Bringing It Home

by Tilda Shalof

  SUZANNE: My VON nurse taught me how to care for my baby when I was a new mom and gave me the confidence that I could do it.

  BERNADETTE: When someone came home after surgery, they knew a VON nurse would be there. And they were. When my own mother was dying at home, I couldn’t handle it alone. In walked the VON nurse with her bag and I knew all would be taken care of. And it was.

  COLLEEN: Each day, I’m excited to get to work. Every day is different. My husband says I never complain about my work. I think of all the grouchy people in the hospital. Whenever I encountered a pleasant person in the hospital, it took me by surprise.

  LOIS: At lunch, we were like homing devices. We got together and couldn’t get enough of each other, because most days we were out there on our own. For a once-a-month treat we met at the Ranch ’n’ Reef for dinner. [Nova Scotians call lunch “dinner,” and what I call dinner, they call “supper.” However, the question remains: What is lunch?] Nowadays, they have phone conferences, teleconferences, et cetera. But back then, we got together for meals and meetings.

  MOLLY: You were a jack-of-all-trades. You had to be creative, think on your feet, figure things out yourself. Improvise. I liked that.

  ENID: At my job interview, I was shaking from nerves. They asked me only two questions: “Can you draw blood?” and “Can you drive a stick shift?” Those were the requirements. To get a job with VON was a wonderful thing. I stayed until I retired. Oh, and the VON cars! The Lion’s Club gave us cars. This was long before Oprah was giving away cars. They hired me to work on a Coast Guard boat. Remember that old series of Cherry Ames’ stories? Well, I was Cherry Ames, Coast Guard Nurse. Cherry Ames, District Nurse. Adventures galore.

  HAILEY: We have a real team spirit here. There’s no gossiping, back-stabbing, or bullying. It’s not part of our work culture, like it is in the hospital.

  GETTING THERE IS HALF THE FUN

  MOLLY: Once, to get to a diabetic in a blizzard, I had to go out on a back hoe.

  BERNADETTE: “What’s the house number?” I asked the husband on the phone. He sends his wife out to check. “What colour is your house?” He sends his wife back out to check the colour. Somehow, I found it.

  ENID: “How far from such and such,” we’d always be asking. Our first job was figuring out where to go and how to get in once you got there. We had to be experts at finding places – long before GPS – and figuring out the entrances because front doors aren’t always where you would think they’d be.

  ME: Hospital nurses often feel stressed and overworked. Even the newbies complain of burnout. How come I don’t hear that from any of you?

  MOLLY SPEAKS FOR THEM ALL: We never looked at our work that way. If there were challenges, we worked harder. We felt proud of our work because we always felt we were helping people.

  HOME SWEET HOME

  COLLEEN: You get used to things you see. You go in some homes and there is so much clutter, others where there’s dirt. Still others where there’s both. The only thing that bothers me is bugs. In one house I visit, there are cockroaches everywhere. I stand the whole time I’m there.

  LOIS: Every newspaper that had ever come into the house was saved. A Christmas poinsettia left since spring. Styrofoam trays from meat. Tools and toys, typewriters and trash. There are so many hoarders out there – way more than we’ll ever know.

  BERNADETTE: One client saved every corn, callus, cuticle, and toenail ever cut off her feet and fingers. She made a display and labelled each from when and from which limb every item came.

  MOLLY: I remember a client who was living alone in a 150-year-old farmhouse, no plumbing, no electricity, no water, only a well, but she was happy. I had to start a wood fire to sterilize the instruments, even the glass syringes had to be boiled to give her insulin.

  ENID: At one house, there was a big hole in the wall. I could see right through to the next room. “See that?” the client said. “The last nurse was doing my dressing, fell back, and bashed into the wall.” In another house, I once found a man nearly frozen to death. He had on gumboots with holes in them and grey socks that I had to peel off because they were stuck to his foot. He hadn’t changed them in months. I put a swipe of Vicks VapoRub under my nose to dull the stink and got to work cleaning him up. He had to go to the hospital and the stench was so bad, the ambulance guys ran out gagging and vomiting, but by then, I was used to it. I was so focused on what I was doing.

