“I’m here for my spa day,” I tell the nurse who checks me in before surgery. We are in a private little room with a television. My husband has taken off to forage for breakfast. I am only a little nervous. I know too much to not be a little nervous.
“Fabulous. You’ll love our luxurious treatments. First, a warm body scrub.” She hands me 2 packets of warmed chlorhexidine towelettes. “Wipe yourself down completely with these. Well, not completely – don’t use them on your face, or genitals.”
“Ahhh…” I say. “Everything but the important parts.”
“Yep. Everything but the important parts. When your husband gets here he can do your back.” She hands me the requisite hospital gown, replete with snaps that don’t snap, ties that won’t tie, and a shortage of fabric that will undoubtedly leave little to the imagination for any one walking the halls behind me. “Opening in the back. I’ll help you if he doesn’t get back soon.” She is all-business, but gentle. Her eyes are kind, her touch light. She is one of my own – a colleague, a peer, a professional.
My surgeon is ahead of schedule. I am taken to the pre-op holding area. I am introduced to my new nurse. She stands at the foot of my bed with a rolling computer. After introducing herself, she turns to the computer, leans on it. She spends the next 10 minutes talking with a colleague about non-nursing, non-surgical, nonsensical stuff – where she bought what, where she went and with whom, “We should get together” type bullshit. I try to remain calm. I know my lucid time is drawing to an end and I want to make sure everything is in order – I clear my throat – repeatedly. I want to feel safe in her care. She turns to me, irritated, and I remind myself: she is a colleague, a peer, and at last she remembers she is a professional…
Somewhere along the line, it has come out that I am not only a nurse, but a nursing instructor. I do not usually offer this information, I don’t want my caregivers feeling nervous about providing care, or to have the feeling they are being evaluated for each skill they perform. Some nurses had horrible experiences with nursing instructors – I just want what everyone wants – the best care each nurse can give.
Another nurse starts my IV. Hands are washed and sanitized appropriately. Information is reviewed, questions asked and answered. My skin is prepped, all precautions taken. The IV catheter slides in painlessly; the dressing is applied expertly. If she is the least bit nervous it does not show – she is calm and competent. Her demeanor is calming, supportive, gentle and sincere. She is one of my own – a colleague, a peer, a professional.
A nurse-anesthestist student introduces herself. She will be assisting with the induction of anesthesia. She is bubbly and smiling. I am at a teaching hospital. I know students, residents, and interns will be on the care team. I have signed papers that I know and understand this fact. I am okay with students; we are all learners at some point. She asks a few questions about prior surgeries and experiences with anesthesia. She does not examine me other than to ask me to stick out my tongue. My nervousness ratchets up a notch or two, but I cannot put my finger on a reason, just a general sense of foreboding. She promises to come see me in the recovery room…She is one of my own: a colleague, a peer, a professional.
I wake up in the recovery room. Something is wrong – horribly wrong. My face is swollen, my lip is throbbing, and I have a breathing tube in my mouth. I cannot speak. A new nurse – with a round, sweet face and smooth voice urges me to relax and not fight the tube. She will call to have someone remove it as soon as it determined I am breathing well on my own. I try to relax but my worst nightmare is being realized. I do not want a breathing tube…I do not want a respirator. I try to modulate my breathing but my diaphragm will not relax. I cannot suck air in. I hear and feel the respirator breathe for me and I cringe. She wipes the tears from my face and calls the anesthesia team. They are tied up in surgery, she tells me. Everything will be all right, she tells me. She wipes more tears and stands beside my bed. Together we work on my breathing – timing my efforts, using accessory muscles, relaxing. I am groggy, struggling, but we make progress. She does not leave my side for a very long time. When she does, it is to harangue the respiratory team to come remove the tube. I hear her on the phone. She is firm, insisting they not leave me on the machine any longer than necessary. My patient advocate. She is one of my own: a colleague, a peer, a professional.
The nurse-anesthetist student stands over me…finally. She is no longer bubbly, or smiling. “Your intubation was extremely difficult,” she states flatly. “You’ll be getting a letter from the anesthesia department informing you of how to better prepare for future surgeries or emergencies. We left the tube in to make sure we had an airway in case you couldn’t breathe on your own.” I watch her deflate the cuff of the endo-tracheal tube. She pulls it away from my mouth and I feel the tube tearing out of my throat, which is raw and has a metallic, bloody taste. I cannot swallow. I can barely breathe. My face feels more swollen and my lip is bloodied. I feel inadequate, blame-worthy – like I didn’t hold up my end of the bargain. I feel small and worthless. I ask myself “Is she really one of my own?” A colleague? A peer? A professional?
I am taken to my room. I am handled ever so gently. My pain is addressed – my breathing, still shallow and ragged, keeps setting off alarms. My oxygen levels are low. Some of my nurses sit with me while I use my incentive spirometer to increase my lung function and expand my lungs. I can pitifully only do about as much as a newborn infant. But we keep at it, making progress in miniscule increments. The aides check my vital signs and print out strips. I ask what the strips are for. “The docs and residents see these – they are posted on your chart.” I notice they only print the strips after my breathing exercise, when my numbers are good. I ask about this. I wonder aloud if my surgeon knows that my breathing is such an issue 98% of the time or if he only sees the “good strips”. My diaphragm is stiff, non-cooperative. When I try to breathe in it stiffens, instead of lowering to expand my lungs, it constricts. It will not relax. But I continue to make progress.
In the wee morning hours before I am to be discharged – I awaken in a panic. My monitor is beeping wildly. My oxygen levels are very, very low. My nose is completely stuffed up – there is no oxygen going into my airway through the nasal canula they have applied, and very little breath through my ravaged throat. I call for my nurse. She is a long time coming, even though I have told her over the intercom that I cannot breathe. She checks the monitor – then silences it – at one point she turns the noisy machine off. She replaces the nasal canula. I tell her I cannot breathe through my nose. She turns the oxygen up a little. I tell her I need an oxygen mask. I again take the canula from my nostrils and place it across my open mouth. At least the oxygen will get in that way. My diaphragm is stiff once again, non-compliant with my attempts to inhale deeply, or even shallowly for that matter. She tells me I am not trying – that I need to relax. I tell her I cannot relax when I cannot breathe. She leaves the room – with me sitting on the edge of the bed, oxygen tubing in my mouth, praying I don’t pass out. She returns and makes an elaborate show of calling Respiratory for a face mask. She is loud, abrasive, demanding. Apparently, Respiratory is not inclined to help her out. She calls another floor – someone delivers a face mask within minutes and I am breathing better. She asks if there is anything else I need…as if she has done some supreme favor for me…I haven’t the strength nor the breath to deal with this woman at this point. I remember that I am a colleague…a peer…and a professional.
I am home and recovering from my recent ordeal. As I reflected on the nursing care I received – the nursing care I will be asked to evaluate by means of patient survey – I was reduced to tears several times. Writing this post has been gut-wrenching. Certain nurses have already been commended by me to the hospital’s Quality Assurance nurses who visited me during my admission. Most were excellent. Some not. Those nurses, as well, have been or will be addressed.