The Making of a Nurse (18 page)

About labour, Casey offered scary, yet reassuring, advice. “It feels like there’s a train blasting through you and all you can do is hold on for dear life and pray you don’t split in two. But you’ll get through it.”

I called George at home. He was on parental leave with his second child and had given me helpful information about epidurals during labour and now I had questions I wanted to ask him about episiotomies, but in the midst of our discussion he broke off: “Gotta go. There’s diarrhea streaming out of Amelia’s diaper.”

Noreen noticed me reading a novel during my break. “Enjoy it now,” she said grimly, “there’ll be no time to read once the baby comes.” I could have cried. I knew that everything was about to change and the problem was, I loved things just the way they were.
But then I thought about so many nurses I had known who struggled with infertility problems and how they longed for a baby. For example, I knew just how badly Jenna yearned for one once when I covered for her so she could take a break and happened to come across her hopeful list jotted on the back of a lab report. “Corey, Colin, Cathleen, Candice.” I just knew they were potential baby names. For Ivan and me, everything was going smoothly. Perhaps it was time to be grateful.

Louise, a nurse I had worked with for a few years but whom I didn’t know very well at the time, came over to me on my last day of work before my maternity leave to wish me well. I’d always admired how she looked so young that her three grown-up kids were often mistaken for her siblings. Louise’s simple words of advice have stayed with me over the years. “Enjoy it,” she said with a reassuring smile. “Have fun. Your kids will be happy if they see you happy.”

Of course. Is anything sadder than a sad mother?

I was determined above all else to be a fun, upbeat mother, but nothing woke me up more to the reality of motherhood than a moment upon returning to my hospital room a few hours after the delivery of our healthy son. Ivan had gone home and the baby – we named him Harry after my father – was asleep in a plastic bassinet beside my bed.
I’ll go have a shower
, I thought,
and freshen up a bit after that little ordeal
. I donned my bathrobe and gathered soap and shampoo.

Snap! Like a dog on a retractable leash, I was yanked back. I couldn’t do whatever, whenever I wanted any more! I was tied forever to this new “patient” – a baby. He was mine, but he was a stranger, and I didn’t even know if I liked him yet! My old life was over! I was now a
mother
. That word had always filled me with apprehension. Luckily, a few hours later, Laura’s Line arrived, laden with gifts for the baby, treats and goodies for me. Frances had knitted a tiny blue sweater and bonnet for the baby and she showed me how to bathe him and soothe him when he wailed. Nicky and I hugged each other and cried. Justine was busy flirting with the obstetrics resident while Tracy cracked open a bottle of champagne. Laura stood holding the baby at the window because
she detected neonatal jaundice due to a delayed clearance of bilirubin. It was common in newborns and direct sunlight was the treatment for it. It was wonderful having them there. I loved their company and they brought me back to myself. They reminded me that I was one of them – a nurse – capable, confident, and knowledgeable. I can handle this, I told myself, and I rose to the challenge.

SINCE I’VE ALWAYS BEEN
a heavy sleeper, I worried that I might not hear the baby crying. But I recalled what a sales representative had told us about a new cardiac monitor as he demonstrated its many features. When he sounded the alarm, we were concerned. Its faint, tinkling sound seemed far too
unalarming
. “No worries. You’ll hear it,” he reassured us and then explained, “Scientists have isolated an acoustic ‘sweet spot.’ There’s a specific quality in the cries of newborn babies that irritates the brain and we’ve put that technology into our equipment.” Maybe it was like that for me because whenever Harry cried, I heard him and I got up and went. It was the most straightforward, unequivocal response of my life even in those moments when I could also hear another baby crying, the one inside of me, welling up with its needs, crying for a mother, too. But I didn’t allow those distractions to disturb me. I focused on my “patient,” and did a thorough “nursing assessment,” ruling out the usual suspects: hunger, fatigue, wet diaper, etc.
I know what an emergency is. I have handled many. This is not an emergency
.

It turned out that what helped me the most as a mother were the things I learned as a nurse.

