Opening My Heart (10 page)

I draw up a dose of sedation and inject it into his
IV
, a central line that goes into a large vein that leads directly into his heart.
What a leap of faith it takes to allow someone to inject a drug into your veins!
Just before nodding off, he mouths, “Thank you” around the
ETT
tube, a message that’s easy to decipher. Most of us have learned to read lips – eyebrows, foreheads, shoulders, fingers, and toes, too.

If my patient gets a good sleep, in the morning when he’s extubated, he’ll do better. But so far, he’s not having a restful night, sleeping on and off, mostly off.

I stand outside my doorway for a moment and call out to Stephanie as she flies past my room, but she’s so focused on what she’s doing she doesn’t even stop to say hello. “Busy patient?” I call out, but I can hear and see the answer for myself by peeking into her patient’s room. The overhead lights are on. The noisy high-speed oscillator ventilator is going full blast, pounding hundreds of tiny breaths into her patient’s lungs per minute. The counter is lined with syringes of medications and there’s a stack of
IV
pumps attached to her patient. Classic signs of a
busy patient
. That phrase is so
ICU
. Once, I told a friend I had a busy patient and he thought I meant a “workaholic,” talking on a cellphone, using a computer, doing business from his hospital bed! No,
busy patient
means a busy nurse.

I return to my patient’s room and see that he is wide awake, and restless, pulling at his ventilator tubing and trying to tell me something. He motions for the clipboard.

I know what lies behind that question. He’s come to trust me and now he’s going to have to trust someone new. Patients often ask why they get a different nurse every day. They’ve gotten used to the quirks of Nurses Dawn, Mercedes, and Hasmina and now it’s May-Ling, Trey, and Scott? Each nurse is so different in personality, style, tone, tempo, and energy – and I know patients feel it.

The way we make up the patient assignment must seem so random and arbitrary to them, but there’s actually logic to it, but it’s hard to crack the code. Though we want to provide consistency of staff to achieve a “continuity of care,” the reality is that with the vagaries of hundreds of work, family, and school schedules, along with nurses’ varying skill sets and all the complicated personality alchemies, it is difficult to do so.

On top of that, we try to take into consideration certain sensitive situations, like not assigning a nurse who’s had a recent death in the family to care for a dying patient. Nurses themselves sometimes request assignment changes because, as one exasperated nurse put it, “my patient was driving me friggin’ crazy” or as another said, visibly disappointed in herself, “I tried my best, but I just wasn’t gelling with the family.” We keep a secret
^*
book, not officially acknowledged by management, stashed in a drawer at the front desk in which we record the challenging or “difficult,” long-term patients so as to not overburden any individuals. We would like to be above such personal failings, but most of us aren’t – though that’s no excuse. It would be nice to offer bespoke care; nursing is neither a one-size-fits-all enterprise nor a one-way interaction. But the expectation that we will be able to care for any and every patient at any time doesn’t jibe with reality.

“No, I won’t be back,” I tell my patient gently. “This is my last shift for a while.”

His disappointment is a compliment. He wants me back. He motions for the clipboard:

Desperation, so politely put
.

There’s something else he wants to tell me. Through gestures, mouthing words, and pantomime, he manages to tell me the story of the eagle tattoo on his shoulder … why the wings face backward. “The eagle has my back,” he tells me and gives a toothless grin around the plastic tube in his mouth.

That’s what he was trying to tell me earlier
. I nod in understanding.

“You are doing so well,” I tell him. “We’ll get that breathing tube out this morning. You’ll be able to talk.” I squeeze his hand and he squeezes mine in return.

It’s 0500 hours, time to record another set of vital signs and perform my hourly checks.

There’s somewhere I need to go, something I need to do. I promise Simone I won’t be gone for long and ask Jasna to cover our patients as well. I leave the
ICU
and take the elevator down to the Cardiovascular
ICU
. I am looking for Meera, a friend who left Med-Surg for
CV
because, as she puts it, “it’s cleaner” – meaning fewer infections – “and most people get better” – meaning they have (usually) one fixable problem.

“Meera isn’t on tonight,” the nurse-in-charge tells me but doesn’t seem to mind my hanging around at the nursing station. She has no idea I’m here on a reconnaissance mission, spying and checking out the place, wondering which bed I’ll be in and which nurses will be taking care of me.

A caravan is making its way down the hall. The patient on the stretcher is motionless, eyes taped shut, flanked on all sides by
people pushing poles of
IV
pumps with green and red lights flashing (the reason we call them “Christmas trees”).

“Quadruple bypass,” the in-charge says as they pass the nursing station. “We took him back to the
OR
. Bleeding.”

“What’s going on in there?” I point to a room so crowded I can’t even see the patient in the bed.

“Two days post-op heart transplant. They’re evacuating a tamponade.”

Here’s yet another post-op complication. Cardiac tamponade is fluid in the pericardial sac surrounding the heart that impedes blood flow. The ultrasound technologist is guiding the surgeon to place the needle to relieve the pressure.

There’s a different vibe here. Even with this crisis, all is calm. In my
ICU
, it’s more chaotic, the rhythm more erratic. We either go full-tilt, non-stop or ride out a steady, slow burn with uneasy lulls. We do more guesswork, try this or that, see what works. We manage problems, but here they fix them.

The ultrasound technologist comes out, wheeling his machine ahead of him.

