I attended the book signing this past August. Farther Along, written by my friend and mentor, Carol Henderson, which tells the stories of thirteen mothers (she is one of them), a bakers dozen as Carol points out, who had lost children at various ages.
I was prepared to cry. I don’t do well with death of children, even adult children. Children shouldn’t die before their parents. Maybe that’s why I choose geriatrics as my specialty. Old folks die. It’s expected. No surprises. I can deal with that.
I teared up but didn’t cry and was somewhat unprepared for the humor, serenity, and lack of self-pity as the six mothers read sections from the book. But then ten years had passed since the women came together under Carol’s guidance and direction. Certainly bereavement takes time to absorb, rant and rage against, come to terms and eventually accept the grievous loss that will never be forgotten until one’s dying day.
How fortunate the women found each other and Carol. Writing their stories seems to have brought them to a better place than they would be if they hadn’t immersed themselves in writing.
Why did these women write?
Carol says in her book:
“Writing about deep and traumatic matters, as many studies now confirm, is good for our physical health. Reflective writing actually lowers pulse and blood pressure, increases T-cell production, and boosts the immune system. Writing can help us cope with chronic conditions like physical pain—and the loss of health, of dreams, and, yes, of children.”
We all write for different reasons. I am haunted by my patients. They walk around in my memory and defy me to ignore them. I need to tell their stories.
While it was time consuming, I loved doing the April Alphabet Challenge A to Z. It got me writing new stories, released memories I had forgotten and expanded my writing skills. Going forward with my Blog, I will intersperse more personal tales.
This is a timely decision since nurses are getting greater attention being on the forefront of the pandemic. Look what nurses do, shout the headlines. Plus, nurses are writing their own stories in essays, news media and books in greater numbers. This is just fantastic. I feel more comfortable cutting a back bit on my emphasis to show how nurses make a difference.
Also, there seems to be a national movement to grant nurse practitioners the legal authority to practice independently. That is, to practice without physician oversight. While I was busy constructing a daily post for the month of April, a friend emailed me an article about nurse practitioners titled: We trusted nurse practitioners to handle a pandemic. Why not regular care? (Lusine Poghosyan, The Niskanen Center Newsletter, March 9, 2021). Before COVID-19, only 22 states allowed NPs to practice independently. Since then, governors of 23 states have signed executive orders to permit NPs to practice without physician agreements.
Sadly, it took a pandemic to unearth the truth that nurses and NPs do improve patient care and make a difference in the health care system.
Marianna Crane became one of the first gerontological nurse practitioners in the early 1980s. A nurse for over forty years, she has worked in hospitals, clinics, home care, and hospice settings. She writes to educate the public about what nurses really do. Her work has appeared in The New York Times, The Eno River Literary Journal, Examined Life Journal, Hospital Drive, Stories That Need to be Told: A Tulip Tree Anthology, and Pulse: Voices from the Heart of Medicine. She lives with her husband in Raleigh, North Carolina. Visit her at http://www.nursingstories.org.
The book will take as long as it needs to take to be done.
My book, Stories from the Tenth-Floor Clinic: A Nurse Practitioner Remembers, took me about seven years to complete. I couldn’t seem to rush the process. A mentor told me “the book will take as long as it needs to take to be done.” And only after I finished the book did I understand what my story was really about.
My nursing career covered forty years. As soon as I retired I began to record those years starting with nursing school. When I reached the early 80s, a tug in my gut told me that I couldn’t go any further. During that time I was the coordinator of a not-for-profit clinic in Chicago targeting the underserved elderly. Throughout the years, I always remembered the clinic as being totally different from any other job I ever had. Located on the tenth-floor of an apartment building for low-income seniors, the open door policy allowed anyone to walk in—with a heart attack or carrying a loaf of zucchini bread.
As a new nurse practitioner (I had been a registered nurse for twenty years before I went back to school to become an NP), I narrowly viewed my role as a health care provider. I would see patients in the clinic for illnesses or health maintenance. That the elderly had multitudinous social and economic problems initially eluded me. Or was it that my lack of education in geriatrics, a new specialty at the time, that contributed to my misconceptions?
Many of my patients’ stories were captured in a journal that I kept while I struggled with the dilemmas that challenged me—patients choosing between food and medicine, or were victims of family abuse, or targeted by scam artists from the community. I often vacillated whether I had any right to step in and take over a patient’s finances or change the locks on the doors. With no road map, I fumbled along, sometimes butting heads with my staff in deciding how to intervene.
