Friday, March 09, 2007

Cubicles, Nurses, and the Passing of Days

We all sit at our desks---solitary figures reviewing care plans, writing notes, answering calls, reading emails. Occasional jokes and conversations break the spell---often by the mailboxes or fax machine, or literally at the water cooler---but then the conversers return to their pens to continue their many tasks. Douglas Coupland, author of Generation X, coined the term "veal-fattening pens" for these cubicles where so many workers spend their days. My own pen sits in a corner, catching some glints of sun as the shadows and light play outside the windows.

Around 3pm, the sounds of children heading home from the school across the street envelop the office. Sometimes fights break out in the park and we call the police. We don't like to get involved, since the protagonists may be among those who occasionally break our windows during the weekends. Kids bang on our door and tap on the glass as they walk by, the ground strewn with candy wrappers, soda bottles, and discarded homework. I try not to leave the office to do home visits between 2:45 and 3:30 due to the massive armada of school buses that jam the city's roads, stanching the flow of traffic like so many errant thrombi.

Sometimes I'm struck by our solitude---even when surrounded by colleagues---as we go about our tasks. Each of us has our seventy to eighty patients to watch over and care for, the demands of which can at times be staggering. You never know when it will be your turn to have a day when all hell breaks loose, and it feels as if you're losing your mind. Those of us who are more tuned in to one another's struggles will reach out a helping hand at such times, the offer of which is like balm to the spirit of the afflicted nurse.

An almost surrealistic image comes to mind: a room filled with worker-nurses toils away silently and efficiently. Suddenly, one of the formerly silent workers breaks into a Saint Vitus's Dance of activity and stress. Hands gesticulate and limbs quake as sweating and shaking commence. The nurse under fire is momentarily stunned with stress as one patient crashes and burns in a cataclysm of drug abuse as another is rushed to the emergency room with chest pain. Meanwhile, the patient for whom the nurse has painstakingly arranged a liver biopsy and cholecystectomy simply decided she would rather go to the mall, blowing off the biopsy. The surgeon---who scheduled with this patient as a professional favor to the nurse in question---is on the phone, furious, spewing venom across the phone line. Another patient walks into the office and may very well have active pertussis, and there's a pregnant patient in the waiting room. What to do?

Even if one does not actually help the nurse who is now in full-fledged panic, a hand on the shoulder or comforting word can go a long way. Sometimes an offer of help can be a god-send. "Would you really be willing to fill these syringes for me? You can't even imagine how helpful that would be!" The gratitude for such small favors can seem out of proportion to the actual assistance rendered, but the magic is not in how much help is received, but in the receiving itself.

An emotional weather report of the office environs can differ from hour to hour. At times, the mood is stable, the activity subdued, with nary a ringing phone. Then, a tumult of activity and sound begins as if on cue from some off-stage director, and one can almost hear the cymbals crashing and the brass section welling up in a crescendo from the orchestra pit as the tension rises like a wave through the room. And again, relative quiet before the next surge.

There is a poetry to the comings and goings of the day. There is also a ballet of movement, perhaps more often like modern dance, disjointed and disorienting. If a video camera was positioned on the ceiling for a week, I wonder what we would see in the patterns of movement in the office. Come to think of it, if we recorded the sounds of the office for a week, what patterns of sound would we hear, what music of stress would we create and record? What cacophony would result? God only knows.

Friday evening at home, it's easy to wax poetic about the vicissitudes of the workweek. But in the midst of the storm, it is anything but creative--it is simply survival. Peace of mind is often at a premium in our line of work, and one can always worry about the toll being taken on one's body and mind and spirit. The sacrifices are many, as are the rewards. And here's to one more Friday evening when we have lived to tell the tale.
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