Don’t Question the Doctor

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My friend Lois and I were talking on the phone the other day. We both graduated from diploma nursing schools in the early 60s. It was a time when the nurse was considered the “handmaiden” of the physician. We played the Doctor-Nurse Game* and even stood up when a doctor entered a room. Feeling powerless to confront their authority, not surprisingly, caused us to harbor much resentment towards the medical profession over our long nursing careers.

I told Lois that my volunteer work at a local hospital has exposed me to the improved interactions between nurses and physicians. Of course, having more female physicians has leveled the playing field somewhat and the emphasis on “team” encourages the professionals to respect and work together to care for the patient. I have fresh insight into the challenges physicians face in the health care delivery system that restrict their practice and autonomy. While I do feel more sympathetic toward physicians, I cannot forget the unbalanced relationship nurses once endured.

 

Here is an example from Lois’ book, Caring Lessons.411isrlw3gl-_ac_us320_ql65_

One afternoon while making rounds, I dashed in to see, Mr. Barnes, my last patient, in 236-1, the triple ward next to the nurses’ station. He smiled when he saw me. “I’m going out for dinner tonight. Dr. Jericho is picking me up at five.”

“Oh? I didn’t know. He didn’t tell us at the desk,” I said, scanning his Kardex card in the vertical file positioned on my left arm. “I’ll check on it.”

Back at the nurses’ station, I checked the doctor’s order sheet for Mr. Barnes. Hospital policy dictated that patients could leave hospital grounds only with written orders from their attending physician. Dr. Jericho was not the attending physician; he was a personal friend. And there was no written order.

I faced a potential explosion. Dr. Jericho’s capacity to be short-tempered was well-known to the nursing staff.  We’d each had our experiences. None of us liked it, but we felt powerless to do anymore than endure. And I didn’t need the problem right then: I wanted to give report on time and get home on time, once.

I dialed his office. “Hello, Dr. Jericho, this is Mrs. Roelofs on Hall Two. Your friend, Joseph Barnes, told me you were picking him up for dinner.” I swallowed hard and took a breath. “I see no written order covering this leave. I’m calling to see if you’ve run this by his attending, Dr. Acorn.”

He barked into my eardrum. “I don’t need to check anything out with anybody. Do you hear me? It’s none of your business….who is this again? What’s your name?”

“Mrs. Roelofs. Head nurse. Hall Two.” I forced my voice to sound strong.

“I’m coming right over to clean your clock,” Dr. Jericho yelled into the phone.

My head and heart spun wildly into one big tuft of fear that settled in my throat. I raced to a friend working on the ward at the other end of my floor. We schemed to hide me on that ward when Dr. Jericho arrived. Then we stationed lookout nurses. Minutes later I got the message. I ducked into Room 214, a five-bed room on East, and hid behind curtains drawn around a vacant bed. When Dr. Jericho arrived, my cohorts told him I was off the floor on an errand. He strode into my nurses’ station across from Room 201, parked himself on my desk chair, and bellowed, “I’ll wait.”

When I was a student nurse a few years before, I had scrubbed to assist Dr. Jericho in surgery. He became irritated with something and kicked a metal wastebasket across the room. Anesthesia saved the patient from being startled off the operating table. However, my nerves, as a novice, vibrated with the intensity of the metal clanging against steel and tile. Now my nerves were vibrating once again.

Suddenly, my friend peeked around the curtain, wearing worry on her face. “He won’t leave until he sees you. He’s camped out. Slicked back hair, black suit, green paisley tie, and all. You better come.”

I returned to the utility room on my ward with its steel cabinets, stowed commodes and IV poles, soaking instruments and thermometers, and corner hopper – a large square toilet-like bowl for rinsing bedpans. Standing in the doorway to the adjacent nurses’ station, I said as confidently as possible, “Dr. Jericho, I’m back. I understand you want to see me?”

Dr. Jericho launched to a standing position. “You bet I do. Who do you think you are to question what I’m doing? To tell me I need a doctor’s order to take my friend out for dinner?” His words torpedoed through the nurses’ station and up the ramp to pediatrics.18064403-angry-doctor-in-glasses-with-notebook

He stomped toward me. I backed away, inch-by-inch, until I was flush with the hopper. One more step and I’d plop into hopper water. I was trapped. Only the smothering smells of disinfectant separated us. “It’s my responsibility to see that hospital policy is followed, sir,” I said. My breath stopped momentarily.

“Who are you to tell me what hospital policy says? You, young lady, are never to question me again. Do you understand?”

His words slapped my face like sleet on a winter walk. I could have punched him – he was close enough – but I thought better of it. “Yes, sir.” I held back a salute that he seemed to demand. He turned, clicked his heels, and marched out, as if on a military drill.

My meds nurse, LPN, and aides crowded into the small nurses’ station. “What happened? What’d he say? I’ve never seen him so mad. At least not this week.”

“Oh, the usual Dr. Jericho stuff. Nothing new.” I said, trying to sound nonchalant with a heart rate of over a hundred.

Reaching for the desk phone, I glanced at a list of phone numbers and dialed Mr. Barnes’ attending physician. He gave me the order. Why hadn’t I called him in the first place?

I determined never to let a doctor’s behavior intimidate me again.

Caring Lessons: A Nursing Professor’s Journey of Faith and Self, Lois Hoitenga Roelofs, 2012, pp 49-50

 

 

* Doctors and nurses: new game, same result

Mark Radcliffe, deputy features editor

BMJ. 2000 Apr 15; 320(7241): 1085.

“In the beginning the relationship between doctors and nurses was clear and simple. Doctors were superior. They had the hard knowledge that made ill people better. The nurses, usually women, were good but not necessarily very knowledgeable. They were in charge of folding pillowcases and mopping brows. . . .

