Opening My Heart
BOOKS BY TILDA SHALOF
A Nurse’s Story:
Life, Death, and In-Between in an Intensive Care Unit
The Making of a Nurse
Camp Nurse
Opening My Heart:
A Journey from Nurse to Patient and Back Again
Lives in the Balance (editor)
Copyright © 2011 by Tilda Shalof
All rights reserved. The use of any part of this publication reproduced, transmitted in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, or stored in a retrieval system, without the prior written consent of the publisher – or, in case of photocopying or other reprographic copying, a licence from the Canadian Copyright Licensing Agency – is an infringement of the copyright law.
Library and Archives Canada Cataloguing in Publication
Shalof, Tilda
Opening my heart : a journey from nurse to patient and back again/Tilda Shalof.
eISBN: 978-0-7710-7994-8
1. Shalof, Tilda—Health.
2. Heart—Surgery—Patients—Canada—Biography.
3. Nurses—Canada—Biography. I. Title.
RD598.S53 2011 362.197′4120092 C2010-906745-2
We acknowledge the financial support of the Government of Canada through the Book Publishing Industry Development Program and that of the Government of Ontario through the Ontario Media Development Corporation’s Ontario Book Initiative. We further acknowledge the support of the Canada Council for the Arts and the Ontario Arts Council for our publishing program.
Published simultaneously in the United States of America by McClelland & Stewart Ltd.,
P.O. Box 1030, Plattsburgh, New York 12901
Library of Congress Control Number: 2010940066
McClelland & Stewart Ltd.
75 Sherbourne Street
Toronto, Ontario
M5A 2P9
www.mcclelland.com
v3.1
CONTENTS
Cover
Other Books by This Author
Title Page
Copyright
Acknowledgements
Note to the Reader
1. No Problem. I Feel Fine
2. Everything to Fear and Fear Itself
3. Fearless Nurses
4. Breathing Lessons
5. Ticking Time Bomb
6. Rock Star Surgeon
7. How Telling
8. A Slab of Meat
9. How Not to Die
10. From Vertical to Horizontal
11. Trusting Strangers
12. Nurses Eating Cake, Drinking Coffee
13. Baby Steps
14. Slouch on the Couch
15. Change of Heart
16. Spinning Wheel … Got to Go ’Round
17. The Diamond Rule
Epilogue: In a Heartbeat
Acknowledgements
Heartfelt thanks to the many people who took care of me and this book, especially:
Dr. Tirone David, Chief of Cardiac Surgery, Toronto General Hospital; Milutin Drobac, Pat McNama, Janet Morse, Len Sternberg, Ivor Teitelbaum, Joy Bartley, Maria Kirchhoff, Marion McRae, Leslie Moffat, Christine Sterpin; staff of CVICU and Cardiology 4A.
Judy Boychuk-Duchscher, Mary Ferguson-Paré, Doris Grinspun, Linda Haslam-Stroud, Paris Jalali, Mary-Lou King, Rosemary Kohr, Ruth Lee, Joan Lesmond, Marlene Medaglia, Judith Shamian, Laura-Lee Walter.
Marilyn Biderman, Elise Dintsman, Daneen DiTosto and family, John Fleming, Joy Friedman, Anna Gersman, Pamela Glass, Tex and Bonnie Shalof, Stephen Grant and Sandra Forbes, Robert Grant, Vanessa Herman-Landau and family, Omri Horwitz and family, Avery Kalpin, Annie Levitan, Solly Katz and family, Elba, Barry, and Nadine Lewis, Robyn, Bob, and Norah Sheppard and family, Michael and Barbara Turner-Vesselago, Chick and Dick Weiner.
The staff of the Medical-Surgical ICU at the Toronto General Hospital, the University Health Network, especially: Robert Bell, Lesley Barrans, Allyson Booth, Sherrill Collings, Nathalie Côté, Ingrid Daley, Belle Dhillon, James Downar, Gail Fairley, Maureen Falkenstein, Marcia Fletcher, Michael Fraser, Maude Foss, John Granton, Laura Hawryluck, Margaret Herridge, Grace Ho-Young, Thileep Kandasamy, Brenda Kisic, Connie Kwan, Neil Lazar, Edna Lee, Vincent Lo, Murry Macdonald, Mindy Madonik, Bella Manos, Kate Matthews, Robert McGregor, Mercelies McHugh, Moira McNeill, Denise Morris, Wendy Radovanovic, Meera Rampersad Kissondath, Juliet Ramsay, Janice Stanley, Andrew Steel, Derek Strachan, Kelly Sundarsingh, Sharon Reynolds, Claire Thomas, Mugs Zweerman; The Critical Care Outreach Team; Arnie Aberman, Wilfred DeMajo, Brian Kavanagh, Stuart Reynolds.
