No Edit Too Mundane

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This is the week we spend our annual family vacation at the beach. While I have enjoyed the ocean and sand, I took some time to complete an assignment. One of my stories had been accepted by Pulse: Voices from the Heart of Medicine, a digital journal. It could be published as soon as this Friday if I could make changes suggested by the editorial staff. And I did.

While most of the edits added clarity and a deeper texture to my story, one area of discussion initially seemed mundane. However, on reflection, I came to realize how important it is to add the actual time period of a story. In this case the mid ’80s.

Desk Phone

An intern who had the lead editing assignment probably was born into the cell phone era and never experienced a “desk” phone that, in most cases, was immovable from its position unless you added an additional cord.

vintage telephone cord

For example, in order to move about room, you had to add a long extension cord from the outlet in the wall to the base phone, then hold the base with one hand and with the other clutch the receiver to one’s ear. This way you could walk away from the desk and check for a report in the near-by file cabinet. (I won’t go into the fact we had hard copies of all our documents).

If you chose to add a long line from the phone base to the receiver so you didn’t have to carry the phone base with you, you would have to scurry back to the base phone to hang up.

Coiled phone extension

Plus that cord was coiled and most often became so tangled that you had to dangle the receiver until it spun and untangled. You had to plan ahead to add the cords. If, as the young intern suggested, you added an extension cord while talking to someone, the call would be disconnected.

This is probably more than you ever cared to know about old-fashioned phones. However, I learned a lesson that sometimes we know something so intimately that we assume all others share our experiences.

 

Check this site: Pulse Friday or next Friday to see if my story made it.

 

 

 

 

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Leaving Our Legacy

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I have been thinking for a long time about the fact that we older nurses are dying off. We will take with us our memories of nursing history. I have always loved to hear from other seasoned nurses about how they size up their nursing careers as they look back. What was important at the time, what were they happy to see disappear, and how do they assess current nursing practice and the future of the profession?

So I decided I would weigh in, occasionally, by spotlighting a nurse of a certain age, i.e., sixty and older, whether this is through an article I have read or by interviewing someone, or through my own stories.

This post is prompted by an article: Diane Saulecke, “There from the Start: A Hospice Nurse Looks Back,” American Journal of Nursing, 7, July 2017, 56-57.

The article features Dianne Puzycki, an 82-year-old nurse, who began to work with the hospice movement when it first started in the early 70s. She still works “the night shift at Connecticut Hospice once a week. ‘I want to be part of it as long as I can,’ she says, ‘It’s become part of my life, my philosophy.’”

 

 

 After graduating from nursing school in 1955, she started her career at Memorial Hospital (now part of Memorial Sloan Kettering Cancer Center) in New York City. There she cared for patients with cancer, many of them young women.

“At that time, we didn’t talk about death and dying,” she says. “We weren’t allowed to talk about that. It really haunted me for years.”

I remember those restrictions well. The diagnosis of breast cancer was withheld from my beloved Aunt Lena. I was in the first year of nursing school but never visited her in the hospital. One evening, when I was talking to my mother on the phone, I asked, “How is Aunt Lena?” “Just fine,” my mother said. That’s when I knew she had died. My mother would give me the bad new when I next went home to visit.

Puzycki mentions that she heard both Cicely Saunders, a doctor who founded the first hospice, and Elisabeth Kübler-Ross, who opened up discussion on dying through her 1969 book On Death and Dying. The early 70s were heady times in health care as discussion heated up regarding the previous taboo of being honest with patients by telling them their cancer diagnosis.

Kübler-Ross’ book was the subject of a workshop for the medical staff at the time I worked for a community hospital in the early 80s. To this day I remember one of the surgeons storming out of the classroom after loudly protesting, “my patients don’t want to hear that they have cancer.”

Being present for patients and “picking up on the little things” is to Puzycki the key to hospice nursing. And she says that seeing the compassionate actions taken by her colleagues, especially the younger ones, makes her feel hopeful about the future of the profession. She recently saw, for example, a fellow nurse lean down and kiss an elderly patient on the head. “I said, ‘That’s a good hospice nurse.’”

