2013-04-23

V. Guitberg

Dawn

Today, February 21^st is the day of the operation. I woke up at a quarter to five in the morning. The dawn is just barely breaking through the window. Tanya already woke up. Perhaps she didn’t sleep well at night.

I can hear Misha downstairs, also awake.

We need to organize the time, so that everyone can have time to shower. It’s a strange situation, perhaps everyone is thinking that we have assembled together for the last time, but I’m trying not to think that way.

-          “Go shower first” - suggests Tanya to me, - “In the mean time, I’ll make the bed.”

I showered as per her instructions. I thoroughly washed the spot of the upcoming incision with the disinfectant gel, which I acquired at the pharmacy of the hospital during the most recent visit.

Tanya was worried that I would forget something, this happens to me often. While underlining her confidence in the success of the operation, she reminds me:

-          “Check that you remembered everything that you’ll need after the operation in the hospital.”

After all, what do I need? Shaver, soap, toothbrush and paste. Packed earlier the small player/radio given to me by Misha. I wasn’t able to add anything to the healing music the he uploaded for me. I was remembering that he wanted me to listen to it during the operation, in addition to the narcosis. He thinks this will make it easier to handle the operation. I think it won’t be permitted.

Me and Tanya got ready and went downstairs. Misha calls us over. He is squatting and performing some sort of Indian ritual in front of smoking sticks of incense. Misha has been practicing yoga and Buddhism for over three years, and has spent a year in India.

The pleasant smell from the smoking incense spread throughout the house. We sensed it even upstairs in our bedroom. It turns out, Misha does this ritual almost every morning.

-          “Misha, its time to go”- says Tanya.

-        “Wait, I have to engulf both of you in smoke”,- he took the smoking sticks of incense and began to wave them, walking around us in a circle.

This ritual was meant to help me endure the operation with more ease.

Although we don’t believe in it, the understanding that, protection from danger with the help of that, in which Misha believes, adds a sense of calm.

In Toronto, the month of February is real winter, but today there is no snow. This year there was no real cold weather. There is no frost, the car is warm, so we dressed fairly light. Misha took the wheel; I wanted to see how well he got accustomed to the car. Before him was 10 days of driving Tanya to see me at the hospital.

The road is very empty, very few cars, so at 6:15 am we had already arrived. Misha dropped me and Tanya off at the central entrance of the hospital, and went to park the car.

Finding the surgical ward is not difficult, its located on the first floor, and large signs pointing towards it greet the visitor from the very entrance. We wait for Misha to return, who bought a weekly pass to the parking lot, costing 50 dollars. Without it we would have had to pay three times as much, as just one day of parking costs 24 dollars.

At this time there is no one in the lobby. We go to the registration, and surprisingly find that it is full with people. Together we approach the registration window. I take out my medical card and place it in the window. A stern and busy registrant marks down my arrival in the computer.

Misha is standing by the window, he tries to joke with the registrar, she smiles at him, then again becomes serious. I wait until she directs her attention to me. Finally, she asks me to extend my hand, and attaches to my wrist a paper bracelet with my data. Now I’m branded, and won’t be confused with other patients, so no worries about the wrong thing being cut off. The registrar invites us to sit and wait until I am called.

-          “Please, take your seats and wait, you will be called.”

We say goodbye to her and wish each other a pleasant day.

-          “Have a nice day.”

 

The registration is located in the waiting room. We took our seats, removed our coats and jackets and prepared for a long wait. I look at the others sitting here. I’m amazed by the calmness of the people going under the knife. Of course, they are not going to die, they are risking their lives for their future health and prolonging of their lives.

Of those who participated in the pre-operational session, I was the only one who was undergoing an operation for the replacement of two valves, everyone else was getting bypass surgery. Judging by these ratios, based on age and difficulty of the operation, I’m subjected to the greatest risk of everyone sitting here.

Tanya calms me by saying to me:

-          “Everything will be fine, Dr. Glenn is a good surgeon, you’ll hold out fine, many have undergone such surgeries, and everything went successfully.”

 

I’m not feeling worried, just a kind of pressure that I may have missed something vital. I may worry and panic ahead of a looming danger, but when it comes I begin to relax and concentrate. I think this comes from my confidence, which remains from my youth, when I didn’t believe anything bad could ever happen.

 

In this case it was useless to worry; there was nothing left that was under my control. This thought calmed me. I said to everyone:

-          “Don’s sit here all day, go home, get some sleep, come back in 6 hours. You won’t know anything sooner anyway.”

 

I wasn’t boasting, I would really have felt better if they went home. I understood that if they stayed here, they would be nervous, waiting for news, and will be very tired. This caused me to worry for them, especially for Tanya. Maybe outside the walls of the hospital they will be able to clear their heads. A different atmosphere will distract them from the thoughts of the operation.

Both of them refuse categorically.

-          “We aren’t going anywhere, and will be here with you; maybe we’ll need to give blood or some other assistance. We don’t want to risk it.”

