Nursing

PROSTATES AND EMPATHY

/ jonathanrobb / 4 Comments

I’ve wanted to tell this story for a long time, but it took me a while to figure out how best to tell it. It’s about a man I met during a nursing placement in my second year of university. I tried writing it as a short story but it felt flat. Then I tried writing it as a verse poem, but quickly discovered it would be the longest verse poem in history, and who has the patience to read a painfully long verse poem?

But I think I’ve figured out the underlying problem: I was telling the story from my patient’s perspective. I thought this would bring some immediacy to the tale, but I’ve decided the power of the story isn’t from showing the elderly patient’s point of view, it’s from showing a young naive nursing student’s. In this case, being an observer is what gives the story its guts.

So now, I’m just going to tell it:

 

The placement was my second effort at actually entering a nursing environment and getting my hands dirty, literally, and my first within a hospital. Before this I had spent two weeks in a nursing home during my first year, and, while shockingly confronting, there was no real acuity to the experience. The patients weren’t patients, they were residents, and the job was to maintain their comfort. This was a real hospital. Looking back, it’s almost laughable; the hospital was the tiny rural hospital of Leongatha, which has a total of twenty-eight beds. A single ward of a metropolitan hospital has more beds than that. But, for me, it was a real hospital, and I felt hopelessly inept within its walls.

I met Ron on my third day. He was in his seventies, a local, and had been admitted because he couldn’t empty his bladder. Or, to be technical, he had benign prostatic hyperplasia. Basically, for whatever strange hormonal reason, when men get over the age of fifty it’s not uncommon for their prostate gland to begin growing. The trouble with this is the prostate wraps around the urethra, the tube through which urine is drained, and a growing prostate literally chokes the urethra. This results in an almost perpetually full bladder. Not a good thing.

I’ve wondered what Ron saw when he first met me. Meeting Ron, I saw a silver-haired old man with smile lines on his face and an ease I immediately admired. He was a person comfortable in any situation because he was comfortable in his own skin. He knew himself and liked what he found. I think, upon meeting me, he must have seen the opposite: an awkward young man unsure of himself and his place within the hospital.

 

The compact nature of the Leongatha hospital meant not only did I get to care for Ron both pre and post his operation, but I also had the opportunity to be there with him during the actual procedure. The operating room was ten meters away from the ward.

I remember stepping back from Ron’s trolley where we had stopped outside the operating room’s double doors to give space for his wife to say goodbye. It felt too formal, that moment, a pause for the wife to say words of sentiment. I both liked the official nature of the final farewell and found it slightly ridiculous, with the staff standing watch like respectful morticians. Ron wasn’t going in for heart surgery, and while there can be complications, death was a very far off possibility. Ron also saw the humour in the moment and joked while his wife attempted to be sincere. She eventually rolled her eyes and laughed him off, telling him to behave with the nursing staff. He threw me a wink as he promised he would.

We went through the double doors, his wife now marooned on the other side, and I waited with Ron while final preparations were made to the operating room. I wanted to keep Ron company, but I also had no idea where I was meant to stand, and beside the patient’s trolley seemed like the most appropriate place. Ron chatted with me while he lay, and I stood, in the cold hallway, and on reflection I realised he did this as much to keep me distracted as himself. Any nerves either one of us felt were diluted with conversation. It didn’t take Ron long to break his promise and give incorrect answers when asked by the surgical staff to repeat his name and date of birth. He found claiming to be twenty-six vastly amusing, and had a way of laughing that made it impossible not to laugh along with him.

 

One of the starkest images I have from that operation was before it had even commenced: seeing Ron have his epidural inserted. The operation Ron had is called a TURP, or a transurethral resection of the prostate, and it is done with the patient fully conscious. The epidural numbed Ron from the waist down. To have the needle inserted the patient sits on the edge of the operating table, curled forward, while the anaesthesiologist counts vertebrae and inserts a sharp splinter of metal into the spine. Given the delicate nature of such a procedure the patient must stay as still as possible, which means they can’t talk.

Seeing Ron topless and hunched forward, his face devoid of the usual animation talking gave it, made him seem so much older than he had before, as if he was now just another patient, a frail and scared man. He looked vulnerable, and it made me admire the strength with which he held himself the rest of the time to hide this fact.

