Published March 4, 1993, this was a favourite of the first Facts & Arguments editor, Philip Jackman: "This essay was a hugely powerful piece of writing that offered a unique personal insight into the world of nursing. Here's a nurse who's leaving her profession because she can no longer stand the emotional stresses of the job, plus the extra menial chores that nurses are being asked to do. After 10 years of caring for the sick, she's quitting because she's disturbed that she no longer cries when one of her patients dies."
He's only 50 and he's dying. He has an inoperable brain tumour that has rendered him speechless and incontinent; a grown man reduced to a baby.
His chart says he is a businessman with his own company; a divorced father of two. The illness has been particularly cruel: His mind is still active.
The evening shift is busy, but I take a few minutes to brush his teeth, and talk. "I hear you play squash," I say, and attempt to chatter about the sport. He grunts out a "yes" or "no" to my persistent questions.
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Finally I gather my courage. "Have the doctors told you what is going on?" I ask. There's a shaking of the head; and suddenly, tears in this gruff man's eyes.
"Do you want to know?" He shrugs. He isn't sure. But the flood of tears tells me he already knows what he hasn't been told. I stay with him for a while, holding back my own tears until I get home.
Soon I won't be there to sit and listen. But I also won't go home and cry.
After 10 years as a nurse, I am taking off my pristine white nursing shoes, tucking away my stethoscope and admitting that I cannot do this any more.
In many ways it was a good career choice. There's some reward in knowing that I helped a patient suffering with cancer relax after a shot of morphine, taught a new mother to breastfeed her newborn, or listened to a 30-year-old woman just diagnosed with multiple sclerosis decide how to tell her young son.
The reason I went into nursing was for that interaction, the chance to make a small difference. But I'm not the same idealistic 21-year-old who wanted to save the world, and nursing as I know it has also changed.
Nurses are expected to attend more committees than a few years ago, to take part in hospital decisions. I think that's important. We now have a voice. But we are often expected to do this and still handle the patient assignment for the day. Because of the increased push for education and extracurricular involvement, there is less and less time spent being with the patient.
In my mind, these changes are detrimental. Increased education and participation in conferences should be secondary to exemplary job performance.
As nurses we are expected to provide information on diagnoses and medications, know about social services and home care, give family counselling and perform a myriad of duties aside from regular nursing care such as bathing and changing dressings.
Hospital cutbacks have led to fewer supplies and services, which has led to some imaginative nursing care. And we try not to let patients suffer because of it. Because there isn't money for auxiliary staff, I change beds, clean spills, assist patients to cut their food, make cups of tea, move furniture. I also call family members, do laundry and explain to patients when there isn't any shampoo or another blanket to be found in the hospital. I jokingly tell my patients that mopping the floor adds variety to my work. It isn't their fault that I never thought my job should include hauling a mop or begging another floor to lend me some supplies.
The recent media coverage on how nurses are abused by patients and physicians took many of us by surprise. I've had an Alzheimer patient throw his dinner tray at me, been pinched by old men who called me cute, been cornered by doctors who have sneered, "Now we're alone." A female surgeon went on a tirade in the middle of the hall when her patient was late for surgery. She apologized after searching in vain to find another nurse on the floor. There wasn't another one qualified to give the prescribed medication. I was the only one in charge of 20 patients either recovering from operations or waiting to be operated on.
These incidents always seemed like part of the job, I'm sorry to say.
Other changes have been more positive. Nursing has taken steps to be acknowledged as a profession in its own right, separate from that of the physician. It's been a while since someone asked me why I didn't pursue medical school, as if nursing were a second-rate choice rather than a separate choice.
I'm glad I was around when we fought for significant pay raises, making nurses in Ontario the highest paid in Canada.
And yet, I am not leaving because of the bad shifts or discontent with changing roles or budget cutbacks that have admittedly made my job more difficult.
I am leaving because somewhere along the way the compassionate role took too much from me personally. So many people were ill. Twenty-year-old men died of bone cancer. Young people who years before had received blood transfusions suffered from AIDS. A woman delivered a stillborn child she desperately wanted. A man cried as he lost his second wife to uterine cancer.
How do you get on with your own life when your shift ends? There are nurses who can do that. They give their all and go home, leaving nursing at the door of the hospital. There are others like myself who can't.
I was so involved that I visited nursing homes to see patients who had been transferred there and had no family, attended funerals of patients who died, and started to dream of work all the time.
The realization that I must leave nursing came six years ago when a patient admitted with a benign medical problem jumped out the hospital window. The chief of psychiatry had determined he was not suicidal, but I blamed myself. Why hadn't I seen it coming?
Then I stopped crying when patients died. I felt cold and unfeeling. Did it mean I cared less and was providing less effective nursing care?
It has taken me six years to gather the strength to pack up my pastel uniforms and know that it's for the best.
I have just resigned. My friend with the brain tumour has now gone home to spend his last days there. He will always be special to me. My last tears were for him.
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