The Making of a Nurse (25 page)

An idea was brewing …

Inspiration can come from unexpected places. A fortune cookie once did it for me. “You have the power to affect the quality of someone’s day.” Nurses have that power in ways that are both obvious and practical but also subtle, even spiritual. And it’s not only nurses who have that opportunity, I discovered one morning when I rode the elevator with the housekeeping staff, who start their day as early as nurses. A cadre of Portuguese and Italian ladies in pink smocks got on at the basement floor, each one carrying a plastic bag containing a mop head. “They give us a clean one to start each day,” one lady told me with obvious pride. “We used to have to wash them ourselves at home, but now the hospital does it for us. Some of the girls weren’t cleaning them properly,” she said, showing her disapproval of such sloppy practice. “It’s so nice to start the day with a fresh mop.”

And none of us will forget the sweet voice of the young man who worked the evening switchboard. We stopped whatever we were doing at precisely 2100 hours to listen to the public announcement:

We looked at each other, amazed. How long could he get away with it? As it turned out, not long. The public announcement soon reverted to the original, terse recorded message: “Visiting hours are now over.”

I WAS BEGINNING
to piece together a patchwork of ideas. What if a collective of nurses created a work of art made out of natural elements such as cotton, wool, and paint in this environment of chrome, glass, steel, plastic, and concrete? A nurses’ patchwork quilt, made by our hands, those very hands that do the work of caring for our patients? It would be inspired both by what is in our hearts and our minds. It could be a symbol of comfort, a soft place to rest one’s eyes, especially the anxious, weary ones of our visitors out in the waiting room where it could eventually be hung and displayed.

I called a meeting of all the nurses. I took a deep breath as I opened a big plastic storage box and pulled out pens, paints, crayons, tubes of glitter, ribbon, and squares of plain white fabric. They looked at me, some dubious, others bemused, and a few annoyed. I explained my idea.

“There she goes again,” they groaned, rolling their eyes, “another of her crazy make-work projects.”

“Who does she think we are? A bunch of grannies?”

“Yeah,
my
grandmother makes quilts, too.”

“The time has come to appreciate these historic domestic arts, not trivialize them,” I lectured. “You’re buying into the usual putdown of women’s work.” (Funny, how it wasn’t any of the male nurses who objected to the quilt.) “It’s because we have come so far that we can feel proud of art created by our hands. It doesn’t stereotype us any more.”

They weren’t convinced. Many walked out, laughing as they went. To the remaining ones, I turned up the heat a notch. “It will be a place to put our stories, our memories and save them from extinction. Nursing might look different in the years to come. This quilt will be a statement of our profession, a historical document of nursing today, now, in this place and time.”

“What’s the theme?” someone asked.

“Comfort measures,” I came up with on the spot.

“Tilda, do you really think that a quilt can change the world?” someone else asked.

I did, in fact, believe that
Art
could, but kept quiet. They’d heard enough from me. Reluctantly, they took their package of
fabric and supplies. A few showed mild interest. But was it such a stretch? Many nurses had creative hobbies of some sort or another. Take Valerie. She’s such an accomplished gardener that tour buses stop at her house to visit her garden. She tends to her patients in the same way. She took care of a prisoner who was brought to the hospital from jail where he had taken a heroin overdose. He was ugly and tough and had a tattoo of barbed wire encircling his neck, arms, and chest. A policeman kept a constant watch over him, even though a critically ill patient could hardly escape. I came over to help Valerie because I knew he could be violent. However, in her hands, he was docile.

“What’s he in jail for?” I asked the policeman, who was sitting in the room.

“Rape, murder. The usual.” He flapped open his newspaper.

The patient/prisoner could not have known, but must have felt, the benefit of Valerie’s profound philosophy of nursing that she once expressed to me: “I don’t care who you are. I’m going to give you the best care I possibly can. It doesn’t take much. It’s really so simple. A smile, a kind word. It means so much.” Valerie puts her gardening skills to use in other ways, as well. Her patients are always well-tended and their rooms are always clean, orderly, and nice-smelling, if possible. And I am positive that it was Valerie who potted a plant in a bedpan and placed it on the counter of the nursing station for all to enjoy.

