Opening My Heart (7 page)

It’s a long and circuitous route to get to the Medical-Surgical
ICU
where I work, high up on the tenth floor. After the stark, ground-floor entrance hall with its hand-sanitizing stations and the lobby with its potted plastic plants, vinyl chairs and benches bolted to the floor, and rows of philanthropists’ bronze busts and donor plaques, you go past a bank of fast-food outlets (communal cafeterias long gone) and commercial gift shops (Volunteer Ladies’ Auxiliary Gift Shops vanished) and enter a twisty labyrinth of corridors (where patients are sometimes cared for, when the
ER
is overflowing, thus the moniker “hallway nursing”). You pass gleaming laboratories and procedure rooms and whiz by “quiet” rooms (a misnomer if there ever was one as they’re more like “disquiet” rooms, where patients go to wait and worry) and multifaith worship spaces. Down a sloping hallway past the
ICU
Reception Area (name changed from “Waiting Room,” presumably to take peoples’ minds off what they’re
really
doing there; it’s more of a “Limbo Lounge”), then enter the heavy steel doors and, voilà, the Medical-Surgical
ICU
, my home away from home.

But tonight I’ve chosen a different route: I’m taking the stairs. I have to see if I can do it.
Maybe I don’t need this surgery after all …

One … two … three steps …
A crushing tightness clamps down on my chest. Stopped in my tracks, crouched down on the bottom step, I try to catch my breath.

Out of the corner of my eye, I see inside-out vinyl gloves flung on the stairwell floor right next to what looks like a dried pool of blood but I’m hoping is an old coffee spill.
This place is disgusting! I’ve seen cleaners swish the filth around in buckets of grey water, push it from one side of the room to the other … splattered cardiac electrodes, the stinky, soggy blood pressure cuff’s …

I take the elevator to the tenth floor.

Progress is probably being made in the way nurses work on the wards these days, but years ago, when I was starting out as a new nurse, I was on a general medicine floor and it felt like a brutal reality shock after my protected life as a student. My initiation period was rough. The staff were unfriendly and the workload gruelling. I was constantly thrown into situations I couldn’t cope with. There was no one to ask questions about things I was unsure of. I was always running, trying to catch up, constantly frustrated and plagued with the feeling that I was supposed to be somewhere other than where I was, doing something other than what I was doing. It was lonely because there was no teamwork whatsoever, nor any of that “multidisciplinary collaboration” that they promised in school. It was the doctors’ world, and nurses were either subordinate, peripheral, or invisible altogether. We were expected to be quiet and just follow orders. Empowered by my enlightened, progressive university education, I had a different vision of how things should be. Though I believed I had more to contribute, I didn’t have the courage to speak up and be a maverick. I had no choice but to stick it out because I needed the salary. It was either “sink or swim,” so I dogpaddled frantically for almost two years.

Then, when an opportunity came up to study critical care, I didn’t know what the
ICU
entailed, or if I had the right stuff to take it on, or even if the working conditions would be any better, but I took a chance. I did and they were.

I found a lot to love in the
ICU
. Here, my ideals about nursing could actually be put into practice; the conditions were in place to actually provide patient-centred care – it wasn’t a distant dream. Here, my contribution was respected and I could work as equals with the other members of the care team. In fact, our slogan is “Every voice is valued.” In the
ICU
, teamwork is essential because you have to depend on one another; you couldn’t do this work alone and you have to be able to count on knowing that whatever comes through the door, we’ll deal with it together.

For me personally, the best part was my good fortune to fall in with a group of nurses dubbed “Laura’s Line.” They soon became mentors and colleagues and now, even though most of them have moved on from the
ICU
, remain close friends.