I suggest to them to go outside, to breathe fresh, not hospital air, to eat something in the cafeteria.

-          “Just don’t sit near the surgical room the whole time.”

-          “First we will wait for Vic, he’ll be here soon, when he gets here we’ll decide.”

 

We didn't have to wait long, soon the nurse appeared with a list of names in her hand, and began calling out the victims. I was called last. I leave my coat and hat with Tanya and follow at the end of the line to another facility to familiarize myself with the operation and with how its conducted in this hospital.

There are 10-12 of us in a large room, maybe even a hall, with two rows of beds lined up along two long side walls. Each bed is blocked of from the next one with a thick curtain.

Along the rows a nurse walks along and explains what must be done.

Remove your clothes and shoes, place them in the polyethylene bags. Two bags are for clothes and shoes; the third is for your outerwear, which you took off in the waiting room. It will be brought by your relatives, when the come to see you.

She points to the bags, neatly folded on a stand near the bed. As she leaves she closes the curtain and gives one more order:

Fold your clothes and put on the robe, first the one which ties at the front, on top of it the one which ties at the back.

The robes prepared in advance are on the bed.

I followed the instructions of the nurse, including that for the robes, which proved to be reliable clothing.

I open the curtain and wait on the bed, waiting for the next instructions. I observe how quickly and precisely the staff actions, with a strong accordance to their functions in the order of the hospital.

Across from me sits an elderly woman, perhaps from Sri Lanka, next to her is a man embracing her shoulders, maybe her son. She appears as if from an old photograph, taken from the start of the last century. Both are still, and look directly at me. She differs from others with her immovable expectation. It seems she is worried, and watching me busily pack my belongings into the bags calms her down.

Being in a situation of a massively organized procedure, preparing for surgery, with tense individuals who no longer belong to themselves, reminds one of a scene in a movie taking place at an interrogative institution. This imaginary situation lowers the fighting spirit, for only a brief moment. I quickly remove all unpleasant thoughts. That we ourselves are undergoing a risky operation, the behaviors towards us by the personnel does not warrant such a comparison.

At the same time, I'm thinking that different cabins for changing, similar to those which exist in all laboratories, would give a different impression of this operation, and wouldn't elicit feelings of fear before a massive sending off to the surgical room.

Everyone waits for the accompanying relatives, who must pick up their clothes. Many have already arrived, but mine still haven't.

Nurse approaches with a file, apparently mine, and begins to verify all of my information. She read everything out loud, and I had to confirm the accuracy.

There were no mistakes. Now I'm completely certain that I won't be mistaken and will undergo the right operation.

 

The groups of relatives come in carrying the outerwear of the patients, and rush to the appropriate boxes. Tanya and Misha appear. They surprised me too, and approach me. Tanya hugs and kisses me, she's on the verge of tears, but keeps her composure and calms me.

-          Don't worry, everything will be fine.

We hug and kiss.

A stretcher is brought out. It's for me. I'm skillfully laid on it. I turn around and see Tanya and Misha, standing with bags of my clothes, watching as I wave and am carried away.

The way to the other wing of the building with the surgical room goes through long corridors. The nurse is moving so quickly that I don't have time to read any of the signs on the walls. Everything looks as if everyone is in a hurry. But I'm not in a hurry. I began thinking that this is my last path to nowhere. My attitude is more uplifted rather than sad. I'm thoroughly determined to live, because I can not leave my dear Tanya a widow. My sons are already burdened with their own families and their own problems, and it will be easier for them to endure my absence.

We stopped in a bright corridor; on the left are windows, on the right doors, looks like the surgical room. In the windows, the starting sunrise is visible. I'm sure as ever that this will not be the last sunrise I see. Between the entrances I see a long row of stretchers with other victims prepared for their operations. Again I'm visited by the thoughts that everything is out of my hands, my life lies in the hands of people who are going to repair my heart.

Now everything depends on their professionalism, state of mind, mood, and many other factors that I'm not aware of. I remind myself that I'm going into the operation willingly, and am fully confident in Dr. Glenn's mastery and leadership.

I'm lying in the corridor, waiting and guessing, which door leads to my surgical room. Here I don't feel rushed. A young, pleasant nurse gives me a friendly smile and takes my hand to check the data on my wristband. It's funny; she's already the third to do so. I decide to check as well.

-          “Who is my surgeon? Dr. Glenn? Is he?”

-          “Yes, he is, don't worry, your surgeon is Dr. Glenn.”

With a smile she assures me that it won't hurt, as she inserts a shot filled with blue liquid into my vein. Without removing the needle, she affixes it with a bandage for future injections. I didn't know then, that this needle would be with me for my entire time at the hospital.

Next everything happened just like in a movie, I've seen these scenes in many different movies. I was taken into the surgical room, I didn't notice which door. Then, from what I remembered, I was surrounded by people in light green coats, skillfully transferred me onto the surgical table, removed the robe over my chest, covered with a sheet, I saw above me a large lamp, and passed out.

