Bringing It Home
BOOKS BY TILDA SHALOF
A Nurse’s Story:
Life, Death, and In-Between in an Intensive Care Hospital
The Making of a Nurse
Lives in the Balance (editor)
Camp Nurse
Opening My Heart:
A Journey from Nurse to Patient and Back Again
Bringing It Home:
A Nurse Discovers Health Care Beyond the Hospital
Copyright © 2014 by Tilda Shalof
All rights reserved. The use of any part of this publication reproduced, transmitted in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, or stored in a retrieval system, without the prior written consent of the publisher – or, in case of photocopying or other reprographic copying, a licence from the Canadian Copyright Licensing Agency – is an infringement of the copyright law.
Library and Archives Canada Cataloguing in Publication
Shalof, Tilda, author
Bringing it home : a nurse discovers the world beyond the hospital / Tilda Shalof.
ISBN 978-0-7710-8000-5 (pbk.). —ISBN 978-0-7710-8001-2 (html)
eBook ISBN: 978-0-7710-8001-2
1. Nursing—Canada—Anecdotes. 2. Nursing—Social aspects—Canada—Anecdotes. 3. Nurses—Canada—Anecdotes. 4. Medical care—Canada—Anecdotes. 5. Shalof, Tilda. I. Title.
RT6.A1S53 2014 362.17’30971 C2013-906883-X
C2013-906884-8
Published simultaneously in the United States of America by McClelland & Stewart, a division of Random House of Canada Limited P.O. Box 1030, Plattsburgh, New York 12901
Library of Congress Control Number: 2013938863
Cover design: Rachel Cooper
Cover image: © Emrah Turudu/Getty Images
McClelland & Stewart,
a division of Random House of Canada Limited,
A Penguin Random House Company
www.randomhouse.ca
v3.1
To the staff and volunteers of VON
CONTENTS
Cover
Other Books by This Author
Title Page
Copyright
Dedication
Foreword by Judith Shamian
1. Naysaying
2. Fifty Shades of Nursing
3. Pictures at an Exhibition
4. Outdoors
5. Safe Home
6. Oasis
7. SMILE
8. It’s a Beautiful Day in the Hospital
9. Shwarma and Hummus at Dr. Laffa
10. Fried Halibut and Rappie Pie
11. You Say Goodbye, I Say Hello
12. Wine and Cheesecake
13. The Smiling Goat
14. Mother of Mothers
15. Back at the Ranch
16. The Far, Dark Side
17. The Way a Hug Matters
18. Home at Last
19. La Dolce Vita
20. Butterflies and Balloons
21. Cherry Blossoms for Everlasting Life
22. 360 Degrees
23. Beyond All Prejudice
24. Socks and Condoms
25. Working Like a Dog
26. Friends With Boundaries
27. Making an Impact
Postscript
Acknowledgements
Foreword
by Judith Shamian
HOME IS A WORD THAT most associate with safety and security, a familiar place where we gather to be with the people we care about. It is therefore not surprising that most of us would prefer to be cared for at home if possible, and even die at home.
In spite of the fact it is so clear to all of us that getting well at home is more natural than in hospitals, the Canadian – as well as other countries’ – health care system is built and judged by the availability of the acute care systems, meaning hospitals. Throughout the last two centuries, governments have consistently reinforced the message that having many hospitals, with the most up-to-date equipment, is the hallmark of good health care. But this does not reflect reality. There is no question that we need high-quality, sophisticated hospitals that can provide complex care to those who need it. But investing most of the health care dollars in the hospital sector (like many countries do) deprives the public of the care they need and deserve.
I came to Victorian Order of Nurses Canada in 2004 as its President and CEO after a rich working history in teaching hospitals, government, academia, and with some primary health care experience. With this background I was able to look at VON and quickly realize that it was a hidden jewel. It had been in existence for more than one hundred years, founded by Lady Aberdeen during Florence Nightingale’s era to serve the underserved in their own community, in their own homes, based on their own needs. Today the buzz words in health care are “patient centered care.” Many think that we in the 21st century discovered this revolutionary concept, yet it was already a defining part of VON’s doctrine back in 1897. Over the years and against many odds, VON has made every effort to hang on to this notion. When I joined VON, I immediately became hooked on this philosophy and it became clear to me that so many countries still don’t “get it.” I felt that VON had a huge responsibility to educate the people and governments on why home, community care, and social services are essential to a healthy nation.
Fortunately, while I was formulating these thoughts around the essence of home, community, and social services, other organizations were also coming around to this thinking. These days most leading global agencies like the United Nations, World health Organization, World Bank, and many others advocate for “Universal Health Care Systems,” where everyone, regardless of financial means, would have access to the care they need. While this sounds like a very reasonable goal, the truth is that it is rarely attained. One of the reasons that Universal Care is out of reach to many is because of the lack of home and community care systems. This major gap in our health care systems and profound lack of understanding of the importance of having integrated home and community services has driven me to take on the advocacy for the home and community care agenda.
