The pretty nurse

Published by pam on Sat, 07/14/2012 - 12:11am


When I was in the third grade, I changed schools.  I changed schools a lot - most ever year.  So for me, most every new school year was a blank slate.  I knew nothing about lunchroom protocol or playground rules. I had no way to know who could be trusted and who couldn't.  And the teachers?  I didn't know which one was hard or mean or fun.  


I had my routine.  On the first day, I walked the halls until I found my my grade.  I looked inside each of the rooms, scanning the decorations, the desk arrangements, and the teachers.  When I decided which teacher I wanted, I crossed my fingers and searched the list posted outside her room hoping to find my name.  I always wanted the pretty teacher, the young one, the one with nice hair, the one who looked nothing like Miss Minchin.  Remember Miss Minchin?  She was scary.  No one wanted the teacher who looked like Miss Minchin.  


The pretty teacher would be nice.  She would give out popsicles and do art projects.  She would read books read out loud.  Books I would never forget.  


Only once did get the pretty teacher.  It was the third grade.  That summer, we moved into a new house with a view of lake Washington.  It had apple trees and a big yard.  But there were no kids on the street, no one to teach me the ropes.  On the first day of school, I stood outside the three third grade classrooms and studied the teacher possibilities.   There was no contest.  I knew what teacher I wanted.  Mrs. Schauber.  She had long hair just like That Girl.  She was wearing an a cute dress.  She was young.  Her first name was Pam.    And there on the list outside her door, I found my name, third from the bottom.  Mrs. Schubert was going to be my teacher.  It was going to be a very good year.  I just knew it.  


But it wasn't a very good year.  I was a terrible year.  A terrible, horrible, nasty, no good year.  The woman was a tyrant, much worse than Miss Minchin.  She was fired shortly after I completed the third grade - right about the time my facial tic went away.  


That's  not a joke.  Around february, i developed a facial tic.  Concerned, my mother - who was also a teacher - spent an afternoon observing the class.  She later told me I wasn't the only one with a tic.  She counted at least five.  


It was a horrible year.  But at least I wasn't the girl who was forced to sit in her seat until she peed.  Really.  The girl's name was Joy, but I doubt here was much joy for her that year.  Mrs. Schauber liked her even less than she like me.  And Joy had a bladder problem.


Never again did I get 'the pretty teacher'.  And I didn't care.  I learned a lot that year.  I learned  sometimes life isn't fair.  I learned thatcher are times when adults just don't understand.  But mostly , I learned that you cannot judge a book by its cover.  Pretty on the outside is not the same as pretty on the inside.


Some lessons you never forget.  Others, not so much.


Today was chemo, and just in case you think you can see where this story is going, I should say, at no point did I pee in my chair.  Even with all the water I drink on chemo days, there was no inappropriate peeing.   Sorry.   If you are the kind of reader who thrives on the embarrassment of the protagonist, this is not the post for you.  


But I did get the pretty nurse. 


Week after week, I watched her walk the hall.  She looked interesting and athletic.  She looked as though she'd have a lot to say and and as if she saw a narrative in nursing, a purpose.  So many of the nurses are kind, but the conversations are a little simple.  Predictable.  And its too bad.  This is a time that brings a lot to the surface in people.  I know many of these nurses have seen amazing things in their patients - good and bad, profound and terrifying.  They have seen people exhibit  unimaginable strength, the strength it takes to save their own lives.  And the strength it takes to let them go.  I could learn so much from them. I want to.  But mostly the conversations are flat.  I press a little, but rarely does anything progress past weather and children.  


Today, I got the pretty nurse.  Today, I thought it might be different.  


Every morning begins with a blood draw.  Before I can be infused with highly toxic chemicals, the oncologist must make sure that my immune system can handle it.  Hence the blood draw.   Red cells and white cells, platelets and lymphocytes,  everything must be in order.  For some reason, I always sit in the same stall.  I get one of three nurses, and they've all been charming, but not exactly lookers.  


Today, as I walk into the lab, I see the curtain of my usual stall is closed and I am lead to the end of the room. And I am met by the pretty nurse.  I forget the lessons of the past.  I feel lucky.  I got the pretty nurse.  But things don't start off well.  


