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COLD CLINICAL FACTS

revising & revising

Four women in my Wednesday evening non-fiction workshop graciously agreed to be my beta-readers and look over my manuscript during a two week break, following suggestions outlined by our leader, Carol Henderson. What Carol stressed, among other things, was not to get bogged down with spelling and formatting but look for flow, bumps and where you fall asleep. How does the narrator come across? Make a note where things are not clear.

The four women are talented writers. Their stories deep, interesting and well told. I consider myself lucky to have willing and skilled readers. Their feedback, positive and negative, can only improve my book. They have heard my stories, isolated, standing alone, without any connection to what had happened before or followed next. Now for the first time they would have the whole picture of my creation.

Stein On Writing
Stein On Writing

The “corrected” manuscripts (Sol Stein, Stein on Writing, says corrections are better done on hard copy.) sat for a couple of days before I ventured to look at them. I had already cleaned my office, cleared my desk and now isolated myself for a day to read.

Had I thought my readers would unanimously tell me that my book was so wonderful that no changes were needed, I would have been delusional. But honestly, I didn’t expect that. I was ready, so I thought, to honor the suggestions. What I wasn’t ready for was the strong agreement among their observations.

With tunnel vision, I had selected stories about patients I had cared for that had “haunted” me over the years—unforgettable because they were complicated and sad. I wanted to show what we nurse practitioners were up against. As an observant professional, I described the sights, smells and  “nasty images” so well that my readers felt, at times, overwhelmed. Plus, I appeared “too clinical.” Could there be less intense patient interactions wedged between the mayhem? Where was my softer, feeling side, they asked? Where indeed?

After the initial shock of realizing I had many more painful hours at my keyboard—writing for me is slow and tedious—adding inner reflections and lightening up, I wondered how much my long-standing role as the professional nurse for over forty years played in this evaluation.

I can see one of my older patients, a short, slight man, sitting on the edge of the examination table. As I monitor his high blood pressure I observe a suspicious discoloration around his left eye. He admits his granddaughter had hit him. He adamantly refuses any interference. I don’t remember my exact response except I’m sure it culminated with a stoic nod of my head.

stature with tearAfter long years of stuffing my emotions in my lab coat pocket, I’m usually surprised by the visceral reaction I have when I resurrect these tales. How much deeper do I need to go to allow the sentiment that I didn’t know I was withholding flow from my vignettes?  How strong are the barriers I constructed to dampen my own despair when I couldn’t correct a problem and will I be able to shatter them after all these years?

While I have always encouraged my fellow nurses to write their stories, I wonder how common it is for us to deny the deep connections we forge with our patients and the influence they have on our psychological well-being? Maybe this is why so many of us resist documenting what we do?

Or slant the telling with cold, clinical facts?

AGING IN PLACE OR WAITING TO DIE?

Aging in place wasn’t in vogue when I first became a gerontological nurse practitioner in the early ‘80s. And my patients certainly didn’t know they were aging in place. Especially Helen. She called it waiting to die.

The Senior Clinic I worked in had just relocated from a one-bedroom apartment on the 10th floor to a larger two-bedroom on the fourteenth floor of a subsidized city-run building on the west side of Chicago. Helen was overjoyed to live in the apartment next door to us. She stopped in every day to say good morning and sometimes brought homemade sugar cookies or zucchini bread. She was in her 90s and in good health. When her hearing difficulty became worse, she would ask me to check her ears to see if they needed washing out. Otherwise, her visits were social.

If the clinic was quiet, Helen would sit by my desk and tell me about her life. Since she was thin and small, barely over five feet tall, I looked at her incredulously when she told me she had worked as a guard in a women’s prison. The next day she showed me her badge: Deputy Sheriff Cook Co. #93.

She had lost a husband many years ago and her one son visited infrequently. Her life had narrowed and became routine. Helen accepted the inevitability of death and was the first to teach me that old folks aren’t afraid to speak of dying. “I lived a good life,” Helen said, “I’m just ready to die.” I can still see her warm smile and dark eyes crinkle as she said these words.

In the blue-collar community where I worked, when you got old and feeble and family couldn’t take you in, you went to a nursing home. If you were terminally ill, you went to a hospital to die. Helen hoped to stay independent and avoid institutionalization but who knew then all the facets needed to meet that goal. I did what I could to keep my older patients as healthy as possible so they could care for themselves but I never thought then to set up a knitting group, coffee klatch or potluck dinners to address the epidemic of loneliness.

