Olden Days of Nursing: Dialysis

I still remember the teenager but not his name or how long he had been getting peritoneal dialysis (PD). I recall him walking between his parents down the long hospital corridor. He was going home to die. A father with small children had preempted the teenager’s spot on the dialysis unit. Restricting patients was necessary because supplies and personnel were in short supply at the time. Dr. Norman Lasker, head of the Renal Division made that decision unilaterally. 

I  had taken care of the teen when he came in for twice weekly treatments. His mother and father came with him bringing magazines with pictures of sweaty wrestlers, which I found repulsive. Not having any brothers, what did I know about teenage boys? However, we did have something in common: the new TV show, Batman. I would watch the show each week (no binge watching then) so when the teen came on the unit, we would have something to talk about. 

What happened to him after he was sent home? Hospice or palliative care hadn’t evolved, as yet. How did his parents manage? Did he wind up in a hospital at the end of his life? 

I called Carol Passarotti-Novembre. She and I worked on the same research floor: a 15-bed unit at Pollak Hospital in Jersey City. Carol was the first renal nurse in New Jersey, working alongside of Dr. Lasker in one of the first Dialysis Centers in the US in 1961. Only three other major Dialysis Centers existed then: Boston, Seattle and New York City. Dialysis nurses received on-the-job-training. 

Carol didn’t remember the teenager.

 

Of course, she wouldn’t since she had so many other patients. Some were on chronic PD, like the teenager. Patients came twice or three times a week, interspersed with emergency dialysis for acute problems like drug overdose, end stage renal failure, and post-surgical renal shutdown. For eight years, Carol was on call 24/7. Only once did she miss an on-call emergency. Another staff nurse from the research unit stepped in. The patient survived. 

Later on, Dr. Lasker was no longer the lone decider. Carol told me that a “board consisting of physicians, administrators, clergy and others reviewed potential patients to receive dialysis treatments.” She sat on this board. 

Carol ran the show at the Dialysis Center. The “Dialysis Center” was in reality four beds devoted to renal patients on the 15-bed unit. 

The procedure for PD was as follows:

After warming two-liter glass bottles of dialysis solution in the sink, Carol hung them from an IV pole. The fluid flowed into the peritoneal cavity and remained in the patient for 30 to 40 minutes. The bottles were taken down from the IV pole, inverted and placed on the floor so the fluid would drain back into the bottles, which took another 10 minutes. Repeat. The patients stayed overnight since each treatment lasted 36 hours. 

Carol managed up to four patients on Monday, Wednesday and Friday or Tuesday and Thursday. The day shift helped when we could. Evening and night nursing staff managed the PD during their shift. Carol discontinued the PD the following morning only to see the same patients come back the next day. 

Not surprisingly, Carol got to know her patients and their families well, as did all us nurses, since each patient came to the unit so frequently. 

One patient, Ellen, a slight Italian women with a large family, stopped breathing and became pulseless when I was in her room. I did what we were taught to do at that time. I slipped her on to the floor, struck her sternum with the side of my hand, breathed into her mouth and started chest compressions. The doctors on the unit came to assist me. We revived her. When she awoke, she told us she didn’t want to be resuscitated. We didn’t ask these questions in 1965. Happily, for me, when Ellen stopped breathing next, I wasn’t in the room. 

Carol had an uplifting story to share: 

“One of our patients was on PD for four years. Her local internist came to her home for each treatment, inserted the trocath [to make the pathway into the peritoneal cavity], and left. Her husband carried out each treatment. Even her little children helped with warming the bottles of dialysate. She switched to home hemodialysis for five years, then continued In-Center Hemodialysis for ten more years. At that point she received a cadaver kidney transplant, which lasted for a good number of years after.“ 

The following is from a speech Carol gave to nephrology nurses and technicians of North Jersey at Marriott Newark Hotel, Newark, NJ, May 6, 2011:  

“The role of the nurse has changed along with each modality of treatment, the changing needs of the patients and families, the advances in technology and the increasing demands for specialized education in nephrology.

. . . My knowledge of nephrology was ‘on the job’ everyday type of learning. I depended upon the physicians I worked with. . . .Working for the medical school had its advantages. The most important being able to be involved in research projects. e. g., vitamin studies, various solute clearance studies, cardiac output studies in the chronic PD patient and also, in developing the original cycler and starting home training programs for PD and hemodialysis.

