The Making of a Nurse (15 page)

But before I had a chance to apply for any of those jobs, my mother’s condition worsened and I was faced with a difficult decision. Her doctor in the hospital called me to come in. We walked together down the corridor. “Your mother has pneumonia,” he
said gently. “Her condition has been severely debilitated for some time. Did she ever discuss her wishes with you?”

My mother had told me exactly what she wanted, but I never really believed I would be in a position to have to carry it out. “I don’t know,” I lied.

“The burden of treatment must be weighed against possible benefits so as to avoid unnecessary suffering,” he said in a kind but formal way.

“What are the choices?”

“To withhold further treatments, discontinue feeding, and wait and see. Or …” He paused before option number two. “To transfer her to the icu, institute life support measures, and then wait and see.”

I told him I would think it over. I hung up the phone and went into the cafeteria. Even though I wasn’t the least bit hungry, I bought a butterscotch sundae in a small plastic cup that had a tiny wooden paddle for a spoon. I thought about using that little oar to push off from shore and row out into the high seas in order to get as far away from all of this as I could. I understood the choices before me, and I wondered how I would feel after each fateful one.
Do me in, she’d told me. Find a way
. From the age of six, I knew my mother’s wishes, but now would I have the courage to carry them out?

I went back up to her room. She had a fever and I sat beside her and placed a cool cloth on her forehead. A medical student came in to take blood. He poked at her arms that were covered in bruises from previous needle attempts, but soon gave up and left. My mother was in her fifties, but she looked eighty. She no longer responded to the music on the radio I played for her and now, barely spoke.

A nurse came in and took her vital signs but there was nothing vital about my mother’s grey pallor or her raspy breathing. When the nurse left, I leaned down close to my mother to hear if there was any last message, but her breath had an unpleasant, medicinal smell that made me pull away. She looked at me but I don’t think she saw me.

“You have a difficult decision to make,” the doctor said when
he came back into the room. “Your mother is critically ill. Again, the choices are to transfer her to the
ICU
and put her on life support or keep her here and focus on her comfort. Did she ever discuss the matter with you?”

“Yes, she did,” I told him. “She told me many years ago, and again on many occasions.” I said I knew she wouldn’t want to go to the
ICU
because whatever they might be able to offer her there, she would never again be able to sing and that was all she really wanted. The doctor agreed that a palliative approach was wise, but we decided to continue with antibiotics and feeding. I guess I wasn’t entirely ready to let go yet.

The nurses kept her clean and comfortable. They talked to her and caressed her and stayed even closer by her side, offering her the loving kindness that I hadn’t been able to for years. I couldn’t bear to visit her. A few days later, a nurse called to tell me the news. “Your mother has improved. Her fever is down.” The doctor was also impressed. “Given her premorbid condition, I didn’t expect a recovery, but her superb pulmonary function pulled her through. She’s got the respiratory reserve of an athlete with huge tidal volumes. It is extraordinary how she sings little tunes for the nurses at a moderate volume but her speech remains barely audible.”

“She always said breathing was the most important thing.”

“Now that your mother has recovered,” the doctor said, “we will have to fill out the papers for her to be placed in a chronic care facility.”

But her recovery was shortlived. Within a few weeks, the pneumonia returned and this time ravaged her even more. One afternoon Pearl met me at the nurses’ station, her face glistening with tears. “She’s gone.” She wiped her eyes with her fingers and hugged me. “And I say, good for her! Praise the Lord!”

I could hardly believe it had finally happened. She had been dying for years but this time it was for real. “Why do you say that, Pearl?”

“She’s in the arms of the Lord. Her suffering is over.”

“Her life was sad,” I lamented.

“Yes, but she was saved,” Pearl exclaimed. “She took the Lord Jesus into her heart just in time, before she died. Read Psalms: ‘Alas for those who cannot sing, but die with all their music in them.’”

“Who was she, Pearl? Did you ever get to know her?”

“I did! I loved that woman. I do! I loved her like my chile.”

