by Tilda Shalof
“Hi, there, dear …” Robyn’s parents … precious faces hover above me, kiss me on the forehead, hold my hand … it’s so nice of you to come, but what is this nice lady’s name – Cora? Dora? It’s Norah! She’s wearing a white blouse, red sweater. It must be July 1. Happy Canada Day! I smile at them.
“It’s August 26, dear,” someone says.
Don’t worry about me … I know what’s going on. Am I saying these words or thinking them? I can’t tell.
“Hi there …” My voice is raspy, unrecognizable.
“Tilda, I’m going to take out the big intravenous and pulmonary artery catheter from your neck. We used it to measure the pressures in your heart, but everything is normal now and you don’t need it anymore … don’t worry … this may feel a bit strange, but it doesn’t hurt.…”
I am completely cared for … I let go … no pain.
Every time a nurse comes toward me, beside me, around me, something pleasant happens. A tube is removed, a soothing word, a touch. I look forward to the voice, the hands. I move toward each thing that happens and each time, I’m lighter, brighter.
I just might make it.
“Hi, Tilda. It’s Christine. I’m your nurse today. I’ll be transferring you to the floor soon. You’re doing so well. That’s good. Open your eyes.… I’m going to remove your chest tubes … first I’ll give you some pain medication … doesn’t hurt but will be uncomfortable for a few moments … as they’re coming out …”
Yes … like I’m being eviscerated … as a cat pulls out the entrails from a mouse … weird sensation … shuddering feeling of being disembowelled … my guts pulled out …
No, it doesn’t hurt, but strange …
Nurse Christine Sterpin at my side. Pretty, pink, cheerful, energetic, hopeful …
I’m a shipwrecked sailor, swimming toward her safe shore.
“Time to transfer you to the cardiac ward now, Tilda. We’re on our way!”
So that was the ICU. I survived!
10
FROM VERTICAL TO HORIZONTAL
I open my eyes. At the end of my bed, a sign on the wall:
Your nurse’s name is: Melissa .
Very good, but what’s my name?
How many days have gone by?
I made it … I guess.
I lift my head up from the pillow … barely.
Brain cells intact … more or less.
“Pleasantly confused” we call it in the biz.
Minutes – or hours? – have passed. Voices buzz at the doorway.
“Isn’t she the one who wrote those books?”
“Yeah, it’s her.”
“I think I’m in one of them.”
Ha, you wish.
—
A nurse – is it Melissa? – arrives. “Here’s the call bell.” She holds it out to me, but I don’t take it. She pins it onto my pillow. I look away. Never! I will have to be in extremis, practically dying, before I’ll use the call bell. I know what it’s like to be summoned like a servant, expected to drop everything, and come running. On the other hand, how reassuring it is to know that help is at hand. Nurses hate the call bell. Patients love it but curse it if it doesn’t “work”: when they push the button and no nurse instantly appears – poof! – like magic, a genie in a bottle.
“When I call you, you come!” a patient snarled at me once. I was working on the floor and had five other patients to get to and call bells were ringing one after another. When I finally got to him, he was in a rage, banging on the siderails with his metal urinal.
“You’re probably gist sittin’ out there on your ass, gabbing with your girlfriends,” he said. “You do as I tell you.” He ordered me to take away his finished breakfast tray, come back and flip his pillow, then raise, lower, then raise again, his bed in infinitesimal degrees.
Remind me, please, why am I supposed to care about you? Silently, I managed to contain my irritation and did what he asked. I wish I’d told him off – I would now – but back then I thought we were supposed to just take that kind of abuse.
The call bell rests on my pillow. I dare you, it taunts me. Just try me and it’s game over, you’ll be a patient, helpless and needy.
I float on a cloud. Sunlight floods the room, warming my eyelids. I open them slowly.
Under anesthesia, you are gone. Where, I don’t know, but it’s far away. Bits and pieces of the ICU linger – Maria’s eyes locked on me, Joy’s healing hands on my body, and Christine’s positive energy, coaxing me back to life. I was incoherent and disoriented, saying strange things; there was no connection between my thoughts and my words. I thought I was speaking out loud when I wasn’t, convinced I was making perfect sense, but I wasn’t.
