Opening My Heart (9 page)

“But you have other meds due and your hemoglobin is only sixty. Your patient needs the blood now. It can’t wait. You’ll have to start a peripheral
IV
and let the doctor know we need a new central line. This one may be a source of infection.”

“I’m not good at them,” she admits, eyeballing her patient’s arm.

Veins are one of my specialties. The plump ones look juicy, but I don’t fall for that easy temptation. I prefer the ones you can feel rather than see. First, I send her on a scavenger hunt to collect what’s needed. It’s like a
mis en place
before preparing a complicated French recipe: if you assemble the angiocath, tourniquet, alcohol wipes, and prime the
IV
tubing before starting to “cook,” you won’t be scrambling and will calmly nab that vein. It doesn’t seem that long ago that I was bumbling around, coming into a patient’s room, forgetting to bring something, going out to get it, coming back in again, running around in circles. “Have you started many
IVS
before?” I ask Simone when everything is ready.

“Yeah, but only on the simulator models at university.”

Ahh, this is the new nursing education, a more
in vitro
process than
in vivo
. What Simone means is that she learned to take a pulse, auscultate lungs, and perform other skills on high-fidelity dummies made of plastic, rubber, silicone, and computer chips. They even mimic human responses like crying out in pain or expressing distress. What they don’t mimic is the disruptions, distractions, interruptions, fatigue, and simultaneous multitasking of real-life nursing.

Way back in the day when I was a nursing student, we practised our skills on one another before working with patients under the close supervision of an experienced nurse. It was the old-fashioned training or apprentice system. We took blood pressures, drew blood, and once, we even inserted naso-gastic tubes into one another. (This is a catheter that goes into the nose, down the throat, and into the stomach, used to drain fluids, deflate air, or give medications.) It was unpleasant, but every single time I’ve done that procedure to a patient, I remember how it feels. You can’t get that from an electronic dummy, just as you can’t pilot a plane after playing a flight simulation game. Something is lost. It fosters the kind of detachment I saw in one young nurse. She sat outside the room, staring at a computer screen, glancing now and then at the patient’s cardiac monitor and ventilator screen. Later, standing at the bedside, she pushed buttons and recorded data from the machines. She didn’t touch or speak to the patient, nor make eye contact. It was nursing by numbers with no connection to the person in the bed.

But how to teach empathy? Compassion may be innate in some, but not in most of us. The skills of face-to-face interaction may be challenging to the “net generation,” or “millenials,” since many are more familiar with online relationships, electronic connections, and virtual realities than one-on-one, real-life ones. But
the new nurses teach me a lot, too, and I love being around them with their verve, idealism, and self-confidence. Their ease in learning new things and their refusal to compromise their personal lives for their careers is inspiring. They’ve all had a chuckle at our old-school ways, like our resistance to new computer programs or when the automated medication dispensing machines were introduced. They were patient with us, holding our hands until we were up to speed. They want to learn from us, but unfortunately not enough of us are willing to work closely with them and impart what we know, thus the need for laboratory models to practise on. Paradoxically, you have to be young to do this work but old enough to do it right (though “old” or “young” in this context has nothing to do with age).

Under my guidance, Simone gets the
IV
in and looks pleased with herself. Everything is under control for now, so I suggest it’s time to bring the family in, but she doesn’t feel ready because the room is still messy and she wants to tidy it up.

“None of that matters,” I tell her. “They’ve waited long enough. Bring them in.”

I’m not always so helpful – or bossy – but I feel a new urgency to pass the torch.

Nathan, our ward clerk, dims the hallway lights, an encouraging sign that nudges the night along.

My patient appears to be sleeping, but it can be hard to tell; I’ve cared for patients who looked like they were in a deep sleep but tell me in the morning they didn’t have a moment of rest. His vital signs are stable and I make sure his monitor alarms are on. “Listen out for a minute, would you?” I call out to Simone to let her know I’ll be stepping away from the bedside for a moment. It means
Stay tuned to my patient’s alarms, extend your radar to cover my patient, too. You are responsible for both of them
. There isn’t a crisis every minute,
but in the
ICU
, there’s a constant expectation of close observation and quick response should a problem arise and so our patients can’t be left alone, not even for a minute to step out to for supplies or a bathroom run. I alert Jasna, too, so there’ll be a nurse for the nurse as well as one for the patient.

