BEHIND THE CURTAIN

As some of my previous posts have demonstrated, nursing is a profession that has exposed me to some of the most confronting and challenging, but because of this, inspiring, aspects of humanity. Nursing lets me see behind the curtain of people’s lives. Because of my job I’ve seen people living with so little, but living nobly, and proud of what they have. I’ve seen people who should be bowed by the accumulative weight of their multiple co-morbidities, but who are living brighter and with more joy than most of us. I’ve seen people in agony, exhausted, sucked dry by their disease reach out to comfort their partner. These acts of generosity display what is best about humanity. They show the dignity of being human.

Other times, it’s not so dignified…

 

I was there for an admission. The woman had been referred to us for assistance with her medications. Her case manager was concerned she’d been muddling up her tablets due to her increasing short-term memory loss, and the client was on warfarin, a medication not to be muddled as the two end results were either blood clots or bleed outs.

Before heading in I sat in my car and read the notes supplied by the case manager. I flicked over her list of medical history (osteoarthritis, atrial fibrillation, hypertension, hypercholesterolemia) and was reading her social situation when my eyes snagged on the fact the she lived with her son. Normally when there’s a child in the mix district nurses aren’t needed. A family member can pop out pills as easily as a nurse. Tucking this information into the back of my brain I swung myself out of the car and walked up the drive to the client’s home. Press of the doorbell, and a knock for good measure.

The door swung open to reveal a tall bearded man in a t-shirt and jeans: the son. I estimated him to be in his mid-forties, and not in bad shape except for a small pot-belly straining the fabric of his t-shirt. I could hear the sound of a shower in the house behind him and took a good guess where my patient-to-be was.

‘Hi. I’m Jonathan, the district nurse. I’m here to see your mum, I believe.’

There was a pause before answering, a shaky smile, and then the response. ‘Oh, right. You’re here for…?’

‘To help with your mum’s tablets,’ I supplied.

‘Oh, okay, sure.’ He grinned. I smiled and gave a nod. He blinked. ‘Right, you should come in.’ He stepped back and gestured for me to enter, his hesitation breeding my own.

‘Is your mum in?’ I asked, pacing over the threshold into the artificially lit family room. The blinds were all drawn despite the fact that it was ten-thirty and the sun had truly dawned.

‘She’s showering.’

I stopped. ‘Is now a bad time, then? I’m happy to come back later.’

‘It’s fine. She’s been in a while. She should be out soon. You can wait.’ He said this and closed the door behind me with a click, then stepped to face me, his grin still shinning from amongst his tangle of facial hair. I glanced down at his shirt and saw it displayed the Fed-Ex logo. I wondered if he fancied himself as a new-age hipster.

‘Sorry, mate, what was your name?’ I asked.

‘Murray.’

‘Murray.’ I decided to gather what information I could while waiting for the showering patient to finish up. ‘Murray, maybe you could tell me what medications your mum is on at the moment. Does she have a webster pack?’

Murray’s face looked like I’d asked him to recite pi to its hundredth decimal. ‘I’m not sure. Don’t know, really. She does all that.’ He glanced around. ‘I can show you…’ he was moving, walking down the hall to the kitchen ‘…this.’ He re-emerged with a red leather purse which he opened to reveal a medicare card tucked into one of the plastic window slots.

‘Oh, okay. Thanks, Murray. I don’t actually need to see that, though.’ I tried to steer the conversation around again. ‘So you and your mum live here together?’

‘Yep.’

The single syllable then silence. Dead end. I tried again. ‘And what sort of health issues does your mum have?’

He clicked his fingers. ‘Come with me,’ he said and disappeared back into the hall.

I followed, already fearing that his next piece of show-and-tell would be as redundant as the last. We moved left into a kitchen, then crossed to a door on the other side of the room. Murray opened it to reveal a garage and, by the doorway, a four-wheeled motorised scooter. He pointed and gave another proud grin.

‘Mum uses that to get around.’

‘Right. Not good on her feet, then?’

He shrugged. ‘She’s all right. She just uses that to go down the street.’

‘Thanks, Murray, good to know.’

He nodded and considered the scooter, and I looked closer at his shirt and realised that instead of “Fed-Ex,” the shirt actually read “Fed-Sex.” My brow furrowed both at the poor pun, and I wasn’t sure putting a letter in front of a word to make it dirty can rightly be considered a pun, and the fact that an adult man was happily wearing a t-shirt displaying it. I was starting to work out why district nurses were needed.

Middle-aged men who still live with their mother tend to fall into two categories. The first are those that have chosen to reside with their parent so they can look after them as their ability to cope alone lessens. These men act out the circle of caring; they are cared for and then care for.

The second are those that never left home in the first place, and never had the desire to leave the initial half of that caring circle. And just as they have never physically left their adolescent residence, usually mentally they haven’t either. I had a good idea which category Murray fell into.

Murray turned and locked eyes with me. ‘I’ve got something that will blow you away.’ He strode off again and I was forced to follow. I think it was around then that I gave up on getting any useful information from this man. We retraced our steps to the lounge and Murray went to a dresser on the back wall and opened a drawer. When he turned he was holding a long large book which he proffered to me with a smug sort of arrogance.

‘Check that out.’

I took the book and opened it at a random page, and found lines and names worked across the paper. It was a piece from a family tree, a limb of great-uncles and aunts. I looked at Murray and hoped I’d arranged my features into something that conveyed the awe he obviously expected.

‘Family tree,’ he said. ‘Shows the McDougalls back for ten generations. My uncle had it made up.’

