Patients Change Us: A Formative Nursing Experience — Off the Charts

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From boliston, via Flickr Many years ago, I was given the greatest gift by a patient who had no idea he would change my life and define my professional outlook as a nurse. While not every nurse will be fortunate enough to have such an explicit experience of the effect of the care they provide…

via Patients Change Us: A Formative Nursing Experience — Off the Charts

The Surreal Hospital Experience

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My husband was discharged from the hospital following two heart valve replacements, and a week later was readmitted with a side effect of the surgery that occurs ten percent of the time. He was taken to his room directly from the ER. I hadn’t the foresight to bring along my coloring book and pencils—mindless relaxing activity given to me by a friend that definitely helped first time around. This time I didn’t even have a hotel room where I could go to take a nap, shower and change my clothes. Confined, along with my husband, to the cramped hospital room, k29217612I watched the cardiac monitor while waiting for the surgeon or his assistants to drop in and give the latest update.

After a couple of days, when my husband began doing better and the updates were less frequent, I left him in the care of the competent nurses and headed out the door, off the unit, and began to walk. The heat of the summer prevented me from staying outdoors for any length of time. I explored the public areas of the hospital complex: the old hospital—where my husband’s room was located—a new hospital and cancer center, children’s hospital and a clinic building—all attached by tunnels, bridges and corridors. Since it was the weekend, most areas were relatively deserted, especially when I ventured out in the evening. However, a steady stream of folks frequented the cafeteria in the old hospital lobby.Unknown

I followed a couple in their thirties joking with each other as they walked into the cafeteria in street clothes, normal looking in every way except the man pushed an IV pole. Later, after I had breakfast, I watched as hospital workers rushed to help the man who was prone on the floor by the main elevators. Then the next morning there they were again, walking toward the cafeteria, arm in arm, laughing.

A man with neat gray hair, dressed in a navy sport jacket and pressed trousers, sipped his coffee at the same table where a bare-chested man with a long white beard and multiple tattoos talked with a skinny woman whose eyes, lined in black, seemed vacuous. Mutigenerational families with children—children who could or could not be patients themselves—were common.

Sunday morning a young couple walked toward me in the sun-dappled corridor chatting happily. The woman pushed a stroller with a baby girl (pink outfit), while her imagesbrother, about three years old, toddled along with denim jeans, t-shirt and shaved head.

But it was the many women my age that sat alone in the cafeteria that made me curious. Were their spouses in a little room under scrutiny as was my husband?

How many times did I wish I could just reach out and grab a hand and say come sit with me and let’s share our stories?

That Monday we were back to the life we had before hospitalization, the surveillance had ended. Except the experience lives on—like a dream.

Hearing Zebras

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Zebra is the American medical slang for arriving at an exotic medical diagnosis when a more commonplace explanation is more likely.[1] It is shorthand for the aphorism coined in the late 1940s by Dr. Theodore Woodward, professor at the University of Maryland School of Medicine, who instructed his medical interns: “When you hear hoofbeats, think of horses not zebras”.[2] Since horses are common in Maryland while zebras are relatively rare, logically one could confidently guess that an animal making hoofbeats is probably a horse. By 1960, the aphorism was widely known in medical circles.[

 

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As planned, my husband was discharged five days after he had open-heart surgery—two valves replaced. The day before he walked three laps around the Cardiac floor with tubes from his chest, EKG leads and wires from an external pacemaker. He leaned on a tall

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Swedish Walker

 

Swedish walker as he took slow steps and here he was being thrust, tubeless and wireless, out of the door into my care.

Should he be relieved to be sent home in my good hands since I am a retired nurse practitioner? Sadly, I am aware that I know too much—too much outdated knowledge. Plus I have a life long tendency to hear zebras. When my children were young, I over reacted to their illnesses —and do so even now that they are adults. The same with my grandchildren. When my middle grandson, then age four, visited my house, he suddenly became ill with a fever and pain in the back of his neck. I called his father and told him to meet me at urgent care—I was sure my grandson had meningitis. The understanding physician told me ear infections could cause neck pain and calmed my anxiety.

Cardiology was my specialty as a young nurse. However, I haven’t set foot on a cardiac unit in over 40 years. What I found out with my husband’s recent hospitalization was what I had learned to be red flags for life threatening problems are now mostly routine side effects of heart surgery and resolve quickly, albeit with sophisticated equipment, improved lab testing, powerful new drugs and experienced staff.

