FYI – to contact me use: email@example.com
Deanie stared mutely at the glass of ice-cold Provencal rosé. A single bead of condensation gathered volume, zigzaging across and down the bulb. Her hand grasped at the stem but a fine tremour contradicted her purpose. Before she could place the glass back on its circular ring, a stray splash dotted her woolen funeral skirt. ‘Damn’ she muttered. ‘Damn him’, added, like a promise, for more accurate measure. The spilled wine soon soaked into the fabric and vanished. Quiet, undisturbed minutes passed; now befell then.
Again, with a scarcely more steady hand, the glass approached her lips. This time she executed with success but not ease. Deanie accomplished a slow, comforting draught. Her eyes closed. Red misery curtained the interior of the lids. Tension, general and specific, faded but did not depart. The sigh was inaudible, heard only by her soul. Darkness deepened around and within her. The weight of her curly head eventually yielded and her ear tipped to her shoulder, awkwardly, the tremour now slack.
As always, Deanie started awake, vigilant and pop-eyed. Ready to certain and pervasive danger. She listened for the sounds of the street at night hoping they would still her pounding chest and roaring ears. Hoping, as always, to distract the collage of horrors, lurking. Yet tonight, at the edge, perpetual fear was tinged, faintly, with hope. ‘Let the past be’. That’s what her sister Nellie said. But Nellie didn’t know everything, not by a long shot. Only Deanie knew the full sickening but liberating picture, burned now in her mind, and delivering her from the ancient, revulsive, shackles of revulsion that soul-bound her to a lifetime of terror.
Deanie shook her head as clear; as clear as she could, then rocked to a stand and stiffly walked the half full wineglass to the kitchenette. She poured the now warm contents into the drain. Barely audible, with eyes focused way in the distance, she whispered: ‘That was easier than I thought. Easier than any of my fantasies’. Easier than the plan that started to hatch since she was 12. Quietly, as was her way, Deanie took to her shower, leaning into the scalding pellets. Scarlet skin dried, she buttoned her flannels and slid into her bed, barely disturbing the covers. Tomorrow dawns the new secrets, the safer secrets.
Deanie recognized the trill of her cell phone. It hauled her into morning. She ignored it, as she usually did, preferring to hear the message first and rehearse her response. Maybe her self-doubt would dwindle in her new world; her new world without Uncle Jack. Her new world without Uncle Jack, his penetrating look slashing her soul. Despite years of therapy, aimed to shift her understanding, Deanie has failed to fully appreciate messages that she was a child; she wasn’t responsible. And that she wasn’t the dirty whore he called her. She was meant to learn that he was the adult. But by that logic, so where her parents and they didn’t keep her safe either. Jack was gone now. Dead. Dead on the floor of his kitchen. Dead after falling down, reaching out to her. Reaching out to stop her words. Dead, like a promise. The weight of this reality pinned her to her to the sheets. Inert. Brimmed with fear and guilt. Full syringes of insulin still loaded in her purse, unused; unneeded.
The day ended and she never rose. The day ended not as it began, at the funeral with her sister urging her to composure, but in the new safety of her tightly tucked bed.Her week ended, not as it began. Not with her standing in her uncle’s kitchen, facing his sneer. Facing his accusations of fault and blame with the fresh courage, rolled up in her plan. His face, purple in rage and fury. Silently watching him reach out with patience unrelenting. Head tilted slightly to the right registering his topple and fall, fat, ugly fist clutching his chest, gasping. The two unused syringes of insulin, corroding a hole in the bottom of her purse. Plan fulfilled. Plan B. Not even B, maybe X.
A week that started with her wordless retreat from the death scene, syringes full and intact, unnecessary. A retreat that never considered a call for help, Wondered not about comfort or assistance. A wheezing old man, dying on the linoleum, ending her misery by the grace of God. Deanie slipped away, unnoticed. She slipped away, gently closing the back door behind her. The snick of the latch, bursting loud in her ears. The sharp strike of the hammer, pounding on that last nail. She slipped away down the street and around the corner, pausing out of range to regard the single branch of mauve bloom on the otherwise dead trunk. Her mother found him. Two days later. Rot now noticeable outside his being. Her penance for not listening, not believing?
Three tears slowed as they touched the pillow. The enormity of her past enveloped Deanie like a shroud. For years flashbacks of hurt and violation had haunted her, shortening her breath and sweating her palms. For years she relived the pain and indelible humiliation. Fear of being alone with him, with any man. Fear of his repulsive touch, the touch of any man. The smell of his putrid breath, reeking of coffee and onions. Choking. The urge to vomit. And his threats. Hanging her cat; ripping her dresses. Thinking, why? What have I done to deserve this? So afraid and believing it was all her. Years of planning and dreaming of how to take him from her life. Since she was 12. Gunshot. Garrote. Poison. She smiled to think how easy it had been. Simply, a confrontation gone wrong. No, gone right.
Again, the phone pierced her memories. The trill of Erik Satie’s Je Te Veux, undirging the funerary organ settled in her ear. She stared down the screen and let it go to voice mail again. Only then did Deanie check the messages. The most recent call was her sister; the previous call was from her friend, Alicia. She decided to return Alicia’s call. Her message said ‘let me know you are ok’ whereas her sister simply directed: ‘call me’. Alicia knew for sure about Jack, the living Jack, the abusive Jack. Now the dead Jack. Deanie wasn’t entirely sure her sister knew their family secret. It was unspoken.
Neither sister nor friend knew her role with dying Jack, if it could be defined as a role. More a witness, Deanie decided. Silent witness, with all the deadliness that silence entails. She did not, could not help him. As no one had helped her. It was fair, she decided. Just. Liberating. She hit recall on Alicia’s number and welcomed her friend’s calm voice. Yes, I’m ok she replied to the re-asked question. ‘No’, Deanie whispered, ‘it wasn’t as awful as I thought it would be’. She left out by omission that the more awful memory was the bubble of spit seeping from his bluing lips. Her own spit pooled near his arm; his fading eyes watching it land. But she knew in time, this memory, both memories would fade, like Jack’s eyes. It would fade she hoped into a comforting beam of sunlight, warming her cheek.
Deanie boiled the kettle, feeling the surprised joy of freedom from fear. She poured hot water over the tea bag and stirred in honey and milk. A piece of toast settled the background gnaw in her gut, empty since her mother’s call to tell her Jack was dead. ‘Jack was, Jack is, dead’. She said it out loud. She replayed fragments of the funeral in her mind. In retrospect, no one cried. No one mourned him. Was he just that awful? Yes, she decided. He was that awful. Pushing him back into the cage reserved for him in her mind, Deanie dressed, standing just for a moment, as she had never tried before, between flannels and jeans without her clothes on, recognizing a new security, a new peace.
She brushed her hair, shouldered her bag and headed to the door of her apartment. She paused to look back, back toward the kitchen. There was no dead man on the floor. There was no danger. No hurtful uncle in her life, anymore. What he had been was gone. Or going, at least. And she could thank herself. She was glad. Relieved. The tide had turned. The high water was receding. Hell was receding. She could work with this, like a new promise.
Because many people find the blog format difficult to access and follow, if you wold like an alternate version of the story, email me at firstname.lastname@example.org or message me through Linkedin. Kate
Over the past year many readers say they have enjoyed my story. I appreciate those who took the time to provide feedback and make excellent suggestions. I have re-written the story and incorporated much of the advice and I hope improved the novel. I also undertook a ‘manuscript evaluation’ and learned that the story itself is viable and as I wished, it portrays Hattie’s life and work, and Bridie’s sad but brave struggle, as both compelling and instructive.
If you read the story already, feel free to skim through again and see the changes – including those you may have suggested.
If you haven’t read the story, now its in better shape for you 🙂
Because some of the feedback I received relates to the set up of the blog site, I have published the novel in one full post (https://wp.me/P8zki4-6C) – and I have learned that I did that first so this post is the first one you see when you log in. Because the whole novel is now in one long post, I can’t tell anymore if people read one chapter (or less) and never return or if you read to the last page – it all just shows as one login on my site. Can do me a favour? drop me a quick line once you have read as much as you enjoy or tolerate and let me know (I know that makes your job harder so its just an ask). You can respond on the site itself, through LinkedIn or you can also email me at email@example.com
Jody offered to join me at the service for Bridie but I declined. Given my role as a care provider, I wanted to be discreet and respectful. I wanted to raise the fewest questions about our relationship. I had spoken with Ben and he let me know Doug was hanging in as well as could be expected. The work he and Bridie had done with the boys was paying off. The kids were grieving but they were not surprised, or afraid. As Bridie had wished, with Doug’s encouragement, they kept reliving that last afternoon. Shirley, the social worker from the St. Germaine team had done a home visit and the boys found this very helpful. She talked them through what a funeral would be like and gave them license to ask any question that came to their minds. Having her there had eased Doug from this tough job. Neighbors were showing up with food. A neighbor had mowed their lawn. A neighbor had collected laundry and returned it clean and folded. And neighbors, friends and family crammed the recreation centre Tuesday afternoon to say farewell to Brigit Lloyd.
I took a seat about midway into the room, on the aisle. I remembered Bridie had thought about the music. She didn’t want any songs played that might be ‘ruined’ for people later. Classical music that most of us wouldn’t remember played softly in the background. At five minutes to three, a tired looking woman walked down the centre aisle with two pre-teens and a man, likely her husband. If I were to guess, given her familiar profile, I would say this was Dianne, Doug’s sister and Bridie’s savior. The room went still and I could sense people turning. Over the heads I saw Doug, wearing a navy suit, carrying a toddler. Lynne. He took a few steps into the room and stopped. I couldn’t see what was happening but I saw him reach down, presumably to lend a hand to one of his boys who was having second thoughts.
Doug’s head disappeared from view. He must have crouched down to speak with one of the boys at his own level. When he reappeared, Doug took an unexpected left turn and rather than enter the hall through the conventional main aisle, he sheparded his family around the outskirts of the room probably giving the boys a semblance that they weren’t the centre of attention. As it turned out, he walked inches from me. I saw Jamie. His head was lowered. He was not crying but it was certain he had been. Joey, the exact image of his mother, was the one holding daddy’s hand. Both boys were wearing navy pants and light blue shirts. I noticed that both boys, and Doug for that matter, showed a band of navy at their cuffs. I looked more closely, thinking it was an armband of some kind, like the Lance Armstrong phenomenon but that didn’t seem to fit what I knew of Bridie, or Doug. It was more obvious at Joey’s wrist because his arm was reaching up to Doug’s hand. I was pretty sure I saw a green fluorescent star. Lynne was resting her head on Doug’s shoulder, her thumb deep in her mouth.
Finally, the family got to their seats beside the woman I was pretty sure now was Dianne. Ben came forward and spoke with each of them, even Lynne. Joey said something that made him smile and Ben tousled the little guy’s hair. Doug shifted Lynne to the other shoulder and shook his head at the likely Dianne who was probably offering to hold her for him. She gently stroked a tear from her brother’s cheek. Ben looked up and around the room. He said something more to Doug who also looked around at the crowd. He smiled and nodded to some folks near him. Then returned his attention to Ben, seemingly giving him the okay to get started.
Ben welcomed everyone. He recognized the overwhelming love and support Doug had experienced in this community. He spoke with such sweet intimacy about Bridie that it seemed he had known her all his life, rather than only these last few months. He spoke to the children, reminding them of their mother’s love, a love that will endure forever. Jamie was struggling. This I could see. Doug smoothly shifted Lynne to his sister’s arms and he leaned in toward his oldest boy. I couldn’t see Jamie’s reaction but I saw that Doug was talking softly to him. One of Bridie’s requests of Ben was to keep the service ‘mercifully short’. I could see her wisdom in this now. In two long strides Ben reached the guitar he had propped in its stand at the side of the room. Ben was a guitar player, a pretty darn good guitar player. And he had a nice voice too. I hadn’t realized this would be a part of the service but I was always happy to hear him sing. “Please don’t stand at my grave and weep” He sang in a clear voice…”I am not here, I do not sleep…I am the thousands winds that blow…” When he ended, the silence was deafening.
“Doug. Jamie, Joey and Lynne. I am honored to be here today as you celebrate the life of Bridie. Your wife, your mother…and your friend. Bridie asked me to sing that song to remind you that she is here, with you all, for as long as you hold her in your heart. She lives. She lives for you all.” Ben continued, addressing the mourners. “Our life is a gift. It is a gift to be lived and to be shared. At birth, we are assured of death. There is no surprise in death. Its only surprise is when it comes too soon. For Bridie it was too soon. For all of you, it was too soon.” Ben looked tenderly at Doug and the children. He returned his message to the community. “Bridie is not gone, she has simply moved from our sight into our hearts. Ben raised his hands in prayer, like a good minister. He spoke slowly and deliberately. “As it was in the beginning, is now and ever shall be. It is ever thus.” He turned. Picked his guitar back up and strummed the chorus he had just finished singing. He nodded to Doug, who retrieved Lynne and stood. His boys mimicked him. They walked together, this time taking the short cut through the centre of the room. Gradually, all the guests filed out behind them. I walked to the front, where Ben stood.
“It was a perfect service.”
“I had some tall orders.” He smiled through his obvious sadness.
“I could sense that. I’m glad she found you to pay her tribute.”
“Things generally unfold as they should.” He hesitated, remembering where he was… “They generally unfold as they should, not always.”
Doug was surrounded by people sharing their condolences. I didn’t want to intrude. The woman I assumed was Dianne approached me. She introduced herself as Dianne and confirmed who I was. “Bridie spoke highly of you.” She remarked.
“And the same of you.” I replied. “I might not get a chance to talk with Doug…” I nodded my head in his direction, noting his preoccupation. “Can you tell him the service was perfect. He did Bridie proud.”
As she turned to walk away, Joey squiggled his way between us. He looked up at me and smiled. Bridie shone through his face. “Auntie Di, he interrupted. Did you tell her we are wearing Mommy’s pajamas?”
The color drained from my face and Diane knew immediately that I understood the significance. She steered me quickly to a nearby chair and I was grateful because my legs were failing me. “Bridie was wearing the new pajamas I made her when she died.” she whispered in her husky tear-sodden voice. “She didn’t know that I made a set for everyone. Because she hadn’t seen them, the boys wanted to wear theirs under their suits today.”
“She would have loved it.” I choked back a sob.
I saw Doug once after the funeral. He dropped off a card that Bridie had prepared for me before she died. Doug had lost weight but he said they were doing ‘pretty well’. I think it was hard for him to come back here, where pain and dying took such sharp focus. I know Ben has dropped over to see him and the kids a few times. I’m glad they have his support. His one piece of ‘good’ news Doug shared was that Bridie’s eyes were seeing for a young woman who lost her sight in an accident; he wasn’t sure of the outcome of her other organs. After he left, I opened my card. It was simple. Bridie’s script was weak but her message was clear: ‘Thank you for recognizing my courage’. Is that what I did? Was that all I could do? It’s hard to quantify the impact Bridie had on my life. I am reminded of her on a regular basis. I would miss Bridie but she is alive with me still. And alive for every other person I had the privilege of meeting in my work, and in my life. My thoughts were broken by Jenn’s voice on the intercom: “Hattie, your client is here”. It is ever thus.
I recognized the number on the call display. My heart lurched. I forgot to say hello after sliding the button to accept the call. “Hattie? This is Doug…Doug Lloyd. Bridie’s husband.”
“Is everything ok?” I managed.
“Hattie, I wanted to let you know…Bridie died last night.”
I froze. My breath caught in my lungs. Finally, exhaling and closing my eyes to hide from the world I stammered “Doug…I’m so sorry Doug.”
“Ya. I’m sorry too…at least she…at least it worked out the way she wanted. We had a great day with the kids. They will always remember their last afternoon together.” His unspoken agony was palpable.
“Doug, you know if there’s anything at all I can do to help…I’m just saying, call me if you need anything.”
“I know Hattie. You were a great support for Bridie. I thank you for that…” His voice was thick with heartache. I recognized that he caught himself from tears. “Reverend St. Croix will do the service. As far as I know, we are looking at Tuesday around 3PM. If you can make it, I’d be grateful.”
“I will absolutely be there Doug. She was a wonderful woman. Thanks for letting me know…” When I realized he had nothing left to say I closed. “I am so sorry Doug. Take care.” Of course I would be able to make it to the service. Tuesday at 1500 hours was exactly the regular time I had scheduled for Bridie.
Bridie’s pain continued to escalate. She used the Morphine drip more liberally. The dose was maxed both in terms of amount and how often she could push the button. Too much and apparently her respirations would suppress, like she cared. Nevertheless, the effect was miraculous. Nearly immediately, the pain was manageable but the effects were unfortunate. She lost her train of thought and had trouble saying what was on her mind. She tried her best not to exercise the magic button an hour or two before the kids visited so she could enjoy their company. When Doug was here on his own, she didn’t mind drifting off, just knowing he was holding her hand and sometimes resting his head on her chest. He had pulled the boys from school so they could come as often as possible. He lifted Lynne into Bridie’s arms and watched them both sleep.
The nurses were very helpful and the open policy of having family come and go anytime of day was just what she needed. The kids didn’t have a long attention span and Bridie knew that while they loved to come and say hi, they just couldn’t prolong a visit. They were unnerved by her condition and the surroundings. Yesterday during a family visit, Bridie could not keep herself from dozing off. When her head jerked forward Joey started to cry and somewhere in the fog of her thinking she heard him say gently to his dad “Daddy, is mommy dead now?” Doug’s heart jolted but before he could scramble to her side Bridie opened her eyes and said to Joey “I’m here honey. I want to look at you for a long time today.” Joey was placated and his smile of relief was heart wrenching. But both Doug and Bridie were on high alert. This was their moment of reckoning; the point they never wanted to reach but knew was inevitable.
This afternoon Bridie did not take any miracle medicine. She felt the pain building in series with cleared sensibilities. Doug arrived with all three babies. Bridie asked to sit up in the chair in the room so she could look at their homework. She told each of her sons how smart they were and how proud she was of them. She doubted they would remember all this but she wanted to embed the feeling of her precious love in their final visit. She sat with Lynne on her lap and asked the boys to tell her jokes to cheer her up and she laughed at them all. She hugged and kissed them all repeating over and over what very wonderful babies they were, and how much she loved them. When Jamie and Joey were ready to leave, she hugged and kissed them more. They were happy on the way out the room, waving and blowing kisses back to her. Doug leaned over to kiss her goodbye. “I will get them to bed and get Di to come over, then I’ll come back.”
“I’d appreciate that.” Bridie whispered, holding back the swell of grief in her soul.
After her family left, Bridie shot a jolt of morphine and asked the nurse to help her bathe. She mentioned that she felt a little sick to her stomach and could she have a bit of Gravol. They had to disconnect her from the line of drugs running into her arm but it felt good to have her hair washed and help to brush her teeth. She asked the nurses to do her a favour. “I brought some special pajamas from home that I want to have on tomorrow morning when my sister-in-law visits. She made them for me.” She said with a sincere smile. “I know the morning shift is busy, so if I sleep in them tonight it will save everyone the bother in the morning.” Dottie, her nurse for the shift was cool with this plan.
“These jazzy ones here?” Dottie held up the navy pj’s with the neon lime green stars. “They sure are bright.” Dottie weighed their heft in one hand. “Jersey is comfortable”. She added with a smile.
“Those are the ones. You’ll be able to check on me tonight without even coming in the room.” Bridie managed a chuckle. “Also, I wonder about something else….”Bridie hesitated. “The last couple of days I’ve noticed a bit of leaking poop…could I wear a diaper or something, so my pj’s don’t get dirty?”
Dottie was cool with it all. The bath complete, hair clean, the pj’s on with barrier protection and teeth brushed; she had the Gravol on board. Bridie stopped the nurse before she left the room. “Dottie, thank you so much. Your gentle care has meant so much to me. Our family appreciates the very difficult job you and all the nurses here do.”
“Bridie, I am so sorry about your situation. We all wish things would be different. Of course we feel that way about everyone but its….its even harder when…you know, its hard when there are young kids. It’s not fair.”
“Nope. It’s not fair. You have my full agreement on that. But fair or not, here I am…Listen, can you do me one last favour? Now that I’m in bed I don’t want to get out. Can you bring me over my makeup bag? I brought some ear-plugs with me and I want to get a really good sleep tonight.”
Dottie dug in the bedside cupboard and delivered the small zippered pouch to Bridie. “Do you use the foam ones or the wax ones?”
Bridie hesitated for just a moment then recovered. “The foam ones.” She answered with a smile. “And can you just push that tray a little closer? Last night I was thirsty as a camel and I couldn’t quite reach the glass.”
“This OK?” Dottie pushed the tray closer.
“I’m set up like a queen. Thanks again.” Just as Dottie turned toward the door Bridie called out. My husband will be back in about an hour, he’ll likely just sit with me for a while even if I’m asleep.”
Then Bridie waited. She gave herself another jolt of morphine and felt a wash of painlessness. She must have nodded off because when she opened her eyes again, Doug was sitting by her side. “The nurse told me you might be sleeping” he said as he leaned in to kiss her cheek. “I see you have your special pj’s on.” Tears rimmed his eyes. He recognized the signal. “The navy suits your hair.” He reached over to brush aside the clean auburn strands.
“Thanks. That was Di’s idea.” Bridie murmured. “Would you mind going down to the café and see if they are still open. I’d like a cup of tea.”
“Sure” And Doug ambled slowly around the corner and down the hall.
As soon as he was lost to sight, Bridie opened the earring case she had carefully stored deep in her make up bag. She retrieved the last eighteen of the morphine tablets that remained from before she was admitted to palliative care. She swallowed them in threes, washing them down with the ice water Dottie had placed near to hand. She was finished and settled back onto her pillow when Doug returned. “The café was closed but the nurses had a pot of tea on the go and sent this cup along to you.” He placed the paper cup on the tray and sat back into his chair.
Bridie reached out for the cup and took a small sip, keeping the ruse alive. “Oh, that’s so nice.” She remarked honestly. “Its real tea, not hospital tea. And you dressed it perfectly. You’ll never know what a kind treat this is.” She took another sip, actually enjoying the sweetness of the tea.
“The kids were so happy with the visit today.” Doug ventured. “They were still repeating those jokes when we were getting them ready for bed.”
“They are great kids. I’m gonna miss them.”
All words eluded Doug. He simply leaned in and held her hand and stroked her hair. “I love you Bird. I loved you from the minute I saw you. I’m glad you were mine, even if it wasn’t long enough…” He brushed away a tear.
“And you know I feel the same. I would only have changed one thing in my life…this cancer…without it everything would have been perfect.”
“It’s so very close to perfect now, Bird.” Doug lay his head against her chest and rubbed her palm with his thumb.
She reached down and gave the morphine button a plunge. She was grateful she had timed it just so and her next dose was available. “Sweetie, I had these earrings on all day…if I reach up and take them out, can you put them away in the box in my makeup case and take them home?’
“Sure.” Doug said curiously. “But don’t you want to keep them here?
“I don’t think so…I mean them for Lynne. I want her to have them when you think she is old enough to pierce her ears. I worry they might get misplaced here in the hospital.” And Doug took the earrings from her hand, placed them in the box, closed the lid and put it in his coat pocket.
“I’m tired Baby. Will you stay here with me while I fall asleep?” She could feel her breath slowing; she could feel the heaviness she had been counting on.
“Of course I will.” And with that, Doug pulled away the tray and nudged his seat closer. Bridie’s arm snaked over his shoulder and he nestled in the crock of her arm. He felt her draw a deep breath and sigh. He felt a tremor in her lower leg and foot. He held her hand tighter, she squeezed back, once. He sat with her, like this, for a long time. Even after he sensed in his heart she had stopped breathing. He unsnaked Bridie’s arm and placed her hand by her side. He raised himself reluctantly from his chair and softly kissed his dear wife’s quiet cheek. “I will always love you.” The whisper snagged on his tears. Before he left the room, he lowered the head of the bed slightly, turned her still head gently to the side as if she were really just asleep. As he left the room, he blew a kiss to this little Bird, who had just flown out of his life.
Spring genuinely was here. And there was no truer indication than a blisteringly sunny Easter weekend. I was grateful for three days off. Jody’s proposal was wrapped up by Friday night and she had that giddy ‘I’m done’ glow about her. Saturday morning the cute monk sailed back into town and regaled us again with bliss and joy. I don’t mean that to sound superficial, it really was how it went down. Afterwards, pumped and happy we pulled out our bikes, wiped them down and pumped them up. We sailed along the paved bike trail, the still brisk air chilling our knuckles. We peddled East skirting along outside two smaller villages until we finally got to a cool little restaurant on the water, likely 45 kilometers from home. By the time we stopped I needed to kick-start Kreb’s cycle to reload my legs with energy. I was so depleted after the log peddle that I was unsteady on my feet, not to mention the odd sensation of moving at a walking-pace instead of racing along as we had been for over an hour.
Despite the temperature, we decided to sit outside in the sun, which spared me from maneuvering through the restaurant. I thought this might be a bit ambitious given the early season but Jody mugged a pout and I acquiesced. Given our over-heated state, it was probably a good idea. We promptly de-layered after sitting down. About a half hour later, right before our order of nachos arrived, we layered up again. It was only the nachos that gave me the strength I needed to peddle home. Sunday morning both Jody and I were lame after our long ride but it took until about eleven o’clock before either of us would admit it. Then, with no pride left to lose, the whining began in earnest. It was a slow, quiet weekend. We luxuriated in it.
Jody committed to riding her bike to school, now that the weather was decent. I said I would too but I just couldn’t bear to get up earlier to arrange biking to work on my day shifts. I had a 0730 start; Jody had until almost 9AM to cross the town. By the time my week of evening shifts came around, I decided I could pull it off and I enjoyed three days of cycling to and fro, then April lived up to its reputation for rain. My days came and went. The contact numbers stacked up and the outcome data looked good. We continued to make money for the hospital with our third-party program. Amy Brixton moved to a new apartment. Dawn had her initial session with the sexual abuse counselor. Kim and I had sketched out a plan that provided more support to the nurses but we were not optimistic because it was not ‘revenue neutral’. I heard from the Seniors team that Nancy, the woman I had referred a few months back had finally moved into a support care facility…we used to call them ‘homes’.
The annual Buttertart Festival came and went. Usually this daylong pastry extravaganza is cool, or more than cool, and overcast, or more than overcast but this year the sun was shining and the ever growing hoards of tarters who descended into our fair town were blessed with an abundance of sweets, and a lovely day to boot. I calculated the number of bike trips I would need to burn off the effects, while eating my ration of 3 oozy, raison-free tarts, which I attacked so vigorously that according to Jody sparks were flying off my plate. My record of never purchasing the winning recipe remained intact.
Bridie was actually doing very well, given the circumstances. Her schedule with the oncology team meant she was regularly away at least one time a week, so we mostly stayed in touch by phone. She had a standing appointment every second Tuesday. The birthday baseball game was at the end of the week. So I didn’t expect her to keep our meeting on Tuesday. But I was wrong. After I buckled my bike up to the railing outside our office I noticed a voice message from a call I had missed during my ride. I checked it and it was Bridie, saying ‘save me a seat’ she would be here. Duty called as soon as I crossed the threshold, so I didn’t call her back. Just after four o’clock, I was just putting the finishing touches on a discharge note when Jenn’s voice on the intercom let me know Bridie was here. I could tell immediately that there was a problem.
She was not amused with my greeting. “You look awful.”
“Well, you aren’t exactly a supermodel yourself!” She tried for a joke but she didn’t laugh.
Bridie explained that over the past few days, she had started to exhibit the same symptoms as she did at the beginning. Her abdomen was bloated and tender to the touch. She was either constipated or she experienced diarrhea, and as unpleasant as the diarrhea was, at least it brought her some relief. The pressure in her abdomen reduced her appetite to zero, which was preferable to the nausea she felt when she forced a even little food into her stomach. Bending and lifting was excruciating. “Our baseball game is Thursday night and I will not miss it!”
She was using the morphine Dr. Leung had prescribed sparingly but she was ready to blast a big dose on Thursday. He’d given her a new prescription to tide her over. She also talked very matter-of-factly about the hospice bed that she figured would be available sometime next week. Her St. Germaine oncologist, Dr. Leung had transferred her care to Dr. Halmanium, a local cat who specialized in palliative care. Her videos were done. Her cards and scrapbooks were finished. Yes, she’d disclosed it all to Doug. Yes, he was able to cover for her at the ballgame. Yes, he knew she was absolutely expecting to move to hospice shortly. And, no. No, the kids were not aware of how close we were to ‘the last inning’. “I’m just about done.” She said, running out of steam before the end of her sentence. Then she repeated again, softly as if to herself alone: “…just about done.”
“Bridie, I’m so sorry.”
“Ya. Me too. But, you know, I had the reprieve. I am going to the ballgame with my son and I am going to enjoy it.” She paused and caught her breath. I realized just how much this was taking out of her. “I wanted to tell you face-to-face Hattie. Not on the phone.”
“Thanks.” A question loomed at the back of my mind. “Did you drive here?
“No. Doug drove me. He is waiting in the car.”
“He didn’t want to come in.”
“He can’t hear it again Hattie. He knows where we are at but he said he just can’t hear it…I understand.”
“I understand too.” I leaned forward and placed my hand lightly on her bony forearm. “I understand.”
“Thanks. I know you do. That’s why I had to see you…in person.” She took a deep breath and looked up and away. “I didn’t know if I would see you again…so it was important.”
My chest crushed with grief. How brave this woman was. How kind and thoughtful. How horrible that this was happening to her. We sat in silence, with only the ambient clinic mumble in the background. “I will visit you in Hospice. It’s right here on the grounds.”
“Sure. I’d like that”. Her smile was small but genuine. “That’s another whole loss for me.” Two large tears welled over her bottom lids and slid along her thin cheeks. My silence pushed her to reveal that in the last two days she sat in every room of her home, remembering events and conversations associated with each place. “I don’t know how I will walk out of my home for the last time…knowing I will never return. I’m not sure I can I do it.” She lowered her head and missed me wipe away a tear. “I should go now. I am resting up tomorrow so I will have every last ounce for Thursday. The kids are so excited.”
“I’ll walk you out.”
“Hattie?” I waited. “Hattie, thanks for all your help…don’t give me that I-didn’t-do-anything look! I didn’t know how to deal with this, this … devastation. I’m still not sure I did it right. But what I know is that your faith in me gave me the confidence I needed to make my own decisions. For that, I can’t thank you enough.”
I had no immediate response. I simply embraced her, gently afraid she might shatter in my grasp. “Bridie…” I finally whispered “never doubt the lessons you have taught me.” And I walked with her to the car where Doug sat behind the wheel, waiting. I helped her into the passenger seat. “I want to see the pictures from the game, ok?” I managed with mock cheer.
“Of course.” Doug lifted two fingers off the steering wheel in the local signal that means either hello or farewell, and I watched until the tail-lights disappeared.
By the following Wednesday Bridie was installed in her Hospice bed. Doug left me a message on Thursday to tell me. I arranged time in my schedule to trek to the grounds on the other side of the hospital complex to see her. As promised, she had photos of the baseball game. She even had a video she could share using her tablet. Other than looking tired, the casual observer would not see the death in her face. I saw her walking hand-in-hand with Joey, up the ramp and into their seats. I saw her fake eating popcorn and ice cream. I saw her singing Happy Birthday to her son during the seventh inning stretch. “You did it.” Was all I could say.
“I did it.” Was all she could reply.
“How long?” I asked.
She knew immediately what I meant. “Dr. Halmanium says he can’t tell… maybe a week, maybe two. But I don’t want this to go on and on. I can’t let this be the final memory for my boys.” I sensed desperation in her voice. “I just want to drift away…”
“How about the pain?” I was dodging like a coward.
“They have this drip hooked up. The doctor said I can increase it as I need more. I wasn’t using the Morphine much at home so at least my system isn’t too used to it, and it works pretty quick…but I don’t want to get foggy. I want my kids to remember me making sense.”
“Use it as little or as much as you need.” Easy for me to say.
I heard a step behind me and turned to see Benjamin St. Croix filling the doorway. “Hi” both Bridie and I said at the same time.
“Doug let me know you were here. I see both Hattie and I had the same idea about dropping by.”
“I’m on my way out…” I started to say when Bridie interrupted me.
“Me too.” And we three shared a final sad laugh. Before I left I embraced Bridie’s diminishing form. She held my hand tightly. Her skin felt unusually soft and cool.
“I’ll be back…” I struggled. She smiled and blew me a quick kiss as I backed out of the room. Bridie and Ben were already in deep conversation before I had cleared the threshold. My plan was to come and visit again but that was my last word with Bridie, the woman who’s bravery scorched my soul.
My mind switched over to the next focus in my day: Dawn. Day five of the agreement was pending. She arrived at the last minute, causing me just a bit of doubt. “I’m sorry I called last night to cancel.” She initiated before she even sat down. “I thought I would ‘show you’.”
“I’m sorry I stopped calling every hour. I thought I would ‘show you’. It’s a tie.”
“Listen.” She assumed a serious air. “While we were being honest with each other, I skipped a page.” I held my breath. “Don’t worry” she added, astute to my condition. “I told you about Dave…what a great guy he was to me…”
“Yes, you did. I know it was hard for you when he died.”
She raised a hand to call me off. “What I didn’t tell you is that he has a daughter. Her name is Evalyn…that’s Eve-ah-lin, she’s fussy about how you say it.” When I added nothing, she continued. “I called her last night, after I left the message on your phone cancelling today. I told her about what’s been going on for me, about coming here and meeting you, about you ditching me…”I raised my hand to object and she waved me off. “I told her about the agreement. She took your side; she reminded me you weren’t abandoning me. Anyway, I asked her the question you asked me…What do I want now? I told her the best idea I had come up with was to go back underground for a year, resurface and collect five more days of crisis service…”
“I never thought of that option.” My eyebrows sprang to my scalp. I was impressed with the ingenuity of the plan.
“Well, Evalynn was not impressed!”
“What did she think?”
“She thinks I should come in today, which I have. She thinks I should hear you out about other supports, which I will. She wants me to be serious about reaching out to someone who can help me in the long term, which I might. And she wants to come and visit me over Easter…” she trailed off.
I did not judge these suggestions, although I agreed with them, I only responded. “So here you are. That’s step one. I have the info here for you about the therapists, case managers, peer support groups…and I am happy to answer any of your questions about them. If one of them sounds like a fit, I am happy to make a few calls to get you set up. That’s step two and potentially step three. I think it would be great to reconnect with Evalynn…”I annunciated the name correctly. “What’s she like?”
“She’s a little younger than me. She works in a bank in Kempenfeldt. I have only seen her twice since Dave died. Once when we had to sign over his insurance money to me, which was tough but I had to accept it, and once for lunch on one of the anniversaries of his death. We always got along…about as much as I can get along with anyone. I admit I was a little jealous of her because Dave loved her dearly…I always thought he loved her more than me.”
“Well, whatever happened, she isn’t scared off.” We reviewed the lists and Dawn recognized the name of one of the counselors she had worked with in the past. I made a quick call and because she had been a prior client she had some priority on the wait list. But it would still be three weeks to the initial contact. Dawn wasn’t sure about the peer support group. She wanted to talk this over with the new counselor. I agreed to continue to see her, so she didn’t have to go underground for another year! But it would be on a less frequent basis. We agreed to getting together in a week.
“Isn’t that Good Friday?” She asked when she consulted the calendar embedded in her phone.
“It’s a long story. The employees at the hospital got to chose Good Friday or Easter Monday as their day off and they picked Monday.”