 

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I HAD A DREAM

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Revisiting the dreams.

Marianna Crane: nursing stories

Mercury Sphygmomanometer

In preparation for moving I discover the darndest things as I unpack dusty boxes stored in the attic untouched for years. This time it’s a mercury sphygmomanometer, packed in its original carton along with a “limited warranty” card that should have been filled out within ten days of purchase. Looks like I didn’t even open the box but put the blood pressure machine away for the day I would open my independent practice.

That would have been in the early 80s after I became a gerontological NP

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after I worked in Chicago with inner city, underserved elderly

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after I became frustrated with the lack of resources and left to become an administrator of an HMO

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after I knew I didn’t want to be in administration

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after going back to work as a nurse practitioner once again

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after moving to three different states

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after finally…

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Getting on the Bus

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This post appeared in two parts on September 8 & 20, 2013.

 

The first night in a hotel room in Estoril, Portugal, my heart, flipping about in my chest, jolted me awake. Thump. Thump. Thump. Silence. Then a rush of horses’ hooves clopped on my ribs. Trying to ignore my heart’s gymnastics, I tried to go back to sleep but the Mariachi band playing under my ribs demanded my attention. Pressing my fingers into my wrist, I palpated the same irregular rhythm. Besides a touch of anxiety, I felt fine. No chest pain, no shortness of breath, no dizziness, no nausea. Then my bladder upstaged my clinical observations. Damn.

Slowly, I rose and sat on the side of the bed, careful not to disturb my husband who slept beside me. I waited to pass out. When that didn’t happen, I shuffled in the dark, feeling my way along the wall, to the tiny bathroom.

Successfully back in bed without tripping, falling, or fainting, jet lag eased me into slumber.

The next morning, I awoke to the same sensation in my chest. More alert than the night before, I diagnosed the uneven heartbeat as atrial fibrillation. A geriatric nurse practitioner until my retirement three years ago, I had treated many patients with this condition—its occurrence increases with age. A fact I couldn’t ignore.

I remembered the day before as my husband and I explored the neighborhood around the hotel we had walked past a medical clinic. Through the large glass window, I saw several people sitting in a waiting room, some reading magazines, not unlike our clinics back home. I had no desire to seek help there. I didn’t speak the language, and who knew how advanced medical practice was in Portugal? Besides, I was counting on this event ending soon.

Getting ready for the day’s adventure, my husband slipped a sweater over his head as I laced my shoes. “By the way,” I said, “I am having some a-fib. It’s nothing serious and I suspect it’ll end on its own. I just want you to know, in case I pass out, get an ambulance and tell the medical folks what’s wrong with me.” I made eye contact. “A-fib, got it?” My husband of forty years knew better than to question me, and nodded. I figured he was happy to put off a deviation in our itinerary—his controlled persona would be spared a chaotic scene.

We rode the elevator down to the lobby, queued up with our tour group and boarded the bus to Cabo de Roca. I grabbed a window seat. The vibrant, coastal city gave way to dry grasses clinging to rocky cliffs. I slipped down in my seat and put my fingers to my neck, checking my carotid pulse. The irregular rhythm ticked off around one hundred beats per minute. No too rapid to worry me—yet.

After a couple of hours, the light blue sky became cloudless as we headed into thinning air. Would the high altitude affect the rhythm of my heart? Would my pulse become so erratic that my blood stagnated, forming a clot that would migrate to my brain and spawn a stroke? My husband remained deep in his book. Or was he consciously ignoring me? The medical clinic near the hotel began to look inviting. And very far away.

The bus turned into an empty parking lot. We arrived before the Japanese tourists. My husband was the only one who headed over to the one-story building that stood at the far end of the lot where one could obtain, for five Euros, a certificate validating that one had stood at the westernmost point of continental Europe. The others headed to the bathrooms or the gift shop.