For almost thirty years, the
ICU
has been my home. I know the place, its routines, and all the players. Even so, I try never to lose sight of how unsettling, disturbing – at times terrifying – it is to patients and families, especially when encountering it for the first time. When I bring visitors to their loved one, they stare in disbelief, hardly recognizing the person, unconscious, entangled in wires and tubes, attached to hulking, noisy machines. One mother insisted I’d brought her to the wrong patient. “This is not my daughter.” She stared at the pale, puffy stranger in the bed. I stood at her side while she absorbed the fact that it was.

The
ICU
is hard-core even for nurses. When it suddenly dawns on you what you’re taking on, it’s daunting – or should be. I’ll never forget the look of utter amazement and discombobulation on one newbie’s face as she looked around and pronounced the place
“phantasmagorical.” She was a Trekkie and nailed it: “They say space is the final frontier, but I think it’s here.” She was trembling with excitement and fear at the prospect of working here. Laura, the eponymous leader of “Laura’s Line,” and a buddy of mine, came over to help bring down her stress level a notch or two.

“Relax. It’s only machines.” Laura gave the ventilator a little kick. “Just keep in mind that that’s a person in the bed and it’s all about hands-on care, you’ll be okay.” At that moment, a high-pitched alarm went off. Laura glanced at the monitor and smoothed the patient’s covers. “See, it’s just an artifact. When an alarm goes off it doesn’t necessarily mean something is wrong, only that something
could
be wrong. Your job is to know the difference.”

Laura herself could detect a problem long before any machine. To her, the truth was with the patient.

In the
ICU
, “vital signs” has a different meaning. On the floor, they are taken once a shift; here, they are noted moment by moment. You have to have a solid grasp of normal before you can recognize abnormal. Further, you have to know what normal is for your patient, like a “personal best.” Take blood pressure, for example. Before I came to the
ICU
, I thought of
BP
as a routine task or something measured once a year at an annual checkup (for those who had them). Very quickly you realize that in the
ICU
, blood pressure is a big deal. Your patient’s blood pressure is always on your mind. We monitor it continuously by a line in the patient’s artery and are concerned not only about the systolic and diastolic pressures but a calculated ratio of the two, called the mean arterial pressure
(MAP)
. It reflects the perfusion of the vital organs, but I tend to think of
MAP
as the force that propels life forward. To me,
MAP
is that poetic.

Heartbeats are given equally close attention as we examine them in second intervals, measure parts of them in milliseconds. We are constantly sizing up whether the hearth rhythm is regularly regular,
regularly irregular, irregularly regular. The same close attention is given to breathing. Second by second, breath by breath, each is counted and measured, as well as the intervals in between breaths.

Then there’s urine! We note the colour, if there is sediment, and the amount, millilitre by millilitre, we tally it hourly, not just allow it to accumulate to the end of the shift. In the
ICU
, all the elements of life – cells, enzymes, minerals, electrolytes, and microbes – are under scrutiny. Moment by moment, bodies are in the balance – beating, dripping, dropping, ticking, pulsing, and pumping.

Another thing I love about the
ICU
is that everything about my patient is my business: heartbeats my responsibility to safeguard, each drop of urine my concern. I’ll never forget the first time I heard an
ICU
nurse say, “My pressure’s low,” and realized she meant her
patient’s
blood pressure. “It’s like when your child coughs, it’s your cough, too,” she explained.

A nurse has to earn the privilege to work here – and stay. You have to study hard and keep on top of your game, proving yourself over and over again. The learning curve is steep, especially at first. For me, the technical skills came slowly and acquiring the mandatory knowledge and critical thinking took even longer. As for the emotional fortitude – well, I’m still working on that.

“Why are you still there?” friends often ask. “Isn’t it time to move on to bigger and better things?”

Like what? I wonder. What could top this? I’ve found my place. To me, what happens at the bedside is the most interesting and important thing – and in the
ICU
, I couldn’t get any closer to the bedside. Besides, why would I leave when I haven’t mastered it? I’m still trying to get it right.

“You’re just here for the stories,” some nurses tease me.

