Opening My Heart (24 page)

Cheery nurses come in and out, not the least bit concerned about my mumblings or glazed stare – or this huge, new lump on my chest.

“Time to get up,” Nurse Melissa says.

Get up? Is she kidding? Is this a joke?
Apparently not. “I can’t do it,” I tell her.

She doesn’t take no for an answer and stands facing me, puts her arms on either side of me, under mine, and eases me up to a sitting position. She gives me a moment to catch my breath, then swivels me so that my legs are dangling at the side of the bed.

She looks so young and I feel so old. Does she see only the rumpled, groggy me or the real me?

She turns her head away to cough.

“Are you sick?” I draw back slightly, afraid to get whatever she’s got.

“A bad cold. But I’m okay.” She lifts me up to stand on my feet. Held there in her arms, I inhale her deeply.
A strong whiff of vanilla and patchouli, a spicy chocolate cake
.

“I have to go to the bathroom.”
How am I going to get there?

“You can walk. I’ll help you.”

I get up –
oh no, I’ve wet the bed. Attention, shoppers. Clean up in aisle nine!

“Don’t worry,” Melissa says, placing me onto a chair and then quickly changing my sheets. “It happens sometimes after the catheter has been removed. Come, I’ll help you to the bathroom.”

She expects me to walk there? By myself? Is she nuts?

Slowly, she leads me there and then back, lowering me down on to the chair. “Here are your pain pills.” She places them on the table in front of me, then hands me my spirometer for my breathing exercises.

I have to do this. I don’t want to get atelectasis
. I pick up my “toy,” as Max called it, and blow into it. The ball remains at the bottom of the contraption. Why isn’t it moving?
It must be broken. Oh, I forgot. “Suck, don’t blow,”
I’ve told many patients, realizing only now how lewd that instruction sounds. Once, a patient joked, “After all I’ve been through and now you’re passing me a bong?”

Melissa watches me do a few rounds as she moves toward the door. I’m sure she has a few others like me to get to.

One more inhalation on the spirometer and the ball jumps to the top of the plastic cylinder tube like it’s supposed to. That’s all for now.

“You’re doing great,” she calls out before she vanishes.

I’m feeling better. They give you give good drugs here. I like this place.

—

Later – how much later? I have no idea – I walk to the bathroom by myself, wobbly on my feet. It feels like a major accomplishment. I pee into a container, measure my urine, then pencil in the amount to a tally sheet taped inside of my door. I want to be helpful to my nurses, but I wonder if they’ll see it that way. Maybe they’d prefer if I were a “regular patient,” but it helps me to stay nurse. “The best care is self-care,” my friend Nurse Deanna Patricia Bone writes in her book,
Nurse Pat’s Practical Guide for Caregivers
. It’s my new mantra. I make my way back to the chair, sit and breathe, not for mindfulness, but for oxygen.
I did it!

Breathing is hard. Something is wrong with my breathing. My heart is racing.

Breaths laboured,
SOB
– shortness of breath – even at rest. Respiratory rate thirty-six breaths a minute – patient is tachypneic. Heart rate one hundred after moderate activity
.

What’s wrong with me?

A cluster of doctors stand outside my door reviewing the case – me! They don’t seem the least bit concerned with my heart rate or my difficulty breathing. They don’t even notice.

“Aortic valve replacement and repair of aortic root,” I hear them saying. “Day three post. Had episode of post-operative bleeding … hemoglobin dropped to forty-eight … given plasma and red blood cells … hemoglobin now seventy … Otherwise uneventful.”

Yes, a routine case, but
FYI
– those are the one’s that’ll get ya!
You see the same things over and over. This is normal for a post-op valve job, but how to stay alert to the exceptions, the ones who veer from the norm and the subtle signs that trouble is brewing?
I’ll keep an eye on it for you
. Sometimes the basic things get missed, like vital signs, for instance.

Relax, let them worry about it; it’s their problem now. My breathing is better. No worries
.

—

Flashes of the
ICU
return. Darkness and light, noise and silence, movement and stillness – far away, down a long, deep tunnel. Not unpleasant but strange.

