Opening My Heart (23 page)

Another voice in the darkness around me
. “…  Could be a coagulopathy … what’s her
INR?
Her platelets?”

Too much garlic, magic mushrooms, Meera told me … they can cause bleeding … funny ’shrooms, she said … It’s funny, but am I laughing or only thinking I’m laughing?

“It’s high … 3.6 … Give her two units of plasma … her hemoglobin is down to fifty … Give her another unit of red cells … that’ll make it three units in total.”

“See if we can bring her hemoglobin up to at least seventy …”

“Her blood pressure is holding, but her heart rate is up to one hundred and twenty … sinus rhythm, no ectopics.… she may be hypovolemic … what’s her
CVP?”

“It’s nine milimetres of mercury …”

“Give her more volume …”

“Tilda, Dr. David here … I’m going to manipulate your chest tubes to try to get the bleeding stopped … if I can’t, I’m going to take you back to the operating room and open you up again.…”

Haven’t I been opened up enough?

“…  there’s a ruptured appendix in the
OR
 … can’t take her back right now …”

“Give her another two units of packed red blood cells and some fresh frozen plasma, two or three units …”

PRESS
 … 
Down, down, down I go … gone
.

“Tilda, I’m the endocrinology resident, on-call … you’re having some blood glucose instability … Your sugar is too high right now … common post-operative complication … sometimes happens with the stress of critical illness … I’d like your consent to start an insulin infusion … Your blood sugar has gone up significantly … can have dangerous results … a precursor to diabetes … lifestyle and diet changes eventually, when you get home, but for now … Your nurse will monitor your blood sugar closely and give you insulin as needed … Are you in agreement with that plan?”

No, no insulin. I’m not a diabetic! You have the wrong patient. Do you hear me? I can’t hear my voice!

“It’s important to keep your blood sugar levels under tight control … you’re a nurse, aren’t you? So you probably know all about this, right?”

I certainly do! I wrote a paper “How Sweet It Is! The Nursing Management of Tight Glucose Control During Critical Illness” … presented it at a critical care conference … Now I’m the subject of the study!

“We’re going to start the insulin infusion, okay? …”

Sure, whatever you say … but I really don’t need it
.

Maria’s calm, serious voice: “I’m concerned about her breathing. Her resp. rate has gone right down … She’s apneic … not breathing enough … using the pain pump frequently … suppressing her respirations … down to six breaths a minute.”

I’ll breathe, don’t worry, I’ll breathe, I promise … in a minute or two … I’ll get to it
.

PRESS
 … 
Down, down, down I plunge into my warm, cozy cave
.

I’m still alive … at least I think so … fading in and out …

“She’s not breathing enough.”

An unfamiliar voice. Who’s this?

“I’m going to lock out her pump. She’s giving herself too much narcotic … Respirations only ten … now six …”

The unfamiliar nurse voice
.

“She needs Narcan to counteract the narcotic.”

No, no Narcan! Bad side-effects. Don’t worry, I’ll breathe. I promise! Just watch me
.

“Her respirations are at five … now four … a minute … She’s not breathing enough.”

“Breathe, Tilda!”

Okay … will do … I’ll get on to it. Just give me a minute or two …

“I’m here, Tilda.”

It’s Maria, her wings spread over me. From a dark, dense fog, I reach out to her
.

Where’s my nurse! Do these people have any idea what they’re doing? Maria is in cahoots with Dr. David … a conspiracy against me … Does he love her now? I thought he loved me!

“Tilda. It’s Maria. I’m right here.”

Her hand in mine. Squeeze
.

“How much narcotic has she had?”

“Six milligrams.”

Only six? That’s not much morphine. Do they think I’m a drug addict?

“What’s she getting?”

“Dilaudid.”

Oh, six milligrams of dilaudid? That’s a whopping dose – fit for an elephant in a zoo. That works! Never mind
.

