Foreword
We all get sick at times, and one day we will need the support of health care professionals to look after our dignity. As we are truly feeling in the midst of this global epidemic. In a time of fear, hatred, and division, author Christy Watson’s skillful writing chronicles the touching experience of nursing, taking us into the often-underestimated world of health care in the health care system. 20 years as a nurse, Christy began her career as an intern and gradually spread her nursing footprint across hospital units, caring for babies from birth to the elderly in their twilight years.
My only experience delivering a baby in obstetrics
“Childbirth is a natural process, not a disease.” Frances, the midwife I had been shadowing, told me. I was studying mental health nursing at the time, and although I didn’t have to be exposed to obstetrics, my first-year group practice was assigned to the obstetrics unit, so I jumped at the opportunity.
Frances’ voice was light and quick, the same way she moved around the room. As she walked around, she tidied up the room, putting blood- and other fluid-stained sanitary pads in a simple yellow trash can, washing her hands, and then making the bed.
She showed me around. We walk past the antenatal ward: “This is where women are cared for who are 20 weeks or more pregnant and feeling unwell.” Daily assessment specialist: “Checking for problems related to the pregnancy period. We can use ultrasound, blood and so on and so forth.”
Then we pass a room where a woman is using a fetal heart monitor to measure her baby’s heartbeat and the frequency of her uterine contractions, fears of stillbirth hanging in the balance. We passed some women suffering from severe pregnancy sickness – severe morning sickness – who were in desperate need of fluid replacement after vomiting day and night. There were also several women suffering from gestational diabetes who might deliver huge babies. A few other women who showed up had no physical problems, but were often in extreme pain because they had already lost one (or more) babies before and were extraordinarily fearful of repeating the experience.
We passed through the induction room and made our way to the delivery room. There, I saw a huge whiteboard listing the woman’s name: room number, gestation, number of babies, summary of condition, progress, pain status and the name of the corresponding midwife. To my right was a room with a pool, followed by seven labor rooms, and at the far end was the multiple birth room.
The maternity ward was stuffy and humid. Frances looked relaxed in her dark blue smock and wooden-soled shoes, even if she was walking fast. She had used an iron to make the collar of her short-sleeved blouse stand up, her face was always properly made up, and her hair was untouched. I, on the other hand, just followed Frances around the place and was already sweating profusely, my hair was out of shape, and I could feel the makeup I had hastily applied to my face slowly falling off.
We were ready to see Scarlett, a young woman in the early stages of labor.
“Young mother,” Frances said, “first baby. There’s no telling what it will be like. Some women look fragile and weak, but give birth as cleanly as peas. Others are rock-solid on the surface and end up having to use assisted means – drugs, epidurals, surgical forceps, C-sections. There’s no telling what’s going on.”
Scarlett sat up as we walked to the door. I paced in the doorway.
“Come on in.” Frances waved her hand, gesturing for me to come in, “This is Christy, she’s a student, she’s shadowing me in my internship today. If it’s okay with you, she’ll come over and check it out?”
Scarlett nodded. “I don’t care if I bring a bunch of people,” she said, “I just want to hurry up and finish the birth now.” She laughed out loud after that.
She was wearing a bra that had once been white and was now a little gray from the wash. There is a tattoo on her arm, “Rocket. Is this Rocket the baby’s father? Her breasts are large and covered with blue-green veins. The belly is big and shiny and looks incredible. She looks very young, too young to have children.
Scarlett was a single mother – “He’s gone, but thank God for this little favor” – and her mother was with her, clutching her hands. Scarlett smiled and looked over at me: “Seriously, I don’t care at all. I just want to get this little thing out of my body.” She had red hair and freckles on her face.
“Her skin is so thin, it tears easily.” Frances says to me a little later, “She’s going to get stretch marks at such a young age, but the muscles will recover quickly.”
The room is bathed in sunlight and hot, but no windows can be opened. Despite the fan, Scarlett’s face is sweating. Mom took a gray towel and gently wiped her forehead. “That’s better, it’s cooler. I still have glucose tablets for you to take, Scarlett. It’s all ready to go.”
Scarlett’s mom was wearing a T-shirt with “Mexico” on the chest and a picture of a palm tree on it. She noticed me staring at it. “We went four years ago. It couldn’t have been a better vacation. The food was great! I ate so many creamy tacos I was afraid I was going to turn into a taco.”
