I attended the book signing this past August. Farther Along, written by my friend and mentor, Carol Henderson, which tells 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 that will never be forgotten until one’s dying day.
How fortunate the women found each other and Carol. Writing their stories seems to have brought them to a better place than they would be if they hadn’t immersed themselves in writing.
Why did these women write?
Carol says in her book:
“Writing about deep and traumatic matters, as many studies now confirm, is good for our physical health. Reflective writing actually lowers pulse and blood pressure, increases T-cell production, and boosts the immune system. Writing can help us cope with chronic conditions like physical pain—and the loss of health, of dreams, and, yes, of children.”
We all write for different reasons. I am haunted by my patients. They walk around in my memory and defy me to ignore them. I need to tell their stories.
Looks like I have started my own tradition. I am posting Happy Lasagna Day on my Blog during Thanksgiving week for the third time since 2016. That year, my husband and I chose to spend Thanksgiving alone. Last year, although we enjoyed a traditional turkey meal with my daughter, son-in-law and the grandkids, I posted Happy Lasagna Day for the second time.
This year we will spend Thanksgiving day alone, again, but not by choice. My husband and I are at high risk for the devastating effects of Covid-19 and we decided to stay safe at home.
Rather than feel sorry for our isolation, I will relive the warm memories of family celebrations of the past by posting Happy Lasagna Day for the third time. Yes, my new ritual.
Happy Lasagna Day
First posted on November 24, 2016
My husband and I are spending Thanksgiving alone—by choice. We had been invited out but graciously declined.
After having three sets of houseguests in six weeks, we are happy to be alone. By the way, the house has never been cleaner.
And we broke from the traditional Thanksgiving dinner—we are having lasagna.
I love leftover lasagna as much or more than leftover turkey, stuffing and gravy.
Over the years lasagna has become the ubiquitous casserole. You can find it premade in deli departments and frozen food cases in grocery stores. It’s the go-to meal neighbors bring over to neighbors on happy occasions (childbirth) and solemn occasions (sickness or death in the family).
My love of lasagna goes back to my childhood when we visited Grandma in Jersey City. She lived in a second floor walk-up two blocks from my house. Who remembers what time she got up in the morning to begin cooking the lasagna and the rest of the meal, including homemade bread and a roasted chicken? As for the lasagna, she made the pasta from scratch. The tomato sauce (we called this gravy) simmered for hours on the stove. She used whole-milk ricotta and mozzarella cheeses that were made fresh at the Italian store down the block.
Being the oldest granddaughter, I sometimes helped by assembling the multiple layers of the dish. First the sauce, the pasta in one layer, a few spoonfuls of cheese mixture (ricotta, parmesan, eggs, oregano and parsley), sliced mozzarella, more sauce/gravy and then I started over again finishing with the mozzarella on top.
If the family ever had turkey for Thanksgiving, I don’t remember.
In Grandma’ s cramped kitchen the men ate first—Grandma’s three sons, her five sons-in law and Grandpa. My cousins and I sat at the “children’s table” that was cobbled together with end tables and folding chairs. The women served and cleared and eventually sat down to dinner with the windows open to let out the steam from the kitchen along with the delicious aromas of the Italian Thanksgiving feast.
So this Thanksgiving I am thankful for the usual, although not insignificant blessings, such as health, family, friends, but also for the memories that warm me and bring me back to Grandma’s table laden with her gifts and in the company of my extended family—some long gone but not forgotten.
Wishing you a Happy and Safe Thanksgiving with Joyful Memories.
Marianna Crane became one of the first gerontological nurse practitioners in the early 1980s. A nurse for over 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 lives with her husband in Raleigh, North Carolina. Visit her at http://www.nursingstories.org.
The book will take as long as it needs to take to be done.
My book, Stories from the Tenth-Floor Clinic: A Nurse Practitioner Remembers, took me about seven years to complete. I couldn’t seem to rush the process. A mentor told me “the book will take as long as it needs to take to be done.” And only after I finished the book did I understand what my story was really about.