For as long as I live, I will never forget Miriam, a patient from Rwanda. I don’t remember her medical problem or much about her, other than her having the worst case of
ICU
delirium I’d ever seen. She had harrowing hallucinations and just witnessing her going through them was disturbing – I can’t imagine what it was like for her. She would be in a deep sleep then suddenly, as if from a shotgun, she’d startle awake, eyes bulging out, finger madly pointing in front of her, at something only she could see, only she could hear. I tried to console her – we all did – but she was unreachable. We tried many different medications to help her but none worked. “What does she see?” I asked her sister one day.

“Her children. She hears their screams. They were murdered in front of her in the village. Then they raped her and left her to die, but she survived.”

What was it about the
ICU
that brought this horror back to her?

“Hi, Tilda, I’m Marion McRae, your nurse practitioner.” A tall, attractive woman bends way down to where I lie in the bed to listen to my heart and lungs. She palpates the pulses in my legs and feet. Gently and smoothly, she slides out the pacemaker wires from where they had been placed, inside my heart – weird sensation but not painful – leading out to a pacemaker box hanging on the
IV
pole.

“How are you feeling?” she asks as she sits down beside me.

“Weak. I have … difficulty breathing … at times. My heart is racing.”

“It’s because your hemoglobin is still low, only seventy-one today. You lost a lot of blood after your surgery. You’re on iron
supplements and your bone marrow will produce more red blood cells, but it takes time. Eventually, you will get your strength back.”

Nurse Melissa has returned to take my vital signs, test my blood sugar, and give me more pain meds. I don’t see her wash her hands before touching me, but I’m hoping she did before she came in. It’s not so easy to ask, from this side, so I let it go. She’s a new grad, she tells me, fresh out of school, this is her first job, she says proudly.

I want to reassure her,
You won’t always have miserable patients like me. Well, you probably will, lots of them. Please stay in nursing for a while, don’t leave us yet, though you might want to lose the perfume!

I once worked with a nurse who wore a perfume called Opium, which made me nauseous. Another time, a patient’s visitor was drenched in Obsession. Within a few minutes, I got a searing migraine and had to go home.

“Here’s your lunch, Tilda.”

A tray is placed in front of me. What’s this? A diabetic meal? This isn’t for me! This is a mistake. Only 1,200 calories a day? Who’s idea is this?

It’s like my father’s old joke: the food is terrible and such small portions!

Breathing is difficult. I take a breath and wait breathlessly for the next.

I reach for the call bell – but stop myself.

A nurse I knew had an automatic signature on her emails with the motto “Until the call bell rings …”
For whom the bell tolls … it tolls for thee
.

“I pushed the call bell a hundred times,” a friend’s mother once said, recounting her hospital war story after bowel surgery. “I was bleeding to death. I was lying in bed and blood started pouring
out of my rectum. I called for help, but no one came. The siderails were up so I couldn’t get out of bed, so I scrunched down and slid out the bottom. I wrapped myself in sheets and I held my arm up, the one with the
IV
. When I got to the nursing station, the nurses laughed and said, “Oh, here comes the Statue of Liberty.”

Ouch!
Outraged patients have been known to exaggerate their hospital horror stories just a tad, but if this one is even partially true – and it comes from a reliable source – it’s horrific.

I’ve heard of patients who used the call bell and when no one came, they got so frustrated they called 911 from their hospital beds. I’ve walked through wards where halls are empty, the nursing station vacant, no one was around.
Who’s minding the mint?
Where have all the nurses gone? Everyone is busy with someone else. If you happen to see a nurse, she or he is rushing past, distracted, running off somewhere else, to somebody who apparently needs them more than you. A nursing professor told me that when he was a patient, he fainted after a hernia operation. A cleaning staff was mopping the floor and pushed the call bell for help. When no one came, she helped revive him herself.

Melissa pops in. “Do you want to go for a walk, Tilda?”

What am I, a dog? Are we going to the park?
“No,” I answer curtly.

“You need to walk. It’s good for you.”

