There Are Some Patients We Never Forget


This was first published on January 29, 2012.

 

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

Spotlight: Marianna Crane

This appeared in the September 2017 Erie Family Health Center Donor Newsletter

 

Anniversary Spotlight: Marianna Crane

 

Over thirty years ago Dr. Sally Lundeen, a nurse and Erie Family Health Center’s first Executive Director, spearheaded a project that would provide care for the underserved elderly right where they lived. The Senior Clinic* opened on the 10th floor of an apartment building on 838 N. Noble, then managed by the Chicago Housing Authority specifically for low-income elderly residents. Marianna Crane was one of the first nurses to join Dr. Lundeen in this endeavor. She had recently left the VA Hospital, disappointed that, due to a lack of funding, she wasn’t able to provide the specialty care she knew that the elderly there needed.

Crane was at the forefront of a shift in health care, one of the first gerontological nurse practitioners at a time when geriatrics was barely beginning to be considered a specialty. The idea that older people required a different approach to care wasn’t yet mainstream, and many doctors weren’t interested. But Crane had grown up with older family members whom she cherished – her own grandmother lived to be 104 years old – and she believed that a change in approach to elder care was long overdue. “During school, I had two classes in geriatrics,” recalled Crane. “Chronic Disease I and Chronic Disease II. It was the older people on the job that taught me what was really important about nursing.”

At Erie, Crane, along with her collaborating physician, Dr. Olga Haring, cared for patients in the clinic while staff members visited isolated lonely seniors, monitored people’s medication, and even arranged breakfasts and luncheons for those who couldn’t afford food. Crane quickly realized that meeting the physical needs of the elderly was only one aspect of care. She witnessed older people being emotionally or physically abused by their family members, and older people with depression or other mental health issues who needed someone to talk to. When she would make home visits, she was often unsure what she would find on the other side of the apartment door. She waded her way through hoarders’ stuffed living spaces, nursed sick alcoholics, and worked closely with an ambulance service to ensure critically ill patients were delivered to the right hospital. But she felt that this was the care she needed to provide. “It was such a unique model of nursing, and the job was so different from anything I had done before,” she said. “Our community nurse would give exercise classes including swimming lessons at Eckhart Park. We brought in a podiatrist, negotiated reduced fees with a local ophthalmologist. We’d host free breakfasts every single Friday. It was just so unique.”

Crane was with Erie for five years before moving on to provide home care at the VA Hospital in Durham, North Carolina. She is now retired and is an active volunteer at a local hospital, where she serves as co-chair of the Patient Advisory Council, recommending ways to keep patient care running smoothly and efficiently.

Crane is also a writer (check out her nursing blog at nursingstories.org) and is working on her first book, a memoir about her experience at Erie Senior Clinic. The book will be published by She Writes Press at the end of August 2018, and Crane has generously pledged that a portion of the proceeds from the book go towards patient operations at Erie Family Health Center.

 

*While the Erie Senior Clinic has closed its doors, Erie remains committed to serving elderly patients and connecting them with the resources and referrals they need for a healthy, comfortable life.

 

 

 

Out of the Blue (aka Mr. Foley)

  • My story was published in Pulse: Stories from the Heart of Medicine on August 18, 2017
  • Out of the Blue
  • Friday, 18 August 2017

Marianna Crane ~

As I sit in the exam room waiting for my first patient of the afternoon, the phone rings. It rings four more times before I realize that Amanda Ringwald, our eighty-year-old receptionist, hasn’t come back from taking a rare lunch break.

I pick up the phone and say, “VA Hospital. Marianna Crane.” Oops, I’m not back at the VA anymore.“Senior Clinic,” I quickly add.

“Hello, my friend.”

The familiar voice makes my throat tighten and my eyes water. How in God’s name did he track me down at work?

“Mr. Foley. How are you?”

“Not good. My wife died. She died a month ago.” He sobs, and more tears flood my eyes.

Eddie Foley, a frail man with thinning white hair and a perpetual smile, had been one of my favorite patients when I was a nurse practitioner at the VA. I haven’t spoken with him since I started this new job, six months ago.

