Photos of the Patients I wrote about in my book: Stories from the Tenth-Floor Clinic: A Nurse Practitioner Remembers

This past Saturday, I received a box in the mail filled with old photos. The nurse practitioner who took my place when I left the Senior Center sent this delightful surprise. “Rita Wisniewski” (I changed all names in my book except for my immediate family) said in her note that sending me the pictures of the patients we both took care of was “long overdue.” Rita had read my book but due to illness was unable to come to the various venues in Chicago where I promoted the book 2019. Between ill health and the pandemic, Rita had forgotten about contacting me. 

Rita read my book and recognized many of the patients I wrote about. Thanks to Rita, now I have pictures of those who appeared in my book. 

Molly, a wiry, eighty-year-old woman with an Irish brogue, lived next door to Ms. Henry. She often dropped into the clinic to socialize rather than to seek care. She didn’t take medication, and rarely complained of aches or pains.  P 103

Jerry Johnson, mildly retarded, wiggled between us, (on the dance floor) gyrating and twisting with abandon. It was a raucous moment that transcended age and ability.  (At a retirement party) P 117

Lilly Parks, a strikingly attractive woman in her seventies, stuffed her shawl down the front of her dress, and staggered about the dance floor on her matchstick legs as if she was going into labor. I had heard she kept a silver handgun in her sock but that evening she must have left it at home since her slim ankles were surrounded only by her rolled-down stockings. She waddled around in the center of the room clutching her belly to hoots from an enthusiastic audience (same retirement party) P 117

Stella Bukowski: (Sitting in a wheelchair) A dirty blond wig sat askew on her head. Only one leg, which was covered with a wrinkled cotton stocking, extended past the skirt of her housedress, and her foot was encased in a heavy black orthopedic shoe.  She reeked of a sharp ammonia smell. Urine? P 144

A picture of me that I have never seen before. However, I remember the poster, which was one of my favorites. I don’t remember where the picture was taken. The picture is too faded to read the citation on the bottom of the poster. Maybe one of you older nurses will recognize the poster and get back to me with the answer. 

Health care today is changing

Today we need someone who can help us manage our health care needs in the hospital, the home, the HMO, the school, the workplace, in long term care and in the community. 

Today we need a provider who can teach us how to stay physically and mentally healthy and how to prevent illness and disease. 

Today we need access to specialty practitioners who can provide expert heath care for individuals and their families. 

Today more than ever we need an advocate who can deliver quality cost-effective care throughout all the stages of our lives.

Today, we need a Nurse

Alphabet Challenge: Y

I’ve signed onto The Blogging from A to Z April Challenge 2021.

The challenge is to blog the whole alphabet in April and write at least 100 words on a topic that corresponds to the letter of the day. 

Every day, excluding Sundays, I’m blogging about Places I Have Been. The last post will be on Friday, April 30 when I finally focus on the letter Z. 

Y: Yacht Club

Sometime back in the 80’s I decided I wanted to learn to sail. Never mind that I had no boat, no plans on buying a boat, no friends who sailed or had a boat or wanted to take a class with me, and I had husband who couldn’t swim and didn’t have the same desire to sail as I had. I registered for classes that were held in the evening at a yacht club on Lake Michigan. 

About thirty of us sat on folding chairs in a large wood-paneled room facing a plain stage. On the stage, two men stood sipping from glasses that I thought could be filled with gin and proceeded to do a comedic take on sailing. One of them resembled Robert Redford. I can’t remember taking notes or having any handouts. I came every week because after the “class” we would sail on Lake Michigan. Members of the yacht club made their boats available for us students, hoping some of us would join the club and come back to crew for them in the future. 

We were assigned a different boat each week. Some of the boat owners loosened the rules and offered beer to the students. All of the owners gave us the opportunity to navigate their boat. 

Skimming along the waters of Lake Michigan as the Chicago shoreline receded and the sky darkened, allowing the stars to sparkle overhead, always took my breath away.  

One night a storm came up abruptly while we were out on the lake. Thankfully, I’d been assigned to one of the larger boats with a captain who adhered to the rules of not allowing alcohol. A small boat not far from us was having difficulty fighting the wind. All I can remember was the swift and professional action of our captain as he tossed a line to the distressed boat  and the “thank yous” from the grateful crew as they docked at the pier safely behind us. 

