Before EMS, before nursing, physical therapy pulled me into the medical field. I was going to Fresno State, taking physical therapy classes and got hired at a district hospital as a rehabilitation aide. This district had a hospital, a rehabilitation facility, a transitional care, a large gym and mental health campuses. As a per diem aide, I went to everything, minus mental health. Most of my time was the rehab facility. Every once in a while I would be sent to the “big house” which was the main hospital. I was young, eager and wanted to learn. The critical care physical therapist (PT) liked that. Most of my assignments were to just follow him. As he was leading me to one of our first patients together, he was also trying to get me lost in the back corridors from our office to the ICU. (At the end of the day I was expected to somehow find my way back alone. But for now, we will see the heart patients.)

This hospital performed many open-heart surgeries. OHS is what you see in their medical records. A common OSH is a coronary artery bypass graft, or CABG. We would call those cabbages. Our hearts have a complex arrangement of blood vessels. If too many get clogged, the heart dies and the patient dies. We try to open up the arteries as least invasively as possible, via a cath lab by means of stenting.  But cases where the stents fail, where they are too blocked, or other reasons, they have a bypass. The patient goes to surgery, has their chest opened, their sternum and ribs cut, and their pericardial sack opened, exposing the heart. A large vein, usually a vein in the leg (saphenous), is harvested from the patient’s body and grafted into the heart to return blood flow and save the patient. It is a big surgery. It is a long surgery. I got to stand in one of these during nursing school. It is brutal to watch. The patient comes out with staples in their chest. It looks like a zipper.  

As a new rehabilitation aide, I knew nothing of a CABG. The PT told me we were going to see a "status post CABG" patient and get her up.  He gave a long talk about how the patients’ outcomes improve the sooner we move them. And I wasn’t drinking the Kool_aide. These people have had open heart surgery and PT is going to get them up just hours later? Don’t they get a break? Can’t we just let them have a day off? Surely they have earned it! I walk into this large command center, surrounded with large rooms. Patients in every one of these rooms. There are ventilators, tubes, beeping noises. It is a jungle of equipment and seriousness. Two rooms were reserved for post operations. We go and look at the chart. There is an old lady. And I mean old. She is in her 90s, probably mid-90s. She just had heart surgery. Wait, a 90-something-year-old getting heart surgery? Isn’t this a little late in the game to be doing massive surgeries? And my PT agrees with me. But age be damned, we will get her up. 

I follow into the room. She is lying there on a gigantic gurney with a large pressure reducing air mattress. She is grey. I think she might be dead. There is a monitor in the corner, with a blood pressure, a heart rate, etc. For the life of me, I don’t remember those numbers. Her nurse is standing there, covered in a blue plastic sheet tied backward and a face mask. She and my PT are talking about things above my pay grade. I go to her bedside. When I said grey, I meant it. She wasn’t pale. She was grey. She had short white hair. Very thick for mid-90s. Her skin was soft and supple. I brushed her cheek and she cracked her eyes open to look at me. She was still intubated. That tube looked so uncomfortable. She also had two larger tubes on her upper belly that were draining large amounts of pink fluid. Later, I would find out that those were two tubes reaching under the rib cage and draining fluid around the heart. There were IVs and ECG leads taped everywhere.

My PT started to talk to her. We were going to put her in a chair and sit her up…. What? wait…. you are joking, right? I think she gave him the same look I was giving him. I thought we were going to make her do some arm and leg exercises in bed, like the PTs on the orthopedic floor and go on our merry way. No, we were moving this lady from her air-o-bed to a chair. A chair! And I'm thinking it's a folding chair you can purchase at Costco. I was scared. The nurse didn’t react to our news. I wanted her to advocate for this patient. LET HER BE! But instead, the nurse was charting and touching buttons on the IV pumps. Our patient just nods her head yes and closes her eyes. She looked too exhausted to oppose our request, which didn’t sound like a request. I start to look at my PT as a drill sergeant in a movie. Opening her eyes looked like a chore. How are we going to get the pasta of lines and tubes around to a chair? We raise the bed and pushed a button to deflate it. The PT walks away and comes back with this monstrosity of a chair. It is pink. It is padded. There are handles everywhere. He lowers the side rail to the chair and pulls out a hidden crank. As he turns it, the chair reclines flat. There is also a foot pedal to pump the chair the same height as the bed. By the time this is done, the air is almost completely deflated from the mattress. The PT explains to the patient, we are doing all the work. She has had her chest ripped open. She can’t push or pull more than 5 pounds. Her rib cage is essentially broken and held together by wires.

They gave her a heart shaped pillow that has the anatomy of the blood vessels and a heart on it. The surgeons signed the pillow with a sharpie and drew on the arteries that had been grafted. Her job is to hug this pillow when she moves, or when she coughs or sneezes. She wraps the pillow, we have the nurse, the PT, a respiratory therapist, another nurse and me, the newbie aide to use a slide board to move her to the chair. The PT reminds me to watch all the lines and go slow. I was on high alert and we slide her over. The nurses were like ninja octopuses with all the lines. It was so efficient. We use the cranks to sit her up. she is pretty uncomfortable. I go to grab her hand. She is short. I can tell by her stubby fingers. I can also tell she has rheumatoid arthritis. Her knuckles are so deformed. My best friend’s mother had this problem. But this patient’s hands were the worst I have ever seen. I hold her hand and look at her exhausted, grey face. She isn’t tolerating the chair well. We have to quickly move her back, with all of her equipment. The chest tube and collection tray attached to low suction, the vent tube and machine, all the IV lines. I was so scared I would pull something out. But we got her back. They called the doctor and he went in. It was our time to exit. I remember telling my parents after I got home that I almost watched a lady die. That night, I replayed her face and the grayness. I was sure she wouldn’t make it.

I got a bit of a reprieve from the main campus. I had much to learn at the rehabilitation hospital. That place was amazing. The services offered 3 hours of therapy a day. We had numerous physical therapists, occupational therapists, speech therapists, nurses and a pharmacist on staff. We saw heart patients, orthopedic patients, strokes, spinal cord injuries, you name it. I learned how to lead groups and I even was allowed to do one-on-one therapies under the supervision of a PT. Typically we would have two patient’s on one large mat and I would get the patient who is getting close to discharge and assist with treatments. My supervisors spoke highly of me and the clinicians were so helpful giving me advice. And I got to see these patients progress. So that was fun. One day, I was chatting with a patient. We will call her Abigail. She had heart surgery. She was so much fun. She was retired for years. Her best friend was her grandson. They both were super short and lived together. They did everything together. He helped her walk around the park yesterday. And she was excited that she was going to get to go home and watch him play video games. She showed me her pillow and talked about her amazing doctors and her stay in the hospital. “It was a rough few first weeks. They thought I wasn’t going to make it. But I have my best friend and I still want to look after him.” She got a little choked up and raised up a tissue with her little hands to wipe her tears from her eyes. Her fingers were so bent, she saw I noticed: “It is my RA. They used to be so much prettier. I had to quit playing the piano.” I looked at her hands, again. I knew them immediately. They were the hands of my first ICU patient. I touched them, they were pink, warm and full of life. 

“How old are you Abby?” 

[Giggles] “I just turn 96. Can you imagine they did surgery on me?” 

She hugged her pillow and logged rolled to a seated position. “Want to see what I can do?” She leaned forward and sat up quicker than I could. “I will race you!” she called and was walking around that whole gym. I stood in amazement. Once grey and mistaken for dead, she is now full of vim and vigor. Her grandson meets her on our way back, she gives him a huge hug. I went back to the office, and in amazement knew that medicine was my forever career.

Our bodies are amazing.