The Making of a Nurse (14 page)

That remark made me giggle as I rushed back into the room, scissors in hand. But by then, the doctor was gone. He’d managed to remove the rest of the bandage by himself. The dirty gauze littered the bed and floor. The wound was left wide open. The patient’s covers were thrown back and his gown was askew.

“How am I doing, nurse?” the patient looked up at me. “The doctor didn’t mention.”

“Your incision is healing nicely.” I was steaming mad as I repacked the wound with sterile gauze and then cleaned up the mess. On the bedside table, beside the chart, I found a fancy pen the doctor had left behind. He’d used it to write in the chart. It had gold-coloured letters spelling out the name of a drug company. I did what anyone would do in that situation. I stole his pen.

THEN THERE CAME A NIGHT
so crazy and chaotic, so stressful and upsetting, that by the end of that shift, I was ready to call it quits – being a nurse, I mean. I was sent to a medical surgical ward where I’d worked before, but this time, they put me in charge. In short order, I had to know everything about the medical condition of all of the thirty-two patients and be the one ultimately responsible for their nursing care. Luckily, Scott, the
RPN
, was on that night, and I knew from experience that I could count on him. However, Colleen, another
RN
, was also on and I knew from experience that I could not count on her. Skinny and low-energy and often in a bad mood, Colleen looked particularly disgruntled when she showed up late that night. She didn’t greet me, but I caught up with her and re-introduced myself.

“Hi,” I said with a fake smile. “I’m new,” I added nervously.

“Hi, New. I noticed someone put you in charge.”

“I mean, my name is Tilda. I’m from an agency, so it makes more sense for you to be in charge as you’re staff here,” I said. “You know the patients better than I do.”

“Who said I wanted to be in charge? They obviously figure a university nurse is better for the job. Anyway, you’re welcome to it. Enjoy!” She showed me a doctor’s note. “Just to let you know. I hurt my back. I can’t do any heavy lifting.”

No lifting? Lifting was easy. The uplifting was the hard part
.

Colleen went off to prepare medications for her patients and I sat down at the nurses’ station beside Scott at a table covered with patient charts. “Colleen’s got a chip on her shoulder,” he explained, opening the box of doughnuts he’d brought in, “but she’s a good nurse. Problem is, sometimes she’s just not that into patient care.”

What else is there, I wondered? “Mmm …” I murmured as if I understood.

“Colleen’s the type that if she worked in a supermarket she’d prefer to handle the cash and bag groceries rather than deal with customers, you know what I mean? Anyway, relax, girlfriend, we’ll manage.” He passed me the box of doughnuts. “Here, have a ‘tractor wheel.’” It was what he called the sugary, ridged crullers. “Or, a Boston Cream, if it doesn’t make you think of draining an abscess.”

I chose a plain glazed one. It was a wonder I ever even had an appetite at the hospital, but I usually did. Anyway, there was no more time to chat because I had just gotten word from the resident on call that we were receiving a new admission from the Emergency department. “Scott, you’d better get started with the vitals and the baths. After I finish transcribing the orders, I’ll go around and do the IVS, dressing changes, the meds, and the peritoneal dialysis.”

“Sounds like a plan. Don’t worry, Tilda. There are only two patients who are
PBS
tonight and one guy coming in now who’s
HIBGIA
.” I waited for him to fill me in and he complied. “C’mon, girlfriend, get with the program. ‘Pretty Bad Shape’ and ‘Had It Before, Got It Again.’”

“You’ll have to keep a close eye on this new admission,” the resident said, wheeling a stretcher into the ward. “He’s a seventy-something homeless man with asthma and congestive heart failure.”

Until I called Medical Records, I didn’t even know his name was Mr. Fred Olsen. His chart was so heavy and in so many volumes that the porter brought it up from downstairs in a wheelchair. I went to see him and stood looking down at a poor, dirty person sprawled in the bed. His breathing was noisy and laboured and when I placed an oxygen saturation monitor on his finger to get a sense of his tissue perfusion, I got an abnormally low reading of 75 per cent, so I cranked up the oxygen concentration.

