All around me it was quiet and still. An uncharacteristic silence so complete that I could hear the soft rasp of each inhale behind my ears, like a heavy truth being dragged across a worn carpet. No one was coming or going. No one was laughing or crying. No wailing pain or whispering secrets. I sunk into the deep hush as if it was thick mud. The many long, still and uninterrupted minutes eventually ticked away at the tattered ends of my emotions and thoughts. I stood, slowly edging the chair back from my extending knees. I slouched forward planting my palms beside the various clutter hiding the desktop. My head slipped its hinge and drooped toward my chest. I exhaled a sigh, not a sigh with vigor or annoyance but a sigh of empty resign. At that very moment, I experienced no anticipation of ‘quitting time’ and no worry about errands or chores waiting to be done. Yet somehow this blankness enclosing me was easier to bear than the deep reality just served up to me.
Breathe, I reminded myself, forcing a slight rouse. Upright now, I collected my few tools, slowly and deliberately: two paper files, a pen with black ink and my agenda. Conference fliers, hospital notices and blank forms and scribbled notes remained in their scatter. It had been a long day and I was weary; mind, body and soul. I locked my loose scribbled notes and my working files in the cabinet drawer beside the desk and dropped my dog-eared daybook and pens into my knapsack. Systematically, I toured the office, turned off the lights and set the alarm. I pulled on my hat and coat, and slipped into my heavy boots. I felt in my pocket for my heavy ring of keys and looked out through the security glass set in the exit door.
I remembered now. It was snowing heavily; it had been for the last few hours. Trees, bushes, powerlines, buildings and cars all shimmered gently, shrouded in velvety white. I studied the thick clusters of snow descending as they invaded slowly, silently, slowly; unimpeded by gale or gust. Their glimmer haloed the lamps that lit the parking area behind our clinic. Ordinarily, this sight would provoke at least a moment of awe and delight. Yet the image that held my eye was not the beauty of a winter wonderland but a single track of footprints furrowing the snow, leading from just outside this door to an area under the lamps marred by car tracks.
Breathe, I reminded myself again and encouraged myself back to centre. I set the lock to alarm the door behind me, braced for the cold then stepped into the winter night, before the beeps of the security code expired. Instinctively, my trajectory drew me to the footprints like true north. I paused over them, watching new snow blur their edges. Solemnly, I set my feet into the footprints of the young woman who left my office only a few minutes earlier and retraced her path in the snow, through the hazy light.
Walking these tracks connected her to my heart. I remembered her tired, sad face. The face of a woman dying; a woman resigned to dying. The woman my job intended me to support through her last days. Walking her steps, peacefully and quietly, kindled grief in my heart. Inches before I reached the yellow jeep heaped in snow, my cell phone trilled a Pharrelltune in my coat pocket, interrupting my reflection. Three ‘Lucky’ choruses split the frosty air while I fumbled to pull off my gloves and check call display. Shit, it was the Emergency Department calling. Reflexively, I lifted the cuff of my parka to check my watch, then accepted the call. “Hattie Crawford. Crisis Services.”
The voice at the other end was apologetic. “Hattie I am sorry. It’s June Windover from emerg I know your shift ended about ten minutes ago but I was hoping we could head off a situation here, if you had a minute.” And without pausing to allow me to beg off, the nurse hurried on. I knew June well so I also knew she really was hoping for a solution rather than just to unload responsibility from her to me. “Amy Brixton just cleared Triage and we have a three to four hour wait. She is pissed with her son because he skipped school again and he was drinking…you remember Amy, right”?
“Yup. I know Amy.” I thought I might sound a little too abrupt and tried to moderate my tone. “Is she threatening him…or herself?”
“Well, she has some superficial scratches on her arms, wrists and hands. Some are old; some are new. She says they’re from hitting the back of the couch.” Barely pausing for a breath, June steamed on. “We remembered that last time, you know, when you said if we called you soon enough we wouldn’t make it worse by asking too many questions; you know, ringing up the account, I think you called it.”
“June! I’m pretty sure I didn’t say making it worse.” I felt chastened.
June snorted comfortably in response. “Probably not but we all knew what you meant.”
I couldn’t elevate my spirits to join June’s mood but I pulled off a reasonable fake, “Well, this is probably a good call then, June,” and I managed a stage chuckle. “Ordinarily I would be dancing with joy that you called but…”
“Sorry again Hattie. Just figured you’d rather have a say now rather than mop up a mess tomorrow…”
“Ya. You’re right,” I conceded. “Who’s the physician on duty?”
“Mickey Burton. You want to talk with him?”
“Actually, if you could put Amy on the phone I can set up something with her tomorrow. That will settle him down when I suggest letting her go home. But while you fetch her to the phone, I need to get into my car because I’m freezing my tarts off out here in the snow.”
June was right. I would rather handle this now because these are the exact situations that emergency departments struggle with. I know this because I work as a nurse with the emergency department, providing crisis and mental health services. My job is to support people who face the overwhelm of life, generally in its most extreme incarnation. And even though I’m pretty sure I never would have said out loud that the nurses make it worse by asking too many questions, clearly they understood my message about supporting mental health crises in new ways. OK, supporting mental health crises in better ways. Mickey Burton had been an emerg doc for quite a few years and I seriously respected his judgment, so I was glad to sort this through with him.
The seat of my jeep was frozen rock hard. It didn’t give an inch when I thumped myself in behind the wheel. The engine started reliably, as it always did. Impatiently I turned the blower on high and earned a roaring blast of freezing air. I suffered this in the short term, knowing that soon my old jeep would start pumping air warmer than the ambient frost. Waiting for Amy I prayed the heater would clear the windshield while I worked on this problem and spare me from scraping off several hours worth of frost and snow.
A mournful “Hello, Hattie,” put my back on my game.
“What’s up Amy?” I invited after she identified herself on the phone. Amy is a woman who has a long history with of mental health involvement with various groups, teams and programs. She has experienced, maybe endured, the many layers of our psychiatric inpatient, outpatient and crisis services, including the usual course of medication and likely overmedication. I expect over the years she has learned how to get our attention and how to dodge it. Right now, she needed some. Her problems were complicated, I would say, by having a son when she was only fourteen years old. He has now grown to that age of extreme rambunctiousness and he exercises those wicked skills routinely. Amy is tougher than she knows but she needs a lot of reminding! Tonight she described her current distress, punctuated by tears and blasts of salty language. While listening to her account, I established that Amy’s son Jordon and Amy were safe. I proposed: “Amy, can we make a deal? You have had a rotten day. You’ve been worried and scared and now you are angry and disappointed, right?”
A sigh and “uh huh,” confirmed my so-called assessment.
“We both know we have stuff to talk about”. Uh huh again. “But I would rather sit down and talk to you face to face.” I paused to let this sink in. “Do you think you can hang on until tomorrow?” Hearing no shriek of contented joy, I continued. “We can meet up at 11:00 at the crisis office? You can even bring Jordon along too.” We backed and forthed a little more before Amy finally agreed, not in small part due to her appreciation that four hours in emerge or an overnight in the mental health unit would not improve the situation and may not even get Jordon’s attention. In under fifteen minutes, I reassured the emergency staff that the situation was within control. I reminded Dr. Burton that a small amount of extra antianxiety medication would ease everyone’s experience. He had Amy’s record up on his computer screen and could see her history.
“Sounds perfect,” he agreed, although from his tone it didn’t sound like the descriptor accurately matched his really feelings about it.
Ordinarily, I’m not the biggest fan of using meds to manage stress but in this case I figured the hard work of shifting Amy’s need for external management of her crisis was something for her and I to address at another time. I’ll bet Mickey would come to this conclusion later after he had a chance to think about it after the unit cleared of other crises. I got June back on the phone and thanked her again, sincerely, for being proactive and I promised to log my interaction with Amy into the computerized record as soon as I was back on duty tomorrow. Miraculously, the windshield was clear of frost and I was more than ready to head home. I turned to look back and already the footprints were disappearing under a layer of frosty white; yet their heavy melancholy haunted my soul.
I pulled down on the lever under my stickshift that easily made the transmission switch to
four-wheel drive. Snow burdened the streets and I needed some bite. I felt my sturdy jeep lurch forward. The short ride through our small town was eerie, quiet. There were only a few cars on the road and even fewer walkers, unidentifiable under hoods and wrapped in scarves, slogging the unploughed sidewalks. From a block away I could see Jody’s form shoveling the last of the plow-slop from the end of our driveway. She turned, stepped to the side and waved me in, like one of those guys at the airport ferrying the plane to its port. I pulled the jeep into the driveway with ease. As I cracked the door Jody shouted, “good timing.” Steam from her breath puffed above her scarf. I hauled my backpack over the console, slung it onto my shoulder then climbed down onto the freshly shoveled lane. The cold snow squeaked under my weight. I embraced my partner Jody. “Thanks for digging me in”.
“I just got in myself,” Jody replied. She is an English teacher at the local high school and her hours often spilled into the evening, which she didn’t mind on the weeks I worked late. “We had a parent meeting that went on forever.” She paused from usual banter and added, “but by the look of you, my day was easier.” Jody knew me and my moods well after 20 years and I’ll bet 20 thousand problems, and I hope 20 million delights.
As she walked toward the house, Jody propped the shovel against the porch for future use. I banged the snow off my boots on the rail and stepped into our small entranceway. I was grateful for the warmth inside. Jody unwound her scarf and pulled off her Nordic cap. She has stunning long, tight auburn curls and tonight the static from her hat sent her hair flying. Before I could even pull off my hat, a soft ball of grey fur came thundering up the hallway meowing his greeting. I hunched to the floor. “Moncrieff! Ah…little man,” I murmured, just a hint of smile creasing my cheeks. Jody named our cat Moncrieff after Scott Moncrieff the little known translator of Proust’s Remembrance of Things Past, an enormous tale that she persevered through all one summer and eventually read cover to cover. Notwithstanding the summer of reading Proust, Jody would say the translator himself did not particularly compel her but she sure took a fancy to his noble sounding name. Moncrieff, the cat, leaned into my bent knee. He butted his head against my outstretched hand and rubbed his neck against the leg of the small stand where we dumped our keys. His eyes were closed and a welcoming purr emerged. Jody placed her hand comfortingly on my shoulder. My cheek dropped to touch her cold skin and I twisted my lips to kiss her still icy knuckle.
“C’mon, tell me about your day,” she murmured.
First and foremost, given his palaver, the shrieking Moncrieff needed feeding. Then we dug around in the refrigerator for leftovers. Together, we chopped up a makeshift salad while I lay out the tale about the woman I met at the end of my day with clinical precision. Without using her name, I described Brigit Lloyd; she preferred Bridie. She is 32 years old. She has three children aged 6, 4 and 4 months. She is currently on maternity leave from her job working as an administrative assistant at a law office. When she had her last postpartum check up she complained to the physician about what she figured was regular constipation, with intermittent diarrhea, which she attributed to her increasingly hectic schedule. Turns out it was a rapidly growing form of cancer. During the surgical investigation they found the cancer had metastasized, or grown into other areas, specifically her pancreas and mesomentum, the tissue that holds everything together inside her abdomen. The involvement of the pancreas was the dangerous piece. Bridie and her husband weighed all the options with their oncologist. They ruled out ‘chemo’ because given the advanced state, it might only make her last weeks harsher. Radiation would bring some symptom relief but clearly Bridie’s days were numbered. To support her and her family during this crisis, the oncology team at St. Germaine, a regional centre about an hour away, arranged her visit to me, exercising her husband’s Employee Assistance Program, or EAP. I am involved because for almost two years, in addition to my job as crisis worker through Emerg, I was also a short term counselor with the community mental health clinic at our local hospital. More recently, we were approved to provide additional services to people who were not in crisis per se; a slight of hand in this case because dying is probably a pretty legitimate crisis. The plan was for me to help Bridie manage informing her children, and supporting her own griefwork.
“Hattie, you’re a nurse. Surely this story isn’t true. In this day and age… it doesn’t happen this way anymore…like so quickly.”
“You’re right, mostly. We’ve got so many checks and balances now. We find problems sooner and there are more treatments to prolong life…I was skeptical myself, to be honest, but the social worker from St Germaine Hospital told me the whole story before the client arrived. Unfortunately, it’s all so true. As the client said, there is an option for radiation as a palliative measure to manage symptoms but in reality, she is looking at 6-8 months.” I felt the prickle of tears as I heard the story out loud, in its stark truth. I could no longer choke back my sadness and tears rolled freely down my face. Jody drew me into her arms and held me, knowing it would solve nothing. Yet, the slightest hint of lavender by her throat was soothing.
The temple bell chime of my alarm shattered me into the next morning. It took two tries to press the tiny button on the side of the clock to un-zen the alarm. The movement triggered Moncrieff to sidle up my legs and stand on my chest, lobbying for his breakfast. The memory of Bridie flickered into my consciousness and the sad weight rekindled in my heart. Moncrieff let out a series of yowls that required my immediate attention. I rolled out of bed quietly as I could, hoping for stealth, although I know my alarm always disturbed Jody a little, especially since I really only silenced it accurately about half the time. And given the other hullabaloo coming from Moncrieff, I knew today’s efforts would fail.
When Jody and I decided to move to Carter, hoped to move into a charming older home. We looked at many variations, some rejuvenated and some tired. When we stepped into the gem that we now called home we were immediately mesmerized by the pristine simplicity of the historical features. The floors, the high baseboards and all the window trim were original, buttery soft and beautiful. Although it is a small house, and I’m pretty sure the original owners, who ran a clock and watch store in town, did not have household staff, the home featured a second, back stairway that led into the kitchen. In truth a back stairway is probably superfluous but I liked the idea of it and in the winter the bay was just about visible out the small window at the top of the stairs, out through the bare tree branches, white etched on white.
This morning, as I scooted down said superfluous back way, I checked out the white on white on white view before I deposited my chilling feet in the kitchen. I quickly poured Moncrieff a handful of low-calorie kibble to staunch his protestations, right before I jacked the heat up to bearable pajama temperature. One of the parade of updates we added after we moved in was a new bathroom tucked under the those very back stairs. I made use of it and then flipped on the pre-loaded coffeemaker. While the coffee made itself, I scaled the back stairs in my sockfeet, neglecting the view this time, and mindfully entered the smaller bedroom we used as a sort-of-study, eased onto a yoga mat and slid into my morning ad hoc stretching ritual, grateful for the heat blaring out of the tall iron grate built into the side of the wall. The luxurious stretching and twisting gently woke my body.
