Bedbugs and Friendships

My husband and I went to Charleston last week and came home with bed bugs—maybe. A lovely city, we have been there many times joining friends at the same hotel. This time, after a hiatus of a couple of years, the hotel was looking a bit rough around the edges. Our first room was quite dirty and we had 30 minutes of dumpster noise at 3:00 a.m. We asked for another room.

The next morning my husband came out of the shower complaining of a terrible itch.

“Stop taking daily showers,” I told him. Our usual battle over dry skin and aging.

The next two mornings, after his shower, he had the same rash and extreme itch. During the day both would subside. While driving home, he showed me the “hives.” What was he allergic to?

I had been too preoccupied with my friend’s behavior to be concerned about my husband’s “allergy.” Her short-term memory loss had side tracked my delight in sharing our mini-vacation with our two longtime friends. Sue, I will call her, and I met while working at the same hospital before either of us married. Over the years we shared family vacations, grew older and retired but continued seeing each other at least once a year. Infrequent phone conversations didn’t reveal her problem. However, at dinner that first night, after Sue asked me for the third time if I had heard from a mutual friend, and then forgot where we were going to dinner the following evening after she accompanied me to that restaurant to make the reservation, I became worried.

Conflicted as how to proceed, addressing or not addressing, Sue’s memory issues, my husband and I spent the late evening hours weighing appropriate responses. I had to call attention to my concerns. How could I ignore symptoms that maybe could be reversible?  Sue’s husband seemed untroubled. The last day, Sue didn’t join us to visit the Magnolia Plantation and Gardens due to the unseasonably cold weather. While walking with her husband past the flowering azaleas, I learned how worried he was about his wife. The short-term memory loss started just six months ago. Any concern expressed by him was met with denial and anger from Sue. Would I speak with her? He was grateful.

silhouette-two-elderly-women-who-450w-464229824That last night after dinner, I took Sue’s arm in mine and we navigated the narrow cobblestone sidewalk toward the hotel. “I’m concerned,” I said, pulling her close and looking into her eyes. How often had I had to discuss uncomfortable topics with my patients over the years; how to talk of hopeless scenarios while still giving hope? But this was not a patient-nurse interaction. Would Sue lash out at me for saying she had memory issues, deny any problems or sever our friendship? My words bypassed any resistance. Sue agreed to see her primary provider when she arrived home. If her primary dismissed her concerns, Sue would seek help from a geriatrician who knew to look for changes not necessarily related to aging.

With hugs and tears, we said our good-byes at the end of the evening after I repeated my suggestions to both Sue and her husband. They had to leave earlier than we did the following morning.

After congratulating myself on my successful intervention, I slept soundly.

My daughter came to visit the day we came home. After she listened to her father’s story of his “allergies” and “rash,” she said, “Sounds like bed bugs.”

Yippes. We immediately went into action: suitcases packed in plastic bags and put it the garage, clothes washed in hot water, emailing a friend who I knew had a recent exposure to bed bugs.

I found out that a dirty environment does not always have to be part of the bed bug scenario. They are bugs of opportunity and settle in upholstery like beds and sofas and rugs and chairs.

And the “rash” that still pops up on my husband’s arms and legs can be residual of the first exposure. It can take up to a week for the sites to subside. In the meantime, I have been spared. I am on the lookout for telltale signs of infestation: blood droplets and brown spots on the bed sheets.

I texted Sue to alert her of the bedbugs. When she didn’t respond, I called her. Her voice flat, and her words curt, she cut me off before I was finished with my story.

I sat for a long time with the silent phone in my hand.

From Disengagement to Balance: The Journey to Positive Aging

 

Many of you reading this are not old enough to remember the disengagement theory. When I started out in gerontology in the 80s this was one of three theories of aging I learned about, and the most depressing.

The disengagement theory of aging states that “aging is an inevitable, mutual withdrawal or disengagement, resulting in decreased interaction between the aging person and others in the social system he belongs to”.[1]The theory claims that it is natural and acceptable for older adults to withdraw from society.[2]. . .

