INVISIBLE Part 1 of 3

“Invisible,” by Marianna Crane, originally appeared in the Examined Life Journal.



The cardinal rule of the game is that open disagreement between the players must be avoided at all costs. Thus, the nurse must communicate her recommendations (to the physician) without appearing to be making a recommendation statement. – – – The greater the significance of the recommendation, the more subtly the game must be played.

– 1967, Leonard I. Stein, M.D.



I left my patient, Ms. O, dozing in her hospital bed. Heading towards the nursing station, I clenched and unclenched my fists, steeling myself to make a call I didn’t want to make.

When I first ambled into Ms. O’s private room that morning, she was sitting up in bed with a breakfast tray in front of her. Her knobby fingers put down a half eaten slice of toast. The eggs and sausage were untouched.

“I’m done. I just want to keep the coffee.” I removed the tray and slid it onto the food cart standing in the hallway. Back in the room, I noticed a stale, musty odor. Sunlight filtered through the only window highlighting Ms. O’s greasy and matted hair. “How about washing up?” I said.

Ms. O’s pale face lit up with a smile. “I’d just love a shower.”

“Sure. Finish your coffee while I get the linens.”

It was the summer of 1980. I had just completed the first year of a two-year master’s degree program in nursing. I had taken this part-time job, working a couple of days a week, in a small community hospital near my home. When classes started back up, I figured, I would juggle being a full-time student with doing what I loved—caring for patients.

Outside of Ms. O’s room, my arms laden with sheets, towels and a hospital gown, I was aware of a tall man as he breezed by me, his copious belly encased in a dark suit. Over his shoulder he shouted back into Ms. O’s room, “See you in my office next week.”

“My doctor just told me I’m going home today,” Ms. O said, as I unfolded the fresh towels. Her chuckle, which trickled up her throat, exploded into a racking cough. When the episode was over, she sank back into her pillow, breathing deeply. Had her doctor heard that cough? He couldn’t have been in her room more than a minute or two.

“Are you okay?” I asked. The night nurse had recorded that Ms. O slept well and hadn’t indicated any problems. Ms. O gave me half a smile but didn’t speak.

“Well,” I said, “let’s get you up, showered and dressed.”

Pushing off the covers, Ms. O inched her legs toward the edge of the bed until they dangled over the side. Her bony hand pulled on my arm as she swiveled to a sitting position. This effort set off another coughing fit. What’s going on here?“ How long have you had that cough?”

“A couple of days. Seems to have gotten worse.”

Bending down, I pressed the skin over her thick ankle. My finger left a half-moon print on her leg.

“Do you usually have swelling in your legs?”

Ms. O glanced down. “No.”

“Who will be home with you?”

“I live alone.”

Something wasn’t right. I pulled out my Littmann stethoscope, a gift to myself after successfully completing the last class of the semester: physical assessment. In that course, my fellow nurse practitioner students and I learned how to take a patient’s history. We used each other to hone our diagnostic skills: we probed bellies with our fingers, placed stethoscopes over lungs, and tapped elbows and knees with a rubber hammer. We hadn’t practiced on patients yet. Instead, we listened to tapes in the computer lab of heart valves leaking, lungs wheezing and large intestines gurgling.

“I want listen to your lungs.” With my hand on Ms. O’s shoulder, I nudged her forward and placed my stethoscope on her scrawny back. What filled my ears were not the same clear blowing reverberations of my classmates’ young, disease-free air passages. What was I hearing? Rales? Rhonchi? Wheezing? The names of abnormal sounds jumbled in my head. “Cough, please,” I said, trying to sound like I had done this for years. We had learned that semester that coughing would clear mucus from airways, resulting in normal breath sounds. After coughing, Ms. O’s lungs were still waterlogged. I straightened up and pocketed my stethoscope.

Ms. O interrupted my thoughts. “I need to go to the bathroom.”

I didn’t like the pasty color of her face or the way her chest rose and fell with each breath. Better she stayed in bed. “Let me get you a bedpan.”

After helping her lie back, I raised her hips and slipped a blue plastic bedpan under her bottom. When I retrieved the bedpan a few minutes later, it was empty.



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.”



