I am in my first month of nursing school. It is the early 70s and this is a three-year program, hospital-based, all practical training. It is my first day in my first ward: the burn unit. A young man, badly burned, must be lowered into the debridement tank. [Debridement /dɨˈbriːdmənt/: the medical removal of dead, damaged, or infected tissue to improve the healing potential of the remaining healthy tissue.] Before that happens I have to remove his bandages. And before that happens I have to inject him with morphine because the pain of bandage-removal and tank-debridement is unbearable. I am 17 years old, a barely-formed human, and must plunge a needle into the flesh of a burned and shaking young man. I have practiced on an orange in a classroom. The smell of burnt flesh is terrible. He screams and my knees buckle. His bandages come off somehow. He is lifted into the tank somehow as he screams.
A medical ward, in the morning: Many patients here have what we are calling senile dementia. An old man weeps in his bed. His dog is hungry, he tells me. He wants to give his eggs to his dog. I place his plate of eggs on the floor. The man is elated and speaks to his invisible dog. I am reprimanded by an instructor.
The orthopedic floor, at night: The hospital’s top orthopedic surgeon has been in a car accident, has been broken into pieces and casted up to his neck. The nurses warn us that he is a sundowner who escapes from bed and has to be restrained. It’s true: I see the white rigid figure, a scarecrow ghost, stumping up the dark hall, a sheet flowing behind him. He is subdued by an orderly.
Pediatrics, on a Saturday: Failure to Thrive is the diagnosis for the children who stay small, don’t grow, turn away from the world. Hector has been followed by a young resident for months and is starting to grow and smile. Now the resident is doing the paperwork to adopt him.
Nursery orientation: A crib in the corner is blocked off by a curtain. A sign says Do Not Feed. I am told it is Down syndrome, “most likely with complications.”
Second year of nursing school: We are living for 12 weeks in an outbuilding of the last state asylum in the area. The grounds are vast and deep green. The buildings are crumbling Gothic on the outside and fluorescent inside. Madness and circumstance and arrested development are jumbled together, old chronics and hallucinating teenagers. John, 17, chain-smokes and rocks and tells me about the helicopters. He bats them away, screaming, and dives under the table.
The asylum: Marie loves me. She runs at me when I come to work. She is twice my size and age, wears a torn flowered dress, laughs at full volume. She has Down syndrome. She links her arm through mine and we go outside to the parking lot. A police patrol car pulls up. Marie snaps off the car’s antenna in one swift motion. The policeman is furious but helpless. I shrug, Marie laughs.
The asylum: My friend Carleen borrows a convertible and we try to escape to the beach. The car breaks down on Route 9 and we hitchhike back to the asylum.
The asylum: The staff tells me not to talk to the patients with dementia because it will only encourage them.
Third year, back at the city hospital, in the private psych ward: Much nicer, with carpets and chairs and an overabundance of staff. A young teen with what we are calling manic depression shuts me into her room and sings out a hundred thousand words and a hundred identities all at once. The purple circles under her eyes are enormous. She is Cher, a dancer, a doll with a thousand outfits, a radio.
Emergency Room: A motor vehicle accident. Mad with cocaine, a driver has wedged his sports car under a semi on the interstate. Partial (mostly complete) decapitation.
Emergency Room: A knife fight between two women who, after they are admitted, discover that their beds are only a curtain’s breadth apart. A skinny man, the object of their fight, tries to separate them.
Emergency Room: A slow Sunday night in the break room. A resident asks me if I’m really reading the New York Times Book Review or just pretending to. I’m not really sure.
Operating Room: A surgeon throws something heavy at me because I’ve handed him the wrong suture material. Another surgeon, three times my age, propositions me after I’ve tied the back of his surgical gown.
Operating Room: A breast is sliced off before my eyes.
The public mental health clinic is across the street from our dorm. There are always people milling out in front. I have the phone number and am always on the verge of calling from the phone booth on my floor to have myself checked out or possibly committed. Time and space will not stop collapsing into each other.
We are not allowed to turn left when we leave the dorm, for we will be mugged. We must turn right, must always go out in groups, must return before 11:00 when the doors are locked. But we find a tunnel from the hospital to the dorm and slither under the cameras when we’ve missed curfew.
My first job as an RN: A coronary intensive care unit in a different city. My first CPR on a living person: I feel the ribs of an old woman crumble under the force of my palms. (This feeling stays with me my whole life.) She doesn’t survive. Not because I have broken her ribs, people assure me.
CCU: We call for the portable x-ray machine at all hours. The x-rays must fly everywhere, for the bed units are separated only by thin curtains. The rate of miscarriage among my co-workers is very high.
CCU: We smoke in the hallway at night, writing up charts while the patients are sleeping.
CCU: It is a Catholic hospital. “Amazing Grace” plays on the intercom every night at 10. Some nurses kneel when a priest enters the elevator. The head physician of the Respiratory Care Unit next to us refuses all thoughts of terminating care for a non-responsive intubated aged woman whose back ulcers now reveal spinal bone. Her family pleads with him.
CCU: We have shocked a man a dozen times and can’t get him back. I hold his hand while he dies. It is warm and soft.
CCU: The cowboy cardiologists sneak in at night to try new meds or procedures on their patients. They beg or bully the night nurses not to tell.
