An Ideal Presence Read online

  VALÉRIE LE PANNO

  NURSING AIDE

  They couldn’t make up their minds. Some members of the family agreed that it was better for her to stay in the hospital. Others thought she should go home. Each thought his or her option was the safer one. As for the patient, she was divided between the two possibilities. Our psychiatrist came in and suggested a “leave,” which in this case meant a two-day release with one overnight at home. Everyone thought the leave would help the family make a decision. But after the leave nothing seemed to have changed.

  It’s easy enough to understand their doubts: our unit is, especially for the sickest patients, a bit like a cocoon. Some patients jokingly say it’s a “five-star” place, in terms of comfort and service. One day, coming from a unit where the doors are a reddish orange, a patient told me he had just crossed through the gates of hell. Three days later he amended his judgment slightly: “A five-star hell.”

  But to get back to this woman: even the nursing aides and nurses, we had differing opinions. One day she asked me, “What’s best for me, Valérie? Should I stay here or go back home?” “Go home,” I answered, at the exact moment that Charlotte, coming into the room behind me, blurted out, “Stay here.”

  DELPHINE ZIEGLER

  NURSING AIDE

  The hardest thing, for me, is seeing children of four, five, six in the hallway. Especially when the patient is their father or their mother. You’ve seen little Léa, I imagine. Her mother has been in the unit for three weeks. Her father or her aunt goes to pick her up from school. She comes here for a little while before going home. She stays longer on the weekends. In the room with a TV and some children’s books, the piano, the sofa, the table, and the kitchenette. I help her a bit with her homework sometimes. I have a daughter her age. It’s easy — no, easy isn’t the word. It’s very hard, as I said before, but paradoxically it also helps to have a child here. Children keep us from getting depressed. We can’t just stop. They’re the life that goes on.

  This morning, going from Léa’s mother’s room to the staff lounge, I see that the little girl seems sadder than usual, almost distraught. So I quickly think up a little speech. I breathe deep. I kneel down in front of her and let my words out, telling myself the whole time that above all I have to listen to her. Soon Léa explains to me that she’s sad because her teddy bear has a long stain on its belly. A bloodstain, Léa says. A chocolate stain, explains her father, who’s sitting next to her. The teddy bear, dirty and stinky, sets the whole unit in motion. As if it were a desperate case. Emergency cleanup. Fragile object. A few minutes later the bear comes out of the dryer, emerging from behind the porthole window like some kind of astronaut. It’s still warm when I place it into Léa’s hands.

  “Is that better, like that?”

  “Yes,” the little girl says to me. Her eyes are shining. “He’s cured!”

  CLÉMENCE LE MAY

  NURSE

  The older sister of the husband of this patient — a woman with a strong personality — came to ask us not to tell her sister-in-law the whole truth, because her condition had just deteriorated again. It was Noémie who spoke to her at first, quietly. But I heard their conversation and I went over. Noémie was trying to explain that you don’t lie to them, ever. And that this isn’t purely an ethical position. That above all it’s a practical one.

  “In fact, madame,” Noémie said to her, “patients always sense the truth. Even the ones who pretend to not want to know. The major problem is usually at the end, when the patient detects the lie and turns inward, overwhelmed by the information that’s just fallen on his head, out of the blue. And worst of all is the lack of trust after the truth is discovered. No, no, you never lie. Embellish the truth a bit, fine … but nothing more.”

  The woman simply said: “Yes, I see.”

  But this woman had the lying bug, so to speak, and she went to tell her brother that we had treated her poorly. That we had intentionally given her incorrect information. Over time, you realize that this kind of thing happens fairly often: a misdirected anger, aimed at the caretakers, as though it were our own fault. Which is, ultimately, another way of lying to oneself.

  MORGANE BRUCKNER

  NURSE

  I was seven or eight, I think, when I first became aware of sickness and suffering. I was keeping my grandmother company, and she was very sick. My parents had entrusted me with this task. I spent almost two years by her bedside. I discovered that I had a knack for this work. It was my grandmother who told me one night, “My dear Morgane, you know what? You’d make an excellent nurse!”

  If you talk to the other girls on the unit, if you talk to the other nurses in the hospital in general, you’ll quickly see that two stories are more or less recurring: girls who, like me, had to take close care of a sick person at home, and girls who have a nurse in the family, for instance a mother, who passed the vocation down to them.

  When I’m tired, when a case turns out to be complicated, when personal troubles interfere with my work, I say to myself: “Morgane, this is your grandmother in this bed. Go ahead, show her that she was right. That you’re an excellent nurse.”

  AUDE LESCHEVIN

  MEDICAL SECRETARY

  I am, along with Marianne Soulier, one of two medical secretaries. It’s the job most removed from the patients, I won’t deny it. And yet I know everything about them, because one of my main jobs is to write or help write the reports that the doctors and the internists file. I know everything from a strictly medical point of view, but usually I know nothing about the patients’ physical appearance. Of course, I could stop in and see them, I could walk into the rooms and take a quick look. But, to be honest with you, I don’t like to. I like to walk down the hall that leads to the rooms, so I don’t lose sight of what the caretakers do; so that the smell of disease, which is more intense the closer you get to the beds, gives my work a greater sense of urgency. But entering the rooms … no, I don’t think it’s my place to do that.

