Nursing

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.

THE FIRST TIME

/ jonathanrobb / 1 Comment

One of the most common things my patients say to me, excluding those unfortunate few who have lived with a chronic condition most of their lives, is “This is the first time I’ve ever been sick.” They say it as if daring me to believe it, because they themselves are having a hard time believing it. Their run of perfect health has inexplicably come to an end. They quote at me their perfect medical history, taking pride in their previous resilience:

“I broke my arm when I was seven, but beyond that I’ve never even seen a doctor!”

They are always surprised that their bodies have let them down. But why? Why are we taken by surprise by the fact that we are mortal, that our imperfect bodies, which until this point have been fighting like a Spartan to maintain homeostasis, have finally, inevitably, let us down?

The evidence is all around us. We watch a plethora of television shows set in a hospital that week-in and week-out cash in on the drama that is a healthy person falling sick. And the reason this is such a successful emotional hook is because we all know that such a thing is possible, even probable, when you consider the multitude of infinitesimal processes that can go wrong within our bodies. We swap stories about the health of our families and sigh in all the right places when hearing of another’s health decline. Yet we fail to, or refuse to, make the connection that we will all eventually have an occasion where we will be, for the first time, admitted into a hospital because something has gone wrong.

The irony is these same people who proudly boast about never having their blood-pressure checked in fifty years are the same people who have been walking around with increasingly high blood-pressure for the past forty years. One morning they pass out while attempting to move a couch, end up in emergency with a stroke, and later state to their nurse with complete surprise, “I’ve never even been sick before, and now all this happens!”

My favourite patient, and by favourite I mean in a sarcastic, eye-rolling sort of way, are the ones who blame accidents or hospitals for the chronic disease they have due to a lifetime of poor lifestyle decisions. One of the best examples I have of this was when a sixty-year old man told me the tale of how he procured type two diabetes. This is a man with a gut that preceded him by at least thirty centimetres, a man who thought a six-pack of sugar-covered doughnuts to be an appropriate between meal snack, and who hadn’t done regular exercise since playing football in high-school.

Out of the two of us, I thought I could give a more accurate rendition of how he procured type two diabetes.

The story went that one day in his fifties he had decided to try riding a bike again. He pumped the tyres of his old bicycle and headed out onto the streets, flushed with the joy of being back on the road with the wind in his thinning hair. Unfortunately a neighbouring dog found the image of an overweight middle-aged man on a bike to be greatly entertaining and decided to join him. While attempting to shake the dog off his tail with a mixture of swerving handlebars, wobbling wheels and wildly kicking feet, our man lost control of his bike, fractured his hip and ended up in hospital. Where, as is common procedure, they took a blood sample and discovered he had previously undiagnosed type two diabetes.

Or, as my patient put it, “Fracturing my hip gave me diabetes.”

Despite my tactful attempt to suggest that it was simply the series of events that resulted in the discovery of his disease, that it was more likely down to the fact that he has three sugars in his tea and has eight cups of tea a day that led to his diabetes, he remained resolute that the act of fracturing a bone in his pelvis gave him high blood sugar. In the end, after half an hour of discussion, I sighed, nodded, and said with complete sincerity that I hope he never fractures his other hip or else he could end up with high blood pressure. To which he responded that he already has high blood pressure, but that he got it from his mum.

We all, every one of us, will eventually find ourselves in a hospital ward due to something that has gone wrong with us physically. It may be our fault, it may be an accident, or it may be a genetic condition that has reared its ugly head in later life, but something will happen someday.

The best we can do is accept this, and in the mean time work towards being as healthy as possible, enjoying and appreciating our health while we have it, and exploring ways we can improve ourselves when a health condition becomes known.

And for god’s sake, try to look after your hips.

They may be the only things standing between you and diabetes.

DEALING IN DEATH

/ jonathanrobb / 2 Comments

I’ve been reflecting recently that a lot of my writing contains death. This is not a conscious decision. Death seems to worm its way into my stories like a recurring character in want of a cameo. And I’ve been trying to decide why I’m drawn to exploring this phenomenon. And I think I know.

