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

By Marianna Crane

ISBN 978-1-63152-445-5, 5 1⁄2” x 8 1⁄2”; Trade paperback; 212 pages; $16.95 U.S. Publication date November 6, 2018

Excerpt from the Memoir: The slap of bare feet on linoleum caught my attention before a tall, wild-haired man in boxer shorts and sleeveless undershirt appeared in the doorway.

Dropping my pen on the desk, I shoved the chair back, ready to bolt from the room— except that he blocked the way, breathing heavily, and leaning against the door jam. He wasn’t angry. He wasn’t carrying a weapon. He looked so unsteady that I probably could have pushed him over with one hand. My surging adrenalin began to subside. After all, this was a clinic.

“What can I do for you?”

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Finalist 2020

Marianna Crane loved her job working in one of the country’s first programs in gerontology. She felt a connection to her patients and valued her role in their care. But when she herself was not valued for her work, Crane decided to make a change and accepted a position coordinating a clinic that cared for poor, underserved elderly and which was located on the tenth floor of a Chicago Housing high-rise.

Crane knew how to be a nurse, but what she didn’t know, and what her memoir so movingly recounts, is how much beyond her role as a nurse practitioner was required to assist older patients. She found herself planning a funeral, exposing relatives preying on the vulnerable, and hauling a mattress up the elevator. Also, she learned to offer medical care in people’s apartments even when people would not seek it —because care was needed. Most importantly, she learned how significant teamwork is in working with this population.

Mary Moore McLean Photography

In Stories from the Tenth-Floor Clinic: A Nurse Practitioner Remembers, Crane offers readers a compassionate and insightful look into the world of nursing but even more so, she offers readers stories about endearing people, stories that remind us all what it means to human.

Long an advocate for the importance for recognizing the invaluable work nurses perform, Crane uses her memoir to give readers a greater understanding of what nurses/nurse practitioners do each day, a perspective that she hopes will increase understanding of the nursing profession.

MARIANNA CRANE became one of the first gerontological nurse practitioners in the early 1980s. A nurse for more than 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.


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Speaking with Marianna Crane

1. Why did you write this memoir?

I began to journal in the 1980s after I became a nurse practitioner and started to work in gerontology. The increased responsibility and the complex needs of my elderly patients challenged me. Writing down my nursing stories eased my anxiety.

When I retired, I began to write in earnest. While I sorted through the stories I collected, I realized that one of my jobs, coordinator of the senior clinic in a Chicago housing high rise, offered the greatest concentration of colorful characters, unique situations, and challenging scenarios. By the time I sifted through my memories, contacted some of my co-workers, and reread my journals, the senior clinic stories became a book.

2. What do you hope readers take away after reading your book?

My book describes a nurse practitioner’s broad scope of practice in a non-traditional health care setting and the effects that a diverse health care team can have on patient outcomes. It also touches on the restraints to nursing practice by the medical establishment during the time period of the story and, I hope, sensitizes the reader to similar barriers that exist today.

Issues facing the elderly thirty years ago still continue. Poverty, multiple chronic illnesses, social isolation, and mental health disorders require more than medications, lab tests, and fifteen- minute clinic appointments to correct. Nurse practitioners are capable and effective in addressing the multiple needs of this population. My book shows that traditional medical care is not always the answer to some problems.

3. You are donating proceeds from the book. Please tell us more about the recipient organization.

When I started at Erie Family Health Centers back in the early ‘80s, the senior clinic was its first satellite clinic—it had just opened in a Chicago Housing high rise—unique and unconventional. I learned from both my patients, and the staff that were dedicated to service and sensitive to the needs of older patients. My experience there provided the freedom to practice and grow in knowledge and skill, albeit sometimes unwittingly. It made me realize how much a team approach to geriatric care improved the outcome.

It was only after I started to write about my experiences at EFHC that I saw what an invaluable experience it was—and how unique my patients and those with whom I worked were. I am indebted to my patients and staff of the senior clinic for providing such a wealth of material for my nursing stories.

EFHC still serves the community: the underserved and at-risk populations. In 2017, EFHC celebrated its 60th anniversary. It remains a model of community care.

4. What do you think, as one of the pioneering nurse practitioners (NP) in geriatric care, that the medical field needs to know about caring for older patients? What about the general public?

Most of the issues facing the elderly that are mentioned in my book, unfortunately, are still a problem today. There is a lack of interest by physicians to train as gerontologists. Insufficient financial rewards and the negative stereotype of the aging population add to this shortage. Many of the health problems of this cohort can be well handled by advanced practice nurses but unfortunately, the medical establishment in some states still restricts NP practice.

The general public needs to recognize that NPs are in a unique position to care for the older population and support legislation that can correct the obstacles. In some states, physicians are not interested in setting up a practice in rural or inner-city areas where the elderly are underserved, and at the same time resist supporting NPs who would step into this role.

5. You care very much about how nurses are viewed and treated. What are your concerns? How do you envision your book contributing to the conversation about the public perception of nurses?

I have very real concerns about how the nursing profession and the contributions of nurses, including advanced practice nurses, are not well understood or appreciated. Nurses are not always involved in making health care policy, which is a sad omission since nurses are the professionals who spend the most time with patients and can speak for the patient and family, ensuring that what is needed for successful outcomes is provided. I keep a blog where I chime in on these issues and continue to encourage nurses to tell their stories. I wrote this book with hopes that the general public will enjoy my stories and that they will see the broad scope of services nurses/NPs provide.

6. When did you start writing? Is all your writing nonfiction?

I began writing as a young girl. I wrote poetry and prose sporadically all my life. I have saved some of my old efforts—handwritten on yellowing lined paper. I have written a few uncompleted fiction pieces that I plan to get back to in the future.

7. Are you still a nurse?

Once a nurse always a nurse. However, I have let my nursing license lapse.

8. Is your book for nurses or the general readers, or both?

Both. Nurses, students and faculty will recognize the challenges and the obstacles to practice that are keeping advanced practice nurses from reaching their full potential. The general public gains insight into the day-to-day responsibilities of an NP caring for a caseload of ambulatory elderly and the barriers that have historically impeded expansion of nursing practice that still exist today.

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