The Making of a Nurse (19 page)

Weep?
“No, it didn’t make me weep,” I said. It wasn’t just about sad, squalid circumstances, it was about overcoming those circumstances.

“By any chance are you a writer?” She pointed to the notebook on the table beside me.

“No, well, yes. I do write, but I haven’t published anything.” She said she was a poet and asked if I would like to write with her and critique each other’s work. I jumped up. “There’s just this one thing …”

“What? If it’s your dream, don’t let any obstacles get in your way.”

“I have a baby. In fact I have to pick him up from the babysitting room right now. I’m late.” But before I ran off, she pulled out her diary and we set a date. I didn’t have to pull out mine because I knew it was empty.

WE MET
at a downtown café called Mocha Mocha. Harry napped co-operatively in his car seat on a chair beside me. (Daphne had a teenaged son but offered me a useful tip she recalled from her own baby days. If I allowed my left breast to fill up all morning, by the time I got to the writing table in the afternoon, I could tuck the baby in place and my right hand would be free to write my heart out.) We ordered cappuccino and discussed Virginia Woolf and Jane Austen, but as soon as Harry woke up I was able only to add a comment here or there because I was also busy chasing down a squeaky plastic porcupine across the room where he kept flinging it. Just then, four mothers walked in, each pushing a stroller. They
took up places around a large oval table and settled in to eat lunch and lift their shirts to feed their babies. They commiserated about how little sleep they were getting and debated the relative eco-qualities of disposable versus cloth diapers.
That table is where I should be. Here I am trying to be a writer … Why can’t I be satisfied just being a mother?
I watched Daphne fill pages with a fountain pen, applying ink with dashes and flourishes, the way a painter would splash colour and texture all over a canvas.

“I’m stuck,” I told her, capping my pen. “I don’t have anything to write about.”

She looked up. “Writer’s block is indulgence. It’s about procrastination and fear. If you want to write, you have to write in every mood, even if it’s difficult.”

I shook my head. “I can’t do it.”

“Write something that will delight me,” Daphne advised.

“I can’t think of anything.”

“Write about your sex life in Israel,” she suggested, “or your New York adventures, like those Fifth Avenue shopping sprees or the all-night parties with those celebrities on the Upper West Side.”

I uncapped my pen, put it to the paper, and have done so every single day since then, almost twelve years ago. Once a week, Daphne and I met in a Starbucks or at the Moonbeam Café, the Golden Griddle, or jazz clubs where we would sip wine and improvise in our own way. We chose places where the servers were either indifferent or else ignored us and we always left a decent tip. After we ate, always sooner than I felt ready, Daphne set aside her food, dabbed at her lips with a serviette, and reapplied her lipstick: these were the signals that it was time to get to work.

Daphne spun out poems about beauty and romantic love. One was about an erotic relationship between a cello, a saxophone, and a piano. Some were even about secret, forbidden love and passionate affairs with lovers’ limbs intertwined like pretzels. Daphne rarely faltered, but when she did she had only to pull out a handful of the paint chips she carried with her and the names of colours such as Blue Reef, Colonial Red, or Peony Blush would be enough to stoke her imagination.

I wrote too, but not nearly as prodigiously. If I filled ten notebooks during our time together, Daphne must have filled one hundred. We had many lovely times together and the only note of discord between us was when I wrote
certain
stories.

“Scary,” she would say, covering her ears. “It’s too depressing,” she said about my hospital stories. I apologized and began to avoid subjects that might disturb her. But those other stories continued to haunt me. I was beginning to realize that there were some things only nurses knew and shared among themselves. Nurses had lots of stories that had never been told publicly before, only privately, in hallways or stairwells, outside elevators, in whispers and in secret. I began to write them on my own at home, away from Daphne.

“Do you have any idea what I do, sitting at my desk?” I asked Ivan one day. He was making a salad and I was watching him rinse the lettuce.
It is hard living with a non-artist
, I thought.
He doesn’t understand me. Maybe I should leave him? I need to go off somewhere by myself!

“You think. You write.”

