We Agers Are Experts On Our Own Aging Experience

A fellow nurse clued me into Doris Carnevali’s blog. Here is what a Seattle news station, K5News, wrote about her. Her blog follows.

A retired nurse is helping explain what happens when we grow old. Some of it might surprise you.
Author: Ted Land
Published: 7:10 PM PDT June 5, 2019
Updated: 7:25 PM PDT June 5, 2019
SEATTLE — A 97-year-old blogger is helping explain what happens when we grow old. Some of it might surprise you.
Each morning, Doris Carnevali sits at a desk in her West Seattle home and starts writing.
“The ideas are bubbling in my head between the time I’m asleep and awake,” she said.
She has plenty to say about what it’s like to age and she’s sharing it all on her blog, Engaging With Aging.
“Sure, there are times when I am down, and the 14th thing I drop in a day makes me frustrated as all get out. But on the whole, it is so much more exciting than I ever thought it was going to be,” Carnevali said.
She is retired from the UW School of Nursing and has written medical textbooks. Then at the age of 95, she picked up a new hobby: blogging.
“I had been ranting about the fact that I thought aging had gotten a rotten deal. That it was much more pleasant, exciting, and challenging than I had been led to believe,” she said.
After hearing that rant, the dean of the UW School of Nursing urged her to publish her thoughts. So Carnevali’s granddaughter created a blog account and the words flowed.
Today, she’s written dozens of passages on what she calls age-related changes.
“My hands don’t pick up things the way I used to, do I say I’m losing my hands? No, I’m changing how I use them and that way I don’t get down in the dumps,” Carnevali said.
Engaging With Aging isn’t a how-to advice blog. It’s more of a diary about what she’s going through. If her readers extract lessons, great. If not, the exercise keeps Carnevali sharp.
“I’m still growing, I’m green, I’m inept, I’m clumsy, I’m learning every day, but I’m green, and I’m growing,” she said. “I thought of aging as being grey, no, it’s green.”
She does not shy away from the fact that there will come a day when her hobby is no longer possible.
“When it happens, it happens, and it would be nice if it didn’t, but I’m too busy doing other things to worry about it right now,” she said.

Engaging With Aging

With that expertise come responsibilities

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Many of the people who study old people, theorize and write about us, take care of us, or relate to us are not “old’ themselves. They experience old age second handedly. Earlier in my life as a nurse I often had older patients. As a daughter I shared my parents’ aging. In my 50’s I blithely participated in three editions of a nursing book about caring for the elderly without taking note of myself as the “outsider.”

Now I feel as If I had been a pilot flying over the city of aging, assuming I knew how the residents lived. What an illusion!   It’s not that what I knew, used or wrote about elderly people was inaccurate. But it paid only narrow attention to the significant ways normal aging was changing agers’ capacities to manage their ever-present tasks and relationships. I had looked at them…

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Meeting Nancy Panko

I was one of about thirty authors who attended the program, Authors in Your Backyard: A Celebration of Local Writers, held at my neighborhood library on a Sunday afternoon not too long ago. I arrived with copies of my book: Stories from the Tenth-Floor Clinic, and the syringes

Highlighter Syringes

to lure readers to my table. I didn’t know to bring a pretty colored cloth to cover my part of the table that I would share with another writer. Before the program started—a keynote address by a well-known mystery writer and five randomly selected readings—I roamed the room meeting the other authors.

At the very first table by the door, a woman about my age set up her books beside a poster publicizing her work. She had brought a table cover onto which she pinned a large sheet that announced: “Nancy Panko, author of Award Winning “Guiding Missal.” Her display could have been inside a book store. She had done this before.

While Nancy’s book was not about nursing, we soon discovered we were both nurses. She became a nurse in her late 30’s. She has been published 10 times in Chicken Soup for the Soul. Her 11thwill be in the next Christmas edition.

Nancy Panko epitomized the type of nurse I have long promoted. One who writes about her life as a nurse. Plus, she is an older woman. A great role model.

So, I asked her if I could spotlight her in my next post.

Here are two of her Chicken Soup stories and a link to her award-winning book: Guiding Missal.

Guiding Missal

Click here to order.

At the end of the stories, Nancy answers two of my questions:

Why do nurses need to publish their stories?

What has nursing done for you?

 

A Journey of Healing

On a sunny July day, my younger brother Terry was killed as he attempted to cut down a tree. He died instantly of traumatic head injury. In the blink of an eye, I no longer had a brother. He wouldn’t be in my life to tease me, give me advice, or to make me laugh. He was just gone, leaving a huge hole in all our hearts. The pain was unbearable.

As I grieved, I found I wanted to pay tribute to my brother’s life. At the age of 14, I announced to my parents that I wanted to be a nurse. As I grew up that goal got pushed aside, I got married and had children. I prayed that somehow I could find a way to go back to school to realize my dream of being a nurse. My husband and children were very supportive and we all prayed that God would show us the way…and he did.

