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.”

Learning to Heal

I’ve long been a proponent of nurses writing their stories to educate the general public about what we really do. Here’s a book: Learning to Heal: Reflections on Nursing School in Poetry and Prosethat does that and more.

The essays, from seasoned nurses as well as recent grads and “respected elders,” are set in the United States and abroad and show the history, rigors, challenges, humor, and sadness that alternate during the nursing school experience. Not every author in this collection makes it to graduation.

The prerequisite of nursing—compassion, empathy, and psychological support—threads through the stories. The reader will learn the depth of the nurse-patient/family connection. This connection becomes ingrained in the nurses’ psyche as evidenced by Courtney Davis’ Wednesday’s Child. Her story mirrors my Baby in the Closet. She, too, wrote about a newborn with a deformity who was left to die in a linen closet. Courtney, like me, carried the fate of the baby along with unanswered questions for almost 50 years!

Never a specialty I wanted to practice, psychiatric nursing demands a special temperament.  Poetry especially captures the depths of human understanding needed to make a difference.

. . . Come to my group, my plea, as I knelt offering

filtered cigarettes as free admission tickets.

In an empty silence, we sat on single beds, arranged

in a square, in a room as cavernous as an airplane hangar.

What was my hurry? Most had lived there twenty years.

Hardly a word dropped into the atmosphere.

—Ward 24, Nancy Kerrigan

I associated with Geraldine Gorman’s Learning the Wisdom of Tea, who takes us though her education from a diploma nurse to a PhD. I, too, wondered where were the “(f)irst person accounts of interactions of patients and family . . .”  Where were the nursing stories? And I, too, questioned the authoritative methods of instructors in nursing academia. And I, too, felt fortunate to find a career path that allowed me to “practice outside the hospital.” My “wisdom of tea” began at the kitchen tables of my patients when I visited their homes as a guest, learning that I needed to obtain their cooperation in order to institute a treatment plan.

The stories and poems in this anthology are varied, educational, entertaining, and poignant. Whether the reader is a nurse or not, all will learn that nursing has come a long way as Learning to Heal stories excellently show.

From Disengagement to Balance: The Journey to Positive Aging

 

Many of you reading this are not old enough to remember the disengagement theory. When I started out in gerontology in the 80s this was one of three theories of aging I learned about, and the most depressing.

The disengagement theory of aging states that “aging is an inevitable, mutual withdrawal or disengagement, resulting in decreased interaction between the aging person and others in the social system he belongs to”.[1]The theory claims that it is natural and acceptable for older adults to withdraw from society.[2]. . .

Disengagement theory was formulated by Cumming and Henry in 1961 in the book Growing Old, and it was the first theory of aging that social scientists developed.[5]Thus, this theory has historical significance in gerontology. Since then, it has faced strong criticism since the theory was proposed as innate, universal, and unidirectional.[6](Wikipedia)

Thank goodness there were two other theories that challenged disengagement theory: the activity theory and the continuity theory.

I mention the disengagement theory to show how negative attitudes surrounded the elderly from the inception of geriatrics as a medical specialty and how far we have come in understanding the aging process, which, of course, is not a-one-size-fits-all.

It’s been over 50 years since the disengagement theory first described aging. I am witness to the evolution of a more realistic description of the multifaceted components of growing old. I try to blog about uplifting examples of the latter stages of our lives.

Two weeks ago, I spoke about one of my favorite TV shows, Grace and Frankie,women in their 70s (at least when the show started), who are depicted in a positive light. Both are strong, independent, smart, creative and refuse to wear the stereotypical label of “old woman.” The show’s popularity delights me because I can envision an audience that not only enjoys the antics of the women but perhaps is learning that the inevitable losses of growing older are intertwined with pleasurable gains.

Then last week I re-blogged my friend Lois’ post about turning 77 after her husband’s recent death. Another positive take on aging even in the face of loss and grief. She closes her post with this observation: “I thank God for the countless blessings I experienced during this first birthday week of my solo life; there’s more fun to share . . .”

With this week’s post, I’m including a New York Times article about women in their 70s. Is it just me or have you also noticed that older women are getting more positive exposure?

Mary Pipher writes, “We (women in their 70s) can be kinder to ourselves as well as more honest and authentic. Our people-pleasing selves soften their voices and our true selves speak more loudly and more often. We don’t need to pretend to ourselves and others that we don’t have needs. We can say no to anything we don’t want to do. We can listen to our hearts and act in our own best interest. We are less angst-filled and more content, less driven and more able to live in the moment with all its lovely possibilities.” Mary Pipher, “The Joy of Being a Woman in Her 70s,”New York Times, 13 January. 2019: 10.

