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The Murder Building

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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

Writing the Book

I’m writing a book. I’ve been writing this book for the past five years. Longer if you count the time I worked with a friend to co-author a book of nursing tales until I knew I had to take this journey alone. Add the amount of time it took for the book to take form and we’re talking ten years. There have been many renditions. It started out as a chronological account of my nursing career. Then it morphed into a story about a particular job I had. I added more about my immediate family. My mother ambled into the book complicating my theme and opening old wounds. I changed the book from past tense to present tense and back to past tense again. I’ve had many more working titles than I can remember. Over the years I paid large amounts of money on writing classes and workshops and to consultants to look over my work only to disregard what they recommended. The book remains incomplete.

I don’t believe any of my efforts were worthless. In fact with each rendition of my book, I grew into a better writer. But now enough is enough. I am ready to declare what this book is really about and proceed to complete the manuscript. That’s the scary part. Maybe it’s the real reason it’s taken so long to be done.

Getting Older

I promptly lost my first Medicare card. When I opened the envelope and saw the red, white and blue border, I was reminded of the elderly I cared for over twenty years ago when I was a gerontological nurse practitioner. I ran a not-for-profit clinic in a converted one-bedroom apartment on the tenth floor of a senior citizen highrise in Chicago. How many times had I asked to see someone’s Medicare card? Most of my patients were poor, illiterate and had multiple health problems. So when I first looked at my card, I could only remember loneliness, despair and disability. This couldn’t be happening to me. And, poof, the card was gone.

Slowly other patients strolled into my memory. Mildred, blind and lived alone, always asked me to put her kitchen cabinets back in order after her daughter visited. Margie, ninety-something with an Irish brogue, came down to the clinic, laughing as she told us how she chased away the prostitutes with her broom. The prostitutes frequently slipped into the building to solicit and rob the older men.

But Helen was my favorite. She lived in an apartment next to the clinic. She dropped in when I wasn’t busy. She called me Kiddo.  She had one son who hardly visited but I rarely heard her complain—about anything. She was the one who taught me not to be uncomfortable talking about death.

Of course, I know older people live longer and are healthier than years ago. I now have the time to write, paint and play with grandchildren. I would like to go back in time and share my experiences of aging with Mildred, Margie and Helen. These resilient women would laugh when I tell them how I lost my first Medicare card.

Same Old New Year’s Resolutions

This year I hesitated to make any New Year resolutions. Why? Because for the last five years, at least, they remain the same:

Write the book.

Lose the weight.

Exercise more.

The only thing that changed was the pounds I wanted to drop. They increased yearly. Now it’s 20 pounds! I felt defeated. Depressed.

But something has happened to make me feel positive in reaching my goals after all. When I took my walk yesterday, I put in my ear buds and tuned my I-Phone to The Peoples’ Pharmacy podcast. The show I heard had aired on December 31st and was entitled “Willpower Science.” For the next forty minutes or so I listened to Kelly McGonigal PhD, psychology instructor at Stanford University and a health educator for the School of Medicine Health Improvement Program, discuss reasons why we often fail in keeping our New Year’s resolutions.  The take-home message that most attracted me was twofold.

First, think about what you really want. What you are willing to do to achieve it? And what will your life be like if it happens? Not just next year but in two years from now. How proud will you feel if you do achieve your goal? Or the regret you will feel not having made the change.

(I must add here Dr. McGonigal suggests small goals like exercising five minutes a day and increasing slowly. Success breeds success.)

Second, we need to feel self-compassion and self-forgiveness. When we slip up, we shouldn’t chastise ourselves and give up but realize we are human. Guilt and shame undermine our ability to get back on track.

Okay, none of this is really new. But the science behind these statements helped me better understand how willpower works or doesn’t work. Check out Dr. McGonigal’s web site and her book, The Willpower Instinct: How Self-Control Works, Why It Matters, And What You Can Do To Get More Of It.

It was serendipitous that I connected to this podcast. I’ll apply the lessons I learned so I don’t have to repeat 2012 resolutions in 2013.

I wish each of you a new year free of guilt and stress.

Be good to yourselves.

Radio Interview

I was listening to my long time friend, fellow writer and nurse, Lois Roelofs being interviewed on the Laura Dion Jones Show from Illinois on WRMN 1410, last week. With my I-Pad up to my ear, I settled in a comfy chair in the living room of my daughter’s home in Raleigh. For the next half hour, my four-year-old grandson repeatedly circled my chair, lunged at the dog, and jumped on his eight-year-old brother who was playing Mario Kart and protested loudly. Besides ignoring my grandsons, I ignored the ringing phone and hoped no one would press the doorbell.

Lois wrote a book: Caring Lessons: A Nursing Professor’s Journey of Faith and Self. Lois not only promoted her book but also discussed the special characteristics of the nursing profession. She told Laura’s audience that nurses are not just caring but use manual dexterity along with cognitive and social skills in their interactions with patients. “It’s an intellectually vigorous profession.” And the ultimate multitasking profession, I might add. Anyone who has been hospitalized will appreciate the benefits of a being cared for by a competent and compassionate nurse.

Lois and I met years ago in a baccalaureate-nursing program. We share the same irreverent sense of humor and the love of nursing. And the belief nurses have an important message to share with the public—how and why we make a difference. Lois does a good job during the interview to make this point.

Listen for yourself. Brew a cup of tea. Click and fast forward into the broadcast to 3:05 minutes and hear Lois promote her book and the nursing profession.