Scarlett rolled her eyes, then pushed the towel away. “I’m going to throw up.” She said.
Frances pushed me away and promptly shoved a small sick bowl made of cardboard under Scarlett’s chin. “Don’t worry, it happens all the time. You’ll be fine when the baby is born.” As a precaution, she kept the sick bowl by her side, which I hadn’t noticed earlier.
When the midwife told Scarlett it was time to see what was going on and asked her to spread her legs, I almost fell over. Botticelli’s Birth of Venus, completed in the 1580s, depicts the scene in which the goddess Venus is born from a seaside shell, using the shell – used since the classical period – to symbolize the female vulva. I love that painting.
Scarlett’s vulva is nothing like a seashell.
The shock of seeing the swollen, torn skin, of seeing it stretched to the point where it was as transparent as a balloon about to pop, took me back to my childhood bedroom where I was once again that skinny little girl with the shell over my ear. I could almost feel its cold touch. I recalled my dad’s words, “If you try hard enough to hear, you can’t hear anything, but at the same time you can hear everything.” But all I heard was screaming.
It was the first time I had ever witnessed a baby being born. Scarlett had just started pushing hard and I was caught up in shock, crying nonstop, thinking something must be wrong. I had been forewarned that the umbilical cord was blue and that the baby’s head would be shaped like an ice cream cone, but the intense pushing during birth still freaked me out.
I was a complete rookie nurse when I first arrived. Although I had already studied the theory, I hadn’t experienced anything outside of the textbook. But in this room, watching Scarlett struggle for her life while her baby was crawling toward that edge, I felt like I knew literally nothing.
I cried and cried all the time. Frances glanced at me with a frown, but I couldn’t stop. After a long time of screaming, Scarlett became very quiet. Then she began to moan in a low voice that didn’t sound like a human voice. I counted the beads of sweat that covered Scarlett’s freckled face and tried not to think about her skin. Tight skin. Tearing.
“I want an epidural.” She screamed, “I can’t take it anymore, I can’t make it.”
Frances was calm. “Let’s wait for one more contraction and then I’ll give you the anesthesia, okay?”
The moan became louder, more and more distant and foreign compared to Scarlett’s normal voice, as if it came from somewhere else. It sounded like a sound from the earth, from an ancient time and a distant place. Scarlett pushed hard, gasped, and twisted her body on the bed as if it were on fire. This was clearly not normal. Meanwhile, Frances had poked half her hand inside her, the glove covered in mucus, and she could almost see Scarlett’s stomach.
“I’m dying.” Scarlett cried out.
Scarlett’s mother cried, too, and couldn’t stop crying until the tears soaked through her clothes, making the color of the letter “M” in “Mexico” different from the other letters.
Frances pulled out her hand, reached under the bed and opened a white sterile package. Her voice hardened. “You’re not going to die. You have to keep squeezing harder. You can do it. Good, you’re doing good now.”
Scarlett stopped screaming, and her body stopped writhing.
The baby’s head is exposed with the amniotic membrane – like some kind of paper bag – wrapped around the fetus, which usually stays inside the mother. Frances unwrapped it from the baby’s head as easily as removing a hat.
“Good. Good girl. I think you need to catch your breath now and then squeeze gently and hard when I tell you to.”
The baby’s head was out, and then the rest of the body came out along with a wave of blood, feces and slimy white substance. There was slimy liquid everywhere, and the walls of the ward seemed to tremble with Scarlett’s screams. Frances wiped the baby’s back like she was drying her hair with a towel, then placed her on Scarlett’s chest.
“It’s a girl.” She said.
Scarlett sobbed. “A girl.” Her body trembled and shook violently, “A girl!”
“Don’t worry about that.” Frances pointed to the fetal membranes, “Some say it’s a sign that the child is destined for success.” She expressed surprise, as if this was the first time she had ever encountered it.
I stared at Scarlett’s face as she gazed at the new baby and her mother. The flow of eyes between them made me cry harder. Scarlett’s daughter’s cry was the most beautiful sound I had ever heard, like strange and beautiful music.