“Oh. At least the stores are open.”
“I think that was the deal-maker.” I added with a slightly cynical chuckle.
“By the way…I don’t know if you can do this but I think those scales you showed me are off. I might like to see them changed. I feel differently now.”
“Sure. I’ll take another run at them.” I wasn’t convinced we were out of the woods. Miraculous outcomes were a bit of an emotional hoax. I knew ghosts would haunt Dawn for a long, long time. But I also had faith in her ability to manage them. Apparently even if it meant going underground for a year, which she was obviously capable of. Some of the people we see as most vulnerable are really the toughest. Anyway, renewed and improved scales were actually in my own best interest.
My messages Friday morning included a request from Bridie to connect today. She sounded okay in the message but this was a change in plans. And, I had a message from Dawn, cancelling. I wasn’t really surprised. Push back is not uncommon when people are put in the position where change is the only option. I pulled Kim aside after rounds and shared my idea about debrief time with her. Oddly, it was something she hadn’t thought of. She said she was touched when I asked if I could back her up for a bit while she got her heart rate down after our incident with Rick the thug. But “let me think about it” was all she offered.
Things were backed up in emerg this morning. I guess an acceleration of the pre-weekend panic before the extended weekend. To move things along a bit, I had to call up and remind the mental health unit that a patient waiting down here for a decision required a psychiatric assessment. I didn’t mean to be testy but I did add suggest it had to be today, sooner would be better, or we would be staring down a Form 1. In theory, an emergency physician can complete a Form 1 Assessment for Psychiatric Assessment at any point up to seven days after seeing someone. But when there was access to a specialist, it seemed the best way to review the situation.
I have seen a Form 1 misused as a ticket to a mental health bed, ergo ‘out of my emerg’ but the physicians at Carter are pretty reasonable about good clinical practice. Mostly they play nice in the sandbox, likely because they have learned that trying to resolve mental health problems without threat of involuntary admission is a sound practice. I dropped in to see the fella waiting for the said psychiatric assessment and explained that the psychiatrist would be here to see him at some point this morning. His mood remained very low. The dark circles under his eyes convinced me he had more on his mind that he was sharing. I left the digging to the psychiatrist but I reached over to touch his arm before I left. “It’s clear to me that you are really down.” His sad eyes met mine. “You might not believe this now but with the right supports you can recover.”
“I hope so.” Was his quiet and wistful response.
“Hope is the place to start.” I gave his arm a squeeze. “I’ll check back”.
At nine o’clock I called Dawn. No answer. I left a message asking her to call me back and enunciated my cell number clearly back to her. I noted her call in the record. Then I called Bridie. She reiterated her message about seeing me today. No details were forthcoming. When I pressed she said “I just need to work out a wrinkle with you.” As it turned out, with Dawn’s cancel, I was free at 1230. For the rest of the morning, I called Dawn every hour, repeating the same message and leaving the number. I knew it was fruitless to get into a battle with her but I had so hoped this would work out. Before I called again, on the hour, I heard Viv’s voice in my head advising: ‘who is this about anyway?’ I missed the next hourly call. At ten minutes past the hour, at 1210, Pharrell made me feel Lucky. Dawn was calling back and yes, she would be there on time. Hmmm. Now that time was filled. I rearranged to see her at 1:30, wondering what it was that had changed her mind…hoping it wasn’t the withdrawal of ‘love’ in my missing call. No more time to hypothesize now, Bridie was on her way.
Bridie was here on her own. She looked tired. She wasted no time introducing our topic for the day. “Dr. Leung is not in favour of another round of radiation.”
“Are you surprised?” I wondered aloud. “When we talked last time it sounded like you knew it wasn’t a given.”
“I’m not surprised.’ She conceded. “Just resigned. This marks the final leg.” Now I appreciated the source of her despair.
“Gottcha.” Was my simple, modestly professional, utterance resembling support.
After letting my remark burn down to ash, Bridie explained that because the first round of radiation was quite aggressive it worked very well but it also compromised the tissue surrounding the tumor. In her case, according to Dr. Leung, it weakened the bowel tissue and the mesomentum, which is basically the binding that holds everything together in her gut. “So,” Bridie expanded, “if this component of the system is already weakened, more radiation will increase the risk that it will rupture.”
“And for you this means…?”
“For me this means an unpredictable end. Maybe I literally burst a gut picking up Lynne, or getting up from the couch. Or on the toilet….” Her voice drifted off but I truly understood.
“I might get another two to three months… I might get that but I can’t trust that during that time I won’t fall down dead in front of my kids; bleeding out internally, in agony.” I nodded my head slowly, the message registering clearly.
“Your worst fear.”
“My worst fear.”
“So, where do we go from here?” I wasn’t sure if I needed the direction more than Bridie.
“I need to get ready. I think I’ve crossed the last bridge…well, the second last bridge, so to speak.”
“How far over the bridge are you right now?”
“…I have most of the videos finished. I have notes and cards ready in a folder for Doug to share with the kids at particular times, like birthdays, graduation…” She stalled. Then she resumed “I’ve spoken with Dr. Leung about pain management, he gave me some Morphine to help me get through the next while. He said to use it liberally and not let the pain get ahead of me. He explained the drip to me, once I get into the palliative bed. I can use as much of that as I need to keep me comfortable at the end, instead of the pills. And speaking of the palliative bed, I have an appointment to walk through next week – that was one of the reasons I wanted to see you today…I hear it’s a pretty good set up. Kids and family can come and go as you wish…” It sounded as though she was losing steam. Then with new resolve she continued. “I’ve met again with Reverend St. Croix. Both Doug and I met with him. He’s a good listener and he will do things the way we want…Hattie?”
“Yes?” I feared I would fail her.
“Hattie, do you think we should video the service. Do you think it would be something the kids would be interested in later, you know like when they are grown up?”
“Now you can’t just dump that one on me from the blue!” I spit out, authentically.
Bridie laughed, genuinely amused. “I know, all these thoughts are so familiar to me because I’m rolling them over all day, every day…think about it. I value your opinion. Reverend St. Croix said he will do whatever I think is best. Doug is torn but he is thinking if we don’t do it and the kids wish we had, we’ll regret it…well, I won’t regret it but he will. But if we have it and they don’t want it, it just stays on the shelf. It’s kinda along the same theme as the videos I am making for them. I want them to see them when I want them to see them but they may have other ideas. All I can do is the leg work.”
“You amaze me Bridie!”
“Ya. I’m getting pretty good at dying”. She managed to keep a straight face. “And I’ve only been at it for a few months.” Now she laughed out loud.
Impulsively I laughed along with her then corrected myself. “I guess we shouldn’t laugh…”
“What else can we do? I’m so weary of crying. And there will be lots more to come. I welcome a little laugh now and again.”
Before she left, Bridie described their upcoming visit to her mother’s home. One of Bridie’s hopes during this visit is to go through some of the old photos, put them in a scrapbook and compose a commentary for her children. “I want them to hear from me that my cousin Danny was the one who spilled turpentine on granny’s lawn not me – just because we are both standing by the bucket.”
I had dinner ready by the time Jody arrived home. Penne noodles loaded with lots of spinach wilted right into the sauce, and a vegan-friendly Caesar salad. Before we sat down, I handed her an envelop from ARC magazine “open it” I said with glee. Jody, however, as I could tell, was filling with trepidation. She excused her self into the living room. I heard the paper tear, ever so gently. A moment passed. With no further fanfare she marched back into the kitchen announcing “Yes. They want to publish my poem.” But she was not beaming as widely as I had expected.
“Are you good with it?” I was perplexed. I had expected glee.
“They want two edits…I like it the way it is. I wonder if I should play hardball…” I didn’t know where to head with this. I guess I don’t understand how personal her work is. So, in an exceptional act of wisdom, I stayed quiet. “I’m gonna sleep on it.” Jody finally proclaimed.
“Would it help to talk about it?” I wondered.
“Nope. I’m mulling. We can talk tomorrow.” How unlike me she is.
We were caught up on House Hunters International, so we enjoyed a meal with conversation. I wasn’t shy about what was rolling around in my head, so I ran my idea about supporting the nurses to have some kind of short relief after serious incidents and Jody agreed. “What’s good for the goose, is good for the gander.”
“Hmmmm. Goose. You know that’s the only flesh that I think might tempt me. It reminds me of being a kid at my Nan’s. She alway cooked a dandy goose at Christmas.” Jody’s non-response forced me to stay on topic. I gave her a few seconds to reconsider, then I continued. “I’ve been thinking, since Frau Blucher, that our work-team is more than the few of us crisis workers. I like the new Team Leader, Kim. She’s interested in how we can all work together. She recognizes we have skills in areas she doesn’t and she realizes she has skills we don’t. If we can fit them together we can be more effective. She doesn’t seem territorial, or scared off by potentially hairy events. I described the incident from earlier this week when the police hauled poor ‘black-eye’ off to The North and how Kim and I had joined forces to make it happen. “Then, when it was all over, I had a chance to sit with Viv and chat it over with a tea and the nurses didn’t.” It isn’t fair that they have to shut down their emotions and keep going…and it isn’t fair to the next person along the line who has to rely on the sound mind of the nurse ranking their pain.”
“My precious little Karl Marx…” Jody touched my cheek lovingly. “She wants the world to be fair.”
“The many forms of worker oppression must be crushed!” I played along banging one fist into the other palm. “And why shouldn’t it be fair?” I re-salted my remaining penne.
“Your blood pressure is already pumped up, you better lay off the salt.”
“Its good to tweak the old pressure now and again. Cleans out the little vessels in my head…I can feel them pulsing free and clear now.” I exaggerated a look of bliss.
“Pass the salt!” Jody reached out her hand, laughing.
“I can’t believe I can sit here and laugh after the stories of trauma and loss I hear all day.” I stopped short, feeling a flash of grief about my personal contentedness.
“Is this still about the tea breaks?”
“No. Something else…”
“Then its something that can go on the back burner. I can only manage the tea break problem today…” Jody knew I was being haunted by a misery that was shared with me today and she was gentle in her distraction from further talk. She stood, gathered my hand in hers and announced: “and now we walk off the carbs.” Who could argue?
On our walk we talked more about a potential adventure, which we still hadn’t ruled out despite the lacking cash. We reminisced about, or I should say Jody reminisced about her last trip to Paris. I’d never been but I knew her stories so intimately I felt I had. She reminded me about her meander through Pere Lachaise cemetery and sitting by Gertrude Stein and Alice Toklas’s monument. Feeling such a deep connection to their not so secret but never openly disclosed lives as lovers. The same was true when she stood by the site of Sylvia Beach’s Shakespeare and Company, although the intensity was amended when she walked into the wrong ‘bookstore’. I’d heard the story often and I longed now to recover her experience with her, for real. Jody armed herself with a wistful far away face as she talked about Natalie Barney and her regret at not exploring her Rue Jacob haunt. Looking me square in the eye, she vowed not to miss it this time. Eventually, our conversation drifted to the more practical details around the extra long weekend that teachers, the banks and civil servants had coming up next week for Easter.
In our hospital’s collective agreement process two years ago, the employees were polled as to whether they wanted Good Friday or Easter Monday off. Most businesses were closed on the Friday and not the Monday. The banks, the liquor and beer stores, and the schools were closed both. Overwhelmingly, the employees voted that the Monday was the holiday. It sort of makes sense in a post-Christian democracy. If you have a day off you might as well be able to shop, even if you can’t go to the bank, or buy a bottle of wine. Anyway, since I would be working on Friday, Jody and Roland had made plans to finish off the proposal for their new course so they could deliver it to their principal on Tuesday morning. “Won’t Maureen be lonely?” I wondered aloud.
“Maureen is off to visit the grandchildren in Hamilton for the whole weekend. Their daughter and her husband are taking a little get-away and Maureen is staying with the kids. She’s over the moon. Roland will drive down and join them Saturday morning.” Jody reminded me about Maureen and Roland’s various family connections. She told me what their daughter and her husband did for a living, where their son and his wife lived and what their kids were up to. I half listened, amazed that in a culture that so apparently loves and protects its children, so many fall between the cracks. No, that wasn’t accurate. So many are pushed into the cracks. I tried to shake it off. Some people are skilled at separating their work life from their personal life. My theory has always been that I only have one life and it’s mine to bear. I enjoy my personal feelings at work; in fact I use them to inform my work. And I mull my work thoughts at home; sometimes that’s the only way I can untangle them. Tonight I lamented my strategy. My thoughts were snagged on Dawn and her tragic life.
Jody recognized I was miles away. She walked along in silence, knowing I’d be back eventually. Finally she asked “Has the young woman, the one you are seeing…has she died?”
I was shocked into the now. “No!” Then with more grace, “No. She is still alive. And going to the Blue Jay game in a few days.” I added with a smile. “I’m caught up in something else. Sorry.”
“Don’t be sorry. It’s just you. I’m used to it now. It used to give me doubts but now I know you are shaving down some raw edges in your mind…so they don’t migrate to your already razor sharp tongue.”
“I love you. You know that.” I kissed her, right there in the street.
Mercifully, over the next few days, Dawn turned up on time and was able to talk about her experiences. I felt obliged to be transparent so I shared with her the results of the suicide/self-harm scale. Doing so actually helped her appreciate my obsessive questions about safety. Each day I reiterated our agreement, noting that we would need to consider a long-term approach to her therapy. Each day she merely nodded. On day three, she disclosed an interesting description of her suicidality: “I’ve been knocking on deaths door for years. I’ve been serving a commuted sentence…on trial for meditating murder, against myself. Everyday, for nineteen years.”
By Thursday, or day four, I reminded Dawn once again that we were approaching the end of our agreement. I asked “What can we do next?”
“You can’t leave me!” Dawn shrieked. Fear of abandonment was blared strong in people with her history.
“It never crossed my mind.” I lied. Then I realized I shouldn’t lie. “Well, to be honest it did cross my mind.” Her face grew stormy. “But hear me out…it only crossed my mind because I’m a crisis worker. My job is get people out of crisis and shifted over to someone who can give them what they need, for as long as they want it.” By the look of her, Dawn was not convinced. So I continued. “Mostly, I’ve been listening to you do the hard work of interpreting and re-framing your story. I’ve heard you say what happened to you was not right and that you weren’t to blame. Having said that doesn’t mean that you believe it – but having said it is a solid start. There are people who work in this field all the time who can push you where you need to be pushed and hold you back when you need holding back. Its not the job I’m best at…” I saw tears rim her eyes.
“Hey, I’m not giving up or turning my back on you but we do need to re-negotiate our next step.” I had her attention now. She sniffed back the tears but still said nothing. I let a full minute go by. “So, tonight, think about what you want to have happen next. Tomorrow when we get together I can share with you the names of some of the folks here at the hospital but also in the community who you can choose to support you in the long haul. There are support groups as well where you will meet other women who have had similar traumatic experiences to you and are at varying stages in their recovery. But I want you to know, I will continue to see you for the next while, just not everyday…” She calmed a bit with this piece of information. “Just a guess,” I added. “I expect tonight will be tough. I expect you will be angry with me. I expect you will be disappointed with me, you may even think I tricked you.” I knew giving her an I-told-you-so would not be productive. “Just remember, my wish for you is to continue to work on your wellness.” She needed to know I could withstand her intense emotions.
Dawn sat quietly, staring at her hands for at least two minutes. Finally she looked up. “Thanks.” She said clearly. “Thanks for believing in me.” As she stood to leave, she smiled and reported: “I’m ok. I’ll be safe. I’ll see you tomorrow.”
I made a quick run down to the emerg to finish up an assessment I couldn’t finish this morning on a fella who had overdosed and remained difficult to rouse. By the time I dashed in to see him he was much more alert and able to answer my questions. His level of depression concerned me and his promises that he wouldn’t harm himself were unconvincing. Because his blood levels were still wonky, he would stay in the medical unit overnight. After confirming with the duty doc, I requested a psychiatric consult in the interim. I let the new Team Leader Kim know what was going on, so she was in the loop. On my walk out the door, I continued to think about Dawn. How did people survive such histories? So much of the suffering was invisible, right until the moment it stopped being invisible. The statistics regarding the numbers of people who were admitted to psychiatric units who had also experienced sexual abuse should have signaled a public health epidemic but we shy away from these messy intrusions. Dawn’s story has been re-played again and again, and again, in our clinics and wards. It made me angry; it made me sad. Then is made me angry again.
After the team meeting I hoovered my tofu bologna sandwich and indulged in what Jody called sparkling-brown-poison, commonly known as a diet Pepsi, from the machine in the hallway outside our office complex. I reviewed the notes from Dawn’s previous contacts and admissions. She wasn’t joking. Her admissions had been problematic. From the look of it, she didn’t get on well with any of the clinicians and there were remarks about her being argumentative, demanding and uncooperative. Two of the admissions had been precipitated by an overdose; it was hard to determine what had caused the third but I would guess it was based on her history of suicidal behaviour. The third admission occurred almost five years ago now. There were two other contacts in emerg, both more recent. The latest was almost six months ago when she was assessed by a weekend reliever and referred for follow-up but she did not attend despite reminder phone calls.
No surprises. This was a common profile with women who had been sexually abused in childhood. They had problems engaging in relationships, mostly because they didn’t trust anyone. They weren’t good at expressing intense feelings. This phenomenon was often misinterpreted by clinicians who generally see the person just as the nurses described Dawn: argumentative, manipulative, demanding and uncooperative. Sometimes these women were overwhelmed by their experiences of intense emotions to the point of dissociating, or checking out of reality. Self-harm was also pretty typical. The women themselves describe it in various ways. Some say the pain of cutting themselves convinces them they are alive; the blood drawn is also a signal of living. Overuse of medications to manage emotions can lead to deliberate or accidental overdoses. In practice, people presenting this way are diagnosed with something called a Borderline Personality Disorder, or BPD, sometimes abbreviated to ‘borderline’. All of these monikers represent the very unfortunate label.
Once applied, The BPD label haunts us all, especially the person herself, since it is primarily a ‘pink’ diagnosis. The label doesn’t really alarm me anymore. Nor does the intensity of the symptoms, which is what rockets the scales and risk checklists off the map. The approach I have adopted, through serious trial and error, has been to recognize the experience of trauma that underpins the experiences of these women, and respond more specifically to that. Also, in my opinion, Borderline Personality Disorder is a feminized version of Anti-Social Personality Disorder, which is a label mostly applied to men, and coincidentally many of those men are also survivors of abuse. Sadly, none of the pale, stale males in psychiatric academia calls me when the lists of diagnostic categories are being prepared. However, I sense a shift on the horizon. We as clinicians are much more attuned to the impact of trauma in personality development.
When I had read enough of Dawn’s file to get me on the right track, I brought my notes up to date in Bridie’s record, including our conversation today about a second round of radiation. I should probably refresh my understanding about such matters, although I knew she was in excellent hands with the team at St. Germaine’s. Imagine though, what if she could get more time. My musings were cut short however when Jenn’s voice on the intercom announced that Dawn was here. I retrieved my note pad and folder of scales and forms from under my lunch debris and marched out for my new regime of daily meetings with Dawn.
We settled ourselves in the smaller interview room because Karen was already spread out in the larger one with a family. I started with my customary banter. “Dawn, yesterday we kinda started in the middle of things and I didn’t finish up some of the paperwork I need to do to open our file. Just bear with me for a few minutes.” Before she could object I had the admission package in front of me and I was starting to print her name into the appropriate boxes. “Date of birth, address, next of kin, family physician…” She answered each question without hesitation. “Perfect. That finishes that task.” Now, how was I going to get into the next phase?
I decided to detour from the usual. I slid the note pad away from my hands and sat back, looking Dawn square in the eyes. She held my gaze. “I pulled your old records.” She did not flinch or look away. “Sounds like your last admissions to the unit were not very productive.” She exhaled a burst of veiled disgust through her nostrils and sat back, crossing her arms over her chest, probably expecting a lecture. “However, that was several years ago.” My strategy was to distance myself from her previous experience. “I don’t know you at all; tell me about yourself?”
Dawn used full three minutes of silence to either test my interest or compose her thoughts. Then she started and with very little guidance or re-direction laid down the sad tale of her life. She was eleven years old when the Uncle who lived with the family began to molest her. He told her that her parents would never believe her. He assured her silence when he threatened to kill her dog. These threats were not uncommon as ways to intimidate children. As you would expect, Dawn was distracted and worried all the time, including at school and her marks deteriorated. Because she had done well in school before this, her parents were pretty sure she wasn’t trying hard enough or paying attention. She was punished and her parents wouldn’t let her go out to visit with friends or play after school sports. This just gave her Uncle more opportunity to have sex with her.
When Dawn asked to move into the bedroom with her sister, her sister objected and her parents thought she was being ‘silly’. After she started menstruating, as birth control, her Uncle forced her to perform fellatio. On the days following this abuse, Dawn was nauseated and gagged when she was eating, especially if her Uncle joined the family for meals. Certain foods could still elicit this response. “Relax, he would repeated, breathless and groping. Relax. I didn’t then and I haven’t since”. By age thirteen she learned that if she drank alcohol before bed she could more easily endure the abuse. When Dawn was fourteen, she ran away from home for the first of many times.
Finally, she disclosed the abuse to her family and, as her Uncle had reiterated, they did not believe her. Her father in particular could not accept that his younger brother would do such a thing and made it clear that Dawn had a wild imagination, proven by her delinquent behaviour. Then came a series of unfortunate and abusive relationships with boyfriends and escalating use first alcohol then prescription narcotics and then cocaine. Finally, about eight years ago, Dawn met a reasonable, older man, who was kind to her. In this relationship she got clean of drugs but still used alcohol, sometimes to excess. She attempted counseling with a sexual abuse specialist associated with the women’s’ shelter but found that each time she broached her past she fell into a mire of anxiety and depression that was overwhelming. This was around the time of her admissions to hospital. Sadly, this also coincided with the time that Dave, her partner, passed away suddenly and she was on her own. For the most part, since Dave’s death, Dawn has holed up in the apartment they shared and turned her back on the world.
When she finished, Dawn sat back in her chair, drained. “How….how did you survive all that?” Was all I could manage. “I could hardly bear to hear it, let alone live through it.”
“I don’t know.” Dawn replied in a barely audible voice. Tears were creeping slowly down her face but she made no attempt to wipe them away. I reached for the tissues all we crisis workers kept at the ready and passed her the box. She held it in her hand but seemed not to have the energy, or motivation, to pull one.
“None of this is in your record.” I was confused.
“No one here ever asked.”
“Oh…” Sadly, I figured this might be true. Only recently have we acknowledged the link between trauma and mental health, even though its been staring us in the face for years. “We haven’t done a very good job by you then, have we?”
“Don’t beat yourself up.” Dawn said unenthusiastically. “No one’s done a very good job by me; even me.”
“Well, I’m glad you shared this with me. It helps me understand a lot better who you are and it makes me appreciate how strong you are to have survived all this.” Dawn leveled me with a confused look. “I know now that I was right to trust you to go home yesterday…” A moment of panic crossed her face. “…and I know that you will be safe when you go home tonight.” Her panic subsided.
“You know, just like before, having resurrected all this today will likely make for an uncomfortable night tonight?” Dawn nodded. “Is there anything practical I can do or help you with that might make it easier for you to hang on until you come back tomorrow?”
Dawn wagged her head and replied “No. I don’t imagine it will get easier for a long, long time.”
“Listen to what you said.” I smiled. But Dawn didn’t smile back. “You said it won’t get easier for a long, long time…you didn’t say it would never get better. I think your heart might feel a wee spark of hope.”
Dawn set her elbow on the arm of the chair, sat her cheek on her knuckles and raised her eyebrows questioningly. “Sure Hattie. If you say so.” But there was at least a shred of amusement in her tone, which laid a wee spark to my hopefulness.
“One last question.” I hated to do this but I knew I had to. “We know this will be a rough night. Are you safe? Are you ok?”
“You called it Sister.” Her spunk returned with a fury. “I am strong and you said it, I’ve been surviving this for a long time… Safe? That’s a strange concept for me. But I will be here tomorrow. Same time?”
“Same time.” I stood. “Dawn, thanks. I know it was hard to tell me your story. I know it will continue to be hard to keep coming back to it. But I’m glad you did.”
“I’m glad I did too.” And she turned and left the room.
After she left, I addressed the required risk scales and as I expected, they were off the charts. Liability experts would rake me over the coals for letting her leave yet I felt that I had no choice. I needed to trust that she could handle this. Not that I throw caution to the wind all the time but this situation was one of the outliers that actuarials don’t cover.
Hattie knew to wait until after 9:30 to call Bridie. That way the boys were off to school and her home was a little less chaotic. The call went to voice mail on the fifth ring. Hattie left a cheery message saying she was checking in and wondering how things were; call back when she got a chance. Ten minutes later Hattie was in the back lounge behind the emerg care desk stirring a mixture of two percent milk and cream into her coffee, in an attempt to mimic the whole milk she preferred, when Pharrell’s lucky tune vibrated in her pocket. “Get Lucky, eh.” Larry Marshall quipped, looking up from the lab results he was scanning. “That oughtta be our theme song.”
“It can happen.” Hattie’s response was equally wry as she tapped the ‘accept’ button on her phone and picked up her coffee while answering. “Hattie Crawford; Crisis Services.” She was pretty sure it was Bridie returning her call but she had decided to concentrate her powers on keeping her uncommonly hot coffee in her cup rather than glance at the incoming number. She walked to the interview room down the hall while she and Bridie engaged in the conventional repartee required before settling in to a serious telephone conversation.
This week was busy for Bridie because she was in the middle of preparing the videos for her kids at the studio St. Germaine had developed. The process was interesting but hard. Shirley, the social worker assigned to the family had shared with Bridie some of the worries that her sons had shared with her, so Bridie was able to include these in her messages to them. She was surprised that one of Joey’s worries was who would teach Lynne ‘itsy bitsy spider’. So, one of the videos was Bridie singing this song for Joey but also giving the song to him to teach his own children. “As sad as it sounds, Hattie this exercise brings me peace. It makes me feel like I will be there for them long after I won’t be there with them.”
“It’s a great idea.” Hattie acknowledged. She was learning a lot through this process as well. But she was learning it with her head, maybe even her heart, but not her soul, as Bridie was.
“I spoke with Shirley about another round of radiation….” Bridie’s words hung in the air. “Doug was….Doug and I thought that since I felt so much better after the last round, we could do it again.”
“…and” I was pretty sure I knew the answer from my nursing training but there had been many developments in the last years.
“Shirley suggested I talk with the oncologist, Dr. Leung. They usually don’t do a second round at my advanced stage but I guess there have been experiments with radiation in someone’s last month for ‘quality of life’. There are side effects that might outweigh the benefits.” These last few comments had the ring of clinical commentary, absent of personal analysis.
“Even though I’m a nurse, I don’t know as much about the new ways of cancer care as I probably should.”
“Well, I guess repeated radiation weakens the tissue around the tumor. The radiation makes the tissue…less tolerant, according to Shirley, and according to what I read on-line. I am meeting with Dr. Leung on Thursday and I will ask him more then. I guess the problem might be something called a ruptured bowel, that could also kill me”…I heard her swallow…”but quicker.” the last syllable drifting away with her breath.
“What are you thinking?” I knew Bridie wanted to control the circumstances of her final hours as much as possible. She didn’t want her kids to witness her in intense pain and risking a ruptured bowel might certainly take her foot off the gas, so to speak.
“I don’t know Hattie.” She paused and Hattie listened as Bridie sat with the weight of it. “I just don’t know. Well, I do know one thing…” her voice faded off and she looked away.
“What does Doug think?” I asked, although I figured he would support any idea that gave him more time with his wife. And I felt like I had missed something but I didn’t know how to get back to it.
“I think he’s good one way or the other,” was Bridie’s surprising revelation. “We have been talking a lot about the practicalities of…of my situation and I know he will support whatever I think is the best for me, and the best for the kids. It’s taken a while Hattie but he is not in denial anymore and he’s on the other side of angry. Now we are just managing the practicalities.” Her voice was tired.
“Is there anything I can do to help?” I offered, feeling woefully below helpful.
“Hattie, its good to talk to you about all this. I can’t burden everyone with a trip through the workings of my mind. I confess though, I try out some of my ideas on you first, then it makes it easier to say them out loud to everyone else.” She chuckled, lightening the air.
“I wish there was more I could do…” My words hung in the air.
“I know. Thanks, Hattie. Can I make an appointment next week to come and tell you what I learned about another round of radiation?”
“Of course. Next week is perfect, I’m working afternoons, so Doug can come too.”
“Earlier in the week is better because next week has the Easter break and I think we are taking the kids to my mom’s so I need to rest up a few days before.”
I used my old-fashioned agenda to save the appointment next Tuesday at 1630 for Bridie and Doug. Then I ended the call, reminding Bridie to call if she needed anything at all. My special coffee, lovingly concocted with reduced fat milk and cream, had cooled to the point of no return. I weighed the pros and cons of whether to nuke it to heat it back up, or pitch it. Eventually, I realized I was stalling. “I’ll try nuking it.” I said out loud to myself. Convincing myself about the direction to take with the cooled coffer conveniently moving Bridie from prominence in my thoughts. The nuking was partially successful. I had avoided the scalding that leaves little floaties on the surface but the process didn’t get the mixture back to its original temperature. It was a fair dose of caffeine though, and that was in part the objective. I was relieved when Dawn answered my call on the third ring, before panic set in. She would be here to see me at 1230. Other than tepid coffee, this day was working out just fine.
At 1100 hours Rudy led our monthly Team meeting. The agenda is dominated by a show-and-tell of policy reviews, reports about compliance with workload data, assessment counts and contact numbers, outstanding risk scales and so in. Today we were introduced to a new category related to compliance with third party reporting also known as: is the hospital completing the requirements and getting the invoices to the employee assistance programs or EAP’s on time, so they can get paid. As it turns out, we have doubled our activity in third party work over the past three months and the hospital administration is “very happy’ according to Rudy. Rudy provided information about three upcoming conferences that we could attend if we had $850 spare dollars.
Sadly, despite the infusion of new EAP income, the education budget for nurses was lacking. “Do you think the hospital would fund us if we did a presentation about our work with EAP’s?” “I wondered aloud while I stared at the flyer for a conference in Toronto about Solution Focused Therapy. I wasn’t interested in that conference in particular but I noticed there was a concurrent workshop listed that would present productivity outcomes in workplaces that used a group therapy approach to problem-solving.
“I can ask Hattie.” Rudy noted my question on his note pad. Then he asked us if we had any safety concerns in our work area or any ideas for improvement. You can say this about Rudy: he swings both ways. He is a consummate corporate player but he can absolutely work around the rules to support his team, or the people they serve. Today, he had on his corporate hat.
“I had an idea…” I introduced when the question had hung so long in the air it felt as though no one else had anything to say.
“Last week we had an incident in emerg…”
Rudy looked nervous, not knowing for sure where I was headed with this. “There was a guy there who we finally sent over to the forensic unit at the North. He presented with a risk of violence but he didn’t act out. After it was over, I had a chance to talk it through with Viv, which I found helpful. It was good just to unpack it all and then let it go. The nurses down in the emerg had to put that incident aside and continue to deal with the other urgent medical issues that required their immediate attention. I offered to cover the phones for Kim, the Team Leader, but she was off to her lunch anyway. Anyway, it got me to thinking.
We recognize how important it is to debrief, or just rest our brains after incidents. What can be done to support other nurses? You know, people die down there…even after the code blue team has been working on them for a long time…and what do they get afterwards. Maybe a moment to sit down, maybe a ‘good work’ from the duty doc but usually not even a cup of tea. I think its wrong and I’d like to figure out how we can support our extended team, down in emerg.” When I finished and replenished the air supply to my lungs, I realized my idea had turned into a rant.
All eyes were on me. Rudy was smiling. Secretly, I think he was happy to chew on something that wasn’t ‘an indicator’. Although he likely knew in its heart that it wouldn’t see the light of day unless it became and indicator.
“Hattie, that sounds like a good idea.” Rudy announced.” I sensed the other shoe dropping. “Can you sketch that up and give me some detail? I’d like to share it with Dan Kennedy, the clinical manager in emerg. Let’s see what we can do.”
“Aye, aye!” I saluted. Then I sat back to accept the next component of the agenda; the part where Rudy gave us updates about the budget and any other important administrivia.
The hospice driver dropped Bridie off at the front of their house. He might have pulled in the driveway but it was littered with a GT sleigh and a hockey net. No kids in sight. “Are you my buddy again on Thursday?” Bridie asked the retired gentleman behind the wheel of the grey Kia.
“I hope so.” The weathered man smiled warmly. Ian was a volunteer driver for the regional Hospice program. He volunteered his time and hospice covered the costs of his mileage. Ian had retired in the Carter area. He was also a cancer survivor and this was his way of paying forward what he called his debt to life. His kind observations were comforting for Bridie while she was going through the palliative radiation. He knew a few tricks to deal with the nausea and burns. He was the one who drove her most often. She only thought about that now. Did they schedule it so there was some consistency in these long road trips? Not that she disliked the other people who drove she and or Doug and the kids. But Ian was a steady influence. He didn’t seem to mind that she preferred the back seat where she could spread out and close down. He was good with the kids. During the treatments themselves, she slept all the way home. Ian also didn’t get excited that because the seatbelt was especially uncomfortable for Bridie, she preferred not to wear it. He understood her comment ‘what difference does it make now’ without argument. One of the other drivers seemed offended when she didn’t sit in the front seat with her and had insisted Bridie buckle-up over her sore belly ‘because that is the law’. Yes, Ian had been a great support.
“I hope so too, Ian.” Gathering her things and unfolding herself from the vehicle was more involved than it had been say two years ago when she could jump and bound with the best of them. Now she took bending and unbending slowly and cautiously. Ian knew all this and busied himself with the notebook he kept up-to-date for hospice regarding each trip. “Thanks again Ian.” Bridie signaled her complete transition from sitting to standing. “I hope to see you Thursday.”
Bridie could hear the vacuum as she neared the back door. With the noise, no one could hear the door open and Bridie step inside. She saw first hand what her kid’s lives were like when she wasn’t here. First, there had been the driveway tangled with toys, now they were laid out on the couch and the floor watching a program about animals Both boys were glued to the close up of a crouching cheetah ready to bring down some kind of deer who at this moment was walking way too slowly toward a watering hole. Both boys flinched as the cheetah landed on the deer and latched on to its neck but Bridie noticed that Jamie looked a little away. She smiled recognizing he was more like her. Now some wild dogs were gnawing on what was left of the deer. The cycle of life…without the blood and gore of it, Bridie realized these babies were more exposed to it than they ought to be at this age. The love for her kids surged in her chest. When she was gone, this is how it would be.
The roar of the vacuum stopped abruptly but the boys didn’t even notice. Dianne walked out from the hallway leading to the bedrooms and saw Bridie standing in the foyer. “Shhh.” Bridie signaled to her putting her finger up to her lips, then pointing at the boys. Di caught her drift and continued past her carrying the vacuum back to the cupboard. On her way back, Di slid beside Bridie and hung her arm over Bridie’s shoulder. Bride dropped her head onto Di’s shoulder. “They just got home from school.” Di whispered. “They played a bit with the boys from next door and I hope you don’t mind I let them watch a bit of TV?”