He’d enjoyed telling me about his wife and adult son. “They mean all the world to me,” he would say. “I don’t need no fancy vacations or new cars. I’m happy as long as I got my family.”

I reach for a tissue from the box on my desk. “Mr. Foley, I am so sorry.”

About two years ago, Mr. Foley, who’d been a butcher for more than fifty years, had suddenly developed swelling and redness in both hands.

“Acute arthritis,” my boss Dr. Leon Logan had said. Although this condition is common among butchers, who constantly handle cold meat, it’s unusual for it to surface so late in life.

“Let’s put him in the hospital so the rheumatology staff can figure out what’s going on and learn from him,” Dr. Logan had decided.

I’d worried that Mr. Foley might contract a hospital-acquired infection from a contaminated stethoscope or food tray, or from a health worker’s hands.

Many infected patients died. Especially the elderly.

I tried to convince Dr. Logan not to send Mr. Foley to the hospital. When that didn’t work, I tried to dissuade Mr. Foley from going.

“You don’t have to be admitted,” I said. “The rheumatology doctors want to see what has happened to you, but there are textbooks they can look at, you know.”

Mr. Foley shook his head. “I’ll do anything to help Dr. Logan and the other docs,” he said emphatically. “If they can learn from me, I’ll go into the hospital.”

Damn.

The battery of tests and invasive procedures that the rheumatology doctors ordered made Mr. Foley dehydrated, and he started to lose weight. After a few days, I walked into his hospital room, trying not to show my concern as I listened to his labored breathing.

He’d developed pneumonia. A plastic bag hung from a pole, dripping saline and antibiotics into his skinny arm.

I sat on the side of his bed and leaned down, my mouth close to his ear. “Mr. Foley, you’d better get well. Your wife and son want you to come home.”

He smiled weakly.

“You can do it,” I urged, feeling guilty. Was I cheering him on so I wouldn’t live the rest of my life with his death on my conscience? I’d let Mr. Foley down by allowing Dr. Logan to get his way with so little resistance.

I’ll never let him down like that again, I vowed.

Three days later, I was delighted to find Mr. Foley sitting up in bed reading the Chicago Tribune. The IV bag was gone.

“The doctors say I’m a walking miracle. I go home tomorrow.” And, to my elation, he did go home to his family. In the two years that followed, he never had another arthritis recurrence, and we haven’t spoken in the six months since I left the VA.

Now, as I clutch the receiver, Mr. Foley continues to sob over the phone while Mrs. Ringwald shuffles through the door.

“Your patient is here,” she says, laying the chart on my desk.

“Mr. Foley, I’m so sorry, I can’t talk. I have a patient waiting for me.”

Mr. Foley’s voice cracks. “Oh, Doctor Crane, I shouldn’t have bothered you.”

I never could get him to stop calling me doctor.

“I’m a nurse practitioner,” I would say.

“You are my doctor,” he would respond. “And my friend.”

“Mr. Foley, give me your address. I’ll come and visit you.” Imagining a smile breaking out on his face, I write down the address he gives me. I tuck the piece of paper into my skirt pocket, resolving to visit him soon.

Before calling the next patient into the exam room, I slip into the bathroom and splash cold water on my face, blotting it dry with a coarse paper towel.

A month later, as I am restocking our medical supplies, Mrs. Ringwald says, “A Michael Foley is on the phone asking to talk with you.”

I freeze, suddenly remembering the piece of paper with Mr. Foley’s address sitting in my top desk drawer. It turned out that he lived further away than I’d thought, so I kept putting off visiting him.

My office doubles as the exam room, and the geriatrician with whom I work is using it to see a patient. There is little privacy in the small clinic, so I take Mrs. Ringwald’s desk phone and drag it with me into the bathroom. I close the door.

“Ms. Crane, this is Mike, Eddie Foley’s son.”

He sounds just like his father.

“My father thought the world of you. So I want to let you know that he died last week. I guess he didn’t want to live without my mother.”

I slide down the wall onto the cold tile floor with the phone in my lap, unable to speak.

I never thought Mr. Foley would die before I got around to visiting him. I’ve let him down, again.

