Hattie knew to wait until after 9:30 to call Bridie. That way the boys were off to school and her home was a little less chaotic. The call went to voice mail on the fifth ring. Hattie left a cheery message saying she was checking in and wondering how things were; call back when she got a chance. Ten minutes later Hattie was in the back lounge behind the emerg care desk stirring a mixture of two percent milk and cream into her coffee, in an attempt to mimic the whole milk she preferred, when Pharrell’s lucky tune vibrated in her pocket. “Get Lucky, eh.” Larry Marshall quipped, looking up from the lab results he was scanning. “That oughtta be our theme song.”
“It can happen.” Hattie’s response was equally wry as she tapped the ‘accept’ button on her phone and picked up her coffee while answering. “Hattie Crawford; Crisis Services.” She was pretty sure it was Bridie returning her call but she had decided to concentrate her powers on keeping her uncommonly hot coffee in her cup rather than glance at the incoming number. She walked to the interview room down the hall while she and Bridie engaged in the conventional repartee required before settling in to a serious telephone conversation.
This week was busy for Bridie because she was in the middle of preparing the videos for her kids at the studio St. Germaine had developed. The process was interesting but hard. Shirley, the social worker assigned to the family had shared with Bridie some of the worries that her sons had shared with her, so Bridie was able to include these in her messages to them. She was surprised that one of Joey’s worries was who would teach Lynne ‘itsy bitsy spider’. So, one of the videos was Bridie singing this song for Joey but also giving the song to him to teach his own children. “As sad as it sounds, Hattie this exercise brings me peace. It makes me feel like I will be there for them long after I won’t be there with them.”
“It’s a great idea.” Hattie acknowledged. She was learning a lot through this process as well. But she was learning it with her head, maybe even her heart, but not her soul, as Bridie was.
“I spoke with Shirley about another round of radiation….” Bridie’s words hung in the air. “Doug was….Doug and I thought that since I felt so much better after the last round, we could do it again.”
“…and” I was pretty sure I knew the answer from my nursing training but there had been many developments in the last years.
“Shirley suggested I talk with the oncologist, Dr. Leung. They usually don’t do a second round at my advanced stage but I guess there have been experiments with radiation in someone’s last month for ‘quality of life’. There are side effects that might outweigh the benefits.” These last few comments had the ring of clinical commentary, absent of personal analysis.
“Even though I’m a nurse, I don’t know as much about the new ways of cancer care as I probably should.”
“Well, I guess repeated radiation weakens the tissue around the tumor. The radiation makes the tissue…less tolerant, according to Shirley, and according to what I read on-line. I am meeting with Dr. Leung on Thursday and I will ask him more then. I guess the problem might be something called a ruptured bowel, that could also kill me”…I heard her swallow…”but quicker.” the last syllable drifting away with her breath.
“What are you thinking?” I knew Bridie wanted to control the circumstances of her final hours as much as possible. She didn’t want her kids to witness her in intense pain and risking a ruptured bowel might certainly take her foot off the gas, so to speak.
“I don’t know Hattie.” She paused and Hattie listened as Bridie sat with the weight of it. “I just don’t know. Well, I do know one thing…” her voice faded off and she looked away.
“What does Doug think?” I asked, although I figured he would support any idea that gave him more time with his wife. And I felt like I had missed something but I didn’t know how to get back to it.
“I think he’s good one way or the other,” was Bridie’s surprising revelation. “We have been talking a lot about the practicalities of…of my situation and I know he will support whatever I think is the best for me, and the best for the kids. It’s taken a while Hattie but he is not in denial anymore and he’s on the other side of angry. Now we are just managing the practicalities.” Her voice was tired.
“Is there anything I can do to help?” I offered, feeling woefully below helpful.
“Hattie, its good to talk to you about all this. I can’t burden everyone with a trip through the workings of my mind. I confess though, I try out some of my ideas on you first, then it makes it easier to say them out loud to everyone else.” She chuckled, lightening the air.
“I wish there was more I could do…” My words hung in the air.
“I know. Thanks, Hattie. Can I make an appointment next week to come and tell you what I learned about another round of radiation?”
