by Mark DeMasi
Gerry sits on her side of the horseshoe
nurses station bent over an already overweight chart, scribbling
away, adding more calories to that fat tome. There are two hallways,
a nurse for each hall, and the call bell that is ringing, is down
her hall. One thing Ill say for Gerry, she sure can focus,
and she charts merrily on, oblivious to the call bell. One of
the aids is off for a smoke and the other is cleaning some thirty
wheelchairs so she wont be available for a while. I close
the chart Ive been writing in (it couldnt possibly
be as important as what Gerrys doing) and walk down the
hall (her damn hall) to answer the call bell. Its two oclock
in the morning and Mr. Has-refused-a-bath-for-six-weeks wants
a toasted peanut butter and jelly sandwich. Who toasts a p &
j sandwich? Probably no one who has to make it themselves. I cancel
the call bell by pushing the button over his head, remind myself
for the hundredth time since his admission that I dont really
want to toast Mr. Has-refused, give him a strained smile and promise
Ill be right back with it. And a cup of coffee too,
he says. Im genuinely grateful for that; he normally waits
until Ive delivered the sandwich before sending me to fetch
the coffee. By the time Ive prepared the snack, Mr. Has-refused
has hit his call bell two more times to remind me that hes
still waiting. Gerry has cancelled out the calls at the nurses
station, without losing a beat in her charting, knowing that Im
already handling it. Mr. Has has two cold cups of coffee on his
bedside table that I clean away to make room for the latest soon
to be cold cup and his sandwich. He manages a thank you that sounds
as strained as my smile felt earlier and I assure him that hes
welcome and head back down the hall thinking that this must be
an example for the gratitude that is supposed to give nurses so
much satisfaction from their work.
I dont make it back to the nurses
station before another call bell is going off, this time down
my hall. Mrs. I-dont-need-to-help-you-its-your-job
needs the bedpan for the fifth time since my shift began at ten
oclock. Actually, Mrs. I-dont is always very cooperative
with me, its the female aids she gives a hard time. She
tells me that I really know how to put a lady on a bedpan. Eighty-four
years old and she wants my body. It must be hard to maintain any
sense of dignity when you have to have help taking a pee, but
she manages to give me a unmistakable come hither smile as I walk
away from her bed carrying her night deposit. I flush it down
the toilet and return her pan to its home beneath her nightstand.
I get her arranged on her side, just the way she likes it, and
give her pillow a flip. Thats the clincher, That feels
so nice, and nobody does it but you. Now I really do feel
pretty good and I manage to get all the way back to the nurses
station without another interruption.
I pour down the sink the cold cup of coffee that I had been sipping
while charting and pour myself a fresh cup. The coffee turns grey
when I add milk so I pour that one down the sink too and start
a fresh pot. While its brewing I go back to charting. It
takes me a moment to remember who I was charting on and what it
was I planned to write. Oh yes, Resident is resting quietly.
No change seen in behavior or sleep pattern. Gerrys
charting up to this point in the night has no doubt been approximately
as profound. Next I fill out a couple of consult forms for people
going out to doctors later in the day. I do some monthly notes,
chart some weekly weights, sign off a dozen meaningless forms.
At three a.m. the two aids begin their
rounds, checking for incontinence, making sure we can account
for the presence of the forty residents of the wing. While they
are doing that, I head off the call bells. Mr. Has-refused has
decided he needs a donut and some jelly and a plastic knife. Makes
his own jelly donuts. The guy is insulin dependent diabetic, but
I give him what he asks for. He has long since made it clear that
he wont comply with any dietary restriction. Who can blame
him? Whats the point in denying yourself all pleasure in
order to live another five years in a nursing home? The aids have
managed to get Mrs. I-dont onto the bedpan again, without
any help from her, so I respond to her bell and get her off the
thing, again going through the repositioning/pillow flipping ritual.
