Why Caring Lessons Goes to Printers Row Lit Fest

My very good friend, Lois Roelofs, says “Too few nurses write their stories.” Read about her interaction with the visitors that come to her table at the Printers Row Lit Fest in Chicago.

Write Along with Me

“Pardon me,” said the well-dressed older man. “But could you tell me when this festival got so big? Last time I was here, there were only a few tents. And today,” he paused, his smile wide, “this is huge, and so many people.”

imageSo began a conversation with a visitor from the East Coast last Saturday at the Printers Row Book Fest, the Midwest’s largest outdoor literary fest. His surprise and enthusiasm is one reason I’ve gone for several years and then displayed my nursing memoir, Caring Lessons: A Nursing Professor’s Journey of Faith and Self, for the past two.

I get excited already when I approach the street where it starts. There are several blocks full of tents with tables lined up on the sides of the streets. You hardly know where to start. Plus there are large outdoor tents and indoor venues for author presentations. When I’m…

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NURSE PRACTITIONER VERSUS PHYSICIAN’S ASSISTANT

tmpAdapted from a post first blogged on May 27, 2012.

Nursing Stories

Last week in a restaurant in Lyon, France, my tablemate turned toward me and asked, “What’s the difference between a nurse practitioner and a physician assistant.”Lyon

My husband and I were on a tour. Our traveling buddies consisted of older folks like ourselves. The woman knew I was a retired NP and had told me she frequently saw either an NP or PA when she went for routine medical appointments. She was satisfied with either but didn’t know the difference.

I became an NP in the early 80s and worked in Chicago when NPs were trying to expand our practice by gaining prescription privileges. We were much maligned by the traditional medical establishment. “If nurses want to act like doctors, let them go to medical school” or something to that effect seemed to be the mantra of the American Medical Association. (Both the AMA and the Illinois Medical Association…

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GUN CULTURE

It seems fitting to re-post what I wrote last year after 20 children and six teachers were killed at the Sandy Hook Elementary School in Newtown, Connecticut.

Let us not forget.

When we were traveling in Ireland this past October, our Irish tour guide told us that Ireland did not have a “gun culture” as we did in the States. Never having heard that opinion expressed before, the term “gun culture” stayed in my head.

After the recent killings at an elementary school in Connecticut, I looked up the word “culture” in Merriam-Webster’s Collegiate Dictionary, Eleventh Edition, which reads in part: the integrated pattern of human knowledge, belief, and behavior that depends upon the capacity for learning and transmitting knowledge to succeeding generations; the characteristic features of everyday existence shared by people in a place or time.

Charles M. Blow wrote in A Tragedy of Silence, New York Times, that public opinion is shifting away from gun control. In a recent Gallup poll 53 percent to 43 percent opposed the ban on semiautomic guns or assault rifles.

As I watched my nine-year-old grandson’s eyes riveted to the front page of Saturday’s New York Times lying on our coffee table, his look of concern told me I needed to speak out in support of gun control. I hope you will, too.

It’s time for a cultural shift.

GETTING ON THE BUS Part I of 2

The first night in a hotel room in Estoril, Portugal, my heart, flipping about in my chest, jolted me awake. Thump. Thump. Thump. Silence. Then a rush of horses’ hooves clopped on my ribs. Trying to ignore my heart’s gymnastics, I tried to go back to sleep but the Mariachi band playing under my ribs demanded my attention. Pressing my fingers into my wrist, I palpated the same irregular rhythm. Besides a touch of anxiety, I felt fine. No chest pain, no shortness of breath, no dizziness, no nausea. Then my bladder upstaged my clinical observations. Damn.

Estoril coast
Estoril coast (Photo credit: Seth Kendall)

Slowly, I rose and sat on the side of the bed, careful not to disturb my husband who slept beside me. I waited to pass out. When that didn’t happen, I shuffled in the dark, feeling my way along the wall, to the tiny bathroom.

Successfully back in bed without tripping, falling, or fainting, jet lag eased me into slumber.

The next morning, I awoke to the same sensation in my chest. More alert than the night before, I diagnosed the uneven heartbeat as atrial fibrillation. A geriatric nurse practitioner until my retirement three years ago, I had treated many patients with this condition—its occurrence increases with age. A fact I couldn’t ignore.

