Leaving Our Legacy

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

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

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

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

 

 

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

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

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

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

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

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

 

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Getting on the Bus

This post appeared in two parts on September 8 & 20, 2013.

 

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

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

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

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

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

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

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

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

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

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

Cabo de Roca

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.

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.”

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 and the monitor gave off a high-pitched sound and began taping. As instructed, I lay still. When the whining stopped, I stumbled out of the bedroom 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 didn’t tell me to go directly to the hospital, as happened with my friend, Norm, after his first submittal. He was sent to the emergency room immediately. A pacemaker was implanted in his chest the next day.

I reassured my husband, who woke up during the taping and trailed 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 fear of the monitor beeping at inappropriate times during the day. Or most of all, the constant state of 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 that’s not life threatening. 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.

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Nurses of a Certain Age

Excepted from Off the Charts, May 31, 2017

 

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

by Betsy Todd, MPH, RN, CIC 

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

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

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

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

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

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

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

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

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

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

Back Rub

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My Book Comes to Life

This past weekend I traveled to Chicago to attend the celebration of the 60th anniversary of the clinic where I worked 30 years ago. The clinic sets the stage for my memoir: Playing Sheriff: A Nurse Practitioner’s Story. The formal function on Friday had 500 in attendance but it was to the intimate and informal Alumni Luncheon on Saturday that I brought a prepared presentation: a short intro and a modified chapter to read during open mike.

I write, as writers do, in isolation. Over the years, my book gradually disconnected from the reality that spurred its inception. At the luncheon, when I stood in front of the room with microphone in hand, I realized this was not a time or place for a formal reading. The tightness in my throat surprised me. Here among the alumni were those who worked with me back 30 years ago at a clinic that defied the establishment by using nurse practitioners and midwives as primary providers and hiring doctors who supported the nurses by ignoring their ultra-egos and espousing the team approach.

I decided last minute to tell the story of the Pigeon Lady. Characters who peopled my book morphed into living, breathing individuals sitting at the tables before me, nodding in agreement about the series of events I described because they were there. At that moment, my book came to life.

 

More on Nurses Week

I am reblogging this post from Lippincott Solutions. My non-nursing followers can read about the history of Nurses Week and the writers among us will be happy to see that Lippincott is asking for “Inspired Nursing Stories” for their annual writing contest.
Calling the Shots: Nursing News and Notes

CELEBRATE NATIONAL NURSES WEEK 2017

Tuesday, May 2, 2017
Mind, Body, and Spirit: celebrating nurses who lead the charge for health and wellness.

Are you ready for National Nurses Week 2017?

Honoring nurses for your hard work and dedication throughout the year, the American Nurses Association (ANA) will be celebrating its annual National Nurses Week from May 6-12, 2017.

ANA’s National Nurses Week 2017 theme — “Nursing: the Balance of Mind, Body, and Spirit” — celebrates nurses who lead the charge for health and wellness in their practice and profession. ANA has designated 2017 as the “Year of the Healthy Nurse.”

HISTORY OF NURSES WEEK

The ANA supports and encourages National Nurses Week recognition programs through the state and district nurses associations, other specialty nursing organizations, educational facilities, and independent health care companies and institutions.

Each of ANA’s state and territorial nurses associations promote the nursing profession at the state and regional levels. Each conducts celebrations on these dates to recognize the contributions that nurses and nursing make to the community.

National Nurses Week runs each year from May 6 to 12, ending on Florence Nightingale’s birthday. These permanent dates enhance planning and position National Nurses Week as an established recognition event. As of 1998, May 8 was designated as National Student Nurses Day, to be celebrated annually. And as of 2003, National School Nurse Day is celebrated on the Wednesday within National Nurses Week each year.

Nightingale, who lived from 1820-1910, was known as the founder of professional nursing, especially due to her pioneering work during the Crimean War. Due to her habit of making rounds at night, Nightingale became known as “The Lady with the Lamp.” National Nurses Week was first observed in 1954, the 100th anniversary of her mission to Crimea.

CELEBRATION PLANS

During National Nurses Week, celebrations and receptions will be held in hospitals and other healthcare facilities across the country.

