PRIMARY CARE PROVIDER: MD OR NP?

13080945-farmers-marketMy husband and I moved to Raleigh four months ago. Yesterday, I went to the Farmers Market for the first time. It had opened just the week before. It was more eclectic than I imagined. Besides spring onions, sweet potatoes, a bunch of radishes, strawberries and a baguette from the stand of a local French bakery, I commissioned, for ten dollars, a cloth purse that would hang from my neck and hold my cell phone, and I got the name of a female health provider.

I was happy I didn’t buy more produce than I could reasonably cook. I love nothing more than talking with the farmers about various ways to deal with, to me, an unfamiliar vegetable only to have it sit, forgotten and rotting, in the refrigerator.19826120-fresh-produce-on-sale-at-the-local-farmers-market

At one stall in the market, a woman was selling handmade cell phone cases along with drawstring cloth purses. At the airport on our way to Costa Rica in February, I watched an older woman pull out her cell phone from a small purse that hung about her neck. What a practical way to have a cell phone handy when you haven’t pockets in your slacks but you do have a family that worries when you don’t answer their multiple calls. Only later do they find out you couldn’t hear your cell phone left in the kitchen because you were upstairs in your office. Together, the woman and I designed a Velcro sealed pouch that will hang around my neck or over my shoulder like a handbag. I’ll pick it up next Saturday.

Next, I noted a stall with the sign: “Duke Raleigh Hospital.” Duke sponsors the market. A young woman sat at a table with stacks of brochures. My husband and I hadn’t, as yet, found local health care services.

“We live just a few blocks away from the hospital,“ I said to the woman. “Is there an outpatient clinic there? I need a new provider, preferable a female.”

The young woman smiled. “Yes, there is a clinic. In fact, I go there and see Mary Smith (not her real name). I just love her.” She continued to tell me how wonderful Mary Smith was as she searched for a pen to write down Mary Smith’s name and phone number. She handed me the card, which also had the Duke website for further information.

When I went home, I unpacked the produce, told my husband about the solution to the cell phone issue and that I had the name of a new provider. Upstairs in my office, I checked the Duke web site. I clicked the link “Doctors“ and there was Mary Smith. But she wasn’t a doctor—she was a nurse practitioner. She was listed among other NPs and physicians.

I sat for a moment appreciating the immensity of this: that NPs were listed along with MDs, therefore allowing patients to choose either as their primary provider. Knowing how some physicians still try to limit advanced nursing practice, here was a site, at a major teaching hospital yet, that treated both equally. And the young woman who gave me Mary Smith’s name never thought to clarify that Mary was an NP, not a doctor. How refreshing.

Then the reality set in. Why I didn’t think my primary provider could be an NP? Was it because I had seen a physician for the past fifteen years? However, I was a retired NP. I had my own patients, albeit in collaboration with a physician. I had been in the trenches during my long career fighting against limitation of the NP role and dominance by medical organizations. I promote the contribution that nursing makes to health care. I support the independent role of the NP.

I was appalled at my sudden amnesia.

PICTURE OF NP

While I try to explain this lapse, I’ll call the clinic to find out if Mary Smith is accepting new patients.

CANDICE BERGEN, MURPHY BROWN AND ME

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On the front of The Arts section of the New York Times this past week was a picture of Candice Bergen. Candice BergenOlder (aren’t we all?) but still lovely even carrying thirty extra pounds. Making no excuses for the weight gain, she says, “I live to eat.” (I can relate to that.) She had written a memoir, her second, which is titled: A Fine Romance.

Candice Bergen played a television reporter in the situation comedy, Murphy Brown, from 1988 to 1998. I loved this show and watched it faithfully. The show resonated with me. Murphy Brown, an independent, smart and tough woman, was in control of her life and took responsibly for her actions. I wanted to live next door to her.

But it was when Murphy Brown was diagnosed with breast cancer the same time as me in October 1997 that I felt a simpatico relationship. As you know, October is Breast Cancer Awareness Month—did the Murphy Brown producers do this intentionally? th-1I wasn’t the only one fixated on Murphy’s cancer—“The show’s handling of the subject was credited with a thirty-percent increase in the number of women getting mammograms.”

One night, I remember sitting in the burgundy recliner with Mittens, our cat, on my lap, in front of the TV watching Murphy deal with her diagnosis. Murphy was shocked and secretive at first, as was I. In that show, she was being carted around in a wheelchair (I think she was being discharged from the hospital) And I don’t know why at that moment she decided not to keep the diagnosis to herself. What I do remember so vividly was that she was stopping people who passed her in the hallway of the hospital, telling them that she had breast cancer. You can imagine the blank look on some faces and on some, fright as if saying, “Let me get away from this lady ASAP.” I nearly fell out of the recliner laughing.

