Opening My Heart (22 page)

As I may have mentioned, I don’t pray, but suddenly a spontaneous prayer comes to me:

If I make it, I will dedicate my life to being a better nurse. I will work toward ensuring that every patient gets this quality of care. It’s what every human being deserves. No less
.

Robyn and I have spent a quiet day together with Ivan and the kids. Now, it’s Sunday evening and time to turn on my computer to watch a YouTube video of Dr. David performing a valve replacement, the exact operation he will do on me tomorrow. It’s oddly reassuring to watch his hands carry out this nearly bloodless procedure (a cell-saver machine vacuums up the spillage and returns it to the patient, thereby reducing the need for a transfusion). Somehow, it helps to see the surgery detached from the person under the green sterile drapes, free of fears and questions.

You don’t have to be mother, nurse, or friend. Take a break from all of that. Just let go and be a slab of meat
, Janet whispered into my ear just before she left.

I pack my bag. There have been many belongings I’ve come across in patients’ bedside tables and carefully packed “overnight” bags – a lock of hair from a dead infant tucked into a locket, $100 bills wrapped into a washcloth, and even an Olympic medal, but practically speaking, you don’t need much at all. Of course, as the old saying goes, when you’ve got your health,
you’ve got everything, and when you don’t, possessions mean nothing. A million dollars or a diamond ring, neither will help you in the hospital.

Here’s what I take: A toothbrush. A flattering photograph of myself – to show them and remind myself who I really am. A Middle Eastern good luck charm called a
hamsa
that has a blue “eye” in the middle. It was given to me by a young man named Boaz, a brave patient who fought many battles and made it home.

“Don’t forget your toy, Mom,” Max says, bringing me my spirometer, the blue plastic gadget the nurse practitioner gave me to use for my breathing exercises post-op, to prevent atelectasis, which is a collapsed lung. He tries it out himself and Ivan tells him to put it down, it could get dirty, scolding him gently. Max and I have a private giggle – two kids behind Dad’s back.

On top of my bag I place my health card. It’ll cover my hospital “bills” (don’t know what one of those thingamajigs looks like), thanks to Canadian taxpayers, myself one of them.

Max has gone downstairs. I hear him singing “The Final Countdown” –
De-de-doo-doo-doo
– and I have a quiet chuckle at that.

Ivan has made a dinner of potatoes, broccoli, and roast chicken – which gives me an idea. I swoop it away, whisk the platter off to the counter, and pull out a sharp knife from the drawer. Insert into the top of the breastbone of the bird. Slice straight down. Crack open. Flatten. A median sternotomy like the one I will have tomorrow. Robyn and Ivan watch my macabre dissection – Ivan horrified, Robyn somewhat amused – but my twisted little pantomime calms me.

Now, after dinner, I’m
NPO
–
nil per os
– to allow my stomach to be empty during surgery to prevent aspiration into my lungs. Mary calls and we speak for a few minutes. “God bless you, Tillie,” she
says before hanging up. From Mary I gladly receive a missive from the divine. I study more codes.

In the bathroom, I remove traces of old nail polish so that they will be able to check my nail beds for perfusion to my extremities. I take a shower and after I dry off, I stand staring into the mirror for one last look at my smooth, unblemished, white chest. Squinting, I imagine the cut that will be there, the bloody trail that the scalpel will make. Another odd idea occurs to me. With a dark red lipstick, I draw an incision down the length of my sternum, so I can get there first and have a hand in transforming myself from wound to window.

I wash the fake lipstick scar off my chest and go outside to watch the kids play basketball on the driveway. I catch each of them and give a quick hug as they rush past me.

“Hasta la vista, baby,”
I say in my best growly Terminator-Schwarzenegger accent. “I’ll be back.”

In the morning, I say goodbye to the kids.

“So long, toots,” Max calls out and Harry gives a little wave. Ivan drives me and Robyn to the hospital. It’s a glorious day, clear and
sunny –
so was the morning of 9/11
, I think and force that thought out of my mind, far away.

