Opening My Heart

by Tilda Shalof

  “Are you ready?” Janet asks, looking me over, sizing up my readiness.

  “Almost,” I say cautiously. I’ve been away from work for six months now, since before the start of the summer. Fall has come and gone, now it’s winter, but suddenly I feel nervous about returning to the ICU. Not as bad as when I started out, years ago, but whenever I’ve been away from it, like after each of my ten-month maternity leaves, or even after a long vacation, I get this uneasy feeling, worrying about whether I still have that edge, if I am up to its challenges. It’s that fear and awe combo.

  “When you get there, you’ll get your mojo back,” Jasna assures me.

  A wave of bagel customers just came in and Eric introduces us, the nurses after night shift. They see us and must think, Knitting nurses. How sweet.

  I watch my friends’ graceful, swiftly moving hands and think of all the lives they’ve saved with those very same hands that are now occupied with this seemingly trivial, decorative hobby. Those onlookers have no idea the mighty battles these hands have waged. I bet they don’t even know that it is nurses like these who would save their lives. If they should be unlucky to land in the hospital, they’d be very lucky to fall into these hands. How do we save this species of nursing from extinction? How to grow more nurses like these and ensure there are enough of them to meet the needs of everyone who needs them, which is everyone, one day?

  All I know is, what strengthens me the most is being a nurse.

  Robyn had told me that as I was being wheeled into the operating room, I gave her a thumbs-up. “It made me so emotional when you did that,” she said. “There you were, taking care of me even at that very moment.”

  “I don’t remember, but that was nice of me. It’s what friends do.”

  “But you weren’t just being my friend,” she continued. “It was more than that. You were taking care of me, as a nurse would, up to the very last minute that you were able.”

  “Nurses don’t like to ask for help,” Stephanie says. “It’s so hard for us to be on the receiving side. When the roles get flipped, we feel we’ve failed, let others down. We’re supposed to be the strong ones, taking care of others. It’s so ingrained in us to feel this way, but we can get sick, too. We need to be able to ask for help.”

  Out of the blue, I think of a patient I hadn’t thought of in years. I was working on a general surgery floor, absentmindedly giving a bed bath to an elderly women, busy thinking about the next patient I had to bathe, all the meds I still had to give out, and the dressings I had to change. I was distracted, my mind not with the patient I was caring for on what turned out to be one of her last days on earth.

  She looked up at me. “I was a nurse, too,” she said quietly, “once …”

  I looked at her gnarled hands, crisscrossed with blue veins, soft and so worn that the tips were perfectly smooth – her fingerprints almost gone – from years of hard work. Yup, I believed her. If I needed proof, there were those hands.

  “I took care of many people …” Her voice trailed off.

  I nodded. She seemed pleased that I knew who she was.

  “Now, nurses are taking care of you,” I said, though she had fallen asleep.

  I’m having a tidal wave surge of love for these three individuals at this table and for many nurses I know. I’m bursting with pride to be a nurse and to be a part of this world. My rhapsodic musings are abruptly interrupted by Stephanie, who pulls out from under the table the big plastic bag she brought with her.

  “What’ve you got in there?” I ask. “A bunch of dirty uniforms?”

  “No. As a matter of fact, it’s a present. For you.”

  It’s a stunning, jacket-length sweater coat. Loosely knit with deep, wide pockets, an oversized collar, and shiny, dark green buttons, in black wool, shot through with streaks and flecks of metallic pink, gold, and green. How well she knows my taste. It’s thoroughly practical and appropriately bohemian – perfect for a suburban mom and artiste wannabe like me. What’s best is that it is handmade.

  “But you always said you were a sock girl, could never commit to a sweater!” I say, getting up to give her a hug.

  “For you I can. Winter is coming. It’s getting chilly. You have to keep warm for your long walks. What with the puppy you were planning on getting?”

  This is all you need, what we all need to have and to be – friends like these.

  At home, I look in the mirror and see myself. I’m ready to be a nurse again.

