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.
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.
Yesterday, 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.
I almost forgot about Dennis. That’s what Carol Novembre thinks his name was. Carol and I worked together in the early 60s at Pollack Hospital in Jersey City. It was a county-run hospital. Dennis was head of maintenance. I learned a lot from him about the political corruption that went on behind the scenes. Not that I had any doubts about the kickbacks and abuse of power. I had seen the cases of liquor at the loading docks that were to be delivered to the administration suite (aka “the penthouse”). One time when I answered the phone on our nursing unit, a voice at the other end reminded me that my “donation” of five dollars was due in order to keep my job. When I identified myself as a nurse, the male voice apologized profusely.
Dennis, a tall, lanky guy with a pocked marked face and disheveled clothes, made rounds in the hospital when he wasn’t off-site, overseeing the unofficial work of prisoners. He would bus the prisoners from the county jail to work on the administrator’s suburban house—building a fence, painting the siding, tending to the gardens in the summer. He seemed especially fond of the nurses. If he learned one of us had missed lunch, he would run down to the kitchen and reappear with a bacon sandwich.
Reminiscing about Dennis was only one of the memories that resurfaced as I spoke to Carol last week. I had asked her if I could write about the fact that she was one of the first dialysis nurses in the country. I worry that as nurses age and die off, stories of nursing history will be lost. My stories included.
You will read more about Carol Novembre in a future post. In the meantime, here is a story I had published about one of the patients I cared for while I worked at Pollack Hospital in the mid-60s.
CLOSING THE DOOR
I screwed off the cap of the Black and White Scotch bottle and I carefully measured out sixty milliliters, two ounces, into a medicine glass. The alcohol fumes gagged me every time. Then I grabbed a pack of Lucky Strikes from the carton on the shelf next to an aspirin bottle. Cigarettes and Scotch balanced precariously on a small tray. I locked the door to the tiny medication room and went in search of Charlie Hobbs.
The tobacco smoke clouded the air in the patients’ lounge. The drab room was empty except for a middle-aged man in blue pajamas staring at pieces of a jigsaw puzzle on the card table in front of him. A cigarette clung to his lower lip.
At times, I imagined myself the airline stewardess I had always wanted to be. Coffee, tea, or me? This day I was a Playboy Bunny as I bent at the knees, stretching to place the drink in front of Charlie, while his blue eyes riveted on my imagined cleavage. But Charlie’s eyes fixed solely on the amber liquid. Not once in the past four weeks had he acknowledged me, the young nurse in a starched white uniform with thick support hose and practical shoes. An unlikely dispenser of booze and butts.
Charlie had arrived with no suitcase, only the clothes he wore. The faded blue hospital pajamas and robe comprised his daily wardrobe. One of the other nurses had donated slippers. I looked down at the top of Charlie’s wild red hair. “I got to get me another puzzle,” Charlie said without looking up at me. “This here one is almost done.” He snuffed the cigarette butt into an overflowing ashtray and reached for the drink. I was glad Charlie had decided to shower that morning or else his pungent body odor would have added to the foul air.
Charlie shuffled the jigsaw pieces about by day, and watched television by night, all a maneuver, I thought, to keep human interaction at bay. No one ever visited him. Did he even have a home to go back to?
Dr. Clark’s research money supported Charlie’s hospital stay. Dr. Clark needed recruits who would agree to have a cardiac catheterization in order to see the effects, if any, that alcohol had on their hearts. Cardiac catheterization was the latest tool of the sixties. It measured heart function but carried the risk of injury and even death.
Dr. Clark scoured the downtown bars searching for men who drank excessively. On a warm summer night about a month ago, Dr. Clark had gotten lucky. Charlie seized the carrot: a roof over his head, three squares a day, free liquor and cigarettes. He agreed to live on the third floor of the county hospital for four weeks and then undergo a cardiac catheterization.
