by Tilda Shalof
Computerized charting will reduce transcription errors and eliminate illegible writing. It will also help protect patient privacy so I probably won’t have the experience I had recently when I was standing in a crowded elevator next to a cardiologist who was flipping through a patient’s chart. I could easily read the name, address, diagnosis, and the treatment. With an electronic chart, it’s not as possible for health care workers to trespass into friends or celebrities’ electronic charts, which are more secure than paper ones. There are undoubtedly additional benefits that I can’t even imagine, but there’s still one thing I have against computers: they take me away from patients. Time and attention spent staring into an inanimate screen when I’d rather be at patients’ bedsides, caring for their bodies, undistracted by technological gadgets, fully present, face to face, being with them and listening to their stories.
I sit at the nursing station, still in my hospital gown, and start to feel chilled. Nurse Yolanda drapes a warmed-up blanket around my shoulders and places a cup of chamomile tea beside me. How does she know I feel chilled?
She guides me back to my room and gives me two pain pills.
“Is this normal?” I ask her about my darkening incision.
“Yes. Red, purple, then back to your natural colour. That’s how a scar heals.”
On her brown skin, too? I wonder, but feel too shy to ask. I chuckle to myself, remembering a Nurses’ Week celebration where there were raffle prizes to be won. A Jamaican friend who forgot to bring her glasses and asked me to read it to her.
“Golf clubs …” was the first item on the list.
“Don’t want it,” she said.
“Day at the spa …”
“I’d love it!”
“A visit to a tanning salon …”
“Don’t need it!” she said, both of us sharing a dry laugh at that.
I look at Nurse Yolanda. I know nothing about her other than she loves Jesus and is a good nurse. We didn’t get to know each other, but lots of times it’s like that between patients and nurses. A relationship isn’t always necessary for a therapeutic encounter to take place, but I do crave some connection to the people caring for me. I can’t stand to be strangers for long.
Yolanda guides me to my bed. I made it myself this afternoon. It took me a long time and I didn’t do a great job. When patients complain that their bed linens weren’t changed, it’s a reliable indication they are capable of doing it themselves. The best care is self-care. We patients have to do as much as we can to help ourselves get better. Maybe there are even ways we can help the people caring for us to do their work.
“Why don’t you pull a mattress in here, for a nap?” I ask Yolanda. I’ve certainly done it on night shifts, but she looks aghast at my suggestion. Taking a rest, when it’s been safe to do so and when trusted colleagues were available to spell me off, has helped me get through many a long night.
Ahh … I sink down. “Sleep, nature’s soft nurse.” A line from Shakespeare floats into mind, out of the blue. These drugs are making me wax poetic. I close my eyes and see tiny bursts of red, purple, and white fireworks behind my lids. Whatever they’ve got me hopped up on, keep it coming. It’s a lovely trip.
I settle back and wait for sleep to come.…
But I can’t sleep. I’m too excited to go home and see my kids who thankfully, as I requested, have not visited me in here – or at least I don’t remember them being here.
“Sleep, God’s free medicine,” Kate, a nurse friend, says. Maybe that’s what patients need the most – a good night’s sleep – and to be kept amused while nature cures the disease, to paraphrase the old French philosopher Voltaire. Maybe I’ll go out there and ask Nurse Yolanda for something to knock me out, but oh, how I hate it when my patients make me into their drug dealer!
13
BABY STEPS
Ivan has gone off to hunt down a wheelchair. I wish him luck. This is a hospital – he’ll never find one here! I wait for him outside my room, sitting and grinning, triumphant at my accomplishment. I made it. Open-heart surgery on Monday and home on Sunday – six days – pretty good!
Nurse Yolanda came to say goodbye to me at the end of her shift this morning. “You were a good patient.” She paused to think it over. “Yes, a very good patient.” I think she meant I didn’t have many complications and wasn’t too demanding.
A cardiology resident checked me out and has pronounced me good to go. My blood sugar has normalized, vital signs stable, incision healing well. My hemoglobin is still low, but that will take time to improve. There’s a list of meds I’m on – a beta blocker, aspirin, iron supplements, and painkillers – and a nurse offers to explain them all to me. No worries, I tell her, I know this stuff inside out. I’m chomping at the bit to get out of here! Okay, she says and gives me a large handbook of information for the cardiac patient, highlighting its main points. No lifting more than ten pounds for six weeks. (The weight of a watermelon.) Showering is okay but there is no bathing until the incision is healed. No driving for six weeks. No sex until you’re able to easily walk up and down a flight of stairs. (Is that because the bedroom is up there?) If you have questions or concerns, call us anytime, night or day.
Eventually, Ivan shows up with a wheelchair – he’s nothing if not tenacious – and I pile into it my vases of flowers and bags of gifts and then walk beside it, leaning on it for support as I move toward the elevator. I’m busting out of here! A hospital is no place for healthy people. I walk through the front revolving door without a care in the world. My only debt is one of gratitude and a new sense of obligation to take better care of my health. The hospital’s only request of me is to complete an evaluation form about my hospital stay because they aim to improve patient satisfaction. They want to know about my “patient experience,” like how long I waited for tests and procedures, whether staff was courteous, and if my expectations were met. I have no criticisms. It’s like my father’s old joke about a perfect wedding – “The bride was too pretty.”
