Opening My Heart Read online

  Soon, the other two arrive. “I can’t stay long,” Stephanie warns as she and Jasna settle into their usual places, Stephanie to my right and Jasna across the table.

  “How was your night?” I ask, wondering what made them so late.

  “I refuse to answer that question,” Stephanie says but then proceeds to do just that.

  “The day nurse called in sick, so we were scrambling to find another nurse because it was not a safe double. Eventually Moira was freed up to take the patient and as I’m out in the hallway, giving her my report, suddenly I smelled something. It was bloody stool – you know that smell, don’t you? Unmistakable.”

  Of course, we nodded. Go on.

  “Our gross-out tolerance is definitely higher than the average person’s,” Jasna interjects quietly as she takes a bite of her bagel and protectively glances around to make sure no one can overhear this conversation.

  “Nope! Bloody stool has no affect on our appetites!” Janet says cheerfully, sipping hot chocolate.

  “… so I rushed through my report so I could clean her up. It wasn’t a complete surprise because she’s a known GI bleed and her platelets are only ten so it was bound to happen at some point …”

  “That’s strange. The same thing happened to me when I took care of her last week, also after a night shift,” muses Janet. “I guess she’s not a morning person.”

  “… her vital signs were stable, so I finished giving my report and then gathered up the cleaning supplies and fresh linen – I couldn’t leave her like that. I was just about to go back to her when Mike, who’d been on with me last night, came out from behind the curtain. He’d stayed behind while I’d been giving my report and gave my patient a complete bed bath from head to toe, freshened her up, and then thought ahead to get a doctor’s order for a platelet transfusion, which he figured was needed, and sent off the requisition to the blood bank. Isn’t that guy the sweetest? He’s my new hero!”

  “Oh, I can just see him,” says Janet, “coming in to town on his white horse, saving the day, so you could get here in time for bagels.”

  “It’s because he’s a Buddhist,” I say, thinking of the handsome, shaved-headed, ascetic Mike, a long-distance runner, team player, steady worker, and a devoted husband and father to two young daughters. “He told me he tries to practise what the Dalai Lama says, ‘Compassion is not a transient emotion but a state of being.’ He takes care of nurses as well as his patients.”

  “All I know is he’s a great guy,” Stephanie says, brightening, “so I am in a good mood now, but that’s why I’m late.”

  They pick up their knitting projects and turn their attention to me.

  “It’s time to assign you your passwords,” I tell them, revealing a little gimmick I’ve invented to test my post-op cognitive state for the dreaded “pumphead,” a known risk of the bypass machine that can include confusion, depression, and memory loss, though in my case, with my prodigious memory, it might be like losing a few pounds – who would notice?

  Janet – Whole Wheat

  Stephanie – Sesame

  Jasna – Poppyseed

  “I want you to test me afterward to see if I remember,” I instruct them.

  “I hope I remember mine,” says Stephanie, knitting a new pair of multicoloured socks. (“How many socks do you need?” I’ve often asked her, but she always insists she doesn’t have the patience for any projects bigger than that.)

  Janet looks at me and offers her reflections on surgery as her nimble fingers knit away. “You have to give up the controls for a while. It’s like being on a plane. You hand yourself over to the pilot, the technicians, the ground control. You know you can’t do any of it yourself.”

  The prospect of surrendering to this degree was one of the things that scared me the most, but now I’m able to take it in stride, breathe, and let go.

  “Yup, when you’re lying on that operating table, you’re nothing but flesh and bones, a slab of meat,” Janet says – and knits – smoothly and unerringly. “Even the Dalai Lama would be a slab of meat on the table, if he was undergoing surgery.”

  “Isn’t he a vegetarian?” Jasna asks with a wink, as she knits slowly and steadily.

  Stephanie shakes her head, knitting fast and furious. She points to one of Janet’s huge bags full of other craft projects in progress, her daughter’s A+ English essay, and assorted low-calorie snacks. “Give it to her now,” she motions in my direction.

  Janet puts down her knitting and pulls out a sheaf of papers bound together like a patient’s chart. “Claire and a bunch of us made this for you last night.” The three of them sit back and clicking and clacking away, smiling, while I read.

