Opening My Heart (31 page)

“They’re busy doing nothing,” I’ve heard visitors complain when they see nurses sitting around the nursing station, joking around or in high spirits. I see how it seems that way, but if only they knew how necessary it is for nurses to regroup, think, study, collaborate, socialize, and commune with one another. These things usually take place in off-hours or stolen moments in equipment rooms, hallways, or waiting for elevators. However, the need to debrief and de-stress can be every bit as urgent for nurses as it is for combat soldiers, firefighters, and police officers.

How can nurses offer comfort when they don’t feel it themselves? We go to great lengths to keep our feelings hidden from patients, to not let on if we’re worried, scared, or quietly freaking out. Then, afterward, we escape – usually off-stage – and let loose. We all know stories of nurses who “lost it” on the job or later, after-hours. Most hospitals make psychological counselling available to employees dealing with job-related – or otherwise – stress.

Sometimes pent-up emotions get the better of us and we need a reminder to rein it in. In fact, we have a discreet sign, a plastic flower that we hang outside a patient’s door at times when there is a particularly sensitive situation, like a crisis or a grieving family. It’s a visual alert to everyone to show more decorum.

At night, we tend to loosen even more. Laura always used to say she behaved better on days, only swearing on nights. One thing is for sure. Whatever petty conflicts or grievances we have on days, we usually manage to put them aside on nights. We try to come
together and help each other. Night shift is hard and it never feels normal or natural to work all night, but what’s the answer? Nursing presents unique challenges to staying healthy.

But some of our harmless shenanigans don’t help our image. Once, I was sitting in the staff lounge with colleagues, eating cake someone had brought in celebration of something or other. Suddenly, we noticed family members peeking in at us through the window in the door. Nurses aren’t supposed to be enjoying themselves. “Nurses just want to have fun!” was our anthem, but “Let them eat cake!” the onlookers must have thought.

In another cake-related debacle, we were gathered and just about to partake of a birthday cake in the “fishbowl” behind the nursing station. Stephanie went off to the pantry in search of a knife, but all she could find was a rather large cleaver, more suited to pumpkin-carving. On her way back, still holding it, she heard an alarm going off in a patient’s room. Seeing that the patient’s nurse was busy with another patient, Stephanie stopped to remedy the problem. “I hope you’re not going to use that on me,” the patient said in terror at seeing a knife-wielding nurse at his bedside!

In another weapon-related incident, none of us will forget the stir Nurse Gina created the day she called over the loudspeaker, “Who has the gun? Whoever has the gun, please bring it to the nursing station immediately!” She was referring to an instrument used to staple chest tubes to the suction apparatus, which we called the “gun.” You can see how that could create alarm, but it was also pretty funny, too.

FYI
to the public at large: if your nurses are noisy or having too much fun and it bothers you, speak up and say so. Know that all you have to do is say, “Please help” or “I need you” and we’ll drop our forks, knives, or “weapons” to come to your aid.

–

It’s 2130 hours. A nurse is writing in a chart, the telephone cradled next to her ear, reading a bedtime story to her child over the phone. “I’ll be there in the morning, sweetie, before Daddy takes you to day care,” she says before hanging up.

Another nurse sits beside her, text-messaging her boyfriend.

Beside a bank of cardiac monitors a telemetry nurse oversees thirty-six patients’ heart rhythms. An alarm goes off, she looks up, studies the screen for a moment before deeming it a “normal abnormality” (there are such things), and silences the alarm.

I listen to a nurse on the phone speaking to a family member. “I’m just calling to put your mind at ease,” she is saying. “I knew you would sleep better if you talked with me before you go to bed. Feel free to call whenever you like and I’ll let you know how he’s doing. It’s our job to worry, not yours.”

You have to be extra cautious on the phone. Once, I gave information to a patient’s husband and later learned the couple was separated. He was only calling to make sure she was still alive so he could continue to collect her pension cheques. Another time, while talking on the phone to one patient’s daughter, all of a sudden I clued into the fact that the background echo I was hearing meant I was on a speaker phone. I had just broadcasted personal information about my patient to unknown people who were also present in the room. Privacy is not only getting tricky to define, it’s getting harder and harder to guarantee.

