INVISIBLE Part 1 of 3

“Invisible,” by Marianna Crane, originally appeared in the Examined Life Journal.

 

 

The cardinal rule of the game is that open disagreement between the players must be avoided at all costs. Thus, the nurse must communicate her recommendations (to the physician) without appearing to be making a recommendation statement. – - – The greater the significance of the recommendation, the more subtly the game must be played.

- 1967, Leonard I. Stein, M.D.

 

 

I left my patient, Ms. O, dozing in her hospital bed. Heading towards the nursing station, I clenched and unclenched my fists, steeling myself to make a call I didn’t want to make.

When I first ambled into Ms. O’s private room that morning, she was sitting up in bed with a breakfast tray in front of her. Her knobby fingers put down a half eaten slice of toast. The eggs and sausage were untouched.

“I’m done. I just want to keep the coffee.” I removed the tray and slid it onto the food cart standing in the hallway. Back in the room, I noticed a stale, musty odor. Sunlight filtered through the only window highlighting Ms. O’s greasy and matted hair. “How about washing up?” I said.

Ms. O’s pale face lit up with a smile. “I’d just love a shower.”

“Sure. Finish your coffee while I get the linens.”

It was the summer of 1980. I had just completed the first year of a two-year master’s degree program in nursing. I had taken this part-time job, working a couple of days a week, in a small community hospital near my home. When classes started back up, I figured, I would juggle being a full-time student with doing what I loved—caring for patients.

Outside of Ms. O’s room, my arms laden with sheets, towels and a hospital gown, I was aware of a tall man as he breezed by me, his copious belly encased in a dark suit. Over his shoulder he shouted back into Ms. O’s room, “See you in my office next week.”

“My doctor just told me I’m going home today,” Ms. O said, as I unfolded the fresh towels. Her chuckle, which trickled up her throat, exploded into a racking cough. When the episode was over, she sank back into her pillow, breathing deeply. Had her doctor heard that cough? He couldn’t have been in her room more than a minute or two.

“Are you okay?” I asked. The night nurse had recorded that Ms. O slept well and hadn’t indicated any problems. Ms. O gave me half a smile but didn’t speak.

“Well,” I said, “let’s get you up, showered and dressed.”

Pushing off the covers, Ms. O inched her legs toward the edge of the bed until they dangled over the side. Her bony hand pulled on my arm as she swiveled to a sitting position. This effort set off another coughing fit. What’s going on here?“How long have you had that cough?”

“A couple of days. Seems to have gotten worse.”

Bending down, I pressed the skin over her thick ankle. My finger left a half-moon print on her leg.

“Do you usually have swelling in your legs?”

Ms. O glanced down. “No.”

“Who will be home with you?”

“I live alone.”

Something wasn’t right. I pulled out my Littmann stethoscope, a gift to myself after successfully completing the last class of the semester: physical assessment. In that course, my fellow nurse practitioner students and I learned how to take a patient’s history. We used each other to hone our diagnostic skills: we probed bellies with our fingers, placed stethoscopes over lungs, and tapped elbows and knees with a rubber hammer. We hadn’t practiced on patients yet. Instead, we listened to tapes in the computer lab of heart valves leaking, lungs wheezing and large intestines gurgling.

“I want listen to your lungs.” With my hand on Ms. O’s shoulder, I nudged her forward and placed my stethoscope on her scrawny back. What filled my ears were not the same clear blowing reverberations of my classmates’ young, disease-free air passages. What was I hearing? Rales? Rhonchi? Wheezing? The names of abnormal sounds jumbled in my head. “Cough, please,” I said, trying to sound like I had done this for years. We had learned that semester that coughing would clear mucus from airways, resulting in normal breath sounds. After coughing, Ms. O’s lungs were still waterlogged. I straightened up and pocketed my stethoscope.

Ms. O interrupted my thoughts. “I need to go to the bathroom.”

I didn’t like the pasty color of her face or the way her chest rose and fell with each breath. Better she stayed in bed. “Let me get you a bedpan.”

