The Shift
One Nurse, Twelve Hours,
Four Patients' Lives

Theresa Brown
(Algonquin Books of Chapel Hill)

When we first looked into this, we found that we would be immersed in the hospital lives of four people in what they call the "heme/onc" part of the hospital. In other words, those who have cancer; in this case, either cancer of the body or of the blood.

Cancer. That very word that chills us to the bone, or --- considering that it might be the bone itself included --- might better be said, offers up the feel of the final chill. A sickness that may come from a fabled land all its own, with its own language, a lovely but lethal poetry: "Basal Kaposi," "Vulvar Lymphoma," "Squamous Malignant Glioma."

These long and complicated compounds suggest a mystery out of the far past, a mystery set by its very sound: Ependymoma, Papillomatosis, Histiocytoma, Astrocytomas, Macroglobulinemia, Rhabdomyosarcoma . . . and, perhaps, the monster of them all, Myeloproliferative Esthesioneuroblastoma.

Caring for patients with these maladies is Theresa's work, there in Pittsburgh, in one of its main hospitals. But, to take the edge off, she suggests that "while cancer used to always imply death, more often than not that's not true anymore."

    Now, cancer involves treatment and its accompaniments: chemotherapy, radiation, surgery, scans, clinic visits, and hospital stays. People survive, often.

And we get to be with her for the whole of her twelve hour shift, coming in fresh on the bicycle in the morning, leaving, weary at the end of the day, filled up to here with the demands of the hospital, the doctors, the patients. And herself.

So when I read the word "oncology," I thought, no, not that. The part of the hospital that we don't even want to get near, the one that we all would equate with the longest, most painful departures from this vale of tears --- the place where the body turns enemy to itself, where, so long ago, when I was allowed to deliver the daily newspaper, at St. Vincent's, the place where, always, the hallways seemed so mournful, the rooms the darkest, the odors with their peculiar bitter tinge, where, when as a boy delivering newspapers, I propped open the doors to the rooms and offered up the daily "Journal" and the patients would look up at me with an edgy indifference.

Except for Mr. Ward, who seemed to live there forever with his own private nurse, the man who would always greet me the most affectionately, and for my 5-cent newspaper, would tip me with a great silver standing-liberty fifty-cent piece, so that I soon went to his room the first thing in my shift, for the present that would pay for my whole afternoon's visit to St. Vincent's . . . until the day when I pushed open the door and the room lay there bright and brightly scrubbed, the bed vacant, the chair where his nurse always perched open and untouched, the vacancy of tomorrow, the quiet except for exhaust fans blowing on the roof nearby. The quiet, the bitter smell now gone.

§   §   §

In The Shift we get to know all of Ms Brown's patients, plus many of the old ones, those that cross her memory as we go through her day, like Mr. Hamilton, huddled down flat in his bed, seemingly indifferent, so the doctors order Rituxan for him --- a twelve hour infusion that, sometimes, instead of curing, manages to kill the patient. Brown seems to seek every distraction possible before sticking this in his arm, somehow convinced that he will die on her shift, for she, like all nurses, everywhere, wants to be sure that all are still alive and kicking at the end of her watch.

There are moments of fine writing here, on the oncology ward. Before she turned to nursing, Brown was an English teacher, with a love of the language and its poetry (would she find any of the words above to be onomatopoeiac?). So she speaks the music of the blood and the blood-pressure cuff, the music that she hears in her stethoscope, "It's the sound of blood flowing through thousands of miles of arteries and veins pumped by a heart that never rests."

Brown is a person who majored in English, so she learned how to build words and phrases. For instance, when the patient named Sheila develops a sharp, unusual intestinal pain, that the young intern finds himself reacting: "Could it be HIT," he says, half to himself. Brown tell us,

    He's talking about heparin-induced thrombodytopenia. People pronounce HIT like the word "hit," but I always think it should be "H-I-T" because that makes it sound a lot more serious.

    Hit is kids squabbling, but H-I-T, like HIV, is a disease.

And there are those times here when the author actually devolves into her earlier training, her English teacher mode. When faced with a new emergency, one that involves Sheila's upcoming operation, one that may leave her with a colostomy, one of the little bags to collect her leavings; but, at the same time, the operation also might leave her dead. For, as the doctor explains, "there is a twenty percent chance you won't survive this operation."

Choices in a hospital may leave you well or not so well or not there at all. Medical choices are matters of life or death. Rituxan can murder you in your bed. Sheila's operation for a perforated intestine may kill her on the operating table.

Which brings the author to recall another operation, one that turned up two hundred years ago, from a literary surgeon, William Blake, with an unusual cutting of words:

    To see a World in a Grain of Sand
    And a Heaven in a Wild Flower
    Hold Infinity in the palm of your hand
    And Eternity in an hour.

It is these moments of elegant discourse that can touch, touch deeply, the reader of The Shift.

§   §   §

The author may want to call this a memoir . . . just a day in the life of your workaday R.N. But the rest of us might consider it a piece of investigative journalism, details of tricks from the often murky world of hospitals, stuff that might be useful when the rest of us are forced into that particular lower circle of Dante. At the least, we think, this book may give us knowledge that is not usually available to the layman.

Such as halfway through her shift, where Brown finds herself thinking, "Does it have to be quite this hard?" Then telling us that "one in five nurses quits their first job within a year." Or the joke between nurses "at the change of shift [knowing] it was a good day because everyone was still breathing when I left."

Or, when she was a nursing student, meeting a man who had "come into the hospital for what was supposed to be a routine cardiac test and ended up with a new heart, the lower half of his right leg amputated, and toes dying on his still-intact left foot." (And my heart doctor wants to know why I still resist a "routine" chemically-induced stress test for my heart.)

Then there is the newest scare, as if we really needed a new scare, where we now find ourselves going into hospitals in order to get sick, sometimes very sick, because of what turns up on the floor, or in the air, or the nurses' hands, or on the doctors' --- why do they always want to shake hand with me? where have those hands been? --- or, even though they've just been throughly scrubbed, now knowing the floors might be teeming with "methicillin-resistant Staphylococcus aureus (MRSA), Vancomycin-resistant enterococcus (VRE), or Clostridium difficle."

§   §   §

"It's not rational that some of us who work in health care expect ourselves to be omniscient," she says. And she does have doubts, some that will not leave her alone. And surprises: when they finally inject Mr. Hamilton with the deadly Rituxan, he suddenly comes to life, sits up in the bed, talks with his buddies who have come to see him: a leukemia patient who has suddenly been returned to life for, despite her fears --- and our own --- hospitals can do and will return people to life, make them alive again. To die another day.

Finally, we must ask, why in god's name did Brown elect to go into nursing anyway? Just blame it on her twins. They arrived by way of a midwife, and after, she decided she wanted to be a midwife, then, later, a nurse.

She reports, "bringing two lives into the world in one day is not a small thing. It gave me a taste for the life-and-death struggles that are our daily bread in the hospital."

    Labor had started at four in the morning. After I got to the hospital and changed into a gown I stood in the bathroom, arms bent, palms against the wall, having a contraction that felt like it would rip my belly apart. Oh my God, how will I survive this, I wondered, but the labor was quick. After just three hours, out they came, four minutes apart: two little bald heads, four eyes and ears, two brains ready to learn about the world, two beating hearts.

--- Pamela Wylie
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