Opening My Heart (26 page)

He hasn’t read Archies in years!

“Ivan said he’d try but didn’t think he could find one at that time of night. He was so sweet and patient with him. When we got home, Harry was leaning over the staircase banister, waiting for Ivan to come upstairs and lie down with him. Ivan said he’d be there in just a minute. I made myself a cup of tea and Harry a hot chocolate – and Ivan poured himself a whisky.”

We have a laugh over that.
So Ivan
.

“I told him to give me a swig so I could brag to you later that I’d needed hard liquor to get me through this night! Then I went upstairs to give Harry the hot chocolate and he was still awake, sitting in his bed, fully dressed, staring at his books, all lined up on his shelves. Funny, it was exactly like you would do, Til. I wonder if something like that is genetic? ‘You’re just like your mom,’ I told him and that pleased him. ‘Is Mom okay?’ he asked me. ‘Everything is fine, but they are watching her closely,’ I told him. Earlier, he’d made Ivan promise you would be okay. Finally, he went to bed. The phone rang about two in the morning and Ivan, Bonnie, Tex, and I were all still up. It was Maria calling to say they didn’t take you back to surgery after all. Dr. David managed to fix the bleeding and your blood pressure stabilized. Then Ivan got off the phone, let out a sigh, and poured himself another whisky. What a relief! It was like fresh air
after a storm. I went to bed, but before I fell asleep, I worried about if you woke up and were frightened, but I knew Maria was with you, so I conked out, knowing I had to be rested for the next day.”

I am beginning to connect the dots …

My head is clearing. I look over at the wide windowsill. Tall flowers, purple and red, stand upright in a glass vase. Today was hot and sunny and the water level dipped down as these intelligent flowers gulped water. Now, in the evening, they take tiny sips, leaving the water level nearly constant. It’s
meniscus
, so maybe I don’t have pumphead after all? I need to find that wise balance, that clever self-regulation, for myself.

“Do you remember any of what I’m telling you?” Robyn asks.

“Very little. I felt safe and that I was being cared for. That’s about it. Oh, and I remember thinking I understood what was happening, but I realize now I didn’t.”

“Where were you? That’s what I kept wondering,” Robyn muses. “I felt you were here, but I couldn’t find you, which was strange because even though we live far apart, I’ve never felt like I can’t reach you, but during the surgery and when you were in the
ICU
, I did. It felt like you could easily slip away while I was out in the waiting room, so I needed to be with you as much as possible.”

“Was there anyone else in the waiting room?”

“A mother and her teenaged son and daughter were waiting for news about their father, who was undergoing complicated surgery. The mother smoothed her hands up and down their backs as they sat on either side of her. ‘What can we do?’ the girl asked her mother. ‘Pray,’ the mother told them and that’s what they did.”

Robyn stays a while longer, then tiptoes out, thinking I’m asleep and not wanting to disturb me. She’s flying home in the morning, but between us there’s no need for hellos, goodbyes, or any formalities, for that matter.

The lights have been dimmed in the hallway. I’ve dozed off and on all day, but I’m still tired. Nurse Ray left his stethoscope hanging on my
IV
pole. Slowly, I ease myself up and manage to pull it down. Sitting on the edge of my bed, I place it on my chest and listen to my heart and silently thank God for each
lub-dub
, every
tick-tock
. For the first time in my life, my heart sounds strong and healthy. It sounds like a normal heart.
Wow
.

Up till now, I haven’t had many rational thoughts, but one occurs to me now – and as grand and over-the-top as it sounds – it makes perfect sense: if every human being could be cared for so lovingly, if we could ensure that every human being’s needs were met so completely – world peace would be possible. How hard could it be? Maybe we could even nurse our planet back to health.

Day four post-op. I’m on the mend, may have even turned a corner, but the morning got off to an unsettling start. I awoke to whispering voices outside my room. “The wrong patient,” it sounded like one nurse was saying to another. “He wasn’t supposed to get it, but he says he feels better than ever.”

Mmm … There are harmless errors, I thought to myself, but here’s something new: a
beneficial
one.