The next day at work I began to share my bad news. I told one of the administrative assistants as she walked out of her office that I was just diagnosed with breast cancer without any preamble. Her face showed a mixture of fright and surprise as I moved on not waiting for her to respond. Later that evening I chuckled at myself.

Thanks Murphy Brown for giving me a reason to laugh many times but especially at a dark moment in my life.

Thank you, Candice Bergen, for ignoring your thirty-pound weight gain in spite of Hollywood’s “beauty standards” and good luck with your new memoir.

NURSE PRACTITIONER VERSUS PHYSICIAN’S ASSISTANT

Marianna Crane:

tmpAdapted from a post first blogged on May 27, 2012.

Originally posted on Marianna Crane: nursing stories:

Last week in a restaurant in Lyon, France, my tablemate turned toward me and asked, “What’s the difference between a nurse practitioner and a physician assistant.”Lyon

My husband and I were on a tour. Our traveling buddies consisted of older folks like ourselves. The woman knew I was a retired NP and had told me she frequently saw either an NP or PA when she went for routine medical appointments. She was satisfied with either but didn’t know the difference.

I became an NP in the early 80s and worked in Chicago when NPs were trying to expand our practice by gaining prescription privileges. We were much maligned by the traditional medical establishment. “If nurses want to act like doctors, let them go to medical school” or something to that effect seemed to be the mantra of the American Medical Association. (Both the AMA and the Illinois Medical Association…

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IT DOESN’T LOOK LIKE MUCH

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Last Saturday, toward the end of a daylong workshop, Carol Henderson, our leader, gave the last prompt. Where is home?

However, knowing we only had a few minutes left, I believe we seven women wanted to share our appreciation with Carol, and with Mamie Potter who hosted the event, before we left.

That prompt fell to the floor, unnoticed.

Afterward, maybe some of the others came back to visit the prompt and, like me, to mull over its meaning. I can hear Carol say, “It means what ever you think it means.”

I’m glad I didn’t write that day about “where is home.” I’m glad I didn’t hear anyone else’s take on it. I glad I didn’t write any cerebral philosophical theory that may have moved my pen knowing I was writing for an audience.

As thoughts of home drifted into my consciousness the following week, I found myself looking for a picture I had taken of an apartment where I had lived from the age of two to twenty-two.

Back in July, 2009, I visited Summit Avenue in Jersey City with my Aunt Anna. (I have already written about her.)

When we drove by, I attempted to take a picture. There just wasn’t a moment when a passing car didn’t obstruct the house. Because of heavy traffic I needed to keep moving. As usual, parking places were scarce. I gave up after circling the block four times.

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It doesn’t look like much. It’s the house on the right, 262—the middle apartment. The gate in front of the stairs was recently added. That gate would have limited the flow of social activity that took place on the concrete steps whenever the weather cooperated. Many of my memories of home when I was growing up happened on the front steps.

On the steps:

 I listened silently at age eight to the neighborhood women as they sat on the steps and talked of childbirth, raising their family and problems with their husbands.

little kids sat while I told spooky stories until the streetlights went on and we all had to go home.

the boy next door knelt on one knee and asked me to marry him when we both were in the third grade.

I walked shoeless from July to September.

my first date gave me my first kiss when I was sixteen.

I trekked on my way to my room to sleep in the mornings after working the night shift at the Jersey City Medical Center around the block.

my husband-to-be didn’t kiss me after our first date.

I know the steps aren’t a home, but they hold pleasant remembrances of growing up.That’s as close to a definition of where is home to me.

LIFE IS A CRAPSHOOT

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As we sat finishing our lunch at a roadside restaurant on our way to the Rainforest in Sarapiqui, Costa Rica, my tablemate said, “It’s all a crapshoot.” MAP OF COSTA RICA

We had been talking about the aging process. She uttered the same term I had been using ever since my husband and I bought a two-story town house rather than an apartment in a continuing care community. The practicality of the choice began to weigh on me soon after moving in the middle of December when I came down with “walking pneumonia” following a bout with the flu. Two weeks later, I fell on a wet floor in a department store. I lacerated the side of my face, therefore, making the second trip to Urgent Care within two weeks.