During my husband’s hospitalization, I anticipated:

  • Pneumonia—he had a slightly elevated temp
  • Immediate need for dialysis—low urine output
  • Trip back to surgery for a permanent pacemaker—irregular heart rate

Now at home, my outdated knowledge of cardiology feeds the anxiety I feel when I wonder if I am seeing life threatening changes in my husband’s health status. I am on the edge of becoming an overbearing, hovering and fretful caregiver. My husband tries to ignore my fisheye looks as I monitor his progress. Frequently, I need to take a deep breath, re-read the information we received on discharge about when to call the surgical resident and admit to myself that I am hearing those damn zebras.

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THE TIME IS RIGHT

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Taking a Blog break. This post appeared on March 10, 2013.

Marianna Crane: nursing stories

A friend deliberated whether she should visit her father for his 95th birthday. She was swamped with commitments. Since he was unaware of his birthday as well of his surroundings and didn’t even recognize his three daughters, there was no urgency to travel to another state.

However, she cleared her schedule and made the trip, as did another sister and a niece. Both lived out-of-state also.

As it turned out, on his birthday, he had a choking episode with difficulty breathing. He stopped eating and died three days later, surrounded by those he loved who otherwise would not have been there had they not come to commemorate the day he was born.

This story reminded me of a patient I cared for back in the early ‘90’s when I worked as a nurse practitioner in a home care program. I had made a first visit to an elderly man…

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Unconventional Nursing

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RuthieThis Post from 2012–written by my fellow nursing classmate, Ruth Donoghue–describes an episode occurring in the early ’90s.

Early ‘90’s December

NAKED IN THE DELIVERY ROOM

Nursery in a Catholic hospital where 5,000 babies pass through in a year

The call comes via unit secretary

A nurse is requested as soon as possible to pick up a baby in delivery room three. (Every newborn baby is sent to the nursery to be bathed and examined).

Request the nurse be naked!

I believed this was a religious event, since it was permitted in the Catholic hospital where I worked. It was a time when we were trying to be more understanding of other religions and promoting better relations. Recently our department had finished seminars on religious and lifestyle diversity. Any employee not willing to extend understanding would be sent for counseling. Since I was close to retirement, I volunteered to take the call.

I grabbed two surgical masks, stapled them together and applied them as a bra. Disposable mother mash pants served as bottoms. A heavy starched doctor’s coat was applied for traveling.

Upon arrival the whole family—mother, baby, grandma, grandpa, father and sibling—is present, smiling and naked. The doctor managed to skillfully leave.

The thermostat is set at 90 degrees and mother and baby fully exposed. I remove my doctor’s coat. Nobody notices.

They allow me to place their beautiful baby in a blanket. I quickly apply my heavy doctor’s coat and depart, pushing the baby in the crib to the nursery.

It was an accomplishment because now I wound not have to go for sensitively counseling in contrast to some others.

A month later (January) in the hospital elevator, I encounter a couple, lightly dressed, carrying a baby in a blanket only. Smiling, happy and healthy. They don’t recognize me.

My Mother’s Boyfriend

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Happy Mother’s Day.

My mother died the day before Mother’s Day sixteen years ago. Each year at this time my memories of Mom revolve around both her life and death. Her last few years weren’t what I would have predicted.

When Ernie and I moved from the Midwest to Maryland in 1993, Mom came with us. I had found an assisted living apartment for her. She was 85 at the time—independent, and mentally sharp.

My father had died over twenty years ago. Since that time her only friends were other women. A couple of months after the move, she had to have new glasses. Then she wanted to replace her old hearing aid with not one but two. Clearly, she wanted to see and hear what was going on around her. Over the phone, she told me, “I am having so much fun,” and mentioned a boy friend. As a gerontological nurse practitioner, I knew that a move to an unfamiliar place could make an old person confused. I dismissed the boy friend as wishful thinking.

Shortly after that phone call, I pulled up in front of Mom’s apartment building on a lovely spring afternoon to take her on a shopping trip. She came to the car and shouted to me through the open window on the passenger side, “Come on out, I want you to meet someone.” After shutting off the engine, I got out of the car and followed her to the bench by the front door. Two men sat side-by-side: one was obese with red blotches over his face and the other, a tall thin man, wore a baseball cap and cowboy boots, with a red-tipped white cane resting between his knees.