  MOLLY: Sterile field? What sterile field? That’s a joke. You try keeping a sterile field where a rooster is hopping around and pecking at everything. I told one lady to boil the instruments before I arrived and I would find them simmering together in a pot with boiled potatoes.

  ENID: That reminds me. At one home I used to visit, there was always a pot of soup on the stove. I swear it was the same pot, the same soup, but she just kept adding things to it. One time there were feathers in it. I will never forget her; it was a sad situation. She had taken a drink from a soda can, thinking it was Coke, but it was car oil.

  MOLLY: In one house there was a terrible smell, cobwebs everywhere. I fell through the wooden floor; it was rotten. The client lay in dirty, tangled sheets. He had a beard down to his waist. It took four hours to get him clean but it was so satisfying. I held my nose and got in there and bathed him. I took out the dirty mattress and got him a new one and clean linens and clothes. I had to start a fire to burn the mattress.

  WHAT WE DID

  ENID: A lot has changed. Our scope of practice is growing all the time. Things I used to do when I started, home care workers do now. Things doctors did in the hospital, nurses now do in the home.

  SUZANNE: When central lines first came in, we felt overwhelmed. “We can’t do this in people’s homes,” I protested. I knew it was a big undertaking. We know the safety risks of an intravenous that leads straight into the heart. Yikes – pulmonary embolus, infection, a clot, a perforation – a simple air bubble could be lethal. The nurse needs to know exactly where the line is positioned and frequently check the external length to ensure it hasn’t migrated. There must be good backflow. The nurse has to ensure the line is clear and flushes easily. Resistance could indicate a clot or that the line’s gotten pushed up alongside a vessel wall, or knotted or gotten kinked. It’s up to the nurse, who is alone in that person’s house, to keep clients safe.

  ME: In the hospital, we confirm the placement of every central line with an x-ray, but obviously that’s not feasible in someone’s home. The crash cart and a code team are always available if needed. I can’t imagine being in someone’s home with a patient lying on a couch in front of the TV and something goes wrong. Who ya gonna call? Ghostbusters!

  LOIS: I had a client whose blood sugar was 2.0. He was almost comatose. I looked in the fridge. There was only a beer so I gave him that. I found a little package of strawberry jam from Tim Hortons and I gave him that, too.

  SUZANNE: I’m sorry to go on again about central lines, but they really freaked me out when we first started doing them. It’s hard enough to keep them sterile in the hospital; it’s been a real challenge to learn how to accomplish that in clients’ homes.

  ADVOCACY

  HAILEY: When I went back to work in the hospital, we admitted a homeless woman one day. I washed her hair with nice shampoo, styled it, bathed her, and talked to her. The hospital nurses were taken aback at how I treated her, but it was because of being a home care nurse. When you see people in their own environment, you develop more empathy. You’re less likely to judge.

  COLLEEN: People have a right to say no, to refuse our care. It’s not like in the hospital where it’s basically “take it or there’s the door.” We’ll still work with them. We don’t give up on anybody.

  MOLLY (NUDGING LOIS): That reminds me. Tell Tilda about the time you and I almost landed in jail.

  LOIS (SMILING): This lady – Myrtle – had very brittle diabetes, and often went into a hypoglycemic state. So every day, Molly and I got there first thing to make her breakfast. She live
d at the centre of town, so we’d meet there and plan our day together. It was our “war room.” One day Molly arrived first and called me. “Lois, you better come quick.” Myrtle was beside herself. The SPCA took her dog, Buster, away, because he bit an intruder, a Peeping Tom. That dog was so protective of Myrtle. When she went into the bank, Buster would wait outside and growl at anyone who went in. No one could go into the bank until Myrtle came out. I promised Myrtle we’d get Buster back, though I had no idea how I would keep that promise. The Mounties said the dog was dangerous and would have to be put down. We convinced the doctor to write a note stating that destroying the dog would be injurious to the client’s mental health. We suggested that the dog’s teeth be removed. Myrtle agreed. She was desperate to save her dog. The vet took out only the sharp incisors, but that was enough to get the dog released and back to Myrtle, with the stipulation that she keep him inside at all times. So, all’s well that end’s well – or so we thought. Not quite. In no time, Myrtle let Buster out again, roaming around, snarling at everyone as before. We were so exasperated. “Myrtle, we’re going to be thrown in jail because of you.” “I’ll visit you,” she said.