I enrolled in nursing school, achieved good grades and made Dean’s List. In my Junior year, I began carpooling with Jeanne, one of the Intensive Care Unit (ICU) instructors. Driving fifty miles a day, we shared confidences and family stories. She became a mentor and a friend. I explained how Terry’s death affected my decision to return to school and how fragile I was just thinking about treating a traumatic head injury patient. She listened intently and seemed sympathetic.

The day before our senior year ICU clinical experience, Jeanne, my mentor and car pool friend, assigned me a traumatic head injury patient. I was in shock and disbelief. I prayed silently for help. I could not let my emotional, personal experience interfere with giving this patient the best care possible.

Upon entering the ICU, I learned that my patient was in surgery, having his second operation to relieve pressure from a blood clot on his brain. The doctors had given him little chance of survival. Terry had no chance at all, but this guy does, I thought. He’s still here, fighting for his life, and I’m going to do everything in my power to help him. I prayed for my patient and his family in the waiting room.

That afternoon and evening I studied the patient’s chart. His name was Sam, he was nineteen years old, the youngest child of a large close knit family and his accident was eerily similar to Terry’s. He worked for a tree-trimming company and while strapped in his safety harness perched in the tree to trim branches, he was hit in the head by a falling branch. He hung upside-down in the tree for nearly an hour before being extricated. He suffered a fractured skull with a large blood clot on his brain. A device was in place to relieve and measure the pressure inside his skull. A ventilator helped him breathe, he had arterial lines, IV’s and a urinary catheter. He had been given The Last Rites. Twice.

The next day, just after dawn, I saw Sam for the first time. His head was swathed in bandages, he was unresponsive and motionless. His tall frame completely filled the length of the bed, no sign of awareness in that young body.

My knees were weak, but I knew every detail about his physical condition, medications, procedures and his monitors. In ICU, the details can mean the difference between life and death. I can do this, I said to myself. All my hard work to this point comes down to this day and this patient. I laid my hand on Sam’s arm. “Good Morning Sam. I’m your nurse for today, my name is Nancy.” I told him the day of the week, the date, the time, what the weather was like. I chattered on while gently caring for him. There was no response. After morning care and charting I took time to speak to his family.

Out in the waiting room, I approached a tired-looking woman and introduced myself to Sam’s mother. She told me all about Sam and the family. I asked her to join me in a plan to stimulate her son and, hopefully, lighten his coma. I asked her to bring in a radio to play his favorite music and family pictures to tape in easy-to-spot places around his cubicle. I shared my nursing care plan with her and she felt included. This plan was also a prayer. Sam’s mother had a glimmer of hope and was pleased that she could help.

Each day we carried out the plan. I talked to Sam and played his favorite music. While completing all my nursing duties, I told him about the leaves changing colors and about the apples and cider for sale along the roadside. His vital signs were stable, no signs of infection but there was no response. It was hard to see this young man remain so still.

One day, as I struggled to put one of his heavy, long legs into his pajama bottom, I said, “Sam, it would be great if you could help me. Can you lift your leg?”  His leg rose five inches off the bed. I tried to remain calm. “Thank you, Sam. Can you raise the other leg.” He did it!  He could hear and follow commands, he had bilateral lower extremity movement, still, he had not regained consciousness or opened his eyes.

The next morning, I was told that during the night Sam had started breathing against the ventilator. As I came into his cubicle, I put my hand in his and told him I was there for the day. Sam squeezed it! I grabbed his other hand and asked him to squeeze again. He obeyed. Both hands and arms working on command. Praise God! I encouraged Sam all day. By the afternoon, he was breathing totally on his own and no longer required the ventilator.

Still his eyes remained closed. As I worked with Sam the next day, he turned his head from side to side to follow my voice wherever I was. I brought his mother into ICU.   “Sam,” I said, as his face turned towards me, “Your mom is here.” A tear slid down his cheek. “Sam,” I repeated firmly, “your mom is here. Please open your eyes.” We watched him struggle to lift his eyelids. Finally, his eyes fluttered open, but he looked toward the sound of my voice. “Sam,” I said, walking around the side of the bed to stand behind his mother, “look at your mom.” Suddenly, recognition dawned in his eyes as he gazed at his mother’s face and began to sob. The staff and my instructor, Jeanne had gathered to watch this miracle unfold, they were all crying. I partially lowered the bed’s side rail for a long awaited mother and son embrace. I felt so blessed to be a part of this journey of healing.

Sam continued to improve rapidly and was soon discharged from ICU to the Rehabilitation Unit where he had to learn to walk, talk and perform all his activities of daily living. His mother was at his side every day.

