Chapter 8

Ryan was on his way from the timeclock to see the first of his 'special' patients. He chuckled to himself that he still thought of it as a 'timeclock, ' even though the terminal that scanned his ID badge and requested his PIN was a long way from what he clocked in and out of at the factory during his summer job.

There were only three special patients tonight, one having checked out that day. The three women were special because they had the least visitor activity, and because their particular orthopedic surgeries left them very constrained and uncomfortable. His supervisor took a dim view of his personal visits to patients when he was off duty, but had not seen fit to forbid it. Since she took a dim view of him in general, as her only male nurse, he didn't pay much heed to her opinion of his visits.

The other nurses in his section did not seem to know what to think of Ryan's after hours visits. Being basically caring people, they weren't about to criticize him for kindness. They did wonder, though, how he could afford the time. Didn't he have a life?

Ryan Herwalt, R.N., had more time than he would like because he was assigned zero overtime. The others were overworked, but his supervisor wanted him on the floor as little as possible. When he was on duty, she found as many non-care tasks as she could to fill his time. He was forbidden to bathe female patients or to help them with toilet or bedpan.

The other nurses liked and respected him, and realized there was no performance justification for the supervisor's attitude. The fact that he would have his M.S. in a month was a source of wonderment to several of them.

It was not supposed to be like this in civilian health care. He had been driven from the Army medical corps by the bureaucracy and by the widespread effects of the Peter Principle. He had learned to his dismay that those problems were endemic to health care. Maybe all organizations were afflicted.

When he was twenty, Ryan had completed two years of college with good grades, but could not picture a clear reason to finish up. He did not think the dart board method of choosing a major was rational, but he had no better criteria in mind. To his parents' dismay, he enlisted.

Once in the Army, he had no such lack of direction. He quickly set his sight on the Rangers, and survived the brutal elimination process. At first, he was not thrilled with his assignment to Medic specialization, but he was still a Ranger, and still had all the physical demands of his comrades.

After eighteen months in the Rangers, it was the infamous training accident that shattered his greatest life achievement to that point. After recovery and rehab, he could have passed the physical for any of the pro sports, but that was not good enough for the Rangers. Rather than falling back into an ordinary line battalion, he bid for Med Corps and was accepted. He found he liked the care aspects of the work, and the patients responded extremely well to him.

His financial prospects and his limited tolerance for school made med school an impossibility, but a wise doctor steered him toward nursing. He was able to start course work while he was assigned to a major Army medical center. Also at the center, he took the opportunity to move around to as many different wards as possible. If training of any sort was offered, he bid for it. Physical therapy and rehab had been his particular favorites, but in typical Army style, his longest stint had been in the surprisingly active OB/Gyn ward.

Ryan was happy with his choice of nursing as a career, but he was totally frustrated with the way medicine was managed in the Army, so he withstood the guilt assaults and left after his enlistment was up.

His return home was shattering. He found out that his mother had terminal cancer, and that his father had left.

He had always considered his family normal and average, for having only one child, that is. His father was a man's man, avidly supporting Ryan's athletic success through High School. His mother was a gem, providing everything he ever imagined a mother could. At the time of his return, he did not realize how stunted his own and his father's emotional development had been.

Though he was basically a good guy, his father never let his mother get really close to him. He treated her well, provided the best he could, and was faithful. When the big blow came, however, he had no way to cope with it. He simply left, quitting his job and everything. To his credit, he somehow found a way to send a good deal of money right up until her death. He did not attend the funeral, and Ryan never saw him again.

Looking back, Ryan was aware that he might have abandoned her in the same way, had it not been for his service as an aide in the OB/Gyn ward. He had inherited his mother's easy, friendly manner, and just naturally talked freely with the patients. That introduced him to a facet of women that he might never have suspected otherwise. He was fascinated, intrigued, and a little in love with the complex personalities he encountered at the time of their greatest fulfillment.

When he found his mother battling the twin traumas of abandonment and impending death, he committed on the spot to staying with her until the end. The ensuing eighteen months produced a man the old Ryan would neither have recognized nor understood. As mothers are wont to do, she tried to talk him into getting on with his life. Because of shame over his father's cowardice, and because he had learned to understand some of the difference between what she said and what she felt, he was unswayed.

