PEGGY RAMBACH

 

Night Nurse
by Mark DeMasi

Gerry sits on her side of the horseshoe nurse’s 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 I’ll 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 won’t be available for a while. I close the chart I’ve been writing in (it couldn’t possibly be as important as what Gerry’s doing) and walk down the hall (her damn hall) to answer the call bell. It’s two o’clock 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 don’t really want to toast Mr. Has-refused, give him a strained smile and promise I’ll be right back with it. “And a cup of coffee too,” he says. I’m genuinely grateful for that; he normally waits until I’ve delivered the sandwich before sending me to fetch the coffee. By the time I’ve prepared the snack, Mr. Has-refused has hit his call bell two more times to remind me that he’s still waiting. Gerry has cancelled out the calls at the nurse’s station, without losing a beat in her charting, knowing that I’m 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 he’s 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 don’t make it back to the nurse’s station before another call bell is going off, this time down my hall. Mrs. I-don’t-need-to-help-you-it’s-your-job needs the bedpan for the fifth time since my shift began at ten o’clock. Actually, Mrs. I-don’t is always very cooperative with me, it’s 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. That’s 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 nurse’s 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 it’s 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.” Gerry’s 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 won’t comply with any dietary restriction. Who can blame him? What’s 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-don’t 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 gentleman’s urinal and bring another fellow a cup of ginger ale and some cookies. One of the aids tells me that Mrs. Ninety-something’s catheter is leaking, so I straighten a kink in her tubing. I massage some ointment into this one’s heels and that one’s 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 I’m officially done for another night. My ninth in a row. By now several of the residents are sitting around the nurse’s station in their wheelchairs and they’ve 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; it’s 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. I’ve 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. There’s 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 couldn’t 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, “You’re 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 didn’t 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 doesn’t 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, Isn’t it enough to be scared of the surgery? Do I really need something else to be scared about? It wouldn’t 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 wasn’t 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 nose.

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 couldn’t 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 couldn’t 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 couldn’t 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 didn’t 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 didn’t 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 didn’t know the song. My shoulders ached.

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 don’t remember learning it. In my mind’s 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 won’t go on endlessly. You can do this. Breathe, slowly in, slowly out. I’m up in the chair. If I hear anything you need to know, I’ll let you know. You picked these guys; you can trust that they’ll do the right thing. Just stay inside till they’re done.”

“Come back,” me in the chair whispered. “They’re 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 wasn’t cold and all the equipment looked familiar, safe.

Evie said, “It was easy, huh?”
I nodded.

 

Amazing Grace
by Debra Opramolla

I need to talk to God and, yes, it’s 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 brother’s “Teddy the Bear.” I wonder what that little lawyer negotiated with Morgan to get it, but maybe he didn’t need it; his hand is resting on Adriel’s 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 can’t. I just can’t. 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 doctor’s appointments in Boston. I just can’t.

Please dear God don’t 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 don’t need the guilt; I don’t 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 Sara’s hand and just like circus elephants we cross the lot to enter Market Basket.

It has taken three aisles before we’ve 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 them—she 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 I’m 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 I’m still grieving for the healthy child that I didn’t have? Above all that, I’m frightened beyond words about my baby’s future. Will he have a future?
“I’m 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 couldn’t 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 she’s been eyeing the toothpaste that has Snow White, Cinderella or some type of princess on it. “Yes,” I reply.
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 doesn’t 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 daughter’s 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 bubble bath?”

I smile. “Yes,” I reply. I know that one day he’ll 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 I’d picked up into the cart, hoping it was ground beef and I sling the food pump over my shoulder; it’s 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 stroller.

“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 Adriel’s stomach and rock him a bit.
I overhear a woman say people with sick children should stay at home.

Okay God. This is what is what I’m talking about. Do you think I needed to hear that now? What I need is help. What I’ve got are the comments and the stares.

The kids are frightened and trying not to cry. I’m 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. It’s 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.
It’s 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 they’re 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, it’s not going to happen, so live with it. Life is just that way sometimes.”

I return to unload the meat, the mac’n 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.”

 

Reunion
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, I’d be there before Christine.

As I stepped onto the ward of the state hospital, I glanced into Debbie’s 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 don’t 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 wasn’t 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 wasn’t 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. I’d imagined that she would seem scattered and edgy. But here was a woman who seemed just the opposite.
“How was your trip?”
“Good. But it’s strange to be away from my kids. I’ve never left them before.”
And I thought again of Kayla and wondered how she was.
“Kathy – I’m Pat, a friend of Christine’s 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 Christine’s visit? In all the confusion I couldn’t remember if I had even told Debbie that Christine was coming.

Debbie’s 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. Debbie’s arms remained on her lap, fingers sticking out in the same position they had been in when I first arrived. She couldn’t move her arms to return the hug or say anything in response, but this did not seem to trouble Christine as she stroked Debbie’s face and hair the way a mother caresses her baby.

I stepped around to the front of the wheelchair and stood next to Pat. Debbie’s 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 didn’t 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 mother’s neck. I saw a tear fall from Debbie’s eyes, and then I left them alone.

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.