Mom nudged me in front of the two men. “Lee, I want you to meet my daughter.”

The man wearing a baseball cap stood up, ramrod straight. His eyes were hidden behind dark glasses. Red suspenders stretched across a pot belly covered with a blue flannel shirt. His right hand shot out in front of him.

“Pleased to meet you,” he said in a strong, even voice, shaking my hand. He smiled showing a scattering of rotten teeth. I felt as if I were meeting my teenage daughter’s beau who so wanted to impress.

Lee was twelve years Mom’s junior. At first they talked of marriage but Mom said no because he was a Jehovah’s Witness and she a Catholic. In her mind that was deal breaker. Then they were going to move into one apartment. But they were never able to decide which one would give up his/her apartment. For the next seven years, they saw each other daily. They took walks together—Mom leaned on Lee while she guided his steps; they sat together at the same table for communal dinner, and they took naps together. Mom never told me outright but I surmised this when she revealed she had lost her favorite earring in his bed. I never asked what else transpired between them.

However, their relationship was not without problems. Mom didn’t trust him. She suspected that he was cavorting with other women.

While Lee was a younger man, he was an unlikely gigolo. Besides diabetes and blindness, he had had two heart attacks, a triple bypass, and a Foley catheter that migrated from his bladder out of his penis and down his pants leg and ended up in a collection bag not so neatly tucked into his left boot. Most times he reeked of stale urine and dirty clothes. Mom, who had had a life-long addiction to cleanliness, never complained of his hygiene. But by God, don’t let him prove unfaithful.

Mom’s suspicious and judgmental nature never seemed to take a toll on their relationship. Lee would laugh and say, “There she goes again” when she would accuse him of flirting with another woman. At the same time, Mom would insist we include Lee on family celebrations and occasional luncheons where Lee would eat with his hands and Mom would inevitably spill her water, or wine, and I would leave a big tip as we left the table and floor in a shambles.

When Ernie accepted a job offer in North Carolina, Lee encouraged Mom to go with us. She had become more frail and had frequent falls. After being hospitalized with a bout of pneumonia, she was admitted for a short-stay in a nursing home not far from her apartment. A kind health care worker would walk Lee to visit. I was glad I wasn’t present to witness their final good-bye.

Mom lived just lived nine months after the move.

I went to visit Lee shortly after Mom’s death to give him her radio/cassette player and large button telephone. On the drive up to Maryland, I had romanticized the visit—he expressing his deep love for my mother, sharing the moments they laughed together and telling me how much he missed her.

During the visit, Lee sat in his recliner in a cluttered apartment never uttering the nice words about my mother I longed to hear. And he didn’t remember the times I took them to the Red Lobster and the neighborhood Chinese restaurant. After I programmed his daughter’s number into the phone and we ran out of polite topics to talk about, I left.

On the long ride down route 85 South toward North Carolina and home, I wondered if Lee didn’t talk about Mom with me since I was the one who took her away—although he encouraged her to leave, or he was losing his memory? Or both?

Nevertheless, I couldn’t be too disappointed since he gave Mom a reason for living and certainly kept her blood flowing if only from the aggravation of thinking her blind prince charming had a roving eye. And I will always remember the time she said she was having “so much fun.”

Thanks Lee.IMG_2668

Nurses’ Books Need More Media Attention

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In my last post, I told you about a couple of books I discovered—short story collections written by nurses. Lynn Rosack wrote a comment on my last post reminding me that Echo Heron, whose book I covered, Emergency 24/7: Nurses of the Emergency Room (2015) had written other nursing books. One of them, Intensive Care: A Story of a Nurse (1988) 51VcTG4-YzL._SX304_BO1,204,203,200_made the New York Times best seller list. She also wrote Condition Critical: The Story of a Nurse Continues (1994) and Tending Lives: Nurses on the Medical Front (1998).

