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.

WHY DO WE WRITE?

Originally appeared on September 16, 2012.

Nursing Stories

I attended the book signing this past August. Farther Along, written by my friend and mentor, Carol Henderson, which told the stories of thirteen mothers (she is one of them), a bakers dozen as Carol points out, who had lost children at various ages.

I was prepared to cry. I don’t do well with death of children, even adult children. Children shouldn’t die before their parents. Maybe that’s why I choose geriatrics as my specialty. Old folks die. It’s expected. No surprises. I can deal with that.

I teared up but didn’t cry and was somewhat unprepared for the humor, serenity, and lack of self-pity as the six mothers read sections from the book. But then ten years had passed since the women came together under Carol’s guidance and direction. Certainly bereavement takes time to absorb, rant and rage against, come to terms and eventually accept the grievous loss…

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THE TIME IS RIGHT

Taking a Blog break. This post appeared on March 10, 2013.

Nursing Stories

A friend deliberated whether she should visit her father for his 95th birthday. She was swamped with commitments. Since he was unaware of his birthday as well of his surroundings and didn’t even recognize his three daughters, there was no urgency to travel to another state.

However, she cleared her schedule and made the trip, as did another sister and a niece. Both lived out-of-state also.

As it turned out, on his birthday, he had a choking episode with difficulty breathing. He stopped eating and died three days later, surrounded by those he loved who otherwise would not have been there had they not come to commemorate the day he was born.

This story reminded me of a patient I cared for back in the early ‘90’s when I worked as a nurse practitioner in a home care program. I had made a first visit to an elderly man…

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My Mother’s Boyfriend

Happy Mother’s Day.

My mother died the day before Mother’s Day sixteen years ago. Each year at this time my memories of Mom revolve around both her life and death. Her last few years weren’t what I would have predicted.

When Ernie and I moved from the Midwest to Maryland in 1993, Mom came with us. I had found an assisted living apartment for her. She was 85 at the time—independent, and mentally sharp.

My father had died over twenty years ago. Since that time her only friends were other women. A couple of months after the move, she had to have new glasses. Then she wanted to replace her old hearing aid with not one but two. Clearly, she wanted to see and hear what was going on around her. Over the phone, she told me, “I am having so much fun,” and mentioned a boy friend. As a gerontological nurse practitioner, I knew that a move to an unfamiliar place could make an old person confused. I dismissed the boy friend as wishful thinking.

Shortly after that phone call, I pulled up in front of Mom’s apartment building on a lovely spring afternoon to take her on a shopping trip. She came to the car and shouted to me through the open window on the passenger side, “Come on out, I want you to meet someone.” After shutting off the engine, I got out of the car and followed her to the bench by the front door. Two men sat side-by-side: one was obese with red blotches over his face and the other, a tall thin man, wore a baseball cap and cowboy boots, with a red-tipped white cane resting between his knees.

Mom nudged me in front of the two men. “Lee, I want you to meet my daughter.”

The man wearing a baseball cap stood up, ramrod straight. His eyes were hidden behind dark glasses. Red suspenders stretched across a pot belly covered with a blue flannel shirt. His right hand shot out in front of him.

“Pleased to meet you,” he said in a strong, even voice, shaking my hand. He smiled showing a scattering of rotten teeth. I felt as if I were meeting my teenage daughter’s beau who so wanted to impress.

Lee was twelve years Mom’s junior. At first they talked of marriage but Mom said no because he was a Jehovah’s Witness and she a Catholic. In her mind that was deal breaker. Then they were going to move into one apartment. But they were never able to decide which one would give up his/her apartment. For the next seven years, they saw each other daily. They took walks together—Mom leaned on Lee while she guided his steps; they sat together at the same table for communal dinner, and they took naps together. Mom never told me outright but I surmised this when she revealed she had lost her favorite earring in his bed. I never asked what else transpired between them.

However, their relationship was not without problems. Mom didn’t trust him. She suspected that he was cavorting with other women.

