The Making of a Nurse Read online

  Scarlatti! Why now the blindfolded boy who pierces a humble breast with golden darts? One victim languishing in vain, while another falls faint? “What’s going on?” I yelled. “Where’s Dad?”

  “The hospital. His heart.”

  My own heart began pounding wildly. He’s okay, I told myself. “He’s okay,” I said out loud to make it so.

  “I’ll drive,” she said with a crazy grin.

  She didn’t even have a licence, but she got in the driver’s seat and somehow we got there.

  The doctor said it was a mild heart attack, but my father should take it as a warning.

  How strange to see my father lying flat-out in bed, still and quiet, the colour and life drained from him. He propped himself up on one elbow to sip water from a plastic straw bent into a paper cup. A pretty nurse with a swinging ponytail and pink stethoscope around her neck, whose name tag said “Cindy,” came in and took my father’s pulse with her big, reassuring scuba-diving wristwatch that had dials and buttons on the side. “His vital signs are stable,” she told me.

  Adopt me, please! I madly radioed her. Take me home with you. I’ll be your little sister.

  My mother and I stayed a few more minutes then kissed him goodnight. When we got off the elevator on the ground floor, she came to an abrupt halt. “Let’s stay here in the lobby. My nerves are shot. I need to gather my bearings.” She dropped into the nearest chair, and I slumped down low in a chair beside her. My mind wandered off. I was drowsy. … She had to gather her bearings … gathering bearings … gathering berries in the forest … teddy bearings … the Bering Strait … I will travel far away … strawbearings … raspbearings. Sleep was right there behind my eyes. It would be so easy to give in, but I couldn’t, I was on duty. Dr. Ben Casey ordered me to monitor the patient closely. Get him through the night, he’d said. It all depends on you. I got up and walked around to wake myself up.

  “Don’t go far,” my mother called out, “I may need you.”

  The Ladies’ Auxiliary had set up a little petting zoo for the children in the pediatric ward. There was an aquarium of tropical fish and a tank with a branch upon which an iguana draped itself. A parakeet pecked at its reflection in a little mirror, jabbering “yakkety yakkety yak.” I stared deeply into its blue feathers at the back of its neck and in a few seconds I knew what I would do. One day, I would become a real nurse. It made perfect sense. Being a nurse was what I knew best. I liked spending time in hospitals, where problems were solved, grown-ups were in charge, and people knew what they were doing. Pleased with my new plan, I returned to my mother in the lobby.

  “If anything happens to your father,” she said when she saw me, “promise you’ll look after me, that you won’t put me away … in some place.“

  “Yes, I promise.” I took her hand. “Let’s go home. Have you found your bearings yet?”

  “They’re nowhere in sight and I’m worried sick about your father.”

  One day, when I’m a real nurse, I’ll be able to leave at the end of my shift.

  3

  THEORIZING, CONCEPTUALIZING, AND CATHETERIZING

  Over the years, I became very familiar with hospitals. I even grew to love them. In fact, I loved them so much that when I was fourteen, I worked as a candystriper at Toronto General Hospital and spent my summer vacation filling patients’ water jugs and delivering flowers and mail. I must have performed my duties well because the next summer I was promoted to the patients’ lending library and put in charge of the mobile cart of books and magazines. Most patient rooms had four beds and since there was no air conditioning, the windows were always wide open to let in fresh air and the long, billowing curtains flapped when there was a faint breeze. To the male patients, sitting up in bed, eagerly awaiting my arrival, I handed out dog-eared “spaghetti westerns” by Louis L’Amour and to the women, I gave the purple-prose bodice rippers by authors such as Barbara Cartland and Taylor Caldwell. They were all pleased to see me and to receive light reading material to take their minds off their problems.