Just as quickly as the wind roared, the wind stopped. I tumbled off the boat on jello legs. 

After graduation, I didn’t join the yacht club. 

Alphabet Challenge: W

I’ve signed onto The Blogging from A to Z April Challenge 2021.

The challenge is to blog the whole alphabet in April and write at least 100 words on a topic that corresponds to the letter of the day. 

Every day, excluding Sundays, I’m blogging about Places I Have Been. The last post will be on Friday, April 30 when I finally focus on the letter Z. 

W: West Catchment Area

When I started my job as a nurse practitioner in home care at a Veteran’s hospital outside of Chicago, I had the choice of taking care of patients in the north or west region. The north region was deemed a safer catchment area. The west region, which surrounded Oak Park where I lived, had pockets of crime caused by rampant gang and drug activity. I wanted to be closer to home and stop off for lunch if I was in the neighborhood. I didn’t think twice before choosing the west side. Maybe I thought I was invincible, a city girl used to the gritty streets and boarded up homes. 

I tried to keep my senses sharp and stay alert when I drove through the neighborhoods making my home visits. I kept my distance from the car in front of me in case I needed to make a quick U-turn. I avoided groups of young males loitering on the street corners and always locked the car doors. 

In the long run, it wasn’t just the neighborhood that proved unsafe. Any home I went into could hold danger regardless how dilapidated the outside environs. My close calls, and there were some, depended on the character of those with whom I interacted. 

Still, to this day, I keep my handbag on the floor of the car and out of sight.

Alphabet Challenge: U

I’ve signed onto The Blogging from A to Z April Challenge 2021.

The challenge is to blog the whole alphabet in April and write at least 100 words on a topic that corresponds to the letter of the day. 

Every day, excluding Sundays, I’m blogging about Places I Have Been. The last post will be on Friday, April 30 when I finally focus on the letter Z. 

U: University of Illinois at Chicago

I graduated from UIC, College of Nursing in 1981 with a master’s degree in Public Health Nursing. During my first semester, in the community assessment class, I was assigned to the Pilsen neighborhood with a fellow student. At the end of this course, we had to write a paper about the community and the health problems that we unearthed. 

In order to get to know the neighborhood, my classmate and I walked the streets, looking at the housing and stopping in the stores. Mexican music played loudly from the shops while mothers, fathers, grandparents and lots of babies and children filled the sidewalks. I fell in love with the Mexican neighborhood. I brought home Piñatas, Mexican pastries and colorful vases. The vibrant sense of this Hispanic community impressed me.

There was another part of this geographical area: modest, detached homes and sidewalks swept clean by elderly Italian and Polish homeowners who soon would no longer be able to keep up their property. It was this population I would meet again in a few years after I became a gerontological nurse practitioner and took charge of a senior clinic on the westside of Chicago. UIC was the conduit for the welcome change of direction in my career. 

Alphabet Challenge: Q

I’ve signed onto The Blogging from A to Z April Challenge 2021.

The challenge is to blog the whole alphabet in April and write at least 100 words on a topic that corresponds to the letter of the day. 

Every day, excluding Sundays, I’m blogging about Places I Have Been. The last post will be on Friday, April 30 when I finally focus on the letter Z. 

Q: Quadrangle

I couldn’t find the pictures of our children, two and four years old, climbing on some sort of sculpture or stone wall on a sunny day in the University of Chicago Quadrangle. There were tulips around the base of the gothic buildings. I wanted to put the pictures on this post to show how happy the kids seemed. 

My husband and I had driven from Jersey City to Chicago with our children in 1971. He had been accepted to a master’s program at the University of Chicago. We planned to stay for the two years and then return to New Jersey where our families lived. That never happened. 

When my husband and I finally moved out of Illinois in 1992, our children chose to stay behind. 

Alphabet Challenge: M

I’ve signed onto The Blogging from A to Z April Challenge 2021.

The challenge is to blog the whole alphabet in April and write at least 100 words on a topic that corresponds to the letter of the day. 

Every day, excluding Sundays, I’m blogging about Places I Have Been. The last post will be on Friday, April 30 when I finally focus on the letter Z. 

 M: Medical Intensive Care

I turned down the position of head nurse at the University of Chicago Hospital. Among the nurses hired to work in the new unit, I was the most qualified. I had been the head nurse of the newly opened Coronary Care Unit run by the New Jersey College of Medicine and Dentistry at the Newark Hospital in New Jersey and, later, I worked as a staff nurse in the CCU in Holy Cross Hospital in Silver Spring, Maryland. 