“You’ll be all right,” Ivan says, giving me a quick kiss. I hand him my wedding ring, which he takes, showing no trace of the ceremony with which he gave it to me eighteen years ago. Practical as always, he attaches my gold ring to his car keys for safe-keeping and hurries off to work, planning to be back when I wake up from surgery later. Robyn stays with me as I check in through Admitting, where I show my health card and that’s it. They’re expecting me. I shower with antimicrobial soap and don my hospital gown – my soldier’s uniform, as I think of it. I climb onto the stretcher, sit on the edge, and breathe, slowly and deeply. Robyn sits beside me on a chair, her knees close to the bed. She scans my face for clues as to how I’m doing and I try not to take in her nervousness. It’s always been like that between us; what she feels, I feel and she experiences my emotions, too. There are few boundaries between us. We mix into each other like water into water or air with air. She reminds me to breathe and I do and she, with me.

“Stop watching me,” I tease her. “A nurse observes without the patient knowing.”

“Maybe I can learn.” She wants to do more but doesn’t know what. Being here means so much. One day I will get around to expressing my gratitude, but how do you thank someone for holding your life in place while you go far away?

“Don’t worry, Tilska,” she says, using her pet name for me, which almost makes me lose it. “I’ll fill you in on all the details.” She knows I can’t bear to miss out any moments of life. “You remind me of my grandfather,” Robyn says. “He used to say he wasn’t afraid of dying, he just didn’t want to miss the news.”

I perch at the side of the stretcher with one leg tucked
underneath me, the other leg swinging casually. I’m not ready to lie down, not yet.

“I’m so proud of you, Tilska. You’re as calm as if you’re sitting on the dock at my parents’ cottage,” Robyn says, “so relaxed and at ease.”

Ah, the wonderful times I’ve enjoyed at Bob and Norah’s summer home situated in the wild majesty of Algonquin Park. I take in the love of those dear friends – like parents to me – and breathe in some of that fresh, clear air.

The anesthesiologist, Pat McNama, arrives and introduces herself. She looks me over and I see what she sees: the way I’m sitting, it looks like I’m missing my leg, like an above-the-knee amputation and she needs to check my circulation, palpate my pedal pulses. “Don’t worry,” I hasten to tell her, unfolding and straightening it out. “I do have another leg.”

“That’s so nurse,” she says with a laugh, “to see something as I might see it.”

Then Dr. David and a nurse appear at the foot of my bed and introduce themselves, saying their names clearly, as if it is the first time we are meeting, though I know them both. The nurse takes my vital signs and measures my oxygen saturation, which is 100 percent. Together with Dr. David they review my latest lab values and test results. They discuss with me the surgery and explain exactly what they are about to do – which artery will be cannulated, which diseased valve will be removed, replaced with the specific type of valve I’ve chosen. They check with the blood bank to ensure that units of my blood type – A positive – are available in the unlikely event I need a transfusion. They ask me about allergies – none. They ask if I agree to having this surgery performed, which of course I do.

I suddenly realize what this is – it’s the famous surgical safety checklist in action! How comforting it is to experience this myself!
I’ve heard many surgeons say, Why haven’t we been doing these basic checks and working as a team all along? It has been proven to reduce complications and errors.

Dr. David asks if I have any questions, which now, finally, I don’t. He asks the rest of the team if anyone has any concerns or something to say, to make sure nothing has been missed, before proceeding. He removes a pen from his breast pocket and signs his name right on my chest. X marks the spot.

I’m yours
.

A nurse gives me a tiny white pill and I place it under my tongue. It doesn’t take long for my world to get small, then smaller. As they wheel me into the
OR
, I look back, try to give a wave. My vision is blurred, but I see the steel table, draped with green towels, the
IV
pole where a glass bottle hangs with milky white liquid, which is Propofol, the sweet “Milk of Amnesia” we call it. People are prepping instruments, setting up machines, chatting among themselves.

They drop to a respectful hush when the patient arrives.

The players take their places around the table.

I’m all open heart now.

“We’ll take care of you,” a nurse says and it’s the last thing I hear.

“The patient is here from the
OR
 … a valve. Where should we put her?”

“That room … over there …”

“Let’s move her onto the bed. One … two … three … lift.”