  PATIENT: Tilda Shalof, RN

  AGE: Whatever it is, she doesn’t look it!

  SEX: Yes! But please wait until fully recovered.

  DIAGNOSIS: Broken Heart

  PLAN: Healthy Heart

  CLINICAL NOTES

  Night Shift: verbal report received, care as follows …

  1930 – Good luck with your surgery, Tilda! Angela R.

  2035 – You can count on us for leg shaves and chin hair plucks! Liz R.

  2104 – Patient sitting up in bed asking for bagels. The Bagel Club RNs

  2323 – Patient asking lots of questions and taking notes. Possibly psychotic? Stephanie B.

  2221 – Prayers right at ya. Janice S.

  0001 – Drugs and Hugs here for you. Kate M.

  0020 – Be sure to report back from the other side of the bedrails. Shauna M.

  0030 – Patient resting comfortably. Good luck, Tilda. Gary F.

  0051 – Tilda, our prayers and thoughts are with you. God bless. Jim M.

  0100 – Come back soon, We need you here! Cheryl A.

  0200 – Vital signs stable. Your ticker will be all better soon. Love ya! Belle D.

  0300 – The Rapid Response Team is on call, day or night, for any problems. We’ll keep you safe. Wendy R.

  0415 – Having a bout of early a.m. stupids and giggles; wishing you were here to share in a chocolate treat. Claire T.

  0530 – Drugs + patient = Happy Nurse. Cyndi R.

  0615 – Last turn and fluff and puff of my patient before I join you for bagels and then home to recoup. Jasna. T.

  0715 – Verbal report given to day RN. Any questions? Ask now!

  Being cared for by your friends? The comfort it brings is greater than my embarrassment or need for privacy. And that Claire! – one of the funniest, wittiest nurses around. It’s actually painful to work with her for all the laughter she causes – my belly aches and my jaw gets sore. Once, after coming on a shift as Claire was getting ready to leave, I saw a look of disappointment come over my patient’s face. “I know, I know, Claire’s a tough act to follow, but you need to rest now,” I told him. He was tuckered out from the laughing workout that Claire had put him through.

  “The end of summer is a good time for surgery,” Jasna says soothingly. “You’re past the July 1 hump with all the interns starting out as first-year residents.”

  “Yeah, if there weren’t nurses quietly saving those green asses, there’d probably be more summer mistakes,” Janet says with a chuckle.

  “And don’t be a difficult patient,” Stephanie warns me. “Listen to your nurses. Do what they say and don’t give them a hard time or else we’ll come down there and straighten you out.” She looks around the table. “Nurses make the worst patients, don’t they? Always meddling and critical. They should know better.”

  Yes, there are plenty of hospital myths and some contain more than a grain of truth:

  Doctors let you know they’re doctors, but nurses will always hide it.

  No one wants to take care of a doctor or a nurse.

  Complications always happen to doctors or nurses.

  Once, we told a family of doctors that their father – a radiologist – was in stable condition and there was no imminent crisis. When they asked again later, we repeated that he wasn’t in any dan
ger and it would be safe for them to go home. Later, we told them his condition was improving. The family finally went home to rest. During the night, their father unexpectedly arrested and died. Was it because we dared predict a good outcome about a colleague? We are more willing to make bad predictions and be wrong than make good ones and be wrong. A nurse will never say, “Quiet shift, so far, isn’t it?” or “Everything is going well.” According to hospital superstitions, these benedictions will cause all hell to break loose.

  Then there’s the widespread belief that doctor and nurse patients get better treatment. We take care of our own. (This one is probably true, but if so, it begs the question, What are we serving up to the others?) When Dr. M.F.X. Glynn, a world-renowned scientist (famous for his work on the coagulation cascade during cardiac surgery, not to mention his invention of Glynn’s Glue, a fibrin adhesive system to help stop bleeding – and for his all-black clothes, sly sense of humour, and love of heavy metal music) and a personal friend to many, was a patient in our ICU, he definitely received preferential treatment. Our nurse manager hand-picked his nurses, assigning him only the best and most experienced ones to care for him.