Now, I was a mother of two small children, ages two and four, and the sole wage earner because my husband was in school full time. Luckily, my upstairs neighbor in the married student building where we lived, was a teacher, had two daughters around the same ages as my kids and wanted to trade off childcare. She worked part-time days. I could work part-time nights. Our arrangement would work seamlessly. 

So, I turned down the head nurse offer. Working half-time: two nights (11 p.m. to 7 a.m.) one week and three nights the next, meant that I didn’t have the responsibility that goes into opening a new unit (been there, done that) or the aggravation of administration on top of delivering nursing care. Besides, my salary for working part-time nights was greater than that of a full-time head nurse position.

A decision I never regretted. 

University of Chicago–Billings Hospital

John’s Live Poultry and Egg Market

I’ve signed onto The Blogging from A to Z April Challenge 2021.

The challenge is to blog the whole alphabet in April and write at least 100 words on a topic that corresponds to the letter of the day. 

Every day, excluding Sundays, I’m blogging about Places I Have Been. The last post will be on Friday, April 30 when I finally focus on the letter Z. 

J: John’s Live Poultry and Egg Market

In the 80’s, when I was married with a couple of kids and worked on the westside of Chicago, I frequented John’s Live Poultry and Egg Market on West Fullerton Ave. 

John’s reminded me of buying fresh chicken with my mother when we lived in Jersey City. I must have been six or seven years-old when my mother and I took the bus down Montgomery Avenue to the downtown markets. My mother led me into a large barn like store with sawdust on the floor and chickens in cages lined up along the walls. Mom gave her order. The worker in a long stained apron grabbed a chicken from the coop. With much squawking and feathers flying, he tied its legs and hung it by the cord upside down on a scale. I remember most that when the chicken was upside down it became very still. My mother agreed to the weight and the worker proceeded to slice the chicken’s neck. He dipped the carcass in a barrel with some sort of liquid which took off most of the feathers. Then rolled the body on a wheel-like contraption which removed any feathers that remained. I had watched the whole process mesmerized.

I waked into John’s Poultry store in Chicago after work one day looking for a fresh chicken for dinner. The man behind the counter told me I could pick out the chicken I liked from the cages to my right. I chose a white, clucking bird out of the many in the coop. He retrieved the bird and laid it on the scale. Just like when I was a child, the bird ceased to move. 

Times had changed since I visited the poultry store with my mother so many years ago. Now the killing and defeathering took place on the other side of a wall. 

After a few minutes of waiting, my name was called. I paid the bill and was handed a package wrapped in brown paper. The package was warm. The reality that I had chosen this chicken for death felt heavy on my chest. No longer a little girl mesmerized with the butchering process, I decided from then on, I would call my order in ahead of time.

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


 

 

The Tale of Two Clinics

Reflections in the December issue of the American Journal of Nursing had an essay by Mark Darby RN, ARNP: The Way of Johnson Tower. Johnson Tower, a public housing building, sounded very much like the Senior Clinic I worked in and wrote about in my book: Stories from the Tenth-Floor Clinic: A Nurse Practitioner Remembers. Seems that the only difference between the residents of the buildings was that Mark’s building housed adults, mine was limited to residents over 60. Otherwise, both sets of folks who sought care from either of us  nurse practitioners were mostly marginalized, underserviced, and poor—and gutsy.

Mark didn’t identify the location of his public housing building but I can surmise that it was in an unsafe part of town, on the first floor and, like my clinic, had been a converted one-bedroom apartment. He says the clinic has . . . “one exam room” and is “below the building laundry. If more than four people use the washing machine, water will drip into the centrifuge.”

Mark describes four of his patients, each with their own challenges but each reaching out to help others. Getting to know patients as intimately as Mark does is facilitated by caring for the patients on their own turf. Mark and I get to know first-hand what challenges our patients face and we know the strengths they gather up to face them.

I bet Mark’s clinic, like the Senior Clinic, promoted low tech/high touch. Here is a copy of the brochure from the Senior Clinic that a friend who had worked with me sent recently. He had been sorting through “memorabilia” from over 30 years ago!

