Photos of the Patients I wrote about in my book: Stories from the Tenth-Floor Clinic: A Nurse Practitioner Remembers

This past Saturday, I received a box in the mail filled with old photos. The nurse practitioner who took my place when I left the Senior Center sent this delightful surprise. “Rita Wisniewski” (I changed all names in my book except for my immediate family) said in her note that sending me the pictures of the patients we both took care of was “long overdue.” Rita had read my book but due to illness was unable to come to the various venues in Chicago where I promoted the book 2019. Between ill health and the pandemic, Rita had forgotten about contacting me. 

Rita read my book and recognized many of the patients I wrote about. Thanks to Rita, now I have pictures of those who appeared in my book. 

Molly, a wiry, eighty-year-old woman with an Irish brogue, lived next door to Ms. Henry. She often dropped into the clinic to socialize rather than to seek care. She didn’t take medication, and rarely complained of aches or pains.  P 103

Jerry Johnson, mildly retarded, wiggled between us, (on the dance floor) gyrating and twisting with abandon. It was a raucous moment that transcended age and ability.  (At a retirement party) P 117

Lilly Parks, a strikingly attractive woman in her seventies, stuffed her shawl down the front of her dress, and staggered about the dance floor on her matchstick legs as if she was going into labor. I had heard she kept a silver handgun in her sock but that evening she must have left it at home since her slim ankles were surrounded only by her rolled-down stockings. She waddled around in the center of the room clutching her belly to hoots from an enthusiastic audience (same retirement party) P 117

Stella Bukowski: (Sitting in a wheelchair) A dirty blond wig sat askew on her head. Only one leg, which was covered with a wrinkled cotton stocking, extended past the skirt of her housedress, and her foot was encased in a heavy black orthopedic shoe.  She reeked of a sharp ammonia smell. Urine? P 144

A picture of me that I have never seen before. However, I remember the poster, which was one of my favorites. I don’t remember where the picture was taken. The picture is too faded to read the citation on the bottom of the poster. Maybe one of you older nurses will recognize the poster and get back to me with the answer. 

Health care today is changing

Today we need someone who can help us manage our health care needs in the hospital, the home, the HMO, the school, the workplace, in long term care and in the community. 

Today we need a provider who can teach us how to stay physically and mentally healthy and how to prevent illness and disease. 

Today we need access to specialty practitioners who can provide expert heath care for individuals and their families. 

Today more than ever we need an advocate who can deliver quality cost-effective care throughout all the stages of our lives.

Today, we need a Nurse

Alphabet Challenge: W

I’ve signed onto The Blogging from A to Z April Challenge 2021.

The challenge is to blog the whole alphabet in April and write at least 100 words on a topic that corresponds to the letter of the day. 

Every day, excluding Sundays, I’m blogging about Places I Have Been. The last post will be on Friday, April 30 when I finally focus on the letter Z. 

W: West Catchment Area

When I started my job as a nurse practitioner in home care at a Veteran’s hospital outside of Chicago, I had the choice of taking care of patients in the north or west region. The north region was deemed a safer catchment area. The west region, which surrounded Oak Park where I lived, had pockets of crime caused by rampant gang and drug activity. I wanted to be closer to home and stop off for lunch if I was in the neighborhood. I didn’t think twice before choosing the west side. Maybe I thought I was invincible, a city girl used to the gritty streets and boarded up homes. 

I tried to keep my senses sharp and stay alert when I drove through the neighborhoods making my home visits. I kept my distance from the car in front of me in case I needed to make a quick U-turn. I avoided groups of young males loitering on the street corners and always locked the car doors. 

In the long run, it wasn’t just the neighborhood that proved unsafe. Any home I went into could hold danger regardless how dilapidated the outside environs. My close calls, and there were some, depended on the character of those with whom I interacted. 

Still, to this day, I keep my handbag on the floor of the car and out of sight.

Alphabet Challenge: U

I’ve signed onto The Blogging from A to Z April Challenge 2021.

