Opening My Heart (6 page)

“Sorry about that.” I pointed out a possible candidate, from which she drew blood quite capably. She started an
IV
and hung a small bag of saline running at a slow rate. “The doctor will see you soon.” As soon as she left, I reached over and sped up my
IV
.
I need more fluid to flush out the stone. This nurse doesn’t know her ass from her elbow!

A few minutes later, the doctor came in and the first thing he said was, “Whoa, this patient is getting too much fluid!”

“I had set it at a slower rate.” Nurse Emma glared at me as she adjusted the
IV
.

“It’s true, normally, you’d push fluids,” the doctor explained to me, “but not when you’re in the midst of passing a stone. One kidney might be obstructed and become swollen while the other continues to produce urine.”

Oh, snap! Hydronephrosis
. Who’s the bad nurse now? I would hate to have me for a patient. Then, just as he was about to order a dose of that magical morphine, he paused. “Any past medical history?”
No, I said, in no mood to quibble about the inane redundancy, only pray he wouldn’t examine me, which might involve listening to my heart with his stethoscope. Luckily, he didn’t bother. Soon, the narcotic kicked in and I dozed off. When I woke up, I went to the bathroom and heard a tiny, metallic-sounding clink in the toilet bowl. With a vinyl glove I’d nabbed from the clean utility room, I fished out my prize and held it up for examination. How proud I felt at what I’d produced. Famished, I was ready to reward myself with a nice lunch. I returned to my room and waited for them to discharge me.

I waited. No one came. My
IV
ran dry and clotted off. I took it out myself, then tidied my room, stripped the bed, and remade it with clean sheets I helped myself to from the linen cart. After dumping my hospital gown and linen into the laundry basket, I was ready to leave. As I walked past the nursing station I overheard a doctor. “We cured her. It’s a miracle.” I chuckled at his little joke. It was exactly the kind of thing I would have said had I been on that side of things.

Now, in the interests of full disclosure, I should mention that, yes, I told Dr. Drobac that I don’t have a family doctor, but I lied about that, too. I do have one – a very good one, in fact. Dr. Janet Morse is smart, wise, kind, and always makes time to see me. A few years ago I went to her for something minor and she pointed out that I was long overdue for a checkup. I heartily agreed. She booked an appointment and I called the next day to cancel it. Coming to her now, she may not be so agreeable to take on a “non-compliant” patient like me and I can’t say I blame her. But she welcomes me back warmly. When I tell her about my visit to the cardiologist she looks concerned. I wonder if she feels a twinge of liability for not insisting I be followed sooner. I rush to reassure her. “I neglected my health. You bear no responsibility whatsoever.”

She reads me every bit as accurately. “Nor do you. You didn’t cause this. You did nothing wrong. This defect was something you were born with.”

But I worry that I may have made it worse by leaving it so long. She senses that I’m feeling at fault, and faulty, too. It’s my own hangup because last night when I apologized to Ivan for this disruption to our lives his look of surprise told me he didn’t see it that way. Ivan doesn’t waste time wishing things were other than exactly the way they are. As for our kids, I’m not ready to tell them, not yet. Of what use is a sick mother? That’s what I had and I vowed never to be that to my own kids. Over the years, I’ve done everything possible to stay healthy – except for taking care of myself, that is.

Dr. Morse orders blood work, and this time I promise to go.

Later, at home, back on the phone with Mary, I let it rip. “What if my heart doesn’t start up again?”
The key is in the ignition, but the motor won’t turn over!

“That never happens,” Mary scoffs, “but if it does, they’ll put in a pacemaker. Tillie, you’re going to make it. It’s not your time to go. God has a plan for you.”

Many people automatically utter such pious phrases, but Mary actually means them. She is sincerely religious, a devout Catholic who doesn’t mess with the Third Commandment – or any of them, for that matter.

“At least you don’t have to worry about medical coverage,” she says on a more practical note. Living in the United States, it’s new for Mary to have to think about health insurance. Yes, it’s true. There are lots of things to worry about when you’re facing open-heart surgery, but how I was going to pay for it wasn’t one of them.

The next morning, Mary calls back.