ANA’s National Nurses Week Toolkit is a useful resource that provides you with additional ways to recognize nurses for their professional skills and abilities. For example, show your gratitude with a branded “Thank You Card.” Give every nurse a certificate of appreciation or hang display banners throughout the office. The National Nurses Week toolkit has plenty of ideas to plan a great celebration.

Nurses are encouraged to sign up for ANA’s free webinar, “A Nurse’s Guide to Preventing Compassion Fatigue, Moral Distress, and Burnout” on May 10 at 1:00 EST. During this one hour exclusive live event, Joyce A. Batcheller, DNP, RN, NEA-BC, FAAN, will discuss the latest research in the field and provide you with tools and strategies to infuse meaning, joy, and restoration into your practice and life. Batcheller is senior vice president and CNO of the Seton Healthcare Family, the largest health care system in Central Texas.

After attending, nurses will be able to:

  • Reduce the physical and emotional consequences of morally complex situations.
  • Build confidence in confronting morally complex situations to reduce moral distress and burnout.
  • Harness expert tips and strategies to build resilient teams.
  • Use current research to prevent and combat compassion fatigue.
  • Apply tools and strategies to recognize and overcome compassion fatigue.

PAYING IT FORWARD 

Once again this year, we are holding our annual ‘Inspired Nursing Stories’ writing contest.  What are your most memorable moments in nursing?  Have you had any poignant moments with patients and their families?  A mentor or preceptor that helped shape you into the nurse you are today?  Or was it a family member that helped you realize your calling to nursing at a young age?

Nurses, we want YOUR story!  The winning entry will receive a FitBit Alta, and the 1st and 2nd runners-up will receive gift cards. All of the top 12 stories will be featured in our 2018 Inspired Nurses: The Heroes of Healthcare glossy print calendars.

Click HERE to submit and help to ‘pay it forward’ by allowing other nurses to share in what keeps your nursing engine firing! You can also browse through some of our best stories from previous years to get your own ‘dose’ of nursing inspiration.

How are you planning to celebrate National Nurses Week? For all the official details from ANA, go to www.nursingworld.org/NationalNursesWeek.

Thanks SO much for all that you do, and best wishes for a terrific National Nurses Week!

Netflix Show Gets Aging Right

I am thrilled that the third season of Netflix’s Grace and Frankie is finally here. As one of the first gerontological nurse practitioners to be certified by the ANA back in the 60s and now a 70-something woman, I am depressed that the very same stereotyping and dismissal of the aged I first encountered is still happening.

I came across this article by Ann Brenoff who says, “Season 3 of the Netflix series gets a lot right—and it’s funny.”

Read what Brenoff says about the series and how Grace and Frankie attack the entrenched biases that are reflected by laws, business opportunities and interpersonal relationships in our social networks, including family.

Grace and Frankie

LIFESTYLE 

03/30/2017 03:37 pm ET

‘Grace And Frankie’ Totally Nails What It Means To Be Getting Older

Season 3 of the Netflix series gets a lot right — and it’s funny.

By Ann Brenoff

The Netflix original series “Grace and Frankie” came back with a vengeance for its third season. The story of two 70-something women who become unlikely friends after their husbands announce they are in love totally nails the aging experience in Season 3.

Here’s what it gets pitch-perfect. Of course, beware of spoilers.

  1. Banks don’t take older women seriously.

Grace (Jane Fonda) has a solid track record of launching and managing a successful business, but to the baby-faced banker named Derrick who she and Frankie (Lily Tomlin) approach for a 10-year, $75,000 business loan, she is unworthy.

Actually, it was probably a combination of their gender, their ages, and the fact that the product they want to sell is a lightweight vibrator for women who have arthritic hands. The very idea of older people having sex has been known to gross out some younger people. Note that Derrick closes his office door at the first mention of the vibrator.

As for age and sex discrimination, banks are regulated by the Equal Credit Opportunity Act, which prohibits discrimination on many fronts, including age and sex. But this is one of those cases where there is the law, and then there is the reality. The law does not require banks to make bad loans.