About the author:

Marianna Crane has been a nurse for more than forty years and became one of the first gerontological nurse practitioners in the early 1980s. “Although I’ve dabbled in writing throughout my life, it was only later in my career that I became passionate about telling stories to educate the public about what nurses really do.” Her work has appeared in the New York TimesThe Eno River Literary JournalExamined Life JournalHospital Drive and Stories That Need to Be Told: A Tulip Tree Anthology. Her memoir, Playing Sheriff: A Nurse Practitioner’s Story, will be published in August 2018. Her personal blog is nursingstories.org.

Netflix Show Gets Aging Right

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 original series “Grace and Frankie” came back with a vengeance for its third season. The story of two 70-something women who become unlikely friends after their husbands announce they are in love totally nails the aging experience in Season 3.

Here’s what it gets pitch-perfect. Of course, beware of spoilers.

  1. Banks don’t take older women seriously.

Grace (Jane Fonda) has a solid track record of launching and managing a successful business, but to the baby-faced banker named Derrick who she and Frankie (Lily Tomlin) approach for a 10-year, $75,000 business loan, she is unworthy.

Actually, it was probably a combination of their gender, their ages, and the fact that the product they want to sell is a lightweight vibrator for women who have arthritic hands. The very idea of older people having sex has been known to gross out some younger people. Note that Derrick closes his office door at the first mention of the vibrator.

As for age and sex discrimination, banks are regulated by the Equal Credit Opportunity Act, which prohibits discrimination on many fronts, including age and sex. But this is one of those cases where there is the law, and then there is the reality. The law does not require banks to make bad loans.

Banks live in fear of the four D’s: death, disability, divorce and drugs. That’s because the four D’s can lead to a fifth D: default. While things can happen to all borrowers, death and disability happen to older borrowers more often.

Plus, older business borrowers aren’t great guarantors ― especially if, like Grace, they’ve been successful and are smart. Successful, smart people generally know to tie up their assets in retirement plans or trusts, which creditors can’t touch. If the borrowers die or are disabled, the bank is left dealing with heirs, who know nothing about the borrowers’ business.

So it was no surprise that the banker Derrick blanched at the idea of making a 10-year loan to Grace and Frankie, who are both north of 70. Derrick was probably wondering whether they would survive long enough to repay the loan. Even the well-regarded Ewing Marion Kauffman Foundation’s Index of Entrepreneurial Activity ― the bible for tracking trends in entrepreneurship ― stops counting at age 64.

Maybe the Small Business Administration needs to realize that people are living longer and healthier, and sometimes our second chapters could use some underwriting ― even when we start them a bit later.

  1. Dealing with the death of a parent is hard, especially one we didn’t much like.

Sometimes, we don’t succeed in resolving our issues with our parents before death slams shut the window of opportunity. Martin Sheen’s character, Robert, visits his elderly and very disagreeable mother to tell her that he has married Sol, the man she previously referred to as “the loud, tall Jew at the law firm.”

From her wheelchair in a well-appointed nursing home, she reacts with predictable disapproval, leaving Robert visibly crushed. The scene scores an additional point for realistic aging: Some of us never stop seeking parental approval, regardless of our age.

Without anything resembling kindness, the “Irish Voldemort” ― as Robert’s spouse Sol calls the tyrant mother ― attacks her son as a “selfish man.”

“I could have happily died never knowing that you were one of them,” she adds.

Caregiving is a tough and unreasonable job if there ever was one. And it frequently involves caring for a disagreeable parent ― even a parent who has harmed us and with whom we have a strained relationship. And then they die, leaving us wondering what else we could have done.

  1. We are scared of the R-word.

Retirement is a mixed bag of worries. Can we afford it? What will we do all day? Will we be bored?

Robert has retired and wants Sol to, as well. Sol insists he must still go into the office at least three days a week to “help Bud” run the law firm. It isn’t until Sol attempts to fire his quirky longtime secretary, Joan-Margaret, that he realizes it’s time for him to hang up his law shingle as well ― not because he’s ready to retire, but because Bud and the law firm need him to.