 

Senior Clinic Brochure
Circa 1987

 

A murder due to a drug deal gone bad occurred just outside Mark’s clinic. Those who planned my Senior Clinic decided to place the clinic on the tenth floor to avoid any drug seekers trashing our clinic looking for narcotics. Neither clinic would attract patients with medical insurance who had a choice of health care facilities.

I especially liked Mark’s answer when asked how he could work in such a setting. He said, “One thing I learned in NP school is that I am a nurse first and an advanced practitioner second. Nurses are supposed to look at the whole person—mind, body, and spirit—as well as the environment. I have found that the residents of Johnson Tower teach me more about being a nurse and a human being than you would imagine.” Amen I say to that.

I’m not exactly sure when my clinic closed. When I went back to Chicago in 2007 the building was no longer a public housing building but was run by the Hispanic Housing Development Corporation. It looked well cared for. I called their office soon after that visit and was told there was no longer a clinic there.

Sad.

 

Mindfulness: Julia Sarazine

I met Julia Sarazine this past June when I spoke to Rush University nurses in Chicago about my book: Stories from the Tenth-Floor Clinic: A Nurse Practitioner Remembers. We agreed on the need for nurses to tell their stories.

When I discovered Julia’s background in teaching mindfulness techniques to nurses in order to reduce symptoms of stress (see How PTSD Is Hurting Nursing) I asked if she would share her expertise and experience about how mindfulness can help reduce Burnout syndrome/Post Traumatic Stress Disorder (BOS/PTSD).

I’m honored that Julia agreed.

 

You’ve said that some experts feel that Burnout syndrome among nurses is a public health crisis. BOS has been affecting nurses for as long as I can remember. Why do you think this problem has been so insidious and tenacious?

Burnout syndrome is now receiving attention as demonstrated by The World Health Organization including it in the Revision of the International Classification of Diseases as an occupational phenomenon.

Levels of burnout are higher in professions that have high risk associated with them, such as a nurse administering medications and treatments that may have a significant impact on someone’s life. Also, nurses are usually the ones that hear and witness the patient and families suffering.  In most situations, nurses see people when they are worried about their health, in pain or being treated for a serious illness.  Over time, this constant exposure to suffering can take its toll on the ability to maintain our own health and wellness.

Moreover, the demands of the healthcare system continue to increase with technology and integration of electronic medical records.  As more patient care is being provided in the outpatient arena, patients are sicker and may require more care than in the past.

 

You left a hospital nursing position because you had symptoms of BOS, yet a few years later you returned to the same position you left. How did you find the fortitude to do that?

 Once a nurse, always a nurse definitely applies to my situation and decision to come back to the nursing profession.  I missed working with patients and the sense of accomplishment I received while helping others.  It is the same reason I was drawn to the nursing profession in the first place.  I know it has been over communicated, but being a nurse is truly a calling, not just a job. It was not an easy decision, but it felt right for me at the time as I changed how I handled stress and suffering.  I basically learned to take care of myself with mindfulness at work and how to transition to be fully present at home.

 

What advice would you give to other nurses who have left nursing?

To leave the nursing profession is a very individual decision.  I believe all nurses are caregivers.  Where nurses are providing care may change and whom they are providing care to may also change.  For example, nurses may be taking care of their children, parents, family, friends or community members.  It may look different, such as volunteering for the food depository, listening to a friend discuss her new cancer diagnosis or asking the cashier at the grocery store how they are doing today.  Nurses are usually empathetic people and naturally take care of others throughout their lives.

 

There are terrible statistics about how many new nurse graduates leave the practice after a couple of years because of BOS. Among all the other tools out there to deal with this issue, what does mindfulness contribute?

 Mindfulness is not the magical wand that can solve all our problems and prevent burnout.  But it is a tool we can use to take care of ourselves so we can take care of others. I think all nursing students should be taught a few mindfulness skills when they begin nursing school.  If you can learn just a few simple skills to protect you while witnessing and feeling someone’s suffering, it can help prevent burnout and lower your stress levels.

 

What is your definition of mindfulness?

The mind naturally wanders from the present moment to the past or future. This is often referred to as autopilot.

  • Have you ever commuted to work and not remembered the drive or train ride?
  • Have you ever eaten something and not remembered tasting it?
  • Have you ever reacted to a situation and later regretted how you handled it?

These are all examples of mindlessness. In contrast, mindfulness focuses on being aware in the present.