I remembered the day before as my husband and I explored the neighborhood around the hotel we had walked past a medical clinic. Through the large glass window, I saw several people sitting in a waiting room, some reading magazines, not unlike our clinics back home. I had no desire to seek help there. I didn’t speak the language, and who knew how advanced medical practice was in Portugal? Besides, I was counting on this event ending soon.

Getting ready for the day’s adventure, my husband slipped a sweater over his head as I laced my shoes. “By the way,” I said, “I am having some a-fib. It’s nothing serious and I suspect it’ll end on its own. I just want you to know, in case I pass out, get an ambulance and tell the medical folks what’s wrong with me.” I made eye contact. “A-fib, got it?” My husband of forty years knew better than to question me, and nodded. I figured he was happy to put off a deviation in our itinerary—his controlled persona would be spared a chaotic scene.

We rode the elevator down to the lobby, queued up with our tour group and boarded the bus to Cabo de Roca. I grabbed a window seat. The vibrant, coastal city gave way to dry grasses clinging to rocky cliffs. I slipped down in my seat and put my fingers to my neck, checking my carotid pulse. The irregular rhythm ticked off around one hundred beats per minute. No too rapid to worry me—yet.

After a couple of hours, the light blue sky became cloudless as we headed into thinning air. Would the high altitude affect the rhythm of my heart? Would my pulse become so erratic that my blood stagnated, forming a clot that would migrate to my brain and spawn a stroke? My husband remained deep in his book. Or was he consciously ignoring me? The medical clinic near the hotel began to look inviting. And very far away.

The bus turned into an empty parking lot. We arrived before the Japanese tourists. My husband was the only one who headed over to the one-story building that stood at the far end of the lot where one could obtain, for five Euros, a certificate validating that one had stood at the westernmost point of continental Europe. The others headed to the bathrooms or the gift shop.

I stepped off the bus last. I felt something strange. Or, rather, I felt nothing. My heart had stopped. No, it just felt that way with the prancing finally gone.

My chest was silent. My pulse was regular. The air smelled cool and crisp.DSCN0064

Released from potential calamity, I dashed off to find my husband.

When we returned to the States, my internist insisted I wear an Event Monitor:  electrodes attached to my chest at one end and at the other end to a plastic box that would hang around my neck for a month. When I noted any flip-flops from my heart, I was to depress the start button and the monitor would record the “event.”

HELLO BEAUTIFUL

The guy on the motorcycle looked like Jeff. My heart did a flip. His muscular arms jutting from his T-shirt were tan. Of course not like the arms of the guy I knew as Jeff. His were thin and weak. But I imagined this is what Jeff would have looked like before his accident. I felt my eyes water and if my husband wasn’t next to me at the wheel of our aging BMW, I would have let myself cry.

I first met Jeff in the four-bed hospital room at the Veterans Administration Hospital a few years prior. He was there for his monthly catheter change. The nurse practitioner that I was going to replace was planning to introduce me. The doctor who worked in the Spinal Cord department was there too. Just in case. As was one of the clinic nurses. A simple procedure like changing a Foley catheter was a possible death sentence for Jeff.

He could have been my son with his dark hair, lopsided smile and an irreverent sense of humor. I wondered what he thought of me, an older nurse, grey hair and, as some folks have told me, an off-putting air of reserve.

Jeff was told he wouldn’t live to see his fortieth birthday after he survived a motorcycle accident in his late teens. When he came to the clinic, he rolled down the hall steering his electric wheelchair by shoving his shaky right wrist against the joystick.electric wheelchair Jogging pants covered his withered legs. A black cord secured his sneakers to the footrest and a water bottle clung to his left hand with a Velcro strap. “Hello beautiful,” he said when he maneuvered into the exam room. I eventually learned this was his universal greeting to women of all ages. Even as a die-hard feminist, his beguiling brown eyes and appealing grin charmed me.

Jeff lived with his cat in a trailer not far from the hospital. The nurses who visited his home a few hours daily didn’t change his catheter even though this was a routine procedure because Jeff had autonomic dysreflexia (AD). Any trauma or irritation, like the Foley change or a fecal impaction or even the beginning of a bed sore, could cause Jeff’s blood vessels to constrict, which, in turn, would trigger a rapid rise in blood pressure. The normal mechanism to dampen this affect was blocked by Jeff’s spinal cord injury. Without immediate medical attention, Jeff could have a stroke and die. It was safer to change the catheter in a hospital where emergency backup was available. Plus, Jeff liked to get out of his trailer and socialize.

