Free Opening My Heart by Tilda Shalof

with right now.
    Ramona, the day nurse, is standing outside the patient’s room waiting for me. She’s been here all day and is eager to hand over so she can go home. She launches straight into her report on our patient, a sixty-six-year-old First Nations man admitted to the hospital three weeks ago for abdominal surgery for a bowel obstruction who then developed pneumonia and respiratory failure.
    “Mr. Beausoleil – he likes to be called George – awake and alert, oriented to person, place, and time. Restless and confused at times. I gave him Haldol 2.5 milligrams IV twice today. Tolerated well, but we’re trying to minimize sedation because we’re hoping to extubate him in the morning. On pressure support of five, oxygen at 35 per cent … if he doesn’t fly he’ll need a trach. Gets tachypneic with anxiety – his resp. rate goes up to fifty or so. Cardiac status stable … normal sinus rhythm with no ectopics; blood pressure stable. Line-wise, he’s got a subclavian triple lumen catheter – site was changed two days ago – with normal saline to keep the vein open … magnesium was low so I topped him up with two grams. On insulin nomogram … last blood sugar 10.2 millimoles.”
    I’m used to this barrage of rat-tat-tat facts coming at me in rapid-fire bullets. I let it wash over me as I mentally highlight key points, what needs clarification, and what questions remain, like this one:
    “Any family?” What I need to know is anyone hovering out in the waiting room, anxious to come in. I want to know who cares about this man in his life outside the hospital, other than me, tonight for twelve hours, for whom it is my job to do so?
    “Oops, forgot about that. No one came to visit. His wife died a few years ago. There’s a daughter in Vancouver, but she didn’t call today.”
    A sad but all-too-common situation.
    But what’s uppermost on my mind is this question: Would I have Ramona as my nurse? Yes. She’s a just-the-facts-ma’am kind of nurse, but I probably wouldn’t die on her watch.
    Before going in, I glance through the window at a frail, elderly man, his arms tied down in restraints. The sedation Ramona gave him has kicked in so I wonder if he still needs them. Most of us do all we can to avoid physical restraints, but if patients are at risk for pulling out their lines or endotracheal tubes (breathing tubes), we have no choice. Some patients can’t be soothed with words, touch, or even drugs. A restless patient can be more challenging to care for than a combative or even violent one; it’s a persistent, gnawing need that’s never quelled or satisfied. You do your best to keep your cool, but we’ve all had moments of impatience. One time I was so rattled by a patient’s agitated state that I caught myself shouting, “Calm down!” as if calmness could be commanded. Justine, my pal from Laura’s Line, used to call it “going nurse!” instead of “going postal!”
    Doctors don’t get this. If they pass by a patient’s room and happen to see the patient in a moment of rest, that’s their snapshot impression. Even if the patient is agitated, it doesn’t affect them like it does us. They aren’t required to be as up close and personal for such extended periods of time as we are. They can keep a remove of time, space, and often emotion, too. One thing that helps me is keeping in mind the motto of the “Dog Whisperer.” Cesar Millan advises people to stay “calm and assertive” when dealing with unruly canines. (Though I don’t have a dog, I watch the show and aspire to be a “Patient Whisperer” by putting into practice Cesar’s advice about “fulfilling the other’s needs” and helping them attain “balanced energy.”)
    After introducing myself to my patient, I loosen the restraints on his arms and then begin my head-to-toe assessment, startingwith his level of consciousness. Though he’s awake and alert, he can’t speak because of the breathing tube in his mouth,