  Janet brings the conversation back to the present. “Tilda, you think you’ve got problems! My Italian friend has psoriasis, arthritis, and breast cancer. If she didn’t have bad luck, she’d have no luck at all! In fact, her name is Fortunata, but she goes by her nickname, Lucky. Think about that! You’ll be just fine, Tillie,” She bundles up her knitting and shoves it in one of her many overstuffed bags. “Well, gotta run,” she says with a wave. “I’m taking my boys to a Westie grooming session.”

  “But you have to work again tonight. Don’t you have to sleep?”

  “Later. I can’t miss this class! Tootle-loo!”

  “One more thing before you go,” I say to them. “There’s something I need to tell you.”

  “Please tell me this isn’t your DNR speech again,” groans Stephanie.

  “If I get out of control … or start acting weird …”

  “We’ll give you a good slap,” says Stephanie, “to bring you around.”

  “Afterward, we’ll tell you the funny things you said,” Janet promises and launches into another story about when she had her gall bladder removed and how she pulled off her gown and went completely loopy after a shot of Demerol.

  “Don’t worry, we won’t let you make a fool of yourself,” Jasna assures me.

  “And another thing …” I say.

  “What now?” they say in a chorus.

  “I know you can’t kill me – that would be asking too much – but please don’t let them try to save me if I’m not salvageable. You’ll know the difference.” They look at one another with mock astonishment, rolling their eyes at my exit strategy, but I press on because they know perfectly well what I’m referring to – they would say the same things if the roles were reversed. Goodness knows we’ve talked about these dire scenarios enough over the years! – and they let me rant. “Another thing, if it is my time to go, I want to die in the hospital. Everyone says they want to die at home, but what for? Think of the mess, the laundry.”

  “Of course!” they all chime in. We nurses are a sensible lot.

  “As for my funeral, burial arrangements, I want you to know that—”

  “Enough!” snaps Stephanie. “We’ve heard enough. I’ve got to get some sleep. I told you I couldn’t stay long.” She gets up but stops to look at me suspiciously. “Hey, by the way, where’s your notebook? Aren’t you writing about this?”

  “No. There’s nothing to say about it.”

  “I’m sure you’ll find something.”

  Oh, how I long to be firmly back again on this side, safe with my buddies, laughing at it all! It’s a lot better where we get to do the reassuring, not be the ones in need of it. This side is where we can enjoy at least the illusion of safety!

  They get up and hug me one by one and even after we pull apart, I swear I can still feel traces of their embraces lingering in my body. It’s like those warm currents you suddenly come upon while swimming in a cold lake.

  As I drive home, I think it all over: the telling is done and the results are in. Nurses lighten my load. I don’t have to nurse them. They don’t react personally and I don’t have to censor myself. They don’t try to talk me out of my feelings. They take everything in stride and find a way to normalize it. They believe I can get through this surgery and have managed to convince me of it, too.

  And, as bluntly as she expressed it, what Janet said is true. On that table, I will be a slab of meat, a conglomeration of blood, tissues, and vessels. I will be pure biochemistry to the perfusionist, carbon dioxide and oxygen particles to the anesthesiologist. To the OR nurses, I will be vital signs, an incision, a body, and someone’s patient assignment. For a time, that’s the way it has to be.

  Once, I heard on CBC radio about a woman who donated her mother’s body to medical school for use as a cadaver. Beside her body she tucked in a letter she’d written about her mother. She wanted the students to know that her mother loved to dance, was an accomplished musician, a loving grandmother. What a clever idea and how meaningful to that daughter, was my first reaction, but then I thought of those students coming upon the letter and struggling to keep their composure. If cutting into a cadaver isn’t unnerving already, finding that note would be enough to freak anyone out. Some degree of emotional disengagement is how many of us cope with this work, especially in the early days. The ability to stay open and connected but remain objective and scientific, that’s true self-mastery. How many young students have that degree of maturity? Or us, now?