I take a stroll around the
ICU
, pausing outside each patient’s door to peer inside, to watch not the patients but the nurses.

There’s Wendy, who brings a sense of order and peace as she chats quietly with her patient and at the same time checks his chest tube drainage and urine output. He’s a nineteen-year-old boy with cystic fibrosis, two days post-op lung transplant, just extubated and experiencing what it feels like to breathe easily for the first time in his life.

Diana has her arm protectively around her patient’s wife as she explains something about her husband’s condition, in her excitable yet comforting way, as they stand outside his door.

Holly is caring for her patient behind a closed curtain, talking to him softly.

Kelly is on the phone calling all over the hospital, hunting down a drug her patient needs right away. There’s no time to waste; waiting until the morning might be too late.

I can hear Jason (who’s Chinese) speaking Tamil to his Sri Lankan patient. (Welcome to Toronto!) He reads from a “cheat sheet” prepared by the family for us to use. “Naan ippoothu unkalai marupakkam thiruppa paakiren. Iruma seiya paakum,” he says to let her know he’s going to turn her and that it might make her cough.

And anyone who is still under the misconception that men aren’t as nurturing as women should hear “Big John,” a manly, strapping, huntin’ and fishin’ kinda guy, speaking to his patient, a thirty-nine-year-old woman with breast cancer and now pneumonia: “It’s 11:30 at night. David is here to help me to turn you
to the other side and I’ll give your sore back a rub. You’re doing great, darlin’. I’ll suction the secretions out of your lungs first. Easy does it. You’re safe. I’m right here with you – not going anywhere.”

I move on to Stephanie’s room and I can see in an instant that her patient is sick – the sickest patient in the
ICU
tonight. I don’t know if Stephanie got the patient she needed, but her patient – a twenty-three-year-old woman in septic shock – surely got the nurse she needed. If it’s possible to do so, Stephanie will pull her through.

There are many such A-listers who work here, including Edna, Allyson, Grace, Connie, Murry, Kate, Lesley, Marcia. From whatever angle you observe them, whatever moment you chose, they are reliably doing something that makes the situation better and safer. Oh, there are a few D-listers, too, but we keep them in check. It’s always like that: some extraordinary professionals, a tiny group of stragglers, and the majority of us in the satisfactory middle. But nurses are the wild card. You don’t know what you are going to get. I remember how one patient put it. “How’s it going?” I asked at the start of my shift.

“Depends on the day.”

“How about this day?”

“Depends on the nurse.”

I get this. The nurse can make all the difference for good or bad.

The wife of one of my patients was fond of me, at least at first. I think it was because of my optimism. Well, in the morning I felt that way, but by the late afternoon her husband’s condition had worsened dramatically and we were working hard to keep him alive. I felt less certain that he would make it, and had not as much time and energy to devote to reassuring and comforting her because I had to stay focused on his care. I watched her mood
plummet. “I’m not feeling as good about things as I felt this morning,” she said, searching my eyes for my faith so that she could be buoyed up again. But frankly, I didn’t have as much to give. I tried to fake it but I could see I’d lost her trust. The next day, she requested a different nurse.

Privately, we ask ourselves, “Would you want this nurse to take care of you?” (The more telling question is, which nurse
wouldn’t
you want?) Yes, I’d have Simone, as long as an experienced nurse is also there to back her up and watch my back at the same time. Problem is, not enough of us “golden oldies” are willing to light the way for the newbies. We say we’re busy or too burnt out.
I’m nursing the patient, do I have to nurse the nurse, too?
they ask. I say, Yes, you do. How else will we pass on the collective wisdom of this profession and sustain it? Too many of us are complaining and acting dissatisfied but not expressing what we treasure or why we’ve stayed, other than it pays the bills.