In 1967 Dr Leonard Stein first outlined the doctor-nurse game. He said that the interactions between the two were carefully managed so as not to disturb the fixed hierarchy. Nurses were bold, had initiative, and were responsible for important recommendations. While being bold, however, they had to appear passive. In short, nurses were able to make recommendations as long as they made it look as if they were initiated by doctors. So the nurse was responsible for the wellbeing of her patients and the nourishment of the doctors’ sense of professional self.”

Are You Glad You Became a Nurse?

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I found an interesting study regarding nurses’satisfaction with their career choice. Note the respondents were middle-aged (45 – 64) and predominately female.

Since my specialty is gerontology, I have included the comments made by three older nurses. Yes, Yes, I know they are all positive.

I look forward to a study that includes younger nurses and more males. Would there be differences in the outcome?

Most Nurses Have Few to No Regrets About Career Choice

by Alicia Ault

Medscape, January 25, 2017

When asked what they liked best about their career, most nurses could not narrow it down to just one answer — instead, they gave multiple reasons, with relationships with patients, being good at what they do, and having a job they liked being among the top answers, in a new survey by Medscape.

The Medscape Nurse Career Satisfaction Report for 2016 surveyed 10,026 practicing nurses in the United States, including licensed practical nurses (LPNs), registered nurses (RNs), and advanced practice registered nurses (APRNs). The respondents were largely female, middle-aged (aged 45 to 64 years), and in practice more than 21 years.

The different nurse specialists varied slightly in how they ranked the most rewarding aspects of their job. For LPNs, the top answers were gratitude from patients and relationships with patients, along with being proud of what they do. For RNs, those answers ranked high in their response, along with working at a job they liked and being very good at what they do.

I have been a nurse for 54 years & am still practicing part time. I have loved almost every one of my jobs & have so expanded my mind & approach. Nursing is so varied that one can do almost anything. I was originally a diploma nurse & have taught in an AD program. After 13 years as a practicing nurse, I returned to school to find that I was given little if any credit for my excellent 3-year diploma program. I had to start all over again & spent 4 years as a full time student (with another year of graduate school). The AD & BSN programs offered similar clinical practica. It’s very unfortunate that the clinical aspects of the diploma programs could not be salvaged for the other two. Nursing needs an internship after the 4-year education. Practical skills will always be necessary for clinical nurses.

I was recently hired by my current employer at 72 years of age because of my experience. How nice to be so valued even at my age. I can’t imagine doing anything other than nursing. What a rich and rewarding professional life it has been.

Lynne D. Pancoast, RN, MSN

Among APRNs, gratitude figured least highly for clinical nurse specialists (CNSs) and certified registered nurse anesthetists (CRNAs), when compared with the higher percentages among nurse midwives and nurse practitioners. Working at a job they liked and being good at that job were the biggest rewards cited by CNSs and CRNAs.

Money was rarely cited by any nurse — at around 2% for most of the specialties — as the most rewarding aspect of their job, although 8% of CNRAs said it was important.

Although salary and pay did not figure greatly into the rewards side of the equation, it did come up when nurses were asked about least satisfying aspects of their job. The “amount of money I am paid” was the top answer for LPNs and CNSs, cited by 23% and 17% respectively, as the least satisfying part of the job.

Surprisingly, some 6% to 11% of respondents said “nothing,” when asked what was least satisfying about their job.

Lack of Respect a Looming Issue

I’m glad I became a nurse and would do it again.  I’ve worked on the same inpatient oncology unit for 35 years. I am nearly 70, work 24 hours a week and wil continue working for sometime.  Financially I do not have to work.

I am employed by one of the largest HMOs in the country which has many unionized employees.  My pay and benefits are excellent.  The most satisfying part of my job is being appreciated by the patients.  I work on a unit that has exceptionally dedicated staff that truely care about the people we take care of.

The least favorite part of my job is charting; it’s cumbersome, duplicative and often not read. It takes us away from comforting, listening to and teaching our patients.

Margaret McGowan-Tuttle|  Registered Nurse (RN)

A good many nurses — LPNs, RNs, and APRNs — found documentation requirements to be burdensome, and 11% to 13% of respondents said a lack of respect from physicians and other colleagues was also discouraging. For CRNAs, the lack of respect was the greatest frustration on the job, with about a third saying it was an issue.

Although the low percentage of survey respondents who said respect was a problem might not indicate a huge problem, it was a repeated theme in comments. Nurses of all stripes indicated frustration with what they viewed as a lack of respect from administrators, physicians, patients, and even peers.

One expressed dismay with the “attitude of some patients that the hospital is a hotel and that I am a glorified waitress.” Another APRN cited “the constant battle to be seen as a provider and not just another nurse by the nurses and support staff in the office.”

Some nurses also expressed frustration with what they saw as a lack of support, citing overwhelming workloads; insufficient staff or resources; and excessive regulations, oversight, and payer denials. On the negative side, managers were called unsupportive, incompetent, uncommunicative, and not having a good appreciation of their jobs. Physicians were described as bullying, rude, and disrespectful.

Most Would Change Practice Setting

Some 95% of survey respondents said they were glad they’d become a nurse, and close to as many said they’d choose nursing as a profession if they had to do it all over again. CRNAs were least likely to say they would choose nursing again (73%).

I chose nursing as a career by accident. I entered a diploma program in 1964 because: it was affordable ($600 for three years of education, books, uniforms and housing); I was good at science; and I didn’t want to be a teacher or secretary. Nursing was the best thing that ever happened to me. I loved every bit of it, working in ICU, pediatrics, mental health and finally teaching.

