SOB SISTERS

Thanks to my friend Lois Roelofs and her post “Growing Older In “Style,” I found Ari Seth Cohen, a twenty-eight-year-old who is spotlighting “stylish senior citizens.” Love it. Older women—and men—who ignore the old adage: “dress your age.”

looking good

How come a twenty-eight-year-old man finds older people so fascinating? Well, I was sure there had to be an older role model in his life. And indeed there was—a grandmother. Aha!

Back in the 80s at my first job as a gernotological nurse practitioner, Betty, a social worker, and I conducted monthly orientation sessions about geriatrics for new nursing staff. Geriatrics was a new medical specialty at the time and Betty and I wanted to sensitize the group to aging issues.

Betty had the nurses imagine themselves at different stages of life. Invariably, someone would object to the exercise, not surprisingly, when Betty had them imagine looking at themselves in a mirror at different ages. “Now you’re 80 years old. What do you see? How do you feel? How are you dressed?”  (We would, as a matter of course, excuse anyone who didn’t want to participate.)

There were incidents of tears. On one occasion a woman picked up her purse, notebook and coat and stormed out of the room shouting her disapproval of our experiential process. From that day on, our boss dubbed us the Sob Sisters.

However, the majority of our class enjoyed the exercise. Those most enthusiastic usually mentioned an older person in their life that they respected and cared about. This anecdotal experience of mine carries over to the assessment of Ari Seth Cohen. He sees older folks in a positive light to be celebrated and acknowledged. Thanks to his grandmother.

Humor and Humility

It started out on a rainy day in January. Like the rest of overweight America, I had resurrected old New Year resolutions. I wandered into a branch of a not-to-be-identified weight loss program and approached a young lady sorting out pamphlets. After giving me the information I requested, she excitedly told me that I would also be able to access her blog, which she updated with helpful hints. She stopped, perusing my persona, and asked, “Do you know what a blog is?”  Or said another way “You have white hair, which means you’re technologically illiterate.” I immediately felt furious. I responded in an icy tone, I have a blog. I think I saw her flinch, at least I hope I did. Our conversation went downhill from there. I ran through the rain back to my car, vowing not to join this group.

I thought later, I wish I had the sense not to get so defensive. I had lost a teachable moment. In my past career as a gerontological nurse practitioner, I met many older people who transcended the stereotypes of aging. They showed me how they dealt with the complexities of old age—with humor and humility. Will I be ready to confront ageism with panache when it happens again? And I am sure it will happen again.

A Nurse By Any Other Name—

I read the New York Times article, A Small Picture Approach to Health Care last week with so what’s new thoughts hopping in my head. Sure, the economics of funding health care services continues to be a challenge but we nurses can see the real change agent of this model’s Advocate Health Care approach is the nurse as Care Manager. And what would the nurse be doing in order to ensure a positive outcome, such as reducing hospital readmissions, especially with geriatric patients as described in the article? Calling the patient on the phone, listening to what she says, educating her and making suggestions for change. Mrs. Cline, the patient described in this piece, has had marked improvement in her health, her “dizzy spells have subsided and she has not been hospitalized since May.”

The article further states, “The extra attention Mrs. Cline receives is the result of a radical departure from traditional fee-for-service medicine.” Well yes, I might concede that fee-for-service medicine has not utilized nurses effectively in the past. But a radical departure? Nurses have long been the patient advocates, case managers, health care coordinators and now care managers. The titles change but not nurses’ skills.

nurse with patient

The radical departure as far as I’m concerned is to recognize nurses cannot only make a difference improving patient outcomes but nurses’ interventions promote cost savings.

Read the article for yourself. Granted, restructuring of our ailing health care system ignites strong opinions. But I for one can see that the nurses role in this restructured delivery model improves the quality of life for all enrollees.