“Not at all Di.” Bridie breathed into her sister-in-law’s shoulder. “I am so grateful to have you helping us out right now.” It had taken a while for Bridie to surrender the heavier work of being a mother. From the time Jamie was born she was fiercely independent. She barely let Doug pitch in with meals, laundry and groceries. She did the night vigils when the kids were sick. Doug accused her of being a martyr or not trusting him to get it right. Part of that was right, she smiled to herself, he put the plates in the dishwasher willy nilly. But right at this moment, Bridie wondered in her heart if she had just been greedy, grabbing every moment she could. Had she sensed deep in her consciousness where life was headed held tightly to her duties as her ration diminished? Now, she relied on everyone else to order her life. She hadn’t cooked a meal in two weeks and she couldn’t remember when she last inspected the dishwasher. She understood that her most important job now was to be with her kids, not fussing around them.
“I have dinner ready.” Di interrupted Bridie’s thoughts. “When Doug gets home he can just pop it in the oven…” Then as an after thought, “or you can pop it in…” Dianne had known Bridie too long and she understood the mixed feelings.
“I am good to wait for Doug.” Bridie conceded lightly. I’ll go watch the rest of this show with the kids.” Bridie left her carry bag in the foyer as she climbed the two stairs down into the family room. The boys heard her footfalls and ran to hug her, regaling her with tales of their day. Di swiped stray tears.
“I’ll fetch up Lynne while you get comfortable. Then I’ll make a quick tea before I leave.” Although Bridie had never said this out loud, Di knew it was hard for Bridie to bend over and picking Lynne up. She slid the offer of tea into the equation knowing Bridie wouldn’t say yes to one thing then no to the other. Bridie simply replied, “Thanks.”
Doug arrived as Di was leaving. When she asked if he would tidy away the driveway, his first response was “the boys need to come and pick up after themselves.”
“Not to worry Doug.” Di countered. “I’ll just slide everything in the garage on my way out.” To punctuate her offer, Di tiled her head toward the maternal cluster in the family room. “The boys are busy….”
“Thanks Di.” Doug muttered. His sister silently witnessed his shoulders deflate.
“Sorry Doug.” She reached out to touch his arm. “I’m so sorry.” And there was nothing else to say.
“Daddy, daddy.” Joey ran over to his father. “Mommy says Lynne has a new tooth! Soon she can eat broccoli!” This was an idea Joey clearly found hilarious because he collapsed into a heap of laughter at his father’s feet.
Twelve new readers are just now encountering the survey and I wanted to share their thoughts, with the hope that it may spark comments right to the blog.
3/4 of the readers work in healthcare, which is an increase from last time but it makes sense because that is the group I have been recruiting.
The story-lines that interest folks are Bridie’s experience; a realistic description of mental health work, and Emergency Dept work; and the relationship between Hattie and Jody
The character most identify with remains Hattie and next is Bridie. One person identifies with Jody and one person with Lowell (this person must have read ahead)
Other comments: would writing the story in the third rather than the first person open space for more analysis of the material – this is a good question and I’m mulling it over. Anyone have any option? Some other people must also have ready ahead and there are an equal opinions about the inserts (poetry and author observation). Two like; two don’t like – 8 are silent.
It took the lion’s share of the morning to sort thought the practicalities of the situation with Rick and how to manage his transfer, while safely and effectively providing care until that time. Dr. Roger Laskin was the psychiatrist we ‘recruited’ to complete Rick’s assessment. Roger had been around the block more than once and he was the perfect guy to get to the bottom of this conundrum. Also, he had worked over at The North, so he had a better idea about their forensic unit.
The police were prepared to lay the charge of ‘utter threat’ but they were reluctant to proceed based on their concern about Rick’s suicidality. Roger’s assessment could not rule out this risk. There was a special mental health court in the city that could turn these decisions on a dime but here in our small town those wheels turned much more slowly. And this delay meant Rick would either be in the local jail until a judge laid eyes on him, or home on his own recognizance. The officer I spoke with was pretty sure jail was the more likely option, bringing everyone back to risk of suicide.
Roger made some calls. The forensic unit at The North could accept someone on a Form 1, especially since there were charges. The police would apprehend him here and complete the transfer. The only fly in the ointment now, so to speak, was informing Rick and mobilizing resources to make it all happen. I had kept my new Team Leader friend Kim apprised of the negotiations along the way. As Rick had become more impatient about a resolution to his situation, Kim had become more concerned about how this would all go down.
Without ado, Kim had taken the proactive move of deliberately assigning new folks arriving in emerg as far from his bed as possible and had gradually been removing throwable objects or potential weapons. She had arranged for Security to be immediately available. I thought she had done a great job and I told her so. As it turned out, the police had a particularly calming influence. Three officers arrived at about 1145. Kim and I kept our distance. Rick listened to their explanation. He spat a few foul oaths then wordlessly accepted the handcuffs required by police. His uneventful departure brought an intense sense of relief. “Thanks Kim.” I said to the new Team Leader after it was over. “I feel a lot more comfortable dealing with someone who’s raving than such an angry person.” I noticed a tremor as Kim reached out to steady herself into a chair behind the care-desk. “You Okay?”
“I will be.” She replied. “This is the first time I’ve done this, up close.” Reflexively, she took a deep breath. “It’s a big responsibility.”
“Yes it is.” I agreed. “You handled everything well. I was impressed by the way you swept the area around him and lowered the risk. That was some cool thinking.”
“It was, wasn’t it?” She smiled; proud of her work. “I don’t know how but I remembered that from crisis intervention training we had….mmm maybe two years ago. It sat in the back of my mind until now.”
“Funny how we store stuff up ‘til we need it.” I smiled back. “If you like, I can sit here and manage the phones and direct traffic for a bit while you go grab a cup of tea.” I offered.
“My break is coming up at 1200 anyway. Thanks Hattie.” She stood with more assurance but before she walked away she added “Thanks again. I learned a lot today.”
When I arrived back at our crisis office, Karen was on the phone but she made the gesture of ‘sit right here and don’t go anywhere until you tell me what’s been going on’. It was a complicated gesture but I understood and heeded it. As it turned out, Karen’s morning had been relatively light. She was just finishing off a phone conversation with someone who had left a follow up message on our machine. Well, not our machine anymore, our phone system. When she had arranged an appointment for the person on the other end of the line and confirmed their contact information, she hung up and turned to me for details. These I easily provided. It was important to rehash such episodes with a peer. First, it always gave us ideas about what we might do the next time. But also, in the re-telling, we get feedback to allay our fears and worries, mostly worries about aggression. I also had a chance to sing the praises of Kim. Praises that escalated when I logged into my email and found the notice from the incident report system correctly indicating a level 2. I contributed my notes electronically and added Kim’s name and her actions in the section noting ‘what went well’. By now I felt I’d earned my luck break, so I took it.
It was a glorious and sunny day. I pulled on my parka and went for a walk. South Carter hospital was appropriately nestled at the South end of town, in an older residential neighbourhood. Some of these homes had been around since the sea captains and timber barons ran the community. The sun was so warm I unzipped my jacket. It felt like Spring was officially here. This realization drew my mind to baseball and it was a very short leap to Bridie and her plan to celebrate her son’s birthday at the game May fourteenth. The Easter weekend was coming up and after that their adventure would be about three weeks away. I made a mental note to call Bridie this afternoon and check in. Rosy-cheeked and full of energy, I returned to my duties. Well, my first duty was to bolt my sandwich.
After lunch the rest of the day unrolled smoothly. Rudy dropped by to get filled in about the incident this morning. He seemed in good spirits, hanging around after my report to tell war stories with Karen and I. Funny how we all do that after an incident. And it’s interesting how experiences of risk make us laugh after the fact. We are much braver people in retrospect. These precious moments drew us closer as a team. It was a luxury I realized the nurses in emerg didn’t have. This wasn’t a problem I was prepared to tackle today but I stored it in the back of my brain for another time.
My last appointment was the no-show from last week. She had responded to one of my messages and agreed to see me today. In our very brief conversation on the phone, Dawn confirmed her need was not urgent; this was a long-term situation. She denied being actively suicidal, although she endorsed frequent thoughts. She filled in the blank about her treatment history. Dawn had been in our inpatient unit four times in the past five years, each admission she described as “awful”. She had no wish to return. I presumed this contributed to her guardedness. I felt a small twinge of worry, which motivated me to start making calls to her various numbers. I could only leave messages. Five minutes later, when I heard Farrell singing and saw the display with one of the last numbers I dialed, I breathed a sigh of relief. It was Dawn. She had fallen asleep and was running late. She would be here in twenty minutes. Ordinarily, my shift would be finished fifteen minutes after she arrived but after my wonderful walk in the warm Spring sun I was feeling generous.
Dawn arrived a half hour later, apologetic. She didn’t look like she has just woken up, in fact her hair was nicely pinned up and her clothes meticulously ironed. She seemed alert but maybe not so eager to make new friends. I began the usual drill of confirming her demographics and having her sign the appropriate paperwork. I hadn’t had a chance to retrieve her previous file so I asked her to fill me in on the highlights of her history. She provided a concise reiteration of the information she had provided on the phone: some risk of self-harm in the past, not immediate; some misuse of drugs and alcohol and a history of childhood sexual abuse. “Sounds like none of this is new to you.” Dawn nodded. “So why call now? Has something changed?”
“When I called I was having an anxiety attack. It happens now and again. Mostly I can manage it but sometimes I just need to hear someone else say I will be ok. That’s about it.” Her explanation was too neat. I needed more detail to find the real bits.
“How do you usually manage it?’ I used her words to get her talking.
“I try to avoid it. Mostly I try to avoid any situation that gives me anxiety.” And she paused again.
“And how do you avoid situations that give you anxiety?” I presented my quizzical face.
“I stay away from people.”
The pleasant effects of my sunny lunchtime stroll were slipping away. I sat forward in my chair, planted my chin in my hand and waited.
“I avoid people.” She reiterated. “I don’t answer my phone. I don’t answer the door. I don’t go out. Sometimes I stay in bed all day.”
“How long have you been living like this?” Her disclosure had earned her another question.
“I’ve had anxiety all my life. I used to drink a lot more; that brought me out of my shell. I’ve been in my place for six years now and I’ve never really gotten used to living alone, even though I prefer living alone.”
“Tell me about the anxiety. What does it feel like?”
“It feels like anxiety.” She revealed a slight but obvious impression of impatience.
Recalculate. “I ask that because sometimes when people experience a long history of anxiety they lose track of what it feels like to their body; they just get used to reacting to it because it is so overwhelming.” It was true. So many people were unable to actually describe their experience of worry, or the more clinical nature of anxiety. It made it more difficult to tackle when it remained a nebulous threat. When no further detail was forthcoming, I helped her out. “You know like does your heart race, do you feel light headed….”
It was time for a different tack. “Dawn, when you have been admitted to hospital before, was it because you were anxious?”
“No.” was her immediate response. Followed by “Yes.” Behaviorally, she was getting edgy. She crossed and re-crossed her legs and it looked like she was wringing her hands under the table.
“Hey Dawn.” I said gently. “Something is going on for you. I know its been going on for a long time and I won’t promise we can fix it but maybe if we work together you can manage it a bit more comfortably.” She visibly tensed.
“I will not go back in the hospital. I can tell you this…” Her voice was rising. “…being locked up didn’t help either. I never shoulda come here…” She stood abruptly. I did too.
“Dawn. I have an idea.” She stopped and looked at me, her eyes filled with terror. I felt guilty about my impatience. “Dawn, sit down a sec and let me give you a minute to gather your thoughts.” I was buying time, wondering what Viv would do.
I sat back down as a signal to her to do the same. Miraculously, and with all my gratitude, she did. “Dawn, I agree that the hospital is not the best place to work on the kind of problems you describe.” She drew a long breath. “But…” her fear returned. “But it is a place where you will be safe.” I noticed her running her right thumb rapidly up and down her fingers, as if they were too hot to touch. “I know you are freaked out right now but are you safe?”
She paused for at least a minute before she answered. “Yes. I am safe.”
“Bear with me for a bit longer. I just have a few more questions and then I think we might try something different. Not admission to hospital. I would like you to come in to meet with me every day this week and lets see if by the end of the week we can create a plan that might bring you a little more comfort.” She continued to stare ahead.
“Dawn?” I really wanted to engage her.
“Okay.” Was her only reply.
“Let’s start with this: how did you muster up the courage to come here today?”
“Ativan.” Not an unusual strategy for folks with intense anxiety.
“3 tabs.” Well now we hit less than usual. Three tabs was a fair whack of antianxiety med but she didn’t look over-medicated so I was prepared to entertain it if it worked. “Well, it worked. Do you have enough to last you for a few days while we get started…if not I can arrange for one of our psychiatrists to look at your meds….what other meds do you use?” I was almost reluctant to learn more knowing it might ring some alarm bells.
“I will bring all my pills with me tomorrow. Right now, I have to go. I am safe. You don’t have to worry. I have lived like this for a long, long, long time. I can last another week.” Before she took her leave, Dawn turned and looked me square in the eye. “Thanks. See you tomorrow. Same time?”
At the risk of disrupting our apparent agreement, I said, “Can we aim for 1230?”
Before her small shadow had disappeared I called after her “I will call to remind you.” Now, how was I going to document this? Sometimes a session starts with a prayer; sometimes, like this one, it ends with a prayer. I had to trust Dawn. She had lived with these experiences for many years. I had to trust she could live through them for one more day. But I would definitely retrieve and review her file before we met up tomorrow. Damn. I thought to myself as I readied to leave for the day. I meant to call Bridie. Maybe emerg would be quiet in the morning and I could do it then.
This morning marked the first shift that Linda Berwick ought to be working but wouldn’t be. No one mentioned her absence or made any remark to me. Karen was my partner today and I went about my business reviewing the notes and assessing the single person held over in the department while Karen began the process of telephoning the folks that Tom had seen over the weekend and sent home to wait for our follow up calls. The young man waiting for assessment was a young guy, twenty-nine years old, named Rick Morris. He was apparently in a fight yesterday and made threats against his ex-girlfriend and himself. He looked a little worse for wear. His clothes could use a wash and his hair hadn’t seen a comb in a while. A shiner was well established under his left eye. “Did you win or lose?” I opened.
His glare suggested the latter. “Sorry. I shouldn’t have joked.” I attempted to recover. “Hi Rick. My name is Hattie Crawford. I’m one of the crisis workers on duty today.”
“I’m ready to go home.” The glare persisted.
“Hmmm. First, we need to know that sending you home is the best plan. I understand you were making threats to hurt other people as well as yourself. The notes suggest you were in a fracas and made some threats. The police brought you here. Can you tell me a bit more about what’s been going on?”
He turned away dismissively. I let it sit for a long minute. “Its kind of a light morning here.” I mused, taking a bit of a risk. “I can sit here and wait, or I can come back in half an hour…either way, your departure relies on my assessment. Do you have a preference?”
Nothing. “OK. I’ll be back.” At the care desk I asked Kim, one of the nurses, about Rick.
“He has been cooperative all night. Just laying there. The head-injury-routine shows no outstanding neurological issues. We haven’t been able to get much out of him but what he says is generally coherent and oriented.”
“Who’s the duty doc?”
“Dr. Burton was here all night. I think he’s still in the back room. Dr. Marshall is coming on duty.”
“What do you think is going on with our friend Rick? I asked Kim.
“Honestly, I don’t know. I’m good at assessing if he has a head injury but I’m not the best judge of his…of what’s going on inside his head.”
“Do you know if Dr. Burton did the Form 1?” A Form 1 was an application for psychiatric assessment, which meant a person could be held, more or less, until a psychiatrist either said they were okay for discharge or decided they needed further involuntary care. Because we have our own mental health unit and psychiatrists on staff, our emerg didn’t need to send folks along to the psychiatric hospital the way some smaller hospitals did but that still didn’t mean that it was always so easy to get a psychiatric assessment on someone in emerge.
Before I tracked down the duty doc, I decided to take one more run at Mr. Morris. “Hi again Rick. It’s Hattie.” I started again. “I know you want to go home and I want that for you too but I just need to understand a little more about what happened yesterday.”
When Rick rolled toward me, his demeanor was different. The edge was gone. “Listen, this is hard for me. I can’t really tell you what happened because I was drunk. My girlfriend walked out last week and I found out one of my so-called buddies was banging her.” I tried to stay focused on his words. “I called him up and when he came over I punched him in the face.”
“…and he punched you back….” I ventured.
“And he punched me back.”
“Strange as it seems, I understand that part.” Start where he is. “It sounds like a bit more went on though. Otherwise, I think you would be somewhere other than a hospital…”
“I told you I don’t remember.” The edge had returned.
Time to backtrack. “The police officer who brought you in agreed you’d been drinking. I’m not sure he knew you were so drunk you wouldn’t remember what happened. But he told the doctor that you said you would ‘take her out’ which the doctor assumed was your girlfriend and ‘take out myself’ which he expects is you.” He sat up abruptly and I took a quick step back away from the bed.
My reaction caught his attention and he presented a more reasonable nature. “Listen, this is all blown up. I’m not taking anyone out. I was drunk and I said some stupid things. Now get me out of here!”
“Before we go there, I need you to bear with me while I ask you a bit of history.” Rick Morris was not warming my heart this Monday morning. His clipped answers did not establish obvious evidence of suicidality but did reveal a pretty high index for aggression. He casually noted two short hitches in jail for assault. He denied partner abuse, despite acknowledging he had been ordered to a treatment program typically intended for men who abuse the women in their lives. I didn’t have a good feeling about this guy. “Okay Rick. Thanks for helping me out with this info. Dr. Burton was the physician you met last night. He still might be here but if he’s not, I’ll share what you’ve told me with Dr. Marshall and he’ll come and see you.
I found Larry Marshall gnawing on a bagel in the room behind the care desk, listening to Mickey Burton describe the events of last evening, specifically the patient with a “nasty” GI bleed that he sent off to Kempenfelt for emergency surgery. “Hattie.” Mickey interrupted himself. “…Did you see that guy yet?”
“Rick Morris.” I reminded him. “Yup. Just finished. I don’t have much more than you though.” I turned to include Larry, the on-coming duty doc. “Did you know he has a history of assault and incarceration? He says he never abused his girlfriend but he said he was ordered into the PPA program…” I answered Larry’s question before he asked. “Preventing Partner Abuse. It’s usually a court ordered program for guys who are violent and abusive to their girlfriends.”
“Suicidal?” Larry queried.
“He wasn’t a compliant candidate with the standard assessment but I don’t have that impression.”
“Homicidal” Larry countered
“Angry, aggressive and historically violent. But I don’t get the impression he is homicidal at the moment.” Which was just my opinion. “We do have a protocol to follow when we feel a woman is at risk from a partner though….I just need to pull it up.”
“Well, Larry…I gotta get going now…” Mickey slunk toward the exit.
“Stop right there, Pal!” And Mickey did.
“You’ve been at this longer than me. What are my options here?” Larry asked.
Mickey described the option of a Form 1; essentially relying on a psychiatric opinion regarding the guys risk of harm to himself or others. If that risk was present, it was possible to restrict a person’s liberties. “But there is one other option, based on Hattie’s information.” Now I was curious too.”
“I only know this because we did it last week in the city.” Mickey Burton worked part-time relief as an on-call physician at St Germaine Hospital in Toronto so he saw situations that were more exaggerated to our typical fare. “Call the police and see what the charges are. Depending on their answer, they could request a forensic assessment. I think we would just need to confirm that he is not suicidal, then they would keep him until a judge ordered transfer to the locked unit over at Carter North. Hattie, tell us more about this protocol…”
We re-read the protocol I had pulled up on the computer screen. I was clear that in a situation where we as care providers were aware that a woman was at risk for violence from her partner, we must engage police and notify the potential victim. Even though the police were already engaged, technically, we all agreed we needed more in-depth consultation with them. After that, we would connect with the potential victim, the ex-girlfriend. The discussion worked its way around to a psychiatric assessment first, which I agreed to facilitate. Since knowing how the police wanted to proceed might affect the outcome of the psychiatric assessment, Larry checked in with the police first to determine their thoughts on the matter.
I also advised Larry that the policy was clear that now that he was on duty he was the most-responsible-physician, or MRP, so he was the one to call Rick’s ex-girlfriend and warn her, unless Mickey was prepared to stay and do so. We both leveled a glace at Mickey who shrugged off his coat and sat back down. Again, it might be helpful to talk with her and hear more about the incident than we seem likely to get from Rick before the psychiatrist conducted his or her assessment. I suggested he give the woman our crisis number as well as the number of the local shelter and let her know I was here all day, so if she wanted to call she could ask for me.
Larry thought the charge might be “uttering threats’ based on Rick’s history. Then, based on where the two points of legal and mental health interest collided, we would mobilize resources to consider specific risk assessments. Mickey finished his calls, reported back to us that the girlfriend already knew what was up. She reiterated what the record already showed. Rick showed up at her place, punched her new boyfriend and said he would ‘take out’ her and himself. She now had Hattie’s contact number and the police had already given her information about the local women’s’ shelter. She seemed ok for now. Then Mickey made hay.
When I arrived home, Jody and Roland were working away at the dining room table. Jody was hunched over a legal pad with notes, Roland leaned over the same notes, hinged at the hip guarding his flawless posture. He also had a short heap of loose notes to his right. Three stacks of thick and narrow paperback books, probably the novels they were considering as texts, were arranged between them. Two-thirds of a large pizza was cooling in the box on the sideboard. I pecked them both on the cheek and examined the pizza for preferred content. “It’s half veggie.” Roland contributed over his shoulder, solving the puzzle of why I was examining the pie.
“You two been at it long?” I asked as I took my first bite of pizza. The cheese was still warm and left a string of residue as I pulled the piece back from my teeth.
“We got here around four or four-fifteen.” Jody sat back and gave me her full attention. “I’m ready to take a break.” She smiled. “How was your day at the shop?”
“Frau Blucher has transferred and won’t be bothering me again.” Jody caught the use of our code-name for Linda Berwick.
“Frau Blucher? The housekeeper from Young Frankenstein, who made the horses go berserk?” Roland asked.
“A woman very much like her.” I immediately regretted introducing the topic in front of our guest.
“I like Cloris Leachman.” Roland was off on his own tangent now and I could relax. “She was perfect in that role. You know Blucher is German for ‘glue’ and that’s why the horses went apeshit when they heard her name.” Roland continued as he sorted his notes into two piles. One pile was obviously for him and one obviously for Jody. “But I preferred Marty Feldman’s character. His hump was always changing sides.” Roland chuckled, most to himself.
“Any chance you can use Young Frankenstein in your new course?” I was eager to keep the conversation from drifting back to me, and my conflicts at work.
“If there was, you can rest assured we would.” Jody added in mock seriousness. “We haven’t really talked much about films to use. Going with Maureen’s thoughts about pairing the historical with the literary, we are choosing through the novels first. Since Tale of Two Cities was embedded in the curriculum, we ought to find a film about the French Revolution…I can happily research that one.”
“Two Solitudes or The Stone Angel are typical Canadian content.” Roland mused out loud.
“We always called it “Stoned Angel.” I cut in with a snort. Roland was not amused by my adolescent recollection and delivered a look of full disdain.
“Who will rid me of this meddlesome priest?” he muttered under his breath.
“A little harsh Roland.” Jody chastised with a smile. “Remember, Beckett became a saint.”
“Stone Angel has its own movie….so does A Handmaid’s Tale.” I continued, ignoring them both.
“The movie must be a compliment though, a device to highlight the relevance of the story. Not a reiteration of the story.” Jody was talking more to herself than to us. “Mississippi Burning against To Kill a Mockingbird…” Jody was also thinking out loud. Then, with delight she turned and announced “Did I tell you Hattie, Luke McGinn the new History teacher is on board and interested in joining up to develop the pilot course?”
“That’s great news!” I was delighted. This project was something Jody could get her teeth into. “Will he be here next Friday night? We’ll need more pizza!” And I bit into another slice. How about the Art guy?
“Dickie Vereen?” Boomed Roland. He’s still under a rock somewhere!” Both Jody and I were a bit shocked by Roland’s derogation. It was certainly not characteristic. But then Roland collapsed in laughter and we knew he was back to normal.
After we had all taken a few more cracks at films and Art to match the established novels recommended by the curriculum, and after we suggested a few more novels or films to add for good measure, Maureen arrived to fetch Roland, and Jody and I were left to our own good company. I explained the situation with Linda Berwick. By neglecting the nickname Frau Blucher Jody knew I was serious. “I wish we had been invited to talk this through like adults.” I shook my head miserably. “I feel like the problem has just been shuffled away to….I don’t know, like to protect me, keep us apart.”
“Frankly Hattie, I think that’s a good start.” Jody reached for my hand. “You have to trust Rudy. You know that if he thinks there’s a chance this can be resolved any other way he will make it happen. Sometimes….”she paused to chose her words. “Sometimes, you try hard to fix what can’t be easily fixed. Sometimes changing someone else’s mind takes more than you telling them why they should.”
I looked her square in the face. “You think I should let it go when she has made derogatory comments about our relationship?”
Jody’s chuckle surprised me. “If she were the only one, I’d say go catch her up but Sweet Jesus Hattie, we are out there!”
Without getting into detail or naming names, I told her about my conversation with Lowell and his struggles and dilemmas. “He’s not alone in that Hattie. I still get odd looks and I over hear side comments. Sometimes people feel like it’s a good thing to tell me what is said behind my back. It’s just the way things are right now in this stupid world. Let Frau Blucher’s skunk-eyed face freeze that way. You and I are having a pretty good life.”
“Now there’s perspective!” I was comforted by Jody’s disclosures. We didn’t always stumble into conversation about the depths of prejudice that existed. “Do you think it is harder for a guy?”
“Absolutely!” Was her immediate answer. “I can only imagine what that poor cat is going through. People jump to the wrong conclusions over just about everything – especially now that we operate in sound-bites and Facebook posts and not real journalistic critique…”
“Whoa Nellie! You have to sleep in about an hour. Don’t shoot your blood pressure off the map.” I interrupted. “But I do agree.” I resumed the conversation a bit sideways from where we left off. “People take a little bit of information and shape it to fit the common stereotype, even when it takes them down the wrong path. Maybe even especially when it takes them down the wrong path. In mental health, people think they have a bipolar disorder because their mood swings up and down but they don’t stop to think about why and with whom their moods are shifting. Then they argue with me when I suggest otherwise. Like they really want to have a bipolar disorder! They just read a description and don’t do the analysis….and then they want tablets to make it right instead of exploring when and with whom their mood changes…”
“OK.” Jody’s raised hands signaled time-out. “Watch your blood pressure! We can solve all the social problems tomorrow. Right now, I am ready to hit the hay.” As she started toward our room, she turned abruptly to announce: “I sent my poem to Arc poetry magazine…”
“That’s fantastic! How long before you hear back?”
“Dunno. I’ll keep you posted.” Her immediate departure from the room signaled the end of the conversation. I knew well enough that she would worry until she heard back, one way or the other, and unlike me Jody was a private worrier.
Now it was time to find Rudy. I caught him as he was packing away his week of incomplete work that would get some attention over the weekend. “Hey.” I called as I approached the open door. “You were looking for me….”
Rudy motioned me in and sat down, which I took as an invitation to do the same. “I wanted to fill you in on something. Pull the door, will ya?” I reached behind and closed the door, wondering which of my many misdeeds he had become aware of.
With our privacy secured, Rudy began. “I just wanted to give you a heads up. Linda Berwick has transferred from emerg to the medical floor.” My silence, and my shocked face, invited more detail. “This was her request…officially. But in reality, when we met with her to review the incident last week, you know the one: with the cops and the nurse from the unit upstairs…and you…” He punctuated the final word by pointing at me with a flourish. “…she said a few things that led us to believe maybe emerg might not be the best place for her to…exercise her skills.”
This was certainly not the conversation I had been expecting. “Tell me what you can Rudy. I understand this isn’t any of my business….unless it is?” I emphasized the last point with the raised eyebrows of a question when I heard the comment come out of my mouth and realized there could be more to this.
“Well, it is kinda your business.” He hesitated before proceeding. “But really, she has been wanting out of emerg for a while, apparently. This last incident just accentuated the problems with ‘fit’.” He sat back in his chair and I realized I hadn’t properly noted the intensity of his presentation. “Listen, there’s more to this. Some of it is what she said about the incident, some of it is what she said about other nurses, some of it is her wish to reduce her exposure to conflict, some of it is personal for her.”
“Can I even know how this relates to me, since it obviously does? At least, in part.”
Rudy’s long exhale, pulled his face into a serious grimace that told me he wanted to spill. “I’m not at liberty to disclose the details…”
“But you know I will hound you until you do.”
“The facts, as they relate to you, include a derogatory reference to your sexual orientation, which is inappropriate and against hospital policy.” He stated without emotion. “She did not make the reference to you; that is why you weren’t included in the investigation. She made the remark to one of the other nurses in emerg, who brought it to her manager, Dan’s attention. He brought it to Beth-Anne, who was already steamed about the coding of the incident…this was why I needed you to steer clear of the situation until after we completed our investigation. I wasn’t trying to brush you off. Hattie.” That explained his earlier reaction to the incident report. He already knew about Linda’s comment and he had my back.
“I get it Rudy. Thanks for your support.” I was genuinely touched. “I’m grateful for the nurse who turned Linda in too. Can I know who it was?” I wanted to send flowers.
“I’m not supposed to disclose any of this. But I know you will dig around until you get the answers you are looking for, you can be as tenacious as a personal injury lawyer.” I tried to look hurt but in truth I think he nailed me. “Here is what I can tell you: you might want to check back with the people who were directly involved in this incident…”
“Jack!” I deduced.
“I’m not saying.”
“You know what, I need to follow up with Jack to see if he was ok with that incident being changed from a four to a two.” I crowed, while Rudy smiled and shook his head, amused. “But Rudy…” another thought had reached my creaking brain. “Just because Linda is on the medical floor doesn’t mean I won’t cross paths with her again. And, she can’t just get her way with a transfer after comments like that.”
“The only detail I can tell you is that she was transferred. I couldn’t tell you, for instance, if there was any other discipline…or correction.” Rudy’s voice was firm and I knew not to push it. This was code for: she got some other comeuppance that I had to trust was fair but none of my business.”
“Thanks for letting me know Rudy. I expect we will cross paths again and this way I can measure my words.”
“That’s a lot to hope for!” Rudy laughed out loud.
“Cross my heart!” And I did. I understood the way institutions worked. I understood how people worked, mostly. Linda was peeved with me, either because of the incident or because I was a lesbian. I might never know for sure. I wish I was the one in control of handling it with her rather than the hard hand of a transfer. Unless Rudy was right that part of her wish was to get out of a very stressful work-site. Anyway, as the wheels of hospital politics turned, I was but a cog. And I understood that an errant cog can jolt the whole contraption into the ditch. So I let it go, just like Jody had so wisely instructed me, citing the cute monk. “See you Monday, Rudy. As you may have heard, I have a job to do” I added over my shoulder, smugly. With that, I strode back to the cubbies, armed myself with two pens and my binder stuffed with ready-to-access forms, a list of essential phone numbers and notepaper. The rest of the shift was quiet and uneventful.
After Bridie left, I finished my note and sent off an email to Shirley, the social worker with the oncology team at St. Germaine’s hospital, noting our session and thanking her for the idea about the videos. Lowell was slouched in a corner chair when I walked out to see if he had arrived. The slouch, it turned out, was not an emotional retreat just the affectation of a teacher on a Friday afternoon. “I’m well.” Lowell proclaimed brightly. His connection with the LGB teachers group had bolstered his mood and his confidence. The news he was looking to share was a new relationship that he was a) hoping would be meaningful and b) hoping would facilitate transfer back to the city, where he could exist with a bit more anonymity.
In part, Lowell was justifiably irritated by what he saw as an unjust situation. I was happy to entertain his critique, having travelled that road. “How do you do it?” He mused, casually.
“Do what?” I replied, aiming for innocence.
“I know you are gay. I’ve known for weeks. Why didn’t you say anything?”
“What gave me away? The haircut?” I smiled and fluffed my short, almost-locks.
“No. I ran into people who know your partner – did it escape you that my situation is similar?”
I can’t run; I can’t hide! “Well, Lowell. You are correct.” Was I imagining his smug look? “My partner and are I are lesbian. She is a teacher at the high school and yes, she has experienced some of what you have. But clearly not all of it.”
“Do you think it might have helped if you had been straight with me? Excuse the pun.”
“That’s an interesting question.” I busied my hands piling up some stray paper on my desk and moving it to the side. “Actually, I wondered myself, early on. But I decided that my job is to hear and respond to your experience and facilitate your own conclusions based on what you are thinking and feeling. Mixing it up with my own experience may not have brought us to this same outcome. What do you think? Would it have made a difference?”
“I don’t know.” His curiosity was genuine.
“Say for instance,” I was curious about this myself. “…say I had shared my experience and inadvertently encouraged you to stay in Carter, to tell your principal the way I told my boss, and it had turned out badly. What if, being ‘out’ at school was a negative experience and made you very unhappy? What if, in despair, you had gone on a bender and harmed yourself. I wouldn’t have served you very well.”
“Do you think there’s a difference between me being a guy and you and your partner being girls?”
I did not want to go there but I didn’t know how to back out. Hesitation on my part would instantly telegraph my opinion. “You know the part you said before about unjust realities? I think the way we gender sexual orientation is similarly unjust…in fact, the way we gender people is unjust. As women, we are seen as less of a threat than a man is – not that I in any way see you as a threat.” I added quickly as I saw a flicker of angst in his glance over my shoulder to the painting on the wall.
“I know. That’s what hurts. I’ve even considered changing my career but I enjoy teaching and I am good at it. If only people could understand. My interest is absolutely adult males!”
“I guess if I were including myself in this discussion, which given your previous comments I am assuming you would endorse, I would say: what can we all do to change it?”
“Don’t even dream of trying to talk me into staying in Carter and making a stand…”He started to laugh…”Carter’s last stand!”
“Pretty good, for a school teacher!”
“Yeah, we can be funny too” Smirking. Then he resumed being serious again. “I can’t do it Hattie. I am not the fighter I want to be. I wish I was. I think I’m a turn-tail-and-run kinda guy. I’m not saying this man I met, this adult male…” He added with emphasis. “I’m not sure this is a relationship that might last but I’m pretty sure after the last few months that I may not find someone to have a relationship with here. I’m not saying I might not return another time but I need to grow a few more thorns first.”
“Thorns?” I didn’t catch his drift.
“I need to get more motivated to pursue my anger in a healthy way. I need to be more prickly – not just a pretty rose.” He smiled. “Right now I’m just angry, and frustrated, and disappointed.”
“And Pretty!” He laughed. “What can I do?” I wondered.
“You and your partner are already doing it. Thanks.”
“I meant what can ‘I’ do to help you with your decision, right now?” I pointed at my chest for emphasis. “Me. Crisis Worker, Therapist.”
“If you are asking about staying on in therapy, I think I’ve worked it through. I’ve made sense out of it all. I don’t like it but I understand the current state of affairs. In retrospect, you were probably right to keep your personal life out of our conversations. I felt safe with you because I knew we were similar but because you didn’t throw your own stuff at me, until I asked, I did in fact come to my own conclusions. And, just to sum up, clearly: I am not an alcoholic, I am not suicidal, I am a gay man looking for understanding. And in looking for understanding, I am moving on to a more anonymous pasture. You can close me out and send the insurance program my bill.”
“Glad to hear it. Lowell, it’s been a privilege to know you. I wish you well.” I stood with my hand out. Instead, he reached over and delivered a hug.
“Thank you Hattie. This did really help.” And Lowell was off to finish the term in Carter, then pursue his other dreams.