Finding the Truth in Revision
I learned that what I wrote initially in the book was not a clear map of what I wanted to convey. I just wanted to tell this story. But what story? My memory cast my co-workers in roles that inhibited my progress. With each rewrite, I softened my harsh critique of others and uncovered some detrimental actions that I had initiated. My insight became sharper when I let the story percolate in my head rather than rushing to rewrite. Reflection and patience, albeit over seven years, finally enabled me to be truthful to what happened in the tenth-floor clinic.
In retrospect, I see that having a preconceived notion of what I wanted to write had caused me to miss what was behind the real story. My belief about the stories from the tenth-floor clinic stemmed from what I remembered—my truth at that moment. The passage of time has a way of rearranging recollections. It was only after examining my place in my memoir that I uncovered what the story was really about, even if I had already lived it.
The book took as long as it needed to take to be done.
She shared many tips, some from other writers. She told her us that we can use all that she shared. She cautioned, however, to give credit to the original source of her advice when appropriate. For example, E. L. Doctorow said: “Writing is like driving at night in the fog. You can only see as far as your headlights, but you can make the whole trip that way.” In other words, Anne stressed, that we should start to write in short increments. We don’t need to have the whole picture before we begin.
She shared the following writing tips:
Stop NOT Writing.
Don’t be pressured to write well. Write badly. ( remember in Bird by Bird, Anne coined: write a shitty first draft?)
Trust you are loaded with stories to be told.
Don’t try to “think” the story—just be available and let it happen.
If you feel blocked, just write about it.
Don’t tell us—start with the action. Describe. It’s a movie behind your eyes.
Don’t force humor.
If you are too close to the story, pretend you are Margaret Mead studying the aboriginal tribes.
Tape record dialogue. Edit when it’s played back.
Spend the most time at the beginning of your work paying attention to structure.
In closing, Anne instructed us to google writing advice from various writers.
Here is a shorten version of an article in Lit Hub written by Emily Temple, August 6, 2019. I “sifted through her interviews and speeches to find out what she thinks about writing.”
Temple has highlighted some of her (Toni’s) wisdom below:
“You Don’t Know Anything.” And Other Writing Advice from Toni Morrison
I don’t want to hear about your true love and your mama and your papa and your friends.
I can’t think of another writer who is quite so universally beloved as Toni Morrison. Her work is magnificent, her legacy is unimpeachable, and she reveals her brilliance at every opportunity. She also taught for many years at Princeton, and I think it’s safe to assume she knows a thing or two about nurturing young minds. So, using the relatively flimsy excuse of her birthday—Morrison turns 88 on Monday, which is also Presidents’ Day (is this a sign?)—I sifted through her interviews and speeches to find out what she thinks about writing. I’ve highlighted some of her wisdom below.
Write what you want to read.
I wrote the first book because I wanted to read it. I thought that kind of book, with that subject—those most vulnerable, most undescribed, not taken seriously little black girls—had never existed seriously in literature. No one had ever written about them except as props. Since I couldn’t find a book that did that, I thought, “Well, I’ll write it and then I’ll read it.” It was really the reading impulse that got me into the writing thing.
I tell my students one of the most important things they need to know is when they are their best, creatively. They need to ask themselves, What does the ideal room look like? Is there music? Is there silence? Is there chaos outside or is there serenity outside? What do I need in order to release my imagination?
Everything I see or do, the weather and the water, buildings . . . everything actual is an advantage when I am writing. It is like a menu, or a giant tool box, and I can pick and choose what I want. When I am not writing, or more important, when I have nothing on my mind for a book, then I see chaos, confusion, disorder.
–from a 2009 interview with Pam Houston in O Magazine
Let characters speak for themselves.
I try really hard, even if there’s a minor character, to hear their memorable lines. They really do float over your head when you’re writing them, like ghosts or living people. I don’t describe them very much, just broad strokes. You don’t know necessarily how tall they are, because I don’t want to force the reader into seeing what I see. It’s like listening to the radio as a kid. I had to help, as a listener, put in all of the details. It said “blue,” and I had to figure out what shade. Or if they said it was one way, I had to see it. It’s a participatory thing.
It’s that being open—not scratching for it, not digging for it, not constructing something but being open to the situation and trusting that what you don’t know will be available to you. It is bigger than your overt consciousness or your intelligence or even your gifts; it is out there somewhere and you have to let it in.
–from a 2009 interview with Pam Houston in O Magazine
Don’t read your work out loud until it’s finished.