In caring for Sam, I had dealt with my grief, loss, fears and emotions. I was able to do for Sam what I couldn’t do for my dear brother, Terry. Against all odds, Sam survived.

A few weeks later, while walking through the Rehab Unit, I heard someone call my name. It was Sam’s mother. We hugged, she was smiling. I saw a tall, handsome young man standing next to her. His formerly shaved head had grown a crew cut beginning to hide the many scars. I barely recognized him.

“Hi Sam, how are you?” I said. “Do you remember me?”

He cocked his head and spoke haltingly.  “Your voice sounds so familiar.”

The lump in my throat only allowed me to respond, “I was one of your nurses in ICU.”

His words came out haltingly, “You..are..Nancy..My..mom..told..me..all..about..you.”

Here was a true miracle standing before me. For two weeks, my life was intertwined with Sam’s as we each experienced joyful healing.

One day, while Jeanne and I were driving to school, I gathered the courage to ask her why she blindsided me by assigning me a traumatic head injury patient, when she knew my story. She explained that she believed in my nursing skills and even more so in my character. She wanted me to face my fear while she was there to watch over and support me. I was emotionally touched to feel her kindness.

A few months later, at my graduation, I received flowers from Sam’s family. The card said,” To our Angel!” On this journey of healing, I believe that both Sam and I had the divine blessing of someone watching over us.

Chicken Soup for the Soul—Find Your Inner Strength, November 2014, 303

 

 

 

 

 

A Cast of Characters

It was the first week of September, a beautiful late summer evening that made you glad to be alive. I wanted to be outside, but I sat at the kitchen table studying for a biochemistry exam. George was relaxing, reading the newspaper. Our fourteen-year-old daughter was attending the first high school football game of the season and our seven-year-old son was in the front yard playing soccer with a friend. Suddenly, a blood-curdling scream outside had us jumping up and racing toward the sound. My gut churned hearing the agonizing howl of pain coming from our child.

George and I burst through the screen door running toward our boy who was lying on the ground screaming, “My leg, my leg.”

Rushing to his side, I cradled his head and told him to lie still and not move. Tears streamed down his face, as he reached toward his contorted leg.

“Call 911,” I said to my husband. I was sure his leg was broken.

At the first sound of sirens and sight of flashing lights, many neighbors flooded into the street. The ambulance and EMTs pulled into our driveway and promptly got to work. They splinted the lower half of Timmy’s body and moved him onto a stretcher.

A nurse neighbor approached me and offered to call the surgeon she worked with to meet us in the ER. Gratefully, we said yes. Timmy was loaded into the ambulance. We followed in the car.

The ride was a short one and the surgeon was waiting for us. Technicians whisked our frightened seven-year-old off to x-ray, George and I trailed alongside the litter, holding his hand.  Minutes later I stood next to the doctor as we looked at the films. “A spiral fracture of the femur is serious business.” I could see exactly what he meant. There were a good three inches between the ends of the broken bones.

I faced the doctor. “What does this mean as far as treatment and hospitalization?”

“He’ll need a pin in his leg then two weeks in traction. When the bones are aligned I’d put him in a hip spica cast.”

“What’s that?”

“It’s a little smaller than a full body cast, starting just under his rib cage extending to his toes on the fractured leg and to his knee on the uninjured one. A stabilizing bar will be attached as part of the cast to keep his legs in alignment.”

I felt weak in the knees and my mind was racing. I was in my first full year of nursing school twenty-six miles away. The only prayer I had of staying in school was to have Timmy transferred to an orthopedic specialist at the hospital in which I was doing my training. I could stay with him when I wasn’t in class and do my homework in his room and spend nights in the nurse’s residence. The surgeon respected my wishes and gave the order for the transfer.

That short term plan would suffice as long as he was hospitalized, but what would we do when he was discharged in that hip spica thing? George calmly reassured me we’d take one day at a time.

As soon as our parents heard what happened they said, “What do you need? And how soon do you need us to come.” We were relieved at their generous offer to help and set up a tentative schedule, to be firmed up as soon as we had a discharge date.

Two weeks later, we were given instructions for home care: two people had to turn him every two hours because he was no longer a featherweight little boy, but a large bulky plaster boy. At all costs, we could not jostle the metal skeletal pin apparatus protruding from the cast. We had to make sure he was adequately hydrated to help prevent blood clots due to his inactivity. He had cut-outs in the cast to allow for bodily functions using a bedpan and a urinal. We borrowed a mechanic’s creeper so we could place him on his stomach to play. Elevated on pillows to keep the metal apparatus from touching the floor, it was easy for him to pull himself around on the ball bearing casters while he maneuvered his little cars and army men. We alternated him between a sofa bed downstairs during the day and his own bed at night.