I loved her that way, too, even when I was a child myself. She was my first patient and a gentle soul who adored beautiful music but cried when she heard it. She adored elegant clothes, but rarely wore them. She admired great books, but never read them. I had missed her all my life and now that she was dead, suddenly, I no longer missed her.

My three brothers were at the funeral, but we didn’t speak much. I could see that Robbie was mentally not well. “I made you take care of me,” he said. “I was very disturbed. Do not underestimate the very-ness of that disturbed.” I tried to put my arm around him, but he pulled away. My other two brothers seemed happy. They would be okay.

“I’m sorry for your loss,” the Rabbi said to us. “We can only hope she’s in a better place now.”

“It couldn’t be much worse,” said Stephen under his breath.

The Rabbi spoke of her magnificent voice and her thwarted career as an opera singer. He told of her dignity and the courage with which she met her challenges. I sat there, squelching my memories of all the harsh things I’d said, the rough way I’d handled her at times, and the promises I’d broken. I thought of the tender nursing care I’d given to other people, yet the only patient for whom I couldn’t muster sufficient compassion was my mother. I sat there and tried hard not to think about the one long black velvet glove with pearl buttons that she wore when she sang. I had found it among her belongings and had searched all night for the mate.

I was in my late twenties and grief seemed familiar to me now, this second time around, mourning my other parent’s death. I knew that the sharp pain would eventually subside, that it would always be lodged inside me, more bearable with time. For a few days I was tempted to follow my old escape route, underground into the subway, but a newer, stronger core within me was developing and I made the decision to go forward with my life. I decided to accept a position at Toronto General Hospital in the Intensive Care Unit. It was the same hospital where I had gone with my mother to her appointments with the neurologist Dr. DeGroot,
and to my father’s various doctors. It was the hospital where I had first worked as a candystriper and then in the patients’ lending library, distributing novels and magazines. Now, its Department of Nursing was offering a critical care course and upon its successful completion, a staff position in the icu. It had only ten beds at that time but there were plans to expand.

The
ICU
was dark and cramped with two patients in each room. In fact, one room was located so far from the nurses’ station and was so poorly lit that it was called the Cave. Needless to say, no one wanted to work there. There was a hushed, tense atmosphere in the icu, punctuated by the frequent beeping, buzzing, and ringing of machines in each room. Attached to the equipment, the patients were unconscious, lying stretched out on huge beds. The nurses all wore green scrubs, the walls and countertops were pale green, and in my imagination, there was a ghoulish green hue on some of the patients’ faces. The place made me queasy. I jumped up a few times during the nights before work, always afraid I would sleep in. The
ICU
environment scared me, and the prospect of taking care of critically ill patients terrified me, yet I think that’s why I chose it. I wanted to face what I was most afraid of and master it. I’ll never forget my first day and how Laura, the charge nurse, greeted me. “Welcome to the House of Horrors,” she said with a grim laugh. She was pretty, but I could tell that her good looks didn’t matter to her. In spite of my fear, I couldn’t help but feel thrilled to be part of the
ICU
team, facing the incredible challenges of bringing people who were on the brink of death, back to life.

I immersed myself into my work – caring for patients with the most catastrophic, life-threatening illnesses imaginable. There were people recovering from massive surgery to their chest or abdomen and the doctors there were even starting to perform liver and lung transplants. There were cases of cardiogenic shock, septic shock, and multi-system failure, where more than one of the major organs was malfunctioning or had shut down altogether. Doctors were on-call at all times, but each nurse was assigned one or two patients at most and assumed complete responsibility for all of the nursing care that patient needed. Doctors came and went, but the nurses always stayed close to the patients and their families.