There are multiple definitions of mindfulness, but the most commonly quoted is from Jon Kabat-Zinn: “Paying attention on purpose in the present moment, non- judgmentally.

 

How did you first learn about mindfulness?

Right after I left nursing, I was struggling with trying to process all of the deaths I witnessed. A friend recommended The Power of Now by Elkhart Tolle.  I read it and then began to meditate each morning. I found I was able to focus more and notice moments of joy in simple things such as a warm breeze on my face, a smile from a stranger and the taste from the first sip of coffee in the morning.

I continued to develop my own practice by taking mindfulness courses, attending silent retreats and eventually becoming a mindfulness instructor.  Mindfulness is never complete; everyone who practices is always learning and evolving through increased awareness.

 

How has mindfulness changed you?

Mindfulness allowed me to process all of the suffering I witnessed and absorbed while working at Cook County Hospital as a palliative care nurse practitioner.  During one of the mindfulness retreats, the teacher said, “ You don’t have to jump into the deep in of the pool, just dip your toe into the water as far as you can at this time.”  This was very helpful for me at the time because I was resistant to processing the deaths for fear I would drown in grief.  From this simple instruction, I was able to process each patient’s death by allowing myself to feeling the sadness and grief; then the grief lessened and I was able to wish the patient and family well.  I realized I was frozen in time, but the family and friends had moved on with their lives the best they could.

When I returned to my nurse practitioner position five years later, I used mindfulness to keep myself grounded in the moment so I could think critically and also not absorb all of the patient’s and family’s emotion.

Now I use mindfulness all day long to recognize when I am stressed and choose how to respond, enjoy pleasant moments more fully and to accept when I have feelings of sadness or grief while taking care of aging parents.

 

Please tell us about the success you have had in teaching mindfulness to the nurses at Rush University Medical Center.

 It is an amazing experience to be able to share the worst moments in my career and now teach how I processed the grief with mindfulness and continue to use it every day.

At Rush University Medical Center, we completed a study and determined that six months after nurses participated in a four-hour mindfulness and resilience workshop; they had reduced burnout and perceived levels of stress and increased mindfulness skills. We were thrilled with the results discovering that a short four-hour workshop can have an impact six months later.

 

 Please add anything else you think my Blog followers need to know about mindfulness.

 Here are some strategies and tips to incorporate into your daily life through informal practice, especially at work, where stress levels can be elevated. Just as a reminder, it is important also to practice informal mindfulness in times of minimal stress since it is easier to focus on being present and will make it more accessible during times of higher stress. Remember, it does not take any more time to be mindful.

 

Informal Mindfulness Practice:

STOP

STOP is a mindful technique that can be used in any situation to slow us down and reconnect with ourselves. It can be used before entering a patient’s room, sending an email, charting, speaking, or entering your home after work. The acronym STOP stands for:
• Stop whatever you are doing to pause for a moment
• Take a deep breath or two
• Observe any specific thoughts, emotions, or body sensations
• Proceed with more awareness

Two Feet, One Breath

This mindful technique can be used in times of stress to ground us and create a little space from the stressful situation being encountered.

With both feet firmly on the ground, while either standing or sitting:

  • Focus as much attention as possible on sensations in the sole of the left foot—perhaps pressure or sensations from contact with the sock or shoe.
  • Then shift attention to sensations in the sole of the right foot, with as much attention as possible.
  • Tune in to your breathing—just feeling the breath as it moves in and out.
  • Now, continue whatever you are doing in a more grounded and present manner.

Mindful Hand Washing

Use all the senses to bring awareness to the activity of washing the hands. Feel the temperature of the water and the sensations of the hands rubbing together, the smell of the soap, and the sound of the water running, and notice the bubbles forming from the soap. This awareness can be applied to any routine activity, such as brushing teeth, taking a shower, or typing an email.

 

Formal Mindfulness:

On-Line Mindfulness Workshop Opportunity:

TheMindfulness and Resilience 4- Hour Workshop has been shown to decrease stress and burnout symptoms and increase mindfulness skills 6 months after participating.

I am teaching it on Saturday, October 19thfrom 8 am – 12 pm CST.

For details:

https://www.sarazinemindfulness.com/corporate-mindfulness-programs

 

 

Julia Sarazine

Sarazine Mindfulness, LLC

www.sarazinemindfulness.com

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