DEMISE OF THE PHYSICAL

Back in the early ‘80s when I ran a not-for-profit clinic on the west side of Chicago for older people before annual physicals were considered “nonspecific” or “inefficient” or “potentially harmful” [“Let’s (Not) Get Physicals” (Elisabeth Rosenthal, The New York Times, June 3, 2012)] I did a complete head to toe exam on each patient who registered, including vaginal exams on the women and rectal exams on the men.

I enjoyed the mechanization of the whole process. Take out your reflex hammer. Tap elbows, wrists, knees, and heels. Put it away. Take out your stethoscope. Listen to lungs, heart and bowel sounds. Put it away. Methodical and expedient. A whole hour was allotted to this first visit. Hard to believe in light of today’s harried health care system.

I remember telling myself to keep my facial expression bland. The slightest furrow on my brow shot a message to my patient—she found cancer or something equally horrible. As if the physical exam was an accurate barometer of health and well-being. As if I, the nurse practitioner, a.k.a health professional or primary care provider, had some secret connection to the Almighty and not only could find abnormalities but could predict life expectancy.

The physical seemed like a test or maybe a comparison of one older person to his/her peers. I can see Mr. Brown sitting at the edge of the exam table as I auscultated and percussed and said such things as “great lungs sounds” or “your heart beat is strong.” And after the exam I pronounced “you’re in great shape.” His smile radiating as he stepped down from the exam table probably thinking of himself in better shape than others his age. Then the common compliment: “That was the best exam I ever did get!”

Although I no longer practice as a nurse practitioner, I mourn the demise of the complete physical. Back thirty years ago when nurse practitioners were attempting to secure our identity as primary health care providers, the physical exam was a powerful tool signifying we could do what doctors did. And Medicare reimbursed this service. It was a vehicle to get us where we wanted to go—to become legitimate in the eyes of our clients and employers.

The physical, like my first car the gold Studebaker convertible my dad bought me that already was 12 years old, was serviceable but became too expensive and unreliable to keep forever.

But what a great ride.

My car was gold and in better shape.

WET YOUR LIPS

Linda Jay, Michele Murdock and I are all writers. We are all of a certain age. And we all want to have a professional photo for our future book jackets.

Enter Layne Sizemore, an accomplished photographer with patience, humor and appreciation of the older woman.

Linda’s post tells the story of the photo shoot session and the how she, a “natural comic,” made us laugh. All true.

Great post, Linda. Keep them coming!

Read Linda Jay’s “Headshots” post here.

24-Hour Woman

“What matters in life is not what happens to you but what you remember and how you remember it.”

—Gabriel Garcia Marquez

I remember Sadie Rooney handing me a brown paper bag on my visit that autumn day in the early 90s. Her husband, Jim, a self-taught preacher, had died the month before. At first it seemed she wouldn’t have the strength to honor his wish to die at home. But on that day, Sadie was pleased with herself because she had cared for Jim up to the end. So when I reached into the bag and pulled out a mug and read the inscription out loud—24-Hour Woman—I figured Sadie was thanking me for being there for her. I was the 24-Hour Woman: the nurse practitioner orchestrating the journey towards the final curtain for Jim. And buoying up Sadie to face, head on, the whole dying business.

All these years I kept the mug. It came with me when we moved out of state—twice. Sat on my desk at each new job. A reminder of my nursing success. Or so I thought.

Godess of Memory

I had made notes of my visits to Jim and Sadie. Now as I write their story for my upcoming book, I am re-thinking Sadie. How resilient she turned out to be. She was there for her husband—night and day—quelling her own fears and insecurities. And at our last meeting, she told me of her plans to become a preacher.

Now with the passage of time, I see Sadie as the 24-Hour Woman. Thinking of her gave me the encouragement to take on new challenges as she had done. I had it all wrong.

MEETING GOALS

I’ve written about getting this book done so a draft will be finished by September first. (Post: Time To Get Serious). I’ve listed goals to be accomplished by the end of each month. I only have to tweak one story to meet my target for April and since there is one more day in April, I will get it done.

It’s difficult for me to do even a little bit of tweaking and not go back and revise over and over again. There will be time for editing when all the stories are written.