“Good morning, Tilda … It’s Tuesday morning, seven-thirty … your surgery was yesterday. I’m your nurse today … My name is Joy Bartley … I’ll be taking care of you, Tilda … be with you all day … you’re doing much better … Maria told me you had a rough night
 … lost a lot of blood … but they got the bleeding stopped without having to take you back to the
OR
, which is great news … Your vital signs are stable … you’re doing very well. We’re going to get that breathing tube out shortly … first I’m going to give you a bath … freshen you up.”

I open my eyes to see my new saviour. Joy … a tall, elegant black nurse, strong, smart, capable, encouraging. It’s her turn to save me. Her arm on my arm … a soothing touch on my forehead. She leans down into my bed to meet me there, touches my shoulders, my forehead, my cheek. Her healing hands all over me.
I’m a baby again, swaddled in warm towels, clean and fresh, like new
.

A tiny ray of sunlight filters through the dungeon window … a sweet voice with bright flashes of ruby red at her neck, sapphire blue on her fingers … Beautiful bling!

“Tilda, it’s Dr. Hawryluck – Laura – from Med-Surg
ICU
. I promised you I would come and check on you.”

There she is, I can see her, bright flashes of colour and singing sounds. Why is she standing so far away?

“I came to see how you’re doing. You had a difficult night, but how are you feeling today?”

Shimmering, opalescent mother-of-pearl, shining like moonlight, she’s moved in closer
.

Love your sparkles! Why are you here again, with your kind face and intelligent hands, tender touch on my arm? Remind me? Chunks of aquamarine, chunks of topaz catch the light on her fingertips … Tripping the light fantastic … She’s elegance and class. I’m lying here, a mess in the bed
.

Laura leans down low, whispers into my ear. “Is this all research for you, Tilda? Are you taking notes in there?”

Of course I am! Why are you whispering?

—

“Tilda, it’s Nurse Joy here. You’re doing well … the bleeding has stopped now and your vital signs are stable. I’ve paged the respiratory therapist to come and extubate you … need to be awake enough to breathe on your own … are you in there, Tilda?”

Of course I am. I made it! Where did you think I’ve gone?

Are you feeling okay? I hear you had a lot of pain.

I feel wonderful! The best I’ve ever felt!

“Hi, Tilda. I’m your respiratory therapist … here to remove your breathing tube.”

Is it still in? I thought they took that out already
.

“There we go. It’s out. Give a strong cough … And another … Good! Your throat might be sore for a while … don’t forget to use your spirometer and do your deep breathing and coughing exercises so you don’t get fluid in your lungs.”

Deep breeding and coffee outside? What? When’s that happening?

“Tilda, you have a visitor. Your friend Joy is here.”

But you’re Joy. You’re Joy, the nurse, right?

“She wants to see you.”

Go away!

“Joy, please wash your hands first and keep your visit short. Tilda’s very tired.”

No! I said no visitors! Am I still in the
ICU?

“Look, Tilda, Joy brought you a box of chocolates.”

Please go away … but you can leave the chocolates!

“I’ll tell her to come back another time.”

“Hi, there, dear …” Robyn’s parents … precious faces hover above me, kiss me on the forehead, hold my hand … 
it’s so nice of you to
come, but what is this nice lady’s name – Cora? Dora? It’s Norah! She’s wearing a white blouse, red sweater. It must be July 1. Happy Canada Day!
I smile at them.

“It’s August 26, dear,” someone says.

Don’t worry about me … I know what’s going on. Am I saying these words or thinking them? I can’t tell
.

“Hi there …”
My voice is raspy, unrecognizable
.

“Tilda, I’m going to take out the big intravenous and pulmonary artery catheter from your neck. We used it to measure the pressures in your heart, but everything is normal now and you don’t need it anymore … don’t worry … this may feel a bit strange, but it doesn’t hurt.…”

I am completely cared for … I let go … no pain.

