The Making of a Nurse (16 page)

“Smile,” Frances said to me afterwards, and I did, broadly, falsely. “That’s better. At least try to look like you’re having fun, then maybe you will.”

I don’t know exactly how she did it, but Frances made patients feel she was doing things
for
them and
with
them, not
to
them. She saw the patients’ room as their personal space that she entered with their permission. And although Frances could perform advanced and high-tech skills as well as anyone, it was providing care and comfort measures that she most prided herself on. “Never neglect the
basics,”
she explained to me on many occasions. “You have to keep the mouth clean and the skin moisturized.” She also meant the turning and the lifting, the rubbing and the massaging, keeping patients’ hair washed and tidy, trimming beards, cutting toenails, removing wax from ears, rubbing mineral oil onto the soles of scaly feet, and at all times, keeping patients clean and comfortable on smooth, fresh sheets. These were the dreary, menial jobs, the “custodial care” that many university-educated nurses assumed a degree would exempt them from. Yet, Frances performed them like they were almost sacred tasks and regarded them at times as having even greater importance than sophisticated procedures. “It’s when you are doing these things that you can assess the condition of your patient’s skin, their oxygenation, and pain
and so on. Some nurses think doing these things is beneath them, but I don’t and never will,” she said.

One day, to my surprise, Frances called upon me to help her. She was caring for an elderly Chinese man who was dying. With the family’s consent, I joined the intimate circle around his bed. Frances instructed me to place warm towels all over the patient, with a few extra around his neck, as this was part of the Chinese custom of keeping the body warm. And when she noticed that the family was ill at ease and unsure of what to say or do, she guided them. “Tell him you are here,” Frances said, motioning them to move in closer around the bed. “Say the names of each person here today with him. Let him hear the sounds of your voices.”

“Can he hear us?” they asked.

Frances nodded. “You may not get a response, but talk to him anyway.”

“We don’t want to disturb him.” They were afraid and drew back.

“This is hard for you, but he is peaceful. He’s comfortable.” Frances let down the side rails so they could be even closer if they wanted. “It’s okay. Hold his hand. That will make him feel loved and secure.” She gave them a cloth to wipe his brow, a moist swab for his mouth, and I could see their fear lessen as they did these small actions. When he began to take his last breaths, Frances put her arms across their backs. She stayed with them until the last heartbeat, the last breath.

For me, it was fascinating to watch how a person died, organ by organ. The technology of the
ICU
exposed everything. All the body’s secrets were revealed. I watched the kidneys shut down, the blood pressure diminish, the heart slow down to a wavy, then horizontal green line, the irregular breathing pattern of the lungs mapped out on the ventilator screen, the incremental diminishment of oxygen to the tissues, and all the while, the gradual loss of consciousness. I watched death happen and saw how it could be measured, charted, documented – even
manipulated
. It was no wonder, in fact, that when Frances shut off the cardiac monitor, the family took that flip of a switch to be the moment of death.
“Is he gone?” they asked and her “yes” was as gentle as possible. They asked her to please open the windows so that their father’s spirit could escape into the afterworld, but Frances explained that that was not possible because the hospital windows could not be opened. That distressed them, but there was nothing that could be done. Then the family left and I helped Frances wash the body and remove all the tubes, lines, and machines. All the while that we worked, she kept a quiet, almost reverential silence. Then she brought the family back in so that they could spend time with the body, pay their last respects, and chant prayers.

“Salt-of-the-earth” Tracy was tall, skinny, utterly unflappable, and at times, inscrutable. She had an uncanny – almost spooky – way of appearing just when you needed her the most, without your even asking. And she had a respectful way of helping, so that you felt she was assisting you, not coming to your rescue because you were freaking out and not coping with the crisis yourself. Tracy said little and in fact was so quiet and serious that occasionally when she cracked a joke, it snuck up on me. I was sitting with her in the staff lounge one day and she was telling me about a patient of hers who had lung cancer. “I was giving her a bath,” Tracy said. “She seemed fine, but all of a sudden, out of the blue, she burst into tears.”