  In the hospital, I felt at ease, almost happy. I liked watching busy doctors and nurses rushing around with a sense of purpose and importance. And the hospital seemed such an equitable and democratic place. Everyone was in the same boat, dressed in the same flimsy blue hospital gowns and all worried about something. And although it was such a vast, public space, you knew that private, intimate activities were occurring between complete strangers. On any ordinary day, you could see people in various states of distress, crying and moaning, and even though these sights were disturbing, they were fascinating, too. The hospital was a place chock full of mysteries, a repository of intriguing stories. Each patient was a book I wanted to read. Why was that man in the plaid bathrobe sitting in a wheelchair by the window looking so wistful? Why did that woman have a plastic tube sticking out of her nose, and how did it get in there? Why was that old lady tied down in a wheelchair, and why did she keep calling out, “Gladys, Gladys, take me to the bank”? As I walked through the halls, pushing my cart of paperbacks, I imagined that one day I would be a part of it all, a calm and selfless presence ministering to the sick and weary. It didn’t seem as if it would be as difficult to take care of strangers as it was taking care of one’s family members. I couldn’t help my own family, but at least as a nurse I would be able to rescue the rest of the world. Being a nurse would make me a better person.

  Best of all, in the hospital, no one knew where I was. I could get lost and not be found. In the basement, there was a chapel and I would often sit in a pew at the back, staring up at the cross above the altar for long periods of time. Other days, I lingered in the hospital gift shop, fingering the pastel knitted booties, pot holders, macramé hanging baskets, and crocheted toilet paper covers (one had a Barbie doll’s head and torso sticking out of it) and imagined those sweet grandmothers who must have made them.

  By the end of high school, my path was clear. I was desperate to leave home and pragmatic enough to reason that nurses would always be needed. Yes, nursing would be my ticket to ride, my escape route. There were only a few small problems. I had read the Nurse Cherry Ames books and I knew about her porcelain skin, rosy cheeks, and wholesome personality. I knew nurses were still supposed to be angels and heroes. Me? I had more than a touch of the devil. As for opportunities to be heroic, I’d blown those, big time. And weren’t nurses supposed to be capable, levelheaded, and practical? They were known to be efficient, sensible, and cheerful. I was none of these things, but I would work on myself, I promised. After all, to be a nurse was such an admirable, altruistic thing and how nice it would be to help humanity in some way or another. How good it would feel to be good!

  THE FIRST YEAR AT the Faculty of Nursing at the University of Toronto, in 1979, was almost entirely spent in classroom lectures. The required courses were physiology, anatomy, microbiology, biochemistry, and Introduction to Nursing Theory, and for my elective, I chose Feminist Studies. I had every intention of being a diligent student, but all too often I got distracted or was overcome by inertia and stayed home keeping my mother company. When I did make it down to the campus, I usually ended up sitting in a coffee shop with my boyfriend, Larry, and then losing myself altogether for the rest of the afternoon in his parked car to the tune of Marvin Gaye’s “Sexual Healing,” which we played over and over on his tape deck.* Mind you, a student could sit in those classes, listen to the lectures, write the papers, pass the exams, and never even come near a patient. We only visited the hospital as observers, wearing our navy uniforms and white lab coats, touring the various departments. I wondered where I would eventually work because I didn’t have any particular allegiance to a specific organ, such as the heart, which would have led me to cardiology, or the kidneys so I could have chosen nephrology. And I wasn’t drawn to the relatively happy obstetrics or orthopedic wards, pediatrics seemed far too daunting, and I couldn’t bear to spend much time in the psychiatric wards with its smell of cigarettes, sweat, and despair. The patients
there were frightened, angry, or sad, and sometimes all of those things. In truth, it felt too close to home.

  During those many hours in the classroom, I sat in the back row with a bag of snacks beside me, watching the professors droning on from the podium. The other nursing students listened intently and took precise notes. I made random scribblings, catching key phrases such as “conceptual framework” or the “theoretical basis of caring.” I took notes about how the nurse was to make “therapeutic use of herself” (there was no attempt at gender-equal language as there was no gender equality in nursing) in order to assist “clients”* toward the generally agreed-upon goal of “self-actualization,” which was the “achievement of one’s full human potential.”

  Nursing scholars created an entire lingo of “nursing diagnoses,” perhaps in order to be like doctors with their “medical diagnoses,” and thereby raise our status. For example, “Altered level of comfort” meant pain and “Altered pattern of urinary elimination” was the euphemism for incontinent. “Health maintenance disruption” meant, simply, illness. My personal favourite was “Disordered nutrition; more than body requirements,” which meant the patient was overweight.