The challenge is to blog the whole alphabet in April and write at least 100 words on a topic that corresponds to the letter of the day. 

Every day, excluding Sundays, I’m blogging about Places I Have Been. The last post will be on Friday, April 30 when I finally focus on the letter Z. 

U: University of Illinois at Chicago

I graduated from UIC, College of Nursing in 1981 with a master’s degree in Public Health Nursing. During my first semester, in the community assessment class, I was assigned to the Pilsen neighborhood with a fellow student. At the end of this course, we had to write a paper about the community and the health problems that we unearthed. 

In order to get to know the neighborhood, my classmate and I walked the streets, looking at the housing and stopping in the stores. Mexican music played loudly from the shops while mothers, fathers, grandparents and lots of babies and children filled the sidewalks. I fell in love with the Mexican neighborhood. I brought home Piñatas, Mexican pastries and colorful vases. The vibrant sense of this Hispanic community impressed me.

There was another part of this geographical area: modest, detached homes and sidewalks swept clean by elderly Italian and Polish homeowners who soon would no longer be able to keep up their property. It was this population I would meet again in a few years after I became a gerontological nurse practitioner and took charge of a senior clinic on the westside of Chicago. UIC was the conduit for the welcome change of direction in my career. 

Alphabet Challenge: Q

I’ve signed onto The Blogging from A to Z April Challenge 2021.

The challenge is to blog the whole alphabet in April and write at least 100 words on a topic that corresponds to the letter of the day. 

Every day, excluding Sundays, I’m blogging about Places I Have Been. The last post will be on Friday, April 30 when I finally focus on the letter Z. 

Q: Quadrangle

I couldn’t find the pictures of our children, two and four years old, climbing on some sort of sculpture or stone wall on a sunny day in the University of Chicago Quadrangle. There were tulips around the base of the gothic buildings. I wanted to put the pictures on this post to show how happy the kids seemed. 

My husband and I had driven from Jersey City to Chicago with our children in 1971. He had been accepted to a master’s program at the University of Chicago. We planned to stay for the two years and then return to New Jersey where our families lived. That never happened. 

When my husband and I finally moved out of Illinois in 1992, our children chose to stay behind. 

Alphabet Challenge: L

I’ve signed onto The Blogging from A to Z April Challenge 2021.

The challenge is to blog the whole alphabet in April and write at least 100 words on a topic that corresponds to the letter of the day. 

Every day, excluding Sundays, I’m blogging about Places I Have Been. The last post will be on Friday, April 30 when I finally focus on the letter Z. 

L: Lou Mitchell’s Restaurant

One day back in the 80’s, Lois, my good friend, and I stood in line waiting to be seated at Lou Mitchell’s restaurant on Jackson Boulevard in Chicago. As the crowd moved inside, Lou Mitchell, a white haired older man in a dark suit, handed out small boxes of Milk Duds to each patron. Lois and I were lucky to snag a booth close to the door. Although sitting at the long communal table in the center of the restaurant would be fun, we tended to talk non-stop whenever we got together, so a booth was best. 

Lou Mitchell’s diner, founded in 1923, is a Chicago icon. It’s open from 6 a.m. to 2 p.m. and noted for its hearty breakfasts. Passing out Milk Duds is a long tradition. 

That day Lois and I had come for lunch. After we left Lou Mitchell’s we planned to stroll along the city streets, window shop and end up at Marshall Fields’ Crystal Palace for hot fudge sundaes. 

Lois and I continued gabbing after we finished lunch. Finally, we stopped talking long enough to notice the silence. We were the only customers in the place. Behind us, the waitress was mopping the floor. It was past the 2 pm closing time. We quickly stood, grabbed our coats, left a generous tip and signaled the waitress to open the locked door and let us out.   

Since that day, I’ve always had a warm spot in my heart for Lou Mitchell’s. 

Alphabet Challenge: E

I’ve signed onto The Blogging from A to Z April Challenge 2021.

The challenge is to blog the whole alphabet in April and write at least 100 words on a topic that corresponds to the letter of the day. 