I stepped off the bus last. I felt something strange. Or, rather, I felt nothing. My heart had stopped. No, it just felt that way with the prancing finally gone.

Cabo de Roca

My chest was silent. My pulse was regular. The air smelled cool and crisp.

Released from potential calamity, I dashed off to find my husband.

When we returned to the States, my internist insisted I wear an Event Monitor: electrodes attached to my chest at one end and at the other end to a plastic box that would hang around my neck for a month. When I noted any flip-flops from my heart, I was to depress the start button and the monitor would record the “event.”

During the first week, after I wrestled with the monitor to find a comfortable position in bed, I settled into sleep. My heart, booming loudly in my ears, jarred me awake. I pressed the record button and the monitor gave off a high-pitched sound and began taping. As instructed, I lay still. When the whining stopped, I stumbled out of the bedroom to call the toll-free phone number.

The nurse talked me though the process of sending the recording across the phone lines. I hung up, relieved that she didn’t tell me to go directly to the hospital, as happened with my friend, Norm, after his first submittal. He was sent to the emergency room immediately. A pacemaker was implanted in his chest the next day.

I reassured my husband, who woke up during the taping and trailed after me, concern covering his face. We ambled back to bed—him to sleep and me to await any further malfunctioning of my heart.

Three weeks later, I mailed the monitor, wire, attachments and unused batteries back to the company. I wouldn’t miss the nightly struggle to sleep with a rigid box digging into my ribs. Or fear of the monitor beeping at inappropriate times during the day. Or most of all, the constant state of surveillance for any twitch in my chest.

The only two episodes I had during the month were not atrial fibrillation but sinus tachycardia: a regular, rapid heart rate that’s not life threatening. Wearing the monitor for a month seemed too much of an inconvenience for such a paltry yield.

No doubt there will be other assaults to my aging body, mildly annoying or life threatening. The trick is to know the difference: whether to stay back and seek medical care or take a chance and get on the bus.

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Nurses of a Certain Age

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Excepted from Off the Charts, May 31, 2017

 

AJN Facebook Readers on Influences, Public Attitudes to Nursing, Practices of Yesterday

by Betsy Todd, MPH, RN, CIC 

What do you remember from early in your career that would never be seen or done today?

We “nurses of a certain age” remember!—and we’re amazed at how far our profession has come. As one nurse commented, in response to early nursing practices that seem primitive today, “Oh my goodness, how has humanity survived?!”

There were, of course, our caps, white dresses, white hose, and white shoes. One nurse recalled that we always wore our school pins on our uniforms. These seem not much in evidence these days, but were always a source of pride and connection (and sometimes, lighthearted rivalries) back in the day.

In addition, nurses pointed out that the scope of practice has certainly changed. Nurses mixed soft soap for enemas, mixed weak solutions of Lysol (!) for vaginal douching. Wound care has, shall we say, evolved. Nurses recalled packing wounds with eusol (chlorinated lime plus boric acid—“cleaned wounds by removing patients’ flesh with it!”), Savlon (chlorhexidine combined with a chemical later used for disinfecting floors), Milton (a bleach solution), or sugar mixed with Betadine or egg whites. Some remembered “vigorously rubbing talc onto bums to relieve pressure” or “Maalox and heat lamp for sore butts.”

Are automated medication dispensing systems (for example, Pyxis machines) and bar codes part of your daily routine? Several comments described pouring meds from stock bottles on the unit or mixing chemotherapy solutions in the medication room. There were no medication carts, just medication trays with cups and handwritten cards for each patient (different colored cards for b.i.d, t.i.d., etc.).

“Point of care” lab testing didn’t include quality checks. One nurse remembered “burning urine samples in a glass tube over a Bunsen burner to check sugar levels.” DeLee suctioning of newborns—“I ended up with a mouth full of stomach contents more than once”—or pipetting blood and urine samples for the lab via mouth suction were also routine.

