After Heart Surgery: Jokes, Aches, Mercy and Intensive Care : A Patient’s Journal of Recovery--Getting to Know His New Heart Sounds

In each human heart are a tiger, a pig, an ass and a nightingale . --Ambrose Bierce

The mechanics have been and gone.

They had rumbled through the ribs, the mechanics had, with one of those neat little mini power saws. Then they’d got right into the sanctum sanctorum of the whole schmear, and replaced a faulty heart valve.

Not the same make and model, they’d said earlier with simulated rue. The line was discontinued in the ‘30s. What they were going to do was bung in a pig’s valve. (“Most appropriate,” the valvee’s wife had said.) Warranty: 10 years or 100,000 miles. Better than Chrysler. All very upbeat, and why not?

Now, though, the mechanics have been and gone--home for supper, one assumes. Maybe breakfast.

The pigpump is whomping away satisfactorily. Idling, as it were. All that’s needed is a shove, just to the on-ramp. But from whom?

The mechanics? They just fix ‘em, they don’t service ‘em.

The patient lies there in the bright darkness, waiting.

The Intensive Care Unit is dark only in a metaphysical sense; a concept of the soul.

To the nearly naked eye, still blinking off the lingering veils of narcosis, the ICU is aglow, almost garish. Overhead lights illumine banks of Star Trek consoles, devices that hum, blip, thump, buzz or just sit there, threatening in their impersonality.

The ICU contains everything, in fact, except human beings. Where the hell is everybody?

For a moment, panic. For 30 minutes, if the truth were known.

“Oink,” the patient says softly, trying out his new equipment. “Anybody out there?”

“Bloop,” answers a proximate contraption that seems to be attached to the patient’s belly, or maybe it’s his neck. Whatever. “Bloop, bleep.”

“Glory,” the patient thinks, slipping back into another dimension, another song an old actor friend who used to sing it.

It’s the mechanics who save your life, they say. They lie. OK, they exaggerate.

It is true that it is the mechanics who grind the valves, reset the timing, whatever else needs patching up.

It is also true that when they have finished their legerdemain, they deposit the object of their ministrations in a place like the ICU. Dump him in there like a rump roast. A side of bacon.

And it is there, the patient determines, there in the Intensive Care Unit, that he can die of fright. Or depression. Even boredom.

No, the patient thinks (now as then), it is another species altogether that really saves the lives--the nurses. If they’re good, that is. Which most of them are. But not all.

In the ICU, there is no night or day. The light never changes.

In focus, finally, the ICU consoles remain disinterested, impartial, neither for nor against.

Bloops and bleeps don’t cut it. What is needed in those strung-out hours of first solitude is an appliance that burps out, “Hang in there, babe.” There’s a fortune to be made . . .

Injections and pills and IVs are essential, no doubt, to keep the rig afloat. Swimming is an entirely different proposition. Taking those first tentative strokes--even wanting to--requires support.

On the first night (day?) there is about as much support as a pair of lead galoshes.

On the first night, it hurts. With the slightest movement, even a sigh, each tube and needle and hose pulls its own way. The torque of Torquemada. Which is to be expected. This ain’t the mumps, Charlie. I ache, therefore I am.

Nevertheless, finding the nurse-buzzer, the patient buzzes.

In time, a nurse appears: harried, annoyed, impatient. Would you believe nasty?

“Well?” she demands.

“Sorry,” the patient says, “but that tube down there? I think it’s pulling out.”

“No way,” says the Angel of Mercy, without even looking. “That was put in by experts.”

“But . . . “

“You trying to tell me how to do my job?”

“OK, but the thing is tearing. I can’t sleep.”

“Don’t be such a baby.”

Three or four times during the night, the nurse, God love her, returns--to draw blood, or insert it. Or drink it, who can tell?

Each time, the patient says, “I’m not sleeping.” Each time, the nurse stares, then walks away.

The overhead lights beat down.

“Bloop,” the machines say. “Bleep.”

“Oink,” the patient says.

Next morning (night?), new shift. A Valkyrie named Darlene takes over: sturdy, authoritative. Not unpretty, but neither was Nurse Ratchett.

