basket and offered me a banana. It was two in the morning. The long night stretched ahead of us. We both yawned at the same moment. I handed her a stack of lab reports and a rubber stamp, and she was pleased to help me while I prepared medications for the morning. Then she sat down on a chair beside me. There we were, the two of us, unable to speak to one another, but understanding each other perfectly. Soon we fell asleep, leaning heavily into each other, our heads resting on the tabletop. A sharp knock at the back door startled me awake. It was 3:00 a.m. Geula’s husband stood on the doorstep with his wife in his arms.
“She’s vomiting blood,” he cried. I saw the trail behind him. “Bring her in,” I said. “Put her in the bed.” I pointed to the empty room.
Although he hadn’t predicted this crisis would happen so soon, Ben Cassis had spoken about this very possibility yesterday on rounds. Geula had received a bone marrow transplant from an unknown donor. The match was good, but not perfect, and he’d seen ominous signs of “graft versus host” syndrome. It is the opposite of what occurs in organ transplants where the person, the “host,” may reject the organ, the “graft.” In GVH , the transplanted bone marrow is seen as a foreign body and is rejected by the recipient.
Luckily, Ben Cassis had left explicit orders in the case of this eventuality and I got to work. I quickly inserted a naso-gastric tubedown her nose and into her stomach to drain the blood. Then I started an IV for fluids, another for antibiotics and steroids, and another for blood and platelet transfusions. I hung the first unit of blood. As I waited until the tubing blushed, pinked up, became crimson, and then deepened to scarlet, I searched Geula’s face for signs of life being revived within her. I had seen blood have fast, almost magical effects, but Geula lay there, limp and pale, barely conscious. Her four daughters gathered around her bed, chanting prayers and a song with a haunting melody:
The entire world is only a narrow bridge
The main thing – the main thing – is never to be afraid.
The youngest daughter, Sarah, who was only nine years old, nestled into the curve of her mother’s bent legs. The older girls dabbed at her forehead and lips with water that had been blessed by the Chief Rabbi of Israel. I recalled Geula’s last admission, just after her bone marrow transplant and how the family had moved into the same room she was in now. In no time it became full of puzzle books, homework notes and textbooks, and a row of their sandals lined up along the wall by the door. I had a feeling that during this admission there would be no time to set up camp as before.
I recalled meeting Geula and her family in the out-patient clinic. I had asked Tikva, the eldest daughter, a question that opened the floodgates: “Tell me about your mother before she got sick.”
“My mother is a successful business woman. She owns a textile factory. She knew from the start how serious her situation was, yet she always said she would beat this thing. Even after each chemo treatment she got up and went to work. We aren’t close, but she’s my mother, you know?”
I nodded.
Yes, I knew about mothers
.
Tikva usually spoke for the family and approached me now. “Nurse Teelda, please don’t give my mom any sedation. We want her to be with us the whole time, even if tonight is the end.”
“Even if she is in pain?” I asked.
“Well, maybe then,” she conceded, “but we want her to know we are with her.”
This was a matter for a longer discussion, but I had to check on Abdullah and Talia. Both were sleeping quietly. Suddenly, I heard Samuel start coughing violently. I ran to him and found him struggling to sit up in bed, spitting frothy blood into a linen handkerchief. He gasped for air. I raised the head of his bed, gave him an oxygen mask, and administered Lasix that had been ordered for him if this happened. It would increase
“She’s vomiting blood,” he cried. I saw the trail behind him. “Bring her in,” I said. “Put her in the bed.” I pointed to the empty room.
Although he hadn’t predicted this crisis would happen so soon, Ben Cassis had spoken about this very possibility yesterday on rounds. Geula had received a bone marrow transplant from an unknown donor. The match was good, but not perfect, and he’d seen ominous signs of “graft versus host” syndrome. It is the opposite of what occurs in organ transplants where the person, the “host,” may reject the organ, the “graft.” In GVH , the transplanted bone marrow is seen as a foreign body and is rejected by the recipient.
Luckily, Ben Cassis had left explicit orders in the case of this eventuality and I got to work. I quickly inserted a naso-gastric tubedown her nose and into her stomach to drain the blood. Then I started an IV for fluids, another for antibiotics and steroids, and another for blood and platelet transfusions. I hung the first unit of blood. As I waited until the tubing blushed, pinked up, became crimson, and then deepened to scarlet, I searched Geula’s face for signs of life being revived within her. I had seen blood have fast, almost magical effects, but Geula lay there, limp and pale, barely conscious. Her four daughters gathered around her bed, chanting prayers and a song with a haunting melody:
The entire world is only a narrow bridge
The main thing – the main thing – is never to be afraid.
The youngest daughter, Sarah, who was only nine years old, nestled into the curve of her mother’s bent legs. The older girls dabbed at her forehead and lips with water that had been blessed by the Chief Rabbi of Israel. I recalled Geula’s last admission, just after her bone marrow transplant and how the family had moved into the same room she was in now. In no time it became full of puzzle books, homework notes and textbooks, and a row of their sandals lined up along the wall by the door. I had a feeling that during this admission there would be no time to set up camp as before.
I recalled meeting Geula and her family in the out-patient clinic. I had asked Tikva, the eldest daughter, a question that opened the floodgates: “Tell me about your mother before she got sick.”
“My mother is a successful business woman. She owns a textile factory. She knew from the start how serious her situation was, yet she always said she would beat this thing. Even after each chemo treatment she got up and went to work. We aren’t close, but she’s my mother, you know?”
I nodded.
Yes, I knew about mothers
.
Tikva usually spoke for the family and approached me now. “Nurse Teelda, please don’t give my mom any sedation. We want her to be with us the whole time, even if tonight is the end.”
“Even if she is in pain?” I asked.
“Well, maybe then,” she conceded, “but we want her to know we are with her.”
This was a matter for a longer discussion, but I had to check on Abdullah and Talia. Both were sleeping quietly. Suddenly, I heard Samuel start coughing violently. I ran to him and found him struggling to sit up in bed, spitting frothy blood into a linen handkerchief. He gasped for air. I raised the head of his bed, gave him an oxygen mask, and administered Lasix that had been ordered for him if this happened. It would increase
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