The pretty nurse is flustered, she's just arrived for work.  I watch her second guess herself, which, of course, makes me do the same.  She takes out the port access kit, does it look different?  Wrong?  It does, but it is entirely possible I wasn't looking before.  Why would I?  I was too busy chatting.  Not this time. Maybe it's nothing.  I think back.  Did she sanitize her hands.  All the others sanitized their hands.  I am being paranoid, I tell myself.  I ask a few questions.  I try to start a conversation.  I try take my mind of the feeling that things are about to go wrong.  All of the others have welcomed the conversation.  They get my jokes anddoes joke back. In minutes those nurses, who didn't seem so 'pretty' when they called my name from the end of the the hall, transform before my eyes as I come to appreciate their sparkling eyes and warm, broad smiles.



The pretty nurse transforms, but in the opposite direction.  She starts to scare me.   My questions confuse her.  I am puzzle in her eyes, a puzzle with all the wrong pieces.  There are no smiles.  There is no sparkle.  



I decide it is best not to start a conversation with this woman.  She struggles to track me and what she is doing.


There is no smiling. And the shots hurt.  They never hurt.  Sometimes they're so painless I don't even notice them.  Today they stung.  Which does not seem like a very good sign.  


What else was about to go wrong?


Everyone is late, for one thing.  Really late.  My oncologist just returned from surgery (his own).  I discover he will be seeing three days worth of patients in one day.  Even though he is more than an hour late for my appointment, not once does he rush me through my list of questions.  He answers them, he jokes a bit, he tells me how great things are going.  He gives me lots of good news.  He shows off the casual jogging pants his wife bought him at Target.  He's never had such pants before, but his usual trousers won't work, post surgery. Neither will dress shoes.  He's wearing sneakers.  He's never worn sneakers to work before.  He's looking  down right sporty.   All the better for racing between offices, I tell him.  He's going to need all the stealth he can muster to make it through the day.  


My red counts are down.  There may be transfusions in my future.  Transfusions? He tells me they are going to do an extra blood test to make sure my kidney is producing enough erythropoietin.  Erythropoietin stimulates the bone marrow to make red blood cells. Most likely the drop in my red blood cells is due to the chemo, but there is a chance is is something more.  


When we finish, he gives me my GOOD TO GO pass for chemo - yes, that's what the pink slip of paper says - GOOD TO GO, like I'm a piece of luggage certified by inspector #37.  I know our time together has made him just a little bit later for his next patient.  But he doesn't seem to mind.  Each patient is worth it, or at least that's how he makes each one of us feel.


His patient back up is reflected upstairs in the Treatment Center.  I still hate calling it the Treatment Center.  A Treatment Center is where they took McMurphy in One Flew Over the CooCoo's Nest.  It is a euphemism that implies lies are necessary to protect us all from a gruesome truth.  But there is no gruesome truth behind those doors.  There is more hope than horror.   


I call it the Chemo Floor.   What happens here is medicinal, not barbaric.  And quite often it works, restoring life, where otherwise there would be only painful death.  


The room is empty, but it won't be for long.  Soon every chair is full.  There aren't enough nurses to handle the sudden onslaught, nor can the pharmacy handle the backup.  Everyone is rushed. There will be no long conversations today.  Better to make sure the nurses are focused on dosages and data entry.  Today is the kind of day when mistakes are made.


First there are premeds - Benadryl and Pepsid.  Then there are more premeds - Aloxi and Decadron.  These are intravenous and are given one after the other over the course of about an hour.  When they are finished, we wait for the pharmacy to catch up.  Finally,  the herceptin arrives.  It is given along with some saline.  The infusion takes another hour.  Meanwhile, I am chugging water.  Chemo is hard on the kidneys.  You want to flush it through as well as possible.  I drink 16 ounces every two hours.  And I pee a lot.  But not in my chair.  


Shortly after the hlast of the herceptin is flushed from the bag intro me, the taxol arrives.  The taxol infusion will take another hour.  If all goes well, we will be on the 3:00 ferry home.  Usually, we are out in time to catch the 1:10.  And there is no rush to catch 1:10, there is always plenty of time.  But not today.   Today is a day of gremlins.  Little things keep going wrong.  Like the puddle that is collecting beside my chair.  There is slow drip coming from the infusion machine.  This is not good.  


It takes two nurses to identify the source.  Luckily, it is nothing serious.  The eruption isn't from the chemo bag, as everyone fears.  Rather there is a crack in the connection leading to the saline bag.  Another half an hour and everything is fixed.  But now our ferry timing is tight.  We were up early (5:30) and the day is getting long.  