The first reason is a rather simple one: I think about death a lot. This is not for any morbid reason. I don’t run fingertips over blades or stand on the edges of buildings rolling a foot over the corner. I’m a nurse. Death refuses to be ignored in my profession. Every time I interact with a patient who is wasting away I’m aware of death waiting in the background. Patients want to talk about it. Family members need to be consoled. Co-workers joke about it. This results in reflection on the nature of death, which in turn works its way into my writing.

The second reason is also rather simple: Death is dramatic. It’s an organic occurrence that shakes things up. It’s a way to test characters, to see their world view when confronted with loss. Death is a catalyst.

The reason I’m writing about death today is that I saw a patient recently who was thick in the absolute and utter realisation of her own mortality. This patient, let’s call her Pat, is a sixty-one year old woman with chronic leg ulcers. She has been in and out of hospitals for the past ten years of her life. She had been ill, recovered, and fallen ill again. And yet none of this was what triggered her sudden confrontation with the idea of death. It was seeing it in someone else that forced the truth of it into her mind.

Pat attended a doctor’s clinic for a regular review and saw another patient whom she had seen in the waiting room during previous appointments. At first she didn’t recognise the man. She though the woman with him was his daughter rather than his wife. It was when she went into the doctor’s room and found the doctor wiping away tears in an effort to compose herself that the connection clicked, and Pat realised that the healthy man from months ago had shrunk into the sickly old man she now saw in the waiting room.

Pat went home shocked. She sat in her empty house over the weekend chewing on the image of the man’s rapid decline. And when I arrived the following Monday she was scared, and desperate to talk to me about death.

So we talked. We discussed the obvious things first; the fate awaiting us all, the loss to ourselves and our families, and the misery of such a loss. And eventually we got to what really was bothering her: What was the point of it all? What surprised me most wasn’t the question, but that a woman almost thirty years my senior was looking to me for answers. And that I had something to say on the matter.

I told Pat that being aware of mortality isn’t a bad thing. It invigorates. It’s not a pleasurable notion to consider, but it forces you to acknowledge that you are alive now, and that that time is limited. It pushes you to make more of your time, and to appreciate the joys you get. I told Pat that I didn’t know what the point of it all was, or whether, in the face of death, our lives held a particular meaning at all. I told her what I knew: that in the face of no meaning, all you can work towards is contentment. That if you spend what time you have happy then you come away on top.

I had some form of an answer for Pat because I had thought about death. My profession meant that I couldn’t ignore the inevitable reality of it like most of us do, and I certainly did before nursing. We, as a race, are too skilled at pushing the knowledge that one day we won’t be on the earth anymore to the back of our minds. We cram it down into the crevasses of our brain and pile trivialities and day-to-day details on top until we can’t see it anymore. And we smile and think we’ve beaten it. But it doesn’t do any good down there. And for Pat, when the truth wiggled its way free and sprung to the forefront of her mind, she had no way to accept it.

Pat listened to my answers like an eager student. She smiled at my closing statement and seemed mollified. The haunted look wasn’t gone from her eyes, but she appeared to be in more control. She was contemplative rather than scared. And I felt shocked and proud that I had been the one to comfort her.

Thinking about death, and writing about it, had given me an answer. I don’t know if it was the right one, but it is better than staring into the void without a form of comprehension.

And reflecting on this, I think I’ll continue to write about death.

BE NICE TO YOUR NURSE

/ jonathanrobb / 8 Comments

It was International Nurses Day a week ago so I thought I’d use that neat segue to describe a scenario I’ve experienced when working on the wards, one I’m sure all nurses have faced at one point or another.

I had an elderly patient who’d recently had a hip replacement. The woman, let’s call her Ethel, was a delight. Patient, pleasant, cooperative. She smiled a lot and consequently I smiled a lot. A smiling patient can be a rare thing. Ethel, unfortunately, had to have a catheter post her surgery. More unfortunately, she developed a urinary tract infection.

