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.

 

Learning the hard way about book promotion

My son-in-law and daughter left for a weekend in Chicago so he could run the marathon. I stayed at their home, watching three grandkids and the two dogs. It was good timing. My life, up to now, has mostly centered on promoting my first and only book. I have been doing little else.

Stories from the Tenth-Floor Clinic: A Nurse Practitioner Remembers, came out a year ago. Initially, I had a publicist but for the past few months I have been driving the marketing train by fits and starts.

UnknownMy recent effort at marketing has been to hop aboard the lecture circuit. I chose a topic, Empowering the Patient, that would attract an audience both interested in my talk, and additionally, would buy my book. I knew about this subject. I am a nurse practitioner, after all. Never mind that I haven’t practiced for twelve years. I have been a volunteer at a local hospital and exposed to the advances in practice and management. Besides, I have experienced the health care system as a caregiver and patient. And I have read lots of books and used online sources to educate myself. I put together an outline, did a Power Point presentation, and developed a reference list to hand out. My audience, I decided, would be impressed with my knowledge and engaging manner and purchase my book.

The lecture sites I choose had restrictions on overtly selling my book. However, I could say I authored a book and leave my promotional literature near the sign-in sheets.

I didn’t sell one book!

While I enjoyed giving the lectures and especially liked interacting with my audience, what became clear was that I didn’t enjoy the time and commitment it took. I was always on the lookout for updated information and the latest health interventions, which took up more time from family, pursuing my other creative endeavors like painting, and time away from writing my second book.

Besides, I found that I was stepping back into my previous nursing role to help out members of my audience. I felt their frustration in dealing with the complicated health care system. I didn’t stop at giving them needed tools. The nurse in me wanted to help by telling them what to do. Could I get sued for giving inaccurate information? Was all this worth the time and effort when it didn’t seem anyone was interested in my book.

What surprised me most of all was how I let myself get so obsessed with book promotion. I am usually sensitive to keeping a balance in my life, protective of my personal space and set limits on getting overly engaged.

Spending time with the grandchildren provided a change of scenery that took me away from my self-imposed author responsibilities. I have come to realize that while I am proud to have authored a book and want to see it sell well, it is after all, only a book

Home Visits Can Be Fraught with Danger

 

One time, long ago, at a nursing conference, I sat fixated as a fellow nurse told a story about the time she rang the doorbell at her patient’s house, and he didn’t answer. It was later that she found out he had been murdered. And in hearing more detail, she discovered that the murderer had likely been in the house the exact time she was ringing the doorbell.

Home visits can be fraught with danger.

One time I visited a patient who wasn’t on my list for that day only because I was in the neighborhood and had the time. He was bed ridden and unable to speak. He had a caregiver, a tall, muscular man who wore a long blond wig and make-up but masculine clothes, such as jeans and a sweat shirt. He was attentive and capable and flamboyant. An exotic array of visitors wandered in and out of the apartment. My patient’s mother, strikingly average-looking compared to the rest of the visitors, lived in an apartment above her son’s and was often present when I came. However, this day, unannounced, I walked into an unlocked and darkened apartment. Only my patient, lying in bed, was present.

Neither the caregiver, nor the patient’s mother, or anyone else familiar to me entered the apartment while I was there. However, as I finished with my evaluation, a man opened the unlocked apartment door. He wasn’t anyone I had seen before. In fact, he was unimpressive in slacks and button-down shirt. My patient smiled at him knowingly. We introduced ourselves. His eyes moved down my body. Acutely aware of the precarious situation I was in—alone in that apartment with a strange man and unhelpful patient—a band tightened around my chest. I promptly packed up my nursing bag and left.

Safely back in my car, I chastised myself for making this impulsive visit. No one back at the office knew where I was. It was a time before cell phones. What If something had happened to me . . . .  I didn’t want to think of that. I never again made an unscheduled home visit.

As I work on my second book, which is about home visits, I contemplate my experiences. I want to include the various unsafe situations visiting nurses may find themselves. It’s not just the “iffy” neighborhoods that may hold danger.

For example, I have previously posted a story about a patient that might have been murdered by a family member. When I drove down the tree-lined street in a middle-class neighborhood to make a last follow-up visit to the widow, it never occurred to me that foul play, and not terminal cancer, could have caused my patient’s death.

There are other dangers to home visits, of course. One nurse I knew broke her leg while stepping on an uneven floor; another was attacked by the family dog. Environmental conditions, such as inclement weather, flooded roads and extreme temperatures, are a constant threat to home visits. Once my windshield wipers died on me as I drove on the highway in a snow storm.

Yes, home visits can be fraught with danger.