There are other professionals who have also found ways to allow their hobbies to inform their work in the icu. On her days off, Monique, our Québécoise physiotherapist, is an extreme athlete who participates in “adventure” races. She’s part of a team that goes four days straight without a break, bushwhacking through wilderness, running through hills and valleys, traversing rivers and streams.

“Incroyable!”
I said. “What about sleep?”

“I got about three and a half hours on the last one. We took a few naps,” she admitted. “It was wild.”

“What about food?”

“Energy bars, pre-cooked bacon for the fat. Lots of water, but we have to carry it with us.”

Her work with our patients involves assisting them to bend a knee or cough out tenacious secretions lodged in their lungs. She helps them dangle their legs over the side of the bed after a prolonged illness or do breathing exercises after surgery. These are their “Iron Man” events and Monique knows that well.
Bien sur
.

“DOESN’T ANYONE GET BETTER?
” friends often ask me. Understandably, they want to hear heartwarming stories. They are tired of my sighs and lamentations about my work. Why have I never told them about Dr. Margaret Herridge’s world-renowned work on the long-term survival of patients with
ARDS
?
*
We took care of those patients only during their stay in the
ICU
when they were critically ill, but Dr. Herridge follows the growing number of survivors who made it home. She documented their progress as they returned to good health.

Why had I never told anyone about the son, his mother, and the liver they now share? She had a rare disease and only a transplant would save her life. The son worked with his parents in a thriving family business and they had gone on yearly family trips to their native Italy and come back tanned and fit – except for one summer when the mother returned weak and jaundiced. Her subsequent deterioration was rapid. It didn’t take long for the son to decide to donate a lobe of his liver to his mother and luckily he was a match. “Imagine this miracle,” the mother said, “a son gives birth to his mother!” A nurse brought the son over in a wheelchair from his hospital room on a surgical floor. She helped reach his arms to his mother in the bed while I lifted the mother’s arms toward the son. Together we made it possible for the two of them to hug each other.

Why had I never shown my friends or family the calendar put out by the organ donor association? It included pictures of a kidney recipient kayaking in a lake, a liver transplant running a marathon, another smiling, sitting in her garden.

What about that eighteen-year-old boy with testicular cancer that had spread throughout his body, who had a tumour, the size of a football, wrapped around his heart? He underwent surgery but then developed pneumonia and kidney failure and landed up in the icu. “We couldn’t remove all of the tumour,” the surgeon told the patient’s mother and brother. “We’ll have to go back in again once these complications resolve.”

“But he’s okay?” they asked in unison, rushing ahead of him into the room.

“For now,” he said.

“Hey, bud, the doctor said you are okay!” The brother grabbed his brother’s hand. “I just about went
boom
, passed out, and Mom’s here, freaking right out.” Amidst the iv and the arterial line, he found a place to plant a kiss on the back of his brother’s hand. “I’d do anything for you, man. You’re my main bro. Maybe I’ll bring the catcher’s mitt, and we can play ball in here.”

After the family left the room, I spoke with the surgeon. “He’s the sickest patient in the
ICU
right now,” I told him, trying to hide my worry.

“He’s young and his type of cancer has an excellent response rate to the chemo plus surgery regimen. We’re aiming for total cure. There’s no other option.” He closed the chart.

“Yes, but he’s developed so many problems and he’s on maximum support.” I gestured around at the room full of machines, including the High-Frequency Jet Ventilator that was used only in extreme cases such as this. It pumps more than 100 breaths into the lungs every minute and makes a loud, rapid, thumping noise you can hear throughout the halls of the icu.

“He’ll be all right. He’ll get out of here.” The surgeon got up to go. “If you nurses would be more optimistic,” he said with exasperation, “the patients would do better.”