 

(Carol was the first nurse to be included in a research study citation in the Annals of Internal Medicine.)

Today’s nephrology nurse is involved in direct patient care, teaching in all the fields: PD, hemodialysis, transplantation to the patients and their families as well as research and development. National and local organizations, such as American Association of Nephrology Nurses and Technicians were formed in order to ensure a high standard of education on both a local and national level and making nephrology nursing an accredited and recognized area of nursing. 

For me, the rapid growth and development in this area of medicine over the past 49 years, has been totally mind blowing, awesome, most exhilarating. The potential for future development is limitless!”

Carol married in 1968 and remained with the renal unit of the New Jersey College of Medicine and Dentistry Renal Division until mid 1969 when she left to have her first child. In 1971, she worked as a staff nurse in hemodialysis unit and later in the Hemodialysis Home Training unit at  Saint Barnabas Medical Center in Livingston, NJ. In 1976, she joined a Renal and Hypertension practice as both an office nurse and researcher in many drug studies. Carol worked  full-time, sometimes 50 hour weeks, before she retired in 2010 at the age of 70.  

After reflecting on Carol Passarotti-Novembre’s long career in nephrology, I ask the obvious question. How could the development of peritoneal and hemodialysis have progressed without the collegial partnership between nurses and physicians? 

Jersey Journal. Carol and Dr. Lasker are standing beside the first hemodialysis machine.

 

Hedda Hopper’s Lemon Pie

When I first read that men thought of sex every seven seconds, I thought that’s me. No, not that I think of sex but that I think of food frequently. 

Even when I worked full time, I planned our family dinner each evening. Meal planning and cooking seemed more of a hobby that a chore. I enjoyed hosting parties and informal get-togethers. 

Food had always been part of my life. Descended from two ethnic groups that think of food as love, there is no doubt I was hit with a double DNA whammy. My paternal Italian family spent Sunday afternoons at grandma’s Jersey City house: her kitchen table laden with homemade soup, bread and pasta, roasted chicken, salad, fruit, and followed by store bought Italian pastries. Expresso coffee for the adults coupled with good cigars for the men. 

My mother’s Polish relatives lived in the New York City suburbs. Our less frequent trips to see them were also food centric: fresh and smoked kielbasa, stuffed cabbage, sauerkraut, boiled potatoes, red cabbage with sour cream, and a selection of homemade desserts, such as cheesecake, lemon pie and baked apples with ice cream. 

My mother was a good cook. I still have her three-ring binder busting with newspaper clippings of recipes, old cookbooks: The Art of Cooking and Serving by Sarah Field Splint, 1929 and educational booklets, such as The Herb-Ox Money Saver, 1949 and Sunkist Lemons: Bring Out the Flavor, 1939. Tucked into the pages of this last book is a typed recipe for Hedda Hopper’s Lemon Pie.

Now that I’m retired and there are only two of us to cook for, food doesn’t hold the same excitement. And I’m less interested in entertaining, if one can even do this in the time of Covid-19.  However, recently I read Bill Buford’s new book, Dirt: Adventures in Lyon as a Chef in Training, Father, and Sleuth Looking for the Secret of French Cooking. After I finished Dirt, I still had a taste for more cooking stories. I dusted off my copy of Kitchen Confidential: Adventures in the Culinary Underbelly by Anthony Bourdain that I never did get around to reading. Either Buford or Bourdain had mentioned Larousse Gastronomique, the “internationally famous bible of cooking.” That’s when I went on a pilgrimage to the bookcase on the second floor stacked with books that mostly were dusted but not read. 

On the bottom shelf stood The World Authority Larousse Gastronomique. It was the first American edition (1961) with 8,500 recipes. If I were to buy this book new on Amazon, I would spend $201.80 plus shipping. Okay, I am a Prime member—no shipping costs. 

On the third shelf, I found a basket with all my mother’s cook books and notes. 

What did this exercise teach me? First of all, the fact that I purchased Larousee Gastronomique reminds me how much cooking had meant to me. I’ll take the time to peruse this tome. Second, the trip down memory lane sorting all my mother’s cooking memorabilia challenges me to carefully sort her recipes and books. Maybe I would even try to recreate some of her dishes starting with Hedda Hopper’s Lemon pie. 