I see I’ve gone from worrying which patient I’ll get to which nurse I’ll get. Does my karmic theory have a corollary – will I get the nurse I need? I’ll soon find out.

It’s two o’clock in the morning and Simone comes over to sit beside me at the desk outside our patients’ room, a post from where we can still observe them and their machines. She looks tired. Because we always work in pairs, on a buddy system, when it is safe to do so we cover each other’s patients and spell each other off so we can take breaks during the night, sometimes even naps.

“If you need to lie down for a while, I can cover your patient for you,” I offer, but she says she’s too keyed up to take a break.

“I don’t feel well. I should have called in sick,” she says, looking more stressed and fatigued than ill. “Nights suck, don’t they?” she says with a sigh. “Do you ever get used to them?”

“Not really. I still find them hard.” There’s no getting around
it – night shift is hard. On the upside, it allows you to escape the hubbub and politics that goes on during the day, but you feel cut off from the rest of the team, not to mention your family, friends, and normal life, which, for most people takes place during the day. Working all night is unfathomable to non-nurse friends. You feel embarrassed to admit you’re working Saturday night. They pity you, and you feel a bit sorry for yourself, too.

I don’t work nearly as many nights now as I used to, but there was a time when I worked so many nights that three o’clock in the morning felt exactly the same as three o’clock in the afternoon. I used to dread coming in, having to tear myself away from friends or family. For years I worked my share of nights (the union decreeing that we split our shifts equally between nights and days), always fighting off an exaggerated feeling of loneliness and isolation from the rest of the world during those dark hours. Most nights I managed to attain the minimal wakefulness required to be safe. Over the years, I’ve learned to make peace with working the night shift, which isn’t to say that at the age of almost-fifty it isn’t difficult, but then again, it was back in my twenties, too. It’s never felt normal or healthy to work at night and sleep all day. But patients need nursing care around the clock, so the night shift is here to stay.

George is now awake and indicates that he’s uncomfortable, so I call for David to help me reposition him. Then I draw the curtains and give my patient a bath, not as much for hygiene as for relaxation. Washing him as I do, soaping his armpits, rubbing his back, massaging his fingers one by one, cleaning his legs, pulling back the foreskin, wiping the folds around the scrotum, actions that in any other context would be sexual. These professional intimacies are decidedly not, but they aren’t strictly clinical either. We each find our own ways to deal with any discomfiting thoughts that come up in these situations of vulnerability, shame, or embarrassment –
at times, our own.

Some nurses seem disinterested or disappointed by these seemingly mundane aspects of patient care. “I like everything about nursing,” one told me, “except actual patient care.” Perhaps they believe that their university education qualifies them to do “better” things and that such “menial” work is beneath them. It’s a class, even a caste, prejudice. Their academic, theoretical education does not adequately prepare them for the shocking realities of the hospital. Patient care seems to have a low priority on the nursing curricula in universities, not accorded the importance it deserves.
Knowledge workers
is the new phrase to describe our role, and while it’s a true description, there is also body work and, for many of us, a spiritual component, too. But many new nurses tell me they don’t plan to stay at the bedside for long. For many, patient care is merely a stepping stone in their career path before moving on to teaching, research, administration, management, or graduate school. Years ago, I felt as they do, and wanted to move on to “better things,” but that was before I saw how nurses heal people with their hands and minds, with their actions and their words. Soon, I discovered that for me, there is no work more meaningful and satisfying than patient care.

George is still uncomfortable. I ask if he’s in pain. He nods but can’t say where or how much, but I don’t need evidence. He has plenty of reasons to have physical pain, and mental anguish, too. We know a lot now about
ICU
delirium, a syndrome that can exhibit as confusion, hallucinations, delusions, nightmares, and an altered sleep-awake cycle. It affects up to 80 per cent of
ICU
patients and a large number of hospitalized patients, particularly the elderly. It can even cause post-traumatic stress syndrome, with long-term flashbacks, bad memories, and nightmares, all from an
ICU
stay. We
use sedation and antipsychotic medications to treat this problem, which, as a nurse, you have to be on the lookout for its signs and symptoms at all times.