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When I worked in the home care program at a VA hospital in Illinois, medical students sometimes came along with us nurse practitioners while we made our visits. I enjoyed showing them the reality of delivering care in the patient’s home—where we were guests—the subtle line between suggestion and decree, education and instruction, doing for the patient and letting the patient do for himself.

One afternoon, when I had a female medical student riding with me, I had trouble finding the house. In the day of no cell phones or GPS’s, I stopped at a gas station to call the patient’s wife. Was I being paranoid when she sounded like she was being deliberately unclear?

We finally drove down the well-manicured block in a rather upscale neighborhood. One house in the middle of the block was “protected” by a row of stately cypresses or if cypresses trees don’t grow in Chicago, then tall fir trees. I’m a city girl. I don’t know trees but these trees were certainly blocking out the sun and hiding the house. And yes, it was the house we were going to visit.

I had met my patient the day he was to be discharged. I don’t remember what brought him into the hospital but he was going to be sent home on Coumadin, a blood thinner, and had to have frequent blood draws to adjust the dosage. The doctors felt he shouldn’t make the long ride back and forth to the hospital and consulted with our home care team. As a nurse practitioner I could draw the blood, interpret the results and change the Coumadin dose as needed. When he was stable, I would refer him back to his primary doctor or in this case, the clinic at the VA that would follow him.

“My wife won’t like it if you visit,” he said.

“Why,” I asked.                                                                     

“Well, we have lots of cats.”

Balding and pudgy he looked a mediocre counterpart to his elegant wife who showed up shortly afterward as if she had reservations at the Pump Room: bangles on her wrists and dangling earrings, dark long hair, bright red lipstick and matching nail polish. I learned she had recently retired from a local newspaper where she had been a journalist.

No, she didn’t want a home visit. But she quickly changed her mind when I told her how often she would have to drive her husband to the VA for blood tests.

So there we were, the medical student and I, trekking behind the forestry shield and up the stone stairs of a Tudor house to a heavy door with a small window covered with a curtain. I rang the bell. I recognized the long red painted finger nails as they parted the curtain. The wife’s face, heavy with makeup, smiled. We listened to her releasing the locks.

The vestibule was dark. The whole house was dark. The only light came from a small T.V. table in the next room.

My patient sat on a sofa in front of the table. He had a urinal beside him, a glass of water on the table and a trash basket on the floor. The room seemed spacious. There wasn’t any scent or sound of animals about.

My memory of the event does not include any direct confrontation. I had always believed we nurses visit the patient in his home and are guests. Not to instill our wills. Besides the wife provided a flashlight which the student held so I could see what I was doing as I drew the blood specimen.flashlight

That had to be one home visit the medical student long remembered. I certainly was happy to have her accompany me that first time. In the weeks that followed, the patient’s wife held the flashlight and the strangeness of the circumstances began to fade. Eventually, I managed to get my patient on a stable dose of Coumadin and discharged him.

On that last visit I had decided I would ask to use the rest room so I could look around for the cats. I doubted there were any.

But I lost my nerve.

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