Wishes, Dreams and Hopes for My Book: Stories from the Tenth-Floor Clinic

ik-wens...

 

I imagine Oprah Winfrey being told by one of her many assistants about a book she should read that is set in Chicago, that focuses on a female protagonist and deals with the disenfranchised on the West Side. Oprah, immediately after reading my book, writes a glowing review in O, the Oprah magazine. Great Summer Read!

My other fantasy is that an older woman who lives in Los Angeles, reads my book, which has been recommended to her by her nurse daughter or nurse son. She loves it so much that she passes it on to her best friend. Her best friend also loves it, and just so happens to be married to a well-connected TV producer, and soon my book is slated to premier as a new Netflix series.

And then reality sets in as I read the following quote.

“I did not get there by wishing for it, or dreaming about it, or hoping for it. I got there by working for it.” –Estée Lauder

Bummer.

 

 

How to Handle This Age Issue

The woman who was interviewing me asked my age. She was apologetic. “My boss wants me to get ages.”

I was ready for her.

“I am 76,” I said. “Not a problem to ask. I think it’s good that folks realize that older people can still be productive.”

“That’s one way to handle it,” she said, flatly.

Handle what, I wondered? But I didn’t ask just in case she would think I was being snarky and end our conversation. She was a columnist from a newspaper published in my old home town, calling to conduct an interview about me and my first book, a memoir.

Quite a few years ago, when I was dipping my toe into the writing life, I heard a local cookbook author being interviewed on a radio program. When the interviewer asked the author her age, she said, “I never tell my age. There are too many ageist readers out there.” I was floored. How would ageist beliefs disappear if those who are successful and of a certain age don’t sing their own praises? I wanted to reach into the radio and shake this woman. Since then I had been on a mission to tell my age. That was the way I was handling the age issue.

Once I stopped into a Weight Watcher’s storefront to get help in dropping the ten pounds that I have habitually lost and gained over the years. The helpful clerk was promoting the additional support one could find on the internet. “There is a Weight Watchers’ Blog,” she said, eyeing me before she continued. “Do you know what a Blog is?”

I immediately assumed she thought that I was too old to know what a Blog was. Since I had just recently set up my own Blog following advice on how to promote my future book, I huffed and puffed and said rather haughtily, that I have my own Blog, thank you, then turned and marched out the door. Only later did I recognize that was the wrong way to educate the clerk. Now she knew I was not only older but super sensitive. I should have just laughed and told her I had a Blog as if it were no big deal. Then she would be impressed by my age and my poise.

Since it is obvious that I am older, my new tack is to just be me and disregard any real or imagined mannerisms of others that are demeaning. While I don’t shy away from confrontation, and in some instances enjoy the battle, I would have to make an extra attempt to be cordial. Why call attention to my age? Let my actions and accomplishments speak for themselves. Yet another way to handle the age issue.

Now you can see that I am conflicted. Tell my age or not call attention to my age?

A week ago, a woman contacted me via email. She had seen my memoir on the publisher’s website. Could she talk with me about the indie publisher I had chosen? She finished her first memoir and now was exploring options. The memoir was about her grandmother who had sold alcohol during prohibition to support her family. The woman told me that she had written a few professional books and self-published a fiction story. We spent almost an hour discussing the pros and cons of self-publishing versus using my indie publisher.

During our conversation, we never mentioned age. Afterwards, looking over her website, I discovered that she was 82. I was impressed with her vitality, and enthusiasm to get her memoir published and promoted. Oh, to be so cavalier about one’s age! I now know how I will  handle this age issue.

Just ignore it.

 

decisionsright

Book tour in Chicago

Saturday, June 1, 2019

I am scheduling this post to publish on Wednesday, June 5, 2019. That day, I will be in Chicago talking about my book to the Advanced Practice Nurses at Rush University. I have three other venues scheduled before I head home on Monday. In between events, I will spend time with old friends. I’m having lunch with one woman that I haven’t seen in over 20 years!

Frank Lloyd Wright Home and Studio, Oak Park, Illinois

On Sunday, I will be reading at the Oak Park Library, Oak Park, Illinois. My daughter and 15-year-old grandson will have flown from Raleigh to join me. Afterwards, my daughter will show her son where she grew up. Maybe we’ll visit the Frank Lloyd Wright Home and Studio where, to get a change from nursing, I volunteered in the gift shop. I learned so much about Frank in particular and architecture in general. I always wondered if my involvement with the FLW Foundation had any influence on my daughter’s choice of a career—architecture.

So, think of me in the Windy City as you read this.

