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The cancer unit.

My patient was in terrible pain. I stood at the foot of his bed watching the color drain from his face. Twenty minutes before I had given him a quarter of a grain of morphine. I might as well have filled the syringe with sterile water.

I was the nurse taking care of Mr. Stone, a patient on the cancer unit. A malignant tumor had wrapped itself around the nerve roots in his right shoulder. He was fifty but looked seventy; his face was gaunt and deeply lined. His jet-black hair was streaked with white; the streaks had become wider and white since his illness, his wife said.

Mr. Stone told me that one night, desperate for relief, he dragged himself out of bed, went into the bathroom, turned on the taps of the bathtub, filled it with water, as hot as it could get and immersed himself in it. From what I could see, he was almost immobilized by the pain. To raise him up on the pillows, I had to get another nurse to help me.

He will die from this pain, I thought. There was nothing I could do; I had to leave him for another patient; through the open door I could hear the sounds of violent retching. Patients were very sick here; I was busy every moment, sometimes overwhelmed. The pace and the pressure were constant.

"Is your wife coming in the morning?" I asked him.

"I don't know."

"I can't stand to see him suffering," I had heard her tell the doctor yesterday. When she was in the room, she would sit with her arms crossed tightly across her chest, her hands gripping her shoulders. She often left the room to pace the long hall or go out on the porch to smoke. I felt it too. Stopping pain was my job. On the cancer unit a complaint of pain was an emergency. We tried to drop whatever we were doing and hurry to keep it at bay. Now all I could do was make useless entries into the chart, a neat record of horrendous days.

"I'll be back soon," I said. Mr. Stone had closed his eyes and was holding two pillows tightly against his shoulder.

In the next room, a patient was vomiting into a wastebasket, holding on to it with trembling hands. "I couldn't make it to the bathroom," he said in an apologetic gasp. I wiped his face and held a basin to his lips until the spasms stopped. He lay back on the pillows, drenched in sweat. In the next bed Professor Donahue, a patient with end stage colon cancer, was sitting up reading, oblivious to his roommate and my own quick movements as I washed the patient and changed his gown and the stained bed sheets. After two months in the hospital, the professor seemed inured to the sights and sounds of the misery around him; his own misery kept him fully occupied. He had endured surgery, radiation, chemotherapy; still his tumor had thrived. He seldom complained and was unfailingly polite.

"Good morning, nurse," he would greet me in his courtly way.

The professor was waiting for his wife; each morning she came in at ten o'clock sharp, helped her husband bathe, got him out of bed and took him out to the solarium where they worked together on a book he was writing. The chapters of his manuscript, the pages in stacks, were spread out along the windowsills. This irritated some of the nurses; there was so little space in the four-bed room to put things. The bedside tables and even the meal tables were crowded with medical paraphernalia, bottles of IV fluid, tourniquets, packages of alcohol sponges, tubes of ointments, jars of lotion.

Professor Donahue had taught physiology at a large university for many years. He liked to reminisce about his retirement dinner.

"I couldn't believe that so many of my former students were there; they came from all over the country," he said, shaking his head.

The professor liked to talk, a habit perhaps from a lifetime of lecturing. Here in the cancer unit, when you asked patients how they were, they usually answered with one word.

"Awful," they would say sighing, or "Better," surprise in their voices. The professor would recount his latest X-ray reports, the results of his countless blood tests, and lately, the ominous news that nodes had been found in his liver. He spoke with an air of clinical detachment.

"The doctors do what they can," he said.

Today he looked sicker to me than usual; his breakfast was untouched and his sallow complexion was tinged with jaundice. An IV ran into his arm, black and blue from the many attempts to find a vein.

I took away his tray and tried to straighten out the room before his wife arrived, her briefcase bulging with more material for the manuscript. I was too late; I could hear the click-click of her heels as she came down the hall. The sounds of her steps reverberated with such purpose, I would have recognized them anywhere.

Mrs. Donahue was neatly dressed in a navy blue suit, her gray hair tightly curled, her wide smile firmly in place. She bustled cheerfully about the room, greeting the other two patients and inquiring how they felt. One of the beds was empty; would there be a new admission, she asked? And if so, who?

"We're waiting for a patient to come back from the recovery room." I said.

"It's so wonderful that we have this time," she liked to say; her tone so buoyant she might have been a bride on her honeymoon instead of a wife getting through her husband's final days. Soon Mrs. Donahue would have her husband dressed in freshly washed and ironed pajamas and ready for their work on his book. Her smile never wavered. I marveled at her spirit. The sight of the professor could make you weep.