While Lee was a younger man, he was an unlikely gigolo. Besides diabetes and blindness, he had had two heart attacks, a triple bypass, and a Foley catheter that migrated from his bladder out of his penis and down his pants leg and ended up in a collection bag not so neatly tucked into his left boot. Most times he reeked of stale urine and dirty clothes. Mom, who had had a life-long addiction to cleanliness, never complained of his hygiene. But by God, don’t let him prove unfaithful.

Mom’s suspicious and judgmental nature never seemed to take a toll on their relationship. Lee would laugh and say, “There she goes again” when she would accuse him of flirting with another woman. At the same time, Mom would insist we include Lee on family celebrations and occasional luncheons where Lee would eat with his hands and Mom would inevitably spill her water, or wine, and I would leave a big tip as we left the table and floor in a shambles.

When Ernie accepted a job offer in North Carolina, Lee encouraged Mom to go with us. She had become more frail and had frequent falls. After being hospitalized with a bout of pneumonia, she was admitted for a short-stay in a nursing home not far from her apartment. A kind health care worker would walk Lee to visit. I was glad I wasn’t present to witness their final good-bye.

Mom lived just lived nine months after the move.

I went to visit Lee shortly after Mom’s death to give him her radio/cassette player and large button telephone. On the drive up to Maryland, I had romanticized the visit—he expressing his deep love for my mother, sharing the moments they laughed together and telling me how much he missed her.

During the visit, Lee sat in his recliner in a cluttered apartment never uttering the nice words about my mother I longed to hear. And he didn’t remember the times I took them to the Red Lobster and the neighborhood Chinese restaurant. After I programmed his daughter’s number into the phone and we ran out of polite topics to talk about, I left.

On the long ride down route 85 South toward North Carolina and home, I wondered if Lee didn’t talk about Mom with me since I was the one who took her away—although he encouraged her to leave, or he was losing his memory? Or both?

Nevertheless, I couldn’t be too disappointed since he gave Mom a reason for living and certainly kept her blood flowing if only from the aggravation of thinking her blind prince charming had a roving eye. And I will always remember the time she said she was having “so much fun.”

Thanks Lee.IMG_2668

Rewriting the Book

writing a bookI’m doing what I said I would never do. Rewrite my book. I completed my manuscript late last year, sent it out to 20 small presses and one agent. While I have been waiting for the results to trickle in—those returned so far have been rejections—I’ve been troubled by a lingering discomfort that I have left something out. Something significant. Something that I couldn’t, shouldn’t ignore.

So for the past few months I have been having an internal dialogue:

“Leave the book alone. You did the best you could do.”

“No, something isn’t quite right. I’m not happy with the final manuscript.”

“You could be rewriting this book for the rest of your life. Let it go. You don’t want to be that writer who never submits her book because it ‘isn’t good enough’.”

“Aha! I know what it is that’s troubling me.”

My book shows how I managed a Senior Clinic in a Chicago Housing complex. I was a new nurse practitioner (not a new nurse). I show the role of the NP. However, in writing the book, I had totally overlooked the fact that while I was indeed a new nurse practitioner, I was also practicing in a new specialty—Gerontology. I say this but I DON’T SHOW IT.

Why is this important? Well, because when I became a Gerontological NP in the early 80s, studying old folks was a rarity. Older persons were generally ignored or worse, discounted and ill-treated. The 1978 best seller House of God by Samuel Shem, an irreverent book about medical interns in an renowned teaching hospital first coined the derogatory term GOMER, meaning “get out of my emergency room.” A term used frequently to classify the old person as someone without worth to cure, much less treat in our medical facilities. Some believed most old folks disengaged from life, deriving no pleasure in longevity. The fact that elders over 60 would still be interested in sex was shocking. WY SURVIVE: BEING OLD IN AMERICAAnd in this same time period the groundbreaking book: Why Survive? Being Old in America by Robert N. Butler, M.D. discussed whether or not to introduce geriatrics in postgraduate medical education.

Nursing was early to recognize geriatrics as a specialty but thought that the medical definition—specializing in the treatment of existing disease in older adults—too narrow.

Nursing developed a much broader vision and used the term gerontology rather than geriatrics.