His mother wanted to sell the house to raise money for living and medical bills, but Ryan sensed her need for the familiarity and comfort of the home she knew. Later, he could not reconstruct just how they made it through financially, but he made sure she never knew the true money situation.

Tight as things were, Ryan was able to take several classes the first semester of his vigil. After that, he worked as many hours as he thought she could handle without him, until he had to be with her full time the last three or four months.

Immediately after his mother's death, Ryan parlayed his experience and education into a third shift EMT job that allowed him to accelerate his schooling. It took two more years for his degree, and he continued on a year toward his Masters. He had intended to finish the M.S., but one of the hospital chains put on a major recruiting drive with exceptional signing bonuses, and he signed up.

His hospital was originally one of the Adventist chain, renowned world-wide as the best from the patients' standpoint. It had been bought by the third largest national chain, and in the three years since the purchase, it was suffering the inevitable but lamentable effects of corporatization. In his two-year tenure, he had seen the nurses' workload increase dramatically while the headcount shrank. Typically, every possible task was offloaded from physicians to nurses, right to and sometimes beyond the ethical limit.

The negatives that had caused Ryan to abandon the Army may not have been present in his civilian hospital, but there was a whole new set that put even more pressure on the nurses. The toughness, endurance, and effectiveness under pressure that got Ryan into the Rangers made him ideal for the pressure cooker environment of the hospital. Unfortunately, since moving to the orthopedic surgery unit six months earlier, the antipathy of his supervisor rendered him nearly useless.

As he headed for his first personal visit of the evening, Ryan passed a room where Chelly (Michelle) was about to replace a medicine bladder on an IV feed. He had a definite romantic interest in Chelly, but absolutely nothing had happened. A single mother with children four and six, she seemed to have all defenses up against any male entanglements. He had realized that the first month they worked together and tried hard to just be a friend.

He was worried about Chelly. More than any of the others, she was showing the effects of the brutal schedule. He had tried to talk to her about turning down some of the extra hours, but they both knew that turning down requests to work was destructive to a nurse's future prospects. That made his treatment by the supervisor all the more frustrating. He could easily handle more hours, and he could always use the money. Furthermore, the others would be relieved rather than angry to have the hours spread around more evenly.

As he turned to leave the doorway and not disturb Chelly at her work, he was brought up short by a glimpse of the bag she was attaching. Reacting quickly, he stepped in and took hold of her wrist. She was startled, and looked up at him angrily. Not wanting to wake the sleeping patient, he put a finger to his lips, then pointed at the label on the bag.

Chelly, still upset at his interruption, looked quickly at the label, then back at him, her eyes flashing. Her face suddenly froze, and her eyes flicked back to the bag. Then, all the color drained from her cheeks and her knees buckled. Ryan was able to catch her and ease her into the nearby side chair. Before tending to her, her replaced the erroneous bag with the correct one.

In the Rangers, every man knew the kit of every squad mate, and they reviewed each others' equipment before a mission. At the Army hospital, Ryan began memorizing the treatment charts of all the patients after a couple of unfortunate mixups. Even though he was just an orderly and it was none of his business, he had a photographic memory and a concern for the safety of the patients.

Ryan used his knowledge only twice, both times with nurses who were grateful for his help and his discretion in keeping it secret. There were occasions when he saw doctors making mistakes with medication, but he did not risk pointing it out. Had the mistakes been lethal, he decided he would have intervened no matter what.

With the potential error avoided, Ryan turned his attention to Chelly, who was conscious, but limp as a dishrag. "Don't worry. Nobody will know," he assured her. "Wait right here." After he said it he cringed. She really wasn't able to do anything else. He went out into the hall to grab a wheelchair.

As Ryan was wheeling a mildly protesting Chelly toward the nurse's lounge, they encountered the supervisor. "What happened to her?" she asked.

"She collapsed from exhaustion."

"Who qualified you to make that diagnosis?" she shot back.

Ryan ignored her sarcasm, except that it stiffened the resolve he had already acquired. He turned to face the supervisor, Mrs. Brandt, squarely, and drew himself up to his full height. "Mrs. Brandt, as of right now, things are changing permanently!" Since he had always responded respectfully, even when she goaded him, she took a step back in surprise.

"You don't tell me how things are! I tell you!" she retorted.