"He looks like death staring you in the face," one of the nurses had said. The professor's arms and legs were like sticks, his abdomen grotesquely distended with fluid. All his hair was gone. He put you in mind of old newsreels showing the survivors of concentration camps.

Down the hall they would go, Mrs. Donahue pushing the IV pole with one hand and supporting the professor with the other, her briefcase attached to a strap over her arm. Her demeanor was so cheerful they might have been going to a picnic in the park. On the porch, she fixed pillows in a chair by the window, settled the professor in a comfortable position and then sat down next to him, pencil poised. Her husband dictated to her in his weak voice; as they worked his voice would get stronger and a faint color would appear in his wan cheeks as if he had been mysteriously infused with his wife's vitality. For two hours, they stayed absorbed, hardly noticing the patients shuffling in and out in their loose bedroom slippers, the doctors gathering for impromptu conferences, the loud commands from the intercom, the relatives or visitors coming in to smoke a cigarette or collapse in a chair and bury their faces in their hands, or burst into tears.

When I got back to Mr. Stone, the doctors were standing at the foot of his bed, the residents and Dr. Lee, the attending physician. Dr. Lee was known for his brilliance, his forthright manner and a quirky sense of humor. But now his face was grave.

"How is the pain?" he was asking.

The patient couldn't describe it--there were no words. He inclined his head toward me.

"This nurse here--she sees."

"A quarter of a grain of morphine does nothing." I said.

"Sometimes these problems have no answer," Dr. Lee said.

He was a tall good-looking man who exuded intelligence. Patients instinctively trusted him, yet he had just admitted that he was helpless.

"We'll double the dose of morphine" he said; then, turning to me, "Give it now."

I had never given such a heavy dose.

I went in search of the narcotic keys; the narcotic box was always locked. I cracked open the glass vial of morphine with a small metal file and drew up the dose in the syringe. Then I checked the chart to make sure Dr. Lee had written the order- nurses took verbal orders at their peril. Next I recorded the dose in the narcotics log, which was checked at the end of every shift by two nurses; no one could leave until the count tallied exactly. On Mr. Stone's chart I wrote the dose, the time and signed my name. It was a cumbersome process but no matter how busy you were, you dare not hurry. A mistake could haunt you forever.

But the heavier does didn't work. I kept looking in on Mr. Stone to check his breathing; morphine depressed respirations. He grew groggy, lethargic but never free of pain. He couldn't eat and barely drank. Each day the doctors gathered around his chart at the nurses' desk--radiation specialists, surgeons, neurologists. The record grew thick with pages of consultants' notes and abstracts torn from medical journals. Through it all, the patient suffered. The resident Catholic priest, a young red haired fellow who ran himself ragged visiting every patient, gave him a blessing, raising his freckled hand in the sign of the cross over the Jewish Mr. Stone.

Early one morning the following week, the professor was sitting on the side of his bed reading his newspaper. His doctor came in and sat down on the bed next to him. Usually the surgeons stood at the foot of the bed; many of them were over 6 feet tall and they loomed over the patient. Startled by this unexpected intimacy, the professor dropped his newspaper and fumbled with the ties of his hospital gown, which had come undone at the neck, leaving his back exposed. The doctor leaned over and in one sure motion fixed them in an impregnable surgical knot. The professor put his hands humbly into his lap.

Caring for the patient in the next bed, I heard the doctor say:

"We're going to send you home, John." The professor began to cough. When the cough subsided, the doctor went on in a soothing tone:

"You don't want to use up all your insurance, John, just in case you have to come back." The professor lowered his head and gripped the sides of the bed. He murmured something that sounded like "Yes, of course."

I was called away then to help another nurse. The unit was electric with activity; nurses were putting patients on stretchers or into wheelchairs to go to X-ray or radiation therapy or to the treatment room for bone morrow punctures or spinal taps. Patients were being bathed, walked, having their IVs started or discontinued, their blood pressures checked, their tube feedings done, their dressings changed. None of us would go to lunch today, just take a quick break in the lounge. A nun visiting her mother had made a pot of coffee for the staff and brought in homemade muffins. Two internes were following the smell of cinnamon into the lounge. "They'll eat up everything," my colleague whispered to me as we lifted her patient out of bed. "There won't be a crumb left for us."