  NURSE SAFETY

  COLLEEN: They tell us not to go into a home if it is dangerous, that we have a right to work in a safe environment. But we’d never visit half the people we do if that was the case! [I think of Leala and her machete-wielding client.]

  ENID: What about those “Beware of Dog” signs? Often they don’t mean anything, but sometimes they do. At some houses, there’s no sign, but there should be. Once, there was a barking, vicious dog, the kind drug dealers use to guard their stash, a Rottweiler, I think. I still went to the visit. I used my VON bag as a shield and planned to use it as a weapon, if needed. “Your dog is scary,” I told the client. “You might want to think of mentioning the dog before someone comes over.” Now, VON has a “no pets” policy. Clients have to put their pet away when the nurse comes.

  HAILEY: Once, I was in an apartment building and the elevator door opened and a dog charged at me. Luckily, I managed to get the doors closed in time.

  LOIS: Once, I was attacked by a rooster. I still have a scar. At another client’s house, I couldn’t leave because there was a black bear outside the front door.

  ENID: Once, I went in and realized I was in a marijuana grow-op. There were weed plants everywhere. I decided to look the other way and commend his interest in horticulture.

  LOIS: In one home, there was a shotgun leaning against the wall. “Is that a gun?” I asked. I was so naïve. He grabbed it and put it away. “It’s just a starter pistol,” he told me.

  MOLLY: I didn’t feel unsafe as often as you’d think – not even at the home of one sweet old lady and some shady characters. Her house was full of car parts, tools, and machinery. They belonged to her son, she told me. She told me not to visit after lunch, only in the morning. Once, I was running late, and when I arrived six men were sitting around the kitchen table that had stacks of hundred-dollar bills on it, and a few empty forty-ounce liquor bottles. Other guys were passed out on the couch. A boom box was blasting. The old lady saw me and whacked the guys in the head. “Get out! Get out! The nurse is here.” A gun fell out of someone’s holster. She had two dogs: one’s name was Piss-Arse and the other, Motherfucker. It was a chop shop; they took parts from stolen cars and sold them for big bucks. There was a garage across the street and a mechanic asked me, “You actually went in there?” He was amazed at my bravery, but it was really naïveté. Later, I found out the old lady and the gangsters were a part of a Canada-wide drug ring.

  ME: You were very dedicated.

  MOLLY: Or foolish. The funny thing is, nothing bad ever happened, despite what seems like risky situations. We felt protected because we were VON nurses. Crazy, isn’t it? People needed our care and so we went in.

  LOIS: It’s true. There was an unwritten code, that you didn’t touch a VON nurse. It was a prestige we enjoyed. You had a lot of pride when you drove your VON car, and felt it gave you immunity from harm.

  HAILEY: In a Halifax apartment building, straight off the elevator, I smelled ganga. Three Rastafarian families lived together in a two-bedroom apartment. I had no problem going in there. I felt safe.

  BERNADETTE: It could be a bad storm, freezing temperatures, a hurricane, whatever. We went out in all conditions. Nothing stopped us. We had to get to the patient, no matter what.

  PETS, LIVESTOCK, MENAGERIES

  COLLEEN: Forget about dog problems - there should be a “no squirrels” policy. That’s what I’m dealing with now. At a home visit the other day, my client and his wife were sitting in the middle of the kitchen floor on overturned buckets, each with a rifle, shooting at red squirrels that were scurrying along the attic beams. I swear, the two of them looked like Ma and Pa Kettle. When I changed the man’s dressing, I felt a squirrel brush up against my arm.

  MOLLY: One lady used to call us to treat her animals. She couldn’t afford the veterinarian. She even took the animal medicine herself, like the horses’ salve for a burn on her hand. She had cat food in her fridge, but little else.

  LOIS: Remember the Bird Man? His house was full of pigeons – what a racket they made, and pigeon poo everywhere. A pigeon jumped on the bed while I was changing a dressing. That client lived for his birds, and who are we to try to change that?