I don’t trust a performance. I could get a response that might make me think it was successful when it wasn’t at all. The difficulty for me in writing—among the difficulties—is to write language that can work quietly on a page for a reader who doesn’t hear anything. Now for that, one has to work very carefully with what is in between the words. What is not said. Which is measure, which is rhythm, and so on. So, it is what you don’t write that frequently gives what you do write its power.
I think some aspects of writing can be taught. Obviously, you can’t expect to teach vision or talent. But you can help with comfort. . . . [Confidence] I can’t do much about. I’m very brutal about that. I just tell them: You have to do this, I don’t want to hear whining about how it’s so difficult. Oh, I don’t tolerate any of that because most of the people who’ve ever written are under enormous duress, myself being one them. So whining about how they can’t get it is ridiculous. What I can do very well is what I used to do, which is edit. I can follow their train of thought, see where their language is going, suggest other avenues. I can do that, and I can do that very well. I like to get in the manuscript.
Those [paragraphs] that need reworking I do as long as I can. I mean I’ve revised six times, seven times, thirteen times. But there’s a line between revision and fretting, just working it to death. It is important to know when you are fretting it; when you are fretting it because it is not working, it needs to be scrapped.
As a writer, a failure is just information. It’s something that I’ve done wrong in writing, or is inaccurate or unclear. I recognize failure—which is important; some people don’t—and fix it, because it is data, it is information, knowledge of what does not work. That’s rewriting and editing.
With physical failures like liver, kidneys, heart, something else has to be done, something fixable that’s not in one’s own hands. But if it’s in your hands, then you have to pay very close attention to it, rather than get depressed or unnerved or feel ashamed. None of that is useful. It’s as though you’re in a laboratory and you’re working on an experiment with chemicals or with rats, and it doesn’t work. It doesn’t mix. You don’t throw up your hands and run out of the lab. What you do is you identify the procedure and what went wrong and then correct it. If you think of [writing] simply as information, you can get closer to success.
People say, I write for myself, and it sounds so awful and so narcissistic, but in a sense if you know how to read your own work—that is, with the necessary critical distance—it makes you a better writer and editor. When I teach creative writing, I always speak about how you have to learn how to read your work; I don’t mean enjoy it because you wrote it. I mean, go away from it, and read it as though it is the first time you’ve ever seen it. Critique it that way. Don’t get all involved in your thrilling sentences and all that . . .
What I’m going to say is going to sound so pompous, but I think an artist, whether it’s a painter or a writer, it’s almost holy. There’s something about the vision, the wisdom. You can be a nobody, but seeing that way, it’s holy, it’s godlike. It’s above the normal life and perception of all of us, normally. You step up. And as long as you’re up there, even if you’re a terrible person—especially if you’re a terrible person—you see things that come together, and shake you, or move you, or clarify something for you that outside of your art you would not have known. It really is a vision above, or beyond.
My Blog, Nursingstories.org, was selected by Nurse Buff: Nursing Humor & Lifestyle Blog as one of the best 100 Nursing Blogs and/or Websites in 2020. While I am honored with this selection, I am also so impressed that we nurses are now publishing our stories on the internet in impressive numbers.
Rather than add an URL I am listing all 100 on my site for your review.
Why It Matters: The Nursing Site specializes in posting about the latest topics regarding the nursing profession, boasting a wealth of content available for multiple different audiences such as newly licensed nurses, student nurses, and even seasoned or veteran nurses.
Great Read: “Healthy Eating for Nurses Who Work Long Hours” is a great article for nurses who may be neglecting a healthy diet because of their long work hours or erratic schedules. It also talks about how nurses should also prioritize taking care of themselves in addition to taking care of others.
Why It Matters: Elizabeth Scala is a nurse who is confident in her knowledge regarding nurse burnout. She is also a Nurse’s Week online program host as well as a bestselling author who often partners with nursing schools and associations in order to help bring about a positive change in the nursing field.
Great Read:“The Physical Benefits of Positive Thinking” talks about how important it is for nurses to think positively and the various tangible benefits that could come as a result of that. Some examples of this are patient pill compliance, appreciative inquiry, and other general physical benefits such as lower stress levels and better cardiovascular health.
The story that I wrote almost thirty years ago was chosen as a finalist from 200 submissions to Carolina Woman Writing Contest. Debra Simon, editor and publisher of Carolina Woman magazine, decided that this year she would include a list of finalists. Lucky for me.
Thank you, Debra Simon and Carolina Woman magazine, for selecting my story to be included in the list of finalists. I am honored.