Pipher’s book, “Women Rowing North: Navigating Life’s Currents and Flourishing as We Age.” is now out in print. I intended to buy a copy.

 

 

 

THE CHOICE

This was published in September 2018 in The Olli Writers Group Anthology

anthology 

On our first night in a hotel room in Estoril, Portugal, the thumping in my chest jolted me awake. Still groggy from jet lag, I tried to go back to sleep but the pounding demanded attention. I pressed my hand over my heart, feeling what seemed like a bird batting its wings to escape my ribcage.

Besides a touch of anxiety, I felt fine. No chest pain, no shortness of breath, no dizziness, no nausea. Then my bladder chimed in, upstaging my clinical observations.

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

Successfully back in bed without tripping, falling, or fainting, I couldn’t help but let the jet lag overtake any further analysis.

The next morning, I awoke to the same sensation in my chest. More alert than the night before, I diagnosed the uneven heartbeat as atrial fibrillation. A geriatric nurse practitioner until my retirement three years ago, I had treated many patients with this condition—its occurrence increases with age. A fact I couldn’t ignore. A-Fib, as it’s called, isn’t life threatening and often stops on its own.

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

Getting ready for the day’s adventure, my husband slipped a sweater over his head as I laced my shoes. “By the way,” I said, trying to sound causal, “I’m having a little irregular heart beat. It’s nothing serious and I suspect it’ll end on its own. I just want you to know, that if by chance I pass out, get the tour director to call an ambulance and tell the medical folks what’s wrong with me—A-Fib.” Before my husband could become worried, I added, “I’m sure I’ll be fine.”

My husband of forty years trusted me, the knowledgeable nurse, to accurately assess my situation, and nodded. I figured he would be happy to be spared an interruption in our itinerary.

We rode the elevator down to the lobby, queued up with our tour group, and boarded the bus to Cabo de Roca. I grabbed a window seat. The vibrant, coastal city gave way to dry grasses clinging to rocky cliffs. I slid down in my seat and discretely put my fingers to my neck, checking my carotid pulse. The irregular rhythm ticked off around one hundred beats per minute. Not too rapid to worry me—yet.

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

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

I stepped off the bus last. I felt something strange. Or, rather, I felt nothing. Had my heart stopped? No, it just felt that way with the fluttering finally gone. My chest was silent. My pulse was regular. The air smelled cool and crisp. Released from potential calamity, I dashed off to find my husband. No further health alarms marred the remainder of the trip.

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

One night during the first week, after I wrestled with the monitor to find a comfortable position in bed, I settled into sleep. My heart, booming loudly in my ears, jarred me awake. I pressed the record button. The monitor gave off a high-pitched sound and began taping. As instructed, I lay still. When the whining stopped, I stumbled into the kitchen to call the toll-free phone number.

The nurse talked me though the process of sending the recording across the phone lines. I hung up, relieved that she hadn’t told me to go directly to the hospital, as had happened with my friend, Norm, after his first submittal. “Get to the emergency room, NOW,” the nurse told him. The next day, a cardiologist installed a pacemaker in his chest.

I reassured my husband, who woke up during the taping and rushed after me, concern covering his face. We ambled back to bed—him to sleep and me to await any further malfunctioning of my heart.

Three weeks later, I mailed the monitor, wire, attachments, and unused batteries back to the company. I wouldn’t miss the nightly struggle to sleep with a rigid box digging into my ribs. Or the monitor’s beeping at inappropriate times during the day. Or most of all, the constant surveillance for any twitch in my chest.

The only two episodes I had during the month were not atrial fibrillation but sinus tachycardia: a regular, rapid heart rate, usually benign. Wearing the monitor for a month seemed too much of an inconvenience for such a paltry yield.

No doubt there will be other assaults to my aging body, mildly annoying or life threatening. The trick is to know the difference: whether to stay back and seek medical care or take a chance and get on the bus.

 

The Building as Character

 

COUNTDOWN TO PUBLICATION DATE: THREE WEEKS

This past week I promoted my book.

Monday, after a class I attended on public speaking, I collared a woman who had also attended the lecture as she exited the ladies room. “How will you use the information?” I asked. She told me she had planned to start a class for widows on ways to rebuild their lives. Then in the course of our conversation, she told me she belonged to one of the oldest book clubs—meeting over 100 years. Maybe, I said, you would want to discuss my book and I handed her one of my business cards.