A UTI is rather common, especially when you’re inserting foreign objects into someone’s bladder, and is treated with antibiotics. For most people it means a little pain and irritation. However, with elderly and frail people it can bring on delirium. Delirium is essentially a fast acting, short-term dementia. In other words, it sends the patient loopy.

Ethel transformed from the perfect patient into a terror.

Sunken deep in her delirium, Ethel held the belief that the hospital staff were holding her there against her will. In her eyes, we were her jailers. She let us know this with a rather impressive and expressive collection of profanity, as well as physical threats. While this made doing even the simplest thing for Ethel a great struggle, a part of me couldn’t help but admire Ethel’s fight. In her head we were the enemy; rather than laying back and taking her imprisonment, she chose to fight. And I mean fight.

Fists swung, feet kicked, and if you weren’t staying alert and got to close to her head, you ran the risk of being head-butted. Ethel was a warrior.

Because of Ethel’s UTI she had to have an intravenous infusion of antibiotics. Luckily she viewed her infusion favourably. Any attempt to touch her cannula was met with, “This is mine! You can’t have it. If you try and have it, it will poison you and you’ll die!” This was a much better reaction than distrusting her infusion and yanking out the cannula, which was the usual course of events in these situations.

One night we had hung her latest infusion. Any interaction left Ethel unsettled so we gave her fifteen minutes to calm down before checking her vital signs. When we returned we found Ethel asleep in her bed. This was brilliant. Her BP cuff was still circling her arm and all it took to measure her blood pressure was the push of a button. Checking her temperature, however, was a bit trickier.

We had a thermometer that had to be inserted into the ear and a button pushed. This sounds simple, but when a person is violent thrashing their head it’s hard to get an accurate reading. A sleeping Ethel was a blessing.

I tiptoed beside Ethel, carefully lowered the thermometer probe, and pushed the button. It beeps as you press it. Ethel woke instantly.

I jerked my hand away just in time to avoid the clacking of her teeth as she tried to bite me. Her eyes darted between me and the thermometer in my hands and understanding spread across her face. Her response was instantaneous.

“You little bitch,” she hissed.

I had to bite my lip to stop from laughing.

After three days of antibiotics, Ethel was back to her charming and lovely self. She had no memories of her delirium, which was for the best.

Despite her reversion back to the grandmotherly old dear, I couldn’t help but remember the warrior that lurked beneath. I was warily impressed.

The point of this story is that this scenario is just one of millions that combine to make what is a rather average day in a nurse’s work life. Threats, physical assault, stress over a patient’s health, juggling ten tasks as once, and trying to decipher medical orders are the hurdles a nurse is facing at any given point, be it day or night.

As you’re reading this there are nurses tending to wounds, bathing patients, administering injections, and stopping sweet old ladies from biting down on their wrists. It’s a strange job, a stressful one, and a rewarding one. And one that leaves you with a lot of stories.

Next time you’re in hospital, be nice to your nurse.

Please don’t bite them.

THE PRIVILEGE AND RESPONSIBILITY

/ jonathanrobb / 1 Comment

For those of you who have stumbled across my blog, let me catch you up: I’m a nurse, but aspire to be a writer. This information is relevant as the following post is a combination of both professions. In other words, I’m about to write about nursing.

Nursing is a job that allows you a backstage pass into people’s lives. This is simultaneously fascinating and confronting. Some days you’re thankful for this privilege; you get to see wounds you could fit your fist into, or have intimate conversations with people who are facing death. Granted, these aren’t normally considered privileges, but trust me, it’s rather incredible. It’s an insight into reality. A harsh stripping back of polite society and a plunge into the fragility of what it is to be a human. Picture a dive into cold water; it’s shocking, but also exhilarating.

Other days, however, you wish the responsibility didn’t fall on you. As a nurse I’ve had patients look to me for answers. They don’t see the twenty-five year old man who feels as inexperienced and naive as a five-year-old; they see a nurse. A medical professional. I’ve had eighty-year-old men ask me when it’s going to get better. I’ve had women the same age as my mother cry as I hold their hand because they’re too overwhelmed to hold it together. Mostly, I don’t know what to say. Thankfully, what these people really want is just someone to listen and empathise. I do that, and feel guilty when they thank me for my help.