Unfortunately, as of May 1, the print magazine was suspended due to COVID-19. You can read the prizewinning submissions on the Carolina Woman web site but there is only a list of the finalists by name and title of the work.
I have printed a copy of my story below.
I lounge on the back deck of my new home sipping a glass of Chardonnay. The October sun is still warm here in the South. No one is hassling me about drinking a good wine with taco chips. I’m not being hassled because I’m alone.
But I’m not really alone. The cat is here. She has wandered down to the brook and is sitting on her furry, black haunches staring at the bubbling stream. This commands her full attention. She doesn’t know brooks. Brooks weren’t common in Chicago where she lived all eleven years of her life. She knows alleys, cement sidewalks and chain link fences.
She was not totally citified, however. She ran around with a family of possums who ravaged the garbage cans in the alley behind our house and made their home under the steps of our old wooden porch. In the evenings’ blue haze, I would see the cat’s silhouette surrounded by pairs of red slits that darted away when I threw open the kitchen window to call her inside.
She hasn’t, as yet, met the beaver that lives in the brook since this is her second exploration outside. Like me, she has left familiar places and faces behind. She’s trying to make sense of this terrain with its newness and unpredictability.
Yesterday, on her first venture outside, I watched like an anxious mother while she delicately descended the steps off the back deck that lead to the grassy slope. Suddenly three, shiny black crows perched in the tulip trees began to make menacing, croaking calls. The crows swooped over the cat, one after the other. She crouched low and crept back to the deck, up the stairs and through the French doors I had opened.
No sooner had I shut the doors behind her, saving her life I am sure, she began to meow to go back outside. No way, I thought. I no longer need to experience that kind of the excitement: dealing with daily disasters, stretching my imagination while awaiting unmentionable accidents. Those worries I abandoned when my children, now grown and free spirited, decided to stay in Chicago when I moved to another state.
The cat rolls happily in the dry dirt by the brook sending up dust clouds. Back in Chicago, she often welcomed me from work by rolling about on the concrete path leading to the back door of our house. I would bend down and rub her soft belly until my work worries dissolved.
I wonder if the cat misses her familiar haunts: the chain link fence she scaled, the alley she explored, or the familiar wooden porch with its family of possums living underneath the steps. Does she miss the variety of laps she could choose to sit on, or the warm hands that reached down to scrub her black and white head, or the beds she shared? Does she miss her life companions, who like her, are testing their freedom?
The cat is gone from the side of the brook. I stay seated. I remind myself that I no longer need to be the mother-worrier.
I go back to my book and try to concentrate. Time passes. The wine and the taco chips are gone. The sun drops behind the tulip trees casting long shadows across the deck. I feel a warm, furry body rubbing against my leg.
I almost forgot about Dennis. That’s what Carol Novembre thinks his name was. Carol and I worked together in the early 60s at Pollack Hospital in Jersey City. It was a county-run hospital. Dennis was head of maintenance. I learned a lot from him about the political corruption that went on behind the scenes. Not that I had any doubts about the kickbacks and abuse of power. I had seen the cases of liquor at the loading docks that were to be delivered to the administration suite (aka “the penthouse”). One time when I answered the phone on our nursing unit, a voice at the other end reminded me that my “donation” of five dollars was due in order to keep my job. When I identified myself as a nurse, the male voice apologized profusely.
Dennis, a tall, lanky guy with a pocked marked face and disheveled clothes, made rounds in the hospital when he wasn’t off-site, overseeing the unofficial work of prisoners. He would bus the prisoners from the county jail to work on the administrator’s suburban house—building a fence, painting the siding, tending to the gardens in the summer. He seemed especially fond of the nurses. If he learned one of us had missed lunch, he would run down to the kitchen and reappear with a bacon sandwich.
Reminiscing about Dennis was only one of the memories that resurfaced as I spoke to Carol last week. I had asked her if I could write about the fact that she was one of the first dialysis nurses in the country. I worry that as nurses age and die off, stories of nursing history will be lost. My stories included.
You will read more about Carol Novembre in a future post. In the meantime, here is a story I had published about one of the patients I cared for while I worked at Pollack Hospital in the mid-60s.
CLOSING THE DOOR
I screwed off the cap of the Black and White Scotch bottle and I carefully measured out sixty milliliters, two ounces, into a medicine glass. The alcohol fumes gagged me every time. Then I grabbed a pack of Lucky Strikes from the carton on the shelf next to an aspirin bottle. Cigarettes and Scotch balanced precariously on a small tray. I locked the door to the tiny medication room and went in search of Charlie Hobbs.
