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


Diane Szulecki, Associate Editor

American Journal of Nursing

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





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.

The Compliment


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Two weeks ago I flew to Sioux Falls to visit my good friend, Lois, in her new home. She and her husband left a Chicago condo off Michigan Avenue facing the lake to settle in a small town with less excitement than a big city. That weekend we attended the South Dakota Annual Festival of Books, a free conference that would be rare in a big city like Chicago. There are pluses for small towns. And I might add, anyplace that is home to one’s grandchildren holds excitement.

Back to the weekend and the Festival of Books. The keynote attraction on Saturday was Jane Smiley on the main stage in conversation with a local radio personality. Smiley came across as a composed, self-assured woman, emitting an occasional monosyllabic answer to the delight of the audience. She was comfortable in the spotlight and seemed to harbor no insecurities. Of course, why not, since she has won a Pulitzer Prize, studied in Iceland as a Fulbright Scholar, and written many books—the most recent a trilogy covering 100 years.  screen-shot-2016-10-07-at-4-18-29-pm

Earlier that day, Lois and I had spotted a solitary tall blond with a bright red jacket, jeans, and matching red running shoes striding briskly toward the Larson Memorial Concert Hall where the festival was held. A few minutes into Smiley and the radio personality’s conversation, Lois nudged me. The lone walker had been Jane Smiley. Lois recognized the red shoes.

On Sunday we had a difficult time choosing which of the various breakout sessions to go to, except for Robert Olen Butler’s discussion of his new novel, Perfume River: A Novel. I like his writing. In fact one of his small pieces, Nostalgia, was in Self in 1994. That piece impressed me so much so I cut it out and saved it all these years, and even included it into a post: So What’s Nostalgizing, that I wrote on February 2, 2015.

Once when a writing instructor asked us to bring a copy of what we considered a good piece of writing, I brought Nostalgia. Others brought longer, more nuanced examples but Nostalgia, to me, was perfect. And it spoke right to my heart. It was like a painting or photograph or snippet of music that trips open a trap door to expose a forgotten memory—soft and misty—unclear to the brain but familiar to the heart.

img_2967Butler sat in a folding chair facing his audience and directly in front of Lois and me in the first row. He and I were eyeball to eyeball. If he moved up a foot our knees would touch. There was the man who wrote words that always caused my breath to catch in my throat whenever I read them. I needed to tell him. I got up and leaned down to speak into his left ear.

“I just want to tell you I Iove your writing,” I said. He smiled. Then I added, “There is something you wrote in the 90s, a short piece about nostalgia. I have read it over and over again for years. It is so well written. Not an unnecessary word. I have carried it around with me all this time.”

He looked pensive. “I don’t remember it.”

I gave him a synopsis as he stared at the floor. He nodded.

Maybe he didn’t remember after all. But, back in my seat, I felt content in finally telling Robert Olen Butler how much his writing has meant to me. And maybe, just maybe, some day someone will give me the same compliment.

I can only hope.



I am delighted that my story, Baby in the Closet, has been reprinted in Hospital Drive: A literature and humanities journal of the UVA School of Medicine. “This anthology is our editors’ choice of work published since the first edition of Hospital Drive in 2007.” It is the first print edition.hospitaldrive-1024x717

Unsolved Mystery?

Visiting my good friend, Lois Roelofs, in her new home in Sioux Falls. Hope you enjoy this post from the past.
Check out Lois’ blog,

Marianna Crane: nursing stories

This happened long ago. I worked for a hospital-based home care program. We, nurse practitioners, received referrals from physicians who had exhausted all options to prolong the patients’ life. We visited the patient in his home and helped the family care for him until death. Traditional hospice services were not an option as yet.

My patient was in his 60’s or 70’s and had a ditzy wife. Just like Edith Bunker on the old All in the Family T.V. show. She looked like Edith with dark hair, a whiney voice and hands that kept flying in the air as she talked. Edith and I sat in the corner of the living room with its high ceilings, dark woodwork and antiquated furnishings talking about her husband. I think he had lung cancer. I can see him wandering around in the turn-of-the-century apartment, seemingly unaware of his wife and me. While Edith…

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I thought it was time to revisit the positive aspects of aging. I wrote this post in October, 2013.