 

Someone told me before the operation:

-          “For some time you will find yourself in the “other world. What do you think you'll see there? ”

If I remembered who it was, I would have disappointed him. Maybe I did visit another world while my heart was turned off, but I honestly did not see anything, and nothing was imprinted in my memory.

Tanya later told me, that she, Misha and Vic waited in the waiting room for about 7 hours. Misha took a picture on his cell phone camera – it was after all an historic moment for our family.

Finally emerged a very tired Dr. Glenn, apparently right from the surgical table. He remembered Tanya, as we visited him together relatively recently. He understood that she was there with our sons, and addressed everyone.

-            “The operation was successful; it lasted 6 hours and 30 minutes. He is now stable. The surgery was done on time, as the aortal valve was in very bad shape, and the mitral valve only slightly better. There is one more leaking valve, but it is too much of a risk to repair 3 valves at once. Especially since this defect isn't dangerous.”

Tanya rushed towards him, wanting to kiss him, but regained herself and shook his hand with both of hers.

As per the house rules of Sunnybrook Hospital, relatives may visit a patient in reanimation two hours after the operation. Here a nurse sits next to the patient and watches the readings on all his vital signs for 24 hours. I think that nurses take shifts of 4-6 hours. That would have been the right way, but how its done in reality I still don't know.

Only two people may visit and only for 5 minutes.

Two hours passed, and my relatives were permitted to see me. Only two were allowed. Tanya and Misha entered. I remember nothing of how their visit went; remember only from the words of my family.

I lay in the last box. To reach me, you had to pass by every curtained off boxes with post-surgical patients from yesterday and today. I laid immobile, with closed eyes, covered in catheters and chords, attached to random machines. It wasn't a sight for the lighthearted, and it scared and bothered Tanya. She nearly burst out crying, she knelt next to me, began to kiss me and whisper:

-        “I love you so much; you know how much I love you.”

Maybe I heard this and came to. Just as in sentimental romance movies, from my eye I shed a single manly tear. Misha also cried, petted me, and asked if I was in pain, I have shaken my head to answer: - “no.”

As Tanya was telling me, she was amazed by the array of machines to which I was attached with a mass of chords. It felt as if being inside a space ship. The machines continuously monitor the functioning of my heart, and create the impression that I remain alive only with their help. Of course this was scary for my family. But they were relieved by the presence of the nurse, who was constantly watching the machines.

 I was told that I relatively quickly came off the drugs. But my state of reanimation I remember very, very vaguely. All that I remember is what is left in my memory from the recollections of my family and the staff there.

I remember the face of the nurse, leaning over me, with a full smile:

-        “Well, squeeze my hand” she said, I stumbled, but squeezed.”

This heroic effort returned me to life. It's possible that I squeezed her hand fairly hard, which means that I still had some strength, and can consider that I survived.

My ability to do this energized me, and excited the nurse.

-            “In my experience, I've never met a patient who after such a long surgery and narcosis could squeeze a hand after only two hours.”

It must be said, what happened next, I don't remember.

According to my family, they spent just over 5 minutes with me, then assured that I was under the constant observation of the nurse, went home, and I continued to slowly return to life.

Misha sent a short account of the visit to friends and family:

Dear all,

We have good news: we visited Vitali/papa in reanimation and found him in a much better condition than expected, not at all gray or cold. Although he was sleepy and barely opened his eyes, he nodded a few times (in response to questions in English and Russian), letting us and the nurse with the appropriate name Leto (In Russian it means Summer) that he wasn't in pain. He continues to breath from the apparatus, but the data for his blood and heart are fine. After talking to the nurse on the phone 5 minutes ago, she confirmed that he remains in the same state: he's moving his hands, sleeps, and occasionally wakes up to nod to the nurse Leto. There is no pain. We are planning to visit him tomorrow at 10 am to be present during the doctor’s examination. Tomorrow it will be determined if he will be transferred to a general ward. Mama/Tatiana is preparing for the visit with chicken soup and various enlivening foods.

Thank you so much for your phone calls and e-mails.

Until tomorrow,

Misha

To avoid unnecessary phone calls Misha continued sending out emails with news of my condition for the entire 10 days he's been with us.

The project “operation” was completed successfully. Now I had to continue living.

Post-surgical observation

I'm writing about the events a month after the operation, when the acuteness of my senses has returned, bolstered by the happy awareness that the scariest part is behind me. I can now more consciously and thoughtfully write about that which really worries me. However, I don't want to appear like an ungrateful person, who received a second life at the hands of a surgeon, a life which was preserved by a highly skilled and professional team of wonderful people. I'm eternally grateful to all of them, and am impressed by their responsible and tireless effort. That which I've seen, and my comments related to this are evoked by my great desire to help remove the shortcomings noted by me in the health system, which is important not just for patients, but maybe more importantly for doctors as well.

