The Making of a Nurse Read online

“What kind of sign?”

  “Open the Book to any page and there you will see the light and the way.” She handed me a brand new, white, leather-bound Bible and I slipped it into my knapsack alongside a People magazine with an article about Princess Diana and her post-partum blues, to read on the airplane. “See God’s purposes, Romans 8:28, and God’s wise plan in Corinthians 2:9.”

  I hugged her. I took comfort wherever I could find it and even though we were Jewish, I was beginning to prefer Pearl’s understanding of things.

  “I’m a grown-up, I want you to know.” My mother swayed from side to side.

  “Who said you weren’t?”

  She shifted from one foot to the other. “So why do you put me in that baby carriage?” She pointed to the wheelchair parked at the front door.

  “Let us offer up a prayer,” Pearl interjected, standing beside her. My mother leaned into her as they bowed their heads. “May the Almighty bless and keep our dear Tilda safe in His loving care. May she go with the love and mercy of our Lord and Saviour, Jesus Christ. Amen.” She walked me to the front door and I stood there, flanked by two duffel bags. I steeled myself not to cry, not now.

  “Stay,” my mother said, “you promised you wouldn’t leave me.”

  Pearl opened the door. “Don’t worry, dear. I’ll take care of your mom. It’s okay.” She pushed me forward with her hand on my shoulder. “Go now,” she said, setting me free.

  I took one last look back and then went.

  * Larry was an engineering student I met at one of the campus social events that brought together the mostly all-female nursing class with the mostly all-male engineering class. It was thought important and logical to encourage this traditional pairing, a kind of academic dating service.

  * The term “patient” was considered paternalistic, yet I noticed that real nurses and doctors called them patients.

  4

  ICE CREAM DAYS

  On my own, high in the sky, enveloped by the gentle roar of the airplane’s engines, I was calm. I had no idea where I was going, where I’d stay or find work, but I was thrilled at the prospect of my adventure. Yes, I was finally a Real Nurse and now had the documents to prove it. However, even with my university degree there were no jobs for nurses in Canada. It was the downward swing of the boom-bust economic cycle, and as hospitals downsized, nurses were the first to be cut. I wasn’t worried because I had long ago decided on my plans upon graduation. I would go to Israel. I told everyone I wanted to connect with my Jewish identity. This was true enough, but I kept quiet about my other reasons: I was seeking fun, romance, and danger!

  ELEVEN YEARS BEFORE, at the age of thirteen, I had travelled to Israel with my father. He had wanted to expand my horizons and believed that Israel was the place to start. That was back in 1972, in the heady, jubilant years after the Six-Day War and prior to the devastating Yom Kippur War, in which Israel was attacked and its very survival threatened. Then, in 1976, there was Israel’s courageous rescue of kidnapped hostages in Entebbe, and in 1991, the daring and precise attack on Iraq’s nuclear reactor. Of course, books influenced me too, especially Exodus, by Leon Uris (a very hunky Paul Newman starred in the movie version) and Raquela, Woman of Israel, about a beautiful and dedicated nurse who rescued lots of sweaty soldiers wounded on the battlefield. She nursed them back to life and they all fell in love with her.

  Something happened on that trip with my father that drew me inexorably back to Israel. It was a small thing, but the memory of it stayed with me. It happened as we were getting ready to leave. I stood on the hot tarmac about to make my way up the metal staircase of the El Al flight to return home to Canada. Soldiers in khaki uniforms surrounded the plane, guarding it as they did every aircraft that flew in and out of Israel. One particularly stunning, suntanned soldier, his rifle slung casually across his back looked right at me and flashed me a slow, knowing wink. Come back, that wink said, and I knew then and there that I would one day.

  This time, arriving in Israel, I felt an immediate sense of belonging to the country and its history even though I knew no one and barely spoke the language. From the airport, I took a bus to the nearest hospital, called Tel HaShomer, a large medical centre located beside a military base just outside of Tel Aviv. It was early summer and the windows were wide open on the bus. I smelled a beautiful, sweet aroma and inhaled deeply. I guess I must have had “tourist” written all over me because the passenger sitting beside me pointed to the orchard groves lining the road. “Orange blossoms,” he said. “Welcome to Israel.”