My nursing career covered forty years. As soon as I retired I began to record those years starting with nursing school. When I reached the early 80s, a tug in my gut told me that I couldn’t go any further. During that time I was the coordinator of a not-for-profit clinic in Chicago targeting the underserved elderly. Throughout the years, I always remembered the clinic as being totally different from any other job I ever had. Located on the tenth-floor of an apartment building for low-income seniors, the open door policy allowed anyone to walk in—with a heart attack or carrying a loaf of zucchini bread.
As a new nurse practitioner (I had been a registered nurse for twenty years before I went back to school to become an NP), I narrowly viewed my role as a health care provider. I would see patients in the clinic for illnesses or health maintenance. That the elderly had multitudinous social and economic problems initially eluded me. Or was it that my lack of education in geriatrics, a new specialty at the time, that contributed to my misconceptions?
Many of my patients’ stories were captured in a journal that I kept while I struggled with the dilemmas that challenged me—patients choosing between food and medicine, or were victims of family abuse, or targeted by scam artists from the community. I often vacillated whether I had any right to step in and take over a patient’s finances or change the locks on the doors. With no road map, I fumbled along, sometimes butting heads with my staff in deciding how to intervene.
Finding the Truth in Revision
I learned that what I wrote initially in the book was not a clear map of what I wanted to convey. I just wanted to tell this story. But what story? My memory cast my co-workers in roles that inhibited my progress. With each rewrite, I softened my harsh critique of others and uncovered some detrimental actions that I had initiated. My insight became sharper when I let the story percolate in my head rather than rushing to rewrite. Reflection and patience, albeit over seven years, finally enabled me to be truthful to what happened in the tenth-floor clinic.
In retrospect, I see that having a preconceived notion of what I wanted to write had caused me to miss what was behind the real story. My belief about the stories from the tenth-floor clinic stemmed from what I remembered—my truth at that moment. The passage of time has a way of rearranging recollections. It was only after examining my place in my memoir that I uncovered what the story was really about, even if I had already lived it.
The book took as long as it needed to take to be done.
She shared many tips, some from other writers. She told her us that we can use all that she shared. She cautioned, however, to give credit to the original source of her advice when appropriate. For example, E. L. Doctorow said: “Writing is like driving at night in the fog. You can only see as far as your headlights, but you can make the whole trip that way.” In other words, Anne stressed, that we should start to write in short increments. We don’t need to have the whole picture before we begin.
She shared the following writing tips:
Stop NOT Writing.
Don’t be pressured to write well. Write badly. ( remember in Bird by Bird, Anne coined: write a shitty first draft?)
Trust you are loaded with stories to be told.
Don’t try to “think” the story—just be available and let it happen.
If you feel blocked, just write about it.
Don’t tell us—start with the action. Describe. It’s a movie behind your eyes.
Don’t force humor.
If you are too close to the story, pretend you are Margaret Mead studying the aboriginal tribes.
Tape record dialogue. Edit when it’s played back.
Spend the most time at the beginning of your work paying attention to structure.
In closing, Anne instructed us to google writing advice from various writers.
Here is a shorten version of an article in Lit Hub written by Emily Temple, August 6, 2019. I “sifted through her interviews and speeches to find out what she thinks about writing.”
Temple has highlighted some of her (Toni’s) wisdom below:
“You Don’t Know Anything.” And Other Writing Advice from Toni Morrison
I don’t want to hear about your true love and your mama and your papa and your friends.
I can’t think of another writer who is quite so universally beloved as Toni Morrison. Her work is magnificent, her legacy is unimpeachable, and she reveals her brilliance at every opportunity. She also taught for many years at Princeton, and I think it’s safe to assume she knows a thing or two about nurturing young minds. So, using the relatively flimsy excuse of her birthday—Morrison turns 88 on Monday, which is also Presidents’ Day (is this a sign?)—I sifted through her interviews and speeches to find out what she thinks about writing. I’ve highlighted some of her wisdom below.
Write what you want to read.
I wrote the first book because I wanted to read it. I thought that kind of book, with that subject—those most vulnerable, most undescribed, not taken seriously little black girls—had never existed seriously in literature. No one had ever written about them except as props. Since I couldn’t find a book that did that, I thought, “Well, I’ll write it and then I’ll read it.” It was really the reading impulse that got me into the writing thing.
