How to Handle This Age Issue

The woman who was interviewing me asked my age. She was apologetic. “My boss wants me to get ages.”

I was ready for her.

“I am 76,” I said. “Not a problem to ask. I think it’s good that folks realize that older people can still be productive.”

“That’s one way to handle it,” she said, flatly.

Handle what, I wondered? But I didn’t ask just in case she would think I was being snarky and end our conversation. She was a columnist from a newspaper published in my old home town, calling to conduct an interview about me and my first book, a memoir.

Quite a few years ago, when I was dipping my toe into the writing life, I heard a local cookbook author being interviewed on a radio program. When the interviewer asked the author her age, she said, “I never tell my age. There are too many ageist readers out there.” I was floored. How would ageist beliefs disappear if those who are successful and of a certain age don’t sing their own praises? I wanted to reach into the radio and shake this woman. Since then I had been on a mission to tell my age. That was the way I was handling the age issue.

Once I stopped into a Weight Watcher’s storefront to get help in dropping the ten pounds that I have habitually lost and gained over the years. The helpful clerk was promoting the additional support one could find on the internet. “There is a Weight Watchers’ Blog,” she said, eyeing me before she continued. “Do you know what a Blog is?”

I immediately assumed she thought that I was too old to know what a Blog was. Since I had just recently set up my own Blog following advice on how to promote my future book, I huffed and puffed and said rather haughtily, that I have my own Blog, thank you, then turned and marched out the door. Only later did I recognize that was the wrong way to educate the clerk. Now she knew I was not only older but super sensitive. I should have just laughed and told her I had a Blog as if it were no big deal. Then she would be impressed by my age and my poise.

Since it is obvious that I am older, my new tack is to just be me and disregard any real or imagined mannerisms of others that are demeaning. While I don’t shy away from confrontation, and in some instances enjoy the battle, I would have to make an extra attempt to be cordial. Why call attention to my age? Let my actions and accomplishments speak for themselves. Yet another way to handle the age issue.

Now you can see that I am conflicted. Tell my age or not call attention to my age?

A week ago, a woman contacted me via email. She had seen my memoir on the publisher’s website. Could she talk with me about the indie publisher I had chosen? She finished her first memoir and now was exploring options. The memoir was about her grandmother who had sold alcohol during prohibition to support her family. The woman told me that she had written a few professional books and self-published a fiction story. We spent almost an hour discussing the pros and cons of self-publishing versus using my indie publisher.

During our conversation, we never mentioned age. Afterwards, looking over her website, I discovered that she was 82. I was impressed with her vitality, and enthusiasm to get her memoir published and promoted. Oh, to be so cavalier about one’s age! I now know how I will  handle this age issue.

Just ignore it.

 

decisionsright

A Long Overdue Thank You

I had finally decided to clean out my office closet. I started with the stuffed cardboard Unknownfile box. The first thing I reached for was a frayed manila envelope. The stack of typed pages spilled out onto the floor. After I read the first two sheets—an early attempt at documenting my nursing life—I knew I was doomed to sit on that floor by the open closet door until I had scrutinized every page. One story especially held a surprise.

In the early 70s, after my husband completed his degree at the University of Chicago, we moved to the far south suburbs where housing costs fit our tight budget. My first job was at a community hospital. Soon after I started, I found out that my salary was the same as a new graduate nurse who had never even done a simple urinary catherization. I, on the other hand, was an experienced ICU nurse. I wrote a letter of complaint and while the Director of Nursing of the hospital commiserated with me, I wasn’t offered a raise. I quit.

I decided to apply for a job at a close-by nursing home in spite of the fact that I thought I was overqualified and working at a nursing home felt demeaning to my young arrogant self. I eventually learned differently.

I wrote about this experience in my memoir:

 

. . .I had worked in a nursing home—a well-run home

with low staff turnover—for a short period of time, but long enough

to savor the slow pace after being an intensive-care nurse for years

before. The residents bestowed many hugs and an occasional slobbery

kiss as I passed out medications on the evening shift.