 

A Long Overdue Thank You

I had finally decided to clean out my office closet. I started with the stuffed cardboard Unknownfile box. The first thing I reached for was a frayed manila envelope. The stack of typed pages spilled out onto the floor. After I read the first two sheets—an early attempt at documenting my nursing life—I knew I was doomed to sit on that floor by the open closet door until I had scrutinized every page. One story especially held a surprise.

In the early 70s, after my husband completed his degree at the University of Chicago, we moved to the far south suburbs where housing costs fit our tight budget. My first job was at a community hospital. Soon after I started, I found out that my salary was the same as a new graduate nurse who had never even done a simple urinary catherization. I, on the other hand, was an experienced ICU nurse. I wrote a letter of complaint and while the Director of Nursing of the hospital commiserated with me, I wasn’t offered a raise. I quit.

I decided to apply for a job at a close-by nursing home in spite of the fact that I thought I was overqualified and working at a nursing home felt demeaning to my young arrogant self. I eventually learned differently.

I wrote about this experience in my memoir:

 

. . .I had worked in a nursing home—a well-run home

with low staff turnover—for a short period of time, but long enough

to savor the slow pace after being an intensive-care nurse for years

before. The residents bestowed many hugs and an occasional slobbery

kiss as I passed out medications on the evening shift.

I had forgotten that experience the day my academic advisor and

I talked about a master’s thesis. In 1979, like most of my classmates, I

wanted to study women—women of child-bearing age. Why did she

think she had to ask me again: “What group do you REALLY enjoy

caring for?” That’s when I remembered the hugs in the nursing home.

At the end of the version of the story about working in a nursing home that had sat in the manila envelope for over 15 years, there was an added comment about Eva Harrison that I hadn’t remembered writing.

Eva Harrison, the nursing home DON, had offered me a salary higher than the one I received from the hospital. She ran a warm and caring facility, valuing her staff and residents alike. I know she felt sad when I left after only six months but a new clinic opened. At the time, I believed that this new job was more prestigious than that of pill pusher in a nursing home.

What I had written was that I wished I had gone back to tell Eva Harrison that my time at her nursing home had so influenced me that when I graduated as a nurse practitioner a few years later, I had declared geriatrics my specialty. Working in a nursing home, Eva Harrison’s nursing home, set me on a career path that would both challenge and reward me.

Thanks, Eva.

Back to where it started: Chicago

I flew into cold, snowy Chicago last week to discuss my book at the main facility of Erie Family Health Centers. This felt like a dream as I stood behind the lectern gazing at the audience that, believe it or not, included a few familiar faces from some thirty years ago. I had been invited to read from my book: Stories from the Tenth-Floor Clinic: A Nurse Practitioner Remembers.I was discussing EFHC’s humble beginnings to this group of employees seated in the conference room on the third floor of an impressively designed modern building.

The main clinic that I remember was housed in a community center. Children’s laughter in the after-school program and the sound of the ball dribbling on an indoor basketball court easily penetrated the partitioned walls of the exam rooms. The dedicated staff experienced delayed pay days when revenue came up short. The clinic where I worked, a short walk from the main center, had mismatched chairs in the waiting area, second hand medical equipment, and roaches in the cabinets. In spite of the physical shortcomings, EFHC cared about the patients, the community, and its staff.

EFHC not only survived its humble roots but thrived and expanded. The non-profit organization now has 14 health centers, and more Advanced Practice Nurses (nurse practitioners and midwives) than doctors and is recognized as providing the highest quality of care by the US Department of Health and Human Services. The Chicago Tribune named EFHC as one of the top workplaces in 2018.

I am honored to be part of EFHC’s history.

 

Retired Nurse Practitioner & Author Marianna Crane presents her memoir,
Stories from the Tenth-Floor Clinic
On February 20, Marianna Crane, retired Erie nurse and author, met with our nursing staff to discuss her memoir, “Stories from the Tenth-Floor Clinic,” which movingly recounts her experiences as a nurse caring for the underserved elderly at Erie in the 1980’s.
We had a full room, a great discussion about the nursing profession, and over $300 were raised for Erie’s patients through the sale of her book!
Please join us in continuing to support Crane’s work! Keep up with her on her blog and website, Nursing Stories.
Buy the Book!
Proceeds from the sale of Crane’s memoir go towards providing quality care for Erie’s patients.
Crane with Dawn Sanks, Director of Health Center Operations at Erie West Town
Crane with Dr. Lee Francis, President and CEO
A full room!
Erie Family Health Center | 312.666.3494 (city) | 847.666.3494 (suburbs) | www.eriefamilyhealth.org

Growing Older – On Turning 77

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

Write Along with Me

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

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

“About three and a half.”

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

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

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

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What Was My Memoir Really About?

This guest post was written for She Writes Blog on November 29, 2018.

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. 

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.

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