I went on to get a BS, MSN and EdD, all paid for by my employers. The flexible hours allowed me to work and raise a family. When I needed money for college for my children, I continued teaching and worked weekends in the hospital. I loved working with patients and sharing my passion, knowledge and skills with students and other nurses.

Although I am retired, I still do occasional consulting to nursing programs. One of my greatest rewards is seeing nurses I have taught at work and knowing I played a small role in their career.

Jessica Price|  Registered Nurse (RN)

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Most nurses indicated they would not choose the same practice setting if given the chance to start over. Those who worked in hospitals were the most likely — at 28% — to say they’d stick with that setting. Close behind, 27% who work in an academic setting said they’d choose that setting again. Those in skilled nursing, home health, or contract/agency positions were least likely, at 11% to 15%, to say they would choose the same setting.

Dissatisfied Not Making Big Changes

Those who were dissatisfied and said they would not choose nursing again were asked what they might do in the next 3 years to address their frustration.

Small numbers said they’d choose a different career path within nursing, retire earlier, reduce their hours, leave nursing to pursue other jobs, or seek other professional training. About a quarter to almost a half said they would not pursue any of those options.

Survey participants commented that nursing paid decently, offered job security, and that it might be too expensive or time-consuming to make a big career change at this point in their life.

APRNs were less likely than RNs and LPNs to say that they planned to act. Not surprisingly, similarly, the survey found that the higher the nurse’s educational level, the less likely the nurse was to plan a career change within 3 years.

When asked what they might do if they left nursing, some respondents said they’d start their own business, pursue an MBA, or go to physical therapy, dental, or medical school.

The desire to become a physician did not necessarily reflect badly on nursing as a career, said one respondent. “I am not sorry about my nursing career, which has been rich and fulfilling, but if I had to do it over again, I would pursue medicine as a career,” the nurse commented.

What is a Student Nurse?

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Carol Ann, a friend of mine from nursing school, recently came to visit. She and her husband live in California. They cruised the Panama Canal over Christmas, drove to see friends in Clearwater, Florida, toured both Savannah and Charleston and traveled to Raleigh, North Carolina to stay with us for a few days. Immediately, we began to reminisce about our school years. I pulled out the Lumine 1962img_0075 yearbook so we could scan our younger selves when we lived in the nursing residence with 42 other young women. For three years, the Gray Nuns of Montreal instilled in us the essence of nursing along with the skills and art of the profession.

Of course, much has changed since then (I will write more about this in later posts). At the time, we nursing students staffed the hospital on the evening and night shifts where a senior student nurse filled the charge position and second year students worked under her. None of us were paid for this “experience.”

The following essay printed in our yearbook describes the student nurse—all young women. I don’t know the author, Barbara Garrity, nor do I agree that student nurses wore white before they graduated.

Many of you older nurses will recognize the out-dated attitudes of the time and most of you youngsters may be scratching your heads wondering could a student nurse be a real person.

What do you think?

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WHAT IS A STUDENT NURSE?

By Barbara Garrity

Student nurses are found everywhere, underneath, on top of, or slithering past patients’ beds. Doctors yell at them, head nurses criticize them, residents overlook them, mothers worry about them, and patients love them.

A student nurse is courage under a cap, a smile in snowy white, strength in starched skirts, energy that is endless, the best of young womanhood, a modern Florence Nightingale. Just when she is gaining poise and prestige, she drops a glass, breaks a syringe or steps on a doctor’s foot.

A student nurse is a composite. She eats like a team of hungry interns and works like the whole nursing staff put together. She has the speed of a gazelle, the strength of an ox, the quickness of a cat, the endurance of a flagpole sitter, the abilities of Florence Nightingale, Linda Richards, and Clara Barton all rolled into one white uniform.

To the head nurse, she has the stability of mush, the fleetness of a snail, the mentality of a mule and is held together by starch, adhesive tape and strained nerves. To an alumna, she will never work as hard, carry more trays, make more beds, or scrub on more cases than her predecessors.

A student nurse likes days off, boys her own age, the O.R., affiliations, certain doctors, pretty clothes, her roommate, Mom and Dad. She’s not much on working 3-11, days off with class, alarm clocks, getting up for roll call, or eating corn beef every Tuesday.

No one else looks forward so much to a day off or so little with working 3-11. No one else gets so much pleasure from straightening a wrinkled sheet or wetting a pair of parched lips. No one else can cram into one little head the course of a disease, the bones comprising the pelvis, what to do when a patient is in shock, how to insert a Cantor tube (usually at 3 A.M.) plus the ten top tunes of the hit parade.

A student nurse is a wonderful creature; you can criticize her, but you can’t discourage her. You can hurt her feelings, but you can’t make her quit. Might as well admit it, whether you are a head nurse, doctor, alumna, or patient, she is your personal representative of the hospital, your living symbol of faith and sympathetic care.

The Story Behind the Message

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Rearranging my bookcase, I came across a book with the following inscription:

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To Marianna–No, it’s not easy! But you can do it. All the best, Molly

This is the story behind the message:

I had been writing for as long as I can remember. I saved many of my stories in longhand on scraps of paper, on faded yellow legal pads, and typed up on an old manual typewriter with multiple errors (I flunked typing in high-school). All were unedited and unfinished.

In the early 90s when I lived in the Washington DC area, I started to take writing more seriously by attending classes and conferences. One of the workshops was sponsored by the Smithsonian. I can’t remember for the life of me the woman who conducted the class. What I do remember was the cross section of adults who sat on folded chairs in the cramped room three stories below ground level at the Dillon Ripley Center. At one session, the instructor had invited her friend who was visiting from out of state, the author Molly Giles.