The World Authority Larousse Gastronomique, the Encyclopedia of Food, Wine & Cookery Hardcover – January 1, 1961

by Prosper Montagne (Author), Auguste Escoffier (Introduction), Phileas Gilbert (Introduction), Nina Froud (Editor), Charlotte Turgeon (Editor)

This is the internationally famous bible of cooking, the encyclopedia-cookbook which, because of its 8,500 recipes and the full information it gives on all culinary matters, has been accepted as the world authority. Ask any chef, ask any cooking expert. You will find a copy of LAROUSSE GASTRONOMIQUE in the kitchen of any superior restaurant anywhere in the world. It is a prized possession of every gourmet who knows French. But until now it has been available only the French language. Because of the complexities of variations in terms and measurements, it has never before been translated into English. Now, after three years of intensive work by a staff of twenty experts headed by two famous editors, it has been converted for American usage. LAROUSSE GASTRONOMIQUE contains in its 1,100 large pages 8,500 recipes from all over the world and 1,000 illustrations, many in full color. Also, there are descriptions of cooking processes; full details about all foods, their nature and quality, and how to cure, treat, and preserve them; the history of food and cooking; articles on table service, banquets, food values, and diet — in fact, just about every topic of culinary interest is covered. Though LAROUSSE GASTRONOMIQUE is the prime reference book of chefs, gourmets, and experts, it is equally useful and convenient for the home cook. All recipes except for banquet specialties are on a small-group basis, stated in simple terms for convenience in the home. For this American edition, all entries have been brought up to date, notable in the articles on the preservation of food. Entries are in alphabetical order and are fully cross-referenced under both English and French names. The illustrations in color, black-and-white photographs, and line drawings, many of which were made expressly for the American edition, show not only the appearance of the cooked dish but in many cases the intermediate steps of preparation as well.

Olden Days of Nursing: Coronary Care Unit

 

I helped open the first CCU in New Jersey in 1967. New monitoring technology and implementation of coronary-pulmonary resuscitation precipitated the development of CCUs across the country in order to reduce deaths from acute myocardial infarcts (AMI).

Bethany Hospital in Kansas had opened the first CCU in the United States on May 20, 1962. The second one opened soon after in Philadelphia’s Presbyterian Hospital. It was at Presbyterian Hospital that Rose Pinneo, head nurse of the unit, along with physicians, Lawrence Meltzer and Roderick Kitchell, coauthored Intensive Coronary Care: A Manual for Nurses in 1965. 

I remember the manual and especially Rose Pinneo. Pinneo became a role model for all the new CCU nurses at the time.

I kept this picture in a photo book over the years. Just recently, as I went through all my old photos as a “sequester in place” pandemic project, this picture took on a new significance. It would fit under: “Olden Days of Nursing,” a new grouping of stories I am starting to post on my Blog.  

It was only after I began to do some research that I recognized that right from the inception of CCUs, nurses ran the show. At the time this benefit eluded me. I was still a neophyte. I had not yet dealt with the paternalist health care system and rigid legislation that limited nursing practice. 

I was pleasantly surprised to read about how nurses were positioned to take charge right from the inception of CCUs:  

The opening sentence (in Intensive Coronary Care: A Manual for Nurses) in set the tone: “It may seem curious that the first book dedicated to a new concept of treatment for acute myocardial infarction has been directed primarily to nurses rather than physicians.” They (the authors) emphasized that the new treatment technologies had to be used immediately in order to save lives. To achieve this goal doctors must abandon traditional notions of a nurse’s limited role in clinical decision making.The authors declared, “Intensive coronary care is essentially an advanced system of nursing. It is not an advanced system of medical practice based on electronics.” Their prescription for saving lives was explicit: “A CCU nurse must be able to perform…therapeutic measures by herself without specific orders.”[Italics mine.]

. . . Support for giving specially trained nurses authority to defibrillate patients grew quickly in the late-1960s as concerns about the legal implications of the practice declined. The CCU-inspired empowerment of nurses represented a critical first step in the evolution of team-based care that is such a conspicuous part of current-day cardiology practice.