 

Here is a short list of other memoirs by nurse authors, in no particular order:

 41U7irryyOL._SX307_BO1,204,203,200_

  • The Door of Last Resort: Memoir of a Nurse Practitioner by Frances Ward (2013)

 

  • 411iSrLW3gL._SX321_BO1,204,203,200_Caring Lessons: A Nursing Professor’s Journey of Faith and Self by Lois Roelofs (2010)

 

  • Beautiful Unbroken: One Nurse’s Life by Mary Jane Nealon (2011)41w2BzudSjL._SX331_BO1,204,203,200_

 

  • Cooked: An Inner City Nursing Memoir by Carol Karels (Second Edition 2005)41r3T9B3MZL._SX321_BO1,204,203,200_

 

  • 419bJlkfr1L._SX314_BO1,204,203,200_Baby Catcher: Chronicles of a Modern Midwife by Peggy Vincent (2002)

 

In researching books by nurses, I discovered a wonderful resource: books.google.com. I had no idea that there were so many books about nursing by nurses —from a book on the Public Health Nurse from 1919 to a new book not yet released by Josephine Ensign, Catching Homelessness: A Nurse’s Story of Falling Through the Safety Net (2016).51uC4Vf+BXL._SX322_BO1,204,203,200_

 

The books I found on googlebooks.com included stories about frontier, hospice, school and rural health nursing, and military nurses in Vietnam, Iraq and Afghanistan, among other settings. (I am limiting my search to nurse authors from the USA).

I am impressed with the scope and number of nursing books out there—although these numbers are nowhere near those of physician authors, and physician books attract more media attention. Great that we nurses are writing our books but we still need to find a way to gain the attention/publicity that physicians receive when they publish their books.

Nursing Stories by the Hundreds!

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Now that my book has been reworked and has a new title—Playing Sheriff: A Nurse Practitioner’s Story—I am ready to get it in print. In order to do this, I’ve been looking for books about nursing, and preferably written by a nurse. to see how these reached publication.

First of all, I found out was that there are more books out there than I had thought. Some have been published with the help of an agent, some by small press or university press, others self-published, and a few worked within publishing partnerships.

41YJN+iZdaL._SX322_BO1,204,203,200_One of the books, The Call of Nursing: Stories from the Front Lines of Health Care by William B. Patrick (2013), which, although not edited by a nurse, is a must-read.

“These twenty-three, first person profiles in nursing are ethnically, culturally, and educationally diverse. Some of the women and men here emulated mothers who were nurses, and were sure of their life paths before they entered high school. Some switched careers in midstream, for better salaries or increased job security, among other things. And others came to nursing much later in life, often answering a mysterious call to follow a vocation that could make a difference for individuals in need. But, taken together, their stories chronicle work experiences and environments that not only illuminate the broad range of career options for nurses but also form a valuable body of health care knowledge. All in all, this book communicates the essence of nursing.” (Italics mine)

Gertrude B. Hutchinson, MSIS, MA, RN, CCRN-R, Archivist, Bellevue Center for Nursing History

Two other books also focus on first-person stories by nurses:

  1. Emergency 24/7: Nurses of the Emergency Room by Echo Heron (2015).

Nurses who work in the emergency rooms and those who were involved in the aftermath of September 11, 2001 share their experiences.51C15U5urzL._SX326_BO1,204,203,200_

 

  1. A Call to Nursing: Stories about Challenge and Commitment by Paula Sergi & Geraldine Gorman (2009).

419HZi8D9zL._SX326_BO1,204,203,200_This book is an anthology in which “nurses speak about the joys and challenges of their chosen career . . .”

 

Collectively, there are a total of 107 nurses sharing their stories. Impressive!

A Nurse’s Hands

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I came across this post on All Nurses. It’s too lovely not to share.

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A Nurse’s Hands

by VivaLasViejas, ASN, RN Guide Mar 16 2016

I’ve been retired for over two years now, but in a rare contemplative moment, here are a few thoughts on what being a nurse meant to me.

Lately I’ve taken to looking at my hands, which appear to have morphed into my grandmother’s in recent years. They are well-worn and the skin is thinning rapidly, much to my dismay. While a layer of fat fills in the lines in my face, the same thing can’t be said for my hands, which tell my life story without words.

And then I remember: these hands have held new life, and comforted the dying.These hands have given the first bath…and the last.

They have been washed literally hundreds of thousands of times in the service of people I didn’t give birth to.

They have administered the first feeding and the last dose of morphine.

They have rubbed sore backs, dressed wounds, smoothed fresh linens over feverish bodies.

They have fed, cleaned, stopped bleeding, performed CPR. They have also prepared the living for surgery, and the dead for their final journey.

They are the hands of a nurse. And even though my career is over, my hands will forever bear the marks of the noble work they once did.

And somehow, that makes the wrinkles OK.

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