Most experts believe that solid retirement planning includes knowing how you will fill your days. The Institute of Economic Affairs, a London-based think tank, says that following an initial boost in health, retirement increases your risk of clinical depression by 40 percent, while raising your chance of being diagnosed with a physical condition by 60 percent. Lisa Berkman, a Harvard professor of public policy, cites social isolation as a significant factor in longevity. If you’re socially isolated, you may experience poorer health and a shorter lifespan.

  1. We don’t want to be a burden to our children.

Grace’s daughter, Brianna, in cahoots with Frankie, loans the business the money it needs. But she loses her status as secret benefactor a few episodes later, and Grace is enraged. “I don’t want my children’s help,” she says.

Not wanting your children’s help is a precursor to not wanting to be a burden. Same idea, and it’s real. Taking help from those who you are used to taking care of feels demeaning. If the parent-child roles haven’t legitimately reversed yet, don’t be like Brianna.

  1. Just because we are older doesn’t mean we are old.

After both women throw out their backs and can’t get off the floor, Bud gifts them high-tech wearable alert buttons that hang on a chain around the neck. Grace removes one of her high heels to smash the device. Frankie, who has an outlandish outfit that she says it will go with, wears hers to a business meeting, where she inadvertently activates it and alerts an ambulance to rescue her.

It’s a funny schtick, and both actresses pull off the comedy magnificently. But it also rings true when it comes to how adult children see older people. Can we please hold off on the Granny-cam?

  1. All marketing is geared toward youth and sex.

Vybrant’s proposed new business partner hopes to woo Grace and Frankie with a peek at a proposed ad campaign. It features photos of the two of them ― but when they were 20 years younger. Yes, even a product designed for older women is afraid to show them.

Grace and Frankie hold their ground.

About 10,000 people a day turn 65. And pretty soon, there will be more older people than younger ones. More to the point: Boomers have more disposable income than any other generation, but they still can’t even find a box of hair coloring where the model even remotely looks like them.

According to a Nielsen study, by the end of 2017, boomers will control 70 percent of the country’s disposable income. Nearly 60 percent of homeowners over 65 are not weighed down by mortgages, compared with just 11 percent of 35- to 44-year-olds. And boomers account for 80 percent of America’s luxury travel spending, says AARP.

  1. Yeah, some of us do still actually chase our dreams ― and occasionally catch them.Frankie’s art show opening may not have been a rousing financial success, but she rightfully deserves the victory lap she takes for having done it. And kudos to her for giving away the yellow painting that represented Sol’s dislike for mustard. Let bygones be bygones.

Chasing your dreams is something you hear a lot about when you reach the end of your working years. Second chapters, next acts ― whatever you want to call it ― it means following your passions and making the time to do whatever it is you want to do, which for us is finishing watching Season 3.

WHY DO WE WRITE?

Originally appeared on September 16, 2012.

Nursing Stories

I attended the book signing this past August. Farther Along, written by my friend and mentor, Carol Henderson, which told the stories of thirteen mothers (she is one of them), a bakers dozen as Carol points out, who had lost children at various ages.

I was prepared to cry. I don’t do well with death of children, even adult children. Children shouldn’t die before their parents. Maybe that’s why I choose geriatrics as my specialty. Old folks die. It’s expected. No surprises. I can deal with that.

I teared up but didn’t cry and was somewhat unprepared for the humor, serenity, and lack of self-pity as the six mothers read sections from the book. But then ten years had passed since the women came together under Carol’s guidance and direction. Certainly bereavement takes time to absorb, rant and rage against, come to terms and eventually accept the grievous loss…

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My Mother’s Boyfriend

Happy Mother’s Day.

My mother died the day before Mother’s Day sixteen years ago. Each year at this time my memories of Mom revolve around both her life and death. Her last few years weren’t what I would have predicted.

When Ernie and I moved from the Midwest to Maryland in 1993, Mom came with us. I had found an assisted living apartment for her. She was 85 at the time—independent, and mentally sharp.