I tried to get back to sleep but couldn’t and I lay there, uneasy. Moments later, I hear them again, now chatting about another nurse’s engagement – “The party’s now, but the wedding’s more than a year away.…” which somehow leads to a discussion of Indian cooking. One nurse advises the other to fry onions, garlic, and ginger in ghee and the other politely insists that coconut is the essential ingredient. One of these nurses comes into my room, introduces herself, checks my armband, hangs a bag of antibiotic on my
IV
pole, and plugs it into the saline line running into my arm.
I look up and examined it. Yup, that’s the drug I’m supposed to be getting, the right dose, right time, right route of administration, and right patient –
me
– but it got me thinking …

It’s a good thing that the nurse identified herself and checked my name band because I haven’t met her before and she doesn’t know me. It’s incredibly easy to mix up patients’ names and faces. Once, in the
ICU
, there were two patients, side by side, a Mr. Scotland and a Mr. London. (This sounds like a joke, but it’s true.)
One’s the country, the other, the city
, I kept telling myself to keep them straight, but a few times over the day, I caught myself addressing them with the wrong name. Luckily, they didn’t care or were too sick to even notice, but I had another patient who did. He was angry, but I couldn’t figure out why. He couldn’t tell me because he was intubated and too weak to write me a note. “His name is Roger,” his wife told me coldly when she came in the afternoon to visit and heard me calling him Richard. I felt terrible and apologized profusely. How upsetting for him! He must have felt I’d been taking care of someone else, maybe even worried I was giving him the other patient’s meds.

During this hospital stay, I’ve been given many tablets, capsules, and
IV
meds. Despite my woozy haze, I know what they’re for, their colours and shapes, possible side-effects, drug interactions, and what I’m supposed to be getting, but what if I didn’t?

“These aren’t my pills,” a patient once said to me, handing them back. I checked and double-checked and indeed they were the correct meds, but she was right to ask me to verify. But what if you don’t know what questions to ask, or you feel intimidated, or aren’t well enough to ask them? Luckily, a friend of mine was. “Hey, what’s that for?” he asked his nurse, stopping her as she was just about to give him an injection. “It’s your insulin,” she told him. He reminded her that he did not have diabetes, though his roommate
in the bed next to him did. “Oops,” was all she said. He probably didn’t find it as amusing at the time as he did months later, when he recounted it to me with a chuckle.

Computerized doctors’ orders and medication dispensing systems will likely reduce errors, but it’s going to take more than that to keep patients safe. Some of the other factors that cause errors – stress, fatigue, distractions, interruptions, time constraints – are common features of nurses’ work, and let’s face it, when it comes to medications, it is nurses administering them to patients. Yet, as a patient, you want – no, need – to trust the people caring for you.

I’ll never forget the friendly-fire interrogation I received years ago from Dr. Arnie Aberman, who was the dean of medicine at the University of Toronto and a staff
ICU
physician at the time. He was known for his exacting standards and his habit of interrogating doctors and nurses – everyone, in fact – to make sure we knew exactly what we were doing in our care of patients. He himself was such a conscientious and caring doctor that he would show up in the
ICU
, at any time, day or night, weekend or holiday, to see a patient. “I’ll always come in,” he would say. “If I’m giving testimony in a court of law, I can’t just tell the judge how the patient was described to me over the phone. I have to see with my own eyes.” He always claimed that was the reason for coming in, but I knew he also did it because he was genuinely concerned and wanted to ensure everything was done properly.

One morning on rounds, he began to grill me about my patient, her diagnosis, medical history, tests she’d undergone, and treatment planned for that day. Then he started in on a line of questioning that felt like a cross-examination, but I knew him well enough not to take it personally. It was an intellectual exercise, meant to teach me something, though at the time, I wasn’t sure what.

“What medications is your patient receiving?” he started off.

I told him, along with the doses and the reasons for each one.

“Did you change your patient’s abdominal dressing today?”

“Yes, I did it earlier this morning.”
I spent over an hour on it, so please don’t tell me you want me to take it down again so you can have a look at it
, I thought, but he had something else in mind.

“How do I know that you changed the dressing?”