I had forgotten that experience the day my academic advisor and

I talked about a master’s thesis. In 1979, like most of my classmates, I

wanted to study women—women of child-bearing age. Why did she

think she had to ask me again: “What group do you REALLY enjoy

caring for?” That’s when I remembered the hugs in the nursing home.

At the end of the version of the story about working in a nursing home that had sat in the manila envelope for over 15 years, there was an added comment about Eva Harrison that I hadn’t remembered writing.

Eva Harrison, the nursing home DON, had offered me a salary higher than the one I received from the hospital. She ran a warm and caring facility, valuing her staff and residents alike. I know she felt sad when I left after only six months but a new clinic opened. At the time, I believed that this new job was more prestigious than that of pill pusher in a nursing home.

What I had written was that I wished I had gone back to tell Eva Harrison that my time at her nursing home had so influenced me that when I graduated as a nurse practitioner a few years later, I had declared geriatrics my specialty. Working in a nursing home, Eva Harrison’s nursing home, set me on a career path that would both challenge and reward me.

Thanks, Eva.

 Bedbugs and Friendships

My husband and I went to Charleston last week and came home with bed bugs—maybe. A lovely city, we have been there many times joining friends at the same hotel. This time, after a hiatus of a couple of years, the hotel was looking a bit rough around the edges. Our first room was quite dirty and we had 30 minutes of dumpster noise at 3:00 a.m. We asked for another room.

The next morning my husband came out of the shower complaining of a terrible itch.

“Stop taking daily showers,” I told him. Our usual battle over dry skin and aging.

The next two mornings, after his shower, he had the same rash and extreme itch. During the day both would subside. While driving home, he showed me the “hives.” What was he allergic to?

I had been too preoccupied with my friend’s behavior to be concerned about my husband’s “allergy.” Her short-term memory loss had side tracked my delight in sharing our mini-vacation with our two longtime friends. Sue, I will call her, and I met while working at the same hospital before either of us married. Over the years we shared family vacations, grew older and retired but continued seeing each other at least once a year. Infrequent phone conversations didn’t reveal her problem. However, at dinner that first night, after Sue asked me for the third time if I had heard from a mutual friend, and then forgot where we were going to dinner the following evening after she accompanied me to that restaurant to make the reservation, I became worried.

Conflicted as how to proceed, addressing or not addressing, Sue’s memory issues, my husband and I spent the late evening hours weighing appropriate responses. I had to call attention to my concerns. How could I ignore symptoms that maybe could be reversible?  Sue’s husband seemed untroubled. The last day, Sue didn’t join us to visit the Magnolia Plantation and Gardens due to the unseasonably cold weather. While walking with her husband past the flowering azaleas, I learned how worried he was about his wife. The short-term memory loss started just six months ago. Any concern expressed by him was met with denial and anger from Sue. Would I speak with her? He was grateful.

silhouette-two-elderly-women-who-450w-464229824That last night after dinner, I took Sue’s arm in mine and we navigated the narrow cobblestone sidewalk toward the hotel. “I’m concerned,” I said, pulling her close and looking into her eyes. How often had I had to discuss uncomfortable topics with my patients over the years; how to talk of hopeless scenarios while still giving hope? But this was not a patient-nurse interaction. Would Sue lash out at me for saying she had memory issues, deny any problems or sever our friendship? My words bypassed any resistance. Sue agreed to see her primary provider when she arrived home. If her primary dismissed her concerns, Sue would seek help from a geriatrician who knew to look for changes not necessarily related to aging.

With hugs and tears, we said our good-byes at the end of the evening after I repeated my suggestions to both Sue and her husband. They had to leave earlier than we did the following morning.

After congratulating myself on my successful intervention, I slept soundly.

My daughter came to visit the day we came home. After she listened to her father’s story of his “allergies” and “rash,” she said, “Sounds like bed bugs.”

Yippes. We immediately went into action: suitcases packed in plastic bags and put it the garage, clothes washed in hot water, emailing a friend who I knew had a recent exposure to bed bugs.

I found out that a dirty environment does not always have to be part of the bed bug scenario. They are bugs of opportunity and settle in upholstery like beds and sofas and rugs and chairs.