Gerontology encompasses the following:

  • studying physical, mental, and social changes in people as they age

  • investigating the biological aging process itself (biogerontology)

  • investigating the social and psychosocial impacts of aging (sociogerontology)

  • investigating the psychological effects on aging (psychogerontology)

  • investigating the interface of biological aging with aging-associated disease (geroscience)

  • investigating the effects of an aging population on societyapplying this knowledge to policies and programs, including the macroscopic (for example, government planning) and microscopic (for example, running a nursing home) perspectives. (Wikipedia)

In 1981, the American Nursing Association certified me as a Gerontological Nurse Practitioner. A Board Certification was developed by the Medical Community 7 years later.

After I rewrite my book, you will see a Gerontological Nurse Practitioner in action.

WHAT I LEARNED

 

I am writing my memoir because of what I learned when I ran a clinic on the tenth floor of a Chicago Housing Authority (CHA) high-rise twenty years ago. All my patients were over sixty years of age. I was an inexperienced nurse practitioner and new to working with older people.

I learned that older folks were generally accepting and forgiving.

old-man-drinking-whiskey-and-smokingI learned that a few drank too much, hired prostitutes, carried guns in their purses, and chewed tobacco.

I learned that some sold their medicine for street drugs or money and some were abusive and some were abused.

I learned that not all families wanted to care for their older members and that family members, who suddenly showed up when someone was dying, might not be family.

I learned that most of them enjoyed sex.

I learned that loneliness was the most pervasive condition among the group.

I learned 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.

I learned 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.

I learned 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.

I learned that a sense of humor was a requirement when working with the elderly.

And I learned that some of my patients were impossible to forget.

PF-Elderlybridge_1201447c

 

WHY CAN’T NURSES RUN THE SHOW?

images-2

Last week I reblogged Josephine Ensign’s Radical Hat-Burning Nurses Unite! because I was moved watching the Politics of Caring. The video, released in 1977, showed in Ensign’s words, “how little things have changed.” Nurses then were striking and joining unions in order to have “control over their jobs” and to promote safe and good nursing care. Ensign mentioned that some nurses, and I was one, left hospital nursing by becoming nurse practitioners or community nurses so they could enjoy autonomy not afforded in hospital nursing.massnurse5

In the 70s a friend of mine who already had a master’s degree in history and two school-aged children entered nursing school. After graduation, she worked only a year in a hospital, “paying her dues,” before she left for a desk job at an insurance company. She found the discrepancy between the culture and promise of nursing education and the reality of nursing practice—poor pay, lack of autonomy and hours that she had no control over—unacceptable.

Also at this time, I had quit my job at a small community hospital south of Chicago when I discovered that a new grad received the same starting salary as I. She was assigned a seasoned nurse to mentor her for her first few months of employment—among other experiences she lacked, she had never inserted a Foley cath in nursing school—while I went directly to the medical intensive care unit. I wrote in my resignation letter that I felt this unfair. The Director of Nursing called me at home pressuring me to reconsider but didn’t offer me an increase in salary. I didn’t go back.

Instead, I found a job in a nursing home that paid me more. A nurse who lived in the community ran the home and many of the residents came from the surrounding area. Most of the staff had been there for years. I loved working there and it was probably the reason I later specialized in geriatrics.

Even though I had sworn not to work in a hospital again, I found myself on a neurology unit when I was in graduate school in-between semesters in the late 70s. I wrote a story about the experience (“Invisible.” Examined Life Journal, 2.1 Fall 2012:55-60.). While I was helping one of my patients get ready to go home, I realized she was still ill. I had the skills to diagnose her congestive heart failure but I didn’t have the power to delay her discharge. I had to call her doctor and tell him I thought she shouldn’t be sent home. It was the first time I deliberately avoided playing the old doctor-nurse game, which would be to suggest he some how was responsible for this decision. My intervention did delay her discharge so she could be treated, possibly preventing readmission and maybe even saving her life. What I did was something any nurse could have done. How many times do bedside nurses who know the patient best see signs of trouble coming and alert the doctors? But we rarely call attention to ourselves. And when the patient gets better and leaves the hospital who does the family think has made all the difference—the doctors.

Getting back to that nursing home run by a nurse.