The following story is a mixture of both aspects of nursing. The privilege and the weighty responsibility. It was an experience that stuck:

On the first day of the year, I learnt that one of my patients had died. We knew she was dying, but it ultimately happened fast. Four months ago they discovered she had cancer. Worse, they discovered she had cancer everywhere.

We were originally looking after the patient’s husband, Ray. When I first met Ray, his wife, Catherine, was in hospital receiving chemotherapy. It was this hospitalisation that brought nurses into Ray’s home to help keep his tracheostomy site clean as Catherine couldn’t attend to his care.

I first met Catherine three months after meeting Ray. To me she had the look of the dying. Pale dry skin, sunken cheeks, a shrivelled frame, and thin wispy hair revealing her scalp. Ironically it was the treatment rather than the disease that caused Catherine to look like this. Chemotherapy is an asshole.

Despite her fragile appearance I found Catherine to have a quick mind and a sarcastic sense of humour. Ray was more quiet, much of this due to his tracheostomy, and unfailingly polite. A fellow nurse described them as “one of those lovely couples.” She nailed it.

Despite her condition, Catherine and Ray carried out their much honed daily routine, of which I was lucky enough to be a witness and occasional player. Breakfast around the kitchen table which carried on into lunchtime. Horse races playing on the radio in the background, crosswords and quizzes from the paper a daily tradition. Often their daughter would be there, easily slipping into the fold of toast and newspapers.

I would clean Ray’s tracheostomy to the side of this scene. It may seem odd to scrape mucous from a hole in a man’s throat meters from where his family are eating breakfast, but the unspoken ease with which they accepted this made the moment poignant rather than unusual.

Catherine returned home from the hospital with a colostomy and needed help tending to it three times a week, and soon she was a patient of ours as well. I would tip Catherine off when I entered that it was her lucky day; she was on my list. She would take her cue and shuffle into the bathroom to begin the process of removing the colostomy bag. Once I had attended to Ray I would knock and enter the bathroom. The image I would see upon stepping into that pink tiled room I still find heartbreaking.

Catherine, her singlet as pale and thin as herself tucked into her mouth, struggling to tug away the sticky mess of bag and wafer from her colostomy site. Her pink glistening stoma squatting in the middle of her sunken abdomen like a parasite. I wonder how she felt when she looked into the mirror and saw a skeletal version of herself with her exposed bowel sitting on her belly. She never said anything disparaging. Never commented on her pitiful state. Often she would joke. I knew she was uncomfortable. Whether it was because I was male, or because of her wasted body, I don’t know. It didn’t matter. I didn’t hold it against her. I was uncomfortable too. I wanted to do something, or say something to ease the tension, but there’s nothing to say when both people are acutely aware that dignity has been replaced with the threat of death. I hated the helplessness of the scene whilst admiring Catherine’s composure.

After a month of tending to both of them, Catherine developed a chest infection and had to be hospitalised. The staff there tried to have her out and home for Christmas but she was too sick. She was never discharged and died on the 31st of December, 2011.

Reading back on this story it appears depressing, and it is. But that’s not the only reason I wrote it. Part of the reason was for me to describe the heartbreaking scenes I am a part of on a daily basis. I needed to describe it because it’s something I face everyday, and something I am expected to carry on with. And mostly I do. But sometimes I want someone to understand the full tragedy of these visits so I can look them in the eye and say, “Isn’t that fucked up? I deal with this everyday.”

The other part is the beauty of Ray and Catherine’s relationship. I don’t care if it’s cliched and sappy. Those two people loved each other and had discovered a comfortable ease in which they lived that love. Most of us want nothing more from life than that. Maybe they had gone through shit to get there, slipped up and made bad decisions. Argued. But at the end, with his wife dying beside him, Ray could still look up, smile, and give the answer for a crossword clue which Catherine would pencil in.

This is the beauty and responsibility of nursing. The consequence of the backstage pass. It is both fascinating and confronting and feels more real than anything else I have experienced. It is a constant inspiration for writing, and more importantly, for living a good life.