Resuscitating a Circulation Abstract to Celebrate the 50th Anniversary of the Coronary Care Unit Concept, W. Bruce Fye, Circulation. 2011 Vol 124 (17), 1886-1893. 

The first few of months in the CCU, I supervised the set-up of the physical space, hired nurses and organized the classes to be given by cardiologists. I gave lectures to the hospital staff nurses and administration about this new clinical specialty unit. 

I worked in the CCU for only ten months. Newly married, my husband and I moved to another state because he had a great job opportunity. Over the next few years, we moved five times, had two children and I worked part-time at two other CCUs. When I started school for my bachelors’ degree in 1970, I never went back to the CCU. Cardiology is still my favorite specialty.  

 

Why Your Imperfections Make You Perfect

Originally posted on March 8, 2016

Nursing Stories

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

 by

Suzanne McDermott

“Perfection itself is imperfection.”

  • VLADIMIR HOROWITZ

 

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…

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The Story Behind the Message

I first posted “The Story Behind the Message” in 2017 before my memoir was published. Now as I work on my second book, this post remains as relevant to me as ever.

Writing for me doesn’t get easier, Molly.

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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.

Let me count the ways—to make a home visit.

As a home health nurse, I made visits in Chicago, Washington D.C., and right before I retired, in the areas surrounding Raleigh, North Carolina. I didn’t climb over the roofs in New York City, nor did I ride a horse or a bike. Unlike the nurses in the Visiting Nurse Service of New York City (1893), or the nurses in the Frontier Nursing Service in Kentucky (1925), and more recently, the midwives depicted on the TV show: Call the Midwife, I drove a car.

One of the handicaps I had in driving a car back in the 80s was that there wasn’t a GPS. Being directionally challenged, I lucked out when I discovered I could put a compass on the dashboard of my vehicle. And even more lucky that I could calibrate the compass on the straight north and south streets of Chicago. I rarely got lost after that. However, I do remember a time that I almost didn’t make a home visit because I couldn’t find the patient’s home. 

I was going to see a new patient in Chicago’s western suburbs; an area where I was unfamiliar. I had looked up the directions back at the hospital before setting out. We kept a stack of street maps in the chart room. For some reason, the directions I wrote down didn’t work. I stopped at a phone booth (remember those?). That phone booth and the others nearby hadn’t been serviced. No one had come to remove the quarters that blocked the coin insert. My stash of quarters were worthless. I found a gas station attendant that let me use the office phone to call the patient’s home. (N.B. The first staff member to visit a new patient made an entry in the patient’s record with accurate directions to the home).

As much as I felt inconvenienced without a GPS, how did my predecessors, who rode on horseback or bikes or climbed over roof tops, find their patients?

The Chicago winters caused the greatest panic: The windshield wiper that stopped working as I drove on the highway in a snowstorm or the time I tried to make a “careful” right turn on an icy road but the car decided to skid sideways in another direction. I carried a shovel in the trunk to dig my way into a parking space when I visited patients who lived in the city. 

Driving in D.C. could be aggravating. The summer roads crammed with tourists. Presidential motorcades halting traffic. A slight dusting of snow would show the incompetence of drivers from tropical countries. 

While I’m most comfortable driving in big cities, the farmlands of the South have challenged me. After one especially wet spring, I drove into a rural town I had never heard of and parked on the lawn in front of a small wood frame house. I sloshed to the front door. No one was home. I tried to call (I had a cell phone then). No answer. 

Back in the car, I couldn’t get any traction to move. I spun the wheels, digging the car deeper into the soggy ground. After I called my auto insurance company to approve a tow, I called a nearby service station. The mechanic at the other end didn’t recognize my patient’s address. Not remembering the name of the main road, I would have to walk a quarter of a mile to read the street sign. The car door barely opened over the lawn. I ventured into the cold rain, hoping not to lose my footing on the muddy, rutted road. 

The tow truck came quickly after I identified myself as a home health nurse in need of getting to my next scheduled patient.  

The local police chief came along for the ride. He was in the garage when my call came in. He thought he could be of some help in tracking down my location. Would I have had such personal attention in Chicago or D.C.? There are trade-offs. 