‘Wow,’ I said and flicked through more pages, finding only more lines and names of people I didn’t know. ‘Incredible, Murray. A lot of history in these pages.’ I handed him back the book. ‘Thanks for showing me that, mate.’ I could still hear the shower flowing behind us and it felt like the falling water would never stop.

Murray took the book and carefully replaced it in the dresser drawer. Then he turned, looked at me, and we waited. The sound of the showering in the background seemed only to amplify the silence. I tried to think of a question I could ask that would yield a useful response while Murray stood silent, his eyes now roaming the room in search of something else to show me. After four minutes neither of us had come up with anything.

‘Well,’ Murray said abruptly, his voice puncturing the quiet, ‘I’m going to my room.’ And before I could respond he had spun and disappeared back down the hall into the bowels of the house. I found myself suddenly alone in the family room, confused by how the visit had progressed so far, and wondering what to do next.

I took a seat on one of two sofas that faced each other and set my laptop up on the coffee table in the centre, arranging my paperwork to one side. Let me take a moment to cement the layout of the house, because the configuration becomes important. I was in the family room, my back to the front yard and facing the hall that led to the kitchen. To my right was an open doorway through which I could see a bed and closet. The patient’s room. Inside this room on the left wall was a closed door, behind which came the sounds of showering. The en-suite.

I starting re-reading the patient notes, more in an effort to pass time that any sense of productivity. From down the hall where Murray had disappeared I heard the sound of the M*A*S*H theme-tune spilling out. Apparently watching M*A*S*H reruns took priority over waiting with the district nurse. I looked around a house where the other two lodgers where either watching television or showering, and wondered what the hell I was doing sitting in their lounge room. Mercifully, that’s when I heard the water turn off.

I began to relax, to feel the visit could finally get underway, when it occurred to me that the seventy year-old woman standing in her bathroom had no idea there was a strange man in her house. I furiously weighed the options and considered stepping out of the house and ringing the doorbell again so the patient would think I’d just arrived, although, with the luck I’d had so far, Murray would probably answer, and it would be too great an effort to explain why I was re-ringing the bell.

In the end I went with the only real option I had: I knocked on the bathroom door.

‘Um, hello, Ada? My name’s Jonathan. I’m the district nurse.’

Sounds stopped from behind the door and a small voice answered. ‘Oh. Hello.’

I had no mirror, but I’m sure a deep blush had impregnated itself across my face. ‘Look, Ada, Murray let me in. I just thought I should let you know I’m sitting in the lounge. Please don’t rush. I just didn’t want you to get a fright.’

‘Okay then.’

‘Okay. Thanks, Ada.’ I shook my head as I walked out of the bedroom, angry at Murray sitting happily in his bedroom watching M*A*S*H, and took my seat on the couch.

I busied myself with my computer, opened the questionnaires I’d need opened, and after another five minutes heard the en-suite door open and saw on the edge of my periphery a person emerge. I gave Ada some time to ready herself, and, after a small wait, decided I should introduce myself before the awkwardness got any greater. Please remember I was trying to reduce the awkwardness.

I pushed off the couch and turned, and stopped, still in a half-crouched position, as I had my first sight of Ada merrily trotting back and forth through her bedroom, completely naked. She hadn’t troubled herself to close the door and was apparently unflustered by the strange young man sitting in her living room. I dropped back to my seat and focused on staring studiously at my computer screen. I could still see the shambling figure of Ada at the edge of my vision and wondered what strange reality I had stepped into when entering the house

Now nudity is nothing new for a nurse. I’ve helped people undress, showered them, made polite conversation while giving their backside a thorough wash, but the unexpected and unnecessary presence of Ada’s nudity took me by surprise. I was not expecting to see the freshly washed body of a senior citizen that day. Normally when interacting with an undressed patient the nudity is an unspoken requirement, and both parties play their part in minimising the discomfort of the situation. Ada tottered around as proud as a peacock.

Eventually the dressed form of Ada emerged from the bedroom and I got the assessments underway. The rest of the visit went smoothly, although it was clear Ada did indeed have memory issues, and needed a lot of prompting to stay on track. It felt like herding conversational sheep.

Towards the end of my visit Murray emerged one last time to ask whether Ada had charged up the scooter because he was planning to head down the street to buy some milk. At this point the image of this perfectly healthy man trundling down the road on a small scooter designed for the aged and frail failed to surprise me.

 

 

This small example is just one of the oddities that nursing encompasses. Nursing lets me see behind the curtain of people’s lives. Sometimes it’s a glimpse into domestic acts of heroism, but other times it’s delving into the bizarre and confusing habits of my patients and their foreign lifestyles.

It’s a profession of opposites. We’re holding the hand of a sick patient and giving comfort. We’re educating and empowering people in managing their disease. We’re helping in healing. But the flip side of this intimate immersion is we’re also showering the demented old woman who is farting every five minutes as she tells us we’re a lot uglier than the other nurses. We’re staring at the backside of an obese middle-age man who’s just flopped himself over the edge of his mattress so we can dress the wound between his cheeks. We’re making small talk with an elderly gentleman we’ve just met five minutes ago, holding his penis in one hand, and about to insert a catheter with the other.

To begin with these situations startled me, but as I’ve become more confident they’ve become almost commonplace. Sometimes, however, I do still find myself having an in-depth conversation with someone about their bowel movements and nodding intently, or bluffing my way through a talk about soccer with a naked stranger who apparently is in no rush to put his pants back on even though I finished dressing his wound fifteen minutes ago, and I have a perfect moment of clarity onto the strangeness of the situation, and wonder how this became a  normal part of my life.

Peeking behind the curtain can be a gamble, but I’ve found that if it offers nothing else, at least it’s interesting.

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