I’m alive! At least I think so …

A warm hand in mine. “Hello, Tilda. I am Maria Kirchhoff, your nurse tonight. You’re in the Cardiovascular
ICU
. It’s Monday, eight o’clock in the evening. Your surgery is over and it went very well. Give me a nod, if you can hear me … good. Can you wiggle your toes? … Good. Now, squeeze my hand, the right … now the left … Good.”

I made it – or is this a dream?

“Here, Tilda, hold on to this …”

What’s this thing? A microphone? Am I supposed to give a speech? Okay, here goes. Ahem … I’d like to thank the Academy, my family …

“It’s your pain pump. Use it whenever you need to. Press it if you have pain.”

PRESS
 … 
down I go … Not a second to waste … the show must go on …

“Hi, Tilda. It’s Maria, your nurse. It’s nine o’clock in the evening, a few hours since your surgery. You’re doing well, but we’re having a little problem … you’re bleeding from your chest tubes … your blood pressure is low … we’re concerned … want to keep a close eye on you … breathing tube in your mouth … you can’t speak right now … let it breathe for you … just rest … nod your head yes if you hear me. I’m going to let Ivan and Robyn come in to visit in for a few minutes …

Tell them to go away! Let me sleep
.

Serious, intelligent, swift, intense, present. Maria will save me!

“Tilda, it’s Maria again … It’s ten-thirty now … still blood loss … your heart rate is good, seventy-five beats a minute, sinus rhythm … blood pressure is a hundred and one over fifty-eight …

I have a blood pressure … whoopee! That’s a start
.

“We’re keeping you intubated … you’re breathing at a good rate of twenty breaths a minute … just let the breathing machine help you, try to relax with it … your chest sounds clear … your blood sugar is up a bit, but I’ll keep an eye on that …

Her voice … soft, low, and gentle. I am safe in her hands
.

“I see you’re using your pain pump a lot. Are you still in pain?”

Yes. No. Don’t know. Get me outta here!
PRESS
 … 
and melt into bed
.

Maria, in a different voice, speaking to someone else … Who’s there?

“I’m worried about her … blood loss … drained 150 cc of blood from the right pericardial chest tube and 220 cc this hour from the left …”

Can I go home now?

“…  her blood pressure has dropped down to one hundred systolic, though her mean is still around sixty … Her hemoglobin is only sixty after one unit of blood … She’s still acidotic with a Ph of 7.34, likely due to bleeding. I’ll give her another unit of blood … She has pain. She’s using a lot of narcotic … urine output is adequate … she’s put out 75 cc this hour …

What is this thing between my legs? It’s a snake! Get it off me!

“That’s your foley catheter, Tilda … for your urine.”

Take it out. I don’t need it!

“Try not to pull at that … you might hurt yourself.”

“Tilda, it’s 11:30 now. You’re still in the
ICU
and you’re losing a lot of blood … hemoglobin is dropping … given you blood transfusions … I’ve called Dr. David at home …”

I’ll be fine. Don’t worry about me
.

“He’s coming in …”

But he has his own surgery tomorrow. Don’t bother him
.

“He may have to take you back to the operating room.… to see if there is a bleeding vessel or a problem with a suture.”

What’s wrong? Something must be wrong!

“She’s still bleeding …”
Maria’s calm voice, telling someone – who?
“She’s put out almost two litres so far … through all three chest tubes … blood pressure is down to eighty sytolic … had to go up on the dopamine … urine output is good, at 50 cc hourly …”

“Tilda, it’s Dr. David here.”

You’ve come in just for me? Maybe you do love me after all!

“…  I’m going to fix this problem …”

Don’t worry about me. How’
s
your arm? How long have I been in here? A year?

“Maria has been trying to stop the bleeding but … blood transfusions … plasma, too.”

I’ll be okay … You’ve all been very nice, but I just want to go home
.

“Tilda, it’s your nurse, Maria. We’re giving you more blood transfusions. You’re still bleeding from your chest tubes … can’t find the cause … may be a reaction to the heparin or a problem from the surgery … Dr. David may have to take you back to the operating room.”