The year I graduated from nursing school I knew very little about nursing except what to wear.
My white uniform, designed with a bib of crisp pleats across the bust, tented into an A-line skirt. The hem fell exactly to the middle of my knees. White stockings and utilitarian shoes worthy of a convent exemplified my look of a novitiate. Infection control and the influx of men into the profession eventually rendered the winged-white caps obsolete. I pulled my long blonde hair into a pony tail, stuffed it into a crocheted “snood’” and secured it with bobby-pins. For convenience I always stuck a few pens in my mound of hair, Geisha hair sticks by Bic. I never wasted time looking for a writing tool. My favorite offered three colors of ink, red, blue, and green, to accommodate each of the eight hour shifts in a day.
Three hospitals provided services to my small college town in the Midwest. A five bed surgical intensive care unit became my basic training camp. Monitoring EKGs and frequent vital sign checks were considered state of the art. On days when less than three patients required this vigilance, I functioned by myself in this new, specialized area of the hospital. I documented changes in EKGs, electrolytes, vital signs, and pain control, and established standards of care. I initiated calls rather than depending on a “head nurse” or supervisor to speak for me. Intensive care necessitated eliminating time delays and the middle man; I answered directly to doctors and the demand for accountability fell on and appealed to me.
Of course I worked my first Christmas on the job. Christmas 1973 gifted me with insight into my career choice and the ever-present threat to ICU patients known as death.
My patient looked like Alan Bates, the actor. Roguish, with curlicues of black hair slick with sweat and oil, the man reclined in a rickety framed gurney. He angled his elbows on the metal frame like a king holding court He strained the cloth restraints that secured his hands to the side rail. With each effort, his biceps bulged and trembled. Shaking his head side-to-side, he uttered incomprehensible sounds and marked his territory with a circle of spittle. My immaculate uniform meant nothing to a man wallowing in a reality fragmented by the effects of alcohol withdrawal and hypotension.
I fantasized about Alan Bates ever since the movie Women in Love, where I watched Mr. Bates and a young, though semi-portly Oliver Reed romp in the first nude male wrestling scene to appear in a mainstream film. The full frontal male anatomy fascinated me. How could I imagine in five years that career experience would reveal every variant of the mysterious penis and turn it into nothing more than a delivery conduit for the precious measure of renal perfusion, urine?
I nicknamed him The Professor. I can’t remember his real name. Today HIPPA would demand I protect it. He epitomized my ideal of an English professor complete with perfect, albeit, slurred diction and a penchant for whiskey. I imagined him fully functional, both cavalier and cerebral in a tweed sports coat with leather patches on the elbows. College girls flocked to his classes, his office, even his apartment. And I, fresh enough, inexperienced enough, thought like all novices with addiction, that a little love and attention could cure alcoholism and all the underlying problems that caused it. I’d say the right things, and The Professor would quit smoking, quit drinking, eat right, and publish a book dedicated to me. I also thought medicine could save him from the massive gastro-intestinal bleed channeling life from his body. In one day I learned what little power altruism, innocence and science wielded.
It was just he and I. The day nurse dashed away as soon as she finished report. Short and to the point: “ 34 year old white male. Bloody emesis with clots in his stool. Found unconscious at home by a neighbor. Two units of blood given in the ER. No family. Sinus tach on the monitor.”
There it was. The security of what I then believed was the pinnacle of technology. In just a few years to merely monitor the EKG would be comparable to using a squirt gun against a light saber.
“Dr. Reisman said there is nothing more to do.” Today it seems there is nothing we can’t do. There are no rules about when to stop.
I picked up my stethoscope to start my assessment and stopped a moment to shift gears. Looking around it disappointed me to see no one had decorated the unit for Christmas. Through an expansive fifth floor window, low hanging clouds rolled over the trees and houses. Smokey mist covered every building and obscured the lights and decorations heralding the season. Loneliness accompanied the focus required for my work.
I approached The Professor with caution. His gown gathered in folds across his abdomen and groin. The monitor electrodes glared white against a thicket of chest hair. Small halos surrounded each electrode where the hair had been shaved. A small slash of dried blood marked a path down his chin. He sat in a smear of maroon with a clot the size of a plum mashed against one rail of the gurney. His writhing agitation caused his blood pressure cuff to slip down his arm to the restraint. I could see his pulse on the monitor and count his respirations. I needed to check The Professor’s blood pressure.
There is nothing more gag-inducing than stool from someone bleeding in the gut. It blends the smell of fresh blood, rotting meat, and swamp gas.
When I started to examine The Professor, I didn’t know this. The odor surrounding him forced me to breathe through my mouth. I stepped closer and started a standard script. “I’m Cindi and I’m going to be your nurse today. I need to listen to your chest, heart, and abdomen.” I said abdomen because he was a professor. A whiff of his body odor reassured me I could have said “gut.” After holding my stethoscope between both hands to warm it, I placed the diaphragm on his chest. I heard the familiar squeaks and crackles of smoker.