I would love to travel back in time and sit with other visiting nurses. I can’t even imagine the challenges they would describe getting to their patients’ home on horseback, or over tenement roofs, or on bikes. I probably would have no cause to complain about driving a car.

Ramblings on Expanding Nursing Practice

 

 

I asked Martha Barry who worked with me at the Erie Family Health Centers in the early 80s, to remind me if the Certified Nurse Midwives delivered babies.

 Here’s what she said:

The model for the Certified Nurse Midwives (CNM) when I arrived was outpatient care only. The CNM did all of the New OBs and sorted out the high-risk patients and cared for the other patients throughout their pregnancies, post-partum and follow-up gyn care. Prenatal care was intense case management. (We took) a lot of care and time to be sure no one fell through the cracks and got “lost to follow up.” Luckily, we could utilize the community health RNs to help find patients who did not show up for a visit. At the beginning, Medicaid was not widely available to all low-income pregnant women and especially not to non-citizens. The patients would be on a payment plan and would need to pay by “7-months” and it was a deal that included their prenatal, postnatal and delivery costs. I remember patients bringing their money stuffed in their bras to pay up at that 7-month mark. Deliveries were at Ravenswood Hospital. I wish I could remember the cost. The consulting OB physician would come to Erie for a few hours each week.

I also remember a few patients who worked at the live poultry plant and they said that although they had no health insurance, the boss would pay their delivery fees! 

I was preparing for my talk to the first class of AdvancingPractice, a one-year fellowship to develop quality care and nursing leadership at the clinic I had worked in over 30 years ago and written about in my book: Stories from the Tenth-Floor Clinic: A Nurse Practitioner Remembers.

I read Martha’s words to the group of eight APRN Fellows especially showing the generosity of the poultry plant employer. Then I told the Pigeon Lady story from my book that ends with a neighborhood funeral home director footing the bill for the wake and burial of one of our patients. He then turned around and donated that amount back to the clinic. (It’s complicated) I wanted to stress the interrelatedness of the surrounding community on the health care clinic. 

Part of my presentation was to discuss the historical context of the advancement of nurse practitioners and nurse midwives (collectively labeled Advanced Practice Registered Nurses, APRN).

One of the handouts for the class (Expanding Access to Primary Care: The Role of Nurse Practitioners, Physician Assistants, and Certified Nurse Midwives in the Health Center Workforce, National Association of Community Health Centers, September 2013) plunged me back to the time I and other new APRNs in the Chicago area were struggling to justify our right to practice to the full extent of our training.

How much had I forgotten—maybe wanted to forget. For example, back in 1957 the American Nurses Association developed a definition of nursing that would retard the advancement of nursing practice for decades: nurses were neither to diagnose nor prescribe. And some groups of nurses called us “little doctors” and didn’t support developing educational programs in nursing colleges.  

I hope the new Fellows I spoke to learned from my presentation something about the historical context of the role, the significance of the role in the community setting and the potential of the APRN career choice. 

I close with a quote from the NACHC fact sheet:

An expanded role for nursing is an idea deeply rooted in nursing’s past and from it, much can be learned for today. Indeed, nurses should take this historical opportunity to think creatively about recycling elements of past practice for today’s unique context—perhaps initiating state-of-the-art nurse-run clinics in rural and inner city areas; reaching others by telenursing; and collaborating with designers in technology firms to create Apps and other high tech solutions to bridge gaps that exist in healthcare today. To do so, they must first read and understand the impact of the historical antecedents, cornerstone documents, and legislative acts that contribute to the nursing profession’s rich history. 

 

Expanding Access to Primary Care: The Role of Nurse Practitioners, Physician Assistants, and Certified Nurse Midwives in the Health Center Workforce, National Association of Community Health Centers, September 2013, Page 9


 

 

Media In-Depth Look at Nurses

Sandy and Harry Summers review in their June 2020 The Truth About Nursing Blog a story that appeared in the Washington Post. I am always happy to see another example of the media covering nurses and nursing issues. And this time the authors talk about “what nurses actually do!”

However, it’s sad that it has taken a pandemic to call attention to the nursing profession.

The Summers, as usual, have done an exceptional job in their textual criticism of the essay. 