I readied myself and got out the door in record time. A nice part of living in a small town was the six-minute commute. The office was empty when I arrived. I wasn’t sure if that was a good omen or a bad omen. In general, Fridays were a busy day. First, the emerg was busier because people left worrisome pains and complaints until the end of the week, probably hoping they might go away. Second, we tended to overbook our follow-ups so that we could connect with folks we were worried about over the weekend. We were lucky to have some excellent relief crisis workers who covered the weekend shifts. They were very good at recreating what we ‘regular’ weekday crisis workers would do with folks we were following. Nevertheless, we often sent emails or put ‘flags’ on a file to alert them to risks or remind them of strategies that worked. Amy Brixton was one person for whom this system of inclusion has been very helpful. Since we started comparing our notes and systematically putting the work back on her and her peer supporter Sandy, Amy and Jordon have been managing their typical mother-son conflicts much better and Amy herself has been coping exceptionally well. She joined a Recovery Group that the peer supporters facilitate on Saturdays. Adding that with her other consistent support has really turned the table for her.
Jenn was probably at lunch so I could easily slide into my chair as though I had arrived early. When I logged into the computer I faced 87 emails, among which was a request from Rudy to meet up at some point this afternoon. Last year, we had a summer student in the program who taught me how to code my emails so any message from Rudy came in with a purple dot. That way I could see immediately all communication from my commander. My schedule was jammed so I typed back asking for a ‘drop-by’ if I could manage it, or suggested my breaktime at around 1630, right about the time he would be out the door. If I was losing my break, surely he could delay his departure, I thought wickedly. Such requests from Rudy were not unusual. Because we worked shifts that covered the program from 0700 to 1900 hours many times our overlap didn’t match his schedule. Rather than send out emails or memos Rudy was good at hooking up and telling us what we needed to know face-to-face, which was up my alley in terms of supervision.
Jenn resumed her duties after lunch and I went though my expected appointments with her. Then I settled into a three-hour series of scheduled sessions; three follow-ups and one new assessment. After my break, I had both Lowell and Bridie booked in before I blitzed emerg for new crises. The first fella was a nice young man who was going through a difficult separation and not handling it well. He’d called the crisis line two days ago and after a quick telephone assessment it was decided he was okay until today. Face-to-face, he really was a nice young man but clearly at a loss to understand why he and his girlfriend were separating and not really invested in talking with her about it. It felt like I was giving more of a pep-talk than counseling, so I put that out there. “I’m missing something here. I need a little more detail so I can understand your experience. I feel like I’m just pitching you ideas and you are giving them back to me.” This was an easy trap to fall into in our line of work.
His response was partially productive “I don’t know what happened…all I know for sure is she is moving out. I think she might be seeing someone else but I’m not sure.” I kept pushing, hoping to find an edge to grab. The couple had been together only a few months. They hadn’t known each other well. Sounds like they didn’t talk much to start with. Maybe they just ran out of gas. I posed a few other questions, embedding my risk scales in as insidious a way as possible but when I still couldn’t get very far I started asking more obvious questions related to self-harm and safety. As it turned out, the most pressing issue for my guy right now was housing. Go figure. There were resources for that and after helping him make a plan to negotiate staying in their apartment until he found something else, he left happy. I did agree to call back in a week and see how things transpired.
The second fella had shown up in emerg a few days ago, intoxicated and rambunctious. When he sobered up enough and agreed to this meeting, we sprung him. Here was where I expected my no-show. I just finished my note on fella number one when Jenn rang to say “Duncan is here for his 1:30 appointment”. When I walked into the waiting room to fetch him I was shocked to see his condition. He looked like he hadn’t slept since he walked out our door. His hair was messy and I wondered if he had showered. Inwardly I suspected he had continued his bender. I was happy to learn however that he had not had a drink since the police hauled him into emerg. His family had stepped in and pointed out to him that he was on the wrong train and had to change his ways or else. His presentation might be indicative of alcohol withdrawal so I had another series of questions to ask to assess that risk. Yes Duncan was experiencing physical illness, nausea, vomiting and diarrhea. He had ‘the shakes’. He felt confused and had tightness in his chest. Duncan revealed quite a heavy history of alcohol abuse that confirmed for me he was very likely in withdrawal. The next question was the extent of the withdrawal and what the best response was. There was no detox centre in Carter but we had a back-door phone number to the detox in Kempenfelt, the larger town further South. I explained to Duncan that we needed to check this out and he sat with me while I called my colleague.
The detox counselor took my information then asked to talk to Duncan directly. He took the phone and I could hear him answering questions that resembled the scales I had already asked him. The answers remained the same. I wasn’t sure where the next questions were headed but I heard Duncan saying “yes, that’s right, OK. And OK.” Then he handed the phone back to me and the counselor informed me that Duncan was a good candidate for transfer. Duncan agreed. “Let me work on it and I will get right back to you.” I hung up the phone and Duncan and I considered options to drive him to detox.
“How did you get here today?”
“My mom drove me.”
Is she waiting for you? Could she drive you to detox? Is there someone else who can drive you?”
Duncan made a call and several texts. Finally, his mother returned a text saying she would be back there to get him in 15 minutes and yes, she would drive him to Kempenfelt. He gave her a quick call asking for some basic supplies like toothbrush, shampoo, a change of clothes. Hearing him now, I realized this was part of his instruction from the detox counselor, given how he rattled them off in a way I thought was beyond his current cognitive ability.
Detox was a good start for folks sometimes. It can make for a smoother referral to a rehab program but it can also scare people off a bit. One sees some wild things in detox, this I knew for sure. But Duncan was serious about changing so I validated his worries and bolstered his hopes. I wrote out some phone numbers and on-line links to local and regional rehab programs but suggested he follow the advice of the detox staff, they would know the quickest referral and the best match for him. I gave him a card with a follow-up appointment with me for next week, letting him know he could call and reschedule it if his treatment got in the way.
Duncan’s phone dinged indicating a text that his mother was on her way. As I walked with him to the back exit, I gave him the stock ‘you can do this’ routine but I also thanked him for his honesty. Honesty is the biggest hurdle for people with addiction. They spend so much time hiding, covering up and lying that being efforts to be straight about their use and their struggles to quit get lost in the weeds. Duncan’s hand was shaking as he held it out to shake mine. I took it in one hand and covered it with my other hand. “I’ll be thinking of you; stay in touch.” He crawled into his mother’s car, they both waved and he was gone.
My new assessment was the no-show. I called both numbers listed in the package. I figured the first number was her cell phone because she stated her name. With this identifier, I left a message identifying myself by name, saying I was calling from ‘the hospital’ and I left her my number. The second number did not convince me this was her own line so I left a vague message for her saying I already left a message for her on her other line and asked if she could she call me back. I checked the information I had about her. It was vague. She reported some risk of self-harm but not immediate; some misuse of drugs and alcohol and a history of childhood sexual abuse. I couldn’t tell about her treatment history. Complicated.
Sometimes once the crisis has subsided folks with this pattern back away, either in fear because revealing or re-telling their story is too painful or because they want to believe the calm after the storm is the end of their problems. Either way, it wasn’t unusual to have a push me-pull you engagement in these situations. I wasn’t worried yet and I was glad to have the chance now to dig up Rudy. When I checked my emails quickly for purple dots, I found that Rudy was in meetings the rest of the afternoon. He would be swinging through the office at the end of the day and see me if I was available.
With my new-found free time, I started the phone calls to people I wanted to connect with before the weekend. I checked the schedule to see which of the weekend crisis workers was working this weekend. I saw it was Tom. He is a new social work grad but he has fallen into this work as though he’s been doing it for years. I sent him a brief email noting Duncan’s name as a person to keep an eye out for, on the off chance detox sent him back our way Saturday or Sunday. Karen, the crisis worker who usually worked the opposite shift to me, arrived in the office, carrying four referral packages, a paper cup likely filled with flavored coffee and a white, waxed bag concealing a cookie from the snack bar. “Hoo, hoo!” I sang out when I saw her. “You look like you had a busy day.”
“Ya figure! I earned my cookie today.”
“I’ve had a no-show. What can I do to help you out?”
“This is my first sit-down.” Karen sighed as she dropped cautiously into the rollie chair by her cubby and took a long swig of her coffee. “Your manic gal…” Karen canvassed her files. “…Jill, Jill Marshall. Remember her?”
“Yup. She’s living with Craig Betts, n’est pas?” I could love the French too.
“Was living with Craig Betts. From what I can gather, the Team found out he was crashing there, saw him as a threat to her wellness and put enough screws in their life that he skedaddled.”
I joined Karen in the adjacent rollie chair. “And?”
“And…Jill has fired the Team, in a big show-down outside her building.”
“Have you talked to anyone in the Team?”
“Aren’t you the Rhode scholar”! Karen laughed at me mockingly. “If I’d had six minutes, that might have been the third call I have made today.” She waved her free hand over the stack of packages she had placed on her desktop. “Actually, as it turned out, one of them arrived in the department right after she did but having them together seemed to stoke the fire rather than calm her down. The guy from the team backed out before I could find out more.”
“Gimme.” I motioned, wriggling my fingers in her direction.
“Gladly!” Karen responded, handing me the folder I presumed was related to Jill. “She’s still down in emerg. They’re trying to decide if she needs an admission.”
“I’m all over it.” I smiled at her. “You reinforce yourself with caffeine and sugar. I’ll let you know what’s up.”
I read the information from emerg. The name of the support worker was not noted so I had to call the general number. I did so, found out that the guy involved in the showdown with Jill’s landlord was Jeff Palonski. I knew Jeff. Not well but we’d shared some work in the past. According to the admin person on the phone, he had likely returned to emerg now. I could hear Karen talking on the other line and it sounded like she was explaining a medication to someone. When she hung up I let her know Jeff from the Team was back to see his gal Jill.
“I can go down and meet him but you’ve got your fingers on this pulse. I have someone else coming in about 20 minutes. Give me something else to do while you get at it. I’m here ‘til 1900, though so load me up.”
“Shit, shit, shit” Karen jammed a hunk of ginger cookie into her ready maw and washed it down with the cooling coffee. Her usual hippie-calm evaporating. “If you can connect with these last two referrals it would be great. If they need more, or if they can wait, Tom can see them on the weekend. I just need to do up the notes. I’m on my own with that. But thanks for the offer…and thanks for calling the Team, it gave me the cookie break I needed.” Karen hauled herself to her feet, retrieved Jill’s folder from me and strode back out the door.
I finished my note to Tom and readied myself for Bridie. She was a little early, so we had a head start.
Bridie wasted no time diving in after she sat down. “I had my conversation with Doug…the conversation about dying in hospital; that I don’t want the kids to be there.” She seemed relieved to have gotten those words off her chest and continuing seemed a bit easier for her. “I know I’ve been shutting him out but I don’t want to burden him with more to think about. And its hard to get a private moment these days, there’s so much going on.”
“How did it go?”
She smiled to herself as she paused to consider her answer. “It started off kinda rocky.” She chuckled out loud.
“Not the emotion I expected in this description.” I was certainly curious about where this was headed.
“It is funny to me now. It wasn’t so much at the time. I introduced the idea of him remarrying…” She caught the movement as my eyebrows shot up and my lips disappeared. “I know. It was risky but when I explained it all it made sense.”
“I’m listening…” I managed to match her smile. “Sometimes this job can amuse me.” Bridie laughed out loud.
“Remember I told you about making those cards for the kids, so they would have messages from me later on? Well the social worker at St. Germaine told me they have a studio there where I could record some messages and I liked the sounds of that. But then I got to worrying about whether Doug’s new wife would be ok with the kids getting them. She’d have to be part of their support and comfort if the messages upset them….I know, I know…” She waved off my questioning look. “It all worked out. He understands what was bothering me. Anyway, he’s convinced me that he won’t remarry anyone who doesn’t accept that my kids will get messages from me.”
“Good grief! I wish I’d been a fly on that wall!”
“It felt so good Hattie to get all that off my chest. Its like it freed up space for me to get moving on other things. And now I am ready to share more with Doug. I’ve been carrying this burden on my own because I didn’t want to hurt him more but it turns out he’s been doing the same. He even had the same thought as me about protecting the boys from….” Bridie drew a deep breath and held it. “…from the end; watching me die.” She exhaled with a sigh.
“Sounds like it was a relief to you both to talk these things through. It is also Doug’s pain to bear, so he shares its weight.”
“That’s what I realized. I can’t do this alone, as much as I want to shield everyone.” She settled back in her chair and gingerly crossed her long legs. “It also struck me, while we were talking, how much of Doug I’ll miss. Until now I’ve been re-running all the moments I will not have with my kids. But as I sat there, running my fingers through his hair, I realized I wouldn’t see him go grey…” her attention faltered. “…or even bald. I knew Bridie well enough by now to appreciate that when she felt overwhelmed she moved quickly to lighten the subject.
“I won’t see him get a little paunchy…or help him with a hip replacement.” She smiled meekly, knowing I understood her motivation. “Busted.” She acknowledged. “I can’t stay with it too long or I will cry.”
“You wanna cry? Cry. You said it. You and Doug are bearing this pain but as your witness, I can also share some of its weight.”
“Thanks Hattie. It means so much to me just to have another person, someone who’s not … not so tangled up in this mess, to talk to. I feel like I can be myself here. I don’t need to protect you from my worries and my fears. I think I’m getting close to that point now with Doug but I had to iron it out here. This disease is consuming me, one bite at a time. Chewing on my soul from the inside out. It takes all my emotional gumption just to put one foot ahead of the other. So, I pack it away as much as I can. But Hattie, I’m afraid I’ve made the mistake of thinking I had more time. There are basics I need to get done. Now, while I have the physical strength.”
“Deal.” I nodded. “What’s next?”
“I’ll make those videos. I’ve been thinking a lot about what to say. I already started the cards, so I won’t repeat all that. I think I’ll just let things roll without a lot of preparation. I don’t want it to look rehearsed. Maybe I can include Doug in a couple….that way his next wife can’t say no.”
“I know.” She laughed. But her laugh also produced a cough and she hovered her hand over her right side.
“I’m good.” She replied but I noticed that as she answered her head was shaking what without words would mean ‘no’. I took her at her word but I was skeptical.
She abruptly changed the subject. “Did I tell you we have Blue Jays tickets for Jamie’s birthday. They weren’t home on May 16th but we were able to get really good seats for all of us on the 14th. We are even taking Lynne. Doug will take lots of pictures and videos. He won’t explain why all the paparazzi to the kids, but we know why.”
“Well I want to see those pictures!” I didn’t feel it was a good time to prod about her health.
I have followed Pat Capponi’s writings for many years. I have heard her speak several times – all compelling. I continue to follow her advocacy work on Facebook. Her wise thoughts have both validated as well as challenged my thinking of social class and social ‘service’. Her late sister Diana was instrumental in helping me arrange the final practicalities of my doctoral research (despite remaining a skeptic of all matters academic or clinical).
After reading Pat’s post (below), I asked her “what can I do to help?” Pat replied “ stay involved, create better ideas/dreams/talk about what worked for you…”. I reached out to ask more direction…I explained I had written a story meant to underscore the social and traumatic factors that influence mental health and addiction problems but admitted I had not gone as far along the edge as her work does. With her permission, I am re-posting her story of “a different kind of revolving door” to fill in my blanks.
I went back to her seminal piece on poverty (dispatches from the poverty line: Penguin Books, 1997) and re-read the horror of the Harris years and his war on the poor. All salient truths today, as you will see in Pat’s post:
Pat Capponi (FB Post: April 18, 2017)
a different kind of revolving door:
She is abused at home from an early age, sexually or mentally or physically. Like other kids in trouble, she acts out at school, small acts of rebellion not thought out or deliberate, and is forced out. She runs away to the streets of the big city. To survive, she hooks up with a guy who seems kind, he’s older and more experienced and likely a product of the same circumstances. They have a child together, putting both under stress. He strikes out, and she takes it, until the infant is threatened. She runs again, someone tells her about the shelter.
Its a big old building, crowded, the staff seem angry, they have issues, they feel underappreciated, certainly underpaid and overworked. One or two are nice, others are stern and demanding. She is not assigned the good ones. Still, there is a kind of freedom, she wants to experience life, lights, fun, admiring men, and she goes a little wild, staying out, breaking rules.
Her child is snatched out of her arms, and she is put out on the street. Rules are the lifeblood of the shelters and she violated them. That she was violated almost since birth never comes up.
Drugs make life tolerable, just, even when paying for them requires prostituting herself. Vulnerable to assault, rape, exploitation, still hoping for a man to rescue her, she finds one who promises to care for her, to help get her child back. She needs to believe him, till he starts pimping her out for harder, more addictive drugs. Even then, she makes excuses for him, afraid of being alone.
Stumbles into an agency, staffed with social workers who look to their education to help them deal with clients. Hard years have passed, the face of her child is fading, though she talks about her to anyone who will listen. She is starved for attention, for something, anything better than what she found on the street. They offer her art therapy, and bad coffee, a community of sorts, though it’s as chaotic here as on the streets, sometimes she can get bus tickets, sometimes she gets into fights and is barred for a while. More years pass, shelters and agencies and workers, rooms she has to share with roaches and bedbugs, her face hardens, her teeth keep falling out, her body is twenty years older than her actual age, she is a long way from the child she was, the hopes she’d had, every day is something to get through, tomorrow she has no energy for.
The child that was taken is sent to foster homes. In some, she gets visits late at night from the man in the house, who warns her not to tell. The second or third time she runs to the streets, finds a man she hopes will save her, she gets pregnant, so desperate is she for an anchor, a sanctioned role, someone to love her like she needs to be loved.
He beats her, threatens the child, she runs to a shelter, breaks rules, loses her child who is taken into “protection”.
Drugs help for awhile, till she is jailed for possession, does time, gets out on the streets again, looking for rescue, looking for drugs to still the pain.
She is seen as difficult, dangerous, and ungrateful. Her lethal overdose comes as no surprise, she won’t be missed. There will still be line-ups at the shelters and drop-ins she used. Her last responders wear gloves when they load her into the van.
“There is research in Canada and elsewhere that says a high number of children who have been trafficked have been in care but there’s never been any research that I’ve ever seen…about why that is.” Toronto Star, Jesse Winter, Page 1
Her child, raised in foster homes after being labelled as disruptive, is sent to a group home. She has difficulty at school, hates going because ‘everyone’s mean to her there’. At the home, she is put on medication that balloons her weight, already targeted because of the twenty extra pounds she carries, this adds to her distress and resolve to run away. She meets a man who promises to watch out for her, he and his friends provide her with different drugs, that keep her thin and awake for her customers.
She is a good earner, she knows she is trapped, but its not like she has other places to go, other choices. It can be bad, the man and his friends beat her if she doesn’t produce, but she has a place to sleep, even if that bed frequently has strangers in it.
We have changed the labels, from pimp to trafficker, from prostitute to victim, but not our approaches.
Why aren’t we paying attention to the first signs of distress Instead of punishing a child who doesn’t know how to articulate what they are going through at home. We’re busy, classrooms sizes keep growing, keeping order is paramount, she won’t go on medication, we’re not miracle workers.
Photo credit: David Zwicker
After our stimulating dinner with Roland and Maureen Friday evening, the rest of our weekend had been slow and relaxing. With the weather warming and Spring officially on its way, the heaviest work Jody and I had to do was gather the winter debris remaining in the front yard and the back garden. Afterward, it was warm enough to sit on the verandah in a fleece rather than a parka. That was progress. March came in like a lion, correct” Jody wondered aloud. I nodded. “Then by my calculations next week will be beautiful, as it slides out like a lamb, n’est pas?” Jody’s obsession with the post Belle Époque literature led to her insert all the French words she knew, randomly, into conversation. Doing so elated Jody somehow and it was a pretty good indication she was in a good mood.
“I hope you are right. I am sick of winter. My bones can’t take any more cold. At least this coming week I am on afternoons so the frost may be gone by the time I have to poke my nose out the door.” Jody and I sat side-by-side, smiling at the odd passer-by and surveying our land until the sun dropped over the big tree across the road. The chill of its shadow threatened to drive us indoors. “We could move around back” I suggested. “Naw, I like the front porch.” Sometimes Jody missed the city and the front porch felt a little more urban, and noisy. When the sun dipped a few notches lower, there was only one option left. “Might as well go in.”
My week was uneventful, well as uneventful as crisis work can be. A bit of depression, a couple of suicide attempts and a naked guy in the parking lot. Pretty typical. No further problems with Frau Berwick, as Jody had come to call her, associating her with the Cloris Leachman character in the movie Young Frankenstein. Despite her apparent aversion to film, Jody loved movies and often made veiled or vague references to characters or scenes to accentuate her points or impressions of people. I, on the other hand, had an uncanny ability to remember exact scenes from old sitcoms like the Flintstones or the Dick Van Dyke show. The other day she Jody was complaining of a headache and I regaled her with reminiscences from The Beverly Hillbillies, including tales of Mrs. Drysdale and her regular ‘sick headaches’ at the hand of the Clampetts. Jody was skeptical though; she thought the nosy neighbor on Bewitched had the sick headaches. This was an intellectual impasse even the internet couldn’t solve.
The weather stayed warm and much of the snow melted away. I was inspired to get out and walk around town in the morning before leaving for my shift. The air smelled like mud; it smelled like Spring. Because the sidewalks were mostly clear, I was able to walk in running shoes, not boots. I celebrated this as some kind of victory over the elements. Bridie was scheduled for Friday afternoon and during my walk that morning I pondered her situation. I admired Bridie; she was tough. But is this really how Bridie feels or is it contrived to spare her family. From what I knew about Bridie, both could be true. She had done her research and understood the physiology of her cancer and the palliative options like radiation. She had researched hospice care and pain management. She seemed to keep a brave face around her kids and mostly her husband. Could I do the same, Hattie wondered.
What about regrets? My mind continued to wander. What would I regret? Certainly I regret many things I’ve done. And many things I haven’t done. Does Bridie have regrets? What dreams are fading; gone? How do you untangle all that? Which thread do you pull first, if any? What are the risks of leaving the ball of knots, or grasping the wrong thread and pulling the knot tighter? Does Bridie even have knots? If she does, does she want to untangle at them? A tangled ball can be a more comfortable nest. It was complicated.
Children were very much one of the complicaters. Without children to consider, I realized I couldn’t really put myself in Bridie’s shoes. What must it feel like to know that at a certain point this may be the last time you see your kids, speak with them. Yes, kids were a complicater. The sense of my own inadequacy for the task of supporting Bridie snuck up behind me and blindsided me. I just can’t grasp the depth of that aspect of loss. I wondered if I should bring it up with Bridie, maybe refer her to someone else who had kids and could relate. Viv would be a good bet but I also knew Viv would say that if I listened carefully and was ‘with’ the person I could relate. I was unconvinced. Maybe I should have this conversation with Viv, or Rudy. Or Bridie. Without realizing it, I was making my way down the incline to our street. Lost in my thoughts, I’d checked out for the whole section of my walk through the main part of town. Yikes, who might I have shunned? And, I am gonna be late!
The children were finally asleep. “Bridie, I don’t want to talk about this now!” Doug was growing exasperated with his wife. He stood and began to pace slowly back and forth across their family room. “We have this gift, this little gift of time to enjoy….” He turned his tear-rimmed eyes to meet hers. “We have this brief but precious gift of like three months. Can we let the rest go?”
Bridie sat quietly, unsure how to proceed. She knew dying was her own hard work but the cascading impact could not be ignored. “Doug, you know me. You know I am always thinking six steps ahead. You have relied on that over the years….”
“Bird, we’re not talking about planning a vacation, or re-carpeting the house!”
“No sir, we are not.” Bridie said with authority. “We are talking about how I will spend my last few months on earth. And by Jesus I will do it the way I want!”
Doug slumped down wordlessly beside her on the couch.
“I want to talk about this with you. I need to talk about this with you. I don’t want to leave it all to the end. Inside my head thoughts are tangled up like a ball of string. I grab an end but when I pull it just tangles more. Hear me out….help me.”
Without responding, Doug reached for Bridie’s hand, drew it into his lap and clasped it tightly.
Taking his silence as an invitation, Bridie proceeded. “I’ve been thinking. I’ve been very lucky in life.” She spoke softly, looking down at her feet. “My parents raised me through some pretty rough times. We didn’t have much but we had fun. Even though I didn’t get to University the way I wanted, I got a good office job that I enjoyed and I was good at. I found you and we have had a very good marriage.” Doug’s grasp tightened. “We wanted two kids and we were blessed with three. We even had a dog who didn’t bark too much.” She paused for a moment to smile at him but he did not see it and could not reciprocate.
“We have a nice house, which I wish I had seen re-carpeted a few more times…OK, I’m making this a bit light because I want to say that when I am gone, like not right away but at some point, I know you will re-marry.” That did it for Doug. He let go her hand, stood and faced his wife.
“No! I will not talk about this.”
“Doug. This is important to me. It’s not in my nature to be selfish but you will talk with me about this. Don’t leave me alone with these thoughts.” This final plea hit its mark. Doug sat, cross-legged on the floor in front of her and placed his head in her lap, holding each of her hands in his corresponding pair. Now that she had his attention, Bridie didn’t know how or where to start.
“I love you. I will miss you. At least I believe I will. I don’t know what it will be like to be dead. That’s part of what occupies my brain. What will that be like?” She felt more than heard Doug sob. She had second thoughts. She wondered if it was fair to share these dark thoughts with him. She decided it might be better to back into this conversation.
“I brought up you getting married at some, much later, point because when I was talking to the social worker at St. Germaine’s after the kids appointment a couple of weeks ago she mentioned to me that they had a studio there where I could record messages for the kids. You know, like for birthdays, graduations and so on. I had already thought about making up cards; actually I had already started composing the messages. Anyway, I got to thinking what if the person you re-marry doesn’t support the kids to see the messages, or doesn’t like the idea of it….”
“Bird! What are you talking about?” The last poke woke the bear. “First of all, I’m not getting re-married, I told you that. Second, even on the very, very outside chance I re-married, fifty years after you were gone and the kids were grown ups, by the way…what makes you think I would ever marry a woman who wouldn’t love our kids enough to share these precious videos with them?”
Bridie felt immediate regret raising this in the clear light of Doug’s logic. “Well, you see this is what happens when I rattle these thoughts around in my head all by myself. I build them into something else. And anyway, its not so far fetched. Can you imagine that Paul McCartney’s second wife tried to erase all the Linda from him? Even his kids didn’t like her.”
Doug sat up straight, shocked and confused by this turn. “You don’t know that!”
“I read it somewhere. I’m pretty sure its true. That’s why he dumped her.”
“Sweet Jesus Bridie. The only good thing in all this is you comparing me to Paul McCartney.” Doug was still shaking his head in disbelief. “But you are right, you can’t let your head control all these wild thoughts without some kind of external management.”
“Okay then. I’m glad we, I’m glad I talked. But there are another couple of points I want to be clear on and that I need you support on.”
“Does it involve any more about the Beatles?”
“No, sadly. I’m done with the Beatles.” They sat in silence for the next few moments while Bridie collected her thoughts. “I don’t want to actually die in front of the kids…” She paused to let this sink in. When Doug did not respond Bridie decided maybe more detail was required. “What I mean is that when it comes close I want you to be on guard and take them out for ice cream or something so they aren’t scared, or they don’t have a final memory of me gasping for breath, or even worse glassy eyed and not making any sense.”
“As strange as this may seem, I was thinking about this myself.” Doug responded, to Bridie’s surprise.
“So, obviously you have your own dark thoughts you aren’t sharing with me.”
“It was fleeting and I didn’t consider it dark. It came to mind when we told the kids. Remember the oncology team said to base our description in reality and all I could think of was going to see my Grampa when he was so sick and unresponsive. I don’t honestly know how much reality kids can bear. Well, I think they can bear a lot but I don’t know that I want them to. I agree to re-visit this topic another time. But, for the record, I will not revisit the idea that I will re-marry, as much as I like being compared to Paul McCartney. Any other items on the agenda for tonight?”
“One last thing, I’ve always said I want to be cremated. Well, I want to be cremated in my pajamas…”
“Like those pajamas?” Doug looked up and tweaked the jersey bottoms she had on.
“No.” Bridie replied after a pause. “No, I think I’ll buy some new ones.”
“Can we go to bed now?”
“Thanks Baby. I don’t think you can know just how much better I feel right now. I’ve been carrying this weight of worry. It’s lighter for me now I maybe I’ve just passed the burden to you.”
“I was already haulin’ it, Bird. Now we are sharing it. I’m serious, can we go to bed now?”
I decided to heed Jody and Rudy’s advice. Friday came and went. There were several assessments in emerg that consumed my time; Linda and I crossed paths twice and in both instances we were civil but guarded. While there was no further conflict, the tension was eating at me. I saw a couple of people for follow up in the afternoon and closed the day crossing all my i’s and dotting my t’s. Then I was free and clear for the weekend. Jody and I were going out for dinner at Roland’s house tonight. We didn’t know his wife well but she was also a teacher. I would definitely be outnumbered.
Jody arrived home shortly after me. This was unusual for her. Generally she puttered in her classroom, marking papers or crafting devious assignments for her students. “This is a nice surprise.” I greeted her with a smile and a hug. “Are those flowers for me?” I noticed she was packing a bouquet.
“Nope. For Maureen, Roland’s wife.”
“Oh” I hoped I sounded dejected.
“ I have wine too, in the car, chilling.”
“You are brilliant and beautiful.” I’d rebounded quickly from my flowerlessness.
We both showered and changed into clothes that were a little funkier than our usual evening attire. Jody wound a fern green and russet pashmina scarf around her neck and over her shoulder, setting off the auburn highlights of her crinkly curls. A few months ago, on a whim, I purchased a pair of ox-blood red jeans and tonight was their debut. I chose a navy crew neck sweater that I believed complimented the jeans exquisitely. I also added a jaunty scarf, mine with a thread of red running though it to pick up the jeans. Then I posed. When no obvious praise for the outfit was forthcoming, I had to remark its perfection myself. “Hattie, you look lovely.” Jody agreed with a happy smile. I wasn’t sure which gesture intensified my joy more, the compliment or the smile. Certainly I had worked hard to draw the compliment. With coats and boots applied, we were out the door.
Roland and Maureen lived at the waterfront. Her family had a cottage there for many years that they had winterized and modernized. My jeep was our chariot because according to Jody, the road into this place was a bit cantankerous, which I assumed meant rough. In reality, it wasn’t that bad. I didn’t even need four-wheel drive. Maureen met us at the door and was delighted with the flowers Jody had chosen. The fireplace blazing in the corner added to the charm of the living room. A tray of cheese, veggies and dip rested on the coffee table. Roland shepherded Jody into the kitchen to sample the wine, a glass of which Roland delivered to Maureen. Jody fetched me a tonic with lime. Maureen gestured to a seat near the fire and settled into the chair beside me. I’d only met her a few fleeting times when we ran into Roland and she seemed a good match for him, sans beard. We considered the weather for a while, comparing this Winter to last Winter; Maureen sipping her drink, me sipping mine.
“How is your work at the hospital?” Maureen ventured. The last time we were together I might have been whining about some aspect of my job or another.
“I enjoy it most days. There’s a good mix of crisis work and counseling. We have a new program now that allows us to provide service to people who have insurance coverage. It increases access to mental health counseling for the community. It also gives us a little bit more variety in clientele.” The private nature of my work precluded sharing anecdotes or wild tales, such as I knew would be forthcoming when all the teachers were assembled.
“So what kind of therapy does that involve?”
“The usual,” I hesitated, not sure how familiar she might be with my line of work. “One of the clients I am seeing right now is dying and we are dealing with grief and loss. A couple of people are dealing with addiction problems. Some folks have a history of sexual abuse, or child abuse that is interfering in some way with their current function.”
“Hmmm. Maureen took another sip of her wine. “It must be hard to stare down death, or help someone else stare down death. Are there any tricks?”
I hadn’t expected this question. “Not tricks, really. I think it’s a matter of listening to fears and worries, providing comfort and hope. There are clear stages of grief but in my experience they don’t fall into neat steps. They transition back and forth over time, eventually moving toward acceptance…or sometimes not. In this case, the client is working hard to cushion her family. And yes, it has had an effect on me. It’s sad to share this experience with another person.”
“My niece recently died. She had a brain tumor. She pursued a course of aggressive treatment for about a year but in the end…well, in the end, it was the end.”
“I’m so sorry.”
“Thanks. I wish she had someone to talk with through her ordeal; someone outside the family. I’m not sure she ever came to grips with her reality. It makes you think about what you would do in the same situation. It made me wonder if I would have fought as hard. Of course my reflections are all in retrospect. At the time we mostly dodged the inevitable. We were all encouraging, of course, and tried to stay optimistic. It was strange…even when we all knew she was in her last days, we didn’t admit it to her. We stayed cheerleaders. ”
“That’s what we do in our families. Its pretty normal, by my account. What I’ve lately found is that people share their experiences differently with a third party. It’s likely safer or more acceptable to question oneself to a relative stranger, someone who is not fighting or grieving alongside you. It makes me think……”
Jody and Roland boomed into the room deep in the throes of debate regarding social history, the advent of technology and the consequences for the literati. Roland noticed Maureen and I seemed absorbed in our own conversation and interjected “What are you two talking about? It can’t be as depressing Jody’s observation that film has ruined the novel.”
“It could be.” Maureen stated matter-of-factly. “We were talking about death.”
“Oh.” Both Jody and Roland blurted at the same time, appearing chastened.
“Well, don’t let us bring you down.” Roland added as he looked away, flapped his hand dismissively and took a seat on the sofa across from the fire.
It was such a bizarre transition that both Maureen and I burst out laughing. “A little more detail about the evils of film will get my attention.” Maureen inquired.
I smiled and shook my head at Jody so she knew it was just fine with me if she continued her social critique. “What is it about film that’s eating at you tonight?” I posed and the topic was effectively shifted.
“Well, Roland and I have been talking for a while about co-teaching a literature-slash-history course about the progression….”
“..or degeneration!” chimed Roland.
“…the progression or degeneration of literature.” She studied us before proceeding, assessing true versus polite interest. “I think, we think, the long history of story-telling is important to understanding literature…and art too but we haven’t been able to engage Dickie Vereen, the senior Art teacher in our scheme.” Jody had been looking at Roland when she mentioned Art, then she turned to engage Maureen and I. Way, way back people sat around the fire telling stories. Sorta like we are.” Jody used both hands to point toward the fireplace in the corner, casting warmth and soft light.
“Did everyone share stories, or just the guys?” I interjected. I regretted my feminist observation when I was given ‘the look’.
Jody continued. “People used to talk more, share tales. Some stories were straight narrative; some described interpersonal transactions. Some stories included simple performance, or dance. They, like the people or tribes, knew each other well and they learned their history from each other. Maybe the guys talked more, as Hattie suggests. I don’t know – this perspective offers a new opportunity for feminist critique. Maybe my dear partner can be a guest speaker….”
I stood and bowed “ I accept.” Then I sat down quick because I’d heard earlier countless versions of this rant and knew there was more to come.
“Anthropology research suggests that all the many and varied firesides produced remarkably similar stories and myths. We are looking for that same similarity of ideas and interest in story-telling and myth that might draw our students in, that are timeless and current. There are underlying human narratives that I think kids can relate to.”
Roland jumped in. “From fire light to candle light, from light bulbs to tablets. I like to think of this as Literary Anthropology.” He was puffed up and proud by his analysis.