It’s a coincidence that I wrote the last entry in my journal on February 28 at the same time I finished my book. Well, my book is not finished-finished but it’s getting its final editing—by a professional content editor—as I compose this post.

journalI have been using a 5-subject wide-rule notebook every morning to put down whatever wanders into my head ever since I decided two years ago I would FINISH THIS BOOK! Daily notations first thing in the morning, something akin to morning pages suggested by Julia Cameron in her book The Artist’s Way, have kept me primed to write.ARTIST'S WAY

And it’s a coincidence that when I started this particular journal on April 4, 2013 I had just received feedback from four beta-readers. In between the first and last journal entry, I have incorporated the changes they suggested and made edits based on feedback from two more beta readers and, later yet, made changes suggested by another two readers. Whee!

Besides acting on feedback from beta-readers, I spent time in May at a writers-in-residence at Weymouth Center Weymouthand attended a writers’ retreat at Wild Acres in September and, of course, kept my pen moving on the pages of my journal each morning.

wild acres -

Get yourself a notebook and begin to journal daily. Who knows what you will accomplish!

Out of the Shadows by Marianna Crane

Wrote this for ElderChicks yesterday.


Writing I love reading all the ElderChick posts by women my age. Such a varied, interesting and involved group. Many are writing memoirs as I am and if we all get published just think what an education we are giving the rest of society! No more “invisible” older women!

Ten years ago, right after I retired as a nurse practitioner, I began to take my “hobby” of writing seriously. I have been lucky to get some of my stories published. My memoir about my nursing career is almost completed. Now I am learning about the rapidly changing aspects of publication.

I am grateful for my energy, health and curiosity that permits me to enjoy this season of my life. (Feel free to visit my blog at

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August, 2007


I’m anxiously awaiting the results of my daughter’s ultrasound. Last night,she dropped off our two grandsons so she and her husband wouldn’t be late for the early morning test. Rather than call us with the news, she will tie a pink or blue balloon to the mailbox. At seven and four years of age, the boys will soon learn whether they’ll have a brother or sister.

As I pack salami sandwiches and juice boxes for a picnic lunch at the lake, I tell myself that it doesn’t matter, boy or girl, as long as the baby’s healthy. Okay, okay. A granddaughter would be nice. If I have to baby-sit a third boy, I’ll have to start pumping iron, buy new running shoes and brace myself for more toilet jokes.

A heavy thought bullies its way into my mind. The ultrasound will also show any anomalies that the fetus may have. Not simply the gender. I dismiss my worries as I picture Molly juggling probabilities of cancer and incapacity for Mike.

Molly is waiting for the results of her husband’s bone scan. A week ago, Mike had a new pain. His doctor thinks it could be bone metastasis from the prostate cancer he was treated for five years ago. Mike was assured that he would get the results on Monday morning. He got through the anxiety of waiting over the weekend by clearing out thirty years of treasures from the garage.

Molly and I, friends for over thirty years, now live in different states. We email each other often with updates of our separate lives. We share the burden of waiting. When we were younger we waited while we decided what we wanted to do with the rest of our lives. Waited for our children to make friends, do well in school, find employment and a life partner, give us grandchildren. Waited while our husbands struggled with jobs, midlife crises and aging. Both of us know waiting doesn’t get easier with age.

Before we leave, I check email. Molly has written. I hesitate opening the message. Like Molly, I think good news but expect bad. Mike’s bone scan is negative. Now the doctor wants to do a chest x-ray. More waiting.

At the lake the August sun stifles us. I grease the two wiggling boys with sunscreen after I unload the pail, shovels and a dump truck onto a Superman beach towel. My husband trots off to the picnic area dotted with tall shade trees, a lawn chair in one hand and the morning newspaper in the other. He doesn’t know how to swim.

The boys and I splash in the turbid water. A few yards away, a group of girls surround a grandmotherly woman. The oldest girl gently holds the smallest child afloat while the two middle girls swim about. The grandmother glides waist deep in the water, her arms skimming the surface. The large brim on her straw hat shades her face as her body weaves among her granddaughters.

I’m reviewing the pros and cons of having all boy versus all girl grandchildren when a torrent of water hits my back. boys playing in water“Get grandma.” I widen my stance as each boy grabs an arm and tries to submerge me. I swing in a circle. They laugh loudly and one at a time each boy’s grip loosens and he hits the water with a splash. My wet hair plasters my face but I’m still standing. After I push my hair off my eyes, I watch the other grandmother float about. Her hat still squarely on her head.

By mid afternoon, we round the boys up. They drag their feet in the sand. “Get a move on.” I’m impatient to see the color of the balloon.

I fidget during the slow-motion ride to my daughter’s house. The little one surrenders to sleep. A block from the house we turn the corner and head up a hill. The seven year old has his hands over his eyes to boost the surprise. The hill obstructs the view of the mailbox and the sun glints off the windshield. As our car edges down the hill, I search for the balloon. The wind has pushed it behind the mailbox. I watch the balloon twist and rise and circle in the breeze.