Marianna Crane: nursing stories

I made an ageist comment. It didn’t seem ageist at the time. I was sitting in the second row of a packed room at Flyleaf Bookstore in Chapel Hill as Pat Schneider finished reading from her new book, How The Light Gets I9780199933983_p0_v2_s260x420n.

I came to hear Pat for two reasons. One, I wanted to see the woman who developed the Amherst Writers and Artist (AWA) writing method. And, second, I wanted to see a fellow writer that was still prolific going into her ninth decade and had the stamina to go on a book-tour at six sites across North Carolina in seven days.

Maybe it was the interview I had heard a few years ago, which had taken residence in my memory that influenced my comment. A local author discussed her new book on a radio talk show. When asked her age, she said she never tells…

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A Hospice Nurse is Featured in The New Yorker


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Larissa MacFarquhar is a staff writer for the New Yorker. She has written profiles on “do-gooders,” people whose altruistic acts “spring from genuine empathy.”

Her subjects are varied: Quentin Tarantino, Diane von Furstenberg and Paul Krugman. Most recently she spotlighted Heather Meyerend, not a famous person, but a nurse. Her story starts on page 62 in the July 11 & 18, 2016 edition of The New Yorker, titled: The Threshold: A hospice nurse’s encounters.

“Heather Meyerend is a hospice nurse who works in several neighborhoods in South Brooklyn—Sheepshead Bay, Mill Basin, Marine Park, Bensonhurst, Bay Ridge. She usually has between sixteen and twenty patients, and visits each at home once a week, sometimes more. Some patients die within days of her meeting them, but others she gets to know well, over many months. She sees her work as preparing a patient for the voyage he is about to take, and accompanying him partway down the road. She, like most hospice workers, feels that it is a privilege to spend time with the dying, to be allowed into a person’s life and a family’s life when they are at their rawest and most vulnerable, and when they most need help. Some hospice workers believe that working with the dying is the closest you can get on earth to the presence of God.

Heather is not brisk or efficient, as nurses in hospitals are. She is purposely inefficient, in fact. Most of the time when she visits patients, she doesn’t have much to do: she takes vital signs, she checks that there are enough supplies and medications in the house, she asks if old symptoms have gone away or new ones developed. If she were rushing, she could do all that in about five minutes, but her visits usually last an hour or more. Sometimes there is a complicated medical situation to take care of. Sometimes she does something non-medical that needs to be done, which is the hospice way—she might sweep a floor, she might heat up dinner. But, even when there’s nothing else to do, the idea is to be around longer, to chat, to sit close by, to put her hands on the patient’s skin as she goes about her checkup. Her visit may be the high point of the day for the patient, who may not be able to get out of bed, or for whoever is taking care of the patient, who may not have left the house or seen anybody else for a day or two; either or both of them may be going a little crazy and may badly need interruption or variety of any kind, ideally someone different to talk to. So Heather moves slowly; she sits down; she delays; she lingers.” (Italics mine)



Heather Meyerend examines Mary, a ninety-two-year-old woman, at her home, in Marine Park, Brooklyn, in September, 2015. Mary died later that month. Heather believes in caring for the whole person, body and mind. PHOTOGRAPH BY EUGENE RICHARDS FOR THE NEW YORKER

Heather Meyerend examines Mary, a ninety-two-year-old woman, at her home, in Marine Park, Brooklyn, in September, 2015. Mary died later that month. Heather believes in caring for the whole person, body and mind. PHOTOGRAPH BY EUGENE RICHARDS FOR THE NEW YORKER


Weaving throughout Heather’s story, MacFarquhar gives us the scope of hospice:

“Hospice believes in caring not only for the patient but also for the family, and tries to address psychological and spiritual needs as well as physical ones, providing social workers and bereavement counsellors, music therapists and chaplains, who work together as a team and consult one another frequently.”

And the history of hospice:

“The first modern hospice was founded in 1967, in London, by Cicely Saunders, who was both a doctor and a social worker: she wanted to offer homelike care that aimed to provide comfort and serenity rather than to prolong life. Two years later, Elisabeth Kübler-Ross’s book “On Death and Dying” focussed public attention on the idea of the “good death.” The first American hospice opened in 1974. In those days, hospices were small nonprofits staffed mostly by volunteers; but in the mid-nineteen-eighties Medicare began to cover hospice, and now roughly twice as many people in America die in hospice as die in hospital.”