My other vivid memory of the surgery was the smell. A TURP is done by inserting a long tube up the penis to where the prostate sits around the urethra, where the blockage is. The tube does two things: it constantly floods the bladder with fluid that drains away down a separate lumen, taking with it the blood from the soon-to-be bleeding prostate, as well as being tipped with a small metal loop that, when electrified, becomes instantly white-hot. The loop is what does the carving. The surgeon sends pulses of electricity into the metal and then scraps it along the inside of the prostate where it is growing into the urethra, burning away strips of gland. Think coring an apple from the inside.

The smell I smelt was cooking flesh. As the loop fried the prostate the smell of it drifted around the room, the smell of a steak in a frypan. It was made worse by the fact that it wasn’t instantly offensive, only when you realised what it was you were smelling. Ron, of course, was unperturbed by his own cooking prostate and found plenty of humour in the situation, joking about what a fine chef the surgeon was.

 

The climax of Ron’s tale, and moment that awed me and made Ron unforgettable even after five years of patients, came on the day after his surgery. He was back on the ward, only his bladder still wasn’t emptying.

After a TURP, an irrigation system is set up so that fluid constantly runs through a catheter into the patient’s bladder and out again into a giant catheter bag that sits beside the bed. The prostate is a highly vascularised gland, and, even with the cauterising effect of the searing hot loop, still bleeds profusely after the surgery. The fluid goes into the catheter clear but drains away a deep red. The liquid lightens as the bleeding slows and eventually stops and this is when the hospital staff know it’s safe to cease the irrigation.

The risk? Clots. Blood pooling in the bladder and urethra is a bad idea on the best of days, but the real risk comes when the blood congeals and becomes a plug, effectively creating the same outcome as a urethral-choking prostate. Unfortunately for Ron, despite the irrigation, clots had still formed and blocked his catheter.

This was the scene: Ron sat reclined on his bed, legs spread and his gown flicked back over his stomach. Two doctors crouched between his open limbs, working with the catheter inserted up his penis. Blood and saline soaked the beds sheets as the doctors took a large syringe and squirted further fluid up Ron’s catheter.

The idea is to create turbidity within the catheter and bladder by quickly shooting liquid up the tube, thereby dislodging any clots. The doctors then draw back on the syringe and hope to suck the catheter-plugging clots out of the bladder.

The problem was the clot stopping Ron from being able to drain had wedged itself in the lumen that took fluid away from the bladder. This meant the doctors could squirt saline up but not drag it down. Ron’s bladder was already full from the irrigation and the pressure was only getting worse. Imagine that moment when you have held off from going to the toilet for too long, the worst incidence in your life, maybe a car trip, or a meeting, when your whole lower abdomen is cramping and you’re bitting your lip to stop from whimpering in pain. When it feels like something might literally rupture inside you. Now multiple it tenfold. Every time the plunger of the syringe went down Ron fought to stop his body from buckling in agony.

So there’s the scene – Ron in torment as his already overfull bladder gets another shot of fluid that has no way of coming out, blood staining the sheets from previous attempted recatheterisations, and all dignity discarded in the heat of the acute situation. Even with his gown covering his top half, Ron was as exposed as a human can get.

This is when his granddaughter chose the unfortunate timing to visit, and to make matters worse, with a new boyfriend in tow.

Naturally the nursing staff intercepted Ron’s granddaughter on the other side of the curtains and explained the situation, suggesting she wait or come back another time. Ron, however, found the idea of his family coming to visit and his failure to welcome them rude, and so insisted they come in. His granddaughter took a chair beside Ron’s head and held his hand, and Ron joked that he never did anything the easy way. The boyfriend, as unsure of his place as I was, and visible overwhelmed by the intensity and intimacy of the situation, stood to the side of the room, his face a beacon of the fear I was hopefully hiding with my professional demeanour.

I can still remember the exact moment when Ron’s gaze lifted and he saw the young man well and truly past his comfort zone. A shudder racked Ron’s frame and I watched as he bit down his pain, forced his face to relax into a smile, and asked the young man how he was going.