"I'm afraid your actions have disqualified you from that privilege." She was too angry to say anything to that, so he continued. "You take Chelly to an empty room and get her in bed. She is to wait until I am finished, and I will take her home." At that, she sputtered, but he raised his hand in his most commanding manner.

"I am going to finish Chelly's assignments."

"But... but you can't! I won't let you!"

"Yes you will. Your mistreatment of me stops right now. From now on, I get the same assignments as all the other nurses. And from now on, my hours will equal the others."

"What you will get is fired! I'll have you before the Administrator tomorrow for insubordination."

"Fine! Which do you think our esteemed Administrator will pay most attention to: your accusations, or my sexual harassment lawsuit against you and the hospital?"

"H... harassment? You can't do that! That's only for..."

"Yes, I can and I will. I will unless I get your agreement right now to treat me equally with the other nurses."

"I... I... but the women patients... you can't..." She was very flustered by this time.

"Why not?"

"It's not proper... it's..."

"It's what nurses do. I've done it many times. I'll make a deal with you. I'll always ask before any personal task with a female patient. If she objects, I'll get someone else, OK?" When she made no response, he pushed harder. "Look, Mrs. Brandt. Credible legal advice tells me I could have you fired with no trouble at all. I'm not vindictive. I just want fair treatment. Now, do I finally get it?"

Defeat was evident, but she was not about to concede gracefully. With an angry stare and the faintest of nods, she took the wheelchair and pushed Chelly down the hall. Only Ryan noticed one of the other nurses peering through a partially open door.

Ryan quickly did several medications from Chelly's list, then found the room where she was resting. He was reluctant to disturb her, but she opened her eyes at his entry. He talked to her long enough to find out that her children were sleeping overnight at her parents, so there was no rush to get her home.

There were three patients to bathe that night. The first was an elderly man recovering from hip replacement. Ryan had talked to him a little and knew him to be fiercely independent. He was healed enough to take a shower with help, and he finished fairly quickly.

The second was one of Ryan's special patients, one with whom he had visited for over a week. A college-aged girl, her leg was in traction after being hit on the sidewalk by an out of control car. It would be another week before she could leave the bed. While not a complainer, the girl was angry and sullen about her misfortune much of the time. She had greatly enjoyed his visits, since he was one of only three people who had taken the time.

First, he asked if she minded him bathing her. When she somewhat reluctantly said no, he asked if she could wait a while for bathroom and bath, then explained why. Assured that she would be happy to wait in exchange for a longer visit, he got the same permission from his last patient.

Chelly was able to walk to her car under her own power, and he drove her home in it. On the way, he had her call her parents to let them know what was happening. Over her protests, he used his wireless, and a cab was waiting to take him back to the hospital.

The girl in traction was able to use her hands fully, so wiping herself and bathing her own privates were handled in the usual discrete manner. The fact that she had become friends with Ryan did not seem to increase her unease, and they had a nice, long visit.

The last person on Ryan's list that night was Fran, and he left her for last on purpose so he could spend more time. Fran was a late forties lawyer. An avowed lesbian, at least so she told Ryan, she was an avid athlete, and a bike/car encounter had put her in the hospital. Besides a full complement of scrapes and bruises, she had broken one shoulder and the other elbow. The shoulder was fixed in position with her arm out to the side and partially raised. The elbow was casted in a bent position.

Fran had almost no use of her hands, neither one able to reach her mouth. Her week had been pure torture. Her cuts and scrapes had gotten to the worst itching stage and she could not get at them. She was able to sit and stand wit help, but was very top-heavy. She could get to the toilet, but could not clean herself. She had no relatives in town, and Ryan's time with her exceeded all her other visits. Despite the terrible discomfort, he had to admire the spirit that allowed her to be a delightful conversation partner.

Ryan had visited Fran the four previous nights, arriving after her toilet and bath had been taken care of, by Chelly, as it turned out. The first night they just chatted, with him doing most of the talking to help distract her. Women always seemed to open up and talk freely with him, and she was no exception. An extremely bright, animated person, Fran captivated his interest, even through the fog of her pain pills, and he stayed over an hour.

The second night, Ryan noticed the squirming, indicative of muscle cramping and spasms. He told her of his physical therapy experience and offered her a massage. After a long look, she accepted, and it was while he worked on her legs that she told him her sexual orientation.

"No offense, Fran, but I wasn't planning on proposing to you, anyway."

