Opening My Heart (30 page)

Lying on my bed, I pondered the pageantry of Code Blues. There are many actors, each carrying out specific roles, all following a script that varies only slightly. There’s lots of behind-the scenes action, high-stakes drama, but in the hospital, where people are already very sick, only occasionally, a happy ending.
^*
It starts with whoever is on the scene first, usually a nurse, recognizing that a
patient is in distress and calls for help. If there is no pulse, the nurse jumps up on the bed to start chest compressions. Help comes quickly and the room fills with people.

The “code” may start out chaotically but soon settles down as the players take up their roles and everyone becomes quiet and focused. (Once, when I was working in the
ICU
, there was a Code Blue cardiac arrest taking place in a room right next door to me, happening so quietly I didn’t know about it.) A doctor is designated as the leader and everyone comes together under his or her direction, egos usually kept in check. When the person performing cardiac compressions gets tired, someone comes forward and takes over. The respiratory therapist manages the patient’s airway. After making certain that the compressions are generating an actual pulse, and on direction from the leader of the code, a doctor or a nurse pushes emergency drugs such as atropine, epinephrine, adrenalin, lidocaine, vasopressin, calcium chloride, glucose, sodium bicarbonate into an
IV
in a large vein in the neck or groin. Someone draws arterial blood gases, runs them to the analyzer machine, then rushes back and reads the results out loud to everyone in the room. From those numbers, we know if the patient is receiving enough oxygen, if the acid-base balance is within normal limits – and much more. If the decision is made to shock the heart, to try to get it back into normal sinus rhythm, the defibrillator is charged up. Pads are put on the patient’s chest so the electricity won’t burn the skin. “Stand back. All clear!” the doctor says.

(We take great caution with this step, especially those of us who were present the day a third-year medical resident got a shock – literally. His lab coat pockets were overstuffed with loose change, a stethoscope, cellphone, and spiral-bound handbooks, causing it to be so heavy it dragged down and made contact with the metal bed frame. He gave the patient and himself an electric shock. He
slumped to the floor and was whisked away to be resuscitated while we stayed in the room and continued the “code.” He made it, but unfortunately the patient didn’t.)

A “code” can go on for many minutes, even an hour. When it’s successful – what satisfaction and jubilation we all feel! When it is unsuccessful and is finally called off, there is a sudden and unsettling calm. The time of death is pronounced. Everyone strips off their vinyl gloves and turns away from the exposed, worked-upon corpse. One by one, they walk away from the messy room, strewn with empty syringes and assorted debris, and return to doing whatever they were doing before they dropped everything and ran in to try to save a person’s life. Everyone leaves – except the nurses. We stay behind with the body, wash it, sponge blood out of the hair, and do all the things that nurses do to bestow dignity upon the body of someone’s loved one. We tidy the room, dim the lights as if to soften the blow, then go out to bring the family in, offering our arms for support and our words for comfort.

But tonight I’m not on duty. I can relax and not concern myself with all the matters an
ICU
nurse has to consider upon hearing “Code Blue”: Is a bed available in the
ICU
if the patient survives the arrest? If not, is there a stable patient who could be transferred to the floor? Is there a nurse for the patient? Is a room clean and equipped? Where is the family? Are they at home and need to be informed ever so gently over the phone that their loved one is in a crisis and may not make it? Or are they in a waiting room somewhere, frantic and distraught, needing someone to throw them a lifeline of hope? Since I’m not a nurse right now, I have the luxury of thinking only what an ordinary person would think:
I hope that poor soul makes it
.

Saturday night. Everyone is either out on the town with friends, having a good time, or else at home, sipping wine and snuggling in for the night. No one wants to be here in the hospital – not the nurses or doctors – or us patients, either.

Shift change. It’s 1915 hours and the night nurses, peppy and fresh, rush in to relieve the droopy and spent ones who are moving slower, tallying up fluid balances, and finishing their charting by writing the words – a tad prematurely – that will release them from the responsibilities they’ve shouldered for the past twelve hours:
Report given to night RN
.

Those going and those coming take up places around the nursing station, ready to give and receive report.

It’s still unbearably hot in my room so I’m sitting in my blue hospital gown, in the hallway, on a chair that I’ve dragged out here. Positioned near the nursing station, I can eavesdrop, watch the action, and vicariously enjoy the familiar activity and
aura of intimacy of shift change. I’m smack-dab in between my two worlds.

The nursing station is the usual setup. There’s a long table in the centre, counters around the perimeter lined with phones and computers, and, at the back, a rack of charts in dark green plastic binders. (We are still in the process of weaning ourselves off paper.) I listen in on the amusing banter going on at our “water cooler.”

“…  I’m switching over to nights, but my body is not happy about it.”

“Tell me about it. When I’m on nights, I have no social life.”

“…  spent the day cleaning the house … my three sons, a husband, and a father-in-law, but not one person in my household who can pee in the toilet.”

How I love this chatter! In my
ICU
, I work with hundreds of people. I know them all by name, am on friendly terms with most, close friends with many, and Facebook friends with quite a few. Recently, a patient asked to “friend” me. Would it be crossing a line to be on Facebook with a patient? It feels that way to me. I couldn’t be friends – neither Facebook nor the flesh-and-blood type – with anyone who is currently my patient. The Internet is shaking up old notions of privacy; there’s a lot more sharing going on, but some boundaries are still necessary, especially in the hospital. (By the way, on the hospital computers we can’t do any social networking, but it’s not for lack of trying. There’s an impenetrable firewall.)