“Didn’t sleep?” she booms.

“Nope. Damn tube is pulling.”

“Yeah, I can see. Let’s fix it. I mean, you gotta sleep !”

Darlene finds a square of white cardboard, on which she writes in bold, black letters, “DO NOT DISTURB THIS PATIENT. HE IS SLEEPING.” Then she renegotiates the tube in question.

The patient sleeps, dreaming Wagnerian dreams, not unpretty.

In the afternoon (evening?), Darlene sits by the patient, explains the functions and purposes of the various stocks and pillories affixed hither and yon. It helps.

Later, she helps the patient to stand for the first time. She is strong, but not strong enough. Patient and nurse flop back, together, onto the bed in a webwork of tubes and catheters.

In spite of herself, Darlene, a thorough professional, guffaws. So does the patient.

It hurts to laugh through a rubble of broken ribs, the patient discovers. But it hurts more not to.

Darlene has popped in half a dozen more times before her shift is over. On her last visit, she had grabbed the patient’s hand. “Hey,” she had said, “don’t let it grind you. You’re doing great.”

Maybe not great, but better, somehow. It’s all in the touch, he thinks.

On this shift, a “temporary” nurse has taken over. She means well, she is functional, but she doesn’t quite have it. Too tentative. No nudge.

The touch business comes home again toward the end of her shift. Something that’s dripping some kind of 40-weight goo into the patient’s arm has worked loose.

She is in a bit of a bind. Anxiety is contagious.

The nurse scoots off for help, returns with--Fernando Valenzuela? The orderly, a huge, square man, has the carnelian look of an Aztec deity. With brute force tempered by savvy, he manages to reinsert the whatzit.

The patient has been squirming. The Aztec, unflappable, looks deep into the patient’s eyes and wills him to be still, to be calm. Within minutes, the patient relaxes.

The Aztec has the touch.

The mechanics, of course, have been convening daily around the bedside.

They are good people, the putative nobility of the staff, and they chatter about EKGs and blood gas and the Lakers.

They stay for 10 minutes and tell the patient he is doing fine.

In truth, the patient, after their brief visits, doesn’t feel any better or any worse.

On the third (fourth?) day (night?), the patient escapes the ICU, thanks entirely to a nurse named Jackie.

Either Jackie is absolutely gorgeous or the patient is getting a whole lot better. Neither of which means much in the overall scheme.

Jackie radiates compassion. It is innate. When the patient says something hurts, there is a look of surpassing concern, and she tends to the problem on the spot.

When he says he’s feeling better, she smiles as if she means it. Actually, not “as if.” She does . He knows it. Big, big push.

It falls to Jackie to supervise intermediate steps to recovery, some of them messy. Not only does Jackie not flinch, she is pleased with the process, when it works.

Having slopped out the sty, Jackie sits with the patient for long hours, fielding puerile queries with aplomb: “Do Jewish people get the pig valve, or do they have to go with a sheep or something?”

At last, the patient is wheeled up (down?) to a private room.

Three hours later, off duty, Jackie sneaks in, gives him a big kiss.

In every human heart is a Nightingale . . .

During the next several days there are at least six more nurses--not to mention the mechanics, who visit daily to scan charts, thump bruises and tender vivid precis of the Kings’ latest losses. They don’t really count any more anyway, the mechanics. Life, as we know it, has been rekindled by the likes of Darlene, Jackie, a few others. And by the Woman in White.

Four of the private-room nurses have been first-rate, one so-so and the other seems to have dressed each morning in a full-length snit.

The pig-powered engine is grooving now, or at least experimenting with a sedate minuet, but there are occasional false starts, breakdowns.

During one such reversal, the patient lies awake again one night, perspiring, hurting, worrying.

A passing nurse, whose name he never gets, glances into the room, stops, comes to the bed.

“Bad patch?” she asks.

“Yeah,” the patient says. “Jeez, I thought I was finished with all this.”

“Lie back for a minute,” the Woman in White says. “Try to relax.”

She puts a cool hand on his forehead. Then she hums. The tune is indeterminate, the vibes voluptuous.

The patient slides into sleep with the nurse’s hand still on his forehead.

The next day he goes home.