I tell my students one of the most important things they need to know is when they are their best, creatively. They need to ask themselves, What does the ideal room look like? Is there music? Is there silence? Is there chaos outside or is there serenity outside? What do I need in order to release my imagination?
Everything I see or do, the weather and the water, buildings . . . everything actual is an advantage when I am writing. It is like a menu, or a giant tool box, and I can pick and choose what I want. When I am not writing, or more important, when I have nothing on my mind for a book, then I see chaos, confusion, disorder.
–from a 2009 interview with Pam Houston in O Magazine
Let characters speak for themselves.
I try really hard, even if there’s a minor character, to hear their memorable lines. They really do float over your head when you’re writing them, like ghosts or living people. I don’t describe them very much, just broad strokes. You don’t know necessarily how tall they are, because I don’t want to force the reader into seeing what I see. It’s like listening to the radio as a kid. I had to help, as a listener, put in all of the details. It said “blue,” and I had to figure out what shade. Or if they said it was one way, I had to see it. It’s a participatory thing.
It’s that being open—not scratching for it, not digging for it, not constructing something but being open to the situation and trusting that what you don’t know will be available to you. It is bigger than your overt consciousness or your intelligence or even your gifts; it is out there somewhere and you have to let it in.
–from a 2009 interview with Pam Houston in O Magazine
Don’t read your work out loud until it’s finished.
I don’t trust a performance. I could get a response that might make me think it was successful when it wasn’t at all. The difficulty for me in writing—among the difficulties—is to write language that can work quietly on a page for a reader who doesn’t hear anything. Now for that, one has to work very carefully with what is in between the words. What is not said. Which is measure, which is rhythm, and so on. So, it is what you don’t write that frequently gives what you do write its power.
I think some aspects of writing can be taught. Obviously, you can’t expect to teach vision or talent. But you can help with comfort. . . . [Confidence] I can’t do much about. I’m very brutal about that. I just tell them: You have to do this, I don’t want to hear whining about how it’s so difficult. Oh, I don’t tolerate any of that because most of the people who’ve ever written are under enormous duress, myself being one them. So whining about how they can’t get it is ridiculous. What I can do very well is what I used to do, which is edit. I can follow their train of thought, see where their language is going, suggest other avenues. I can do that, and I can do that very well. I like to get in the manuscript.
Those [paragraphs] that need reworking I do as long as I can. I mean I’ve revised six times, seven times, thirteen times. But there’s a line between revision and fretting, just working it to death. It is important to know when you are fretting it; when you are fretting it because it is not working, it needs to be scrapped.
As a writer, a failure is just information. It’s something that I’ve done wrong in writing, or is inaccurate or unclear. I recognize failure—which is important; some people don’t—and fix it, because it is data, it is information, knowledge of what does not work. That’s rewriting and editing.
With physical failures like liver, kidneys, heart, something else has to be done, something fixable that’s not in one’s own hands. But if it’s in your hands, then you have to pay very close attention to it, rather than get depressed or unnerved or feel ashamed. None of that is useful. It’s as though you’re in a laboratory and you’re working on an experiment with chemicals or with rats, and it doesn’t work. It doesn’t mix. You don’t throw up your hands and run out of the lab. What you do is you identify the procedure and what went wrong and then correct it. If you think of [writing] simply as information, you can get closer to success.
People say, I write for myself, and it sounds so awful and so narcissistic, but in a sense if you know how to read your own work—that is, with the necessary critical distance—it makes you a better writer and editor. When I teach creative writing, I always speak about how you have to learn how to read your work; I don’t mean enjoy it because you wrote it. I mean, go away from it, and read it as though it is the first time you’ve ever seen it. Critique it that way. Don’t get all involved in your thrilling sentences and all that . . .
