Bringing It Home

by Tilda Shalof

  “My body is yours.” Louise lifts her sweater so Janice can inject a shot of cytarabine, a chemotherapy drug, into her abdomen. Her face is bruised from a fall she had in her kitchen, but she’s mobile, very sharp, and still drives.

  “Yes, I’d drive with you,” I say after chatting with her for a few minutes.

  “My husband built this house and I don’t want to leave it,” Louise tells me. She goes over to play songs for us on a pipe organ. She sings “Cry Me a River” and then “Blue Heaven,” her stiff, swollen, arthritic fingers stumbling over the keys. “I’m not ready to lie down, yet,” she says, standing on the porch to wave goodbye. “Keep me alive, Janice. I’m not ready to go yet.”

  “We’ll do our best.” They exchange an expression that conveys the message, We’re in this together.

  Next, we see a Sri Lankan woman with legs that are inflamed and wet with sores.

  “They look painful. Are they?” Janice asks.

  The son translates and the mother nods, clasping her hands at Janice in gratitude. She’s Hindu, has a grey smudge on her forehead, indicating she’d done puja, her morning prayers. The TV plays loudly – a Tamil soap opera – and the air is thick with cumin, fenugreek, and garlic. The sensory overload makes it hard to concentrate on these legs, the reason we’re here. To me, they look infected, but Janice explains that the problem is poor circulation. She’s set up an appointment with a vascular surgeon and for now is putting a compression dressing on the legs to improve venous blood flow.

  The day whizzes by. We see a woman in a retirement home with polymyelitis in her foot, a stubborn wound that resists healing. Janice cauterizes it with silver nitrate.

  “You’ve tried everything, haven’t you, Janice, even prayers,” the woman says to Janice gratefully.

  We meet a man who’s living in a rundown and filthy group home who has a number of medical problems, including epilepsy, a gang-related gunshot wound that resulted in a colostomy bag on his abdomen, and abscesses on his arm along the vein he uses to inject drugs. At a previous visit he’d mentioned extreme thirst and that he was losing weight. Janice arranged for him to see a doctor, who diagnosed diabetes. “Until we’ve got your blood sugar under control, your wound won’t heal,” Janice tells him, but he barely reacts.

  “Is he capable of injecting himself with insulin?” I ask when we’re outside.

  “I think so,” says Janice. She gives a dry laugh. “He’s certainly capable of injecting himself with heroin. The question is will he care enough about himself to do it.”

  The next client is a fifteen-year-old Native girl with tuberculosis who’s living in a group home. We’re here to check if she’s taking her meds. But in the midst of our visit, she gets a text on her phone that makes her jump up. “Oh, I gotta go. My pimp is looking for me.”

  “Where’s your mother?” I blurt out the first of many questions that come to mind.

  “My mother?” She gives a laugh and runs out the door, leaving it open behind her.

  “This is so wrong. I still drive my fifteen-year-old son to school, make his lunch.”

  “You see things you can’t believe,” Janice says. “That young girl has been an alcoholic since the age of twelve. She’s been abused by her father and her uncles and has been beat up so many times, it’s a wonder she’s alive.” She sees me struggling to take this in. “I guess you don’t get to know much about your patients’ lives, do you? That’s what I didn’t like about hospital nursing.”

  She must feel I’m in need of a change of subject, so she launches into an amusing story to make me laugh and it works. “When I worked in the hospital, there was one surgeon I always clashed with. One Monday he used number eight gloves. On Tuesday, I handed him a pair of eights and he threw them on the ground. ‘I want seven-and-a-half,’ he barked. ‘You used eight yesterday,’ I told him. ‘So, what? Are you paying for it?’ he asked. ‘Yes, Dr. Wong. We all are. Those gloves are ten dollars a pair.’ I couldn’t stand the waste in the hospital. Ask nurses. We know where the waste is.”

  At the next apartment building, the elevator is broken, so we walk up the eight floors to get to the next client. As we make our way up, Janice fills me in on a disturbing backstory.

