Country Music

I’m not writing my second book whose working title was to be “Home Visits.” The Pandemic has cast a spell on my brain, resulting in lethargy and an inability to focus on structuring another book. So, instead, I’ve decided to take each home visit story and submit it to a literary magazine for potential publication as a “stand-alone” essay. I plan to email one of the stories, Country Music, at the end of this week to an online journal. 

Country Music tells the story of three patients that I cared for when I worked as a nurse practitioner in a home care program at a Veterans Hospital outside of Chicago. They were at various stages of dying. In the late 80s, the hospice movement was just taking baby steps into the medical/nursing world. I was learning about dying and death from my patients and their caregivers. 

The locations of the three patients’ homes lined up perfectly for me to make the visits to them conveniently in the same day. This lasted for about three months. On the day of the story, a dreary, rainy day, I show the challenges I faced working with my three male patients and their wives (few women were enrolled in the VA health care system at that time), how each man played the hand he was dealt and how the women dealt their husband’s decline. 

One of the men loved country music. Talking with him about songs and artists, rekindled my interest in the genre. I found a great country western radio station on my government-issued compact car. The earthy, raw lyrics telling of common human emotions became my therapeutic passenger that accompanied me on my home visits. 

While I am editing this story for submission, I find myself checking into YouTube to listen to the familiar songs that supported me so many years ago. This is more fun than writing that second book. 

Home Visits Can Be Fraught With Danger

As I write my second book, which is about the home visits I have made over the years, I am resurrecting memories from my mind and the pages of my journals. Today’s post shows a time when I didn’t use common sense and how home visits can be fraught with danger. 

One day in early fall, on my drive back to the hospital after making all my scheduled home visits, I found myself passing by a patient’s apartment on the westside of Chicago. Since I was ahead of schedule, I decided to drop in, unannounced. I had the time. My patient had a caregiver: a tall, muscular man who always opened the door to the first-floor apartment wearing a long blond wig and thick make-up. Despite his flamboyant appearance, he gave competent care to his charge: a bed-bound, uncommunicative middle-aged man with multiple sclerosis. An exotic array of visitors wandered in and out of the apartment. My patient’s mother, strikingly average looking compared to the rest of the visitors, lived in rooms above her son’s and was often present when I came. However, this day I walked into an unlocked and empty apartment. Only my patient, lying in bed in the darkened bedroom, was present. 

Neither the caregiver, nor the patient’s mother, or anyone else familiar to me entered the apartment while I was there. However, as I finished with my evaluation, a man opened the unlocked apartment door. He wasn’t anyone I had seen before. My patient smiled at him knowingly.

The man removed his jacket and tossed it on the sofa. We introduced ourselves. His eyes moved down my body. Acutely aware of the precarious situation I was in—alone in that apartment with a strange man and unhelpful patient—a band tightened around my chest. 

“I’m just leaving,” I said as I promptly packed up my nursing bag. 

Safely back in my car, my breathing heavy and my hands shaking, I chastised myself for making this impulsive visit. No one back at the office knew where I was. It was a time before cell phones. What If something had happened to me?  I didn’t want to think of that. I never again made an unscheduled home visit. 

Sometime after that impromptu visit, at a nursing conference, I sat fixated as another home health nurse told a story about the time that she had made a scheduled visit. She rang her patient’s doorbell. He didn’t answer. It was later that she found out he had been murdered. And in hearing more detail, she discovered that the murderer had likely been in the house the exact time she was ringing the bell. Good thing the door wasn’t unlocked. 

Home visits can be fraught with danger. 

NURSES REALLY MAKE A DIFFERENCE

 

Betsy, a writer friend, emailed me the story she had read in our workshop since I had to miss the class. She knows I hang on every episode of her life in Ireland where her second child was born and she negotiated the daily vicissitudes of a different culture. In this episode she had left the hospital with her new baby girl. She happily accepted the offer to have a nurse visit her and the baby at home.

Her daughter is in college now but Betsy still remembers how helpful the nurse was—and knowledgeable and reassuring, which, in turn, made me remember the article I read not too long ago by David Bornstein, The Power of Nursing (NYT, May 16, 2012) about nurses who made regular home visits to at-risk pregnant women and continued these visits until their children reached the age of two. The program, Nurse-Family Partnership (NFP), conducted studies that demonstrated the visits improved both child and maternal health and financial self-sufficiency and provided a five to seven point boost to the I.Q of these children. Plus many more positive results.

NFP, which has been around since the ‘70s is implemented in forty states, empirically proves what many of us already know: nurses REALLY make a difference. Training paraprofessionals to do the nurses’ job didn’t yield the same outcomes.

We nurses do make a unique contribution. No one else can fill our shoes.

THE WEIRDEST HOME VISIT

This originally appeared on 08/12/2012. The Weirdest Home Visit is one of many stories that didn’t make it into the first book. I am considering it for inclusion in my second book.

Nursing Stories

When I worked in the home care program at a VA hospital in Illinois, medical students sometimes came along with us nurse practitioners while we made our visits. I enjoyed showing them the reality of delivering care in the patient’s home—where we were guests—the subtle line between suggestion and decree, education and instruction, doing for the patient and letting the patient do for himself.

One afternoon, when I had a female medical student riding with me, I had trouble finding the house. In the day of no cell phones or GPS’s, I stopped at a gas station to call the patient’s wife. Was I being paranoid when she sounded like she was being deliberately unclear?

