Into the light: the post-"asylum" experience — 3

Here are Parts One and Two.

Psychiatry as it was practiced in the cheerful bright wing on the fourth floor of the Montreal General Hospital was, to quote myself, "leaping ahead by a couple of centuries" from our experience at the Verdun Protestant Hospital. I'm pretty sure there's been another great leap ahead since then but at least at the time, we felt we had very much moved into modern day.

My most vivid memories of the fourth floor are not so much the dramatic treatments still in use — electro-convulsive therapy (ECT) and insulin shock therapy — but the relaxed atmosphere and the emphasis on talking. The patients weren't nearly as ill as the patients in the Verdun and individual psycho-therapy and group therapy were widely used. A lot of the therapy was private between the patient and her psychiatrist but we got to sit in on certain group therapy sessions and it was endlessly fascinating.

We were also encouraged to sit and talk with our patients as much as possible and they really meant it in this case. In theory, we were supposed to talk to our patients on our other floors but in practice, we never felt quite comfortable with that. We felt there were more points to be scored by looking busy even if we had to invent extra tasks.

But on the fourth floor, talking — listening really — and taking and recording copious notes, were both expected and evaluated. Many of the patients, suffering from what is now known as bi-polar disorder (known then as manic-depressive disorder), depression and schizophrenia were often pleasant and good conversationalists. Our notes were expected to be detailed, reporting dialogue, facial expressions, hand gestures — we were to paint a word picture so a psychiatrist reading it would feel all aspects of our encounters.

Our patients also were prescribed lots and lots of drugs. Many of the psychiatric drugs were in their infancy so much of our job was also to watch what happened after the drugs were administered — behaviour, thought and speech patterns, side effects.

I have specific memories of only a few patients; the great majority have become anonymous beings that I remember only as treatments or as room locations. One of the patients I do remember was a 17-year-old boy, a very smart boy who was bi-polar and who was barely in control when he was manic but who also spent whole days in bed. It was always very mysterious to see a brain working two very different occupations.

Even though the listening and the talking and the writing are the most memorable, most of our patients also were treated with ECT and insulin and these were major events in our nursing week. Both these treatments were labour-intensive for the nursing staff, in the preparation stage, at the height of the treatment and probably most importantly, bringing our patients back from a sometimes terrifying trip. After ECT particularly, the patient's memory would be mostly gone with even the simplest functions forgotten as the brain waves had been zapped and fragmented with the electric shock. The patients were also usually sore after having had violent seizures. It took days to recover.

Following the insulin, they were often sick and disoriented.

My goodness. What they went through all just to try to feel somewhat normal and to be able to function out in the world.

The treatment I haven't mentioned, which in fact I only encountered once, was the lobotomy — a procedure almost too painful to think about.

The purpose of the operation was to reduce the symptoms of mental disorder, and it was recognized that this was accomplished at the expense of a person's personality and intellect. . . Following the operation, spontaneity, responsiveness, self-awareness and self-control were reduced. Activity was replaced by inertia, and people were left emotionally blunted and restricted in their intellectual range.

The woman I saw who had had a lobotomy appeared to me to be simply a shell, looking straight ahead out of empty eyes, not reacting to anything around her. No one knew quite what to say.

There was a very dramatic incident during my time on the fourth floor. We had a patient who was suffering severe post-partum depression. She had spoken not a word since the birth of her baby and was non-reactive to everything around her. She was admitted because she was considered a severe danger to herself and was on high suicide alert. This meant that anything that could cause any harm was removed from the room and someone popped into her room every 10 minutes or so.

Shortly after one of the routine checks, there was a mighty crash from her room. Now you have to remember, this was a woman who hadn't spoken or moved or reacted to anything in weeks. This crash was unfathomable.

But apparently, someone had left a heavy glass ashtray in her room.