I am pleased to share this article from Reiki News Magazine ReikiInCancerCenter RNM 2 March 2012 written by Jane Van De Velde, DNP, R.N. Reiki is one example of the different skills nurses and nurse practitioners use in treating the whole patient: body, emotions, mind and spirit. Reiki is a complementary holistic healing practice, which creates many beneficial effects that include relaxation and feelings of peace, security and well-being.

Never Too Old

I am empowered knowing age does not limit our creativity. James Arruda Henry learned to read and write in his mid-nineties. He didn’t stop there but went on to write a book: In a Fisherman’s Language.

As a gerontological nurse practitioner and woman of a certain age I am delighted to promote his story.

Long Lost Story

Just last week I came across a folder in an old box on the bottom of a closet. There I found accordion-pleated sheets of paper where I had written about the Donovan family in single space dot-matrix some twenty years ago. Bill Donovan had lung cancer with metastasis to his bones and brain. He died on a cold December day in Chicago.Winter in Chicago

I still have my Day Timer—who is old enough to remember those? I kept statistics on my patients: address, phone number, date of birth, diagnoses, if and when they received a flu shot and the date they either were discharged from home care or died. I wrote sporadically about my more difficult or worrisome patients in journals, which I kept all these years. I knew someday I would write my nursing stories.

But I never did forget Bill. I just didn’t remember enough detail about him and his family to add him to the book I’m working on. But now I’ll flesh him out along with his three daughters, a live-in girl friend and a hired caregiver, Stanley, who emigrated from Poland where he claimed to be a medical student and who withheld Bill’s medication on the grounds he, Bill, could die from the morphine.

Now you couldn’t make this stuff up.

The Importance of the Poem

Earlier today I attended a poetry reading at an independent bookstore a few miles south of where I live. A former instructor of mine, Florence Nash, along with two other female poets read from their chapbooks. Throughout the readings, I drifted on the words, phrases, rhythms, twists, poignancy, humor and surprise endings.

I took Ms. Nash’s poetry class after I had heard a speaker at a conference say he assigns students enrolled in his Creative Writing course to write poetry in order to develop creativity, an ear for cadence of a phrase and ability to make every word count.

I loved the poetry class. But I found I struggled with writing poetry even more than I struggled with writing prose. Besides, the amount of time I devoted to writing poetry eclipsed the time I spent on my creative non-fiction projects. I had to make a choice and chose to concentrate on finishing my non-fiction book. I suppose I’m a one-skill person.

However, reading poetry out loud helps me appreciate the beauty of language and hopefully makes me a better writer.

I did complete one poem that I liked, a pantoum,  (see below) in Ms. Nash’s class. I sent it off to a contest. It was rejected. Not much difference with the results of my prose submissions. Oh well.

images-1

GRANDMA

Pasta and beans and basil soup

Soothing the cold rainy day.

Memories drift in the steam from the mug

Washing the years away.

Soothing the cold rainy day,

She cooks in the morning hour

Washing the years away.

Her gnarled hands crusted with flour.

She cooks in the morning hour,

And gives me a garlicky kiss.

Her gnarled hands crusted with flour.

It’s the warmth of her love that I miss.

 

The Murder Building

CT-BIZ-VACANT-BUILDINGS-B_CTMAIN0501SR-d55be438
When I visited a patient in my caseload that lived in an “unsafe” part of the city, I went in the morning. Right after the pimps and drug dealers had called it a night and before the shop keepers pulled up the bars over the store windows and the women came out to sweep the sidewalk litter into the streets.

One day Pearl, the social worker, asked to come with me to see a patient. She had a meeting in the morning so we left after lunch against my better judgment.  If I were going to go to an iffy part of the city, this was the last place I would want to visit. The Chicago Tribune ran a story a few weeks previously about the  “Murder Building.” I knew by the address it was next door to my patient’s apartment.

Everyone knows it simply as “the murder building.“

“They call it `the murder building` because people have been known to go into that building and not come out,“ said one young man standing on a nearby street. “You got to stay away from that place. Things go on in them halls you don`t want to see.“

What does that say about the neighborhood we drove through and the scattering of young men gathered on the stoops, some leaning against the parked cars, all seeming to be without a sense of purpose? I felt their eyes following us.