Frances had work to do. After removing the placenta and cutting the umbilical cord, she pulled out a set of sutures and prepared to repair Scarlett’s weak skin. “Severe tears can even cause incontinence in women, and the condition is more common than one might think.” A study in the British Journal of Gynaecology showed that 85 percent of women had experienced skin tears of varying degrees during the birth of their first child.
Fortunately, Scarlett did not suffer a “severe” tear: obstetricians refer to this severe trauma as “obstetric anal sphincter injury” (because the laceration of the entire tissue extends to the anus, causing muscle and nerve damage). She did not need to go into the operating room to repair the injury. Although she also had a minor laceration, it was only a “grade 2,” which meant that Frances could stitch it back up herself. But before doing so, Frances knelt beside Scarlett for a moment, admiring the child. “She’s perfect.” She said. She touched the child’s little cheek, then reached back and touched Scarlett’s cheek. “You’re lucky, and so is the baby. Good job, Mom.”
I had to leave the room. I leaned against the wall outside, surrounded by red fire extinguishers and cork display boards covered with baby pictures, and I broke down.
Childbirth is a bloody business. My head felt light and my eyes were dizzy. But it wasn’t the gore of the birth scene that made me dizzy. The air was different, and so was the world. The collar of my practical nurse’s uniform was soaked with tears, but I couldn’t stop them from falling. I was in utter amazement at women, midwives and humanity.
Later, in the dirty utility room, Frances taught me how to examine the placenta. She placed it in a plastic tray. The placenta was larger than I had expected. “If you can see clear bubbles from the outside,” she said, “that could be a sign of gestational diabetes or congenital heart disease.” She said as she examined the placenta in her hand. It looks like the animal liver you’d see in just about any butcher store, but a little lighter: a dark purple, pinot noir grape color. “Around the umbilical cord is Wharton’s gum – there’s this stuff in the eyeball, too.”
I look at this gelatinous substance and try not to spit it out. “It looks a little like the filling of a pork pie.” I said.
“Indeed.” She responded, not laughing.
“It’s so animalistic,” I said to Frances, “she moans like an animal. I don’t know how to describe it, but the sound was unreal, like a cow!”
Frances glanced at me, then returned to gazing at the placenta. “That’s normal.”
Human birth is very different from births of other species. Numerous studies have shown that a complex biochemical dialogue occurs between the mother, the fetus, and the placenta. The human placenta lacks the enzyme CYP17, which acts as a stimulus during animal births. Human birth is more of a language – a dialogue between mother and fetus, and it is the placenta that acts as a translator, such as this one that Frances holds on her chest – the secret language of women.
“Childbirth is the most natural and human thing.” She says, “There’s nothing more human than it.”
She always manages to explain things in a way that makes sense, yet still leaves me confused on some level. “Birth and death go hand in hand,” she told me, “and in the same moment we are born and come to an end.”
In 1998, I finally became a fully qualified nurse. Unable to cope with the grief and depression involved, I decided to stop doing mental health nursing and change my specialty to pediatric nursing.
I moved to an apartment in South East London with 3 of my best friends, all of whom were apprentice midwives. I reminisced and told them about my one and only experience of delivering a baby: “Scarlett was brave and young. It’s not unusual, but it’s not unusual at all!” My friends greeted each other with smiles in their eyes. It takes 40 births to become a midwife, and they were already halfway through.
The determined hands of a surgical assistant nurse
The scene in the operating room must have been terrifying for the patients, but I’m used to it. It’s actually kind of amazing to get used to this kind of thing, because life isn’t always like this.
The first surgery I ever saw in person was a heart-lung transplant. I was 19 years old and a trainee nurse at the time. The surgery was extraordinarily long, over 12 hours. It required the medical staff involved in the surgery to behave like a relay team, except instead of a baton in their hands, they were passing the human heart and lungs.
I have been caring for a patient waiting for a new set of lungs: a 14-year-old boy named Aaron with cystic fibrosis (a common genetic disorder. This condition affects the entire body, leading to progressive mobility difficulties and early death. The most common symptom is difficulty breathing due to chronic and recurrent lung infections.) He was confined to bed with an oxygen tube in his nose, coughing tiredly and weakly all day, and his skin ashen. I helped him prep for surgery, put cocoa butter on his dry knees, took away his game console and vowed to protect it with my life. I moistened his lips with a salmon pink, sterile water-soaked sponge, not wanting to risk exposing him to any germs at all.