  Sometimes there were debates about what was, in fact, the role of a nurse. They posited a number of theories. One theory was that the nurse was there to assist the patient with self-care and to perform for them what they could not do for themselves. This sounded good to me, but another theory asserted that the nurse’s function was to help patients achieve “wellness” and “homeostasis.” Another invoked the words of Florence Nightingale: “The nurse is to put the patient in the condition for Nature to do the work of healing.” Another position claimed the nurse was a “body expert” and “health counsellor.” Oh, there were nursing theories aplenty, oodles of them!

  I think the professors felt they had to justify nursing as a profession worthy of university study. After all, for years, most nurses had diplomas and learned on the job, working in hospitals. One professor insisted that the rightful place of nursing was at the “Table of the Humanities,” in that it drew from the disciplines of philosophy, sociology, and psychology. Another argued that nursing straddled an equally secure position at the “Table of the Sciences.” Regrettably, I raised my hand to ask, “Doesn’t nursing also have a place at the Kitchen Table?” The professor frowned, but I felt that to be a nurse required certain personal, human qualities such as courtesy, warmth, kindness, and respect, attributes one presumably learned at home. No, they countered. These old-fashioned values held nursing back from making progress. Clinging to these outdated notions kept nursing in the Dark Ages. To be a nurse required skill and knowledge, not merely virtue and morality.

  But if nursing was both a science and an art, the science – the math and chemistry, etc. – was the easy part. The “art” involved lofty goals that were difficult, if not impossible, to attain. It was the “art” of nursing that required the nurse to enter the patient’s world, to understand the patient’s point of view and mitigate his isolation or her suffering. As a nurse, you were there to understand your patients’ existential questions and to assuage their pain, whether of body, mind, or spirit. You were expected to receive without judgment their emotional expression, whether it was to cry or to complain, or even to be rude to you. You were to praise them when they passed gas after surgery or had a successful bowel movement and then go off and empty the bedpan cheerfully. Your only need was to be needed and to meet other people’s needs. If a patient rang the call bell, you were to jump. You were there to make a cup of tea, if required. Along with all of that and above all, you were to assist your patient to achieve the ultimate, uncontested goal of all human beings: self-actualization. Oh yes, and don’t forget about their medications, fluid balances (their “in’s and out’s”), IVs, dressings, plus all the secretarial work, too. It was a tall order. No wonder they called us angels.

  IT WASN’T UNTIL second year that they finally let us get our hands on real, live “clients.” My first one was Mrs. Lenore Thompson, an eighty-three-year-old woman living in a retirement home in downtown Toronto. (I had to chuckle when I noticed that the facility was located kitty corner to The Anti-Aging Store, a place that sold elixirs, balms, and potions, touted to be life-enhancing and prolonging.) I was supposed to interview her and identify any health problems. She was a regal, white-haired lady who opened her display case to show me her collection of glass unicorns with great pride. She brought out her blood-pressure pills and I made a note of their names and the dosages she was taking. Then, she invited me to join her for lunch in the communal dining room. She cut up a slice of pizza with her knife and fork and chewed slowly. Then she put two chocolate sundaes on a tray and asked me to carry it back to her room. We sat enjoying them, but then it was time for “business” and my hands suddenly got jittery when I asked if I could take her vital signs.

  “Do you promise to return them to me afterwards?” she said impishly.

  That morning, I had made sure to put on my watch that had a second hand so I would be able to take my patient’s pulse. It was eighty beats per minute, strong and steady. (I had taken mine earlier and it was right up there, racing at 122.) Her blood pressure was high at 160 over 95, but she promised to cut back on her sodium intake. I looked at the thermometer and hesitated. Should I tell her that she was extremely hypothermic? Her temperature was so low it barely registered! I broke the news to her.

  “Perhaps it’s because of the ice cream, dear?” she asked helpfully.

  “Ah, yes. Of course.” It reminded me of those myths of patients who prolonged their hospital stay by putting a thermometer in their mouth after drinking a hot beverage to simulate a fever.

  Next, from the corner of my eye, without letting on what I was doing, I counted her respirations so that she would not speed them up or slow them down to confound me, as I’d heard that some patients did.

  “You’re a nice girl, dearie,” she said, catching me watching her chest rise and fall. “You’ve a sweet face.”