Disengagement theory was formulated by Cumming and Henry in 1961 in the book Growing Old, and it was the first theory of aging that social scientists developed.[5]Thus, this theory has historical significance in gerontology. Since then, it has faced strong criticism since the theory was proposed as innate, universal, and unidirectional.[6](Wikipedia)

Thank goodness there were two other theories that challenged disengagement theory: the activity theory and the continuity theory.

I mention the disengagement theory to show how negative attitudes surrounded the elderly from the inception of geriatrics as a medical specialty and how far we have come in understanding the aging process, which, of course, is not a-one-size-fits-all.

It’s been over 50 years since the disengagement theory first described aging. I am witness to the evolution of a more realistic description of the multifaceted components of growing old. I try to blog about uplifting examples of the latter stages of our lives.

Two weeks ago, I spoke about one of my favorite TV shows, Grace and Frankie,women in their 70s (at least when the show started), who are depicted in a positive light. Both are strong, independent, smart, creative and refuse to wear the stereotypical label of “old woman.” The show’s popularity delights me because I can envision an audience that not only enjoys the antics of the women but perhaps is learning that the inevitable losses of growing older are intertwined with pleasurable gains.

Then last week I re-blogged my friend Lois’ post about turning 77 after her husband’s recent death. Another positive take on aging even in the face of loss and grief. She closes her post with this observation: “I thank God for the countless blessings I experienced during this first birthday week of my solo life; there’s more fun to share . . .”

With this week’s post, I’m including a New York Times article about women in their 70s. Is it just me or have you also noticed that older women are getting more positive exposure?

Mary Pipher writes, “We (women in their 70s) can be kinder to ourselves as well as more honest and authentic. Our people-pleasing selves soften their voices and our true selves speak more loudly and more often. We don’t need to pretend to ourselves and others that we don’t have needs. We can say no to anything we don’t want to do. We can listen to our hearts and act in our own best interest. We are less angst-filled and more content, less driven and more able to live in the moment with all its lovely possibilities.” Mary Pipher, “The Joy of Being a Woman in Her 70s,”New York Times, 13 January. 2019: 10.

Pipher’s book, “Women Rowing North: Navigating Life’s Currents and Flourishing as We Age.” is now out in print. I intended to buy a copy.

 

 

 

Growing Older – On Turning 77

My friend, Lois, turns 77 and shares her thoughts on celebrating her birthday without her husband, Marv, and cooking a dinner for her family.

Write Along with Me

“Can I help you?“ a butcher yelled from a packaged meat display.

A few feet away, I was standing, clueless, in front of an impressive array of glass-encased chunks of red meat. “Yes, I guess,” I bellowed back. When he was situated across from me, I asked, “How many pounds of a chuck roast do I need to serve six adults?”

“About three and a half.”

“How long would I have to bake it in the oven?”

After he outlined exact hours and temperatures, I gushed my thanks. “It will be the first roast I’ve made in forty-seven years; I want to impress my family.” After no response, I added, “I’ll take about four pounds; I’ll want left overs.”

As excited as I was to purchase this $25.00 piece of thick, marbled and bladed meat, his bland facial expression told me he was not interested in why it was the…

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Netflix Show Gets Aging Right

I am reblogging this post because Grace and Frankie are coming back this Friday on Netflix with the fifth season. You can bet I will be sitting on my sofa in the TV room ready to laugh, cry and thoroughly enjoy these two older women breaking down the stereotypes of aging. My only problem is how to make Season Five last a really long time.

Nursing Stories

I am thrilled that the third season of Netflix’s Grace and Frankie is finally here. As one of the first gerontological nurse practitioners to be certified by the ANA back in the 60s and now a 70-something woman, I am depressed that the very same stereotyping and dismissal of the aged I first encountered is still happening.

I came across this article by Ann Brenoff who says, “Season 3 of the Netflix series gets a lot right—and it’s funny.”

Read what Brenoff says about the series and how Grace and Frankie attack the entrenched biases that are reflected by laws, business opportunities and interpersonal relationships in our social networks, including family.

