The Making of a Nurse (17 page)

Frances agreed. “It’s true. Sometimes I touch the patient, take a
guess at his temperature, and then measure it. I’m always accurate within a few tenths of a degree.” Nicky and I looked over at Tracy, who didn’t say anything. We had both seen Tracy predict a fever before the temperature even began to rise. She had a preternatural ability to know exactly what was going on with her patients long before the machines proved her right.

They were incredible nurses and the
ICU
provided perfect conditions in which to do our work.

“If only the nurses on the floor were as good as you
ICU
nurses,” a doctor said to me one day with a huge sigh of exasperation. It was late afternoon and we were sitting at the nurses’ station catching up on our charting. He was a third-year resident who was enjoying his
ICU
rotation. “The nurses on the floor don’t know as much as you
ICU
nurses.”

“It’s not fair to compare them to us in our ideal conditions,” I explained. “There aren’t enough nurses on the floor and their workloads are impossible.”

“But they don’t even look at lab results. They don’t know what’s going on with their patients.”

“They have no time, they’re just trying to keep up.” It hadn’t been that long ago that I had worked on the floor myself and I well remembered how many times I’d left at the end of a shift feeling frustrated and discouraged. My work had fallen so short of my ideals that my ideals began to seem impossible. I had felt at the mercy of others, at everyone’s beck and call, and powerless against whatever might be thrown at me. Nurses were often pitted against each other, even sabotaged one another, and were stressed and unhappy. But here in the icu, nurses had a feeling of empowerment and a sense of their capacity to take action. We expressed our opinions vocally, sometimes even vociferously. None of us hesitated to do whatever was required to make things better. All nurses had a right to work like this and every patient had a right to receive care in a respectful, healthy environment, didn’t they? Yet, that wasn’t always the case. It was only when I got to the
ICU
that I finally experienced the possibility of mastery. Mastery was within my grasp.

COFFEE BREAKS WERE
a respected and inviolable tradition in the
ICU
. The nurses all took turns covering for each other so that we could get away for even a few minutes. At first, I refused to leave, saying I needed to stay behind to catch up. “No matter how busy it is, you have to take a break,” said Justine, that first day, herding me out the door. “The work here is never done,” said Frances pulling me along by my arm. “You have to pace yourself.” By then, Laura had already left for her break, taking a longer, circuitous route down the back stairs so she could avoid walking past the room where the worried families waited.

In the cafeteria, we sat and watched Justine over at the menu board, removing the decimal places so that the price of the lunch special shot up from $5.95 to $595. We could hear her griping to the head cook: “Does the World Health Organization know what prices you’re charging for this slop?” He pointed to a posted notice that the cafeteria would soon be closed to make way for the more profitable Subway, Burger King, and Pizza Hut chains. “The forces of globalization strike again,” Justine said, shaking her head. “Retrenchment is in the works, too, I bet. What’s your union say about all this?”

“The hospital management promised us jobs,” the cook said, stirring a huge vat of soup.

“Ahh, I get it.” She came back to explain to us. “They’ll get the pastry chefs to bathe patients so they can get rid of us ‘expensive’ nurses. You’ll see. That’s the plan in the works.”

Her worry was not unfounded. We knew from experience that the hospital management didn’t always value the work of skilled, educated nurses, but at least we had Justine on our side, fighting for our rights – and our jobs – if they became threatened once again.