“If he deteriorates during the night,” the resident said almost hopefully, “we’ll be able to transfer him out to the
ICU
.” The doctor’s beeper rang and he had to run off, but I stayed behind with the patient. His oxygen mask hung loosely on his thin face and scraggly beard and I tightened it to fit better. I saw that he had soiled himself and so I went to get a basin of water, clean sheets, and a fresh gown. I got to work bathing him, all the while thinking about the multitude of equally pressing things that needed attending to. A man peeked into the room and asked to see the doctor. “He was just called away, but he’ll be back in a few minutes. Is there a problem? Can I help you?” I came out into the hallway to talk to him.

“No offence, but you’re just the …”

Yes, what am I? I dare you to say it
. He changed his tack.

“How is my mother doing?” he asked politely. “She seems confused.”

Which one was she? I ran through my notes to refresh my memory. Luckily, I had read her chart. “Confusion is common after a stroke. It may improve with time. It’s still too early to say.”

“What? Mother had a stroke? Why didn’t anyone tell us?”

The man followed after me as I went to the nurses’ station and reviewed her chart, but there was nothing much to tell him about his mother as the doctor hadn’t yet examined her. The
CT
scan done in the Emergency department showed she had suffered a stroke and that lots of blood work had been drawn and other
tests performed, but the results were still pending. Since I had nothing more to tell him and about twenty other places I had to be at that moment, I turned away from his anxious face and whizzed past him. I couldn’t spare a moment even to help him prop his mother up in bed so that she could sip a cup of tea. Colleen was nowhere to be found and Scott needed help with a patient, a forty-year-old man who that afternoon had swallowed paint thinner in a suicide attempt and was now vomiting blood. I showed Scott how to irrigate the patient’s naso-gastric tube with saline and left him with that and went out to the large group of family members waiting outside the door. “How was Salim before this happened?” I asked them. There was so little information in the chart and a considerable language barrier between us.

“He was good, very good, thank you, miss.” They bowed slightly, grateful for my concern.

“Was he unhappy about something?”

“Oh, no, nurse, he wasn’t unhappy. Salim is such a very happy person.”

“What led him to do such a thing?”

“Well, he lost his job at the paint factory and his wife left him and took the kids back to India.”

“Oh, I see.” Now I had too much information. I smiled at their old granny who was blowing kisses to me. She was hobbling around with a cane and looked like she’d just flown in from the streets of Calcutta with her black teeth, dusty feet in sandals, wearing a flowing brown sari with a veil that trailed down her back and nose ring in the shape of a daisy. She smiled at me, put her palms together, and bowed. I bowed to her in return and then went to find her a wheelchair. Since I couldn’t find one, I put her on a swivel chair from the nurses’ station and she blew more kisses at me as her grandchildren gave her rides, wheeling her up and down the halls. Just then I heard Colleen call out, “Come quick!” and I rushed into the room and saw a mini-geyser of blood spurting out of her patient’s groin. He had undergone an angiogram that day and the site where a huge needle had been placed was
gushing. I grabbed a pile of sterile gauze, reached down into the folds of his belly and slapped it on the spot. I pressed my full weight upon it to staunch the blood. I put Colleen in place to keep pressure on the spot until the bleeding stopped and I went off to page the surgeon.

I spent the entire night running from crisis to crisis. In between, I was answering the telephone, speaking with families, ordering drugs from the pharmacy, filling out forms, paging doctors, ordering trays from the kitchen, restocking cupboards, cleaning rooms. It was well after four o’clock in the morning and I had yet to begin to make a dent in my charting, but I decided to check on the homeless man one more time. I turned the light away so as not to wake the other patient in the room who was snoring lightly. At first I thought Mr. Olsen was asleep, too, but upon closer examination, I saw that he was dead. Now, there would be a slew of paperwork, a call to the morgue, and, once his bed was vacated, the possibility to get a new admission in his place. “Well, at least it’s one less to worry about,” the resident said, coming up to stand beside me at the patient’s bedside, and I hate to admit it but I had just had the exact same thought.