I empty a gentlemans urinal and bring another fellow a cup
of ginger ale and some cookies. One of the aids tells me that
Mrs. Ninety-somethings catheter is leaking, so I straighten
a kink in her tubing. I massage some ointment into this ones
heels and that ones coccyx. I change a dressing over a superficial
wound that would probably be better off left alone.
A little later I pass medications,
then do some more charting, give the not-quite-awake nurse who
is relieving me the report, count the narcotics, hand over the
keys to my relief and Im officially done for another night.
My ninth in a row. By now several of the residents are sitting
around the nurses station in their wheelchairs and theyve
all got my number. I pour coffee for those who require it, and
fetch whatever was forgotten by the aids when they were dressed:
eyeglasses, footrests, a handkerchief, teeth. My pace is sedate
compared with that of the aids; its no wonder they occasionally
forget these little things. I bid a general Have a nice
day to anyone who might be listening and head for the door.
Ive gotten good at turning off the voice in my head that
tries to review all the things I had intended to do during the
night but never got to. Theres always tonight.
From NSMC-Union Hospital
Getting to Inside
by Harvey Zarren MD
The room was stark white with fluorescent
lighting and sterile looking oxygen and suction equipment on the
walls. The chrome rails of my bed were shiny and hard. The air
smelled sharp and unforgiving. The intravenous line in the back
of my hand tugged on my skin when I moved. I was grateful for
how painlessly Beverly had inserted it.
I knew her from the many times she
and I had consulted on her patients in the same pre-op holding
area. She dressed neatly in a clean, crisp smock and pants, attractive
without a lot of clutter. Her hair was a warm brown, cut to just
above shoulder length; it was clean and moved neatly when she
turned. I remember that hair; it made me comfortable and secure
to watch it.
Before I had changed into my hospital
gown, I asked her what she was going to do to me and she calmly
told me she would take down my history, take my pulse and blood
pressure and put in an IV. She was just as attentive and knowledgeable
as she had always been when I saw her with patients. When I had
worked with her in crises, she never raised her voice or looked
agitated and always found ways to be helpful, appearing with medications
or equipment I needed even before I had asked.
Now, she put her hand on mine, looked
me in the eyes and asked if I had had surgery before. I said,
First time. My mouth and tongue felt like blocks of
ice and I had to move my mouth consciously to shape words; I felt
so cold that my teeth couldnt even chatter. My muscles were
frozen; shivering was not even an option. Then I wondered, was
I cold or afraid? Beverly held my gaze and quietly said, Youre
going to be just fine! For a moment I believed her. I felt
warmer. I wondered if I could go through surgery with her holding
my hand, but didnt ask.
When Beverly and her reassuring hair
walked out of the room the fear came back. So did the cold. The
previously familiar tools in the room looked different. The oxygen
outlet and the blood pressure cuff were scary, the cuff curled
up like a constrictor waiting to consume my tender arm. Maybe
I would need oxygen. My jaw clenched and my breath got short thinking
about the possibility. I pictured the nasal prongs of the oxygen
tubing digging into my nostrils. Then, I thought, what if whoever
uses the blood pressure cuff on me doesnt use it properly?
If that happens, do I say something? If I said something, would
I be punished with a look or a tone? Should I risk angering a
person who is preparing me for surgery?
Then, another thought, Isnt it
enough to be scared of the surgery? Do I really need something
else to be scared about? It wouldnt be hard to totally lose
control, maybe start shouting, totally lose it, pull the IV and
get my clothes and leave. How would I ever work here again if
I did that? I was ashamed to even have the thoughts. Now my face
felt flushed. I wondered if anyone could see it? My stomach gurgled.
I wondered if anyone could hear it. My breath got short; maybe
I did need oxygen. I could feel how the prongs would poke into
my nose. This wasnt helping me. I needed to get control.