Every day, excluding Sundays, I’m blogging about Places I Have Been. The last post will be on Friday, April 30 when I finally focus on the letter Z. 

E: Eckhart Apartment

In the mid 80’s I worked in a clinic on the tenth floor of a subsidized building for the elderly on the west side of Chicago. The twenty-story apartment building proved to be a training ground for me: an inexperienced nurse practitioner and new to working with older people.  

I learned:

            that older folks were generally accepting and forgiving. That they enjoyed sex.   Some of them drank too much, hired prostitutes, carried guns in their purses, and chewed tobacco. Some sold their medicine for street drugs or money. Some were abusive and some were abused.

            that not all families wanted to care for their older members. That loneliness was the most pervasive condition among the group. I learned that family members, who suddenly showed up when someone was dying, might not be family. 

            how to plan a funeral, hand over firearms to the local police precinct, how to put folks in a nursing home, transfer them to an emergency room, and commit them to a psychiatric hospital.  

            to listen to a person’s story before I examined her. And that making a home visit told me more than I could ever learn from an office visit.

            that I didn’t need the support from a highly educated and professional staff but from people who were caring and didn’t walk away from a problem. And I learned that a sense of humor was a requirement when working with the elderly.

The Cat

The story that I wrote almost thirty years ago was chosen as a finalist from 200 submissions to Carolina Woman Writing Contest. Debra Simon, editor and publisher of Carolina Woman magazine, decided that this year she would include a list of finalists. Lucky for me.

Thank you, Debra Simon and Carolina Woman magazine, for selecting my story to be included in the list of finalists. I am honored.

Unfortunately, as of May 1, the print magazine was suspended due to COVID-19. You can read the prizewinning submissions on the Carolina Woman web site but there is only a list of the finalists by name and title of the work.

I have printed a copy of my story below.

 

 

 

THE CAT

I lounge on the back deck of my new home sipping a glass of Chardonnay. The October sun is still warm here in the South. No one is hassling me about drinking a good wine with taco chips. I’m not being hassled because I’m alone.

But I’m not really alone. The cat is here. She has wandered down to the brook and is sitting on her furry, black haunches staring at the bubbling stream. This commands her full attention. She doesn’t know brooks. Brooks weren’t common in Chicago where she lived all eleven years of her life. She knows alleys, cement sidewalks and chain link fences.

She was not totally citified, however. She ran around with a family of possums who ravaged the garbage cans in the alley behind our house and made their home under the steps of our old wooden porch. In the evenings’ blue haze, I would see the cat’s silhouette surrounded by pairs of red slits that darted away when I threw open the kitchen window to call her inside.

She hasn’t, as yet, met the beaver that lives in the brook since this is her second exploration outside. Like me, she has left familiar places and faces behind. She’s trying to make sense of this terrain with its newness and unpredictability.

IMG_3252Yesterday, on her first venture outside, I watched like an anxious mother while she delicately descended the steps off the back deck that lead to the grassy slope. Suddenly three, shiny black crows perched in the tulip trees began to make menacing, croaking calls. The crows swooped over the cat, one after the other. She crouched low and crept back to the deck, up the stairs and through the French doors I had opened.

No sooner had I shut the doors behind her, saving her life I am sure, she began to meow to go back outside. No way, I thought. I no longer need to experience that kind of the excitement: dealing with daily disasters, stretching my imagination while awaiting unmentionable accidents. Those worries I abandoned when my children, now grown and free spirited, decided to stay in Chicago when I moved to another state.

The cat rolls happily in the dry dirt by the brook sending up dust clouds. Back in Chicago, she often welcomed me from work by rolling about on the concrete path leading to the back door of our house. I would bend down and rub her soft belly until my work worries dissolved.

I wonder if the cat misses her familiar haunts: the chain link fence she scaled, the alley she explored, or the familiar wooden porch with its family of possums living underneath the steps. Does she miss the variety of laps she could choose to sit on, or the warm hands that reached down to scrub her black and white head, or the beds she shared? Does she miss her life companions, who like her, are testing their freedom?