My viewpoint of what happened to me before and after the operation, is not of course the viewpoint of a medic. But I am after all, a user of the medical system, and I hope that my experience and my impressions with regards to this system will be interesting for medics as well.

-            “You know what worried me a lot when we went into the reanimation to see you” - Tanya told me, when I was already in a different ward,- “we were permitted to not take off our outside clothes. I noticed there were other people in coats and jackets. Everyone is walking around without white robes and with outdoor shoes.”

Although me and Tanya have long ago left the former Soviet Union, we are still not accustomed to the Canadian system of health care, with which we became acquainted here in Toronto, and unwillingly continue to compare it to that which we had in the USSR.

We still remember the hygienic rules which were strictly enforced when visiting a Soviet hospital. An amazing coincidence (although this happened to me more than once), but today, March 23^rd, as I'm writing these words, there was an announcement over CBC Radio, and a day before on the CBC website, with the following headline: “Poor hospital cleaning revealed as major problem.” The sub-headline read: “Some hospitals are a real freaking disaster.” The article talks about patients who once entering a hospital catch other infections, which lead to complications or death. Among the most common infections is c. difficile. Statistics provide the following numbers: more than 250,000 hospital patients are infected each year.  More than 12,000 of them die yearly. It's the highest rate of incidence among developed nations.

This is talking about just the cleaning up of the facilities, expenditures for which have been cut by 15%. It's easiest to talk just about the clean up, because it can be described in concrete numbers. In reality, the overall hygienic culture, and accordingly, the procedure for visitation leave one wanting more.  I think that Dr. Glenn would be highly upset if, having performed a successful surgery, his patient would not survive due to complications as a result of infection.

Why is it permitted to visit a patient who has just undergone an operation, and is therefore in a weakened state, and more susceptible to infection, without proper hygienic precautions? This question arises as soon as you enter the hospital.

In the mind of a person from the former USSR, a hospital is a closed facility, wherein entrance is allowed only with special permission and a special pass. Inside the hospital one had to wear a white robe.

To imagine a doctor at work without a white robe was impossible.

 At one point there was a very popular book by Gleb Samoilov, titled “People in White Robes”, it was a romanticized novel about the people of this noble profession.

A white robe symbolized in our consciousness a doctor, and the entire medical profession. At concerts and on the radio there often played a song written by a famous Soviet composer Eduard Kolmanovski, based on the poem by Lev Oshanin:

“Death does not wish to pity the beautiful,

Nor the happy, the angry, the winged,

But standing in its way,

People in white robes,

People in white robes,

Once again in it's way...”

Canadian doctors don't have symbols like the white robe. Even if doctors are written about, then a few small articles will be dedicated to their successes, but mostly they are criticized, often when the doctors are not at fault, but indeed the healthcare system within which they are working is. There are always plenty of reasons for critique.

The procedure for visiting patients is determined by the organization providing in-care to the patients. It's of course a very humane act with regards to the family, allowing them the assurance in the success of the operation and rehabilitation process. The patient also requires live interaction with family, not through a glass window as is the case during registration. It's also understandable that giving hospital robes to visitors will greatly increase the spending budget of the hospital, although precautionary measures such as providing robes and masks can very well be covered with extra fees. Anyone will pay a reasonable sum to avoid infecting their loved one. In all this would not only cover the hospital expenditures, but may even bring a decent profit.

This is simply my reasoning, stemming from the desire to not catch any dangerous infection. For me likely all infections are dangerous right now.

My interest in the hygienic culture of Canadian hospitals stems from the fact that I am currently developing a computer system with my colleagues (I will talk about it more detail in the last chapter), the implementation of which in the field of medicine will facilitate not only healing, but also the service provided to patients. The latter refers also to the visitations by friends and family.

The singular healthcare system proposed by us for utilization by all health facilities in Canada would verify each potential visitor according to their health history, confirming they are free of all illnesses which could pose a risk to other patients. After this inspection, which would only take a few seconds, it may be possible to restrict access to the patient ward for visitors carrying an infection. This inspection, along with the issuance of robes, masks, hand disinfectant and hygienic clean-up would significantly increase the culture of hospital service.

By the way, there is a fairly large fee for using the parking lot. In this case the safety of the automobile is insured. Is it really more important that the safety of the patient, to whom such efforts and resources have already been expanded?

D3 Communications Board

A few years ago I already had experience being under a general anesthetic during a short operation, lasting less than an hour. At that time I quickly came to, seeming in less than an hour. This time I began coming off the anesthesia after 2 hours, and slowly began comprehending my surroundings.  The stay in reanimation usually lasts about 24 hours. I was transferred to the department of therapy D3 Communications Board after only 18 hours. Seemingly I had fully regained my consciousness by that point, although it's said, that the aftereffects of the narcosis can remain for a period of several months.