Thoughts of my personal vulnerability and the volatility of Mother Nature began to circulate in my head. How timely that we had planned this trip to Costa Rica months ago? And fortuitously, I was getting some validation from another older woman that aging isn’t a downhill trip to infirmity. Plus, observing the other 15 travelers slowly tore apart my misconceptions. (Our ages ranged from 63 to 80. The average was 71 one year younger than I.)

The day after my conversation about life being a crapshoot, I had planned to go white-water rafting for the first time. The rapids were a class three. How rough was that, I wondered knowing that the range went up to a five. But still . . .

I woke up the next morning to a thundering rain. This was the Rainforest after all. Would the rafting trip be called off?

Well, no.

Pushing myself to go, I put on a bathing suit, brim hat, a semi-waterproof jacket—which took three days to finally dry out—and Keens. Ten of us showed. After brief instructions, we donned life jackets and helmets and were each handed a paddle and assigned seats in the inflatable raft. Heavy rain pelted us as we followed directions from our guide. “Row” “Stop.” “Down.” “Down” was the scariest. I can still see the raft rushing toward a thick tree trunk extending over the river. The leaves from the tree swept across my face as I hunched on the floor of the boat.WHITEWATER RAFTING

We rose up and dropped down and spun around in the white-capped waves. We dodged rocks. Once, when we slammed into a wall of water, I unintentionally shrieked into the noise of the rain and river. During the river’s calm moments, our guide pointed out the birds and reptiles that watched us from the trees and shore.

THE RAFTING PARTYHalfway into our trip, we beached our rafts, shared a pineapple and watermelon snack and posed for a group picture. (I am fourth from the right) The outing ended all too soon.

As I, along with the others, hiked back to the hotel in the rain, we congratulated ourselves on not falling out of the raft. I felt tired but exhilarated. Tossing aside feelings of fragility had made room for experiencing the challenges and excitement of life.

Yes, life is a crapshoot.

Celebrating Forty Years of Friendship

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Marianna Crane:

Thanks Lois for describing our week with such vivid detail. However you did omit the decadent chocolate cake with peanut butter mousse filling we had at the Hayes Barton Cafe and Dessertery.

Originally posted on Ramblings by a Retired Nurse (in Chicago):

Proverbs 18:26 Friends come and friends go, but a true friend sticks by you like family.

FullSizeRenderReaders of Caring Lessons know I was desperate to find a friend when I was in my early thirties, someone like me, a nurse and mom who wanted to go back to school.

That friend turned out to be Marianna.

I met her on the first day of a required course to complete a bachelor’s degree in nursing. In the interim, we’ve raised our kids, completed advanced degrees, taught and/or practiced nursing, retired, and moved to different cities, but have worked at staying connected, including seeing each other in person at least once a year.

We held our annual meeting last week.

We never need an occasion to celebrate, but it helps. When Marianna asked if I’d like to splurge on a spa day, I pondered a bit and figured out we had an…

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SO WHAT’S NOSTALGIZING?

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Nostalgizing is a new word for me. I discovered it in a New York Times article: Tierney, John. What Is Nostalgia Good For? Quite a Bit, Research Shows. The New York Times, 8 July, 2013.

I needed to re-read the essay for reassurance that feelings of nostalgia I’ve been experiencing with some frequency could very well be positive. (The Oxford dictionary defines nostalgia as a sentimental longing or wistful affection for the past.)

Just the other day, I made the trip from my new home in Raleigh to Chapel Hill where we used to live, about half an hour away, to meet a friend for lunch. We moved three months ago, yet as I walked up the steps to the restaurant, memories flooded my mind. I recalled that I had sat at one of the outside wooden benches with a writer consultant that helped me put together a proposal for a grant I didn’t get. How enthusiastic I had been. And once an acquaintance stopped me in front of the counter with coffee carafes to tell me she enjoyed an essay I had published in the local newspaper—the closest I ever came to having a fan club.

When I left the restaurant, I felt a pull to return to my old home, to be back where the grandkids visited us in that tree-lined cul-de-sac. They graduated from babbling in strollers to riding tricycles, to skate boards and on to bicycles. They made friends with the neighbors’ children. Of course, I see them more often after our move since we live a lot closer but those remembrances doggedly follow me.

Tierney’s essay describes the work of Constantine Sedikides’, Professor of Social and Personality Psychology, a pioneer in the study of nostalgia. Sedikides’ findings show that nostalgia is a way of thinking about the past. “ . . . topics are universal—reminiscences about friends and family members, holidays, weddings, songs, sunsets, lakes. The stories tend to feature the self as the protagonist surrounded by close friends.”

