by Tilda Shalof
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.
9
HOW NOT TO DIE
“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 bl
ood … 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.”
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.”