My father had died over twenty years ago. Since that time her only friends were other women. A couple of months after the move, she had to have new glasses. Then she wanted to replace her old hearing aid with not one but two. Clearly, she wanted to see and hear what was going on around her. Over the phone, she told me, “I am having so much fun,” and mentioned a boy friend. As a gerontological nurse practitioner, I knew that a move to an unfamiliar place could make an old person confused. I dismissed the boy friend as wishful thinking.

Shortly after that phone call, I pulled up in front of Mom’s apartment building on a lovely spring afternoon to take her on a shopping trip. She came to the car and shouted to me through the open window on the passenger side, “Come on out, I want you to meet someone.” After shutting off the engine, I got out of the car and followed her to the bench by the front door. Two men sat side-by-side: one was obese with red blotches over his face and the other, a tall thin man, wore a baseball cap and cowboy boots, with a red-tipped white cane resting between his knees.

Mom nudged me in front of the two men. “Lee, I want you to meet my daughter.”

The man wearing a baseball cap stood up, ramrod straight. His eyes were hidden behind dark glasses. Red suspenders stretched across a pot belly covered with a blue flannel shirt. His right hand shot out in front of him.

“Pleased to meet you,” he said in a strong, even voice, shaking my hand. He smiled showing a scattering of rotten teeth. I felt as if I were meeting my teenage daughter’s beau who so wanted to impress.

Lee was twelve years Mom’s junior. At first they talked of marriage but Mom said no because he was a Jehovah’s Witness and she a Catholic. In her mind that was deal breaker. Then they were going to move into one apartment. But they were never able to decide which one would give up his/her apartment. For the next seven years, they saw each other daily. They took walks together—Mom leaned on Lee while she guided his steps; they sat together at the same table for communal dinner, and they took naps together. Mom never told me outright but I surmised this when she revealed she had lost her favorite earring in his bed. I never asked what else transpired between them.

However, their relationship was not without problems. Mom didn’t trust him. She suspected that he was cavorting with other women.

While Lee was a younger man, he was an unlikely gigolo. Besides diabetes and blindness, he had had two heart attacks, a triple bypass, and a Foley catheter that migrated from his bladder out of his penis and down his pants leg and ended up in a collection bag not so neatly tucked into his left boot. Most times he reeked of stale urine and dirty clothes. Mom, who had had a life-long addiction to cleanliness, never complained of his hygiene. But by God, don’t let him prove unfaithful.

Mom’s suspicious and judgmental nature never seemed to take a toll on their relationship. Lee would laugh and say, “There she goes again” when she would accuse him of flirting with another woman. At the same time, Mom would insist we include Lee on family celebrations and occasional luncheons where Lee would eat with his hands and Mom would inevitably spill her water, or wine, and I would leave a big tip as we left the table and floor in a shambles.

When Ernie accepted a job offer in North Carolina, Lee encouraged Mom to go with us. She had become more frail and had frequent falls. After being hospitalized with a bout of pneumonia, she was admitted for a short-stay in a nursing home not far from her apartment. A kind health care worker would walk Lee to visit. I was glad I wasn’t present to witness their final good-bye.

Mom lived just lived nine months after the move.

I went to visit Lee shortly after Mom’s death to give him her radio/cassette player and large button telephone. On the drive up to Maryland, I had romanticized the visit—he expressing his deep love for my mother, sharing the moments they laughed together and telling me how much he missed her.

During the visit, Lee sat in his recliner in a cluttered apartment never uttering the nice words about my mother I longed to hear. And he didn’t remember the times I took them to the Red Lobster and the neighborhood Chinese restaurant. After I programmed his daughter’s number into the phone and we ran out of polite topics to talk about, I left.

On the long ride down route 85 South toward North Carolina and home, I wondered if Lee didn’t talk about Mom with me since I was the one who took her away—although he encouraged her to leave, or he was losing his memory? Or both?

Nevertheless, I couldn’t be too disappointed since he gave Mom a reason for living and certainly kept her blood flowing if only from the aggravation of thinking her blind prince charming had a roving eye. And I will always remember the time she said she was having “so much fun.”

Thanks Lee.IMG_2668

Luther

I received my memoir manuscript from my editor this past week. Thankfully, she hadn’t any issues with structure. (I’m not counting the many grammatical errors she found that I thought I had addressed but still missed).