Grace and Frankie

LIFESTYLE 

03/30/2017 03:37 pm ET

‘Grace And Frankie’ Totally Nails What It Means To Be Getting Older

Season 3 of the Netflix series gets a lot right — and it’s funny.

By Ann Brenoff

The Netflix

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Nursing Truths for a New Era: Author Interview with Marianna Crane

A serendipitous meeting with Michele Berger reminded me of the long road I traveled conceptualizing, creating, and finally completing my book. Many folks that I met along the way inspired and supported my efforts. Most I never had the chance to thank. Fortunately, now I can tell Michele that her creativity workshop and follow-up coaching encouraged me to stay on track.

Thank you, Michele.

Below is Michele Berger’s recent post spotlighting me and my book.

The Practice of Creativity

Happy new year, everyone! It feels especially poignant to begin the first post of the year with a special Author Q&A. More than a decade ago, before I formally began my coaching practice, I taught creativity workshops at UNC-Chapel Hill’s The Friday Center. They had a thriving adult enrichment program. My classes were popular and I met and coached people from all backgrounds. It is always a delight to run into people many years later and hear about their creative adventures.

Two months ago at the North Carolina Writers’ Conference, out the corner of my I saw a distinguished-looking woman. Her face looked familiar, but I only caught a glimpse before moving on to my next panel. To my great delight and surprise, this same woman came up to me at the reception. We immediately recognized each other. She had taken one of my classes at the Friday Center and…

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SOB SISTERS

Originally posted on April 4, 2012.

Nursing Stories

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…

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THE CHOICE

This was published in September 2018 in The Olli Writers Group Anthology

anthology 

On our first night in a hotel room in Estoril, Portugal, the thumping in my chest jolted me awake. Still groggy from jet lag, I tried to go back to sleep but the pounding demanded attention. I pressed my hand over my heart, feeling what seemed like a bird batting its wings to escape my ribcage.

Besides a touch of anxiety, I felt fine. No chest pain, no shortness of breath, no dizziness, no nausea. Then my bladder chimed in, upstaging my clinical observations.

Slowly, I rose and sat on the side of the bed, careful not to disturb my husband who was asleep beside me. Thinking I might pass out, I sat quietly waiting to topple. When that didn’t happen, I shuffled in the dark, feeling my way along the wall, to the tiny bathroom.

Successfully back in bed without tripping, falling, or fainting, I couldn’t help but let the jet lag overtake any further analysis.

The next morning, I awoke to the same sensation in my chest. More alert than the night before, I diagnosed the uneven heartbeat as atrial fibrillation. A geriatric nurse practitioner until my retirement three years ago, I had treated many patients with this condition—its occurrence increases with age. A fact I couldn’t ignore. A-Fib, as it’s called, isn’t life threatening and often stops on its own.

I remembered that the day before, as my husband and I explored the neighborhood around the hotel, we had walked past a medical clinic. Through the large glass window, I saw several people sitting in a waiting room, some reading magazines, not unlike our clinics back home. I had no desire to seek help there. I didn’t speak the language, and who knew about medical practice in Portugal? Besides, I was counting on this event ending soon.

Getting ready for the day’s adventure, my husband slipped a sweater over his head as I laced my shoes. “By the way,” I said, trying to sound causal, “I’m having a little irregular heart beat. It’s nothing serious and I suspect it’ll end on its own. I just want you to know, that if by chance I pass out, get the tour director to call an ambulance and tell the medical folks what’s wrong with me—A-Fib.” Before my husband could become worried, I added, “I’m sure I’ll be fine.”

My husband of forty years trusted me, the knowledgeable nurse, to accurately assess my situation, and nodded. I figured he would be happy to be spared an interruption in our itinerary.

We rode the elevator down to the lobby, queued up with our tour group, and boarded the bus to Cabo de Roca. I grabbed a window seat. The vibrant, coastal city gave way to dry grasses clinging to rocky cliffs. I slid down in my seat and discretely put my fingers to my neck, checking my carotid pulse. The irregular rhythm ticked off around one hundred beats per minute. Not too rapid to worry me—yet.