I'm feeling a sense of security in my condition, and am full of gratitude to the surgical team, most and foremost to Dr. Glenn. I'm certain that he did everything brilliantly.

I had no prior expectation about how I would be taken care of in D3. But it was clear that recovering after such an operation can only be possible under very good care and attention.

In the former USSR free healthcare was one of the main industries of the national economy, in Canada; healthcare is also free and is defined as an industry. I don't see any difference therein. In both cases they are expenditures of the nation's economy. The product of the medical industry is the healed patient. As in any “production”, experiments are preformed, and defects are permitted, when healing a patient is not possible. The technological projects of the workings of the industry, include all of its institutions, and determine the quality of the healing process and its result.

“Post-operation therapy” is the second, after the surgical operation, determining component of the healing process. I can not analyze what happens during to my operation, although it's something I would be very interested in, but I will attempt to document the therapy stage of my experience.

I remember complains, of the similar to Dr. Glenn high level surgeons in Russia:

-            “We are able to perform the most complicated operations, but we can not provide proper treatment for the operated patient, there isn't enough qualified medical staff, medicine, equipment, materials, etc.”

I did not physically feel the operation, although I understand that it was extremely difficult for all those involved: myself, the surgeon and his assistants. I'm sincerely grateful to all of them, but especially filled with feelings of gratitude to Dr. Glenn, upon whose mastery my life depended. I really want to thank him immediately. I thought about in mind, what would be the most appropriate and memorable gift for him. I wanted it to be something from me directly, something that I made. I decided that I still had time, and I had to think carefully and choose something that he would like.

Thinking that surgery is necessary and very important, but is only the first step in the process of healing, establishes my patience. Ahead there is still a long and accountable process of rehabilitation, in which the main role is played by the medical personnel, but also depends on me. When transferred to D3 Communications Board, I was already fully conscious and adequately perceived all that was occurring around me. I was moved to a room for 3, a box that was closest to the door and the toilet, and placed on the bed in the box, the other two boxes were already occupied.

Soon my family arrived. Vic doesn't like that my room is small, and my box is dark. The proximity to the toilet was also disapproved. I think he correctly reasoned that, I am too sick to be in this environment, and that my comfort is also an important healing factor. He said he will ask for them to move me to a 2 person room. This turned out to be not so cheap; it cost 240 dollars per day. I try to protest, after all the difference is just one person. But Vic persists:

-            “Never mind it. It's my affair. The operation costs maybe more than 30 thousand, we're not paying for it, and we're not going to spare 1.5-2 thousand.”

After a while he came with two nurses, who very quickly and as it seemed to me very eagerly transferred my bed to a room for two people. Perhaps it's easier for them to do their job when there are fewer patients to a room.

In the new room, besides me, there is no one else yet.

The room is large, and my box is next to the window. For me, daylight and the ability to see nature, that which enters a space, visually enlarging it, are very important. The new, seemingly better environment, immediately has a positive psychological effect on me. This feeling became an important factor in sustaining my positive attitude during my entire stay at the hospital.

The neighboring box is larger, as it's attached from both sides to fairly wide passageways. It is already reserved for someone who, seemingly had health insurance giving the right to staying in a 1 or 2 person room. The toilet is not far from the entrance to the room. In front of it is a sink, built into a wide table with a marble covering, and an outlet for an electric shaver and other electronic grooming devices.

I was really hoping that I would have a chance to interact with the surgeon, who performed on me such a complicated operation. This thought accompanied me for my entire stay at the hospital. I wanted him to supervise my ongoing rehabilitation. I imagined he would come to me and say something along the lines of that he spoke to my family about the operation. Contact with the person who sliced open my heart, would for me be very important, beneficial and interesting. But it didn't happen, because he didn't know about my wish.

A doctor's assistant who would be responsible for my rehabilitation appeared. Her name was Caitlyn; she was energetic, busy, pleasant, and looked Russian. She asked me:

-        “Do you remember how many days it has been since your operation?”

I answer:

-        “Two days”

-        “No, only one.”

She told me to sit up for a little. I felt very weak, and also could feel an onset of arrhythmia.

 

It seems I wasn't yet freed of all the catheters (only the one in my mouth was removed), also remained the oxygen tube, and to the chords on my chest was attached a mobile monitor, a device the size of about 15 by 8 cm, transmitting data to a central processing unit, maintained by the nurse. On the other side I had a pacemaker attached, which would turn on if the speed of my pulse dropped below 40 bps. So far this has not happened.

It turns out that immediately after the operation my pulse was 180, and only when I underwent therapy in reanimation was it lowered to 115-120.

The process of coming back to life was not easy. At night I started getting heavy thoughts, as if I wasn't prepared for what had happened:

 

“What did they do to me? They attached a foreign object to my heart. In order for it to stick, I have to conquer my weakness and endure unknown to me procedures. Will I have the strength and patience for all of this?”