The tobacco smoke clouded the air in the patients’ lounge. The drab room was empty except for a middle-aged man in blue pajamas staring at pieces of a jigsaw puzzle on the card table in front of him. A cigarette clung to his lower lip.
At times, I imagined myself the airline stewardess I had always wanted to be. Coffee, tea, or me? This day I was a Playboy Bunny as I bent at the knees, stretching to place the drink in front of Charlie, while his blue eyes riveted on my imagined cleavage. But Charlie’s eyes fixed solely on the amber liquid. Not once in the past four weeks had he acknowledged me, the young nurse in a starched white uniform with thick support hose and practical shoes. An unlikely dispenser of booze and butts.
Charlie had arrived with no suitcase, only the clothes he wore. The faded blue hospital pajamas and robe comprised his daily wardrobe. One of the other nurses had donated slippers. I looked down at the top of Charlie’s wild red hair. “I got to get me another puzzle,” Charlie said without looking up at me. “This here one is almost done.” He snuffed the cigarette butt into an overflowing ashtray and reached for the drink. I was glad Charlie had decided to shower that morning or else his pungent body odor would have added to the foul air.
Charlie shuffled the jigsaw pieces about by day, and watched television by night, all a maneuver, I thought, to keep human interaction at bay. No one ever visited him. Did he even have a home to go back to?
Dr. Clark’s research money supported Charlie’s hospital stay. Dr. Clark needed recruits who would agree to have a cardiac catheterization in order to see the effects, if any, that alcohol had on their hearts. Cardiac catheterization was the latest tool of the sixties. It measured heart function but carried the risk of injury and even death.
Dr. Clark scoured the downtown bars searching for men who drank excessively. On a warm summer night about a month ago, Dr. Clark had gotten lucky. Charlie seized the carrot: a roof over his head, three squares a day, free liquor and cigarettes. He agreed to live on the third floor of the county hospital for four weeks and then undergo a cardiac catheterization.
I carried the empty medicine glass on the tray back to the nursing station. How could Charlie drink alcohol at nine in the morning? Or all day long, for that matter? What would make a man so desperate that he would consent to have a procedure that might kill him?
Even though I didn’t particularly like Charlie, there were times as I placed the Scotch in front of him that I wanted to nudge him and jerk my head towards the exit sign down the hallway. Get out, Charlie. The catheterization isn’t worth all the free alcohol and cigarettes that Dr. Clark’s giving you. Get out. Now. But I didn’t have the audacity to undermine Dr. Clark’s research, no matter how conflicted I felt.
At twenty-three and a nurse for just two years, I vacillated between professionalism and irreverence. I struggled with knowing when to step back and when to dig deeper into my patients’ psyche. How to be empathic and not sympathetic. How to balance cool detachment with overbearing involvement. Charlie needed someone on his side to help him understand what he was getting into.
Nellie Mineo interrupted my thoughts as she waved to me from the doorway of her husband’s room. She looked like the Italian housewife that she was: salt and pepper hair piled in a bun on the top of her head. A well-worn cardigan sweater covered the simple cotton dress she wore. Behind her thin frame I could just make out her husband’s outline under the starched white sheets.
The Mineo’s had known the chances weren’t in their favor when they first met with Dr. Clark to discuss replacing Joe’s diseased heart valve with an artificial one. At that time Joe was so short of breath that he could hardly talk, much less continue to work in the family grocery store. Joe had been my patient during the week Dr. Clark evaluated him for surgery. The Mineo’s large, gregarious family resembled my own extended Italian family. Joe could’ve been my Uncle Tony with olive skin, dark eyes and soft smile.
An artificial valve, which clicked audibly, replaced Joe’s faulty one. I had worked overtime on the surgical unit as Joe’s private nurse the first night after surgery. At first things looked great, but soon Joe developed a cough, and then his legs swelled. Diuretics only worked for a while, and the antibiotics failed to prevent the infection from ravaging his body. Although the valve was being rejected, it continued to click on.
Joe had the first room near the nursing station. The floor was dedicated to research and held only fifteen patients. The patients stayed for a long time or returned frequently for evaluation. Not surprisingly a strong bond developed between the professional staff and the patients and their family.
Joe’s family and friends usually came and went at all hours, but this day only Nellie stood guard. When I ambled towards her, she grabbed my hand. “He looks worse,” she said, rubbing my hand in absent-minded distraction. “Promise me you’ll stop in before you go off duty today.”