Jody grasped the baton. “Stories moved beyond the fire’s glow when we began to draw and write, like more than just on cave walls. Over time, talkers became writers. Realistic scribing led to great realistic novels. We also had the great, realistic paintings.” She would not let go of the Art aspect of this plan. “We developed imagination, attention and focus. We wrote long, newsy letters, not emails or texts. We didn’t rely on Facebook for information. We read pamphlets, like those prepared by Darwin. We read real paper magazines and newspapers. And here is the climax: photography trumped painting…”
“But in my understanding didn’t it precipitate the abstract, impressionist painters…” Maureen interrupted, clearly intrigued by the Art aspect.
Roland responded to his wife. “Yes, yes. But that is my…our point. The response is interpretive. When it is narcissistic or ego centric, I see it as regressive, or degenerative but when it becomes inclusive, I believe it is more progressive…generative. I see how the narcissistic perspective works…but I think stretching outside this brings easier access to alternatives. Hmmm. That’s a bit tangled, isn’t it?” Roland paused to think as he spoke and I could tell that even though he and Jody had the germ of this idea, they were developing it interactively. For me, my head was several sentences back trying to figure out the regress from the digress. I would ask Jody for the Cole’s Notes in the morning.
“So, if I jump ahead, I’m guessing your idea is that because film is easier to access, people chose it over novels?” Maureen seemed better at following their tack.
“More or less, Maureen.” We were back to Jody. “And not just novels into movies; its also about snippets of text over pages of description and dialogue. A recent study found that the average young person will likely read fewer than two books a year. And apparently even that stat is declining. As English teachers, how do we reconcile this?” She was looking at Roland. “How do we encourage reading in the face of technological alternatives that are so much easier to access, require less attention and focus and may not require the effort of interpretation, imagination or incite curiosity?”
“How do we stave off extinction?” Roland concluded, mugging a grave face, while I watched his bobbing beard.
“So, you two are taking this idea and translating it into an English course?” Maureen added. “It seems paradoxical. But I do look forward to seeing how it turns out.” Maureen taught Grade five in elementary school so she understood course design and curricula development. “Truly, I always wonder high school English and History don’t pair up. How do you teach A Tale of Two Cities without teaching the French Revolution? Only after I finally understood French social history did I love that book. The same is true with To Kill a Mockingbird. How do you teach that without teaching the history of the American South; you know, teaching about the State’s Rights, slavery, white supremacy and Jim Crow?”
“You are absolutely right!” Jody jumped on this one. Literary relevance was one of her favorite rants. “Why do we segregate…essentially why do we Jim Crow our study of Literature and History, and Geography, and Social Studies!
“And Art!” Maureen was in now with both feet.
Jody nodded in agreement and continued. “Roland and I have a lot more work to do but we have a sketch to show our principal and she has already put the bug in the Superintendent’s ear. The thing about it that I think will seal the deal is the use of electronic sources, as well as conventional sources like books and magazines. We plan to teach it together but as you said Maureen, why can’t we include Art and History… an eclectic approach. Many of us don’t see the novel as in decline but we know people are not getting, or more likely not choosing, the same level exposure we did.”
“To enlarge that point, in this room,” Roland polled, “how many books did you read last year? Maureen?”
Maureen paused. “16, maybe 20”.
I was grateful to have had that moment while Maureen was answering to calculate. “Probably about the same. At least 15 for sure.” I didn’t want to get this wrong in a tough crowd.
“This is the phenomenon we want to explore. There’s a chance the Board will approve this course as a research study; they are big into that now. Even though coming at it as a preliminary study will take a bit more work, that approach will provide more detail to inform our program. We want to engage the students in the process. We want to understand reading preferences and behaviour.”
“Living with you two is like living with Bethune!” My lips were ahead of my brain. “I didn’t mean any disrespect…” I added quickly. But my stab at an apology was not required. Everyone appreciated the humor I intended and recognized the timeliness of the next shift in topics.
Dinner was an enchanting combination of vegetarian and carnivorous options. I stuck to the veg but Jody dabbled with meat. Conversation drifted back to the various aspects of teaching and learning. I have read widely in the literature of transformative learning. I described my fave theorist, Paulo Freire, who in my opinion is the Carl Rogers of education. I shared how I lean on these theories in my clinical practice. In my opinion, therapy cannot be only a journey of self-discovery; it must include the component of learning new ways of thinking and acting. Otherwise, we would go through life understanding why we made all the wrong decisions but never changing them. Although, as Roland pointed out so brutally, based on this assumption I should give up the Leafs and back the Pittsburgh Penguins. Bastard!
Dessert is an event for me and my sweet tooth. I can always find room, even when I declare complete satiation. In the true spirit of collaboration, Roland and Maureen co-created a light and fluffy pomegranate cheesecake. It was divine. I had my customary two pieces!
Friday night became early Saturday morning before we fell into bed, and stayed there until well after the high noon sun painted the shadow of the front garden trees onto the wall. I made us Chai tea and we lay in bed reading, our precious paper books, until nearly two!
“Do you think we are losers because we still have our pajamas on and the sun will set in the next couple of hours?” I wondered aloud.
“Nope, we are winners.” Jody said without lifting her head from her book.
“What did we win?”
“Well, I won you.” She finally looked up and smiled. “And you drove me home last night, you made me Chai tea just the way I like it and you are making me dinner tonight!”
The maximum number of readers connecting with the site is 55. To date I received 18 responses. Maybe some people aren’t far enough along in the story to comment – or maybe they haven’t liked the story and they’ve moved on.
Here’s what people said:
- About 2/3 of you work in healthcare.
- The character most people connect with is Hattie. Two folks named Jack (I think maybe these are readers who recognized him).
- Reactions to the storyline include: identification with the horror and sadness of Bridie’s situation; interest in day-to-day mental health work (with clients and with the team); familiarity of the setting (I’m guessing this reader is from said small town); and the tension between Hattie and Linda.
- Other comments (consolidated): team dynamics and tensions are common, relatable and transcend workplaces; blogposts are too short and sometimes it’s hard to find the next chapter on the site; the writing is a little too ‘clinical’; the stories sound real; I am enjoying it.
Thanks again! This feedback is helpful to shaping the story.
I joined a sports-fan site for a while but the derogatory references to women drove me out. When my responses named and corrected certain comments, I was told by another contributor: it’s a sense of humour – get one! I noticed later that the moderator of the group lay out some rules about these kinds of comments because ‘women are members of the group’ which made me wonder if it’s ok then for men to talk like this when there are no women around … this insidious misogyny is getting harder and harder to bear.
As I’m sure you’ve experienced, when you think about a blue door, all you see are blue doors. So, it’s no surprise I started picking up on other examples of rampant sexual objectification. Staying on the sports theme (the Leafs are still in the playoffs and the Blue Jays will start winning soon), we might think we are a step ahead with women announcers in the male dominated arena of sports but take a look at their uniform. It’s all tight, sleeveless, short and low cut with high, pointy shoes? Imagine Evanka Osmak talking about The Jays in a cardigan or the equivalent suit and tie? Would her content be equally compelling? And about those high heels; we praise men for their charity; running in high-heeled red shoes, in sympathy for us poor gals. Really, they ought to be committed to a world where damaging high heels are not required.
Oh yes, I understand, we women want high heels, short skirts, tight jeans and obvious cleavage…except lets ask why. It’s clear we have been socialized to see our gendered objectification in a certain way…as attractiveness; as sex. Sex we are responsible to ward off or sex we are responsible to invite. How about when a major political leader won’t meet with a woman unless his wife is with him – because, as you know, we are all temptresses. That’s why even when we are unconscious we are still provoking intercourse (would the consequence for a man raping an unconscious man be as light at the Stanford rapist received for raping an unconscious woman).
Counter the sexualization of women in North America with the common perception of ‘those poor’ Muslim women, ‘modestly covered’. It got me to thinking. I started where we all start nowadays, the internet. I read that the burkha, niqab and hijab as well as the chador and dupatta are all items of clothing worn by Muslim women to ‘cover and be modest’. Sources vary in their attribution, so it is unclear to me if all women are obligated to wear these coverings according to the Koran, or due to personal, relational or societal obligation. Yet, the current of potential sexual objectification in this case (humility/aka worthiness; protection of a male’s possession/evil seductress/aka blaming women lust and its outcomes) is not unlike the phenomena of the sports announcers, or ‘no lunch without me unless a witness is there’.
Although Canada has taken a strong stand against Sharia law, the Jian Ghomeshi coverage was blatant in its hostility to women. Any suggestion that we are gender enlightened is only self-congratulatory. When it comes to women’s dress, are we any less sexualizing than societies that insist on modest covering. Although collectively I think we see North American women as ‘free’ to wear what they want (although I wonder if the cameras would roll a women announcer if she wore a suit and tie), I am of a mind that both ‘modest covering’ and engineered bareness are oppressive sexualization.
That night with Jody, I went over it all again. I worried I’d made a mistake; overstepped along the way. We both knew I could be a little quick to take over. Actually, according to Jody, I was more than a little bossy. But no, after hearing the story, albeit from my perspective, Jody thought the situation did call for a quick decision and both me diving in and me recruiting reinforcements were required. The only saw-off for Jody was whether or not I suggested Linda call the unit for help, or if I ordered her to call. I re-sawed-off on it being in the ear of the beholder.
Once we had sifted through the details of my predicament, I needed advice about what to do with Linda. Jody vetoed all my ideas. But then who could blame her, they were mostly all illegal. “Hattie, why do you have to do anything? Why do you want to resolve every conflict?”
“Well, why wouldn’t I?” I was genuinely confused. “Isn’t it good to make peace and play nice?”
“I say just let it go. I have conflict at work all the time. There are just come people I don’t like. I stay cool but civil. I don’t need to do a group hug and make everything right. I can sleep at night.”
“But I have to work together with Linda. We need to be on the same page!”
“That’s bullshit and you know it.” Jody wasn’t pulling any punches tonight. “You can work just fine until she decides to come to you. Just let it go Hattie. Don’t try to fix it all. I agree with Rudy, let the dust settle. ”
“Are these comments meant to double as support right now? Because I’m not feeling the love.” I pouted.
Jody embraced me and tenderly stroked the back of my hair. “This is the love Precious. If I didn’t love you, I wouldn’t care if you knocked yourself out against that brick wall called Linda. Let it go. Remember that cute Buddhist monk. Think about it as the conditions and consequences. If it’s that important some kind of solution will reveal itself without one inch of effort on your part. You trust Rudy right?” She could sense my nod. “And you trust me, right?” She sensed the next nod. “Then you ought to also trust yourself”.
A gear shifted somewhere deep in my mind and I believed her. I could make, and have made, interpersonal problems worse by trying too hard to fix them, conditions and consequences. Then again, I have also mended relationships by being persistent in resolving conflict, conditions and consequences. I figured that in this case, I would heed Jody’s advice and see where the chips fell. At the very least, I felt unburdened of my wicked day. “I don’t think a Buddhist monk ought to be referred to as cute…” signaled my shift away from the matters so lately at hand.
“Don’t get jealous darling, I meant cute in the kitten sort of way.” And that signaled that Jody had moved along too.
Before we fell asleep…I curled against Jody and asked “Jody, if anything ever happens to me, will you find someone else?”
“What are you talking about now?” She rolled over and would have been staring me in the face if it hadn’t been dark in the room.
“I’m just wondering”.
“Wondering? Geez Hattie! Right before I fall asleep you want drama?”
“Sorry.” I said genuinely. “With all the other stuff that went on today I didn’t get a chance to think about my conversation with ‘the dying woman’ until just this minute.”
Jody kissed my cheek and gently murmured, “I don’t think I’ll look for anyone else if you die. You may have spoiled me for the real world”.
“If you wore my ashes in an amulet around your neck it would scare other women off… But then you might not be happy alone. Or maybe you wouldn’t be happy without me, regardless.”
“I’m pretty sure there’s a dangling participle in there. Anyway, this is a daytime conversation”.
“OK. Love you; good night”. A few minutes later, I could tell Jody hadn’t fallen asleep yet. “…. I was thinking, I’d like to be cremated wearing my pj’s.” Bridie’s idea was a good one.
My shift was finished at 1500 hours but I was still steamed about this morning so after tidying up the outstanding workload data I sidled back over to Rudy’s office to fan the flames, only to find he was out. Viv was over in emerg but I knew she would likely show up here at some point in the next hour or so. In the interim I logged back into Dennis’s file to read the series of notes. Jack’s were there. They were brief but accurate. He focused more on the conversation with Dennis and less on the environment of the unit. Dr. Juli Ward’s were also brief and mostly described her observations related to the prn meds. She did comment on Jack’s involvement. I sunk back in my chair and wondered what I would have done differently. I was still stewing when Viv charged in, carrying an armload of supplies: note pads, tissue boxes, a box of tea bags and a tin of coffee.
“Hey! Whadda you know” I called out.
“I know Linda Berwick is an asshole”.
I laughed right out loud. “Who told you that?”
“It’s a consensus.” Viv said seriously. “I don’t know for sure what happened but there’s a buzz down there. The other nurses were glad you and Jack got involved. But that Linda, she’s got other ideas….don’t even ask me what ideas, I’m not paying attention”.
I envied Viv’s ability to extract herself from these conflicts. “Not even a hint, for your poor, dear, fretful colleague?”
“Nope. But I do know Rudy was in emerg this aft with Beth-Anne and Dan.” Dan Kennedy was the manager of the emergency department, well of the nurses, not the doctors.
“I guess I’ll hear tomorrow…. I wish he would come back now so I could find out how bad things are, otherwise I will spin it ugly”.
“I’m not even sure what happened” Viv offered “but I know you and I know Linda and I know which horse I will back”.
“Its not a horse race.” Rudy was standing outside our shared office. His face was unusually serious.
“Can I know what’s going on?” I asked him, I distracted him from Viv.
He turned back to me. “We’ve reviewed the incident. We’ve looked at the notes and spoken with Dr. Ward. Beth-Anne called the police, technically to thank them for their help, and they verified the events more in line with your description. The incident has been changed to a category two. Jack’s supervisor has spoken with him and commended his performance. I am now commending yours.”
“Sweet Jesus!” Viv crowed with delight.
“Thanks Rudy.” I was relieved. “And what about Linda?”
“What happens between Linda and Dan, is between Linda and Dan.” Dan was the Nurse Manager in emerge, Linda’s supervisor. Obviously this was code for butt out and maybe even you-bad. Sadly, I am not that obedient. “Should I talk to her? Should I raise this? It might haunt our relationship?”
“You are fishing Hattie! Let the dust settle. We can talk about it next week”
“Aye, aye” I saluted like a good foot soldier.
I’m curious about what your reaction is to the story so far. This survey is anonymous. Please chime in.
Bridie looked tired but her face flickered toward a smile when I greeted her in the waiting room. “Come tell me all about it” I said as I invited her into the interview room. She explained the series of treatments and their immediate effects. The treatment went as expected. Despite causing fatigue and some burning and irritation on the skin of her lower abdomen, the radiation succeeded in shrinking her tumor by at least half. Bridie was happy to tell me that according to her oncologist, this treatment bought her at least another three months. And that was a conservative estimate. Bridie’s gamble had paid off.
“I’m tired a lot Hattie but now the pain is not so bad as it was. I can pick up Lynne and carry her around. I can sit on the floor and play with the boys. The nausea is over and now I can eat a lot better. After being able to be with my kids, the best thing is that Doug and I can make love again”. She looked embarrassed to have blurted this out but I could tell it was important to her.
“I guess I hadn’t thought of that.” I added casually. And I hadn’t. “I’m glad everything feels like it’s getting back to normal”.
“Well, it is and it isn’t.” Her smile faded. “Doug is over the moon but I’m afraid he isn’t seeing this as a reprieve as much as he might see it as a cure.” She looked down at her hands while twisting her rings. “He won’t talk at all about …” I let her sit with her thoughts without interrupting. After a few moments, I noticed tears rimming her eyes. I leaned forward and handed her the miniature box of hospital tissues.
“Thanks” she sniffed. “It was a reprieve alright. The whole topic has disappeared and I haven’t thought about it since the treatments started. Well, that’s not true. I think about it all the time but I haven’t mentioned it…by it I mean me dying.”
“I understand, Bridie. It’s like the cancer is going away. It makes sense that the focus changes. Tell me what it is you are thinking about all the time.”
“I’m angry sometimes and I can’t stop thinking about why this is happening to me. I am watching my words all the time because I don’t want to be mad and have people remember that about me. But I am pretty damn mad!” Her tone changed and I could hear her anger and frustration. “Then, sometimes I am just so sad I can’t take it.” Her frame deflated. She dabbed her eyes and blew her nose into the scratchy institutional tissue. “I’m cried out.”
“Have you and Doug…”
She sensed where I was going and interrupted “No. We haven’t talked in two weeks. Not since we saw the oncologist right before the last treatment.”
“Hmmm. Where do you want to go with this?” I didn’t want to be the one to bring her down.
“That’s something I wanted to talk about today. Hattie, I know I’m going to die. I realize I can expect three more months but the outcome is the same. I kinda like it not being in the air all the time at home, well not in everybody’s air.” A brief strangled grunt resembled a chuckle. I want to talk with you about the specifics. Here’s what has been burning my brain…” Bridie sat back in the chair and carefully and laid out the details of her developing plan. I leaned forward, with my elbows on my knees, giving her my full attention.
“I want to die in hospital. I don’t want to die at home. I don’t think that’s fair to the kids. They have to live there afterwards. I don’t want to die in pain but I want to be careful about the amount of medicine they give me so I can stay alert. I haven’t made up my mind if I want the boys there at the final moment, again I worry about their memories of me. I want to have my affairs, such as they are, in order. I have certain messages for the kids and I have started writing them a series of cards; birthday cards, graduation cards…” Bridie’s sob brought a pause in her obviously rehearsed disclosure. “I figure Doug will remarry.” She raised an open hand toward me to ward off any kind of redirection or consolation, probably in response to my dropped jaw. “I want him to. The kids need a whole family. I want him to wait a decent amount of time though.” A smile creased her sad face. “But I want the kids to stay tight with my family and know them well. I want a lot of flowers at my funeral….and by the way, Reverend St. Croix has agreed to do the service. It will be at the community centre near our home. I think I want my organs donated but I’m not sure if the radiation…or whatever…” she peeped up to look at my in this pause…I don’t know if my organs will be good for anyone else. I will talk to Doug about finding out; anyway, my driver’s license is clear that they can go to someone else. And, I want to be cremated, in my pajamas.”
When I finally composed myself, I said gently “Pajamas?”
“Yes. I want to be comfortable for all eternity.” Bridie nodded silently.
“Good idea”. Was all I could manage, biting the inside of my lower lip. “So, have you written all this down? You know Doug will need to be included in these plans.”
“I know” Bridie shook her head back and forth as she exhaled in a long sigh. “I just can’t talk to him right now. I will do this work for us both right now, then … then when reality returns, we will talk about it.” Her voice was determined. “Hattie, I want, no I need to do this on my own right now. It means so much to me to have this interlude of calm at home. I have to manage this my way right now. I don’t know if this is normal or not, or advisable or not; I just know this is right for me”.
“Then it is the right thing to do”. This was my only fair reply.
As it turned out, only one other person had arrived overnight. He was a thirty-four year old man who presented with and endorsed extreme anxiety, which responded pretty well to a bit of medicine. Now he was settled and ready to go home. Often the duty doctor will just cut these folks loose without involving crisis workers so I was curious what else was going on for this fella. The answer was in the notes. This was his third visit. The presentation was similar each time, always at night and always late in the week. I wasn’t sure what that meant but I figured I knew who could give me an answer, the anxious man.
A half hour later I was ready to look for the duty doctor, Juli Ward, to fill her in on Dave Maxwell, the anxious man. I found her washing her hands in the anteroom behind the care desk. “Do you have five minutes to talk about Mr. Maxwell, the anxious guy that was held over last night for me to see?”
“I sure do? Why didn’t they send him home last night?” Recognition flickered over her face. “Hattie thanks for this morning. Thanks for taking the lead and getting someone down from the unit. And thanks for working with the police. It all went quite smoothly. That Jack guy was great! Thanks again.”
“Hey, no problem. I was glad it didn’t get out of hand. I thought we worked pretty well together. And yes, Jack always does a great job. If you get a chance, when they do their review of the incident, can you mention him? It helps us justify pulling from the unit to help out.”
“Of course. I forgot about the incident review. The incident part seemed to evaporate once we got into it. I better get my notes dictated. I will make sure to recognize Jack’s great work.”
“Well, if you can mention your observation that it seemed to evaporate once he got into it would be appreciated. They are looking at near-misses and that one comes close to the definition. Anyway, back to the business at hand” I smiled as I ploughed on… “our friend Dave Maxwell would generally have been sent home last night but I think that when Dr. Leroux, the duty doc on last evening, pulled up his records he saw that this was visit number three with same presentation. Coincidentally, the other visits were also on a Thursday. So, I asked Dave Maxwell a few questions around that.” Juli Ward nodded for me to continue. “He’s visiting from North Bay to consult on a production improvement on the line at the car plant. The work is stressful because his assessment of their current state-of-affairs revealed a need for more substantial change and both brass and line-workers are peeved. He’s been sorta fighting his way through the whole consultation. On top of that, on the weekends he goes home but he and his wife have been having some issues and he doesn’t look forward to more arguing.” Juli Ward made the hmmm sound.
“On his last visit, which was the first repeat, once the loraz had done its job the duty doc gave him some literature and robust encouragement to look up someone to help him work his way through this. He didn’t do that because he didn’t know how long he would be here in Carter. His schedule is up on the air. Because he’s not back in North Bay during the week, it’s hard to set something up. He’s basically overwhelmed off the map. He seems to be able to hold the demons back for a while and then they storm his beaches. If you are good with this, I am happy to put him on our list for post-emerge crisis service and see if we can bridge the gap for him. He just learned he has up to three more weeks in town, so if you add a little bit of anti-anxiety…just a little bit…” I emphasized by putting my thumb and forefinger up to my nose, about a quarter inch apart “then we can likely avoid three more late night visits.”
“That sounds reasonable.” Juli concluded. “I will need to eyeball him myself. Do you have a moment now?” I knew the duty physician would need to have a look herself, especially since I was asking her to renew a prescription of anti-anxiety medication. In fact I might have been concerned had she not wanted to confirm it all with her own ears. For many years the risks associated with ‘pams’ like diazepam, or Valium and Lorazepam, or Ativan were underestimated. These meds are pretty addictive and are now taken very seriously. We are getting to the same place with narcotic meds like oxycodone, in its various forms but in the interim many, many lives have been unalterably damaged. I appreciated this in a very, very personal way.
Juli Ward and I reconnoitered with Dave. He gave a thumbnail of his story to her, confirming what he told me. Dr. Ward explained the medication she was prescribing, explained why she was ordering such a limited number of tabs and advised that she would notify his family physician back in North Bay because she expected him to follow up on this before it became more problematic. I checked the calendar and entered him in a slot with Viv on Monday evening, after he finished work. Juli thanked me and headed off to her next destination. I checked my watch and realized I was running late. So much excitement for one short morning, and I was meeting up with Bridie later this afternoon!
It was 1145 by the time my butt hit my chair in our shared office. Jenn had stacked my mail on top of the keyboard so I wouldn’t miss it. Conference fliers, internal announcements, phone records and ….ah ha there was the reason she’d left everything so prominently: an overdue file report. There went my lunch hour. But first I wanted to track down Rudy to give him the heads up about the incident this morning.
“Jenn!” I announced as I rounded the corridor “Thank you for delivering…the mail” I said holding up the delinquent notice with a smile and a wink.
“You better get at it girl! That’s a second notice.”
“I’m all over it.” I nodded with fake solemnity. “Where’s Rudy? Anywhere nearby?”
“I think he’s expecting you. With this on-line incident reporter, he knows about trouble before its even over. Not to worry though, I believe his exact words were: when Hattie thinks its time to come and fill me in, I’m pretty sure she will. Send her my way.”
Rudy is a cool customer, so I wasn’t worried about being chastised. I rapped on his half open door and peered around it into his office. The space wasn’t large to start with but Rudy wasn’t a good putter-awayer, so the room shrank in proportion to the piles of reports and magazines. He was on the phone but motioned me in. I moved a stack of notices, likely including my delinquent workload report, and sat in the chair across from him. It sounded like his call related to setting up a meeting; in short order the task was complete and Rudy provided me his full attention.
“Sounds like you had an interesting morning” was his greeting. “You OK?”
I noticed he wasn’t smiling but I couldn’t judge the origin of his concern. “I’m good.” I stated with certainty. I was just on my way to see you. There was one other guy in emerg I had to finish first.” I guess its just human nature to be a little defensive when one’s performance feels like its being called into question, although I wasn’t sure so far if it really was or if I was reading more into this.
“Oh right. Thanks.” He nodded. “You don’t have your notes in the system yet, so I just need to get the facts from you verbally…”
I cut him off “Rudy, I just got into the office. I will get the notes done right after this. Actually, it was my plan to do them while I ate my lunch because my afternoon is jammed.” It wasn’t ordinarily Rudy’s nature to wind himself up about timelines. “Have I missed a deadline?”
My growing annoyance was now discernable. “No, no, no. Sorry Hattie. I’m not troubled with you…” I shrugged, lifting my open hands and cocked my head to the right in the universal ‘what’s up’ signal.
“Linda Berwick, the Team Leader in emerg entered the event into the system as a category four and that means an alert was forwarded to each and every member of the senior team. Now, I need to know what really happened before Beth-Anne crawls up my ass!” Beth-Anne, our Director was Rudy’s boss and in my experience she was a serious manager; she took it all by the book.
“A category four! Why in heaven’s name!”
Rudy turned to his computer screen and clicked open a box he had obviously minimized while he was sorting out his schedule, during the previous phone call. “Code White, police involved, property damage, chemical restraint, significant risk of personal harm to patients and staff…” he read from the glowing template.
“In theory, those criteria were all present.” I muttered through pursed lips. “However, does she in any way indicate that Jack, Jack Solomon from the unit, and I had it under control? The man settled right down, took the so-called chemical restrain orally and without argument, then departed willingly with the cops.”
Rudy paused to re-read the text in the report. “More or less…she focuses on the damaged bedside table and the fear expressed by a couple of the other patients in the department, and by a couple of the nurses. I should probably tell you, even though she didn’t put this in the report, she spoke with her boss about you taking over and managing the event. She said you even called off the police.”
I let that hang in the air while my blood pressure rose, probably to near-stroke level. I noticed that I was sitting forward in the chair, as if ready to pounce so I tried to calm myself with a deep breath before I answered. And I sat back. “Rudy, this perception will need to be corrected.” I blew the next deep breath out into my lap. “In my opinion, and apparently in the opinion of Dr. Ward, the police and Jack Solomon, this situation was handled well, and safely. Obviously, my notes will reflect that. My notes, which I will be entering as soon as we are finished here.” I checked my watch to see it was now 1205 and my next appointment was with Bridie at 1330, or 1:30 PM. “I’m assuming, unless you have any other questions or accusations, I am free to go back to work?”
“Hattie, calm down.” Did I detect a note of gentleness? “Of course, I am not accusing you of anything. I’m sorry it sounded that way.”
I cut him off again “I don’t think you are accusing me of anything but clearly someone is – and as far as I can see that someone is Linda Berwick.” I paused only a second to steady my voice, which can tend toward shrill when I get my back up. “This needs to get fixed.” I added slowly and calmly. “There was a risk this morning and we resolved it. We resolved it so that no one was hurt. We resolved it so that the patient received the care he needed. His safety and dignity was not jeopardized. I didn’t even realize the damn bedside table was damaged. Listen, I responded to a Code White, I did take control but that’s because I knew immediately what to do…I wasn’t hiding behind the care desk! Jack Solomon did a phenomenal job settling the guy down and the cops, the cops did what they are supposed to do – only the amount of involvement that was required. I didn’t call them off; I asked them to standby until we completed our assessment.”
“OK”. Rudy replied. “Get your notes in. I will document our conversation and meet with Beth-Anne. Based on what you describe, this was not a category four. But at this point only Beth-Anne can change that. As for Linda, let me think about how to handle her”.
“I can handle Linda. I will handle Linda…”
This time Rudy cut me off “don’t handle anything but your notes for just now; savvy?”
“Savvy.” I resigned. “I’ll touch base with you before I leave for the day. Right now, I have more to do than I have time for.”
I departed without further comment and marched back to my cubby-hole. It was now 1220. I spent the next forty-five minutes constructing my notes bout the incident in emerg this morning then entering them in the system. I deliberately did not check Linda’s entry before hand. Let someone else iron out the discrepancies. Then I added the link to the incident report. Only after all this did I check the original entry. As I said to Rudy, in theory everything Linda had documented was fact but somehow her facts insinuated more danger than I believed was present. I noticed that Jack’s notes were linked already. Juli Ward’s notes were not on file yet but given I had just left her I suspected they may not arrive until later. My guess is that physicians had a bit more leeway and I figured her note would be linked later by someone from medical services. Sadly, I didn’t have the file authority to read Jack’s account unless I logged back into the patient file and I was reluctant to leave those tracks. I checked my watch again. It was now 1315 and Bridie was coming in for the first time since her radiation. I still had to gobble down my sandwich and brush my teeth. While I ate, I sent a quick email to Rudy indicating the paperwork was finished. Instantly, I received a ‘thanks’ in reply.
Photo with permission of Sharon Light
Some people reading this story might recognize the character Jack Solomon. “Jack” is based on a peer, mentor and a friend. Sadly, “Jack” passed away this week – a very profound loss to his family as well as the people he served and his colleagues and friends. Although all the stories in this story are made-up, clustered themes and impressions, based on the many, many people I have met in my work for over 35 years, “Jack” is true. I know that this is exactly how he would have handled the made up (but not uncommon) crisis situation in emerg. His compassion and skill were exceptional. His insights into behaviour and dynamics made him an invaluable advisor. He was humble about his practice and thought it was amusing that I wrote him into this story, although he was also tickled. If you knew “Jack” you will hear his voice – I hope.
That night I slept so hard I know I didn’t move. The temple chime roused me from pleasant slumber, like a dirty joke. I slid out from the covers, trying my best to leave Jody undisturbed and enjoy her rest. Moncrieff was begging for his chow and I had to get there quickly lest his wild cries wake everyone on the street. Last night I left my clothes for the day in the back room, so I wasn’t barging around getting ready for work. I skipped my daily yoga stretches, promising my right knee and my shoulders I would work them out later, after work.
I was running a bit late because I forgot that I needed to give at least a cursory shovel to the bank at the end of my driveway to get my jeep back on the road. I arrived just before report and had to hear Linda out in full Winter regalia, with Linda staring at my dripping boots. I had just uncoated and unbooted myself and dropped my belongings in the crisis office down the hall when I heard the distant shout: “Hey!” a split second before the crash. I knew to haul ass out onto the unit. Attention attention code white emergency department east wing; Attention attention code white emergency department east wing. Another crash. Everyone was in motion.
As I had learned in report, a young psychotic man had been waiting for transfer to the psychiatric hospital across town. It sounded as though he had lost his battle with being patient. I hadn’t spoken with him myself but Viv left info about him after she completed the assessment. Neither of us knew him but his record showed he had been treated on our mental health unit. Viv was also aware that early this morning he had accepted a second dose of medicine intended to clear his thinking, and calm his behaviour. As I turned the corner and saw he had in fact rocketed the side table across the hall, I concluded he likely needed a little more medicine.
In the immediate reality, what we needed was to keep him, all the other patients in the area, and all the nurses and physicians safe. At times like these, our hospital security runs to help out but they are reluctant to wrestle with people. Probably someone had already called the police. “What’s this guy’s name again?” I asked as I passed the care desk. “Dennis” came the reply from someone. “Call up to the unit and see if they can send somebody down here to help us out”. I suggested, although it probably came out more as an order.
“Hey, Dennis” I broke the hush with a firm but not too loud voice. “What’s going on? What can we help you with”.
Dennis was a slender man with shoulder length greying hair. He didn’t look that athletic but I was pretty sure he could take me. He turned and looked toward me, I saw everyone else freeze. “I can see something has pissed you off. How about we figure out what happened and find a way to deal with it, me and you, so nobody gets injured by flying chairs….”
“Let me out of here!” He screamed in a loud and desperate voice. His hands grabbed at the arms of the extra heavy chair and I was instantly grateful for the weight of those suckers.
My legs felt weak but I knew our best approach was to get him talking, so I took a fortifying deep breath. “Dennis, my name is Hattie. I’m a nurse here…”. He glared at me. I couldn’t tell at this point if his message was menace or fear. But he did stand straight and remove his hands from the chair.
“Dennis, listen. I understand you are angry and maybe scared. That’s not what we meant for you. I’m sorry. We want to try and help” From the corner of my eye I saw Jack from the mental health unit arrive. Jack Solomon was a tall, stout man with a ton of experience. His size was one thing that usually calmed a situation but more compelling was his gentle way of just being with a person. I’d seen him in action enough that I was glad to turn over the reins, especially since it didn’t look like anyone else was ready to step up. “Hey Jack.” I turned my head without taking my eyes fully away from Dennis and Jack pulled in beside me. “Do you remember Dennis? He told the nurses earlier that he had been up on the ward a while back.”
“I think I do remember you Dennis. My name is Jack” he said with a small smile and nod. Whether he did remember Dennis or not wasn’t the issue. Most importantly, now he had Dennis’s attention. And with little more ado, Jack walked toward Dennis and said softly “let’s figure this out Dennis. You know this has to turn around. There are some people here who are really sick, and really afraid. What’s been going on?”.
Dennis looked around the area warily. His eyes darted between Jack and me. He turned and saw the other nurses then turned toward the general care area where, as if on cue to prove Jacks point, a woman’s voice called out weakly from behind a curtained partition “What’s going on out there. Is everything alright?”
“C’mon with me” Jack said gently but with authority. “You want a juice?”
A plastic tub of hospital apple juice appeared by my hand like magic and I passed it to Jack. When Jack held it out, Dennis retrieved it. He turned and shuffled back into the specially designed safe room he had been waiting in before the kerfuffle. Okay, it was more than a kerfuffle, and it would require considerable reports and data entry, but it did appear to be winding down. Jack and I looked at each other. He side-nodded his head toward the safe room and I noted Jack’s intention to go into the room to talk with Dennis. A lot of nurses would not do this. Most would slam and lock the door shut and unleash whatever happened next. Jack was one of the nurses who understood the nature and importance of this kind of work and he knew not only his skills but his limits.
“Check for prn’s…oral is better…then join me”. Jack directed me, looking distinctly un-nervous and almost bemused but focussed. A ‘prn’ is a medication someone can take when they need it, instead of at a regular time. When someone needs the medication in their blood stream immediately, prn’s are given by injection. I understood Jack’s wish to go with an oral medication because at this point we didn’t want to lay hands on Dennis unless absolutely required. Once you hold someone physically, you are pretty much assured of a struggle.
Jack headed to the safe room under the watchful eye of Security while I held up my end of the bargain. As I approached the care desk to ask about meds, I saw the police had arrived. I recognized Pete Hamilton, an officer with whom I had shared the stage in a couple of presentations about partnering with police in crisis work. His raised eyebrows asked all the questions. The nurses ceased their excited commentary when they saw me. I had a sense they were furious about the disruption but unraveling that knot was work for another moment of this increasingly interesting day. “Thanks for coming out”. I smiled at Pete. He introduced me to Kevin, the other officer.
“Everyone OK?” Pete asked, looking at me but moving his eyes to the nurses, who had now resumed their duties, clearly distancing themselves from this incident, and me.