Twenty minutes later, a steamy cup of coffee in hand, I had completed my ablutions: the simple hair and face wash of a forty-something. I poured a second coffee and sat down to check emails. Finally, as if I had been avoiding it, I logged into the remote version of our clinic’s electronic recording system and wrote my consult note for Brigit Lloyd. Until about a year ago, my role as one of the four crisis and short term counselors working at the mental health clinic of our local hospital, South Carter Health Centre, was to support and guide people through immediate and urgent personal, emotional and social problems. Recently, to assist the community but more likely to add revenue for the hospital, our program has started to recruit clients covered by short-term, third party insurance funding, like Brigit’s husband’s Employee Assistance Program, or EAP. This new counseling program allowed people who might ordinarily have to wait for an opening in local or even distant therapy services to get care nearer to home.
This kind of third-party and short term therapy work was what I did before we moved to Carter, so I volunteered to take on the first few files. I say ‘files’ deliberately. The counseling part of the work pales beside the paperwork required to justify, then explain, then bill for these services. I opened the standard electronic forms and tapped out a ‘proposed’ service plan for the insurance company, although to date the funders had never questioned or adjusted my ‘proposals’ other than to grant the odd extension, which may actually be the case in this instance. For Bridie, I proposed the initial assessment, the maximum eight sessions adding the potential to extend by three more and also noted the time that would be required to liaise with the partner services in Oncology.
The small luxury we had working with insurance clients over the typical ‘walk-in’ at Emerg was that we could see them longer than the usual three visits government funders assume is ample to resolve a ‘crisis’. Well, to be fair, in reality we can bridge a person beyond three sessions if their ‘crisis resolution’ is imminent and if one or two more sessions will facilitate transfer to a ‘more appropriate longer-term service’ but more often the wait-lists are long and the person chooses to wait on their own, without support. Then if, or more often when, the crisis cracks the surface again, we can add in three more sessions. Bridie, with her EAP insurance, was a luxury client.
The clinical facts I loaded into the electronic forms felt sterile. Devoid of context, these data were unable to convey the magnitude of the inevitable consequence. As I reflected about our conversation last night, I considered that while Bridie appeared stoic and resolved last night she had only scratched the surface of what she was facing. She hadn’t told her kids yet, or her family, and her husband Doug was still in a state of shock. In that first meeting, Bridie told me that right now her main concerns were supporting her children and getting things ‘in order’. My experience with kids was underwhelming so I followed up my promise to Bridie and sent an email along to the social worker at St. Germaine’s where Bridie’s Oncologist worked. This message included a wish to work together with their team, satisfying the insurance company’s ‘proposed’ plan.
By the time I heard Jody opening drawers in the bedroom, my typing fingers had turned to Amy Brixton and her Emerg encounter. I entered the few details of our conversation last night, noting the follow up arrangement for today. The practice for our crisis team was to hold next-day appointments for people who used emergency services the night before. When people used crisis services frequently, as Amy had been trending, it was our job to try to shift them over to other ‘more appropriate’ supports. I knew Amy had once been connected with the Long Term Support Team, commonly referred to as ‘The Team’, who provided ongoing service to folks who had been kicking around the system a long time. But for Amy, this relationship seems to have deteriorated and she has shown up in the emergency department in personal crisis about once every second month, usually following a similar pattern of problems with her son, like last night. In theory, this was no longer a typical crisis and it was time to discuss a new support network for Amy today at eleven o’clock. Because Dr. Burton had given Amy medication to help her calm, I expected she would need a reminder phone call around 0900. I made a note on my electronic agenda, since I also need reminders.
“Good morning Pet.” I looked up to smile at Jody entering the dining room. She has long since given up complaining about me working off the end of the table instead of using the proper, antique desk we hauled up from the city, which sat idly in the ersatz study I used as a yoga studio. I usually tidied up after myself, mostly because there were no papers associated with the work I loaded into the remote health record. But apparently I could produce an ‘unholy mess’ in the dining room.
“You too.” I smiled up at her and she cupped my cheek in her sleep-warm hand and kissed my head on her way past. I got back to refreshing my electronic schedule, logged off the system and welcomed Jody to the table. She arrived with a top up for my coffee and two bowls of high fiber granola with almond milk. I could hear my colon singing! We went through the typical morning banter about how we slept and what our adventures our days held, munching and chewing to beat the band.
“Remind me what time are you finished tonight,” Jody asked? This was a fair question, given my chaotic schedule.
“We have a relief worker in tonight. I need to orient him for the weekend but I should be finished all that by six-thirty. Because it’s Friday though I have to make a few calls around to folks ‘on the verge’ and that might hold me up a bit at the end. I want to make sure they know they can catch me on Monday if they can hang on”. The question lingered on her face, reminding me that I hadn’t given her much of an answer. “I will be home at 7ish,” I said and swallowed my last scrap of cereal.
Jody nodded and smiled. “What do you want to do when you get home? There is a jam session down at the town centre at eight…if you feel like heading back out into the cold. Or do you feel more like a movie?”
I paused over the options. Maybe I paused too long because Jody interjected “I’m good either way.” Still mulling, I pondered Jody’s love of music and I knew her wish was likely to haul her guitar the few blocks to the jam session and join in the fun.
“I’m good either way too,” I finally announced, probably lacking commitment.
Without malice, as was her way, Jody simply chuckled and proposed that we had ample movies sitting unwatched in a stack by the TV to occupy us for one small Friday night. I was secretly relieved and damned if she didn’t know it! “I’ll pick up fixings for a pizza on my way home and be ready when you arrive.” Then, within the hour, we ventured off to our respective professional commitments.
Amy Brixton answered the reminder phone call on the sixth ring, right about when my worry was rising to panic. She was feeling better and begged off the appointment. But I knew from her recurrences that these crises were important grist for the mill. Finally, with encouragement, Amy ‘decided’ to come in for our meeting. I double-checked with her about her current clinical connections and she confirmed that she is no longer working with The Team. I left it at that for now but would certainly ask more when we met. It seemed clear to me that we should reconvene that relationship PDQ, or pretty darn quick, since they were both a more efficient and a more effective match for her than crisis services were in the long run. Maybe I do have the makings of a ‘company girl’.
Before I unloaded my gear in the crisis office, I officially started my day with a brief report from the nurse in charge of the emergency department, or the Team Leader. If you’ve ever been in one, you know that Emergency departments are hopping spots, sometimes moreso than others. As a result, most communication is typically short and to the point. During her general report, the Team Leader gives a very concise overview to the incoming nurses about each and every patient currently in the department, and in the hallway. For we crisis workers, who get our report long past the early hour the other nurses arrive, the Team Leader gives a similarly concise but separate overview of only the people who are experiencing mental health issues. No need for me to know that my neighbour is having problems with his gall bladder, unless he tells me about it himself.
Sometimes the duty physicians join in on report and chime in helpful tidbits of information, especially if there are fresh donuts behind the care desk. Today looked like it might be a relatively calm morning. Everyone behind a celery-green curtain had been assessed. They were properly wired to machines and either waiting for a test, a test result, or a bed. The waiting room held only three souls: a mom with two little ones. Given the way one of the tiny girls was gingerly holding the side of her face, I assumed an ear infection was the culprit. The rest of the people waiting on folding chairs along the far wall were here for the monthly orthopedic clinic that the South Carter emergency department hosted. South Carter was a local hospital with a few specialty programs that served the broader region. Orthopedics was one of those programs. Our department’s third-party counseling program was another.
I’ve been a registered nurse for almost 20 years. After I graduated, I toyed with positions in short term surgical ‘post-op’ and longer term ‘rehab’ nursing, or ‘complex care’. I steered clear of paediatrics because sick kids make me nervous; their conditions can change so quickly. Then I landed a part time job in mental health. I loved it right away. I continued my education and finished a post grad program in Psychiatric Nursing as well as several certifications for counseling and behaviour management. Along the way, shortly after landing my first full time job as a mental health nurse, I realized what I hadn’t learned about the mental health field in nursing school and I completed a degree in Psychology. Apart from the relevance of the material in my psychology program, the other good thing about going back to school was meeting Jody at the campus Print Shop. And the rest is history, as they say.
As for mental health nursing, I feel like I’ve found my niche. The work is differently hard and taxing than other fields of nursing. I think it’s a specialty that is often overlooked and sometimes looked down on by other nurses but these skills I’ve worked hard for have truly helped the people I serve and I think would help more people if they were taken more seriously and valued by all nurses. OK, off my bandwagon but just for now.
In my career, I’ve worked in a few hospital emergency departments, some bigger, some smaller but they are all pretty similar. Tucked away beyond the various waiting rooms are semi-enclosed workstations with requisite binders, computers, phones and clipboards. Uncomfortable, sometimes rickety chairs line the counter-tops designed for filling in forms. If you are lucky you might find luke-warm coffee and powdered milk. Beyond the formal workstations are a series of curtained ‘wards’ housing folks enduring all manner of injuries and ailments requiring urgent medical care. With this level of acute illness and distress, you would think these areas would be loud, banging and clanging. Yet really, the general bustle of people and machines usually produces more of a low octave thrum.
In Emerg, the doctors and nurses run, sometimes literally, from bedside to bedside assessing, testing and treating patients. It leads to checking boxes on clipboards and collecting the short-hand notes needed to communicate who is where and what we are doing to them or planning to do with them. Later, these paper scratches are transferred to an electronic record embedded in our secure computer system. Some of these computers are wheeled from room to room to make the entry all the easier. Vital signs, like pulse, blood pressure and temperature are all recorded electronically, directly from the machines! Even the intravenous fluid is calibrated and delivered electronically. Despite the intermittent alarms that squeal from these machines, it is certainly an improvement from my long-ago days as a student, holding my watch up to the dripper to actually count the drops per minute. Because the priority for quick diagnostics is recognized, arrangements for x-ray and bloodwork are still made over the phone, rather than the on-line booking system the rest of the hospital requires, which speeds the process considerably, but results in more ringing and dinging than the typical care desk on a regular hospital ward.
There is lots of hustle in our little Emerg but like staff of most emergency departments would agree, there is too little muscle: work eventually gets done but there are not quite enough people to do it all as quickly as we would like. Mental health crises are often part of the work that gets left on the long finger, as my Auntie Dorey used to say. Level 1 and 2 patients, with urgent and life threatening presentations, get attention lickety-split but 3’s and 4’s, where many mental health presentations land, get pushed down the line. Also, mental health crisis work takes those skills I just ranted about, which the usual emerg staff feel that they lack. Interpersonal interventions are also machine-free and therefore labour intense. The current perspective is that crisis work is a specialty service that belongs in emergency departments but only when the proper resources are in place, such as our cadre of crisis specialists.
For many years, South Carter’s Emerg didn’t have access to a crisis worker. But a few years ago they saw the wisdom in adding one. So, administration supported a pilot project that has grown to include the crisis team that is now linked to the existing psychiatric inpatient unit. This is the unit with beds where people who have to be admitted can safely stay in hospital for their care. I wasn’t one of the first crisis workers they hired but I’ve worked here since early in the development of the program. Mostly the program has unrolled with minimal drama, in part due to the positive clinical and workload outcomes reports by the doctors and nurses, not to mention more and more timely support to patients. The larger care team has welcomed me but even though I’d shown up every day for three years, I still feel a little like an outsider. I can’t recite the names of previous medical directors and chiefs of nursing the way some of the staff here can. I am also from out-of-town so I can’t dissect family trees the way some of these folks can. Nevertheless, I think I have forged decent relationships with the Emerge staff.
Most of the nurses at the hospital are friendly, at least as friendly as one can be running from emergency to emergency. Some of them were happy for the partnership but one or two seemed unimpressed in general with people struggling through mental health problems, no matter who did the work at the bedside. Suturing self-inflicted wounds and post overdose gavage, or stomach-cleaning, required medical intervention that some nurses believed ‘took away’ from care of ‘really sick people’. The tension could bubble over into conflict on occasion. I appreciate that people experiencing mental health crisis present in ways that can be disruptive, or outside the typical scope of Emerge nurses – but that’s why we are here to work together. I vacillate between being understanding and wanting to shriek “get over it!”
One of the nurses I had trouble connecting with was Linda Berwick, the dour Team Leader. Not that it’s my place to judge another’s measure of joy in life but as Jody’s Irish granny used to say: she looked like someone died and left her no money! Linda was cool and distant but in the end she seemed to understand my role and mostly kept her opinions to herself. Notwithstanding our touchy personal relationship, she was nevertheless efficient and obviously no-nonsense, despite the incongruous smiley faces stenciled into the top of her navy blue scrubs.
Anyway, after shucking off my coat and boots I hit the care desk to start my shift. Linda’s separate report described two people who had arrived in the department last night after my shift and after Amy Brixton had departed. The first was a young man who had been intoxicated but was now sober and regretful about his threats of self-harm. He was the person I headed out to see first. In consultation with the physician on-duty and the family, we decided to discharge him with information about other mental health services. I made a note to give him a follow up call on Monday to see if there was more information or support I could provide. It was my experience that sometimes people in crisis rally their spirits and inflate their intentions to get out of these touchy, nay perilous personal situations but in reality, they are still in trouble and have lots of loose ends that can get tangled up again next week and maybe the week after that.
The second person Linda described was a woman who had taken a pretty serious overdose of her prescription medicine. Linda and I agreed that she required a psychiatric consultation. Am I paranoid? Did I sense Linda aiming to trump my influence? Nevertheless, because my position is linked to the inpatient unit that includes the beds we are meant to guard, supposedly from misuse because as you know everyone is clamoring to get into the psych ward. Anyway, it is my role to facilitate the consults with psychiatrists. In theory, this service matrix that attaches me to the inpatient program makes it easier for me to access resources, like a psychiatrist, or to follow up with a person after a brief admission. I say in theory it makes it easier because in reality it relies on who is around and who is on-board with the concept. I did the same work in the city before I came to Carter and because the folks there had been practicing as a matrixed team for years, their transfers generally unrolled smooth as silk. I gave South Carter a lot of credit for making this shift in care and I knew that with time healthy flesh would fill in on these sound bones.
The fleshing out at this point comprised the three other regular workers on our crisis team who I’d come to know pretty well: Rudy, Karen and Vivienne, Viv for short. Rudy and Viv are nurses, like me; Karen is a social worker. All of them have nerves of steel, paired with compassionate hearts. Karen and Viv are my age or maybe a few years older, even though we bring in cake for our birthdays no one has openly identified their age. Karen is a bit hippie-ish and Viv is a bit more buttoned-down. Rudy appears to be the youngest of us, we don’t know for sure and everyone is reluctant to ask. He is a tall, athletic black guy whose family originally came to Canada from Trinidad. He was born in Canada so he has no accent but he can certainly mock one when the situation called for it. He functions as our boss but he also keeps up a fair pace of clinical work. We have a small cohort of weekend and relief crisis workers with whom we have all forged strong alliances. I have enjoyed my worked in mental health for many years. Really, after that brief spate with surgical and rehab nursing it’s all I’ve ever done. I’ve worked in inpatient and outpatient services, emergency crisis service, and for a while I even ran a community clinic. Despite the aforementioned shortcomings of being the newcomer to this community, my peers respected my clinical experience, as I did theirs’.