The cat is gone from the side of the brook. I stay seated. I remind myself that I no longer need to be the mother-worrier.

I go back to my book and try to concentrate. Time passes. The wine and the taco chips are gone. The sun drops behind the tulip trees casting long shadows across the deck. I feel a warm, furry body rubbing against my leg.

The cat has come home.

 


Mindfulness: Julia Sarazine

I met Julia Sarazine this past June when I spoke to Rush University nurses in Chicago about my book: Stories from the Tenth-Floor Clinic: A Nurse Practitioner Remembers. We agreed on the need for nurses to tell their stories.

When I discovered Julia’s background in teaching mindfulness techniques to nurses in order to reduce symptoms of stress (see How PTSD Is Hurting Nursing) I asked if she would share her expertise and experience about how mindfulness can help reduce Burnout syndrome/Post Traumatic Stress Disorder (BOS/PTSD).

I’m honored that Julia agreed.

 

You’ve said that some experts feel that Burnout syndrome among nurses is a public health crisis. BOS has been affecting nurses for as long as I can remember. Why do you think this problem has been so insidious and tenacious?

Burnout syndrome is now receiving attention as demonstrated by The World Health Organization including it in the Revision of the International Classification of Diseases as an occupational phenomenon.

Levels of burnout are higher in professions that have high risk associated with them, such as a nurse administering medications and treatments that may have a significant impact on someone’s life. Also, nurses are usually the ones that hear and witness the patient and families suffering.  In most situations, nurses see people when they are worried about their health, in pain or being treated for a serious illness.  Over time, this constant exposure to suffering can take its toll on the ability to maintain our own health and wellness.

Moreover, the demands of the healthcare system continue to increase with technology and integration of electronic medical records.  As more patient care is being provided in the outpatient arena, patients are sicker and may require more care than in the past.

 

You left a hospital nursing position because you had symptoms of BOS, yet a few years later you returned to the same position you left. How did you find the fortitude to do that?

 Once a nurse, always a nurse definitely applies to my situation and decision to come back to the nursing profession.  I missed working with patients and the sense of accomplishment I received while helping others.  It is the same reason I was drawn to the nursing profession in the first place.  I know it has been over communicated, but being a nurse is truly a calling, not just a job. It was not an easy decision, but it felt right for me at the time as I changed how I handled stress and suffering.  I basically learned to take care of myself with mindfulness at work and how to transition to be fully present at home.

 

What advice would you give to other nurses who have left nursing?

To leave the nursing profession is a very individual decision.  I believe all nurses are caregivers.  Where nurses are providing care may change and whom they are providing care to may also change.  For example, nurses may be taking care of their children, parents, family, friends or community members.  It may look different, such as volunteering for the food depository, listening to a friend discuss her new cancer diagnosis or asking the cashier at the grocery store how they are doing today.  Nurses are usually empathetic people and naturally take care of others throughout their lives.

 

There are terrible statistics about how many new nurse graduates leave the practice after a couple of years because of BOS. Among all the other tools out there to deal with this issue, what does mindfulness contribute?

 Mindfulness is not the magical wand that can solve all our problems and prevent burnout.  But it is a tool we can use to take care of ourselves so we can take care of others. I think all nursing students should be taught a few mindfulness skills when they begin nursing school.  If you can learn just a few simple skills to protect you while witnessing and feeling someone’s suffering, it can help prevent burnout and lower your stress levels.

 

What is your definition of mindfulness?

The mind naturally wanders from the present moment to the past or future. This is often referred to as autopilot.

  • Have you ever commuted to work and not remembered the drive or train ride?
  • Have you ever eaten something and not remembered tasting it?
  • Have you ever reacted to a situation and later regretted how you handled it?

These are all examples of mindlessness. In contrast, mindfulness focuses on being aware in the present.

There are multiple definitions of mindfulness, but the most commonly quoted is from Jon Kabat-Zinn: “Paying attention on purpose in the present moment, non- judgmentally.

 

How did you first learn about mindfulness?