My patient lived on the second floor with his common law wife and various other relatives. The front door was locked and since there wasn’t a bell, I had to stand under the window and yell the patient’s name. The patient’s wife would come to the window before she sent one of the grandchildren down to let me in. This was before cell phones.

I dreaded leaving the safety of the car. Did any of the men think we carried drugs? I scooted out and quickly grabbed my nursing bag from the trunk along with a white bathroom scale. The patient was on tube feedings. It remained unclear if his wife was able to manage the procedure and give the feedings on schedule. I was monitoring his weight as evidence of success.

When Pearl and I completed our visit, we took quick, long steps to the car, avoiding eye contact with anyone near-by. As I stuffed my bag and scale into the trunk, I felt someone tap me on the shoulder. I waited for the command to hand over my nursing bag. Instead a soft voice asked, “Before you put that scale away, would you weigh me?”

I turned to see an older man with short gray whiskers on his chin and a pleasant smile. He moved aside as I slammed the trunk closed and carried the scale to the sidewalk. He took his shoes off and stepped on the scale. “I can’t see the numbers,” he said. I read them off to him, he stepped down, retrieved his shoes and said, “thank you.” Behind him stood a young man with dreadlocks. “Can I get weighed too?” He slipped out of his high tops. I called out his weight and he left with a “thank you.”

Behind him a line of men snaked along the sidewalk. Pearl emerged from the car and began joking with the men, young and old, as they waited their turn at the scale.

Back in the car, the scale packed away in the trunk, Pearl and I drove to the corner. As we pasted the Murder Building, ominous and frightening with smashed windows and debris scattered around its foundation, I realized a building doesn’t define a neighborhood.

Unsolved Mystery?

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

My patient was in his 60’s or 70’s and had a ditzy wife. Just like Edith Bunker on the old All in the Family T.V. show. She looked like Edith with dark hair, a whiney voice and hands that kept flying in the air as she talked. Edith and I sat in the corner of the living room with its high ceilings, dark woodwork and antiquated furnishings talking about her husband. I think he had lung cancer. I can see him wandering around in the turn-of-the-century apartment, seemingly unaware of his wife and me. While Edith jabbered on, I thought about how much information I should give her. Could she handle her husband dying at home? Thankfully, time was on my side. Her husband didn’t look close to death. I could parse out information slowly.

I began by telling her about our program, giving her our twenty-four hour phone number. I would make another visit soon and go into the dying process in more depth and review potential problems. She seemed so scattered, but she cried occasionally giving me the feeling she realized the gravity of her husband’s condition.

At the end of my visit, Edith walked me to the hallway outside the apartment. For some reason, as I perched on the top stair, I told her to pick out a funeral home. “You’ll have to do this eventually. Call them and tell them your husband is on our program and our doctors will sign the death certificate.” Maybe I thought it would give her something to do before I made a follow-up visit.

Before I made that visit, I received a message from the funeral home that Edith’s husband had died over the weekend and that a service had been held just for the family.

A few days later, I made the mandatory bereavement visit. Edith’s daughter and her husband were with Edith in the kitchen. The son-in-law, GI Joe crew cut and heavy shoulders, stood by the sink washing dishes. The daughter, a replica of her mother, but with some extra padding, sat on one side of Edith with a box of thank you notes in front of her. The couple came from out of state and would stay only for a few more days. When Edith introduced them, they nodded without smiling as if I were a diversion they hoped would soon leave. While I sat at the table talking with Edith I could feel their ears on high alert. Was the son-in-law washing the same dish over and over again? I was distracted by the tension I felt in the room while Edith babbled on.