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Saving us from ourselves

by Sandy and Harry Summers

Washington Post report on nursing in Covid era offers unusually deep look at profession

A long April 2020 piece in the Post had information from a diverse group of nurses. Of course, they were able to explain how it feels to be a nurse in the Covid-19 era—a common press theme now. But they also described the nature of the profession, what nurses actually do for patients, and nurses’ protests about inadequate PPE.

April 28, 2020 – Today the Washington Post had a good story by Dan Zak and Monica Hesse headlined “Nurses are trying to save us from the virus, and from ourselves.” That last part signals that this won’t be just a standard “nurse-hero” piece about how difficult it is to care for Covid-19 patients. Instead, the article manages to provide a surprisingly in-depth look at the nursing profession, from its historical roots to its key roles in patient surveillance and advocacy, including why many nurses are now protesting about shortages of personal protective equipment (PPE). One highlight of the piece is a capsule description of what direct care nurses do by Laurie Combe, the president of the National Association of School Nurses. Combe talks about the subtle but critical assessments and the vital psychosocial care nurses provide. The piece also discusses some of Florence Nightingale’s work to revolutionize care settings and improve survival rates in the 19th Century. And it describes nurses’ protest activities during the current pandemic, particularly efforts by members of National Nurses United to push for the federal government and hospitals to ensure that nurses have adequate PPE. One nurse protester mocks the “hero” narrative nurses often hear now as just “gaslighting” when it’s accompanied by a failure to provide them with PPE. These elements point to nurses’ key patient advocacy role, although the article does not make that link specifically. And the report is not perfect, as a few elements tend to support the incorrect notion that nurses are virtuous adjuncts of physicians, rather than autonomous professionals whose focus is serving patients. But overall the piece gives a vivid sense of what nursing is about and the situation of nurses trying to care for Covid-19 patients now. We thank those responsible.

Strong and smart

The Post report does start by discussing the demands of Covid care. It explains how hard it is to provide expert and empathetic care for 12 or more hours while wearing burdensome PPE in an under-resourced setting while “confronting the most frightening pandemic in 100 years.”  

But then the piece backs up and asks what nurses really do. Apparently they are “the glue” and the “link between patient and doctor,” and their profession is consistently rated the “most honest and ethical” in Gallup surveys. Those descriptions are all somewhat problematic—the familiar polling point because it often masks a lack of true respect for nurses’ skills, and the earlier descriptions because they present nurses as adjuncts to physicians, which they are not. Nursing is an autonomous profession that exists to serve patients, not physicians. The reporters do say that nurses don’t want to be called heroes, but for the public to stay home and stay alive. And then they turn it over to a nurse expert, who picks up on the standard “most trusted” message the piece has just presented.

“But I don’t think that means people really understand what nurses do,” says Laurie Combe, president of the National Association of School Nurses. It’s a complex job, requiring knowledge of both biochemistry and psychology, in myriad environments. Nurses are helping your fourth-grader learn to track her insulin levels at school, and they are putting pressure on a gunshot wound at 2 a.m. while noting that the victim has no pulse. They are monitoring both your heart rate and your spirit. When they touch your arm, in what would appear to be a simple gesture of friendliness, they are also testing if you’re hot, swollen, dehydrated, tremoring. “I can observe what is on your bedside table that you’re reading — if I can talk with you about that, I can strengthen our connection to build trust,” says Combe, who has been a nurse in the Houston area for 45 years. “I can see who’s in your room visiting, what the interaction looks like, and see whether that’s a trusted person or not, so I know what I can talk about during that visit.”

This is one of the best capsule descriptions of nursing that we have seen in almost two decades of doing this work. Ten stars for Laurie Combe! She identifies the problem with the angel narrative, and then she addresses it, with a short, compelling description of how nurses help people in ways few even realize are happening. 