He was fighting down agony, blood spilling from his penis, and he cared enough to reach out and attempt to comfort the stranger who had intruded on this mortifying moment. He had seen a person in distress and acted. I’m sure it was that simple to Ron, regardless of his own torture at the time. He was just that kind of man.

 

The last memory I have of Ron is as I was leaving, having finished my final shift at that strange and small hospital of Leongatha. We had shaken hands, he had wished me luck, and thanked me for my help. I can’t remember if I thanked him, but I hope I did. If I was back there again I would remark on what an incredible human being he is. I would tell him I admire his strength, and his consideration, and thank him for teaching me an important lesson about empathy, and humour. The final image I have as I left that ward was seeing Ron, the ringleader amongst four other men his age, all having had a TURP, holding up his catheter bag and remarking on the lovely pink colour of his handbag. The men all chortled and displayed their respective bags, commenting on the various shades of red they each had.

He had turned something as embarrassing and awkward as a blood and urine filled catheter bag into a joke they could all join in on, and I think that one example is enough to show why Ron’s is a story worth telling.

BEHIND THE CURTAIN

/ jonathanrobb / Leave a comment

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.

LEGACY

/ jonathanrobb / 7 Comments

Today my family and I celebrated my grandfather’s ninetieth birthday. As part of the event each member of the family – children, grandchildren, and great-grandchildren – all contributed a few pages of writing detailing their own accomplishments in life and memories they had of Frank Robb. The book that was eventually collated, in no small effort by my eldest uncle, Chris, who harvested well over fifty entries, stands as a legacy of not only my grandfather’s life but of all the lives he went on to father. In a sense, each one our accomplishments are also his, for without him the beautiful collection of talented, kind and incredible people who are my family wouldn’t exist.

For this post I’ve decided to put up my contribution to Grandpa’s book. For those reading who aren’t family, some of the following may be obscure references to people you don’t know, but if you’re happy to preserver let me just state one pertinent detail: I have a twin brother named Damian.

The rest I think you can figure out yourselves.

—

MY first encounter with Grandpa has, regrettably, been forgotten. I was three months old and it was just after my family’s departure from Launceston, Tasmania. My perpetually generous grandparents had agreed to temporarily house the in-transit Robbs, and brave a household that contained four children under four.

Although I don’t remember the first time Grandpa picked me up and held me in his arms, that first contact, I appreciate the effort involved in providing a roof over my young head. I’ve since wondered, as he cradled me, if he had any clue whether it was me or Damian he was holding.

IT was in Barry Street, Preston, that I have my first memory of Grandpa. I remember waking under the layers of sheets and blankets in a foreign bedroom, seeing my brother in a bed opposite me, and creeping out of the room into the sun-splashed bedroom of my grandparents. Grandma would usually see me first as I stood unsure in the doorway and call out a greeting, giving me the invitation I was waiting for. I would crawl over the bed and wiggle down between my grandparents, and Grandpa would wrap an arm around me. I remember the weight from the layers of coverings and the warm clean smell of that bed. I felt safe, and happy, and Grandpa would turn his head, focusing on my face, a smile in his eyes, and ask, “Now, which one are you? Damian?”

THE next memory I can conjure is in the early Traralgon days. These were the days of the mazda van, of a crowd of cousins playing in and around the almost clean pool, of food in huge platefuls emerging from the kitchen, where a collection of aunties and uncles laughed and talked, to be taken to the carport where Dad was preparing the perfect coals for a barbeque. These were the days of long weekends and bonfires.

I can remember the frenetic pre-cleaning of the house and then the silence before the storm as we waited for our family to arrive. Then that first car would appear, its white hood emerging from the head of the driveway, with Grandpa behind the wheel. The bubble of anticipation would burst inside my stomach, sending waves of excited energy through my limbs, because it meant the holiday had begun. Next would follow the cries of happiness and hellos, the procession of kisses and hugs, with Grandpa stopping amongst the activity to hold me at arms length, study me, and ask, “Damian?”

MY teenage memories are of a plethora of Robb-Family gatherings, of the Stewart’s backyard, the Donahoo’s house, and the Benalla-Robb’s shed, of Christmases, birthdays, and twenty-firsts. Of speeches (always peppered with a call-out from Lindsay), of food and dancing, and talking and laughter.