“Hey, Gary. How’re you doing?” I greet him.

“Good,” he says cheerfully, “as long as I stay on this side of the bedrails.”

As if he knew!

On my way back to the
ICU
, I run into Janet making her rounds, “checking on my babies,” as she says. “Gotta make sure everyone’s hunky-dory.” We stop to chat. “Are you
bagelling
with us this morning, Tillie?” she asks, rushing away when her beeper goes off.

“I’m in,” I call out, though I’m in no mood for the jovial cream cheese chatter.

I’ve been gone about twenty minutes and it’s time to get back to my patient. As I’m rushing through the halls back to the
ICU
,
stopping occasionally to catch my breath, I hear, “Code Blue, Code Blue.” I wonder if it was the patient that Janet was on her way to see. The person may need to come to the
ICU
, I think.
It’s not my problem. I’m going home
, I remind myself.

Soon Ramona, the day-shift nurse, arrives back and now our situation is reversed. I know everything about our shared patient and she’s starting all over again. I rush through my report and hurry off. George is sleeping so there’s no opportunity to say good-bye. I would have liked to be there when he’s extubated and hear his voice, but it’s time to go. So often it’s like this. We get to read only one page in a chapter of a person’s life and don’t get to hear how the story turns out.

“Thanks for your help, Tilda,” Simone calls out. “You were awesome.”

Before leaving the
ICU
, I slip a note under the office door of Denise, our manager, to let her know I’ll be off on an extended sick leave, much longer than the two weeks I’d booked off for camp.
Will call to explain
.

I walk out and don’t look back.

After most of my friends from Laura’s Line left the
ICU
, I joined a new group: The Bagel Club. There’s Janet, a.k.a. the Grand Poo-Bah; Stephanie, a.k.a. Shorty; and Jasna, a.k.a. Jazzy. They call me Tillie. Every second Sunday morning after night shift we go
bagelling
. It’s not a legit Yiddish word (though it sounds like it could be), just another of Janet’s spoonerisms. Eric Bailis, the owner of St. Urbain’s Bagels on Bathurst Street, greets us. “Lose anyone last night?” he always asks, though we never tell him if we did. The place is steamy, fragrant with coffee and hot bagels. It’s hopping with regulars who fill brown paper bags with bagels and pastries, then stop by our table to say hi and joke, “Save any lives?” and then seek advice about a skin condition, a knee
problem, a mother who has Alzheimer’s.

When we first started coming to this suburban Jewish enclave in Thornhill, the Sunday-morning tradition and the friendly but argumentative clientele was a new experience for these friends. I took it as my duty to explain the incessant
kibitzing
and
shmoozing
(gossiping and kidding around), the frequent
kvetching
(whining and complaining), and constant
fressing
and
noshing
(snacking and nibbling). I filled them in on the age-old rivalries between fans of Montreal-style bagels (chewy, dense, slightly sweet) versus Toronto-style (fluffier, heavier, saltier) along with bagel etiquette, such as not toasting a fresh bagel and discouraging ersatz varieties such as sun-dried tomato or chocolate chip. They are amused whenever I recount the corny, nutshell version of Jewish history: “They tried to kill us, we survived, now let’s eat!”

“Is this what they learn you in the sin-ee-gogue?” Janet asks. With her baby blue eyes, brilliantly blonde hair (which she comes by naturally, I know she’d want me to add), and mock hillbilly voice, she likes to act like a white trash hick chick but she’s actually a sophisticated culture vulture. A huge reader, her taste is classic and high-brow (favourites are Jane Austen and Thomas Hardy), plus she’s a world traveller who’s been to France, Italy, and Denmark. With her gregarious and playful personality, curvaceous figure, and robust good looks, Janet stands out in any group. She’s always bursting with life and has a full-of-beans personality – such fun to be around! – and though she may look cherubic, there is a permanent mischievous twinkle in those baby blues. She sits, sipping a hot chocolate, proudly wearing an oversized T-shirt emblazoned with one of the many charities for which she’s the volunteer captain of the medical team. Today it’s bright yellow Ride to Conquer Cancer, and with the event, a bike ride from Toronto to Niagara Falls, coming up soon, she’s recruiting
additional volunteers. I turn it down but can’t bring myself to tell her why.

After a shift, we always are dress in our casual, comfy clothes, having thrown our used uniforms into the hospital laundry or brought them home for laundering. (Wearing scrubs outside of work is strictly taboo due to infection control concerns and the unprofessional image it projects, despite the fact that you’ll see this infraction around town in grocery stores or coffee shops. All I can say about that is:
Yuck
.)

Jasna sips on a chamomile tea. Her quieter, even-tempered presence is a calming flava to our group. Always dressed down and understated, Jasna is implacable and gentle, though she occasionally gives a sly smile and surprises us with an insightful zinger. Modest to a fault, Jasna seriously contemplated being a no-show at a recent award ceremony in honour of her outstanding nursing care.

Then there’s Stephanie, a petite, sassy ball of pure energy. She often says she’s tired but never looks it or acts it and always gives her all to every patient in her care. She’s arguably the best dresser among us in her faded jeans, leather bomber jacket, and kick-ass boots – finds from second-hand clothing shops and bargain basements that she sources out as much for economical reasons as environmental ones.

There is so much I admire about these women, but as nurses what I love the most is how they always do what’s right for their patients and will fight for them, if necessary.