“We have a young man in there who is psychotic. He is meant for transfer to the locked unit at North Carter but we haven’t gotten the go-ahead yet to send him. I’m not sure what sent him over the edge but it seems like he flipped over some furniture and was quite disruptive. Jack Solomon, a nurse from upstairs, is in there with him now.” Since I knew the nurses at the care desk were listening I turned and asked “Is that how it went down, Linda?” The only first name I was sure of.
“Yes. That’s about it”. Clipped, with a serious glare.
“Can you do me a favour, Linda?” I continued without waiting for her replay. “Can you see if there is an oral prn for him – something to settle his behaviour, when he gets to his next stop at The North, they can work on the thought disorder. If there isn’t a prn order, can you see if the duty doc can give us one? Jack is pretty clear on it being oral. Thanks a million Linda.” I closed with a smile and turned back to the business at hand.
I faced the police officers “Do you cats have a little time? We might be able to convince The North to accept the transfer immediately, then you can help us get him there?”
Pete smiled knowingly “You take care of our friend. We will be right here, out of sight unless you need us”. Using police in this kind of crisis was one of the situations we covered in our public presentations, so I was sure glad to have Pete here. He knew that sometimes police are seen as a comfort to folks in crisis but sometimes their presence can escalate a situation. Since we weren’t sure how Dennis might react, he was right to hedge his bets.
When I returned to the scene, Dennis was sitting at the side of his bed, which in this special room had been bolted to the floor. Jack had taken root at the other end of the bed. Juli Ward, the duty physician had arrived and she was leaning against the doorframe in an attempt to look casual, while actually on-guard. “I can’t go today” I heard Dennis mumble. “Today is the seventh day after the seventh week…I can’t do it today”.
“OK Dennis, I hear you. Let’s talk about any way we can work around the date”. Jack was a genius. There was no point arguing with a guy who was psychotic, especially one who flips furniture!
Dennis didn’t expect this response and looked up at Jack, pursing his lips. He was thinking, as crooked as that thinking might be right at this moment. He held Jack’s gaze for a long time, and time was ticking very slowly right now. Then Dennis began to sing the gospel hymn: When the Roll is called up Yonder. We three stood riveted while he worked his way through the first verse then repeated the chorus three times. He was nearly out of breath by the end.
“I know that song, Dennis” Jack interjected before he could start off again. As pleasant as Dennis’ voice was, it was a little loud for an emergency department. “Why do you like it so much?”
Dennis began to speak in a rambling bent about his lifelong connection to the gospel church. He mentioned other favourite hymns. I was grateful he didn’t burst into song again. He just kept talking to Jack, who leaned forward in his chair and kept him engaged. Jack was putting on a clinic this morning; his management of this situation was exceptional. Juli was taking note. She likely knew she could leave but she seemed drawn to watch. Finally, Linda drew in beside Juli and motioned to speak with her. “Dennis, I’m sorry to leave this conversation but one of the nurses needs me to see someone else. Remember, this is a busy emerg and we have a lot of folks here who we have to see. If there’s anything I can do to help you through this wait, let me know. Or let Hattie or …. Sorry, I didn’t catch your name…” she directed to Jack.
“I’m Jack. From upstairs” Jack smiled and stuck out his hand in greeting. Dennis watched the everyday civilities unfold.
Juli shook his hand in greeting. “Jack. Thanks, Jack. We appreciate your help. Then she reoriented herself to Dennis. “I’m sure Dennis appreciates your help too. Take care and shout if you need me…”well”… she chuckled at Dennis, “how about don’t shout. Just let me know.” Miraculously, Dennis’s worried face eased into a sheepish smile and Jack and I laughed out loud. This may actually have been a little too much for Linda, whose frown carved grooves down her jowls. Nevertheless, Juli and Linda departed without incident and Jack and I were left with Dennis. “I asked the nurses if there was some medicine they could give you to help you with the wait.” I turned to Dennis.
“Ya. OK”. He muttered, unconvinced. “How long will it take?” Breakthrough!
I decided to experiment with the card up my sleeve. “Well, would you be willing to go with the police if they were available? Sometimes we can get them faster than the transport service.”
Dennis looked at me long and hard. He seemed to be measuring my commitment to him, or maybe it just felt that way. “That’s true Dennis” Jack chimed in. “Police get to run the lights”. Jack added with a smile.
“Sure.” Was all Dennis replied but his attention had returned to Jack.
“I’ll tell you what” Jack began a proposal to Dennis. “I will stay here with you. Hattie will get you some medicine to help you with the wait. She’ll check to see if the police are handy. And we can get you over to Carter North as soon as we can. Once you get there you won’t be cooped up in this tiny room and there will be other nurses who can get you settled in….”. I took that for leave. As I nodded to Dennis and walked away I heard he and Jack talking a little more about The North and what to expect there. Security stayed nearby to keep a watch out.
At the care desk Pete Hamilton announced: “The North is ready! When can we go?”
“Give us about 15” I asked trying to keep the ‘plead’ out of my voice. Juli Ward had come and gone from the desk but she had written an order for Dennis’s medicine. It was a tablet that dissolved under the tongue and delivered its effect PDQ. As a crisis nurse, I am not really meant to prepare or administer meds in emerg. Therefore I needed a quick and ready volunteer. I saw Linda walking toward us. “Linda, thanks so much for getting the Loraz from Dr. Ward. Dennis will take it now and then our friends here…” head nod to the officers “…will scoot him over to The North. Jack Solomon will stay here with him for the duration. Can you get the prn in to him quick?” Despite her reservations about the situation, Linda knew this was a reasonable approach and agreed. “Thanks guys.” I directed to the police officers, who were gracious players in this dance.
The rest of the transfer went smoothly. Linda delivered the prn. Jack sat vigil. Pete and Kevin smiled and introduced themselves to Dennis as the “cab drivers” and Dennis, in a calmer state of mind, was cooperative. “I know you had some medicine Dennis” Pete said calmly and he and his partner moved in close and placed their hands on Dennis’s elbows “let Kevin and I walk with you so you don’t trip or fall”. Brilliant! I owed these guys a coffee!
Jack took a moment to call over to The North admitting unit and explain what had gone down here and what to expect. He reminded them about the prn’s and described how Dennis had responded to calming and distraction. “All I can do now is cross my fingers…and maybe cross my heart” Jack’s baritone laugh was absolutely comforting. The work spun on around us. Jack was clear he had to get back to his own unit pronto. I just wished there was a chance to touch base with the folks working to see if there were loose ends. I saw Linda exit a curtained partition just inside the triage area. When she missed my wave, I asked Jack to stay planted for a sec and walked over to ask if everything was OK before we left.
“Fine. Now” was her terse reply.
“Funny Linda, it doesn’t sound that way from your voice”. An awkward, fruitless pause was the only response. “Jack has to get back upstairs and I have to get moving too, so I just want to see if there’s anything else I can do…”
“You’ve done enough”. Was the quiet icy blast through pursed lips. Before I could ask more, she turned wordlessly and slipped down the hallway.
Even though a ‘thanks’ wasn’t really required, it might have been nice. Not so much for me, I kinda belonged here but for Jack, who didn’t actually have to short his unit and come here to manage this problem. More than that, I had the feeling something else was going on and I wasn’t sure if or how much it involved me. Maybe not at all: maybe a lot. I’d have to check it out.
“What was that about?” Jack wondered when I got back to him.
“She said to thank you for coming to their rescue” I pasted a smile on that fib.
“Nope. She did not”. Jack said bluntly.
“What are you, the all knowing, all seeing Oz?” I tried to lighten it up a bit.
“Do I look like a little wizard to you?” Jack burst out with an emphatic laugh and stood facing me with his hands out to his sides, obviating his full figure. “Sweet Jesus Hattie. We mighta sent the wrong crazy person off with the cops!” Discomfort averted.
“Well, I do remember, for a fact, that you can be a fetching elf…” I laughed as I recalled a scene this past Christmas on the ward. Jack was wearing his usual attire, which included shorts despite the howling December winds, and topped it off with a green felt elf-hat with pointy ears painted on the sides. He meandered among the patients spreading well needed cheer interspersed with the odd blast against organized religion to the rest of the nurses. He worried the hat made it look like he’s ‘gone soft’ but we all knew he’s soft to the core.
His raised eyebrows signaled a wish to change the conversation before I outted his inner elf beyond the walls of the ward. So, changing the course a bit, Jack and I talked about which us would document what and I agreed to have Rudy call his supervisor to explain why he was pulled away, and for how long. We knew the Risk Manager would do a review as well, so our notes would have to be complete and timely. Once Jack’s elevator light was green as his elf-hat and the box was ascending I returned to the crisis cubicle and jotted a few notes and times so I could finish off my part of the report as soon as I was finished my tour of the other folks waiting for crisis assessments this morning.
Three weeks sailed by, in all the usual ways. I can’t remember which is the cruelest month but if I had to choose it would be February. I was glad it was over. March came in like a lion. It snowed plenty but not enough to cancel the busses, much to Jody’s dismay. Jody and I spent at least one grouchy week during report-card time. This was a standard outcome and we understood it, even though it took a couple of days each term to remember why it was Jody was so touchy. I was grateful to have my monthly week of evening shifts in there so I could stay of her way. We attended the talk by the Buddhist monk, that we learned about thorough yoga. It was held at the library, just a short, brisk walk away. He was a charming young man who told amusing but meaningful stories about the conditions and consequences of life. There was a pretty good crowd assembled so we hoped he might come to visit Carter again. The monk’s easy words were not quite enough for me to convince Jody that the condition of report cards provoked the consequence of suffering. But it was enough for me to appreciate that the condition of whining about your partner’s mood provoked the consequence of more mood.
Bridie was deep into her palliative radiation. I kept in touch with her by phone, every few days. I came to work, I talked with people and I tried to be helpful. For instance, I raised my hand in a team meeting and was included in an internal hospital review regarding elopements. In institutions, elopement has nothing to do with the thrill of running off to marry your lover. For us elopement means that a person we are supposed to keep safely on-site got out of hospital. I was particularly interested in how we could improve our way of managing these situations because I was involved in a recent elopement situation. A woman I had just finished assessing eloped from the emerg. Thankfully we were able to track her down and get her back intact. But since it involved no boots, no coat and a stroll down Jenkins Street, the hospital was under scrutiny and understandably there were a lot of questions to answer.
My assessment recommended transfer to The North, where she had previously been treated on a long-term care unit. The North didn’t accept admission after hours so we made arrangements to admit her to our local mental health unit. On the surface it seemed reasonable to everyone except the woman. With the result that she decided to take a flyer from the back emergency exit and visit the Dairy Queen a block over. Ei yi, yi. On a cheerier note, the Leafs were on a winning streak!
Lowell and I continued to meet. He did finally take a month to tell me his story, which we examined and critiqued along the way. The rascal disclosed a suicide attempt at age seventeen, when he was struggling with his sexual identity. He insisted he forgot about it during all my initial interrogation. It reminded me just how much we have to rely on the power of interpersonal connection and relationship to hear, and sometimes truly understand, the personal experience of another person. Anyway, as we worked through his story, Lowell decided to pull aside the other teacher who knows about his orientation and confide his worries with her. She was savvy, which will buy him some time to decide when and how to disclose who he is, in a way that he is in control of. Through the teachers’ federation, he has connected with some other gay and lesbian teachers in Toronto, and that has been very supportive for him.
March is a magical month for teachers, so it is probably the farthest from cruel. Midway through the month there is a March Break. A week off work! Ordinarily, Jody and I would fly off and enjoy a warmer clime and be silly for the week. Sadly, this year, we had some repairs scheduled for the house and we were grounded, financially. Nevertheless, I couldn’t watch Jody suffer for the seven long days. So, I booked two vacation days and on the Tuesday and Wednesday she and I headed down to the city for a small vacance. We went to the Art Gallery and soaked in beauty while dodging the rooms that contained the March-break children’s programs. We had a primo Mexican lunch in the Market area, topped off with fresh churros, tubes of dough flash fried then rolled in sugar and cinnamon. I liked my plain; Jody liked her tube filled with dolce de leche.
We had planned a special Tuesday night. Mary Gauthier, a brilliant but alarmingly dark songwriter and musician was playing at a small venue, and our Christmas gift to each other was tickets to the concert. Dinner was available at the lounge so we didn’t have to scurry around looking for a place to eat, and we could get there in ample time to catch a good seat. Me, I’m always worried about getting a good seat. At my height the right seat is very important. Jody, not so much; she can see over the others. We managed to slide in one table back from the first row and tucked into our plates of pasta and bread, carbs be damned. We even splurged on a salted caramel brownie to share. “Why hasn’t the person who first put the salt in the caramel been nominated for a Nobel Prize?” Jody wondered aloud.
“Is there a Nobel Prize for dessert?” I moderated, not wanting to spoil the ambience.
“Think about it!” She laughed. And I really did have to agree with her.
Mary Gauthier was as magnificent as we remembered. The words to her songs take your soul, wring the life out of it then, coincidentally, with ‘Mercy’, the name of one of my favourite songs, her striking voice pours it back in. Even she jokes that after a performance she feels better after emptying the hurt out to her newly bummed audience. But she laughs kindly as she says this, so it makes it all easier to take. In all, it was a wonderful day with my love. After the concert, we walked to the subway and took the train back into downtown to check in with Jody’s brother, Chuck. He was expecting us at his condo. We proceeded to spend the next two hours exchanging tales and laughing at each other. And, snacking!
We rose late the next morning, luxuriating in our light schedule. Chuck was also a teacher, so he was enjoying March Break too. That meant he could enjoy a stroll around the corner with us for café au lait and croissant at a hole in the wall French bakery. Yes, this joint had multiple bakes, so the croissants were almost always fresh out of the oven. Crispy, flakey, buttery; decadent! Somehow we scrounged up another two hours of stories while breaking our fast. Chuck asked Jody about her poetry, a topic I didn’t talk enough with her about. Every few days I see Jody scribbling in either the small moleskine notebook she carries in her bag or keeps by her bedside. She usually lets me know when she has something to share but I’ve had no announcements lately so I was a bit shocked to hear she had finished a poem she started two years ago when we drove through Virginia in March.
“Jody!” I retrieved her hand in mine. “You haven’t shared that with me yet. Spill!”
“Well, really I just finished it last week; I’m just finished. You know me I go back and over and around and make changes each time I read it. So, I think I’m finished…”
“Hattie says: Spill!” Her brother echoed.
“Okay, Okay”. Jody zipped open the main component of her bag, then dug in deeply and unzipped an interior compartment, then pulled out a moleskine worn on the edges and help closed with an alligator clip”.
“Sweet Jesus Jody! That is secure.” Chuck laughed. Are your poems state secrets”?
She opened the moleskine, turned it toward Chuck showing him a page with a crossed off grocery list. “No secrets”. She laughed back. “Unless soy cheese is code for ‘the nukes are in the garage’.” I knew that the elaborate security system was to keep her work private, until she was ready to share. That being so, I felt a little sheepish about putting her on the spot. “Jody, only read it if you are ready…”. Her tender smile recognized my guilt. Nevertheless, she opened the page to a page midway through the notebook where a passage was outlined in a box.
“This is my first reveal” Jody smiled nervously. “I scratched a few images while we were driving through one of the rock cuts off the interstate in Virginia a couple of years ago. It was cold and icy. Water was seeping through the rocks and had frozen into clear icy drips that sparkled in the sun. I found the notes about a month ago while I was looking for something else and I got back to playing with it. I call it Virginia’s Veil.” She bent her head slightly and slowly recited the words inscribed on the page.
pasted like hope
on fractured stone”
Jody stopped and looked up at her tiny audience. Neither Chuck nor I had fully absorbed the beauty of the words. “Once more…please?” I asked. I watched her carefully enunciate each syllable as she spoke the poem the second time. “I absolutely love it” I whispered when she had finished. “Thank you”. She beamed in response.
Chuck agreed but with more vehemence. “You have to get that one published Jody”. Despite several rejection slips, Jody had two of her previous poems published, one in a poetry magazine and one in a high school poetry textbook. This poem, in my estimation was her best work. We chatted on, developing a strategy for Jody to be famous and overcome her inherent humility. Finally she agreed to give this poem a shove out into the world, where Chuck and I thought it belonged. The time was flying because we were having so much fun. Chuck and his wife had separated almost three years ago and his kids were off at school, so he was grateful to enjoy a break from his lonely days. We bade him farewell after walking back to his building and fetching Jody’s hybrid from his guest parking.
We weren’t headed straight home yet. Along the way, just off the main highway, is a small gallery devoted primarily to the Group of Seven painters and this was our next stop. We both loved the Group of Seven. I was a fan of Thom Thompson and last summer we finally made the pilgrimage to the Leith Church in Owen Sound so see his supposed grave. Apart from his use of colour and contour, Thompson’s life is a parallel mystery. He might have been murdered, he might have fallen out of a canoe but without a doubt he was dead. Jody preferred Lawren Harris. His work is stark in its genius. Our rankings were pretty fluid however and we easily enjoyed the whole brilliant lot. We pondered the paintings, dodged the March Break children’s programs and walked back to the car in the wind, arm in arm, me and my precious poet.
One last stop was a natural grocery store where we could stock up on a few essentials that weren’t available in Carter. We exited with three bags of goodies, including duck eggs and curried tofu! The snow began to tumble out of the sky about a half hour before we arrived at our street and since it had been clear all the while we were away, the driveway did not need to be shoveled to let us in. Just a short run over the short furrow of plough slop and we were home.
Lowell arrived as scheduled at 1600 hours, or four o’clock. It happened rarely but today Jenn had to leave early for a dentist appointment. This meant I was sitting at the reception desk waiting for Lowell. At a couple of minutes to four a tall man, probably in his late twenties approached the clinic door. He was wearing a hunter-green quilted jacket and a University of Western Ontario ball cap. “Lowell?” I asked as he came through the door. He looked alarmed at being addressed by name without having identified himself first. I caught myself and added “I’m Hattie Crawford. I’m the nurse you are here to meet up with. Our receptionist left early so I was just sitting here waiting for you”.
“Oh” he looked relieved. “I wondered how you could already know who I was”.
“C’mon in,” I signaled to the interview room. After he shucked off his jacket and neatly lined his snow-covered boots in the rack, we walked together and sat in chairs set across from each other. I don’t necessarily like to sit behind a desk but I do find it easier when I have a bunch of forms to complete, as is always the case for initial appointments. Nevertheless, today using my knees as a tabletop would have to do. The necessary patter about confidentiality and insurance forms fell easily from my lips. Lowell followed easily and had no questions. He had accessed his employee assistance program once before so he was familiar with the process and he understood there was no information leak to his principal or the Board.
When the formalities were resolved, I started “so Lowell, you called the office at the end of last week. You spoke to Rudy and he set you up with me. He gave me a little bit of information but I’d rather hear from you about what is going on for you. What happened last week?”
Lowell had been sitting forward while we were working out the details of our contact. With my question, he exhaled, puffing breath through frowning lips and leaned back into the chair. He removed his cap and ran his fingers through his curls. Then he clasped his hands together, interlacing his fingers, and brought them to his chin. Like a prayer, I thought to myself. “It’s kinda complicated” was his initial salvo.
“It always is”. I countered. And I meant it. “Folks don’t often come into my world who aren’t tangled up in life”.
“Yeah, I guess” he surrendered, making solid eye contact for the first time, sort of measuring me. “I’ll cut to it. I called last week because I scared myself. I was longing to die. I don’t feel joy in my life…forget that, I barely even have any interest in my life”.
I held his gaze. My silence was his signal to keep talking. “I am not suicidal.” He added quickly, apparently appreciating the triggers and consequences.
“For sure?” I asked raising my eyebrows to accentuate the question.
“For sure. Hattie, it is Hattie, right?” I nodded. “Hattie, my life is complicated.” I gave him the keep-going nod again. “Here’s the deal. I work at Brookdale elementary school. I transferred to Carter two years ago after a relationship I was in collapsed. I teach Grade four. I am a good teacher. I like the kids. Rather, I should say I like being a teacher. I have to be careful about saying I like kids because I’m gay.” He looked at me square, assessing my response. I bobbed the keep-going nod again, accompanied by a shoulder shrug, signaling acceptance. Lowell relaxed, leaning forward. He placed his face in his hands. His voice was muffled but his words were clear “I am attracted to men, not boys. But people don’t get that. They think if I’m gay I must be a pedophile. I’ve kept my secret for two years knowing I could be ruined.” He pulled his damp face away from his hands and continued. “About six weeks ago, a new teacher started at our school who knew me when I worked in Guelph. Actually, she knew both me and my partner. She is cool but I am worried that she might say something, you know, innocently.”
“And you think if people find out about your orientation they will judge you?” I knew this was a real concern. Jody had wrestled with the same reality when she and I made the commitment to move in together and it was certainly intensified when we moved to a small town where your business was a little more transparent. But Jody is a woman, and the stigma is not as obvious.
“You know, really, I can live with people judging me. I frankly don’t give a rat’s ass…sorry. I don’t care much about what people think of me. But I don’t want them to see me as dangerous, or a threat… I am not dangerous; I am not a threat!”
“Well, that is complicated”. I sat back in my chair too, a signal that I was considering all this and taking it seriously. “Is it enough to drive you to suicide?” Lowell paused long enough to draw me forward toward him again and repeat my question in a gentle, prod. “Is it enough to drive you to suicide?”
“No.” He finally responded. “No, I don’t think this is enough to make me kill myself. But I would not be sad if for some reason I were to die”.
I led the conversation as inconspicuously as possible through an assessment of the personal factors associated with suicide: family history, previous attempts, high-risk behaviours, formulating a plan. Then asked about social and protective factors such as supportive family, network of friends, home and income security. All of these he dodged or negated. Because I knew he had described himself to Rudy as leaning toward alcoholism I asked the question about disinhibitors last.
“When you talked to Rudy, the guy on the phone who set this up, I think you told him you were leaning toward alcoholism.” He looked away briefly then continued to make direct, unwavering eye contact. I pressed on. “Alcohol is a red flag in our business, especially when people have a wish to die.” He did not respond. “It’s a problem for us because alcohol can disinhibit you. That means that even if you don’t want to actively kill yourself, you might do it impulsively when you are intoxicated.” Again I paused for a response and did not get one. “Alcohol can also be used to avoid or cover up our feelings. It becomes a way to escape from our realities. In some cases this is addiction, alcoholism, as you say, but in other cases it is just a way to cope. How worried should I be about you and your use of alcohol?” I find that sometimes giving people a choice in how they attribute their substance use yields a more accurate response. More importantly, it gives them an option of not denying their use.
“I drink everyday”. Lowell said softly, finally looking away, down at his still clasped hands. “I’ll be honest, when I called the crisis line I had finished a bottle of wine. But I haven’t had a drink since then. I said that to the guy on the phone because deep in my heart I know I am drinking too much but I don’t really think that is the main problem. I think we are closer to the truth in your second point. I drink to relieve the worry. I drink to relieve the pain of being alone. I drink to relieve the pain, no the agony, of being different…and having that difference used against me.”
This was a lot for me to take in. I struggled with disclosing my own situation. New evidence indicates that self-disclosure can be helpful. Under the right conditions, sharing personal experiences with a client can promote empathy and engagement. Under the wrong conditions, it might not. At this point I had to take into account that this was about Lowell, not about me. Rather than shift focus in this initial meeting, I pulled back. Instead, I relied on Carl Roger’s old standard: “Tell me more about your worry and your pain and how you deal with it”. Carl Rogers was a therapeutic giant and although he is long departed, his wisdom still warms my soul and guides my practice.
“Do you have a month to sit here while I tell you the whole story?” The crease of Lowell’s face faintly resembled a smile.
“In fact I do.” I delivered a definite smile in my response, which shifted his presentation to sight shock. “Just not all together in one appointment” I added. Lowell’s shock dissipated into relief.
Having confirmed Rudy’s first conclusion that suicide risk was present but not imminent, Lowell and I spent the rest of our first meeting negotiating a schedule of therapy in which he could tell me his story, describe his worries and pain and explore how to deal differently with his reality. Given the risk I sensed from his alcohol use, we developed a crisis plan in the event he felt he couldn’t wait until our next appointment that included among other strategies a guarantee that myself or someone at the crisis service would see him the next day.
As he rose to leave I offered “Lowell, I know you feel overwhelmed right now. I absolutely get that. I don’t know what I would do in your situation either. But I am glad you came here. I am glad that you chose to look at other options for yourself. You seem a nice guy and I’ll bet you are a fantastic teacher. We will come out the other side of this…it may take some wailing and gnashing of teeth but I have a feeling you can handle it”.
“I hope you are right Hattie.” Lowell paused, standing in front of his chair, his hands loose at his sides. His lips pulled thoughtfully to one side, with a nod he added “I think you are right”.
With that he reversed his entry donning cap, boots and jacket and raised his hand in mock wave as he departed. Lowell was correct, his situation was undeniably complicated.
Another Saturday, another run to CUPtopia and Beacon Bakery. This time we examined T.S. Eliot’s life and poetic contributions ‘between the wars’. Neither Roland nor Jody were sold on his personal ebullience, he was wound a little tight, but they appreciated his innovation. I enjoyed my date square while I listened carefully to the tutorial. We returned home to a spectacular vegetarian onion soup Jody made for lunch. Its perfection was elevated by fresh Dutch Crunch bread and semi-soft, unsalted Normandy butter. The sun was streaming in the dining room window, revealing only a few dingy smudges. Outside the sun sparkled like diamonds off the snowdrifts in the back garden where unlike the front yard the snow was pristine. We finished off the soup and decided to enjoy the day from the outside. We bundled in layers of fleece and Gore-Tex. I activated two packaged hand warmers and stuffed them in my mittens, pulled on my Sorels and my hat. Jody pulled her Nordic hat low on her head, her tight curls spilling around the earflaps. Off we ventured.
Carter sits right on the water, so heading in most any direction will lead you to the bay. Today we turned left and ambled toward a boardwalk along the water that skirted a newer, high-end housing development. That way we could spy a bit on the other half and enjoy the spectacular view out to Georgian Bay. As we walked along we reviewed our week. We laughed at our observations about ourselves and the innocent folks who amused us. I told Jody about the cherry-chip cake Viv brought for our Team meeting and she told me about a conflict brewing between two teachers at her school over planning-time coverage. We mused about buying one of the big houses with a view that lined the walkway. We decided about the birthday gift for Jody’s sister. We discussed a little politics. Mostly, we simply enjoyed each other’s intimate company.
At the end of the boardwalk, we continued along a path created and maintained by snowmobiles. Snow machines were like motorcycles with skis instead of wheels. They were a bit on the loud side for me but they were a big deal in this neck of the woods. I learned early not to disparage them. I realized that about the same time that I learned, the hard way, that many people in this area are related. Beware who you critique; it is likely they have at least one relative in the room. The one good thing about noisy snowmobiles is that with the roar you could hear a machine coming and get yourself far enough over on the path to let them pass. We encountered two on our way to the town dock, a lovely small harbor that looked back out toward the full vista of Georgian Bay. “This is the part I like best about being in the country.” Jody proclaimed blissfully, looking out to sea. Jody was a real city-girl and anything outside the city was the country. It was harder to pull her away from her life in Toronto than it was for me. Of course, I had more to run from than she did. I’m eternally grateful she joined me.
The next morning, with gratitude, I eased Jody awake with a chai tea, served bedside. I pushed stray tight curls away from her cheek and replaced them with a soft wake-up kiss. My workday would start today at 1300 hours which meant that for one week every four to five weeks I could take care of my Love’s every AM need. Mostly, it was just a tea delivery and some mundane chores. My week of afternoon shifts started at 1300, or 1PM and ended at 2100 hours 9 PM but one of those days was a short one and I could deke out at 1900, or 7PM. The evening rotation was how I scored Lowell.
As part of my love-duties, I ran errands the mornings I start work late. Today this included a re-stock of fresh items of our fridge and fruit bowl as well as the few other supplies we required. It was a luxury not to battle the weekend crowns. I put my purchases away on shelves and drawers that Jody would likely change once she came home and prepared myself for the shop. When I arrived at the circle of cubicles we call our crisis office the morning crew were nowhere in sight. This is where we access the tools of our trade: telephone, paper scales and computers. We carry our wits in our pockets! Although the space is meant to be communal, given human nature we divide it into our own small space and generally decide to sit at the same station, and this I did. When I logged into my account on the shared computer the system told me I had a voice message. So, I moved to my next duty quickly and checked my messages. I heard Bridie’s voice.
Her appointment with her oncologist had gone well and she was hoping to start palliative radiotherapy next week. She had arranged her rides through the program volunteers and she was cancelling her next two appointments with me. She was narrowing her focus. I called her back and in a brief conversation I applauded her decision, both her plan to buy some time and to put our meetings on the back burner. She dropped a little bomb near the end. “Hattie, Di asked me about a Minister. We don’t go to church regularly. The last time we were in church was when we got married. We didn’t even have the kids baptized. Do you think this is a good time to go shopping for a Minister?”
“Yikes Bridie! Who expected that on a Monday morning!” And we both had a chuckle.
“Have you talked to Doug about this?” I was conscious of the importance of his inclusion.
“I did but he equates this with a funeral and he backed away.”
“Well, what do you think? Is it important to you?”
“I don’t know. That’s the problem. It might be important and because its not one of my natural worries I might be missing it”.
My wheels were turning. “Because you are hooked up with South Carter, you can access one of our Chaplains…” a plan was forming as I spoke. “The guy I’m thinking of is Reverend Benjamin St. Croix… I know” I chuckled “it’s a fitting name, and he is a gem. He and I have worked together before and I love him. He attends to the spirit, he won’t overwhelm you with hard core religion….” I paused before I added “he also does funerals, if it comes to that.”
After a short pause I heard Bridie exhale in a sigh “it will come to that; eventually. I am going to miss my chance to die dis-gracefully”.
I agreed to bring Ben up to speed with Bridie’s situation. She agreed that he ought to call her directly and set something up in the next three weeks. “Actually Hattie, I feel relieved just to have made this connection. When Di mentioned it I realized it was an area I was avoiding…not the funeral so much as preparing my soul, if you know what I mean?” I nodded in agreement then realized we were on the phone. Bridie seemed to sense the unseen nod and proceeded. “And I’d like to have the details tidied up in advance. One less thing for Doug to….” Bridie’s words drifted away.
Viv and Karen were working the day shift. The morning had been busy and they had only now cleaned up the emerge list. Now they were seeing the people scheduled for follow up. This gave me another luxury beyond non-weekend grocery shopping: culling emails and logging my monthly activity statistics. Paperwork, as we call it, is one of the tasks where I procrastinate. I think this is true for most direct care clinicians. The relevance for us is seldom noticed. I can put in real high numbers one month and not hear a word about how wild my workload has been. Then, if I miss a few activities and it looks like I was taking a stroll, I get a little comme a c’est va from Rudy, via a command performance from Beth-Anne, our Director. This is healthcare in our era. Make sure the boxes are ticked and there is no liability. I guess you could call this cynicism on my part but whether other nurses say so out loud or not, it is our prevailing perception.
I called Ben St. Croix. As it turned out, he was here are South Carter in his consulting office, so I told him to sit tight and I would be right over. Ben’s part-time, consulting-chaplain’s office was adjacent to the Spiritual Centre. A more religiously inclusive version of what was previously known as the Chapel. The Spiritual Centre was near the coffee shop/snack bar, which made it more visible for families. For me it was just a short jaunt down the hall and around the corner, barely far enough to raise my heart rate. Reverend Benjamin St. Croix saw me coming through his open door. He is a tall, lanky man who can bring your heart rate down with his gentle smile. People love him; so do I. He ‘gets’ mental health and he has been counseling in this field for many years. We were lucky the psych hospital shared him with us a day or so a week. After I described Bridie and her family and explained her diagnosis and prognosis he immediately committed to calling her and offering his support. His next move was also predictable. “How are you with all this?”
I felt the telltale burn behind my eyes and knew it would be pointless to dodge my sadness while sitting at the feet of the master. “I come and go” I replied honestly. “Its very sad, and it will continue to be very sad all the way to the end…and even after the end it will be sad”.
“She’s lucky to have drawn you Hattie”. Ben was genuine in his support of our team’s work. “I know you will be strong when she needs it and soft when she needs it”. How does he know me so well, I wonder. This is exactly the balance I am seeking in my relationship with Bridie. I felt renewed in my commitment to her in just a few short minutes. We agreed to keep each other posted. We ended with a brief commiseration about the Leafs and our hopes for the Blue Jays in the coming season. This infusion of compassion was just what I needed to face the rest of my shift.
Two different scenarios: Bridie wants to live, more than anything. Lowell wants to die, maybe not as much as he thinks. Why is death so often at the centre. We have too much of it; we don’t have enough of it. I suppose it’s a pretty usual feeling for a lot of people, at least based on the scope of my conversations, which I admit are not a normal sample. In my work, it’s how we respond to these thoughts and feelings that makes the difference. I remembered right before I went to detox, I had thoughts of ending my own life. I store these memories in my deepest heart and I conjure them up every now and again so I can re-appreciate just what that experience was like. I remember I felt like such a failure. I had let so many people down, including myself. I couldn’t see going on. Narcotics had replaced me. The sensation they gave me was so attractive. I guess that’s the difference between recreation and addiction.
Narcotics took me to a place where I felt at home. I’d heard others use that same language: at home. And abstaining took that away. Back in the day, right at that moment of transition, I thought I would miss it all too much. For a very short time I even tried to use alcohol to mimic the effect of the narcotic but that just loosened my behaviour, not my soul as the pills did. It’s hard to explain unless you’ve been down that road. And that road was leading Jody and me on a journey neither of us wanted to take. Inevitably, as I changed we changed. I began to be the failure I feared I already was. We were unraveling.
One afternoon almost ten years ago, I was in a very dark, Corona induced tongue-loosened state when I revealed my wish to die to Jody. She was especially frightened because over the last few months she had become familiar with my many subtle references to death and with these last comments the lock pins fell into place for her. Her response was to take me to the hospital. I am forever thankful that she took me to The Royal, not the hospital where I worked, and thankfully I was able to convince her in the parking lot not to strong arm me into the emergency department.
I wonder now just what would have happened in my life, in my career, if I had been certified as an involuntary patient and admitted. Not that it should have such a deleterious effect but it certainly would have. Theoretically, involuntary commitment is meant as a safe guard, a last ditch measure to manage unraveling behaviour when a person can’t manage it him or herself. Had this happened to me, the consequences would have been compounded by the fact that I did not want to go down that road and I was prepared to stop the outcome. And by stop, I mean physically deter and abscond. Aggression and elopement are very serious matters in psychiatry. They have their own scales and check boxes, which means they have very serious consequences. This does not for a moment mean that people who feel like killing themselves should not look for help but it absolutely means that we as a system should consider helping differently. And this is how I exercise my personal experience in my role as a nurse.
I came to value that dark night of my soul above almost all others in my walk on this earth. It affected my work, it affected my personality and it affected my relationship with Jody, all for the good – eventually. Being able to disclose and talk through my deepest secrets, my disappointments and regrets, with the person I respected the most brought me a new perspective, a ‘high definition’ perspective. I wasn’t just keeping the lid on my drug use. I was transforming myself. And it got much easier to abstain after that; after I decided I wanted to be a different person, to experience life differntly. In my work now, I understand entirely when people give an ultimatum to someone they love. But I understand deeply, from my own experience, that it will take the person him or herself to make up their mind before any substantial change is realized. And that’s the hook I use in my work. So, I hoped to take a stab at shifting Lowell’s perspective on Monday. And, of course, this was third-party pay work so I was also making money for the program! Win-win.