Nellie and I both knew that there would be no miracle for Joe. His once muscular body shriveled into sagging skin covering a bony frame. He didn’t open his eyes to Nellie’s voice. Even a sharp pinch to his face couldn’t get a reaction. “Stop and see me before you go off duty,” Nellie repeated. I nodded. Only then did she loosen her grip on my hand.
At the end of the day, as I flung my coat over my arm, I heard a racket from the patients’ lounge. Charlie stomped past me, head down and fists clenched. “I’m outta here.”
“What happened?” I asked the nurse who jogged after Charlie.
“Charlie kicked over the card table. No reason I could see for this.” She shrugged her shoulders and continued down the hall.
Nellie watched the commotion from the other side of the hall. I walked towards her. She pulled me into her husband’s room, grabbed my coat and purse and held them tight against her body. She stared at me for a long while without speaking. From behind her I could hear Joe’s wet bubbly breaths. Even in my short stint as a nurse I recognized the rancid smell of impending death.
Nellie moved her face closer to mine and whispered, “He’s dying.” She caught a sob and swallowed hard. “I don’t want him resuscitated. Stay with us, please stay with us. Don’t let them resuscitate him. Please don’t.” She wept quietly, clutching my coat and purse closer to her body.
What was I to do? I had never faced this dilemma before. I knew Nellie had witnessed plenty of resuscitation attempts as she lingered outside her husband’s hospital room day after day. Cardiopulmonary resuscitation was so new that all patients were candidates. At the first moment a patient stopped breathing, we leaped into action. We flung him to the floor and straddled him. With the side of our hand we walloped the sternum to get the heart started, then breathed frantically into his mouth. Pumped on his chest. We worked until we were exhausted. In most cases the patient died anyway with fractured ribs and a lacerated liver. Nellie didn’t want this for Joe.
Thoughts flew in and out of my mind. If the staff saw Joe turning blue, they wouldn’t give a second thought to trying to revive him. A resuscitation attempt might bring Joe “back to life,” but only briefly. Then there would be more pain and agony before his heart gave out and he died—again.
What would I want for Uncle Tony? A quiet death, or zealots in white coats beating on his chest? What should I do? Was there a choice? I looked at Nellie, her dark eyes pleading.
I heard Charlie’s voice from down the hall spewing curses. Perfect timing. Charlie would leave the hospital AMA—against medical advice—right before his scheduled catheterization. I hoped whatever he was up to would distract the staff just long enough for Joe to die.
My heartbeats kicked up a notch as I reached over and slowly shut the door. Nellie’s hold on my coat and purse relaxed and they slid to the floor. Wordlessly, she settled down in the chair next to Joe’s bed, lifted his limp hand into her lap and clutched it. I commandeered the chair by the door: the sentry blocking the enemy from entering.
I sat knotted tight while Joe’s breaths became more erratic. The lapses between his gasps for air stretched farther apart. Just when I thought he had quit breathing, he gulped for air.
Finally, the mechanical valve stopped clicking and the room became silent. I walked to the bed and placed my hand over Joe’s clammy hospital gown. I didn’t feel any movement in his chest. I didn’t feel a heartbeat. Joe’s open eyes stared at nothing. I stood there for a long minute before I smoothed down his lids.
Nellie gripped her husband’s hand to her breast and sobbed softly.
I stood over her, my hand lightly on her shoulder. While I felt relief that Joe died peacefully with his wife by his side, each footfall by the door made my heart flip. What if one of the staff would walk in and find I had made a decision that wasn’t mine to make. “ I really need to leave, Nellie,” I whispered, taking Joe’s lifeless hand from hers and placing it by his side.
Tears slid down Nellie’s cheeks. She rose from the chair and embraced me. “Thank you,” she said, her voice cracking. I felt Nellie’s tears soaking into my shoulder as my own tears fell. Then Nellie pulled away and sat back down next to Joe, taking his hand again into her lap. I wiped the moisture off my face with the back of my hand, grabbed my things from the floor, cracked open the door, and glanced up and down the hallway. No one was around. Retrieving my coat and purse, I walked leisurely toward the exit leaving Nellie waiting for the evening nurse to discover Joe dead in the bed.
The floor was unusually quiet. The medication door was ajar in the nursing station. I had no intention of poking my head inside and saying so long to the evening nurse. Just a few more steps and I would be in the clear. As I turned the corner of the white tiled hallway, Charlie Hobbs’ presence blocked me. “Hi,” he said as if we were old friends. “I’m leaving. Can ya spare a buck for bus fare?”
