by Tilda Shalof
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.
“Is this your first time performing this procedure?” I tease him.
“On you it is,” he says with a wink.
He’s eager to get started. There are about ten of us. Now we’re more like idling cars awaiting test drives, our motors revving.
“Do you have any questions?” he asks before rushing off.
“No. No questions, I just want to tell you something.” He stops to listen. “If something bad happens … If there’s no chance of survival … I don’t want my life sustained on machines.”
“No one does,” he says, leaving me to muse on his true, but cryptic, answer.
When they wheel me into the angiogram suite, it’s so cold that I imagine I can see my frosted breath. If I didn’t know they kept these rooms like a freezer and the reasons – to prevent growth of bacteria and to minimize bleeding – the sudden chill would be shock. A technician places a heavy lead blanket o
ver me for protection from the radiation.
“I’m going to give you some light sedation,” Dr. Sternberg says.
“I’d rather not have it,” I tell him. I can’t lose control.
“I’d recommend it. I’d have sedation if it were me undergoing this procedure,” he says cheerfully while a nurse cleans the area and places sterile drapes over the lower half of my body. I agree to a local anesthetic only and in the opening of the drapes, he finds the right spot and freezes the area. Yes, for a few moments there is an intense pain, but I take it like the spiritual warrior I am aspiring to be. Push through the pain, John said. Breathe.
At first, Dr. Sternberg has difficulty locating my artery, probably because my pulse is weak.
“Oh, I’ll find it,” he says confidently. “I’ve had bigger challenges than this.”
Soon, I feel the needle deep inside me, where arteries lie, not superficial, like veins. Then, suddenly, on the fluoroscopy screen on the wall to the left of me, I come face to face with my own heart.
Oh, hello there. What a wondrous sight. Tucked away, undercover, out of sight, you’ve been working hard all these years. Taking care of business. Finally, we get to meet. Steady there, old dog. Don’t stop now. Please keep it up.
Dr. Sternberg keeps up a running patter of commentary for my entertainment and edification. As he injects the dye, he points out the main arteries – the right coronary, the circumflex, and the left anterior descending (also known by its ominous nickname, “the widow-maker,” because if that artery gets suddenly blocked, by atherosclerotic plaque for example, for which middle – aged men are at a higher risk, it causes a massive heart attack and usually sudden death). But he has left out the most important information – what really matters – can he see any blockages?
“Now I’m going to inject dye into the aortic root to measure your valve. It may cause an unusual sensation,” he warns me with a sly grin.
Wow. Suddenly, I am flooded with warmth … down there. It feels like … a hot flash, but down there.
He grins behind his mask with a twinkle in his eyes. “I had a patient once, an elderly lady, who said when I did that, ‘I think I’m having an organism.’ ”
When it’s done, he gives me a partial verdict. “Your valve is point-seven square centimetres. That’s a severe constriction and explains your symptoms. Surgery is indicated for anything less than one square centimetre.”
“Could I suddenly arrest? Am I a walking time bomb?” Kaboom!
“We all are,” he says quite cheerfully as he peels off his gloves and disposes of them. It sounds blunt, but again, it’s honest and I appreciate his directness and unexpected humour. He gives a huge grin and hustles off to the next case.
They wheel me back to my stall and place a C-clamp on my groin with firm pressure to stop the bleeding from the artery. Nurse Louellen checks my pulses and compares my legs. “The doctor will come and tell you the rest of the results,” she says and goes on her coffee break. A few minutes later, Nurse Zahra, who’s covering for Louellen, comes in to assess and palpate my pulses. She looks closely at my feet and legs and notes some mottling in the right one so she loosens the clamp to ease up the pressure, all the while explaining what she is doing. Why can’t I have Nurse Zahra instead of Nurse Louellen? Both are competent, but Nurse Zahra is fabulous. One inspires confidence and the other not so much; one communicates well, the other, not. I never realized just how closely patients watch nurses’ every move, hang on to every word. Maybe I once knew, but over the years, it’s easy to forget.
Dr. Sternberg moves down the row of patients, giving his reports. Some patients need to have angioplasty to open up narrowed arteries and others are getting stents, an artificial device used to keep the arteries open.
“Partially blocked,” he tells an elderly man in the bed beside me, “but no surgery at this time. We’ll keep an eye on it. Diet, exercise … same as last year.”
Then it’s my turn. Dr. Sternberg appears at the foot of my stretcher with my results. “Your arteries are perfectly clear. No blockages.”
I sink down in a huge exhalation, peacefully jubilant, quietly ecstatic, containing my happiness. “Thank you,” I say, as if he’s responsible for the results as well as the procedure. I clasp his hand. “Thank you,” I repeat. “Thank God,” I say softly, putting it out there, testing it out.
“You’re welcome.” He says goodbye, leaving me to muse over which of my thank yous he was accepting.