It’s a glorious morning! I stare out the window at the world that’s still there, waiting for me to be a part of it again. The hospital world envelopes you so completely that the real one outside vanishes in your mind.
We stop to pick up a few groceries at the supermarket. Ivan tells me to wait in the car, but I follow in after him. I need to test-drive my new heart – not new exactly, but it feels that way. I wouldn’t miss this exciting field trip for anything! On the shelf, a bottle of ketchup! Pickles! It’s still summer so there are baskets of sweet plums and juicy peaches! It’s a whole new life for me. Yogurt! Cherries! Cornflakes! Olives – yes!
“You’re not supposed to lift anything.” Ivan rushes to take the cereal box from my hands. He’s hovering, like when we drove home with our newborn baby.
When we pull into the driveway, the kids run out to greet me. Harry unloads the car and Max throws his arms around me, wrapping me in a squeeze so tight, it makes me gasp.
I may pass out.
“Breathe, Mom,” he tells me.
“You’re part pig now, Mom,” Harry says. “How cool is that?”
I agree, but as much as I love the pig, it’s not exactly a compliment. He must realize this because he hastens to add, “The pig is a very smart animal, Mom. It suits you.”
Max wants to see my scar and looks at it in fascination. He likes those crime investigation TV shows, so maybe I look like a stabbing victim to him?
Everyone is so happy to have me home – even Phoebe the cat comes over to purr and weave in between my legs.
First thing, I take a shower to wash off all residue of the hospital. I dry myself off and, in my own bathrobe, pad into my office to greet my books. It was touch and go there for a while, I tell them, but here I am. I made it. Maybe there are a few too many of you. It’s time to give some away. It suddenly strikes me as an odd activity to hold on to things. Right now, possessions don’t mean as much as before, but I’m sure in time, I’ll get back into the joys of
shopping.
I look over the instruction pamphlet the nurse gave me, but I can’t remember what she said. Why did they put me on a beta blocker? How long do I have to take iron? Why am I taking aspirin and what dose and for how long? For pain, they’ve prescribed oxycodone (a.k.a. OxyContin, the trade name) and it says take two tablets, every four to six hours as needed. Should I take them now or only when I have pain? My nurse tried to explain all of this to me, but I didn’t listen, too eager to leave. Now I’m too impatient to read the instructions, but Ivan helps me sort it out.
I’m exhausted from not sleeping, from pain, the blood loss (my hemoglobin is seventy, almost half of what I came into hospital with), and from the sheer relief that it’s over. I crash on the new maroon leather recliner I find in our family room. Ivan bought it as a surprise; a must-have for every convalescent!
A tap on my shoulder. Ivan peers down at me sunk into the depths of the recliner. Hours must have passed. “Let’s go for a walk. Once around the block.”
“Later,” I promise. “I’m too tired.”
“They told you how important it is to walk. C’mon, let’s go.”
“Let’s not and say we did.” I drag myself upright and slowly trudge along the sidewalk, just behind him, each step a supreme effort. I make it only a few steps down the street and am ready to turn back. I can’t go farther. I look one hundred years old and feel ancient.
“You’ll do more tomorrow. It will get better,” he says. “Each day, you’ll get stronger. You’ll see.”
For the next two days, Ivan doesn’t leave my side, attending to my every need. But the third day he has to get back to the office and he’s worried about leaving me alone. Friends will be visiting throughout the day, but he’s hesitant to go. “I’ll be back in a few hours,” he tells me, placing the cellphone, TV remote control, pain pills, and a glass of water beside me.
“I’ll be fine,” I tell him and of course I am.
As soon as he gets home, he starts to grill me. “Did you take your pills? What did you eat today? How far did you walk?”
He’s a nag. For dinner he fries iron-rich steaks and slimy liver to boost my iron, but I can’t eat a thing – certainly not that. He yells at me for not doing enough and at other times for doing too much, like when he catches me unloading the dishwasher, slowly, stopping, out of breath.
“You still haven’t learned to be a patient, have you?” He takes a stack of dinner plates out of my hands.
“What does it require?”
“Patience. You have none, but that’s you,” he says with a sigh.
“Unfortunately, yes.”
“Time for your walk.”
I’ve recovered from the dishwasher, now it’s time to move.
“I can’t. I’m too weak.”
“A few more steps than yesterday,” he coaxes me. I follow the leader.
We stop, halfway around the block. “Am I a difficult patient?”
“You’re a pain in the ass,” he says grimly, “but worth it,” he adds, grinning.
Over the next few days, I spend most of my time in the recliner, eyes closed. Not asleep but taking a break from being awake. In the evening, I look forward to the reward of my bed. If I pop a few of those Oxy-babies, I sleep all night, too. I take one and in a few minutes there’s a jolt of pure pleasure that melts into a calm, robust, glowing feeling of well-being. Pain? Who cares! I’m not looking forward to stopping them. How easy it would be to become dependent on them; I have to be careful. It could happen without even knowing it.