Our parents lived with us and cared for Timmy for three weeks. Everyone had the tutorial on how to care for the boy in the cast. George came home for long lunches to pitch in. However, weeks loomed ahead where we had no help.

When our wonderful neighbors heard there was a possibility I’d have to leave school to take care of Timmy, one, in particular, became a lifesaver setting up a schedule of volunteers to help during the work week. A nurse herself, Lynne was eager to assist. She was a Godsend. Words can never express how grateful we were for her help. She brought a red stake body wagon which was padded with many pillows so she could pull Timmy around the neighborhood on nice days. She set up a chaise lounge in the shade of the front porch with, you guessed it, lots of pillows, and Tim would color or read books.

For three weeks my neighbors covered Monday through Friday so I didn’t have to take a leave of absence from school. My heart burst with thankfulness for their sacrifice and kindness.

After six weeks in the cast, Timmy was admitted to the hospital to have the contraption removed and begin physical therapy to learn to walk all over again. I stayed in the nurses’ residence until he came home using a tiny walker. He was not allowed back to school until he could manage walking with crutches. When that goal was reached, George drove him to school in the morning and Lynne picked him up in the afternoon. Both the kids got home about the same time and Margie supervised her little brother until I got home at four PM. It was a team effort.

One afternoon in the first week of December, three months to the day after the accident, I came through the door to see my two beautiful children sitting at the table having an after school snack. “We have a surprise for you, Mom. Close your eyes.”

“Okay, they’re closed.”

Several seconds passed. “Open your eyes now.”

I opened my eyes to see both kids grinning from ear to ear. Timmy was standing unassisted and slowly walked toward me. I began to cry as he reached out his arms for the best hug ever.

Three years later, I graduated from nursing school, having made the Dean’s list six times. It humbles me to know my achievement would not have been possible without the kindness and sacrifice of family and friends to get us through a most difficult time.

Chicken Soup for the Soul—My Kind of America, August 2017, 240

 

Why do nurses need to publish our stories?

Nancy: As helpers, we know that there is more than one way to heal the body, mind, and soul. In writing fiction, we entertain while providing information and giving the reader a chance to escape reality – temporarily. Non-fiction can be instructive, informative, and educational in a private non-threatening way. Nurses on the job are creative, improvisational, and innovative, not only caregivers. Nurses are often underestimated but everyone knows that it is the nurse who is with the patient for 8 – 12 hours a day, not the doctors. The nurse is the patient advocate, she is the communicator of the patient’s condition while under her care, she is the liaison between the doctor and the patient. She is the glue that holds the entire hospital system together. If a nurse also has a penchant to write, those qualities come through onto the page.

 

What has nursing done for you?

Nancy: Nursing has enriched my life beyond measure. I returned to University 17 years after I studied the first time. At the age of 35, I was the oldest in my nursing class. It was the hardest 4 years of my life but I wouldn’t change it for anything. I graduated the spring before my 40th birthday and watched as my family cried when I walked across the stage to accept my diploma. Non-traditional students, that’s what they called us, are typically more motivated and focused in their studies and on each clinical rotation and that was true for me. As a well-educated nurse, my basic knowledge and ability to reason have never left me. Nursing is like the mafia, I can’t get out even in retirement because family and friends always ask my opinion on health-related issues. I’m always having to palpate bumps and lumps and looking at spots and rashes. My stock advice is usually, “I think you should see your doctor” or “put some calamine lotion on that poison ivy.”

The Physician Supports the Nurse 

I am following a physician’s blog: Suneel Dhand.

Reading his post for the first time, I had a gut feeling I would like this guy. I think he represents a new and steadily growing wave of physicians who are becoming more aware of the effects that good communication has on patient outcomes and improvement in health team collaboration.

After I read his blog today: Doctor, I am just double-checking that you spoke with the nephrologist before I give that? September 4, 2018, I was moved to write this comment:

Thank you for this very timely and important post. We older nurses have many unfortunate memories of altercations with physicians who were more concerned over their status than the welfare of the patient and the benefits of team collaboration. With a renewed interest to improve the patient experience and prevent medical errors your post shows what physicians can do to improve communication with co-workers, especially nurses.

Here is Dr. Dhand’s post:

(I highlighted what he said that so impressed me)

I was recently seeing a rather complicated medical patient in the hospital. We were treating both a heart and kidney condition, and things were not going so well. To spare anyone non-medical who is reading this the scientific details of the bodily processes involved, we were essentially balancing hydrating, with the need to get rid of excess fluid. After seeing the patient, I spoke with the nurse, went over the clinical dilemma, and mentioned that I would speak to the kidney specialist before making the decision—and would perhaps order an additional medication if appropriate. I went back to my desk, entered a note onto the computer, spoke with the nephrologist, and we decided to go ahead and order the medication. A few minutes later, the nurse came back to me and asked: “Dr Dhand, I saw your order and just wanted to double-check that you spoke with the nephrologist before I give that medication?”.