  At the hospital, I met the Director of Nursing, Shoshana Zamir, a tall, commanding woman in a white uniform and sandals. She welcomed me warmly like I was her long-lost daughter and praised my halting Hebrew. It was as if by clasping me to her huge bosom, she was enfolding me into the entire country, its history and collective destiny. Yes, indeed, they needed nurses badly, she lamented, especially well-educated ones like me. There was a shortage of nurses in Israel and an over-abundance of doctors. “I guess every Jewish mother wants her son to be a doctor,” Shoshana said with a chuckle, “and not many Jewish mothers encourage their daughters to be nurses, do they?”

  Nor their sons either, I thought. But surely it was only a matter of time until gender equality would be achieved in the nursing profession?

  Shoshana suggested I start in a general medicine ward where most of the patients were elderly, bedridden, and had chronic illnesses with no cure. It wasn’t the most exciting department, especially for a nurse with my impressive credentials, she said, but she wanted me to share with those nurses the benefit of my university education and thereby raise the standards of the nursing care. She walked me over to the patient wards, which were actually rows of Quonset huts, long, narrow buildings that had been built, makeshift, in the 1940s. They were made of corrugated steel and were so rundown it looked like they should be condemned. But as shabby and ramshackle as they were on the outside, they were gleaming and modern on the inside, replete with the unmistakable smells of disinfectant, rubbing alcohol, fresh laundry, and urine underlying it all.

  Shoshana introduced me to Yaffa, the head nurse, who had a roly-poly body, solid as a truck, encased in a crisp white uniform. Sticking straight up on her head was a white winged cap, its corner points sharp as daggers. “Teelda? What kind of name is zat?” Yaffa made my name sound too much like the word gleeda, which was Hebrew for ice cream. She looked me over. “Where’s your kep?”

  “I don’t have one,” I answered with a superior smile. Obviously, Yaffa was not aware of the great strides being made in our profession. The nurses’ cap was an outdated symbol of a long-gone time when nurses were passive, subordinate, and merely doctors’ assistants. “Nurses don’t wear caps any more. They’re old-fashioned.”

  “You’re not a nurse without zee kep. Wear it tomorrow if you want to work here.”

  Well, we’ll see about that, I thought.

  “Vhat? Again vit no kep?” Yaffa said as soon as she saw me the next morning. (She insisted on speaking to me in English, even though my broken Hebrew was better than her broken English.)

  “Affirmative,” I replied in an English I knew she wouldn’t be able to grasp, “I refuse to don the aforementioned distasteful article of obsolete headgear.”

  “You are forbidden to take care of patients without zee kep.” Yaffa folded her arms across her chest. I stood equally firm. She handed me a mop and a pail. “Here,” she said. “Do sponja.”

  I lasted two weeks, hating every minute of it. Every morning I did the sponja. It involved filling a bucket with warm soapy water, dumping it out all over the floor, and then sweeping the water outside into the cow pasture behind the hut. Afterwards, I folded laundry and gave out lunch trays to the patients. The other nurses under Yaffa’s regime tiptoed around her. She scolded them if they so much as made a sound during the doctors’ rounds. It was demoralizing. This wasn’t nursing! Luckily, Shoshana Zamir came for a visit and saw how miserable I was. I guess she didn’
t want to lose me, as she offered me a position in a new unit to be added onto the back of Barrack Thirty-six, to be called Thirty-six Alef, which tacked on the first letter of the Hebrew alphabet.

  “It will be a bone marrow transplant unit. You will start working in the hematology clinic and when the transplant unit is opened, you’ll work there. They’ve pioneered this procedure in Seattle, San Francisco, and Jerusalem, and now we’ll be on the map, too. How does that sound?” Hematology was blood diseases and that meant mostly cancers, like leukemia and lymphoma. It was an honour to be chosen for the challenge; Shoshana must have seen potential in me.

  After I’d been in Israel a few weeks, I called home. My mother was the same: angry, confused, and inaudible. Pearl seemed to be managing just fine. Once again, I thanked her for making it possible for me to have my freedom. I had even made progress toward my other goal – to let loose and have fun. I had begun to make friends with the other nurses and doctors. On days off they took me to interesting places, like caves with stalagmites and stalactites, a Tel Aviv discotheque, a place on the West Bank called “Little Switzerland” because of its lush valleys and hills, and of course “up” to Jerusalem, the city holy to so many. The language actually dictated that one “ascended to Jerusalem,” and I understood that the grammar referred not only to the elevation above sea level, but to the spiritual high possible there.