That is thick glass and it must have taken superhuman strength to hurl it with such force that it broke on the tile floor. But break it did and by the time staff reached her room, she had used a piece of the glass to cut her wrist and was bleeding heavily. Staff sprang into action, got the material needed to stop the bleeding, called emergency and within a very short time a stretcher arrived and she was taken down to the emergency department where she was met by a team to deal with all aspects of the care that was needed.

As far as I know, she survived and I've always hoped that she defeated the post-partum depression and was able to enjoy her family and the new baby.

Anxiety, panic, drama: life in the operating room (2)

You can read part one right here.

Operations were always scheduled in advance unless there was an emergency which didn't seem to happen as often as you might think. A GI bleed, a perforated appendix, a patient from Casualty who may have come in after an accident — these are the types of cases that weren't planned ahead.

I had gone back to sleeping at night and managing with my OR routines. As we all realized at some point, the operating room bosses had nothing invested in us and it was as if our operating room experience had been divorced from the rest of our quite intense training. I've thought about it some in the years since and my theory is that if a student showed interest and aptitude, the powers-that-be would lavish attention on her and prepare her for induction into their exclusive club.

As for the rest of us, we would put in our time and meanwhile, we'd be assigned lots of cleaning jobs. There definitely were times when we thought we'd joined the housekeeping staff.

And then one day, about two weeks in, I checked the next day's schedule on my way off-duty and there was my name: scrub nurse. My surgeon was Dr. Harry Scott, already well-known just for being interesting and flamboyant, not yet a legend for being a pioneer in cardio-vascular surgery — specifically, open-heart surgery.

Don't worry. I wasn't going to scrub for open-heart surgery! Dr. Scott must have still been doing some general surgery; I don't remember what the operation was but I think it was fairly routine.

It was my first time as scrub nurse but not my last so I don't have specific memories of getting ready for that one. This time, of course, I had the circulating nurse working for me and it was a whole set of new experiences to be the one being dressed and masked.

The scrub nurse put on her own gloves. When the circulating nurse opened the cotton packet, the gloves were lying on their backs, palms up. The wrists were folded back a couple of inches. With your bare right hand, you held the left-hand glove by the fold, touching only the inside of the glove and pulled it on — leaving it folded. With your gloved left hand, you slid your fingers under the fold on the right glove touching only the outside of the glove and pulled it on. With sterile fingers on both hands, you then flipped the fold up over your wrists and voilà — gloves on both hands whose outsides have not been contaminated! Aren't you glad I told you how to do that?

I do remember the intensity and the focus required while getting the instruments ready with the circulating nurse. And then getting ready for the surgeon.

The surgeon came into the theatre gowned and masked and scrubbed but not gloved. I just described to you in a short paragraph how to get those sterile gloves on without contaminating the outside but for some reason, this was not taught in medical school. The surgeon's gloves were put on to his hands by the scrub nurse. As she was already wearing her sterile gloves, she could pick his up, stretch out the opening, point the fingers to the floor and he would lower his hand into the glove.

You may have noticed I've said nothing about the patient in all of this. The truth is, the patient — the reason we were all there — was not prominent in our preparations. At this point, the patient was heavily sedated and was the responsibility of the anaesthetist. All we did was prepare and lay down the drapery that would render the patient even more anonymous than s/he already was.

When we were ready to start that morning, Dr. Scott asked me my name. We can only see each other's eyes in this situation but he at least recognized that he didn't know me. I told him — "Miss" of course. There were no first names in the hospital, ever.

The operation started and it really is much like you've seen in the movies. The surgeon puts out his hand and you're expected to know what to put into it. The scalpel first and then, for a few minutes it gets really tense, as controlling the bleeding becomes the prime focus.

"Forceps. Gauze. Gauze. Gauze. A little more gauze."

(If you listen carefully, you might hear the voices of Mike Nichols and Elaine May.)

Once the bleeding was under control and the surgeon was working away, he would often relax a bit. In my first case, Dr. Scott asked me where I was from. New Brunswick, I said. We continued, handing the instruments back and forth. The circulating nurse and I did the count that always followed the first round of bleeding — scalpel blades, forceps, bloody sponges. They were all placed in a basin nearby — more counts to come.

