Authors: Tilda Shalof
And it’s not all that unusual that big, obvious signs of trouble like this get wildly missed. Unfortunately, it’s been known to happen and it’s one of the reasons that the Rapid Response Teams were
created in hospitals. There’s even a name for this kind of situation: failure to rescue. Sometimes it occurs when doctors don’t listen to nurses, but here, the nurses aren’t even speaking up to the doctor on behalf of their patient.
“Page the Rapid Response Team!” I demand.
“We don’t have one yet, we’re still developing it.”
Precious minutes go by, but at last the nurse tells Vanessa the doctor is coming and they’ve called the respiratory therapist to assist with intubation. Steven’s blood pressure is still low, but he’s responding to a bolus of saline that the nurse finally started. They’ve gotten the ball rolling. It may be too little, too late, but Steven’s condition seems stable for now. It’s time for me to go home.
“Is he going to make it?” Albie asks when I come out of the room.
“I think so,” I say wearily, “for now, anyway.”
I get home, turn on
Dr. Phil
, open a bottle of wine, and start dinner. It’s romantic, having the house to ourselves, like old times.
Soon, I hear Ivan’s car in the garage, then his key in the door, and I get that familiar flutter. Did I happen to mention how handsome Ivan is, in a rogue-ish, pirate-y sort of way? Short, strong, swarthy, and rough-looking, he’s completely my type.
Would I be able to have sex, one last time?
I greet him as the phone rings. It’s Sue, Vanessa’s neighbour from across the street. She had arrived at the hospital just as I was leaving, less than an hour ago.
“Steven died. He went into cardiac arrest just after you left. They called a Code Blue and worked on him for almost an hour, but he didn’t make it.”
Now I know what my biggest fear is. It’s the best-kept hospital secret. Nurses are capable of the greatest good and also the greatest harm. They will cure or kill me – or worse. They will protect or neglect me, save or sabotage me. The worst thing to have if you’re a patient is a scared, cowardly nurse, one who sees a
problem but looks away and does nothing, a timid nurse who’s afraid to go out on a limb or an indifferent one who doesn’t care enough and gives up.
To survive this experience, I will need nurses caring for me who have guts and grit; smart, staunch, stubborn, protective, feisty, fierce nurses, savvy nurses with moxie, pluck, and chutzpah. I’ll take a brave nurse over a nice one any day! Patients always say they want the best doctor, the most qualified, the top of the class. Fair enough, but they rarely give a thought to the quality or qualifications of the nurses who will be caring for them. This is a dangerous oversight because nurses are the ones who will keep you safe – or not. They are in charge of seeing that you get better. The problem is they are the salvation and the danger, both the rescue and the risk – and possibly the weakest link.
Chocolate doughnuts, double-cheese pizzas, Rocky Road ice cream, and other sugary and trans-fat-laden delights – I’m on the phone confessing all my dietary transgressions to Mary and am coming to the realization that my
carbohydrate foodprint
is more damning than my carbon footprint.
“But what about the olives!” Mary reminds me, in my defence.
She’s got a point. In my refrigerator right now, there’s a jar of dry, wrinkled black olives from Morocco, containers of green, Spanish ones stuffed with chipotle peppers, and smooth-skinned, dark Kalamata from Greece, chock full of vitamins, omega 3s, and antioxidants. Also on my kitchen shelves are walnuts, blueberries, and bran. Does it balance out? Risk factors and lifestyle choices – each only half of the picture.
I didn’t completely come clean with Dr. Drobac: I do have a significant cardiac family history. My father had coronary artery disease, which caused him frequent bouts of crushing chest pain
(angina) for which he popped nitroglycerin pills like candy. He ignored his doctor’s advice to lose weight, even when he eventually developed diabetes and had to go on insulin. At sixty-two, he had a massive heart attack that caused cardiac arrest and he died. My eating habits are also bad and I’m always carrying around an extra twenty (more like thirty) pounds. I guess I’ve been in denial about that, too, because I seem to have the opposite problem than most women, always thinking I’m thinner and fitter than I really am.