After a couple of hours, the light blue sky became cloudless as we ascended into the thinning mountain air. Would the high altitude affect the rhythm of my heart? Would my pulse become so erratic that my blood stagnated, forming a clot that would migrate to my brain and spawn a stroke? My husband remained deep in his book. Or was he consciously ignoring me? The medical clinic near the hotel began to seem inviting, but very far away.

The bus turned into an empty parking lot. We arrived before other tourists. My husband was the only one who headed over to the one-story building that stood at the far end of the lot where one could obtain, for five euros, a certificate validating that one had stood at the westernmost point of continental Europe. The others headed to the bathrooms or the gift shop.

I stepped off the bus last. I felt something strange. Or, rather, I felt nothing. Had my heart stopped? No, it just felt that way with the fluttering finally gone. My chest was silent. My pulse was regular. The air smelled cool and crisp. Released from potential calamity, I dashed off to find my husband. No further health alarms marred the remainder of the trip.

When we returned to the States, my internist insisted I wear an Event Monitor: electrodes attached to my chest at one end, and at the other end to a plastic box that would hang around my neck for a month. When I noted any flip-flops from my heart, I was to depress the start button and the monitor would record the “event.”

One night during the first week, after I wrestled with the monitor to find a comfortable position in bed, I settled into sleep. My heart, booming loudly in my ears, jarred me awake. I pressed the record button. The monitor gave off a high-pitched sound and began taping. As instructed, I lay still. When the whining stopped, I stumbled into the kitchen to call the toll-free phone number.

The nurse talked me though the process of sending the recording across the phone lines. I hung up, relieved that she hadn’t told me to go directly to the hospital, as had happened with my friend, Norm, after his first submittal. “Get to the emergency room, NOW,” the nurse told him. The next day, a cardiologist installed a pacemaker in his chest.

I reassured my husband, who woke up during the taping and rushed after me, concern covering his face. We ambled back to bed—him to sleep and me to await any further malfunctioning of my heart.

Three weeks later, I mailed the monitor, wire, attachments, and unused batteries back to the company. I wouldn’t miss the nightly struggle to sleep with a rigid box digging into my ribs. Or the monitor’s beeping at inappropriate times during the day. Or most of all, the constant surveillance for any twitch in my chest.

The only two episodes I had during the month were not atrial fibrillation but sinus tachycardia: a regular, rapid heart rate, usually benign. Wearing the monitor for a month seemed too much of an inconvenience for such a paltry yield.

No doubt there will be other assaults to my aging body, mildly annoying or life threatening. The trick is to know the difference: whether to stay back and seek medical care or take a chance and get on the bus.

 

The Building as Character

 

Announcing Publication Day: Stories from the Tenth-Floor Clinic

 Immediate Release 

RETIRED RALEIGH GERONTOLOGICAL NURSE PRACTITIONER’S IMPORTANT MEMOIR OFFERS LESSONS FOR TODAY 

Retired nurse practitioner and Raleigh resident Marianna Crane’s memoir, Stories from the Tenth-Floor Clinic: A Nurse Practitioner Remembers, has earned kudos for its depiction of the early days of gerontological nursing. Windy City Reviews called the book “important” and Kirkus Reviews praised it for being “thoughtful and compelling.” Released by She Writes Press this month, the memoir has been heralded for the valuable insight it brings to understanding the complex web of care required still today for this vulnerable population. 

Crane celebrates publication with events at Flyleaf Books in Chapel Hill on November 11th at 2 pm, at Two Sisters Bookery in Wilmington on November 17th at 7 pm, and at Quail Ridge Books in Raleigh on December 5th at 7 pm. 

Crane loved her job working in one of the country’s first programs in gerontology. She felt a connection to her patients and valued her role in their care. But when she herself was not valued for her work, Crane decided to make a change and accepted a position coordinating a clinic that cared for poor, underserved elderly and which was located on the tenth floor of a Chicago Housing high-rise. 