It’s almost over
, I told myself as the day shift began to arrive.
This is my last shift, my last night as a nurse
. I was throwing in the towel. (I would have thrown in my cap, too, if I wore one in the first place.) I sat down to collect my scattered thoughts as I prepared to hand over to the oncoming charge nurse. I went through them one by one. “Mr. X … wound still inflamed, spiked a temp last night … Mrs. Y, slept well, good pain control … Mr. Z … less nausea but urine output still low.” Then I came to a report about a patient I couldn’t recall. “Mr. Henderson,” I said, reading the note slowly. “Low blood pressure. Cerebral hemorrhage, unconscious, neck fracture …” Who was this? How could I not know about a patient, especially one this sick? I saw Colleen snickering and whispering to her day shift friends, who looked over at me and laughed. She had set me up! Some jokes are meant to provoke laughter and others to provoke embarrassment and this was of the latter type. But hadn’t I been warned?
Nurses eat their
young
. Unfortunately, I had never learned how you avoided becoming someone’s live bait.
*

Just as I was leaving, the nurse manager came over to ask me to stay for a few hours of overtime. “We’re dangerously short-staffed. How ’bout it, Tilda?”

“Sorry. No can do,” I told her curtly without even offering a reason.
Let me outta here. Let me put an end to this nightmare
. But still, it was not to be. As I tried to leave again, a nurse shouted from the medication room. “Call the Mounties! The narcotics count is off.” She’d said it like a joke, but it was a serious situation and no one could leave until we reconciled the count. The morphine tallied, as did the Codeine and the Dilaudid, but two vials of Demerol were missing. As the nurse in charge, I was held responsible and had to fill out an incident report. Unaccounted-for narcotics was never taken lightly and I knew this report would become a permanent part of my record. Again, I saw Colleen smirking as she left. I didn’t know if she had had anything to do with it – whether she was a possible user or simply a troublemaker – and I didn’t even care at that point.

“Rough night?” said the nurse manager, coming back over to me.

I shot her a murderous glance but my rudeness didn’t dissuade her from reaching out to me.

“Come to my office. Let’s have a chat.”

I shook my head because I knew if I spoke, I would cry, and if I cried, I would lose it altogether. “I’ll come,” I told her, “but I have nothing to say.” Yet the moment she sat down opposite me and gave me her undivided attention, I spilled my guts and told her everything. Not just about that horrific night and the homeless man who had died alone and the bleeding groin and Colleen, but about Buddy, too, and about the suppurating wound, and the patient who called me Maggie and about how impossible, frustrating, and
soul-destroying it was to be a nurse. She listened to me, nodding her head from time to time. I expected her to tell me to toughen up and get better at my skills and at organizing myself, but she said none of that. What she did say surprised me. “You have to learn how to get in and how to get out.” You have to care, she explained, but not too much, or it will interfere with your ability to be effective. “Fix what you can and leave the rest. Some things you can’t make better.” I must have looked dubious. “I know it sounds harsh,” she said, “but it’s the kindest thing. The most helpful.”

“I may be having a nervous breakdown,” I warned her, holding my head in my hands.

“You’re exhausted,” she said kindly.

Yes, there are times when sleep is the only solution.

T
he “All-Day-Breakfast” must have been invented for people who work at night because nothing tastes better than poached eggs, buttered toast, and hot coffee in a greasy spoon diner, in the late afternoon after an entire day lost to sleep. That horrible night shift, I had intended to call it quits, but with sleep and food so fine, my outlook improved. I decided to stay, after all. Besides, I needed nursing more than nursing needed me. Fortunately, around that time – it was 1988 – there was a sea change in the job market and hospital officials decided that instead of layoffs, more nurses were, in fact, needed. Headhunters went scouting, offering incentives of sign-on bonuses and education subsidies. Opportunities abounded. “Recruitment and retention” suddenly became the new buzzwords, making it sound like a military operation.