Opening My Heart

by Tilda Shalof

  Now it’s finally time to come clean with my own health history and face up to the fact that I’m not exactly a “virgin” patient as I like to think of myself. Here we go:

  A few years ago, while I was working in the ICU, I was sprayed in the eye with lung secretions from a patient who had HIV and was hepatitis C positive. I was freaking out and in my terror kicked up quite a ruckus in my hospital’s ER. “I must be seen immediately,” I demanded. “I’ve been exposed to biohazardous material!” When that didn’t work, I reminded them that I worked here and had patients to take care of.

  Yeah, let me get back to risking my life in this dangerous job!

  They wouldn’t budge. I would be triaged just like everyone else, and since I wasn’t bleeding, unconscious, or having chest pain and the place was hopping busy, it would take a few hours to be seen. In case you don’t believe that I didn’t get special treatment, while I was waiting to be seen I happened to catch sight of the brilliant physician with the BBM, walking down a corridor outside the ER. Maybe she can move things along! I called out to her. She looked back, but at first glance all she saw was a patient in a hospital gown. When she recognized me but realized that my problem involved my eye, not the part of the body she specialized in, she lost interest and waved goodbye.

  No longer enjoying any insider status, fuming, I settled down to wait along with the rest of the walking wounded. In due course, I was seen by a doctor, my eye was irrigated, and I was given a tetanus booster and my hepatitis titers were tested. For the next year, I had monthly baseline blood work, was checked for signs of infection, and did lots of worrying but fortunately didn’t get sick.

  Years later, I was a more reluctant patient when I became pregnant. At a pre-natal checkup, a doctor listened to my heart and sent me straightaway to a high-risk pregnancy clinic. When I protested what I saw as his excessive caution, he gave me a stern reality check. “You could get into serious trouble, go into heart failure or cardiac arrest. Your baby might not receive enough blood supply or oxygen.”

  Oh. I hadn’t thought of that. Never mind.

  Luckily, all went smoothly during the birth, and both times my babies were healthy. However, as I was leaving the hospital, two days after the birth of my second baby, the obstetrician warned, “You need to be followed by a cardiologist. Your valve is getting worse.”

  A day later, at home, I felt terrible – I had never felt so unwell. True, I was exhausted, but isn’t every new mother? Harder to explain away were my swollen ankles and the difficulty I had sitting and breathing. When I listened to my chest with my stethoscope and heard the wet crackles in both of my lungs, I knew I was in congestive heart failure. Fluid from my heart was backing into my lungs. I swallowed a few Lasix tablets I had stashed away, which I kept on hand in case of just such an occurrence, and took it easy, laying low for a few days until the diuretic got rid of the excess fluid my heart couldn’t handle.

  [Public Service Announcement: Do not try this one at home, folks. Don’t do as I did. Seek treatment from a doctor or other health care professional if you are in congestive heart failure. It’s a medical emergency.]

  That was twelve years ago and I can’t believe I’ve made it this far with a heart like mine.

  Then there was an evening, two years ago, working in the ICU with Cara, a young, pretty nurse fairly new to the ICU at the time. She was busy with her patient on the one side of the room, and I was busy with mine on the other, when two things happened. My patient, a seventy-two-year-old man, three days post-op thoracic aneurysm repair, became violent and confused. At the very same time, a sharp pain rose up from deep inside of me and grabbed me at my back.

  “Those guys next door … Tell them to deal me in! Now!” my patient shouted at me from his bed. I clutched my side as he craned his neck, trying to peer into the next patient’s room. The pain was sharp. Yikes, what is this?

  My patient pulled at his IV tubing, then yanked it out of his vein. “I’m out of here,” he yelled, throwing off the covers and banging on the siderails. Dark red blood splattered his sheets. “Give me my balloon! I’m going to the party.” He grabbed so hard at the IV tubing that the pole toppled to the floor with a crash. Luckily he had sedation ordered and had another IV site in his neck. With shaky hands, I drew up five milligrams of Valium in a syringe and made my way over to give it to him. If I can get him calmed down, I can figure out what’s wrong with me.