We chatted and acted as if nothing had happened. But when the porter came in to help me take him to the operating room, he clung to his mom. “Don’t leave until I’m asleep.” He said, then looked at me, “Will you always be over there?”
“I will. Are you ready?”
He shook his head that he wasn’t yet. But I nodded at the porters anyway, and they wheeled his bed out of the ward and down the hallway. One of the porters was a perky little girl who kept whistling. His mother held his hand and followed the bed at a fast pace. I kept my eyes on the display at the end of the bed with Aaron’s blood oxygen level on it. I wouldn’t let it drop.
The operating room is a maze of corridors and trundle beds, covered in sterile blue coverings everywhere, holding defibrillator pieces and difficult-to-tackle airway components. The OR nurses are quick on their feet, their wooden-soled shoes creaking down the hallway, their half-tied, half-open surgical gowns fluttering behind them like wizards.
Most people don’t make memories of the operating room. We go to sleep and then wake up, unable to take into account what happened in between. The operating room is a place where “life and death are in the hands of others. Most of the time everything is safe, but when things go wrong, it can be a disaster. When a patient’s condition suddenly deteriorates, what was once an orderly, quiet, and spotless environment can become a battlefield.
I tried not to think about what was going to happen in the operating room and all the mistakes that could be made and had been made. I assume a “calm on the outside, panic on the inside” posture until we arrive at the anesthesia room with its reassuring equipment and a very relaxed, smiling anesthesiologist.
“Hello, ma’am. Hello, Aaron.” The anesthesiologist introduced herself and then locked eyes with Arlen as the surgical assistant stayed busy near by, preparing monitors and labeled syringes.
I stood at the head of the bed, close enough to Arlen’s mother to take her out when necessary – like after Arlen fell asleep under the anesthetic gas – and within seconds of reaching and pulling her out. We didn’t want her to see the next stage of the patient being anesthetized: eyes taped shut, head wrenched back as far as possible, a tube inserted into his trachea, needle stuck into a vein, and the rest of his clothes all removed. Then we would also apply a cloudy copper and Pitocin solution (for pre-op sterilization) to his skin until he looked less like a person and more like a piece of meat.
I walked Aaron’s mom outside the operating room for a while, hugged her, and searched my heart for something to say to comfort her.
“That was just the worst time in my life,” she said, “the worst.”
I vowed that I would never underestimate the hardship of entrusting my child’s life to strangers, no matter how professional those people are.
Leaving the immaculately white hallway, I walked Aaron’s mother back to the hospital room as she broke down in tears. I sat by her side for a while, saying nothing. Finally she looked at the clock.
“This surgery is going to take a long time,” I said, “all day, so you’re going to have to find something to do. I have to go back later, to Aaron’s side.”
“I’m going to my sister,” she said, “I have to find something to do.”
I gave her a small smile and didn’t say what she wanted to hear. I’d already had my lesson. Last week, one of the first babies in my care had to undergo a relatively simple surgery to repair his heart. “He’ll be fine.” I told his parents repeatedly. But he wasn’t fine. He didn’t make it out of the operating room and died on the table. I made a mess of things and his parents were extremely dismayed and close to going crazy.
“Get busy,” I said, “and the time will go by quickly.”
The large operating room was packed, but very quiet, and I stood on the observation table with a group of medical students and junior doctors. A packed large operating room is standard for an attention-grabbing or groundbreaking surgery, and it is common practice to teach during the procedure.
Aaron is in the center of the room, his body like a canoe. The surgeon’s hand is inside his body. What a strange privilege it is to put your hand inside someone’s body, to touch the heart with your fingers, to become briefly one with that person.
I thought as I watched the operation: how much surgeon and patient, like a mother and her unborn child, both share a shell for a time. The room smelled of chlorine, bleach and sweat, and a strange pungent metallic odor that could have been blood. The walls were clean, but I knew that once the extracorporeal circulation membrane oxygenator – the machine that drives a person’s entire body into circulation during certain procedures – cracked, the walls, the ceiling, and all the doctors and nurses and machines and equipment would be submerged in a sea of blood.
I shuddered and stared intently at a lock of Aaron’s hair. It reminded me that Aaron was not a corpse to be slaughtered, but a boy who loved astronomy and whose worn-out game console had been safely locked away from me.