What I’m going to say is going to sound so pompous, but I think an artist, whether it’s a painter or a writer, it’s almost holy. There’s something about the vision, the wisdom. You can be a nobody, but seeing that way, it’s holy, it’s godlike. It’s above the normal life and perception of all of us, normally. You step up. And as long as you’re up there, even if you’re a terrible person—especially if you’re a terrible person—you see things that come together, and shake you, or move you, or clarify something for you that outside of your art you would not have known. It really is a vision above, or beyond.
I first posted “The Story Behind the Message” in 2017 before my memoir was published. Now as I work on my second book, this post remains as relevant to me as ever.
Writing for me doesn’t get easier, Molly.
Rearranging my bookcase, I came across a book with the following inscription:
This is the story behind the message:
I had been writing for as long as I can remember. I saved many of my stories in longhand on scraps of paper, on faded yellow legal pads, and typed up on an old manual typewriter with multiple errors (I flunked typing in high-school). All were unedited and unfinished.
In the early 90s when I lived in the Washington DC area, I started to take writing more seriously by attending classes and conferences. One of the workshops was sponsored by the Smithsonian. I can’t remember for the life of me the woman who conducted the class. What I do remember was the cross section of adults who sat on folded chairs in the cramped room three stories below ground level at the Dillon Ripley Center. At one session, the instructor had invited her friend who was visiting from out of state, the author Molly Giles.
Molly looked to be about my age. She had reddish blond hair and a warm, earthy persona. I immediately wanted to be her best friend. She described the office she rented so she could write undisturbed.
After the class, I stood along side of the table where Molly was autographing her latest book: Creek Walk and Other Stories (still in print). She was poised with pen in hand ready to inscribe the book to me as I chatted on about how much I enjoyed her talk and how I thought writing was fun. She cocked an eyebrow at me as if I had just told her I still believed in the tooth fairy. Gently, she told me that writing could be difficult.
Now, over 20 years later, I have written many words, finished and published some stories. I completed a memoir and am investigating self-publishing venues. For me, writing is more arduous than exhilarating. My greatest strength is persistence.
How I wish I could meet with Molly over a mocha latte at some cozy coffee house. I know what she was trying to tell me so long ago. She was right.
The story that I wrote almost thirty years ago was chosen as a finalist from 200 submissions to Carolina Woman Writing Contest. Debra Simon, editor and publisher of Carolina Woman magazine, decided that this year she would include a list of finalists. Lucky for me.
Thank you, Debra Simon and Carolina Woman magazine, for selecting my story to be included in the list of finalists. I am honored.
Unfortunately, as of May 1, the print magazine was suspended due to COVID-19. You can read the prizewinning submissions on the Carolina Woman web site but there is only a list of the finalists by name and title of the work.
I have printed a copy of my story below.
I lounge on the back deck of my new home sipping a glass of Chardonnay. The October sun is still warm here in the South. No one is hassling me about drinking a good wine with taco chips. I’m not being hassled because I’m alone.
But I’m not really alone. The cat is here. She has wandered down to the brook and is sitting on her furry, black haunches staring at the bubbling stream. This commands her full attention. She doesn’t know brooks. Brooks weren’t common in Chicago where she lived all eleven years of her life. She knows alleys, cement sidewalks and chain link fences.
She was not totally citified, however. She ran around with a family of possums who ravaged the garbage cans in the alley behind our house and made their home under the steps of our old wooden porch. In the evenings’ blue haze, I would see the cat’s silhouette surrounded by pairs of red slits that darted away when I threw open the kitchen window to call her inside.
She hasn’t, as yet, met the beaver that lives in the brook since this is her second exploration outside. Like me, she has left familiar places and faces behind. She’s trying to make sense of this terrain with its newness and unpredictability.
Yesterday, on her first venture outside, I watched like an anxious mother while she delicately descended the steps off the back deck that lead to the grassy slope. Suddenly three, shiny black crows perched in the tulip trees began to make menacing, croaking calls. The crows swooped over the cat, one after the other. She crouched low and crept back to the deck, up the stairs and through the French doors I had opened.
No sooner had I shut the doors behind her, saving her life I am sure, she began to meow to go back outside. No way, I thought. I no longer need to experience that kind of the excitement: dealing with daily disasters, stretching my imagination while awaiting unmentionable accidents. Those worries I abandoned when my children, now grown and free spirited, decided to stay in Chicago when I moved to another state.