  He eyed me warily. “If you come near me with that, I’ll scratch your eyes out.” He fumbled around with his arterial line, then in one fell swoop ripped that out, too. Now, bright red blood was pumping out from his artery, spraying in an arc around the room.

  I retreated to my side of the room, panting with pain that was by then excruciating. He’ll bleed to death without pressure on that artery. I called over to Cara for help, but she had already come running when she heard the IV pole crash. “Take over for me!” I yelled. I had no choice but to leave her alone with two unstable patients, one of whom was combative. As I staggered down to the emergency department, lurching along hospital corridors and vomiting into a plastic bag, I heard, “Code White, Code White, Medical-Surgical ICU” over the loudspeaker. It means a violent patient and summons the security guards to help out. I prayed that guy hadn’t attacked Cara.

  In minutes, I’d gone from a walking, talking nurse to a flat-out, full-blown patient. I even looked the part in my ICU scrub pants and a hospital-issue gown.

  An ultrasound showed a kidney stone. A nurse started an IV and injected one milligram of morphine for the pain and an antiemetic for the nausea. Ahh, relief came in moments. After a few hours, I passed the stone. I felt great, good to go.

  I put the incident out of my mind until about a year later. I awoke during the night with a start, certain I was being stabbed. It was the same searing pain but now on the other side. It’ll pass, just like the last time. Ride it out. Don’t go to the hospital!

  Within an hour, the pain escalated. I was frantic. “Take me to the hospital,” I begged Ivan and he drove me to the nearest one. In the car, I writhed and moaned, tried to stand up on the seat, even considered jumping out. I have known patients who bore their pain with great dignity, but I had none. I was the opposite of dignity. Pain turned me into an animal.

  At the hospital, there was the usual chaos and desperation so familiar to me that it actually calmed me down. All the seats were taken, people were standing around sipping coffee, leaning against the walls. It was any Toronto scene with hijabs and backpacks, turbans and jeans, jallabeyahs, saris, and dashikis. It was also any ER scene: a gaunt, bald woman draped with a homemade, brightly coloured crocheted afghan, sitting in a wheelchair vomiting into a basin; a biker dude in black leather and studs bleeding from slash wounds on his arms and neck; a red-faced baby crying in its mother’s arms. Even the requisite drunk who was in a room by himself, screaming, “I’ll kill you, Mommy. You’ll be dead in three days!” Ho-hum. Another day at the office. To me, the only thing that mattered was my pain.

  It looked like it was going to be a long wait, so I sent Ivan home to look after the kids while a triage nurse listened to my story, took my vital signs, and sent me back out to the waiting room. I knew the score: in my street clothes, I was a civilian like everyone else. I found a plastic chair jammed up beside a vending machine, sat down, and waited. The pain came in waves. I moaned and groaned with the rest of them.

  A nurse appeared and one man called out, “I’m dying, I’m dying!”

  “Wait until the doctor sees you,” she said. “He’ll decide if you’re dying or not.”

  “Let’s try another hospital. It’s taking too long,” said a young girl pulling on her boyfriend’s arm. How serious could her problem be? (Or was he the one with the problem?) I’d seen them smooching hot and heavy in the corner just moments ago.

  After those two left, the group of us that remained kept up one another’s spirits. We began to bond. When someone was called in, we cheered and gave them high-fives. I
joked that after this, we should all be friends on Facebook.

  “What are you in for?” I struck up a conversation with a fellow inmate – I mean, patient – a guy in his twenties who’d cut his finger slicing potatoes and had a superficial wound. That happened last night and now his entire hand was red and swollen.

  “Thought I’d come in, get it checked out,” he said cheerfully.

  “May I?” He nodded and I felt his hand, wrist, and arm – all warm. I took a pen out of my purse. As he spoke on his cellphone to his girlfriend, I drew a border outlining the inflamed area that reached to his wrist.

  We sat. One hour, then two. Patients came and went. Paramedics rushed in with a motor vehicle accident victim. I went over to watch the action on the sidelines. When I returned to my seat, I took a look at the guy’s hand. The redness was extending beyond the line I’d drawn at his wrist, to his arm.