  “When I first met Warren he greeted me with, ‘You’re the nurse? You didn’t sound black on the phone. I don’t usually open my door to black people.’ ‘Don’t make an exception for me,’ I said and turned to leave. He called me back in a panic. I’ve been taking care of him for six weeks and his attitude hasn’t improved. At one visit, he was so rude, his dogs looked apologetic, like, ‘Please excuse his bad behaviour.’ ”

  At the last visit, Janice discovered what was really bothering him.

  “He kept going on about this ‘f-ing shit bag this’ and the ‘f-ing shit bag, that’ and the ‘f-ing health care system.’ ‘There’s a lot of f-ing going on today,’ I told him, but he kept on cursing. Finally, I said, ‘This visit isn’t very pleasant. I’m leaving.’ I got up to go and suddenly he broke down and cried. He poured his heart out to me. His anger was about the colostomy. He couldn’t accept it. ‘You must hate me,’ he said. ‘Of course not,’ I told him. I’ve long ago learned not to take anything personally – not everyone has social graces.”

  “That’s putting it mildly.” I’m impressed by her tolerance of such bad behaviour.

  We move on. It’s one-thirty, and so far there’s been no mention of lunch. Janice says she never stops for lunch.

  “Being in and out of so many places, I never feel my hands are clean enough and I’m still in my uniform.”

  At the next stop, a husband cares for his wife who’s terminally ill with a brain tumour. She lies in a bed in the living room. He turns her every two hours to prevent skin breakdown. He charts her morphine doses and correlates it with her bowel movements because of the constipating effect of narcotics. He milks her catheter tubing to drain drops of urine. Her urometer is covered with a colourful cloth bag.

  “What a good idea. We should do that in the hospital. Urine is private.”

  “I came up with that idea to prevent the cat from biting the bag, right, sweetie?” he says to his wife.

  I reach down to pet the cat and she hisses at me. I toss a crinkly ball and she stalks it, moving in for a kill. The husband picks her up and cuddles the vicious little thing. In his arms, she purrs. “You’re a real caregiver,” I tell him.

  “No, she is.” He points to his wife, Rosie. “She helped me care for my mother.” He points to her picture on the wall. “Now, it’s my turn to care for her.” He sings while she moans softly, but soon she joins him in song. He turns her and as he lifts her legs, she screams out again. “I remember when you liked me to lift your legs.” They look at one another in a moment so intimate I turn away and focus on a sign on the wall – “God is a Senior Citizen” – and a reliquary of the bone of St. Francis of Assisi.

  “How are you doing?” Janice asks the husband. “Have you had a break?”

  He looks surprised, and touched, but doesn’t know how to answer. “I’ve never been asked that question before.” He looks like he’s never thought about how he’s doing, either.

  “We tend to forget about the family caregivers,” Janice says softly to me. “The Lord is with you,” Janice says to them. “He’s looking after you both.”

  Knowing them as she does, she can say this. I’ve always admired nurses who know how to sensitively infuse their nursing care with spirituality. I haven’t figured that out myself.

  At the door, the cat takes a parting swipe at me and I scoot out of the way.

  “God bless,” the husband says to us both.

  When we are in the car, we sit silently for a few moments, until Janice expresses the exact same sentiments that are on my mind.

  “When I get old or too incapacitated to take care of myself, I don’t ever want my kids to care for me. I tell them: Put me somewhere. If I have dementia I won’t know the difference. I won’t be hurting, you’ll be. Visi
t if you like, but get on with your lives.”

  “I tell my family the same thing but they won’t listen,” I say. Perhaps this is a nurse’s view. We only want to be on one side of the bed rails, the carer not the caree.

  “Everyone says they want to stay at home. Family members suffer guilt when they can’t keep their loved one at home, but it’s not always feasible. Not everyone can do it.”

  “I agree. All I want is my lipstick and my dog. Maybe some chocolate pudding,” I say.

  “My kids know I want my high heels and my leopard prints. That’s all I need.”

  “People don’t get nurses’ sense of humour. We have to be careful when speaking to non-nurses.”

  “We do tend to have a different take on things, don’t we?”