The cat rolls happily in the dry dirt by the brook sending up dust clouds. Back in Chicago, she often welcomed me from work by rolling about on the concrete path leading to the back door of our house. I would bend down and rub her soft belly until my work worries dissolved.
I wonder if the cat misses her familiar haunts: the chain link fence she scaled, the alley she explored, or the familiar wooden porch with its family of possums living underneath the steps. Does she miss the variety of laps she could choose to sit on, or the warm hands that reached down to scrub her black and white head, or the beds she shared? Does she miss her life companions, who like her, are testing their freedom?
The cat is gone from the side of the brook. I stay seated. I remind myself that I no longer need to be the mother-worrier.
I go back to my book and try to concentrate. Time passes. The wine and the taco chips are gone. The sun drops behind the tulip trees casting long shadows across the deck. I feel a warm, furry body rubbing against my leg.
I am happy to pass along a gift from my publisher, She Writes Press, plus SparkPress. Together they are offering free She Writes University classes. Timely since we, writers/authors, are sequestered in our homes because of COVID-19. I, for one, will be happy to learn something new while taking a break from thinning out my files, learning how to digitalize hundreds of old photos and chaining myself to my desk to work on book #2, and last but not least, snacking most of the day.
Thanks Crystal, Brooke and the digital team.
I hope you enjoy the following classes.
Last week we notified you that we’d be offering several She Writes University classes at zero cost. A dozen of these classes are now up and available—for you and to share with your friends and networks.
These classes will be free for 60 days, until May 31. They can be viewed by entering your email address, and you can browse the offerings here: http://shewritesuniversity.com/free
We hope you’re all staying healthy and strong. We’re thinking about all of you every day.
—Crystal, Brooke, and our amazing digital team who put this offer together.
FREE UNTIL MAY 31
Usually $197, these courses span hours of materials that breakdown how to edit, prep and publish your book like a pro.
These She Writes University classes are coming out of the vault and are available only until May 31, 2020.
Last Friday I discussed my book, Stories from theTenth-Floor Clinic: A Nurse Practitioner Remembers at the Wonderland Book Club, which was held at a local independent bookstore. The audience was quite engaged and we shared discussions not only of my book but of the status of nurses, problems within the health care industry in general and in North Carolina in particular.
Here are some of the questions/comments:
How do you deal with the stress of caring for patients? Do you take these problems home with you?
Me: I have always taken home patient problems as evidenced by what I wrote in my journals. Journaling was a way I dealt with problems at work. The more difficult the patient issues, the more time I spent writing in my journal. A lot of the stories from the book have been documented in my journal. In fact, the last chapter, Playing Sheriff, was written before I found the journal from that time period. I was surprised to find the story closely paralleled the journal entry.
How brave you were to write about your mother. (I’ve had this comment before. The first time, I really didn’t understand what the person was talking about)
Me: It was difficult to write about my mother. We didn’t get along. It was especially disturbing that I was a gerontological specialist and couldn’t get along with my own elderly mother. But it was truth and I felt it was part of my story. (At another reading, I was asked what happened to my mother when she had a place of her own. I told how my mother found a boyfriend. Wish I had thought to add that to my response.)
How do you deal with writing about yourself? (Asked by someone who doesn’t write non-fiction)
Me: I look at this book as a story about someone I know. I tried to dissociate from myself so it was easier to be honest about my actions.
Who was your most memorable patient?
Me: Helen Stoltz. She lived in the apartment next door to the clinic. When I wasn’t busy, she would drop-in and sit a few minutes beside my desk and teach me about aging. Of course, she didn’t know that what’s she was doing. She talked about getting older and eventually dying, which showed me that older folks aren’t afraid of talking about death. She was ready to die. However, she was cheerful and upbeat and accepting of her life until her time came.
What was the most memorable line your wrote in your book?
Me: I didn’t write it but it came verbatim from my notes at the time. The funeral director told me how to go about purchasing a grave site for the Pigeon Lady: The Greeks are tight but the Catholics will give you a break. (page 96). I’m thankful that I wrote down what he said. He was such a character—embodied with Chicago smarts and a big heart.
