Opening My Heart (11 page)

“Do we have a quorum?” Stephanie starts off, as if it’s a formal meeting.

Now that they’ve finished their bagels, they wipe their hands and reach into their bags for balls of yarn and knitting needles. An hour ago in the hospital, they wielded another type of needle, and
their handiwork was patient care. Janet is knitting a soft, custard yellow baby blanket; Jasna, fingerless gloves for driving; and Stephanie, a pair of socks. (She says she only knits socks, claiming she doesn’t have patience for the sweater I’ve been begging her to make me.) Their knitting is the cue to pull out my tools: a pen and paper, but last night before work, in my distracted state, I forgot to throw my notebook into my knapsack. Ever helpful, Jasna flattens open the empty paper bag from the bagels and hands it to me, along with a pen.

“Be careful what you say.” Stephanie gives a sideways glance at me. “She writes down everything. You might end up in a book.”

“Is that what you think?” I say, faking indignation. “That I only come here for material?”

She considers this. “No, you like the bagels.”

My pending surgery is weighing heavily on my mind and I feel guilty about letting them think I’m only going to be off work for the next two weeks. Even though we’ve talked openly about everything (kids, husbands, even our sex lives), I can’t bring myself to share my secret with them – not yet. Besides, they each have their own worries. Stephanie’s a single mom raising teenagers alone. She had her own health scare recently, but thankfully everything is okay. Jasna has three sons, one of whom is severely developmentally delayed. At sixteen, he is non-verbal, wears diapers, and has frequent, daily seizures. Ten seizures is a good day. Janet is tackling health issues and a weight problem and has recently lost sixty pounds. “I was facing diabetes, high blood pressure, the whole kit and caboodle,” she told me privately. “I took myself in hand and did something about it.”

Yes, we share a lot, but today I keep quiet.

So we turn to what we always do, what we need to do, which is review the night. In order to put it all behind us, we must first go
over it in detail, taking care to lower our voices and never mention patients’ real names.

“I can’t stay long,” Stephanie warns us, as she usually does, before we begin. “I’m exhausted.”

“You always say that,” I remind her.

“I mean it this time. And I have to take my kids to their music lessons before I go to sleep. Tilda, you’re going to have to write fast.”

I start off by telling them about Simone. “She’s stressed out and doesn’t seem to be coping. I hope she stays – we could work with her – but she has a lot to learn.”

“I hope she sees it that way,” Janet says with a chuckle. “Not all of the young’uns take to our direction. Some of them act like they know it all.”

Janet’s words might seem harsh, if you didn’t know that she’s a fabulous nurse and generous mentor. And the younger nurses would likely be horrified at our critiques of their work, our strictly-in-jest, off-the-record
American Idol
–type reviews, complete with thumbs-up or -down. There’s only a few we’d like to “send off the show,” but even with those, we vow to help them improve their performance. We take turns being the various judges, like the dismissive critic; “That was a horrendous! Give it up, you have no talent” or more the gentle adviser: “You’re not ready, dude.” We lavish praise on the deserving ones: “I gotta give you major props, dog, cuz you know who you are. You’re ready for the big time.” We encourage those who show promise: “I see you’re trying, sweetie, but you have a lot of work to do. Learn to sing first.” But we revel in coming across the real deal where we can say, “That was a fabulous performance. You’re going to Hollywood!”

Despite our behind-the-scenes grandstanding, we actually take a great deal of pride in nurturing new nurses and watching them
blossom under our guidance. Nurses have a reputation for being hard on our young, and though they may feel like we’re picking on them, we do it because we know how important it is to get everything right.

Janet is itching to tell us about her night. “It was quiet until about three, then my beeper went off. A nurse from the general surgery floor called, not sounding too concerned, but a little birdie told me I’d better go up there and have a look-see. Well, it turned out to be a good call. A middle-aged lady two days post-op bowel surgery was decompensating but fast. She was on 80 per cent O
₂
but her sats were meh – so-so. I wasn’t happy. She was having difficulty breathing and her pressure was in her boots, heart rate, 150. ‘We already gave her a litre of fluid,’ the floor nurse told me. ‘Yeah, but it’s not doing anything,’ I said. ‘You have to see if what you tried had any effect.’