One surgeon’s body lay completely on top of Aaron’s, with only his hands and arms still moving. The other four surgeons were around the operating table, facing him, one of them holding a suction catheter to suck the blood out of the doctor’s hand so that he could better observe. Another surgeon was simply in charge of holding a large lamp to illuminate the inside of Aaron’s body. There were lights everywhere, and even with only a thin gown on, it was still hot in the operating room. But there was never enough light, and I watched the entire surgical team-mostly gray-haired men, only a few women-imagine that they all began their careers by holding up the light: how they went from being responsible for holding up the light to drawing blood to making their hands the patient’s body. It must have been a lifetime of watching.
My nursing career
But I’m not here today to see the chief surgeon. Standing next to him is a broad woman with thinning hair peeking out from the front of her hat, her double-gloved hands in front of her, fingers stretched out in a starfish pattern, palms down. In front of her was a long table with various metal instruments, which reflected a diamond-like shine on the white ceiling.
Usually, the primary or secondary surgeon would say something without raising her eyes, and she would pick up an instrument – a scalpel, suture, forceps or arterial hemostat – and hand it to them, placing the handle end in their hands, just like handing scissors. Sometimes she handed the instruments over without waiting for the doctor to speak, in perfect silence.
She was the surgical assistant nurse, and when one instrument ran out, the surgical assistant nurse would turn to the nurse standing behind her and wink at her, and this one nurse would carry the tray with the instruments and place it on the table behind the operating table. Nothing in the room would be taken out and counted again and again. “Lest the surgeon accidentally leave a swab in some hole in the patient’s body, or a scalpel in the lung and gauze in the intestines.”
The next day, the surgical assistant nurse told me, in a serious voice: “We have worse cases of loss. Sometimes the surgery doesn’t go well and they throw my instruments away and then they can’t find them.” She looked at me, squeezed her eyes and gave a smile, “This job is really stressful.”
There was a sparkle in her eyes that was only visible when she was close. She had a hole in her nose from wearing a nose ring, and I later learned that she was obsessed with motorcycles, not at all what I thought a nurse would look like.
Today, OR nursing has evolved to require nurses to work across areas that include the surgical inpatient lounge, the main operating room, the recovery room and the day surgery room, but back then, surgical assistant nurses were expected to be surgical assistants throughout their careers. I knew I wasn’t very organized and couldn’t stand on my feet long enough to tolerate the temperature in the operating room. These were enough to make me realize that I was not cut out to be a surgical assistant nurse.
But during the hours of surgery, I often stared at the determined hands of the surgical assistant nurse: hands that were perfectly still, then suddenly had a purpose, moved with great force, and then were still again – moving in a completely different way than the wonderfully light hands of the doctor.
I watched the nurse’s eyes and imagined what she was looking at. Her eyes would occasionally fall on the procedure we were witnessing, then wander around the room, landing on the monitor behind the doctor, where I could see her eyes watching the vital sign readings; then she would look to the licensed medical technician (the blood gas analyzer specialist), who was wearing a large colorful tie-dyed handkerchief and sitting on a stool next to the cardioverter, scribbling frantically on a writing pad.
The diverter looked very sci-fi, full of all kinds of twisted tubes, like a complicated water slide in a water park. The nurse turned her head and glanced at the assistant surgical nurse standing in the doorway, then the organ donor coordinator nurse, who was holding the box containing another person’s heart and lungs. It was a plain white box with the words “human tissue” written on it.
The surgical assistant nurse’s eyes stared at the box for a long time, and then she looked up at the organ donor coordinator nurse, and they seemed to exchange glances and something I didn’t understand at the time. But I was grateful for the importance of what was before me, the whole room was littered with miracles: technology, surgical medicine, science and luck.
Organ donation coordinating nurses are the ones who stand in the middle of the courtroom of life and death. They have to talk to families about donating the organs of their recently deceased beloved loved ones so that others can live. That’s how Aaron survived. A few weeks after his surgery, Arun looked a different person. His skin was glowing, he no longer needed to breathe through an oxygen tube, and his heart-breaking cough had completely disappeared. His bedroom is now filled with books, games and cards.
I stood on the observation table that day until I couldn’t feel my toes, and the entire team – including the surgical assistant nurses – had changed shifts three times. I felt more exhausted than ever before, and I also felt more awake than I had ever felt before.