  “Great work, Tilda!” Steve calls out to me in my new spot in the middle of the pack, no more hiding in the back row as I did at first. “Go, go, go!” he shouts at us. During the cool-down, he offers advice: “Whatever you do, do it the best you can. If you don’t know how to do something, learn it.”

  I feel better, stronger, fitter than ever. Your chronological age isn’t always the same as your real age. Maybe age is like weight. How old you are has a set-point, a mind of its own. Forty is mine. I’m almost fifty but feel forty. When I turned forty, I found my voice and finally felt grown-up. Now I feel neither old nor young, but as I get on in years, I feel younger.

  At home in the evening, watching TV with Ivan on the couch, I feel blood flowing through my body to places it never reached before – through my veins, to my earlobes, fingertips, the back of my knees. I feel ready for anything and everything.

  I take another quick glance at the Cardiac Patient Handbook.

  “The energy expended during sexual activity is approximately equal to that required to climb a flight of stairs,” it says. Why, I can race up and down stairs now! I recall Dr. David’s prescription for sex and the health benefits of lovemaking – and the inspiring example of the super-sexed swine. Thirty minutes? Watch out, Ivan!

  I feel loving again.

  After we drink our coffee and watch the late-night news, I take Ivan’s hand. We go upstairs and close the door.

  The pig is back.

  * SLED stands for slow, low-efficiency dialysis.

  17

  THE DIAMOND RULE

  “I’m baaa-aaack!” I announce to everyone at the nursing station.

  It feels great to be here. I’ve been away from work for six months. It’s now three months since my surgery and I can run, climb stairs, even lift weights – I’m ready to lift patients. It’s early–0600 hours, more than an hour before the official start of my shift at 0715 hours – but I was so nervous/excited all night, I hardly slept. My jitters melt away in a moment when I am welcomed back with greetings, hugs – and, of course, cake.

  When I see Dr. Laura Hawryluck, I discover we have something in common: she was recently a patient and is also newly back, recovering from a knee operation.

  “Until you’ve had surgery, you think you know what pain is, but you don’t. I learned so much from being a patient. It’s made me a better doctor.”

  How could that be? She was already one of the best.

  Most of the nurses know why I was off work, but one pretends she doesn’t.

  “Did’ja have a bad case of writer’s block?” she teases. “Are you back for more stories?”

  Now I have my own story. And they still don’t believe I love this place, this work. Though most of them wouldn’t admit it, they love it, too – if the way they do it is any indication. Isn’t it natural to love what we’re good at and to be good at what we love?

  Ingrid Daley is in charge today – she and I go waaayyy back. I see her at the front desk, bent over the staff list, making up the patient assignments.

  “I’ve kept you as extra today, Tilda,” she tells me, “to ease you back in gently.” She glances up from this complicated match-making to look at me squarely. “What was it like being a patient?” she asks. “The truth. You must have been te-ri-fi-ed,” she says, making it a four syllable word. “Any nurse would be.”

  I nod my head in agreement; there’s no time to tell the full story.

  “Hey, welcome back, Sister Shalom Shalof!” calls out Claire, arguably the funnies
t of the wise-cracking nurses, as she gives me a new nickname and joins us at the nursing station. “I feel a book coming on,” she says. “What’ll you call this one? Secrets Within the Bedsheets? How about Nurse Under the Knife?”

  They all call out “helpful” suggestions.

  “Cardiac Confidential!”

  “Nursed!”

  “Nightingale Down!”

  “You should write about this,” someone says. “People love to read about doctors and nurses getting a taste of their own medicine. Doesn’t it infuriate you when people ask if it’s made you a better nurse? As if you have to be sick in order to understand what patients go through.”

  Here’s yet another myth that holds a grain of truth – that you have to go through something yourself in order to understand what someone else is going through. Yes, I do have a better appreciation of what it’s like being a patient from having gone through it myself, but the capacity for empathy shouldn’t be limited by one’s personal repertoire of experience. You can expand that ability with your imagination, by asking a lot of questions, and listening closely.

  “How did you prepare yourself for open-heart surgery?” they all want to know.

