The Making of a Nurse (42 page)

She nodded but she seemed content to complain. “Tilda, are you okay with this patient?”

“Yes. No problem,” I said, not letting on what I really felt, which was a sinking sense of dread. I got up. It was time to go in. I donned a mask, gown, and gloves to add yet another barrier to all the others that already stood between us. As soon as I opened the door of his room, I reeled back from the stench. I couldn’t do my head-to-toe assessment, or check his heart rhythm, or listen to his lungs: hygiene was top priority. It would have to come first, admittedly, more for me than him.

He’d managed to wriggle out of all of his sheets, leaving himself exposed. Standing at the door, I could see the long red dotted lines of scabies along his legs and arms. His inner arms had raw, oozing purple-blue track lines along his veins. Whatever I felt or thought
didn’t matter. I filled a metal basin with hot soapy water. I got two more and filled them as well. More than ever did I wish I had that portable shower I had been dreaming up for years.

I stood at the foot of his bed. “I’m Tilda, your nurse,” I said dully.
Lucky me. Lucky you
.

It’s usually hard to make out the words of intubated patients but there was no mistaking this message. “Fuck off!” he mouthed, his eyes filled with rage.

I told him I was going to give him a bath, and he neither consented nor refused so I pulled the curtains closed and got to work. He was tall, maybe six feet, but all skin and bones. As I worked on him, he continued to thrash around, his fists clenched, still straining at the tube. Gradually, the water calmed him down a bit, but he kept shaking his fists at me. I was tempted to sedate him, but that might delay extubation. I wondered if loosening the restraints would calm him down but I was afraid to get hurt. I have received punches and kicks from patients and I realize that it is delirium that makes them combative, but still, it’s not easy. I looked down the hall for help, but everyone was busy. I had to take a chance. As I untied one hand, he grabbed my arm in a tight grip. I shook it off. “Let go of me,” I shouted, jumping back. “Don’t touch me!” I threw the washcloth into the basin, splashing water all over the bed. “Are you going to let me take care of you or not?” He nodded and I released his legs. He kicked them around, perhaps just to feel them again after being tied down. I began to wash his face and neck with the warm, soapy water, maybe a bit roughly at first to show him who was boss, and then more gently. I shaved around his beard and then soaped up his arms and legs and chest and splashed lots of hot water all over him. I washed and combed his hair. He lay there, indifferent to what I was doing. Then I attacked the streaks of dried shit and urine that stained his genitals and legs. I have cleaned excrement from patients who were unconscious or who for other reasons had lost control, but this man had relinquished his continence. It didn’t matter to him. It was the shit of not giving a shit any more.

I have never read much of the New Testament, despite the many copies that have been pressed upon me over the years by sincere
and well-meaning Christians. But I knew that Jesus had washed the disciples’ feet and that was a very impressive act indeed, although they probably weren’t as dirty as this patient’s. I thought about that as I washed his stinking feet, as I parted each toe and scrubbed away and tried not to look too closely at what I was pretty sure were bugs in there. I changed his sheets and put a fresh hospital gown on him. I pulled opened the curtains and didn’t say another word or give him a backwards glance. I peeled off my gown and gloves, washed my hands, and hurried out.

PREJUDICE IS A TERRIBLE THING
, but in a nurse it is unconscionable and dangerous. We hold ourselves to a high moral standard. Every professional does, but few are challenged in the way that nurses are to confront what most repels us. I once asked Tracy if there were patients she had difficulty caring for and she admitted, “I can’t stand the way men in some cultures treat their women.” She told me about a female patient who had tribal slashes all over her face and who had been circumcised. “I realize it’s their culture, but it’s too alien to me. I couldn’t get past it and definitely couldn’t get close.” And when Laura had judgments about patients who made suicide attempts, she never showed it, at least not to them or their families. Noreen certainly hadn’t recoiled from the hostile, angry family of Jerome, the young man who died of liver failure. Funny how Carmel, the one who complained that others discriminated against her, once complained to me about a patient. She told me about a new immigrant to Canada from Pakistan who was not yet a citizen but nonetheless was put on the list to receive a lung transplant. “Don’t you think a real Canadian should get one before her? Not only that, but our tax dollars are paying for her health care! Don’t you think it’s wrong?” No, I didn’t, but I had my own prejudices to contend with. Mine were against people who gave in to despair, just like I had.