EVERY MORNING THE ENTIRE TEAM –
the staff doctor, the residents, the nurse manager, the charge nurse, the patient’s nurse, and a whole range of other professionals, including the dietician and pharmacist, the physiotherapist, and respiratory therapist – gathered outside each patient’s room to discuss the plan of treatment. The resident presented a summary of the patient’s medical history and current
condition and then the nurse highlighted particular problems identified in his or her morning assessment. Then the interesting part ensued – the debates. We looked at X-rays together and discussed the patient’s fluid balance and whether or not the patient was in overload or in fact needed extra fluid. We might review the reasons for performing a lumbar puncture, weigh the risks and benefits of transporting an unstable patient for a
CT
scan, or consider the merits of various antibiotics. And always, there were complex dilemmas that we faced, such as whether to perform resuscitations on patients with multiple organ dysfunction even with the documented low success rate. Is this a futile practice? someone might ask, and we would all get an opportunity to express and explore our views. Morning rounds were like the Town Hall gatherings of philosophers in Ancient Greece. Questions were posed and discussions raged about great mysteries of the universe. Everyone had a say and all voices were heard and valued.

At the end of each twelve-hour shift, it was time to hand over our patients, and all the information we knew about them, to the oncoming nurse. Handover was a form of storytelling and some nurses were known for their engaging, even entertaining delivery, all the while still giving a comprehensive and organized report.
*
One nurse even had the hockey game on the radio and stopped to cheer when her team scored. I learned to give a decent, organized report and luxuriated afterward in the feeling of release of a weight of tension so palpable I was certain I had to be a few pounds lighter. When I got home, I was exhausted but elated, too, from a day intense with thinking, doing, feeling, and seeing so much.

ONE MORNING
after I’d been working in the
ICU
for almost a year, the nurse in charge came over to tell me she’d assigned me the sickest patient. He had been admitted the night before into the room we
called the Cave. She was paying me two compliments: I was being entrusted with the most unstable patient, and therefore the most challenging one, and I was expected to work independently. The rest of the team would not be as readily available, but of course would come running in an emergency. I went in and got to work. My patient was a sixty-five-year-old man, two days post abdominal surgery, who had developed subsequent complications of bleeding and infections. He had so many tubes, drains, ivs, and incisions that one nurse had drawn a map and labelled everything to help others navigate around the patient’s body. Another nurse had thought to demarcate the area of bleeding around his incision with a permanent marker so that we could all keep an eye on its possible spread. I started off by searching for a flicker of the person, beginning with the neurological part of my head-to-toe nursing assessment. He was unconscious, but I spoke to him anyway. I listened to his heart and lungs and suctioned him efficiently. Justine came by to see how I was doing. She handed me a blood culture result on my patient and updated me on the latest tiff she’d had with the laboratory technicians. It seems she had told them her name was “Chi Chi” so they wouldn’t be able to find her,
that nurse with the attitude
, and when they asked for her first name, she said, of course, “It’s Chi.” I saw that I could take care of everything for my patient and also laugh at her silly joke, too. Justine suddenly recalled the reason she’d come down to visit me in the Cave. “Oh, by the way, your patient is growing
filamentos fungus
in his blood,” she chuckled. “I think I ordered that once in a Mexican restaurant.” On the basis of that report, I spoke with the doctor and we changed the antibiotic to one that was sensitive to the particular organism growing in the blood culture.

“Your family is here,” I told my patient as I beckoned them to come in. His wife and two grown-up children were shocked at the sight of their father, intubated, unresponsive, his face swollen, his entire body bloated. They couldn’t bear to look at him and instead stared up at the monitor. I had the feeling the children almost envied me that I could do things for their father that they wished they knew how to do. I knew things about their father that they did not, such as his lab values and what they meant, how much
urine he was producing and if he had called out for them during a moment of need. When he suddenly started coughing and his oxygen saturation plummeted from 99 per cent to 70 per cent, they jumped up and looked to me to fix the problem. I acted quickly and smoothly to extract a tenacious mucous plug lodged deep in his bronchus, all the while reassuring them and the patient, too.

“Good work, Tilda,” one of the
ICU
doctors said as he passed by the room, and the family looked pleased I was their father’s nurse.

“I’ll take good care of him and you can call anytime,” I reassured them as they were leaving.