Nurses are good poker players
As a nurse, you have to get used to all kinds of flavors. But I couldn’t get used to the horrible smell of vomiting, diarrhea and bleeding adults most of the time. At the time, I was interning on the medical ward of another hospital, a place of long-term recovery where patients either get sicker and sicker or get worse and worse. Internal medicine care can be urgent or long-term, but it’s all in the details.
At the same time as my internship, I was preparing for my specialty certification exam.
The lines between nurses and junior doctors are increasingly blurred, and the senior nurse role is being influenced by a political agenda that is not necessarily concerned with treating patients properly, but more focused on cutting economic budgets. Jobs that previously required more qualified health care workers are now being given to more “affordable” nurses.
Nurses are administering drips, taking blood, analyzing blood results, even intubating and perfusing arteries, and, in some areas, appearing on doctors’ rotas. Nurses are taking on tasks such as diagnosing, treating, prescribing, and leading cardiac arrest team efforts, as well as teaching advanced life support classes and acting as assessment consultants, but they are still being paid only for their work as nurses.
Gladys lies on a bed in the medical unit and has to scream every few minutes. She had previously refused to use the potty and now began screaming, “I pooped, I pooped,” as health care assistants darted in, rolling up their sleeves as they ran.
“Can you help us?” Fatima asked me, pulling back the curtains at the same time.
Changing the beds: what a daunting task. The smell made me snotty.
In one case, I even had to leave the room midway and never forgot the horrible sight of a man throwing up his own feces due to a blockage in his intestines. On top of that, there were the colostomy bags that needed to be changed; the sticky green discharge that spewed from tracheostomy patients; the yellow penile discharge or gray vaginal discharge; the black feces from the rectum, which was the worst smelling thing ever because of the bleeding stomach. And all the work of cleaning, washing, changing clothes, cleaning body fluids, opening windows, spraying air freshener, all had to be left to the nurses or nursing assistants.
Even though I needed to touch and smell it all, there was one other person in this scenario who felt as tough as I did, and that was the patient in the middle of it, scared and embarrassed.
The nurses are excellent poker players and understand the importance of holding your breath. Hold your breath secretly so that the patient is unaware, so that the patient can’t see any expression except the face of routine. The hideousness of our bodies – our humanity, our flesh and blood – is something nurses need to take on so that patients don’t waffle; after all, the loss of dignity can make a person incredibly vulnerable.
“I’m pulling, I’m pulling.” Gladys was still chanting. She was clearly in great pain, her body curled and twisted constantly while continuing to spread dirt and odor. She was covered in poop.
I remember when I started nursing, I studied the Bristow stool classification chart, a set of charts that show the different types of stool and assess the severity of stool abnormalities. But charts, references and quantitative ratings don’t prepare you for real life. The stools that Gladys passes at one time cover all the types in the chart. They were lumpy, drippy, rough and uneven around the edges, oozing fluid from incontinence pads that stained her back and pillow. Her hair was stained with green spots and lumpy stools were everywhere. The only thing I could do was suppress dry heaves.
“Gladys, let’s help you.” Fatima held a basin of warm, soapy water and tested the temperature of the water with her elbow, like she was preparing a bath for a baby. Gladys watched, quieted, as if some memory had suddenly been triggered.
Like many people, Gladys has dementia. It is estimated that by 2021, the number of people with dementia in the UK will reach one million.
Gladys has been looking for her old friend, Dolphy. Her memory is trapped somewhere, in and out of life, in a confusing chronology. Fatima later tells us that Dovey now lives in Australia, where she and Gladys worked together in a school cafeteria 60 years ago. The sadder Gladys gets, the further back her memory goes. One can never really go back, but with dementia, you can easily go back and re-live the old days. It’s an odd comfort in this nightmarish experience.
“Is Dolphy here yet? We’re going to be late, what time is it?” I folded Gladys’ leg over her other leg, then placed my hands on her hips and shoulders and gently rolled her over in my direction. When a person’s muscles are not working due to illness, medication or attrition, the nurse must become the patient’s muscle.
Nurses all suffer from back pain. Back injuries and pain account for 40% of all illnesses in the NHS, with an extra £400 million spent on nurses’ sickness absence alone, a figure that would reach 1 billion if you include health care assistants. Lifting or moving patients often causes muscle and bone damage, and nursing can be described as heavy work.
