If I could be sure of what it is that I do it would be a great comfort. It has a title, it has rules, responsibilities, regulations and expectations. You would think that this would make it simple.

I started out to help but I’ve hurt. I wanted to defend, but I became a judge. I was to be warm and generous but I grew cold. In doing for others I forgot myself. I’m supposed to be feminine and defer but I’m a male and chafe.

It started as a way to cash scholarship checks. A place away from home — room and board, ladies and liberty. A structured education for an unstructured youth. No great emotion was brought to it and none was expected in return.

The school was situated on the grounds of the world’s largest psychiatric hospital. It was a massive affair, built as a public works project during the Depression. Dozens of dark brick buildings housed thousands. Fresh out of proms and study halls we cloistered in our dorms while a city of the forgotten teemed around us.

Those who wanted were given weekend jobs at the institution: state grade four/housekeepers. The supervisors saw us as cheap labor, the old employees saw us as amusing puppies but possibly dangerous informers, the patients saw us for what we were — easy marks. Since we had an association with the school of nursing we were quickly placed in key positions. My job was to be in charge, on weekends, of a forty-bed diabetic unit. I did not have the slightest idea of what diabetes was.

The wards were long and dimly lit. Human excrement and institutional colors stained the walls and floors. The most lasting memory is the odor. At first it was impossible to associate with a human source. It was not the scent of a person or an illness but the stench of years of neglect.

During the week we learned to make beds, give meds and dress wounds. We learned anatomy, physiology, psychology, nutrition. They taught us that we could lessen the pain of others.

On the weekend I learned distance. I learned to defend myself and to be silent. I learned to drink and tried not to hurt.

School gave us a tool that was important; it made me important. I took it with me on the weekends and worked with it as hard as I could. The skills made it possible to give something real, something concrete. It made the corruption that much more ugly. It was futile.

After graduation I got as far away as I could. I took my tools to the trauma unit of a major medical center. The patients were young and strong, they had a life ahead of them, and they were very ill. I learned and I grew. It was a happy time.

In a way, it was a game. Doing a good job on the body attached to the respirator was a form of competition. The doctors, nurses, med students and supervisors flaunting their coups and cutting their losses. We were good but for reasons I hadn’t expected.

I transferred to the burn/plastic surgery unit, partly out of an academic interest, partly to give me room to maneuver. The place sucked you dry; there was so much anguish. It was not a glamour service. As I grew in experience and knowledge I gained more responsibility and through some sticky bit of politics became assistant head nurse.

Being dominant over a group of people seemed to reaffirm my maleness, while traveling in a female profession. Being a resource person, being needed, having special skills, became more reinforcing than wanting to help people. In a year I became the youngest and the first male, head nurse.

In the year that followed I did a lot of good, and inflicted a lot of casualties. Most of the damage was visited upon myself but certainly not all of it. The burns, the competition, short staffing, frustration, the corrupted ideals all took their toll.

As a rule I don’t remember my dreams, but this one was exceptional: I dreamt I was sitting in my living room but instead of one of the walls were the doors to my unit. And behind one of the walls of the unit were wooden supports, giving the effect of a Hollywood set. As I walked down the corridor I noticed that the nurses and patients weren’t moving, but were mannequins. The wounds, dressings, and sutures were painted on.

I’m going to school now. Things that didn’t seem important the first time around have a new meaning. I’m still a nurse, but I work in a small local hospital. The patients there are my neighbors. I like them and they like me. I just wish I could figure out what I’m supposed to do for them.