“What happened?” I gasped.

“She told me she was afraid the surgeons didn’t get it all and that she might die.”

“What did you say?” I asked, wondering what I would have said.

“I said, ‘C’mon, knock it off, don’t be such a crybaby. Put on a happy face.’”

“You said that to her?!”

“No, you doofus. There was nothing to say. I just sat with her and held her hand while she cried.”

She said it as if it were nothing, but it seemed to me something fairly important.

In contrast to Tracy and her subtle manner, Justine was known to be a spicy chili pepper and not just because of her flaming red
hair. She had a fiery tongue and could be brutally honest, but most people took it from her – even patients’ families – without question, because she was totally fair-minded and completely without malice. She enjoyed working in the
ICU
but saw its limitations. She believed we often went too far with some patients and decried the fact that we didn’t know most of our patients’ wishes. She was convinced that if they could speak for themselves, many would refuse the extreme measures we were offering them. Even though these were delicate situations, Justine’s humour could be outrageous. Once, I went over to chat with her and she casually mentioned with a wicked grin that her patient was about to be transferred out. I looked at the number of pumps and machines in the room and the ominous numbers and abnormal waveforms on the monitor screens. “Transferred out? You mean he’s going home? How?”

“Yeah, he’s going home all right – in a jar. He’ll be transferred out to the Eternal Care Centre. You know, the Celestial Discharge Unit.”

It was a horrible joke, but what a relief it was to laugh. Justine provided that opportunity for all of us on many occasions and sometimes for patients as well. “You’re a Scorpio?” she said to one young man she was caring for, noting the date of birth on his chart. “Hey, me too! Scorpios rock!” As anxious and worried about their loved one as a family might be, Justine always managed to get a laugh out of them. Walking past her patient’s room one day, I was shocked to hear her say to a family who was barraging her with questions and demands, “Stop it, you guys! You’re driving me crazy!” Rather than being affronted by her, I saw how she put them at ease. After all, they must have figured, how bad could it be if the nurse was joking around?

As for Nicky (pure maple sugar), it was probably not a good idea for us to work together because we chatted far too much. We gossiped about boyfriends, travel plans, and forbidden liaisons and rendezvous between certain doctors and nurses that only we knew about. We talked as we bathed our patients. Nicky would wash one leg, and I, the other. She soaped up one armpit while I rinsed off the other. She took temperatures and I recorded the
blood pressures. One patient moved his head from side to side watching our routine and as ill as he was, couldn’t help but laugh at our antics.

As for me, I thought of myself as coriander, a herb my father used liberally in his cooking. It has a flavour that most either love or decidedly, not. My father claimed it was a delicate yet hardy plant with both a sweet and bitter flavour, and in the proper growing conditions, it would flourish. Coriander, he explained, had special properties because it was neither exclusively wild nor domestic; it was a “cultivated weed.” I was coriander in those days in the
ICU
where I felt I was finally flourishing in the proper environment. It was a place where I also had the opportunity to explore many different ways of being a nurse.

I studied all of the nurses I worked with, adopting the traits I liked. I was in awe of Laura, who engendered such affection and confidence in her patients. There were others like her who were no less caring even as they kept their emotions intact. I admired Frances and Nicky and other nurses like them who
did
connect personally with patients, yet I often saw, in private moments, how it took its toll on them. I longed to be as calm and focused as Tracy. As for Justine – what a pistol! I hoped one day to have the courage she had to stand up for what she believed was right – whether it was advocating for patients or for nurses – and to find a way, as she did, to use humour to make people feel better.