The night is moving along. I hum a few bars from “Strangers in the Night” –
shooby-dooby-doo
– an old Frank Sinatra song. These pain meds are great! Feelin’ groovy!
Whoa-oa-oa! I feel good, I knew that I would, now … sugar and spice …
Thank you, James Brown! Here in the cardiac ward, most of us are getting better – like me: I’m going home tomorrow.

It seems like the nurses are running the show around here.
Haven’t seen any doctors tonight, but there must be at least two because I heard one nurse ask another which doctor wrote an order for her patient because she needed to clarify something about it. She asked, “Was it the resident with the blue hair or the one with the purple tattoo?”

(I swear, I don’t make this stuff up.)

The din has died down. The hallway lights are lowered. Beddybye time for us patients, but the nurses’ night is just getting underway. Janet, of Bagel Club renown, pops in for a visit. “Just making my rounds, checking on my babies, and thought I’d see you, too, Tillie.” But the wave of heat in my room hits her too and we don’t stay in there for long.

“It’s freakin’ hot in here.” Janet fans herself with her clipboard of papers, notes on her patients. “Stick a fork in me – I’m done. Let’s get out of here.”

We walk to the visitors’ lounge and she slows down her brisk steps to match mine.

Janet gives me a once-over. “Jeepers, you’re looking a heck of a lot better,” she says. “You were in rough shape down in the
ICU
. Not a healthy-looking specimen at all.”

“Were you there?” I have no recollection of visitors.

“You don’t remember, do you? We were all there and saw you, stewed, blued, and tattooed. It figures you’d hemorrhage – nurses are always the ones to get complications.”

Satisfied with my progress, Janet turns to her
real
patients. “Did you hear that Code Blue yesterday? She was my patient. I’d been following her all day. Vital signs were normal and I didn’t have specific concerns – just a bad feeling. I talked to one of the vascular surgeons about her, a guy who was an intern on a floor I worked on many moons ago. Back then, he wouldn’t even talk to me, but now that I’m an
ICU
nurse, he does – go figure. He’s one of those jerks
who’s always complaining about nurses, how useless and incompetent they are or how many times he got woken up at night, etcetera, etcetera. ‘Go easy on them,’ I told him. They’re young and have no one else to call. Anyhoo, I told him I was worried about this patient. He said, ‘What’s the problem? She’s doing fine,’ but I had a bad feeling about her. Sure enough …”

“What made you think something was wrong?” Janet’s observations are never vague or ambiguous, but her ability to recognize subtle clues – some would call it intuition but it’s much more than that – is unerring, absolutely
bankable
. This quality is priceless in a nurse.

“I couldn’t put my finger on it, but she did not look right. No sir-ee, Bob! The operation went well. Her numbers were hunky-dory. On paper, she was a rose, but in person, not so much. I gave her
IV
fluids and took some blood work, but then I had to check out the lay of the land in the rest of the hospital. Meanwhile, other fish were being fried and I didn’t get back to her until five in the afternoon when she was right on the edge.”

“So what did you do?”

“I always ask myself, How can I fix or improve the situation? I have to do something and I’d rather do it before a patient arrests. She was chugging along at over forty resps per minute, her heart rate was one hundred and thirty. I drew an arterial blood sample and it was absolute garbage – dark cherry red. The respiratory therapist put her on 100 per cent oxygen. She was pre-arrest and I needed help, so I called a Code Blue. I wished I could have prevented it, but in this case, I couldn’t.”

“How is she now?”

“I just visited her in the
ICU
. She’s hanging in there. The family was grateful I made things move along faster. ‘You told us to trust you and we did. We took you at your word. You were the only one who saw there was something going wrong.’ They appreciated that
I hadn’t walked away. On the floor, some nurses are reluctant to engage. We’re not used to that in the
ICU
. If we see a problem, we have to do
something
. We don’t walk away. ‘You saved her life,’ the family said. Isn’t it the best feeling in the world?”

We sit on the couch for a while, thinking about this, the best feeling in the world, until it’s time for Janet to walk me back to my room and for her to get back to work.

A man in a dark green uniform carrying a toolbox arrives at my door. He’s here to fix the heater in my room. We chat briefly and I hear his Farsi accent. “What did you do back in Iran?”

“Mechanical engineer,” he said with a wry grin. “No work here.”

It’s a reminder of other people’s concerns and the world outside of the hospital – something I’d completely forgotten about – and countries where many people have a lot more to worry about than the temperature of their rooms. Sheepishly, I thank him for fixing my problem.