The piece moves on to note that the coronavirus has changed what nurses do, as they may be working in unfamiliar units under extreme conditions without adequate PPE, “facilitating virtual goodbyes with dying family members” and “organizing protests against hospitals and the White House.” Some are running Covid testing sites, and the article profiles Brenda Lagares, who had been a “night nurse” in New York City before being recruiting to be a “sampling nurse” at a drive-through testing site in Bear Mountain, NY. She tests motorists after having “been given 15 minutes of training to potentially save their lives.” These descriptions do not convey a very full picture of nursing education or expertise. Fortunately, Lagares gets to explain what she does for patients even in the fast-paced and limited drive-through setting. She describes how, even encumbered by PPE, she can read patients’ emotional state (by examining their eyes) and provide reassurance (with explanation, encouragement, a wave and a thumbs up). The article also talks to another nurse at a test site, in Orlando, FL. Sasha DeCesare went to nursing school in Venezuela. DeCesare believes it’s great to be a nurse in the U.S. because (in the report’s words) “it’s a female-dominated profession, filled with strong and smart women.” But now she has worked 22 days straight, and sleeps in a hotel to protect her family from infection.

The piece has some history. This starts with Nightingale’s work for soldiers in the 1850s Crimean War, which the article explains in some detail. It involved better hygiene, ventilation, nutrition, and fundraising. As the piece explains, “the death rate for admitted patients fell by more than half. [Nightingale] wasn’t only a caretaker. She was a revolutionary.” And she wrote Notes on Nursing, which “became a bible for modern care.” The piece quotes Barbra Mann Wall, director of the Eleanor Crowder Bjoring Center for Nursing Historical Inquiry at the University of Virginia, on the diversity of early nurses in the United States. (The piece might have noted that Mann Wall is herself a prominent UVA nursing professor with a PhD.) Apparently relying on Mann Wall, the piece describes the growth of nursing during and after the Civil War, as well as the development of nursing education from a two-year apprenticeship based mostly on skills — wound care, bedsores prevention — to a four-year program equally based on science. … Eventually, nursing would encompass a range of specialties and career paths; a nurse anesthetist might make $175,000 a year, while a nursing assistant might make $14 an hour.

Not surprisingly, the piece pauses at the 1918 flu pandemic. Apparently relying again on Mann Wall, it notes that the best treatment available then was “rest, hydration, hygiene — the pillars on which Nightingale had built her practice.” And it quotes then-health commissioner of Philadelphia Wilmer Krusen on what was needed in that epidemic, given that beds and physicians were in sufficient supply: “Nurses, more nurses and yet more nurses.” That is a timely comment today, when much of the early media on Covid-19 focused on beds and ventilators, ignoring the nurses who would be needed to care for the patients using that equipment. 

Gaslighting

And the article has a substantial amount of material on the protests, i.e., the patient advocacy. The reporters explain:

People keep saying that nurses are on the front lines, but they are actually behind enemylines, surrounded on all sides. They are trying to save us, and save us from ourselves. Nurses are protesting protesters, standing in their scrubs and masks to glare at “freedom-loving” citizens who spew insults as they rally for the economy to reopen. Nurses are taking to social media to convey the extremity of their situations: They talk about war zones, about titrating a dozen IV drips while troubleshooting fluky ventilators, all without reliable stockpiles of supplies.

The piece relies fairly heavily on Elizabeth Lalasz, a Chicago union steward for National Nurses United (NNU). Lalasz herself was out of the clinical setting for 18 days with Covid-19, which she says she got because of inadequate PPE; she calls the nurses “cannon fodder.” The report explains that Lalasz became a nurse in her 40s, after watching an oncology nurse caring for her dying father advocate successfully for him “against a phalanx of male superiors” to go home to die, 35 years ago. Presumably that means a group of physicians; of course, they were not “superiors,” but surely they had far more power, so that sounds like some impressive advocacy. 

And Lalasz does some advocacy too, pointing to the dysfunctional U.S. health care system, which even before Covid-19 “left front-line workers feeling burned out, with high rates of attrition and suicide.” The reporters also talk to nurses at the California hospital that suspended 10 nurses for refusing to care for Covid-19 patients without an N95 mask. One of the suspended nurses, Jack Cline, explains why the surgical masks are inadequate, regardless of CDC guidelines saying otherwise. The piece also describes the recent White House protest by NNU members seeking more PPE for health workers—over 230,000 of whom have been infected with the virus, and 600 nurses have died from it. One protesting nurse was Charles Dalrymple, who spends hours caring for Covid-19 patients in negative-pressure rooms, in some cases helping them say goodbye to family through virtual means. He held a sign saying “20 SECONDS WON’T SCRUB THE BLOOD OFF YOUR HANDS,” with “HERO” in quotes. Why the quotes? Dalrymple said:

I feel that it’s being used to placate us — gaslighting this entire situation. A ‘we signed up for this’ kind of thing. But we didn’t. We didn’t sign up to go into a room without proper gear. . . . They can’t be throwing this word around just to make it seem like, ‘Oh, it’s okay that they’re dying. It’s because they’re heroes.’