I went inside my mind. I had lots of
practice going inside. Inside was a familiar place: warm, softly
gray, accepting, very comfortable. No sharp edges here; indirect
lighting and no shadows. No drafts, no threats, just quiet stillness
and a sense of enduring strength. No particular smell and lots
of clean air; breathing was easy here and so I did - in and then
softly and slowly out, feeling the flow pass gently through my
Getting to inside was easy. I had done
it many times. I took a deep breath and as I let it out, I let
myself spiral down a smooth giant corkscrew to quiet at the bottom.
Going here was like putting on a flannel shirt in a cold room.
It only took one breath. It worked. I had practiced a lot. Now
I could look at myself and my situation with reasonable perspective.
I noticed that I had unclenched my jaw and my hands had released
their death grip on the rails. My body was warmer, warm enough
to be comfortable. I could feel my toes.
Then, quite unexpectedly I was watching
the ceiling move by. Intermittently I saw familiar faces appear:
Helen, Mary, a secretary whose name I couldnt remember;
they were looking down at me with encouraging smiles. Some of
them were saying things. My face felt like it smiled back. I think
my mouth and cheeks moved. A clock went by, up on the wall, but
I couldnt see the time. The bed wobbled just a bit. Suddenly
it was glaringly bright; I was looking up at operating room lights.
I can do this, I thought, I really
can. I had practiced and practiced being specifically in this
place. I can do this.
Somehow I was up on the operating table.
It was hard, unyielding. The room was very cold and the overhead
light was intense. I couldnt look directly up at it; I had
to either move my eyes to the sides or close them. How could I
see what was being done to me? Without warning, some man whom
I didnt know, gently strapped down my arms out to the sides.
No one was going to hold my hand while I was Christ on the cross.
The surgeons, Hubie and Bob, were bright,
personable, caring and had great clinical judgment. I had worked
with them for years and knew they were the best at using local
anesthesia. One of the OR nurses, Evie, gave me a brief hug. I
had known her for years and had treated her parents and her brother.
Helen, another nurse, was always energetic and displayed great
common sense in the face of clinical problems. She gave me a big
smile and asked if I had any new jokes. I smiled back but didnt
answer. Both nurses told me that they had heard I was going to
use self-hypnosis for my hernia repair. Evie said that she knew
it was going to work well, that she had confidence in me. Hubie
came over, peered over his mask and asked, Are you ready?
Ten minutes, I said. Let me do my thing.
No problem, he said and walked out of my view. Then
I heard some rock music. I didnt know the song. My shoulders
I tuned out the music, tuned out the
ache, looked up at the harsh circular operating lights, took a
deep breath and went for the spiral. Nothing happened. Nothing
happened! The music got louder, the lights got brighter and I
was on that hard, damned table, my arms stretched out and sweat
pouring down my forehead. I closed my eyes against the infernal
lights and distinctly heard someone behind me moving surgical
instruments around huge, sharp instruments. I was absolutely
terrified. Every muscle tightened up, my nose started itching,
the room got colder and the table got harder. I tried again to
go inside. The fear stopped me like a cave-in in a tunnel.
Suddenly my mind looked around. When
I was in serious trouble my mind always looked around. I think
I came here with that gift; I dont remember learning it.
In my minds eye I put myself up in a high chair like a professional
tennis match referee and that me started telling me what to do.
Take a breath, spiral down to that warm detached place;
make your groin numb. Now I was very focused, very busy,
very intent and in I went.
Me on the table listened very hard
to me up in the chair. We can do this. Way
in the distance I felt the first local anesthesia and I let all
my muscles go loose. Breathe slowly and deeply. Relax that
area. relax every area. It will all be finished at some point.
It wont go on endlessly. You can do this. Breathe, slowly
in, slowly out. Im up in the chair. If I hear anything you
need to know, Ill let you know. You picked these guys; you
can trust that theyll do the right thing. Just stay inside
till theyre done.
