Chapter 44

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.”

“I will.”

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.

 

 

 

 

 

 

Chapter 42

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.

 

Chapter 41

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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.

Chapter 40

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.

“What’s up?”

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.

 

Chapter 39

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.

Chapter 38

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.”

Chapter 37

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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.

Chapter 36

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.

 

Chapter 35

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.

 

Chapter 34

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.

Chapter 33

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.