Jody and I moved from what the locals call ‘the city’ to Carter, a small town on Georgian Bay, about three years ago when Jody was offered a position teaching English at the local high school. I reinvented my career as a downtown crisis counselor to a small town crisis counselor. Apart from not appreciating family trees, it was presumed that being from ‘the city’ could also pose barriers to understanding ‘how we do things here’. Not really, as it turns out. Rural problems were not so very different from city problems. When it came to family lineage that was something I preferred to ask the person about directly. Jody’s experience at her school was similar. Kids tend to be kids. They get in the same scrapes and conflicts. By high school many of them had already fallen in and out of love. Some fell hard: some fell soft. Some managed, some didn’t. I see worry and angst as relatively normal teenage states. I lean away from what I see as a raging popular desire to fold all adolescent problems into a mental illness. I recognized, from hearing it from the other side, the side of the folks themselves, that many of the challenges kids face probably come more from family and social fractures than early onset chemical imbalances – although angst can upset anyone’s chemical balances in the short term. Jody and I whiled away many hours trying to fix up the world, kids first, since I would actually prefer that I went “out of business” in my lifetime. Sadly, today’s report gave no indication that going out of business was imminent.
When I checked in on the second person on my list to see, I learned that the woman who overdosed last night had been moved to the Intensive Care Unit. I updated the psychiatrist on-call so she knew where to head to do the assessment I’s asked for. I returned to the care desk to tell the Team Leader and the two other nurses standing there keying their notes and test results into computers that I had contacted the psychiatrist and she would assess the woman sometime this morning. I thanked them for looking out for this woman. I am a nurse so, as I said, sometimes nurses in emergency departments get edgy with the mental health component that is so unrelenting in their work. Emerg nurses always feel more competent responding to cardiac arrest or a compound fracture than self-injury but mental health crisis is a serious and sometimes lethal condition. When we all work together we provide much better care. And as it turns out, working together lightens everyone’s load. ‘Working Together for Better Care’ was the key message behind South Carter hospital’s move to set up the partnership with their inpatient unit, their community clinic and their emergency department. It wasn’t meant to make the nurses happy but wouldn’t that be a good start!
My hospital-sanctioned cell phone buzzed a text notifying me that Amy Brixton had arrived. Linda Berwick was not at the care desk so I let one of the other nurses know where I was headed in case they needed me, patting the pager strapped to my belt as a reminder of how to make it happen. I walked over to meet Amy at the cubbyhole adjacent to the Emerg that they called the ‘Crisis Office’ as opposed to the Crisis and Short Term Counseling Suite in the adjacent building. Our ‘Suite’ is located through two relatively short corridors but in reality it is miles and miles away. After about a year’s hiatus, I met Amy again several weeks ago, when her visits to Emerge increased. I liked her and wanted to help but it would take more time than my job gave me to really get her onto a new track. It’s hard to make personal change and learn new ways, for any of us, but all the more so for people who for so many years people have been convinced there is no hope, or at the most generous ‘guarded hope’. For people who have experienced our system for as long as Amy has, this was our sad legacy.
When she walked in the room I saw the evidence that Amy’s night had been rough; her hair was disheveled and spilling on to her face despite the jaunty pink headband. Her eyes looked puffed. I kept my commentary to myself. I figured it would be more productive to get on with todays agenda. Nevertheless, Amy opened our conversation by recounting her problems last night with her teen-aged son, specifically his unwillingness to abide any direction from his mother. There was no doubt the kid had had a tough few years since his father walked out but Amy’s dissolution into crisis each time they had an argument wasn’t helping either of them. I listened for a bit then, at my first opportunity, slipped in some timely redirection.
“Amy, you’ve been through this before. What has worked to calm you in the past? What is it that has helped you in the past to be calmer in a conflict?”
“I don’t know. If I get to it in time I can take my meds. Mostly, I just blow up.”
“I’d like to talk with you about the minute before you blow up…..” And the conversation continued as I encouraged and cajoled Amy to consider and focus on alternatives. In my experience, including my very own reactions, people respond to problems without even realizing how they got from zero to sixty. For many years, our job in mental health has been to tell people how to handle their lives, or how to medicate their lives. As it turns out, I figure we’ve likely been jamming a lid on people and not supporting real change. I wasn’t alone in this understanding, yet the loudest voices in the forest were still the easiest to hear. It took patience to do this work differently. Patience and time was a dual luxury in this business.
Amy was quiet for several minutes and I thought I had lost her but she was obviously on task because finally she recalled that one time when she felt like she was ‘losing it’ a friend called her. She wondered if maybe the interruption, or maybe having someone else to talk to who was calm, calmed her.
“Hmmm…That’s an interesting observation.” I paused to let that sit there for a while.
“Do you think it might work again?”
“Like I should wait for my friend to call?” She looked puzzled. “I don’t think that’ll work, Hattie.”
“Well, it might work if your friend could read minds….do you think she can?” I laughed in a kind, not derisive way. She smiled back but I knew she still didn’t understand what I was aiming at. “No, what I meant was I wonder if we could hook you up with someone you could call in that minute or two before you blow up or lose it? Someone who can help you calm yourself, or at any rate, distract you the way your friend did before.” I shrugged to reiterate that this was question not a demand. “It’s possible if it worked once, it can work again. Sounds like it’s something we could try first, like before you think about going to Emergency.” She seemed willing to hear some of the details but I didn’t think she was convinced. I tackled Amy’s skepticism and made obvious my intense hope for the plan. When she finally gave me a weak nod, I seized the moment and called up Sandy, one of the Peer Supporters associated with the mental health clinic.
As we waited for Sandy to walk through the hospital maze to meet up with us, I explained peer support to Amy. Peer supporters, who have personal experience working through and around their own mental health problems, have proven to make a real difference for people in crisis, even if Amy wasn’t so sure. They have intimate knowledge about how to survive through sad news, bad news and madness, not to mention all the social horrors and realties of the world. When Sandy arrived, I made the introductions and arranged a follow up call with Amy on Monday, which given my need for reminders, I made note of in my schedule. I also figured that Sandy would set up a series of meetings to get to know Amy and maybe even Jordon. In this way Sandy would be available more than just in that last few minutes where Amy wanted the support. They walked away chatting amiably.
I confess; I have a repertoire of several bad habits. Some of these habits impact my personal life and some impact my work. Although it’s relatively harmless and I think pretty common, one of the habits that I wish I could change is procrastination. When I have to do something that I don’t want to do I busy myself with anything and everything else. Usually, I substitute an inarguable task like cleaning. When I had a paper due at university, my room was spotless. For years I have explained, okay excused, this to myself as ‘readying my mind’. Sorting and settling all the vagrant thoughts in the back of my mind into their place, so I can activate and use them when I am ready. Maybe this is true but if I were a mental health client they would call me avoidant. Even after exercising my ritual of tidying all the loose paper on my desk, filing it away or trashing the rest and sorting through emails, and making a new pot of coffee, I knew the time to follow up with Bridie had arrived. I could put if off no longer. I felt a sick mixture of dread and sadness.
Bridie answered the phone on the first ring. Her voice sounded tight. She was alone. The boys were at school and her baby was at her sister-in-law’s. Doug was at work negotiating to rearrange his schedule so he could accompany his wife to her growing list of appointments, which now included meeting up with me. After the initial warm-up banter, I moved to the issue most pressing to guide my work. “Bridie. I have been thinking a lot about you since we met last night. I have been asking myself how I can help? What I can do to support you?”
“I’ve been thinking the same Hattie. I’ve been thinking exactly the same. I really don’t know what to expect or what I really need….”
“Well, let’s start with what you want…is there anything you want?”
Through the pause I heard her soft breath brush against the phone. Bridie broke her silence speaking softly but clearly. “ I want to live.” Her voice caught on the ache she was swallowing and I imagined tears on her cheeks. It was my turn to pause and gather my response.
“Well, that may have been a dumb question on my part but lets start there. Let’s start
with wanting to live.”
After her conversation with Hattie, Bridie lay down on her bed but her mind would 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 choke out as he joined her on the bed. He lay his head on the same pillow, wrapped his tall, muscular frame around her and buried his face in her hair. 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. I am so sorry Bird; so sorry for all of us.”
“It was strange today Doug. Hattie, the counselor I saw last night, she called and she asked about me; 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 reached down to stroke said ass. “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’d talk with them separately, then all together. All except Lynne….” Bridie’s voice broke. At four months old, Lynne was far too young at 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.” She raised her hand in a reluctant gesture then let it drop.
“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; 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’s wide chest. “This is just the beginning. It’s not going to get any easier or 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, one short bellow each.
“Maybe…” he mused aloud “I need therapy too”.
“Been saying that for years!” Bridie chirped with a smile but a full laugh eluded her. 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.”
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 impressions 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, really more of a necessity. When I want to check my own observations of subtlety and nuance, and sometimes when I just want to unload about the obvious, I have two peers in particular I run to. 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! Although I shouldn’t be facetious, I suppose in many ways it is.
Before moving to work at South Carter, Viv worked at the specialized psychiatric hospital in North Carter for many years. North Cater, or ‘The North’ is only for people with mental health problems and, in addition to managing people who are aggressive and people who have criminal problems, they tend to hold their rolls to people that have not stabilized or benefited from our short term treatments. So, after many years supporting people in their long-term recovery from mental illness, Viv transferred to the mental health unit here at South Carter, or ‘The General’. She worked in sort of the reverse flow that patients tended to follow. According to Viv, over the years, she saw too many people get admitted to a bed when she and others at the front line figured they might more effectively benefit from outpatient crisis services and uninterrupted support from family and friends. It was Viv who concocted an on-call system to increase our clinical availability to assess and support people in crisis, in Emerg and afterhours She volunteered to pilot a project where she and three other nurses carried pagers and responded to the mental health crises at the emergency department. It was a ripping success for patients and staff but it took a while for the brass to cotton onto it because, of course it needed funding.
That was ten years ago. Viv’s concept has since morphed into the emerg department ‘crisis worker project’ and about 5 years ago The General christened the flashy ‘crisis program’ I work at now with all its glorious 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,” Viv 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, here’s one,” I said puffing my chest, “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 intuition in the work they do. And they routinely pray, cross their fingers and knock wood.
“I know,” I slumped 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 also 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 continued. “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 a note, pushing me to explain. “I asked her what she wants…what I meant was how might I help her during this. Well, she said she wants to live. How dumb a question was that?”
Viv looked down at her hands, buying time; an old therapist’s trick. “Not dumb Hattie, just real,” she smiled gently and slowly shook her had side-to-side. “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 currently situated is a standard piece of her advice. In practice this means understanding how the person sees and feels their present moment and appreciating how they interpret 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 change or fix the lives of the other annoying 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 how I can support them to think and act differently, and to provide hope it can happen. They have to decide to become what or who they want, or to come close enough to what they want to feel contented. Viv and I have described this as the ‘want-get balance’. If you always want what you can’t get, you’ll always be dissatisfied. Once you adjust to wanting more of what you can get, you can feel more satisfied. In this case, Bridie and I, and Bridie, Doug and I must talk about what is the most important to her and what she, and they, can get vs. what she and they want. Now, Bridie wants to live, which she won’t get but it’s a place to start.
In my work I’ve met people faced with death who 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 emotional work to do that is miles away from that of their partner. It is complicated. Messy. But I do know, and I know it because I have erred and pushed to hard 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 concede. “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.” I crossed my heart.
“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 we have 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 as the momentary benefits of distraction washed away. “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 with more confidence than I felt. “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.
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 a substantial 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. 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 and their families are 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 – aka still suicidal? 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, again, this was the beauty of our matrixed team; medicine and psychiatry working together with all the facts. To support the availability of the right facts, I had a bit more time to spend with her to complete my part of the assessment, the part that informs the psychiatrist in her conclusions.
I looked into the ICU room at Nancy. She was lying in the bed with her head turned to the wall. She sure 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 swiveled 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 and perched against the window ledge, since there were no chairs nearby and I didn’t want to hover over her like a school marm.
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 for themselves. 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 her 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. She agreed with her kids that maybe she could meet some new people and make some new friends. Although she lamented that they might just all die too but at least this note arrived with a half smile. 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; I reminded her this might help her deal with her departing new friends too. She rolled her eyes in response but her smile this time was large and genuine. 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 interested 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 Seniors’ 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 to one of our Team meetings for ‘show and tell’. 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 in their homes, 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 a “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. Bingo!
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 medical ward she had been admitted to. She greeted me with a full, 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?”
“Yup. 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. She’ll be here tonight. 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 honor to meet you. You have had a couple of rough 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’re 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.
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 tofu cheese 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, and steady. 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, broad 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, given the weather I could assume he was also 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 both sat through the canned orientation regarding my role and the role of the clinic that I am obligated to deliver to new clients. I’d given an abbreviated version to Bridie last night that she stared through. She he didn’t seem to be attending to this one either but she 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,” He reached out for the forms and passed his eyes over the text. “This first form is for Bridie…” Doug shifted the paper over to her. So, 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 acute disdain cross his face like a dark cloud. “I know, 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.” A glance in her direction confirmed her position with a nod. “But this is our policy, actually it is the law, because in some other situations couples aren’t 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 why the forms… 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.
I continued. “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.
The only response I had to offer 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 he was about to interrupt.
“Just hear me out,” Bridie continued. “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 with tear-rimmed eyes. “I don’t want the kids to think I am falling apart, even though I feel like I might explode to bits any minute. I don’t want to tell you I’m angry and I don’t want people to know how afraid I am.” Her last words trailed off and her sharp inspiration of breath at the end 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 gently 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 about death and dying 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. That’s why when I told you, Hattie, that I wanted to live, and you heard me…”
“…of course we want Bridie to live!” Doug could no longer reserve his interruption. He’s upset. He’s mad. I worry he’s probably mad at me but as if he can read my mind he expands. “I’m not mad at you,” he said looking up at me then he repeated to Bridie, “I’m not mad…at you.” But his 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 offered, a few moments later. 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. It’s 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 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 just a starting point; the 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 me where and how I might 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 something about the stages of death and dying and grieving,” 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, if you don’t mind,” and both nodded for me to continue. 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, pressed-lip 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 of 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, our family will 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 and at this point, she was my boss.
“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,” he glanced nervously away from Bridie and I. “I’d feel safer not being behind the wheel.”
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,” and I drew a quick circle around the phone number before handing it over. 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 out 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 last 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.
It was snowing again! Cold, driving, gusty snow. I stood at the front window pondering the scene. Where does it all come from, I wondered? But at least it was Saturday and we were on our own schedule. I could expose myself to it now, later, or not at all. Or so I thought. On typical Saturday mornings Jody and I like to hit the local coffee shop for the weekend treats we are convinced we deserve, after a long week at work. After our treats, we wander around town a bit 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, to get it we had to step out in this weather. We were driven by another sad 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 alas it was gone. Which reminded me about the third reality – the driveway would need shoveling at least once more, maybe twice the way this damn snow was driving in from the North.