By the end of the day his blood pressure had stabilized, his fever was down, and he was beginning to wake up. Even the reddened area on his toes was beginning to recede. I stood there taking it all in, feeling triumphant, even heroic, claiming a lot of the credit. Frances came over to see how I was doing and I told her I thought we could probably start weaning down the settings on the ventilator and how I planned to get my patient up in the chair the next day.

“That’s thinking like a nurse,” she said.

“How does a nurse think?”

“Like the way you considered all the aspects of the situation and set goals, planned ahead. How you supported the family, explained everything to them. That kind of thing.”

MY FIRST YEAR
working in the
ICU
with Laura’s Line was unforgettable. I learned so much, and made wonderful friends. It was also the year my mother died after so many years of being so ill and the year in which I got married to Ivan, a South African man I’d met during my trip to Israel. He came to live with me in Toronto, we bought a house, and together made it a home. It was a surprising year. As I worked through the fresh grief over my mother’s death and the residual grief over my father’s, I found tremendous gratification at work and in my friendships with my colleagues, and enormous happiness in my private life. Unexpectedly, joyfulness overtook me. So, that year, the juxtaposition of mourning and celebration made perfect sense to me. I had always known that sadness and happiness could coexist. And
along with all of that, there was so much fun! Laura’s Line made sure of that. No holiday, milestone, or birthday ever went uncelebrated. After work or on days off, we’d get together. Once, at a late-night karaoke bar, I got up on stage and belted out a mean version of “Hit Me With Your Best Shot,” then Justine did her raunchy rendition of “Love Shack,” which brought the house down. (Also memorable was the cake with green icing on St. Patrick’s Day and the chocolate bars Laura brought in on Halloween that were shaped like skeletons and sarcophagi. And Justine was the first person I had ever heard use the word
party
as a verb.) We got about an hour or two of sleep those nights, even when we had to work the next morning. We were tired but we knew we could get through anything together. They were colleagues, soon became friends, and will always be my sisters.

M
any decisions in my life have been fraught with ambivalence and anxiety. But when it came time to ask my true love to marry me, I plucked up the courage. Luckily, he had no such hesitations.

“Yes, of course” was Ivan’s immediate answer.

Eighteen years of marriage have been pretty good, mostly wonderful, in fact. Even during the first few years when Ivan, originally from South Africa, had to leave his thriving business and close family in Israel, the country he loves most, uproot himself, and join me in Canada, he never once complained or expressed any doubts about his choice. And over the years when inevitable misunderstandings and conflicts have arisen between us, he remains steadfast. “You make the decision to love someone and that’s it. You don’t stop” is how he puts it. And any doubts
I
might have had were completely banished one romantic evening about twelve years ago as we took a leisurely stroll in our new neighbourhood. I was nine months pregnant with our first child and I had a feeling it would be the last of such serene moments. Since Ivan was still fairly new to Canadian ways at that time, I felt it my duty to inform
him about an essential requirement for our new citizen-to-be. “You know,” I said as we strolled hand in hand. “If it’s a boy, you will have to get up very early in the morning and take him to hockey practice.”

Without missing a beat he answered, “And if it’s a girl, I’ll get up early and take her, too.”

I don’t think he knew how his comment made me love him more, if that was possible, and even more, since.

AT WORK THE OTHER DAY
, I shared a laugh with the other nurses. It was right before starting our shift and we were gathered at the nursing station, checking our patient assignments. A few of us were chatting about our kids. “Can you believe it?” I asked them. “Me. A hockey mom!”

Because of our two hockey-playing sons, I have learned about hat tricks, drop passes, and one-timers. I have even begun to understand breakouts, offsides, and penalty kills. I am intimately familiar with the exact location of every hockey arena in Toronto. Yes, I have become a bona fide, albeit at times reluctant, hockey mom. But the nurses had reason to laugh because many of them still recall how I faced the prospect of motherhood: with a mix of excitement and dread, anticipation and fear. They tried hard to encourage me during my pregnancy.