A pizza delivery guy has arrived. The nurses have ordered in food. Believe me, you don’t want a hungry nurse! There’s a nurse I know who brings a bag of celery for lunch and drinks coffee all day. How much energy does that provide? Would you want her caring for you? On the other hand, one hungry nurse went down to the food court late at night, just before it closed, to buy a Subway sandwich. She returned in a state of shock, visibly shaken.

“What happened?” we gasped when we saw her, rushing over to her with a chair.

“I was buying a sub and suddenly I hear weird sounds from the back of the dining area, you know, where the Coke machine is? I went over to check it out and there was this guy moaning, his pants down around his ankles, jerking himself off. Where’s a security guard when you need one?”

She was still carrying the plastic bag with her submarine sandwich, so I couldn’t resist:

“Was it a six inch or a twelve?”

How we howled with laughter!

Yes, such juvenile jokes and sophomoric pranks help to get us through the night. Call it nurse bonding. Sometimes our work makes us as needy as our patients. There’s the heavy-duty labour that results in neck, back, and muscle injuries – as much as construction workers – and the hazards of night shift. Sometimes even more draining is the emotional labour. All in all, it’s a risky career we’ve chosen and hospitals aren’t usually very healthy environments for nurses. We have to work extra hard to stay healthy, but I know many who don’t.

“We’re parents, nurturers, caregivers,” Janet was saying one evening in the staff room. “Between home and work, we’re holding down two jobs and not taking care of ourselves because we’re too busy taking care of everyone else, patients, their families, and our own families, too.”

She would know, I thought, because she does all of those things.

“Yeah, tell me about it, girlfriend,” chimed in Nina. “They say, ‘God can’t be everywhere, so he created mothers.’ I say mothers can’t be everyone so that’s why there are nurses. We give, give, give, but it’s never enough.”

Nina would know, too, because she was none of those things. She was one of those nurses who always feels hard done by. We all have moments like that, but she never seemed to rise above it as most of us do. That night Nina was particularly bitter in the wake of a heated encounter with her patient’s wife.

“Her husband isn’t getting better, so what does she do? Blame the nurse! I feel burned. I gave so much and next thing I know, she reports to our manager, saying that I had crossed the line, that I was
‘unprofessional,’ too emotional. I swear I’ll never get involved with families again.”

Ah, being professional – contained, businesslike, definite of your boundaries. If only expertise, skill, and knowledge were all that was required, it would still be a tall order. On top of that we’re also supposed to be mindreaders, purveyors of cheer, hope, comfort, kindness, and inspiration. Most of us start out idealistic and enthusiastic, trying hard to provide all these qualities to our patients, but many of us fall short at times along the way. There’s so much in a hospital that can break your spirit.

There’s one aspect about being “professional” that’s still a challenge for me. It’s the distance you’re expected to keep, that stance of formality that is required. I’ve always treasured the more human moments when I’ve ditched the “professional stance” and allowed myself to be real, when I’ve chatted one on one with patients and their families, joked around, shared a laugh or something of myself. Boundaries can be hard to establish because of the intimate, familiar quality of nurses’ interactions with patients. For example, at the end of that unintended group conversation with the roomful of people on the speaker phone, just before hanging up, the daughter said, “Give Dad a kiss from all of us.” Would they say that to any other “professional”? I admire nurses who use their individual flair, personality, and humour in their interactions with patients. They put their very selves into their toolbox. I love what my friend Rosemary once said, “When I go into my patient’s room, they get
me
. I’m the treatment.”

It’s good to be real and human, but in balance. Some people can’t see beyond initial impressions. We don’t always do a great job of managing our image. I learned this lesson long ago, on one of my first shifts as a new graduate. I was working with Hannah, an excellent nurse whom I looked up to as a role model. At one point, she
checked her watch and said, “C’mon, let’s go. It’s time to flip the steaks.” I was offended by her crude, off-the-cuff words, so callous and at odds with her otherwise professional demeanour, but then I figured, so what? Did it matter if Hannah was a bit rough around the edges? She was kind to patients and clearly knew the importance of repositioning immobilized patients to reduce the incidence of pressure sores. Who cared if she talked like this, nurse to nurse? It didn’t change my opinion of her and I’ve long since learned to see beyond the brash talk or seemingly “unprofessional” behaviour of some wonderful nurses.