And the “rash” that still pops up on my husband’s arms and legs can be residual of the first exposure. It can take up to a week for the sites to subside. In the meantime, I have been spared. I am on the lookout for telltale signs of infestation: blood droplets and brown spots on the bed sheets.

I texted Sue to alert her of the bedbugs. When she didn’t respond, I called her. Her voice flat, and her words curt, she cut me off before I was finished with my story.

I sat for a long time with the silent phone in my hand.

Nursing Truths for a New Era: Author Interview with Marianna Crane

A serendipitous meeting with Michele Berger reminded me of the long road I traveled conceptualizing, creating, and finally completing my book. Many folks that I met along the way inspired and supported my efforts. Most I never had the chance to thank. Fortunately, now I can tell Michele that her creativity workshop and follow-up coaching encouraged me to stay on track.

Thank you, Michele.

Below is Michele Berger’s recent post spotlighting me and my book.

The Practice of Creativity

Happy new year, everyone! It feels especially poignant to begin the first post of the year with a special Author Q&A. More than a decade ago, before I formally began my coaching practice, I taught creativity workshops at UNC-Chapel Hill’s The Friday Center. They had a thriving adult enrichment program. My classes were popular and I met and coached people from all backgrounds. It is always a delight to run into people many years later and hear about their creative adventures.

Two months ago at the North Carolina Writers’ Conference, out the corner of my I saw a distinguished-looking woman. Her face looked familiar, but I only caught a glimpse before moving on to my next panel. To my great delight and surprise, this same woman came up to me at the reception. We immediately recognized each other. She had taken one of my classes at the Friday Center and…

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SOB SISTERS

Originally posted on April 4, 2012.

Nursing Stories

Thanks to my friend Lois Roelofs and her post “Growing Older In “Style,” I found Ari Seth Cohen, a twenty-eight-year-old who is spotlighting “stylish senior citizens.” Love it. Older women—and men—who ignore the old adage: “dress your age.”

looking good

How come a twenty-eight-year-old man finds older people so fascinating? Well, I was sure there had to be an older role model in his life. And indeed there was—a grandmother. Aha!

Back in the 80s at my first job as a gernotological nurse practitioner, Betty, a social worker, and I conducted monthly orientation sessions about geriatrics for new nursing staff. Geriatrics was a new medical specialty at the time and Betty and I wanted to sensitize the group to aging issues.

Betty had the nurses imagine themselves at different stages of life. Invariably, someone would object to the exercise, not surprisingly, when Betty had them imagine looking at themselves…

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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.

 

New Love in Old Age

I wanted to post an upbeat aspect of aging after my last one focused on death. While we can’t deny that the ultimate conclusion of aging is death, there are many diversions along the aging journey that turn out to be a surprise and delight.

I, for example, would never have predicted that after I left nursing and focused on writing, I would have written a book. And now I’m preparing to take to the road to promote it.

One of my new friends, Margaret, who has recently retired after years at a desk job in human resources, has learned that she has a talent for painting. She also plans to write about her parent’s tree farm, a biography she will give to her grandchildren. Margaret says, “There are not enough hours in the day to do all I want to do!”

Then there is my writing friend I call Helen who found true love with Tom. Longtime friends, they both lost their spouses and reconnected to find a “spark” that ignited “true love.” See a previous post that I wrote about them.

I have heard from Helen recently. She and Tom are now living together in California. “Tom and I have ten children and stepchildren between us. His live on the west coast, mine on the east coast. And he has a fulltime job in California. We haven’t figured out how to navigate these difficulties yet.”

Recently, they traveled to east coast to attend one of Helen’s grandchildren’s graduations. “Thanks for making my Nana so happy,” her fifteen-year-old grandson told Tom during that trip.

“Our love is truly a miracle for us both,” Helen writes. “Tom is one of the nicest people I have ever known, and there is an ease and flow to our days.”

They work out at a gym several evenings a week and they both swim a quarter of a mile most nights. Both have lost weight—fifteen pounds each–and leave the gym “energized and with a sense of relaxed well-being. Not bad for almost seventy-nine.”

Helen ended her email by writing “We have trouble letting go of the evening and going to bed, like two little kids. I joked recently that we need a parent. But all is not lost — we do still brush our teeth.”