Before I left for the day I called around to check in with a few folks. One of them was the man who had been intoxicated then discharged when he sobered up. He had agreed to talk to me about addiction programs and I held him to it. I had the feeling his interest was part of an ultimatum but we all start somewhere. He asked the right questions and sounded like he was taking down the contact information and thanked me. I reminded him he could call anytime and if I wasn’t available right then, I would get back to him. The short instant of genuine consideration I felt in his response gave me hope. Amy Brixton was making out well with Sandy’s peer support added to our weekly face-to-face. And Nancy, the sad and lonely old gal was hooked up with the Seniors Team and was seriously considering a care home closer to her daughter. But that damn Lowell was nowhere to be found!
Viv took over emerg coverage at 1400 hours, or two o’clock, so I shot her a text to let her know there was an MIA who might show up. But before I locked up my files, Rudy pitched himself around the corner announcing: “I just spoke with a man named Lowell.”
“Fare-thee-well” I said as delighted as Christmas morning.
“He called back himself. He noticed the call display”.
“Spill.” I demanded
“Lowell says he is a gay elementary school teacher leaning toward alcoholism.
“None of that equates to crisis….on its own, I guess”.
“Last night he had an awakening. He has been wrestling with a wish to die. He said he wished on the first star that he would die, and that scared him. He called the line to find out how to get help. He was going to call in sick to work, that’s why he accepted the appointment at first, then he reconsidered. He’s been at work all day, that’s why he missed our calls – no cell phones in the classroom!”
“So what did you tell him?” Now I was quite compelled.
“I told him that we have a new program that allows him to use his Employee Assistance insurance here at our clinic and that you would be delighted to meet up with him next week…of course I did the quick and dirty suicide questions and this guy is legit. He wants to die but he isn’t actively thinking about killing himself”.
“On accountta you are working late next week and he can’t get here before 1600.” Rudy raised his eyebrows and looked down at me sitting at my desk, in mock authority. “And I am your boss, technically. And, you are good at this stuff”. Rudy teased.
“Great! Half my caseload desperately wants to live and the other half is wishing on a star to die…sounds like I should start a group.”
“You are reeeeal good!” Was all I could distinguish with Rudy’s ancestral Caribbean cackle as he wheeled out the door and back down the hallway.
Friday mornings were busy in crisis services. Maybe people who hung on tight all week started worrying that they wouldn’t make it over the weekend. Maybe people who lived too much for the weekends worried their lifestyle might overcome them before Monday. There were four people waiting in the emergency department for assessments when me and my teammate Viv arrived at 0730. After a brief report from Linda, the Team Leader, we checked the office for phone messages then put our heads together to decide how to divide the workload.
About once a week someone who felt they could wait it out overnight called the office after hours to request a next-day appointment. Last night a man named Lowell left his number for a call-back. Of the four folks waiting, Viv was familiar with two. Of those two, she believed there was one person she could quickly re-direct. So I agreed to call Lowell and schedule him in at ten-thirty, my last appointment of the morning. He answered the phone immediately, as though he had been sitting beside it all night willing it to ring. Yes, he would be there at 10:30 and yes he knew where the office was.
The first client I went to meet up with still needed to sober up a bit before we could be sure of all the safety issues. Sadly, there was no detox centre in Carter, so the hospital became the defacto spot for people to overnight when they pushed their intake past the limit. The nurses really didn’t like these folks. Notwithstanding the fact that they were difficult to assess, it was this particular cluster of people who were more likely to get aggressive. Being assaulted is not uncommon for nurses, especially in emergency departments and although some people with acute psychosis, who are out of touch with reality, can be very scary, it’s the people who are intoxicated on drugs and alcohol who pose the greatest risk. And of course these are just the cats to whom we have to provide the most direction, redirection and redirection so they stay in bed, stay out of other places, don’t yell and use obscenities and so on. Anyway, crisis client number one today had just dozed off and there was no collective appetite for me to rouse him right at this moment!
Crisis client number two was a person I met few weeks ago. She was in-and-out of the bedded unit for a few years but then she was stable for about a year. Now she has started to show up again but we have been able to keep her out of hospital. She was awake and eager to talk, so my priorities were clear. “Hi Jill” I said as I walked through the curtain into her corner of the department. “I’m not sure if you remember me. We met about two weeks ago. My name is Hattie Crawford.”
“Yup, I remember you. You’re the new one. I didn’t know you before.” She appeared alert and her memory was apparently good. “Look at that short hair. You look like a radical, feminist dyke!” She laughed a little too loudly. “Well, I’m not really that radical, Jill” I smiled. I liked my hair real short so my looks often invited comments like this. Jill’s speech was rapid and clipped but coherent as she was talking to me. She wore tight jeans and I couldn’t make out the message that had worn off the front of her oversized t-shirt. Her dirty blonde hair was pulled back into a ponytail. Her mouth was moving but otherwise her behaviour was relatively still. I wondered if there was a hint of mania, or elevated mood in her presentation. Or, sometimes people had loose brakes and wide filters because they have had to expose their intimate lives to professionals all too often and in so many ways. Sometimes people with histories in the system have brakes that are a little too tight because they have had their trust breached. I thought perhaps Jill checked the first box.
“Do you want to talk with me here or should we shoot over to the interview room where it may be a little more private?”
“I’ve got nothing to hide from anyone!” Again, her voice was about a half a decibel too loud.
“How about this,” I interjected “there are some other folks here who are kinda sick. Let’s go over to the interview room and then we won’t disturb them. Savvy?”
“Cool with me” she nodded, gathering up a fleece sweater as she scissor-kicked off the adjustable bed. She slipped on her running shoes stepping down onto the backs so they slid on like slippers. I let the nurse assigned to Jill know where we would be. She rolled her eyes in exasperation. I knew people like Jill could be a distraction in a busy emerg but I made a note to make sure I gave the nurse feedback she needed to understand Jill’s difficult life.
As it turned out, once she started to open up, Jill was aware she was in a spiral. She recognized that her circumstances contributed to her mental state. Not her exact words, but I took from her description that she didn’t have the skills or the resources to keep herself in the housing and social setting that kept her stable and out of ‘the loving arms of the system’, as she called us. As often happens, when people with long-standing mental health problems are managing well, they turn away from the people and programs who can support them…and sadly the people who can support them often welcome the break. There is always more work to do than there are souls to do it, or money to pay for it for that matter. It was my impression that Jill she was living in a very good situation, she was connected to the long-term mental health team and she had a reasonable regime of medicine now, which it sounded like she was using on a somewhat regular basis and which seemed to be keeping her on the rails. But I sensed all this was in jeopardy now.
My innocent question intruded her repartee. “Jill, everything was going so well for you…we can get it back if we act now. What can we do to help?”
She became still as if pausing to collect her thoughts. She breathed deeply then looked me square in the eyes. “I hate it! I hate living the way you all want me to.” Words spilled vehemently from her lips. But it did not strike me that she was angry.
I was a bit taken aback by her disclosure. “Hmmm. Tell me what you want?” This might be the question she was angling for.
“I don’t want to be under the microscope. I don’t want the landlord to call the police if I am up all night. I don’t want to feel drugged up so I can’t get out of bed in the morning. I don’t like getting fat from these meds” again the intensity but clearly more frustration than anger, at least anger that I had to worry might be directed at me.
“Alright. Let me get my head around this. You are here in emerg now. You were here two weeks ago. You don’t wanna be here; I don’t wanna see you here. I’d rather run into you at the library.” She held my gaze and nodded. I had her attention. “So, step one: how do we crank it back so these visits to emerg are out of the picture? I doubt the landlord called the police because you were sitting quietly watching the moon over the rooftops…I’m guessing there was more.” I paused to let her fill in the gap.
“OK. I had the music a little loud. I had Craig Betts over and we were singing along. That old bat knocked on the wall and told me to keep it down, so I said go fuck yourself!” Craig was another familiar name. A bit sketchy but he was her friend so it was none of my business.
“Was this the first time, or have there been other times the landlord has complained?”
Jill slumped just noticeably in her seat and looked away before she answered. “Craig is living with me now. I love him and he has nowhere to go. You can’t make me tell him to move out. I won’t do it!”
I figured this was a good time to hear Jill out. I didn’t interrupt but I guided and encouraged her to reveal the details of the past three months. Jill explained that her friend Craig was evicted because he didn’t pay his rent. Jill let him sleep on her couch because she wanted to help him and because she was lonely. Then they became intimate. Craig liked to drink beer and smoke pot; Jill was interested in these diversions as well. The long-term mental health team that had been providing support was running into resistance because Jill was withholding some of these facts. She believed they would chastise her for letting Craig move in and they might have tried to talk her out of it, for obvious reasons. Jill’s timetable was turned around and she had become a night owl. Had this been me, the landlord might have done the same thing but the police wouldn’t have fetched me along to the hospital. They might have just delivered the same lifestyle pep talk I was about to deliver.
“You still haven’t answered the one important question I have. Before we move on, what do you want? This crisis thing doesn’t seem to be the way to go…”
“I want to have fun! I want Craig to love me!” was her quick response.
“That’s reasonable”. Her look was inscrutable. “But, how can we do all that and keep you out of emerg?” I wasn’t sure how reasonable her wish sounded to me but it was her wish and it met her test of reasonable and that was the only place we could productively work from. After another fifteen minutes or so, we sawed off at me calling in her community support worker who would take it from here. Jill’s situation would be tenuous for the next while but if the team hopped up their support they might guide her through it. I wasn’t convinced Craig was the best boyfriend but Jill had to come to her own conclusion about that.
Client number one was now awake and rambunctious but his family had also arrived and they were prepared to manage him. They were speaking with the doctor on duty which left me a few minutes to seek out the eye-roller and provide a little context that might help her to be a bit more understanding and welcoming the next time she encountered Jill, since I was pretty sure that there would be a next and likely a next-next time
At ten-fifteen Jenn texted to say Lowell had called to cancel his appointment. Ordinarily, a no-show was a chance to catch up on paperwork but I had a nagging feeling about this guy. All nurses know that their gut can’t be ignored. I looked through my notes to find his number and called him back. No answer. I wrote up my note and completed the scales on Jill. I checked to find out that the duty doctor had discharged client number one and there was no further need to me to follow up. I called Lowell again. No answer. There was no clear protocol around people who used the crisis service to arrange next day appointments, other than to call them back and make it happen, and of course document all that. I wasn’t in a position to call out the troops.
Before I ate my lunch I called Bridie to confirm her appointment at 1300 hours. Yes, she was still on for it and yes Doug was joining her. I tried Lowell again, No answer. Rudy and I rehashed last night’s Leaf game as we picked away at our lunch. Our observations were meant with the interest of true fans but also revealed our deep betrayal. A couple of years ago, the Leafs were about to move on in the playoffs when they allowed three goals in the last five minutes. That stake still burned in our hearts. Just before Bridie arrived I called Lowell once more. When there was still no answer, I decided it was time to document. I recorded his name, time of call, and the number of attempts I made to try to reach him. These details would be most helpful if he called back again to complain but least helpful if something happened to him.
Bridie and Doug arrived on time. As an absolute indication of her perpetual hope and resilience, she smiled warmly. I knew she and Doug had spoken with the kids and I was keen to hear how it went. I was hoping her smile might signal the answer.
“How are you two?” I opened, once they had settled in their usual seats. Human beings are funny creatures. People almost always sit in the same places. I am no different. When Jody and I go to the movies, if I’m not in my usual seat it takes me a long time to focus and I unconsciously, sometimes even consciously, glare at the people who are in ‘my’ seat.
“We are working on things.” Doug offered. No smile from him. If it was even possible, he looked even more exhausted.
“I know you had a chance to talk to the kids. That must have been rough.”
“The social worker from the oncology team was great. She had given me lots of tips and said I could call her to talk afterwards to see if there was anything she could do for me or the boys right away. Joey doesn’t really understand what’s going on. He’s only four. Yesterday when he didn’t think I was watching him, he was sitting on the sofa holding his breath. When I asked him what he was doing he said he wanted to know how it was going to feel to stop breathing”. While Bridie explained Doug stared at his clasped hands. “They tell me this is natural curiosity. Jamie seems less curious. I think he does understand how serious this is. He’s gone quiet and he isn’t even interested in all the pizza dinners we’ve been having. They are both going with me to St. Germaine’s the day after tomorrow to meet up with Shirley, the social worker”.
“How are you two after telling the boys? I can’t imagine how awful it was”.
Without looking up, Doug offered “It was all kind of a blur…Bridie did most of the talking. I watched them hear her words and try to…figure it out”.
Bridie continued. “There were some things I knew I could say, things I had practiced. I’m not sure if they heard my message that I will love them long after I’m gone or that I want them to love each other for me…but I will repeat that again and again”. Doug reached his hand over and cupped her thin shoulder. Bridie’s cheek moved almost imperceptibly toward the hand on her shoulder. She paused, and swallowed. “I’ve been thinking about the radiation, Hattie. For Jamie’s last birthday we went to a Blue Jay game. He asked me if we could do that again this year. I want to get to that. His birthday is May 16. This is the end of January now, so I need three or four months. I figure the radiation can do that for me.”
“Bridie, this is obviously very important to you and to Jamie. And to Doug”. I added when he looked up. “Have you talked to your oncologist?”
“The oncologist mentioned it in the first place.” Doug explained. “She said shrinking the tumor would be a short term solution to manage the pain. We are going to talk with her more about it Monday. We will meet up with her while Shirley spends some time with the boys”.
We spoke for a while about the in’s and out’s of radiation. Both Bridie and Doug had done their homework and they understood the physical toll the treatments could take. They knew that in Bridie’s situation the treatments were palliative and they knew that external radiation was required because the internal drink that contained radiation precluded contact with small children for a period afterwards. Despite the many improvements in cancer care, with aggressive and advanced tumors people still needed to make hard decisions about the very invasive treatments like radiation.
Bridie saw the benefit of reducing her pain and getting to her son’s special birthday request. But her feelings were mixed. “I am sorry that I will get to Jamie’s birthday but I probably won’t get to Joey’s in July…and I won’t see Lynne’s first birthday. I want to give some thought about how to recognize them in a special way. A little extra time can help me out with that too”.
“We’ll take it one step at a time, Bird” Doug looked her deep in the eyes and smiled. “We will get through this.” I could see the strength he lent her.
Jody and I curled at opposite sides of the sofa with the television muted and she listened as I unpacked my experience with Bridie earlier today. I referred to her as ‘the dying woman’ so Jody could keep track of who I was talking about. And I knew Jody absolutely appreciates the importance of confidentiality and she would never, ever break my trust in her as my support.
I have colleagues who would never dream of taking their work stories home. I guess this works for them but I don’t find it works for me. I carry these stories no matter where I am, the same way I carry my home stories into work some days. When Jody and I first met, she was unfamiliar with mental health work so I had to parade my expertise. But of course I had been to high school, so I knew all about her work. Ha! That didn’t go over so well. Over the years, however, we have become very good mirrors to each other. Mostly, of course not always, we listen carefully to the other person and ask questions that open up the situation we are talking about. Sometimes we give advice, some times dumb advice, but mostly we support each other to mine the solution that we trust the other already knows but hasn’t realized yet. Tonight Jody witnessed my sorrow regarding Bridie. “What is it that bothers you so much in this particular case?” She wondered.
“I’m not sure if it bothers me more than any of the other very sad stories I’ve heard but maybe it’s just the cleanest and therefore the easiest to process.”
“Cleanest? It seems pretty messy to me.”
“I mean clean in the clinical sense. A young woman is delivered sudden, unexpected news that she will die. It is imminent. She has three young children. She and the family are in shock but she is wrestling control over it, until of course the end. If it were more complicated like a woman finds out her husband is having an affair and she has to decide the impact of all of the many consequences – for her, her kids, her financial well-being, her….you know.”
“OK. If that’s what you call clean.”
“And so, so sad. Jody, this woman is an inspiration to me. She is so tough yet obviously so soft and real. Not that I have a list at the ready but if I had a list of people I wouldn’t mind seeing dead, she isn’t anywhere near it.”
“Let me know when you finish your final draft of that list. I have some names to add.” I knew Jody wasn’t really interrupting me, just priming my narrative.
“One of the things the client said was that she was talking to her kid’s teachers about her condition…she was worried about one of the teachers who she isn’t sure will be kind to her little one during this. What do you think?”
“I don’t know many elementary school teachers” Jody replied, pursing her lips and thinking. “But she is right to tell the teachers. Young kids can respond so many different ways. And certainly this will affect them over a long time, probably over into the next year or two, even”. Jody knew about teachers; that was for sure. She has stacked up many years worth of experience and she has faced many difficult personal situations. I wished she were Jamie’s teacher. “I’m sure this teacher will rise to the occasion. I’ve met most of the principles in this area and there are only a couple I wouldn’t trust to support a teacher through something like this if they were struggling”.
“Let’s hope we hit the right combination!” I added.
Just before bedtime, Jody and I were folding fresh laundry from a pile on the bed. I like to fold hot clothes, right out of the dryer. These clothes were a little too cool for me but I was trying not to complain about little things, Bridie’s situation bringing life into perspective. Alas, old habits die hard. “I think I’ll throw this shirt back in before I hang it up” I muttered casually, trying not to make a big deal that Jody brings the laundry up to the bed instead of folding it as it comes out of the dryer. “Whatever…” was all Jody replied. I bit my tongue rather than show her that the shirt was completely unacceptable and quietly hung it on the back of the bedroom door, ready to be re-heated and unwrinkled when she wasn’t looking.
As I said, I rattle stories around in my head. Our conversation about Bridie was still lurking. “Have you ever thought about what it might feel like to get a death sentence? To have to tell me and your family that you were going to die?” I asked Jody, while I folded a pair of jeans, the proper way.
“No. I have not.” She looked askance.
“That’s pretty emphatic. You’ve never, ever thought about dying?” I persisted, probably at my peril.
“Not really…these topics don’t enter my life very often. Honestly, Hattie. We are young. We are both healthy. We take good care of ourselves. Other than the odd time I consider putting arsenic in your potatoes I am convinced we will live forever”. Finally a smile softened her face. The cool, wrinkly shirt moment had passed.
“Well, I’ve thought about it more lately, as you might have noticed. I can’t imagine the sensation. Remember when your cousin Craig died and we went to see him in that last week…he seemed so peaceful and resolved at the end.”
“He suffered a lot Hattie. I think for him death was a better place. It sure was for his family too.”
“But no matter that they were prepared and knew he would die, I remember his wife Darlene’s agony when she told us. And she was so sad for months. She really struggled. Gone is gone, I guess.”
“Think about it. For years they were together everyday, through all the mundane and ridiculous day-to-day accouterment. The end was never in sight. Then, when he had his stroke, everything changed but it also didn’t change. She had the mundane and ridiculous job of going to the hospital and rehab centre every day. Bringing him coffee he barely touched. Changing his pajama top after every meal and dealing with nurse, doctors, family. That was her new day-to-day. When we knew things were getting worse, she had to work with him…communicate with him as best she could to decide what to do. She finally decided to do nothing and let him slip away. For him it was likely peaceful. For her, it wasn’t.”
“I hope I have you around to change my pajama top…” I reached for Jody’s hand and drew her toward me. “But I don’t ever want to live past my ability to swallow. No puree for me – except, I will go on for one week of Dairy Queen Blizzards. Then pull the plug!”
“Of course” Jody murmured into my neck. “I will do that for you because you can be so serious about these matters”.
“I am very serious. It just sounds like I am safely hiding behind humor. Look at me. I’m not even smiling.” And I wasn’t. “One week of Blizzards then done. Promise me.”
“Diapers?” A fair question.
“No…maybe…no, actually. No diapers”
“You may regret that. On TV you can’t even see the diapers on the dancing woman”.
That evening Doug and Bridie also sat quietly together, side by side on their sofa as the last of the light drained out of the living room. They were spent, emotionally and physically. Grief, exhaustion and pain eroded their core. The children were watching television in the family room with Auntie Di, who was desperately trying to distract them from the awful news their parents just delivered.
“It went a little better then I thought it might.” Bridie whispered.
“I guess we’ll see over the next few days how much sunk in”.
“Doug. Are you ok?”
“No. No, I am not ok. I am not in the least ok.”
“I’m sorry Baby. I’m so sorry to put you all through this…”
“Bridie, this is not your fault.” His address was uncharacteristically formal. “I’m just not ok. I don’t think I will ever be ok again.”
“You will be Love. You have to be…but I understand you are not ok now, and you won’t be for a while. I will need you to pretend to be ok for a bit though.”
“That I will do…for you…for the kids. But I can’t do it right this minute. Not now. I can’t get the images of those poor boys out of my head…trying to figure out what is going on; what’s going to happen. I saw you wince when they crawled up on your lap and hugged you so tight…”
“I think I need to talk with the oncologist about the pain. I’ve been holding off because I don’t want to get dopey. But its probably time to start to thinking about this. I might ask about radiation too. If it shrinks the tumor I might get some relief”.
“It’s a plan.” Doug murmured. And they fell silent again, sitting side by side on their sofa, her elegant and long fingers surrounded by his familiar, sturdy hand. Spent, in their now dark living room.
On Wednesday morning, Bridie was back to see me. She was alone. Doug had returned to work. Her sister in law Dianne was looking after two of the kids. Bridie looked way less perky and way more tired. I expected that her skin likely always paled against her dark curls but today, mauve half circles broadly underlined her eyes. I wondered if this was just a might of bad sleep or if she had been pushing herself to look more composed when she was here with her husband. “You look tired” was my way to introduce my observations.
“I haven’t been sleeping well.” She agreed in a voice not fully committed to conversations. She sounded even more wounded than she looked.
“Tell me what’s been going on for you in the past few days?” I encouraged.
Without hesitation Bridie laid it out. “Doug and I went around to some of our other family and told them in person about my situation”.
“Wow. That must have been tough,” I added although it wasn’t a question I needed an answer to. I just wanted her to know that I understood this was difficult.
She puffed out her cheeks as she exhaled with force. “Pheeew!” Then she crumpled into her chair, as though someone pulled the plug and released the air from her body. “Yes, it was tough”.
“How many times did you have to go over it? How did you find the strength to share this news face-to-face with so many people?”
“Doug’s family is all in town. His sister Dianne already knew something was going on because she kept the kids while I had all the doctor’s appointments. But she hadn’t asked for details so she didn’t know the extent of it. So, we told her and Marc first. Marc is her husband. We are real close to them…” Bridie halted. I didn’t interrupt while she willed herself to continue. “She knew something bad was coming but she didn’t know it was this bad. Doug kinda lost it…they lost it together”. She strained to see something, anything, of interest out my tiny window… something that would distract her from recounting, no reliving, this pain.
“How did you do with it all?” I asked gently, knowing that part of Bridie’s worry is her ability to keep providing support to everyone else, physically and emotionally.
“I went numb, Hattie. I drew a blank. I was no help. I couldn’t remember all the details about what the doctors told us. I couldn’t explain it all. You know it was like on TV where everything is in slow motion. It felt so weird…”
“Were all the visits like that, or just Dianne and her husband”? I was curious about how she managed the series of disclosures. Understanding how she managed now might give me some idea about how to build on those strengths down the road.
“I felt a little more in control, a little more able to get into talking with Doug’s brother Bart. Strangely the easiest person to tell was my mom. She’s living in a home over in Geneva about half an hours drive. I just told her blunt and when she started crying I just hugged her. We didn’t say as much”. She didn’t ask so many questions and she…”
I waited for at least a minute for Bridie to finish that sentence. I’ve learned over the years that the idea or message that trips someone up is generally pretty complex. It can’t be rushed and it can’t be forced. Sometimes people use that pause to filter and edit what they want to say. I try to file it away and come back to it because its usually important. Sometimes people just don’t have the language or even the experience to express what they are feeling, so finding the words with them helps them get it out. The most emotional pieces never come out clean. They bump around in the swell before a person can shore them up; if they shore up. Bridie was working hard to understand these new emotions. “It’s hard to find the words sometimes.” was all I added as encouragement.
Holding back tears, Bridie resumed. “I feel like I’m disappointing people.” Pause. I feel like I ought to be fighting this.” Sob. “Everyone knows somebody they call a survivor…at the hospital the doctor told me I was too advanced. They said all they could do was reduce the tumour so I didn’t have as much pain. I didn’t know I had to fight…” She cleared the stream of tears from her cheeks with her sleeve. I reached over gather the handy tissues.
“Bridie, when you first told me about your diagnosis, well really your prognosis, I was skeptical myself. There are so many advances in cancer care these days I thought there must surely be something that can be done to halt, if not slow, this disease for you”. She looked deeply into my eyes, maybe my message added to her deep haunting hurt; that’s how I felt it. “But I listened to you. I heard you explain what you’d been told. I also heard it straight from the oncology team. Your cancer is aggressive, and very far advanced. Your pancreas is involved. But don’t miss this point: you can fight. You are fighting now. Only for you the fight is different. You are fighting to manage this disease to the end; to support yourself and your family through the worst. That’s not giving up by any long shot, as far as I’m concerned.”
Bridie drew a deep breath, raising the fingers of her left hand to cover her mouth while she closed her eyes and folded forward. “I know.”
When she had gathered her thoughts, Bridie regarded me with a gentle certainty. Softly, she confided, “When we met first, me and you and Doug, you said there were things I could talk about just between me and you?” I nodded, not wanting to interrupt her. “Well, you were right, there are some things I need to work through without Doug. Well, work out is the wrong word. I have to talk about this straight. No window dressing.”
“Of course. I replied.
“ We talked to the social worker and the oncology nurse at St. Germaine yesterday about the kids. It was a really hard afternoon. I have mixed feelings about telling them but we have to because we let other people know and they suggest we control the information.”
“What else did they suggest?” I encouraged.
“Mostly it all makes sense. Because they are all different ages, and they will understand it differently, they suggest telling them alone, then bringing them together afterwards so they know to support each other…except Lynne, of course.” Bridie looked up and away, breathing in deeply then exhaling slowly through pursed lips.
I didn’t interrupt. In time, she resumed. “Since, they already know something is wrong with me the social worker said to verify that I am sick and explain all the appointments. And explain why Auntie Di has been there to help…”. She enunciated slowly and perfectly, clearly working hard to contain her emotions. “They told me to talk about the pain and the medicine. Kids are concrete, they said. Jamie will understand better than Joey. They said to use the right words, don’t sugar coat it. Tell them I will die. My heart will stop beating and I will stop…breathing.” She rocked back in the chair, shoved her hands under her thighs and leaned forward, inspiring to the bottom of her lungs, as if to compensate for her eventual failure to breathe.
“I’m sorry Bridie. This is so hard.” I felt my eyes prickle. She noticed my suspicious blink.
“I…we have to do it Hattie. There’s no way out. The social worker and the oncologist said they would meet with the kids if they had questions and I’m sure if there was no way Doug or me could do it they would tell them but I have to do it; there’s no way out of it.” Pause. “They offered to meet up with the kids right afterwards, and then as much as they wanted after that, to answer questions and make sure they were okay. They said to expect disbelief and denial but that kids understand when things are wrong and of course, over time, it…my condition will all be so much more obvious.”
“Is there anything I can do to help?” I offered gently.
“Keep me afloat Hattie!” Bridie responded quickly and with vehemence. “Keep me together; keep both Doug and I together. That’s what we need right now. Once the boys get the details of my condition, and it’s outcome, the social worker suggested we talk with the kids about how to keep my memory alive and to keep my love for them alive, even, even…even when I am dead.” She looked me straight in the eye, without wavering. “I especially need Doug and the boys to keep my memory alive for Lynne. She will have no real memory of me.” No effort on my part could prevent one slow tear from rolling down my right cheek. “I know Hattie. This is real sad, isn’t it?” was Bridie’s barely audible reply.
The rest of the meeting transitioned to more practical issues and some rehearsal of what Bridie may say tonight when she and Doug tell their children about Bridie’s illness. Bridie and Doug have talked about who will say what but neither really knows what to expect. They have both supposed certain reactions from the boys and they have considered how to respond but really, neither is entirely sure what to expect. Dianne will help them out, occupying and supporting the alternate small boy who is not in the process of being handed the most devastating news they will get in their whole lives. “We are telling their teachers this afternoon. I’m not fussy on Jamie’s teacher but I think Joe’s teacher will be very kind to him”.
“What’s going on with Jamie’s teacher?” I wondered. I hadn’t thought about the significance of telling the teacher but the oncology team was correct, they needed to be on board because there would be absences and maybe some behavioural regression.
“I just don’t get a good vibe from her. I can’t put my finger on it but its like she expects a lot from the kids. I hope I’m wrong. I guess I’ll know soon.” Bridie unhitched her hands from under her legs and rubbed some blood back into them.
“I’ll give you a call tomorrow and see how it went. You can call me anytime too.”
“I know Hattie. I do appreciate it” She nodded. I noticed a slight flinch as she reached for her coat. Without comment, I held it out for her as she slipped her arms down through the sleeves. “Thanks” she replied knowingly as she turned and walked out of my office, toward and eventually through the waiting room.
It was snowing again! Driving, gusty snow. I stood at the front window pondering the scene. Where does it all come from? I wondered. But it was Saturday and we were on our own schedule, I could expose myself to it now, later, or not at all. Usually on Saturday mornings Jody and I like to hit the local coffee shop for the weekend treats we felt we deserved. After treats, we wander around town then pick up fresh bread at the bakery as our last stop. Today I sure didn’t feel like stepping outside. “Alright Hattie! The governor isn’t gonna call!” Jody shouted from the hallway. Yes, Jody is the practical one. “We need to get to Beacon Bakery soon or all the good bread will be gone”. We had friends coming for dinner tonight, so I knew two things: one, fresh bread was important and two, that meant heading out in this weather. We were driven by another reality of small town life: the single bake. Whereas the bakery we haunted in the city baked bread three and maybe even four times a day to meet demand, in Carter there was one bake in the morning and when it was gone…it was gone. Which reminded me about the third reality – the driveway would need shoveling at least once more.
When we moved to Carter two years ago, I invested in a stout pair of Sorel’s for just such blizzardy days. Even though we had only lived about an hour and a half South of here, the weather in Toronto was always milder and the snow didn’t seem as treacherous, or intrusive for that matter. Maybe it was all those millions of people tramping it down, or the tall buildings re-funneling the gales. The locals here chalk it up to what they call the lake effect. Because Georgian Bay is a huge body of water off Lake Huron it attracts the snow. I’m not a climatologist so I don’t understand how the bay attracts the snow but I admit it is true! I knew for sure that that it was blisteringly cold and the snow pellets blasting my face wouldn’t make life any easier – Sorel’s or not!
On the other hand, I didn’t fancy driving the three blocks required to accomplish our coffee-slash-bread goal. Especially since driving involves scraping and shoveling! So, I pulled a pair of Columbia snow pants up over my jeans, zipped up a fleece over my turtleneck sweater and wrapped my Toronto Maple Leafs scarf around my neck. If you know anything about the Leafs, you know that sometimes its good to have signature clothing that can be obscured, covered and out of sight. Jody had been duplicating my actions but from a seated position at the chair by the window. Toque, gloves, Sorel’s and go.
We peered in the misty windows of CUPtopia, where the local coffee wallas drip and steam their miracle beverages. There were seats. The floor near the doorway was a bit slick with slush. Jody prefers to sit on the couch near the front window. Prefers is likely the wrong word; she gets a bit pouty when someone else is siting there. Fortunately, even though there was someone there today, it was someone we could join. Roland is one of Jody’s teaching colleagues from the high school. Roland was maybe a bit older than we are and certainly a bit more rotund but I envied his exceptional posture. He also sports a long, thick beard that circles his face. It mesmerizes me; I’m conscious of watching it bob while he’s talking.
I hurried to the line to beat the next folks through the door while Jody loosened her outerwear and started talking with Roland. I placed our latte order, mine with almond milk, Jody’s with skim milk and one sugar and I selected a dandy raspberry scone for us to share. I paid and pointed out our seat to Bev, the barista. I was glad Bev was filling the order because she’s one of the regular baristas whose lattes I trust. According to Jody, I am too fussy about coffee. I’m known to walk away from a weak cup. Really? The way I see it, a $7 coffee ought to be damn near perfect!
As I joined Jody and Roland they were debating James Fennimore Cooper’s role as a disillusioned provocateur in mass American ex-patriotism. This is how English teachers amuse themselves I guess. I looked around for another nurse to engage in a discussion about bodily functions. Alas, I was bound to be drawn into Jody and Roland’s debate and to study the bobbing beard. Jody’s graduate studies focused on literature produced in Paris ‘between the wars’ as she says. While JFC’s time in Paris predated that period by just shy of a century, Jody was generally eager to connect various dots contributing to the period stretching before and beyond her preferred era. My interest in this body of literature was keen but not obsessed, which was my clinical assessment of Jody’s interest.
“Good morning Roland” I said as I slid onto the couch beside Jody. I mugged a delighted face as I displayed the raspberry scone at a jaunty angle. She leaned over with a grateful smile and placed a quick peck of appreciation on my cheek. “Only half though we’re sharing”.
After her eye roll Jody brought me up to speed on their conversation. “Roland and I were talking about James Fennimore Cooper” Jody said to me while looking at Roland.
“Like, the Last of the Mohicans guy?”
“That’s the one. Roland is thinking about adding The Last of the Mohicans to the senior reading list. JFC’s narrative is said to be inspired by Sir Walter Scott’s Ivanhoe”.
“Ivanhoe makes me think of Roger Moore. They don’t make TV shows like that anymore. Now its all arguing drama, yelling drama and raucous sex and innuendo.”
“As much as I’d love to debate television right now, Hattie, I’ll just close by agreeing that Ivanhoe never took his clothes off.” The beard! Roland wanted to get back to his primary audience, Jody.
“Pity that.” Jody closed the discussion of Ivanhoe.
“I read Last of the Mohicans a million years ago” I replied to Jody, also looking at Roland, at his eyes. “Do you think it’s a story girls can relate to?” I don’t remember connecting with it in any big way. All the action is kind of …I don’t know…manly.”
“I was hoping that might emerge from the analysis and discussion as we read it in class” Roland half defended himself.
“Hmmm. Seems a bit risky. What if the kids don’t notice? Or if they aren’t distressed by the conventional ideas about women in the early 1800’s, or our relationships with First Nations people?” I added sipping on my latte and surveying the scone, which I had placed a little to far away for casual grazing.
“That’s what Jody was saying and just so you know,” Roland raised his eyebrows adding emphasis to his thin patience with my response, “it’s the dilemma I opened the conversation with. My wish is to add an early ex-pat to catapult my term on American Literature and Benjamin Franklin didn’t write enough fiction.”
“And Gertrude Stein is too late” Jody mused, smirkish. Roland was fully aware of Jody’s penchant for Gertrude.
“And a bit unintelligible for the average high school student…maybe even the average anyone”. I quipped. Then added quickly Gertrude I mean, not JFC.” My comment didn’t warrant a single beard bob.
The conversation about James Fennimore Copper, Parisian literature, and High School English programs in general died down shifting to a casual exchange of ideas and experiences, including the best price for grapes at the three grocery stores in Carter competing for our market – literally. When our coffees and scone were deep in our satisfied bellies, we layered up again, bid farewell to Roland who was staying on to wait for his wife, and struck out for the bakery.
A chime noted our entry into the Beacon Bakery alerting the owner to a potential customer. She smiled as she wiped her hands on her apron, like the grand old bakers I imagine of old. “Good morning ladies. What can I get you?”