Harry was only about a month old and late one evening, I peeked in on him. He was sleeping and I tiptoed out. Of course I utterly loved him by then. I closed the door behind me and burst into tears. I would never hear all the music in the world! I would never be able to read all the books or travel the globe like I’d wanted to! Even if I lived to be a hundred, it would not be enough. Life was bearing down on me. I was having a recurring dream of not getting to the airport in time or running behind a train, trying to catch up.
“My life is over,” I wailed to Ivan, plunking myself down at the kitchen table.

“What’s wrong?” He was at the sink, washing the dishes.

“You don’t understand anything!” I launched into a diatribe about women’s enslavement to biology, the history of women’s oppression in a patriarchal society, and about the physiological and psychological effects of hormone disruptions.

He placed a cup of tea and a cookie on a plate in front of me.

In other, equally irrational moments, I bemoaned my miserable childhood and my crazy family, but Ivan had zero tolerance for wallowing, blaming, or self-pity. “You can’t keep using your family as an excuse. It’s time to get over it,” he said with a
click, click
of the
TV
remote control.

It seemed there was this mantle of maturity I was expected to wear as a mother. Clearly, the statute of limitations of being angry at my parents and holding them responsible for my problems was over. It was time to grow up. No, I didn’t have parents, grandparents, or siblings to rely on, but I had wonderful friends and something else – my own private twenty-four-hour hotline. At any time of day or night, I could call a colleague at work and receive practical advice. I learned about colic, teething, toilet training, and ear infections from my
ICU
family. I turned to them not only because many were mothers and fathers themselves, but because they were scientifically minded, well-read professionals who knew what they were talking about.

Still, I often felt lonely at home with my baby. Had there been online chat groups in cyberspace with other mothers back then, I might have done that, but it wasn’t “parenting” I wanted to speak to them about. It was art, music, literature, and nursing. I wanted to find a way to stay connected to the outside world and at the same time, to the inside one, in between my baby and me.

ONE AFTERNOON
, I was sitting in a rocking chair feeding Harry when I got a call from Dr. Darryl Price, who was a staff physician from the
ICU
. I was very fond of him and had always admired the
exceptionally kind way he talked to patients and their families. He was calling to invite me to sit on a panel of critical care experts at a symposium to discuss the topic “When Medical Treatment Is Deemed Futile.” I looked down at my pink terrycloth slippers and flannel nightgown, damp from leaking milk. The last time I’d seen him, I’d been wearing scrubs and a lab coat and he was explaining to me his research on the cellular inflammatory processes in septic shock.

“Futile?” I gazed down at my baby’s milk-drunk face, the very antithesis of futility. “I can’t talk about
that
, Darryl. Nurses don’t believe in it. It’s not a word nurses ever use.”

“I’m referring to situations when there is no benefit in continuing treatment. When the decision is made to withdraw life support.”

“I know what the
word
means … well, let me think about it. I’ll get back to you.”

He paused for a few seconds. “Was that enough time?”

I laughed, “Okay, I’ll do it.”

“I knew you’d come around,” he chuckled.

Big mistake
.

LATER THAT DAY
while Harry was napping, I sat at my desk to make notes for my speech. Yes, I had cared for many patients who had no chance of survival and a number who had died. In so many cases, we had pressed on, performing more and more procedures, tests, and treatments, even when no member of the team truly believed there was any chance of benefit, often at the insistence of family members who wanted “everything done.” Yet, in other similar situations, different choices were made. Whatever the decisions, what always troubled me the most was that we rarely knew directly from patients themselves what their wishes were. Even with those who had written “advance directives” or had appointed individuals as their decision-makers, when the time came, we were often uncertain how to proceed. It was never a clear-cut or easy decision.

Where did I stand in all of this? As a nurse, I knew exactly where I “stood”: at the very nexus between the patient and the family, right in the space between the patient and the rest of
the team. As nurses we are closest to the patient, both physically and metaphysically and thus, we are in the ideal position to see all sides. Yet, it is also that very proximal position and intimate role that makes us the most conflicted and distressed as we witness our patients’ suffering on a daily and nightly basis.