Tuesday, I spent the day at a retreat for my hospital volunteer group. The facilitator was a nurse whose office was located in Chicago. Didn’t I write my book about a clinic I ran in Chicago? And am I not scheduled to give a talk at that clinic early next year? And don’t I need to schedule some more speaking engagements to make that trip worthwhile? So I approached her during a break and asked if she would she be amenable to helping me figure out what venues in Chicago that might be possible?

Wednesday, I spoke with a nurse who organizes the Jersey City Medical Center Alumni Association. Jersey City is my hometown and my first job after graduation was at the JCMC. I accepted an invitation to speak at their 2019 spring luncheon.

Thursday, I happened to be a hospital gift shop. I approached the woman who buys the merchandise and offered my book. I’m still working on that connection.

Friday, I attended the NC State Fair with my longtime friend, Carol.  We met in the second grade at Saint Aedans School in Jersey City, and reconnected when she moved to North Carolina 15 years ago. Carol is in my book. The day before, postcard-size cards advertising my book had arrived in the mail, so I gave her a handful to distribute to her Bunko friends and dropped off the rest at strategic places at the Fair.

IMG_1629

Saturday, again laden with my postcards, I handed some of them over to a friend at lunch. She, too, is a writer and supportive of my book selling efforts.

After lunch, I drove to my monthly writing workshop. I passed the cards out to the women who have heard many versions of my stories over the years.

It is not lost on me that I am fortunate to have a group of friends that encourage, support and believe in me and my story.

On Sunday, I rested.

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

411isrlw3gl-_ac_us320_ql65_

 

 

A Day in the Emergency Room for a Nurse Who Loves Her Job

Reblogged from Off the Charts, August 16, 2018 by Tarra Midgette, RN, is a nurse in an emergency department in North Carolina.

I love this post and wanted to share it with you because Tarra Midgette so poignantly describes her inner thoughts and feelings as she goes about her not routine day in an ED. No one has to guess how hard it is to be a nurse after reading her story.

Another day begins.

Nursing shoes, always left in the car It’s hard to explain how I feel after yesterday . . .

I wake up and head to work with a smile. I’m wearing my normal attire, blue scrubs. The color is rather ironic. I put my shoes on in the car like always. The shoes never go inside, as they bear remnants of the day before.

I walk in to meet my tribe. We laugh off the previous day’s challenges as we start over. Patients come in and are greeted with the warm Southern welcome of this community emergency room. Coughs, chest pain, leg injuries, moms, dads, babies, grandmas. A patient with my story who is fighting battles that I fought years ago. My heart aches. I give her hope. She is optimistic. I’m soaring, feeling high on life.

A girl who lost a baby. My heart aches. Why does this happen? What do I say? How do I comfort her? I pray for her. I make a funny joke, at which she has a two-second reprieve from grief and we share a laugh. I feel peace.

A boy is vomiting and writhing in pain. He is scared as he gets his first IV. It’s in and he’s proud of himself for not crying. The medicine works. He is discharged and can’t wait to go play video games with his friend. I give him a hard time; we laugh together.

In comes a child with mental health concerns. He wants to die. He is searching the room for potential weapons. He is overstimulated and needs to decompress. He tries to choke himself with a bed cord. He cries. I cry. I go to the bathroom and pray.

There’s a code coming in? Lines, compressions, CT, return of patient’s pulse! No pulse. Resume compressions, pulse check, nothing. Last round of CPR, pulse check, “I have a pulse,“ pulseless V-tach, resume compressions. Time of death. I’m tired and out of breath. I feel defeated , , ,

New patient. I must smile and pretend that today is a good day. Many emotions at the end of a shift.

I drive home and can’t unsee what has happened today. I pray, I am confused, I am proud, I am sad, I am overwhelmed. I leave my shoes in the car, the blue scrubs in the laundry, and I shower to wash away today’s pain. Tomorrow I will wake up and head to work with a smile because I love being a nurse.

Marv Roelofs and Apple Sauce

Making applesauce sort of represents living life to the fullest. I think prayer is sometimes about asking God to let us do what we can and enjoy ourselves. Picking apples and making applesauce has made me do that.

—Marv Roelofs

 

I called Marv soon after he received the diagnosis of Stage IV Small Cell Lung Cancer this past January. I don’t recall if I have ever called him in all the 40 plus years his wife, Lois, and I have been friends. Now in the past few months, I had called him twice.