  The day brought so much. If you spend even a few minutes with people in their homes, you can’t help but feel a measure of their despair, isolation, loneliness, even desperation. Somehow, if there’s a home care nurse like Janice there, you feel there’s hope. And at least you’re outdoors.

  SAFE HOME

  FALL ARRIVES AND IT’S TIME to set out on the next leg of my journey to Kingston and Trenton, both cities east of Toronto, along the shores of Lake Ontario. Looking at a road map, I see that if I make a detour along the way, I could make a brief stop in the little town of Kemptville (population: 2,500) to finally meet Audrey McClenaghan, my most dedicated and loyal reader.

  I’ve always been a writer (the kind of kid who was always scribbling in journals, a practice I still continue), but it’s only recently that I’ve become a published author. For the past few years, I’ve been on an amazing ride, writing books about my life as a nurse, travelling, and speaking to nurses, doctors, other professionals, and the public at large. I am fortunate to have many readers, all over the world. However, my most devoted fan by far is Audrey McClenaghan of Kemptville, Ontario. At seventy-nine, she’s been “stalking” me with fan mail, all handwritten in her quaint, rigidly regular cursive style, each letter and envelope decorated with stickers – flowers, balloons, kittens, cupcakes.

  I call Audrey on the phone.

  “Slow down, slow down,” she says in a shaky voice. “Who’s calling?”

  I tell her again, but it takes Audrey a few more moments to realize who it is, to recover from the shock of hearing from me on the telephone, and then to put her hearing aid in place. Once all that is done, she’s thrilled to hear from me.

  “I’m tickled pink!” she exclaims. “I can’t hear. I can’t see. I can’t stand, can barely walk. I am not long for this world, but my dream has come true. At long last, I hear the voice of Nurse Tilda, the famous author. You must come see me as soon as possible, before it’s too late. From Toronto, it’s only a five-hour train ride.”

  Clearly, Audrey’s sense of time is from a bygone era.

  As we’re about to hang up, she says, “I await your visit. There’s lots of room in my big house for you to stay with me. Don’t dilly-dally. Come soon, the sooner the better. My dying wish is to see you, Nurse Tilda.”

  I’m on someone’s bucket list?

  Audrey’s letters have always been full of questions about the patients, nurses, and doctors I’ve written about. Here’s a sampling from a recent letter.

  How is “Suzanne” who had pulmonary hypertension?

  Doing well after a lung transplant.

  Is purple your favourite colour?

  No, blue.

  Your heart surgeon, the famous Dr. Tirone David, is that his real name? Is he as handsome as you say?

  Yes and yes!

  Do you have a live-in nanny?

  No.

  Is night shift awful?

  It’s often difficult, but only occasionally awful.

  Which is more serious: intensive care or critical care?

  They’re the same thing.

  Each letter contains an update on her health status, questions about me and my books, and, always, clippings from the Kemptville Advance or The Ottawa Citizen tucked into the envelope, which she indicates by writing “encl.” – a short-form now replaced by the paper clip icon to indicate an attachment.

  Audrey insisted that I take the train to Kemptville so she wouldn’t have to worry about me on the highway, but I need my car for my home care visits afterwards. So, I meet her in the train station, near the platform where the train would have let me off. I don’t want to risk getting a reprimand. It’s like a real old-time train station, with the big round clock, wooden benches, and even a spittoon. It’s easy to identify Audrey. There are only two farmers chatting and a mother with her child waiting to board the train. Then there’s a frail-looking woman with white hair, thick, large-framed glasses, and orthopedic shoes who has to be Audrey. She stands slightly stooped, leaning into a walker. Beside her is her “young friend,” Debbie, who must be in her forties and who Audrey has told me is like a daughter to her. Audrey is overjoyed to see me, but has an unexpectedly formal air about her, so I don’t hug her as I went to do at first. In fact, because of her regal bearing and imperious manner, I’m almost inclined to curtsey. Instead, we shake hands and slowly walk out to the parking lot to her 1978 powder-blue Oldsmobile. It’s in mint condition with an odometer reading in the triple digits. After Debbie manoeuvres Audrey into the passenger seat, she gets in behind the wheel. I sit in the back seat. At Audrey’s urging, Debbie drives slowly, at a rate that seems not much faster than a walking speed. In this neck of the woods, no one seems to mind slowpoke drivers. All the locals know Audrey. As they pass her car, they call out to her with a friendly wave.