Right after I left nursing, I was struggling with trying to process all of the deaths I witnessed. A friend recommended The Power of Now by Elkhart Tolle.  I read it and then began to meditate each morning. I found I was able to focus more and notice moments of joy in simple things such as a warm breeze on my face, a smile from a stranger and the taste from the first sip of coffee in the morning.

I continued to develop my own practice by taking mindfulness courses, attending silent retreats and eventually becoming a mindfulness instructor.  Mindfulness is never complete; everyone who practices is always learning and evolving through increased awareness.

 

How has mindfulness changed you?

Mindfulness allowed me to process all of the suffering I witnessed and absorbed while working at Cook County Hospital as a palliative care nurse practitioner.  During one of the mindfulness retreats, the teacher said, “ You don’t have to jump into the deep in of the pool, just dip your toe into the water as far as you can at this time.”  This was very helpful for me at the time because I was resistant to processing the deaths for fear I would drown in grief.  From this simple instruction, I was able to process each patient’s death by allowing myself to feeling the sadness and grief; then the grief lessened and I was able to wish the patient and family well.  I realized I was frozen in time, but the family and friends had moved on with their lives the best they could.

When I returned to my nurse practitioner position five years later, I used mindfulness to keep myself grounded in the moment so I could think critically and also not absorb all of the patient’s and family’s emotion.

Now I use mindfulness all day long to recognize when I am stressed and choose how to respond, enjoy pleasant moments more fully and to accept when I have feelings of sadness or grief while taking care of aging parents.

 

Please tell us about the success you have had in teaching mindfulness to the nurses at Rush University Medical Center.

 It is an amazing experience to be able to share the worst moments in my career and now teach how I processed the grief with mindfulness and continue to use it every day.

At Rush University Medical Center, we completed a study and determined that six months after nurses participated in a four-hour mindfulness and resilience workshop; they had reduced burnout and perceived levels of stress and increased mindfulness skills. We were thrilled with the results discovering that a short four-hour workshop can have an impact six months later.

 

 Please add anything else you think my Blog followers need to know about mindfulness.

 Here are some strategies and tips to incorporate into your daily life through informal practice, especially at work, where stress levels can be elevated. Just as a reminder, it is important also to practice informal mindfulness in times of minimal stress since it is easier to focus on being present and will make it more accessible during times of higher stress. Remember, it does not take any more time to be mindful.

 

Informal Mindfulness Practice:

STOP

STOP is a mindful technique that can be used in any situation to slow us down and reconnect with ourselves. It can be used before entering a patient’s room, sending an email, charting, speaking, or entering your home after work. The acronym STOP stands for:
• Stop whatever you are doing to pause for a moment
• Take a deep breath or two
• Observe any specific thoughts, emotions, or body sensations
• Proceed with more awareness

Two Feet, One Breath

This mindful technique can be used in times of stress to ground us and create a little space from the stressful situation being encountered.

With both feet firmly on the ground, while either standing or sitting:

  • Focus as much attention as possible on sensations in the sole of the left foot—perhaps pressure or sensations from contact with the sock or shoe.
  • Then shift attention to sensations in the sole of the right foot, with as much attention as possible.
  • Tune in to your breathing—just feeling the breath as it moves in and out.
  • Now, continue whatever you are doing in a more grounded and present manner.

Mindful Hand Washing

Use all the senses to bring awareness to the activity of washing the hands. Feel the temperature of the water and the sensations of the hands rubbing together, the smell of the soap, and the sound of the water running, and notice the bubbles forming from the soap. This awareness can be applied to any routine activity, such as brushing teeth, taking a shower, or typing an email.

 

Formal Mindfulness:

On-Line Mindfulness Workshop Opportunity:

TheMindfulness and Resilience 4- Hour Workshop has been shown to decrease stress and burnout symptoms and increase mindfulness skills 6 months after participating.

I am teaching it on Saturday, October 19thfrom 8 am – 12 pm CST.