Another hard part for me is to follow my outline. I still find it surprising I was able to write an outline in the first place.

I remember reading Robin Hemley for the first time and laughing out loud. Was he writing about me?

“I am not one to write outlines. I hate outlines. I hate the idea of outlines. I’m one of these artsy types, who, if not relying solely on inspiration, at least tries to allow a book to proceed organically—– It basically means we don’t know what the hell we’re doing and it wouldn’t take us so long to finish a book if we wrote a simple outline.”*

Well I’ve spent five or seven years, depending how you count, avoiding outlines. Even though this is my first book and I don’t consider myself “artsy,” I say amen to Robin Hemley’s words.

I continue to plug away.

Two months down. Four to go.

*Hemley, Robin. “The Loneliness of the Long-Distance Writer.” In Carolyn Forche & Philip Gerard., eds., Writing Creative Nonfiction. (Cincinnati: Story Press  2001), 57.

BEST TIME TO BE A WRITER

Seems that this is a great time to be a writer. At least that’s what I heard at the fifth annual Triangle Area Freelancers Nonfiction Writers Conference yesterday. I had attended the last three. Each year only gets better.

What I liked most was the conference was small enough to feel part of a friendly, local group and yet large enough to offer diversification of attendees and interests.

What I thought was important follows, in no special order:

Writing your creative nonfiction book:

  • Write the best book you can (although we all know this, it was repeated over and over)
  • Make sure facts are accurate
  • Spend money on a copy editor
  • Be able to concisely describe your book
  • Be able to concisely describe what makes you the right person to write this book

Networking and self-promotion:

  • Besides developing a platform by getting a blog and joining Facebook, Twitter and LinkedIn, use local media such as newspapers and magazines
  • Get interviews on local television and radio programs
  • “Blog rolls” now take the place of bookstore signings
  • It’s not all about you, plug other writers

I’m not sure I can accurately explain all the details and advances made in the self-publishing arena so I’m not even going to try. However, Writers’ Digest magazine devotes the May/June issue to e-publishing and ways traditional publishing is changing.

I intend to buy my copy tomorrow.

Write What You Are Afraid Of

I didn’t attend the 2011 Fall Conference in Asheville sponsored by the North Carolina Writers Network but I kept this description of one of the master classes: “If You’re Afraid to Write About It, You Probably Should Write About It”   

Often a writer’s breakthrough comes when he finally faces up to material he’s been avoiding. Maybe it’s too personal or too painful or maybe he assumes it just wouldn’t interest anyone else. Whatever the reason, we writers often overlook our own obvious strengths, dismissing the very things that are central to us. Consequently, we write around the edges of our lives or our characters’ lives, so that our stories are pale imitations of what they could be. They may be well-written, they may even be entertaining, but they lack heart. As a writing teacher, I spend a good bit of time helping students recognize and appreciate their own writerly landscapes. When a writer makes the shift to writing about a world he knows, embodied with places and characters that matter to him, the writing almost always comes alive.

Tommy Hays

I’m currently writing about making home visits to three men that shared the same life situation. They all had terminal cancer. I visited the men on the same day because of their geographical proximity. With little experience in working with dying patients at the time, I found the visits depressing. While there are many completed chapters in my book, I had ignored this trio up to now. What is it about these men that disturb me?

time to write
time to write

What do you avoid writing about?

Time To Get Serious

the time is nowI woke up one morning this past January and decided it was time to get serious about losing weight and finishing the book.

First of all, I have been carrying around ten extra pounds for years until they magically morphed into twenty extra pounds.

Second, over the past seven years I have written and rewritten my book of nursing stories. And I have written and rewritten the first chapter at least five times, not counting changing from past tense to present tense and back again. Furthermore, I hadn’t followed any of the many outlines I generated because I was constantly changing the structure of the book.

Why I decided that particular morning to stop procrastinating baffles me. However, I don’t intend to waste precious time analyzing why as long as I continue to make advancements.

What I have accomplished so far:

  • Engaged my friend and mentor, Carol Henderson, to monitor my progress and coach me to succeed. There is nothing like having to be accountable to someone.
  • Met my first month’s goal by writing three new stories.
  • Developed a working outline of the complete book, which I intend to follow.
  • Set a date for completing the draft: September 1, 2012.