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 maybe the tall buildings re-funneled 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, or even why, but I admit it’s true. This bay attracts snow!
Lake effect or not, I knew for sure that that it was blisteringly cold and the snow pellets blasting my face wouldn’t make life any easier even with my dandy Sorels. On the other hand, I didn’t fancy driving the three blocks required to accomplish our coffee-slash-bread goal either. Especially since driving involves scraping and shoveling! So, I pulled my Patagonia 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 it’s 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 aborted our silent trudge after a left, a right and another left turn and before venturing further we peered in the misty windows of CUPtopia, where the local coffee wallas drip and steam their miracle beverages. Saturday mornings are often busy with other Cartorians, who believe they are equally deserving of a latte and a treat. The floor near the doorway was slick with slush allowing us to pause innocently while we scoped the best seats. 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. He is maybe a bit older than we are, by just a bit. He is certainly a bit more rotund than we are and 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, at Jody’s wordless urging, to beat the next folks through the door while Jody loosened her outerwear and started talking with Roland. I placed our coffee order: mine a latte with almond milk, Jody’s a latte with skim milk and one sugar. And, I selected a dandy raspberry scone for us to share, just out of the oven. 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’ve been known to walk away from a weak cup. Really? The way I see it, a $7 coffee oughtta be damn near perfect!
I joined Jody and Roland mid-stride in a debate about 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 conversation. Jody’s graduate studies focused on literature produced in Paris ‘between the wars’ as she describes it. 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 honestly keen but not obsessed, which was my clinical assessment of Jody’s acute level of interest.
“Good morning Roland,” I said sliding onto the couch beside Jody. I mugged a delighted face as I displayed the raspberry scone at a jaunty angle, turning the crispy nobs toward me because they are my favourite. She leaned over with a grateful smile and placed a quick peck of appreciation on my cheek. “Only half though we’re sharing,” I added as an afterthought.
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,” I added while breaking a crispy nob from the scone. My lips and tongue worked around the wodge of melting pastry, “they don’t make TV shows like that anymore. Now it’s all arguing drama, yelling drama, people storming in and out of rooms… and raucous sex and innuendo.”
“As much as I’d love to debate the current state of your television experience right now, Hattie, I’ll just close by agreeing that Ivanhoe never took his clothes off.” Roland was eager 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 would not be dismissed. “Do you think it’s a story girls can relate to, Roland? 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, don’t ya think? What if the kids don’t notice? Or what if they aren’t properly distressed by the conventional ideas about women in the early 1800’s, or with our then and now relationships with First Nations people,” I added, sipping on my latte and surveying the scone, which I had pushed a little far away to avoid 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 day-to-day 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, renewed in our commitment to our frosty errands, 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 Dutch Crunch 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, wheat-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, stopping dead still with alarm.
“Obviously someone else is onto the Dutch Crunch,” Jody asserted seriously, also still at my side. “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, pathologically relived at our decision. And we trudged single file through the path that early footsteps had ploughed through the snow covered sidewalk.
When we entertain, my assignment is to clean, tidy and mostly stay out of the way. Jody is much more interested and skilled in cooking and baking. I know I’m biased but I believe she is an exceptional soup maker. She enjoys concocting new arrangements of flavor and texture with the creative precision of an architect, and I always enjoy consuming them. While Jody 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 the corners of our home. We shouted conversation through the three-by-four foot hole that we hammered between the kitchen and dining room the same week we moved into the house. Really, we knocked through the lathe and plaster ourselves with a big sledgehammer 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, like a stager from HGVT. I scoured both bathrooms, changed all the towels and set the dining room table. “Looks great,” Jody assessed as she walked through. “Thanks, smells great too.” I bowed in respect.
In the end, 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 our culinary greed and decided to share. We can be so grown up sometimes. Our friends Elaine and Guy loved it. Their compliments about the bread were alarming. At first we lied, telling our guests we drove to a bakery in Geneva about 40 minutes away. Then we fessed up but with long faces, worrying that full disclosure might further impact our ease of local access.
Sated after devouring our meal, we sat comfortably around the table, raising the stock of our various opinions about the state of the world, the small local world and the bigger world-world. Guy and Elaine were comfortably compatible friends. We met them 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 political leanings and our perpetually irreverent cheek that might be misconstrued by the casual eavesdropper. 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 continuing to re-build the team. To my account, this was a perennial operation but more recently realizing some fruition, with two playoff appearances in two years. And tonight, the Leafs were victorious, adding exponentially to a fun evening.
Jody and our guests sipped Irish whiskey in celebration, a’ la St. Patrick, the patron saint of the Toronto Maple Leafs. Meanwhile, I devoured a second piece of Jody’s lemon and green tea cake with vanilla cream icing instead. Extra dessert is 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, narcotic-euphoria life a little too attractive and, in very short order, I was hooked. Because I am a nurse and because 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 of the usual red flags went up.
Recovery was long and tedious. I always knew in my head that addiction is a real thing, on its own, and not just an absence of willpower as some people believe, but now I also knew this truth in my heart. Jody stuck by me, actually it was her encouragement and love that pushed me to change before my drug use 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 again. 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 diligent hosts, Jody and I believed it was our ‘duty’ to our guests. Also, it was important to us not to gender the heavy work. To Guy and Elaine’s amusement, because neither of us really wanted to go out in the elements, we resorted to our standard way to resolve the ‘who will be the gentleman’ question, the one we used in all those situations when a ‘gentleman’ usually steps up – rock-paper-scissors. This way we two girls could do away with the stereotypical pink and blue jobs and miraculously, mostly, all the duties were accounted for. Alas, Jody’s rock crushed my scissors. The job itself was mercifully short. It 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 snug 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 luxurious. 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 knotted thread and soon, without my full commitment to mindfulness, I was successfully distracted, despite my perpetual aim to still my monkey mind.
Today, I couldn’t wrestle down the thread untangled 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 habitués 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 weeks but it would be on a Tuesday. And a new 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 pre-ing or post-ing Cuptopia for latte. 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 instantly the seriousness of my offense.
I padded into the kitchen, chastened. “Yes. Yes, I ate both pieces of cake,” confession was the only viable option.
“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 sputtered. 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 sight and tempting me less was the wrong action,” was she weakening?
“Hattie, sometimes you are a selfish bitch!” I knew it. It was true. Guilt is a phenomenon one experiences as a relationship with oneself. Blame is the phenomenon can only emerge from one’s relationship with another. And shame is the outcome of one, the other, or both guilt and blame. I wasn’t sure if Jody’s intention was to blame me for eating the last of the cake, although she may have been aiming to draw out some shame. One way or the other, the shame I felt as the outcome of my own private guilt pushed me to apologize. I also knew in my heart that further détente would be unproductive, so I delivered the I’m sorry as a single, brief offering. Rarely fierce, Jody’s fury at this moment was notable given that bitch is a word that she holds very strong opinions about. The air was frosty inside for a good long time but I took some solace knowing that at least the air outside was free of new snow and there was no shoveling in our future.
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 was likely always so pale against her dark curls but today the mauve half circles broadly underlining her eyes accentuated her pallor. 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 a conversation. 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 our families and told them in person about my situation.” She kept her eyes on her hands, folded neatly in her lap.
“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. “And tiring.”
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…and very, very tiring.”
“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 this 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…better 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 it’s 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 tumor 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 ever-handy, non-hospital 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; betrayal. “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, half worried about where this might head.
“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 now we let other people know… it’s real important we control the information.”
“What else did they suggest,” I encouraged.
“Mostly it all makes sense. Because they’re all different ages, they say the kids will understand it differently…so, 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.
Again, I didn’t interrupt; in truth I had nothing to say. 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 so much 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 deeply to the bottom of her lungs, as if to compensate for her eventual failure to breathe.
“I’m so, so sorry Bridie.” My eyes prickled. 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 have the social worker meet up with the kids at home right afterwards…and then as much as they wanted after that.” Pause and sigh. “You know, 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.”
“What can I 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 it’s 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.
Jody and I curled at our 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 without revealing any detail. I knew Jody absolutely appreciates the importance of confidentiality and she would never, ever break my trust in her as my support. And as much as I rely on Viv and Karen and Rudy, sometimes I need someone who understands me, knows me inside out, for counsel. Not clinical advice but more like a sentry to support me to manage the impact of intensely emotional experiences. It took ma a long time to appreciate that my work affected me, positively and negatively sometimes. Harnessing its influence has made me, I think, a better support to others and it’s moderated, I think, the effects of my work on my homelife.
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. In my experience, the pointy-headed idea that you just turn off work when you end your shift strangles personal awareness and limits what I can learn from what I do. Besides, let’s be real here, seeing life and death at sometimes its ugliness doesn’t lend to pleasant dinner conversation – better our intimates have some idea that it isn’t them dampening our worlds at the minute. But, as I say, this attitude is a bit rogue for the officials.
When Jody and I first met, she was unfamiliar with mental health work so I had to describe my work in the only way that made sense, obscured stories, or she never would have figured out why one day I was effervescent and one day mute. 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, sometimes dumb advice, but mostly we support each other to uncover factors or solutions 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 then. 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 the final draft of that list. I have some names to add.” I knew Jody wasn’t really interrupting me, just priming my narrative, so I stayed on track.
“One of the things the client said was that she was gonna talk 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, maybe even more.” 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, Jody doesn’t seem to care. 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 Jody’s terse reply. I bit my tongue rather than show her just how completely unacceptable the condition of the shirt was, and I just 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. As I re-folded a pair of jeans, the proper way, I wondered to Jody, “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?”
“No. I have not.” She looked askance, maybe at the question, maybe at the re-fold.
“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 sorta young. We are both healthy. We take good care of ourselves. Other than the odd time I consider putting arsenic in your potatoes I’m convinced we will live forever.” Finally a smile softened her face. The cool, wrinkly shirt and re-fold 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 nurses, 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, way on the other side of town, 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 it’s 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, in their now dark living room.
For some reason Fridays were busier for everyone 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. Whatever the cause, there were already four people waiting in the emergency department for assessments when me and my teammate Viv arrived at 0730. After our abbreviated report from Linda, the Team Leader, we checked the office for phone messages, looking specifically for people who were looking for follow up today before we 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 day was off to a ripping start.
The first client I intended 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. Sadly, 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 that pose the greatest risk. And of course these are just the folks we are most likely to get into conflict with because they require direction and redirection, with more redirection to get them to stay in bed, stay in their own space, don’t yell, don’t use obscenities, keep your hands to yourself, 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 every couple of weeks or so but to date we have been able to keep her out of hospital. She was awake and eager to talk, so my priority was her. “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 Jill, I’m not really that radical,” I smiled, a real one with teeth. 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 a history in the system have brakes that are a little too tight because they have had their trust breached, usually more than once. I thought perhaps Jill checked the first box, likely also the second.
“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, in my assessment, 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 I hoped would help her understand Jill’s difficult life. And, maybe add a trick or two to help her manage Jill in the future.
As it frequently turned out, once she started to open up, Jill acknowledged, with her head thrown back, that she was “spiraling.” As she described her circumstances, at considerable length and still considerable volume, it was clear she knew how her recent life events and decisions contributed to her mental state. Although she didn’t say exactly 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, I took it was certainly implied. As often happens, when people with long-standing mental health problems are managing well, they turn away from the people and programs that can support them, for many legitimate ego-preserving reasons. And sadly, the people who can support them often welcome the break, a missed appointment here and there provides a welcome opportunity to catch up on something else. The secret is to re-connect before it’s too late. 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 for the last year or so Jill had been living in what we ‘the system’ would call a very good situation. She was connected to the long-term mental health team and she was prescribed an effective 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 stilled, pausing to safely organize her thoughts; for her this was a loaded question. She breathed deeply, chest rising, 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 stark disclosure. “Hmmm,” I murmured, buying time for me to safely organize my thoughts. “Tell me what you want?” This might be the question she was angling for.
“I don’t want to be under the microscope…your microscope and everyone else’s. 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 there was intensity but it felt more like despair or frustration rather 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,” where I saw her a few times over the summer. 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 and sat back, inviting her to contribute more and 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. If I recalled, he was a bit sketchy but he was her friend so really 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 sooner or later one of us would have to hear Jill out so this was as good a time as any. Without interruption, I encouraged her to reveal the full detail of the past three months with a series of nods and uh hums. Every once in a while, I needed just the slightest verbal nudge to keep her narrative moving straight, not sideways. Eventually, Jill got to the crux of the current situation. 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; Viv’s Number 1. 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.
In the time I’d spent with Jill, intoxicated client number had roused and was becoming rambunctious. But his family had also arrived and they were prepared to manage him, as in take him home. 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, as I said before, a cancelation or 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 both our love and our deep-seated uncertainty, even when they were playing well we sat on pins and needles. A few 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. The last couple of years the team has turned around. They had a new cast of young and exciting players and we had hope. In the last two years they made the playoffs but haven’t moved past the first series. Rudy and I pondered the need for a couple of bruisers and we disagreed about Coach Babcock’s lineups. We did agree that our next Stanley Cup has been a long time coming.
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 as he exhaled. 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 thinning 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.
Before I left for the day, I called around to check in with the few folks on my list of unsettled folks. One of them was the man from this morning who had been intoxicated then discharged with his family 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 from someone else but we all start somewhere. He asked the right questions and sounded like he was taking down the contact information and he 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!
Another crisis worker, Karen, 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 ten minutes ago; he noticed the call display on his phone.”
“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,” Rudy continued. “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.
Rudy’s reply came sweet as syrup. “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. Then he added “…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.”
“See! You are reeeeal good,” Was all I could distinguish with Rudy’s ancestral Caribbean accented cackle as he wheeled out the door and back down the hallway.
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 of human distress? 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 in terms of supporting personal change. My responses were grounded in my own experience, not that they needed to be to be helpful to the person but in my case, I had some insider knowledge. Right before I went to detox, I had thoughts of ending my own life. Having stored these memories in my deepest heart, I conjure them up every now and again so I can re-appreciate just what it was like to face that grave question – literally.
I remember that I felt like such a failure. I had let so many people down, including myself. I couldn’t see going on; had no will for it. Narcotics had replaced me, the person who was me. The sensation they gave me was so attractive, seductive. 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 home base away. Back in the day, staring down my own death and right at that moment of transition to abstinence, I believed I would miss the narcotic cloud of release all too much. Its power was lethally persuasive. 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 Lonsdale Grace and not the hospital where I worked. And thankfully, with much pleading and promising, 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 because I was a ‘risk to self’. Not that it should have had such a deleterious effect but it certainly would have. Theoretically, involuntary commitment is meant as a safeguard, a last ditch measure to manage high-risk behaviour when a person can’t manage it him or herself. Had this happened to me, the consequences of being ‘locked up’ would have been compounded by the fact that I did not want to go down that road and I was prepared to stop that outcome. And by stop, I mean physically deter, fight, and abscond if I had to.
Aggression and elopement are very serious matters in psychiatry. They have their own scales and check boxes, which verifies their very seriousness and the consequences are also serious: restraint, seclusion, isolation, even intended or unintended derision and disdain. Sometimes, there is sympathy and compassion but sadly this happens mostly once the person is contrite and compliant. 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, given my own personal experience with suicidality, this is how I exercise my approach and interactions 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, and my private covenants, with the person I respected the most, brought me a new perspective on life, 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 differently. In my work now, I understand entirely when people give an ultimatum to someone they love. But I also understand deeply, from my own experience, that ultimatums fail because 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.
Another Saturday; another run to CUPtopia and Beacon Bakery. Roland was installed in his usual seat, waiting. This time we examined T.S. Eliot’s life and poetic contributions ‘between the wars’. Neither Roland nor Jody was 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 Patagonia 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 almost 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 while we enjoyed the spectacular view out to Georgian Bay. As we strode along with vigor, we warmed up allowing us to drop to a more comfortable pace. We reviewed the events of our respective weeks. 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 that lined the walkway, with a panoramic view out over the water. We decided about the birthday gift for Jody’s sister. We discussed a little topical politics. Mostly, we simply enjoyed each other’s intimate company and the sunshine.
At the end of the boardwalk, we continued along a path created and maintained by snowmobiles. Snow machines are like motorcycles with skis instead of wheels. They are a bit on the loud side for me but they are certainly 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 in a small town; 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.
Sunday was another quiet day, mostly a repeat of Saturday but the sun was less bright and the sharp wind meant a truncated walk. We might have forgone the walk but we were seized by a sense of Calvinistic duty to get off the couch. Monday 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 late today 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, although I tended to lionize my contributions. 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 family-love-duties, I run errands on 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, knowing that Jody would likely change their stations once she came home, then I prepared myself for work. By the time arrived at the circle of cubicles we call our crisis office, the morning crew were nowhere in sight. This small chamber is where we access the daily tools of our trade: telephone, paper scales, files and computers. Our wits, we carry in our pockets, near our cell phones! Although the space is meant to be communal and any one of us can log into any one of the computer terminals, given human nature we divide it into our own small territories and generally decide to sit at the same station. So, this I did. When I logged into my account on the shared computer, the system miraculously informed 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 the necessity 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 that his inclusion was important.
“I did,” she started and then paused. “But he equates this with a funeral, which of course it does…and understandably 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 it’s not one of my natural worries I’m afraid I might be missing it.”
My turning wheels suddenly caught traction and a key link fell into place. “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 and drew a long breath to steel myself before I added, “he also does funerals, if it comes to that.”
After a short pause on her end 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 connect with Reverend St. Croix and bring him 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, you know, preparing my soul, if you know what I mean,” I nodded in agreement then realized we were on the phone. Nevertheless, 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.
“I’m so sorry Bridie.”
“I know Hattie. I really, really, really know.” We tidied up our last few arrangements and agreed to connect once a week during the radiation, or more often if Bridie wished, and rang off. I settled back in my chair and crossed my legs. I’m not sure how long I idled in my own sad thoughts but the sound of a ringing phone out in the adjacent reception area reminded my core that there was work to do.
Viv and Karen were working the day shift. When I ventured out to check, Jenn, our receptionist told me the morning had been busy and they had only now cleaned up the emerge list. Both Viv and Karen were currently ensconced in the two interview rooms seeing the people scheduled for follow up. This quiet interlude gave me another luxury beyond non-weekend grocery shopping: culling emails and logging my monthly activity statistics. Paperwork as we call it, even though ironically most of it no longer involves paper, is another of those tasks where I procrastinate. I think this is true for most direct care clinicians. The relevance for us is seldom noticed or felt. I can put in real high contact 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 a prevailing perception.
Next, 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 just 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. “It’s very sad, and it will continue to be very sad all the way to the end. Even after the end it will still 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 baseball season. This infusion of compassion was just what I needed to face the rest of my shift.
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, maybe early thirties, 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 peered into the suite. 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 my knees would have to serve as a tabletop. The necessary patter about confidentiality and insurance forms fell effortlessly from my lips. Lowell followed easily and had no questions. He explained that 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 of Education.
When the formalities were resolved, I started “…so Lowell, you called the office at the end of last week.” He nodded. “You spoke to our supervisor, 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, elbows on his knees. At 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. He intuitively understood that my silence was his signal to keep talking. “I am not suicidal,” he added quickly, apparently appreciating the unspoken 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 dipped 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 anguished 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…without thinking.”
“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 more than 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. And back to my key question. “Is it enough to drive you to suicide?” Lowell paused long enough to up my worry. I leaned 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, honestly, I would not be sad if for some other reason I would 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, he says 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…not for me but for having that difference used against me.”
This was a lot for me to take in. I struggled with disclosing my own situation. New evidence suggests 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.” Dr. 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 definitive 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, then amusement.
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 pursed lips pulled thoughtfully to one side and with a nod he added “I think you are right.”
With that, he reversed the steps of his entry donning cap, boots and jacket, then he raised his hand in mock wave as he departed. Lowell was correct; his situation was undeniably complicated.
Three weeks sailed by, in all the usual ways; people came through our doors and people departed our doors, all without major incident. In one of our Saturday CupTopia tutorials a few weeks ago, I learned that T.S. Elliot proposed that April is ‘the cruelest month’ but I thought perhaps his evidence was flimsy. If I had to choose it would be February. I was glad when the calendar flipped a page. 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 occurrence 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 scheduled in the midst of it so I could stay out of her way.
We attended the talk by the Buddhist monk that we had learned about through the yoga studio. 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 role, function and impact of ‘conditions and consequences’ of life. There was a pretty good coterie of potential Buddhas assembled so we hoped he might be enticed to visit Carter again, if a monk can actually be enticed. The monk’s easy message was not quite compelling enough for me to convince Jody that the ‘condition’ of report cards, or more likely the ‘condition’ of her perception of report cards, provoked the ‘consequence’ of suffering. And by suffering, I meant both of us! But the message was enough to get me to appreciate that the condition of whining about your partner’s mood only provoked the consequence of more mood.
Bridie was deep into her palliative radiation. I kept in touch with her by phone, every few days. She was toughing it out. She was tired and worn down. We both looked forward to our next face-to-face. I kept up a solid work routine, listening with mercy and aiming to mend sorrow. I was even being a good corporate girl. 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, or ran away from, hospital – some say absconding. It was a big deal for the liability folks. Not that it wasn’t a big deal for the rest of us, just that our prospect on these events was a little different, a little more personal and a lot more defensive.
I was particularly interested in how we could improve our way of avoiding 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! Rudy and I hoped it would last.
Lowell and I continued to meet. He did finally take a month to tell me his story, which we examined and jointly 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 I guess for them it is probably the farthest from cruel. Midway through the month there is a ‘March Break’ also known as a week off work! Ordinarily, Jody and I would fly off, enjoy a warmer clime and be silly for the week. Sadly, this year, we had some repairs scheduled for the house so 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, which I can inflate to 5 foot 3 under the right circumstances, getting 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 knew her from her digital music. 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 at the end of 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 and evening with my Love. After the concert, we walked to the subway and took the train back downtown to spend the night with Jody’s brother, Charles who we affectionately called 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 too was enjoying March Break too. That meant he could enjoy a stroll around the corner with us for café au laitand 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 to share 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. 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 compartment 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.
“Good grief 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 to a page midway through the notebook, where a passage was outlined in a box.
“This is my first reveal” Jody smiled nervously. “It started when we were driving through one of the rock cuts off the interstate in Virginia a couple of years ago. I scratched down a few of the images then…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 persisted and two of her previous poems were 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 tremendous 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. And Jody and I were grateful operators in alleviating his isolation. 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 pay homage at his grave. Apart from his innovative 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, especially his later work is stark and otherworldly 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! We would be dining like queens for at least a week with these ingredients. The snow commenced to tumble out of the sky about a half hour before we arrived at our street but 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.
That night I slept so hard I know I didn’t move. Just before sunrise, the temple chime roused me from my deep 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. I responded 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 goose my jeep back on the road. I arrived just before report and had to hear Linda out wearing my full Winter regalia, with Linda staring at the last melting drips that I was unable to shake off my boots in my scurry across the thick entry carpet. After noting my assignment, I headed to the small crisis cubical. I had just uncoated and unbooted myself and dropped my belongings on the table 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 her impressions about him after she completed her cursory 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 of that 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. As you can imagine, these events, though rare, are very stressful. Over time, I have found it easier to manage my emotions so I can focus and not collapse into a heap of fear. I’m sure everyone has had the experience of cruising through scary events then after the fact the calm shatters and all the potentialities of the situation rise to the surface, and weaken the knees. In this case, I was still cruising on ‘focused’.
“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, maybe fifty years old, with shoulder length, greying hair. He didn’t look that athletic but I was pretty sure he could take me. Focus. He turned and looked toward me. On the periphery, I saw everyone else freeze. I stood slightly to the side, exposing more of my larger and sturdier, thigh muscle in the event he took a run at me. “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.
I battled the weak legs and swallowed the rising gorge 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 up 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 ever so slightly, without taking my eyes fully away from Dennis while 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, a connection. 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 Jack’s 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 at 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. 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, with my heart hammering in my chest. As I approached the care desk to ask about meds, I saw that 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 reply. “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 fellas 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. Nurses are generally middle class, law-abiding folks who figure everyone is like them. They think everyone ought to have the same kinda yes-sir response to police and do just what they ask. So many factors prove this assumption wrong. Since we weren’t sure how Dennis might react, he was right to hedge his bets.
By the time I returned to the scene, my blood pressure was no longer in the stroke-zone. 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 remaining 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 time he reached 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 but out of sight 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, and the transfer. It was a tablet that dissolved under the tongue and delivered its effect PDQ, which I think is an old military term for ‘pretty damn quick’. 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 order 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 but before he and his partner moved in close and placed their hands on Dennis’s elbows, he explained, “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, my vital signs returned to baseline. 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 any 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 second. I walked over to ask if everything was OK before we left.
“Fine. Now” was her reply.
“Funny Linda, it doesn’t sound that way from your voice.” An awkward, fruitless pause was her 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 tight 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 a feeling something else might be going on and I wasn’t sure if or how much it involved me. Maybe not at all; maybe a lot.
“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 as green as I remembered his elf-hat was and I knew he was ascending, I returned to the crisis cubicle. Before I jotted a few notes and times to remind me about times and names for my notes and the required incident report, I wondered again about Linda’s demeanor. I knew this wasn’t her first Code White, not by a long shot. It sure wasn’t mine either but I can tell you, I hated them all. Some codes have gone so far south they fell below the equator. Yet, in this case, I felt like we never really lost control. If I think about an image, it feels a little like those tight rope walkers. They make it look kind of easy but of course it’s not. I met up with one of those high wire gals a few years ago and she confided that along with nerves of steel and years of practice the long pole is essential to keeping their balance. That metaphor stayed with me in my work. Over time, I think my nerves have definitely steeled and I’ve grown a pretty long pole to keep me balanced on my particular tight rope. Alas, I couldn’t ponder any loner. There were crisis assessments to finish off.
As it turned out, only one other person had arrived overnight last night. He was a thirty-four year old man who endorsed extreme anxiety, which responded pretty well to a bit of medicine. Now, he was settled and ready to go home but the doc wanted me to check him out. The duty doctor generally just cuts 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 had the intell I was looking for. I was ready 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 whole ‘incident’ part,” she made quotes in the air, “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 also mention your observation that it seemed to evaporate, as you said, once he got into that would be greatly appreciated. They are looking at near-misses, you know, to see what we can learn from them, 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 initiative on the line at the car plant. The work is particularly stressful because his assessment of their current state-of-affairs revealed the need for a more substantial change,” I decided to breath, “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, effective in getting me to continue.
“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 intervening years, so 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, verifying 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 that once again today I was running late. So much excitement for one short morning, and I was finally 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 displayed: 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 it’s even over. Not to worry though,” Jenn laughed, “I believe his exact words were: when Hattie thinks it’s 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 him wanting to see me, the way I have been worried about supervisors in the past. He knew the work and he trusted us to do it right. 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 a supervisor’s copy of 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 it’s just human nature to be a little defensive when one’s performance feels like it’s 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 electronic template.
“In theory, those criteria were all present,” I muttered through tight 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 restraint 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…am I 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 figure 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, deliberately slow and calm. “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 about 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 also guessed her note would actually be linked in later by someone from medical services.
I didn’t have the file authority to read Jack’s account in the incident report unless I logged back into the patient file and I was reluctant to leave those tracks in the system, just in case. I felt eyes welded at my back. 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.
Bridie looked tired but her face flickered a hint of 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 outcome was 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.” At first she looked embarrassed to have blurted this out but her shy smile revealed how important this was 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 sees 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 single ply hospital tissues.
“Thanks,” she sniffed. “It was a reprieve alright. The whole topic has disappeared and we 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 as if 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 watch my words all the time because I don’t want to be mad and have people remember that as the last thing about me.” She cocked her head back and rolled her eyes, “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.” Physically, she deflated. Her shoulders slumped and she looked smaller, shrinking in the chair. 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, point her in a direction she didn’t want to go.
“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 again and carefully 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, you know, the final moment…again I worry about their memories of me. I want to have my affairs, such as they are, in order.” She paused but only for a moment then continued, keeping the falter from her gentle but noble words.
“I have certain messages for the kids and I’ve started writing them a series of cards; birthday cards, graduation cards…” Bridie’s precipitous, deep, sob brought another 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 me 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.”
I thought I was taking it all in then before I could compose myself, I snagged on the last detail, “Pajamas?”
“Yes. I want to be comfortable for all eternity,” Bridie nodded silently.
“Good idea,” was the only comment I could safely manage, biting the inside of my lower lip. “So, have you written all this down? Doug will need to be in on all 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 suddenly determined, as if she had turned a corner in her internal deliberations. “Hattie, I want to…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 own 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 and prudent reply.
My shift finished at 1500 hours, or three o’clock but since I was still steamed about the incident this morning, after I 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 most of this aft with Beth-Anne and Dan.” Dan Kennedy was the manager of the emergency department, well of the nurses, not the doctors. That meant he was Linda’s boss. Another wrinkle.
“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.” Her confidence was infectious.
“It’s 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, distracting 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.” When I felt the flood of relief, I realized that the whole damn incident had been resting more heavily on my soul than I thought. “And what about Linda?”
“What happens between Linda and Dan, is between Linda and Dan.” 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.”
Busted. “Aye, aye” I saluted like the good foot soldier that I knew I wasn’t.
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. She confirmed that 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 and right 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 good and right, as you say. 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 together just fine ‘til she decides to come to you. Just let it go Hattie. Don’t try to fix it at 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. Although I can’t decide if your angst is the condition or the consequence,” she hesitated in her pep talk, likely pondering the monk’s assessment. Then she continued, gently, “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, tethered to the odd chunk of angst. I figured that in this case, I would heed Jody’s advice and see where the chips fell, there were no other choices anyway but that was a bit uncharitable. 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,” I insinuated, signaling my shift away from the serious 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,” I sensed a smile. “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.
Jody and Rudy’s advice was compelling, albeit hard to endure. Nevertheless, 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 cool and guarded. Even though 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 to enjoy my 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 unusually early 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.” Another local weather reality.
“You are brilliant and beautiful.” I’d rebounded quickly from my temporary dejection about the flowerlessness.
It wasn’t often that Jody and I either visited friends for entertainment or hosted friends for entertainment. We were generally satisfied in the company of each other. Our separate lives and interests are important constituents of the glue that holds most couples together. We respected each other as women, with our own minds. Don’t get me wrong, we shared most of the same ideas and beliefs but there was also enough unique action in our lives to fuel our interests and passions were they divereged, and complete the interdependent matrix of our love. I, for one, would feel incomplete without Jody, although I don’t think I’ve ever told her that out loud. I hope she feels the same. Tonight, I would share Jody with her friends.
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 struck a model’s pose. 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, which was my reward for working so 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, which 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, just a few ruts and bumps. I didn’t even need four-wheel drive. Maureen met us at the door. She was delighted with the flowers Jody had chosen. The fireplace ablaze 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 had run 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 must 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.” She didn’t interrupt, so I kept my ball rolling. “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 a sad experience to share.”
“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. It’s 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 yourself 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 of death 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. It was my pleasure to hear Jody’s idea about literature and, I assumed Maureen was equally interested. “I think, we think,” she gave a side-glance to Roland, “we think the long history of story-telling is important to understanding literature. This is the angle we want to use in this new course…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 back 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’.
The look itself is usually effective. In this public setting it was moreso. Jody went on to introduce the short treatise about narrative history that she and Roland were working from in their project. “People used to talk more, share tales. Some stories recounted events, some described interpersonal transactions, some combined both. Some stories were accompanied by performance, like dance. They taught, or reminded people of their history. 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.
And I was not incorrect. Jody continued, “Anthropology research suggests that all the many and varied firesides, in all the many and varied cultures, produced remarkably similar and unvaried stories and myths. We are looking for that same similarity of ideas and interest in story-telling and myth,” She looked to Roland who nodded for her to proceed, “We hope to draw our students in to stories that are both timeless and current…the underlying human narratives that I, we, think kids can relate to.”
My heart swelled with love, pride and respect listening to Jody. She was so intelligent, so committed to her work…so beautiful. Roland jumped in but he couldn’t completely burst my romantic woolgathering.
“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 of his analysis.
Beautiful Jody retrieved the baton. “Stories moved beyond the fire’s glow when we began to draw and write, like more than just on cave walls. So, 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.
After her nod to Maureen, Jody went on. “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,” again with a nod to Maureen, “photography trumped painting…the replica became more seductive than the likeness.”
“But in my understanding, didn’t the move to likeness 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…It degenerates. But when it becomes inclusive…”
“Hmmm. You’re getting a bit tangled, aren’t you?” Maureen observed as only a partner could in that moment. Roland stopped to consider Maureen’s point, which I secretly saw as valid. Listening to he and Jody speak I could tell that even though he and Jody had the germ of this idea, they were developing it interactively. But I could also hear that it was a way from usable yet. Actually, for me, my head was several sentences back trying to figure out the seduction of the replica, or whatever Jody said. I would ask her for the Cole’s Notes in the morning.
“So,” Maureen was undaunted by the ‘degeneration of the interpretation’ and seemed better at following their tack, “if I jump ahead, I’m guessing your idea is that because film is easier to access, people chose it over novels?”
“More or less, Maureen,” Jody picked up the thread. “And not just novels into movies; it’s 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 looked at Roland, her English teacher partner. “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 summarized. “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 wondered why high school English and History don’t pair up. How do you teach A Tale of Two Citieswithout teaching the French Revolution? Only after I finally understood French social history did I love that book.” I silently agreed. I’d read it again two years ago after gaining a better understanding of the run up to the revolution and for me it was delicious, like chocolate.
Behind my private thoughts, Maureen was continuing. “The same is true with To Kill a Mockingbird. How do you teach that book 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. “You know, there’s a program, I think invented by Hogarth Publishers, that has fiction authors re-write certain of Shakespeare’s classics, only in current time and space…I read Margaret Atwood’s Hag Seed – well, mostly because she’s Margaret Atwood, but it was just as you are talking about: relevant now.”
Jody tapped her head with her right forefinger, the one not holding her wineglass, and nodded, “I’ve heard of this book; I’m going to check it out…and the whole program. It might be a good reference for us to cite.” After a sip to rejuvenate herself Jody 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… even Shakespeare – an eclectic approach. Many of us, like people our age, or people in ‘the business’ 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,” Roland polled in his schoolhouse voice, “in this room for instance, how many books did you read last year? Maureen?”
Maureen paused to think. “16 maybe 20”.
“Hattie?” I was grateful I 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,” Roland boomed. “A recent report says that people in their 20’s read, on average mind you, less than five books a year. Are we properly preparing these young people as readers? 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, should, 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, scanning the faces. 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. Linda Berwick, scales and forms and poor dying Bridie flew miles from my radar. I was enjoying my evening with Jody and her ilk.
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 could go through life understanding why we made all the wrong decisions but never putting that learning into action and 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 always 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. Without shame, I had my customary two pieces!
Friday night became early Saturday morning before we fell into bed, and stayed there until well after the shadows of the front garden trees were painted onto the wall by the high noon sun. I finally put my feet on the floor and made us Chai tea. But 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!” Oops, I walked right into that one.
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 thumped 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 a sound, 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 even where to start.
“I love you. I will miss you,” she proceeded, now unabated. “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, rather than full frontal.
“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 maybe doesn’t like the idea of it….”
“Bird!” Doug interrupted vehemently. “What are you talking about?” This last poke stirred the embers into flames. “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 aspect of the future hearing it all now 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, it’s 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, shocked and genuinely confused by this turn. “You don’t know that!”
“I read it somewhere. I’m pretty sure it’s 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 a good while to let this sink in. When Doug did not eventually 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 quietly, 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.” Silence. “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…but sorry, 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?” Doug’s emotional exhaustion was consuming. Like walking in deep, deep sand and gaining no distance.
After our stimulating dinner with Roland and Maureen Friday evening and our lazy Saturday, the rest of our weekend had been slow and relaxing. With delight, Jody roused me Sunday morning with a poke, “Listen,” she whispered, but loudly enough to get my attention. “Cardinals!” With the weather warming and Spring officially on its way, regular birdsong returned to our little enclave of trees and bushes. We were not in a position to lie in bed for two days. Today we had household chores we couldn’t ignore. We decided to start outside, in the sunny chill.
We began with the heaviest work, as a sort of warm up. Jody and I gathered all the winter debris remaining in the front yard and the back garden, then we raked what was free of snow and bashed remaining blocks of snow with the back of the shovel to abet their departure. 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’re right. I’m sick of winter. My bones can’t take any more cold. At least this coming week I am on afternoons, so the frost might 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 led to us eventually just calling her Frau Blucher, like a secret code. Despite her apparent aversion to film, Jody loves 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 was this really how Bridie felt or was 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. I wondered if I could I do the same.
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’m gonna be late!
I quickly readied myself in work clothes, packed my ‘lunch’ and got out the door in record time. One of the advantages of living in a small town was the six-minute commute, no subways or buses. 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. The emerg was busier with all kinds of people because people left worrisome pains and complaints until the end of the week, probably hoping they might go away. For us in Crisis Services, 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 and they were very good at recreating what we ‘regular’ weekday crisis workers would do with folks we were following, so most transitions were pretty seamless. Nevertheless, we often sent emails or put ‘flags’ on a file to alert them to risks or remind them of strategies that worked for us.
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, knock on wood. She joined a Recovery Group that the peer supporters facilitate on Saturdays. Adding that to her other consistent supports has really turned the table for her. Historically, the prevailing attitude in mental health is that people don’t ‘recover’ per se. Recovery is a process, a journey not a destination. People learn how to adapt to their situation – their environments and relationships. They manage, or even accept, their symptoms, their illness. A movement initiated by people who have survived their symptoms, and maybe even moreso survived their experiences with our psychiatric system, has lead to a new understanding about mental health recovery. I appreciate it as a radical redistribution of responsibility, which other than a radical redistribution of wealth, is the foundation of most rebellions. Amy is proving my point; she has radically redistributed responsibility from us to her, with the support of others who’ve ‘been there’. This makes me smile as pour a quick coffee before heading to my station, sauntering as though I’d been there for hours instead of just prancing through the door.
Luckily for me, 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, or seven AM to seven PM, 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 bunting 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 collective 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. He did agree to call back in a week and tell me 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’ which he verified by lifting his right hand, nearly a blur with tremor. 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. 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, as it turned out. I called both numbers listed in the package compiled during her visit to emerge earlier this week. 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 to refresh her memory, “…Jill, Jill Marshall. Remember her?”
“Yup. She’s living with Craig Betts, n’est pas?” I could love the French language 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’s 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 the direction of the papers in her hand.
“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, and he can hang on a bit ‘til you get there… 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 it’s 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. It’s 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 the motivation behind the joking. “Busted.” She acknowledged. “I can’t stay with it too long or I’ll 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 the 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 16thbut 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 her more about her health, or her pain.
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. When I checked the waiting area to see if Lowell had arrived, I found him slouched in a corner chair. The slouch, it turned out on further examination, was not an emotional retreat just the affectation of a weary teacher on a Friday afternoon. “I’m well.” Lowell proclaimed brightly. His connection with the LGBT teachers group had clearly bolstered his mood and his confidence. The news he was looking to share was a new relationship that he was hoping would become meaningful and therefore he was hoping it would facilitate transfer back to the city, where he could exist with a bit more anonymity. In truth, 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.”
“Don’t 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 the 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 said, accompanied by a smug grin, “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.” 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 sturdy my spine first.”
My vague look telegraphed that 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. But really, right now I’m just angry, and frustrated, and disappointed. Disappointed in small town life and disappointed in what it brings out in me. I’d like to be more of an advocate, fight a little…”
“It’s been a long fight for a lot of us,” I mused then returned to business. “Really though, what can I do to help?”
“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 as much sense out of it all as I think I humanly can. 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. And the hospital could bill the insurance a max fee. Win, win.
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 mercilessly 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.
“As you well know,” his tone was authoritarian, “I am not supposed to disclose any information personal to Linda. 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, likely the former but the latter was a convenient oath to lay on me. 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.” 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.
When I arrived home, Jody and Roland were working away at the dining room table. Jody was hunched over a legal pad scratching notes. At her side, 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 were arranged between them, probably the novels they were considering as texts. Two-thirds of a large pizza was cooling in its 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 without looking, 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, innocently.
“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 chuckled at his own joke as he sorted his notes into two piles. One pile was obviously for him and one obviously for Jody. He continued his welcome digression, “But I preferred Marty Feldman’s character. His hump was always changing sides,” Roland chuckled again.
“Any chance you can use Young Frankensteinin 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 Citieswas embedded in the curriculum, we ought to find a film about the French Revolution…I can happily research that one. We could consider a field trip to see Les Miserable…I’m sure it’s still in production somewhere.”
“Two Solitudesor The Stone Angelare both typical Canadian content.” Roland mused out loud, redirecting novel content to me.
“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, likening my interruptions to the same degree as those of Thomas Beckett, the erstwhile priest who conspired against the king of England, in olden days and who earned himself a stabbing in the cathedral.
“A little harsh Roland,” Jody chastised, but with a smile. “Remember, Beckett was later canonized as a a saint.”
“Stone Angel has own movie….so does A Handmaid’s Tale…now a smash hit since its been rediscovered by the U.S.,” I continued, ignoring them both. “And, don’t forget Maureen recommended that new Margaret Peggy Atwood novel,” I added, using my best imitation of Mary Walsh from This Hour Has 22 Minutes.
“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 Burningagainst To Kill a Mockingbird…” Jody was also thinking out loud. Then, with sudden delight she turned and announced “We have news, 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 also 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,” Roland boomed with his heavy vox bass. “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, just being silly.
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 overhear snide comments. Sometimes people feel like it’s a good thing to tell me what is said behind my back, like I need to know. Sadly, prejudice is still a real part of 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 stigma that existed for us, and folks like us. “Do you think it is harder for a guy?”
“Absolutely!” Her answer was immediate and adamant. “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. Partial information should equate with a partial understanding but instead people jump to convenient conclusion, except when they are really inconvenient conclusions. 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, like maybe they are mixed up with jerks or they can’t make a friend. 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, as soon as I put away the rest of this pizza, I’m 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.
Thoughts of Linda and Lowell tumbled around in my head while I tried to sleep. One person was being persecuted for being different; another person was being persecuted for attending to someone else’s difference. Hmm. Was Linda’s consequence persecution? Did I feel persecuted by Linda? Obviously I wasn’t at risk due to her comments; she was. Who was persecuting Jody? Why am I using the word persecuting? Is that accurate? I don’t feel persecuted…What do I feel? I feel a strange energy stirring in my chest, above my diaphragm. Is that pending fury? Is it a call to action? Is it sadness? Well, whatever it is, it’s keeping me wide awake. My usual calming self-talk is useless at this point of the brain-storm. I tried yogic breathing, focusing on my breath. Noticing the sensation of my breath exiting my nostrils. Nope, that’s not gonna work either! I checked my bedside clock and see it is already 0115. I quickly calculate that with a wake-up at 0800 I will approach seven hours of sleep, then I work at tricking myself into thinking that laying still will at least rest my body. My thoughts stray to Bridie and her news about the Blue Jays game. As I roll over on my right side, and settle my legs around Moncrieff who is hogging the middle of the bottom of the bed on my side, I finally, gratefully drift off.
I woke the next morning to the sound of Jody playing her guitar. Moncrieff was currently curled in the dent on Jody’s side of the bed, with his arm covering his nose and eyes. Some would say ‘paw’ but Jody and I assume our pet is more human than animal. When Jody’s rendition of Dirty Old Townended, I sent out a peal of applause. My reward was one more chorus, this time with Jody singing along. I swung my legs over the side, plunged my feet into my fleece-lined slippers and padded out to join her. We ended the song together.
