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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WHY CAN’T NURSES RUN THE SHOW?

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Last week I reblogged Josephine Ensign’s Radical Hat-Burning Nurses Unite! because I was moved watching the Politics of Caring. The video, released in 1977, showed in Ensign’s words, “how little things have changed.” Nurses then were striking and joining unions in order to have “control over their jobs” and to promote safe and good nursing care. Ensign mentioned that some nurses, and I was one, left hospital nursing by becoming nurse practitioners or community nurses so they could enjoy autonomy not afforded in hospital nursing.massnurse5

In the 70s a friend of mine who already had a master’s degree in history and two school-aged children entered nursing school. After graduation, she worked only a year in a hospital, “paying her dues,” before she left for a desk job at an insurance company. She found the discrepancy between the culture and promise of nursing education and the reality of nursing practice—poor pay, lack of autonomy and hours that she had no control over—unacceptable.

Also at this time, I had quit my job at a small community hospital south of Chicago when I discovered that a new grad received the same starting salary as I. She was assigned a seasoned nurse to mentor her for her first few months of employment—among other experiences she lacked, she had never inserted a Foley cath in nursing school—while I went directly to the medical intensive care unit. I wrote in my resignation letter that I felt this unfair. The Director of Nursing called me at home pressuring me to reconsider but didn’t offer me an increase in salary. I didn’t go back.

Instead, I found a job in a nursing home that paid me more. A nurse who lived in the community ran the home and many of the residents came from the surrounding area. Most of the staff had been there for years. I loved working there and it was probably the reason I later specialized in geriatrics.

Even though I had sworn not to work in a hospital again, I found myself on a neurology unit when I was in graduate school in-between semesters in the late 70s. I wrote a story about the experience (“Invisible.” Examined Life Journal, 2.1 Fall 2012:55-60.). While I was helping one of my patients get ready to go home, I realized she was still ill. I had the skills to diagnose her congestive heart failure but I didn’t have the power to delay her discharge. I had to call her doctor and tell him I thought she shouldn’t be sent home. It was the first time I deliberately avoided playing the old doctor-nurse game, which would be to suggest he some how was responsible for this decision. My intervention did delay her discharge so she could be treated, possibly preventing readmission and maybe even saving her life. What I did was something any nurse could have done. How many times do bedside nurses who know the patient best see signs of trouble coming and alert the doctors? But we rarely call attention to ourselves. And when the patient gets better and leaves the hospital who does the family think has made all the difference—the doctors.

Getting back to that nursing home run by a nurse.

I have always played with the vision of nurses being in charge of a hospital and where doctors were the employees. I don’t have all the details worked out in my reverie but my hospital would let patients sleep at night without disruption for vital signs, lower noise levels in corridors, schedule tests around the circadian rhythm of the patients, imagesserve tasteful, nutritious food and post prices of procedures and surgeries so patients would know what costs were attached to their care up front. No health professional (read doctors) would be allowed to throw a temper tantrum or refuse to follow infection control precautions.

The “Nurse Hospital” wouldn’t have a nursing shortage. Why wouldn’t nurses want to work in an institution where they are appreciated and well paid and are included in decisions that affect their practice? And why wouldn’t patients want to be in a safe, patient-centered environment? Nurses wouldn’t need to join unions to have control over their practice and provide good patient care.

Things would change.