Molly looked to be about my age. She had reddish blond hair and a warm, earthy persona. I immediately wanted to be her best friend. She described the office she rented so she could write undisturbed.

After the class, I stood along side of the table where Molly was autographing her latest book: Creek Walk and Other Stories (still in print). creek-walk-by-molly-gilesShe was poised with pen in hand ready to inscribe the book to me as I chatted on about how much I enjoyed her talk and how I thought writing was fun. She cocked an eyebrow at me as if I had just told her I still believed in the tooth fairy. Gently, she told me that writing could be difficult.

Now, over 20 years later, I have written many words, finished and published some stories. I completed a memoir and am investigating self-publishing venues. For me, writing is more arduous than exhilarating. My greatest strength is persistence.

How I wish I could meet with Molly over a mocha latte at some cozy coffee house. I know what she was trying to tell me so long ago. She was right.

Dad and the Bride Doll

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My father, a complicated man, was the oldest son of 10 children. His parents came to America from Naples, Italy via Ellis Island at the turn of the century, and settled down in Jersey City, New Jersey.

He left school in the sixth grade to pick up bits of coal from the railroad tracks, placing them in a wagon, to later sell to buy food for the family.

Brookyn Navy Yard

Brookyn Navy Yard

My father was a tight package of a man. Dark and solid with biceps of steel and large hands heavily calloused. He worked on the docks of the Brooklyn Navy Yard during World War II and then in construction. When we visited Grandma for Sunday dinners, he would flex his muscles and I, and another cousin or two, would hang on his arm as our legs swung above the floor.

A hard drinking man, he was the black sheep of the family but my grandmother’s favorite. She would cook the foods he loved and he would sing and dance her around the kitchen, dodging the hot wood stove and the table that could expand to serve her large family. He never failed to make her laugh, she who took to her bed with headaches; dour and sad, more days than not.

I was his only child. I knew he would have preferred a son who he would teach to box, throw a ball and take to the Yankee games. To please him, I learned to swing a bat, hit a fastball and bob and weave as I sparred with an imaginary opponent. He took me out of school to see the 7th game of the World Series when the Yankees beat the Dodgers in 1952.

One Christmas when I was about eight or nine, I wanted a bride doll. I knew it cost a lot of money and money was always tight. My father shook his head indicating I would not get my wish.

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Close to Christmas, when my father went into his bedroom and pulled the door behind him—not quite closing it—I crept up to watch through the slit. He opened the closet and reached on the top shelf and took down a box. Opening it, he removed a beautiful blond doll with a white gown and stroked her veil with his heavy hands. I guess I faked my shocked reaction when I opened the present on Christmas day. I don’t remember if I wished at the time I hadn’t peeked into the bedroom, since it diminished my surprise. However now as I look back I treasure the sight of my father gently smoothing out the doll’s veil and knowing he was making his little girl happy on Christmas.

 

Merry Christmas and a Happy and Healthy New Year.

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Cardiac Advances Versus Patient Benefit: A Moral Dilemma

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My story, Closing the Door, recently published in Stories That Need to be Told: A Tulip Tree Anthology, tells of the emergence some fifty years ago of cardiac catheterization, artificial heart valves and cardiopulmonary resuscitation and how I, as a young nurse, had to make sense of the advancement of technology versus patient benefit.

This story is especially significant to me because just six months ago my husband had open-heart surgery replacing two valves with biological valves. I witnessed, first hand, the tremendous advances in cardiac surgery and treatment.

 

CLOSING THE DOOR

I gagged on the alcohol fumes as I carefully measured out sixty milliliters of Black and White Scotch into a medicine glass. Balancing the small plastic tray with a pack of Lucky Strikes and the Scotch on one hand, I locked the door to the tiny medication room with the other. Then I went in search of Charlie Hobbs.

A plume of tobacco smoke drifted from the patients’ lounge. A ripped vinyl sofa and two orange bucket-like chairs lined the walls. The sole occupant was a middle-aged man hunched over a jigsaw puzzle on the card table. Charlie Hobbs had been admitted to the research unit on the third floor of the city hospital with just the clothes on his back. Every day he wore the hospital issued striped robe and pajamas. One of other staff nurses had donated slippers.

I gazed down at the top of Charlie’s wild red hair. He shuffled jigsaw pieces by day and watched television by night, all a maneuver, I thought, to keep human interaction at bay. No one ever visited him. Did he even have a home to go back to?

“I got to get me another puzzle,” he said without looking up. “This here one is almost done.”

At twenty-three, and a nurse for just two years, I vacillated between professionalism and irreverence. At times, I imagined myself the airline stewardess I had always wanted to be. Coffee, tea, or me? This day I was a Playboy Bunny as I bent at the knees, stretching to place the drink in front of Charlie, while his blue eyes riveted on my imagined cleavage. But Charlie’s eyes fixed solely on the amber liquid. Not once in the past four weeks had he acknowledged me, the young nurse in a starched white uniform with thick support hose, and practical shoes. An unlikely dispenser of booze and butts.

Charlie snuffed out the remnant of his cigarette into an overflowing ashtray and reached for the drink.

Harold Clark’s research money supported Charlie’s hospital stay. Dr. Clark needed recruits who would agree to have a cardiac catheterization in order to see the effects, if any, that alcohol had on their hearts. Cardiac catheterization was the latest tool of the sixties to measure heart function. This new procedure carried a high risk of injury, and even death.

Dr. Clark had scoured the downtown bars searching for men who drank excessively. On a warm autumn night he had gotten lucky. Charlie seized the carrot: a roof over his head, three squares a day plus free liquor and cigarettes. He agreed to live on the research unit for a month, and then undergo a cardiac catheterization.

