The Making of a Nurse (20 page)

Loud and clear we all heard a terrible drama playing out in the corner room. A young man had been brought to the
ICU
in fulminant liver failure, a life-threatening consequence from the anabolic steroids he’d been taking for bodybuilding. The waiting room was jampacked with visitors, all wanting to see him, so many that they spilled out into the hall.

“Are all those people
family?”
someone asked Noreen, who was his nurse that day. “There are cans of Coke and bags of potato chips everywhere and they reek of cigarettes and alcohol. You should inform them that only two visitors at a time are allowed and they have to call in first.”

“To me, family is whoever they say they are,” Noreen said in her matter-of-fact manner. “As far as I’m concerned, they can come in whenever they want. The kid is going to die.”

On one side of the bed, a slim teenaged girl wearing a doo rag and tattered jeans was doubled over, sobbing. On the other side, sat an older woman wearing a dress that draped her body like a tent. “That’s the girlfriend and that’s the mother,” Noreen whispered. I had heard vicious screaming going on and had come over to give Noreen a hand, but she didn’t seem to need my help.

“You just want a piece of him,” the mother shouted at the girl, “you fuckin’ whore!”

Noreen stood at the foot of the bed, a bit closer to the girlfriend. “Now, now,” she clucked. “Keasha loves him, too.”

“Yeah, right,” the mother snarled. “Jerome has lots of chicks and this here bitch is only one of ’em. He’s my boy. I want her the hell out of here.” She lunged across the bed to take a swing at Keasha, but Noreen grabbed her arm and stopped her in time. “You better control yourself, or you’ll have to leave.” She pulled up a chair for Keasha, who smiled sweetly but then retaliated in an equally nasty manner. “I hate you,” she screamed at the mother, “and Jerome hates you, too. He told me so.”

“That’s enough,” Noreen snapped, but then softened. “Easy does it, sweetie. Take a deep breath. Think before you speak.”

“Alls I wanted to do was wipe his forehead, but
she,”
Keasha glared across the bed at the mother, “slapped my hand.” She turned to the safety of Noreen. “Something like this has never happened to me before.” She fell onto Noreen and cried into her shoulder. “I never had a sick boyfriend.”

“Of course not, you’re still a baby,” Noreen put her arm around her, and held her close, comforting her the way a mother would her child. “You’re so young to have to go through this.”

“It’s not her going through this, it’s Jerome,” the mother said, pointing at her son, who was completely unconscious and unaware of the storm taking place, literally, over his body. “A piece of work like her’ll get herself another boyfriend, but I’ll never get myself another son.” She caressed his arm.

“Jerome’s going to make it,” Keasha said. “You’ve given up on him.”

“You’re nothing but a fuckin’ ho!” shouted the mother, gripping the side rails of the bed and hauling herself to her feet. “You have no right to even be here.”

“Yes, I do, you bitch!” The girlfriend lunged at her neck, but Noreen held her back. “We’re getting married,” she held up her hand to reveal a ring with a blue stone in it. “Jerome loves me. He told me how you abused him and screwed up his life.”

Noreen stared at them over the top of her bifocals. “Both of you are disturbing my patient. Now, you better show respect for Jerome. He’s the focus here. Get a grip or get out!”

“You can’t get rid of me. I’m his mother.” She settled back down into the chair and crossed her arms across her chest.

The war continued all day. It was ugly and unrelenting, but it didn’t flap Noreen in the least. She focused on caring for her patient in her usual calm, methodical manner and on supporting all members of the family as best she could. Meanwhile, Jerome’s condition was deteriorating. He began to vomit blood and suddenly had a seizure that deepened his coma. His blood pressure was dropping and the Ph, oxygen, carbon dioxide, and bicarbonate levels in his arterial blood gases began to reach dangerously abnormal amounts, indicating that he was near death.

“Jerome is dying,” the liver specialists told them. “There is nothing more we can do. His liver has been damaged beyond repair and unfortunately he is too sick to be listed for a transplant. We are very sorry.” Then they left.