“Tillie, I just got home from night shift. My patient was a seventy-two-year-old woman, twenty-four hours post – aortic valve replacement. As soon as we extubated her she was raring to go, practically jumping out of bed. She told me, ‘You call your friend, dearie, and tell her not to worry. She’ll be okay.’ ”

Up until now, nothing has cheered me, except this, a little.

Night shift.

I have to be a nurse again, one last time before going off to camp, and then who knows when I’ll be back at work?

“Should you be doing this?” Ivan asks as he watches me getting ready. He seems worried about me – or maybe about the patients who will be in my care – but, as I tell him, I need to do this. I leave the house around 6:30 in the evening – or 1830 hours – and drive downtown for my shift, which starts at precisely 1915 hours. On the way, I turn on the
Saturday Evening Golden Oldies
and listen to the Four Seasons sing “Big Girls Don’t Cry” and Elvis croon “It’s Now or Never.”

Welcome to Toronto General Hospital, my world. Affectionately called “The Big House” by insiders, this huge, venerable medical centre is a mecca of world-class research, academic teaching, and exemplary patient care (according to the corporate mission statement) that specializes in cardiac surgery, organ transplantation, the
treatment of eating disorders, and stem cell research (among other things). It has also been my place of work for eons and I have always felt proud to work here. But now, entering the revolving front door and standing for a moment in the main lobby, I see it with new eyes and am reminded that most people don’t like hospitals. (I guess I forgot.) Not too much
hospital-ity
around here or many friendly faces or smiles, especially this late in the day when everyone who doesn’t have to be here is scurrying off in the opposite direction, heading home. People coming in are reluctant and frightened; those leaving are eager and relieved.
No one wants to be here!

In the hospital, everything and anything can happen – and frequently does. Nothing that goes on here surprises me. I’ve seen it all – birth, life, and death – in all its variations – not to mention sex, drugs, and rock ‘n’ roll. Every human emotion and activity takes place here: fainting, yelling, joking, sobbing, laughing, doctors crying, nurses dancing; gentle folk raise their fists, the cheerful become melancholy, and the timid learn to be outspoken. A patient gets married moments before dying. A son donates a lobe of his liver that saves his mother’s life. A woman swallows the contents of her medicine bottles and we race to rescue the life she’s tried to escape. A man breathes easy for the first time, now with new healthy lungs, a gift from an unknown family. No, it’s not an episode from a television show, it’s any day – or night – in a big-city hospital.

If you walk these halls and take a peek into the rooms you will see grim, ghastly sights. You’ll smell the pungent mix of bodily fluids and industrial-strength chemicals. You’ll hear people calling out in distress or confusion, and sometimes their cries go unanswered. Like a prison or a battlefield, the hospital is every bit as raw and extreme. You will be reminded that human suffering is close at hand; you don’t have to travel to faraway places to find it.

I feel right at home here. It’s my comfort zone. Hospitals are my second home; they’re in my blood. As a child, I accompanied my parents to their numerous doctors’ appointments. As a teenager, I spent my summers as a volunteer “candy striper.” Years later, I resurfaced as a student nurse, and for the past twenty-eight years, I’ve been showing up, taking care of patients, and still trying to figure out the mysteries of this world, as a nurse.

I have stayed the course, working during the profligate 1980s, laid off suddenly in the me an, restructuring 1990s, when there was no “job security” and the joke was, “Don’t bring a lunch.” Eventually, I was rehired to do the same job and have remained employed here throughout these sober, downsizing times. Because I’ve been in it so long, I’m often asked the question: What has changed?

A lot.

Back when I was a teenager spending summer vacations in hospitals, strolling the wards, pushing a blue cart filled with books and magazines that I handed out to patients, I would stop to sit on the edge of their beds to chat and joke around. It’s a different reality now. There’s a huge shift. These days, hospital patients are not reading novels. They’re too sick. Patients who are deemed “stable” or sometimes merely partially recovered are sent home to be cared for there – or not. The ones who remain in hospital have complicated, chronic medical issues, are unstable, often older, and need a great deal of complex nursing care. They have multiple
IVS
, are on oxygen, many have wounds and are receiving invasive treatments. (I have heard of hospitals in the United States that offer gourmet meals and spa treatments in order to improve “patient satisfaction.” Want my advice? If you are well enough to enjoy such things, stay home.)