The way the question was asked, may have come across to some as slightly condescending. I could tell some of the other doctors in the room were surprised with such a direct question. After all, I’m a reasonably experienced physician—why would I order a medicine I didn’t want to give? And how dare I be asked so bluntly if I’ve double-checked with another colleague, after I’ve already said that was part of the plan? Did this nurse not trust me?! It wasn’t even a particularly strong or toxic medicine, but one that we use everyday on the medical floors.

I paused for a bit, and said: “Yes, I’ve double checked, and it’s fine to give, no problem”. The nurse, sensing this question may have come across in the wrong way, then said: “Oh, I just wanted to check because you said you were going to speak with the nephrologist…and I looked at your note, and you didn’t even mention the medication”.

Indeed, that was correct—I wrote my note just before I had the conversation.The nurse was spot on. Whether or not the question could have been phrased differently is irrelevant, and I actually found the fact that this nurse sought to clarify the issue with me, highly impressive. I passed on that compliment. Not to mention the fact that the question was based on the conscientious act of actually reading the physician’s note!A more junior doctor colleague in the room afterwards commented on how what was asked to me sounded like a bit of an affront. Actually, I said it was the opposite, and explained why. There’s no room for ego in healthcare, and that’s frequently how mistakes happen, and what the nurse did was outstanding.

That interaction interested me, because as someone who teaches communication, I know I myself would have handled that situation very differently 10 years ago. Indeed, many doctors would have snapped right back at the nurse or taken offense that they were being so directly questioned. Perhaps even with a sarcastic response. “Of course I have, do you think I would have ordered the medication if I didn’t want it?!” “Yes I’m a doctor too, and wouldn’t order a medicine for no reason (you dare question me like that!)”. Imagine if that had happened, what the effect would have been on the nurse of being chewed out, possibly leading to not double-checking an important clinical issue in the future if they felt like something wasn’t right. A bad thing to happen to a well-meaning professional! Many doctors I’m afraid to say would have responded very differently to how I did, and chosen the latter approach during a hectic day when they already felt overloaded with questions and issues. I’m sure if you ask almost any nurse, they will tell you about countless times when they’ve been needlessly talked to in a terse manner by doctors. That’s not to say these don’t represent a small minority of interactions, but certainly enough to remember.

The one thing I feel most proud of as I’ve (hopefully) matured over the years, is how I handle situations like that. I may have always had a relatively calm demeanor, but I was definitely much more of a hot-head around the time when I finished medical school. Not confrontational, but definitely more somebody who could get into needless conflict over things like this. For anybody not working in the high-paced and frequently emotionally charged healthcare arena, you may not realize that run-ins, disagreements and personality clashes are part and parcel of the job (frequently between physicians too). They happen every day, everywhere. I remember after one negative interaction I had with a colleague many years ago, I was talking to another group member, and was given some great advice. She said: “You know what Suneel, always remember the saying: Great Minds, Don’t Mind”. That saying, Great Minds, Don’t Mind, has always stuck with me. It’s so very true, in all aspects of our lives, and something I strive for every day. The very best of us don’t take offense, become hyperreactive, or needlessly be petty and escalate situations, when we could easily interpret something as a personal insult. Especially when we are all doing our best for our patients at the frontlines of healthcare.

 

Just to reinforce what older nurses experienced when we were considered the handmaidens of the physician, I’ve included this previous post of mine: Don’t Question the Doctor,February 19, 2017, describing my good friend Lois Roelofs’ altercation with Dr. Jericho:

 

One afternoon while making rounds, I dashed in to see, Mr. Barnes, my last patient, in 236-1, the triple ward next to the nurses’ station. He smiled when he saw me. “I’m going out for dinner tonight. Dr. Jericho is picking me up at five.”

“Oh? I didn’t know. He didn’t tell us at the desk,” I said, scanning his Kardex card in the vertical file positioned on my left arm. “I’ll check on it.”

Back at the nurses’ station, I checked the doctor’s order sheet for Mr. Barnes. Hospital policy dictated that patients could leave hospital grounds only with written orders from their attending physician. Dr. Jericho was not the attending physician; he was a personal friend. And there was no written order.

I faced a potential explosion. Dr. Jericho’s capacity to be short-tempered was well-known to the nursing staff.  We’d each had our experiences. None of us liked it, but we felt powerless to do anymore than endure. And I didn’t need the problem right then: I wanted to give report on time and get home on time, once.

I dialed his office. “Hello, Dr. Jericho, this is Mrs. Roelofs on Hall Two. Your friend, Joseph Barnes, told me you were picking him up for dinner.” I swallowed hard and took a breath. “I see no written order covering this leave. I’m calling to see if you’ve run this by his attending, Dr. Acorn.”