“I need…I need…”
I heard his voice drone as the sound traveled through his chest and the diaphragm of the stethoscope, up the slick black tubing, and through the ear pieces into my head. I pulled back. “What is it that you need?” Pompous satisfaction. I was making progress with the man. He trusted me enough to ask for something.
“I need…” A blast of red erupted from his mouth and landed in an abstract design of spatter on my uniform. I looked at the chrome paper towel dispenser and saw nothing on my face, but from mid chest down I easily could have been mistaken for a gunshot victim or a Pollack. I washed and dried my forearms and returned to The Professor. Before AIDS and public awareness of the dangers of hepatitis, it never dawned on me to be afraid of exposure to body fluids.
The Professor’s head dropped against his shoulder. His heart beat twenty beats per minute faster to compensate for the loss of blood from his system thus maintaining his blood pressure. I sped up his IV fluids and paged Dr. Reisman.
When waiting for a physician to return a call, when it feels like all the responsibility is on you, time shows no mercy. My heart pulsed in my temples. Sound amplified. The Professor’s sonorous breathing seemed to roar through the unit.
The monitor warned of irregular heartbeats. Unable to hear a blood pressure, I palpated one with the systolic throb recognizable at 45. The phone rang. I reported the events of the past ten minutes and hoped some new medical development had evolved in that time.
Dr. Reisman was as new to his medical practice as I was to my nursing practice. When we worked with patients and each other, two pairs of fresh eyes explored changing professional roles, planning care with new knowledge and inspiration, reshaping old traditions. I represented a new breed of nurses with my four year degree. Just starting his practice, he seemed to approach me differently than the older, well-weathered MDs. Or perhaps he simply heard the uncertainty, the disbelief, and, yes, the desperation in my voice. “I’m on my way.”
The Professor rallied and resumed thrashing about the gurney. His heart rate remained high. A pallor circled his mouth. With a violent twist of his head, he resisted the green plastic prongs for supplemental oxygen. He repeated the move when I tried to wipe his mouth and wash the blood from his chin.
A small man with thick, pre-maturely silver tipped hair and an earnest demeanor, Dr. Reisman arrived. I noticed the five o’clock shadow of his beard. He noticed my uniform. “Did this just happen?”
I nodded.
“There really is nothing more we can do.” Dr. Reisman stroked his chin and walked over to The Professor.
“Can you hear me? You are really sick. At this point we can’t get you better. Is there anyone we can call? Is there anything I can do for you?” He rested his hand on The Professor’s forearm.
The Professor stared across the room and said nothing. Guttural sounds rumbled in the back of his throat. Watching a man’s demise, tethered to a bed in my ICU, gobsmacked me.
“Call me when something happens. I’ll be in the ER.”
I admired tailored slacks and polished shoes as Dr. Reisman stood at the elevator. In a time when patriarchal practice dominated medicine, Dr. Reisman showed me a glimmer of the collaborative practice of the future. That day I sensed something about the potential of my profession that would come to fruition many years, many patients, and many challenges later.
“Doc.” The Professor sputtered in a coarse whisper. “Doc, can I just have a cigarette?” His head lolled to one side. The monitor warned of disaster.
When I looked up at the small black screen, three to four beats of wide amorphous conduction, the kind that drop cardiac output and blood flow to the brain, interrupted the rapid, but regular white P-QRS pattern of tachycardia. The Professor lost consciousness. The irregular rhythm looked like a child’s drawing where a tiny hand zig-zagged a crayon across a piece of paper. More and more clusters of chaos appeared. Finally chaos reigned.
Without a regular heart rhythm, the heart failed to perfuse. Within minutes The Professor stopped breathing. A white line, as clear and sure as a jet stream, crossed the monitor screen. The monitor screamed its proclamation of death with a continuous high-pitched alarm.
What happened after The Professor died, I don’t remember. I knew the mandatory procedural rituals performed after a patient’s death. In 1973 plastic body bags didn’t exist. I assume I wrapped The Professor in a sheet. Today I sing Native American chants to patients as I prepare their bodies to be taken away. There was no singing for The Professor. I had much to learn about what was right and proper and comforting to me when working with the dead.
Nor do I remember what I did that Christmas night when I got home. Until I owned a house with a fireplace, I made one out of construction paper and corrugated cardboard painted like bricks. The felt Christmas stocking my mother made me hung by the faux-fireplace on a tiny nail. Mom decorated the stocking with symbolic cut-outs. Beads and sequins sparkled on a candle, a train, a ball, and other various mementos of childhood. There was no nursing cap; that identity had not entered my being when Mom created the stocking.
For many years, the memory of The Professor’s last words, the loneliness of his death, and my feeling of inadequacy stayed with me. I saw myself, like a candle in an infinity box, as a myriad of nurses expanding in many directions, burdened with the responsibility for another person’s life, alone to experience the loss of a man who, at first glance, seemed a person of looks and intelligence and potential, but who was simply a man I tried to help and failed.
I could have changed jobs, gone to work in the newborn nursery or a doctor’s office. I could have quit nursing altogether. The Professor would have no second chance, but I continued nursing in search of my mine.
Leave a Reply