When we settled back into the operation, Dr. Scott said, "Do you know where Harvey Station is?" "Yes, I do," said I. "Then you're definitely from New Brunswick!" he said, quite gleefully. I thought he said he had been born in Harvey Station but I read later that he was born in Montreal so maybe he said his father was born in Harvey Station. It was a nice memorable little exchange anyway.

As far as I remember, everything went smoothly and there was no drama in my first scrub. As always, when the operation was finished, the surgeon leaves and asks someone to "close" for him. It would generally be an intern or resident or, depending on the time of year or the day of the week, it might be a medical student. "Closing" was quite a complicated procedure, dealing — as it did — with several layers of patient and several different kinds of sutures. But we all have to learn somehow.

Dr. Scott thanked me for my help before he left and I thought that was gracious and unexpected.

There were, without a doubt, many surgeons who were not nearly as well-mannered as Dr. Scott. There were surgeons who threw their instruments across the room, causing the circulating nurse to have to duck to avoid a forcep in the eye. There were surgeons who lost their temper and swore and blamed others for their own mistakes. I was very lucky not to have had any of those experiences but I know for certain they happened.

Memory is an amazing thing. When I started writing this, I thought — in fact, I wrote, "The memories I have of the time spent there are vivid, vague and jumbled up" — that I would have a hard time remembering almost anything of the operating room experiences. I remember way more than I thought I did and the more I write, the more I remember. I could probably go on for several more pages!

Don't worry though. I'm not going to.

This is me, just after our capping ceremony — probably several months before my operating room experiences.

Anxiety, panic, drama: life in the operating room (1)

The morning I got off the elevator on the 8th floor of the Montreal General Hospital and headed toward the operating theatres, I hadn't slept a wink the night before and for all I knew, I would never sleep again. Anxiety had never been an issue for me but I was starting my affiliation as an operating room nurse and, as a second-year student, I had reached a whole new level of near-panic.

I can't remember being with anyone although the six members of our affiliating group were mostly close and usually travelling together. My memories of that morning are that I was completely alone as I walked down that long hall to meet the nurse in charge.

We had heard about the nurses in charge of the operating rooms. They were legendary and all the stories were scary. Some of the top nurses were from England and they had brought with them not only those frilly pill-box caps — some of them with the short veil attached in the back — but utter disdain for frightened students and a fairly obvious joy in being able to intimidate so easily.

I looked for stock photos of nurses of that era to help you picture what I was facing but all the nurses in the pictures I found looked too kind for my purposes. This is the closest I could come:

(Yes, you're right. It's Agnes Moorehead from Magnificent Obsession. She's got the expression though.)

I think there were 12 or 14 or 16 operating theatres. I honestly don't know how many there were but my memory is that there were favourites that seemed to be in use constantly and then there were the others — for some reason, just not up to surgical standards.

In this picture, pretty much dead centre, you can see a floor extending from the tall wing on the left to the short wing on the right that has no windows. There are two windowed floors above it. The floor of no windows is the 8th floor.

So there was no natural light on the theatre wing of the 8th floor and it was kept at a very cool temperature at all times. There was something disorienting about working there all day, in the cold under bright lights.

At least two of the theatres had galleries, where spectators — medical students usually and sometimes nursing students although if we were on affiliation there, we were more likely to be down on the floor — came to watch the big surgeries. Some of the surgeons were showmen (always men in those days) and they loved an audience.

The memories I have of the time spent there are vivid, vague and jumbled up. I have no idea of the order things happened in but I do remember some of the things we learned.

We had already learned, in other circumstances, the principles of sterility and the method of preparing a sterile field. That remained the foundation of our duties but there was so much more. We learned the name and function of hundreds of surgical instruments. We learned how to clean and sterilize them. Most importantly, we learned how to set up the basic surgical tray.