I managed to prepare a speech and then turned to a more mundane challenge: What to wear to such a prestigious occasion? Since I swore I wouldn’t buy new clothes until I’d lost my pregnancy weight, I managed to squeeze into an old plaid skirt and a black jacket over a blouse that was far too tight. It pulled across my chest and under my arms.

The first speaker was a physician who talked about the high mortality rates in the
ICU
and the futility of offering treatment that has no benefit to patients. The second speaker was an economist who spoke about the rising cost of health-care technology and the imperative to utilize precious health-care dollars judiciously. The third speaker was a lawyer who spoke so far above my head – and I was so anxious about my own speech – that I couldn’t follow what he was saying. Then it was my turn. I glanced longingly at the exit door and slowly mounted the stairs to the podium. I looked out at the crowd. I had no Power Point presentation and no research to report, nor statistics to recite, but surely all my years of experience counted for something? I moved closer and took a huge breath. There was a screech and a squeal.
Oh, too close to the mike. Step back
. “Futility,” I cleared my throat. “Futility is …” I looked down at the notes I had prepared and found them useless. I set them aside. “Futility is a concept that is not part of nursing’s philosophy. It is not in most nurses’ lexicons. I cannot imagine a situation where offering nursing care would be futile. I have never felt that anything I did as a nurse was futile. That’s the beauty of nursing. We don’t have dilemmas about futility, though we do have other dilemmas, I can assure you.”
Laugh, laugh, laugh
, from the audience, which emboldened me to continue and tell them about the many times when I put aside my tasks and preoccupation with numbers and simply sat down and listened to patients and their families and tried to share the burden of their suffering. I described some of the many occasions when nurses believed that “comfort
measures” – simple human touch and caring – were more important than medical intervention. “Of course, we are saddened when a patient dies, but for us it is not the defeat or failure it seems to be for doctors,” I acknowledged.

“In conclusion, I wish to quote one of my
ICU
mentors and teacher Dr. Imré Sandor, who always says that ‘while there may be times when we may decide to withdraw
treatment
, we never withdraw
care.’
Thank you very much.” I stepped down. My head was pounding, I was dripping with sweat, my breasts were engorged, and I was flushed with embarrassment at my remarks, so hokey, sentimental, and simplistic. I’d been reading too many
Tales of Thomas the Tank Engine
and not enough back issues of
Critical Care Nursing!

“I would like to take exception to two points raised by speaker number four,” someone said.
Yikes, that would be … me! What would the Teletubbies do in this situation?
I can’t recall the objections, but I answered as best I could. I was way out of my depth. My mind had gone to mush. Futility! What was futile here was my attempt to juggle everything – being a nurse, a mother, a wife, and a homemaker all at the same time. I couldn’t do it.

TOWARD THE END
of my eight-month maternity leave, in the last few weeks before returning to work, I joined a fitness centre. They had a babysitting service and I intended to use those precious two hours to myself to exercise, but all too often, I put them to a different use. On the sign-in sheet where you had to indicate where you would be in case your baby needed you, where the other mothers wrote, “Treadmill” or “Running Track,” I pencilled in “Cafeteria.” I went there not to eat and drink, but to read and think.

One day sitting there I looked up from my book as a tall, striking woman swept in. She wore a long black coat, a black velvet hat, and bright red scarf. She carried herself regally and even the way she plucked a few coins from her purse with long, manicured fingers to pay for a bottle of water looked elegant. She smiled at the cashier, as if her payment was a tip. I suddenly became aware
of my baggy sweatpants, T-shirt, and running shoes. For some reason, she caught sight of me and strode over, sipping her Perrier through a straw. “Hi, I’m Daphne Marcus. What are you reading?” She extended her hand. I had noticed her before in an exercise class, always in the front, facing the mirror, toes turned out and arms raised in a manner more suited to ballet than aerobics.

I introduced myself and showed her my book. It was
Angela’s Ashes
. She gave a slight, involuntary shudder. “Oh, I can’t read that. Such things make me weep.”