 

After his diagnosis there was a sense of urgency. The doctors had told him the cancer was very aggressive so when Marv declined treatment, I figured I better talk to him right away. How long would he be around? I needed to tell him how I appreciated his encouragement and support of my friendship with Lois.

 

Lois and I met in Chicago. Two nurses with two young children each: a boy and a girl, and both ready to break out of the stay-at-home-mom mode. Together, in the late 70s and early 80s, we completed undergraduate and graduate nursing degrees. In 1992 I moved from Chicago.

 

We didn’t need to get permission from our husbands to spend time away from home or to spend money on plane tickets when we rendezvoused over the years. But it was Marv’s encouragement and support of our long-distance friendship and warm reception and hospitality during my visits that I wanted to acknowledge. Since Lois didn’t cook, or wash dishes for that matter, it was Marv who made the dinners, baked the banana bread, and served Lois and I as we continued deep into our conversation—as women are inclined to do.

 

That phone call melted into tears for both of us. Maybe the rawness of Marv’s diagnosis and the awareness of impending death were too close to the surface. I was glad I had called to say thank you.

 

After that first phone call and when Marv didn’t die in a matter of days or weeks as the doctors had suggested, I called him a second time. It was about six months after the first phone call. He had written a book of his life and made fifty-five copies to pass along to family and friends. I read it almost all in one evening. I knew some of Marv’s stories already, but his life on the farm and the details of his self-started business was new to me. I was especially taken with the way he wrote—as if we were sitting in his living room in Sioux Falls, or back in Chicago, just sharing his recollections.

 

That second phone call was more uplifting. We laughed more. Cried less. I told him how much I liked the book, especially the story about him making applesauce.

The first Fall after Marv and Lois moved from Chicago to Sioux Falls, he noticed that many people didn’t pick the apples from their trees. The apples just fell and rotted on the ground. He knocked on doors asking to harvest the apples, not for profit, but to donate them to the homeless and churches, and to make applesauce.

 

It was right around apple picking season that I visited Lois and Marv in Sioux Falls. With a refrigerator and freezer stuffed with applesauce in zip-lock bags, Marv sent Lois and me into the neighborhood to give away the first samplings of his culinary concoction to neighbors that Marv and Lois had barely met. The friendly neighbors graciously accepted our offering.

 

Marv was a successful business person, a loving husband, dad, and grandfather. Like all of us he was also a complicated human. But it was Marv, the person who picked the apples and made applesauce, whose memory is the warmest in my heart.

 

Marv died at 4:10 a.m. on July 25.

 

Lois’ Blog “Write along with me” chronicles their journey with a terminal illness.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

My Book is on Amazon

Stories from the Tenth-Floor Clinic: A Nurse Practitioner Remembers 

Paperback – November 6, 2018

by Marianna Crane (Author)

Running a clinic for seniors requires a lot more than simply providing medical care. In Stories from the Tenth-Floor Clinic, Marianna Crane chases out scam artists and abusive adult children, plans a funeral, signs her own name to social security checks, and butts heads with her staff―two spirited older women who are more well-intentioned than professional―even as she deals with a difficult situation at home, where the tempestuous relationship with her own mother is deteriorating further than ever before. Eventually, however, Crane maneuvers her mother out of her household and into an apartment of her own―but only after a power struggle and no small amount of guilt―and she finally begins to learn from her older staff and her patients how to juggle traditional health care with unconventional actions to meet the complex needs of a frail and underserved elderly population.

 

Review

“Marianna Crane writes with compassion and insight about what it’s like to serve on the front lines of the medical profession―treating the most vulnerable among us. Her vivid account is moving and enlightening, a valuable contribution to the literature of social justice.”
―Philip Gerard, Professor, Department of Creative Writing, University of North Carolina, and author of The Art of Creative Research

“Nurse practitioners are well known for their willingness to be primary care providers for the ‘underserved’―those people who are waking bundles of multiple chronic and acute illness and myriad ‘social determinants’ of poor housing, little income, and almost no family or friends to call a support system. Society prefers that such patients remain invisible, because acknowledging their existence is too unsettling. It is my fervent hope that Stories from the Tenth-Floor Clinic will find a wide audience of readers who are willing to meet and care about the people nurse practitioners allow into their lives every day.”
―Marie Lindsey, PhD, FNP, health care consultant and founding member and first president of the Illinois Society for Advanced Practice Nurse

 

About the Author

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.

 

Note: Still waiting for the cover to be designed.

%d bloggers like this: