Clydesdale, Nova Scotia, Canada
The writer E.B. White accused our society of being suspicious of anything non-serious. Thank the stars, then, for humour. I had a teenage patient with advanced cancer tell me after I had given him some none too hopeful news: “Lighten up, doc, I don’t need solemn doctors around me.” A good lesson from a wise child.
One busy Friday, Betsy, the nurse manager on our Pediatric ICU, beckoned me into her office as I was wrapping up rounds for the day. I knew tensions had been running high on the unit after a series of tragic outcomes. She and I had been buddies for years, and it crossed my mind she might want to get something off her chest.
“I’ve called a meeting of all my nursing staff,” she said without preamble. “They’ll be here in a few minutes. Can you stick around? Just the nurses and you. They’ll think you’re here because of Sandra.”
Sandra—the most recent child to die on the unit—had been a patient of mine. She had a glioblastoma—an almost universally fatal brain cancer. The little girl had lapsed into coma even before she was transferred up from our pediatric cancer ward; she hadn’t been feeling much of anything when they put out yet another code within an hour of her reaching the PICU. It turned out she had already taken her final breath.
“They don’t have to know you’re really here to hold my hand if the going gets rough,” Betsy added. “We’ve lost five children in the past two weeks.”
I knew what she was getting at. Betsy had called this meeting specifically because of conflicts building between the nurses and the ICU docs—and some of these nurses could be hard to handle. Rose—the nurse caring for Sandra when she died—had come close to boiling point with the attending doctor and his over-heroic efforts.
A brief knock on the door and the nurses filed in. They must have assembled together outside to reinforce their solidarity. I knew all seven by sight, most by name, and I sensed they all knew me. There were only two vacant chairs, one large enough for two, so the other four sat on the carpet and leant up against the legs of the ones in the chairs. There was some friendly jostling as the room filled to capacity. Things settled into an expectant silence, then Betsy looked around at everyone in turn.
“It’s been real hard up here lately, we all know that. So this is just a time for y’all to vent, share your feelings, whatever you need to do.”
Rose spoke up fast. “Too right it’s been hard. Some of those kiddies were never going to make it, Betsy. But the docs just don’t seem to get it sometimes.”
Annie picked it up. “Yeah, with that last code—as soon as Dave finally called a halt, he just went straight back on rounds. Like nothing had happened. Left it to the poor little intern to break the news to Mum. Jeez, he’s an unfeeling brute.”
Annie’s outburst gave everyone permission to blow the lid off.
“I never thought it could get this bad.…”
“Five deaths in—what, a week and a half.…”
“Some of those guys just don’t know when to stop.…”
“Maybe we should have called a few ethics consults.…”
“My boyfriend’s getting pissed at me, crying every night.…”
“Mine took off. I’m about ready to quit.…”
The cacophony persisted for several minutes. Two nurses began crying freely, feeling the unspoken permission to vent feelings too long held in check. A sense of release surfaced around the room, and Betsy let things run, knowing they needed to do this. As things quietened, she stretched out both hands to the two closest to her, and the rest took the cue, hugging and holding hands.
Then tears gave way to brief grins. I laid a hand on the shoulder of Mia, whose back was propped against my knees. She freed her own hand, raised it to grasp mine, returned my squeeze. My throat thickened. I grabbed a handy box of tissues and blew my nose, then offered the soggy mess to Mia. Grins became guffaws. These nurses knew well the crucial resource of laughter, even—or especially—in an intensive care setting. Betsy took the time to embrace everyone with her beaming smile.
“Thanks for coming—all of you. And feeling you could say your pieces. We’ve all got a lot of crying to do. To hell with boyfriends who can’t hack it. There really are some good men out there!” More giggles. “Hey, maybe those attending docs could use a few hugs. Can’t hurt, might help!”
Rose looked at Betsy like she was about to blow off the very idea, but she stayed quiet. Maybe even picturing the scene?
“Just be sure you don’t blame yourselves,” Betsy went on. “Like things could have turned out okay if you’d just done things a bit differently. Second-guessing can keep you awake at night.” She paused to take in everyone in turn. “Just know you did your best. I’m real happy you all decided to work here.”
Which brought fresh sniffles around the room. None of the nurses had launched any more attacks on the ICU docs after their first few salvos. The anger had surfaced fast and hard, then quickly given way to free expressions of grief. As if everyone knew this was the core thing, this big knot of helplessness and heartache. And shedding it was what this precious time was for. Not for blaming absentee doctors for their decisions and actions.
Rose freed up a hand to tear open a couple of packs of marshmallows. They made the rounds along with someone’s flask of Gatorade. People grabbed handfuls like they hadn’t eaten in a week. Candy quickly started spilling. After a bunch of face-stuffing and chomping, one suddenly flew through the air and caught Rose in the chest. Someone yelled, “Marshmallow fight!” cuing Rose to hurl several back in the general direction the first missile had been launched. At once everyone was scrambling for larger handfuls and slinging them in random directions. Tears became guffaws of laughter.
After several minutes of bedlam, the energy started to stall. Rose finally yelled out, “Okay, eat ’em all up now!”
There were no takers—most of the marshmallows had gathered a coating of rug or got ground under knees or butts. The brief feast over, we set about working with damp cloths from the bathroom, wiping off bits of goo from chairs and carpet.
As I left, I checked my watch. Less than an hour—not too long out of a 168-hour week. And nobody was going to burn out today. Someone’s boyfriend might even get a big grin and a spicy kiss tonight.
JOHN GRAHAM-POLE, MBBS, MD, MRCP-UK, ABHM, a graduate of University of London, was a clinician, teacher, and pioneer researcher in the field of childhood cancer and palliative care for forty years. He co-directed bone marrow transplant units at Case Western University and University of Florida. He co-founded the University of Florida Center for Arts in Medicine (www.arts.ufl.edu/) and HARP: The People’s Press (www.harppublishing.ca), dedicated to publications on art and health. He is an author of eleven books of fiction, poetry, and non-fiction. His website is www.johngrahampole.com, and he can be found on Facebook and LinkedIn.