My throat is scratchy from the tube, but I don’t have any memory of the sensation of being intubated. How bad could it have been if I don’t remember it? Perhaps pain only hurts if you’re aware of it? They must have given me sedation for comfort, analgesia for pain, but made sure I was alert and breathing enough to breathe on my own. That takes skill. Who wants to be awake while intubated? Not I. As for discomfort, I had none, but I was using the pain pump repeatedly, going at it like a drug fiend, as if I had no understanding of its use.
I glance down. On my chest is a white, heavy bandage. I touch it lightly. It feels much bigger than it looks. I gaze around the room, but that effort tires me so I close my eyes.
Cheery nurses come in and out, not the least bit concerned about my mumblings or glazed stare – or this huge, new lump on my chest.
“Time to get up,” Nurse Melissa says.
Get up? Is she kidding? Is this a joke? Apparently not. “I can’t do it,” I tell her.
She doesn’t take no for an answer and stands facing me, puts her arms on either side of me, under mine, and eases me up to a sitting position. She gives me a moment to catch my breath, then swivels me so that my legs are dangling at the side of the bed.
She looks so young and I feel so old. Does she see only the rumpled, groggy me or the real me?
She turns her head away to cough.
“Are you sick?” I draw back slightly, afraid to get whatever she’s got.
“A bad cold. But I’m okay.” She lifts me up to stand on my feet. Held there in her arms, I inhale her deeply. A strong whiff of vanilla and patchouli, a spicy chocolate cake.
“I have to go to the bathroom.” How am I going to get there?
“You can walk. I’ll help you.”
I get up – oh no, I’ve wet the bed. Attention, shoppers. Clean up in aisle nine!
“Don’t worry,” Melissa says, placing me onto a chair and then quickly changing my sheets. “It happens sometimes after the catheter has been removed. Come, I’ll help you to the bathroom.”
She expects me to walk there? By myself? Is she nuts?
Slowly, she leads me there and then back, lowering me down on to the chair. “Here are your pain pills.” She places them on the table in front of me, then hands me my spirometer for my breathing exercises.
I have to do this. I don’t want to get atelectasis. I pick up my “toy,” as Max called it, and blow into it. The ball remains at the bottom of the contraption. Why isn’t it moving? It must be broken. Oh, I forgot. “Suck, don’t blow,” I’ve told many patients, realizing only now how lewd that instruction sounds. Once, a patient joked, “After all I’ve been through and now you’re passing me a bong?”
Melissa watches me do a few rounds as she moves toward the door. I’m sure she has a few others like me to get to.
One more inhalation on the spirometer and the ball jumps to the top of the plastic cylinder tube like it’s supposed to. That’s all for now.
“You’re doing great,” she calls out before she vanishes.
I’m feeling better. They give you give good drugs here. I like this place.
—
Later – how much later? I have no idea – I walk to the bathroom by myself, wobbly on my feet. It feels like a major accomplishment. I pee int
o a container, measure my urine, then pencil in the amount to a tally sheet taped inside of my door. I want to be helpful to my nurses, but I wonder if they’ll see it that way. Maybe they’d prefer if I were a “regular patient,” but it helps me to stay nurse. “The best care is self-care,” my friend Nurse Deanna Patricia Bone writes in her book, Nurse Pat’s Practical Guide for Caregivers. It’s my new mantra. I make my way back to the chair, sit and breathe, not for mindfulness, but for oxygen. I did it!
Breathing is hard. Something is wrong with my breathing. My heart is racing.
Breaths laboured, SOB – shortness of breath – even at rest. Respiratory rate thirty-six breaths a minute – patient is tachypneic. Heart rate one hundred after moderate activity.
What’s wrong with me?
A cluster of doctors stand outside my door reviewing the case – me! They don’t seem the least bit concerned with my heart rate or my difficulty breathing. They don’t even notice.
“Aortic valve replacement and repair of aortic root,” I hear them saying. “Day three post. Had episode of post-operative bleeding … hemoglobin dropped to forty-eight … given plasma and red blood cells … hemoglobin now seventy … Otherwise uneventful.”