People are in the hospital because they need nursing care, and too often there aren’t enough nurses to do the job properly. We all
know of cases of patients who needed more nursing care than they received. “I rang the call bell and no one came.” “I didn’t see a nurse all day or night.” Then there are worse tales of insufficient monitoring or inattention to serious problems.

All true, but there is one relatively new innovation that offers me a great deal of comfort as a soon-to-be patient. It’s the
ICU
Rapid Response Team, now a standard feature in most hospitals. On-call twenty-four hours a day, this mobile
“SWAT
team” covers the entire hospital, scouting out high-risk or deteriorating patients. If they are alerted quickly to a patient in need and can get there during the crucial “golden hour,” as it is called in the scientific literature, treatment is most effective. An
ICU
nurse is the first responder to arrive and assess the situation. Then, in consultation with a physician and other members of the team, the nurse administers oxygen, fluids, takes blood work, arranges for X-rays, and starts medications. My friend Stephanie, who’s on the team, jokingly calls it the
“ICU
Roadshow.” Another friend who’s on the team, Janet, says, “it allows us to light a fire under the situation to get things moving along faster.” What it does is bring the
ICU
to patients so that they might not need to come to the
ICU
. In a way, the Rapid Response Team is like a “virtual
ICU”
because it’s about the people and their expertise, not the place or its equipment. The
ICU
is a way of doing things.

I have seen the results of the Rapid Response Team and have read the reports: they are catching problems early, preventing mishaps, saving lives, and reducing
ICU
admissions. What’s comforting to me to know as a patient is that anyone – doctor, nurse, patient, family member – can call on them. I plan to keep their phone number close at hand in case I get into trouble post-operatively.

Something else has changed and it’s not just at Toronto General Hospital, though
TGH
has been leading the way. It’s the adoption
of a corporate philosophy called “patient-centred care” that espouses “respect for patients and their values, beliefs, and concerns … and the promotion of physical comfort and emotional and spiritual health …” These ideas seemed a “no-brainer” to us nurses when it was first introduced a few years ago.
Wasn’t our care already all about the patient?
We were there to meet patients’ needs – it’s could be the definition of nursing. That’s why we chose this profession in the first place – to serve patients. Nursing care
is
patient care. To us, these terms are interchangeable. “Patients R Us” is like “Toys R Us.” Would you ask a dentist to be more “teethcentred?” Yet, the reality was that we often fell short, and we knew it. We’ve been pulled in too many other directions as we’ve tried to meet doctors’ demands, perform housekeeping, secretarial, and administrative duties, and, of course, all the “hunting and gathering” of equipment and supplies, tending to machines, completing paperwork, and charting on computers – all activities that dragoon us away from patients. Not to mention our own personal failings in trying to meet patient needs.

I will never forget the horrific experience of one nurse who was a patient. Her book,
Bed Number Ten
, had a huge impact on me as a young nurse. Nurse Sue Baier’s harrowing account of the cruel and indifferent treatment she received at the hands of hospital staff made me vow to never become one of those callous nurses like the ones who cared for her. Rendered paralyzed by Guillain-Barré syndrome, a rare neurological disorder, Nurse Baier was in the
ICU
for months and endured unspeakably insensitive, at times cruel, treatment by the staff. I hate to think that there might still be places where patients experience such inhumane treatment, but it’s possible.

However, I sense a sea change taking place in the delivery of patient care. Sincere and real efforts are being made to transform
the hospital culture into a kinder, friendlier place. These days, patients themselves have a much greater awareness of their right to courteous and respectful care and I hope they will not tolerate any less. Patient affairs departments are there to listen to families’ concerns and to step in to mediate conflicts when necessary. Hospitals are making efforts to raise awareness among all staff to improve our communication skills and to be more attuned to patients’ needs. We may still fall short at times, but progress is definitely being made. Well, I guess I’ll soon find out for myself, won’t I?