Banks live in fear of the four D’s: death, disability, divorce and drugs. That’s because the four D’s can lead to a fifth D: default. While things can happen to all borrowers, death and disability happen to older borrowers more often.

Plus, older business borrowers aren’t great guarantors ― especially if, like Grace, they’ve been successful and are smart. Successful, smart people generally know to tie up their assets in retirement plans or trusts, which creditors can’t touch. If the borrowers die or are disabled, the bank is left dealing with heirs, who know nothing about the borrowers’ business.

So it was no surprise that the banker Derrick blanched at the idea of making a 10-year loan to Grace and Frankie, who are both north of 70. Derrick was probably wondering whether they would survive long enough to repay the loan. Even the well-regarded Ewing Marion Kauffman Foundation’s Index of Entrepreneurial Activity ― the bible for tracking trends in entrepreneurship ― stops counting at age 64.

Maybe the Small Business Administration needs to realize that people are living longer and healthier, and sometimes our second chapters could use some underwriting ― even when we start them a bit later.

  1. Dealing with the death of a parent is hard, especially one we didn’t much like.

Sometimes, we don’t succeed in resolving our issues with our parents before death slams shut the window of opportunity. Martin Sheen’s character, Robert, visits his elderly and very disagreeable mother to tell her that he has married Sol, the man she previously referred to as “the loud, tall Jew at the law firm.”

From her wheelchair in a well-appointed nursing home, she reacts with predictable disapproval, leaving Robert visibly crushed. The scene scores an additional point for realistic aging: Some of us never stop seeking parental approval, regardless of our age.

Without anything resembling kindness, the “Irish Voldemort” ― as Robert’s spouse Sol calls the tyrant mother ― attacks her son as a “selfish man.”

“I could have happily died never knowing that you were one of them,” she adds.

Caregiving is a tough and unreasonable job if there ever was one. And it frequently involves caring for a disagreeable parent ― even a parent who has harmed us and with whom we have a strained relationship. And then they die, leaving us wondering what else we could have done.

  1. We are scared of the R-word.

Retirement is a mixed bag of worries. Can we afford it? What will we do all day? Will we be bored?

Robert has retired and wants Sol to, as well. Sol insists he must still go into the office at least three days a week to “help Bud” run the law firm. It isn’t until Sol attempts to fire his quirky longtime secretary, Joan-Margaret, that he realizes it’s time for him to hang up his law shingle as well ― not because he’s ready to retire, but because Bud and the law firm need him to.

Most experts believe that solid retirement planning includes knowing how you will fill your days. The Institute of Economic Affairs, a London-based think tank, says that following an initial boost in health, retirement increases your risk of clinical depression by 40 percent, while raising your chance of being diagnosed with a physical condition by 60 percent. Lisa Berkman, a Harvard professor of public policy, cites social isolation as a significant factor in longevity. If you’re socially isolated, you may experience poorer health and a shorter lifespan.

  1. We don’t want to be a burden to our children.

Grace’s daughter, Brianna, in cahoots with Frankie, loans the business the money it needs. But she loses her status as secret benefactor a few episodes later, and Grace is enraged. “I don’t want my children’s help,” she says.

Not wanting your children’s help is a precursor to not wanting to be a burden. Same idea, and it’s real. Taking help from those who you are used to taking care of feels demeaning. If the parent-child roles haven’t legitimately reversed yet, don’t be like Brianna.

  1. Just because we are older doesn’t mean we are old.

After both women throw out their backs and can’t get off the floor, Bud gifts them high-tech wearable alert buttons that hang on a chain around the neck. Grace removes one of her high heels to smash the device. Frankie, who has an outlandish outfit that she says it will go with, wears hers to a business meeting, where she inadvertently activates it and alerts an ambulance to rescue her.

It’s a funny schtick, and both actresses pull off the comedy magnificently. But it also rings true when it comes to how adult children see older people. Can we please hold off on the Granny-cam?