Jeff’s fortieth birthday fell on the day he had to have his catheter changed. The clinic staff surprised him with a birthday cake. After the appointment, I watched him roll down the hall with a large black balloon bobbing from the back of his wheelchair: 40 and over the hill.

Over the next year, Jeff developed a urethral stricture. Now, threading the tube through the narrow urethra caused trauma that set Jeff’s blood pressure skyrocketing. I began doing the procedure in the emergency room. Finally, Jeff agreed to have the catheter inserted through the abdominal wall directly into his bladder, which would side step the episodes of AD.

No longer hampered with a tube in his penis, Jeff requested a prescription for Viagra. The Spinal Cord Team discussed Jeff’s request at our weekly conference. Because there was evidence that sexual activity increases the risk of AD, we denied his request.

Jeff had been chatting over the Internet with a woman who lived in Michigan. He paid for a round trip ticket for her and her five-year-old daughter to spend the weekend with him. After the second visit Jeff confided he had managed to obtain Viagra. And it worked. No complications. And he was in love. Not just with the woman but with her little girl. His eyes grew soft as he told me “She climbs onto my lap, wraps her arms around my neck and kisses me on the cheek.”

Jeff could not be dissuaded of his plans to fly to Michigan. He boarded the plane with documentation of his medications and medical problems along with an automatic blood pressure monitor, a tube of nitro paste (in case his blood pressure started to rise to frightening heights), four catheter insertion kits with extra catheters, a few pamphlets on AD to pass out to the flight attendants or anyone else, and a special present for his girl friend: an expensive silver necklace.

Jeff returned smug and nostalgic—his lady friend and he made love, he partied with her friends and she even hired a van to take him to a rock concert. He also returned with a broken wheelchair. The airline paid for the repairs on the chair. But no one could repair Jeff’s heart when he received the let’s be friends e-mail.

“It was the necklace,” he said. “It scared her off.”

When I left the VA, I gave Jeff my e-mail address. He sent silly jokes, sappy poems and updates on his health. At some point I realized I hadn’t heard from him in a while. The e-mail I shot off came back undeliverable. I called a friend, a nurse who worked at the VA. “I’m so sorry to tell you,” she said, “Jeff died of AD while he was in the hospital getting treatment for a kidney ailment.” He died five years after his fortieth birthday.

After a long career in nursing, I’ve collected many patients who wander around in my memory. Some stomp and growl, others tread softly. Jeff glides toward me in his wheelchair. His dark hair pokes out from under the baseball cap. He smiles.

“Hello beautiful.”

FINALLY SHARING OUR STORIES?

nurses make a difference

Nurses Week starts tomorrow, May 6, which is known as National Nurses Day and ends on Florence Nightingale’s birthday, May 12th170px-Florence_Nightingale_by_Goodman,_1858

While I feel nurses deserve appreciation for their work 365 days a year, who am I to disregard an opportunity to spotlight actual nurses and their contribution to health and healing.  

I have previously blogged about The American Nurse Project, which shares photographs and narratives of nurses at work. The story of each nurse is moving and educational—telling the reader what nurses really do. Check this site, which singles out a few of the contributors.

For example, Jason Short (#6) states, “I have found that once you get a taste for helping people, it’s kind of addictive. You want to empower yourself to be more and more helpful.” So he’s back in school to become a nurse practitioner.

american nurse project

And Mary Helen Barletti (#13) who says, “How often does anybody get to come home from their job and know they saved someone’s life? Or, if I couldn’t save them, I stood at the bedside of a dying patient with my arm around the daughter who was losing her mother.”  She, also, has empowered herself to be more helpful by pursuing “additional education in Reiki healing techniques and in the spiritual needs of the dying.”

It’s probably no coincidence that a new book of stories written by nurses has been published just in time for Nurses Week: I Wasn’t Strong Like This When I Started Out: True Stories of Becoming a Nurse: edited by Lee Gutkind.true stories of becoming a nurse

Again, like The American Nurse Project, real nurses tell their stories. They are harrowing and mesmerizing stories, spattered with guts and blood and antagonism toward the health care system’s bureaucracy but reflective of the real world nurses live in when they commit to helping their patients.

Lee Gutkind states in the Introduction, “Nurses tend to keep their experiences to themselves—-.”  Amen, brother.

However, we may be seeing an uptick in the willingness of nurses to share their stories.