By the way, I have lost ten pounds.

What is it you have been putting off?

Never Too Old

I am empowered knowing age does not limit our creativity. James Arruda Henry learned to read and write in his mid-nineties. He didn’t stop there but went on to write a book: In a Fisherman’s Language.

As a gerontological nurse practitioner and woman of a certain age I am delighted to promote his story.

Long Lost Story

Just last week I came across a folder in an old box on the bottom of a closet. There I found accordion-pleated sheets of paper where I had written about the Donovan family in single space dot-matrix some twenty years ago. Bill Donovan had lung cancer with metastasis to his bones and brain. He died on a cold December day in Chicago.Winter in Chicago

I still have my Day Timer—who is old enough to remember those? I kept statistics on my patients: address, phone number, date of birth, diagnoses, if and when they received a flu shot and the date they either were discharged from home care or died. I wrote sporadically about my more difficult or worrisome patients in journals, which I kept all these years. I knew someday I would write my nursing stories.

But I never did forget Bill. I just didn’t remember enough detail about him and his family to add him to the book I’m working on. But now I’ll flesh him out along with his three daughters, a live-in girl friend and a hired caregiver, Stanley, who emigrated from Poland where he claimed to be a medical student and who withheld Bill’s medication on the grounds he, Bill, could die from the morphine.

Now you couldn’t make this stuff up.

The Murder Building

CT-BIZ-VACANT-BUILDINGS-B_CTMAIN0501SR-d55be438
When I visited a patient in my caseload that lived in an “unsafe” part of the city, I went in the morning. Right after the pimps and drug dealers had called it a night and before the shop keepers pulled up the bars over the store windows and the women came out to sweep the sidewalk litter into the streets.

One day Pearl, the social worker, asked to come with me to see a patient. She had a meeting in the morning so we left after lunch against my better judgment.  If I were going to go to an iffy part of the city, this was the last place I would want to visit. The Chicago Tribune ran a story a few weeks previously about the  “Murder Building.” I knew by the address it was next door to my patient’s apartment.

Everyone knows it simply as “the murder building.“

“They call it `the murder building` because people have been known to go into that building and not come out,“ said one young man standing on a nearby street. “You got to stay away from that place. Things go on in them halls you don`t want to see.“

What does that say about the neighborhood we drove through and the scattering of young men gathered on the stoops, some leaning against the parked cars, all seeming to be without a sense of purpose? I felt their eyes following us.

My patient lived on the second floor with his common law wife and various other relatives. The front door was locked and since there wasn’t a bell, I had to stand under the window and yell the patient’s name. The patient’s wife would come to the window before she sent one of the grandchildren down to let me in. This was before cell phones.

I dreaded leaving the safety of the car. Did any of the men think we carried drugs? I scooted out and quickly grabbed my nursing bag from the trunk along with a white bathroom scale. The patient was on tube feedings. It remained unclear if his wife was able to manage the procedure and give the feedings on schedule. I was monitoring his weight as evidence of success.

When Pearl and I completed our visit, we took quick, long steps to the car, avoiding eye contact with anyone near-by. As I stuffed my bag and scale into the trunk, I felt someone tap me on the shoulder. I waited for the command to hand over my nursing bag. Instead a soft voice asked, “Before you put that scale away, would you weigh me?”

I turned to see an older man with short gray whiskers on his chin and a pleasant smile. He moved aside as I slammed the trunk closed and carried the scale to the sidewalk. He took his shoes off and stepped on the scale. “I can’t see the numbers,” he said. I read them off to him, he stepped down, retrieved his shoes and said, “thank you.” Behind him stood a young man with dreadlocks. “Can I get weighed too?” He slipped out of his high tops. I called out his weight and he left with a “thank you.”

Behind him a line of men snaked along the sidewalk. Pearl emerged from the car and began joking with the men, young and old, as they waited their turn at the scale.

Back in the car, the scale packed away in the trunk, Pearl and I drove to the corner. As we pasted the Murder Building, ominous and frightening with smashed windows and debris scattered around its foundation, I realized a building doesn’t define a neighborhood.