We finally drove down the well-manicured block in a rather upscale neighborhood. One house in the middle of the block was “protected” by a row of stately cypresses or if cypresses trees don’t grow in…

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Home Visits Can Be Fraught with Danger

 

One time, long ago, at a nursing conference, I sat fixated as a fellow nurse told a story about the time she rang the doorbell at her patient’s house, and he didn’t answer. It was later that she found out he had been murdered. And in hearing more detail, she discovered that the murderer had likely been in the house the exact time she was ringing the doorbell.

Home visits can be fraught with danger.

One time I visited a patient who wasn’t on my list for that day only because I was in the neighborhood and had the time. He was bed ridden and unable to speak. He had a caregiver, a tall, muscular man who wore a long blond wig and make-up but masculine clothes, such as jeans and a sweat shirt. He was attentive and capable and flamboyant. An exotic array of visitors wandered in and out of the apartment. My patient’s mother, strikingly average-looking compared to the rest of the visitors, lived in an apartment above her son’s and was often present when I came. However, this day, unannounced, I walked into an unlocked and darkened apartment. Only my patient, lying in bed, was present.

Neither the caregiver, nor the patient’s mother, or anyone else familiar to me entered the apartment while I was there. However, as I finished with my evaluation, a man opened the unlocked apartment door. He wasn’t anyone I had seen before. In fact, he was unimpressive in slacks and button-down shirt. My patient smiled at him knowingly. We introduced ourselves. His eyes moved down my body. Acutely aware of the precarious situation I was in—alone in that apartment with a strange man and unhelpful patient—a band tightened around my chest. I promptly packed up my nursing bag and left.

Safely back in my car, I chastised myself for making this impulsive visit. No one back at the office knew where I was. It was a time before cell phones. What If something had happened to me . . . .  I didn’t want to think of that. I never again made an unscheduled home visit.

As I work on my second book, which is about home visits, I contemplate my experiences. I want to include the various unsafe situations visiting nurses may find themselves. It’s not just the “iffy” neighborhoods that may hold danger.

For example, I have previously posted a story about a patient that might have been murdered by a family member. When I drove down the tree-lined street in a middle-class neighborhood to make a last follow-up visit to the widow, it never occurred to me that foul play, and not terminal cancer, could have caused my patient’s death.

There are other dangers to home visits, of course. One nurse I knew broke her leg while stepping on an uneven floor; another was attacked by the family dog. Environmental conditions, such as inclement weather, flooded roads and extreme temperatures, are a constant threat to home visits. Once my windshield wipers died on me as I drove on the highway in a snow storm.

Yes, home visits can be fraught with danger.

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.

 

The Murder Building

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Originally posted on February 19, 2012 

 

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 of a three story apartment building 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.

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

Laughter: the measure of a friendship

I believe the better the friendship the more raucous the laugher—the real belly laughs that make you think you are going to die of asphyxiation. I have a number of friends that are enjoyable to be with but I have just two or three that make me really laugh.

Donna and I worked in home care at a Chicago area VA in the late ’80s. Our caseload mostly included veterans who were elderly with chronic disease or dying of cancer. Both NP’s, we worked four-ten hour days a week, each covering for the other on the day we had off. Jane, a third NP who worked with us, had young children and requested to work a regular schedule.

Many times after work, Donna and I lingered in the large 4-bed room on a deserted patient unit that served as an office for us three NPs. Each of our desks was centered against a wall. No other furniture filled cavernous room. Donna and I would take turns rolling our chairs next to the other’s desk. We discussed our patients before we wandered off into the personal and humorous. Our laughter ricocheted off the walls. If we became raucous, we didn’t care since there was no one nearby to complain.

After my husband and I had moved to the DC area, Donna came to visit. At one of my favorite art museums—The Phillips Gallery, Donna and I burst into unrestrained laughter. I can’t remember the trigger. What could be so funny in an art gallery? The other patrons gave us wide berth while we two middle-aged women tried to control ourselves. The more we worked to settle down, the harder we laughed. That was the last time Donna and I were together.

In 2000, Donna moved to southern Illinois and I to North Carolina. We emailed and occasionally spoke on the phone. In 2013, Donna was diagnosed with lymphoma.

During one of her remissions she reviewed my manuscript checking for any inaccuracies in my descriptions of NP practice in the 80’s. I sent her a thank you bouquet of flowers.

Now as I ready my book for publication, I am composing the Acknowledgements. The realization that Donna won’t see a formal appreciation saddens me. She died on July 9th.

I will miss her laughter.

I HAD A DREAM

Revisiting the dreams.

Nursing Stories

Mercury Sphygmomanometer

In preparation for moving I discover the darndest things as I unpack dusty boxes stored in the attic untouched for years. This time it’s a mercury sphygmomanometer, packed in its original carton along with a “limited warranty” card that should have been filled out within ten days of purchase. Looks like I didn’t even open the box but put the blood pressure machine away for the day I would open my independent practice.

That would have been in the early 80s after I became a gerontological NP

and

after I worked in Chicago with inner city, underserved elderly

and

after I became frustrated with the lack of resources and left to become an administrator of an HMO

and

after I knew I didn’t want to be in administration

and

after going back to work as a nurse practitioner once again

and

after moving to three different states

and

after finally…

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