“How long had her pressure been low?” Jasna asks, concern in her voice.

Low blood pressure is a huge miss
.

“According to the chart, four o’clock yesterday afternoon, but no one did anything about it, only now they call me,” Janet grumbles as if annoyed, but I know she’s pleased she could help, maybe even save the day. “ ‘Why didn’t you call us sooner?’ I ask her. ‘We thought it would get better on its own,’ she says. Meanwhile, the patient was confused, with a decreased level of consciousness …” Janet’s voice trails off so that we can think through the situation ourselves and imagine what each of us would do. All the while, her fingers continue to fly, the needles clicking and clacking over the soft yarn. “I was thinking maybe she’d gotten too much sedation,” Janet continues the story. “I was wondering if she needed an
anti-dope
, like Narcan.”

I’m about to correct her, then realize it’s a Janet-ism. Classic.

“So anyway, she’s tanking and I’m thinking we’ll have to tube her and bring her to the
ICU
. Her Ph was 7.1 …” She says all of this without pausing or even glancing at the lengthening swath of the intricate patterned blanket growing in her hands by the minute.

“Not good,” we murmur.
Too low
. Inadequate ventilation, poor gas exchange.

“Her CO
₂
was ninety and her bicarb only twelve!”

We all recognize that it’s an uncompensated acid-base imbalance indicating metabolic acidosis, pending respiratory failure, and we shake our heads at the seriousness of the situation.

“She needed to be in the
ICU,”
Jasna says in alarm, “like yesterday.”

“I spoke with the
ICU
resident and told her that in my humble opinion …”

“Yeah, right,” says Stephanie with a grin to Jasna and me.

“…  not only that but based on the lab work, she was dry. She needed fluids and the resident agreed, so I banged in an eighteen-gauge needle, shot in a litre and a half of saline, and you know what? She perked up in a few minutes and she might not need to be tubed after all …”

As they continue to discuss this complicated situation, all I can think of is that now, hearing our clipped nurse short forms anew, I realize how flippant and cavalier they must sound to outsiders. We toss these phrases off like they mean nothing, knowing they mean everything. How alienating this bravado of ours is to others, yet how necessary to us. What will it feel like to hear talk like this when I’m on the “other side of the bedrails”?

Janet looks at me. “You getting all this down, Tilda?”

“I’m quite sure she is,” Stephanie says dryly. “Go on.”

“So anyway, her improvement didn’t last long. She quickly became completely
kaplooped
, so I arranged for her to be
transferred to the
ICU
, but we had to get that tube in first. The respiratory therapist and
ICU
resident – we were all in agreement with that. The family had come in, very upset. High-strung people. Understandable. I get that. I told them I was calling a Code Blue because she needed to be tubed – stat. ‘No, no, don’t do that,’ they said, looking terrified. To them, it meant the worst thing, but the family was watching me and they could see knew I knew what I was doing and that I was going out on a limb for their mother. They trusted me. So, we got her tubed and sedated and she looked more comfy. My work was done, but just before I left the hospital I went to the
ICU
for a peek. You know what? She looked better. She was in florid sepsis, but we got to her in time and she might make it.”

“Good save,” we congratulate her, but she doesn’t easily accept the accolade.

“It’s not about me – we’re a team. I love being on the RRT because I need to know that patients will get what they need in their time of need.”

“You sound awfully needy.” Stephanie gets in one last jibe.

And this is what I will need – fearless nurses like these.

People always say they want kind, sweet, gentle nurses. That’s nice, but even better are
smart
nurses who know what they’re doing. If you want to survive a hospital stay, you’ll need to have bold, take-charge, go-to, problem-solving nurses like these. More than
caring
nurses, you want nurses who
care
, as in
give a damn
. You need nurses who have the guts to take initiative, speak out, stand up to bullies, rattle the cage, smash hierarchies, kick up a fuss, rock the boat, and blow whistles if necessary.

But even cowboys and crusaders get tired.

Janet yawns. “I’m losing it. I’m going home to my boys.” Tess, Darcy, and Mr. Bennett are her three West Highland terriers. “If I give them cookies, they’ll sleep with me in bed.”

