I can’t pass up today’s Daily Prompt, which invites bloggers to “Tell us about a bullet you’re glad you dodged — when something awful almost happened, but didn’t.” My biggest challenge is deciding which bullet to write about.
In a previous post I treated you to an excerpt adapted from an unpublished book manuscript. Here’s another snippet from that same manuscript…
It is never fully night in the Intensive Care Unit. There are always lights, and a steady buzz of human and mechanical activity. If you are in the ICU, it is because you are not stable enough to be entitled to eight hours of uninterrupted sleep. You need frequent checking, and so do all your neighbours. The classic hospital joke—where the nurse wakes you to say it’s time to take your sleeping pill—is not a joke in ICU.
Although ICU nights consist of catnaps wedged between inspection tours, there is a distinctive rhythm to the 24 hour period that helps to maintain some semblance of day and night. Hospitals in general are very rhythmic. Everything is scheduled—except, of course, the crises. If you want to see frenzied improvisation at its most improvisationally frenzied, hang out in the adult Emergency Room of a downtown hospital on a Saturday night. Travel up into the medical wards where people with slower paced problems are slowly getting better (or worse), and you will find everything chugging along like clockwork. Mind numbingly boring clockwork.
But in ICU, the two poles of this continuum arc around and crash into one another. This is the reason that, in my opinion, there is no human being—not even the most perfectly disciplined athlete or ballerina—who can embody a more exquisite balance of precision and flexibility than an ICU nurse.
The ICU nurses I encountered were made of tough stuff. They worked 12-hour shifts tending to the sickest of the sick. They were in constant motion—each nurse only focused on a couple of patients per shift, but they kept up a seamless rotation of activity. Check vitals. Clean patient. Change bedding. Calibrate tubes. Chart progress. Repeat. Competent, efficient, and in the case of the nurse I recall most vividly, in possession of a wicked sense of humour.
You’d have to have a sense of humour to survive a job like that. I think ICU nurses would make good astronauts. They have the patience and attention to detail necessary in a situation where the smallest error could mean the difference between life and death, and when the crisis hits they somehow keep that control and levelheadedness, but at a much accelerated pace.
The ICU doctors too, were a different breed. As the head of ICU, succinctly put it: “first you save a life.”
His colleague explained this philosophy in more depth to my mother: “When someone is as sick as Anna is now, our priorities shift. Priority number one is to keep her alive. Priority number two is to save her kidneys. Priority number three is to get the bleeding under control. While her eyesight is important, at this point, it can wait for another day.”
Of course controlling the bleeding would have been easier if they had known where I was bleeding from— they still couldn’t explain why my haemoglobin kept dropping. The doctors were now tossing around terms like “multi-organ breakdown”—as always more descriptive of what was happening than of why. One doctor admitted to my husband that the entire medical team was “baffled” and they were considering the option of transporting me to the Mayo Clinic.
But by the next day it was decided I was too unstable to transport, so the Mayo Clinic was out.
Unstable I was indeed. An MRI confirmed that the fluid was now collecting in my head—putting pressure on my brain and messing with my perception and cognition. Sometimes I had double vision, and sometimes my vision was clouded. I was vomiting blood, and the diarrhoea continued unabated. Pressure on my lungs from the fluid in my abdomen made it difficult to breathe. Dialysis made me dehydrated, but they were afraid to give me fluids because they still couldn’t explain why I was retaining so much fluid.
I was anchored to the bed by an impossible spaghetti-tangle of tubes. I had IV tubes to keep me hydrated. Stomach tubes to deliver the liquid food substitute on which I was subsisting. Oxygen tubes clipped to my nose. And the nasty intra-jugular tube, in my neck, through which I received hours and hours of dialysis for my failing kidneys as well as transfusions of whole blood and plasma.
Shortly after my arrival in the ICU, one of the nurses decided it was warranted to bend the rules and allow my five-year-old daughter in for a visit. Much later my husband confessed that the staff agreed to the visit on the grounds that, at that point, the odds of me making it out of ICU alive were looking pretty slim.
I was too weak to interact with her. She just stared down at me from her father’s arms, wide-eyed and silent. Back at daycare, after what must have been a truly horrific experience for a 5-year old, she made an attempt to express the inexpressible in a drawing. On a tiny scrap of pink paper she drew a meticulously detailed depiction of me—in a bed—surrounded by a tangle of tubes. Her caregiver recounted to me later how she laboured over the portrayal of each tube. When she was satisfied that she had captured the scene fully, my daughter sat back and stared at the portrait in silence for a long time. After this period of reflection, she picked up her pen again and scribbled a heavy “blanket” over the figure in the bed—effectively obliterating the tubes from view. If only.
The ICU was a big room with patients arranged in a ring around a sort of “command centre.” The beeps and hums of the machines busily keeping me alive blended into the beeps and hums from everyone else’s machines, and the result was an oddly comforting white noise. I didn’t mind the machine noise, but the endless talking of the staff irritated me and kept me awake. Each bed had a curtain for when privacy was called for, which didn’t seem to be often. The fact that I was too sick to care about my surroundings meant that I equally didn’t care about being “on display.” If I wasn’t noticing my neighbours, they sure as heck weren’t noticing me. Although it was possible to see other beds, they seemed to be arranged so that, open curtains notwithstanding, I was never really aware of what was going on with the other patients.
Except once. On one of the not-quite-nights when I was at the lowest of the low, I had more trouble than usual sleeping. In my disoriented state I was having trouble making sense of what was happening around me. I remember feeling irritated throughout the night by the lights from the neighbouring bed shining in my eyes. I was vaguely conscious of a commotion that deviated from the usual slow dance of night-time activity. I recall a curtain being sharply drawn—enough to obscure my view, but not enough to mask the lights and sounds. Still, I didn’t put it together, even in the morning when I could see that the bed next to me was vacant. It was evening again before my husband explained to me that my neighbour had gone into cardiac arrest in the night and had died.
It felt quite plausible that I would be next, so I started mentally planning my funeral.