I guess I’ll stay

TWO AND A HALF YEARS LATER
, in 1997, I became a mother for the second time with the birth of Max. It was a much easier transition this time, though credit is also due to Barney, the purple
TV
dinosaur who babysat Harry during the first few weeks. During that happy time, I received upsetting news in the form of a letter from the hospital. It was a layoff notice. I became one of hundreds of nurses whose jobs were cut all across the Province of Ontario in a new mandate called “health-care restructuring.” I was one of the lucky ones offered the option of “re-deployment” (again, the military terminology) to a “relief pool.” What a misnomer that was! There was no relief to be had and the only thing remotely aquatic about it was that you had to sink or swim. I would no longer be a critical care nurse or belong to a team. I would be a generic worker in a large corporation, expected to fill in wherever “labour units” were short. Stunned, I considered my options.

Meanwhile, as hospitals madly scrambled to care for patients, administrators once again came to the obvious realization that the so-called
surplus
of nurses was, in fact, quite the opposite – a
shortage
of nurses. I reapplied to my old job in the
ICU
and was able to return, this time in a part-time position. Going part-time was my choice back then, but many nurses didn’t have that luxury and had to patch together a number of jobs in various hospitals in order to bring in a full-time salary to support their families, now as casual workers, without benefits.

Returning to work after a second long maternity leave, three years later, it didn’t take me long to regain my groove. And during that time, without fail, every week, Daphne and I continued to meet. Until one day, after six years of writing together, I realized the time had come to break away from her. There were stories I wanted to tell but felt I couldn’t in her presence for fear of upsetting her. By bowing out, I was protecting both of us, she from hearing my disturbing stories and myself from frustration at having to squelch, or at best, sugarcoat them. Daphne was angry when I ended our partnership that for such a long time had been so productive for both of us. In time, I think she forgave me. At any rate, she went on to publish two books of poetry, and years later, a third. But neither of us could have known or imagined in those days that within only a few years Daphne would be diagnosed with an illness herself and be forced to enter the world of the hospital. But back then, if she preferred not to think about such unpleasantness, who could blame her?

I
t takes a nurse to teach a nurse. There have been many teachers along the way for me and now I teach others. It’s relatively easy to show someone how to insert a naso-gastric tube to decompress a patient’s stomach. Adjusting the ventilator to improve a patient’s arterial blood gases is a more complex skill. It’s even more complicated to teach someone how to attend to the multitude of details required to manage a patient in multi-system organ failure. But I still haven’t figured out how to teach another nurse to manage the emotions this work can evoke. I know many experienced nurses who still struggle with this challenge. How do you care, but not so much that it hurts? How do you make your care patient-centred, yet still keep your personal boundaries intact? There are huge emotional risks in caring for critically ill people. This work can break your heart.

I began to understand something about these boundaries one night a few years ago during a hockey game. It was the Stanley Cup playoffs, in a match between the Toronto Maple Leafs and the Detroit Red Wings. A Detroit player slammed into Maple Leafs goalie Curtis “Cujo” Joseph, who got angry and hit back.
Well, the gloves came off and the punches started flying. The referees had to pry the players apart to end the brawl. Then, when they must have assumed the camera was off, Cujo lifted his goalie mask (that depicted a ferocious beast) and mouthed to his rival, “You okay?” The opponent nodded and pointed with his chin, “You?” Seeing that tender, sincere moment helped me understand something about nursing, the place to which for me, all roads lead. Not that I ever saw myself as an adversary with any of my patients – not at all – but it is so easy to imagine that the gap between them, the sick ones, and us, the healthy ones, is much vaster than it is. Sometimes I took off my mask, too, and went over to the other side. But in my need for intimacy and my desire to rescue others, I often took on patients’ emotions in ways that helped neither of us.