It’s blue.balloons

In the driveway, the seven year old, curiosity satisfied, runs into the house. My daughter hugs her father, then me. She releases her hold and stares into my eyes. I swallow disappointment that I didn’t know I had.

My daughter tells us the ultrasound showed no deformities or potential problems. Thank goodness, I think. Then she reaches inside the car, unbuckles the little one and gathers him into her arms. He lifts his head off her shoulder, rubs his eyes and remembers about the balloon. “Do I have a brother or sister?

“A brother.”

“Where is he?” he asks, looking about. We three grown-ups stand immobile. Who would have guessed that he thought the baby would be waiting for him?

“The baby’s still in my tummy,” my daughter says softly. He cries.

Later, I will tell him waiting isn’t easy. Molly would agree.

P.S. Mike is doing just fine.


I made an ageist comment. It didn’t seem ageist at the time. I was sitting in the second row of a packed room at Flyleaf Bookstore in Chapel Hill as Pat Schneider finished reading from her new book, How The Light Gets I9780199933983_p0_v2_s260x420n.

I came to hear Pat for two reasons. One, I wanted to see the woman who developed the Amherst Writers and Artist (AWA) writing method. And, second, I wanted to see a fellow writer that was still prolific going into her ninth decade and had the stamina to go on a book-tour at six sites across North Carolina in seven days.

Maybe it was the interview I had heard a few years ago, which had taken residence in my memory that influenced my comment. A local author discussed her new book on a radio talk show. When asked her age, she said she never tells because she would have problems getting published. She believed there was a great deal of prejudice toward seniors in our society. Well, what of it, I thought at the time. She was already published. Why hide her age? She didn’t look like a 20-something on her book jacket. Telling her age would only prove older writers do get published.

So that evening at Flyleaf Bookstore, when Pat Schneider acknowledged she would be 80 years old on her next birthday, I raised my hand and congratulated her for acknowledging her age in front of this audience. How smugly self-satisfied I felt to call attention to that fact.

Author photo for LIGHT by BethanyIt was only later that I wondered why I felt the need to recognize Pat’s age? The audience consisted of people of all ages. Did the 20 or 30 year olds come to see what an 80 year old author looked like? No, they came to celebrate her new book, her legacy of great writing in various genres, and to affirm her talent.

And there I was, calling attention to age as if being an older author on a book-signing tour was in some way unique. After all, I know first hand what older folks are capable of from my many years in practice as a gerontological nurse practitioner.

Had I forgotten that the three other women in my writing group were in their 70’s, the same as I, and we all are writing memoirs. One had already published a book and was working on her second, and three of us have Blogs.

And what about Greta Matus, OLYMPUS DIGITAL CAMERAwho was 74 when I meet her this past July. She mesmerized me with tales of her exciting life. I told her about my Blog and within a week she emailed me that she had begun a Blog. “I consider my Blog stories part of a memoir, or memories. That’s the incentive for me, looking back at the stories of my life and remembering them in detail. I’m not looking back because my life is winding down, hardly, but because life changes all the time, and so rapidly, that grabbing and capturing highlights seem important.

And, sharing stories is a good thing to do.”

I came across Emile Betts who wrote her first book at 80 and is working on a second book: a novel. Then there’s Jim Henry who wrote his story while in his 90s. I had forgotten that I had written about him in one of my earliest posts.

And check out this web site : Writers at Seventy, Eighty and Ninety.

So since I heard that local writer a few years ago citing prejudice, it seems there is evidence this is abating. More and more “older” writers are sharing their stories to a welcoming audience. I need to remember age is not a barrier to accomplishment. So whatever age I will be when my book is finally written and published, I know I will be in good company.


“Something looks back from the trees,/and knows me for who I am.” —

American poet, Jane Hirshfield. 

WILD ACRESI spent five days at Wildacres in Little Switzerland, North Carolina at a writers’ retreat: The Powerful Narrative lead by Carol and Bill Henderson this past September.

My good friend, Lois Roelofs, flew in from Chicago to join me.

Lois and I at Wild Acres

Without phones, clocks or television in our rooms, we wander on wooded paths forest pathaccompanied by our thoughts and the music of nature.

the bellA bell rings to alert us to go to the dining hall for meals.


dining hall


Lois reads from her book: Caring Lessons.