  Audrey turns around to me. “See, my madcap scheme to kidnap you and bring you here worked, didn’t it?” Her expression is triumphant and gleeful. “Look what a simple, old-fashioned handwritten note can accomplish. It brought you here to me. Emails aren’t the same as letters. I don’t know anything about emails, only that I don’t want any. Would an email have tugged at your heartstrings the way my letters did?”

  “Probably not,” I concede.

  Audrey instructs Debbie to stop at Tim Hortons. “We need to feed the famous author,” she says. “There’s ‘nothing worse than a hungry nurse,’ right, Tilda Sue?”

  I cringe at hearing my middle name, which I never use, but I stand by the quote from A Nurse’s Story. No one wants a hungry, tired, distracted, or stressed-out nurse, do they? Good luck finding one who’s not. I decline the snack, but Audrey wants a coffee and a doughnut and sends Debbie in to get it.

  “Use cream. Not the blue milk.”

  When Debbie gets back in the car, we wait while Audrey daintily sips her coffee and nibbles at her chocolate doughnut and then is ready to move on. (No cup holders in this vintage model.) She taps Debbie’s shoulder. “Let’s give Charles Dickens back here a tour.” Audrey’s old clunker moves like a cruise liner smoothly sailing into various ports of call: her bank, where she keeps all the money she plans to bequeath to her church; the town bakery, where she instructs me to roll down the window so I can inhale the sweet fragrance of sugar, cinnamon, and yeast. Outside St. James Anglican Church, where her pew is fourth from the front on the left, she points out her tombstone in the cemetary. “It’s ready and waiting. But no flowers, remember?” She glances pointedly at Debbie.

  “Mama Audrey hates flowers,” Debbie explains.

  We move on to the public library where we meet Jean Kilfolyle, a library volunteer and Audrey’s best friend. “This is our sacred place for reading and for our teenagers to hang out after school. Here, we hold meetings of the ‘Youngsters of Yore Club,’ ” Jean says.

  When we get to Audrey’s quaint, cozy home, she shows me around, room by room, pointing out various treasures – pictures on the wall, Royal Doulton figurines, and china teacups, all of which have been provisionally divvied up among her friends, neighbours, and caregivers. Together they have made it possible for Audrey to remain at home. However, lately, she’s been getting more frail and unsteady, needing more and more care, and that’s been a concern t
o them all.

  As we’ve been sitting and chatting, various people have been coming and going in and out of the house, fussing around Audrey. They’ve brought trays of food and are warming up casseroles in the oven and setting the dining room table with a white tablecloth, all in preparation for what looks like a festive meal.

  “What are we celebrating?”

  “A celebrity has come to town!” Audrey claps her hands in jubilation. Then, with utter seriousness, adds, “I wanted you to meet all the supporting actors in our little drama. It will be good material for your book.”

  I nod. “It really wasn’t necessary to put them all to this trouble.”

  “Oh yes, it was. Good thing you made it here to visit me. I could go any day now.”

  “She’s got it in her head she won’t live much longer,” Hilda tells me. She’s Audrey’s main caregiver and had been waiting for us at the house when we returned from the train station. She cajoles Audrey. “You must make it to your eightieth birthday bash.”

  Audrey shakes her head. “Now that I’ve met Nurse Tilda, I am ready to go. I want to die now, while I’m still healthy. At seventy-seven, I didn’t get to heaven. At seventy-eight, I knocked on the pearly gates. At seventy-nine, I feel fine, but now, I’m afraid, old chum, my time has come.” At the kitchen table, she opens a notebook to a list of questions she’s prepared for me.

  “But I want to hear more about you, Audrey.”

  “Of course. I expected that. You came here for that exclusive interview.” She settles into her chair, ready to field my inquiries. “As my biographer you’ll need to know all about me for this little book you’re writing.”

  “Actually, it’s about home care. Nursing outside the hospital.”