To advocate, promote, fight, and influence can be done in many ways. This wonderful book by Tilda Shalof is one of the means by which we can advance the home and community care programs. Many people, including nurses themselves, do not even know what home care is until they need it – and then they see how poor the system is. One of the myths we need to dispel is that home care is just about visiting the elderly. By reading these stories you will get a glimpse of the variety and great value of home care. As Tilda and I discuss early in the book, most health care professionals do not value and do not understand the role of those who work in the home and the community care sector. This book showcases those highly skilled, hard-working individuals. As a proud nurse as well as a health care executive, I believe it is important that we understand the role and the contribution that these silent heroes play. Without volunteers, family members, personal support workers, in addition to nurses and others, we could not provide the support and care people deserve in their own home.
From an economic perspective, it is important to understand that home, community, and social services are the most cost-effective and impactful solutions. Canada spends less than five percent of our health care dollars on this sector – which is a serious flaw in our health care system. Many other countries spend three to four times more than Canada does and the relationship is clear: countries that have better home, community, and social services have better overall health status.
As you will read in these pages, I had a difficult time convincing Tilda to write this book. I could have asked various authors but I was set on Tilda. Tilda is the “Nurse Cherry Ames” of the 21st Century, to reference a heroic (but fictional) charac
ter. Her previous books showed me that she is the kind of nurse that we want to see working in this profession all over the world. Tilda is a smart, caring, engaged, and personable nurse. She advocates for her patients and families while working collaboratively with the rest of the health care team, which can be a fine line to tread. She has an ability to capture the reality of the nursing world and to make us feel part of the story. So I knew I needed her to say yes to this important and challenging project – to tell the real story of nursing care in the home and the community.
I want to thank Tilda for saying “YES” and going on this journey with the most amazing staff, families, and clients. For eight years I was privileged to be at the helm of this incredible organization and I am extremely proud of the valuable work VON has been doing in Canada for over 110 years. My hope is that when you read Bringing It Home, you will share in the experiences of those giving and receiving this care, and ultimately understand why we must support these programs.
NAYSAYING
“NO!”
“No way.”
“Big mistake, Tilda. Don’t do it.”
Then the kicker: “You’ll never come back. No one does.”
That’s my fear, too. There’s something about the hospital that makes a nurse think, If I leave, I’ll never go back.
Our nursing station chatter ends with the approach of a stretcher, the high-pitched beeps of a cardiac monitor becoming increasingly louder. My patient has arrived from the operating room, swarmed by a bevy of serious people in green scrubs: the surgeon and her residents, an anesthesiologist, an OR nurse, a respiratory technologist, and a porter. A fresh liver transplant. Six IV pumps, a unit of blood hanging, oxygen set at 100 per cent. I eyeball the cardiac monitor – heart rate 136, sinus tachycardia, blood pressure 82 over 44. Oxygen sats 85 per cent. No urine in the urometer. Diagnosis: a sick patient and a busy night ahead for me.
The surgeons go into a huddle. I listen to a verbal report from the OR nurse and the anesthesiologist while the rest of the team attends to the patient. Ashley attaches cardiac electrodes to his chest so that Belle can connect the cables to the monitors. Riccardo orders a stat chest x-ray, draws arterial blood gases and a slew of other blood tests. Charity calibrates transducers, zeroes pumps, and records starting totals of each infusion. Edna hangs a bag of blood. Jasna sees the mean arterial pressure has dropped to 59 mm Hg so she titrates the Levophed drip up from 0.021 mcg per kg per minute to 0.030. The patient’s oxygen saturations are only 84 per cent on 100 per cent oxygen, so Manju, the respiratory therapist, increases the FiO2. I’m ready to approach my patient, introduce myself, and begin my head-to-toe assessment, starting with “head”; my patient is deeply sedated, unconscious, and unresponsive.
What could beat this – the excitement of a new admission? Working together to save someone’s life? It’s energizing, even exhilarating – why would I ever leave? How could I be a nurse without a crisis, without everything at stake?
We work steadily into the night. The distraught wife and son stand on either side of the bed holding their loved one’s hand. They try to read our faces and decipher the machines and monitors. As I go about caring for her husband, his father, I answer their questions and explain every single thing I do. They can see the situation is serious, getting worse, and I don’t deny it. An abdominal ultrasound proves what we suspect: internal bleeding.
“Your husband is not doing well,” the surgeon says. “He has to go back to the OR.”
The mother and son are shocked. We prepare the patient to return to the operating room. I put my arm around her. This is good news, I tell them. We can fix this problem.
In the ICU, there are occasional ebbs in the frenetic flow, little lulls when you can take a break and tune out, even rest and think. One of those times is when your patient goes to the OR. First, I check the arrest cart to make sure it’s well stocked, and then I ask around if anyone needs help. Tonight I’m on a mission. I’m conducting a survey. As I make my way around the ICU with a clipboard on my hip, I stop at every room to ask each nurse a question.
“Home care. What’s your first thought?”
In research, n refers to the number of subjects, and my n is nine. Here are the findings:
“I don’t know anything about home care. Isn’t it just chit-chatting with people?”
“Is home care the same as public health?”
“Sound’s boring. A snoozefest. I’d lose my ICU skills.”