It’s about time.

ONE SMALL STEP

Brady Campaign

I hear my five-year old grandson laughing and think of the twenty first-graders killed at the Sandy Hook Elementary School. How safe will his school be next year? The National Rife Association suggestion of an armed guard in the hallway of each school doesn’t reassure me but persuades me all the more to do what I can to change our gun culture so that my grandchildren will live in a peaceful, healthy, and loving world.

No small undertaking. But if we all stay conscious of the issues and support gun control, we can make a difference. Just today I joined and contributed to the Brady Campaign to Prevent Gun Violence.

It’s one small step.

There is more to do.

GUN CULTURE

When we were traveling in Ireland this past October, our Irish tour guide told us that Ireland did not have a “gun culture” as we did in the States. Never having heard that opinion expressed before, the term “gun culture” stayed in my head.

After the recent killings at an elementary school in Connecticut, I looked up the word “culture” in Merriam-Webster’s Collegiate Dictionary, Eleventh Edition, which reads in part: the integrated pattern of human knowledge, belief, and behavior that depends upon the capacity for learning and transmitting knowledge to succeeding generations; the characteristic features of everyday existence shared by people in a place or time.

Charles M. Blow wrote in A Tragedy of Silence, New York Times, that public opinion is shifting away from gun control. In a recent Gallup poll 53 percent to 43 percent opposed the ban on semiautomic guns or assault rifles.

As I watched my nine-year-old grandson’s eyes riveted to the front page of Saturday’s New York Times lying on our coffee table, his look of concern told me I needed to speak out in support of gun control. I hope you will, too.

It’s time for a cultural shift.

Humor and Humility

It started out on a rainy day in January. Like the rest of overweight America, I had resurrected old New Year resolutions. I wandered into a branch of a not-to-be-identified weight loss program and approached a young lady sorting out pamphlets. After giving me the information I requested, she excitedly told me that I would also be able to access her blog, which she updated with helpful hints. She stopped, perusing my persona, and asked, “Do you know what a blog is?”  Or said another way “You have white hair, which means you’re technologically illiterate.” I immediately felt furious. I responded in an icy tone, I have a blog. I think I saw her flinch, at least I hope I did. Our conversation went downhill from there. I ran through the rain back to my car, vowing not to join this group.

I thought later, I wish I had the sense not to get so defensive. I had lost a teachable moment. In my past career as a gerontological nurse practitioner, I met many older people who transcended the stereotypes of aging. They showed me how they dealt with the complexities of old age—with humor and humility. Will I be ready to confront ageism with panache when it happens again? And I am sure it will happen again.

Same Old New Year’s Resolutions

This year I hesitated to make any New Year resolutions. Why? Because for the last five years, at least, they remain the same:

Write the book.

Lose the weight.

Exercise more.

The only thing that changed was the pounds I wanted to drop. They increased yearly. Now it’s 20 pounds! I felt defeated. Depressed.

But something has happened to make me feel positive in reaching my goals after all. When I took my walk yesterday, I put in my ear buds and tuned my I-Phone to The Peoples’ Pharmacy podcast. The show I heard had aired on December 31st and was entitled “Willpower Science.” For the next forty minutes or so I listened to Kelly McGonigal PhD, psychology instructor at Stanford University and a health educator for the School of Medicine Health Improvement Program, discuss reasons why we often fail in keeping our New Year’s resolutions.  The take-home message that most attracted me was twofold.

First, think about what you really want. What you are willing to do to achieve it? And what will your life be like if it happens? Not just next year but in two years from now. How proud will you feel if you do achieve your goal? Or the regret you will feel not having made the change.

(I must add here Dr. McGonigal suggests small goals like exercising five minutes a day and increasing slowly. Success breeds success.)

Second, we need to feel self-compassion and self-forgiveness. When we slip up, we shouldn’t chastise ourselves and give up but realize we are human. Guilt and shame undermine our ability to get back on track.

Okay, none of this is really new. But the science behind these statements helped me better understand how willpower works or doesn’t work. Check out Dr. McGonigal’s web site and her book, The Willpower Instinct: How Self-Control Works, Why It Matters, And What You Can Do To Get More Of It.

It was serendipitous that I connected to this podcast. I’ll apply the lessons I learned so I don’t have to repeat 2012 resolutions in 2013.

I wish each of you a new year free of guilt and stress.

Be good to yourselves.