And always amongst the mass of family and the thrum of conversation I could be sure to find the matriarch and patriarch in the thick of it, the foundations stones that had brought us and held us all together. Grandpa would recite stories with nods and smiles from those who had heard them multiple times before, and keen interest in the faces of those first-timers, myself often among them. There was always a hand shake and a hug, a quick query to determine who he was talking to, “Don’t tell me. It’s Damian?”, and I was folded once again into the festivities and family.

AS I moved into working life as a nurse and relocated to Brunswick West and the charm of McLean Street, my memories of Grandpa moved as well to Latrobe Village, which the Robbs quickly infiltrated with our large numbers and animated chatter. The memory that stands out most of the Village actually occurred towards the end of my high-school days. We had congregated in the function centre to celebrate Grandpa’s eightieth and I, against warnings from my mother, had consumed too much alcohol at the after-Deb party I had attended the night before. Alcohol poisoning would later be used to describe my state, and while I, regrettably, was in no form to interact with Grandpa that day (as my sister who found me spread-eagled on the lawn bowl’s field can attest) I was led to his bed where I was left to sleep it off.

Ironic that after all those years I found myself back in the bed of my grandparents, and more so, that the warmth, weight, and cleanliness of those blankets still offered the comfort and safety that they had ten years before.

FINALLY I’ve arrived at the most current stage of my life and the most recent memories of Grandpa. I live in Ardeer, and work as a district nurse across the North-West of Melbourne. My work as a nurse has given me a particular insight, and bred a distinct admiration, for the endurance and energy my grandfather continues to display. At an age where many of his contemporaries settle into a sedate and unchanging lifestyle, bowed by their weariness and ailments, Grandpa continues to make the most from his life, refusing to let age be an excuse, even to the point of having a knee replacement in his late eighties. His love for life and family act as a guide and a benchmark, and are attributes I would be lucky to emulate in my life.

THIS book has been made to commemorate ninety years of living. From the stories he shares, from his collection of memoirs, and from the sheer scope of his progeny, it seems to me that’s exactly what Grandpa has been doing.

And, thanks to him, so are all of us.

AND because I wouldn’t exist without Grandpa, I guess I can overlook his mistaking me for Damian.

ENCOMIUM – PART 2

/ jonathanrobb / 3 Comments

My last post detailed a typical visit to a patient named Ted, an eighty-four year old man I saw twice a day for over a year. Ted lived alone in a run-down unit, due for demolition, and had such severe short-term memory loss that within the course of a visit he could tell the same story multiple times. Luckily Ted retained his long-term memories, and, even luckier for me, the stories he told were so interesting it was no burden to hear them repeated.

As nurses we assisted Ted by administering his medications, ensuring he was having something to eat, moisturising his legs, and occasionally dressing any wounds he developed. We also gave the solitary man company, and, uniquely, Ted gave back. Some days it was hard to tell who was accompanying whom.

Ted was a joy. Normally seeing a client this often, particularly one who offers up the same conversation like a meal repeated until you’re sick of the sight of it, would become wearisome, but Ted was so genuinely happy, and so sharing in his happiness, that visiting him felt like recharging. Each rendition he gave of his stories was animated and energetic. His jokes, which after a few months I could mouth along with him, were always delivered with such sincere amusement and enjoyment that it was impossible not to laugh with him.

I was moved from the area where Ted lived and began nursing further north, and my visits with Ted were cut off. It was a different nurse who got to hear about the time his car broke down on a set of train tracks and was hit, with Ted still in the car, by a train. Ted walked away from the accident, went to get a beer at a nearby pub to steady his nerves, and decided the car was probably a wreck, and so hitchhiked his way home. True story. I heard it at least seventy-eight times.

