The Making of a Nurse (12 page)

“SURE, YOU COULD STAY HERE
, I guess …” my brother Stephen said slowly when I showed up one evening on the doorstep of his new condo in my subway clothes and tangled hair. Kindness had never been his strong suit but it was a failing he was trying to correct. “When did you get back from Israel?”

“A few weeks ago. I’ve sort of lost track of time.” As I followed after him, I caught an appalling glimpse of a scruffy, unwashed hobo person in the hallway mirror.

“Well, come on in.” If he was reluctant to let my unsightly, unwashed self into his home, he was charitable enough not to
show it. He settled into a black leather chair and chomped on a cigar. “I have to tell you, Til, you’re looking rather unkempt. You’ve got to pull yourself together.” He continued on in this new, amiable vein. “Well, you’re welcome to stay as long as you like. At least until you get your act together.” He looked me over. “How long do you think that might take?”

I stayed overnight. As I slept, the sections of his leather couch would slip apart and I had to keep getting up to shove them back together. I tried to hold myself still so they wouldn’t separate, but by the morning I was balancing on the middle section, my legs off one end, my head suspended off the other end, like a damsel on a magician’s levitation table. By then, Stephen had left for work. I wrote him a thank-you note, left it on the dining room table, and went back underground. It was easier to live like a rat, wander the streets, sleep under bridges or in bushes, eat garbage, ride the subway all day, and not think about anything, rather than face my life.

Of course, I was still a nurse, but I had sunk into such a pit of depression and self-pity that the prospect of taking care of others, of assuming responsibilities as I had done in Israel, and hardest of all – having to be empathetic to other people’s problems – seemed too much for me. For a while, I couldn’t imagine I’d ever be able to be a nurse again. But after a few more miserable weeks of living a vagabond life and a scary glimpse of where I was about to end up, I managed to pull myself together and make myself passably presentable to apply for work. I signed on with a nursing agency on a freelance basis and started off with private duty assignments, caring for people in their homes after an illness or surgery such as a hip or knee replacement. The clients were wealthy and had high expectations of tip-top “customer service” from their nurses. One woman summoned me by ringing a silver bell! It made me feel like one of her little dogs. In fact, in addition to nursing care, I was also expected to run errands, do her shopping, and walk those dogs for her, but at least they were a lot friendlier than she was.

On another assignment in the home of a man recovering from a stroke, I had no sooner arrived when his wife imperiously told me to “rearrange his luggage.” It seemed she wanted me to
reposition his testicles while he was sitting in the wheelchair. I was uncomfortable with this instant familiarity, this required intimacy, just because I was a nurse. When the wife was out of earshot, and I was doing as she asked, the husband gave me a lurid grin. “Harder, faster,” he whispered. All day he kept trying to touch my breasts and at one point, actually grabbed at my crotch. I stayed till the end of the shift, but told the agency I would not go back there, without explaining why. I felt I should have been able to put a stop to him myself. After all, I had defied Yaffa and refused to wear a cap. I had been in charge of the bone marrow transplant unit. But now, I was reduced to this – servant, dog-walker, babysitter, and now sex object!

As bad as it was, it was also a productive period in its own way. It helped me get back on my feet and after a few weeks I had enough cash to put down first and last months’ rent on an apartment. I found a tiny bachelorette in a rough, down-and-out neighbourhood but it was the start of a home for myself.

After a few months of those relatively cushy assignments, I was feeling stronger and ready to request a more demanding placement in a hospital. I got there early, feeling nervous as I walked slowly to the medical-surgical floor of a large downtown hospital where I’d been assigned, trying to steel myself for what might be thrown at me. There was always a sense of the unpredictable and that I might be expected to deal with more than I could handle.

That day I had eight patients who needed a great deal of nursing care. It seemed overwhelming but luckily, Scott, a Registered Practical Nurse, was working with me. Whatever superior attitude or reservation I might have had about working together with an
RPN
, a nurse with a more rudimentary nursing training than I, vanished in minutes when I saw how skilled and professional he was. Not only was Scott an excellent nurse but his constant patter of jokes kept my flagging spirits buoyed.

