November 2003 Issue - Essay # 2
Choosing
to Care
By
Helen Keville
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There
are many reasons why women enter caring professions.
Like many social workers, I find it hard now to untangle my early
career decisions. It is
easier to explain my choices through the values I held at the time - my
strong sense of injustice at the way society treated disadvantaged
groups, and my desire to understand people who were living lives very
different to my own. But
values are pure and reality is complex, as my memories of one of my
first caring jobs shows. In the late 1970's, I took a job as an
unqualified nurse on a renal unit in an English hospital.
I had just finished my degree and had no idea if I wanted to be a
nurse. I just wanted to do
something useful. Renal
nursing, it turned out, required a level of technical expertise quite
beyond me. Dave the charge
nurse took me to see a dialysis machine not long after I arrived.
It was a white box, the size of a wardrobe, which hummed
constantly. Phillip, the
patient attached to it at the time, scarcely looked up as Dave pointed
to the transparent loops of plastic that took blood from a vein in
Phillip's leg into the machine and out again.
I
soon came to realise that Dave was deeply respected on the ward for his
knowledge of dialysis. Whenever
I call him up in my memory, he is peering at a machine, checking dials,
and making notes. Looking
back, I can see how much I was on the edge of everything.
I can't remember the name of the consultant in charge, or
listening to any detailed case discussions about the patients.
I received my instructions at a nurses' report at the start of
each shift, where I was treated as a useful spare pair of hands.
Over the next few weeks, I moved shyly around the patients,
taking pulses and filling in fluid charts. I was attentive but
undemanding, as I felt I had so few legitimate skills to offer. Besides,
renal patients were unexpectedly dynamic.
The only clue to their condition was the pallor of their skins -
always white, but grey or yellow on bad days.
Otherwise, they were young, mobile, articulate, able to debate
the implications of their latest blood chemistry results with the
doctors and each other. They
usually sat around a table in the middle of the ward, purposeful and in
charge, like a board of directors. There
was It
was a gathering of regulars, back to have reviews and adjustments to
their treatment. Other
patients, more recently diagnosed, were eavesdropping like me, to learn
about the life ahead of them. Arthur
was one. I noticed him
listening apprehensively from his bed at the other end of the ward.
He was in his early 60's, his kidneys in the final stages of
decline. He didn't ask many
questions, but amidst the continuous bustle of tests and results, he
waited patiently to hear when his treatment would begin. And perhaps that would have been it, the insight a 21 year-old wanted into how people lived their lives with a chronic illness. Except that one day, a staff nurse, her sense of vocation dented by a busy day, pointed out to me what was really happening. "Just think," she said, "all of these patients would be dead if it wasn't for us." After
that, I felt more deeply sucked more into the drama of it all, as I
touched people, whose physical grip on life was so tenuous, they needed
a complex operation of machines and technical expertise to recreate
kidneys that no longer worked. And
I knew I had grasped something important when, one day, the
resuscitation team suddenly thundered down the corridor and crowded
around At
the time, I was beginning to experience the work as baffling and
contradictory. Only now can
I see that caring relationships, like any other, are a struggle for
power. But I had more to
learn. The
patients in the middle of the ward were still talking about I
didn't realise what was happening until the initials 't.l.c.' slipped
into the nurses' report at the start of the next shift.
Nurses' black humour: 'tender loving care' -- gradually increasing
doses of morphine to numb and hasten the end.
As I was always on the outside, I don't know whether Arthur and
his family were ever told why he was being helped to die.
It seemed to me that only the staff knew he couldn't go on the
dialysis programme because, at 63, he was considered to be too old. In
his new room, out of sight of the others now, he still managed to sit by
the window for a few hours every day.
I found myself assigned to look after him, whenever I was on
duty. "Just make him
comfortable", Dave would say. Before
long, he was too exhausted to get out of bed at all.
As his kidneys continued to fail, his blood began to poison him
and the morphine was increased. A
glazed look came into his eyes and we stopped being able to understand
each other. I wasn't even on the ward when he died. I
did not stay long after that, but I still remember how shocked I was at
the rawness of Arthur’s death. Later,
I trained as a social work, and over the years that followed, I
continued to work in many more situations where there were too many
people in need and not enough money in the budget.
But although my early values have been frequently shaken and
challenged in a state system of care, they have not yet been destroyed,
and that is why I am able to continue doing this work.
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Author's Biography I
live in I have had articles published in social work and general magazines, but with two children, two part-time jobs and a life to lead, finding time to write just gets more difficult. I enjoy writing personal essays most of all. E-mail
Helen at hrkeville@hotmail.com
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Essay
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