After helping her lie back, I raised her hips and slipped a blue plastic bedpan under her bottom. When I retrieved the bedpan a few minutes later, it was empty.

THERE ARE SOME PATIENTS WE NEVER FORGET

01/29/2012 BY MARIANNA CRANE

When you have been a nurse as long as I have there are patients who take residence in your memories and resurface frequently. They could almost be family except they have a short history in your life. What they were like before or after you knew them usually remains a mystery.

Mr. G was a cantankerous, legally blind, brittle diabetic I had taken care of in the late 80’s. His house was the worst on the block: paint peeling off the frame, rickety wooden stairs and overgrown weeds. Thankfully he lived close to the police station because I had to drive there one day when Mr. G didn’t answer the door. He was convulsing on the floor as I peered through the window. I had to beg the police to break down the basement door to enter because Mr. G often complained to me how many times they had axed into the front door and how expensive it was to repair. He frequently had hypoglycemic reactions.

Mr. G. gave himself insulin injections using low vision equipment to measure out the dose. His much younger wife worked full time, leaving him lunch, usually a sandwich, piece of fruit and a drink on the dining room table. He had confided in me that he thought she was having an affair with her boss. Having an active imagination (I’m a writer aren’t I?), I wondered if his wife was trying to kill him. Maybe the house, inside and out, was in deliberate disarray leading to a potential life-threatening accident. I don’t remember the other scenarios I entertained as I drove to and from his home.

When I left my job to move to another state, my friend, co-worker and fellow nurse practitioner, Jane Van De Velde, took over his care. He died on her watch. She recently emailed me with remembrances about him.

“But I really remember his memorial service. It was so touching, all the people who attended and spoke so highly of him. I was literally brought to tears. I got up and spoke about how wonderful it was to see another side of someone–the strong, healthy, community-involved and well-respected side. We saw him at end of life when he was so very ill and depressed and visually impaired.”

Jane adds, “There are some patients we never forget.”

Amen

MOVING

My husband and I are planning to move from our home of 14 years to be closer to the grandkids. I’m looking forward to our new life but I’m dreading the shedding. Our last two moves were compliments of my husband’s employer so we didn’t have an incentive to discard our “treasures.” I still have my record collection of 331/3, Vinyl record45 and 78’s (some of you younger readers haven’t a clue what I am writing about). Now that I know I can find any song by any artist on Spotify, giving them up won’t be difficult, especially since I don’t even own a record player.

After my mother died a decade ago, I had one suitcase and a cardboard box with all her belongings that I collected from the nursing home. In our attic I still had her pots and pans, silverware, dishes, cookbooks from the 1920s, an afghan she crocheted, a framed picture of the Black Madonna,

Black Madonna

Black Madonna

and a prayer book written in Polish.

My son is coming to visit over the weekend. He doesn’t know it yet, but he will leave with a box packed with a blue case holding his Hot Wheels collection; Morgan, a tattered white long-eared dog; a story he wrote in the 5th grade about his hamster, Squeaky, and pictures he drew of the family when he was three. What he does with these treasures I don’t want to know.

Morgan

Morgan

I had given my daughter a similar box last year. I haven’t heard any comment from her but I can imagine with a husband, a job and three boys to take to soccer, baseball and football practice and swimming lessons, she put the box in storage with thoughts to look through it when she had a moment to herself. However, after she placed the valuable objects I had brought by the stairs to her basement, she reached in and grabbed the stuffed animal I safeguarded over 40 years and said “This isn’t Pookey!”

In anticipation of cleaning out the attic, I have fortified myself to donate, recycle, re-gift and responsibly discard some of the stuff we have taken with us in the past two moves.