“Nostalgic stories aren’t simple exercises in cheeriness, though. The memories aren’t all happy, and even the joys are mixed with a wistful sense of loss. But on the whole, the positive elements greatly outnumber the negative elements . . .”

Some positive outcomes of nostalgizing include feeling less lonely or depressed, “having stronger feelings of belonging and affiliation,” and becoming “more generous toward others.”

I was reassured when I read that nostalgizing increases with age and “helps us deal with transitions.”

An old friend is coming to visit. Our first houseguest. She is especially flexible, thank goodness, since our new home is in a state of disruption. I look forward to showing her around the neighborhood and the city. But what I am really looking forward to is our trips down memory lane covering 40 years of friendship. We will be nostalgizing together.

Afterthought: I have kept a short essay by Robert Oren Butler since 1994 that moves me every time I read it.

 Nostalgia by Robert Olen Butler

“A wistful or excessively sentimental yearning for return to some real or romanticized period or irrecoverable condition in the past . . .”

When the word came into common usage in America in the early nineteenth century, nostalgia, a sickness for home, was considered a form of insanity. This is not a surprising attitude for a new country driven to explore, to expand, to push on to a far sea—even at times conquering and dispossessing others in search of a new place. Now, after nearly two centuries have passed, we have settled into a sort of national middle age and nostalgia has become a cultural virtue. Golden-oldies radio stations and movie remakes, Elvis stamps and classic cars, the moral certitudes of the Gulf War and of Family Values: We have now institutionalized the backward look, the moist eye for where we’ve been.

But for me, nostalgia is this: When I was studying the Vietnamese language in an Army school in Arlington, Virginia, my teacher was a young Vietnamese woman who had come to America for the love of an American soldier. It was 1970 and she had grown up near the ancient city of Hue with the sounds of war thumping and chattering through most of her childhood like the angry ghosts of the tales her mother told. She was happy with her man here, happy with her job, happy with the televisions and the rock ‘n’ roll and the frozen foods and with her Ford Mustang convertible and with the night sky that would flare only with lightning. But when the sunset came and they fired the ceremonial cannon over at Fort Myer, she would weep. The sound of cannon fire made her think about Hue, and she would grow sick with yearning for home.

Self, January 1994.th-1

 

THE FALL

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I entered a large department store on a rainy Sunday two weeks ago. My foot hit a slick spot and I became airborne. You know that awful feeling when you’re going down and there is nothing you can do about it. I drifted in slow motion closer and closer to a display table, finally making contact with my right temple, surely breaking the skin. My glasses flew off my face. I landed on the ground, half sitting and half lying. The two men who had been looking at clothing—this was the men’s department—when I first walked in started to run toward me. They could have been father and son.

“Are you alright,” the dad said.

“Let me help you up,” the young one said.

By that time I had grabbed a wad of tissues stored my jacket pocket and slapped them on the side of my head, pressing hard. I knew the laceration would bleed profusely. Thank goodness I had tissues in my pocket ready for an episode of coughing. I was recovering from a mild case of walking pneumonia.

“No, I’ll sit here a while,” I said as I reached over to retrieve my glasses. They weren’t damaged.

The nurse in me did a quick assessment. Nothing hurt. In spite of feeling a little shaky from the surprise of the accident, I was oriented and felt in control.

I pulled the tissues away from my face. They were soaked with blood. I could feel the stream of blood oozing down my skin. I quickly put the pressure back on.

“I’ll get help,” the older man said and hobbled down the long aisle. The younger fellow stood guard beside me. If we made small talk I don’t remember. In short order, two women with department store nametags rushed up to me.

Did I want an ambulance? Of course not. What I wanted was that this had never happened and get on my way looking for a pair of slippers.

I asked for some ice and time to think about what to do.

One of the women moved the jeans that were folded neatly on the display table that just damaged my face, making space for me to sit while I pondered my dilemma.

I took a selfie picture of my wound. There was no denying it would need attention. I called my husband to schlep me to yet another Urgent Care facility.

This would be my second trip to Urgent Care in less then two weeks.

Christmas Eve, after a bout of coughing and shortness of breath, I decided to head to an Urgent Care to forestall any problems I might face over the Christmas holiday. My daughter drove me to the closest one. Did I mention how I hate to admit I’m sick? I am the ultimate denier that anything is wrong. Is this a nursing trait?

The two Urgent Care units were vastly different. The one I went to on Christmas Eve was a clean, well-lighted facility with a couple of adjoining waiting rooms with comfortable chairs. A nurse introduced herself, asked what was wrong and if I had allergies and some other pertinent information that I had already put on the four pages of admitting paperwork. The repetition was reassuring. And the doctor was attentive and sat down to talk with my daughter and me as if he had all the time in the world. Both the nurse and doctor washed their hands in the sink in the room before touching me.

