by Tilda Shalof
“Okay, I’ll come in for a twelve-hour night shift,” I tell Voula, the nurse in charge who’s been scrambling all day to find more nurses for tonight.
Hey, I’m a sucker for being needed and patients need nurses. There’s no shortage of patients. If there’s a shortage of anything, it’s nurses and caregivers.
My journey is over now, and I feel nostalgic for it already. I’ve sent off my impressive collection of hotel swag – over 100 bottles of shampoo, conditioner, body lotion, and bars of soap – to the 360 Clinic for their clients – a tiny token of appreciation.
There are so many things that still make no sense to me in the hospital, like the waste we create and the excessive use of technology; the restricted visiting hours and the no-pet policy. The fact that patients aren’t invited to participate in team rounds about their own care. Why aren’t people allowed – no, encouraged – to read their own charts? Why do we have so much computer charting that it takes us away from patient care? Why are there nurses and doctors who don’t talk kindly – or at times even courteously – to patients, or who can’t find it in themselves to sit down and simply listen to what the patient has to say? Why does a nurse have to call a doctor to get a Tylenol or a laxative for a patient? Why can’t patients who are well enough to administer their own meds do so? Why are the people who provide the most care to patients (nurses) and to everyone else, the sickest themselves? Why do hospitals have to be so gloomy, bereft of music and art and beauty? Why do staff walk into patients’ rooms without knocking? Why is the food so bad, so unhealthful, often inedible? Why, given all the technological advancements, policies, checks, and double-checks, are medication errors still so frequently made? And why is it so easy to get so busy and distracted that you can completely forget that your patients aren’t feeling very well? Why is there so much waiting in hospitals, and if you do have to wait, why can’t someone come out and tell you why and how much longer you’ll still have to wait, and maybe even do it with a smile?
I’ll stop here.
I’ve wondered about these things for years. However, in all of my travels outside of the hospital, in all of my visits to homes, clinics, community centres, I saw patient care that was governed by logic, fairness and common sense, administered with kindness and goodwill – not to mention fiscal responsibility and restraint.
More, please.
I’ve always chosen to care for the sickest patients, making the assumption that that was where the biggest challenges were, where the need was greatest, and where there was the most excitement. But there are other challenges to face and work to be done that are no less important and every bit as exciting.
“So,” they’d all asked when I was back at work, “how was it?”
“Good. Very good.”
“And are you back now for good?”
“For good,” I say. “For now, anyway.”
It doesn’t have to be this or that, either-or; it can be and.
Audrey always planned that her home would be her last address until the cemetery. After her brief stay in the hospital, she did come home. Hilda, Virginia, and Audrey’s cadre of caregivers, friends, and neighbours came to take care of her, even taking turns staying with her around the clock. Now, though, her care is getting to be more than they can handle and she needs a nursing home. But she seems to have reconciled herself to it because she visited one to inspect it. Soon I receive a few more letters – sunflowers, goldfish, fancy bows, and teacups.
At the nursing home they range from 79 to 102 years young. It’s a friendly place, clean and very home-ish. A place where it would be hard to become alone-ish.
Yes, I sold my darling little house and contents. I’ve never been as popular in my life until now that I’m cleaning out the house …
I’ve always known that everyone’s life is a story worth telling. With each letter I received from her, Audrey tried to convince me that this was her last chapter. She’s said that from the first letter, in the first phone call, during the first visit. Perhaps that’s a good way to live.
But now, a few weeks later, the letters have stopped. I’ll call her when I get a chance, I tell myself, making a note of it on my mental “To Do list.” But before I get around to doing so, a call comes late at night, just after midnight. Who calls this late? It can only be bad news.
“Is that Nurse Tilda?” a quavering voice asks.
“Audrey,” I gasp. “Are you okay?”
“No. Enough is enough.”
“What’s wrong?”
“I want you to do me in.”
“I can’t do that, Audrey, you know that. You sound like there’s still life in you.”
“No, I’m on the way out. I’m almost dead.” I hear the sound of rustling pages of paper and can visualize Audrey’s slow fingers turning them. “I have a few questions for you, Tilda Sue.” Then Hilda gets on the line and explains that Audrey has a bad cold, is very weak, and can’t walk anymore. Hilda has been staying with Audrey at night until she goes into the nursing home.
“When will your book be done? I’m not long for this world and I want to read it before I go.”
“It’s almost finished.”
“I hope I live to read it.”
“I hope so, too.”
“You always say I should hang on longer. Is that for me, or for your readers? Wouldn’t it make a more dramatic ending if I die tragically in the final act of your book?”