The delay does give me time to chat with the nurse.  I find out her husband is a competitive body builder and that she has been a chemo nurse for a very long time.  She spent the first eleven years of her career working the night shift on the chemo floor in the hospital. She tells me the work was demanding.  Her patients we sick.  Very sick.  The hardest part was training new nurses only to see them leave, unable to handle the emotional stress of the job.  A lot of patients on the chemo floor don't get better and not every nurse is cut out for the work.  But she loved it and I could see why.  She is strong and pragmatic, the kind of woman who single handedly guides her village through a famine never losing a soul.  This nurse inspires confidence.  She is pretty from the inside out.


Will I remember the lesson this time?


She knows we have a ferry to catch and hurries to get us out the door just in time.  Ryann and I rush down to the car.  We don't need to rush.  We have 30 minutes.  That's plenty of time to catch the 3:00.  


Only it isn't.  There is an extraordinarily long line in the parking lot.  The line of cars goes up the ramp and around the corner, ending who knows where.  We wait and wait and wait as the line goes nowhere.  


That ferry, the one we have 30 minutes to catch, it is looking much less likely.  


Gremlins.  There are gremlins everywhere.  


It takes us 20 minutes to get out of the parking lot exit.  We discover there had been an accident right in front of the pay stall and it took all this time to clear the disabled vehicle.  


We have 10 minutes to get down the hill to the ferry.  Just long enough to give us the illusion that it might just be possible to make it.  Unlikely but possibly.   Every missed light, every slow driver, every indecisive lane changer makes the journey infinitely more stressful.  


The ferry could be late, we tell each other.  Enough things have gone wrong today..  Maybe this one thing will go right.  Maybe the ferry will be just a few minutes late.


It is late, but not late enough.  We miss the boat by two minutes.  It is a fitting end to the day.  I tell myself I should be grateful we suffered annoyances and nothing more.


It isn't until I get home that I begin to wonder about that blood test and what the oncologist might not have said.  Googling makes it worse.  Googling gives me just enough knowledge to make me wonder if there isn't one more gremlin left.  A bigger one.  One with muscle.


Failing kidneys stop producing erythropoietin.  And they don't start again.  


With cancer, it's always something.   Even when it isn't.







Ted and I just returned from a week in Maine at daughter Katherine's where we all convened for a family gathering.  Even our son who works in Ecuador came. It was rich.
I read your latest posting.  Your reflections remind us to acknowledge and appreciate the good moments in each day.  Thank you for that. 
I think of you often, particularly as I row past your property early in the morning.  Now that we are back, perhaps we can take a row - or go for a walk? 
Much love.
PS. Why DID your parents move so often?????

I'll bet it was beautiful as it usually is this time of year.  I am always up for a walk.  I have been trying to get ou t twice a day these days. I'll try emailing you directly to see if we can set up a time.

"The Pretty Nurse" is so beautifully written and engaging that you can hardly be worried about the chemo affecting your mind, I'd think (a concern you expressed earlier). Thanks so much for taking the time to write these posts. And we are so glad that your treatment is as close as it is to complete.

Hope all is well.  Thanks for not pointing out all the typos in the blog post.  This particular blog tool is unbelievably difficult to edit, so while my chemo brain might not be that bad, it often appears so because of all the typo or uncorrected editorial mistakes.  But, I tell myself that frustration is hazardous to my health and hope people wont mind s few incongruous tense or grossly misspelled words.
Give everyone our best.  Miller and I will be in NY in february.  Hopefully we wil have a chance to reconnect then.

Pam, your father's concern led me to your blog.  I am left emotionally moved by your acuman into your personal experience with cancer and it's treatment.  It warms me to share your experince and feel your victories when challenged by such a  threatening foe.  You've treated each episode of your journey as a venture, almost a gift , viewing it objectively with amazing courage, insight, humor and grace.
Who would be as brave examining all of this through a young mother's eyes. 
You give strength and encouragement to all who read these pages.  Thank you.
You are in my heart and in my prayers.
Sincerely, Dana England

Hey Pam, remember when we worked together at MS all those years ago? Sorry to hear about your health issues, I'm glad it sounds like you are thru the worst of the treatment.
Bryan Ballinger

Even though it's been a LONG  time.  Hope all is well with you.  I'm guessing you have a family by now.  How in the heck did you find me anyway?

I love your work Pam. You are a really talented writer and a highly motivated individual.
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