  Even with the tensions and ever-present threat of war, it was easy to find fun in Israel. Sometimes, even my bus ride home after work provided unexpected delights. One night after finishing a shift well after midnight, the driver serenaded the passengers with folk songs as he detoured off the main road to take me right to my apartment door to ensure I got home safely. On another chilly and rainy night, I sat at the back of the bus. “Do you want to get warm?” a handsome soldier asked and opened his jacket for me to snuggle up close. We stayed on long past our stops, quietly making out in the shadows.

  It didn’t take long before I was conversing in basic Hebrew. I had never learned it as a colloquial language, only as it was written in prayer books. The modern vernacular was vibrant, colourful, and at times, unavoidably blunt. It simply did not allow one to sit on the fence, beat around the bush, or act false. In Hebrew, I spoke louder and more boldly and found myself saying things I would never have dared say in English. Perhaps it was also because in Israel, I had a fresh start. People only knew me as I was then, in front of them, during that blossoming time of my life. And when I spoke to men in Hebrew, I felt beautiful and alive. It was as if sexual innuendo was built right into the grammar. The different forms of address identified the speaker and the one spoken to as male or female. It was a turn-on when a man recognized my femininity by the suffixes he used. When I spoke, I identified myself as a woman and him as a man. I’m not sure this titillating frisson was what ancient biblical linguists intended, but that was how I experienced it.

  The hematology outpatient clinic was a casual, informal place, despite the seriousness of the patients’ illnesses. The doctors and nurses all wore loose green scrubs and sandals, and everyone called each other by their first names. Every patient had to have blood tests before seeing the doctor. Aviva Shofet was one of the senior nurses in the clinic and she taught me how to draw blood and start IVS and soon I got pretty good at it. It was a thrill to see the tiny speck of blood, called the “flashback,” in the plastic sheath of the angiocath. It was the surest sign I was in the vein. I discovered that the best way to locate a “difficult vein” was by touch and sometimes I even closed my eyes to feel for it. I learned the secret, idiosyncratic places in patients’ arms and hands where the best veins were hidden. First I got to know a patient’s veins, and then I got to know the patient.

  One day an entire platoon of new soldiers came to the clinic. They weren’t sick, but they needed routine blood tests before Basic Training. That day I palpated hundreds of “antecubital spaces” – the soft place inside the bend in the arm – where easy, obvious veins are often found. One soldier boasted how tough he was, that he had seen it all, but he cringed when I drew his blood and looked like he was about to faint. He could take everything, he claimed – except the sight of blood.

  Aviva drew my attention to a number circled on one soldier’s chart. It was his medical profile, she explained, but even the most virile, healthy-looking male specimens could only achieve a ninety-seven out of one hundred. “They can never get one hundred. Do you know why?” she asked with a grin, knowing that I did not. “They’re all circumcised, which is a surgical procedure, so they get three points knocked off the top – so to speak – right away.”

  Children, even infants, were brought to that clinic, and Aviva explained that if they were upset and crying, it was actually the best time to swiftly slip in a needle because their veins bulged out and were easier to visualize. So, when tiny baby Adi, who was just six months old, was brought in to the clinic screaming in her mother’s arms, I gritted my teeth, steeled myself, and nailed that vein, as slender as a single silken thread. Aviva nodded her approval. Here I am, taking care of kids with cancer, I praised myself. See, my mind can trump my emotions when necessary.

  After they had their blood drawn, the patients waited to see the doctor, who would examine them and review the results of those tests. Meanwhile, the nurses began the treatments that usually involved chemotherapy, antibiotics, and/or blood transfusions. An astonishing array of patients came to us in that tiny clinic.

  A Bedouin shepherd arrived for his chemotherapy, directly from tending his sheep. He had dark skin and a bushy white moustache that curled up at the ends. He wore the traditional keffiyah wrapped around his head and rested his walking stick made from the branch of an olive tree against the wall. As he sat down, ancient dust and biblical sand billowed up from the folds of his caftan. When I looked out the window, I identified his “vehicle”: tied to a post in the parking lot was a donkey swishing its tail.

