Over my 40-year career, most of it spent caring for children with cancer, nurses were my companions and my mentors. Here’s a piece I wrote in praise of them.
What I Learned from Nurses
Barts Hospital, London, 1967: Oncology Internship
Staff waylays me in the intern’s office. “Have you thought of writing Jeffrey for opiates? He must get some relief—the radiation’s not helping.”
The eighteen-year-old’s bone cancer had spread from thigh to hips, then to his spine. I had had to bite my lip to suppress tears when I’d admitted him.
“I wasn’t sure I could. Might make it hard for them to tell if he’s responding. And I thought opiates were only for terminal patients.”
“It’ll be fine, John. Those doctors leave all that to you interns.”
She’s got caring eyes. And it’s the first time anyone’s used my Christian name.
“Thanks. I’m really worried about him.”
What if I find him dead in bed in the morning? I check the precise dose of morphine, embarrassed to quiz Staff, though I sense she’d be tactful towards my oh-so-fragile ego. I write for the smallest dose, but at her urging make it three times a day.
“So he won’t have to ask for it all the time.”
I hurry to check on Jeffrey next morning. He greets me before I can speak—with a grin. Something I’d never expected.
“Doc, that new medicine, the sweet-tastin’ one. It’s really ’elpin’. I got to sleep last night easy.”
“Great to hear, Jeffrey. Not feeling too sleepy, are you? No trouble breathing?”
“Nah. Even ate breakfast. And made it onto the bedpan!”
Ten day later, the senior resident announces Jeffrey is ready for discharge.
“Seems to be doing a lot better.”
Not just your rads, buddy. Wouldn’t explain his cheeriness and hearty appetite.
I write for five-hundred mls of morphine oral for home.
“Make sure you’ve got the exact dose, Jeffrey. Three times a day regularly—but no more. And bring this bottle to outpatients so they can fill your prescription.”
“Thanks, doc, I feel real chipper.”
I thought I was going to kill him with that stuff. Where would I be without Staff’s prompting—a lot more use than my bosses. As I sit down to write up Jeffrey’s discharge notes, I offer a prayer of thanks for Florence Nightingale’s daughters.
Jenny Lind Children’s Hospital, 1969: Pediatric Residency
The night nurse ruffles his curls. “One of your OR cases. Circs.”
“Don’t they do those at birth?”
“Much choosier nowadays. Only do the essential ones.”
I enter the OR at eight next morning. I’m the only possible surgeon in sight. I eye my scrubbed-in partner anointing the tiny penis with Betadine, encasing it in sterile green. She hands me a miniscule scalpel, then breaks the silence.
“Fear not, I’ve trained a few residents in my time.”
Nurses teaching doctors? Is this even legal?
I sense the smirk beneath her mask, spot wisps of white hair escaping beneath her cap. I’m ready to obey orders.
“Slit his foreskin open, doctor. Right here.”
I snip tentatively along the tiny pecker.
“Now push back with your fingers, so just the business end sticks out.”
Am I cutting into this mite’s future pleasure?
She plucks a diminutive plastic ring from her surgical arsenal.
“Just draw his foreskin over the top.” She guides my hesitant hands. “Tie this ligature to staunch the blood when you chop it off.”
Sweat trickles down my forehead as I tighten the suture. She hands me miniscule surgical scissors.
“Now for the coup de grace! Lop it off!”
The tiny integument plops into her waiting basin. She cocoons the remaining member in bandage.
“Well done, doctor!”
“Can’t claim much credit.”
“Nonsense! See one, do one, teach one. You’ll be a pro in no time.”
Shands Children’s Hospital, Florida, 2007:
My beeper buzzes as I’m finishing rounds: Cendra, my new hospice nurse.
“I’m at Marie’s house. The little one with the brain tumor. Her headache’s worsening. I need a stat order to up her morphine.”
This has to be a first: ordering IV narcotics by phone to my hospice nurse from fifty-odd miles away.
“What’s she on?”
“2mg every four—I want to go straight to 3.”
“Agreed, and another milligram in ten minutes if need be.”
Thirty minutes later, another buzz.
“She’s still writhing. Can I up it some more?”
“What weight is she?”
“Just over 15 kg.”
The usual dose is 0.1mg/kg, so we’re already at over twice normal. But Marie’s been fading fast, and on my last visit her parents were more than ready to let go.
“Go with 4 mg, and another 2 every thirty.”
“The local pharmacy’s only got one IV dose left. A van’s coming from Shands with supplies.”
“I’ll be with you in twenty minutes. 5mg every ten till then.”
When I get there, Marie is gone. Mom cradles her in her arms while Dad and Cendra hold Mom between them. Cendra looks weary but calm.
“It was peaceful at the end, John.”
I reflect that between us we’d brought this little girl’s life to a quite intentional end. But it was Cendra who had done the heavy lifting.
Nurses, for forty years you were my mentors and my companions. Thank you, all of you.