For many years, I took off my mask and crossed over frequently and sloppily. Perhaps it was how I learned as a child to care for my mother by sharing her sadness. I showed her my love by feeling her pain. Growing up, my personal boundaries were always uncertain. So often, my own emotions blended and mixed with whatever others around me were experiencing. When I became a nurse, I continued on in that style of caring, even though it made things worse for me and sometimes for my patients, too. They needed to feel that I was steady and in control, but I couldn’t always offer them that security. I caught their emotions as if they were contagious. Sometimes, merely being in the presence of a patient, family member, or even another nurse, who was flustered, anxious, or angry would affect me, and I would respond in tandem. Patients may even have felt they had to take care of
me
. Too often, I was a gushing, emoting heart that rendered me less effective as a nurse. Nurses are supposed to keep their emotions under control, but it’s been a struggle for me.

WHEN I THINK OF
Mr. Salvatore, I think of his daughter, Yvette. Mr. Salvatore was a seventy-two-year-old with esophageal cancer who developed abscesses throughout his abdomen. The doctors were hopeful that they could drain them and that he would then
be well enough to undergo surgery to remove the cancer. In the meantime, he went into respiratory failure and had to be admitted to the icu. Every day Yvette stayed at his side. She kept her eyes locked on me the whole time, watching every move I made. When I went to suction his lungs, she leaped out of her chair. “Should I panic?” she asked, searching my face for clues as to how she should react.

“No need to panic,” I said extra calmly and slowly. “Your dad is doing just fine.”

“Look, Daddy, your nurse is smiling. She wouldn’t smile if things weren’t looking good.”

Yvette asked me if she could go home for a little rest. I knew she wanted my reassurance that nothing bad would happen while she was away from her father’s side. With her eyes she implored me,
I need to rest, shower, see my kids. Please grant me permission to do so
. I wanted to tell her to go home and take care of herself but I didn’t dare. If something did happen while she was gone, she would never forgive me. She left briefly only for a coffee and a phone call. “Take good care of him while I’m gone,” she pleaded, throwing kisses at her father as she left. “He’s special. He’s my dad.”

Later that afternoon, when Mr. Salvatore’s heart suddenly went into an erratic rhythm, Yvette was right there at his side. When the alarm sounded, she grabbed my arm. “I’m panicking!” she shouted. I tried to calm her down and deal with the emergency at the same time. The doctor came in and ordered an intravenous beta-blocker to slow the heart rate. Shortly after I gave it, Mr. Salvatore’s cardiac problem was resolved, but no amount of reassurance I offered eased his daughter’s anxiety. Later that day, Mr. Salvatore had to be transported to another part of the hospital for the radiologist to drain the abscesses in his belly.

“Is
this
reason to panic?” Yvette asked, clasping my hand. In answer, I put one arm around her and pushed the bed along with my other hand as we made our way down the hall to the procedure room. There, the radiologist met with her and told her that if the “collections” turned out not to be fluid-filled then he wouldn’t be
able to drain them. “In that case, I can’t do anything,” he said as the technician spread out a green sterile drape over the patient’s abdomen in preparation for the procedure.

“What does that mean?” she asked him. “Does that mean it’s serious?”

“It means I can’t drain it,” the doctor said without further elaboration. Draining abscesses under fluoroscopy was his specialty, but for whatever reason he didn’t explain that if there wasn’t fluid to be drained, then it was probably a solid mass, such as a tumour, and in this case, likely malignant. But Yvette sensed the ominous implication. “Are you saying it would be bad?” The radiologist was preoccupied, already in the midst of the procedure, so she turned back to me, but I was busy giving her father sedation and assisting the doctor with the procedure. Out of the corner of my eye, I saw her terror-stricken face, her tiny, rigid body that looked like it might snap in two. She held on to her pale forehead. “I’m panicking,” she said in a tremulous voice. I looked around the room for a chair and luckily, just then, the technician caught her as she keeled over. Fullblown panic had finally done her in, but at least it allowed me to now focus my attention on taking care of her father. I exhaled. I hadn’t realized how shallow my breathing had become, how tight my chest was, how jittery I felt. I had caught a bad case of her panic.

I’VE WORKED WITH
Noreen for the past ten years or so. She has a tough, abrasive personality and often has a sour look of disapproval on her face, but I have learned to ignore it because she’s really very kind-hearted and an excellent nurse. Noreen is someone who always seems to have her emotions under control, even the day she took care of a patient whose family pushed her to the limit.