Inexplicably and undeservedly, my test results came back perfect. My blood sugar is normal, my good cholesterol is high, and the bad is low. But tomorrow is the big reveal: a cardiac angiogram is the ultimate report card. If there are blockages in my coronary arteries, that’s a failing grade. It means I will need a bypass as well as a valve replacement and will require an even longer, more difficult surgery with greater risks and potential for complications.
“Tilda, if you had stayed, could you have saved Steven?” Albie asks me.
“I’m sorry. I wish I could have, but … no.”
Steven had massive irreversible heart and brain damage. He couldn’t be saved, but the nurses and doctors didn’t even try. But what about patients who do need rescuing – a patient like me, for example? Will they give up on me, too? Will important things be missed? Will my nurses fight for me?
Albie is looking for answers, trying to fathom the death of his son. As hard as it if for her, Vanessa seems more accepting of the situation. She knew how sick Steven was and, given his underlying medical problems coupled with such extensive brain damage, how unlikely was the chance of any significant recovery. She knows Steven wouldn’t have wanted to live under those circumstances, but what disturbs her is that he died in such a violent and undignified
way. A Code Blue involves pounding on the chest, possible cracking of ribs, often electric shocks, and possibly other extreme measures but, in this case, futile efforts.
It’s the day after, and according to Jewish law, the burial must take place as soon as possible. I’m helping Vanessa with funeral arrangements, the shiva, and keeping it all together.
At the cemetery, Albie gets out of the hearse slowly. When he sees me, he says sadly, “You spend your life stopping at red lights, but when you’re dead they let you go right through them.” Together, we follow the ancient custom of tossing a shovel-full of earth onto the casket. I put my arm around his back that sags with grief. “No matter how you work and strive, you don’t get out of life alive,” he says.
“You’re a poet, Albie.”
“And don’t even know it.”
One day, these corny, old jokes will be gone, too
.
We stand at the graveside, each of us with a damaged heart: Albie’s is failing, Vanessa’s is broken, Steven’s is dead, and mine, defective.
At the house with the other mourners, I stay near Vanessa, as close as she’ll let me. She wants to be alone, to grieve by herself, but it’s not allowed. Jews have a tradition of insisting on communal mourning.
“Many people have unhappy marriages,” she tells me privately. “We didn’t. Steven and I had our problems, but we loved each other. We enjoyed each other’s company.”
It showed.
I’ve done the neck vein ultrasound, more blood work, and have just undergone the most thorough examination in my life by a nurse practitioner
(NP)
, who prodded and palpated every part of my body
and reviewed my entire health history. I hadn’t weighed myself in a while, so the number on the scale takes me aback, but she merely notes it without judgment. “Our focus used to be on the scale, but now it’s the measuring tape,” she explains, placing one around my waist. She’s more concerned about my waist circumference, which is a few inches more than the thirty-five considered normal for women (or forty for men), than she is about the extra pounds I carry. My basal metabolic rate is in the “moderately overweight range” with my fat deposits around the waist and belly making me a classic “apple.” It’s much better to have the healthier “pear” shape. My excess abdominal adipose means I have a greater likelihood of developing diabetes, high blood pressure, and certain types of cancer. Scary to contemplate.
The
NP
shares an office with the cardiologist who will do the angiograms. On the wall, I happen to see a framed letter from Elvis, return address “Graceland.” Interesting. I always like to know something personal about the people caring for me.
Afterward, back at home, I call Mary to report to her the results of the neck vein test. “My carotid arteries are clear.” Less risk of stroke. One bit of good news. I should be more cheerful, but I’m still glum.
“Lucky they didn’t check your head. That’d be clear as mud,” she says in her Maritime twang.
It’s the night before the angiogram and I practise sitting calmly and breathing through my anxiety.
Don’t try to get rid of fear or escape from bad feelings
, John had said.
Sit still. Lean into them. Note each thought as it arises and then let it go. When feelings arise, observe them. Pay attention to your breathing. Ride each breath
. I use these techniques to try to tame my wild mind, but an endless stream of bad thoughts, like wedding crashers, keep intruding. Yet, during the few fleeting
moments when I do stay in the present and focus on my breaths, I’m not flooded with terror. How to sustain this Zen-like state? It takes practice, John kept reminding me.