Yes, a routine case, but FYI – those are the one’s that’ll get ya! You see the same things over and over. This is normal for a post-op valve job, but how to stay alert to the exceptions, the ones who veer from the norm and the subtle signs that trouble is brewing? I’ll keep an eye on it for you. Sometimes the basic things get missed, like vital signs, for instance.
Relax, let them worry about it; it’s their problem now. My breathing is better. No worries.
—
Flashes of the ICU return. Darkness and light, noise and silence, movement and stillness – far away, down a long, deep tunnel. Not unpleasant but strange.
For as long as I live, I will never forget Miriam, a patient from Rwanda. I don’t remember her medical problem or much about her, other than her having the worst case of ICU delirium I’d ever seen. She had harrowing hallucinations and just witnessing her going through them was disturbing – I can’t imagine what it was like for her. She would be in a deep sleep then suddenly, as if from a shotgun, she’d startle awake, eyes bulging out, finger madly pointing in front of her, at something only she could see, only she could hear. I tried to console her – we all did – but she was unreachable. We tried many different medications to help her but none worked. “What does she see?” I asked her sister one day.
“Her children. She hears their screams. They were murdered in front of her in the village. Then they raped her and left her to die, but she survived.”
What was it about the ICU that brought this horror back to her?
“Hi, Tilda, I’m Marion McRae, your nurse practitioner.” A tall, attractive woman bends way down to where I lie in the bed to listen to my heart and lungs. She palpates the pulses in my legs and feet. Gently and smoothly, she slides out the pacemaker wires from where they had been placed, inside my heart – weird sensation but not painful – leading out to a pacemaker box hanging on the IV pole.
“How are you feeling?” she asks as she sits down beside me.
“Weak. I have … difficulty breathing … at times. My heart is racing.”
“It’s because your hemoglobin is still low, only seventy-one today. You lost a lot of blood after your surgery. You’re on iron supplements and your bone marrow will produce more red blood cells, but it takes time. Eventually, you will get your strength back.”
Nurse Melissa has returned to take my vital signs, test my blood sugar, and give me more pain meds. I don’t see her wash her hands before touching me, but I’m hoping she did before she came in. It’s not so easy to ask, from this side, so I let it go. She’s a new grad, she tells me, fresh out of school, this is her first job, she says proudly.
I want to reassure her, You won’t always have miserable patients like me. Well, you probably will, lots of them. Please stay in nursing for a while, don’t leave us yet, though you might want to lose the perfume!
I once worked with a nurse who wore a perfume called Opium, which made me nauseous. Another time, a patient’s visitor was drenched in Obsession. Within a few minutes, I got a searing migraine and had to go home.
“Here’s your lunch, Tilda.”
A tray is placed in front of me. What’s this? A diabetic meal? This isn’t for me! This is a mistake. Only 1,200 calories a day? Who’s idea is this?
It’s like my father’s old joke: the food is terrible and such small portions!
Breathing is difficult. I take a breath and wait breathlessly for the next.
I reach for the call bell – but stop myself.
A nurse I knew had an automatic signature on her emails with the motto “Until the call bell rings …” For whom the bell tolls … it tolls for thee.
“I pushed the call bell a hundred times,” a friend’s mother once said, recounting her hospital war story after bowel surgery. “I was bleeding to death. I was lying in bed and blood started pouring out of my rectum. I called for help, but no one came. The siderails were up so I couldn’t get out of bed, so I scrunched down and slid out the bottom. I wrapped myself in sheets and I held my arm up, the one with the IV. When I got to the nursing station, the nurses laughed and said, “Oh, here comes the Statue of Liberty.”
Ouch! Outraged patients have been known to exaggerate their hospital horror stories just a tad, but if this one is even partially true – and it comes from a reliable source – it’s horrific.
I’ve heard of patients who used the call bell and when no one came, they got so frustrated they called 911 from their hospital beds. I’ve walked through wards where halls are empty, the nursing station vacant, no one was around. Who’s minding the mint? Where have all the nurses gone? Everyone is busy with someone else. If you happen to see a nurse, she or he is rushing past, distracted, running off somewhere else, to somebody who apparently needs them more than you. A nursing professor told me that when he was a patient, he fainted after a hernia operation. A cleaning staff was mopping the floor and pushed the call bell for help. When no one came, she helped revive him herself.