Come back, me in
the chair whispered. Theyre finished. I opened
my eyes. The overhead lights no longer shined on me. The doctors
stepped back, smiling. The nurses bustled around removing drapes.
My arms were free. The people in the room were noisy. I sat up
easily; my right groin area was numb. I felt exhausted but elated.
I hugged the anesthesiologist who had stood by, just in case,
with a syringe full of general anesthesia. I wasnt cold
and all the equipment looked familiar, safe.
Evie said, It was easy, huh?
by Debra Opramolla
I need to talk to God and, yes, its
going to be a why me kind of conversation.
I have circled this parking lot eight times looking for a handicap
space. There is a white conversion van with a high top, its springs
sagging to the left, making it look as tired as I feel. Then there
is the tricked out Toyota truck I would have to bring my leg up
over my head to get into. But my favorite is the jet-black BMW
sport coupe with a ragtop; it can go 0-60 in 6.5 seconds. I could
fly in that. But everyone needs those spots as much as I do.
I glance in the rearview mirror and
notice Adriel is a sleep. The soft whirl of his feeding pump and
the steady motion of the car has done its job. Finally! Sara is
snoring softly. Her head is hanging down allowing her red curls
to fall in her face as she is hugging tightly to her brothers
Teddy the Bear. I wonder what that little lawyer negotiated
with Morgan to get it, but maybe he didnt need it; his hand
is resting on Adriels lap. I would give anything to point
this vehicle towards home, to let my babies rest peacefully in
their beds. To let me rest. I just cant. I just cant.
Joe is in China, I have a frozen bag of lima beans in the freezer,
a half bottle of ketchup and a green fuzzy thing in the fridge.
Adriel needs his meds picked up; the PT is coming tomorrow? Ahh,
tomorrow is a round of tests and doctors appointments in
Boston. I just cant.
Please dear God dont let me run
into his PT in this store. I know putting him in his stroller
is not good, but that huge monster size blue car seat-like Snug
seat and its base with the lunar moon wheels takes Herculean strength
to get out of the trunk. Just this once he can be lying down instead
of being properly positioned. I dont need the guilt; I dont
need the tsk, tsk or the stares. Speaking of stares, Lord it would
be nice if you turn those stares into something more helpful Like
someone pushing this damn cart.
I push the car and pull the stroller.
Sara grabs the string on the stroller. Morgan holds Saras
hand and just like circus elephants we cross the lot to enter
It has taken three aisles before weve
run into someone I know. Thea is a church friend who has an unshakable
faith. If only she could be practical. Thea would tell a starving
person she would teach them how to fish so that they can feed
themselves. Me, I would feed, then teach.
Thea greets the kids first with a smile.
How is my favorite redhead and her handsome brothers?
Morgan turns to Sara expecting her to answer for themshe
usually does. But somehow Sara seems too weary. Morgan answers,
Fiiinnne. I give him the look. You know,
the one that mothers use, that says it would be in your best interest
to use the manners I taught you. NOW!! Morgan catches the look
and adds, How you be doing?
I am doing grrreat, Thea says. You said more
than one word to me.
She turns to me, her smile dims just
a bit and she reaches to pat my arm. How are you doing?
Thea seems so sincere. I wonder should I tell her? Should I tell
her that Im so exhausted that I would need to sleep for
a week just to be tired? That since I had to stop working, our
budget is so tight that buying groceries is a treat? That Im
still grieving for the healthy child that I didnt have?
Above all that, Im frightened beyond words about my babys
future. Will he have a future?
Im okay, I say.
Adriel starts making gagging sounds
just as the food pump begins a loud shrill beep. I check him for
seizure activity but he only needs a few swift pats on the back
and settles down. I fix the kink in the tubing that was stopping
its flow and reset the pump.
Thea is wide-eyed, You handle
things so well. I couldnt be so calm. God is going to bless
you. And as she starts to push her cart, she says, If
you need anything, give me a call.
