Heart Trouble

Raindrops ping my umbrella and roll down the waterproof dome as I rush into the hospital breezeway. My glasses begin to fog, clouding my visibility as I pull up my jacket collar, trying unsuccessfully to prevent soaking my neck, back, and sweater underneath. With every labored step, my breath puffs out clouds of steam like that determined train from The Little Engine That Could. My galoshes slosh through unlit puddles that cover the dangerously uneven paved walkway. I wonder how many people have sued the hospital for broken bones before checking in with their original issues.

The evening winds gust around me as my steps squish on the soggy carpet leading into the building. The automatic doors open readily, inviting me in as if I’m an expected guest. In spite of prior trips to hospital and navigating my way through its many corridors, I pause for a second to figure out the quickest way to the ICU.

I navigate to the repetitive dings where the lifts are busy shuffling sad and worried people to where they need to go. I accelerate past the buzz at the nurse’s station and information desk until a security guard stops me to sign in. He also reminds me that visiting hours are almost over. Time is not on my side, but hopefully it’s on Nan’s.

The lift abruptly stops on the 4^th floor and before the doors open, I hear muffled voices on the other side. The chaos of people and machines inundate me as I exit the cold steel cube, forcefully pushing past the small crowd waiting to get on. The arrows on the wall point me in the direction of her room. Only a whisper of air separates me from the surrounding noises that are becoming more muffled and indistinguishable as I try to process what’s next.

The night nurse is in Nan’s room when I arrive. She glances over her left shoulder at me as she finishes placing a new Lactated Ringer IV bag onto the hook just above the bed. She also reminds me that visiting hours are almost over. I nod like a bobble head to acknowledge hospital policy for the second time. She leaves the room.

The brief silence gives way to the ventilator that clicks and shushes in its hypnotic up and down motion. Before taking my seat next to her bed, I check the monitor that continuously beeps to keep time with her breathing. So many colors. So many different numbers and symbols as wave patterns arc their way across the screen.

I hear laborious snoring from the other patient in the room. Drawing the curtain for more privacy, I feel the shiny curtain rings gliding across the metal bar, occasionally clinking when the rings clump together. I dimmed the lights in the room, which helped lower the amplified sounds of the equipment, the steady beep of the monitor keeping time like the rhythmic pulse of an old metronome.

Here wiry white hair, now matted, frames her delicately creased face. How she loved when I sponged her short strands, washing away the suds from her hairline and the stress from her X. Her slow, now arrhythmic heartbeat skipped about every three beats, causing the pulse oximeter placed on her left ring finger to flicker and skip in time. For a nanosecond, a brief respite warrants my attention. I look up from the Good Taste magazine article that I’ve been reading and rereading for the past ten minutes. I know the hospital staff will soon fetch me to leave, but no one from the Nan’s family is here, yet.

The bed rails are overdue for a spritz of silicone spray to minimize the wretched screeching of metal on metal as I adjust the side rail downward. I pull the blanket up closer to her chest. The flimsy pale pink hospital gown flutters with each breath as her chest rises and falls. What a contrast of when I saw her onstage years ago in Paris as a ballerina. Her pirouettes unsurpassed and her pliés gracefully executed. Closing my eyes, I trace the tiny ECG electrodes underneath her gown, and I feel the cable poking through the armhole to attached to the ones on her frail arms.

The surgeon arrives. He startled me because my back was turned, and his orthopaedic shoes made no sound when he approached. He checks Nan’s chart, flipping back and forth between the first two pages on the clipboard. He compares notes by slightly curling half of the first page over the second, exposing the bottom halves of each page. He replaces the chart and removes his stethoscope from around his neck. He widens the headset and places the black tips into his ears. He then takes the chest piece and briefly warms it in the palm of his right hand before placing it atop her bony, Betadine-stained sternum. Pulling down the top of her gown exposes her post-operative chest, unleashes a foul, necrotic stench that forces me to pinch my nostrils until he removes the scope and readjusts the gown up over her shoulders.

I ask him if everything is okay.

“Her vitals are failing. You’ll need to contact the family to decide what happens next,” he dismally replies. He checks over his shoulder at her one more time, then nods at me before leaving. I glance at her before looking at my wristwatch. I’m not sure if I can ring Graham to get him here in time. The night nurse returns to the room to inform me that visiting hours are over. I plead with her for just a little more time while I find a family member to get here and sign the paperwork. She apathetically agrees to allow extra time.

I rifle through my bag, searching desperately for my mobile phone. I’m annoyed now by the competing beep-beep-boop tones as I punch in numbers, hoping to get someone to come to the hospital. Just as the call begins to go through, I hear the blaring alarm of the monitor. Lights pulsate, and the arcs previously rhythmic and syncopated are now vehemently erratic with longer blips between the cresting pulses. I can see the distress on Nan’s face behind the oxygen mask. Her brow furiously furrowed, her body seizing, struggling to capture any remaining air available to her.