“No need, Audrey. You’ve provided enough drama.”
“Won’t your readers want to know if I made it to the end of your book? Tell them I did.”
“Will do. Oh, and Audrey, you’re not dying. You’re not there, yet.”
“That’s good to hear.” She pauses. “There’ll be no more letters from me, Tilda Sue. That’s it.”
“It’s late, Audrey,” I say, longing for my bed.
“This is my last chapter. My book of life has now been completed.”
“Yes, Audrey.”
“Tilda Sue. Are you listening to me?”
“Yes, Audrey.”
A long pause ensues. It’s time to say goodnight, and hopefully hang up, when Audrey stops me in my tracks. “I’m glad you were part of my dash.”
“Your dash? What’s that?”
“It’s the space in between birth and death, like it will say on my tombstone, 1933–2013. It represents all the important people and events of one’s life.”
To care and be cared for. Anything can be endured if you have that. A home, too.
Live-streaming allows me to sit at my desk in Toronto and attend the ICN conference in Melbourne, Australia, to watch and listen to Judith who is about to give her acceptance speech to nursing representatives from all over the world. Here it’s afternoon but in Australia it’s tomorrow – fitting for a person as progressive and forward-thinking as Judith Shamian.
This morning, I received a mass email from her, copied to thousands of other Canadians who care deeply about our health care and that of the world.
“I am now president of the International Council of Nurses,” it said simply.
Mention of her appointment is in the front section of the national newspapers and on CBC Radio. I don’t imagine many people take much notice, but maybe they should. In fact, it’s time they did, because even if a small part of Judith’s huge vision comes true, it will improve everyone’s life. It won’t be easy. Will her strong voice be heard over the dominating ones of political interests, big corporations, and the medical establishment? If anyone can do it, Judith Shamian can.
Looking resplendent in a royal-blue blouse and a burnished-orange blazer, and wearing a chunky artsy necklace, Judith stands on the podium before the world, and greets the assemply in Chinese, Spanish, French, and in her own Hebrew/Hungarian-accented English. She starts off with a surprising announcement.
I dedicate my four years as your president to a woman named Tova. She was my roommate in nursing school. I met Tova at the age of eighteen and it was the start of a lifelo
ng friendship until she died of cancer five years ago. Tova immigrated to Australia and lived here in Melbourne. She worked as a burn unit nurse, a mental health nurse, and then a palliative care nurse. She wasn’t the president of an organization. She wasn’t a politician or a researcher or a manager or director of anything. She was a nurse who cared for patients, families, and communities in the most knowledgeable way possible. Tova, like millions of nurses around the world, worked to make an impact on the lives of the people they touch.
My commitment to you is to remember the impact nurses have on the lives of people. For the legacy of Tova, I have chosen “impact” as the watchword of my term as your president. In English, impact is a noun and a verb, a means and an end. It embodies action and outcome. As nurses, we are here to serve, to make an impact, and to ensure that we can practice the best nursing possible, without risking our lives, safety, and without compromising our family life.
Many countries are dealing with poverty, economic crisis, and lack of access to health care. There are growing concerns about the increase in chronic diseases, mental health, aging populations. Too many decisions are being made without nursing’s voice. This is unacceptable, because the only way to make an impact on global health is through nursing knowledge and participation, both at the decision-making tables and in hands-on nursing care, from birth to death and from health promotion, disease prevention, primary, acute, critical, chronic, long-term, home, and palliative care.
… a nation’s prosperity is enhanced by a strong nursing profession. It is simple: you see, the wealth of our nations depends on the health of people, and the health of people depends on nursing. How we will have an impact? Look around and cast your eyes on this global nursing community. We know how to keep people well, help them heal, and save lives. We can transform illness-focused health care to a wellness-focused one. When we unite as one profession we are a powerful force. We are the nurses of the world, and we have the potential to make the people of our countries healthier.
She tells them she has 1,460 days to make a difference and that she intends to make use of every single one of them. “Let’s get to work,” she says. “There’s no time to waste.”
A few days later, Judith’s back in town, and I get one more meeting with her, at her home on the Sabbath. There’s no real purpose for this meeting, I just want to congratulate her personally. She’s just arrived home from Australia and should be jet-lagged, but doesn’t look it in the least. She’s fresh and refreshed, younger-looking than I’ve ever seen her in a loose comfortable dress and silk stockings without shoes. To my delight, I notice that she’s had a pedicure, her toenails polished in a pattern of copper, silver, and gold – shiny celebratory colours. Her fingernails are in the same multicoloured pattern. She looks content, the way a person looks, not immediately after crossing the finishing line of a marathon, but a few hours later. Tonight, when three stars appear in the sky and the Sabbath ends, her week will begin and she’ll be back to work. In fact, tomorrow she leaves for Europe to attend a conference on health care workers in war-torn countries.