Crane knew how to be a nurse, but what she didn’t know, and what her memoir so movingly recounts, is how much beyond her role as a nurse practitioner was required to assist older patients. She found herself planning a funeral, exposing relatives preying on the vulnerable, and hauling a mattress up the elevator. Also, she learned to offer medical care in people’s apartments even when people would not seek it —because care was needed. Most importantly, she learned how significant teamwork is in working with this population. 

In Stories from the Tenth-Floor Clinic: A Nurse Practitioner Remembers, Crane offers readers a compassionate and insightful look into the world of nursing but even more so, she offers readers stories about endearing people, stories that remind us all what it means to human. 

Long an advocate for the importance for recognizing the invaluable work nurses perform, Crane uses her memoir to give readers a greater understanding of what nurses/nurse practitioners do each day, a perspective that she hopes will increase understanding of the nursing profession. 

MARIANNA CRANE became one of the first gerontological nurse practitioners in the early 1980s. A nurse for more than forty years, she has worked in hospitals, clinics, home care, and hospice settings. She writes to educate the public about what nurses really do. Her work has appeared in The New York Times, The Eno River Literary Journal, Examined Life Journal, Hospital Drive, Stories That Need to be Told: A Tulip Tree Anthology, and Pulse: Voices from the Heart of Medicine. She earned her Diploma in Nursing from Saint Peter’s School of Nursing; her Bachelor of Health Sciences at Governors State University; and her Master of Science in Public Health Nursing at University of Illinois at Chicago. Crane lives with her husband in Raleigh, North Carolina. She is a member of the North Carolina Writers Network. Find her online at https://nursingstories.org/. 

She Writes Press is part of SparkPoint Studio, LLC.    

PRAISE for 

Stories from the Tenth-Floor Clinic: 

“…an important memoir detailing the complex needs of an aging population…” 

—Windy City Reviews 

In this thoughtful and compelling memoir, Crane’s keen eye for detail brings her stories, by turns heartbreaking and humorous, to life on the page. . . . Crane’s passion for helping others is obvious even as she struggles to figure out the best way to do that. An honest, compassionate look at what it takes to care for some of America’s most vulnerable citizens.”—Kirkus Reviews 

“Marianna Crane writes with compassion and insight about what it’s like to serve on the front lines of the medical profession—treating the most vulnerable among us. Her vivid account is moving and enlightening, a valuable contribution to the literature of social justice.”—Philip Gerard, Professor, Department of Creative Writing, University of North Carolina, and author of The Art of Creative Research 

“The book is a case study on how nursing is so much more than caring for a patient’s medical needs. Nurses care for the whole patient including all of their medical, physical, mental, emotional and social needs. Being a nurse myself, I really enjoyed reading this book and getting to know glimpses of the patients she saw in the clinic. This was a quick and easy read and really reminded me that we have such an impact on our patients’ lives long after we stop caring for them. I would recommend this book to any nurse or human-being who enjoys reading about human relationships and the bonds we form with one another.”—Nerdy Book Nurse 

Crane truly is an inspiration . . . Readers will see her compassion, heartache and ability to admit her mistakes in her emotional writing . . . I highly recommend Stories from the Tenth Floor Clinic by Marianna Crane to all families, caretakers and those who work with the elderly.”—Reader Views 

“Nurse practitioners are well known for their willingness to be primary care providers for the ‘underserved’ . . . Society prefers that such patients remain invisible, because acknowledging their existence is too unsettling. It is my fervent hope that Stories from the Tenth-Floor Clinic will find a wide audience of readers who are willing to meet and care about the people nurse practitioners allow into their lives every day.”—Marie Lindsey, PhD, FNP, health care consultant and founding member and first president of the Illinois Society for Advanced Practice Nurse 

“ . . . poignant and compelling . . . With empathy, compassion and wit Crane makes an important contribution to the literature of a frail population. We, who research these folks, are indebted to the author for her insights and unvarnished truth.” —Peter J. Stein, Ph.D. former Associate Director, Aging Workforce Initiatives, University of North Carolina Institute on Aging 

RE: Stories from the Tenth-Floor Clinic: A Nurse Practitioner Remembers 

By Marianna Crane 

        

Web
 

She Writes Press

 