Many comments reminded us of tools rarely seen in today’s hospitals. There were time-taped IV bags, glass syringes and IV and chest tube bottles, mercury thermometers, crank beds and egg-crate mattresses, “gloveless everything,” and no hand sanitizer.

Routines and work practices of years ago may be hard to imagine today. Nurses recalled smoking during report, and patients smoking in bed. Patients were admitted “just for observation,” or a day or two prior to surgery. Each shift charted in a different color of ink. Nurses recalled time to talk with patients, and actual “acuity-based staffing” (“RIP,” as one nurse commented).

Another nurse summed up a certain sadness as she described some lost aspects of patient care:

“morning care before breakfast, clean sheets every day, evening care with back rubs, trash emptied, fresh water and being aware of the patient’s environment. [We] took time to assess the patient by the RN and listening. The care was impeccable because of the nurses who controlled the patient experience.”

Back Rub

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A Little Music and Movement Can Make You See Things Differently

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Yesterday, I went to the North Carolina Art Museum at 10 a.m. to move to music.

Two women led, followed by a man in a suit holding an open laptop channeling the songs that were mostly by the Bee Gees. The women, in sequined dresses and sneakers, stomped, marched, trotted in time with the music. Thirteen women and two men, ranging in age from 20 to 70 plus, followed behind, mimicking the women’s movements. We didn’t talk.

I felt exhilarated racing through the empty museum with music bouncing off the walls surrounded by other exuberant people. The moves were not stressful. I did most of them except balancing on one leg and I stopped halfway through the jumping jacks.

The group stopped intermittently in front of a piece of art: statue, still life, portrait, and continued to move/exercise in place. Short inspirational narratives, previously taped by Maira Kalman, punctuated the music. Normally, when I visit a museum, I would gaze at the art in quiet contemplation. This time my mind and body seemed as one, absorbing the stimuli transmitted from the environment, my thoughts suspended.

When the two women dropped to the floor, I felt as if someone turned off the lights. Lying among my fellow participants with arms and legs outstretched, I realized that fifty minutes had flown by.

Now the day after, the residual glow from yesterday remains with me.

My new goal is to have more days where I step out of the ordinary.

Thanks Monica Bill Barnes & Company!

Anna Bass,me,Monica Bell Barnes, Robbie Saenz de Viteri

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The first performance The Museum Workout appeared at the NYC Metropolitan Museum of Art.

Check out the video of the performance. 

 

photograph by loulex for the New Yorker

Madame X, meet Ladies in Sequined Dresses and Sneakers. For “The Museum Workout,” which starts a four-week run on Jan. 19, Monica Bill Barnes and Anna Bass, Everywoman dancers of deadpan zaniness, guide tours of the Metropolitan Museum of Art before public hours, leading light stretching and group exercises as they go. Recorded commentary by the illustrator Maira Kalman, who planned the route, mixes with Motown and disco tunes. Might raised heart rates and squeaking soles heighten perception?

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My Book Comes to Life

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This past weekend I traveled to Chicago to attend the celebration of the 60th anniversary of the clinic where I worked 30 years ago. The clinic sets the stage for my memoir: Playing Sheriff: A Nurse Practitioner’s Story. The formal function on Friday had 500 in attendance but it was to the intimate and informal Alumni Luncheon on Saturday that I brought a prepared presentation: a short intro and a modified chapter to read during open mike.

I write, as writers do, in isolation. Over the years, my book gradually disconnected from the reality that spurred its inception. At the luncheon, when I stood in front of the room with microphone in hand, I realized this was not a time or place for a formal reading. The tightness in my throat surprised me. Here among the alumni were those who worked with me back 30 years ago at a clinic that defied the establishment by using nurse practitioners and midwives as primary providers and hiring doctors who supported the nurses by ignoring their ultra-egos and espousing the team approach.

I decided last minute to tell the story of the Pigeon Lady. Characters who peopled my book morphed into living, breathing individuals sitting at the tables before me, nodding in agreement about the series of events I described because they were there. At that moment, my book came to life.