  The triage nurse came out. “Telda Shalcot?” she called out.

  Close enough. I got up to go in, then stopped short. I was in pain, but this young guy had a rapidly advancing skin infection that could be potentially life-threatening. In a few hours the bacteria could be in his bloodstream and he’d end up in the ICU, unconscious, septic, and on life support. Why didn’t this nurse see what I saw? Too busy to see the obvious?

  “Take him next,” I told her. The other patients looked at me in awe. A saint in their midst!

  “Suit yourself,” the nurse said. I returned to pacing and tried to distract myself by reading the posters plastered on the walls. “Your Pain Matters to Us” and “Pain Is a Corporate Priority.” No one around here seemed to be feeling my pain. One poster explained triage: “Along with major injury, no pulse or breath, unconsciousness, bleeding, shortness of breath at rest, unmanaged, severe pain is a medical emergency.” My pain was an emergency to me. The others have a low-pain tolerance. They’re exaggerating. They say it’s bad, but trust me, mine is worse. I once knew a nurse who was a midwife (he was male so “midhusband”?) from the Philippines. He told me he used to offer women in labour two Tylenol and they were grateful for that. “I hope it was extra-strength,” I kidded him.

  At last, salvation came and her name tag read “Emma, R.N.” in cartoon letters, with her surname crossed out. (I’ve never understood the reasoning for this. Nurses say it’s to prevent stalkers, but how likely is that? Do we really need protection from each other and does hiding your name give it to you? I guess these days, everyone feels vulnerable in the hospital, nurses as well as patients.) Bent over in pain, I trailed in after Emma, who walked briskly ahead of me. She directed me to a cubicle with a stretcher and handed me a hospital gown. She looked bored, like, Get me out of here. I know how to take care of myself in hospitals, so I didn’t need her bedside manner, but what about real patients who did? In the hospital, emotions can become so heightened that a nurse’s mild indifference feels like cruelty. Likewise, for frightened or anxious people, common courtesy can come across as extraordinary compassion. “Thank you for your extreme kindness,” a family member once said when I accompanied them into the ICU for the first time; they felt my ordinary gesture so keenly.

  “How’s your pain?” Emma asked as she was about to leave.

  Here’s what I know about pain in hospitals: whatever dose or frequency of whatever drug is ordered, it all comes down to a nurse’s mercy; it’s in a nurse’s hand. In school we learned that pain is whatever the patient says it is; pain is the Fifth Vital Sign (after pulse, blood pressure, temperature, and respiratory rate); doctors under-prescribe and nurses under-administer.

  On a scale of one to ten, my pain was a nine a few minutes ago, but now it’s a seven. Another spasm will probably hit me in a few minutes so should I play it safe and say nine, or should I conserve my points and say six? Better to keep eight or nine for later, but what if Nurse Emma’s not around then?

  “Seven – seven and a half,” I equivocate. “The Russian judge gives it an eight.”

  She didn’t find my joke funny, so I figured I’d better stop kidding around or she wouldn’t take my pain seriously, even though humour was the only way I could endure it.

  “I’ll get you something,” she said and then disappeared behind the curtain. An hour passed. The pain came and went, but Nurse Emma didn’t. I got up to find her, and another nurse told me she’d gone on a break. “I’m having pain!” I announced loudly at the nursing station, then retreated to my cubicle. Eventually, Nurse Emma showed up.

  Her total indifference was maddening. I was embarrassed we were even in the same profession, but I decided to put her on notice. “I’m a nurse, too.” My eyes are on you.

  “Cool.” She prodded my arm. “Your veins are bad.”

  “Sorry about that.” I pointed out a possible candidate, from which she drew blood quite capably. She started an IV and hung a small bag of saline running at a slow rate. “The doctor will see you soon.” As soon as she left, I reached over and sped up my IV. I need more fluid to flush out the stone. This nurse doesn’t know her ass from her elbow!