It was when I returned home from travelling to Israel. I was twenty-four. My father had died, my mother was dying, I was estranged from my brothers, our house was sold, and I felt so bereft of family and comfort and all alone in the world. Friends
offered me places to stay, but in my condition it felt like too much of an imposition. I was just as angry, just as homeless as this man. I had resources and supports but I chose not to turn to them. Instead, I went underground and hid. This man was me. I was him. I had been that lost, that close to the edge.

IN MORNING ROUNDS
the team gathered to discuss his case. The staff doctor peered in through the glass. “He looks familiar,” she said. “I’ve seen him before.”

How could that be? He looked like any of them. He could be any of many derelicts loitering on Carlton Street on Sunday morning after a Saturday night binge or even that greasy bum near the University of Toronto who I used to rush past whenever he begged for a bus ticket.

“Where?” I asked her. “In emerge? The nurses there said he’s a ‘frequent flyer.’” I had obtained his old charts from medical records where it stated his name was Zbigniew Zwiezynskow, but there was no home address and no family, next of kin, or friends listed. He was all alone.

“No, I’ve seen him on the street, panhandling. Maybe around Yonge and Bloor.”

It impressed me that she saw him as an individual, not as an anonymous street person. I, however, was not so noble. On the other hand, she didn’t have to get as close to him as I did. She wasn’t in his face as I had to be, breathing his air, smelling his pollution, hearing his grunts and obscenities. I was close enough to sense his thoughts, read his life story, and feel a bit of his pain.

When it was my turn to speak, I raised the question of whether he still needed the breathing tube. Initially he had required maximum support, but today he was more awake. Although his blood gases showed poor oxygenation, and he had a lot of thick, infected secretions, if we did a lot of deep breathing exercises and chest physio, he might be able to improve on his own. I suggested we extubate him and see if he would “fly.” If he didn’t do well, he would have to be re-intubated, but if that happened, then he could be sedated and allowed to get the rest he needed.

The staff doctor agreed. “It’s worth a try.”

The respiratory therapist removed the tube and I sat my patient up in bed and helped him cough out his secretions. He looked around, bewildered. “I need a drink,” he muttered.

“Not yet,” I said. “Easy does it.” I put my hand on his shoulder.

We placed an oxygen mask on his face, but he ripped it off and threw it down on the floor.

Carmel popped in to ask me if I wanted to go for coffee with her. She must have been feeling guilty about her switcheroo, but it was karma: I was meant to have this patient.

“No, maybe later,” I told her and sat down to think. I hadn’t thought much about my own similarly dismal period in years, but now, taking care of this man who had nothing – no home, no family or friends – brought it all back to me. Eventually, I had decided I didn’t want to live that way any more and faced the daunting task of taking up my life in my arms. The first thing I had to do was find a place to put myself, a shelter of some sort. “Home” seemed like an impossibility. I took the first place I saw.

“Donna! Get the screwdriver!” the landlord of Regal Mansions hollered down the hall to his wife. “The hacksaw, too!” Clearly, there were some loose screws, but I had no idea what this man was planning with the hacksaw. He led me down a dark, narrow hallway that smelled of cigarette smoke, cooking, and the bodies of the many lives living in the rooms behind the doors. It was dimly lit with shaded lights and sand-filled spittoons at the elevator. We stopped at the bachelor apartment for rent on the second floor. It was at the back of a three-storey building overlooking a parking lot. It didn’t have a kitchen, only a tiny refrigerator and a hotplate in the corner of the room. There was only one rule at Regal Mansions, the landlord informed me: no pianos.

Drugs and guns are welcome, I suppose
. “That won’t be a problem.”

It was in a rundown building in a seedy neighbourhood. “Toronto’s twenty-fifth homicide of the year happened right around the corner,” he boasted. The apartment was dirty and the walls were crumbling and needed paint. “It ain’t the Taj Mahal,
but if you get bored, you can go across the street to the church and watch the weddings.”

Joy didn’t hesitate to offer her opinion. “Don’t even consider this dump, Tilda. Come stay at my apartment until you get yourself sorted out. I have a futon.”

“I kind of like this place. It’s growing on me.”

“Yeah, it grows on you all right. Like a fungus.”