  Marianne, the other secretary, does it from time to time. It’s easy to do, and if you want to you can always find a reason to justify your presence. Me, no, I prefer to just imagine the patients. It’s very strange, though: some patients resist my imagination … and, on the contrary, there are some I can conjure, so to speak, completely. It’s like when you read a book, a novel. You can picture certain characters perfectly, and not necessarily because the writer has given you a long and scrupulous description of them — and others, conversely, you can’t. It’s a mystery, I think.

  At first, three years ago, when I started working in the unit, Marianne said things to me like “Ah, Monsieur Whatsit, yes, a very thin man, blond, in his fifties … ” and she wouldn’t stop until she’d described him from head to toe. In time I managed to explain to her that no, I didn’t want to hear these little portraits, that I prefer to imagine the patients for myself … plus, that way, we’re even, since they don’t know me either. Go ask them what the old medical secretary looks like! We could have some fun with the imagined portraits they’d make of me, don’t you think?

  PATRICIA LONG

  NURSING AIDE

  He was a man who complained constantly. An unpleasant, disagreeable man, from what I’ve heard, but who are we to judge people that way? What will we be like on our deathbeds? I told myself I had to see him with my own eyes. And yes, it was true. He wasn’t an easy man to be around. Not at all. He was someone used to giving orders, someone who had been powerful and now couldn’t bear his impotence, in the ordinary sense of the word. Someone who, out of arrogance, didn’t want anyone to see that he was petrified with fear.

  Bizarrely, he was very polite with me. Maybe because I talked to him sweetly. Maybe because I found a way to make it seem like he was giving me orders. Superficial orders, obviously, and simple to accomplish. But it did him good, and it was so easy for me to arrange.

  My colleagues continued to speak of him reproachfully. It was a bit unfair, but at the same time I understood —
it was enough to hear him protest whatever they were doing. Even his family had a hard time putting up with his bad moods.

  One day I sensed a nervous energy in him. He wouldn’t stop giving me orders: go fetch some water, or throw the water in the toilet because it tasted strange. Raise his bed, or lower it.

  “Can you close the door and come here for a moment, please?” he asked me at last.

  As a rule, I always have a colleague with me in front of patients. And I certainly don’t close the door if I find myself alone with one of them. You never know, you can’t be too careful. But our entire relationship was on the line here, I felt: if I showed him I didn’t trust him, if I showed him I was afraid to close that door and hear what he was going to say to me, I would no longer be able to look him in the face.

  I thought: I’ll obey. And I approached him with all the serenity I could feign.

  “Thank you,” he told me then, in a whisper-thin voice. “Thank you for giving me my dignity back.”

  SYLVIE COMPÈRE

  DOCTOR

  Relations between doctors and caregiving personnel can be tense. Doctors criticize nurses and nursing aides for being too emotional; they criticize us, on the other hand, for being too impersonal. It’s true that some doctors will say “I’ll be back, I’ve got to go see a pancreas,” that they don’t see the whole person, only the sick parts — the pathology. Obviously you can’t generalize. You’ll find all types: doctors convinced of the accuracy of what is in my opinion a disgusting metaphor (that they’re the brain of the unit and that the nurses and nursing aides are the arms and heart), nurses who think they know more than us, etc. There is ultimately a great misunderstanding that comes from a false perception: nurses can spend an hour a day with each patient; we spend barely ten or fifteen minutes with them, because we have other things to do. Things that also affect the patients, but this relative invisibility leads some nurses to think that we don’t care very much, that we’re less engaged than they are.

  Things are better these days. Twenty years ago, when I started working in hospitals, I had some rather aggressive experiences. I spent a few years at a hospital in Lille where there was a rumor that the doctors were taking bets on the health of certain patients. Bets for money, I mean. Bets about their date and time of death, for instance. And that they were wagering astronomical amounts. This was false, complete nonsense. But the rumor blew up so much that a tabloid published a little article on the subject. The article went so far as to imagine that a doctor could hasten the death of a patient in order to win a bet or help one of his friends win … hell of a get-rich-quick scheme! The older doctors got quite angry and claimed the nurses had started the rumor. Me, I don’t believe so. It was an urban legend, as they say. That gives you a good idea of the situation.

  JEANNETTE ROMANO

  INTERN NURSING AIDE

  I get an urgent call from the new patient in room 6. As soon as I open the door, the woman begins to bark:

  “You’re just a nursing aide! I demand to see a nurse! And I know you’re not even a nursing aide, just an intern! No, no!”

  Some people believe strongly in hierarchy. People who start to look, the moment they arrive, for a hierarchical code on our scrubs: the color yellow for the nursing aides, the color green for the nurses, the color blue for support staff … All told, it’s a good sign when they get worked up, when they manage to express their feelings. Much better, you know, than fatalism and resignation.