I have always played with the vision of nurses being in charge of a hospital and where doctors were the employees. I don’t have all the details worked out in my reverie but my hospital would let patients sleep at night without disruption for vital signs, lower noise levels in corridors, schedule tests around the circadian rhythm of the patients, imagesserve tasteful, nutritious food and post prices of procedures and surgeries so patients would know what costs were attached to their care up front. No health professional (read doctors) would be allowed to throw a temper tantrum or refuse to follow infection control precautions.

The “Nurse Hospital” wouldn’t have a nursing shortage. Why wouldn’t nurses want to work in an institution where they are appreciated and well paid and are included in decisions that affect their practice? And why wouldn’t patients want to be in a safe, patient-centered environment? Nurses wouldn’t need to join unions to have control over their practice and provide good patient care.

Things would change.

WHY DO WE WRITE?

I attended the book signing this past August. Farther Along, written by my friend and mentor, Carol Henderson, which told the stories of thirteen mothers (she is one of them), a bakers dozen as Carol points out, who had lost children at various ages.

I was prepared to cry. I don’t do well with death of children, even adult children. Children shouldn’t die before their parents. Maybe that’s why I choose geriatrics as my specialty. Old folks die. It’s expected. No surprises. I can deal with that.

I teared up but didn’t cry and was somewhat unprepared for the humor, serenity, and lack of self-pity as the six mothers read sections from the book. But then ten years had passed since the women came together under Carol’s guidance and direction. Certainly bereavement takes time to absorb, rant and rage against, come to terms and eventually accept the grievous loss that will never be forgotten until one’s dying day.

How fortunate the women found each other and Carol. Writing their stories seems to have brought them to a better place than they would be if they hadn’t immersed themselves in writing.

Why did these women write?

Carol says in her book:

“Writing about deep and traumatic matters, as many studies now confirm, is good for our physical health. Reflective writing actually lowers pulse and blood pressure, increases T-cell production, and boosts the immune system. Writing can help us cope with chronic conditions like physical pain—and the loss of health, of dreams, and, yes, of children.”

We all write for different reasons. I am haunted by my patients. They walk around in my memory and defy me to ignore them. I need to tell their stories.

“Why do we write? To make suffering endurable. To make evil intelligible. To make justice desirable and . . . to make love possible”

Roger Rosenblatt, Unless It Moves the Human Heart: The Craft and Art of Writing

Why do you write?

ONCE A NURSE, ALWAYS A NURSE By Jane Van De Velde, DNP, RN

My nursing career has taken me down many paths over the years. Presently, I am a Reiki Master Teacher as well as the founder of a nonprofit organization called The Reiki Share Project.

People often ask me what I “do.” And I usually begin by telling them that I am a registered nurse.

Their next question is…”Where do you work?”

This question always trips me up. People seem to think that if you aren’t employed as a nurse, then you stop being a nurse.

However, in my heart and my mind, I am always a nurse—no matter what. My nursing education and experience influences the way I view and interact with the world on a daily basis.

Thanks to all those client caseloads that I managed, the patient assessments I conducted and plans of care I wrote and implemented over the years; thanks to all those papers I wrote for graduate school—I am very systematic in my everyday approach to problem solving, organizing my life, and getting things done. My experience in dealing with patients also serves me well in my Reiki practice. And I have found joy and satisfaction in the process of writing articles, developing Reiki teaching curriculums and putting together newsletters for my nonprofit organization.

Thanks to that dying hospice patient who taught me that even though her life was nearly over, she could still experience healing on many levels—I bring that lesson forward to my Reiki practice knowing that even though curing many diseases may not be possible, there is always the potential for healing.

Thanks to all those hours of attending to patients and caregivers—I have honed my listening skills and have learned that sometimes that’s all that people want—just to be heard. So my husband, children, family, friends, and Reiki clients give me the opportunity to continue refining these skills.

Thanks to all those elderly homebound clients I visited who served me coffee and cookies, treated me like an honored guest, and sometimes begged me to stay just a little bit longer. I learned that simply being quietly present is a wonderful gift that we can give to others. Our “time” is a gift.

So, I continue to do my nursing work every day both personally and professionally in my Reiki practice. And I have developed a new response to the question: where do you work? I tell people that I am self-employed.