Except maybe for the old nurses’ cape with the red lining that my son put on when he was a superhero one Halloween.nurse's cape

Patty, me and Sherry

Patty, me and Sherry

WHAT JOURNALING WILL DO

It’s a coincidence that I wrote the last entry in my journal on February 28 at the same time I finished my book. Well, my book is not finished-finished but it’s getting its final editing—by a professional content editor—as I compose this post.

journalI have been using a 5-subject wide-rule notebook every morning to put down whatever wanders into my head ever since I decided two years ago I would FINISH THIS BOOK! Daily notations first thing in the morning, something akin to morning pages suggested by Julia Cameron in her book The Artist’s Way, have kept me primed to write.ARTIST'S WAY

And it’s a coincidence that when I started this particular journal on April 4, 2013 I had just received feedback from four beta-readers. In between the first and last journal entry, I have incorporated the changes they suggested and made edits based on feedback from two more beta readers and, later yet, made changes suggested by another two readers. Whee!

Besides acting on feedback from beta-readers, I spent time in May at a writers-in-residence at Weymouth Center Weymouthand attended a writers’ retreat at Wild Acres in September and, of course, kept my pen moving on the pages of my journal each morning.

wild acres -

Get yourself a notebook and begin to journal daily. Who knows what you will accomplish!

A Physician Finally Gets Nursing

Marianna Crane:

I couldn’t write better coverage about Dr. Arnold Relman’s comments about nursing, so I’m reblogging this Post. The comments he made are both “good” and “bad.” Good: Dr. Relman, physician and former editor of the New England Journal of Medicine, stated “When nursing is not optimal, patient care is never good.” Bad: Dr. Relman finally recognized this at age 90!
This just reinforces my belief that nurses need to make themselves more visible (see my post “I was the only one.” )

Originally posted on Off the Charts:

RelmanArticleCaptureBy Shawn Kennedy, editor-in-chief

Earlier this month, the New York Review of Books published an article by a patient who described his hospital stay following a life-threatening accident. This was no ordinary patient—the author, Arnold Relman, is a noted physician, emeritus professor of medicine at Harvard, a former editor of the New England Journal of Medicine, and along with his wife Marcia Angell, well known as a critic of the “medical–industrial complex.” His account is very detailed and gives a good example of how it can look when the system works (and when one has access to it).

His understanding of his condition and treatment, his knowledge of the system, and also his relative prominence as an individual, all undoubtedly helped him avoid some pitfalls and make a remarkable full recovery. However, as a number of others have pointed out recently, one comment in his account was surprising.

In reflecting…

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Out of the Shadows by Marianna Crane

Out of the Shadows by Marianna Crane

Marianna Crane:

Wrote this for ElderChicks yesterday.

Originally posted on ElderChicks:

Writing I love reading all the ElderChick posts by women my age. Such a varied, interesting and involved group. Many are writing memoirs as I am and if we all get published just think what an education we are giving the rest of society! No more “invisible” older women!

Ten years ago, right after I retired as a nurse practitioner, I began to take my “hobby” of writing seriously. I have been lucky to get some of my stories published. My memoir about my nursing career is almost completed. Now I am learning about the rapidly changing aspects of publication.

I am grateful for my energy, health and curiosity that permits me to enjoy this season of my life. (Feel free to visit my blog at http://nursingstories.org/).

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FMM 1 17 14 Self-Efficacy

Marianna Crane:

I am enjoying a break this Sunday from posting. As of 5 p.m. I finished editing my book before sending it off for a professional evaluation.
Hope you enjoy reading Self-Efficacy as much as I did.

Originally posted on Friday Morning Messages:

Live as if you were living a second time, and as though you had acted wrongly the first time.”~ Viktor E. Frankl

Studies show that you can predict a person’s ability to change a habit by the degree to which they believe in their ability to change.  Self-efficacy is the term given to that belief in your own capabilities.  Many people go on a diet without truly believing that they are going to lose weight, in fact they often expect to put it back on.  How can we succeed at anything when we doubt ourselves?  And how do those doubts get planted in our brains?

There is a whole industry dedicated to affirmations, those daily positive sayings that are designed to inspire you, that tell you of your abilities, your beauty and your worth.  There are bookshelves full of self-help books that have capitalized on the knowledge that…

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