I carried the empty medicine glass and the tray back to the nursing station. How could Charlie drink alcohol at nine in the morning? Or all day long, for that matter? What would make a man so desperate that he would consent to undergo a procedure that might kill him?

Even though I didn’t particularly like Charlie, there were times when I placed the Scotch in front of him that I wanted to nudge him, and jerk my head towards the exit sign at the end of the hallway. Get out, Charlie. The catheterization isn’t worth all the free alcohol and cigarettes. But I didn’t have the audacity to undermine Dr. Clark’s research, no matter how conflicted I felt.

In the small sink in the medicine room, I rinsed out the glass and turned it upside down to dry on a paper towel that rested on the narrow windowsill. Still thinking of Charlie Hobbs, I started down the hall to check on my other patients.

Nellie Mineo waved to me from the doorway of her husband’s room. She looked like the Italian housewife that she was: salt and pepper hair piled in a bun on the top of her head. A well-worn cardigan sweater covered her simple cotton dress. When I walked toward her, she grabbed my hand. Behind her I could just make out her husband’s outline under the starched white sheets.

“He seems worse,” she said, rubbing my hand in absent-minded distraction. “Promise me you’ll stop in before you go off duty today.”

The Mineos had known the chances weren’t in their favor when they first met with Dr. Clark to discuss replacing Joe’s diseased heart valve with an artificial one. He was so short of breath that he could hardly talk, much less continue working in the family grocery store.

In the operating room, Dr. Clark had removed the incompetent valve, and slipped the artificial one, a silastic ball encased in metal cage, into the excavated space. The ball-valve clicked audibly. Not a pleasant side effect.starr-edwards-mitral-valve

After my regular tour of duty, I rode the elevator to the fifteenth floor, the surgical unit, and worked overtime as Joe’s private nurse. He reminded me of my Uncle Tony with olive skin, dark eyes, and soft smile. At first things looked great, but soon Joe developed a cough and a fever. His legs swelled. He had difficulty breathing. Diuretics worked for a while. Antibiotics failed to prevent an infection. His once muscular body had shriveled into sagging skin covering a bony frame. Although the valve was being rejected, it continued to click on.

“Stop and see me before you go off duty,” Nellie repeated. I nodded. Only then did she loosen her grip on my hand.

At the end of the day, as I flung my coat over my arm, I heard a racket from the patients’ lounge. Charlie stomped past me, head down, and fists clenched. “I’m outta here.”

“What happened?” I asked the nurse who jogged after Charlie.

“Charlie kicked over the card table. For no reason I could see.” She shrugged her shoulders, and continued on.

Nellie watched the commotion from the other side of the hall. The Mineo’s large, gregarious family resembled my own extended Italian family. Visitors came and went at all hours, but that day only Nellie stood guard. When I approached, she pulled me into her husband’s room, grabbed my coat and purse, and clutched them against her body. From behind her I could hear Joe’s wet bubbly breaths, which barely muffled the click of the valve. Even in my short stint as a nurse I recognized the rancid smell of impending death. I wanted to escape the hopelessness of Joe’s futile struggle, but Nellie moved her face closer to mine.

“He’s dying,” she whispered.

She swallowed hard as if to stop herself from crying. “I don’t want him resuscitated. Please stay with us. Don’t let them resuscitate him.”

Nellie had witnessed plenty of resuscitation attempts as she lingered outside her husband’s hospital room day after day. Cardiopulmonary resuscitation was so new that all patients were candidates. At the first moment a patient stopped breathing, we leapt into action. We flung him to the floor and straddled him. We thumped the sternum with the side of our fist, then breathed frantically into his mouth. Pumped on his chest. We worked until we were exhausted. In most cases the patient died anyway with fractured ribs, and a lacerated liver.

Nellie kept her gaze on me; her dark eyes pleading. What would I want for Uncle Tony? A quiet death, or zealots in white coats beating on his chest? What should I do?

Charlie’s voice boomed from down the hall spewing curses. Perfect timing. Charlie would leave the hospital AMA—against medical advice—right before his scheduled catheterization. He wasn’t as clueless as I had thought.

Hopefully, Charlie would distract the staff long enough for Joe to die. My heartbeats kicked up a notch. How could I ignore Nelly’s plea? I reached over and slowly shut the door.

Nellie’s hold on my coat and purse relaxed, and they slid to the floor. Wordlessly, she settled in the chair next to Joe’s bed, lifted his limp hand onto her lap. I commandeered the chair by the door: the sentry blocking the enemy from entering.

I had seen dead people before but never lingered for that final breath. The valve and the minutes clicked on. The lapses between Joe’s gasps for air stretched farther apart. Just when I thought he had quit breathing, he gulped for air. I silently cheered him on. Die Joe. Come on, get it over with.

I sat knotted tight. How would I explain the closed door to a co-worker who decided to check on Joe? Or the fact I was still there after my shift had ended?

Finally, Joe’s noisy breathing ceased. Then the mechanical valve stopped clicking. The silence sounded thunderous as I grappled with the fact Joe had actually died. I walked to the bed to see his torturous face frozen, his dark hair matted with sweat, his mouth agape. His open eyes stared at nothing. I placed my hand over Joe’s clammy hospital gown. No movement in his chest. No heart thumping against my palm. As I smoothed down his lids, Nellie gripped her husband’s hand to her breast and sobbed softly.

While I felt relief that Joe had died with his wife by his side, each footstep by the door made my heart flip.

“I really need to leave, Nellie.”

Tears trickled down her cheeks. She placed Joe’s hand over his chest before she rose from the chair to embrace me.