“We’d like two loaves of Dutch Crunch please” we said in well-rehearsed unison. We discovered this bread shortly after we moved to Carter and it quickly became our mainstay of wheat and gluten, much to the chagrin of some of the more trendy, whet-frees we sometimes associate with. It was mostly a regular bread-shaped loaf but on the top were extra pieces of crust baked right into the dough.
“You are half lucky, ladies. I have one loaf left” was the cheerfully delivered only partially cheerful news.
Jody and I exchanged an alarmed glance and quickly negotiated getting that last loaf into our hands immediately. Only then did we agree on a substitute as our second loaf. We paid up and headed out into the wild again.
“I blame James Fennimore Cooper!” I said with vehemence when we were safely out of the baker’s earshot.
“Maybe it was you dragging your ass this morning instead of just putting on your gear and getting out the door” Jody countered.
“Maybe someone else is on to the Dutch Crunch” I worried aloud.
“Obviously someone else is onto the Dutch Crunch.” Jody asserted seriously. “Now we have to be ever more wary…”
“…and swift in acquiring our treasures” I laughed but only half in jest, I was also seriously worried about the future supply of Dutch Crunch.
“So, now what do we do? We have guests coming for dinner. We were going to serve the Dutch Crunch with the soup…”
“Sweet Jesus Hattie! We can serve any friggin’ bread with the soup”. The few kicky curls that had escaped from her hat shook with intensity. I was glad that Jody had come to this conclusion but I mocked a horrified gasp nonetheless.
“Works for me” I laughed. And we trudged single file through the path that early footsteps had ploughed through the snow covered sidewalk.
My job when we entertain is to clean, tidy and mostly stay out of the way. Jody is much more interested in cooking and baking. She is an exceptional soup maker and enjoys concocting new arrangements. While she was ‘building’ her current soup, I worked away like a guilty man, well a guilty woman I guess, and tidied away all the books, magazines, coffee cups, notes and thingamajigs that littered our home. We shouted conversation through the three-by-four foot hole that we jackhammered between the kitchen and dining room the same week we moved into our home. I say poked deliberately; we knocked through the lathe and plaster ourselves, leaving the finishing up to my brother, who unlike me knows a thing or two about carpentry. I vacuumed, dusted and placed the cushions strategically. I scoured both bathrooms, changed all the towels and set the dining room table. “Looks great” Jody commented as she walked through. “Thanks, smells great too” I bowed in respect.
And it turned out, it more than smelled great; dinner was delicious. Jody’s incarnation of curried butternut squash soup served with the precious Dutch Crunch bread was a hit. As it turned out, once we laid out the ingredients for the meal, we realized that the Dutch Crunch was the absolute correct match for the soup. We surrendered and decided to share. We can be so grown up sometimes. Our friends Elaine and Guy loved it. At first we lied, telling our guests we drove to a bakery in Geneva about 40 minutes away. Then we fessed up with long faces, worrying that full disclosure might further impact our ease of local access.
We sat comfortably around the table after devouring our meal, raising the stock of our various opinions about the state of the world. We met Guy and Elaine shortly after we moved to Carter. He is a lawyer in town and she is a professor at the local college. They match Jody and I in terms of irreverent cheek and we find similar things amusing. Elaine also teaches English so she and Jody have a lot in common. Guy and I always have something interesting to add to their banter. This being Saturday night in Canada, my Maple Leafs were on television. Being it was the Leafs; I had the sound turned down. My hopes, nay the hopes of we all, have been dashed all to often. This year the Leafs were re-building the team. To my account, this was a perennial operation. Nevertheless, all observations about rebuilding aside, the Leafs were victorious. Adding exponentially to a fun evening.
Jody and our guests sipped Irish whiskey in celebration. I devoured a second piece of Jody’s lemon and green tea cake with vanilla cream icing instead. Extra dessert was my strategy, more correctly my reward, to abstain from alcohol. About ten years ago, I was involved in a skiing accident. The injury to my right knee was pretty substantial and required three different surgeries to correct. As you can imagine, the pain was excruciating at times and I am not the kind of person who can really put my feet up and rest. To manage the pain I used narcotic pain medication. Sadly, I found a pain-free life a little too attractive and in very short order I was hooked. Because I am a nurse and my physician trusted me, and because really and truly it was clear that I had significant pain to manage in my day-to-day activities, I had a very large supply that I was able to stockpile before any red flags went up.
It was a long and tedious recovery for me. I always knew in my head that addiction is a real thing on its own and not just an absence of willpower but now I also knew this in my heart. Jody stuck by me, actually it was her encouragement and love that pushed me to change before I risked my job, my career – everything. After a stint in medically supported detox, I joined a regular outpatient rehab group and found others in the same boat as me. I still attend the reunions and I value some of the connections I made long the way. I tried Narcotics Anonymous but when we moved to Carter I found too many familiar faces, given my job. In rehab I learned to live clean and I respect that now. I find it relatively easy to abstain from alcohol, even in these social kinds of settings. But I am an absolute failure when it comes to cake.
Before Guy and Elaine could leave, we needed one more scoop of the driveway. Guy was insisting but as hosts, Jody and I believed it was our ‘duty’ to our guests. Also, it was important to us not to gender the heavy work. However, neither of really wanted to go out in the elements. To Guy and Elaine’s amusement, we resolved it the way we resolve the ‘who will be the gentleman’ question in those situations when a ‘gentleman’ usually steps up – we used rock-paper-scissors. This way we could do away with the stereotypical pink and blue jobs and all the duties were accounted for. Alas, Jody’s rock crushed my scissors. The job itself was mercifully short. It almost took me longer to gear up and make faces in the window than the actual shoveling. Everyone was suitably entertained. Being out in the cold made my crib feel warmer than ever and I fell easily into my slumber.
After a late evening entertaining friends, my usual Sunday morning lay-in was much appreciated. I usually attend a yoga class Sundays but as I pondered a third cup of coffee I had second thoughts. “C’mon” Jody encouraged. “I’ll join you”. We finished the post-soiree tidy up together and within half an hour we two were bundled up again in our winter-wear, layered over yoga-wear. Jody scraped the icy snow off my jeep and I wheeled it out over the most recent hump left by the plough and we headed to the yoga studio at the edge of the next town.
We arrived just in the nick of time. The room was warm and welcome. We recognized many friendly and familiar faces. We smiled and waved silently not wanting to disrupt the peaceful environment. Jody and I staked out our territory with our mats and sat quietly to prepare our minds for practice. I have trouble with a few postures because I will never have full range of motion in my left knee but I can get close enough to yield the benefits of each pull and stretch. Although in yoga one is meant to concentrate on posture and breath, my usual experience was a wandering mind. When I didn’t extinguish a stray thought, it casually coiled itself into a thread and soon, without my full commitment to mindfulness, I was successfully distracted. But I always did aim to still my monkey mind.
Today, I couldn’t wrestle down a thread sparked by Bridie. Death. Being born makes death inevitable. There is no immunity. Down dog; inhale; lunge. Love equals hurt. The more I love you, the more hurt I will experience when you die. Is the opposite true? Arch; twist; bend. How is loss different when we can prepare for it? Kinda squat; exhale. Nancy’s remark: I welcome death. I chastised myself for distraction but I could not reel in my thoughts. Without focus, does my body still benefit from the postures? Does my mind need these contortions as well? Stop thinking!
After class, we hung out at the studio for a while chatting with familiars and hearing about the upcoming events and workshops that we missed during the announcements at the outset of the class. There was a special meditation class starting in two week but it would be on a Tuesday. And a Yin class on Thursdays. For us, Sunday is the only predicable opportunity for class because both our schedules can easily slide through into the evening. We learned that next month a Buddhist monk was giving a talk on a Saturday morning and Saturdays were doable. We both entered the event into our phone calendars, a sure sign we would do our best to get here. I set a calendar alert to remind us that an early Dutch Crunch run would be required that morning. Other than one small incident, the rest of the day was lazy. To be fair, I was operating with both mine and Jody’s interest at heart but Jody didn’t quit see it that way.
“Hattie! Did you eat the last two pieces of cake?” I realized the seriousness of my offense in Jody’s shriek.
I padded into the kitchen, chastened. “Yes. Yes, I ate both pieces of cake.”
“Why the…” I knew Jody was mad when she came close to over-riding her school-teacher aversion to cursing “why the…hell did you eat both pieces.”
“Well…” Her stare was grinding me down. “I’m starting a diet tomorrow”. I could tell this wasn’t giving my explanation any traction. “OK” I continued, hoping I could win her over. “I know in my brain that all those calories are stored away in my body turning ever so slowly into fat. And I know that eating them up so they were out of my site and tempting me less was wrong.” Was she weakening?
“Hattie, sometimes you are a selfish bitch!” I knew it. I apologized but I also knew from experience that further détente would be unproductive. Jody’s fury was notable given that bitch is a word she holds very strong opinions about. At least he air was free of new snow and any shoveling would be in our future.
I keyed the various scales and checklists into the electronic file for the new assessments from today. After submitting the scales and checklists related to each person, I clicked the outcome boxes, all while devouring a healthy sandwich that I incongruously washed down with Diet Pepsi. I took that last five minutes before one o’clock to prepare for Bridie. I made sure there was a chair for Doug and I made sure my heart was ready. My phone rang and Jenn our program assistant said your client is here. Game face on.
When I met Bridie in the waiting room, she introduced me to Doug. She looked tense and he looked like he hadn’t slept in a month. Doug was a tall man, dwarfing me but clearly a solid match for his wife who was also on the tall side. To say he looked sad would be an extreme understatement. His sorrow filled the room. It was palpable. He was dressed in loose-fitting jeans and under his unzipped jacket I could see he wore only a tee shirt. So he was hardy. I drew in a deep breath to fortify myself. “C’mon back with me. Can I get you anything? Coffee or tea?”
“If you have some water that’s all I need” Doug said, nodding. “Nothing for me thanks” Bridie added. I was back in a jiffy with a drink for Doug. They sat through the canned orientation of my role and the role of the clinic. Bridie watched me, biting her top lip. Doug mostly looked down at his feet with intermittent nods in my direction. I started with the practicalities. “Doug, before we get started talking, there are a couple of forms that need signing. Let me explain them. First, because Bridie is the person registered to receive care, we need her permission to talk with you about anything that involves her.” I saw the look of disdain cross his face like a cloud. “It seems strange but that’s the way it works.” I added gently. “I know the two of you are in this together, Bridie was clear with me about that. But this is our policy, actually it is the law, because in some other situations couples are not so together as you two. Some people want to be in absolute control of their information. They may hide or limit some of the details for their partners and families. I’ve worked with other families where the client needed to talk about other aspects of his relationship with his wife that he didn’t want disclosed to her until he was ready. It sounds to me like that’s not the case with you two but this process is designed to protect the client, in this case Bridie.”
Doug looked to Bridie, his deep breath was audible and his lips pulled so tightly together they nearly disappeared in his face. She nodded to him and said gently “I have nothing to hide but I understand. “I also had to sign one of these for the Oncology Team to share my info with you but I didn’t think to tell you.” Bridie leaned forward from her perch at the end of the chair and scribbled her signature.
“The next form I need signed is almost the same. It allows our program to share information with St. Germaine Hospital and specifically the Oncology Team.” Again, her signature appeared. I signed as witness to both. “And the last form is for you Doug. Because it’s your insurance that’s covering some of the extended care, I need you to sign here indicating that you confirm your coverage”.
“Ya, I signed this one at the hospital too. For the social workers.” He signed on the correct line above my finger and again I was the witness.
“Thanks. I can’t guarantee that’s the end of the forms but I know that’s all for today” I tried to be light, smiling. They smiled back, politely. “So, let me start by saying I am so sorry about having to meet this way. You two have been delivered a horrible blow. I understand you have been fully briefed about the medical side of what has and will happen. From what I’ve seen in your file from St. Germaine Team well, you are in good hands. As I said at the beginning, my job here is to offer support and….”
“Help us deal with the worst” Bridie interrupted. All I could add was a nod.
“I’ll start.” Bridie sat up a little straighter, steeling herself. “I know how this will end.” Doug grimaced and looked away. “I hate that this is happening but I need to do it right. So much rides on it for me…”. Bridie swallowed hard and continued. “I am torn up Hattie. Since the diagnosis I’ve had to talk about this with so many people. Almost everyone I’ve spoken to is upset about the kids; some are upset about Doug but mostly because he has to deal with the kids when I’m gone.” She extended her hand in Doug’s direction, sensing that she knew he was about to interrupt. “Just hear me out. Hattie you are the first person to be interested in me first and what I am thinking and feeling. I’m touched by that…but I’m also uncomfortable with it. I feel guilty if I don’t put the kids and Doug first. I’ve thought a lot about some of the questions you asked me that first meeting, then asking me what I wanted in this process…I said I wanted to live and you said we could start there. That meant so much to me. There was no pity in it….”
Doug reached out to put his arm around his wife but the chair arrangement made it awkward so he wrapped his large hand around her knee. “I’m sorry Bird. I just don’t know what to do, or what to say.”
“Everything is new to you too, Baby. I think that’s why I need to talk with Hattie. There are things I can’t say to anyone else. Well, that’s not exactly right; there are things I don’t want to say to anyone else. I don’t want to tell you how sad I am…” she was looking directly at her husband. “I don’t want the kids to think I am falling apart, even though I feel like I might explode any minute. I don’t want to tell you I am angry and I don’t want people to know how afraid I am.” Her last words trailed off and ended in a sharp inspiration of breath that nearly swallowed them. “These are the reasons I need to…just for the next little while…believe that I am going to live”.
I was thinking hard about where to go with this but I had nothing to say right then. I let the comment sit quietly between us all. Doug’s hand was imperceptibly kneading Bridie’s knee. Her hand was on top of his, her thumb very slowly drawing a circle around his knuckle. I was distracted by the thought: how well they knew each other’s hands. Bridie filled the space eventually “I read some of the papers they gave me at St. Germaine and it sounds like I’m in denial but I am most certainly not in denial. I know exactly how this will end. I am aware of it every minute of every day…and night. I am holding myself together so tight I feel like I might crack but I have to do it… I have to do it this way”.
“…of course we want Bridie to live!” Doug is upset. He’s mad. I worry he’s probably mad at me but he expands. “I’m not mad at you” he said looking up at me but they underlying glare remained. “I’m just mad…and thinking for a minute…pretending…you aren’t going to die isn’t helping me. I want it to be true so bad….Bird, I want it to be true so bad…”. Doug’s head and shoulders sagged in resignation. Bridie squeezed the hand he still had wrapped around her knee. He looked up. She turned her head to meet his eyes but made no sound.
“Let me back this up a little”. I leaned toward them, elbows on my knees. Doug, I apologize. In my work it’s important to appreciate how the person understands his or her own situation. Its important for me to know how they want to work with, or through their situation. It’s important for me to hear what the person wants, or what they hope to learn, or come out of a situation with. Sometimes the person doesn’t know these answers and we talk that through it all to find a direction. When I asked Bridie what she wanted, she was pretty clear. She wants to live. So that is where we start. I didn’t mean it to sound like we could stop this train from roaring down the track. It’s a starting point that shows me how much she loves you and her kids, how she doesn’t want to see you hurting. How much she knows she will lose…she will lose all of her life.” I paused to take two deep breaths, as unobtrusively as possible then before I lost my nerve. “Bridie’s wish shines a light to show where and how I support her”.
I sat in the excruciatingly long silence. Try it sometime. Even three minutes feels like forever, especially when emotion is thick in the air. With a sharp, swallowed sob, Bridie offered “all of the above.” Tears soaked her stony quiet cheeks.
She turned and looked straight at her husband. “Doug, I want to make this last bite of life last as long as I can. I know I will get sick, so I need to do what I can now. I want to think about how my kids will remember me. They will only have me in their memories. How can I stay important to them? I want to stay alive for them. I want to stay alive for you too…” and she reached over to wipe away a tear before it splashed from his chin “but you have lots of memories of me. The kids don’t have enough”.
“I get it…I get it now”. Doug looked over to me “I get it Hattie. I don’t want to but I get it. I want to help. I want to be a part of this. Keeping Bird alive is my duty for my kids…now that we all seem to know what that means…”
“I don’t know how much the oncology team has explained, or what information they have provided you. It sounds like they have given you some about the stages of death and dying…” it felt both awkward and a relief to say those words out loud. “I don’t know if they have given you some timelines around how physically able you will be over time; you know, how to manage your energy – especially with three little ones. We can spend a bit of time sketching out what kinds of things you want to do, or get done and see if we can build a schedule that will match your energy?”
“That’s a good idea. I already feel worn out early in the afternoon, that’s not like me. But I lay down with Lynne and even if I don’t sleep, I get to look at her while she does”.
“I have a few more practical questions. Doug what is your situation like? Are you able to take time off work?” I knew from the insurance forms that Doug worked in a car manufacturing factory, on the line.
“I have applied to be off, but….”
“Any leave right now is without pay” Bridie interjected. “Besides the financial hit, right now I want to keep our routines as close to normal as possible, whatever that is.” She managed a small smile. “I also think….we need…I would prefer that Doug take time off later.” Her voice cracked just a hair as she wrestled with her understanding of ‘later’ but she continued quickly leaving no space for debate. “His sister Dianne lives nearby and she can come and help around the house. Jamie is in school full days now and Joey is half days. They play well together most the time at home. Lynne needs a bit more but Di can help me for now”. She turned to Doug “Baby, I want you with me but I don’t want to bankrupt our family. Work now while you can because I think we’ll need you later…”. Doug’s face was set in stone; I didn’t know him well enough to know what he might be thinking, but this was clearly the way Bridie saw it going down.
“So, it sounds like for now the support is in place for you to manage your energy Bridie and I suppose that also means you can manage the pain. She nodded. And it sounds like you have someone to get you to and support you in your appointments. Another nod. Just so you know, the St. Germaine oncology team has transportation available. There are drivers who will take you, you and Doug, or the whole family to your appointments, and any appointments for the kids. You don’t have to drive yourself”.
“I didn’t know that” Doug said looking up. That would be great because I find it hard to shut off what I’m thinking when I drive home from there”.
We spent some time arranging the next meeting. It would be just with Bridie, since Doug was returning to work in two days. I like to leave some of these more neutral tasks until the end of a meeting because it gives some transition time for people to re-compose before they walk back out through the waiting room. But I also had a little trick up my sleeve “Thank you both for being so open in this conversation. I absolutely appreciate that this is a devastating situation for your family. I have a sense you know we can’t fix it but we can manage it so you two are in control of how it happens. I am here to help you through. You can call me anytime; if you leave me a message my stats say I am 96% sure to get back to you the same business day”. Small, polite smiles recognized my lame attempt at levity. “Here’s my card”. As we stood to leave I added: “One last thing. I know this has been a very emotional meeting. If you don’t feel like you can face anyone else right now, I can get you to the back door to the parking lot with only a very slight risk of running into one other person. Bridie, you know the way – you took this exit the other night”.
They looked at each other then nodded “Thanks”. Doug took the reins. “We’ll take you up on the escape route, I appreciate it. Our goal the next time will be the front door”. And with that, he gently folded Bridie within his arm and I led them around the back hallway and out the door. Doug’s arm sheltered his wife as they walked slowly to their car.
Revived after my morning peer support session with Viv, I returned to assess the second crisis patient from this morning, the older woman named Nancy who was currently in the intensive care unit, the ICU, and who had taken an overdose yesterday. The psychiatric assessment I had requested earlier was still outstanding; mornings were busy on the inpatient unit. I reviewed what we knew about her from the file. Nancy’s seventy-sixth birthday was coming up and she lamented the loss of her husband a year ago, and at least three friends so far this year. She was still able to take care of herself and live in her home but she was lonely. Her kids live several hours away, which meant she didn’t see them very often.
Last week on the phone her son suggested she think about a retirement home where she could be with others and go on outings…she didn’t like that idea. Her nurse in ICU predicted that in 24 hours she would likely be medically clear for discharge but was she safe to go home alone? This was a situation where we had to decide if she required an admission to a hospital bed, or if there were other options. In theory this was the beauty of our matrixed team; medicine and psychiatry working together with all the facts. To support this process, I had a bit more time to spend with her to complete an assessment and an opportunity to follow up.
I looked into the ICU room at Nancy. She was laying in the bed with her head turned to the wall. She didn’t take up a lot of room under the covers. I waited in the doorway to determine if she was awake or sleeping before I entered. When she raised her hand to scratch her ear, I confirmed she was awake and stepped over the threshold with a neutral “good morning”. Her head swivelled slowly and she looked me in the eye without expression. She looked tired and sad. “I’m Hattie Crawford, from Crisis Services. I wonder if we can talk for a bit?” She nodded just perceptibly and I took my cue.
As it turned out, although Nancy certainly wished her ‘time’ would come around sooner rather than later, she had scared herself with the overdose. She was embarrassed and sorry to have alarmed her kids, who were on their way to Carter to see her. Her voice was weak but I felt the underlying truth was strong. Listening to her story, I understood her motivation completely. Here was a woman at the very other end of life from Bridie – too bad they couldn’t switch out. Finally, even with Nancy’s very extreme response to her situation, a mental health admission was not what I thought would best support Nancy to get the resources she needed. She agreed. One large tear slid from the corner of her eye and down her cheek. She made no attempt to stop it as she denied any further wish to kill herself.
We talked a bit more about her, her life and what might help support her to feel better. She was clear that she wanted to continue to live in her home but also thought she needed more activity, maybe even meet new people. I described a new Senior Support Team to Nancy. It is available to provide in-home and day program options to engage older folks in activities and ensure they live where they want for as long as they can manage. This team also offers support groups for the inevitable grief and loss that bombards people as their spouses and friends drop around them. Provided the psychiatrist agreed, I told her I would recommend Nancy be discharged once the Senior Team met up with her and had a plan for immediate response. She was also interest to hear that the team had resources to answer questions from the family and provide them with support, and she hoped her family would take advantage of this.
I knew the Team could do all the things I said because one of my peers worked through a similar situation a couple of months ago, and as a result we invited the coordinator of the Seniors Team to one of our Team meetings. I also knew the Seniors Team was keen to do all this because hospital beds are costly and everyone who isn’t in one is saving us all a lot of money. The human side of the argument compliments the budgetary; people generally prefer to be in their own homes. The balance slips when we nickel and dime the services we provide, which I suspect occurs more often than it ought to, if the tales I hear from families are true.
Nevertheless, in Nancy’s situation the home care was superior to anything else we had to offer and I would support this plan. Before I left her, I offered to follow up with Nancy in person if it turned out she was either admitted or was still in ICU tomorrow. I told her I would give her a phone call to check in next week one way or the other. We have learned from listening to our clients that reaching out is an effective addition to our crisis assessments. People are different in their own haunts and getting that perspective improves our understanding. Nancy would get all that, and more. I hoped things worked out for her.
While I’d been working away with Nancy, two more folks were in emerg presenting with mental health issues. These two assessments were relatively straightforward. One was an obvious admit and one was obviously not. In the meantime, the psychiatrist had checked in with Nancy and I learned that with her agreement Nancy was being admitted to a medical floor for another day just to make sure there were no lasting effects of the overdose. If the person isn’t entirely sure when they swallowed the meds or can’t remember what they ate an hour or so before, even a strong dose of charcoal to sop up the chemicals or “gavage” to flush the stomach won’t touch what made it into the bloodstream and older folks metabolized their drugs more slowly.
I agreed with the psychiatrist. Nancy’s situation deserved a more cautious approach. I was also happy that Nancy would be admitted to a medical floor rather than a psych floor. The symptoms they were looking for were medical. An admission would also get the Seniors team to connect with her today, since pre-discharge took a bit more priority to someone already at home.
My work in the emergency department was finished for now so on my way over to the Mental Health Clinic I rolled in to see Nancy on the ward she had been admitted to. She greeted me with a warm smile and held out her tired hand. I grasped it and she held mine as we talked. “I’m sorry I don’t remember your name but I am very grateful for your help. Yesterday everything was so bleak. I welcomed death. Now, today, I feel like I can go on.”
“My name is Hattie” I replied.
“Hattie…that’s short for Harriet, isn’t it?
“Yes. Not many people pick up on that. I’m named after my grandmother”.
“My grandmother’s name was Hattie too” her eyes crinkled as they smiled, clearly her troubles were more recent than life-long.
I smiled back. “I am glad to hear things are sorting out for you. You and the psychiatrist, her name is Dr. Lindsay by the way, made a good decision to stay here overnight. Make sure you tell the nurses if you have any strange feelings in your heart, your belly or your bowels – those will be signs we didn’t get all the medicine out of you”.
“That’s what the nurse who left just said. She also said that someone from the Geri Team would be here to see me soon.”
“Wow, that was fast! You must pay your taxes on time!” We both laughed. “I’ll give you a word to the wise though: they call it a Seniors Team, not a Geri, or Geriatric Team. Don’t ask me why but somehow they see being a senior as more comforting than being geriatric”.
“It’s no mind to me” Nancy replied seriously. “I am glad to meet up with them. My daughter called and she is really upset. I hope they can help her out with this too, and she isn’t a senior or geriatric!”
“Not yet, anyway! Nancy, it was an honour to meet you. You have had a rough few years. You’ve lost too many people you were close to. And it’s been a very sad time for you. But I have a feeling that you are ready now to start gathering up some of those loose threads. Don’t take this the wrong way, but I hope we don’t run into each other again – at least professionally.”
Nancy tightened her grasp of my hand. “Thanks, Hattie”. Despite intermittent prohibitions about inappropriate touch, I leaned forward and hugged Nancy. Ever the rebel! She hugged me back, unknowingly also a rebel. The effect was positive.
Crisis work operates in a gray zone much of the time, leaving you to rely on your wits and instincts. I suppose the ‘Science of Nursing’ advocates would argue with that but ask any crisis worker in the real world and he or she will tell you that nuance and subtleties drive impression more than depression scores and suicide indexes. But hospitals and organizations need paper tests to demonstrate to their insurers that the people they hire did all they could to properly assess risk, just in case. Because of the subtleties inherent in the work, I find being part of a team a true benefit of the job. When I want to check my observations of subtlety and nuance, and sometimes when I want to unload about the obvious, I have two peers in particular I check it all out with. Viv is my first stop. She has been in this role for many years. She’s what we call a seasoned veteran, like we’re in a war for heaven’s sake!
Viv worked at the specialized psychiatric hospital in North Carter for several years. After many years supporting people in their long-term recovery from mental illness, she moved the mental health unit here at ‘the general’ where people stay only long enough to sort through their immediate problems, or until we transfer to ‘The North’. Over the years, Viv saw people admitted to a bed when they might more effectively benefit from outpatient crisis services, and uninterrupted support from family and friends. So, she concocted an on-call system to increase clinical availability and volunteered to pilot a project where she and three other nurses carried pagers and responded to the mental health crises at the emergency department.
That was ten years ago. Viv’s concept morphed into the emerg department ‘crisis worker project’ about 5 years ago and now we have the flashy ‘crisis program’ I work at, with all its protocols and guidelines. But it all started back with Viv, and she’s literally seen it all. About twice a month, I enjoy a one-week overlap of my shift with Viv’s. Not that I don’t enjoy working with my other peers but Viv and I see most things the same way, including the humorous side of what is going on. The other wise counsel I tap frequently is my supervisor Rudy, also a well-seasoned veteran. Today, Viv and I are both scheduled in the Crisis office and I need to talk with someone about Bridie.
“This can only mean two things…you are stumped or you are pissed.” She laughed as she accepted the cup of hospital Joe I handed her after the Team Leader’s report. I’ve been down this road so many times I know exactly how she takes her coffee – black with sweetener.
“Ha! Neither!” I exuberated back at her. “But I would like your perspective on a very sad situation”.
“Perfect. Come in here and bring me down. Got any happy stories Hattie?”
“Well, I set Amy Brixton up with Peer Support and I haven’t heard from her in about a week”.
“Jinx. Never say that out loud.” Nurses are very superstitious. Again, not in keeping with the scientific approach but ask any one of them and they will all say they rely on ‘feeling’ and ritual in the work they do.
“I know.” I pouted back, exaggerating a frown. “But I do have a sad story to tell you about a young woman who’s going to die”. During the pause that signaled the shift from lighthearted to serious conversation, I set myself in the second chair in the interview room. These chairs are made to be too heavy for someone who is aggressive to pick up and throw, so they are hard to maneuver. Their weight makes it hard to position them so you are facing each other. Therefore, I ended up perched on the corner, leaning forward crookedly.
I laid out the details of Bridie’s situation, reiterating the evidence from the St. Germaine oncology team. Viv realized the gravity of this situation right away. “So, you are going to see her this afternoon? Do you know how the husband is doing?”
“I am seeing her and her husband at 1300”. That’s one o’clock in hospital time.
“I believe I can be a good support.” I added. “I just need to stay focused. I don’t want to start crying or say something stupid, or…well…I already said something stupid”. Viv’s eyebrows rose, just perceptibly, pushing me to explain. “I asked her what she wants, meaning how might I help her during this. She said she wants to live. How dumb a question was that?”.
Viv looked down at her hands, smiled gently and slowly shook her had side-to-side. “Not dumb Hattie, just real. If you have a sense it put her off, then re-wind. I think what you were trying to do is find out where she is at emotionally in this process and she may not even know herself yet”.
“I acknowledged it was a dumb question, like to her, but she didn’t reply. I did say we could start there; start with wanting to live”.
“If that’s where she is at then that’s where you start. Rule number one!” Viv had a multitude of rules number one that shifted depending on the situation. But assessing and starting at the emotional point where someone was is a standard piece of her advice. In practice this means understanding the person in the present moment, appreciating how they see their situation and their own assessment of what and how to change. So many people come to counseling to fix their lives, or actually, more often, to fix the lives of people around them but people are not always aware enough, or they don’t understand themselves or those around them deeply enough, to change how all our thoughts and behaviours shape our own lives and the lives around us.
People can only change themselves; this I know. My job is to find out what and how I can support them to think and act differently. They have to decide to become what or who they want, or to come close enough to what they want to feel contented. In this case, Bridie and I, and Bridie, Doug and I must talk about what is the most important to her. Some people who are faced with death need to have the logistics like wills, funerals and so on shored up from the start. Some people need to reflect on their legacies, or the meaning of their life. Some are too angry or too overwhelmed to face the piles of stuff, more commonly called ‘shit’ in their lives, or grieve the holes where they know in their hearts that the shit should be. Families may be at a different point from the person; the spouse can have work that is miles away from their partner. It is complicated. Messy. But I do know, and I know it because I have erred and pushed for production in the therapeutic relationship, that people can only move forward from where they exist now, not from some future state of mind that they hope to achieve. I share Viv’s most common rule number one: start from where the person is.
“So, she wants to live – that’s where we start. I don’t have the sense that she is in denial or anything about her illness. She seems well informed, even resigned. But I feel like she wants to put that on the back burner and deal with the moment, right now, while she is still alive. I guess I need to understand how I can support her in that”.
“You always just come in here to tell me you already know!”
“Nope, just came to me as I said it out loud. Promise.”
“And, rule number two, how are you?” Even though Viv had a few favourite rules-number-one, she really only ever had one rule number two: get and keep yourself in an emotional place where you can be available, authentic and supportive to the client.
“Well, it’s sad, as I said. But it’s also an inevitability, as Bridie knows. So there is nothing really that I can do to change the outcome”. A stray worry popped into my head. “Do you think this will mess up the database; I reckon death is a big deal in our outcome data?”
Questionable humor is a mainstay for nurses. I know if some of what we said was overheard it could be construed as unkind or hurtful but it’s just a way of coping. I expect the same is true in any profession. I suppose accountants have their own little way of mocking the tax foibles of we the unwashed. In this case, it was my way of lightening the reality that Bridie would die, and she would likely die on our books; my books. I didn’t want to think about it, so I thought about the silliness of the books.
I slumped back into the heavy chair. “It hurts my soul. It’s so sad. This woman is so young and her family is so tiny and it’s so not fair.” Viv reached out and placed her hand over mine. “You can do this. You have an open heart and this is just what she needs right now.”
“I hope you are right” I murmured back. “She deserves a soft landing on the other side.” In our business there’s always someone with a pressing problem to work out or some nascar level steering needed to keep his or her wheels on the road, so to speak. I was grateful that Viv shared her few precious moments of peace with me this morning. I would reciprocate another day, and she knew that. This was teamwork. It was the glue that pulled us into a tight ball so we could roll pretty straight without getting caught up in the snags and pitfalls inherent in the real day-to-day realities of mental health nursing. In theory, anyway. Some days the ball swerved and bounced, as if the gremlins were in charge. But mostly, we kept the game on-side.
After her conversation with Hattie, Bridie lay down on her bed but could not ease into sleep. She heard the door snick as Doug came into the house. She could not muster the will to lift her head. He paused in the doorway, unsure whether to join her or leave her undisturbed.
“I’m awake” Bridie said softly, her voice husky from a day full of tears.
“Ah, my little Bird…” was all Doug was able to get out as he joined her on the bed. He wrapped his tall, muscular frame around her and buried his head in her neck. Bridie sunk into his embrace and they curled together on the bed.
For a long time, only occasional sniffles broke the silence of their unspoken grief, a grief that had no language, no words.
In a halting but robust voice Bridie broke the spell. “Everyone keeps talking to me about the kids. How are they? How will this affect them? How sad all this is for them…what does all this mean to them? I get that but can someone once, just once, think about me. What does all this mean to me! How am I? How sad this is for me! I won’t see my babies grow up. I am losing them”.
“You are right” was all Doug could say. “I am so sorry Bird; so sorry for all of us”.
It was strange today Doug. Hattie, the counselor I saw last night, called and we talked about me. I haven’t taken the time to think about me in all this. It’s so much easier, more natural, to think about everyone else”.
“That’s what you do. That’s why I love you”.
“I thought you said you loved me because I had a nice ass?”
“That too” Doug replied unable to suppress a small smile as he stroked his dear wife’s hair. “…That too”.
“Hattie contacted the St. Germaine oncology team and connected with the social workers who will meet up with the kids. She said they will talk with them separately then all together. All except Lynne….” Bridie’s voice broke. Lynne was far too young at four months to talk to anyone.
“I’m here for them Bird…you know I will always be here for them. Doug whispered behind her ear.
“I know. You are my rock. You will be their rock too… Hattie wondered if you need to hook up with someone, you know, to talk about it…all this”.
“Not now Bird. Not now. I don’t want to talk about it, all this, at all. I really want it to go away. I want to wake up tomorrow from this nightmare and carry on with our life. I want to go back to arguing about the toilet seat and my underwear beside the hamper. I want to go back to shouting at the boys to be quiet and behave”. Doug’s voice trailed off and tears welled in his eyes.
“Well, why don’t we do that? Let’s be as normal as we can…for now”. Bridie rolled over to face her husband. “And by the way, it hurts when I bend over, can you pick up your fucking underwear for once!”
“I love you” was all Doug could manage to reply, simply and quietly.
“This is a long way from over Honey.” Bridie stroked her husband under his chin. “This is just the beginning. Its not going to get any better and the ending won’t change. The only thing we can change is what we think about it and how we respond to it. We have to control what we can and manage the rest.”
“How did you get so smart?”
“Ha! I’m in therapy!” They both laughed out loud.
“Maybe” he mused aloud “I need therapy too”.
“Been saying that for years!” Doug knew Bridie would use humour to get through these moments. She was his rock too, his anchor. He had no idea how he would manage without her.
“I’m going to go pick up the kids. You wanna come along, or get some rest?”
“I’m coming with you! I can’t spare a minute”.