m about to correct her, then realize it’s a Janet-ism. Classic.
“So anyway, she’s tanking and I’m thinking we’ll have to tube her and bring her to the ICU. Her Ph was 7.1 …” She says all of this without pausing or even glancing at the lengthening swath of the intricate patterned blanket growing in her hands by the minute.
“Not good,” we murmur. Too low. Inadequate ventilation, poor gas exchange.
“Her CO2 was ninety and her bicarb only twelve!”
We all recognize that it’s an uncompensated acid-base imbalance indicating metabolic acidosis, pending respiratory failure, and we shake our heads at the seriousness of the situation.
“She needed to be in the ICU,” Jasna says in alarm, “like yesterday.”
“I spoke with the ICU resident and told her that in my humble opinion …”
“Yeah, right,” says Stephanie with a grin to Jasna and me.
“… not only that but based on the lab work, she was dry. She needed fluids and the resident agreed, so I banged in an eighteen-gauge needle, shot in a litre and a half of saline, and you know what? She perked up in a few minutes and she might not need to be tubed after all …”
As they continue to discuss this complicated situation, all I can think of is that now, hearing our clipped nurse short forms anew, I realize how flippant and cavalier they must sound to outsiders. We toss these phrases off like they mean nothing, knowing they mean everything. How alienating this bravado of ours is to others, yet how necessary to us. What will it feel like to hear talk like this when I’m on the “other side of the bedrails”?
Janet looks at me. “You getting all this down, Tilda?”
“I’m quite sure she is,” Stephanie says dryly. “Go on.”
“So anyway, her improvement didn’t last long. She quickly became completely kaplooped, so I arranged for her to be transferred to the ICU, but we had to get that tube in first. The respiratory therapist and ICU resident – we were all in agreement with that. The family had come in, very upset. High-strung people. Understandable. I get that. I told them I was calling a Code Blue because she needed to be tubed – stat. ‘No, no, don’t do that,’ they said, looking terrified. To them, it meant the worst thing, but the family was watching me and they could see knew I knew what I was doing and that I was going out on a limb for their mother. They trusted me. So, we got her tubed and sedated and she looked more comfy. My work was done, but just before I left the hospital I went to the ICU for a peek. You know what? She looked better. She was in florid sepsis, but we got to her in time and she might make it.”
“Good save,” we congratulate her, but she doesn’t easily accept the accolade.
“It’s not about me – we’re a team. I love being on the RRT because I need to know that patients will get what they need in their time of need.”
“You sound awfully needy.” Stephanie gets in one last jibe.
And this is what I will need – fearless nurses like these.
People always say they want kind, sweet, gentle nurses. That’s nice, but even better are smart nurses who know what they’re doing. If you want to survive a hospital stay, you’ll need to have bold, take-charge, go-to, problem-solving nurses like these. More than caring nurses, you want nurses who care, as in give a damn. You need nurses who have the guts to take initiative, speak out, stand up to bullies, rattle the cage, smash hierarchies, kick up a fuss, rock the boat, and blow whistles if necessary.
But even cowboys and crusaders get tired.
Janet yawns. “I’m losing it. I’m going home to my boys.” Tess, Darcy, and Mr. Bennett are her three West Highland terriers. “If I give them cookies, they’ll sleep with me in bed.”
“Is that how I can get a man?” Stephanie asks, stowing away her knitting.
Then it catches us all simultaneously – a wave of pure exhaustion.
“The neurons aren’t firing.” Jasna sticks her needles into a ball of yarn.
“Yup, the synapses have shut down,” Stephanie says. “But first, Tilda will read the minutes of this meeting.”
As if.
“Are we adjourned?” I ask.
“I’d say,” she says and we all get up to go.
“Okay, ladies. That’s it. Get to bed!” Janet calls out.
The Grand Pooh-Bah has spoken.
Toddling off to our cars, we compare HOP – Head On Pillow – time. Stephanie has to drive to music lessons so it will be a while before she sees her bed, but Jasna and Janet estimate twenty minutes, including hot showers first. Me, I can’t sleep. My mind is buzzing with thoughts of warm bagels, night shifts, and good friends, wondering how many more will be allotted to me.
“Good night,” we call out to one another in the bright morning lig
ht.
* Not anymore!
4
BREATHING LESSONS
On Monday, Dr. Drobac calls to tell me he’s ordered a Doppler scan, similar to an ultrasound, of my neck arteries to check for atherosclerosis, which is plaque buildup in the arteries, and an angiogram to rule out coronary artery disease. All necessary preoperative tests, but no can do.
“I’m going away for two weeks to work at my kids’ sleepover camp.”
“You’re symptomatic now and could get into trouble.”
He means crash and burn. Sudden cardiac death.
“I’ll do the tests when I get back in two weeks.”
“You have to take it easy. You need surgery as soon as possible.”
Unless I drop dead first. In which case I won’t have to do anything.
“Have fun. Try to relax and enjoy yourself,” Ivan said as I got into my car for the two-hour drive due north to the Muskoka region of Ontario. Fat chance. Easy for him to say. He’s getting a break from me and the kids, along with extra late-night poker games and long afternoons of golf with the guys, so who’s going to be enjoying themselves?
Ivan is loving – in a gruff, irascible way. He practises his own brand of “tough love” and can be hard on me. The worst was the night of the car crash when Princess Diana was killed. At around 2:00 a.m. the news broke and I was glued to the TV, in shock as I watched the aftermath of the horrific accident in a Paris tunnel. I ran to wake Ivan up and tell him.
“Princess Diana died!” I sobbed. “She’s dead!”
Ivan sat up in bed and pointed his finger at me. “And you killed her! It’s because of all those magazines you buy. You’re as bad as the paparazzi.”
You get the picture. This is what I’m dealing with.
Ivan may get emotional but never sentimental. He’s not one to molly-coddle, cajole, or offer unnecessary hugs – only necessary ones. He has little tolerance for self – absorption, no patience for self-pity. He’s never meditated on a mountaintop, attended an ashram, sat at the foot of a guru, nor contemplated his navel, but Ivan has attained enlightenment, albeit in his inimitable, idiosyncratic way.