A few months ago I found out Ted was no longer on our books. Ted has chronic obstructive pulmonary disease, which is a fancy way of saying his lungs are shot. He spent his early adulthood chewing on cigars, sucking on cigarettes, and even having the odd puff of a pipe. His later adulthood was spent working in a pottery factory at a time when OH & S didn’t include face masks, and so, even though he had quit smoking, the deterioration of his respiratory system continued with lungful after lungful of ceramic dust. Because of his COPD, Ted was particularly prone to chest infections, which made him particularly prone to hospital admissions. And so the decision was made by his case manager that Ted wasn’t safe to be living alone and a nursing home was arranged. This meant district nurses were no longer required.

The abrupt departure of a patient is an aspect of my job I find disorientating. Let me set the stage: we go into the intimate confines of a person’s home, are welcomed and offered tea. We administer care, which by its nature creates a bond between patient and nurse. We talk as we work, and learn about out patient’s lives and families. Then, as inevitably happens, one day they’re gone.

Sometimes it’s due to death, but more often it’s that they’ve been put into a nursing home. Or gone to live with family. Or are in hospital. The latter is the hardest because they disappear into the hospital system and it’s not until months later that you realise they haven’t returned and are left wondering what happened to them.

District nurses are, at best, a band-aid. We are a temporary fix, and the best we can hope to achieve is to maintain the status quo for a while longer until health deterioration catches up with our patients. Please don’t let this observation cheapen the profession. Those extra few years we buy our clients at home are years of comfort in a familiar environment, but it’s still frustrating to know we are a quick, and non-lasting, solution.

So Ted had disappeared into that world of post-district nursing, but because of where he had lived I still found myself driving past his unit most days. (Despite his absence, the demolition has yet to commence). And each day I was reminded of the man and what an incredible life he had led. I would remember the story of how, on an impulse, he quit his job in New South Wales and travelled to Melbourne with a friend to visit his friend’s aunty. And how, six months later, he married his friend’s aunty. She was twenty years his senior and initially refused to marry him, stating that he could stay until he was bored with her. Ted was outraged at the suggestion that he wouldn’t make an honest woman of her and slept on the couch until their marriage day.

And I remembered how, twenty years on, his wife had a stroke and, mentally, reverted back to an infant. And how Ted fed her, and washed her, and cared for her whilst she called him “Mum,” until the day she died.

An encomium is a tribute, either spoken or in text, to a person and their accomplishments. My previous post set out to capture just a slice of what it was like to know Ted. To immortalise a fraction of a fraction of his life, but one that demonstrated his humour, and his vitality, and his kindness. To protect and praise a man who had done some incredible things but who had been largely forgotten by the community he lived in.

Ted will undoubtedly have no memory of me and the small part I played in his story, but hopefully these posts will preserve my memories of Ted and the part he played in mine.

ENCOMIUM – PART 1

/ jonathanrobb / 4 Comments

I watch my feet as I walk up the cracked and sloped path between the red-brick wall to my left and the overgrown hedge to my right. Ted’s backyard appears before me, a lawn in want of mowing, a small aluminium shed, and the odd sun-faded lawn gnome peering out from the dense brush of a bush. I shake my head and wonder why anyone would want to populate their yard with the eerily smiling porcelain figures.

Ted’s back door is a mess of flaking green paint and I stop a moment to read the sign nailed to it.

WARNING: THIS BUILDING HAS BEEN CONDEMNED AND IS AWAITING DECONSTRUCTION.

Ted told me they can’t knock the unit down until he leaves or dies, and that he has no intention of leaving. I smile at his contentment in keeping the sign in place, his complacency in spite of the words written on it. I glance at the thumb-thick cracks veining the brickwork and wonder if it wouldn’t be better for Ted to relocate. But, as he says, this is his home.

I knock and the door shakes against the brick wedging it open a hand span. The gap is for his ladies to come and go.

‘Ted!’ I call out and enter before waiting for a response. I know where Ted will be.

The stink of putrefying cat food billows up at me and I glance down at the bowl by my feet. Globs of brown muck have spilled over onto the kitchen’s scuffed linoleum, but, thankfully, there are no maggots in the bowl this time. By the smell, they can’t be far off.

‘Ted,’ I say again, ‘it’s the nurse.’ I step through the doorway to my right and into Ted’s living room. The cold and silence of the kitchen is replaced by a thick heat and the whirr of a heater’s fan, and Ted is slouched in a one-person sofa in the corner of the room. His legs are stretched out inches from the glowing filaments. One day his pants will alight.