This news made the mother and girlfriend even more violent. They lunged at each other. The girl scratched the mother’s face and neck. The mother yanked the girl’s hair. Noreen sprang into action. “That’s it! Get out, the two of you! Take it outside. I’m calling security.” But before they could arrive, the mother stomped out of
the
ICU
and Keasha fled to the waiting room. Noreen looked at me with the same exasperated expression I had seen on her face at the behaviour of her own teenaged kids. Otherwise, as far as I could tell, she remained unperturbed by the chaos swirling around her, steadfast in the face of the impending, inevitable tragedy. She was a calm centre around which the two of them could safely rage.

The problem was, you weren’t supposed to speak like this to patients. The scripts we had been taught as students, the stock phrases and prescribed responses we were supposed to offer, such as “you seem angry,” “what are your concerns?” or “what is this situation like for you?” were inadequate for many of the extreme situations we encountered in the icu. Noreen spoke to this family in the same way I’d heard her speak to her own kids when they misbehaved. She tried to bring them into line. She scolded them. She took a stand and called them on their bad behaviour. She used her own pragmatic personality and no-nonsense, straight-talking manner to nurse this family, and it seemed the perfect way to handle the situation.

Later that day, Jerome had a cardiac arrest and no further resuscitation efforts were attempted. His mother and his girlfriend had no more energy to expend on their anger, as they were forced to expend it on their grief. Noreen removed all of the tubes,
IV
s, machines, and pieces of equipment attached to Jerome and then she bathed his body thoroughly and put fresh sheets on the bed. Then she brought his mother and girlfriend back into the room, along with other members of the family, and allowed them to be with his body for as long as they wished. Noreen stayed strong and silent amidst the room full of mourners who were wailing and pulling at their hair and clothing in their anguish. Other nurses came over to offer their support, as well, but I had my patient to get back to and my own work to do. I got busy and didn’t think any more about them.

At the end of the shift, I found Noreen sitting on the bench in the locker room, sobbing uncontrollably. She apologized for her emotions. “I guess I got too involved.” She wiped her face and stood up. “I don’t know what happened. I usually never let myself go there.” I waited while she slowly put on her coat. We were planning to meet
up with a few other nurses for drinks, but Noreen bowed out. She said she was tired and was going home instead.

YES, I’LL ADMIT IT:
certain patients still crank me up, especially the angry, distrustful ones or the combative, hostile ones. I feel more comfortable around patients who are sad or depressed, perhaps because those emotions are more familiar to me. Expressions of emotion from the nurse mean a lot to families. When I cry with them, they appreciate that I share their grief. Sometimes it seems to matter more to families how sympathetic I am than how skilled I am. When they see how hard it is for us, too, somehow it lightens their burden.

Patients expect nurses, and nurses expect themselves, to make every effort to see, feel, and understand a patient’s experiences. But all too often, when I did that, I became overwhelmed with someone else’s sorrows. I lost myself. I came to realize that I wasn’t going to be able to stay in this profession if I didn’t change my ways. I had to learn how to safely enter a patient’s world and still keep mine intact.

We once had a social worker who came up with the idea that the nurses should make more of an effort to attend patients’ memorial services, to stay in touch with grieving families, send them sympathy cards, and even pay them visits in their homes to help them find “closure.” I wasn’t the only nurse who felt uneasy with this plan.

“Don’t include me in on that,” one nurse told her sharply. “Some of us need to make a separation. Most of us do.”

The social worker looked even more dismayed when I expressed my opinion that some families might not wish to have any reminders of the
ICU
if their loved one had died there. She seemed to consider anything less than a full, emotional demonstration, replete with weeping and moaning, to be cold and callous. She would sit with families and commiserate with them about every setback. She told them about her own problems. She had such demonstrably personal reactions to patients, especially select ones who suffered from diseases her own friends and family members
had lived through, such as
HIV
and psychiatric illnesses. But who was I to judge? I had my own weaknesses. I always broke down when children came into the
ICU
to say goodbye to grandparents, or even parents. When one little boy said to his mom, “It doesn’t look like Daddy on the outside, but it’s still Daddy on the inside, isn’t it?” well, I lost it altogether. Once, when I found a clipboard with the one word
perché?
which I knew was “why?” in Italian, scribbled by a dying old man, I burst into tears.