  “Thank you,” I said, but inside I cringed, thinking of my mother. You’re wrong there, lady. I’m neither nice nor sweet.

  EVERY MORNING, before leaving for my classes, I put out my mother’s pills for the day and made sure there were plenty of the small brown glass bottles filled with my father’s tiny white nitro-glycerin pills for chest pain. “Make sure they’re with him at all times,” his doctor had instructed me. “His life depends upon it.” My father claimed it was nothing but a sugar pill, but the label said sublingual tablet, indicated for fast-acting vasodilation of the coronary arteries. I put a bottle in the glove compartment in his car, one next to his typewriter, and one on the spice rack in between the marjoram and the oregano. He popped a few of those pills when he would pull up short on winter evenings and his face went ashen as he set out for his university classes in pre-Confederation history or art appreciation. Then he could carry on like an Arctic explorer, his breath frosty in the air and snow crunching under his feet.

  When I came home from school, I fed my mother and got her ready for bed. Sometimes, I claimed to have a lot of schoolwork and let my father take over. Once, after putting her to bed, he joined me with his crossword puzzle and settled in front of the TV. “How do you do it?” I asked him.

  “I love her,” he said simply. “Hey, Til, what’s a four-letter word for a Mexican pot?”

  It was all he had to say on that matter, yet about everything else he spoke endlessly.

  “IT WILL BE A powerful experience,” said students in my Feminist Studies class, encouraging me to join them on a march for International Women’s Day. We had been learning about the history of women’s oppression by the male patriarchy, about the Women’s Liberation movement, and useful things such as “assertiveness training” and “consciousness-raising.” “There’ll be thousands of women marching in solidarity,” they said. “Don’t miss it.” On a blustery day in March, I joined those women and some men, as we started on Queen Street and ma
rched up Spadina Avenue, our arms linked. There were women of all colours, lesbians, straight, liberals, socialists, macrobiotics and vegans; professors, filmmakers, and abortion activists; women with babies on their backs, with children in hand. We wore buttons on our jean jackets that said: “Sisterhood Is Powerful,” and “Women Make Policy, Not Coffee.” “Take back the night,” we chanted. “Women’s right, women’s might!”

  How thrilling it felt to belong! At the end of the march we hugged each other and pledged to keep up the good fight. I decided to stop off at a Kensington Market groceria to call my friend Joy on a pay phone. We were making dinner and our boyfriends were coming over that evening, and I wanted to find out if we needed anything. She picked up on the first ring. “Phone your brother,” she said. “Right away.”

  “What for?” I said, ignoring the urgency in her voice.

  “Just do it, now.”

  So I did.

  “I’ve got some bad news.” Stephen tried to soften his curt tone. “Are you sitting down?”

  Like they say in the movies. Maybe this is a movie.

  “I don’t know how to say this …”

  It was strange to hear a member of my family at a loss for words …

  “Dad died.”

  I held the phone away and tried to imagine my father gone. Impossible! My brother’s voice continued on, like the barking of a dog in the distance. I put the phone down with shaking hands and stumbled along the sawdust-strewn grocery aisles, toward the exit. Seeing my distress, the worried owner hurried after me but I waved him off and ran out into the cool air. The market was closing for the day. The vendors were putting away their baskets of fruits and vegetables, tubs of cheese, and bins of rice and grains. I ran through the grey slush in the streets as tears streamed down my face.

  I CAN HARDLY REMEMBER the funeral, I was in shock and preoccupied with holding my mother together and upright. Afterwards, I brought my mother home, and it was just the two of us. Now, I was in charge of everything. I put out her slippers and nightgown and went to get her ready for bed. The problem was, she was nowhere to be found. I searched the house, calling her name, but either she had wandered away or was playing a twisted game of hide-and-go-seek. At last, I found her in the basement, standing next to the furnace, shifting from foot to foot. I pulled her along up the stairs and tugged her nightgown down over her head. I shoved her feet into her terrycloth slippers and didn’t even bother brushing her teeth. I placed her pills on her tongue, held a glass of water to her lips, and waited impatiently. They stuck there melting. “Swallow them!” I shouted at her. Do I have to do that for you, too?