"Oh, damn. I do so love to reject men when they propose," she countered with a giggle. "Weren't you even working toward a proposition," she teased.

"Of course. Don't you recognize this as my first subtle move?" In that jocular spirit he was able to make her much more comfortable. Nor was it an onerous task. Despite his professionalism, Ryan thoroughly enjoyed the feel of a female body - any part of a female body. Not that he got instantly aroused, or anything. He just enjoyed the smoothness of the skin, the softness of the subcutaneous layer, and the play of the muscles under their padding. With Fran, it was even more enjoyable, for her body was very well toned.

The third and forth nights, she asked for a massage immediately, and he also helped her walk the halls a bit, taking as much of the weight of the shoulder apparatus as he could. During those visits, they got deep into discussion of each others' lives. It was during those discussions that she had introduced the idea of a lawsuit, something he dismissed out of hand as not his style. That was certainly not the Ranger approach.

This night would be different, as he would be helping her with toilet and bath. He felt only a little strangeness as he entered her room, and hoped it would not be any harder on her. She had obviously been waiting for him, and for an obvious reason. "I almost went in there by myself, Ryan. I really have to go. Hurry!" 'Guess a full bladder trumps shyness every time, ' he mused as he helped her from the bed.

Modesty was a non-factor in the design of hospital gowns, but they were well suited to Fran's current need, as she was able to sit right down without him having to lift her garment out of the way. He turned to walk from the bathroom, but she told him "Don't bother!," and let loose a torrent. Her sigh of relief was unrestrained, assuring him that his presence was not disturbing her.

Thus emboldened, Ryan turned back to her as soon as her stream ceased. Without hesitation, he took some paper, eased her legs farther apart, and wiped her off. "Wow, you even know which way to wipe," she remarked with a grin. The previous night, he had talked freely of caring for his mother, so Fran was well aware of how much he knew.

As often happens, Ryan's mother, was not feeling terribly ill when her diagnosis came down. An aggressive last-ditch course of chemo was suggested, and she debated a couple of days before deciding not to take it. The odds quoted her were very small, and almost as large a percentage failed to survive the treatment.

For several months, Ryan took her to every tourist spot or attraction they could reach on their restricted budget. In the process, their relationship became something he desperately wished he had enjoyed from his youth. He took her to visit every relative she had any contact with, most of whom had trouble with the 'final visit' idea. The time was precious, even allowing her some moments of levity.

He realized early on that a big part of her fear was the impending loss of dignity at the end. She was a mentally strong person, proud yet modest. He could see that her last months would be made worse by the shame of having someone else do the very private tasks she could no longer do. She had already talked about having to go to a hospice or get private help when she could no longer take care of herself. It was hard for her to accept that he was willing to give her complete care. It was harder still to think of him, her son, doing those things for her.

"Mom," he said one morning as they were eating brunch, "I think I know something that's bothering you a lot."

"Oh? Besides dying too young, you mean?" When he hung his head after that gibe, she apologized and asked him what he meant.

"I don't want to sound crude, but to be blunt, it's the thought of me having to wipe your ass after you no longer can." Not sure what to expect, he was somewhat relieved when her initial shocked look disintegrated into tears and soft sobs.

"H... how could you tell?"

"I guess I've gotten to know you pretty well lately. I can see how hard you fight not to give up any independence or self-sufficiency."

"Well, you're right. It terrifies me," she told him.

"I really want to try to ease that fear, Mom. Remember, I am a nurse, and to me, those things are not awful or disgusting. But more than that, I'm your son, and I love you. There's nothing I can do to stop the cancer. I just want to take away as many of the other hurts as I can."

"But how can you do that?"

"Please don't get upset when I say this. When you can't wipe yourself any more, if it's no big deal because I've already done it before, you shouldn't feel so bad. Maybe you can even take it as the expression of love it will be."

With wide eyes, she asked "Are you saying you should practice it, even if I'm still able?"

"That's the general idea. I guess the main point is that if we can get rid of the modesty problem now, while it's still your choice, it will make all of those things easier." When she looked troubled but said nothing, he continued. "I think we should completely dispense with modesty between us. Let me start right now bathing you, shaving you, washing your hair, massaging you, and everything. You can get used to it, even enjoy it while you still feel good. When it comes the time that I have to do those things for you, it won't be such a trauma."