Lois Read from her book

The last night’s line-up to read. I am first. signed on to read

After I’m halfway though the story, Trying to hold it together I’m surprised that my voice breaks and my eyes begin to tear.

It’s the first time I have read “Hello Beautiful” to an audience. After all these years,

this patient still gets to me.

Anything can happen on a writing retreat.


Weymouth Center
Weymouth Center

I spent part of last week at the Weymouth Center in Southern Pines, North Carolina working on my memoir.

There was a sign on the door, DO NOT ENTER, WRITER IN RESIDENCE, which led to the hallway where I and another writer had accommodations. My room was the Paul Green room and the second was the Thomas Wolfe. None of the other quarters had plaques on the door or I would’ve searched for a female author designation. Virginia Woolf where were you?

At Weymouth I felt like a writer. I worked like a writer.

Typical day:

Breakfast* on the veranda. I watched birds dart by and listened to a deep guttural sound, more like an improperly functioning piece of heavy equipment, which I imagined might have been a frog. The sound came from a stagnant pond nearby. I didn’t feel the need to investigate.DSCN0737

Back to my room to write.

Paul Green room
Paul Green room

Lunch in the small kitchen solely for use by writers-in-residence.

In the afternoon, I worked until I got hungry.

Dinner at my desk.

After dinner I wandered into the library to connect to the Internet and check and send emails—okay, I did glance at emails on my I-phone while I worked. Hard habit to break.

North Carolina Hall of Fame James Brody Library
North Carolina Hall of Fame
James Brody Library

In the evening, with a glass of Merlot, I sat on the balcony, writing in my journal and watching the sky turn crimson and transform to a deep blue. When it grew too dark to see my notebook, I ambled back to my room to reenergize my gray cells with a New York Times fiction bestseller.

*I went grocery shopping on my first day, stocking the refrigerator in the writer’s kitchen with salads, soups, yogurt, granola, carrot slices, hummus and a bottle of red wine.

And what did I accomplish? I did address the issues raised by my beta-readers. I dropped the slow, plodding first chapters and incorporated sections as flashbacks throughout the book. And a fast paced chapter, which served as my first chapter a few revisions ago, became my first chapter once again. I came home with a new outline, clear areas for expansion and a goal to complete this version of my manuscript to give to my second round of readers by the middle of this month.

Thank you Weymouth Center.Weymouth Center


Work expands so as to fill the time available for its completion. 

~C. Northcote Parkinson, 1958

This Tuesday I leave for a four-day stay at a writer’s center not far from my home. As an act of desperation, I will seclude myself with my manuscript and concentrate on incorporating changes that have been percolating in my brain but somehow never found their way to the memoir.

In an attempt to finally finish the book I had, naively, cut back on social activities, travel, and other commitments. Well, silly me. It only became easier to avoid writing knowing that I had less pressure. Days became weeks and now two and a half months after my beta readers returned the manuscripts, I have yet to act on their pen editing

I have four days to edit the book. While I can’t predict I will accomplish my goal, I’m going to give it my best shot. The last thing I want is to be writing this book for the next ten years. I have to get on with my life.

Let you know how I did in my next post.

Radio Interview

I was listening to my long time friend, fellow writer and nurse, Lois Roelofs being interviewed on the Laura Dion Jones Show from Illinois on WRMN 1410, last week. With my I-Pad up to my ear, I settled in a comfy chair in the living room of my daughter’s home in Raleigh. For the next half hour, my four-year-old grandson repeatedly circled my chair, lunged at the dog, and jumped on his eight-year-old brother who was playing Mario Kart and protested loudly. Besides ignoring my grandsons, I ignored the ringing phone and hoped no one would press the doorbell.

Lois wrote a book: Caring Lessons: A Nursing Professor’s Journey of Faith and Self. Lois not only promoted her book but also discussed the special characteristics of the nursing profession. She told Laura’s audience that nurses are not just caring but use manual dexterity along with cognitive and social skills in their interactions with patients. “It’s an intellectually vigorous profession.” And the ultimate multitasking profession, I might add. Anyone who has been hospitalized will appreciate the benefits of a being cared for by a competent and compassionate nurse.

Lois and I met years ago in a baccalaureate-nursing program. We share the same irreverent sense of humor and the love of nursing. And the belief nurses have an important message to share with the public—how and why we make a difference. Lois does a good job during the interview to make this point.

Listen for yourself. Brew a cup of tea. Click and fast forward into the broadcast to 3:05 minutes and hear Lois promote her book and the nursing profession.