I wonder if any of the nurses suspected that I was “spying” on them, listening in to their conversations with patients and watching how they handled difficult situations. I admired how some always managed to find something hopeful or positive to say, even when the patient was getting worse or dying. Some nurses took such care with seemingly small things, for example, ensuring to cover up parts of the body they weren’t washing to keep the person warm and unexposed or warming up a metal bedpan before putting it in place underneath the patient – and how others didn’t take or make the time to do these things. Some noticed even minute things, such as the discomfort caused by a bit of plastic jutting out from the iv tubing. They would fold up a pillowcase and place that softness between the plastic and the patient’s skin. They would
ensure the urinary catheter was anchored so that it wouldn’t pull and they would gently ask a family’s permission to remove jewellery, especially a wedding ring, with soap or Vaseline, knowing very well that soon the fingers would swell, making it impossible to remove without cutting it off. I watched nurses who accompanied families into the
ICU
for their first visit and how they caught them when they drew away, fell back, or even fainted, shocked at the sight of their loved one’s condition. Some nurses knew how to actually help the family
befriend
those scary machines. This is what we do in the icu, they explained to them. It’s what’s normal here. Once those machines have served their purpose, they will be removed, but for now, they are needed.

They could make the most extreme situations seem ordinary in a way that calmed the patient. “There’s blood pouring out of your rectum,” I heard a nurse say to his patient as if that was an everyday occurrence. Later he told him, “Your heart is going in and out of a wacky rhythm, but I’m giving you a medication in your iv and we’ll get it settled down.” I went over afterward to tell him that I liked the way he’d handled the crisis, but he brushed the compliment aside and waved me away.

And I don’t think any nurse ever forgets the first time they participated in a “code,” a cardiac or respiratory arrest. That’s when you truly feel you are an essential member of the team. Finally, in the icu, I wasn’t just standing by while the rest of the team sprang into action, everyone knowing what to do. I became one of the ones who ran in to help. Undeniably, we were having an adrenalin rush as we came together, our hands swarming over the patient, doing chest compressions, giving electric shocks, drawing blood, and pushing medications. Often we didn’t even know if we were keeping someone alive or staving off death, but in those moments it didn’t matter. (Perhaps it amounted to the same thing, but it implied a different mindset.) We were united in our efforts and if there were times that we were even grooving on that high and feeling so heroic and powerful, who of us would admit it?

Soon, I, too, could read the subtle clues and speak the insider language. If I started a shift and saw the crash cart wasn’t in its storage corner, I searched for the room where there was a “busy”
or “sick” patient, a patient in trouble who was “crashing.” Coming into a patient’s room and seeing
ECG
strips spewed out of the monitor, trailing all over the floor, curling up like party streamers, meant the patient had likely been having irregular heartbeats, called “arrhythmias.” If the patient was on “bug drugs,” I knew that antibiotics had been instituted and likely “tropes,” too, which were inotropes, drugs, like Dopamine or Levophed, used to raise the blood pressure when it had dropped dangerously low. “Going travelling” meant transporting your patient to a test in another part of the hospital – no simple matter, considering how unstable they were and all the equipment they were attached to, including the portable “zapper,” which was the defibrillator and all the “Christmas trees,” the ringing, dinging, flashing
IV
pumps on either side of a patient.

But there were moments, after I got over my awe at it all, that I wondered, was I nursing the patient or the machines? Was I caring for the body in the bed or an electrophysiological representation of bodily functions on a monitor screen? There were many hours when my attention was entirely given over to the gadgets and gizmos of chrome, metal, glass, and plastic, as much as, if not more than, to the patient. I couldn’t always bring the two together. It was Laura who got me thinking about these things. She fixed her level gaze on the patient first and the machines second. “That’s where the truth is,” she told me, nodding at a patient in the bed. “Don’t believe everything you see up there,” she waved at the cardiac monitor. “Hey, Tilda, watch this.” She jumped up and down beside the monitor to create “artifact,” making the screen imitate ventricular fibrillation, a lethal heart rhythm. We’d all seen her occasionally give a little kick or punch to a malfunctioning
IV
pump and get it started up again, buzzing happily back at work. “Oh, I believe in the sanctity of life, all right,” Laura said one day after morning rounds, “but I don’t worship technology. Take temperatures, for example. We measure them by mouth, under the arm, in the tympanic membrane of the ear, or in the rectum. We use mercury, water pressure, electronic pulsation, or a thermodilution catheter in a patient’s pulmonary artery. But most nurses can feel their patient’s forehead and tell if there’s a fever.”