He barked into my eardrum. “I don’t need to check anything out with anybody. Do you hear me? It’s none of your business….who is this again? What’s your name?”

“Mrs. Roelofs. Head nurse. Hall Two.” I forced my voice to sound strong.

“I’m coming right over to clean your clock,” Dr. Jericho yelled into the phone.

My head and heart spun wildly into one big tuft of fear that settled in my throat. I raced to a friend working on the ward at the other end of my floor. We schemed to hide me on that ward when Dr. Jericho arrived. Then we stationed lookout nurses. Minutes later I got the message. I ducked into Room 214, a five-bed room on East, and hid behind curtains drawn around a vacant bed. When Dr. Jericho arrived, my cohorts told him I was off the floor on an errand. He strode into my nurses’ station across from Room 201, parked himself on my desk chair, and bellowed, “I’ll wait.”

When I was a student nurse a few years before, I had scrubbed to assist Dr. Jericho in surgery. He became irritated with something and kicked a metal wastebasket across the room. Anesthesia saved the patient from being startled off the operating table. However, my nerves, as a novice, vibrated with the intensity of the metal clanging against steel and tile. Now my nerves were vibrating once again.

Suddenly, my friend peeked around the curtain, wearing worry on her face. “He won’t leave until he sees you. He’s camped out. Slicked back hair, black suit, green paisley tie, and all. You better come.”

I returned to the utility room on my ward with its steel cabinets, stowed commodes and IV poles, soaking instruments and thermometers, and corner hopper – a large square toilet-like bowl for rinsing bedpans. Standing in the doorway to the adjacent nurses’ station, I said as confidently as possible, “Dr. Jericho, I’m back. I understand you want to see me?”

Dr. Jericho launched to a standing position. “You bet I do. Who do you think you are to question what I’m doing? To tell me I need a doctor’s order to take my friend out for dinner?” His words torpedoed through the nurses’ station and up the ramp to pediatrics.

He stomped toward me. I backed away, inch-by-inch, until I was flush with the hopper. One more step and I’d plop into hopper water. I was trapped. Only the smothering smells of disinfectant separated us. “It’s my responsibility to see that hospital policy is followed, sir,” I said. My breath stopped momentarily.

“Who are you to tell me what hospital policy says? You, young lady, are never to question me again. Do you understand?”

His words slapped my face like sleet on a winter walk. I could have punched him – he was close enough – but I thought better of it. “Yes, sir.” I held back a salute that he seemed to demand. He turned, clicked his heels, and marched out, as if on a military drill.

My meds nurse, LPN, and aides crowded into the small nurses’ station. “What happened? What’d he say? I’ve never seen him so mad. At least not this week.”

“Oh, the usual Dr. Jericho stuff. Nothing new.” I said, trying to sound nonchalant with a heart rate of over a hundred.

Reaching for the desk phone, I glanced at a list of phone numbers and dialed Mr. Barnes’ attending physician. He gave me the order. Why hadn’t I called him in the first place?

I determined never to let a doctor’s behavior intimidate me again.

Caring Lessons: A Nursing Professor’s Journey of Faith and Self, Lois Hoitenga Roelofs, 2012, pp 49-50

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Nightingale Tales

My new project involves interviewing my classmates from nursing school. We “older nurses” are dying off. Who will be around to tell our stories?

As I gear up to start this project, I’m educating myself in the art of interviewing. In the meantime, a serendipitous thing happened. Lynn Dow, RN, wrote about her long career in nursing in a new book: Nightingale Tales: Stories from My Life as a Nurse.

Lynn Dow entered nursing school in 1956, three years before I did. She attended the diploma program at the University of Rochester, which like my diploma program at Saint Peter’s School of Nursing in New Brunswick, New Jersey was three years long without any summer vacation breaks. The stories she shares of her nursing school days entertained me the most since my experiences so mirrored hers.

In her book, she reminded me that after a patient went home we had to strip the bed and then wash it. Yes, the plastic coated mattress and exposed metal coil springs were washed by hand. When the bed dried, we made it up for the next patient. There were no housekeepers at this time. Two cranks at the foot of the bed were used to raise up the head or to “gatch” the knees so the patient wouldn’t slide down. Later, a third crank was added that raised or lowered the bed. I remember having black and blue marks on my shins from hitting the cranks that were left on the bed instead of taken off and stored somewhere, like on a window sill.

Lynn recalls when cardio-pulmonary resuscitation was still in its infancy, a surgeon might bypass this effort and “crack the chest.” This rarely was successful. Once when I worked in the recovery room my patient went into cardiac arrest. Her surgeon dragged her off the stretcher to the floor, cut her open and pumped her heart with his bare hands. She was an old woman and I felt at the time he did this for the experience rather than to revive her.