Since the last version of my book, I have changed the title, dropped five chapters, deepened some others, and added more about gerontological nursing.

Here is chapter 10 that I dumped. It repeats a lot of what is in the first chapter of the book.

I am writing about a time in the early 80s when I worked as a nurse practitioner in charge of a recently opened geriatric clinic housed in a one-bedroom apartment on the 10th floor of a senior high-rise on the Westside of Chicago. I am new to the role and stumble with the unexpected. Mrs. R is an 80-year-old volunteer that serves as the clinic receptionist. Luther is the building custodian.

 

LUTHER

 

I heard heavy footfalls shuffle into the waiting room and Mrs. R’s shrill voice ask, “Why, whatever is wrong, Luther?”

I ran out of the exam room just in time to watch Luther, grimacing in pain, flop down in the chair next to Mrs. R’s desk. Sweat beaded on his nutmeg complexion. His overalls were dotted with blood. He gripped a towel that was wrapped around his upper arm.

“I was fixing a window. The glass cracked.” Luther’s words came in breathy bits. “Cut me.”

He was one of the custodians in the building, a short, sinewy man with a generous smile and warm personality.

I moved on heavy legs toward Luther as if wading across a pool: slow and deliberate. Standing in front of him, I could smell his sweat mixed with the musty, sweet odor of blood. I hated the stench of blood. Trying to suppress my gag reflex, I grabbed his wrist and held his arm up over his head hoping that gravity would slow the bleeding.

“Where did you get cut?” I asked.

Luther pointed to the underside of his arm still covered with the towel. With my free hand I applied pressure. Soon I felt the wet, stickiness of his blood steep into my palm. Acquired Immune Deficiency Syndrome hadn’t yet walked into my medical world, but the thought of what might be under the towel made me want to vomit.

No one else was in the office but Mrs. R and me. I didn’t want to tell her to dial 911 until I knew what I was dealing with. Still nauseated, I forced myself to concentrate on Luther’s injury.

“Do you think there are any pieces of glass in your arm?”

“The window didn’t shatter.” Luther’s voice was tense.

He was still sweating and breathing rapidly. His eyes darted around the room as if looking for a quick way out.

Maybe my own nervousness showed.

“Luther, concentrate on breathing more slowly. In. Out. In. Out.” I breathed along with him. “Good. That’s it.”

After a few minutes Luther stopped sweating and my nausea dissipated, but my arm trembled with fatigue holding Luther’s arm upward. The blood from the towel began to congeal. The bleeding probably stopped but I still needed to see the wound. Not something I was anxious to do.

“Okay, let’s put your arm down.”

Luther rested his arm in his lap. I put Luther’s other hand where mine had been.

“Press,” I instructed, “while I get some supplies to clean you up.”

I kept half an eye on Luther while I scrubbed his blood from my hands in the sink across from the waiting room. While his breathing had returned to normal, his eyes still darted about the room as if watching for some unexpected calamity.

I laid the supplies—a bottle each of iodine solution and sterile water, tape and several sterile gauze pads to replace the towel—on the edge of the Mrs. R’s desk and went back to snatch a tourniquet, quickly slipping it into my lab coat pocket, praying I didn’t need to use it.

Snapping on a pair of disposable gloves, I braced myself for the worst.

“Let me see what this cut looks like.”

With shaking hands, I slowly peeled the towel from his skin with my right hand. My other hand clutched two thick gauze pads that I would slap on the wound if it were still bleeding. Trickles of sweat from my brow dripped down my face and over my eyes blurring my vision. My imagination slowed me down. What was under the towel? Muscle and bone? Shards of glass? A gaping wound spewing blood? If that happened, I would need to apply the tourniquet and tell Mrs. R to call 911. I decided against alerting her ahead of time. Luther might pass out from the expectation.

Caked blood covered the wound. No fresh bleeding was evident. The muscles in the back of my neck softened.

“I cut an artery, right Miz Crane?” His eyes large with worry.

I tossed the bloody towel into the wastebasket by the desk and wiped my eyes with the back of my hand before I answered.