“Thank you,” she said, her voice cracking. She cried on my shoulder as my own tears fell. Then she pulled away, and sat back down next to Joe, taking his hand again.

Grabbing my coat and purse from the floor, I wiped the moisture off my face with the coat sleeve. I cracked open the door, and glanced up and down the empty hallway. I forced myself to walk leisurely toward the exit.

Nellie waited for the evening nurse to discover Joe dead in the bed.

The floor was unusually quiet. The medication door stood ajar in the nursing station. I had no intention of poking my head inside, and saying so long to the evening nurse. Just a few more steps and I would be in the clear.

I turned the corner of the white tiled hallway, my thoughts back in the room with Nellie and Joe. My body jerked as Charlie Hobbs blocked my way.

“Hi,” he said as if we were old friends. “I’m leaving.”

He sported a bright green jacket that covered the rumpled clothes he had worn when first admitted. “Borrowed this from the guy in the next room,” he said, noticing my eyes on the jacket. “I’ll return it.” I nodded even though I knew the coat would never make it back to its owner.

“I ain’t got no money on me. Can ya spare a buck? I’ll pay ya back.” He shifted his feet nervously waiting for my answer. For a fleeting moment, I thought to try to persuade him to stay. But that would have been hypocritical. I reached into my purse knowing he would head for the nearest tavern, and never give a second thought to repaying me.

“Thanks,” Charlie mumbled, shoving the dollar bill into the pocket of the purloined jacket. He turned abruptly, and disappeared though the doorway under the exit sign.

While I jogged down the three flights of stairs following behind Charlie’s footfalls, I attempted to justify my behavior. Frightening to me was how quickly I intervened for my patients without foresight into the repercussions.

However, I felt positive that Charlie had planned all along to leave the hospital before the catheterization. Not giving him the dollar wouldn’t have made a difference. And who would question that my closing the door to Joe’s room to allow him to die naturally had violated any ethical rule? Even if I didn’t intervene, the chances that anyone would get past Nellie Mineo to resuscitate Joe seemed unlikely.

How could I have realized that over the years I would continue to struggle with knowing when to step back, and when to dig deeper into my patients’ psyche. How to be empathic and not sympathetic? How to balance cool detachment with overbearing involvement? It was just the beginning. There would be many choices throughout my long nursing career that would test my allegiance, and strain my conscience.

Before I reached the last flight of stairs, Charlie had flung open the door to the street, and let it crash behind him.

Happy Lasagna Day

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happy-thanksgiving-images

 

My husband and I are spending Thanksgiving alone—by choice. We had been invited out but graciously declined.

After having three sets of houseguests in six weeks, we are happy to be alone. By the way, the house has never been cleaner.

And we broke from the traditional Thanksgiving dinner—we are having lasagna.

lasagna

I love leftover lasagna as much or more than leftover turkey, stuffing and gravy.

 

Over the years lasagna has become the ubiquitous casserole. You can find it premade in deli departments and frozen food cases in grocery stores. It’s the go-to meal neighbors bring over to neighbors on happy occasions (childbirth) and solemn occasions (sickness or death in the family).

My love of lasagna goes back to my childhood when we visited Grandma in Jersey City. She lived in a second floor walk-up two blocks from my house. Who remembers what time she got up in the morning to begin cooking the lasagna and the rest of the meal, including homemade bread and a roasted chicken? As for the lasagna, she made the pasta from scratch. The tomato sauce (we called this gravy) simmered for hours on the stove. She used whole-milk ricotta and mozzarella cheeses that were made fresh at the Italian store down the block.

Being the oldest granddaughter, I sometimes helped by assembling the multiple layers of the dish. First the sauce, the pasta in one layer, a few spoonfuls of cheese mixture (ricotta, parmesan, eggs, oregano and parsley), sliced mozzarella, more sauce/gravy and then I started over again finishing with the mozzarella on top.

If the family ever had turkey for Thanksgiving, I don’t remember.

In Grandma’ s cramped kitchen the men ate first—Grandma’s three sons, her five sons-in law and Grandpa. My cousins and I sat at the “children’s table” that was cobbled together with end tables and folding chairs. The women served and cleared and eventually sat down to dinner with the windows open to let out the steam from the kitchen along with the delicious aromas of the Italian Thanksgiving feast.

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So this Thanksgiving I am thankful for the usual, although not insignificant blessings, such as health, family, friends, but also for the memories that warm me and bring me back to Grandma’s table laden with her gifts and in the company of my extended family—some long gone but not forgotten.

Wishing you a very Happy Thanksgiving and joyful memories.

80 year-old male model

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As a retired gerontological nurse practitioner and a woman dealing with my own aging, I am always happy to read about successful aging. This one comes all the way from China. I hope you enjoy 80 year-old Wang Deshun’s story as much as I did.

 

An 80-Year-Old Model Reshapes China’s Views on Aging

 

Sinosphere

By DIDI KIRSTEN TATLOW NOV. 3, 2016

 

Wang Deshun, who turned 80 this fall, at the China Fashion Week in Beijing last year. Credit Quan Yajun

Wang Deshun, who turned 80 this fall, at the China Fashion Week in Beijing last year.
Credit
Quan Yajun

BEIJING — Before cranking up the techno music at his 80th birthday party, the man known as “China’s hottest grandpa” paused from his D.J. duties to poke fun at the country’s staid traditional celebrations for the elderly.

“I should wear a long robe, with the word ‘longevity’ embroidered on the front,” the birthday boy, Wang Deshun, said at his party in September.

Far from looking frail, the silver-haired actor, model and artist wore a crisp white shirt and black jeans, his back straight and his eyes glittering with humor.

“Two young maidens should help me into an old-style wooden chair,” he added, pretending to hobble.