Melissa pops in. “Do you want to go for a walk, Tilda?”
What am I, a dog? Are we going to the park? “No,” I answer curtly.
“You need to walk. It’s good for you.”
She won’t take no for an answer. She stands holding my leash – my IV pole – waiting for me to get up. I guess I’m supposed to be able to do this by myself by now. Oh snap! This is hard. Melissa’s still not feeling well herself. She’s sniffling and congested. Her eyes are bleary. She stands away from me to cough. The prospect of coughing makes my chest ache. Sneezing? Forget about it! What if I get her cold? Will I have the strength to fight it off? “Maybe you should have called in sick?” I ask her.
“They were short-staffed and, besides, I’m casual.”
That means she has no sick benefits, but it’s no excuse for coming to work and spewing out germs on others. She walks me outside my room and I catch sight of myself in the hallway mirror, my hair going in all directions, pale, hunched over, frail, and dopey-looking, like a zombie. I’m stoned. I force myself upright, pretend to be strong.
“Time for your chest X-ray, Tilda, and an echocardiogram.” A porter pushes me along in a wheelchair that I have no recollection of getting into. We’re rolling down the highway – I mean, hallway – at a good clip … turning a sharp corner – wheeeee! They should put a fake steering wheel on these things to give us patients at least the pretense of control. I am backed into the elevator, not facing the wall. I appreciate that.
Enid, the service elevator operator, cranes her neck to get a look. “I know you!” I nod weakly. “I used to see you like this.” Her big arm flaps up and down beside me in a vertical chopping motion. “Now I see you like this!” Her arm slices the air across my chest, flattening the horizon.
After the chest X-ray, I ask the technician, “Wha
t are those things?” I point at little squiggles on the black and white picture of my heart, lungs, and ribcage on the computer screen. Little bows that look like twist ties on garbage bags.
“They are the sternal wires to hold your ribcage together,”
Oh. My chest was cracked open – I forgot about that. That’s why it hurts to laugh. Good thing nothing’s funny.
The radiologist reviews the images of my heart. “It looks good, although it will take time for your heart to recover. But all the cardiac measurements show improvement.”
Still, my body feels fragile, cracked into pieces. Will I ever be strong again?
In the afternoon, Mindy, my perfusionist, comes for a visit and brings me a strawberry and banana protein shake from the downstairs juice bar. I sip it slowly. So cool and refreshing. She tells me about the operating room and how quiet it gets when the heart is stopped and the surgeon is sewing. “There was definitely more tension in the room because it was one of our own,” she says. “We even talked about your books.”
“What, during the surgery?” I look at her in surprise.
“Yes, Dr. David said he read them and liked them. A lot.”
“Lucky for me!” Imagine if he didn’t.
How am I going to thank all of the people who saved my life?
Dear Mindy,
Thanks for stopping my heart and for keeping oxygen flowing to my brain! Thanks also for starting it up again. Have a nice day. Best wishes, Tilda
What about the people who donated blood? Had blood been unavailable or had I not agreed to blood transfusions, I would surely have died.
Marion, the nurse practitioner, comes back and sits with me for a while. She explains that the diabetic diet is to get my blood sugar levels back to normal. They can be unstable post-operatively or with an episode of bleeding. “You’re in a pre-diabetic state. It will likely resolve, but you are going to have to watch your diet from now on.”
I’m starting to connect the dots. I’m not diabetic yet but could be soon if I don’t start taking better care of myself.
As the day wears on, I’m vaguely aware of visitors coming and going and their mild shock at seeing me. But when my gal pals from Laura’s Line – Laura herself, Frances, Tracy, and Justine – arrive, they take one look at me and aren’t the least bit fazed to see me like this, frail and helpless, sitting there in my faded blue hospital gown. Maybe it’s one I put on a patient myself! They’re wearing bright summer clothes, so animated, full of life, in their usual high spirits, chatting and laughing.
