A Change of Heart

nursemike, ASN, RN

April 18, 2016, I began my third of three 12-hour night shifts, but I didn't finish it.

Sometime after midnight, I felt a dull, but fairly strong pain under my sternum, which I first attributed to the Chinese food we had ordered, earlier. After another pang, though, I thought the pain was a bit too severe to be gastric. At least, that's how I recall it, although I'm told by my friends who were there with me that I continued to insist it was just gas, even though I was pale and diaphoretic. Apparently, after throwing up, I told the charge nurse that I probably would need to leave early to go and lie down for a bit. She and my other buddies weren't having it, though, so they loaded me into a wheelchair and hauled my sorry butt down to our emergency department. Recently, I was told that as they wheeled me away, my last words were, "Don't worry, it's probably just a heart attack." In retrospect, those would have been pretty cool famous last words. Half an hour later, my friends back upstairs heard a Code Blue paged to the ED and hoped it wasn't me. Guess what--it was me.

One benefit of being a hospital nurse is that if you have a major heart attack at work, you're already at the hospital. If I had been at home, that night, even if I'd had sense enough to call 911 at the first sign of trouble, it's unlikely I'd have survived the ambulance trip. I coded again in the Cardiac Cath Lab, but once again my ACLS training came through and I knew just what to do as the patient. (It isn't entirely clear to me whether my third arrest was at my home hospital, WVU Medicine Ruby Memorial, or after they shipped me to Allegheny General Hospital, in Pittsburgh, but as you may have deduced, I lived through that one, as well.) So, while I have little memory of that memorable night, the phrase "heroic measures" has a much more vivid meaning to me than it once did.

I have total amnesia about the next several weeks. I'm told I was responsive, at times, and even able to follow instructions, but all I recall are some bizarre dreams. My hospital problem list included dementia, and I'm told I did my share of trying to climb over the bedrails and even became combative a couple of times. One friend who came to see me said she instantly regretted making me laugh while I was intubated, but I find it comforting that I was able to keep my sense of humor during such trying times. I also had a dream about a young man saying they would tie me down if I didn't behave, and at least in my dream he got a bit of a lecture about never using restraints as punishment or even speaking in a way that might suggest you would--no matter how much the patient might deserve it. What can I say? Once a charge nurse, always a charge nurse, and I sure didn't want the boy to get sued.

My first clear memories of my adventure were from the first week of June, waking up in the AGH ICU with a trach and an NG tube and someone telling met no to pull out my NG. I had it in my mind that there were actually three tubes in my right nare, which seems improbable, but I recall much more clearly how frustrating it was not to be able to talk. I don't seem to recall being especially surprised to learn that I was awaiting a heart transplant. Perhaps that information had somehow made it past my dementia, before. It did take a couple of days to be convinced I was at Allegheny. In one of those dreams, I'd dreamed I was at UPMC--also a fine hospital, I suppose, but far more odious to a loyal Mountaineer than Allegheny ever could me. (Surely my docs back in Morgantown would have done the only decent thing and just let me die before shipping me to Pitt.)

Coming out of sedation in the ICU was the beginning, for me, of a very interesting time in my life. For a week or so, my daily activity was sitting up in a chair, after being transferred there in a sling that was suspended from the ceiling. I learned a lot about my LVAD (Left Ventricle Assistive Device) since I pretty much didn't have a left ventricle. I found, to my considerable dismay, that assisting someone else with their, um, ADLs, is far, far less embarrassing than being assisted with my own. I decided whoever came up with the curse, "May your life be filled with lawyers" must have never met a doctor, and I gained a far less hypothetical sense of just how important the right nurses, nursing assistants, and even those damned doctors can be during one of one's most trying ordeals.

When I say my experience has taught me some things, about nursing and about life, I'm not so much saying it has changed my mind nearly as much as it has confirmed what I thought. But that's not a small thing. I've known for a long time that the ability to listen is an important nursing skill. But now I've felt what a nurse who listens meant to me. For as long as I can remember, I've believed life is precious. Now I have a sense of how precious. I've known for a long time that I am mortal, but that mortality no longer seems nearly as hypothetical.

I've heard stories of veterans being nostalgic for war, of ex-convicts who've been homesick for prison. Most of my memories of my time in the ICU are happy ones. Not all of them. It was truly a miserable place to be. But what I think about most are things like getting up to walk with a whole team to assist me, including one nurse to push my life support equipment around with me. I haven't forgotten what hard work it was, but that pales in comparison to the sense of victory when I finished my first complete lap around the unit. It's entirely possible that I may be the first 1:1 ICU patient to have ever been taken outside to get some fresh air. I hope I won't be the last. Like my 4th of July trip to the other end of the hall to watch the fireworks, it was exhausting, but unforgettably wonderful. And while I wasn't remotely in any shape to be the dirty old man I'd always assumed I would be as a patient, I will forever adore the pretty young nurse who came to my room for an hour on Sunday nights to watch tv with me. I may not remember the times these people were the difference between life and death, but I will forever be grateful for all the times they were the difference between life and survival.

A thing happened while I was awaiting my heart transplant. A patient was brought in in much the shape I had been when I arrived. A nurse rather reticently asked if I would mind if that fellow's wife came to talk with me about what her husband was going through. I don't know whether he made it or not. I can't honestly say whether I helped her or not. It's the nature of my work as a nurse that I often don't know the ultimate outcome of what I do. But when my nurse came to thank me for trying to help, words failed me to fully express how much it meant to be able to act like a nurse instead of a patient. She could not have given me a greater gift.

Almost exactly a year after my heart attack, I started back to work. It may well be the hardest thing I've ever done. It has certainly been the most humbling. Early on, I had some serious setbacks that made me, and everyone else involved, doubt whether I could do this. I sometimes joke that they must have given me a woman's heart, and I actually am tearing up as I write about the amazing help and encouragement I've received throughout my recovery and my transition back to work. I have always believed people are good, but Dear Lord, I had no idea how good!

It isn't a miracle that I am alive. It's a whole series of miracles. Not the least of those miracles is that a suitable donor died an untimely death. Miracles aren't always pretty. But as I look back, my heart attack itself was the first in that series of miracles. I can't say more than anyone else what would have happened if I hadn't have lived through it. But I can feel vividly how grateful I am that I did live through it. I work two 12-hour nightshifts a week. It gives me a decent, modest living. It gives me a sense that I have a purpose in life, that I'm doing things that matter, on a part time basis. It gives me a chance to pay forward, in some part, what others have done for me. I am, literally, the luckiest man alive.

A Change of Heart

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