She won’t take no for an answer. She stands holding my leash – my
IV
pole – waiting for me to get up. I guess I’m supposed to be able to do this by myself by now.
Oh snap! This is hard
. Melissa’s still not feeling well herself. She’s sniffling and congested. Her eyes are bleary. She stands away from me to cough. The prospect of coughing makes my chest ache. Sneezing? Forget about it! What if I get her cold? Will I have the strength to fight it off? “Maybe you should have called in sick?” I ask her.

“They were short-staffed and, besides, I’m casual.”

That means she has no sick benefits, but it’s no excuse for coming to work and spewing out germs on others. She walks me outside my room and I catch sight of myself in the hallway mirror, my hair going in all directions, pale, hunched over, frail, and dopey-looking, like a zombie.
I’m stoned
. I force myself upright, pretend to be strong.

“Time for your chest X-ray, Tilda, and an echocardiogram.” A porter pushes me along in a wheelchair that I have no recollection of getting into. We’re rolling down the highway – I mean,
hallway
– at a good clip … turning a sharp corner –
wheeeee!
They should put a fake steering wheel on these things to give us patients at least the pretense of control. I am backed into the elevator, not facing the wall. I appreciate that.

Enid, the service elevator operator, cranes her neck to get a look. “I know you!” I nod weakly. “I used to see you like this.” Her big arm flaps up and down beside me in a vertical chopping motion. “Now I see you like this!” Her arm slices the air across my chest, flattening the horizon.

After the chest X-ray, I ask the technician, “What are those things?” I point at little squiggles on the black and white picture of my heart, lungs, and ribcage on the computer screen. Little bows that look like twist ties on garbage bags.

“They are the sternal wires to hold your ribcage together,”

Oh. My chest was cracked open – I forgot about that. That’s why it hurts to laugh. Good thing nothing’s funny.

The radiologist reviews the images of my heart. “It looks good, although it will take time for your heart to recover. But all the cardiac measurements show improvement.”

Still, my body feels fragile, cracked into pieces. Will I ever be strong again?

In the afternoon, Mindy, my perfusionist, comes for a visit and brings me a strawberry and banana protein shake from the downstairs juice bar. I sip it slowly. So cool and refreshing. She tells me about the operating room and how quiet it gets when the heart is stopped and the surgeon is sewing. “There was definitely more tension in the room because it was one of our own,” she says. “We even talked about your books.”

“What, during the surgery?” I look at her in surprise.

“Yes, Dr. David said he read them and liked them. A lot.”

“Lucky for me!”
Imagine if he didn’t
.

How am I going to thank all of the people who saved my life?

What about the people who donated blood? Had blood been unavailable or had I not agreed to blood transfusions, I would surely have died.

Marion, the nurse practitioner, comes back and sits with me for a while. She explains that the diabetic diet is to get my blood sugar levels back to normal. They can be unstable post-operatively or with an episode of bleeding. “You’re in a pre-diabetic state. It will likely resolve, but you are going to have to watch your diet from now on.”

I’m starting to connect the dots. I’m not diabetic yet but could be soon if I don’t start taking better care of myself.

As the day wears on, I’m vaguely aware of visitors coming and going and their mild shock at seeing me. But when my gal pals from Laura’s Line – Laura herself, Frances, Tracy, and Justine – arrive,
they take one look at me and aren’t the least bit fazed to see me like this, frail and helpless, sitting there in my faded blue hospital gown.
Maybe it’s one I put on a patient myself!
They’re wearing bright summer clothes, so animated, full of life, in their usual high spirits, chatting and laughing.

When a nurse comes in to take my blood pressure, Justine nudges her. “Is Tilda giving you a hard time? Put the cuff around her neck instead.”

The nurse places the temperature probe in my outer ear canal.

“Why not take it rectally?” Justine suggests ever-so-helpfully, and the others cackle with laughter. “I hear it’s more accurate that way. Tell me, is she being a difficult patient? If so, I give you permission to ‘go nurse’ on her!”

“I thought you were my friend,” I complain. “Don’t make me laugh. It hurts.”

“You’re saying some pretty funny things yourself,” Frances tells me.