I called the landlord to say I’d take it. I hired a painter, a Russian man who promised to do “special job for young lady.” I handed up a cup of coffee and a doughnut in a paper bag to the top of the ladder and stood back to gaze around at my new periwinkle blue walls. It was the colour of dusk and dreams; of in between, of day turning into night and night turning into day. It was a
becoming
colour, I thought, pleased with the paint and my pun.

“Let me ask you something.” The painter rested the roller on the can of paint. “What’s nice girl like you living in dump like this? You should live with parents until wedding. What boy want girl who lives in bachelor apartment? A
parscutzveh
we call this type.”

“I hear you,” I sang out. “Thanks for the advice.”

At night, I heard babies crying, people screaming, cats yowling, a dog’s toenails clicking on bare floors in the upstairs apartment. Vibrations of Bob Marley and the Wailers thrummed through the wall and floorboards along with the earthy whiff of dope, when I left the windows open. I lay down on the bare floor so I could feel the warm throb of Jamaica in my bones. The smell of hot, steamed fish and fragrant jasmine rice permeated the hallway each evening as I trudged down the hall after spending the day with my mother. A Vietnamese family lived across the hall. There were about twenty pairs of plastic sandals and slippers outside their apartment, beside the front door. Once, when the door was open, I saw the family squatting on the floor in a circle, their rice bowls cupped in one hand, chopsticks in the other. I left the window wide open and one night a squirrel scurried in. I tossed him a few kernels of popcorn, grateful for his undemanding companionship. We were all looking for places to call home.

I bought a little travel alarm clock with green hands and numbers that told the time in Tokyo, São Paulo, and London. I took
my parents’ stuff out of storage and donated my father’s clothes to a home for alcoholic and homeless men. I imagined the bums at the Silver Dollar Tavern on Spadina Avenue sporting my father’s lime green polyester shirts, black beret, and paisley cravats. There wasn’t anything useful like furniture or kitchen utensils, but there was a foot-long sign with my father’s credo, THINK, in bold letters and his Underwood typewriter with the keys that stuck. A bunch of dried up ballpoint pens from dry cleaning plants and a stack of library cards from every small town he’d passed through. There was his Ponderosa Steakhouse discount card and a catalogue from a medical supply store featuring raised toilet seats and bathtub bars.

Joy came for a visit. “How’s your new place?” She stepped gingerly over the threshold. “I’m so glad you’re back. I missed you. We have so much to talk about,” she said like old times, like we were fourteen again. She handed me a plant in a pot as a house-warming gift. I didn’t want something I would have to take care of and she read my thoughts.

“It’s a cactus, you goof. Put it on the windowsill and give it a few drops of water every other month. You can handle it. Cocooning is what you have to do now.”

I had no curtains so I cut up green garbage bags and before taping them over the windows I caught a glimpse of a pretty garden in someone’s back yard. It seemed unimaginable that I would ever sit in a garden like that with civilized people. Even with my garbage bag curtains in place, the sunlight filtered through along the sides, like shafts of light slicing through an aquarium. I slept on a mattress on the floor and didn’t bother with sheets or blankets, just pulled my jacket over myself like I did when I slept in the park.
Home
, I kept trying out the word before I fell asleep.

One morning, I got up and went to the refrigerator. It was empty from the top shelf to the bottom. It was entirely up to me to make this place a home. I was coming to the bitter realization that the mother/nurse I yearned for was going to have to be me. It was up to me to fix myself – or not. I was tired of always being homesick. I had been yearning for a home for so long, even when I was at home. I got to work. That day, I scrubbed and scoured that place until it shone. In the evening I went out to buy bubble
bath. The options promised were “revitalizing,” “rejuvenating,” and “soothing,” but since I had no idea which remedy I needed, I settled on “moisturizing.” I realized that the time had also come to buy a few groceries.

I HELPED MY PATIENT
out of bed, eased him down onto a comfortable chair, and went back out to my desk and computer. As I sat there, I returned to the question I’ve asked myself every day of my life as a nurse. Do I love my patient? Some would say love is a lot – too much – to ask; only skilled caring and basic respect are necessary. Many would claim that love is not a requirement for the job. Nonetheless, it’s what I’ve come to expect of myself. Because, after all, what is prejudice if not a failing of the ability to love? And if I couldn’t manage love, at least I wanted to offer
loving kindness
.