Laura’s Line: Lisa Huntington, Ann Flett, Cecilia Fulton, Judith Allan-Kyrinis, Mary Malone-Ryan, Linda McCaughey. The Bagel Club: Stephanie Bedford, Janet Hale, Jasna Tomé, and honourary member Amber Verdoni; Eric Bailis of St. Urbain Bagel.
All of Dr. Mehmet Oz’s books have been helpful to me in improving my wellness and overall health. An excellent resource on cardiac surgery is www.heart-valve-surgery.com. Shop Class as Soulcraft by Matthew B. Crawford clarified my ideas about the value of hands-on work as it applies to nursing care. For the best writing teacher in the world, check out www.freefallwriting.com.
Everyone at McClelland & Stewart, especially Doug Pepper, Elizabeth Kribs, Terri Nimmo, Scott Richardson, Heather Sangster, Ashley Dunn.
Ivan, Harry, and Max Lewis – closest to my heart.
Note to the Reader
My heart was opened on an operating table and I knew that in order to tell this story, I would have to crack it wide open all over again. However, I am happy to do so if you will find something of your story in mine.
After twenty-five years as a nurse, I suddenly became a patient and was surprised to discover I had a lot to learn on the other side of the bedrails. Being in the hospital can be a confusing and frightening experience, even for me, a seasoned professional, entirely familiar with that world. What helped me the most was staying in charge of my patient experience and working in partnership with all of my caregivers. I show you how you can do that, too.
This is a true story. Details have been changed to protect privacy. Clinical information is accurate, but please consult experts about your medical issues. Don’t pull some of the stunts I did: I didn’t always make the wisest decisions about my own health care.
This book is for patients and caregivers (most of us will have the chance to be both at one time or another). I hope it is a comforting companion to anyone facing not just cardiac surgery but any hospitalization or illness. It’s a lot to ask of a book, but many have done that – and more – for me.
Here’s wishing you strength and courage to take care of yourself and others.
Tilda Shalof, RN, BSCN, CNCC (C)
Spring 2011
1
NO PROBLEM. I FEEL FINE!
The story of my heart begins with an earache in the night.
The ear belongs to my eleven-year-old son, Max, who wakes me, head in his hands, tears welling up. Sleepy mom and hard-boiled nurse that I am, I dope him up with a slurp of purple painkiller syrup and send him back to bed. But in the morning his ear still hurts and he’s spiked a temperature, so I take him to the doctor.
The waiting room is packed. How much longer until our turn? I pester the receptionist, but she’s too busy to answer. Hovering around the front desk, I scan the rack of doctors’ business cards. Three general practitioners and an asthma specialist share this office. Oh, a cardiologist, too, and I pocket one of his cards. Some people collect stamps, antiques, or lovers. I collect cardiologists – a hobby of mine for years.
Eventually, we get to see Dr. Ivor Teitelbaum. He’s my husband’s doctor, and Max and his older brother, Harry’s, doctor, but not mine. I don’t go to doctors.
&nb
sp; Ivor is a handsome, smartly dressed, young-looking middle-aged guy with an old-school manner. Always relaxed, he never rushes us along, despite the bustling waiting room. He examines Max, then offers me his otoscope so I can look into the ear canal myself and see the bulging, inflamed tympanic membrane, severe enough for Ivor to prescribe an antibiotic.
We get up to go, but I pause. “This cardiologist” – I wave the card at Ivor – “is he any good?”
“Very.” He looks up from writing in Max’s chart. “Who needs a cardiologist?”
I shoo Max back out to the waiting room, pull up my T-shirt, and nod at the stethoscope around Ivor’s neck to remind him of my secret. I’d had to tell him so that my children’s hearts could be checked for defects. Fortunately, neither inherited my heart problem.