 

More on Nurses Week

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I am reblogging this post from Lippincott Solutions. My non-nursing followers can read about the history of Nurses Week and the writers among us will be happy to see that Lippincott is asking for “Inspired Nursing Stories” for their annual writing contest.
Calling the Shots: Nursing News and Notes

CELEBRATE NATIONAL NURSES WEEK 2017

Tuesday, May 2, 2017
Mind, Body, and Spirit: celebrating nurses who lead the charge for health and wellness.

Are you ready for National Nurses Week 2017?

Honoring nurses for your hard work and dedication throughout the year, the American Nurses Association (ANA) will be celebrating its annual National Nurses Week from May 6-12, 2017.

ANA’s National Nurses Week 2017 theme — “Nursing: the Balance of Mind, Body, and Spirit” — celebrates nurses who lead the charge for health and wellness in their practice and profession. ANA has designated 2017 as the “Year of the Healthy Nurse.”

HISTORY OF NURSES WEEK

The ANA supports and encourages National Nurses Week recognition programs through the state and district nurses associations, other specialty nursing organizations, educational facilities, and independent health care companies and institutions.

Each of ANA’s state and territorial nurses associations promote the nursing profession at the state and regional levels. Each conducts celebrations on these dates to recognize the contributions that nurses and nursing make to the community.

National Nurses Week runs each year from May 6 to 12, ending on Florence Nightingale’s birthday. These permanent dates enhance planning and position National Nurses Week as an established recognition event. As of 1998, May 8 was designated as National Student Nurses Day, to be celebrated annually. And as of 2003, National School Nurse Day is celebrated on the Wednesday within National Nurses Week each year.

Nightingale, who lived from 1820-1910, was known as the founder of professional nursing, especially due to her pioneering work during the Crimean War. Due to her habit of making rounds at night, Nightingale became known as “The Lady with the Lamp.” National Nurses Week was first observed in 1954, the 100th anniversary of her mission to Crimea.

CELEBRATION PLANS

During National Nurses Week, celebrations and receptions will be held in hospitals and other healthcare facilities across the country.

ANA’s National Nurses Week Toolkit is a useful resource that provides you with additional ways to recognize nurses for their professional skills and abilities. For example, show your gratitude with a branded “Thank You Card.” Give every nurse a certificate of appreciation or hang display banners throughout the office. The National Nurses Week toolkit has plenty of ideas to plan a great celebration.

Nurses are encouraged to sign up for ANA’s free webinar, “A Nurse’s Guide to Preventing Compassion Fatigue, Moral Distress, and Burnout” on May 10 at 1:00 EST. During this one hour exclusive live event, Joyce A. Batcheller, DNP, RN, NEA-BC, FAAN, will discuss the latest research in the field and provide you with tools and strategies to infuse meaning, joy, and restoration into your practice and life. Batcheller is senior vice president and CNO of the Seton Healthcare Family, the largest health care system in Central Texas.

After attending, nurses will be able to:

  • Reduce the physical and emotional consequences of morally complex situations.
  • Build confidence in confronting morally complex situations to reduce moral distress and burnout.
  • Harness expert tips and strategies to build resilient teams.
  • Use current research to prevent and combat compassion fatigue.
  • Apply tools and strategies to recognize and overcome compassion fatigue.

PAYING IT FORWARD 

Once again this year, we are holding our annual ‘Inspired Nursing Stories’ writing contest.  What are your most memorable moments in nursing?  Have you had any poignant moments with patients and their families?  A mentor or preceptor that helped shape you into the nurse you are today?  Or was it a family member that helped you realize your calling to nursing at a young age?

Nurses, we want YOUR story!  The winning entry will receive a FitBit Alta, and the 1st and 2nd runners-up will receive gift cards. All of the top 12 stories will be featured in our 2018 Inspired Nurses: The Heroes of Healthcare glossy print calendars.