When Gladys had a convulsion, I didn’t spill my hand, as we had asked to do during training. Her face was filled with shame and pain. Even though my back was hurting, I instantly decided to take the pain compared to the damage this poor old man would suffer if he fell into the feces again. Maybe one day I’ll be Gladys too, and so will you.
Gladys’ skin is fragile and I have to be careful not to break it. The smallest unhealed wound could become a bed sore, a bruise or a wound. Her face was hanging over the spot on my stomach while Fatima scrubbed her body and she looked at me. Fatima had brought a large yellow clinical garbage bag and a large bag of soft paper towels, which were now half used and stuffed with garbage bags, and the water in the basin was becoming cloudy.
“Are you okay, Gladys?” She asked, “Hang in there a little longer and we’ll get you comfortable.” She went to the bathroom to empty the basin and came back with a new basin of clean, soapy water. She tested the water again with her elbow, scrubbed Gladys’ back a second time, and then stretched out the sheets before laying her down so that any small folds wouldn’t cause skin problems.
We gently rolled Gladys back onto the bed, repositioned the pillows, and raised the bed slightly.
I looked at the clock and stayed for a while. Gladys was still clutching my hand. She looked out the window, at some place in the distance. She stopped screaming and her breathing became even and steady.
After a few minutes, Gladys seemed to come to her senses and she thanked me. “I feel much better, we’re not late. Doffy will be here soon, so let’s get ready. Can’t let those kids go hungry.” Her eyes skimmed over the empty bed next to her, and back toward the dusty windows and sky. “What time is it? Is she coming?”
I told her it was almost 5:00. “Really? It’s already so late. Time waits for no one.” She looked at me, “Time waits for no one.”
I found a home in the intensive care unit.
I have cared for patients in surgical wards, medical wards, psychiatric wards, infant and child wards, and obstetrics and gynecology wards. Eventually, I found my home in the intensive care unit. It was also there that I met Tommy.
Tommy was 9 years old and had broken his neck and pelvis in a traffic accident, leaving him paralyzed from the neck down. Because of the tracheotomy, the words coming out of his mouth and the sounds he made could not be heard, and people could only watch him inhale sharply and tearfully over and over again.
For a long time, I spent many nights in a row caring for Tommy.
I wondered what he used to be like. I always tried to imagine what life was like for the patients I cared for and looked for clues that would help me care for them. I try to imagine how the dilemma at hand will affect their whole life. Tommy’s dad needs to go away for weeks at a time to work in an oil drilling tower. Tommy’s mom supported the network of interconnections: their relationship, resilience and expectations.
Caring for Tommy meant I needed to find all the clues I could to help him and his family. It was a series of step-by-step tasks. Every hour, I would record his observations and ventilator settings on time, marking them on a poster-sized chart with a different colored pen. I traced the points and looked for patterns: temperature rising, blood pressure rising.
Patients with spinal injuries like Tommy’s are at risk of developing autonomic response disorder, an abnormal physiological response to damaged spinal cord nerves that can eventually lead to severe hypertension. It can be triggered directly by causes such as constipation or kinked urinary passages, so good care is essential. I watched carefully to catch possible signs to avoid this life-threatening emergency.
Caring for Tommy also required close care, as I scrubbed and turned him to make sure he didn’t stay in the same position for too long, or risk developing bed sores. Despite the countless metal devices still holding his entire body in place and the multiple pelvic surgeries ahead, Tommy’s body stabilized. Everything is fragile and the details make all the difference. For example, I make sure his socks don’t crease on a regular basis. It’s a simple thing that can have devastating consequences, especially now that he has such a poor resistance to infections like methicillin-resistant Staphylococcus aureus.
I need to get him food: Tommy can’t eat with his mouth yet. I’m going to put up some milk-like food in a large bag and pour it into a tube that goes straight through his stomach, a method known as a gastrostomy. The medication is also given through this method.
However, while I did all the physical care for Tommy, his mind was the part that needed the most care. So, although it appeared to be physical care, it was mental health care that I was doing. One of the most beneficial things was to build a trusting and friendly relationship with him and to listen to him, to really listen.