There was so much to learn, so many numbers and formulas to memorize and complex concepts to grasp, that for the first few weeks, I operated on a strictly need-to-know basis. I couldn’t absorb anything extra. Everything seemed urgent and top priority and I wasn’t always efficient enough to get technical jobs done fast enough. For example, I often spent an inordinate amount of time sorting out the tubes, wires, and lines that always bunched up around the patient. The nurses called it “spaghetti” and invariably one of them would sense my frustration and arrive on the scene to help me out. (It was a task akin to disentangling necklaces that become inexplicably and impossibly intertwined from merely lying in a jewellery box.) Those experienced nurses knew lots of tricks with their hands, like how to use gravity or negative pressure to get fluids to flow in or out of the body and how to apply traction or leverage to position patients more comfortably in bed. They often jerry-rigged various pieces of equipment to get them to work the way they liked and some even kept a screwdriver and a surgical clamp (which they used as a wrench when needed) in their pockets.

Within the larger team of nurses, there were six of us whom I ended up working with closely for many years. We were dubbed “Laura’s Line,” but if we had been the “Spice Girls,” Laura would have been pungent Garlic; Frances, heart-warming Cinnamon; Tracy, elemental, essential Salt; Justine, spicy Cayenne Pepper; Nicky, sweet Maple Sugar; and I, Coriander, an acquired taste that grows on you over time, or so I’ve been told.

Even back then, Laura was a paradox. Brusque and sarcastic toward doctors, demanding and critical of other nurses, irreverent and dismissive toward administrators and politicians, Laura was at all times exquisitely kind and exceedingly gentle with her patients. She was intelligent and very well read, yet she had little respect for formal education. Patients loved her, but Laura prided herself on never getting too attached to them.

“One thing, I can tell you,” Laura said to me early on. We were sitting in the staff lounge during a coffee break, and she stretched out on the couch, her arms behind her head. “The personal stuff is highly overrated. I never get emotionally involved with my patients.”

“How can you care for people and not have a relationship with them?” I asked in dismay.

“I’ve taken care of a lot of patients over the years and never felt I had to get to
know
them,” she shot back. “Give me a break, Tilda! There are too many of them and they’re too sick and there isn’t enough time or enough of us.”

“Haven’t you noticed how it means so much to patients when nurses get emotionally involved with them?”

“Patients also tend to favour nurses who give them the right medications on time, too!”

Laura showed little deference to doctors. She addressed them all by their first names and when a weekend was coming up, she not-too subtly suggested that they treat the team to bagels and cream cheese or pastries. And if a resident wanted to perform a procedure on her patient and asked her to bring him sterile drapes, an angiocath, a scalpel, and a pair of forceps, Laura didn’t miss a beat. “Do you want fries with that?” she’d ask. When the doctor finished the procedure and if he should turn to walk out of the room, she would call him right back to clean up the mess of bloody towels, used swabs, and especially “sharps” – the needles, wires, and blades – he’d left behind. “Why should she clean up his mess or risk her safety handling things he had used?” she’d ask him. And just before she released him, if he had written a slew of orders in the chart, she stopped him. “Whoa, there. You can’t split without discussing those with me. I’m in charge of this patient’s care.” Eventually, she set him free and he would scurry off.

She spoke in the same way to senior staff doctors. If one of the specialists asked Laura about her patient, she might say, “That depends,” not looking up from whatever she was doing. “Tell me who you are first. If you’re from Neurology, then he’s improving. If you’re from Cardiology, he’s stable, but if you’re from the liver team, he’s in a bad way.”

Once I asked Laura about my patient’s Central Venous Pressure. “Where do the doctors want the
CVP
to be?” I asked her. By then I understood the various manipulations that we could make with fluids and medications to affect the heart’s functioning. “Where do
they
want it?” she shot back. “Where do
you
think it should be? Don’t just follow orders. Think it through yourself.”

Frances was the softie in our group, and I don’t know how I would have survived those first few scary weeks in the
ICU
if she hadn’t been there. She always made herself available to me and was at my side the first time I had to suction a patient, something we had to do to remove secretions from the lungs. He was on a ventilator and had a breathing tube. “This will make you cough,” I told him timidly, and he nodded his assent for me to proceed. “I know it’s uncomfortable, but afterwards you’ll feel better,” I explained unconvincingly. I hesitated and tried to steel myself to perform this procedure that I knew would be unpleasant for him. “Here,” said Frances, “let me show you.” She did it smoothly and the patient nodded his appreciation of her more confident style.