What I didn’t say was that “I killed all my darlings.” Therefore, there are no “precious” sentences that have survived my editing, thank goodness.
I almost forgot about Dennis. That’s what Carol Novembre thinks his name was. Carol and I worked together in the early 60s at Pollack Hospital in Jersey City. It was a county-run hospital. Dennis was head of maintenance. I learned a lot from him about the political corruption that went on behind the scenes. Not that I had any doubts about the kickbacks and abuse of power. I had seen the cases of liquor at the loading docks that were to be delivered to the administration suite (aka “the penthouse”). One time when I answered the phone on our nursing unit, a voice at the other end reminded me that my “donation” of five dollars was due in order to keep my job. When I identified myself as a nurse, the male voice apologized profusely.
Dennis, a tall, lanky guy with a pocked marked face and disheveled clothes, made rounds in the hospital when he wasn’t off-site, overseeing the unofficial work of prisoners. He would bus the prisoners from the county jail to work on the administrator’s suburban house—building a fence, painting the siding, tending to the gardens in the summer. He seemed especially fond of the nurses. If he learned one of us had missed lunch, he would run down to the kitchen and reappear with a bacon sandwich.
Reminiscing about Dennis was only one of the memories that resurfaced as I spoke to Carol last week. I had asked her if I could write about the fact that she was one of the first dialysis nurses in the country. I worry that as nurses age and die off, stories of nursing history will be lost. My stories included.
You will read more about Carol Novembre in a future post. In the meantime, here is a story I had published about one of the patients I cared for while I worked at Pollack Hospital in the mid-60s.
CLOSING THE DOOR
I screwed off the cap of the Black and White Scotch bottle and I carefully measured out sixty milliliters, two ounces, into a medicine glass. The alcohol fumes gagged me every time. Then I grabbed a pack of Lucky Strikes from the carton on the shelf next to an aspirin bottle. Cigarettes and Scotch balanced precariously on a small tray. I locked the door to the tiny medication room and went in search of Charlie Hobbs.
The tobacco smoke clouded the air in the patients’ lounge. The drab room was empty except for a middle-aged man in blue pajamas staring at pieces of a jigsaw puzzle on the card table in front of him. A cigarette clung to his lower lip.
At times, I imagined myself the airline stewardess I had always wanted to be. Coffee, tea, or me? This day I was a Playboy Bunny as I bent at the knees, stretching to place the drink in front of Charlie, while his blue eyes riveted on my imagined cleavage. But Charlie’s eyes fixed solely on the amber liquid. Not once in the past four weeks had he acknowledged me, the young nurse in a starched white uniform with thick support hose and practical shoes. An unlikely dispenser of booze and butts.
Charlie had arrived with no suitcase, only the clothes he wore. The faded blue hospital pajamas and robe comprised his daily wardrobe. One of the other nurses had donated slippers. I looked down at the top of Charlie’s wild red hair. “I got to get me another puzzle,” Charlie said without looking up at me. “This here one is almost done.” He snuffed the cigarette butt into an overflowing ashtray and reached for the drink. I was glad Charlie had decided to shower that morning or else his pungent body odor would have added to the foul air.
Charlie shuffled the jigsaw pieces about by day, and watched television by night, all a maneuver, I thought, to keep human interaction at bay. No one ever visited him. Did he even have a home to go back to?
Dr. Clark’s research money supported Charlie’s hospital stay. Dr. Clark needed recruits who would agree to have a cardiac catheterization in order to see the effects, if any, that alcohol had on their hearts. Cardiac catheterization was the latest tool of the sixties. It measured heart function but carried the risk of injury and even death.
Dr. Clark scoured the downtown bars searching for men who drank excessively. On a warm summer night about a month ago, Dr. Clark had gotten lucky. Charlie seized the carrot: a roof over his head, three squares a day, free liquor and cigarettes. He agreed to live on the third floor of the county hospital for four weeks and then undergo a cardiac catheterization.