Every time a nurse comes toward me, beside me, around me, something pleasant happens. A tube is removed, a soothing word, a touch. I look forward to the voice, the hands. I move toward each thing that happens and each time, I’m lighter, brighter.

I just might make it
.

“Hi, Tilda. It’s Christine. I’m your nurse today. I’ll be transferring you to the floor soon. You’re doing so well. That’s good. Open your eyes.… I’m going to remove your chest tubes … first I’ll give you some pain medication … doesn’t hurt but will be uncomfortable for a few moments … as they’re coming out …”

Yes … like I’m being eviscerated … as a cat pulls out the entrails from a mouse … weird sensation … shuddering feeling of being disembowelled … my guts pulled out …

No, it doesn’t hurt, but strange …

Nurse Christine Sterpin at my side. Pretty, pink, cheerful, energetic, hopeful …

I’m a shipwrecked sailor, swimming toward her safe shore.

“Time to transfer you to the cardiac ward now, Tilda. We’re on our way!”

So that was the
ICU
. I survived!

I open my eyes. At the end of my bed, a sign on the wall:

Your nurse’s name is: Melissa
.

Very good, but what’s
my
name?

How many days have gone by?

I made it … I guess.

I lift my head up from the pillow … barely.

Brain cells intact … more or less.

“Pleasantly confused” we call it in the biz.

Minutes – or hours? – have passed. Voices buzz at the doorway.

“Isn’t she the one who wrote those books?”

“Yeah, it’s her.”

“I think I’m in one of them.”

Ha, you wish
.

—

A nurse – is it Melissa? – arrives. “Here’s the call bell.” She holds it out to me, but I don’t take it. She pins it onto my pillow. I look away. Never! I will have to be
in extremis
, practically dying, before I’ll use the call bell. I know what it’s like to be summoned like a servant, expected to drop everything, and come running.
On the other hand, how reassuring it is to know that help is at hand
. Nurses hate the call bell. Patients love it but curse it if it doesn’t “work”: when they push the button and no nurse instantly appears –
poof!
– like magic, a genie in a bottle.

“When I call you, you come!” a patient snarled at me once. I was working on the floor and had five other patients to get to and call bells were ringing one after another. When I finally got to him, he was in a rage, banging on the siderails with his metal urinal.

“You’re probably gist sittin’ out there on your ass, gabbing with your girlfriends,” he said. “You do as I tell you.” He ordered me to take away his finished breakfast tray, come back and flip his pillow, then raise, lower, then raise again, his bed in infinitesimal degrees.

Remind me, please, why am I supposed to care about you?
Silently, I managed to contain my irritation and did what he asked. I wish I’d told him off – I would now – but back then I thought we were supposed to just take that kind of abuse.

The call bell rests on my pillow.
I dare you
, it taunts me.
Just try me and it’s game over, you’ll be a patient, helpless and needy
.

I float on a cloud. Sunlight floods the room, warming my eyelids. I open them slowly.

Under anesthesia, you are gone. Where, I don’t know, but it’s far away. Bits and pieces of the
ICU
linger – Maria’s eyes locked on me, Joy’s healing hands on my body, and Christine’s positive energy, coaxing me back to life. I was incoherent and disoriented, saying
strange things; there was no connection between my thoughts and my words. I thought I was speaking out loud when I wasn’t, convinced I was making perfect sense, but I wasn’t.

My throat is scratchy from the tube, but I don’t have any memory of the sensation of being intubated. How bad could it have been if I don’t remember it? Perhaps pain only hurts if you’re aware of it? They must have given me sedation for comfort, analgesia for pain, but made sure I was alert and breathing enough to breathe on my own. That takes skill. Who wants to be awake while intubated? Not I. As for discomfort, I had none, but I was using the pain pump repeatedly, going at it like a drug fiend, as if I had no understanding of its use.

I glance down. On my chest is a white, heavy bandage. I touch it lightly. It feels much bigger than it looks. I gaze around the room, but that effort tires me so I close my eyes.