Her husband comes into the room and wishes me a Shabbat Shalom, Sabbath Peace. He nods at Judith. He’s beaming, busting with pride – levelling, would be the exact Yiddish term. “Are you as proud of her as we are?”
Yes, of course, but even more than proud, I am happy, more hopeful for the world.
There’s no need for tea or coffee, nor reading or debating. We take up our usual places on the chairs. Is it my imagination or has our relationship shifted? I don’t know for sure, but I face her now as a partner, as colleagues. We sit back and take a break from the work that usually occupies us both so intensely. It’s far from completed, our goals have not been reached, but it’s time to rest. Together we sit, gazing out at the street, the neighbourhood, the city, and the world unfurled before us, the world with all its goodness and all of what still needs repair.
“I like how you mentioned nurses’ health and safety, and their family life.”
“Yes, I worry about how nurses can maintain their health – and their compassion – and sustain it for an entire career. It’s not enough to care for patients. We have to care for nurses, too.”
I have to ask. “Was Tova her real name?”
“Yes.”
We both know the meaning of that word. Good.
It’s all good.
Yes.
Postscript
Early this morning, I finished writing this book. I typed the last word – “Yes” – and pushed the Send button to shoot this manuscript off to Elizabeth Kribs, my editor at McClelland & Stewart/Random House Canada.
A little less than an hour later, I received a text from Jean Kilfolyle, Audrey’s friend.
“Audrey is in palliative care. She’s on oxygen and unresponsive.”
It won’t be long now, though knowing Audrey, anything is possible.
Around five o’clock this afternoon, Jean called to say Audrey had died.
“She’s at peace. She waited for you to finish your book. Thank you for being one of the brightest stars in Audrey’s life.”
From the first time I met her, Audrey told me she was ready to die. Vivacious and morose, charming and aggravating, generous and stubborn, there were many sides to her, but I never met someone as thoroughly prepared for death and as joyfully engaged in life as Audrey McClenaghan of Kemptville, Ontario.
Safe home, Audrey. Safe home.
Tilda Shalof
October 2013
Acknowledgements
To all who shared their stories, and thus themselves, with me.
Judith Shamian for the opportunity to learn what real health – not illness – care is all about.
Elizabeth Kribs, Terri Nimmo, and Linda Pruessen at McClelland & Stewart for their superb editing and design.
VON and its staff and volunteers. Special thanks to Owen Adams, Derrick Babin, Darlene Billard-Croucher, Stacey Bourque, Marilyn Chuli, Carol Cooke, Lori Cooper, Krista Dalliday, Maria DesRoches, Suzanne D’Entremont, Joshua Dougherty, Cherie Gilbeault, Sandra Golding, Robert Fraser, Kathy Hardill, Laurianne Hébert, Irene Holubiec, Nicole Hunter, Jon Jewell, Robin Kish, Irena Kesminas, Anne-Renée Landry, Christine LeBlanc, Elizabeth Loftus, Beverlee McIntosh, Janet McLeod, Connie Milliken, Sylvia Mingo, Irene Pasel, Kathryn Roka, Gayle Sadler, Bonnie Schroeder, Judy Stewart, Jan Stutz, Stephanie Vandevenne, Helen Vink, Karen Ursel, Andrew Ward, Joan Wekner, Jackie Wells, and Robert Zwicker.
To VON nurses of Halifax and Yarmouth, Nova Scotia – especially: Josephine Blynn, Frances Brison, Julia Cottreau, Sheila D’Eon, Marg Jenkins, Barb Lutz, Thelma Newell, Ellen Pothier, Barb Rodney – for a rollicking good evening of stories.
Celine D’Gama, Rose Faratro, Anna Gersman, Jennifer Kazmaier and CalaCare Home Health Care, Annie Levitan, Anne Moorhouse; Merilyn Simonds and Jan Walter; Doris Grinspun and the Registered Nurses Association of Ontario; Sandy Zidner, Diane Moretto and Toronto Public Health; Natalie McLean and Hospice Toronto; Denise Morris and team of the Medical-Surgical Intensive Care Unit, Toronto General Hospital – especially: Stephanie Bedford, Belle Dhillon, Janet Hale, Margaret Herridge, Edna Lee, Kate Mackenzie, Wendy Radovanovic, Janice and Audrey Stanley, Jasna and Jack Tomé and sons.
To the ones who bring me home: Harry, Max, and Ivan Lewis.
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