And an overview of the dying process:

“As the end approached, patients sometimes fell into an agitated delirium in which they saw people from their past appear in front of them as they lay in bed, often people who had died years before. This happened more often than Heather had expected—to about a third of her patients. The spectres appeared sometimes sitting in a chair by the bed, sometimes standing near the door. Often, a dying patient saw his mother or his father in the room, waiting. Sometimes these spectres were welcome: it seemed to the patient as though someone he loved who had gone on before had come back to accompany him to a life after. But other times the spectres were terrifying. Sometimes a patient believed that someone was running after him, out to get him; sometimes he was haunted by someone he had hurt long ago.

When death drew closer, a patient usually began to withdraw, not wanting to see people, and talking less if someone came. He began to sleep more. There was a kind of quieting, a kind of drawing in, as if he needed time to prepare. He might open his eyes for a minute and smile, but then he closed them and returned to wherever he had been. Hearing was the last sense to go. The patient might seem to be asleep or far away, but still he might hear what his family said around him. People tended to whisper around a dying person, so Heather might say to them, Don’t whisper! Talk, play music, he can still hear you.

When death is imminent, the breathing changes, and discoloration begins. The skin under the nails starts to get cyanotic, to turn blue. The legs grow dusky and cool. When Heather sees these signs, she calls family members who aren’t there and tells them, If you want to be here, this is the time. But she has seen, many times, that the patient seems to choose whom he wants there at the moment of death. Sometimes he waits for someone to arrive; but just as often he waits for someone to leave. Heather would see a husband or a wife or a child sit by the bedside day after day, hour after hour, and then he or she would say to the patient, I’m just running out to the market for ten minutes to get lunch, or I’m just going to take a shower, and that would be the time the patient would go. This happened over and over again. She wasn’t sure why. Maybe the dying person wanted to spare his spouse or his child the grief, or maybe it was harder to let go with that particular person around. Maybe dying was just easier to do alone.

If Heather was there when the end was very near, she would ask if the family wanted to gather together in the room. Then she would hang back, leaving the family to say goodbye. If the family were Christian, and if they had talked about that before, she might ask if they wanted to pray together. If the family were not Christian, she didn’t want to impose her beliefs, so she prayed silently in her head: God, here is this person, have mercy on him.”

“The patient’s breathing changes. He might stop breathing altogether for half a minute or so, and then start again. Then he stops again, but for longer. Then starts again, but shallower. This means that death is very close. For a person who hasn’t seen dying before, this strange, unpredictable breathing can be bewildering, a horror: because of the irregular intervals between the breaths, there is no knowing until a while afterward which breath is the last. Just before it happens, there is a staring. The eyes don’t focus anymore. The person is not there behind the eyes. Even so, Heather may need to step forward, after waiting some time, because the family may not know that the patient is dead.”


Impressive how MacFarquhar entertains and educates The New Yorker reader about both hospice and the life of a hospice nurse, topics not usually given such high visibility. It’s the attention to Heather’s interactions with her patients that I so enjoyed reading. You see, I once worked as a hospice admissions nurse. The immediacy of connection with the patient and family could be overwhelming. I never knew what I would find with each new admission—anxiety, fear, apprehension resided in most households. The caregivers, who could be spouses, friends, siblings, adult children, and parents, had to learn about medications, side effects, how to care for the patient, and be prepared for the final outcome, death. It was not a time to rush with instructions. I knew that assessing strengths and shortcomings of the family unit would save problems later on. I loved my job.

One day, the supervisor pulled me aside before I left to see my first patient. In the chill of an empty hallway, she told me I was too slow. Not that I was performing poorly, but that I was too slow.

I knew “too slow” meant that I was costing the organization money. But I also knew I was doing a good job as evidenced by the frequency of hugs I received from the family/caregivers before I left, and the appreciation from the nurses who took over the care of those I had admitted and went out of their way to tell me, “the caregivers are always so well informed.”

It saddened me that management didn’t appreciate my efforts. I didn’t want to work for an organization that valued the bottom line over patient/family satisfaction.

And since I didn’t want to be faster, I quit.

It’s clear MacFarquhar’s did her homework, depicting the specialness of hospice and a nurse who chose to work there. Hospice is not the same as an acute care hospital. The patient and family needs are different and there is no need for hurried nursing care. What is necessary is a nurse who lingers.