  “The ‘before’ was the hardest part,” I say. “I was scared out of my mind. But the ‘after,’ recovering at home, was rough, too. Much harder than I expected. But the actual surgery and hospital stay weren’t that bad at all. They give you good drugs.”

  “You would say that. It’s so you, Tilda. Always looking on the bright side.”

  Yes, I am a “cockeyed-optimist,” but I had to overcome a lot of fear and negativity in order that I could be as positive as I am now.

  In the staff lounge, before the start of the shift, Janet looks up from the book she’s reading to salute me. “Yo, Tillie! Listen to this.” She reads the opening lines.

  It was the best of times, it was the worst of times, it was the age of wisdom, it was the age of foolishness, it was the epoch of belief, it was the epoch of incredulity, it was the season of Light, it was the season of Darkness, it was the spring of hope, it was the winter of despair, we had everything before us, we had nothing before us, we were all going direct to Heaven, we were all going direct the other way.

  “A Tale of Two Cities,” she says. “That sums it up pretty well, wouldn’t you say?”

  I’ve travelled to those cities, gone far away and made it back safely to my hometown.

  The shift starts. As a roving “extra,” I have light duties – restocking the intravenous line cabinet, checking that the arrest cart is fully equipped and functioning properly, and helping anyone who has a busy patient. Truth be told, not having a patient assignment also gives me an opportunity to stroll around the ICU, chat with friends, and catch up on the latest news – a computer workshop I have to attend, another lecture on patient-centred care – and, best of all, the dish and dirt: nurses who left the ICU and why; the lowdown on romances and breakups; updates on who’s blissfully pregnant and who’s still trying; “secret” affairs and racy scandals galore. (Why would I ever stop working here? This stuff is irresistible!) More than a village, it’s a kibbutz. Everyone knows one another’s business – and I like it like that.

  Later on in the morning, down in the lobby, I even catch sight of Dr. Tirone David, distinguished as ever in his long, immaculate white labcoat, standing in line at Tim Hortons along with the rest of us mild-roast Java drinkers.

  “What are you doing here?” he asks, not recognizing me out of context.

  “I work here,” I remind him. “I’m a nurse in Med-Surg ICU.”

  He forgot me, which is a good thing. Maybe it means I didn’t get preferential treatment after all, which is as it should be. He offers to buy me a coffee, but I treat him to one instead, with my super-duper charged-up Tim Hortons coffee card, a gift from the ICU team.

  “How do you feel?” he asks.

  Great, I tell him and ask about his arm, which has been surgically repaired to his satisfaction and is back to normal. Eyes lowered, I sip my coffee, blushing at the memory of my confused state and inappropriate fantasies during my anesthesia-and-narcotic-induced stupor.

  When I get back up to the ICU, Ingrid rushes over to tell me there’s a patient on the way. She had hoped to give me a quiet day to allow me get my groove back, but if I’m up to it, she says, she’d like me to take this assignment.

  “She’s sick, Tilda,” Ingrid says but assures me that if I don’t feel I can handle the challenge, she can switch things up to give me a “quieter” patient.

  “The patient’s on the floor, in respiratory distress, deteriorating fast. The Rapid Response Team is on their way up, bringing her to us. What’ll it be? Decide!”

  Does she realize the compliment she’s giving me? To assign a sick patient to a nurse is one of the highest compliments of all, second in rank only to choosing that nurse to care for yourself or a loved one.

  “Yes,” I say, suddenly pumped. Adrenalin is racing through my body. Can I handle this? I think for a split second. Yes, I can!

  The room is ready, the team is ready. I am ready. I plunge in.

  The bed is wheeled in. One glance and I see it’s serious. A woman in her thirties is struggling to breathe, her breaths fast and laboured. She’s on 100 per cent oxygen. She needs to be intubated and I wonder why she isn’t already. I try to hold off judgment and questions until I receive the complete report from the floor nurse.

  Again, I pause: Can I do this? Am I ready? No time for that. Get to work.

  I go back in and in a flash, it all comes back to me.