“Is that how I can get a man?” Stephanie asks, stowing away her knitting.

Then it catches us all simultaneously – a wave of pure exhaustion.

“The neurons aren’t firing.” Jasna sticks her needles into a ball of yarn.

“Yup, the synapses have shut down,” Stephanie says. “But first, Tilda will read the minutes of this meeting.”

As if
.

“Are we adjourned?” I ask.

“I’d say,” she says and we all get up to go.

“Okay, ladies. That’s it. Get to bed!” Janet calls out.

The Grand Pooh-Bah has spoken.

Toddling off to our cars, we compare
HOP
– Head On Pillow – time. Stephanie has to drive to music lessons so it will be a while before she sees her bed, but Jasna and Janet estimate twenty minutes, including hot showers first. Me, I can’t sleep. My mind is buzzing with thoughts of warm bagels, night shifts, and good friends, wondering how many more will be allotted to me.

“Good night,” we call out to one another in the bright morning light.

On Monday, Dr. Drobac calls to tell me he’s ordered a Doppler scan, similar to an ultrasound, of my neck arteries to check for atherosclerosis, which is plaque buildup in the arteries, and an angiogram to rule out coronary artery disease. All necessary preoperative tests, but
no can do
.

“I’m going away for two weeks to work at my kids’ sleepover camp.”

“You’re symptomatic now and could get into trouble.”

He means crash and burn. Sudden cardiac death.

“I’ll do the tests when I get back in two weeks.”

“You have to take it easy. You need surgery as soon as possible.”

Unless I drop dead first. In which case I won’t have to do anything.

“Have fun. Try to relax and enjoy yourself,” Ivan said as I got into my car for the two-hour drive due north to the Muskoka region
of Ontario.
Fat chance
. Easy for him to say. He’s getting a break from me and the kids, along with extra late-night poker games and long afternoons of golf with the guys, so who’s going to be enjoying themselves?

Ivan is loving – in a gruff, irascible way. He practises his own brand of “tough love” and can be hard on me. The worst was the night of the car crash when Princess Diana was killed. At around 2:00 a.m. the news broke and I was glued to the
TV
, in shock as I watched the aftermath of the horrific accident in a Paris tunnel. I ran to wake Ivan up and tell him.

“Princess Diana died!” I sobbed. “She’s dead!”

Ivan sat up in bed and pointed his finger at me. “And you killed her! It’s because of all those magazines you buy. You’re as bad as the paparazzi.”

You get the picture. This is what I’m dealing with.

Ivan may get emotional but never sentimental. He’s not one to molly-coddle, cajole, or offer unnecessary hugs – only necessary ones. He has little tolerance for self – absorption, no patience for self-pity. He’s never meditated on a mountaintop, attended an ashram, sat at the foot of a guru, nor contemplated his navel, but Ivan has attained enlightenment, albeit in his inimitable, idiosyncratic way.

In the 1980s, when I first met him, Ivan was making the seemingly trite and ubiquitous pronouncement that everyone says: “It is what it is.” The thing is, Ivan really means it. He accepts whatever life brings. To Ivan, “do your best” and “don’t sweat the small stuff” aren’t empty platitudes; he actually lives this way. His priorities are clear: for example, when his insured clients tell him they’ve been in a car accident – whether it’s a minor fender bender or they’ve totalled their car – the first question he asks and the only one he claims that matters is, “Are you okay?” Satisfied with himself, he figures if others aren’t, it’s their problem. He doesn’t
mean to offend, yet often does. In Ivan, there is a total absence of guile, malice, or spite. Though he’s far from perfect – he’d be the first to admit – he accepts himself as he is. He’s completely at ease with himself.

We’re a good balance: he’s a man of few words and I am a woman of many.

“Yes,” he said twenty years ago when I asked him to marry me.

“Do you love me?” I asked.

“Of course.” And that was that. What more needed to be said?

On the other hand, I do all the things he doesn’t: ruminate, wonder, dream, imagine, speculate, brood, and ponder. We’re so different, but somehow it works.

One evening, a few days after seeing Dr. Drobac, Ivan gives me a pep talk.

“You’re going off the deep end. Get a grip. You’re losing it.”

“No, I’m not, but feel I might at any moment.”