Today, a grass roots movement is growing among the elderly themselves to develop/provide/support services and programs that promote independent living. In fact, in my own neighborhood of 160 single-family homes, those of us who are over 55 had our first meeting last week to discuss aging in place. We have come a long way in understanding what it takes to keep us older folks in our own homes. Various models have popped up across the nation, which are not just reliant on health interventions to maintain independent function but also on new technologies that open and lock doors, monitor outdated food in refrigerators, and help in sorting laundry.

I wonder how all this would have made a difference in Helen’s life. One day she didn’t show up for her “good morning visit.” I knocked on her door. No answer. When the janitor let me into her apartment, I found her crumpled on the floor next to her sofa. The ambulance brought her to the hospital where she had a hip replacement. She died shortly afterwards of surgical complications.

A couple of weeks later, after he cleaned out his mother’s apartment, her son gave me her Sheriffs’ badge.

Helen's badge

THE TIME IS RIGHT

A friend deliberated whether she should visit her father for his 95th birthday. She was swamped with commitments. Since he was unaware of his birthday as well of his surroundings and didn’t even recognize his three daughters, there was no urgency to travel to another state.

However, she cleared her schedule and made the trip, as did another sister and a niece. Both lived out-of-state also.

As it turned out, on his birthday, he had a choking episode with difficulty breathing. He stopped eating and died three days later, surrounded by those he loved who otherwise would not have been there had they not come to commemorate the day he was born.

This story reminded me of a patient I cared for back in the early ‘90’s when I worked as a nurse practitioner in a home care program. I had made a first visit to an elderly man in the western suburbs of Chicago who was referred by his doctor because he had terminal cancer (I don’t remember his diagnosis). But I do remember his sunny apartment. He and his wife sat on the sofa, holding hands, his wife’s face streaked with tears. She had just been informed she had breast cancer. The patient calmly told me he wanted to help his wife through her ordeal. He would call me when he was ready to be admitted.

Sure enough, a couple of months later, he called telling me he was “ready to die.”  In another sunny living room, the patient and his wife held hands as they sat side-by-side on a floral sofa in his daughter’s home where they had relocated. His appearance had changed little since I last saw him. His wife had had successful treatment of her cancer and now his responsibility ended. The serenity of that visit remains vivid in my mind as he, his wife and daughter discussed his impending death.

After he disclosed he was having pain, we agreed I would return the next day bringing morphine with me. When I arrived the following afternoon, he was comatose. His daughter called later that evening to say her father had died.

Was it a coincidence my friend’s father died during the time his family gathered around him? Did my patient let go when he knew his wife no longer needed his support?

Calla lilyMaggie Callanan and Patricia Kelley, both nurses, co-authored Final Gifts, a book that speaks to the dying experience. They use the term “nearing death awareness” which “is a special knowledge about—and sometimes a control over—the process of dying.” In a chapter called “Choosing a time: the time is right, they describe how some dying people “choose the moment of death.”

Vignettes of both sudden and lingering death portrayed in Final Gifts show us “what is needed in order to die peacefully” and how “those close at hand can help bring that person peace and recognition of life’s meaning.”

I read this book years ago. Having read it again, I only appreciate all the more how much of a contribution Callanan and Kelley make toward our knowledge and understanding of the dying process. They do this by telling their nursing stories.

I encourage you to read this book.

What stories can you share about your experience with “nearing death awareness?”

Lois Roelofs posted this story of Martha Keochareon, a nurse dying of pancreatic cancer who selflessly allowed nursing students to be present during her last days at home in order to learn about hospice care.
I hope this poignant story moves you as much as it did me.

Write Along with Me

As she lay dying from pancreatic cancer, Nurse Martha Keochareon wanted to do more than plan her funeral. So she called her alma mater and offered to become a “case study” for nursing students. She reasoned she could help students learn about the dying process while, at the same time, it would be a way for her “to squeeze one more chapter out of life.”

I loved this story. First, as a retired nurse educator, I was struck by Nurse Keochareon’s selfless giving. I could identify with her desire to teach; as nurses we are taught, along with being caregivers, to be teachers (as well as communicators, researchers, leaders and more). I believe we consider it a duty and a privilege to empower our patients or students with the resources they need to function successfully in their lives.