Commonly, student nurses staffed the hospitals because there was a shortage of registered nurses, and students were a cheap substitute. In the third year of school, students were put in charge of a ward on the evening or night shifts. Lynn reminds the reader that the student nurses were “teenagers, too green to realize the extent of our responsibilities.” Sometimes the students worked a “split shift,” covering baths and meds in the a.m. and returning to help with dinner trays and get the patients ready for bed in the evening. Before I graduated from nursing school this “abuse” of student nurses was no longer allowed.

Nightingale Tales goes on to cover Lynn’s long nursing career and is filled with educational information and surprising vignettes. While I am especially glad she shows us nursing in the “olden days,” her book also depicts the advancements in current nursing practice. But she feels that possibly “the nurturing aspect of nursing has given way to technology.”

Read her book and decide for yourself.

Nurse at the Switchboard

Ten of us from a class of 44 traveled to Cape May, New Jersey to attend our 55th nursing reunion. We first met as young Catholic teens in the late ’50s enrolled in the diploma program at Saint Peter’s School of Nursing in New Brunswick, New Jersey. Hard to believe we are now in our mid-70s.

At our luncheon at the Inn of Cape May on a glorious sunny day this past September, we laughed and reminisced about the three years we lived together, when Connie mentioned that she had to man the switchboard at night during the psych rotation at a private psychiatric facility in a Maryland suburb.

Never heard of this we said. But one of us (can’t remember exactly who that was) chimed in to say she remembered at the time how glad she was that she never had to do this. So there was validation that Connie’s memory was intact. Imagine having to work at a telephone switchboard! What does this have to do with learning about psychiatric patients?

lady at switchboard

I found a picture of a telephone switchboard for you too young to remember this contraption that connected folks to each other via telephone lines. Or you could just watch the old movie: Bells Are Ringing with Judy Holiday and Dean Martin.

 

 

 

After hearing about the switchboard, we began outdoing each other with anecdotes about our early nursing days.

I wanted to take notes to capture these unique tales but decided I would rather just enjoy the fellowship. Later, I asked my classmates if I could call them, one by one, and document what they would want to share with current nurses about life in the “olden days.” They all consented.

So now I have a new project. I had been thinking about surveying my classmates about their nursing lives for quite a while. Since our 55th celebration is over, I realize it is now or never. We are dying off. Sad to say but true. Who will remember us? Or what nursing was like years ago? Who would believe that as part of the educational program to learn to be a psych nurse you had to know how to work a telephone switchboard?

You’ll be hearing more about my classmates.

No Edit Too Mundane

This is the week we spend our annual family vacation at the beach. While I have enjoyed the ocean and sand, I took some time to complete an assignment. One of my stories had been accepted by Pulse: Voices from the Heart of Medicine, a digital journal. It could be published as soon as this Friday if I could make changes suggested by the editorial staff. And I did.

While most of the edits added clarity and a deeper texture to my story, one area of discussion initially seemed mundane. However, on reflection, I came to realize how important it is to add the actual time period of a story. In this case the mid ’80s.

Desk Phone

An intern who had the lead editing assignment probably was born into the cell phone era and never experienced a “desk” phone that, in most cases, was immovable from its position unless you added an additional cord.

vintage telephone cord

For example, in order to move about room, you had to add a long extension cord from the outlet in the wall to the base phone, then hold the base with one hand and with the other clutch the receiver to one’s ear. This way you could walk away from the desk and check for a report in the near-by file cabinet. (I won’t go into the fact we had hard copies of all our documents).

If you chose to add a long line from the phone base to the receiver so you didn’t have to carry the phone base with you, you would have to scurry back to the base phone to hang up.

Coiled phone extension

Plus that cord was coiled and most often became so tangled that you had to dangle the receiver until it spun and untangled. You had to plan ahead to add the cords. If, as the young intern suggested, you added an extension cord while talking to someone, the call would be disconnected.

This is probably more than you ever cared to know about old-fashioned phones. However, I learned a lesson that sometimes we know something so intimately that we assume all others share our experiences.

 

Check this site: Pulse Friday or next Friday to see if my story made it.

 

 

 

 

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Leaving Our Legacy

I have been thinking for a long time about the fact that we older nurses are dying off. We will take with us our memories of nursing history. I have always loved to hear from other seasoned nurses about how they size up their nursing careers as they look back. What was important at the time, what were they happy to see disappear, and how do they assess current nursing practice and the future of the profession?

So I decided I would weigh in, occasionally, by spotlighting a nurse of a certain age, i.e., sixty and older, whether this is through an article I have read or by interviewing someone, or through my own stories.

