The Making of a Nurse Page 14

  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 w
ear 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.”

  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 stori
es.

  “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.