Each morning, at the exact same time, the phone rings. It’s the hospital’s automatic check-in system. “We care about you!” it starts off in a standard-issue, electronically generated voice. It asks questions about my incision, pain, constipation, activity, and mood. I punch the # key for yes and the * for no to answer each question. “We care about you,” the voice repeats before clicking off. Right. Some house call.
Ivan, on the hand, is a real nurse. He oversees my diet, gives me my pills, and makes sure my incision is healing. He monitors my pain, energy, and exercise. I read an article about “cardiac spouses” that says they “often feel overburdened and that their needs are forgotten.” They haven’t met Ivan. He’s a nurturer through and through and is thriving on this new project of taking care of me; he puts his whole heart into it and has never looked happier.
I pop two more pills, not for pain, but to avoid pain and remind myself that OxyContin is a highly addictive neurotic – I mean, narcotic. I could get $50 on the street for one of my tablets of “hillbilly heroin.”
Throughout the day, friends drop by bearing flowers, chocolates, get-well cards, a tray of lasagna, and pots of soup. Laura and gang have left a bunch of funny movies with a note: “Don’t bust a gut!” The ICU team sends me a gift card for Tim Hortons worth $100. That’s a lot of coffee, something I usually love and have every day, but now I can’t drink coffee, tea, or much of anything. Food tastes strange, slightly off.
Visitors get a shock when they see me as an invalid, weak, and pale, lying there on the recliner, not doing much of anything. They hug me carefully, sensing my fragility. Does seeing me give them an inoculation, like a tiny exposure that confers immunity? Do they get a tiny guilty pleasure knowing it’s not them? I have felt both ways, at times, about patients. It’s hard being on the receiving end of sympathy and concern.
“How are you?” some say gently, as if the question itself might be too much for me.
“You must be so glad it’s over,” one friend says, more conversationally.
“I’m glad I made it.” I’m operating on that level, still amazed at having survived. It’s an unexpected gift of gratitude but also a new responsibility to bear.
I’m happy when visitors come, then after a few minutes I want them to go. Thanks for coming, now please leave. They can’t win with me. I try to be gracious but usually doze off during their visit. It’s strange for me to have visitors and not be able to jump up to greet them or make them a cup of tea or a meal. Ivan takes care of that as well as being the gatekeeper, making sure I don’t overexert myself, kicking out visitors who stay too long.
As soon as they leave, it’s time for a painkiller.
The next day, the electronic “nurse” calls again. Maybe if I hang up an actual person will call and we will have a real conversation. But I guess there once was a time when telephone talk seemed unnatural, too. It puts me in mind of one of my worries about my profession: what is happening to face-to-face, hands-on nursing care? It’s beginning to seem like a rare and precious commodity. I’m sure it’s acceptable for marketers, radiologists, writers, editors, architects, salespeople, and programmers to toil in the “electronic workshop,” but if your work requires building, making, doing, communicating, observing, feeling, being present, emoting, empathizing, witnessing, or listening – all essential nursing activities – a live human presence in real time is required. I know a public health nurse whose work involves teaching, counselling, and consulting, but she always says with a touch of smug pride, “I don’t touch patients.” I guess she means she’s strictly a “knowledge worker,” which is how nursing is branded these days by the universities where nursing is taught. Lots of research, policies, theories, and “new knowledge” are being produced there, but patient care is accorded lesser importance. There’s a disproportionate amount of thinking over doing. We now have researchers, scholars, and intellectuals in our profession, but not enough people willing to do the yeoman’s work of skilled caregiving – an imbalance that is going to have a huge impact on our aging population – in fact, it already has: there’s a worldwide nursing shortage.
And why is moving away from the bedside always seen as career advancement? It puts me in mind of Margaret, who was a fabulous hospital assistant. She helped the nurses with patient care in a professional and compassionate way but was thrilled the day she was offered a “promotion” to a ward clerk position. “Now I can use my brain, not my body,” she said with
pride. In her new position, she gets to wear her own stylish clothes instead of a uniform, sits at a desk, answers the phone, and works on a computer. Many think that hands-on work is unskilled or brainless. No one wants to get down and dirty! Even nurses themselves have been known to say that trained monkeys could do some of the tasks we do. I don’t see it that way. To me, nothing about caring for patients is trivial, inconsequential, menial, or routine.
In fact, this point came home to me one day at work when I happened to be riding in an elevator with the hospital’s CEO. He wore an elegant tailored suit and I, wrinkled green scrubs and a lab coat with a ketchup stain on the sleeve. (At least I hope it was ketchup.) He makes more than $700,000 a year – and I make, well, considerably less. (For the record, a full-time senior nurse in Ontario makes around $85,000.) I don’t begrudge him his lavish salary. He has duties and responsibilities I can’t even imagine, along with a skill set that is way beyond me, but neither do I bemoan my very decent income. But think of this – if you’re a patient, who’re you gonna call? Which of us is of more use to you? In your time of need, who do you want to show up at your bedside? A patient needs a nurse more than a CEO and that’s why I’m glad to be one.
Thanks for the virtual house call, but the nursing care I value can’t be phoned in.