“C’mon, girlfriend, let’s go.” He pushed a linen cart alongside us. “Most of our patients are
NFW
, and we have a few who are
FVB
.“ I shot him a questioning glance and he explained: “‘Not Feeling Well and Feeling Very Bad.’ But no sweat, most are walkie talkies.”

“Come again?”

“Up and about, walking and talking. Don’t worry. You’ll get used to me.”

A woman with curly grey hair wearing a bright blue terrycloth robe approached us. “My bed hasn’t been changed in three days.” Scott gathered up fresh sheets and we followed her into her room. “The service here is terrible,” she said, supervising our work. “I’m going to transfer to another hospital.”

We moved on to the next room where a patient was lying in a huge bed, under loads of covers. She was morbidly obese and bloated, too, from a buildup of fluid due to liver failure. She was so swollen it was difficult for her to get up or even move her body. She was scheduled for a procedure to insert a temporary shunt to drain the excess fluid from her body, but it was a stopgap measure at best. Only a new liver would save her life.

“When can I book my transplant?” she asked me.

“It doesn’t quite work like that,” I said but didn’t have the time to explain the complex process.
*
Scott and I helped her to get up and out of bed and wash herself and then he took her vital signs and I gave her her medications. I looked at my watch and spurred myself to move faster. We still had six more patients to see.
A good nurse is a fast nurse. A fast nurse is a good nurse. Work harder, faster
, I told myself.

There were so many patients to see and problems to attend to. I spent entire shifts running to and fro, popping in and out of patients’ rooms. I’d get one patient out of bed, run to give a medication, then have to dash off to answer a call bell. Wherever I was, I always felt like I was supposed to be somewhere else, dealing with something even more urgent. Everywhere I turned there was someone in distress. Patients were crying out or short of breath. They were sad or angry, wandering off or calling out, and many were confused, demented, and even hostile. There was no point lingering in a patient’s room or delving too much into anyone’s problems, as that would only create more information to chart and
make me get too far behind in my work. The work seemed never-ending, but I did see other nurses handling it quite capably. Some even stopped to chat with patients or share a laugh, but I never felt organized enough or fast and efficient enough to take the time. But the main reason was that I knew my ability to listen and be empathetic was limited by my preoccupation with my own problems. How far I felt from being that “therapeutic presence” the professors had extolled, or from being a member of a dynamic team like I had been in Israel. Exhausted and miserable, I kept at it. I got by and, thankfully, so did my patients.

WORKING FOR A NURSING AGENCY
, I never knew where I would be sent and I rarely returned to the same floor two shifts in a row. The agency would call me early in the morning or late at night to inform me where my next gig would be. After a few months, I had worked in so many different hospitals that it was becoming a blur of patients and their crises and all I was left with was my constant and nagging feeling of inadequacy. One morning, at five o’clock, the supervisor called to say they were sending me to an
ICU
. I quickly reminded them I didn’t have the qualifications to care for critically ill patients. I had to refuse that assignment, but it got me thinking about what it might be like to work in an
ICU
. Like the operating room or the emergency department, the
ICU
was a specialized area where many nurses aspired to work. Perhaps it was time to look for a permanent job and become part of a real team?

There was a patient I cared for during that time who I will never forget. My only regret is that I never returned to find out what happened to him. I choose to believe that he got better and is out there somewhere, crooning “Blue Suede Shoes.” Tom Buckley was a spry seventy-year-old, originally from Newfoundland, who had worked as an Elvis impersonator for parties and events. He’d even won contests, boasted his girlfriend, Iris, especially when he sang “Love Me Tender.” He was a jolly, stocky man who was always smiling. Iris was constantly at his side, dolled up in gaudy costume jewellery, thick pancake make-up, and a huge coral lipstick smile. She called him “Buddy,” and so did we, the nurses. He was scheduled for a
coronary artery bypass, but a
CT
scan
*
revealed that he also had a large aortic aneurysm, a potentially lethal condition. For days, the cardiovascular and the thoracic surgeons discussed the prospect of the complicated surgery he required as each staked out a claim to their portion of the patient’s inner organs.