Charlie had on a bright green jacket I was sure wasn’t his. Noticing my eyes on the jacket, he said, “Borrowed this from the guy in the next room. I’ll return it.” I nodded even though I knew the coat would never make it back to its owner. He shifted his feet nervously as he waited for my answer.
I wasn’t anxious to break any more rules but I was glad he was leaving. Why even try to entice him to stay? That would be hypocritical. I reached into my purse guessing he would head for the nearest tavern rather than the bus stop.
“Thanks,” he mumbled. Shoving the dollar bill into the pocket of the purloined jacket, he turned abruptly. In two long strides he disappeared though the doorway under the red exit sign and raced down the steps. I followed. A cold wind chilled my stocking legs as Charlie opened the door at the bottom of the stairs to the outside world. In his haste to escape he let the heavy door slam shut behind him.
I pushed the heavy door open with my shoulder. Unlike Charlie, I had no desire to announce my departure from the hospital by slamming the door. Leaving my covert actions behind me, I griped the handle with both hands and eased it closed.
The Closing the Door was a winner of the TulipTree’s Stories that Needto be Told Contest and is featured in their 2016 anthology: Stories that Need to be Told.
This is my 262nd Blog post. It’s a significant number for me. I spent the first twenty years of my life in a two-bedroom apartment in a three-story brick building in Jersey City, New Jersey: 262 Summit Avenue.
Most of the buildings on the block were three stories with an apartment on each floor. I could name everyone who lived on the block. Few people moved. Multigenerational families stayed in close proximity. My grandparents’ place was a two-block walk away.
We children couldn’t do anything wrong without a neighbor correcting us or telling our parents. In the summers we played outside until evening darkened the skies and the streetlights came on. In the colder weather, when the chill kept folks indoors, the older women sat by their windows as if afraid they would miss something.
Across the street, taking up most of the block, sat the massive New Jersey National Guard Armory. The National Guard soldiers came for weekend training. Blaring brass bands cut above the street traffic. It was only when I reached my teens that seeing all the young men in uniform kept me close to home.
In summers, the Armory hosted the Rodeo and big-name performers: Frank Sinatra and Jimmy Durante. My friends and I, probably around ten or eleven years old, had managed to sneak through a side door and wander around before the Rodeo started, watching the workers set up the stands for the audience and the pens for the animals. During the show, we edged up so close to the action that we could hear the cowboys’ grunts, as they desperately tried to stay on the backs of the bucking horses or angry bulls.
We listened to Frank Sinatra from the shadows along the walls. A spotlight followed his lanky body on the stage as he crooned into a microphone. We felt invincible.
In retrospect, it seemed easy for my friends and I to slip into the Armory. I don’t remember ever once getting kicked out. Perhaps the workers chose to look the other way.
My best friend, Carol, lived at one end of the block and I lived on the other. I’ve written about her in a post: Taking the Bus. We met when we were four or five years old, attended the same grammar school and high school. After she married, she and her husband moved to south Jersey. Two years later, I married. We moved to Newark, then near DC, making other moves until we eventually settled down in North Carolina.
After many years of exchanging Christmas cards, Carol and I now live 20 miles from one another. When we get together, we rehash our childhood memories on the 200 block of Summit Avenue. The city street that was the Village that raised us.
I came upon this post on KevinMD.com, written by a nurse. I am pleased that a physician has provided a vehicle for nurses to tell their stories and, in this case, share the heavy toll that working in a hospital setting can have on nurses.
Every time I hear that there is a nursing shortage in America, I feel myself cringe. There is not a shortage of nurses in America. There is a shortage of nurses who choose to work at the bedside. There is a reason, and it is called post-traumatic stress disorder.
Medically, we have learned that PTSD can occur after a single event or as a result of chronic stressors for a period of time. As a living organism, we know that the body can only sustain so much stress before it starts to break down. These ailments can be physical and/or mental. Sometimes they happen over a period of time, however often times we do not even realize the symptoms until they have forced us to take notice. As a nurse, I know when our bodies have had enough, and they need to rest, they will make us rest.
Bedside nursing is hard and very stressful. The bedside nurse is responsible for caring for multiple people every minute of every shift. That is, multiple sick and potentially dying people. The nurse is responsible for monitoring the patient’s response to treatment, the patient’s condition, the patient’s mental health, the doctor’s orders, assisting the patient with activities of daily living, and being there for the family.
Bedside nurses are the coordinators of care. We are the ones who make sure that all parts of the care plan are being carried out and that the system is working the best it can. We are the ones who comfort the patients when they need us the most.