‘Ted!’ I say louder, and the crumpled marionette of Ted’s form becomes animated as he jerks awake and looks around. Even with his advanced age he is a tall man and his knees come up high as he straightens in his chair. His watery blue eyes find mine and a smile spreads across his narrow face, his white stubble parting to either side. He blinks a few times, orientating himself.

‘Oh, hello!’ His voice still has a northern English accent despite forty years of living in Australia and I’m charmed by it immediately. ‘I must have dozed off. Now, who are you?’

The question is asked with a carefree attitude. Ted is completely unfazed at being awoken by a stranger in his living room.

‘My name’s Jonathan. I’m the district nurse. I’m just here to help with your tablets. How are you doing?’ I wonder how many times I’ve introduced myself to this man. It’s probably in the hundreds.

‘Oh, just fine. A pleasure to meet you, Jonathan. Can I get you a drink?’

His hands are already moving, looking for his cane and preparing to hoist himself from his seat. I wave a hand and assure him I’m fine. ‘I’ve already had my morning coffee, so I’m all fuelled up. Thanks anyway, mate. I’ll just have a look in your book and get your tablets ready.’

I drop my bag to the floor, place my work laptop on an empty seat, and turn to the table set against the opposite wall. Ted’s medical folder is spotted and splotched with stains, a testament to the meals he’s eaten on this small square table. I open it and put it to the side, then unlock the metal box that holds Ted’s medications. I peruse the list of drugs in the folder and begin the process of picking through the packets and bottles jumbled in the box.

‘You’re a strapping young lad,’ Ted says from behind me. I smile and turn and await his next sentence. ‘You’d make a fine soldier.’

‘You reckon?’ I ask with a smirk and he nods emphatically. Ted has told me daily for the past year that I would make a fine soldier. I don’t know what he bases this statement on; I’m not particularly tall nor heavily muscled. Still, I get a small flush of pride every time he says it, as if I’ve passed some sort of test.

‘Oh yes. I was a soldier, did you know?’

I knew. ‘Really?’

‘Queen’s guard.’ He straightens as he says it, his chest full. ‘I used to parole Buckingham Palace. Spooky place at night. Haunted, you know?’

‘That’s incredible, Ted.’ I turn back and shake a warfarin tablet from its bottle, rattling as it hits the medicine cup, then grab a box of omeprazole. ‘So you wore the hat and everything?’

‘I did, I did. And you couldn’t move.’ He raises a finger as he says this, his whole body joining in the telling. ‘Tourists would come and tie our laces together, and you had to stay perfectly still. They’d send out guards every hour to give us a drink and untie our laces.’

‘They’d tie your laces together?’ Having heard the story so many times before my incredulity is a little forced. ‘The bastards.’

Ted chortles a laugh and nods, and his eyes unfocus as he sorts through his memories. ‘And then I worked as a soldier out in the desert. Oh, it’d get cold at night out there.’ He chuckles. ‘One time I lit myself on fire!’

His declaration is designed to spark my interest and by now I know my lines well. ‘You lit yourself on fire? How did you manage that in the middle of the desert?’ Having memorised the stories means I can concentrate on sorting Ted’s tablets while still giving the appropriate responses.

‘Well, each night when we’d set up camp it would be one man’s job to dig the fire pit. This night I had dug the pit and put the fuel at the bottom,’ he stands to do the reenactment justice and I have to resist the urge to step over and stabilise him as he wavers on his feet, ‘and I lit it.’ He squats and mimes throwing a match into an imaginary hole. ‘We used oil, you see, and the fire roared.’ His hands spread in an imitation of high-burning flames. ‘I turned to get the pot,’ he chuckles at this point and does another shaky squat, ‘and my shirt tales went right in the fire.’

My face is an open expression of disbelieving shock. Of course, I know this story, but Ted is a good story teller and he has me engaged.

‘I hear a fellow call out, “Ted, you’re on fire!” I say, “What? Fire!” and I bolt off into the desert.’ He claps his hands and he’s wheezing with laughter and I laugh along with him. ‘Three men had to chase after me through the desert to put me out.’