This post is prompted by an article: Diane Saulecke, “There from the Start: A Hospice Nurse Looks Back,” American Journal of Nursing, 7, July 2017, 56-57.

The article features Dianne Puzycki, an 82-year-old nurse, who began to work with the hospice movement when it first started in the early 70s. She still works “the night shift at Connecticut Hospice once a week. ‘I want to be part of it as long as I can,’ she says, ‘It’s become part of my life, my philosophy.’”

 

 

 After graduating from nursing school in 1955, she started her career at Memorial Hospital (now part of Memorial Sloan Kettering Cancer Center) in New York City. There she cared for patients with cancer, many of them young women.

“At that time, we didn’t talk about death and dying,” she says. “We weren’t allowed to talk about that. It really haunted me for years.”

I remember those restrictions well. The diagnosis of breast cancer was withheld from my beloved Aunt Lena. I was in the first year of nursing school but never visited her in the hospital. One evening, when I was talking to my mother on the phone, I asked, “How is Aunt Lena?” “Just fine,” my mother said. That’s when I knew she had died. My mother would give me the bad new when I next went home to visit.

Puzycki mentions that she heard both Cicely Saunders, a doctor who founded the first hospice, and Elisabeth Kübler-Ross, who opened up discussion on dying through her 1969 book On Death and Dying. The early 70s were heady times in health care as discussion heated up regarding the previous taboo of being honest with patients by telling them their cancer diagnosis.

Kübler-Ross’ book was the subject of a workshop for the medical staff at the time I worked for a community hospital in the early 80s. To this day I remember one of the surgeons storming out of the classroom after loudly protesting, “my patients don’t want to hear that they have cancer.”

Being present for patients and “picking up on the little things” is to Puzycki the key to hospice nursing. And she says that seeing the compassionate actions taken by her colleagues, especially the younger ones, makes her feel hopeful about the future of the profession. She recently saw, for example, a fellow nurse lean down and kiss an elderly patient on the head. “I said, ‘That’s a good hospice nurse.’”

 

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Nurses of a Certain Age

Excepted from Off the Charts, May 31, 2017

 

AJN Facebook Readers on Influences, Public Attitudes to Nursing, Practices of Yesterday

by Betsy Todd, MPH, RN, CIC 

What do you remember from early in your career that would never be seen or done today?

We “nurses of a certain age” remember!—and we’re amazed at how far our profession has come. As one nurse commented, in response to early nursing practices that seem primitive today, “Oh my goodness, how has humanity survived?!”

There were, of course, our caps, white dresses, white hose, and white shoes. One nurse recalled that we always wore our school pins on our uniforms. These seem not much in evidence these days, but were always a source of pride and connection (and sometimes, lighthearted rivalries) back in the day.

In addition, nurses pointed out that the scope of practice has certainly changed. Nurses mixed soft soap for enemas, mixed weak solutions of Lysol (!) for vaginal douching. Wound care has, shall we say, evolved. Nurses recalled packing wounds with eusol (chlorinated lime plus boric acid—“cleaned wounds by removing patients’ flesh with it!”), Savlon (chlorhexidine combined with a chemical later used for disinfecting floors), Milton (a bleach solution), or sugar mixed with Betadine or egg whites. Some remembered “vigorously rubbing talc onto bums to relieve pressure” or “Maalox and heat lamp for sore butts.”

Are automated medication dispensing systems (for example, Pyxis machines) and bar codes part of your daily routine? Several comments described pouring meds from stock bottles on the unit or mixing chemotherapy solutions in the medication room. There were no medication carts, just medication trays with cups and handwritten cards for each patient (different colored cards for b.i.d, t.i.d., etc.).

“Point of care” lab testing didn’t include quality checks. One nurse remembered “burning urine samples in a glass tube over a Bunsen burner to check sugar levels.” DeLee suctioning of newborns—“I ended up with a mouth full of stomach contents more than once”—or pipetting blood and urine samples for the lab via mouth suction were also routine.

Many comments reminded us of tools rarely seen in today’s hospitals. There were time-taped IV bags, glass syringes and IV and chest tube bottles, mercury thermometers, crank beds and egg-crate mattresses, “gloveless everything,” and no hand sanitizer.

Routines and work practices of years ago may be hard to imagine today. Nurses recalled smoking during report, and patients smoking in bed. Patients were admitted “just for observation,” or a day or two prior to surgery. Each shift charted in a different color of ink. Nurses recalled time to talk with patients, and actual “acuity-based staffing” (“RIP,” as one nurse commented).

Another nurse summed up a certain sadness as she described some lost aspects of patient care:

“morning care before breakfast, clean sheets every day, evening care with back rubs, trash emptied, fresh water and being aware of the patient’s environment. [We] took time to assess the patient by the RN and listening. The care was impeccable because of the nurses who controlled the patient experience.”

Back Rub

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