Helen and Al should have been included in Ari Seth Cohen’s newest book Advanced Love.

From the creator of the popular blog Advanced Style, photographer Ari Seth Cohen’s Advanced Love collects affectionate portraits of subjects who prove that love is bound by neither the constraints of age or time. The book includes 40 profiles of inspiring couples from around the world, and more than 200 photos. The profiles explore themes of love and companionship through firsthand insight from the subjects; they share their stories of falling in love, what they have learned after decades of partnership, and valuable relationship advice. Advanced Love is a touching look at the often-ignored partnerships of the senior set. Filled with couples who have built their lives together, it’s an indispensable trove of wisdom on love and the lessons they have learned along the way.

This book only includes couples who have been together for a long time. I hope Cohen considers writing another book about couples that have found new love in old age. Helen and Tom would certainly be an excellent addition.

 

There Are Some Patients We Never Forget


This was first published on January 29, 2012.

 

When you have been a nurse as long as I have there are patients who take residence in your memories and resurface frequently. They could almost be family except they have a short history in your life. What they were like before or after you knew them usually remains a mystery.

Mr. G was a cantankerous, legally blind, brittle diabetic I had taken care of in the late 80’s. His house was the worst on the block: paint peeling off the frame, rickety wooden stairs and overgrown weeds. Thankfully he lived close to the  police station because I had to drive there one day when Mr. G didn’t answer the door. He was convulsing on the floor as I peered through the window. I had to beg the police to break down the basement door to enter because Mr. G often complained to me how many times they had axed into the front door and how expensive it was to repair. He frequently had hypoglycemic reactions.

Mr. G. gave himself insulin injections using low vision equipment to measure out the dose. His much younger wife worked full time, leaving him lunch, usually a sandwich, piece of fruit and a drink on the dining room table. He had confided in me that he thought she was having an affair with her boss. Having an active imagination (I’m a writer aren’t I?), I wondered if his wife was trying to kill him. Maybe the house, inside and out, was in deliberate disarray leading to a potential life-threatening accident. I don’t remember the other scenarios I entertained as I drove to and from his home.

When I left my job to move to another state, my friend, co-worker and fellow nurse practitioner, Jane Van De Velde, took over his care. He died on her watch. She recently emailed me with remembrances about him.

“But I really remember his memorial service. It was so touching, all the people who attended and spoke so highly of him. I was literally brought to tears. I got up and spoke about how wonderful it was to see another side of someone–the strong, healthy, community-involved and well-respected side. We saw him at end of life when he was so very ill and depressed and visually impaired.”

Jane adds, “There are some patients we never forget.”

Amen

Out of the Blue (aka Mr. Foley)

  • My story was published in Pulse: Stories from the Heart of Medicine on August 18, 2017
  • Out of the Blue
  • Friday, 18 August 2017

Marianna Crane ~

As I sit in the exam room waiting for my first patient of the afternoon, the phone rings. It rings four more times before I realize that Amanda Ringwald, our eighty-year-old receptionist, hasn’t come back from taking a rare lunch break.

I pick up the phone and say, “VA Hospital. Marianna Crane.” Oops, I’m not back at the VA anymore.“Senior Clinic,” I quickly add.

“Hello, my friend.”

The familiar voice makes my throat tighten and my eyes water. How in God’s name did he track me down at work?

“Mr. Foley. How are you?”

“Not good. My wife died. She died a month ago.” He sobs, and more tears flood my eyes.

Eddie Foley, a frail man with thinning white hair and a perpetual smile, had been one of my favorite patients when I was a nurse practitioner at the VA. I haven’t spoken with him since I started this new job, six months ago.

He’d enjoyed telling me about his wife and adult son. “They mean all the world to me,” he would say. “I don’t need no fancy vacations or new cars. I’m happy as long as I got my family.”

I reach for a tissue from the box on my desk. “Mr. Foley, I am so sorry.”

About two years ago, Mr. Foley, who’d been a butcher for more than fifty years, had suddenly developed swelling and redness in both hands.

“Acute arthritis,” my boss Dr. Leon Logan had said. Although this condition is common among butchers, who constantly handle cold meat, it’s unusual for it to surface so late in life.