Right. Nurses have always faced the virtuous-angel narrative, in which they get lip service but are expected to endure abuse and resource shortages without complaint. But now, the “hero” narrative seems to be functioning in a somewhat similar way for everyone on the Covid-19 front lines. If we call them heroes enough, and have the Blue Angels fly overhead to say thanks, then apparently it’s OK that we are still not giving them the PPE, tests, and other supplies they need. 

On the whole, because of the detail about what nurses actually do, the material about the history of nursing, and the reporting on nursing advocacy—particularly the PPE protests—the piece is an unusually valuable one in the Covid-19 category. We thank those responsible.

See the article by Dan Zak and Monica Hesse “Nurses are trying to save us from the virus, and from ourselves,” posted on April 28, 2020 on the Washington Post website.

Time to Take a Break

I want to revisit a time that made me happy. I invite you to look back to a moment that brought you joy, too. Find what you can to feed your soul and rejuvenate your body so you can participate in finding the solutions to our current troubles. Take a break in this time of the Pandemic and Black Lives Matter to temporarily distance yourself from the daily bombardment of negative news.

It is a time that I truly hope is not a moment but a movement. May we all keep the movement alive until we have made lasting changes.

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I remember how I felt on a lovely June day in 2017 when I visited the North Carolina Museum of Art and joined the “Ladies in Sequined Dresses and Sneakers” from New York that led us through the art galleries marching and stepping up to the music of the Bee Gees: Staying Alive. Ironic title, isn’t it?

I hope that the video at the end of this post lifts your spirits.

A Little Music and Movement Can Make You See Things Differently

Originally published June 6, 2016

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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Home Visits Can Be Fraught With Danger

As I write my second book, which is about the home visits I have made over the years, I am resurrecting memories from my mind and the pages of my journals. Today’s post shows a time when I didn’t use common sense and how home visits can be fraught with danger. 

One day in early fall, on my drive back to the hospital after making all my scheduled home visits, I found myself passing by a patient’s apartment on the westside of Chicago. Since I was ahead of schedule, I decided to drop in, unannounced. I had the time. My patient had a caregiver: a tall, muscular man who always opened the door to the first-floor apartment wearing a long blond wig and thick make-up. Despite his flamboyant appearance, he gave competent care to his charge: a bed-bound, uncommunicative middle-aged man with multiple sclerosis. An exotic array of visitors wandered in and out of the apartment. My patient’s mother, strikingly average looking compared to the rest of the visitors, lived in rooms above her son’s and was often present when I came. However, this day I walked into an unlocked and empty apartment. Only my patient, lying in bed in the darkened bedroom, was present. 

Neither the caregiver, nor the patient’s mother, or anyone else familiar to me entered the apartment while I was there. However, as I finished with my evaluation, a man opened the unlocked apartment door. He wasn’t anyone I had seen before. My patient smiled at him knowingly.

The man removed his jacket and tossed it on the sofa. We introduced ourselves. His eyes moved down my body. Acutely aware of the precarious situation I was in—alone in that apartment with a strange man and unhelpful patient—a band tightened around my chest. 

“I’m just leaving,” I said as I promptly packed up my nursing bag. 

Safely back in my car, my breathing heavy and my hands shaking, I chastised myself for making this impulsive visit. No one back at the office knew where I was. It was a time before cell phones. What If something had happened to me?  I didn’t want to think of that. I never again made an unscheduled home visit. 

Sometime after that impromptu visit, at a nursing conference, I sat fixated as another home health nurse told a story about the time that she had made a scheduled visit. She rang her patient’s doorbell. He didn’t answer. It was later that she found out he had been murdered. And in hearing more detail, she discovered that the murderer had likely been in the house the exact time she was ringing the bell. Good thing the door wasn’t unlocked. 

Home visits can be fraught with danger. 

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