I carried the empty medicine glass on the tray back to the nursing station. How could Charlie drink alcohol at nine in the morning? Or all day long, for that matter? What would make a man so desperate that he would consent to have a procedure that might kill him?
Even though I didn’t particularly like Charlie, there were times as I placed the Scotch in front of him that I wanted to nudge him and jerk my head towards the exit sign down the hallway. Get out, Charlie. The catheterization isn’t worth all the free alcohol and cigarettes that Dr. Clark’s giving you. Get out. Now. But I didn’t have the audacity to undermine Dr. Clark’s research, no matter how conflicted I felt.
At twenty-three and a nurse for just two years, I vacillated between professionalism and irreverence. I struggled with knowing when to step back and when to dig deeper into my patients’ psyche. How to be empathic and not sympathetic. How to balance cool detachment with overbearing involvement. Charlie needed someone on his side to help him understand what he was getting into.
Nellie Mineo interrupted my thoughts as she waved to me from the doorway of her husband’s room. She looked like the Italian housewife that she was: salt and pepper hair piled in a bun on the top of her head. A well-worn cardigan sweater covered the simple cotton dress she wore. Behind her thin frame I could just make out her husband’s outline under the starched white sheets.
The Mineo’s had known the chances weren’t in their favor when they first met with Dr. Clark to discuss replacing Joe’s diseased heart valve with an artificial one. At that time Joe was so short of breath that he could hardly talk, much less continue to work in the family grocery store. Joe had been my patient during the week Dr. Clark evaluated him for surgery. The Mineo’s large, gregarious family resembled my own extended Italian family. Joe could’ve been my Uncle Tony with olive skin, dark eyes and soft smile.
An artificial valve, which clicked audibly, replaced Joe’s faulty one. I had worked overtime on the surgical unit as Joe’s private nurse the first night after surgery. At first things looked great, but soon Joe developed a cough, and then his legs swelled. Diuretics only worked for a while, and the antibiotics failed to prevent the infection from ravaging his body. Although the valve was being rejected, it continued to click on.
Joe had the first room near the nursing station. The floor was dedicated to research and held only fifteen patients. The patients stayed for a long time or returned frequently for evaluation. Not surprisingly a strong bond developed between the professional staff and the patients and their family.
Joe’s family and friends usually came and went at all hours, but this day only Nellie stood guard. When I ambled towards her, she grabbed my hand. “He looks worse,” she said, rubbing my hand in absent-minded distraction. “Promise me you’ll stop in before you go off duty today.”
Nellie and I both knew that there would be no miracle for Joe. His once muscular body shriveled into sagging skin covering a bony frame. He didn’t open his eyes to Nellie’s voice. Even a sharp pinch to his face couldn’t get a reaction. “Stop and see me before you go off duty,” Nellie repeated. I nodded. Only then did she loosen her grip on my hand.
At the end of the day, as I flung my coat over my arm, I heard a racket from the patients’ lounge. Charlie stomped past me, head down and fists clenched. “I’m outta here.”
“What happened?” I asked the nurse who jogged after Charlie.
“Charlie kicked over the card table. No reason I could see for this.” She shrugged her shoulders and continued down the hall.
Nellie watched the commotion from the other side of the hall. I walked towards her. She pulled me into her husband’s room, grabbed my coat and purse and held them tight against her body. She stared at me for a long while without speaking. From behind her I could hear Joe’s wet bubbly breaths. Even in my short stint as a nurse I recognized the rancid smell of impending death.
Nellie moved her face closer to mine and whispered, “He’s dying.” She caught a sob and swallowed hard. “I don’t want him resuscitated. Stay with us, please stay with us. Don’t let them resuscitate him. Please don’t.” She wept quietly, clutching my coat and purse closer to her body.
What was I to do? I had never faced this dilemma before. I knew Nellie had witnessed plenty of resuscitation attempts as she lingered outside her husband’s hospital room day after day. Cardiopulmonary resuscitation was so new that all patients were candidates. At the first moment a patient stopped breathing, we leaped into action. We flung him to the floor and straddled him. With the side of our hand we walloped the sternum to get the heart started, then breathed frantically into his mouth. Pumped on his chest. We worked until we were exhausted. In most cases the patient died anyway with fractured ribs and a lacerated liver. Nellie didn’t want this for Joe.