  A few minutes later, the doctor came in and the first thing he said was, “Whoa, this patient is getting too much fluid!”

  “I had set it at a slower rate.” Nurse Emma glared at me as she adjusted the IV.

  “It’s true, normally, you’d push fluids,” the doctor explained to me, “but not when you’re in the midst of passing a stone. One kidney might be obstructed and become swollen while the other continues to produce urine.”

  Oh, snap! Hydronephrosis. Who’s the bad nurse now? I would hate to have me for a patient. Then, just as he was about to order a dose of that magical morphine, he paused. “Any past medical history?” No, I said, in no mood to quibble about the inane redundancy, only pray he wouldn’t examine me, which might involve listening to my heart with his stethoscope. Luckily, he didn’t bother. Soon, the narcotic kicked in and I dozed off. When I woke up, I went to the bathroom and heard a tiny, metallic-sounding clink in the toilet bowl. With a vinyl glove I’d nabbed from the clean utility room, I fished out my prize and held it up for examination. How proud I felt at what I’d produced. Famished, I was ready to reward myself with a nice lunch. I returned to my room and waited for them to discharge me.

  I waited. No one came. My IV ran dry and clotted off. I took it out myself, then tidied my room, stripped the bed, and remade it with clean sheets I helped myself to from the linen cart. After dumping my hospital gown and linen into the laundry basket, I was ready to leave. As I walked past the nursing station I overheard a doctor. “We cured her. It’s a miracle.” I chuckled at his little joke. It was exactly the kind of thing I would have said had I been on that side of things.

  Now, in the interests of full disclosure, I should mention that, yes, I told Dr. Drobac that I don’t have a family doctor, but I lied about that, too. I do have one – a very good one, in fact. Dr. Janet Morse is smart, wise, kind, and always makes time to see me. A few years ago I went to her for something minor and she pointed out that I was long overdue for a checkup. I heartily agreed. She booked an appointment and I called the next day to cancel it. Coming to her now, she may not be so agreeable to take on a “non-compliant” patient like me and I can’t say I blame her. But she welcomes me back warmly. When I tell her about my visit to the cardiologist she looks concerned. I wonder if she feels a twinge of liability for not insisting I be followed sooner. I rush to reassure her. “I neglected my health. You bear no responsibility whatsoever.”

  She reads me every bit as accurately. “Nor do you. You didn’t cause this. You did nothing wrong. This defect was something you were born with.”

  But I worry that I may have made it worse by leaving it so long. She senses that I’m feeling at fault, and faulty, too. It’s my own hangup because last night when I apologized to Ivan for this disruption to our lives his look of surprise told me he didn’t see it that way. Ivan doesn’t waste time wishing things were other than exactly the way they are. As for our kids, I’m not ready to tell them, not
yet. Of what use is a sick mother? That’s what I had and I vowed never to be that to my own kids. Over the years, I’ve done everything possible to stay healthy – except for taking care of myself, that is.

  Dr. Morse orders blood work, and this time I promise to go.

  Later, at home, back on the phone with Mary, I let it rip. “What if my heart doesn’t start up again?” The key is in the ignition, but the motor won’t turn over!

  “That never happens,” Mary scoffs, “but if it does, they’ll put in a pacemaker. Tillie, you’re going to make it. It’s not your time to go. God has a plan for you.”

  Many people automatically utter such pious phrases, but Mary actually means them. She is sincerely religious, a devout Catholic who doesn’t mess with the Third Commandment – or any of them, for that matter.

  “At least you don’t have to worry about medical coverage,” she says on a more practical note. Living in the United States, it’s new for Mary to have to think about health insurance. Yes, it’s true. There are lots of things to worry about when you’re facing open-heart surgery, but how I was going to pay for it wasn’t one of them.

  The next morning, Mary calls back.

  “Tillie, I just got home from night shift. My patient was a seventy-two-year-old woman, twenty-four hours post – aortic valve replacement. As soon as we extubated her she was raring to go, practically jumping out of bed. She told me, ‘You call your friend, dearie, and tell her not to worry. She’ll be okay.’ ”