Analysis, pills, injections all begin immediately, and are performed strictly according to schedule, quickly and precisely. Everything really appears like a thoroughly developed technological process, in which the main function of taking care of me is performed by the nurses.

My first nurse is Jocelyn, an immigrant from the Philippines. She is larger than most Philippines women I have met, but no less mobile and agile. As I found out, a “personal” nurse like her takes care of 4 patients during a day shift, and 6 patients during a night shift.

Jocelyn brought a diagnostic apparatus, placed on a mobile stand. With its help she measures my blood pressure, pulse, blood oxidation levels, body temperature, all of this four times per day, at a strictly determined time. She writes down the data in my file every time. Once per day she does an ECG. Blood for analysis is taken by other nurses.

Just as strictly, by schedule, Jocelyn brings me pills, water and gives me injections.

Everything that is happening around me, is felt by me, as a well rehearsed play. Here it is especially evident that “The world is a theater, and we are all actors”. It would have been better if I was just watching this play, not playing an active part in it. The medical personnel thoroughly fulfill their functions: in predetermined time they clean the room, bring trays with food, etc.

The personnel are very ethnically diverse. Most of the nurses are immigrants from Asian countries, including China, Thailand and Indonesia, some are also from Europe. Everyone is very courteous, patient and caring. Maybe if I wasn't an immigrant from the former USSR, perhaps I wouldn't have noticed it, stemming from not knowing that it could be different. But I have very far from pleasant recollections about the hospital system, especially of nurses, from my country of origin. The differences present themselves constantly.

When my mom was placed in a prestigious 32^nd Olympics Hospital in Moscow (based on acquaintance with the ambulance), especially built for the Moscow Olympics in 1980, she spent two days in the hallway before she was put in a room. When I saw her in this room, where without any dividers, on hard metal bunks she lay with at least 20 other women, I wanted to return her back to the hallway.

In the morning, instead of saying “Good morning, dear women”, a nurse entered and proclaimed with a harsh voice:

-            “Come on you broads, get up and make your bunks, do you think someone is going to do it for you?”

 

On the third day my mom developed gangrene, she underwent an urgent operation for it, and she died from it two days later.

 

On my bed there is a remote control, which I can use to raise and lower the mattress at my head and feet, to get the most comfortable position. There was also a button to call the nurse. Jocelyn told me right away about this button:

-          “If you feel bad, or if there is anything you need, press this button and I will come right away.”

I can't get my poor mother out of my head.

 

 When I was brought into my room, on my bed there was already a bright red pillow in the form of a heart. It is a present from the hospital to those, who endured a cardiac operation. It was very nice. I had to press it to my chest if I had a cough. I wouldn't let go of it, like a child with a doll. It was constantly on my bed, and came with me when I left the hospital.

Having been assured that I'm well placed in my new surroundings, and that I'm being well taken care of, my relatives left to let me relax and not to interfere with the personnel.

On the wall in front of me hangs a board, with all my vital signs entered on to it. Every nurse that comes for her shift in the morning enters her name and date, Katelyn and the physiotherapists leave their instructions for the nurses on it.

The first day in D3 is spent half asleep, interrupted occasionally by the visiting nurse. Three times a day they bring me food, and as many times clear the empty dishes. My snoozing smoothly changes to a night dream, which I really want to talk about before it evaporates from my memory. Seemingly, it was brought about by my worries, which I didn't really recognize, so they manifested themselves in a short, but strongly felt by my dream. Everything seemed so bright, as if I really took part in all the events that came to me in the dream.

They say that after difficult operations people often have nightmares. I experienced something similar. As I was falling asleep, in my head there persisted a continuous thought: “no way out”. It repeated itself many times, drowning out other thoughts. It was as if these words detached themselves from a full phrase, which spun around in my head: “No way out, the operation is inevitable, it has to be done”. Evidently this was the vocalization of my previous doubts.”

I imagined that the words “No way out” could be the title of a film. In my mind there already appeared separate scenes of an already written and realized story. In the movie there are no real actors, they are guessed the quality of energy, which they attempt to direct towards me, themselves being clots of some sort of energy. The individuality of the actors is determined by strength and the specifics of the sound effects which accompany their destructive actions.

It feels as if I'm watching a fantastic action movie, about dark powers having escaped the depth of the Earth, wanting only to wreak destruction. It's a cruel and scary movie in which I play a main role. There are no human casualties, but only the inevitable destruction of massive, heavy duty structures. I didn't however feel any fear, I simply new that, although someone kept telling me that there is “no way out”, I will find it. While my impressions have not cooled off, I'll think about it and try to retell this dream-movie.