It takes Ivor only a quick listen and then he looks up at me, hard, grips me by the shoulder, and steers me down the hall to the office of Dr. Milutin Drobac, the cardiologist.
“She needs to be seen,” he tells the secretary, “as soon as possible.”
“It’s your lucky day,” she says. “I just got a cancellation. Tomorrow at 11:00?”
“Sorry, I can’t make it,” I say. “I’ve booked a haircut.”
She shoots me a glance. What’ll it be, your hair or your heart?
Okay, heart it is.
At home I give Max the first dose of antibiotic and another dollop of grape-flavoured syrup. Soon he’s back to his usual cheery self, so I hustle him off to school, leaving me alone to muse on my funny-sounding heart. It’s only a murmur, I remind myself. What a cozy-sounding word. It almost sounds like a good thing to have. Who wouldn’t want one? Many people have murmurs and most are normal or “innocent.” But not mine. Murmur is a term that refers to any irregularity in the heart’s blood flow, and in my case it’s due to a serious heart defect – a faulty valve. It’s congenital, meaning I was born with it.
As a child, I sensed something was wrong from the get-go. The heart specialists who spoke in solemn tones and the protective, cautious way my parents held me all conveyed the message: Fragile – Handle with care!
Then, around the age of ten, on one of many days off from school, I sat in a pediatrician’s office and heard him say to my parents: “In time, her condition will worsen. One day she’ll need open-heart surgery.” He probably assumed I wasn’t listening (a mistake many adults make around children) because my head was buried in a book. “No overexertion,” he warned them, “and no sports or gym classes.”
For my parents, that was a perfect prescription. It dovetailed with their need to keep me close, conveniently available to help my chronically ill and depressed mother. As far as they were concerned, school was optional.
Don’t think I didn’t hear the doctor’s parting comment to my parents before he left the room: “A certain percentage of these children experience sudden death.”
That’s some experience, I thought and dove deeper into my book.
I’ve always known my heart could stop suddenly, but I banished the thought. I accorded my heart no respect, never allowing myself to think I had any physical limitations. I avoided strenuous physical activities, but in my mind, I was swimming the English Channel, riding horses, even running a marathon. Meanwhile, my parents became preoccupied with their own health problems and I became a nurse so that I could focus on other people’s problems, not dare think of my own. My MO has always been to fly low on the medical radar and hope that an apple a day would keep the doctor away. (I eat a lot of apples.)
After a quiet, sedentary childhood, I threw caution to the wind and became a wild, adventurous teenager, then an active adult and energetic mother of two boys. I’ve always done whatever I wanted to do. That is, until recently. Lately, I haven’t been feeling my best.
The next morning, I find myself where I always intended to never be – a cardiologist’s office. First, there’s the electrocardiogram (ECG) and an echocardiogram, tests I’ve helped many patients through, so I know the ropes. I strip off my T-shirt and bra, don the blue paper gown, jump up on the table, and lie down on my back. As Cezar, a big, burly guy who’s Dr. Drobac’s technologist, does the ECG, I glimpse the tracing over his shoulder, noting that my heart is in a regular rate of sixty beats per minute. Normal sinus rhythm. So far so good.
Cezar tears the printout off the machine and attaches it to my chart with a paper clip. For the echo, I flip to my left side so that he can obtain the best view. He glides the probe around my chest, digging it in at certain landmarks for a closer look, pausing, peering at the screen, then moving on. While Cezar works, I take a look around the small room, dimly lit as a nightclub to enhance the clarity of the picture onscreen. In the corner there’s a treadmill for stress tests and a red “crash cart,” equipped with defibrillator, pacemaker, and emergency drugs.
“Ever had to use that?” I point at it. For a patient like me?
“Yup.” Cezar’s brow creases, his eyes widen then narrow, but he keeps them trained on the screen in front of him. The sound of the amplified beats of my heart fills the room.
“See anything?” I inquire, well aware that he’s not supposed to divulge anything, but I’m quite sure Cezar knows a thing or two. “Don’t worry,” I assure him. “You can tell me. I’m a nurse – an ICU nurse.” He stays focused while I chatter on. “There’s a problem with the valve, isn’t there?”
Cezar pauses his probe and looks at me. “Big-time.”