“It’s too slow, too much paperwork. You’re out there on your own. No team.”
“It doesn’t pay as much as the hospital.”
“You have to go into creepy homes. It’s dangerous and I’m not prepared to put myself at risk.”
“My uncle was rude to his home care nurse and she just took it. I didn’t like that.”
“It’s just clipping old ladies’ toenails and getting people to their doctor’s appointments, isn’t it?”
Only Riccardo has something positive to say. “Home care nurses made it possible for my grandmother to be at home in her last years and die there. Why not care for people in their homes where they want to be rather than in the hospital where no one wants to be?”
I slip into the Wellness Room, provided for us by Denise, our manager. It’s a quiet place to read, watch TV, or lie down. I sit on the recliner and put my feet up to mull things over. I have a decision to make.
Before coming to work, I spent the afternoon with a prominent leader of the nursing profession, Dr. Judith Shamian. We’d met a few times before on the nursing conference circuit, where I entertain audiences with stand-up comedy nurse jokes and my funny/sad, heartwarming/heart-wrenching ICU stories, and where Judith lectures on nursing leadership, health care policy, global health, and, generally, how to make the world a better place. In my world, Judith is a big deal, a “who’s who” – the closest we have to a celebrity. Out of the blue, she called me up and invited me to stop by her house for a visit. I assumed it was purely social, as she’d explained that Saturday is her only day for visiting with people. She is über-busy and is out of town a lot. She has more titles than a library – president of this, professor of that, and, currently, CEO of the Victorian Order of Nurses, “a homecare and community support organization,” according to a VON brochure she gave me to read.
For some time, I have wondered why someone as brilliant and highly educated, as dynamic and visionary as Judith Shamian would be involved with something as old-fashioned and dreary – as Mickey Mouse and rinky-dink – as home care nursing. And as for the Victorian Order of Nurses? That dinosaur is history, a part of Canadian folklore, a horse-and-buggy operation, with pioneer roots dating back to the Klondike Gold Rush and Spanish influenza outbreak.
When I arrived at her modest, midtown home, Judith met me at the door before I even had a chance to ring the bell, and I suddenly realized why. Judith is Jewish – I am, too, but she’s an Orthodox Jew and would not want the electric doorbell to be rung on a Saturday, the Jewish Sabbath. She wore a plain navy dress, dark stockings, and low-heeled patent pumps, which seemed like formal attire for a day of rest at home. I felt a bit out of place, casually dressed in jeans and a purple sweatshirt with a big pink tie-dyed heart. My scrubs were packed in my knapsack for changing into in the hospital locker room.
Judith and I greeted one another warmly, exchanging pleasantries and compliments about each other’s recent, albeit minuscule, weight loss. She offered tea or coffee and I followed her into her large kitchen. On the counter there was a pair of tall silver candlesticks with hardened wax dripping down the sides. They had been lit the evening before, Friday at sundown, to welcome the Sabbath.
Judith drew hot water from a preheated urn. I was going to request tea, which I take black, but decided to ask for coffee, which I take with milk, so that she would open her refrigerator. A quick glance confirmed what I suspected: it was dark inside. Before sundown on Friday, she’d disconnected the light bulb so that electricity wouldn’t be activated by openi
ng the door. (It is permissible to avail oneself of electricity but not to activate or deactivate it.)
From the kitchen we moved out to her elegant, simply furnished living room. It had an old-world, European feeling, with elegant furniture and heavy oil paintings on the wall hanging next to framed children’s drawings. We settled in front of a large bay window, into two comfortable chairs, turned slightly toward each other. A small antique table between us was piled with books and journals. A quick peek at their spines revealed eclectic interests – a copy of The Economist, a detective novel, a book called To Heal a Fractured World, and a well-worn Hebrew prayer book. I’m sure that on every other day of the week Judith reads electronically, but not on the Sabbath.
I had brought her a copy of my latest book as a gift and she seemed delighted to receive it. However, when I reached into my knapsack for a pen to write an inscription, she held up her hand and placed it lightly on my arm. “Would you please sign it for me another time?”
Of course. In this house, writing is forbidden on the Sabbath.
Orthodox Jews mystify me. In addition to the famous “Top Ten” commandments, they follow an additional 613 laws that rabbis and other scholars have identified from the bible.
As for me, I unreliably observe maybe three or four – give or take, hit or miss – and only the fun ones involving foods and presents, not the uncomfortable or inconvenient ones involving restrictions and prohibitions. As for observing the Sabbath the way Judith does, I can’t fathom the idea of disconnecting from the world for even an hour, much less an entire day every week, not to mention the numerous holidays and festivals around the year, each requiring abstinence from work and adherence to rules and prohibitions.
Judith and I are professional acquaintances. We aren’t friends, though I’d like to be. She’s not my mentor, though I wish she were. She’s warm and friendly, but formidable and slightly intimidating, though I don’t think she means to be. Her intelligence is fierce and her energy legendary. She is a force to be reckoned with. The age difference between us is only about ten years, but we move in different circles and she’s way out of my league. Yet, we do share important things in common – our belief that the sun rises and sets with nursing, and that nursing is the solution to most of the world’s problems.