Thoughts flew in and out of my mind. If the staff saw Joe turning blue, they wouldn’t give a second thought to trying to revive him. A resuscitation attempt might bring Joe “back to life,” but only briefly. Then there would be more pain and agony before his heart gave out and he died—again.
What would I want for Uncle Tony? A quiet death, or zealots in white coats beating on his chest? What should I do? Was there a choice? I looked at Nellie, her dark eyes pleading.
I heard Charlie’s voice from down the hall spewing curses. Perfect timing. Charlie would leave the hospital AMA—against medical advice—right before his scheduled catheterization. I hoped whatever he was up to would distract the staff just long enough for Joe to die.
My heartbeats kicked up a notch as I reached over and slowly shut the door. Nellie’s hold on my coat and purse relaxed and they slid to the floor. Wordlessly, she settled down in the chair next to Joe’s bed, lifted his limp hand into her lap and clutched it. I commandeered the chair by the door: the sentry blocking the enemy from entering.
I sat knotted tight while Joe’s breaths became more erratic. The lapses between his gasps for air stretched farther apart. Just when I thought he had quit breathing, he gulped for air.
Finally, the mechanical valve stopped clicking and the room became silent. I walked to the bed and placed my hand over Joe’s clammy hospital gown. I didn’t feel any movement in his chest. I didn’t feel a heartbeat. Joe’s open eyes stared at nothing. I stood there for a long minute before I smoothed down his lids.
Nellie gripped her husband’s hand to her breast and sobbed softly.
I stood over her, my hand lightly on her shoulder. While I felt relief that Joe died peacefully with his wife by his side, each footfall by the door made my heart flip. What if one of the staff would walk in and find I had made a decision that wasn’t mine to make. “ I really need to leave, Nellie,” I whispered, taking Joe’s lifeless hand from hers and placing it by his side.
Tears slid down Nellie’s cheeks. She rose from the chair and embraced me. “Thank you,” she said, her voice cracking. I felt Nellie’s tears soaking into my shoulder as my own tears fell. Then Nellie pulled away and sat back down next to Joe, taking his hand again into her lap. I wiped the moisture off my face with the back of my hand, grabbed my things from the floor, cracked open the door, and glanced up and down the hallway. No one was around. Retrieving my coat and purse, I walked leisurely toward the exit leaving Nellie waiting for the evening nurse to discover Joe dead in the bed.
The floor was unusually quiet. The medication door was ajar in the nursing station. I had no intention of poking my head inside and saying so long to the evening nurse. Just a few more steps and I would be in the clear. As I turned the corner of the white tiled hallway, Charlie Hobbs’ presence blocked me. “Hi,” he said as if we were old friends. “I’m leaving. Can ya spare a buck for bus fare?”
Charlie had on a bright green jacket I was sure wasn’t his. Noticing my eyes on the jacket, he said, “Borrowed this from the guy in the next room. I’ll return it.” I nodded even though I knew the coat would never make it back to its owner. He shifted his feet nervously as he waited for my answer.
I wasn’t anxious to break any more rules but I was glad he was leaving. Why even try to entice him to stay? That would be hypocritical. I reached into my purse guessing he would head for the nearest tavern rather than the bus stop.
“Thanks,” he mumbled. Shoving the dollar bill into the pocket of the purloined jacket, he turned abruptly. In two long strides he disappeared though the doorway under the red exit sign and raced down the steps. I followed. A cold wind chilled my stocking legs as Charlie opened the door at the bottom of the stairs to the outside world. In his haste to escape he let the heavy door slam shut behind him.
I pushed the heavy door open with my shoulder. Unlike Charlie, I had no desire to announce my departure from the hospital by slamming the door. Leaving my covert actions behind me, I griped the handle with both hands and eased it closed.
The Closing the Door was a winner of the TulipTree’s Stories that Needto be Told Contest and is featured in their 2016 anthology: Stories that Need to be Told.