Second, Nurse Keochareon had lived with pancreatic cancer for more than six…

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I WAS THE ONLY ONE

#1I can’t believe I was the only one.

In my last post I referenced The Truth About Nursing blog in which we are asked to write to two journalists who did not mention nurses in their article about Hillary Clinton’s hospitalization. The story read as if doctors were the only health professionals caring for her.

I’ve always been angry about how we nurses are represented in the media and, in this case, how we are ignored in the media. On February 5th, I wrote the journalists the following and copied The Truth About Nursing.

 

Matthew Lee and Marilynn Marchione,

As a long time nurse I am always sad when I read stories related to health care that omit any mention of the contribution of nurses. In your December 3, 2012 article: Hillary Clinton hospitalized with blood clots, http://www.businessweek.com/ap/2012-12-31/hillary-clinton-hospitalized-with-blood-clot, you stated Hillary needed hospitalization. Indeed she did. The main reason a patient is hospitalized is to receive the oversight, management and personal care from professional, knowledgeable nurses.

The general public relies on well informed reporting and accurate facts. The doctors were responsible for Hillary’s care in conjunction with nursing care. It is a disservice to the largest group of health care providers that they are dismissed without a mention in your timely and well presented story.

My hope is that in the future you will give credit to the role nurses play in our health care setting.

Thank you,

Marianna Crane

I received the following email from Sandy Summers, co-founder of The Truth About Nursing.

Hi Marianna,

I’ve been meaning to write personally, I’m sorry for the delay. You were the only person out of the 10,000 on our list who wrote a letter to these two journalists. We were thrilled to get your letter and also to read your blog, which laid out so well the problems of the media. Thank you, and keep up the good work! 

Sandy

I can’t believe I was the only one.

SILENT NO MORE

When will nurses cease to be invisible? The web site The Truth About Nursing discusses an article about Hillary Clinton’s hospitalization in which the author did not make one reference to nursing hospital room(MatthewLee, “Hillary Clinton hospitalized with blood clot,Bloomberg Businessweek, December 31, 2012 *). The Truth About Nursing suggests if Clinton needed to be hospitalized then she needed nursing care or she could have received treatment at home. Think about it. Can hospitals function without nurses? Instead doctors were the only ones mentioned that monitored and assessed her condition while she was an in-patient.

Do you think doctors stay at the bedside of their patients 24/7? No, they go home for dinner. If there were a problem, most likely they would be paged by the nurse on duty—perhaps at 2 a.m. Or they would hear how the nurse independently solved the problem when they made rounds the next day. Or not.

Unfortunately, to our detriment, we nurses avoid seeking attention for what we do that improves patient outcomes. Because we are so self-effacing, is it any wonder the media rarely mentions us and therefore “reinforces the damaging misimpression that physicians provide all the health care that matters.”?

Isn’t it time we spoke up for ourselves, demanding recognition for what we do? It is a sad fact that the media have long ignored nurses and nursing practice. Nurses continue to shun publicity as if calling attention to what we do is a sign of hubris. I’ve mentioned in the past that I had asked nurses in a hospital where I worked to write stories about what they did that made a difference in a patient’s life. I received few submissions. The most common reason for not writing was they didn’t want to sound as if they were bragging.

I have been guilty of not taking credit for my nursing actions in the past. The story I wrote for The Examined Life Journal, Invisible, tells of a time back in the early ‘80s when I told a doctor that I believed the patient for whom he just wrote a discharge order should remain in the hospital. The challenge there was to avoid the old doctor-nurse game. But, and this is the big but, I never told the nurse with female ptpatient I was worried about the fluid in her lungs, her labored breathing and lethargy. So she never knew a nurse made a difference in her care when a few days later she went home without those troubling symptoms. Now, years later I wrote my story.

Let’s all of us nurses start speaking out by following a suggestion from The Truth About Nursing:  email authors Mathew Lee and Marilynn Marchione at mlee@ap.org and mmarchione@ap.org, stating our concerns about omitting any reference to nursing in their article. And send a copy of your email to: info@truthaboutnursing.org

I plan to do that. I hope you will, too.

*A P Chief Medical Writer Marilyn Marchione in Milwaukee contributed to this report.