“Besides the fact that I’ve just told you and charted it, too? And that I signed and dated the wound care assessment sheet?” But these answers weren’t what he was looking for. I tried again. “The wound is healing well with a moderate amount of serous sanguinous drainage but no purulent discharge. There is pink granulation tissue around the circumference and the edges are beginning to approximate.”

“Now we’re getting somewhere. An eyewitness account.” He continued his questioning. “Okay, tell me, what’s running in her
IV?”

“Normal saline at
TKVO
– To Keep the Vein Open,” I added, in case he wasn’t familiar with our nurse lingo, “piggybacked with an antibiotic. Ampicillin.”

“How do I know there is ampicillin in that bag?”

“Because I just told you I put it in there.”
Where was he going with this?

“How could someone else know what was in that
IV
bag?”

“They could read the label I stuck on the bag. ‘Ampicillin, one gram.’ I dated and signed it, too.”
What more was required?

He looked at me askance, eyebrow cocked. “Do you believe everything you read?”

“We’re professionals. We trust one another.”

“That’s a dangerous habit. If you were on a witness stand, and this was all the evidence you could come up with it wouldn’t hold up in court. It would be hearsay.”

Thankfully, I’ve never had to testify in court, but how could we do this work if we didn’t rely on one another? Yes, it’s true you can’t
be sure something was done correctly unless you do it yourself, but what about teamwork and trust? Both are essential to do this work. And you need enormous amounts of trust to be a patient. (How stressful to be cared for by people you don’t trust!) Yet, a healthy dose of
circumspection
on both sides is needed to keep patients safe. You can have all the computers, patient identification mechanisms, and safety checklists in place, but if don’t have true partnership, no one
feels
safe.

Years ago, I worked with a very experienced nurse. She had lived in different countries and had many specialties – obstetrics, pediatrics, orthopedics, and, when I knew her, critical care. Victoria was knowledgeable and capable and I had no reason not to trust her until one day I found a large syringe filled with fentanyl hidden behind the sharps container on her side of the counter. Noting the concentration, I calculated that there was 1,000 mcg of narcotic in that syringe. I was shocked. That amount is given to a patient in divided doses over hours, with close monitoring, during general anesthesia for surgery. In the
ICU
, we never give more than 25 mcg
IV
in a push dose, and then only if the patient is intubated and on a ventilator. When I asked her about it she didn’t seem at all perturbed by my question, casually saying she’d withdrawn that amount by accident and was planning to put it back in the narcotic cabinet later. We both knew it was impossible to return liquid to the original glass vials that had already been broken open. Then she came up with a different answer. She said she had been planning to inject that large dose of fentanyl into a bag of saline and use it for a continuous infusion for her patient. That was a more plausible explanation, but still, it was a huge red flag. Besides, for me it was too late: I had already gone from trust to mistrust.

I suggested we go to the med room to dispose of the narcotic. She said she would do it herself later, but I insisted we go together to
“waste” the medication and I would witness its disposal, a practice we do whenever there is unused narcotic. Thinking back now, I should have notified our manager, but luckily, other nurses had their own concerns, too, and they reported her.

Soon after that incident, she was off on extended sick leave and I heard that Victoria was in the process of becoming Travis and was suffering severe pain following gender-reassignment surgery. That provided a possible explanation if she had been “diverting” medication for her own use, but I never found out for sure if she/he was a drug user.

I am a trusting person. Trust is where I begin, unless I have reason to think otherwise. But it seems like old-fashioned trust is becoming scarce. Over the last few years, with the increase in security measures and the tightening of practices to protect privacy in all areas of society, it feels like there’s more of a culture of fear and suspicion than ever, even in the hospital, where trust is needed more than almost anywhere else.

For the nurses, one of the first signs of a loss of trust happened when Corinne, our fearless union rep, political activist, and superb nurse, found what she believed to be a surveillance device installed in the medication room, on the ceiling. “It’s a spy cam!” Corinne said, appalled. She went straight to our manager in indignation. The administration said it was an “air quality monitor,” but we didn’t buy that. Someone else told us it was an “inventory control device,” but if so, shouldn’t we have been informed that we were being watched? Corinne took matters into her own hands and dismantled the contraption herself, with the rest of us standing by, cheering her on.