We are in the Health and Beauty aisle
when Sara says, Can I pick out something, Mommy? I
know shes been eyeing the toothpaste that has Snow White,
Cinderella or some type of princess on it. Yes, I
My little cherub happily skips by the toothpaste and picks up
a box of black hair dye.
I give Sara a wide smile and tell her, Honey, Mommy thought
you wanted the special toothpaste, not hair dye. Put it back and
you can get the special toothpaste.
Sara looks stunned. You are breaking
a promise. You said I could pick out something. I pick this. I
want black hair, not red, she wails.
I give Sara The Look. It
doesnt work. She is in a full fledge tantrum, yelling that
I broke a verbal contract and she needs a phone to call her lawyer.
Right now! Because she has rights!
As I kneel down to be eye level with
Sara, I wish a hundred paper cuts on the tongues of all those
who only seem to notice my daughters beautiful red hair
and fail to mention nothing else to her but her hair. I quietly
say, This hair dye costs $8.00. You can have it if you pay
for it. I now have her attention, so I continue, You
will have to open your piggy bank and give me the money.
It takes a microsecond for her to return
the dye and head for the toothpaste. Morgan comes forward and
puts his hand on my shoulder. He says, Can I have the yellow
I smile. Yes, I reply.
I know that one day hell find out that his favorite bubbles
are Joy dish detergent.
Adriel starts crying and bringing his legs up to his stomach.
I turn off the food pump and change his position, hoping to buy
some more time in the store. I only have milk, eggs, boxed mac
n cheese, boxes of cereal and some other quick and easies.
I just need to go down a couple more aisles.
I get to the meat counter and the baby
starts retching and he is making all the sounds that go with it.
I throw the meat Id picked up into the cart, hoping it was
ground beef and I sling the food pump over my shoulder; its
in a bag that looks like the kind that the airlines used to give
out. But instead of Pan Am, it says Kangaroo Pump. I must wear
it to pick up Adriel.
His stomach is a tight little knot,
he is gasping for breath between the retches. His face is a bright
red with his eyes screwed close tight with pain.
What should I do?
I take a few steps. There is a line
of black plastic chairs in front of the store. This sets the children
into motion. Sara starts to pull the cart and Morgan pushes the
Chairs, I say in a calm
voice that I do not feel.
I sit down and begin my checklist. What do I need, can I handle
this myself or do I need a doctor? I press lightly on Adriels
stomach and rock him a bit.
I overhear a woman say people with sick children should stay at
Okay God. This is what is what Im
talking about. Do you think I needed to hear that now? What I
need is help. What Ive got are the comments and the stares.
The kids are frightened and trying
not to cry. Im still not sure what I should do.
I notice that the store has music playing, the light rock that
I might be prone to sing along with. For generations, in times
of need, my family sang spirituals. My favorite was Amazing Grace.
I gather my children close. Then softly, I start to sing and gently
rock my small son.
Amazing Grace, how sweet the sound
That saved a wretch like me
I once was lost but now am found,
Was blind, but now, I see.
As I sing, the store and the people
fade away. Its just me and mine. I begin to feel an inner
strength, a place of peace that I had forgotten that I had. It
reminds me that everything is going to be okay.
My children seem to exhale, to settle just a bit.
Its time to check out.
I reach the cashier, a woman behind
me asks if she can go in front of me; she only has a few things
and she is running late. I turn to give her my best are
you crazy look. She must be, because I am holding a whimpering
baby in one arm, unloading a cart with the other and trying to
direct two children with a stroller where to stand so that theyre
out of the way.
You are going to be late,
I tell her.
She begins a tale that I have no desire to hear. I say, Look,
its not going to happen, so live with it. Life is just that
I return to unload the meat, the macn
cheese, and the woman is mumbling something about people being
so unkind, when the cashier takes a look at me and says to the
bagger, Help her.