  NOÉMIE SAINT-ANDRÉ

  NURSING AIDE

  The worst thing you can do is talk about them like they’re not there. I’ve seen doctors, nurses, and relatives do it. Once, a family was speaking in raised voices in front of the patient. They were planning their Christmas dinner. A meal the patient wouldn’t be going to, obviously, because he would be spending Christmas at the hospital. On December 26th, coming back from a two-day break, when Marie Mahoux told me that the patient had passed away the night of the 24th at eleven o’clock exactly, I wasn’t surprised at all.

  Other families do exactly the opposite: they don’t talk about anything in front of the patient. As though the slightest comment could hurt him, distress him. It’s the other extreme. An excess of protection. In that case, over the silence, the patient begins to fantasize.

  I remember one old man, very nice and very clever: Monsieur Pascal. Everyone told him, “Come on, Monsieur Pascal, you’re just fine the whole day, and then as soon as your family arrives you fall asleep!” He would laugh. He wouldn’t say anything, he’d just laugh. I quickly understood what he was up to. When his wife and his son thought Monsieur Pascal was sleeping, they whispered things that they normally hid from him. That way he got all the information he wanted.

  Ah, I can still see Monsieur Pascal’s face as he slept. What an actor. The day he died, I wondered if he wasn’t just playing another trick on us.

  SIMONE TERWILLIGER

  PSYCHOLOGIST

  She left three years ago after spending barely seven or eight months as a nurse in the unit. I don’t know where she is now, I just hope she hasn’t insisted on remaining in this profession. In our work you can’t have any transference, can’t claim patients as your own, can’t identify with their pain because you’re likely to make it worse instead of easing it. So many golden rules that this girl wasn’t able to respect.

  You can feel called to nursing when you’re capable of charity and pity, but that’s not enough. Protocol and savoir-faire are also indispensable: they protect everyone, including the nurses themselves.

  This girl had the grave flaw of fixating on a particular patient: she made him her invalid, or her pet patient, in her words, and held herself accountable for all the bad things that happened to him.

  The first month she spent in the unit, everyone thought she was very young, very sensitive, and above all very inexperienced. Over time, it became clear that she had a tendency to get attached to patients and that she couldn’t quite separate work from life. One day, visibly concerned by the situation. Madame Gosselin came to talk to me about the girl. After reflecting at length we decided that, as the care service psychologist, I would speak to her. Multiple things were off about her conduct.

  The girl was charming, well bred, fairly pretty. At first, I found it hard to get through her shell … She seemed to be on the defensive, too. Little by little, I decoded her way of looking at things: the extraordinary thing about this girl was that she felt inexplicably liable for the state of her preferred patient’s health. If the patient was feeling well, she attributed the good state to herself, thinking it was a logical consequence of her work. On the contrary, if his health deteriorated, it was her fault. If the patient died, it was her failure. Then, increasingly tormented, she told herself she had to do better, much better, the next time.

  She lived convinced that each of her actions, and not only the professional ones, had repercussions for her patient. Worse yet, she believed that the smallest thing she thought could have a direct influence on her patient’s health. It must have been intolerable for her … Poor thing, it was like she made this all up to torture herself.

  After a week, I understood that we were dealing with a perfectionist. An obsessive temperament. The trouble with perfectionists, as Tolstoy said of his own childhood, is that they confuse self-perfection with perfection itself. The trouble with perfection is that it’s impossible to attain. Getting rid of imperfection is a perfectly utopian notion … just like eliminating death.

  ANNE-LAURE BELMONT

  DOCTOR

  From experience, I dare say most of the people who work in the unit are opposed to euthanasia. In my view, people ask to die mainly because they can’t deal with great physical suffering. But once the physical suffering is relieved, the request disappears … I’ve seen this even in cases where the patient is confined to his bed. It’s interesting. Contrary to certain received ideas, it’s not death that creates suffering; it’s suffering that creates the desire or the need to die.

 
MARIE-FRANCE BERGERET

  MOBILE UNIT DOCTOR

  This morning Joséphine and I went a few kilometers away to visit an old woman, ninety-nine years old. It’s funny to say, but she doesn’t look ninety-nine. She seems much younger … let’s say eighty-two or eighty-three. I don’t know. After eighty, I have a hard time estimating ages.

  In spite of her healthy appearance, this woman no longer wants to eat, no longer wants to take medicine or sedatives. She’s tired of everything: of her body, of her pain, of seeing her family waste time at her bedside. “I’m even tired of the sunrise,” she told us. But her children and grandchildren don’t agree: they want to have someone in their family reach a hundred. It would be a pity, as they see it, to fall short by so little.

  There’s a bit of egotism in all this, to be sure. But at base, there’s something inspiring in it, a little bit of affectionate bait to spur on the almost-hundred-year-old.

  The lady will turn one hundred in four months, in October. Four months—a trifle for you, for me, for her children and her grandchildren. For her, though, it’s like crossing the desert. She told me this in confidence, furrowing her eyebrows: “I can’t do it.” And she added, “The idea of being a hundred horrifies me.” And then she let out a bitter laugh, while we gave her a sedative injection and Josephine spoke with her family. Just then I remembered that I had bought train tickets this morning for a trip my husband and I are taking in December. And such a simple thing struck me as obscene.

  SUZANNE DAVIEL