For details:

https://www.sarazinemindfulness.com/corporate-mindfulness-programs

 

 

Julia Sarazine

Sarazine Mindfulness, LLC

www.sarazinemindfulness.com

Murder Building

I am reviewing posts that I will consider for inclusion in my second book, which focuses on home visits I have made in Chicago, Washington DC, and Durham, NC. I came upon Murder Building that was originally posted on February 19, 2012. It’s a keeper.

CT-BIZ-VACANT-BUILDINGS-B_CTMAIN0501SR-d55be438

When I visited a patient in my caseload that lived in an “unsafe” part of the city, I went in the morning. Right after the pimps and drug dealers had called it a night and before the shop keepers pulled up the bars over the store windows and the women came out to sweep the sidewalk litter into the streets.

One day Pearl, the social worker, asked to come with me to see a patient. She had a meeting in the morning so we left after lunch against my better judgment.  If I were going to go to an iffy part of the city, this was the last place I would want to visit. The Chicago Tribune ran a story a few weeks previously about the  “Murder Building.” I knew by the address it was next door to my patient’s apartment.

Everyone knows it simply as “the murder building.“

“They call it `the murder building` because people have been known to go into that building and not come out,“ said one young man standing on a nearby street. “You got to stay away from that place. Things go on in them halls you don`t want to see.“

What does that say about the neighborhood we drove through and the scattering of young men gathered on the stoops, some leaning against the parked cars, all seeming to be without a sense of purpose? I felt their eyes following us.

My patient lived on the second floor with his common law wife and various other relatives. The front door was locked and since there wasn’t a bell, I had to stand under the window and yell the patient’s name. The patient’s wife would come to the window before she sent one of the grandchildren down to let me in. This was before cell phones.

I dreaded leaving the safety of the car. Did any of the men think we carried drugs? I scooted out and quickly grabbed my nursing bag from the trunk along with a white bathroom scale. The patient was on tube feedings. It remained unclear if his wife was able to manage the procedure and give the feedings on schedule. I was monitoring his weight as evidence of success.

When Pearl and I completed our visit, we took quick, long steps to the car, avoiding eye contact with anyone near-by. As I stuffed my bag and scale into the trunk, I felt someone tap me on the shoulder. I waited for the command to hand over my nursing bag. Instead a soft voice asked, “Before you put that scale away, would you weigh me?”

I turned to see an older man with short gray whiskers on his chin and a pleasant smile. He moved aside as I slammed the trunk closed and carried the scale to the sidewalk. He took his shoes off and stepped on the scale. “I can’t see the numbers,” he said. I read them off to him, he stepped down, retrieved his shoes and said, “thank you.” Behind him stood a young man with dreadlocks. “Can I get weighed too?” He slipped out of his high tops. I called out his weight and he left with a “thank you.”

Behind him a line of men snaked along the sidewalk. Pearl emerged from the car and began joking with the men, young and old, as they waited their turn at the scale.

Back in the car, the scale packed away in the trunk, Pearl and I drove to the corner. As we pasted the Murder Building, ominous and frightening with smashed windows and debris scattered around its foundation, I realized a building doesn’t define a neighborhood.

 

Book tour in Chicago

Saturday, June 1, 2019

I am scheduling this post to publish on Wednesday, June 5, 2019. That day, I will be in Chicago talking about my book to the Advanced Practice Nurses at Rush University. I have three other venues scheduled before I head home on Monday. In between events, I will spend time with old friends. I’m having lunch with one woman that I haven’t seen in over 20 years!

Frank Lloyd Wright Home and Studio, Oak Park, Illinois

On Sunday, I will be reading at the Oak Park Library, Oak Park, Illinois. My daughter and 15-year-old grandson will have flown from Raleigh to join me. Afterwards, my daughter will show her son where she grew up. Maybe we’ll visit the Frank Lloyd Wright Home and Studio where, to get a change from nursing, I volunteered in the gift shop. I learned so much about Frank in particular and architecture in general. I always wondered if my involvement with the FLW Foundation had any influence on my daughter’s choice of a career—architecture.

So, think of me in the Windy City as you read this.