It was two in the afternoon when I went back into the professor's room. I was giving out medications and my cart was piled high with pills and potions and injections of every description. The professor was wandering about the room restlessly, waiting for his wife. She was readying the apartment for the homecoming and arranging for a wheelchair. She had told the head nurse Millie she would take her husband home this afternoon. "It'll be wonderful for him to sleep in his own bed," she had said.

The pages of the professor's manuscript were undisturbed on the windowsill; no work had been done on the book this day.

I was measuring out a dose of liquid Donnatal when the professor shuffled slowly over to where I stood. I hated being interrupted while I was concentrating on the medicines, but there was no help for it.

"Did you know, nurse, they're sending me home?" he said. His eyes were huge behind the thick glasses. I nodded. He gave a deep ragged sigh, gazing down at his feet, so swollen I had cut holes in the sides of his slippers with my bandage scissors to accommodate them.

"Well, that's life," he said, with another deep sigh. All I could do was pause for a moment and let myself absorb some of the waves of shock that emanated from the professor. Everything had come to an end so suddenly; all the hopeful rituals were over--the doctors each morning pressing their stethoscopes to his fast beating heart, the nurses cajoling him to eat and walk and swallow his pills, the internes listening to his careful catalog of symptoms, the daily weigh in on the large white hospital scale, the young nurses' aide smiling when he gained an ounce.

"Is there anything I can do for you?" I heard myself say.

The professor gestured toward the piles of papers on the windowsill. I gathered them up, telling him I'd put them in a labeled envelope and leave it at the nurses' station; his wife could collect it on their way home. I was afraid to leave it in the room; it could get thrown in the trash. There were three other patients in the room now needing a lot of attention; one was having trouble breathing. I had to stop and adjust his oxygen before I put the manuscript pages on the lower rung of my cart. The empty bed was now occupied by a Mr. Jordan, who had had a large tumor removed from his neck. "Carotid Precautions" a sign on his bed read; a tray piled high with pressure dressings sat on his bedside table. All day long we were checking his vital signs and the dressing on his wound.

I went back to my medications and my rounds in and out of the patients' rooms. It took me a long time--some patients had trouble swallowing and I had to fetch more water, others needed to be turned in bed, or asked for pain medication. At last I finished. As I was pushing my cart down the hall I heard shouts for help coming from the professor's room. I ran inside; Mr. Jordan, the patient with the neck surgery, was collapsed on the floor; a resident was kneeling down next to him pressing a roll of gauze into his bleeding wound. In seconds, the room was crowded with nurses and doctors; an interne handed me a bottle of plasma that seemed to appear out of nowhere; as the doctor bent to start an IV the patient was lifted back into bed. The resident, his fist still compressing the patient's wound, climbed up on the bed next to him. With one hand, I held up the bottle of plasma, and with the other helped push the bed on to the waiting elevator and we rode up to the operating room, everyone terrified.

It was late in the afternoon when I finally sat down with my colleagues at the nurse's desk to write my nurses' notes. A nurse called from the O.R. Mr. Johnson had survived and was in the recovery room. There were low murmurs of relief, then silence except for the rustle of paper, the clang of the charts being put back in the metal rack, the scratching of pens. Fatigue had taken over. I was thinking of what bliss it would be to go home and collapse on my couch when the evening supervisor came in.

"Does this belong to anybody?" she said. "I found it on the bottom of the medicine cart." She was holding the professor's pages.

I had forgotten all about the manuscript.

"It's Professor Donahue's," I said. "He lives somewhere near the hospital. I'll drop it off with the doorman on my way home."

People looked up from their charts. Someone said:

"What's the big deal?" Patients left things behind all the time, plants, pajamas, underwear, rosary beads. We labeled everything and kept it in a hall closet in case they returned to collect it, which they seldom did.

I wasn't even sure where the professor lived, only a vague memory of his pointing out the window to show me his apartment building one day. To get his address, I would have to go down to the record room in the bowels of the hospital and find a harried clerk to retrieve the chart. I gave a martyred sigh.

"Listen, you don't have to go; his wife will come for it, believe me," Millie said.

There was some laughter; people were punchy at the end of the day. I imagined the professor and his wife unpacked, the long evening ahead to be faced without the book.

"No, I'll go," I said.

"You'd better clean yourself up," Millie said. "The doorman will think you just left the scene of a crime." She was looking down at my shoes, spattered with blood.