We talk through our feelings. “I’m not surprised,” I said when doing the mouthing to indicate he was going home, “I think I would have felt the same way. You must miss your life before the accident.”
He closed his mouth and froze for a moment. No one had ever said anything like that to him before. They would all tell him that it would soon be okay, that he would soon be able to go home and see his bedroom, and that he would be able to meet his friends when he recovered enough. But I heard what he really meant. I understood that he wanted to go home because he wanted to go back to his old life. He wasn’t talking about “home” in the actual sense.
“But I don’t think you’ll always feel that way. In fact, I’m pretty sure. It’s a terrible thing, and I can’t even imagine how you feel about it. But I’m going to do everything I can to make you feel better. I’ll be with you every hour, every second.” As I spoke, I gently stroked his hair. “I’m here with you, right here, all night long.” Those words weren’t enough, but they were all I could muster.
That night, I kept reading to Tommy. For many a sleepless night, his eyes were wide open in the near total darkness of the night. We read Harry Potter, and as the story progressed, his eyes would close slightly, seemingly free of a little pain. He needs a ventilator – a broken neck means he may no longer be able to breathe on his own – so he has to stay in intensive care despite being stable; he has a pseudomonas infection, which makes his neck smell like a sewer; his tracheostomy wound oozed green pus and coughed up green sputum; a colostomy bag and catheter were also required.
Tommy’s condition was so complicated that it could be a long time before he could be discharged-perhaps many years-before he could return to an actual home. I sat outside his room and listened to the rolling sound of the machine.
Tommy’s 10th birthday was spent in the hospital room. The nurses had decorated the bed with leftover tinsel and silver thread from Christmas, taped cards to the metal bed sides, held the ventilator in place with surgical tape, and one nurse brought in balloons she had bought on her break. But in the glare of the intensive care unit, the balloons also became something sad.
Tracy, the most experienced nurse in the pediatric intensive care unit, brought a bouquet of flowers grown in her own garden, their colors refractory and their shapes free and sloppy, and stuck them in a small plastic cup on top of the ventilator. “That’s much better,” I said, “What a pretty flower, Tommy, what a pretty flower.” Tommy looked away, then closed his eyes.
The charge nurse came over, “You can’t put flowers in here, Tracy, that’s absolutely not allowed.”
Tracy grunted and took the flowers from the ventilator to a nearby table. I saw her lean over toward Tommy. “A good boy deserves flowers for his birthday.” She said, kissing her fingers as she did so, then stroked Tommy’s cheek. “Double digits now, 10 year olds, know what it’s like to have your heart broken.” She loved him, we all did, after spending so much time with us, but Tracy was the favorite. She talked to him all day, to soccer games on the radio or upbeat dance music, scrubbed and oiled and stretched his legs. She also gave him a dance, which she did poorly, waving her hands in the air. That was the only time I ever saw Tommy smile.
There were a ton of presents under Tommy’s bed, many from the nurses, but Dad came in with a big bag too. “A birthday little one!” Kissing Tommy on the cheek, father and son smiled at each other, “You’ve done a great job this year.” One by one, they began to pull out the presents and pile them on the bed until Tommy’s eyes were round.
After Tommy falls asleep, his parents stay in the hospital room. “He wanted a bike,” Mom said, “and I kept telling him I’d get it for him when his 10th birthday came. All these years he’s wanted a bike. I didn’t want to spoil him. I told him it would be a special gift, so I could only give it to him on his special birthday. Only when he was well behaved.” She bent down and covered her stomach.
I touched her shoulder. “I’m so sorry.” I said, tears coming to my eyes.
Tommy’s dad reached his arm around and hugged her. “It’s all temporary, or so I thought anyway. My son is a man. I know he’ll be able to get back on his feet. I just know it, honey. Doctors make mistakes all the time. And you’ve heard about all the treatments over in the U.S. No I’ll go to double shifts and save up enough money to go. Got a soccer game to play on the field soon, don’t you?”
He looked at Tommy, who was sleeping in the middle of a pile of machinery and equipment. Tommy’s mom stared straight at me. At that moment, Dad turned his head and nodded to me. It was one of those very slow nods, the kind you expect from someone who agrees with what you’re saying.
But all I could do was wipe my zinging tears to the sides while flashing a fake smile. I move my eyes away and stare at Tracy’s wildflowers, the colors of nature.
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