By Kathy Knoblauch
Kayla was sick and on any other day
I would have stayed home with her, but not this one. On short
notice that weekday morning the babysitter could only stay for
a few hours. By the time she arrived I was already an hour late
for work. Still, Id be there before Christine.
As I stepped onto the ward of the state
hospital, I glanced into Debbies room and was relieved to
see that the nursing assistants had already dressed her in the
pair of new blue jeans and the blue plaid blouse I had bought
for her. Her gray/brown hair, still wet from her bath, shone in
a beautiful, long straight ponytail. She sat partially reclined
in a padded wheelchair. Her hands rested in her lap with fingers
sticking out in different directions. Anticipation hung heavily
in the room like the mid-morning mist outside the windows.
Is she here yet? the nurse
asked as I approached the desk.
I dont know - I just got here, I said. A moment
later, at the end of the long corridor, the automatic door swung
open. Two people walked onto the ward - a woman carrying a flowered
gift bag and next to her, an older woman. I wasnt sure,
but I said Christine?
Kathy? said the younger woman. I was surprised. I
thought of the phone calls that had come first from Las Vegas,
then Seattle, and Key West. She had called to give me her new
address, and would then ask questions like why her mother wasnt
able to talk on the phone, and how could she find a genetic counselor.
She had wanted to know if her children could get the disease.
Each time she called she was pregnant with yet another child.
Id imagined that she would seem scattered and edgy. But
here was a woman who seemed just the opposite.
How was your trip?
Good. But its strange to be away from my kids. Ive
never left them before.
And I thought again of Kayla and wondered how she was.
Kathy Im Pat, a friend of Christines
father, said the other woman. Is it okay if I join
you? I wanted to be here for support. I was relieved to
find that Christine had help from someone else. Over the phone
she had sounded so alone.
The room was empty. Shiny pink tiles
covered the wall. Two large heavy gray chairs faced two sides
of a square wood table. I suggested that they sit on the vinyl
gray couch against the wall while I went to get Debbie.
I walked down the hall and wondered what I should say to her.
Had anyone told her about Christines visit? In all the confusion
I couldnt remember if I had even told Debbie that Christine
Debbies chair was heavy and difficult
to maneuver; the wheels seemed to have a mind of their own. It
was too wide for the doorway and it bumped the door jam, so we
had to back up to make the turn. Christine and Pat watched our
entrance and I felt nervous. I mumbled something like Debbie
someone special is here to see you.
Christine stood up and said Mom! She reached out and
gave her mother a big hug. Debbies arms remained on her
lap, fingers sticking out in the same position they had been in
when I first arrived. She couldnt move her arms to return
the hug or say anything in response, but this did not seem to
trouble Christine as she stroked Debbies face and hair the
way a mother caresses her baby.
I stepped around to the front of the
wheelchair and stood next to Pat. Debbies beautiful blue
eyes were wide open. She gazed at Christine and managed to raise
her head several inches off the back of the headrest. She stared
straight at Christine and didnt take her eyes off her during
the next hour. I looked at them and realized that their profiles
were almost identical. And they had the same big blue eyes, round
face and creamy skin.
After a few minutes, I moved next to Debbie, facing Christine,
not sure whether to sit or stand or where I should be exactly.
Christine pulled a gift out of the bag and handed it to me to
unwrap. Inside the small box was a necklace with a painted cross
pendant. Christine lifted and fastened it around her mothers
neck. I saw a tear fall from Debbies eyes, and then I left
When I got home, Kayla toddled over
and hugged my leg. I bent down to pick her up and her forehead
felt warm but not hot. I paid the sitter and saw her out, and
then nestled with Kayla in the rocking chair. I thought about
Christine and her courage, and how she could finally hug and hold
her mother. I shifted my weight and lifted Kayla to kiss her hair.
I wondered if she, too, would ever meet her birth mother. If she
did, who would she find? But for now, my breath brushed her cheeks,
and her small body on mine was a warm blanket.