The professor's building was only a short walk from the hospital. The doorman, dozing at his post, roused himself to take the package. As I left to go home, lights were appearing in a few of the apartments. It was beginning to get dark.

I was off for two days. When I got back on duty, Mr. Stone's room was empty. He had been taken to the O.R. very early that morning, Millie said. The doctors would try to remove the tumor, a daunting challenge. It would be hard not to damage the nerves. She didn't know how he was--no one had reported back yet.

In the afternoon, technicians from the radiology department came and posted large yellow signs outside his room. In red letters they read, "Danger--Radioactive Zone."

When Mr. Stone came back to his room, I saw at once he was better. For the first time in days he was alert, saying "Hello" to me as I helped the orderly transfer him from the stretcher to the bed. He moved more easily than before despite his large incision and gave his wife a little wave as she stood at the door, peering anxiously into the room.

The doctors had embedded radioactive material into the part of Mr. Stone's tumor they couldn't remove. He would be emitting radioactivity so visitors were not allowed into the room. Nurses would have to wear devices to measure the amount of radiation we received, small metal clips we called our "badges" that we attached to our uniforms. Every month the physics department collected the badges and measured the levels. If they were too high, you got a letter advising you to avoid exposure for the next six months. I had received such a letter once.

I went out to the nurses' desk to check on the new orders for Mr. Stone. Dr. Lee and a young resident were arguing about how much time a nurse should spend in his room. She should have a strict schedule," the resident said, casting a worried glance at me.

Dr. Lee didn't agree; there was no danger, he said. But the resident persisted; he kept talking about the "half life," an expression I vaguely remembered from my physics classes. In my mind's eye, I saw my insides shriveling up and disintegrating under the deadly rays emanating from innocent Mr. Stone. "What does he mean?" I asked Dr. Lee. "He means," he said teasing, patting a hand on my shoulder, "that you deserve better."

The situation was resolved when the X-ray department sent a lead apron for me to wear over my uniform. It was so heavy it weighed me down and I moved sluggishly. Worse, it was July and the city was in the middle of a heat wave. Each day temperatures hovered near 100 degrees with high levels of humidity. We had no air conditioning; a lone fan stirred the air. Sweat poured into my eyes and pooled under my arms. Sometimes I felt dizzy; I had to sit down until my head cleared. When my patient slept, I went into the bathroom, bathed my face and drank cup after cup of cold water. At the end of the day, I floated on a wave of exhaustion. The heat finally broke when sudden rains drenched the city. I walked home in the downpour, rejoicing in getting completely soaked. Passers by, huddled under their umbrellas, stared.

But Mr. Stone was much better. The horrific pain had gone; he had only the normal ache from the incision. Sitting in a chair by the window, he looked absorbed in the view of the drab city streets crowded with people going to work, the traffic--backed-up cars and trucks and taxicabs, the vendors offering coffee and bagels. His demeanor was so serene it seemed a kind of bliss. He put me in mind of the scene in old movies where the prisoner finally freed, walks into the sunlight, marveling. Mr. Stone was moving back into the living world, returning from that place where he had been trapped and held down by a smothering force, a place where there was no companionship, only doctors who came and went with grave faces, where nurses, always in a hurry, dispensed medicines that gave no relief, a place where even his wife, who loved him, couldn't follow.

The doctors were elated. There was heady talk about going home once the wound had healed. Mrs. Stone sat in her chair outside the door and strained to hear. She was knitting an afghan; it helps pass the time, she said. The fatigue and strain of the past weeks were etched in her face; she seemed drained of strength except for the quick movements of her hands as she worked the skeins of yarn.

Three days after the surgery, Mr. Stone put on his glasses, asked for his shaving kit and declining my arm, walked to the bathroom. He stood for a moment staring with dismay at his reflection in the mirror. He had lost weight so his cheeks were thinner but the shadows were gone from his face, the dark circles under his eyes had faded, his haunted expression had vanished.

I heard footsteps. Looking into the room, Mrs. Stone had seen the empty bed and called out in a frightened voice: "Joe!"

Mr. Stone turned his head toward the door. He might have been anyone's ordinary husband, his cheeks white with the thick shaving cream, as he groomed himself for the day. He put down the razor and walked to the doorway, standing so his wife could see him. Sunlight was flooding the windows and glinted on the rims of his glasses.

"Here I am," he said.
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Author:Valinoti, Eileen
Article Type:Essay
Date:Sep 22, 2013
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