  Yes, I’m ready. It’s taken a lot of work, but I’ve brought myself from worrier to warrior and now I do feel optimistic. I believe I’m going to make it. But how much harder this would be without my health care team, my armada of watchers, and my circle of friends and loving family! How bewildering it would be if I didn’t know this world, its rules, routines, and players as I do! Every patient deserves to feel this confident, secure, and informed. Every person needs to be able to trust that they will receive this kind of care.

  As I may have mentioned, I don’t pray, but suddenly a spontaneous prayer comes to me:

  If I make it, I will dedicate my life to being a better nurse. I will work toward ensuring that every patient gets this quality of care. It’s what every human being deserves. No less.

  Robyn and I have spent a quiet day together with Ivan and the kids. Now, it’s Sunday evening and time to turn on my computer to watch a YouTube video of Dr. David performing a valve replacement, the exact operation he will do on me tomorrow. It’s oddly reassuring to watch his hands carry out this nearly bloodless procedure (a cell-saver machine vacuums up the spillage and returns it to the patient, thereby reducing the need for a transfusion). Somehow, it helps to see the surgery detached from the person under the green sterile drapes, free of fears and questions.

  You don’t have to be mother, nurse, or friend. Take a break from all of that. Just let go and be a slab of meat, Janet whispered into my ear just before she left.

  I pack my bag. There have been many belongings I’ve come across in patients’ bedside tables and carefully packed “overnight” bags – a lock of hair from a dead infant tucked into a locket, $100 bills wrapped into a washcloth, and even an Olympic medal, but practically speaking, you don’t need much at all. Of course, as the old saying goes, when you’ve got your health, you’ve got everything, and when you don’t, possessions mean nothing. A million dollars or a diamond ring, neither will help you in the hospital.

  Here’s what I take: A toothbrush. A flattering photograph of myself – to show them and remind myself who I really am. A Middle Eastern good luck charm called a hamsa that has a blue “eye” in the middle. It was given to me by a young man named Boaz, a brave patient who fought many battles and made it home.

  “Don’t forget your toy, Mom,” Max says, bringing me my spirometer, the blue plastic gadget the nur
se practitioner gave me to use for my breathing exercises post-op, to prevent atelectasis, which is a collapsed lung. He tries it out himself and Ivan tells him to put it down, it could get dirty, scolding him gently. Max and I have a private giggle – two kids behind Dad’s back.

  On top of my bag I place my health card. It’ll cover my hospital “bills” (don’t know what one of those thingamajigs looks like), thanks to Canadian taxpayers, myself one of them.

  Max has gone downstairs. I hear him singing “The Final Countdown” – De-de-doo-doo-doo – and I have a quiet chuckle at that.

  Ivan has made a dinner of potatoes, broccoli, and roast chicken – which gives me an idea. I swoop it away, whisk the platter off to the counter, and pull out a sharp knife from the drawer. Insert into the top of the breastbone of the bird. Slice straight down. Crack open. Flatten. A median sternotomy like the one I will have tomorrow. Robyn and Ivan watch my macabre dissection – Ivan horrified, Robyn somewhat amused – but my twisted little pantomime calms me.

  Now, after dinner, I’m NPO – nil per os – to allow my stomach to be empty during surgery to prevent aspiration into my lungs. Mary calls and we speak for a few minutes. “God bless you, Tillie,” she says before hanging up. From Mary I gladly receive a missive from the divine. I study more codes.

  Robyn – Lemon

  Meringue Pie Mary – Faith

  Vanessa – Picasso

  Door to staff lounge – 3601

  Medication room – 1011

  Password – Rambo

  Locker room – 323

  Combination lock – 11, 25, 15

  Bank PIN – 1234 (isn’t everyone’s?)

  In the bathroom, I remove traces of old nail polish so that they will be able to check my nail beds for perfusion to my extremities. I take a shower and after I dry off, I stand staring into the mirror for one last look at my smooth, unblemished, white chest. Squinting, I imagine the cut that will be there, the bloody trail that the scalpel will make. Another odd idea occurs to me. With a dark red lipstick, I draw an incision down the length of my sternum, so I can get there first and have a hand in transforming myself from wound to window.