“In my dream I clearly hear the words “no way out!” - spoken firmly and authoritatively. It feels as if I'm the one saying them, and the more often I say them, the stronger the feeling that I have to find him, he has to exist. I begin slowly moving in the direction, where I can disprove those words and find an exit. I'm slowly moving among giant, formless, multicolored shards of concrete blocks sticking out from the ground in all directions. The gray-blue, gray-pink, gray-black tones of cement heaps prevail among the rest. At first everything is quiet, there are no sounds, but as I approach, the blocks explode with unimaginable power. This is someone trying to block my path. I change my direction, moving towards stronger walls, which appear to me to be sturdier, but as I approach, there are even stronger explosions, and giant pillars of fire. It's now someone else trying to attack me, but so far my power is stronger. The explosions don't harm me.

I move through the piles of shards, and each time I try to change my path to find an exit, the same thing happens: explosions, fire, hail of falling stones, lightning and destruction, and the whole time I hear in my head the evil “no way out!”.It continues for a while, in many variants, I search for an exit, I feel within me an unimaginable strength, and fearlessly move forward. But with my every attempt to find him, some new, more destructive than before power, blocks my way to escape with even stronger explosions with various colorful effects and destruction.

In the end, before me appears a clot of energy with unimaginable strength, which engulfs all the other powers. They can't free themselves from it. This mighty energy is also set against me and wants to destroy me. And here, “I” stand before it. My energy is much stronger, and as I approach, everything explodes. I free all the other energies; they have already lost their destructive tendencies. I feel they slowly escape to freedom, because the overall tension around me lessens. I fill with pride, knowing that I have a lot of power, a lot of energy, which nothing can oppose, nothing can block my way out. The way out is found!”

This calms me; I fall asleep, and have no more dreams.

I think this dream would be interesting for a psychologist.

In the morning my first visitor is a thick, above average height, handsome man of Asian descent, seemingly a resident doctor. He looks over my stitches, feet, listens to me, asks about my digestion, says that I'm well on my way to recovery, the leaves, holding under his arm a notebook.

Then a nurse comes in with a portable scale, and with a very strict and businesslike appearance tells me to get up from the bed and stand on the scale. My weight was 72.3 kg, which meant I lost about 6 kg. She writes down the number on a carefully folded paper, and hides it in her pocket. Seems that later she has to enter this data into my computer file. I notice that all the nurses write the results of their analysis on these papers. The should be writing in down into observation notepads, but I haven't seen any of the nurses with them. Before the background of high-tech diagnostic tools surrounding me, this method of data entry appears archaic. I think that in these cases it would be best to implement a wireless connection with a central computer, as is taken into account in our computer system, about which I wrote earlier, as similar methods for medical implementation are already in existence.

I'm very happy to see Jocelyn in the morning, she will be with me on this day, February 23^rd as well. As far as taking care of me, her shifts fell on the two most difficult days, but she did everything tactfully, gently, caringly and very professionally, causing me absolutely no discomfort.

 

Tanya and Misha arrived in the morning, unfortunately a little after the doctors’ inspection, which they were planning to see. The doctors inspection consisted of Kathleen inspecting the place of the cut, and being satisfied checking for edema of the legs.

The sight of my feet surprised Kathleen.

-            “Look”she said to Jocelyn with Kathleen excitement,  

-            “He has the feet of a 16 year old youth”.

 

Misha asked her about the results of the two days of recovery, and wrote everything down in his iPod. He will then send the results by email along with my photo to the entire “support group”, and will send out again, each time he has new information about my recovery.

I told Kathleen that Misha is our house doctor and psychologist, and that he spent a few years in Sunnybrook Hospital, but for 3 years now is living in Victoria.

Misha immediately became for her a colleague, which changed her attitude towards him. Permeated with respect for Misha, Kathleen wanted to know more about all of us, especially when and from where we came to Canada. These are the most common questions that Canadians usually ask each other. Having learned that we are from Russia, she tried to remember the few English words she had learned from previous patients. Misha decided to add his own contribution to her education, and said that translated into Russian her name Kathleen would sound like “Katya – Katyusha”, and that there is a song with that title, and that during the war soldiers affectionately refereed by this name to mortar rockets which helped win the war. She laughed:

-        “I am a Russian missile!”

The name “Katyusha” stuck with her, and me and Misha continued calling her that during every encounter. She was very pleased; she liked the sound of it in Russian. In general, she liked the sound of Russian conversation.

 

A nurse comes in and takes blood for analysis. After her, Jocelyn brings a stand with an apparatus and attaches a chord to my finger. I can see on the screen that my blood pressure is fine, blood oxygen levels are plentiful, but my heart is beating too fast – 112 beats per minute.

Then she brings breakfast, and so, all day long someone is engaged with taking care of me.

The most active one around me is Jocelyn, she is constantly asking about my wellbeing. After Kathleen removed the attached catheters, leaving only the oxygen one, she carefully turns me over, sponges me with warm water and changes the linen. In the second half of the day a physiotherapists comes to see me, she looks like Kelly, and her name is Kelly, but she's a different Kelly. She made me stand up and walk with a walker to the toilet. I was able to do it fairly easily. She wrote down on a chart on the wall, how much I should walk down the hallway each day.