Maybe it was just a bad day or I had seen too many losses and attended too many “M and M” rounds of late, where the mortality and the morbidity of our patients were reviewed and we spent hours discussing all that had gone wrong and the ways we could do better next time.

“How is he?” said the mother, rushing in later that day in her coat and scarf.

“About the same,” I said evenly. “He’s holding his own. No better and no worse, but that’s saying a lot.”
Around this place, it is
.

“Amen,” she said, clutching my arm. “Amen.”

But the next day, I was able to tell her, “He’s getting better,” and he was, a little.

“Praise the Lord for this miracle.” She clasped her hands up to God in gratitude and then out toward me. “Thank you, Nurse, for everything you are doing for my boy.”

We saw that young man again just a few weeks later. Tall and shy-looking, with the requisite baseball cap turned around and baggy pants, he came to visit us under duress from his mother. Was it a miracle or merely an accurate reflection of statistics and the laws of large numbers that bore out the doctor’s confident prediction? Sometimes everything went well, not only as prayed and hoped for, but as planned and intended for also. This is what the
ICU
is about and one of the reasons I work here, yet these are not the stories I regale my friends and family with, when I tell them anything at all. Why don’t these stories leave as strong an imprint on my memory or as lasting a residue on my emotions as the ones that disturb me, even
haunt
me at times? I suppose it’s because, generally speaking, our patients are the ones with complications; they come to us when things don’t go as planned and hoped. The cures and successes aren’t the ones who need us or who keep us busy or up late at night.

A NURSE CALLED
from the floor one day and I happened to answer the phone. “There’s a patient here named Mr. Robichaud who wants you to pay him a visit,” she said. “He’s doing great after his liver transplant, but he says he has some concerns.”

“Me? I didn’t take care of a Mr. Robichaud.”

“He says any nurse will do. He has questions about his stay in the
ICU
.”

I volunteered to go and another nurse took over my patient while I went to the seventh floor.

“I hear they drugged me,” said a wan, worried-looking man in his forties, after I introduced myself. “I lost eight whole days of my life.”

“Yes, it must feel like that,” I said. “Pain medication was given to you after the surgery. Some of those drugs make you lose your memory for those events, others can distort your thinking.”

“Yeah, I can’t remember what happened there. I was terrified. All I could think of was if this is my life now, I want to end it. The clock moved so slowly. I couldn’t talk and always felt like I was choking because of the tube in my mouth. I panicked when I couldn’t see the nurse. Most were nice, but there were a few who were rough.”

“I am sorry to hear that,” I said quietly.

“But why did they dope me up so much?”

“You were probably in discomfort or pain,” I explained, but then tried a different tack. “What do you feel you missed?”

He thought for a moment. “My wife bought the kids a puppy and there was a hurricane in New Orleans …” He was incredulous that the world had gone on in his absence. “Wait, there’s more …”

“Yes? Tell me.”

“The morning of my transplant, before I even knew there was a liver for me, I sensed something. The nurses moved differently. They kept stepping out of my room to whisper to each other. The day before, I had been given a meal tray, but that morning, nothing, with no explanation. Hardly anyone spoke to me and when they did it was with these bright, overly cheerful expressions pasted on their faces as if they had a secret.” He gave a weak chuckle. “Oh, they had a secret all right. But I didn’t dare ask what it was. I had been carrying a pager for two years. One time it went off, but it was a wrong number and that sent me into a tailspin. I’m ashamed to admit how long I’d been praying for some young, healthy person to die. If it was going to happen anyway, why not for me? I was hoping for a car crash, headlong collision preferably, so that the vital internal organs would still be intact.” He paused and I sat there until he was ready to say more. “I’ve always been a light drinker, on social occasions only, or a glass of wine at dinner – doesn’t everyone? Haven’t done
drugs for years, but how I got hepatitis – I have no idea. They say it’s idiopathic – no known cause.”