Click HERE to submit and help to ‘pay it forward’ by allowing other nurses to share in what keeps your nursing engine firing! You can also browse through some of our best stories from previous years to get your own ‘dose’ of nursing inspiration.

How are you planning to celebrate National Nurses Week? For all the official details from ANA, go to www.nursingworld.org/NationalNursesWeek.

Thanks SO much for all that you do, and best wishes for a terrific National Nurses Week!

Just Say No to Nurse Angels

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I just spent the morning at a table in the cafeteria in the hospital where I volunteer. I had post-it notes and pens for the staff and visitors to jot down a note of appreciation to the nursing staff and place it on a large white board on the wall–a “Gratitude Wall”. We volunteers will continue to do this between 12 and 2 p.m. today, Monday, until Friday May 12th for Nurses Week. Nurses even wrote notes of appreciation for their colleagues. I especially enjoyed hearing the patients say how grateful they were for nurses and the care and attention nurses gave to them and/or their family.
Since I retired from nursing, I generally ignored Nurses Week having experienced empty platitudes and silly gifts when I worked in the profession.. Seems things are changing as evidenced in my volunteer hospital and from the recent nursing blogs and articles written by nurses.
I am reblogging Josephine Ensign’s post “Just Say No to Nurse Angels.” I agree with her sentiments and only wish my book was published and included in her list of real books by “real nurses.”

Medical Margins

FullSizeRenderThe American Nurses Association has declared this National Nurses Week (May 6-12, 2017) theme as “Nursing: The Balance of Mind, Body, and Spirit” to accompany their designation of 2017 as “The Year of the Healthy Nurse.” To help nurses celebrate the week, a host of businesses are offering “freebies” to nurses, including 1,000 calorie cinnamon rolls. I have nothing against high-calorie baked goods, but to celebrate nurses I recommend books and inkpots. Books, as in real books by real nurses (my current favorites listed below). And inkpots? I explain that in the following excerpt from my upcoming commencement address to graduates of the Yale School of Nursing:

“Thank you for this opportunity to speak to you about a topic I am passionate about: nursing. But not traditional nursing—not the Lady with the Lamp during the Crimean War—and not the white uniform-clad nursing angel of Hallmark moments. About that nurse angel…

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Keeping “To-Do” Balls in the Air.

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Have you ever been caught in the rain without an umbrella, raincoat or a nearby shelter? Since I’m a city girl and don’t hike, camp, bike over mountain trails, I rarely get caught unprepared.

There is a lot going on in my life right now. I am in the process of publishing my first book, Playing Sheriff: A Nurse Practitioner’s Story. I am preparing to give a talk this evening to the oversight board of the hospital where I volunteer. I am co-chair of a patient advocacy group and am working on a power point presentation. (I haven’t used Power Point once in the last ten years!) What part of my book do I read when I am in Chicago two weeks from now at a luncheon celebration for the clinic where I worked over 30 years ago? And I’m scheduled for some extra sessions of kid duty, aka, babysitting in the next few days. And the most telling of my self-imposed angst is that I am six New Yorker editions behind rather than the usual two.

In the middle of this effort to keep my “to do” balls in the air, my husband and I set out for a walk. The newspaper didn’t predict precipitation so we dismiss the gray clouds loitering above. Shortly after we start, soft drops of rain dampen our heads. We turn around. At first we walk under the shelter of the tall trees that line the walkway. The last part of our trail is on concrete sidewalks lacking cover.

The rain teases us by alternating between a soft drizzle and plummeting shafts of water. A block before we reach the house, wind slams even heavier sheets of rain down on us, flattening my hair, soaking through my stretchy dry-fit sport shirt. Rivets of water run down my arms. While my husband picks up his pace, I saunter. The gray landscape takes on a surreal element, blurring the houses with shades of red, purple and white azaleas like a Monet painting. The smell of earth, sound of the wind and the wet slog of each footfall heightens my awareness of the surroundings and lightens my stress. I glide home in the downpour.

I step through the front door dripping water onto the rug and I drop my “to do” balls to the floor.