“I need to wash your arm so I can see better, but I don’t think you cut an artery.”

Luther exhaled slowly and his shoulders relaxed.

The laceration was about three inches long with even edges and deep enough to need stitches. I told Luther my assessment.

Mrs. R had fixed her gaze on Luther from the moment he arrived. I raised my voice to get her attention.

“Mrs. R, call Sam Levy and tell him to come up here right away. Thanks.”

Her body jerked as she snapped out of her trance.

“Why Sam?” Luther asked.

“Sam’s your boss. Your injury’s workman’s comp. He can drive you or pay for a cab to get you to the ER for stitches. And probably get a tetanus shot. Do you remember when you had one last?”

“No.”

While Luther and I waited for Sam, I reached over and poured some of the iodine solution onto the gauze squares and slapped it on the wound.

“Ow! Ow!” yelled Luther.

Blinking back tears, he searched the floor as if he were embarrassed to have yelled so loud. How dumb of me, I shouldn’t have used full strength iodine on the wound.

All I could say was “Sorry, Luther.”

After Luther and Sam left, I thought how easy it was for anyone to walk into the clinic and expect immediate service. Rather than acknowledge my own inadequacies, I blamed Karen Cranston who hired me. She should’ve told me I would be running an emergency room. I didn’t have the supplies or equipment to handle unexpected events. I didn’t acknowledge that even she couldn’t have predicted how the clinic would operate.

I was flying blind.

While Mrs. R looked on, I dragged the mop and bucket from the closet and washed the blood from the floor.

 

 

Rewriting the Book

writing a bookI’m doing what I said I would never do. Rewrite my book. I completed my manuscript late last year, sent it out to 20 small presses and one agent. While I have been waiting for the results to trickle in—those returned so far have been rejections—I’ve been troubled by a lingering discomfort that I have left something out. Something significant. Something that I couldn’t, shouldn’t ignore.

So for the past few months I have been having an internal dialogue:

“Leave the book alone. You did the best you could do.”

“No, something isn’t quite right. I’m not happy with the final manuscript.”

“You could be rewriting this book for the rest of your life. Let it go. You don’t want to be that writer who never submits her book because it ‘isn’t good enough’.”

“Aha! I know what it is that’s troubling me.”

My book shows how I managed a Senior Clinic in a Chicago Housing complex. I was a new nurse practitioner (not a new nurse). I show the role of the NP. However, in writing the book, I had totally overlooked the fact that while I was indeed a new nurse practitioner, I was also practicing in a new specialty—Gerontology. I say this but I DON’T SHOW IT.

Why is this important? Well, because when I became a Gerontological NP in the early 80s, studying old folks was a rarity. Older persons were generally ignored or worse, discounted and ill-treated. The 1978 best seller House of God by Samuel Shem, an irreverent book about medical interns in an renowned teaching hospital first coined the derogatory term GOMER, meaning “get out of my emergency room.” A term used frequently to classify the old person as someone without worth to cure, much less treat in our medical facilities. Some believed most old folks disengaged from life, deriving no pleasure in longevity. The fact that elders over 60 would still be interested in sex was shocking. WY SURVIVE: BEING OLD IN AMERICAAnd in this same time period the groundbreaking book: Why Survive? Being Old in America by Robert N. Butler, M.D. discussed whether or not to introduce geriatrics in postgraduate medical education.

Nursing was early to recognize geriatrics as a specialty but thought that the medical definition—specializing in the treatment of existing disease in older adults—too narrow.

Nursing developed a much broader vision and used the term gerontology rather than geriatrics.

Gerontology encompasses the following:

  • studying physical, mental, and social changes in people as they age

  • investigating the biological aging process itself (biogerontology)

  • investigating the social and psychosocial impacts of aging (sociogerontology)

  • investigating the psychological effects on aging (psychogerontology)

  • investigating the interface of biological aging with aging-associated disease (geroscience)

  • investigating the effects of an aging population on societyapplying this knowledge to policies and programs, including the macroscopic (for example, government planning) and microscopic (for example, running a nursing home) perspectives. (Wikipedia)

In 1981, the American Nursing Association certified me as a Gerontological Nurse Practitioner. A Board Certification was developed by the Medical Community 7 years later.