While I drove back to the hospital, I replayed Edith’s words. I heard her squeaky voice tell me her daughter and son-in-law drove a long distance from out-of-state. “But,” she said, “As tired as they were, they thought of me.” Did I notice her daughter’s back suddenly straighten up?  “My daughter said I needed a break. ‘Let’s go and get your hair done,’ she told me.” Edith patted her head full of tight curls reinforced with a heavy application of hair spray. Her smile showed she basked in the attention they had showered on her. She left for the beauty salon with her daughter while her son-in-law stayed to watch over her husband. “When we came back,” she said, tears flowing down her cheeks, “my husband was dead.”

I had other patients to see that day and quickly put the visit out of my mind.

Over the years I have thought about that bereavement visit. I felt so lucky I was distracted and didn’t register the implication of those words: alone with son-in-law and dead when wife returns. I didn’t think the patient was anywhere near death when I first saw him. Sure he could have had any number of problems that would cause system failure and death. However, if I never mentioned contacting the funeral home, Edith would have had to call 911 after her husband died. Without enrollment in our agency, a sudden death in the home would necessitate an autopsy. I would have no grounds for suspicion if the autopsy showed death from natural causes. But there was no autopsy. So I continue to exercise my vivid imagination and rehash possible scenarios. In one, I see Edith’s daughter and her husband nod to each other as the daughter takes her mother out of the house. The son-in-law waits a few minutes after they leave. He walks into the bedroom where Edith’s husband sleeps, takes the extra pillow off the bed, and presses it over the man’s face bearing down with this strong arms until he is sure his father-in-law is no longer breathing. After carefully replacing the pillow on the bed, he pulls a pack of Marlboro’s from the front pocket of his khaki’s. He ambles into the living room, settles into an overstuffed chair, lights up and waits for his wife and her mother to return.

I’ll never know what really happened

Not Guilty

On my last post, I speculated that Betty, the wife of one of my patients, Mr. G, might have been plotting to do him in. Now my friend, co-worker at the time, Jane Van De Velde, writes that Mr. G was admitted to the hospital because his hemoglobin was very low and he died there. “So it turns out Betty was blameless.”

For twenty years I thought of Betty as a scheming, conniving and murderous wife. How interesting to find out that my suspicions have been unfounded. Sorry to let this one go. But I do have another patient I believe might have had an untimely death.

I’ll tell you about him on my next post.

There Are Some Patients We Never Forget

When you have been a nurse as long as I have there are patients who take residence in your memories and resurface frequently. They could almost be family except they have a short history in your life. What they were like before or after you knew them usually remains a mystery.

Mr. G was a cantankerous, legally blind, brittle diabetic I had taken care of in the late 80’s. His house was the worst on the block: paint peeling off the frame, rickety wooden stairs and overgrown weeds. Thankfully he lived close to the  police station because I had to drive there one day when Mr. G didn’t answer the door. He was convulsing on the floor as I peered through the window. I had to beg the police to break down the basement door to enter because Mr. G often complained to me how many times they had axed into the front door and how expensive it was to repair. He frequently had hypoglycemic reactions.

Mr. G. gave himself insulin injections using low vision equipment to measure out the dose. His much younger wife worked full time, leaving him lunch, usually a sandwich, piece of fruit and a drink on the dining room table. He had confided in me that he thought she was having an affair with her boss. Having an active imagination (I’m a writer aren’t I?), I wondered if his wife was trying to kill him. Maybe the house, inside and out, was in deliberate disarray leading to a potential life-threatening accident. I don’t remember the other scenarios I entertained as I drove to and from his home.

When I left my job to move to another state, my friend, co-worker and fellow nurse practitioner, Jane Van De Velde, took over his care. He died on her watch. She recently emailed me with remembrances about him.

“But I really remember his memorial service. It was so touching, all the people who attended and spoke so highly of him. I was literally brought to tears. I got up and spoke about how wonderful it was to see another side of someone–the strong, healthy, community-involved and well-respected side. We saw him at end of life when he was so very ill and depressed and visually impaired.”

Jane adds, “There are some patients we never forget.”

Amen

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