  1. All marketing is geared toward youth and sex.

Vybrant’s proposed new business partner hopes to woo Grace and Frankie with a peek at a proposed ad campaign. It features photos of the two of them ― but when they were 20 years younger. Yes, even a product designed for older women is afraid to show them.

Grace and Frankie hold their ground.

About 10,000 people a day turn 65. And pretty soon, there will be more older people than younger ones. More to the point: Boomers have more disposable income than any other generation, but they still can’t even find a box of hair coloring where the model even remotely looks like them.

According to a Nielsen study, by the end of 2017, boomers will control 70 percent of the country’s disposable income. Nearly 60 percent of homeowners over 65 are not weighed down by mortgages, compared with just 11 percent of 35- to 44-year-olds. And boomers account for 80 percent of America’s luxury travel spending, says AARP.

  1. Yeah, some of us do still actually chase our dreams ― and occasionally catch them.Frankie’s art show opening may not have been a rousing financial success, but she rightfully deserves the victory lap she takes for having done it. And kudos to her for giving away the yellow painting that represented Sol’s dislike for mustard. Let bygones be bygones.

Chasing your dreams is something you hear a lot about when you reach the end of your working years. Second chapters, next acts ― whatever you want to call it ― it means following your passions and making the time to do whatever it is you want to do, which for us is finishing watching Season 3.

Don’t Question the Doctor Part 2

I posted last week about my friend Lois’ run in with a nasty doctor soon after she graduated nursing school in the 60s.

Here is my story about working with a difficult physician that took place in the mid 80s.

The medical director, Doctor X, sat me down in her office on my first day as a nurse practitioner in a home care program at a large VA Medical Center and said, “When the doctor and nurse disagree, the doctor WINS.” She repeated this twice with a glare to discourage whatever protest I might be considering.

I can still see her fleshy face framed by cropped curly hair and a white lab coat stretching over her heavy shoulders. We sat in two chairs in her warm office facing each other without a desk between us. Did she know something about me that prompted this confrontation? Or was she always so caustic with nurse practitioners? She was a rising star in the organization. I didn’t expect this intimidating behavior.

I nodded my head as if I agreed with her dictum. What good would it do to argue since I hadn’t a clue what kind of disagreement we would have? What could happen in a health care setting that would be black or white, right or wrong, a doctor wins and a nurse loses?

What reassured me that Dr. X and I might never have a run in was that I would have autonomy when I made home visits. And I would call another doctor on the team if I needed advice, not the medical director.

One day, while visiting a patient his wife stated, casually, that Dr. X had stopped by on her way home from work. She felt flattered that the medical director would take the time to see how she and her husband were doing. What reason did Dr. X have to visit and not tell me? Not wanting to involve the patient’s wife in a conspiratorial alliance, I smiled and said nothing.

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Dr. X visited a second patient. The scenario was the same: wife mentions the visit, I smile and say nothing. An uncomfortable sense of being under surveillance hounded me. What was Dr. X looking for?

Shortly after, Dr. X was promoted to a leadership position and left the home care program. There was no fallout from her clandestine visits to my patients. Would there have been if she stayed with the home care program and continued her unorthodox conduct?

I am grateful that I didn’t need to confront her—for surely I would lose.

Unsolved Mystery?

Visiting my good friend, Lois Roelofs, in her new home in Sioux Falls. Hope you enjoy this post from the past.
Check out Lois’ blog, https://loisroelofs.com/2016/09/05/cartwheels-in-my-living-room/

Nursing Stories

This happened long ago. I worked for a hospital-based home care program. We, nurse practitioners, received referrals from physicians who had exhausted all options to prolong the patients’ life. We visited the patient in his home and helped the family care for him until death. Traditional hospice services were not an option as yet.

My patient was in his 60’s or 70’s and had a ditzy wife. Just like Edith Bunker on the old All in the Family T.V. show. She looked like Edith with dark hair, a whiney voice and hands that kept flying in the air as she talked. Edith and I sat in the corner of the living room with its high ceilings, dark woodwork and antiquated furnishings talking about her husband. I think he had lung cancer. I can see him wandering around in the turn-of-the-century apartment, seemingly unaware of his wife and me. While Edith…

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