“I thought Shane MacGowan had dropped over for tea and biscuits.” I said, when we stopped singing. Shane MacGowan being the desperate but desperately talented Irish drug-addled and frequently toothless equivalent to America’s Bob Dylan, at least in me and Jody’s opinion.
“It’s so much harder singing around all these teeth.” Jody mugged a wide grimace, displaying a full set.
“Most unlike Himself. Although I read somewhere Shane has some new teeth…even a gold one,” I mused. “Got anymore songs?” I sat on the chair in the corner and drew my legs up under me.
“Here’s one I’ve been working on, while you’ve been saving lives.” It took me a few bars to recognize Gentle on my Mind. Then I joined in on the lines that I could remember, which were surprisingly many, once we got started.
“Poor old Glenn Campbell. He sure ended in a sad state. Are all your songs by the washed up?”
“Hold on! Shane MacGown is not washed up!” I hit a nerve. “He’s currently on hiatus…he’s working on some new stuff. And Glenn Campbell, well he just hit a bad patch there for a few years. And now, you can’t disparage the dead!” Jody ended her rebuttal with a curt nod as she propped her Taylor guitar against the side of the couch without looking up.
“That’s it? You play enough to wake me up then quit?”
“I’ll keep playing. You get me a coffee. Deal?”
“Deal.” As I refilled Jody’s mug and dressed my own the sad melodic of the Irish standard Botany Bayfilled our home. Jody sang all the words she knew, so there were a couple fragments of the song when her Taylor was unaccompanied. Then she experimented with Mary Gauthier’s Mercy Now. I joined her. We struggled with the words, but belted out the chorus.
Then we turned to serious coffee drinking and planned the garage-cleaning adventure we had been dreading. Now that the season of snow may actually be over, we had to address all the clutter that had accumulated since last Fall. The snow arrived early in November and never really let up, so all the things we stashed quickly in the garage, intending to put away properly, sat frozen in place for the last few months. Today, our plan was to liberate and organize.
Despite the bright sun, the air was downright cold. Gathering and stacking in gloves and parkas is a pretty bizarre version of fun. Nevertheless, in under three hours, the garden chairs and ceramic pots for plants were re-located to their summer positions in the back garden. With the seriousness of a UN peace accord, we debated the likelihood of more snow but decided they were sturdy enough to survive, provided we removed the cushions. I shoveled out the last heavy chunks of grey ice that had accumulated when we tromped in and out of the garage to our back door. While I was at it, I chopped up as much of the tenacious ice bordering the driveway as I could, hoping it would not be replaced after it melted. When we were satisfied with our work, Jody served up a brilliant potato soup topped with green onion and grated pepper jack cheese. It almost made the garage cleaning adventure rather worth it, even though we had to endure regular bread since we had deferred our Dutch Crunch run this morning.
The deadline for Jody and Roland, and now Luke McGinn, to submit the proposal for their pilot course in ‘cultural literature’ was in two weeks. They would submit it to their principal, who would review it and make sure she understood it all before she presented it to the Board of Education by the end of April. They knew they had their principal’s support and they trusted she would make the best pitch to the Board. At this point, Jody and Roland planned to attend the Board meeting, in case there were questions the principal couldn’t answer. So, Jody continued to work away at her part of the proposal while I spent the rest of the afternoon and evening binge watching Chopped,the television culinary contest that eliminated contestants who struggled to incorporate odd ingredients they were presented in wicker baskets. Between episodes, I read the most recent novel unraveling Alexandra Cooper’s exploits while solving sex crimes in New York City. I watched the first and last period of the hockey game. I watched the first with hope, switching back to Choppedwhen the Leafs dropped behind by two goals. I watched the last period with glee until the three minute mark when the Red Wings scored in the empty net. I avoided the after-game commentary.
Sunday was much the same, except we hit Cuptopia for a latte to recover after Yoga and to fortify us before our walk. “Last week one of the nurses was talking about her vaycay in Paris,” I offered, knowing this was a certain hook for Jody. Correspondingly, she gave me her full attention. “She and her husband stayed in a barge at the foot of the Eiffel Tower. She said they could see its lights through the porthole window in the toilet.” Since I had Jody’s attention, I continued. “I was wondering…” here came the pitch, “…I was wondering if maybe, to help you prepare for your new course next year, maybe we could go to Paris this summer…”
Bingo! I had her. “That would be great.” She blurted. Her eyebrows leapt, almost brushing her scalp. “But I don’t think we can afford that.” And so as I raised up her spirit, I watched it crash.
“I think we likely could afford it.” I was hedging my bets. “We can put off re-tiling the upstairs bathroom, no one sees it but us anyway…and isn’t this just why credit cards were invented?”
“Well, it’s funny you should bring this up because I had a similar thought when I was reviewing some of my notes for the course. But I didn’t come to any practical conclusion because I worried about the cost. Now that you say it out loud, why don’t we at least start looking.”
As we walked off our lattes and shared cranberry scone, we put the plan to further incubation, each of us sharing our wish-list of things to do and see in Paris. Later in the evening, during a fast-forward through multiple commercials dividing the episode of House Hunters International that we were watching after dinner, Jody surprised me when out of the blue she asked “Do you think you will do anything more about Frau Blucher?”
“Since 0115 Friday night, she hasn’t crossed my mind.” I lied a little; she had crossed my mind but only fleetingly. “I’m gonna sit with it for a while…see where the chips fall. If there are any chips. The tempest may be all in my own tea pot and no one else might even care.” I amazed myself at the way this situation had settled peacefully into my psyche.
“Speaking of chips….” Jody was up and racing toward the pantry. She returned with potato and nacho chips, which we devoured as House Hunters International resumed and the young couple moving to a new home in West London argued about the size of the oven in all of the flats that the poor estate agent showed them. Jody’s streak of picking the winning option remained intact as the couple apparently agreed with her about price and location.
Bright and early the Zen alarm chimed. I crept down the back stair and started the coffee then crept back up and managed an abbreviated yoga routine, justified by yesterday’s ninety-minute practice. I was showered, dressed and sipping coffee by the window as the sky shifted from black to mauvey green, highlighting the bare tree branches across the street. It would be a couple more weeks before I could stop along the way to work and see the first rays of sun sparking over the bay. Coffee was delivered to Jody with a sleepy kiss by 0645 and I was off.
This morning marked the first shift that Linda Berwick ought to be giving me report but wouldn’t be. No one mentioned her absence to or near me but Karen was my crisis partner today and she raised a clandestine eyebrow. After report Karen and I parted and I went about my business reviewing the notes and assessing the single person held over in the department. Karen set off to telephone the folks that Tom, the weekend guy, had assessed and sent home to wait for our follow up calls. The 29-year-old man waiting for my assessment was named Rick Morris. He had apparently been in a fight yesterday and had made threats against his ex-girlfriend and himself. He looked a little worse for wear. His clothes could have used a wash and his hair hadn’t seen a comb in a while. His body exuded stale whisky; not a great start. A deep bruise 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, embarrassed by my nonchalance. “Let me start over. 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. OK. Let’s see if we can make that happen,” I was trying to soften him after my bad start. Can you fill me in a bit? I understand from the notes that there was an incident at home…I’m told you were in a fracas and made some threats. The police brought you here because apparently you were making threats to hurt other people as well as yourself. 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. “It’s 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?” My radar was giving me bad vibes about Rick’s character. He’d have to convince me I’d misread him.
Nothing. “OK. I’ll be back.” At the care desk I asked Kim, the nurse who had given Karen and I report, about Rick. As it turned out, Kim was now the acting Team Leader, in Linda’s absence.
“He’s been cooperative all night, according to the notes. 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?”
“Burton was here all night. I think he’s still in the back room. Marshall is on today.” Most of the nurses and also most of the docs dispensed with the title ‘doctor’ when referring to physicians, although Linda always added it. When I was in nursing school the rules were damn straight: yes, Sir – because they were all men; of course Doctor; here, have my seat. Now most of the docs were cool with first names but only when the patients weren’t around. Can’t lose the magic, you know.
“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. To be honest though, I don’t get a great felling from him.”
“Yes Mam,” I agreed, with a snort. “He looks like a bit of a tom cat. 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 gave it another try. “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. Maybe I had misread him. “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. I steeled myself; dug down to that grit I would need and gripped my highwire pole a little tighter.
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 heart skipped at least one beat. Shit! Balance.
My reaction caught his attention and he resumed his, relatively, more reasonable nature. I stayed put, out of his reach. “Listen, this is all blown up. I’m not taking anyone out. I was drunk and I said some stupid things.” Then his eyes chilled. “Now get me out of here,” he concluded with a growl. I was glad my exit was near. But I still had my job to do.
“Before we make plans for discharge, 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. My bad feeling about this guy deepened. “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, the doctor in charge today, and one of them will come and see you.”
I found Larry Marshall gnawing on the end of a bagel in the miniature staff 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 in-coming duty doc and noticed Kim leaning against wall by the door. “He says he was so drunk he can’t remember any of the events. Did you get a blood alcohol last night?” Mickey gave a thumbs up and I rolled on. “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. I noticed Kim following the banter with her eyes.
“Angry, aggressive and historically violent. But I don’t get the impression he is homicidal at the minute.” 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. Kim laughed out loud.
“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,” Mickey added. 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 extreme than our typical fare. “We can call the police and see what the charges are. Depending on their answer, they could request, aka we could suggest they request, a forensic assessment. I think we would just need to confirm that he is not suicidal, and no longer drunk, then they would keep him until a judge ordered transfer to the locked unit over at Carter North. Hattie, tell us more about this partner abuse protocol…”
We re-read the protocol that I had pulled up on the computer screen while Mickey was running through legal options. It 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, especially since they were about to become our confederates in getting Rick Morris placed. 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 agreed to check 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 who had 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 reluctantly shrugged off his coat and sat back down. He agreed that it might be helpful to talk with her and hear more about the incident. It was unlikely we would get more 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. Based on where the two points of legal and mental health interest collided, our plan was to mobilize resources and consider the need for 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 opened the electronic file under his own name, clicked in the appropriate updates about his call to the girlfriend and kicked stones out the door.
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 the charges were laid. 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. Along the way, I kept my new Team Leader friend Kim apprised of all the negotiations. When I passed each detail along to her she responded with a variation of “for sure” or “no worries”. I think the “for surers” and “no worriers” are about a decade younger than me. Generally this talk pulls my eyebrows together but I found Kim’s use of the current cultural colloquialisms strangely comforting.
As Rick had become more impatient about a resolution to his situation, Kim had become more concerned about how this would all go down. She had taken the proactive move of deliberately assigning new folks arriving in emerg as far from his bed as possible and had been gradually and inconspicuously removing throwable objects or potential weapons. She had arranged for Security to be immediately available, without breaching any confidentiality. 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 “for sure” 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 my new favourite 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.
“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. I was tempted to say “no worries” but I couldn’t roll it off my tongue. “You handled everything perfectly. 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.”
“No worries. 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. Can I check with you if I have problems with the incident report?” A secret part of me wondered what, if anything, she knew about my skirmish with Linda.
“You bet,” I offered although once it was out I wished I’d said ‘for sure’.
When I arrived back at our crisis office, Karen was on the phone but she made the gesture that means ‘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. “No worries” I mouthed to her, eliciting a quizzical tilted-head ponder. 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 per se, those were the old days. It was all a bit invisible phone system but most of us still called it the answering machine. When she finished arranging an appointment for the person on the other end of the line and confirmed and noted 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 lunch 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 neighborhood. 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 and I harkened back to the Cardinal song Jody and I heard. This realization drew my mind to baseball and it was a very short cognitive 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 blanks 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 neatly pinned up and her clothes meticulously ironed. She seemed friendly 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, these symptoms are 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 her to salt it a bit with more detail to make it real.
“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.” Her too well moderated face revealed just the slightest 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.” Her manner was becoming less composed. Behaviorally, she was getting edgy. She crossed and re-crossed her legs and it looked like she was wringing her hands under the table. I wasn’t sure if this was a good or bad thing.
“Hey Dawn.” I said gently. “Something is going on for you. I know it’s 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…” the fear in her eyes 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 and drew a deep breath before she answered. “Yes. 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 let’s 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?”
That 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 seems to have 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 night.” 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.
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.
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’.
“I hope so.” The weathered man smiled warmly. Ian’s 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 her, or she and 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 when they travelled to appointments. During the treatments themselves, she slept all the way home. Ian also didn’t get excited when she preferred not to wear the seatbelt because it was especially uncomfortable for her. 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 you drive you next time too, Ian.” Gathering her things and unfolding herself from the vehicle was more involved than it had been 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 cleaner running from the step as she neared the side door. The roar allowed her to open the door and step inside without notice. 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 the boys 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…all 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 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 return, 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 mothering. 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 did 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 two long 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 saw 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.
I 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. I left a cheery message checking in and wondering how things were; call when you get a chance. Ten minutes later I discovered hot coffee in a large take-out box in the small lounge behind the emerg care desk. Bonus! I mixed two percent milk and cream into the coffee, in an attempt to mimic the whole milk I preferred, when Pharrell’s lucky tune vibrated in my 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.” My response was equally wry as I tapped the ‘accept’ button on the phone and picked up the coffee while answering. “Hattie Crawford; Crisis Services.” I was pretty sure it was Bridie returning my call but I decided to concentrate my powers on keeping the uncommonly hot coffee settled in the cup rather than glance at the incoming number. I walked to the interview room down the hall while engaging Bridie 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,” I acknowledged. I was learning a lot through this process as well. But for me the learning was in my head, maybe even my heart, but not my soul, as it was for Bridie.
“I spoke with Shirley about another round of radiation….” Bridie’s words hung in the air. “Doug was….Doug and I thought…well, 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,” I confessed.
“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’m meeting with Dr. Leung on Thursday and I’ll ask him more then. I guess the problem might be something called a ruptured bowel, that could also kill me…but quicker.”
“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. I listened, inviting her to her own conclusions. “I just don’t know. Well, I do know one thing…” her voice faded away.
“What does Doug think,” I asked. I figured he would unquestionably support any idea that gave him more time with his wife. And I felt like I had missed something in my pressure to move the conversation forward but I didn’t know how to get back to it.
“I think he’s good one way or the other.” Bridie’s revelation surprised me. “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, it’s 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. I drove by a sign at the school the other day. It said Dream it; Believe it; Achieve it.” I heard her sigh in the background. “It pisses me off a little. Life is just not that cut and dried…if only dreaming and believing worked…Can I make an appointment next week to come and tell you what I learned about another round of radiation?”
“Of course.” What to do about the pissed off piece? “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, well the plan is to, take 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, or 4:30 PM, 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 coffee, 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 Rudy’s 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. So, 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 it’s 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. For one, I was pretty sure he was delighted I hadn’t resurrected the Linda situation and secretly, I think he was happy to chew on something that wasn’t ‘an indicator’. Although I think he likely knew in his heart that no good idea would 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 daydream about Paris during the next component of the agenda; the part where Rudy gave us updates about the budget and any other important administrivia.