  A cultured Romanian woman was nervous. Her veins were deep in her fleshy arms, but I managed to find a tiny blue one, hidden on the inner aspect of her pale forearm. When she smiled weakly in thanks to me, I noticed her bleeding gums and I knew I would likely be transfusing her with platelets later that day.

  Twenty-one-year-old Talia had completed her army service and had just been accepted to law school, but on a hiking trip in the Galilee with friends, after climbing Mount Gilboa, she had noticed bruises along her arms and legs. She was diagnosed with a rare disease called aplastic anemia, a complete malfunction of the bone marrow and only a transplant could save her life. Luckily, her sister was a close and willing match.

  Amos was a brilliant scientist, specializing in cellular biology, who was diagnosed with leukemia. I asked him what it was like to know so much about his disease, right down to the molecular level. “I wish I didn’t know,” he said bitterly. “I can’t enjoy the luxury of denial.”

  Dr. Yosef Ben Cassis, the Chief of Hematology, grabbed his shoulders and shook him lightly. “But, Amos, you have the best diagnosis,” he said. “You of all people should realize that! Your type of leukemia has the best survival rate. Don’t you realize how lucky you are?”

  No, he didn’t. Apparently, he didn’t want any kind of leukemia.

  Samuel Abulafia always came with his wife who fussed over him. He was a well-dressed, elegant gentleman who whistled to the little sparrows outside the clinic. He had pet names for them such as “Tzippy,” “Pastilla,” or “Yona,” and they would alight upon his shoulder, come right into the clinic with him, and keep him company during his chemotherapy.

  There was Yeshai, a young rabbinical student, dressed in a long black coat and black hat. He was pale, not just from leukemia, but from living a life indoors, immersed in the study of the Torah and its commentaries, the Talmud. His strict religious observance prohibited a woman’s touch, except in cases of “life endangerment.” So, when I held his arm to take blood from him, I teased him by reminding him it was for medical reasons only, but I couldn’t coax a
smile out of him. One day, as he lay on a stretcher receiving his chemo, I asked him about the tract he was studying. It concerned the question of whether or not it was permissible to eat an egg laid on the Sabbath.

  “But the chicken did the work,” I said, getting involved in a discussion I knew nothing about.

  “Are Jewish chickens supposed to observe the Sabbath, too?” the patient lying in the bed next to Yeshai joined in. He was a secular Jew, a farmer from a kibbutz.

  “It is forbidden,” Yeshai began weakly. His chemo was finished and I opened up his saline line to give him more fluids. He was shivering and I covered him with a wool blanket. “It is forbidden to partake of products created on the Sabbath. The chicken has broken the sanctity of the Sabbath and thus the egg it produced is rendered unkosher.”

  “We must train our Jewish chickens better,” the farmer said, bemused.

  Yuri was an eighteen-year-old new immigrant who had had to defer his army duty because of his illness. He was worried about the stigma of not serving in the army, but I heard Dr. Ben Cassis say privately that he would probably not survive long enough to experience that stigma and would have to endure only the stigma of cancer. His parents tiptoed around him, speaking in Russian. Yuri translated for them and had his own questions, too, such as, “What does ‘white blood cell’ mean?” or “When will be my last day?” He was alarmed to overhear Dr. Ben Cassis say he had “no cells.” He came over to where I stood in the blood-drawing alcove. “What that means, no cells?” I explained that the chemotherapy had wiped out all his cells, good and bad, to the lowest possible level, called the nadir. This had made him very vulnerable to infection, I said, but soon his bone marrow would begin to produce healthy cells that would protect him.

  Later, Aviva reprimanded me. “Don’t talk to patients so much, Tilda. Leave that to the doctor.” But Hannah, who was the head nurse of the clinic, didn’t mind what I did and she preferred to offer patients warmth and affection rather than factual information. She was a petite, lively woman with a mane of wild dark blond hair and lots of jangling jewellery and silver rings on her fingers. Hannah ran the clinic like the hostess of a cocktail lounge, moving amongst the patients, chatting and laughing with families, offering advice, tea and coffee, and ensuring everyone was comfy. She made her rounds to each patient receiving chemo or a transfusion, offered blankets (it was blazing hot, but after chemo, most patients felt chilled), painkillers, or a clean vomit basin, and always a kind, encouraging word.