CCU: The local Gypsy King is a patient. Visitors fill the waiting room and the hallways. When they are ushered out, they fill the parking lot outside his room, looking up at his window, and then leak slowly back into the hospital and into the waiting room and hallways. He survives.
CCU: Half of my male co-workers come out and move to San Francisco.
CCU: A Puerto Rican patriarch is a patient. Visitors fill the waiting room and the hallways. There is a language barrier. What sound like threats might be questions or requests. Mother-aged women weep in different voices. He takes a bad turn, punches are thrown. He survives, is moved, the halls empty.
A different city, where I have enrolled in my first two college courses: A temp agency calls at 5 a.m. to direct me to a CCU. It is being renovated. Sheets of plastic cover everything and I can’t find anything. I am still a half-formed human.
Another call from the temp agency, a different CCU: A patient has had most of his aorta replaced with tubing that looks like a vacuum cleaner hose. (I am shown a sample.) I must prevent him from kinking it at all costs.
A locked adolescent psychiatric ward in a different city where I am now a full-time college student on a scholarship: Anorexic girls must be weighed in their hospital gowns on the industrial scale in the basement before breakfast. I am to accompany them and to check for hidden ballast.
Psych ward, night shift: The teens are restless at bedtime. I have them lie down in the hallway, side by side, while I hypnotize them with deep-breathing exercises. They sleep.
Psych ward, night shift: The attending psychiatrist is named Dr. Organ. This is not lost on the teens.
Psych ward, night shift: Half of my teens are victims of incest. We don’t say “victims.” We don’t know what to say. Three brothers come in at once, and their intake charts haunt me. This feeling stays with me my whole life.
Psych ward, night shift: A troubled boy has pushed his grandmother down a flight of stairs. We have three weeks to assess this behavior and determine his fate. Same with the troubled girl who has threatened her teacher.
Psych ward, night shift: The temporary diagnosis for every patient is Adolescent Adjustment Reaction. A violent boy asks me if it means adjusting to the fucked-up lying world of adults. It does.
CCU in another city where I am now in graduate school: The nurses are wonderful, almost to a person. I can hardly believe it. And when the doctors aren’t wonderful the nurses take note.
CCU, night shift: A code blue runs for hours, we open the man’s chest and do internal heart massage, he is purple and occasionally opens his eyes, to our horror. He has been a dead man for hours, I think. He survives and is discharged, intact, the following week.
CCU: A drunk man has fallen out of his boat and inhaled the contents of the bottom of a lake. We suction sand and grass out of his lungs for weeks.
CCU, night shift: A patient who is clearly used to giving orders asks me why I am bothering with a book written 600 years ago. (It is The Canterbury Tales.) I say something about the past being the present, or the present being the past. She takes it in, but hopes I am not planning to abandon a practical nursing career.
CCU, night shift: A man is bleeding out and we are trying to stop it. I am up to my elbows in his body fluids. I can’t see how he will survive, but I am not about to give up. In the morning at home I reread an assigned essay on the social construction of the body. Betadine and blood are under my fingernails.
CCU, night shift: We think a woman’s aorta is dissecting [Aortic dissection: a potentially fatal tear in the aorta’s inner wall which causes blood to flow between the wall’s layers, forcing them apart; a surgical emergency associated with severe pain described as “tearing” in character], but the doctor on call doesn’t agree, or doesn’t know what to do, or is just frozen in fear. The woman is in terrible, terrible pain. He won’t let us give her morphine because he’s afraid it will drop her blood pressure. He seems to have a vague hope that a cardiovascular surgeon and an operating suite will somehow materialize. The woman dies in the morning, in terrible pain.
CCU, night shift: A house painter who cut himself now has full-blown tetanus and is on a ventilator. We have paralyzed his diaphragm with curare to override the muscle spasms, and so we must fog his mind with a cocktail of drugs. We take excellent care of his body and read to him when we can. If the unit gets busy we play audiotapes for him, mostly about American history. Weeks later when the tetanus has run its course and we wake him up, he is convinced that FDR is president. Otherwise, he is fine.
CCU: I am informed that the man who bled out and died has tested positive for HIV. I am advised to add condoms to my preferred form of birth control until further testing is conducted.
CCU, night shift: A man in his 80s has pneumonia and is doing poorly. He and his wife have agreed that no excessive measures should be taken to prolong his life. I talk with him long into the night, as I do with patients whose efforts at sleep are no match for the rhythms of the CCU. He is a former professor of mathematics. His work has been important, even paradigm-changing. He likes that I am getting a PhD in English, he likes what he thinks is my erudition. On the second night a buried story comes out of him and it makes him weep. We have been talking about historical change and the subtle changes in moral values that it brings. He tells me that he is a living example. That he had gone to college in New Orleans in the 20s, that he had been witness to a lynching, that he had believed, with the other whites in that satanic mob, that lynching was a regrettable but necessary measure of law and order, a threat and a warning to all blacks visited upon the body of one. He shakes his head, over and over, and says he can’t believe he was a part of that. The next night I learn that he has died. I attend his funeral in the campus chapel. It is packed with scholars and admirers who deliver eulogy after eulogy.
CCU, my final week as a practicing RN: I am informed that the second HIV test has come back negative. The first result was a false positive, probably due to the terrible trauma visited upon my patient by still-unknown forces.
–Janet Lyon is an English professor at Penn State University, where she also directs the Disability Studies minor.