I’ll admit it – I’m an adrenalin junkie, getting high on the drama and action and grappling with the various complicated ethical
dilemmas, but my real fix is stories. I never tire of being let into my patients’ lives. I’m insatiably curious about the multitude of challenges that people face and the infinite ways they respond to them.

As fascinating as it all is, I rarely let outsiders into my world. I don’t tell my friends or family much. When I do, they either don’t get it or it makes them worry about themselves – or me. Then I have to reassure them that I’m okay.
This is what I’ve chosen, what I love to do
. I have never nursed sick children, worked in disaster zones in the aftermath of earthquakes or floods. I’ve never taken care of trauma victims, women in labour, or babies, only critically ill adults. Violence, cruelty, trauma, abuse are harder for me to compute, but illness, disease, and existential suffering make more sense to me.

Our patients have complicated metabolic diseases, overwhelming infections, or rare auto-immune disorders; many have undergone major thoracic (chest) or abdominal surgeries or organ transplants. Some have multiple organ failure; few have only one thing wrong with them. Many, but by no means all, are elderly. In all cases, outcomes are uncertain. But there is one thing there’s no getting around: our patients suffer. We do our best to ameliorate their discomfort, but there’s no denying it. At times, it’s hard to tell the difference between the suffering caused by the illness and that caused by the treatments. More than anything, there are always more questions than answers, way more problems than solutions. “We’re like
CSI
detectives,” one nurse said, “always gathering evidence, building a case, trying to solve puzzles.”

After the mystery is “solved,” more or less, our patients move on to a step-down unit or a medical or surgical floor. When they eventually go home, they don’t usually stay in touch, but a few do. One grateful patient took the time to write to us recently:

It’s lovely to hear from them, but those aren’t the ones we get to know as we do the ones that end up with complications, whose paths are rocky and turbulent. They loom larger in our psyches. In other parts of the hospital there are faster turnarounds, even “miraculous” recoveries, but here, triumphs are hard-won and tenuous; progress more fragile, usually partial and imperfect. It’s more of a slogging away, a day at a time, two steps forward, one back, or one step forward and two back.
Down seven, up eight
.

And yes, over the years, I have seen many deaths. I once had an argument with an administrator who designed a poster to represent our
ICU
. She chose a photograph of a sunset and a tree, the light glinting through the leaves at sunset. It sends the wrong image, I insisted. People come here to fight. The pastoral beauty of nature is not what inspires them here; they want cutting-edge science and sophisticated technology. This is not a hospice or a place to die – at least not at first. We admit a patient to the
ICU
because we believe we can make them better – at least it starts off that way.

But not everything can be fixed and death can’t always be “cheated,” as we like to believe. Those of us who’ve worked here for any length of time have seen too much of the other side of things – or maybe that’s just what we remember best.

“Do the math,” said a friend, another old-timer who’s worked here twenty-five-plus years like me. “We’ve witnessed the equivalent of the death of an entire town.”

True, but it’s not the numbers that stay with you, it’s the stories. For most of us, it’s not the death, but the way many people die, spending their last days cared for by strangers, in this alien environment, tethered to machines, chrome, and plastic.

Most of our patients do get better – we do have many success stories, for example, organ transplants. Rarely an easy course, but when all goes well, it is thrilling to meet the recipients, walking and talking, weeks later. Through the selflessness of a family who has just received the worst news of their lives, or the generosity of a family member or friend, the gift of lungs, kidney, pancreas, heart, or liver can save lives. No one who does this work can fail to be in awe when that happens.

Tonight, the hustle and bustle at change of shift is at a fever-pitch. There are some
sick
people. I catch fragments of conversations as I pass by the rooms.

“… forty-two-year-old female, idiopathic pulmonary hypertension … satting only 71 per cent on 100 per cent oxygen … awaiting lung transplant … top of the organ list.”

“… twenty-eight-year-old male, found at a bar … overdosed on Ecstacy … unconscious, tachycardic … no urine output … kidneys shut down – not even bladder sweat … dialysis to be started shortly … can’t locate family.”