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. Go figure. They weren’t good at expressing intense feelings. Clinicians, who generally see the person just as the nurses described Dawn, often misinterpreted this common interpersonal phenomenon: 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; seeking relief or safety at any cost. 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. I say herself deliberately, since BPD is primarily a ‘pink’ diagnosis. Many of us believe that 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. 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.
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 disconnected the laptop computer from its dock, retrieved my note pad and folder full 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 booted the laptop while 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 open on my screen in front of me and I was starting to enter 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 closed the lid of the laptop, 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 this time 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. “Relax, he would repeat, breathless and groping. Relax… I didn’t then and I haven’t since,” these last fragments of description were uttered slowly, Dawn pausing a length between sentences. But she continued, now that she had started.
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. 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,” I finally stuttered. “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 at the hospital 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’ve been symptom obsessed. “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 revealed 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 in my now hopeful heart.
“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.” With no show of emotion, 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. I sent up a solicitous prayer to the inquest faeries.
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 death’s door for years…I feel like I’ve been serving a commuted sentence…on trial for meditating murder. 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. Like she really shrieked, making me wonder if my colleagues might break the door down, which thankfully they didn’t. Fear of abandonment was very strong in people with her history and it was so often verified in their lives.
“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…and don’t forget, I explained this going in…”
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. It’s not the job I’m best at.” Tears rimmed 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 hope you do 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, even though it was my recollection I’d laid the ground rules clearly at the outset. “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 that 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.
I was ready with dinner 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 directed, 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, outburst or warning, 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 reciprocal glee.
“They demand two edits…I like it as it is. I wonder if I should play proprietary hardball?” I didn’t know where to head with this. I knew how personal her art is to her but I guess I underestimated just how personal. 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.
As it turned out, we were caught up on our favorite dinner-eating television program, House Hunters International, so we enjoyed a meal with conversation. Unlike Jody, because I wasn’t shy about what was rolling around in my head, 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.”
“Strange saying that,” I pondered, lost in a casual reminiscence. 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 cooked goose at Christmas.” Jody’s non-response forced me to stay on topic and forget about my culinary memories. I gave her another few seconds to reconsider and 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. Like, she recognizes we have skills in areas she doesn’t and she realizes she has skills we don’t. She seems to get that if we can fit them together we can be more effective. She doesn’t seem territorial, or scared off by the potentially hairy stuff.”
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 but 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. “But why shouldn’t it be fair?” I asked in earnest, as I re-salted my remaining penne.
“Your blood pressure is already pumped up, you better lay off the salt.”
“It’s 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. “Don’t forget, I’m a nurse,” I added smugly.
“Well then, 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 guilt about my personal contentedness.
“Is this still about the tea breaks?”
“No. Something else…”
“Then it’s 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, “… now we walk off the carbs.” Who could argue?
On our walk we talked more about a potential Parisian adventure, which we still hadn’t ruled out despite the lacking cash. We reminisced, 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 of her reverie was quickly 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, an American ex-pat socialite cum art provocateur, and her regret at not exploring Natalie’s Rue Jacob haunt. Jody looked me square in the eye and 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, reminded that in a culture that so apparently loves and protects its children, as with Roland’s family, so many other kids fall between the cracks. No, that wasn’t accurate. They didn’t fall through the cracks, 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.
The telephone messages I collected Friday morning included one from Bridie, requesting 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. They were tough cats, these emerge nurses.
We wouldn’t have had a lot of time to converse about it all anyway; things were backed up in emerg this morning. I guess it was an acceleration of usual pre-weekend panic only worse because this was an extra long 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 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.
Over the years, I’ve seen Form 1’s 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 works best for everyone in the long run. 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.” He whispered, wistful.
“Hope is the place to start.” I gave his arm another 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’s this about anyway? I omitted the next hourly call to Dawn. 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 phone call. No more time to hypothesize now, Bridie was waiting. She was here on her own. She looked tired. As son as we sat down, 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.” A 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 who needed direction more, me or Bridie.
“I need to get ready,” Bridie sat upright. Resolved. 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. After a minute of deep thought, 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. I will have it available 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 the unit here 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…” Her voice softened and it sounded as though she was losing steam. A deep breath later, 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.” Bridie met my eyes with intensity. “Hattie?”
“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. When I heard it, I corrected. “I 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. It’s not clear because we are both standing by the bucket.”
Next stop of the day was 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!”
“Tell me, 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,” she paused to draw a quick breath. “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, you are here now. That’s step one. I have the info for you about the therapists, case managers, peer support groups…and I’m 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 Kempenfelt. 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 get together in a week.
“Isn’t that Good Friday,” she asked as 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 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 said with all the conviction I didn’t really feel. I’ll take another run at them.” I figured we were still a long way into the woods for a miraculous outcome. I knew, with conviction this time, that 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.
Spring was genuinely here. The Cardinals first, then 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, blissfully rambunctious, we pulled out our bikes, wiped them down and pumped them up. We sailed along the paved bike trail joining several communities along the shore of the bay. The still brisk air chilled our knuckles. The joins for the series oversized sidewalk segments created a tick, tick, tick as our wheels rocketed along them. The shade from the budding trees balanced against the dead heat of the sun that beat through the empty spots. The smell of new pine needles tickled our beaks. We peddled East skirting along outside two smaller villages until we finally got to a funky 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 – that’s nurse-speak for: my sugar stores were so depleted after the long peddle that I needed to restock them with food. I was unsteady on my feet. The sensation of moving at a walking-pace felt odd after racing along for over an hour.
Despite the cool breeze, we decided to sit outside in the sun, which spared me from maneuvering my wobbly pins through the restaurant. I thought sitting on the patio might be a bit ambitious given the early season but Jody mugged a pout and I acquiesced. With 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.
Now the weather was consistently civil, Jody committed to riding her bike to school. I promised I would too but I just couldn’t bear to get up any earlier on my day shifts to arrange biking. I would have an 0730 start but Jody had until almost 9AM to cross the town. I won the proposal that I delay for a week. Jody was a bit pompous about her endeavors that first week but that would not sway me to rise any earlier than I already thought was ungodly. By the time my week of evening shifts came around, I waded into the plan and I enjoyed three days of cycling to and fro, until April lived up to its reputation for rain and I was back in my jeep.
The next week unfolded. I saw people in emerge, I saw people in the office. I saw sad people, mad people, lost people and scared people. 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 and she said she was “okay with it so far”. 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 Senior’s 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’ back in the day. I kept in touch with Bridie by phone; her family visit was tiring but she accomplished much of what she hoped to. The scrapbook and messages were taking shape. She looked forward to the baseball game; they all did.
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 between meetings we stayed in touch by phone, some of which I didn’t even bill for! She had a standing appointment every 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 my 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.”
“You aren’t exactly a supermodel yourself!” She tried for a joke but she didn’t laugh.
“What’s up?” We sat down.
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 even a 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 doc 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 they all 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 recently 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 slithered down 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 from my own face. “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 arms. “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,” Bridie replied with similar forced cheer. 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 over 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 the fact that she looked tired, the casual observer would not have seen 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 muster.
“I did it,” was all she could reply.
“How long?” I asked, after a moment.
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…I won’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.
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.
Before the next visit, 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.” He swallowed his sob and tears filled 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… It’s real tea, not hospital tea. And you dressed it perfectly. You’ll never know what a kind treat this is.” She took another sip, enjoying the sweetness of the tea on her tongue.
“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.”
Letters and sounds stuck in his throat but he could not form them into words. 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 laid 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.” 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 sensed a tremor in her lower leg and foot, as she feel into deep sleep. 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.
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?”
“Hattie, I wanted to let you know…Bridie died last night.”
I froze, exhaling and closing my eyes to hide from the world. “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 imagined that he held back 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…if you can.”
“I will absolutely be there Doug. She was a wonderful woman. Thanks for letting me know.” I realized he had nothing left to say, so 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.
I let Rudy know about Bridie, aka Brigit Lloyd. I didn’t have to close the file because technically her final contacts were in the Hospice records, since we were a shared service. But I did have to close out our outcome indicators for the third-party invoice. Deceased. So easy to click a box; so hard to accept the reality.
“Are you OK?” I was alone in our room of cubby holes when Rudy walked, sat down and rolled his chair closer to me.
“I will be,” I said honestly. “Right now, not so much.”
He leaned forward, resting his elbows on his knees and looking me in the eye. “Its tough work. You do it well. Just remember, if it didn’t hurt it means you didn’t care…”
“Maybe I care too much…” and the floodgates unleashed.
“Hattie…” Rudy’s hand was on my arm. “You let me be the judge of that.” And his gentle smile eased my sorrow.
The bicycle ride home was always easier than the ride to work because it was a slow downhill slope. After Rudy’s calming influence, I was able to finish off my shift, pausing only a few times to recognize the intrusion of grief. Jody figured out immediately what had happened. She held me as I wept and finally fell asleep. I woke up while she was readying for bed and she fetched me a toasted heel of Dutch Crunch with crunchy peanut butter. She is kind. After she came to bed, I lay there quietly, thinking it all through. I replayed our conversations and I wondered how it was that Bridie carried this burden? How she shouldered its weight with such grace? I didn’t think I would have the fortitude to do it. And Doug. I looked across the darkness and heard Jody’s soft breathing and I wondered, could I do it? ‘You do what you have to’ I heard Bridie’s voice, clear as if she was sitting right there at my bedside. ‘You do what you have to’. I heard again. Then it was gone. Yes, I thought, you do what you have to. And I was very grateful in that moment that I ‘didn’t have to’.
A strange thing happened the next day at work. It was almost as strange as me hallucinating Bridie’s voice in the middle of the night. After lunch Jenn told me I had a visitor waiting in the interview room. I wasn’t expecting anyone but sometimes a client drops by to say hi or let me know how things turned out for them. My pulse quickened when I recognized Linda Berwick through the window inset in the door. I paused and for just a minute I considered walking away. Who would know? But in my pause I thought it was a good time to ‘do what I had to’. So I strode through the door like I owned the place. Technically, this was my turf. “Linda.” I greeted her. “What can I do for you?” It sounded cheesy but I hadn’t time to compose any good lines.
She looked uncomfortable. Which made me momentarily happy, then I felt awkward. “Really Linda,” I softened. “What’s up?”
“I owe you an apology,” she blurted. “I don’t know how much of this you know but I said some things about you that I regret. I was mad and I….”
“And you took it out on me.”
“Sort of.” She looked away. “Actually, I really was mad at you…but I should have just said that. I think we could have dealt with that. I shouldn’t have been unprofessional.”
“Linda, I don’t know exactly what happened. I don’t know exactly what you said…and frankly, I don’t want to.” I worried just for a moment that she might actually tell after all that time wondering what it was. Perhaps Jody’s message had finally gotten through to me. “I agree, though. I think we could have worked it out if we’d had a chance. Certainly, we don’t have to be friends at the end of the day, we just need to work cooperatively.”
“ I guess you know I was transferred.”
“Well, I noticed you haven’t been in emerg lately.” Rudy said not to let on and I was playing by his rules.
“I was transferred to the medical unit…”
“Is that why you’re here? To undo that?” My mood shifted immediately.
She looked startled. I wasn’t sure if maybe I hadn’t just stumbled on the truth. “Because if this is all about undoing the transfer this conversation might take a different course.”
“No. This isn’t about the transfer,” she sighed. I wasn’t convinced but I continued to listen. “I’m actually happy about the transfer. I already requested it awhile back, like before any of this happened.” Now I was really flummoxed.
Linda pressed ahead without hesitation. I guessed the transfer conversation was over. “Kim Bayley tells me you and she are working on a plan to support the nurses in emerg. I wanted to tell you that I think it’s a good idea.” She paused. “You probably don’t know this…” she continued. “A couple of years ago there was a patient…a patient who hit me…hit me really hard and nearly knocked me out…”
“Linda, I’m sorry. I didn’t know.” Now I was chastened.
“Anyway, I don’t want to dredge all that up again. But now, when someone is…when I feel like there’s danger, I hate it. I have to control it. I need to keep the lid on it.”
“I understand that Linda. Why didn’t you tell me?”
“What difference would that have made,” her tone suggested she was hanging on a bit to our conflict. “You still would have sashayed in on that crazy guy…just walked up and talked to him like he wouldn’t hit you too…” She caught herself with a sharp inhale. I let her gather her thoughts. “See, I get unreasonable.”
“I don’t think it’s unreasonable, I think its understandable based on your experience. Did you even tell anyone how you felt?”
“Dan Kennedy knew. He had to. I was off work for three awful weeks. After that I didn’t want to make a fuss. I didn’t…I still don’t want anyone to know…to know I’m afraid.” Now we were at the crux of it.
“Linda, can I give you a bit of advice?”
“I have a feeling you will anyway.” She actually smiled, but reluctantly.
I smiled back, genuinely. “I think we should let this go.” She looked at me blankly. “Linda, It took a lot of gumption to come here and apologize. I appreciate that. I respect that. I also respect that even though you were assaulted on the job, you still came in everyday and worked really hard. We don’t have to agree on how to manage a potentially violent incident, in fact I think we never will, but I know now why you reacted the way you did…my advice is this: you are out of the pressure cooker now, according to you that was something you were looking for, so why don’t we just let this go. Life is too short.”
“That will work for me, Hattie.” She relaxed visibly. “I just want to say…I hope you and Kim can sort something out. I know just how tough it is down there.”
When I told Jody her face was wide with disbelief. “She said what?”
“She told me about how she was mad at me because she was afraid someone might get hit again.” I explained to Jody, after I described the strange turn of events.
“Will you tell Rudy?”
“I think so…” My heart analyzed the options and instantly concluded. “Yes. I will tell Rudy. If this is about nurses getting hit, then I think it’s important. I think it’s also important they know she came to apologize.”
“I can’t believe you didn’t pester her to find out what she said about you.”
“Likely she called me a stupid dyke…who sashayed into a dangerous affair and putting her and everyone else at risk.”
“Hattie, I’m pretty sure dykes don’t sashay.”
“Yeah! Watch me.” And I did my best salsa-hop around the room. It was nice to have at least one monkey off my back.
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 also wanted to raise the fewest questions about our relationship, reduce distractions. 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 spared 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 tiny girl. 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 square 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,” he looked around the room, “to all of you, 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.
I caught up with Ben. “It was a perfect service.”
“I had some tall orders.” He smiled.
“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.”
“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. I was grateful because my legs were failing me.
“Bridie was wearing the new pajamas I made her when she died,” Di 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. The one piece of ‘good’ news Doug shared was that Bridie’s eyes were now 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.