We do not mind doing all of this. In fact, this is what we signed up for when we graduated from nursing school. We can handle these tasks if we have a partnership with the hospitals that we work for. This partnership all starts with the nursing grid. Each unit in a hospital has one. It is basically a chart that states how many patients each nurse should have. It is a chart that is supposed to indicate the safe number of patients that each nurse should be assigned every shift. It is a topic of heated discussion in the nursing world.
Normal patient-to-nurse ratios depend on the unit and the acuity of the patients. For instance, most nurses agree that in the intensive care unit (ICU) nurses should not be assigned more than two patients each. If a patient needs continuous dialysis or another procedure that needs to be monitored, then this ratio goes to 1:1. This is a common theme. If a nurse is assigned to a critical care unit or cardiac unit, then the patient to nurse ratio is acceptable and safe at 3:1. This means that each nurse on the unit should only have three patients. Acceptable medical-surgical unit ratios are usually either 4:1. This means that for every four patients, there should be a nurse. Another rule of safety is that there should never be only one nurse on a unit. Too many things can change quickly, and safety comes in numbers. Remember we are talking about human life.
When these basic rules are followed, then nurses and patients have better outcomes. Nurses stay at the bedside longer and patients do better overall. The problem that nurses are having is these basic safety numbers are not being followed, and we are burning out as a result. This has to change if we are going to keep our valuable nurses at the bedside. It has to change if people are going to receive the care they deserve when they are in the hospital.
Nursing salaries also need to be increased. Most nurses have their bachelors in nursing degree (BSN). Many hospitals require it as a condition of employment. A bachelor of nursing degree takes about five years, and the cost of the education starts at $50,000. Many nurses have to take out loans to pay for school. If we look at a 10-year repayment plan that does not include interest — a $50,000 loan means a monthly payment of $417.00.
I work in the Midwest. Our new nurses start at $22.00/hour. Some nurses earn a differential for working nights and weekends, too, although those shifts come with health and family costs. If we multiply $22.00/hour by the average 160 hours that most full-time people work each month, we end up with a gross monthly salary of $3,520. Most accountants say that taxes and benefits equal at least 30% of our pay. This means that on average, a new nurse can expect to bring home $2,464 a month. If we subtract the student loan payment, this means a new nurse will need to live off of a little over $2,000 a month. Trying to pay for housing, food, transportation, and utilities each month, forces many nurses to choose to work overtime.
Working 12-hour shifts are rough. In fact, 12-hour shifts often are 13-hour shifts, and many times, nurses do not get breaks. We want breaks, we do! They just become impossible with the increased patient loads and the increase in patient illness that we see. If a nurse somehow gets to leave to go on break, the relieving nurse needs to assume the responsibility for double the patients for the period of time. If that nurse is already having a hard time staying afloat of the assigned tasks at hand, then giving this nurse more responsibility doesn’t make sense. Bedside nurses are tired.
We also are often asked to float to other areas of the hospital — without training. Yes, I learned about basic orthopedics in nursing school; however as a neurology nurse, my knowledge of repairing bones is limited. Nurses should never be asked to float to another unit of a hospital unless they receive adequate training. This is a matter of safety. No other professional business would do this. A payroll accountant would never be asked to float to the sales department. A salesperson would never be asked to work as an architect. A cardiologist would not be asked to fill in for a neurologist. It just isn’t done. Why do nurses have to risk their licenses to do this? It is not safe patient practice.
We get scared.
When nurses have all of these stressors constantly, they may not even realize that they are having symptoms of chronic stress that can lead to PTSD. It sneaks up on us as we are caring for our patients. We learn to compartmentalize the constant stress and emotions that we feel, as we chalk them up as “another part of the job.” We suppress them, until one day, all of a sudden, the compartment opens, and we find ourselves overrun with anxiety and depression. We find ourselves having flashbacks, feeling guilty and having trouble sleeping. We begin to doubt our ability to be a nurse. We begin to question everything. We find ourselves unable to work, at least at the bedside at least until we heal, maybe never again.
Nurses need support from our hospitals, our government officials and our communities. We need regulated patient ratios and increased pay. Hospitals need to stop floating us to other units unless we are trained in that area of nursing. We need classes on caring for ourselves, and we need to take advantage of employee-assistance programs that offer free, confidential counseling. We need hospital-provided exercise rooms. We need to learn coping skills. We need to be able to process all of the emotions that we feel that have always been discarded as, “part of the job.” We need to talk about our issues, and we need to feel like we are being heard. We need to heal.
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
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.
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.”
“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.”