“Let’s put him in the hospital so the rheumatology staff can figure out what’s going on and learn from him,” Dr. Logan had decided.

I’d worried that Mr. Foley might contract a hospital-acquired infection from a contaminated stethoscope or food tray, or from a health worker’s hands.

Many infected patients died. Especially the elderly.

I tried to convince Dr. Logan not to send Mr. Foley to the hospital. When that didn’t work, I tried to dissuade Mr. Foley from going.

“You don’t have to be admitted,” I said. “The rheumatology doctors want to see what has happened to you, but there are textbooks they can look at, you know.”

Mr. Foley shook his head. “I’ll do anything to help Dr. Logan and the other docs,” he said emphatically. “If they can learn from me, I’ll go into the hospital.”

Damn.

The battery of tests and invasive procedures that the rheumatology doctors ordered made Mr. Foley dehydrated, and he started to lose weight. After a few days, I walked into his hospital room, trying not to show my concern as I listened to his labored breathing.

He’d developed pneumonia. A plastic bag hung from a pole, dripping saline and antibiotics into his skinny arm.

I sat on the side of his bed and leaned down, my mouth close to his ear. “Mr. Foley, you’d better get well. Your wife and son want you to come home.”

He smiled weakly.

“You can do it,” I urged, feeling guilty. Was I cheering him on so I wouldn’t live the rest of my life with his death on my conscience? I’d let Mr. Foley down by allowing Dr. Logan to get his way with so little resistance.

I’ll never let him down like that again, I vowed.

Three days later, I was delighted to find Mr. Foley sitting up in bed reading the Chicago Tribune. The IV bag was gone.

“The doctors say I’m a walking miracle. I go home tomorrow.” And, to my elation, he did go home to his family. In the two years that followed, he never had another arthritis recurrence, and we haven’t spoken in the six months since I left the VA.

Now, as I clutch the receiver, Mr. Foley continues to sob over the phone while Mrs. Ringwald shuffles through the door.

“Your patient is here,” she says, laying the chart on my desk.

“Mr. Foley, I’m so sorry, I can’t talk. I have a patient waiting for me.”

Mr. Foley’s voice cracks. “Oh, Doctor Crane, I shouldn’t have bothered you.”

I never could get him to stop calling me doctor.

“I’m a nurse practitioner,” I would say.

“You are my doctor,” he would respond. “And my friend.”

“Mr. Foley, give me your address. I’ll come and visit you.” Imagining a smile breaking out on his face, I write down the address he gives me. I tuck the piece of paper into my skirt pocket, resolving to visit him soon.

Before calling the next patient into the exam room, I slip into the bathroom and splash cold water on my face, blotting it dry with a coarse paper towel.

A month later, as I am restocking our medical supplies, Mrs. Ringwald says, “A Michael Foley is on the phone asking to talk with you.”

I freeze, suddenly remembering the piece of paper with Mr. Foley’s address sitting in my top desk drawer. It turned out that he lived further away than I’d thought, so I kept putting off visiting him.

My office doubles as the exam room, and the geriatrician with whom I work is using it to see a patient. There is little privacy in the small clinic, so I take Mrs. Ringwald’s desk phone and drag it with me into the bathroom. I close the door.

“Ms. Crane, this is Mike, Eddie Foley’s son.”

He sounds just like his father.

“My father thought the world of you. So I want to let you know that he died last week. I guess he didn’t want to live without my mother.”

I slide down the wall onto the cold tile floor with the phone in my lap, unable to speak.

I never thought Mr. Foley would die before I got around to visiting him. I’ve let him down, again.

About the author:

Marianna Crane has been a nurse for more than forty years and became one of the first gerontological nurse practitioners in the early 1980s. “Although I’ve dabbled in writing throughout my life, it was only later in my career that I became passionate about telling stories to educate the public about what nurses really do.” Her work has appeared in the New York TimesThe Eno River Literary JournalExamined Life JournalHospital Drive and Stories That Need to Be Told: A Tulip Tree Anthology. Her memoir, Playing Sheriff: A Nurse Practitioner’s Story, will be published in August 2018. Her personal blog is nursingstories.org.

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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