He collapses back into his seat, a grin of reminiscence riding his lips. I’m always amazed this man can describe being burnt and find it amusing. His optimism is inspiring. I drop his final tablet into the medicine cup and carry it to him.

‘There’s your tablets, Ted. Can I get you a drink to wash them down?’

‘Oh, sure, that would be lovely.’

I nod and hand him the plastic cup, then step back through the doorway into the kitchen, careful to give the dish of cat-food a wide berth. I open his ancient fridge and pull out a carton of milk and take it to the sink. A tin of nutritional supplement power sits on the bench and I pop the lid while taking a glass from Ted’s drying rack. I study the glass and find a cosmos of dried foodstuff clinging to the walls of it. The water is icy as I turn the tap and give the glass a quick scrub, and behind me I can hear Ted standing from his chair. I glance over my shoulder and see him leaning in the doorway. He’s come looking for conversation.

‘So, tell me, Ted, what happened after you were burnt?’

‘What’s that?’ His brow furrows. He’s forgotten already, my brief absence wiping his memory clean.

‘In the desert. You were telling me you lit yourself on fire.’

‘Was I? Well. I ended up in a hospital in Libya. For a month I had to lay on my belly while the nurses changed the dressings to my back each day.’

‘A month?’ I say and look around for a tea towel. The only one in sight is dried and crusted with a lifetime of wiped-up spills. I decide a wet glass is preferable and scoop two spoonfuls of powder into it, followed by a large pour of milk.

‘A month! And then—’ I pause in stirring the mixture and look at him as he says my favourite line, ‘—my old fellah got septic!’ His cackle is infectious and my brows are high in my hairline as I laugh with him. ‘Blew up to the size of an eggplant.’

I carry the glass to Ted and place a hand on his back as I guide him into the warmth of the lounge room and to his chair. ‘No luck at all, mate. I’m sure the nurses were impressed, though.’

He chortles and knocks his tablets back like a shot, takes a gulp of his drink and settles into the cushions, a stain of milk marking his top lip. A soft curious meow sounds from the doorway and a mottled long-haired cat slinks into the room. She gives another quick meow and rubs her body against Ted’s leg. Ted’s hand drops and his long fingers run from head to tail.

‘Oh, there’s my lovely lady. How are you, darling? Hmm?’ He looks at me. ‘I’ve got three ladies: Evelyn, Lucy, and Dot. This here is Evelyn.’

‘She’s a beautiful cat, Ted.’

‘Oh yes. You are, aren’t you? I don’t where the other two are, but they’ll show up. They always do.’

I know where they are. Ted’s told me he buried Dot in the south corner of his backyard, and his case manager phoned two weeks ago to let me know they had to put Lucy down. I don’t bother reminding Ted of their deaths; he’d only forget again anyway, and he’s not disturbed by their absence.

I smile as I watch this man enjoy the texture of his cat’s soft fur, a smile on his milk-lined mouth, and listen to the low rumble of Evelyn’s purr. Ted looks up at me.

‘You’re a strapping young lad. You’d make a fine soldier.’

That persistent flush of pride reawakens again and I smile. ‘You reckon?’

‘Oh yes. I was a soldier. Queen’s guard.’

I tilt my head. ‘Impressive.’ I glance at my watch and sigh. ‘Sorry, Ted, I had best be moving on. But I’ll see you again this afternoon, okay?’ I hoist my bag from the floor to my shoulder and pick up my laptop.

‘No worries, lad, my door is always open.’ He spreads his hands wide, a universal gesture of welcome. The generosity of this man who has so little is humbling. ‘And thanks for coming by.’

I extend my arm and give him a firm handshake. I feel hard muscles in his palm amongst the knobbly joints of his fingers. ‘Thank you, Ted. You’re a good man.’

‘Not a worry.’ He gives me a grin and I nod back with one of my own.

I step into the kitchen and pause. ‘Oh, and, Ted?’ I call out. ‘I think the cat food’s about due for a change.’

‘Will do,’ his call comes back.

I pull open the door, walk past Ted’s backyard, and head down the path beside his house, my eyes finding the cracks that spread like rivers between the brickwork.