Yes, if I knew how to go about it, I would offer up a prayer of gratitude. You can’t go through something like this and not occasionally think about God because if you want to give thanks, who are you thanking? Personally, I don’t allow myself to pray for specific outcomes, but I do feel moved to say “thanks” from time to time. Until now, gratitude felt impossible, but now it’s here. I’ve spent these past three weeks being worried and now this is hope. No wonder everyone wants a piece of it.
I am beginning to think I actually might make it, but still, I take nothing for granted.
Nurse Louellen brings me a cheese sandwich. Peeling off the plastic wrapper, I’m suddenly ravenous. I take a bite into what is quite possibly the most delicious thing I’ve ever tasted. I feel myself turning a corner. I’m feeling great, relishing my state of quiet rapture until a new worry occurs to me – one I hadn’t even thought about. How long will I have to wait for surgery? I’ve heard stories of long wait times for urgent procedures, even surgeries, and like every patient, I want it now.
I ask Nurse Louellen about this and in answer she hands me a brochure about a cardiac surgery hotline I can call if I have any concerns. “The cardiac care network ensures that all cardiac patients receive the best and most timely care,” it states in the brochure. Even though wait times for cardiac procedures have improved over the past few years, it’s easy to fall through the cracks and get missed, but like a good citizen, I’m determined to play by the rules. I don’t want special treatment and refuse to pull in my connections. I’ll let it play out as it will. I am counting on being able to trust that I’ll get what I need when I need it.
In preparation for me to go home, Nurse Louellen lists the warning signs for complications post-angiogram over the next twenty-four hours but stops with a laugh. “Why am I telling you? You’re an ICU nurse? You know all of this, don’t you?”
“Tell me anyway. It calms me down to hear you say it.”
Suddenly, we hear a cry from another bed. “Nurse!”
“Someone will go to him,” she says, handing me more pamphlets about heart disease, heart healthy diets, and cardiac rehabilitation programs.
“Nurse!” the voice calls out again from a stretcher behind a closed curtain. A cardiac monitor goes off. It could be nothing or something, but Nurse Louellen goes to the nursing station to finish her charting. Sitting there, she keeps glancing at her watch to see when her shift is over. No one is going to the patient.
“Nurse!” the voice calls out again. “I need help.”
Nurse Louellen says to another nurse – I can read her lips – “Not my patient.”
That phrase should be banned.
The clamp is now off my groin so I get up and hobble over, pushing my IV pole. An old man needs a urinal. He looks at me in surprise and I assure him that I’m a nurse in real life and his nurse is busy. I pull back the covers, position everything in place, and wait for the tinkle in the metal jug. “It’s hard lying down, isn’t it?” I often say to my male patients. “It’s easier for us women.”
I think of all the years I’ve been a nurse and the thousands of patients I’ve cared for. Why should I stop now? In these few minutes helping that man, I am freed from my worries. As a nurse, I feel powerful and capable; as a patient, I feel weak and vulnerable. Maybe my inner nurse can see me through this. It’s time to be that good nurse to myself.
Nurses are notorious for not taking good care of themselves, only others. My long-time colleague Maureen springs to mind. She’s an incredibly skill
ed nurse, but I came upon her one day in the supply room, taping up a raw, irritated poison ivy rash on her arms with the medical equivalent of duct tape. She would never dress a patient’s rash without cleaning it first, applying soothing cream and a comfortable, soft bandage, but she didn’t do that for herself. Nurses don’t offer themselves the same care and attention we offer our patients. It’s been said you can’t treat yourself, but why not? It will only help me to stay nurse, even to myself. Why should I give it up now, just because I’ve become a patient? After all, I have used my knowledge and skills to help others, why not myself, too? I would never treat a patient like I’ve been treating myself! I have always prided myself on being a patient advocate, speaking up for patients, looking out for their best interests. I have always used my words to encourage and give hope, not to scare and create fear, as I’ve been doing to myself. What if I decide to treat myself with the same compassion that I have for my patients? If I stay nurse and actively participate in my own care, I won’t feel helpless and as if things are being done to me.
As Kevin at camp asked, “What can I do to help myself feel better?” I’ll let that question guide me, too. All the ways I’ve encouraged patients, given hope, and bestowed dignity on others, I will do those very things for myself. I have been so gentle, even loving, with patients; now I will do that for myself. I want to get myself in the state of wanting this surgery. To do this, I need to come over to my side; to move from adversary to partner, from passive victim to strong nurse.
It will take courage to make these changes and to be this way to myself. It will be a choice to be more positive and stop generating endless negative thoughts of all that could go wrong, completely ignoring the fact that mostly things go right. Most people do their jobs properly. Most patients get better.
It’s going to take determination and courage to make these changes. Courage takes practice, effort, and courage itself. (I will fake it in the meanwhile until it feels real.) Thinking these new thoughts, I feel a lifting of my mood and an upswing in my outlook. It’s time to make new choices. I don’t want to go into surgery kicking and screaming. I want to want this. I will have to put my whole heart into this project, pun intended.