Why Your Imperfections Make You Perfect


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imagesI’m now taking watercolor classes, struggling to create something that I can be proud of but mostly learning how to be humble and not compare myself with my fellow classmates. As hard as I try to enjoy the journey and not focus on the end result, I still strive to have my finished product an example of perfection.

I never thought of imperfection as an asset until I read my watercolor instructor’s latest post.


08 MARCH 2016

Why your imperfections make you perfect


Suzanne McDermott


“Perfection itself is imperfection.”



The gap between Lauren Hutton’s two front teeth.

The wiggly lines of Gahan Wilson’s cartoons.

Uneven brush marks in hand-painted china.

The leaning tower of Pisa.

The tempo at which Toscannini or Glenn Gould raced through pieces.

Odd chisel marks in hand-made furniture.

These are just a few examples of what might be thought of as imperfections that, in fact, make a person, place or thing memorable, beautiful, unique.

My favorite live figure model of all time hated her thighs. What a pity. She was stunning.

Make a little list for yourself of physical things, personality traits, or emotional baggage that you think make you imperfect. Forget about what you think anyone else may think about these things. You’ll never know for sure anyway. Plus, it doesn’t matter what anyone else thinks. It matters what you think, how you feel about yourself.

Take that little list and find a way to accept, embrace, and ultimately love each and every one of those things, traits, and pieces of baggage. You may find that this exercise can make it easier to let go of said baggage because, hey, who needs it and who has places to store that old crap anymore?

Anyway, all the little marks and bruises, faux pas and clumsiness, guilt about Bad Things You’ve Done and so forth, all of those things make you you. And by the way, you—the real you— is just traveling in this body and personality temporarily.

You’re much bigger and brighter and shinier than you remember. There is no one like you. Never to be repeated, you are a miraculous variation of the human being.

Learn to love yourself.

 I Am Grateful to the Nurses


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In 2013 I toured the new intensive care units back at the hospital where I volunteer. At the time I was acutely aware how outdated my nursing skills were and realized that I wouldn’t even be safe to flip on a light switch. The state-of-the-art machines were daunting. I never thought that three years later I would have a family member, my husband, in the new unit.

It did help my anxiety that I knew what the ICU looked like. I remembered there was a sort of bench under the window—all the rooms had a window—that could be converted into a bed for family to stay over. I had decided before Ernie’s surgery I would spend the night and as many nights with my husband as needed. So many errors occur in hospitals. In my mind, hospitals are not safe places to be sick. I would be the sentry for safety.

After my husband’s six-hour surgery, two heart valves replaced, my daughter and I found him in a high-tech Hill-Rom bed, unconscious, intubated, and surround by snakes of IV tubing and lines attached to various machines.Hill-Rom bed

The nurse caring for him introduced herself and gave us a “tour” of the landscape, that is, what medications he was getting, what fluids were draining out of what orifices and what the monitors were monitoring. The breathing tube, she said, will come out soon and he would be awake and alert tomorrow. Really?

That was when I decided to spend the night in a hotel room. Fatigued from worry about the outcome of the surgery, I knew a good night’s sleep would be more helpful than spending the night with beeping machines. Besides, I felt an immediate sense of comfort knowing that Ernie would be getting excellent care.

As I look back on this event, I am reminded of the post I wrote on February 23, 2014 about Dr. Arnold Relman, the former editor of The New England Journal of Medicine. He had just turned 90 and fell at home, cracking his skull and breaking three vertebrae in his neck. After he had made a full recovery, he confessed that he had never made the connection between good nursing care and the patient’s outcome.

I had never before understood how much good nursing care contributes to patients’ safety and comfort, especially when they are very sick or disabled. This is a lesson all physicians and hospital administrators should learn. When nursing is not optimal, patient care is never good.

This he found out at the ripe old age of 90!

The next morning finding my husband alert and sitting up in a chair beside the bed without his breathing tube and looking surprisingly good brought me close to happy tears.

It’s been two months since Ernie’s surgery. He is getting better, slowly, every day. I continue to be impressed with the surgeon and his team that stopped my husband’s heart, touched, repaired and restarted it with skill and accuracy. They bring big bucks into the hospital coffers. They get the accolades and attention. At the end of the operation, they take off their surgical scrubs. Go home. Have a good meal. Get a good night sleep. But it was the nurses that watched my husband’s battered body around the clock, monitored his fluids, medicine, breathing, pain and his heart and put him on the road to recovery.images

And I am grateful.

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



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.[



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


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.