Determined to avoid mental and physical stagnation, Mr. Wang has explored new skills and ideas while devoting ample time to daily exercise. Last year, he walked the runway for the first time, his physique causing a national sensation. He takes obvious joy in subverting China’s image of what it means to be old.

Wang Deshun explains how he became a runway model last year. Video by Redstart Media

And old age in China begins relatively early. The legal retirement age for women is 50 for workers and 55 for civil servants, and 60 for most men.

Being older in China typically means being respected, but also, often, sentimentalized. Someone as young as 50 may be addressed as “yeye” or “nainai” — grandpa or grandma — regardless of whether they have offspring.

Mr. Wang is having none of that.

“One way to tell if you’re old or not is to ask yourself, ‘Do you dare try something you’ve never done before?’ ” he said in a recent interview at a hotel in Beijing.

“Nature determines age, but you determine your state of mind,” he said.

Mr. Wang has not escaped being called grandpa — he has two children and a 2-year-old granddaughter — but the honorific is accompanied by accolades for his vigor and his embrace of the new.

“Grandpa, you’re my idol!” one admirer wrote on Mr. Wang’s Weibo social media account, one of thousands of similar comments.

Sex appeal is part of the mix.

“Grandpa, your stomach is so gorgeous! Incredibly handsome!” another person wrote next to a photo of Mr. Wang, topless in a gym, his skin smooth and pectorals buff.

Mr. Wang said he was always athletic. An avid swimmer as a child, he still swims more than half a mile each day. “Morning is my learning time,” he said. “I read books and news. From 3 to 6 p.m. is my exercise time, in a gym near my home.”

He also drinks less alcohol now, he said, but that is about as far as his dietary restrictions go. “I am not picky at all about what I eat. I eat whatever I want.”

Mr. Wang was born in the northeastern city of Shenyang in 1936, one of nine children of a cook and a stay-at-home mother. At 14, a year after the Communist Party came to power in 1949, he began working as a streetcar conductor.

Mr. Wang blowing out the candles on his 80th birthday cake in Beijing on Sept. 20. Credit Shen Qi

 

“I liked acting, singing, dancing, playing musical instruments so much that I joined my work unit’s band,” he said. At the Workers’ Cultural Palace in Shenyang, he took free lessons in singing, acting and dancing. He later took a job at a military factory and joined its art troupe. Sometimes they entertained soldiers.

“Even if there was just one sentry, say, at the top of a hill, like once in Dalian, we’d surround him and perform,” Mr. Wang said.

Later he worked in radio, film and theater. In the early 1980s, Mr. Wang, who would teach runway modeling at a Beijing fashion school, staged what he believes was the first modeling show in the northeastern city of Changchun.

“In 1982, the clothes Chinese wore were so out of date,” he said. “I went to the city’s biggest department store and told the sales clerks, ‘Give me your nicest clothes, and I’ll organize a show.’ They agreed. The best clothes they had were fur coats, and for men, woolen Sun Yat-sen suits” — also known as Mao suits.

Back then, he said, “Chinese had no sense of color or style. People wore black, white, gray or blue. Some people wore army uniforms. I wanted to start a sense for fashion among ordinary people. We did a swimming-suit show. The girls refused at first, thinking it was indecent. But I insisted.”

By 49, Mr. Wang was eager to move to Beijing, China’s cultural capital. He wanted to be a “living sculpture.” He also needed money.

He began working out, determined to have a lithe body that would allow him to interact, almost naked and covered in metallic paint, with copies of Auguste Rodin’s and Camille Claudel’s sculptures of women. The idea, he said, came from his wife of 48 years, Zhao Aijuan.

After the first show in Beijing, in 1993, the authorities, disturbed by its sensuality, barred Mr. Wang from performing in public. He continued to perform privately.

“I really admire him very much,” said Xiao Lu, 54, a performance artist. “I do body art, and you know, after a certain age. a person’s abilities decline. But he has this amazing sculpted body and spirit. Such power for life really comes from the inside. He makes the feeling that’s in the Rodin sculptures come alive.”

Last year, he appeared bare-chested in a fashion show in Beijing’s 798 arts district, featuring designs by Hu Sheguang.

His appearance on the runway earned him a cultlike following. Some fans call him laoxianrou, or “old fresh meat,” making a play on the word for teen idol: xiaoxianrou, or “young fresh meat.’’

So has old fresh meat replaced young fresh meat?

Perhaps not. But Mr. Wang’s physicality, notable in a society where men rarely highlight their attractiveness, also sets an example in a nation that is growing older fast.

“People can change their life as many times as they wish,” he said. Having a goal is important, he said.

“Being mentally healthy means you know what you’re going to do,” he said. “For example, a vegetable vendor, when he wakes up, he has a goal, he works hard. And when he finishes, he feels fulfilled.”

For Mr. Wang, fulfillment comes in many forms: acting, modeling, exercising and creating art.

And one day soon, he said, parachuting. That is the plan.

 

 

 

 

TRICK OR TREAT AT THE FRONT DOOR; HEARSE AT THE BACK

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Reblogged from September 20, 2012. Happy Halloween.

Marianna Crane: nursing stories

I have been pestering my classmates from nursing school (we are about to celebrate our fiftieth anniversary next month) to write their stories so I can post them on my blog. Maybe pestering is too mild a word. Regardless, I have succeeded. Two women have sent me stories.

The first comes from Joan Moore. 

This is her story when she worked for a Hospice in Central New Jersey in the late 1990’s.

THOUGHTFULNESS IN THE FACE OF GRIEF

Written by Joan Moore

One of the most important aspects of hospice nursing is that a nurse is available 24/7 for the patients. This means every nurse on the team is required to take a turn being “on call”.