Publication Date: November 6, 2018; Memoir: ISBN 978-1-63152-445-5; 5.5 x 8.5; Trade paperback; $16.95 U.S.; 212 pages 

E-book ISBN 978-1-63152-446-2, $9.95 

Part of the proceeds of the sales of this book will go to Erie Family Health Centers 

For more information, please contact: 

Caitlin Hamilton Summie, President 

Caitlin Hamilton Marketing & Publicity, LLC 

Phone/Fax: 865-675-3776 

caitlin@caitlinhamiltonmarketing.com        

                            

Countdown to Publication Date: One Week

I have three readings scheduled at local books stores in the next few weeks. I will send out an e-vite tomorrow. It’s both a stressful and exciting time. I have to remind myself to “have fun.”

The latest review of my book: Chicago Writers Association, Windy City Reviews:

Stories From The Tenth Floor Clinic. Marianna Crane. Berkeley, CA: She Writes Press, November 6, 2018, Trade Paperback and E-book, 212 pages. 

Reviewed by Deb Lecos. 

Marianna Crane has written an important memoir detailing the complex needs of an aging population and how a humane society should shift its thinking about what is “conscious-care” when people reach a certain level of fragility. The reader journeys along with Marianna while her beliefs change as a nurse practitioner, running a senior clinic within a Chicago-based, subsidized-housing building. 

As a nurse practitioner specializing in gerontology at the Veteran’s Administration, Marianna is governed by strict parameters. When a job change takes her to a senior clinic within a CHA building, she faces an environment quite different from where she trained, and is forced to adapt so she can help those under her care. Many of her patients are alone, disconnected from family, and easy prey for those intent on stealing their meager incomes. Continuing to live independently can be difficult when a patient’s health moves swiftly downhill and there are no friends or relatives to assist in decision-making. Residents of the building have come to rely on the clinic and its support staff to ensure they have social interaction, food in the refrigerator, and a fan when the heat becomes dangerously high. 

After work, Marianna’s home life is fraught with similar issues, as a complicated relationship with her mother has reached an unsustainable level of dysfunction. Her mother has become increasingly combative, and her disinclination to engage therapeutically requires Marianna to devise a solution that is respectful to her husband and two teenage children, while ensuring her mother has a safe place to land. Utilizing the new approach that she’s been reluctantly taking with her patients affords Marianna necessary skills to handle this emotionally-challenging situation. 

With chapters unfolding in story form, the reader glimpses the lives of vulnerable people. We learn what happens when the frail are shuttled into the corners of society without enough support. Filling that gap in care are Mattie and Mary, who work under the direction of Ms. Crane and are devoted to building humane over-sight relationships with the residents. Mattie and Mary compel Marianna to redefine her role in the clinic community by introducing her to Angelika, a woman choosing to die in her apartment instead of going to a hospital. Angelika has refused a diagnosis of the ailment ending her life. After losing the battle of Angelika’s resistance to leave her home, Marianna allows herself to adjust to the 

needs of those she is intent on helping. She comes to understand that sometimes care means respecting the wishes of a dying woman and not requiring her to take a final breath in the hospital, even if doing so breaks a dozen rules in the process. 

The stories Ms. Crane starkly and, at times, graphically illustrates occurred in the 1980’s. Similar events are continuing to unfold today in subsidized housing and homes all across the country. Difficulties the aging and poor experience in navigating ill-health and death within a system built for the well-off and healthy have worsened in the time since the author encountered these experiences. The VA, health clinics, and senior care programs are still underfunded and mismanaged, exacerbating the condition of buildings and staffing needs. 

There are no concrete solutions to the problems we face in determining how to care for a growing low-income, aging population. It is my fervent wish as a reader of this memoir that we do so with an ability to change our thinking, much as Marianna Crane convinced herself to do. Convenient, easily-enacted answers to the complex struggles of the elderly, many of whom are not connected to functional families, will not be successful. As Marianna came to her own epiphanies on how to be of assistance, so must our national community. This is a relational issue and it deserves a relationally-creative response, one that is centered on humane and caring treatment for all ill, infirmed, and end-stage-aged people.