The instruments had to be placed in the order the surgeon was going to use them. The lay-out had to be the same, every time. I so remember the stern unapproachable nurse who was teaching me this task telling me that if I were blindfolded, I should be able to locate the instrument immediately when the surgeon demanded it.

I can't remember the exact order of the instruments but this looks like it could be close:

There were several people around when an operation was about to get underway but on the nursing side, there were the circulating nurse and the scrub nurse. In our lowly position, we had to do a lot of scut work before we got to either of those roles but eventually, we made it to circulating nurse.

I always thought the circulating nurse was not accorded nearly the respect she deserved. She performed a number of essential, important tasks throughout the surgery but sadly, she never had the status of the scrub nurse. She was the theatre's Cinderella and a lot of her job before the operation began involved getting the Princess Scrub Nurse ready.

Fortunately, we students had been well-schooled in humility and this was right up our alley.

The circulating nurse was ready and available as the scrub nurse was getting scrubbed. The water faucets and soap dispensers were foot-controlled but when the 10 minute scrub was finished, the circulating nurse was waiting with sterile towels. She then dressed the scrub nurse in sterile gown and tied it at the back, never touching the front or the sleeves. She capped and masked the scrub nurse, then opened the sterile folded cotton package that contained the gloves.

When the scrub nurse reached the patient's side and the circulating nurse opened the draping on the instrument tray, the scrub nurse was immaculate in all the areas that were anywhere near where the surgery was going to happen.

During the surgery, the circulating nurse was in charge and in control of the room — who came in, how they were dressed, how near to the patient they were allowed. Before, during and after the surgery, she — along with the scrub nurse — was responsible for counting and recording all instruments, needles, blades, sponges.

She would anticipate needs throughout the surgery and be ready at the end with a selection of suturing materials and then, of course, be ready and responsible for the big clean-up.

I came to enjoy the role of circulating nurse. It was busy and challenging and required constant responsibility and accountability but even with all that, it didn't come close to having the tension and the drama of the lead role: the scrub nurse.

I still remember my first time. I'll be back to share that story — and maybe more — soon. (Part two here.)

A tale of the times (2)

"What did they call sexual harassment back then?"

"Life."

I had a hard time writing A tale of the times (1) and I'm not sure I ever succeeded in saying what it was I wanted to say. I think it shows how complex these issues are.

I began to write this story because of the news — not just today's news, but yesterday's news, and last year's news. I wanted to bring clarity to the complexity but I'm pretty sure I've just added new layers of confusion.

Two things I wanted to make clear: I liked Mr. J. He was a nice guy and I enjoyed his company. I get really impatient when reading the news of sexual assaults and harassment and I see the perpetrator described as a "monster" or a "jerk" or a "creep." My experience — and I have quite a lot — is that the men involved in these cases are not monsters. They're regular guys. That's part of the problem and that's what makes it so difficult.

But the second thing is, no matter how hard I tried and after all these years, I still couldn't find a way of saying that I liked him without feeling that I was taking responsibility for what had happened. I felt I would be admitting that this was, indeed, my fault and my nursing superiors were absolutely right to burn me at the stake.

(Cartoon by David Hayward)

The third thing is, Mr. J. was genuinely surprised at my rebuff. He obviously felt entitled and he truly believed I would welcome his advances even though I had been very clear about where the line in our relationship was.

Mr. J. and I continued to see each other on the ward. There was no way I could avoid him and I didn't really want to avoid him. I wanted, as Lucy DeCouture said about Jian Ghomeshi after he attacked her, to "normalize" the situation and thus, to make it seem that it had never happened. (I want to acknowledge that what I went through in this case is nothing like what Lucy and the others went through with Jian.)

When you have been raised and socialized in a certain way, not to make a fuss, this is a natural way to behave.

The incident with Mr. J. happened in the mid-1960s, just before women's liberation was about to break through into the mainstream. The question that still needs to be answered is this: why are the reactions of women facing this today so similar to the reaction I had 50 years ago? Why have we not moved beyond women trying, on some level, to placate, to explain and excuse and protect the men who attack them?