A roommate was brought in. An elderly man of 89 years, very thin, from which he appeared to be very small. He had hip surgery performed at another hospital, but he had heart complications, and was brought to the cardiac department of Sunnybrook. He was feeling very bad, and was moaning. Unfortunately it was difficult to find out anything about him, or explain anything in English, as he only knew a few words, just slang. His native language is Italian, but amongst the medical personnel there was no one who spoke or understood Italian. Jocelyn and one other nurse fussed around him in full disarray. Misha also tried to help them, it turned out he knew a few everyday Italian words, which he picked up during his short stay in Italy 3 years ago. But none of it was enough. With the exception of “pi-pi”, he couldn't understand anything.

The situation improved when, in the second part of the day his family arrived, two sons, who spoke both languages, and an elderly woman, perhaps his wife, who also did not speak English. Along with the nurses they worked out what was going on with him, and what he wanted.

However, at night he could not sleep, he kept moaning, and he couldn't find the call button, so I had to several times call the nurse for him.

My night was ruined, I barely slept.

On the morning of the 24^th, on the third day, I decided to walk to the toilet on my own. I was brought a walker, to which I attached my monitor and cardio-stimulator. I must have been a very entertaining sight, like a person returning from another world adapting to life on Earth. Actually, that's exactly what it was like.

I wash up, exit the toilet holding on the walker, and see Dr Glenn waiting for me. I think my appearance, with my half fastened patient coat, naked legs and chords extending to the walker elicited a smile from him.

-        “You are doing very well”– he cheered me on.

Not being prepared to speak to him, I answered only:

-        “This is only thanks to you.”

My obvious embarrassment, weakness and unrepresentable appearance did not dispose him for a lengthy talk. He began to hurry, wished me well and quickly left. I regretted that he didn't come while I was in bed. Perhaps our talk wouldn't have been so brief. I think that my reply was fairly correct. I awaited this encounter, I wanted to thank him, but was only able to do it rather awkwardly.

Lying in bed I began analyzing our “talk”, and began to think that my response may have had two meanings for him. On hand, it seemed I was expressing to him my gratitude for a well performed operation, but on the other hand, I seemingly blamed him, because he agreed to do the operation that transformed me into a sick, weak and helpless man. As for that I adapt well to healing, is perhaps my achievement, and the achievement of the medical personnel taking care of me. I thoroughly tried to think of another short version of the answer, and not finding anything better, decided to prepare a speech for the next encounter, which I might even write down on paper.

Inside I feel that I believe in my surgeon, and that he performed everything excellently. This belief in the necessity of the operation, correctly chosen hospital and surgeon, give me the strength to heal further, fulfill all instructions and obey those who work hard to heal me.

Perhaps this kind of conviction is necessary for everyone. My Tanya also has it – she believes in me and in what I do. This gives us both the strength to overcome the inevitable obstacles that life has for us.

Today the nurse on duty has the same name as my wife – Tanya (I hope I don't mix them up in my current condition!). Tanya is a middle aged woman, an immigrant from Russia, but as I learned later, she lived in Israel and came to Canada in 2007.

I feel her Israeli and Canadian training is very thorough, caring, and with attention to details.

I was brought breakfast, but unfortunately this food isn't for me. I don't eat corn flakes with cold milk. My stomach does not digest them well, therefore my family doctor, Dr. Beltof, ordered me to take lactic pills with all dairy products.

With my food I'm brought a list-menu, where I must indicate what I want to eat the following day. I'm still not able to do this myself, so this list will have to wait the arrival of my family.

Tanya and Misha arrived soon. They brought with them, amongst other things, a porridge made by Misha from the grain “Chia”. Misha assures me that it increases energy and strengthens one's immunity.  It has at least one positive effect – with it, food that is under-salted tastes better. 

I ate very little hospital food, but Misha is already sending everyone the message that I have begun eating solid food. And why not? After all, my digestive system was not touched by the operation. Although it wouldn't have hurt to improve it.

So that the next day they don't need to bring me food from home, I show Misha the menu, and he helps me to fill it out. They didn't stay long, as Misha has a meeting with old friends in the afternoon.

After a bad night I want to sleep, but I'm not allowed to. First arrives the physiotherapists, the smiling Kelly. She took me for a walk along the corridor. I'm feeling very weak, but manage 100 meters with a walker. She prescribed to walk by myself or with a nurse, and left.

My Italian neighbor continues to cause problems for everyone, not allowing the nurse to leave him.

Before going to sleep Tanya called me and wished me a good night, she's waiting for Misha.

I lie there and think about what to occupy myself with. I listened to a little bit of music on Misha's MP3 player.

To improve my mood, I start remembering difficult events in my life which I've had to endure. After all I survived them. It raised my hope that I will deal with this adversity too. The assured and calm behavior of the medical personnel was evidence that that there is nothing to worry about. With this I fell asleep.

 

to be continued.

Translated from Russian by Elijah Guitberg