But I feel fine! Well, maybe not my best … “How bad is it?”
“I’ll let Dr. Drobac speak with you about it.”
I get dressed and graduate to the office of Dr. Drobac, who greets me warmly. As he reviews my ECG and echo report, I check him out. He’s a tall, thin, elegant man who looks like he may have run a few marathons himself.
“You’ll never see a fat cardiologist,” my old nurse buddy Laura says. “Yet, there are many neurotic psychiatrists,” she points out. Laura has developed extensive character profiles of every medical specialty. According to her, neurologists are precise and nerdy, gastroenterologists are messy and swear a lot – “think of what they do!” – and all ophthalmologists have small, legible handwriting. Her theories have yet to be tested.
Dr. Drobac introduces himself and we sit down opposite each other for the “functional inquiry,” also known as the “patient interview.”
“How have you been feeling?” he starts off.
“Great! No problem!” I say. “Asymptomatic,” I feel compelled to add.
“Any history of family illnesses?”
“My mother had early onset Parkinson’s disease and manic depression. My father had type 2 diabetes and coronary artery disease.” Died from it, too, but I keep that detail to myself so as not to prejudice my case.
“Do you smoke?”
“Never!” How virtuous am I?
“Take any prescription drugs on a regular basis?
“No.” My body is a temple!
“How about recreational drugs?”
“No …” Well, not lately …
“What about alcohol?”
“Clearly, not enough.” Now that gets a laugh out of him.
“Are you a Muslim?” he asks, breaking from the script of a standard cardiac history to figure out who I am. He hasn’t quite got me pegged.
“No,” I say. “Jewish. We like to eat. But I plan to start drinking more red wine as soon as possible. In moderation, of course. Strictly for the cardio-protective properties.” Broccoli and dark chocolate, too. From now on, I’m going to do everything right. My mouth is dry, my hands are beginning to shake. “I have a feeling you’re about to give me bad news.”
“No, I’m not.” He smiles. “Not at all.”
Maybe it’s nothing. What am I worried about? I feel perfectly fine.
“Any shortness of breath?” he continues.
“No … Not really.” Well … maybe, a little, now that you mention it.
“Chest pain …”
“No, never!
”
“What about chest discomfort or tightness, or racing heartbeats? Have you had any dizziness, light -headedness, coughing, or fainting spells?”
Now that you mention it … I swallow the lump in my throat and stifle the harsh, dry cough I’ve had for a few months. Suddenly, I realize it is a cardiac cough. I’d have recognized it in a patient!
“How do you feel after you walk up a flight of stairs?”
“Not great,” I admit. The truth is I haven’t been able to walk up stairs for a few months now. I’ve been avoiding them when possible, and when not, I take them slowly, pushing against the heaviness in my chest, out of breath within moments. Ditto for hills and any inclines, for that matter.
“Do you have much stress at work?”
“Not at all.” My patients do, but not me! But dare I mention that lately I can barely make it to the end of my shifts at the hospital? I am exhausted by lunchtime. “What’s wrong with Tilda lately? She’s always lying down,” I heard a nurse say in the staff lounge the other day. “I’m taking a power nap,” I said, popping up. At the end of my shifts, I’ve been dragging myself home and crashing into bed, not a drop of energy to spare.
“Are you able to do your daily activities at home?”
“Yes,” I say but don’t tell him that I couldn’t rake leaves or shovel snow this past winter and the house is a mess. I move the vacuum cleaner two sweeps and have to sit down to rest. A laundry basket full of folded clothes sits at the bottom of the stairs, too heavy for me to lift and carry to the top.
“How about sexual activity?”
“Absolutely!”
“Sex is very beneficial for heart health,” he explains.
In that case, I’ll have sex every day – twice a day – if necessary! (Note to self: Notify Ivan of this new treatment protocol.)
“What about exercise?”
“I have a gym membership. I’ve done a few aerobics classes …”
Yes, I’ve showed up at all those classes with the improbable names like Guts and Butts, Cardio Funk, and Jazzercise. But my workouts have become lame and “half-hearted.” I can’t get my heart rate up above 100 and it takes a long time to recover and return to my resting rate. Oh, and I’ll never bring a water bottle so I can have an excuse to keep stopping for a drink at the fountain to catch my breath.