“Of course. Next week is perfect, I’m working afternoons, so Doug can come too.”
“Earlier in the week is better because next week has the Easter break and I think we are taking the kids to my mom’s so I need to rest up a few days before.”
I used my old-fashioned agenda to save the appointment next Tuesday at 1630 for Bridie and Doug. Then I ended the call, reminding Bridie to call if she needed anything at all. My special coffee, lovingly concocted with reduced fat milk and cream, had cooled to the point of no return. I weighed the pros and cons of whether to nuke it to heat it back up, or pitch it. Eventually, I realized I was stalling. “I’ll try nuking it.” I said out loud to myself. Convincing myself about the direction to take with the cooled coffer conveniently moving Bridie from prominence in my thoughts. The nuking was partially successful. I had avoided the scalding that leaves little floaties on the surface but the process didn’t get the mixture back to its original temperature. It was a fair dose of caffeine though, and that was in part the objective. I was relieved when Dawn answered my call on the third ring, before panic set in. She would be here to see me at 1230. Other than tepid coffee, this day was working out just fine.
At 1100 hours Rudy led our monthly Team meeting. The agenda is dominated by a show-and-tell of policy reviews, reports about compliance with workload data, assessment counts and contact numbers, outstanding risk scales and so in. Today we were introduced to a new category related to compliance with third party reporting also known as: is the hospital completing the requirements and getting the invoices to the employee assistance programs or EAP’s on time, so they can get paid. As it turns out, we have doubled our activity in third party work over the past three months and the hospital administration is “very happy’ according to Rudy. Rudy provided information about three upcoming conferences that we could attend if we had $850 spare dollars.
Sadly, despite the infusion of new EAP income, the education budget for nurses was lacking. “Do you think the hospital would fund us if we did a presentation about our work with EAP’s?” “I wondered aloud while I stared at the flyer for a conference in Toronto about Solution Focused Therapy. I wasn’t interested in that conference in particular but I noticed there was a concurrent workshop listed that would present productivity outcomes in workplaces that used a group therapy approach to problem-solving.
“I can ask Hattie.” Rudy noted my question on his note pad. Then he asked us if we had any safety concerns in our work area or any ideas for improvement. You can say this about Rudy: he swings both ways. He is a consummate corporate player but he can absolutely work around the rules to support his team, or the people they serve. Today, he had on his corporate hat.
“I had an idea…” I introduced when the question had hung so long in the air it felt as though no one else had anything to say.
“Last week we had an incident in emerg…”
Rudy looked nervous, not knowing for sure where I was headed with this. “There was a guy there who we finally sent over to the forensic unit at the North. He presented with a risk of violence but he didn’t act out. After it was over, I had a chance to talk it through with Viv, which I found helpful. It was good just to unpack it all and then let it go. The nurses down in the emerg had to put that incident aside and continue to deal with the other urgent medical issues that required their immediate attention. I offered to cover the phones for Kim, the Team Leader, but she was off to her lunch anyway. Anyway, it got me to thinking.
We recognize how important it is to debrief, or just rest our brains after incidents. What can be done to support other nurses? You know, people die down there…even after the code blue team has been working on them for a long time…and what do they get afterwards. Maybe a moment to sit down, maybe a ‘good work’ from the duty doc but usually not even a cup of tea. I think its wrong and I’d like to figure out how we can support our extended team, down in emerg.” When I finished and replenished the air supply to my lungs, I realized my idea had turned into a rant.
All eyes were on me. Rudy was smiling. Secretly, I think he was happy to chew on something that wasn’t ‘an indicator’. Although he likely knew in its heart that it wouldn’t see the light of day unless it became and indicator.
“Hattie, that sounds like a good idea.” Rudy announced.” I sensed the other shoe dropping. “Can you sketch that up and give me some detail? I’d like to share it with Dan Kennedy, the clinical manager in emerg. Let’s see what we can do.”
“Aye, aye!” I saluted. Then I sat back to accept the next component of the agenda; the part where Rudy gave us updates about the budget and any other important administrivia.