The call goes to voicemail just as the overhead hospital PA system announces “Code Blue in ICU Room 4102”. The staff scrambles in response. I’m pushed out of the way by attendants scurrying to get to their intended target. The room is now abuzz with nurses, doctors and other emergency care professionals, their shoes squeaking and thudding across the linoleum floor to make room for a crash cart with a wobbly wheel that rubs and grinds in motion. Plastics and trays are being ripped, torn, and tossed to the floor in order to swiftly collect the vital instruments, solutions, and medical paraphernalia needed to resuscitate. Bodily movements are definitive and resolute. Voices in the room are converging into one another as directives are being issued and responses echo to affirm those instructions. The monitor continues to sound the alarm as the staff attempts to get the situation under control.

In the far corner, out of the way, but still attuned to the medical staff’s actions, I keep trying to complete the call to no avail.

It’s difficult to watch her fragile, almost lifeless body being pounced upon by robust healthcare workers. She’s being poked by needles that miss the narrow veins barely visible underneath her skin and cajoled into as close to a normal sinus rhythm and heartbeat as possible.

In the midst of it all, my phone rings. I get a disapproving stare from a nurse trying to administer meds. I immediately answer. It’s the call I’ve been trying to complete and the one desperately warranted to decide Nan’s fate. The voice on the other end is curt and egregious. Her son Graham has never been my favorite person, but after all, he is her only family and the only one to decide what happens next.

“Graham, can you hear me?” I ask.

“Yes, I can hear you, but what’s going on in the background?”

“I’m at hospital with your mum. She just went into cardiac arrest and the staff is in her room trying to revive her.”

Silence.

“So what do you want me to do about it?” He asks.

“The surgeon needs someone from the family here to decide what happens next to your mum. I cannot make that decision given I’m only her caretaker.”

More silence.

“Can I just do it over the phone?”

“I don’t think so. I think you have to sign a document or something to state what you wish to have happen.”

I hear a slight crackle in his voice before I hear him clear his throat.

“I’ll be there as soon as I can.” The static click startles me.

The clock is ticking, but I have no concept of time until I look at my watch again. It’s been 15 minutes since the staff rushed in to stabilize her. I see beads of perspiration on the forehead of the staffer doing chest compressions as gently but forcefully as possible so as not to crush her ribs or further damage her heart.

A nurse asks me if someone in the family is coming. Eyes closed, I nod.

“He should be here soon,” I say underneath my breath, hoping it is true.

I walk over to the other side of the room to check on the patient in the other bed. Appearing heavily sedated, she continues her raucous snoring through the frenzy. I turn my attention back to what’s happening at the forefront of the room. I check my watch once more.

The staff is growing tired as she’s still not responding to the CPR. They’re contemplating to cease compressions and attempt defibrillation.

The paddles are removed from the crash cart and a voice projects, “Clear!” to forewarn anyone near her body or bed before beginning the shock.

We all watch in anticipation as the high-pitched whir signals the time at which the paddles are to be applied to the chest. Thiccup. The first attempt at low voltage is complete. Her body jumps slightly off the bed as if being lifted by an imaginary string.

“Clear!” I hear a second time. Graham is here. He asks what’s going on. I take him aside and explain that they’ve been using manual compressions but have just now opted to defibrillate, hoping for a better result. He stands there stone-faced, watching and waiting.

The high-pitched whir once again followed by an immediate thiccup concludes the second attempt at reviving her. There’s no change to the monitor at this point which continues to show longer intervals of sinus rhythm.

The night nurse comes over from the bed and approaches Graham to inquire why he’s in the room. Once she understands he’s family, she ushers him out of the room to the nurse’s station to get the paperwork. It all hangs in the balance now as the clock ticks on and I anxiously wait.

Graham returns to the room, paperwork and pen in hand. He takes a last look as the staff takes one more pass with the defibrillator—“Clear!”

The pen scratches across the bottom of the page on the signature line as he signs his name and makes his choice. A tear rolls down his cheek and plinks onto the page smearing and spreading the ink.

The emergency team begins to unplug Nan from the monitor which starts the process of shutting down. Clicks turning off connected devices give way to beeps and blips, then finally the click and swish of the ventilator slows to a hush. As the nurse removes the oxygen mask from Nan’s face, the intubating tube hangs off the left side of her drooping lip. The night nurse wipes away drool that dribbles past Nan’s chin. Then finally, the slow ebbing of her last breath escapes through the tube out into the room. All that can be heard now is the low communications between the staff as they remove the crash cart and tidy up before leaving the room.

I watch Graham adjust his coat collar and walk out, heading toward the lifts.

I stay a bit longer, staring at Nan’s lifeless body, longing for a sound—any sound—but only the guttural snoring from the other side of the drawn curtain continues.

I leave shortly thereafter and make my way back to the main floor. It’s still raining. Instead of using my umbrella, I walk out, face up, allowing the rain to become my tears.