Yes, learning to be mindful does takes intention and effort. It is much easier and more familiar to default to anxiety and worry. Now I have a better understanding of women who choose to go through childbirth without painkillers. “Go toward the pain,” birth coaches and midwives advise. The idea is that the pain will bring about the baby’s delivery and ultimately the mother’s relief, too. You have to be brave to want that pain, even ask for it. For my births, I didn’t go
au naturel
, but for this experience, I feel a need to stay wide awake and face it head-on, not numb my feelings.
But I keep thinking of Charlotte, an old friend from the
ICU
who I ran into recently at the hospital. She’d just gotten engaged. I didn’t even know she was dating anyone, but it was like her to be ultra secret about her private life. I’d been working beside her in the
ICU
the day we heard over the loudspeaker: “Code Blue. Cardiac Angiogram Suite.” Her body jolted and her hands trembled as she tried to compose herself. “My mother is having an angiogram.” She looked at her watch. “Right about now. I was going to see her after it was over.”
“Go now. I’ll cover your patient for you.”
“Mom’s okay, Mom’s okay,” I heard her whisper to herself.
By the time she got there, a full resuscitation was underway. Her mother arrested during the angiogram. When Charlotte arrived, they had just pronounced her dead.
Two months later, Charlotte returned to work but clearly wasn’t ready because at the end of the day she resigned. She now works in Nursing Information Systems.
After a restless sleep, the next morning I arrive early at the hospital for my angiogram. I have banished Ivan from coming
with me because he’s terrible at waiting. He paces around, drinks too much coffee, makes phone calls, and keeps checking the clock. I told him to go to the office and I’ll call him to pick me up when it’s done. He gave me a quick hug – this, a necessary one – and rushed off, relieved to be off-duty. It’s good. I want to keep my family out of the hospital. No one should spend time here unless they have to.
I’m assigned to a stretcher in a bay and sit on it in my flimsy gown and wait. Waiting is always involved. I expect to wait. I can’t add waiting to my stress, on top of everything else. They tell you ten minutes? Count on an hour. You have to be patient to be a patient. Waiting is time to practise my new hobby, mindfulness. I breathe and slow down my mind, which if left unchecked, races in circles.
It’s not working! This stuff is for the birds
.
A small group of student nurses approaches me, holding out their copies of
A Nurse’s Story
for me to sign. They’d seen my name on the patient roster. “Is it you?” they ask, even though I have the kind of name that’s unlikely to be mistaken for anyone else’s. It’s a nice diversion and of course so flattering to be recognized that I overlook this minor breach of confidentiality.
Waiting with other patients for our angiograms, we lie on gurneys, lined up like cars in a parking lot. I strike up a conversation with my neighbour and his glamorous wife, Esmé. At sixty-five, Edward is a sailor and golfer. He has no symptoms and was taken by surprise when his doctor told him at a yearly checkup that he had valve disease. His was caused by ordinary wear and tear, not faulty from birth, like mine. He’s an engineer who works in “predictive maintenance,” estimating the lifespan of industrial machinery, calculating depreciation, and deciding on repair or replacement. I can’t help but draw a comparison to the situation he and I find ourselves in with our own internal mechanisms.
I’ve never worked in this part of the hospital and don’t know any of these nurses, nor them me, which is just as well. A nurse comes over and introduces herself to me as Nurse Louellen. She takes my vital signs, looking preoccupied and distracted. I ask her what’s wrong and she tells me that she is worried about her back. She has a doctor’s appointment today after work. Nurse Zahra is taking care of Edward and I hear her outlining exactly what the angiogram will involve, explaining that a catheter will be inserted into the femoral artery in his groin and dye will be injected. I listen in to the conversation because even though I know this information, it’s soothing to hear it explained in simple terms.
When Dr. Sternberg comes to meet me, we chat first about Elvis, “Jailhouse Rock,” and “Heartbreak Hotel,” from which he segues straight into the risks of angiograms: heart attack, arrhythmias, bleeding, clots, infection, adverse reactions to sedation or to the dye, and cardiac arrest. With a bouncing, eager energy and a boyish grin, he’s positively jovial. This is a man who loves his work. I consent to it all and sign on the dotted line.
Bring it on
.