LOVE OF FOOD

As I continue editing my book (I’m a tiny bit behind schedule), I am adding more food references. Food has always had a hold on me. Growing up in both Italian and Polish traditions, the fabric of my childhood was knitted with gustatory delights. Food meant comfort and caring.

italian-familyOne repast I’ll never forget was the first time my husband-to-be visited my Italian Grandma’s second floor apartment in Jersey City. At our traditional Sunday mid-afternoon meal, italian-feastthe men ate first. After the men, the children were served. Lastly, the women sat, ate and then washed the dishes—a paternalist, ethnic ritual I rebelled against at the time, only now to look back with pure nostalgia.

Grandma and my aunts, Ann, Jennie, Pam and Anna and their sister-in-law Chris, served. That day, I sat with the men beside Ernie, American hot-dog and hamburger aficionado, at the table in the cramped, hot kitchen. There wasn’t a dining room. He had seconds of the bean soup and the pasta with tomato sauce and slathered butter on Grandma’s freshly baked bread. He had an awakening when the meat course arrived. crusty-italian-bread_1I remember Uncle Mickey commenting on Ernie’s voracious appetite. Salad and cheese followed. Ernie’s intake dwindled.

After espresso, my uncles left to smoke cigars in the front parlor. Ernie staggered behind them as Grandma smiled with delight over how much he had eaten. A good appetite was paramount to sainthood.

My book covers a time in the early ‘80s when I worked as a nurse practitioner in a clinic on the west side of Chicago. I could walk to a Polish deli for the foods of my childhood on my mother’s side: kielbasa, kielbasapierogi and babka. (A good appetite at a Polish table also ranked next to godliness.)

I found a hole-in-the-wall Mexican Restaurant. There I fell in love with a soup crammed with a hunk of corn and a whole chicken breast. Mexican Chicken SoupIn that blue-collar neighborhood, I often stopped at a take-out stand specializing in greasy fries and Chicago red hots. All part of my immersion into community nursing. I was eating my way into appreciation of my clientele’s way of life.

Now as I write, I’m relishing the memories.

HAPPY NEW YEAR

 Highlights of 2012

  Watching grandsons growgrandsons

                                   

                                                                                                           

                                                                                                                                                   

                                                                                                                                                           

                                                                                                                                                 Touring France in spring                               Paris

 

Writers Museum

 

 

 

 

Ireland in fall

   

    

anniversary1                             

Celebrating 46 years  

                                                       

                                                                                                                           Perfecting deep-dish Chicago pizzachicago pizza jan. 2012

 

 

 

 

 

Having my story “Invisible” accepted for publication by “the Examined Life Literary Journal.

 

 

I wish you happiness, health and peace in the New Year.

*Two other nurses contributed to this issue of The Examined Life

 

 

 

ONE SMALL STEP

Brady Campaign

I hear my five-year old grandson laughing and think of the twenty first-graders killed at the Sandy Hook Elementary School. How safe will his school be next year? The National Rife Association suggestion of an armed guard in the hallway of each school doesn’t reassure me but persuades me all the more to do what I can to change our gun culture so that my grandchildren will live in a peaceful, healthy, and loving world.

No small undertaking. But if we all stay conscious of the issues and support gun control, we can make a difference. Just today I joined and contributed to the Brady Campaign to Prevent Gun Violence.

It’s one small step.

There is more to do.

GUN CULTURE

When we were traveling in Ireland this past October, our Irish tour guide told us that Ireland did not have a “gun culture” as we did in the States. Never having heard that opinion expressed before, the term “gun culture” stayed in my head.

After the recent killings at an elementary school in Connecticut, I looked up the word “culture” in Merriam-Webster’s Collegiate Dictionary, Eleventh Edition, which reads in part: the integrated pattern of human knowledge, belief, and behavior that depends upon the capacity for learning and transmitting knowledge to succeeding generations; the characteristic features of everyday existence shared by people in a place or time.

Charles M. Blow wrote in A Tragedy of Silence, New York Times, that public opinion is shifting away from gun control. In a recent Gallup poll 53 percent to 43 percent opposed the ban on semiautomic guns or assault rifles.

As I watched my nine-year-old grandson’s eyes riveted to the front page of Saturday’s New York Times lying on our coffee table, his look of concern told me I needed to speak out in support of gun control. I hope you will, too.

It’s time for a cultural shift.