When we left, the receptionist wished me a speedy recovery.

The Urgent Care I went to the day I fell—nearest to the department store—had a bleak and dreary waiting room with white washed walls, scruffy linoleum and metal folding chairs. After filling out one page of admitting info, I was called into a room. The physician’s assistant came promptly and introduced herself but didn’t wash her hands or put on gloves before she touched my laceration.

“Glue,” she said. “The nurse will get your vital signs.” She left.

A young man in blue scrubs motioned to me from the hall to follow him and had me sit next to a exam table where he rolled up my sweater sleeve, took my blood pressure, stuck a thermometer under my tongue and a pulse ox clip on my finger with minimal words and no eye contact. When he sat on a chair at the end of the table to jot down the numbers, I asked his name and if he were the nurse. He was. He didn’t wash his hands either.

Oh, how I wanted to step into my long ago role of nursing instructor and berate him for not identifying himself or washing his hands. And I didn’t say anything later when the PA came back and put on gloves without washing her hands first before she proceeded to glue me up. I figured I wasn’t having brain surgery and just wanted to have my cut sealed so the bleeding would stop and I could go home.

After she was done, she stood by the exam table where I still reclined and ticked off what complications to watch out for. No smile, no handshake and she was gone. The receptionist told me I could go home.

What a contrast in Urgent Care facilities. I could bemoan my behavior at not speaking up at the last one. But you know, I really don’t care because I never want to visit another Urgent Care center again.

PERSISTENCE

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In 2014, I finished my memoir.

In spite of myself, I persisted and finished.

Ten years ago, I left a full time nurse practitioner job and began to write in earnest. The book I just birthed is not the one I started then. It has been configured many times: moving chapters, changing tenses from past to present and back to past again, deleting some stories and adding others. I went through seven titles.

I recognize now that I did everything to prolong that actual moment when I would let the book go. But then 2014 came along. A busy year of interviewing realtors, decluttering our old home, making improvements to increase the potential for the house to sell. And sell it did—quickly.images-3

Somewhere in the midst of all this, I managed to keep writing, gave the manuscript to two more beta-readers and hired a line-by-line editor. And even settled on a title.

How do I explain my success? First I think I was so busy with the distractions of selling and buying homes that I forgot to further undermine the completion of my book and second, some inner determination took hold.

It’s now that I remember a quote I long ago ripped out of a magazine and saved over the years. When I find the yellowed page, I will frame it and hang it on the wall of my new office.

In the meantime, I googled the quote for you.

Nothing in this world can take the place of persistence. Talent will not: nothing is more common than unsuccessful men with talent. Genius will not; unrewarded genius is almost a proverb. Education will not; the world is full of educated derelicts. Persistence and determination alone are omnipotent.

Calvin Coolidge

I have made only one New Year resolution: to keep up my persistence and determination in getting published.

May the New Year hold many pleasant, surprising moments for you.

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TAKING THE BUS

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My husband and I will move into in our new Raleigh town house at the end of the week. Part of the reason for our move, besides being nearer to the grandchildren, is that we want more of a city life. Our last house, in a lovely forested neighborhood, was tranquil and isolated. We needed a car to go anywhere. We were happy to discover that a city bus passes by our new development.

I haven’t taken a bus in years.

I grew up in Jersey City where, as children, my best friend, Carol, and I would hop on the bus—any bus—and ride it to the end of the line and back. I think the fare was nine cents. The bus drivers had coin dispensers

Coin Dispenser

Coin Dispenser

to give us change and then we would drop the correct amount in the fare box.

Fare Box

Fare Box

At least that’s what I remember happened back then. Later, we used tokens.

Carol and I felt independent and adventurous. We never told our mothers.

In other cities where I lived, I took mass transportation, not only buses but more frequently trains:

Chicago El

Chicago El

the El in Chicago and the

Metro in the greater Washington DC area,

DC Metro

DC Metro

and on frequent visits to NYC, the subway.

NYC subway

NYC subway

What a liberating feeling not to depend on a car.

I have a brochure of the Capital Area Transit (cat) bus route. The bus starts from the northern part of Raleigh, passes our home and turns south toward the city. Seniors ride free. I plan to call my friend, Carol, who lives a suburb not far from our new home. (How’s that for serendipity?) I’m sure she will be excited to join me on an adventurous bus ride.

And we won’t tell our mothers.

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