After I rewrite my book, you will see a Gerontological Nurse Practitioner in action.

WHY CAN’T NURSES RUN THE SHOW?

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Last week I reblogged Josephine Ensign’s Radical Hat-Burning Nurses Unite! because I was moved watching the Politics of Caring. The video, released in 1977, showed in Ensign’s words, “how little things have changed.” Nurses then were striking and joining unions in order to have “control over their jobs” and to promote safe and good nursing care. Ensign mentioned that some nurses, and I was one, left hospital nursing by becoming nurse practitioners or community nurses so they could enjoy autonomy not afforded in hospital nursing.massnurse5

In the 70s a friend of mine who already had a master’s degree in history and two school-aged children entered nursing school. After graduation, she worked only a year in a hospital, “paying her dues,” before she left for a desk job at an insurance company. She found the discrepancy between the culture and promise of nursing education and the reality of nursing practice—poor pay, lack of autonomy and hours that she had no control over—unacceptable.

Also at this time, I had quit my job at a small community hospital south of Chicago when I discovered that a new grad received the same starting salary as I. She was assigned a seasoned nurse to mentor her for her first few months of employment—among other experiences she lacked, she had never inserted a Foley cath in nursing school—while I went directly to the medical intensive care unit. I wrote in my resignation letter that I felt this unfair. The Director of Nursing called me at home pressuring me to reconsider but didn’t offer me an increase in salary. I didn’t go back.

Instead, I found a job in a nursing home that paid me more. A nurse who lived in the community ran the home and many of the residents came from the surrounding area. Most of the staff had been there for years. I loved working there and it was probably the reason I later specialized in geriatrics.

Even though I had sworn not to work in a hospital again, I found myself on a neurology unit when I was in graduate school in-between semesters in the late 70s. I wrote a story about the experience (“Invisible.” Examined Life Journal, 2.1 Fall 2012:55-60.). While I was helping one of my patients get ready to go home, I realized she was still ill. I had the skills to diagnose her congestive heart failure but I didn’t have the power to delay her discharge. I had to call her doctor and tell him I thought she shouldn’t be sent home. It was the first time I deliberately avoided playing the old doctor-nurse game, which would be to suggest he some how was responsible for this decision. My intervention did delay her discharge so she could be treated, possibly preventing readmission and maybe even saving her life. What I did was something any nurse could have done. How many times do bedside nurses who know the patient best see signs of trouble coming and alert the doctors? But we rarely call attention to ourselves. And when the patient gets better and leaves the hospital who does the family think has made all the difference—the doctors.

Getting back to that nursing home run by a nurse.

I have always played with the vision of nurses being in charge of a hospital and where doctors were the employees. I don’t have all the details worked out in my reverie but my hospital would let patients sleep at night without disruption for vital signs, lower noise levels in corridors, schedule tests around the circadian rhythm of the patients, imagesserve tasteful, nutritious food and post prices of procedures and surgeries so patients would know what costs were attached to their care up front. No health professional (read doctors) would be allowed to throw a temper tantrum or refuse to follow infection control precautions.

The “Nurse Hospital” wouldn’t have a nursing shortage. Why wouldn’t nurses want to work in an institution where they are appreciated and well paid and are included in decisions that affect their practice? And why wouldn’t patients want to be in a safe, patient-centered environment? Nurses wouldn’t need to join unions to have control over their practice and provide good patient care.

Things would change.

VANISHED Part 3 of 3

A couple of weeks after our hallway discussion, I spotted them exiting the elevator. Margaret pushed Josie in the wheelchair with one hand while lugging an IV pole with the other, rushing to the back door of the building and out to the parking lot in a obvious effort to avoid me. The bottle that hung from the pole had a milky beige color that could only be a supplemental feeding. Josie had a tube in her stomach. A conduit to deliver nutrients to keep her alive.

As much as Margaret had badgered me for recommendations, it was clear she no longer needed, or wanted my input.

I never saw either of them after that day. Soon rumors circulated that Josie had died. No one knew what happened to Margaret.

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