For a time I thought that perhaps the way to counterbalance my emotional nature would be to hold myself back.
What would happen
, I asked myself,
if I didn’t try to connect personally with each and every patient and family?
I would give correct, safe care, of course, but maintain a dispassionate stance and keep my guard up. I would not take off my mask and go over to the other side. After all, didn’t Laura always say you didn’t have to get to know your patient in order to give good care? What about Frances, who always gave so much of herself but never let her emotions get out of control? “When you come to work,” she told me on many occasions, “leave yourself at the door.” She believed it was her function to ensure her patient’s well-being. “I treat all my patients as if they’re members of my family,” she explained to me. But still, how did she do it, I wondered?

Justine was a nurse who willingly took on emotional risks, but eventually it got the better of her, and I think it was the reason she ended up leaving the
ICU
. She once was furious at a family that never visited their grandmother, yet kept calling to insist that “everything be done” to resuscitate her. Justine hung up the phone on them and returned to her patient. She looked down at the frail old woman, pushed the machines aside, parted the tubes and lines with her hands, crawled right into the bed and lay down beside her. I can still see that lady’s soft white hair and Justine cradling her in her strong arms and rocking her like a baby.

My problem was that I got into too many patients’ beds! I felt their despair. I worried along with the family. At times, I even took their pain home with me. I decided to make that conscious effort to hold back, not let myself feel too much. I kept focused on numbers and facts and didn’t make myself as readily available for
patients to tell me their stories. I lasted about a week. I had made such a complete disconnect from feelings that my actions began to feel empty and meaningless. Caring for patients became drudgery and every task a chore. Without emotions to fuel me there was only logic and reasoning to figure out what was needed and my sense of duty to carry it through. I couldn’t find a balance between my emotional nature and the rational thinking required to be a nurse. There had to be an alternative to losing myself or else keeping strictly within the confines of my nursing role, as if it were part of my uniform. I knew that only by bringing those two sides together could I be the nurse I wanted to be.

Many nurses struggle with the emotional stress of our work, yet rarely talk about it. I have long suspected that burn-out and the disproportionately high rates of smoking, drinking, substance abuse, and depression among nurses, and the high numbers of sick days that nurses are known to experience aren’t entirely due to the physical demands of our work, yet there are plenty of those. But I have always recovered from the sore backs caused by lifting heavy patients and the headaches after a stretch of night shifts. I’ve even had needlestick injuries that caused me worry for weeks, but that fortunately didn’t cause serious harm. Once, I was splashed in the face by spray from a ventilator accidentally disconnected from a patient with hepatitis C. Droplets of sputum melted in my eyes as I yelled, “Cover for me!” and ran out. Laura was there and she grabbed a bottle of sterile saline, clamped my eyelids open, and poured the whole bottle of fluid into my eyes, drenching me all over. I worried for weeks, but as it turned out, I didn’t get infected, after all.

It seems that almost every nurse has a war story or two.

Casey recently reported an ailment that was serious, but in her telling, at least, fairly amusing. We were sitting at the nurses’ station late one night when she launched into her latest drama. “I swear, I had the worst diarrhea of my life after taking care of that patient with
C. diff
.
*
This place is such a cesspool we should wash our hands
before
going to the bathroom. I was shitting myself, literally.
There were no safe farts. I had only to hold the little specimen bottle over my butthole to give the doctor a sample, can you picture this?”

Unfortunately, I could, yet Casey felt it necessary to enact a pantomime with an empty Styrofoam cup before continuing on with her rant. “The manager called to challenge me about my sick time. The nerve of her to imply that I would take advantage of the system!”

It was lucky for her that Monica was not on that night, as she also would have taken her to task about her sick time. Monica was a nurse with keen ambitions and vowed when she was manager of an
ICU
, she would crack down on malingerers and abusers of the system. But how was she going to distinguish between those individuals (if there were such fraudulent claims) and all the legitimate complaints such as Casey’s? Every one of us had to some degree or another experienced the real hazards of our work. We knew that most nurses’ sick time was but a partial compensation for taking the brunt of only some of the very real risks of this work.