Stay tuned.

A tale of the times (1)

The Montreal General Hospital is built on a hill — the hill, Mount Royal.

This (above) is how it looks when you're looking up the hill and if you enter from this side, through Emergency and Out-patients, you're on the first floor.

But if you walk around the block — quite a long irregular block — you'll come to the main entrance to the hospital and when you go in this door, you're already on the sixth floor.

I worked on the sixth floor for a couple of years in the mid-'60s, as a young graduate on a brand new ward called the Diagnostic Unit, 6 West. Looking back, I think what a coveted job that must have been and how lucky I was to have such a job.

The patients on 6 West weren't sick. They were there for tests, for diagnostic purposes. They were all up and about, they ate in a dining area near the nursing station, they mostly took care of their own personal needs. There was a kitchen next to the dining area and they could freely use the kitchen for snacks — some of which were provided, some of which they or their families brought in.

As nurses on 6 West, we did a lot of paperwork; we kept track of all the tests, made sure our patients were prepared for testing — whether they needed special medication, needed to fast, needed a close record of vital signs. We made appointments with the various labs and departments and transported our patients around the hospital as needed. There was plenty to do but no bed-baths, no bedpans, no enemas or other nursing treatments, no back-rubs or passive exercises or IVs.

There was a very casual atmosphere there, an informality that we had never experienced on other floors.

I remember many patients I had there but this is a story about just one. I'll call him Mr. J. I thought of him as "older" but I was in my early 20s and now that I think about it, I suspect he was in his 30s. He was very good-looking and charming and he liked me a lot. He wanted me to call him by his first name but I didn't. There were two other guys around his age there at the same time — the three of them hung out together. They liked me too but I think of them as his wingmen — they were very careful how they treated me because they thought of me as "taken."

Mr. J. took pictures. He took lots of me and I still have them, to this day. He used to go home sometimes during the afternoon and do his developing. This is one he took of me and the two sidekicks:

You can see that hospital life was very different in those days. People smoked everywhere (not the nurses though; we never smoked in view of our patients). The little glasses with the thermometers in them were a 6 West thing: our patients came along and took and recorded their own temperatures on a little nearby chart.

I treated Mr. J. with the same warmth and friendliness I had toward everyone. I never encouraged his romantic overtures and I shut him down quickly when he wanted to talk about the problems he had at home and how he and his wife were having serious marital difficulties. I told him I could make him an appointment to talk to someone about that but it wasn't me.

I worked a lot of nights on 6 West. Mr. J. always knew my schedule and he and the pals would usually stay up late when I was coming on. He would send the others to bed at a certain point and sit nearby while I worked on my paperwork. I almost always had to really persuade him to go to bed because I'd be expecting the supervisor on her rounds and I didn't want to get caught.

One night, alone on the floor, I was working through my nightly list and, with my arms full of equipment, I went into the treatment room. I heard the door close behind me; I turned and it was Mr. J. I put my stuff down and asked him what he was doing up. He said he couldn't sleep. He came toward me and reached for me, trying to put his arms around me. I put one arm straight out and said, "Stop this." He told me he knew the supervisor had already been there on her rounds because he had been keeping watch. He tried to overpower me. He was quite persistent and a lot bigger than I but I fended him off and managed to reach the other door of the treatment room which led into the nursing station.

I put my hand on the phone and told him I wanted him to go back to his room and we'd pretend this had never happened. I certainly had no wish to call anyone; neither did I want to fill out an "incident report."

Here's why: If I had described the incident to officialdom, there is only one answer that I could have given that might be accepted as they bound my wrists and led me to the stake. It didn't matter that I had never encouraged him. It didn't matter that I was simply re-stocking my treatment room, as was my job.

The only thing I could have said was, "This was my fault. I'm sorry it happened. It will never happen again."

And they probably would have burned me anyway.

This story has a point. I'll be back later to let you know why I wrote it. (It's right here.).