  HAILEY: I once bathed a flea-infested dog and gave insulin to the cat. You have to use a 25 gauge, but still get down into the subcutaneous tissues. If you just go too superficially, under the fur, it doesn’t get absorbed properly.

  ME: Good to know.

  ENID: Does anyone remember the house with the horse in the living room? A new bylaw stated you couldn’t keep a horse in the city so they hid him in the house. I was changing a dressing when all of a sudden, I hear a neigh. “What is that?” I asked, though it was unmistakably a horse.

  LOIS: A cat peed in my bag once.

  BERNADETTE: Dogs? Dogs are nothing compared to Susie the Monkey. Her owner ran a boarding house [air quotes]. It was really a brothel. Susie, the spider monkey, sat on her shoulder and threw her poos at anyone who came near. I’ll never forget walking past her cage and her screeching at me, her arms clawing at me through the bars as I walked down a long, dark hall.

  THERE’S NO PLACE LIKE HOME

  SUZANNE: Even if a client chooses to live in unsafe conditions, we have to respect their choices. I recall a morbidly obese patient – over five hundred pounds – who lived in her bed. She couldn’t have gotten out in an emergency. She was trapped in her body and trapped in her home. She left the door unlocked, because she couldn’t get up to let me in. She was also a hoarder and had no money, so her possessions were trash and garbage she’d collected.

  HAILEY: I’ve been in houses that have been condemned, but as my dad used to say, you never know what another person is going through. He made us clean toilets and give rides to these local mentally handicapped people. He wanted to keep us humble.

  SUZANNE: VON nurses taught me about respect. I had to learn that “normal” is not how I define it. People have a right to live the way they want to live.

  DYING AT HOME

  MOLLY: I was always hyperactive, and palliative care calmed me down. You have to slow down when you’re caring for dying patients. I loved palliative care and did it almost exclusively in the last six years until retirement. Some of my best moments as a nurse were bringing comfort and dignity to people in their final days. I’ll never forget a young mother with sarcoma. She wanted to die at home, but toward the end, she went into respiratory distress and we decided to take her to the hospital. She said, “Wait. I have to make my bed first.” Then she went to the hospital to die. Another client, a man in his eighties, was in congestive heart failure. I visited him in his trailer and stayed with him until the end. But I had no meds to offer him. That was a painful death for him – for me, too. I’ll never forget it. Lois helped change all of that. You tell what happened, Lois dear.

 
; LOIS: I cared for a patient who died in excruciating pain. The doctor wouldn’t order anything without seeing him. He told me to bring him to the hospital, but the patient was too uncomfortable and unstable to move – I didn’t want him to die on the way. Easy for the doctor – he wasn’t there to hear the patient’s cries, or look him in the eyes and tell him, “I have nothing to relieve your pain.” I’ll never forget the family’s eyes, begging me to give him something to relieve his pain, and their fury at me when I had nothing to offer. A few days later, at a team meeting, Molly nudged me to tell them what happened. But I was shy; I couldn’t speak to doctors. What if they felt I was criticizing them or overstepping their territory? But I found the courage and got up to speak. I tried to control my emotions, but there were tears in my eyes.

  SUZANNE: Lois’s speaking up was the impetus to develop the Symptom Relief Kit. There’s no need to admit people to hospital for pain control. If they truly want to die at home, pain management – and all other symptoms of dying – can be accomplished.

  SUZANNE: Before we had the Symptom Relief Kit, patients were dying agonizing deaths at home or were transferred to the hospital to die on a stretcher in the emergency room. After Lois spoke up about her experience, it pushed us to develop a Symptom Relief Kit that contains meds for the common discomforts of the dying process: anxiety, secretions, nausea, pain, seizures. We taught the families how to administer the drugs if a nurse wasn’t there. This innovation has allowed people to die at home in comfort. Of course, there are risks with lay people administering drugs, and having narcotics out in the community. In one instance, we discovered that a son was selling his mother’s Dilaudid on the streets, depriving her of pain meds. But in most cases, it works out just fine. Now, nurses are allowed to pronounce a death. They do not need to wait for the doctor to arrive or, worse, have to transfer a client to the hospital so an ECG can be done to prove the obvious with a documented flat line.