There’s always a commotion at change of shift, and I know one nurse who prepares herself for what’s ahead by finding a quiet spot and meditating. She says it helps her get centred before diving into the unknown fray. My friend Mary, in North Carolina, passes a church as she drives to work. “I say a blessing and ask God
if He could do rounds with me again this shift, and give me an extra dose of wisdom and patience,” she told me once. Then there’s the rest of us, who merely plunge right in, hoping for the best.

Soon, the nurses settle down to the business of giving report. Don’t worry – we patients aren’t left on our own – they are a few steps and a call bell away. They’ve gone into a tight huddle so I take my chair and return to my room to give them space to exchange confidential information about patients.

There’s an art to giving “good report.” There’s a lot of important – often crucial – information and instructions that must be conveyed in the midst of noise, distractions, and interruptions. You have to be focused and organized in your presentation of your patients’ history, plan of care, and remember to mention any pressing work you’ve left undone that needs immediate attention. You can’t just relay facts: a good report also conveys interpretations, opinions, and impressions but manages to avoid biasing or swaying the oncoming nurse. You try to sneak in a helpful hint of how the previous shift was for you and what sort of scene the oncoming nurse is facing. A few “heads-ups” are always welcome! Receiving a good report is the best way to start your shift.

Unavoidably, individual styles come out in our report-giving. I once knew a nurse with amazing panache. She used handover to showcase her own accomplishments as much as the patient’s progress. Phaedra’s reports were perfect – thorough, to the point, and delivered concisely. “I weaned him off the Levophed and got the blood pressure stabilized. I improved his creatinine, normalized his lactate, treated his potassium, and brought the hemoglobin up to eighty-five from seventy after transfusing two units of blood.” She beamed with pride, taking full credit for any and all improvements in her patient, as if she was a one-woman show. Phaedra was a superb nurse – and made sure you knew it!

One of the most memorable reports I ever gave was about a patient whom I’ll call Violet. It was a very sad situation. Violet lived a hardscrabble life on the streets of downtown Toronto, working as a prostitute and in the drug underworld. In addition to mental illness, Violet had cardiac damage as a result of cocaine abuse, respiratory issues, and acute kidney disease requiring dialysis. She also suffered a side-effect from one of the drugs she was on. It caused poor circulation to her extremities and her fingers became necrotic – blackened and shrivelled. They were hanging on by mere threads of mummified skin. (Think
Tales of the Crypt.)
That was one of many shocking details that had to be included in my report. In order to give a complete and accurate picture to the oncoming nurse, I also had to describe Violet’s bizarre behaviour, like her attempts to rip into her rectal drainage bag to eat her feces; the multiple genital piercings that necessitated delicate perineal care; Violet’s unusual “relationship” to a stuffed Winnie-the-Pooh she placed between her legs and “made love to” (there’s a more accurate word but this book is rated
PG)
. I tried to keep my composure as I hurried through my report, then rushed away to escape the sheer gnarliness of it all. I was desperate to get home and into a hot shower.

But in the car on the way, I suddenly realized I had forgotten to inform the oncoming nurse about the loose fingers.
What if she came across one of those desiccated, dangling digits – a flying phalange that had come dislodged among the bedsheets?
She’d get a fright and be scarred for life. I pulled over to call the hospital.

“Don’t worry. Of course you told me about the fingers,” the nurse reassured me.

As I mentioned, a good report prepares you for what’s ahead.

The nurses are interrupted from handover by the patient in the room next to mine. He has started moaning, “Take me home, man,”
“Help me, sir,” and “Help me, ma’am,” over and over. The nurses haven’t finished their reports, but one of them gets up and goes to his room, first putting on a gown, gloves, and a mask because he’s still in isolation. Another nurse goes to help her. Then, about a half-hour later, when they come out and as they are finishing washing their hands, a family member approaches and asks them to please go back in because the man is still not comfortable. The nurses glance at each other, yet show no sign of impatience, and gown up again and go back in.

“Do you want the radio?” I hear one of them ask twenty minutes later, as she’s about to leave again. No answer.
“AM
or
FM?”
Muffled response.
“AM
or
FM?”
she repeats. It’s not long before they’re all laughing with the instant familiarity of old, easy friends.

His nurse is my nurse, too, and after a reassuring squirt of antibacterial hand sanitizer, she comes into my room, introduces herself as Yolanda, and takes my vital signs. In her crisp, white uniform she stands out from the rest in their pastel or patterned ones. You don’t see many people wearing white uniforms these days, but it’s a sure sign of a nurse. As she takes my temperature, I see on the lanyard around her neck that holds her name tag and hospital
ID
, the phrase “I
Jesus.” Many patients find that comforting. I do, too.

Good times! It’s someone’s birthday and cake and coffee are being served at the nursing station. A green bedspread is the tablecloth and wooden tongue depressors, forks. Nurses are the designated celebrators, party planners, and potluck dinner/baby shower organizers – and the ones who stay afterward to clean up the mess.

Raucous peels of laughter. How rebellious it feels to be cheerful around here! It’s not seemly for a nurse to be eating, resting, chatting, or laughing. Sometimes it’s even uncomfortable to tell patients or family that I’m taking a break. It surprises them, maybe
because nurses are expected to be constantly available, there to meet others’ needs, not have any of their own.

(It’s always best not to take too long on a break. A nurse once told me that she’d been gone for more than an hour and during that time, her patient got married. She missed the wedding ceremony, but luckily they saved her a slice of cake!)