I wanted to follow up with Buddy so I asked the agency to send me back to that ward the next day. I wanted to go to him first, but I had to see a few other patients beforehand. I knew immediately that it wasn’t going to be easy to establish any kind of “therapeutic relationship” with my first patient. She took one look at me and slammed down the phone on whomever she’d been talking to. “Fuck you, Maggie!” she yelled, pointing a long, manicured finger at me. Gospel music played loudly from a radio on her bedside table.

In these situations, we had been taught to say, “You seem angry. Do you want to talk about what’s bothering you?” but I had no desire to step into the maelstrom of her anger. I kept it short and sweet. “How are you feeling this morning, Miss Wilson?”

“How the hell do you think I am? And I’m not taking any of those fuckin’ pills of yours.”

We will lift up to the Lord. Sing in Jesus’ name
. She began to hum along and snap her fingers, more to block out my presence and ignore me, I felt, than in worship. “I’m Tilda. I’m your nurse and I’m here to give you your antibiotics,” I said, nodding at her
IV
.

“You can call me L’il Roxy. That’s my stage name. Now you get the fuck out of here, Maggie, unless you got any painkillers on you! I told you never to come back. Oh, you can tidy up this shithole before you leave.”

“You must be confusing me with someone else. Who is Maggie?”

She didn’t answer. “And don’t you touch my catheter or steal my pee. I have to measure what goes in and what comes out.”

The nurse-client relationship is based on trust
, I recalled reading somewhere.
Displacement of anger is a defence mechanism they’d taught us in Introduction to Psychology. Come back
later and take her vital signs
, I told myself.
Let another nurse change her dressing. Move on
.

There were six more patients to get to before I could reward myself with a visit to Buddy and Iris. I gathered the supplies I would need to do a large dressing change, and as I was about to enter the room, another nurse saw me. “Brace yourself for that one,” she advised, not explaining further.

I opened the door and immediately smelled something bad. The patient was a young woman who had undergone radical surgery for breast cancer, and I introduced myself to her.

Suppurating
, I told myself,
is the fancy way to say ‘full of pus.’ Suppurating, suppurating
, I thought over and over like a mantra, as I peeled back thick layers of gauze that covered a huge, gaping, ragged incision that looked like it had been made with a hatchet. Her wound had become horribly infected and the sweetish, putrid smell was overwhelming. Rivulets of sticky green and yellow pus dripped down onto her gown and onto the bed. I tried to hide my revulsion. I swallowed hard and looked away.

“The other nurses wear a mask,” the patient said. “In fact, they wear two masks and dab a few drops of mouthwash in between the layers. They say it helps. You’ll know for next time.”

Suddenly, I gagged. I ran out of the room and made it to a garbage can and vomited. When I came back I saw the patient had managed to dispose of the dirty bandages and had cleaned her wound and covered it with clean sterile gauze by herself. “I’m so sorry,” I said.

Finally, I went to Buddy. “How are you feeling today?”

“Better than dead! You’re the one who looks stressed.” He settled back into his pillows. “Hey, Miss Tilda, have you seen my rash?”

“Rash?” I searched my notes. “Where do you have a rash?”

“On my skin. That’s the best place for a rash!”

Iris and I exchanged exasperated looks. “That’s bad, Buddy. Really bad,” she said.

“What’s for lunch, dearie?” he chirped when I brought him his tray. He lifted the cover and made a face. “Back home, at midday, I always have two poached eggs, side by each.” He turned to Iris.
“You know what we’ll do, dearie? We’ll take Tilda home with us, screech her in, and make her kiss the codfish.
*
Then we’ll prepare her a Jiggs’ dinner.”

“What’s that?” I sat down on a chair beside his bed, wishing I could stay there all day.

“Salt beef, carrots, turnips, potatoes, sometimes an old rubber boot.”

“Buddy puts a bit of salt beef in, on Sunday, for sure. Moose, if we can get it.”

“Horse, if we can’t. And guests. See, if we runs out of horse, then we use the guests!”

“Don’t mind Buddy.” Iris shook her head.

“Are you okay, Buddy?” I asked when he suddenly winced. “Are you having pain?” He rubbed his back and his chest. “Oh, it’s pain, all right,” he said. “It’s good pain. Real good pain.”