I’d like to share one of my many on call experiences.

My weekend started quietly. It was a Saturday in October. Halloween. In that neighborhood when Halloween falls on a weekend, the kids…

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The Gray Area of Nursing: Being Uncertain of One’s “Moral Role.”

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Here’s a great example how one nurse saved a patient’s life.

American Journal of Nursing

American Journal of Nursing

Speaking Up to Save a Life

by

Diane Szulecki, Associate Editor

American Journal of Nursing

October 2016 – Volume 116 – Issue 10 – p 68–69

 

 

Abstract

 

A nurse’s advocacy alters the path of a patient with locked-in syndrome.

On a winter day several years ago, critical care nurse Katie L. George began her first of four day shifts in a row. Among her tasks was taking over the care of Ms. A., a young woman who had a traumatic head injury after being involved in a car accident. Ms. A. had been sedated for several days to allow for intracranial pressure monitoring; her fiancé had stayed in the room with her the entire time.

Katie L. George

Katie L. George

At the start of George’s shift, Ms. A.’s physician decided to stop her sedation so she could undergo a neurologic exam. Within an hour, Ms. A. opened her eyes and her fiancé jumped up, grabbed her hand, and began talking to her. But the initial assessment George conducted yielded troubling findings: Ms. A. had no spontaneous movement and her heart rate didn’t elevate in response to noxious stimuli. She appeared, however, to be looking around the room and tracking George and her fiancé.

Ms. A.’s physicians repeated the assessment and arrived at the same conclusion. Magnetic resonance imaging revealed that she had sustained a severe C2 fracture in the car accident and that her spinal cord was nearly severed.

Ms. A.’s parents, who lived abroad, were en route to the hospital but wouldn’t arrive for another day. In the meantime, Ms. A.’s fiancé stayed by her side and quickly established a way to communicate with her. He would read her the title of an article from her favorite magazine, then tell her to blink once if she wanted him to read it to her or twice if she wasn’t interested.

“Throughout the day it became clear to us that she absolutely could understand what we were saying,” said George. Ms. A. was suffering from locked-in syndrome—a condition in which the patient is conscious and certain eye movements remain functional despite full body paralysis. When her parents finally made it to her bedside the following morning, they faced devastating news. The attending physician informed them that because of the severity of Ms. A.’s injuries, she was unlikely to regain movement of her extremities. She would always be dependent on a ventilator and she had a high risk of dying within a year from complications of immobility such as pneumonia.

Ms. A.’s parents were advised to take some time to think about how to move forward. The next day, they decided to have their daughter withdrawn from life support. Despite Ms. A.’s apparent cognizance, George said, “I think her family was trying to do what they thought was best. In their minds—and understandably so—they didn’t want to put her through this.”

But, according to George, Ms. A’s fiancé pushed back on his future in-laws’ decision. “This isn’t right—I think she’s in there, and this should be her call to make,” he said to George. George agreed, and scrambled for a solution: Ms. A. was due to be removed from life support that afternoon.

First, George discussed her concerns with the attending physician. He agreed with her, but emphasized that since there was no way to determine Ms. A.’s mental capacity from a legal standpoint, the decision of whether to continue life support remained with her family.

Despite the physician’s response, George was determined to find a way to help give Ms. A. a voice in deciding her own fate. So she reached out to a colleague in palliative care, who referred her to a speech pathologist. Over the phone, the pathologist confirmed that Ms. A.’s capacity could, in fact, be legally validated through the blinking of her eyes.

“At that point I went to the attending and the resident and said, ‘Here are the calls I’ve made; we can prove her capacity by doing this,’” said George. “They weren’t happy that I had persisted after they’d said no, but they were receptive.”

A plan was made for Ms. A.’s parents and fiancé to gather in her room along with her physicians, a chaplain, and George, her nurse. Once assembled, they explained her condition and prognosis to her, and reassured her that she wouldn’t be in any pain if she chose to discontinue life support. She was instructed to blink once if she wanted to continue life support and twice if she preferred not to. Everyone in the room let out a collective gasp at Ms. A.’s response: “She blinked once and opened her eyes so wide—it was very clear what she was telling us,” recalled George.

After that, the situation resolved uneventfully. Ms. A.’s parents supported her choice, and the decision to continue care was formally made. Eventually, she was transferred to a rehab facility in another state. It was the last George would see of her patient for a long time.

A few years later, George was at work when one of the attending physicians who had cared for Ms. A. called her over. The physician had come across a recent video of their former patient.

George watched the footage, in shock. Ms. A. had made enormous progress in her recovery: she was now able to move most of her extremities and no longer required a ventilator or a feeding tube. The footage showed her dressing herself, using various tools to help her perform basic tasks, and getting around in a motorized wheelchair. Her mental capacity was fine, and her fiancé was still by her side, now as her husband. “You did this,” the physician told George. “She’s alive because of you.”

Looking back on the situation, George said she never doubted that getting involved on behalf of her patient was the right thing to do, despite facing pushback from some of her colleagues. “This was something that was way too wrong not to stand up for. I was sick knowing what would take place that afternoon. It really made me feel like, ‘OK, this is what we have to do.’” Taking a stand was intimidating, she said, but her instinct reassured her. The experience exemplified what she called the gray area of nursing: being uncertain of one’s “moral role,” and wanting to tread carefully.

George says the experience of advocating for her patient and witnessing the rewarding results has kept her driven, both personally and professionally. “It’s given me the motivation to keep challenging things even when they’re tough, and in my day-to-day patient care, not to sit back if I feel something is truly wrong,” she said. “You can’t pick every battle, but you need to pick the ones that matter and stand up for what’s right.