  The patient is vomiting into a basin and I leap to her side to support her head so she doesn’t aspirate. Her oxygen saturations are down to 85 per cent. The respiratory therapist is on standby to intubate and I get the drugs needed, but we stop; hesitation hangs in the air. We’re in a holding pattern, but why? We are not protecting this patient’s airway and breathing – the A and the B that will soon affect the C.*

  Over the hubbub of all the people who have converged into the room to help, I catch the patient’s name – Suzanne – and her diagnosis – pulmonary hypertension.

  How I hate this disease! It’s a rare condition where the arteries of the lungs become narrow and stiff, causing high pressure in the lungs and enlargement of the heart. It can be managed medically for a while, but eventually the only “cure” is a lung transplant. Meanwhile, she’s struggling to breathe and for some reason we’re stalling.

  “Why hasn’t she been intubated yet?” I ask the doctor and nurse from the floor.

  “She’s refusing it,” the doctor says.

  “She’s terrified of the tube,” the floor nurse explains.

  She tells me that the doctors have explained to Suzanne and her family that with her condition, intubation carries additional risks: she might not be able to get off the ventilator and is likely to develop complications. An artificial lung may offer a “bridge” until donor lungs become available, but until that can be put in place she needs to be on a ventilator that will breathe for her. She cannot hold out much longer.

  “Yes, but she still refuses intubation.” As an aside, the floor nurse adds, “I don’t blame her. I’d be the same way” and gives an involuntary shudder. “Her family’s in the waiting room. They want to come in right away.”

  I go back to Suzanne and introduce myself, but she doesn’t care about my name – only having a sip of water, which I can’t give her because she is at risk for aspiration into her lungs. I get to work, assisting the doctor to put in central IV lines, a pulmonary artery catheter to measure pressures in her lungs, and an arterial line to monitor her blood pressure and draw blood, and helping the respiratory therapist set up equipment to have on standby. How long can she last like this without crashing? I take blood samples, call for a stat chest X-ray, do a twelve-lead electrocardiogram, and start my head-to-toe assessment. Suddenly, I stop. It sounds crazy, but I swear I can feel the family’s anxiety from the waiting room. I go out there t
o bring them in and try to prepare them as I guide them down the long hall toward the ICU.

  As gently as possible, I say, “You will see lots of machines, flashing lights, and noises … it’s scary, but it will get easier each time you come to visit.”

  Once in the room, her three sisters swarm her bed. Her husband and elderly parents retreat to the sides, to let them have their turn to be closest to her right now.

  “Why can’t she have a sip of water?” one sister demands. “You see how thirsty she is!”

  Suzanne grabs my arm and mouths, “Water.” Seeing her thirst, my own mouth feels dry, too. I lick my lips and swab hers with a moist washcloth. Her husband unpacks her bag – toiletries, a pair of furry slippers, and a photograph that he places face down – on the top of her bedside table. He tells me about their two young daughters at home, being cared for by his mother. Suzanne was diagnosed with pulmonary hypertension a few months ago, he says. She’s been at home on oxygen and an IV medication called Flolan but has deteriorated over the past few weeks.

  The sisters recede to let the parents move closer. They tuck in the covers over their daughter’s restless body and smooth them out, probably as they did when she was a child, before bed. What can we do to help? their eyes beseech. Her sisters tell me that Suzanne is a mother of two young girls. She’s a lawyer, a marathon runner. Yes, she was a smoker, once, a long time ago but stopped ten years ago. She takes excellent care of herself and was always healthy, until this.

  “That’s in her favour,” the ICU resident says to them encouragingly, loud enough for the patient to hear, too. “Right now, Suzanne needs antibiotics for her pneumonia and support for her breathing with a ventilator. She can’t hold out much longer.” I can feel him striving to find that balance of reality and optimism. “It’s serious,” he says. “A transplant is her only hope.”

  She’s worsening by the moment, before our eyes. Her respiratory rate is fifty to sixty breaths per minute. Her blood pressure is skyrocketing and her pulmonary artery pressures are nearing the triple digits – the highest I’ve ever seen. She will tire soon – arrest and die if we don’t do something. She may die anyway, but this is her only chance at life.