I carried the empty medicine glass on the tray back to the nursing station. How could Charlie drink alcohol at nine in the morning? Or all day long, for that matter? What would make a man so desperate that he would consent to have a procedure that might kill him?
Even though I didn’t particularly like Charlie, there were times as I placed the Scotch in front of him that I wanted to nudge him and jerk my head towards the exit sign down the hallway. Get out, Charlie. The catheterization isn’t worth all the free alcohol and cigarettes that Dr. Clark’s giving you. Get out. Now. But I didn’t have the audacity to undermine Dr. Clark’s research, no matter how conflicted I felt.
At twenty-three and a nurse for just two years, I vacillated between professionalism and irreverence. I struggled with knowing when to step back and when to dig deeper into my patients’ psyche. How to be empathic and not sympathetic. How to balance cool detachment with overbearing involvement. Charlie needed someone on his side to help him understand what he was getting into.
Nellie Mineo interrupted my thoughts as she waved to me from the doorway of her husband’s room. She looked like the Italian housewife that she was: salt and pepper hair piled in a bun on the top of her head. A well-worn cardigan sweater covered the simple cotton dress she wore. Behind her thin frame I could just make out her husband’s outline under the starched white sheets.
The Mineo’s had known the chances weren’t in their favor when they first met with Dr. Clark to discuss replacing Joe’s diseased heart valve with an artificial one. At that time Joe was so short of breath that he could hardly talk, much less continue to work in the family grocery store. Joe had been my patient during the week Dr. Clark evaluated him for surgery. The Mineo’s large, gregarious family resembled my own extended Italian family. Joe could’ve been my Uncle Tony with olive skin, dark eyes and soft smile.
An artificial valve, which clicked audibly, replaced Joe’s faulty one. I had worked overtime on the surgical unit as Joe’s private nurse the first night after surgery. At first things looked great, but soon Joe developed a cough, and then his legs swelled. Diuretics only worked for a while, and the antibiotics failed to prevent the infection from ravaging his body. Although the valve was being rejected, it continued to click on.
Joe had the first room near the nursing station. The floor was dedicated to research and held only fifteen patients. The patients stayed for a long time or returned frequently for evaluation. Not surprisingly a strong bond developed between the professional staff and the patients and their family.
Joe’s family and friends usually came and went at all hours, but this day only Nellie stood guard. When I ambled towards her, she grabbed my hand. “He looks worse,” she said, rubbing my hand in absent-minded distraction. “Promise me you’ll stop in before you go off duty today.”
Nellie and I both knew that there would be no miracle for Joe. His once muscular body shriveled into sagging skin covering a bony frame. He didn’t open his eyes to Nellie’s voice. Even a sharp pinch to his face couldn’t get a reaction. “Stop and see me before you go off duty,” Nellie repeated. I nodded. Only then did she loosen her grip on my hand.
At the end of the day, as I flung my coat over my arm, I heard a racket from the patients’ lounge. Charlie stomped past me, head down and fists clenched. “I’m outta here.”
“What happened?” I asked the nurse who jogged after Charlie.
“Charlie kicked over the card table. No reason I could see for this.” She shrugged her shoulders and continued down the hall.
Nellie watched the commotion from the other side of the hall. I walked towards her. She pulled me into her husband’s room, grabbed my coat and purse and held them tight against her body. She stared at me for a long while without speaking. From behind her I could hear Joe’s wet bubbly breaths. Even in my short stint as a nurse I recognized the rancid smell of impending death.
Nellie moved her face closer to mine and whispered, “He’s dying.” She caught a sob and swallowed hard. “I don’t want him resuscitated. Stay with us, please stay with us. Don’t let them resuscitate him. Please don’t.” She wept quietly, clutching my coat and purse closer to her body.
What was I to do? I had never faced this dilemma before. I knew Nellie had witnessed plenty of resuscitation attempts as she lingered outside her husband’s hospital room day after day. Cardiopulmonary resuscitation was so new that all patients were candidates. At the first moment a patient stopped breathing, we leaped into action. We flung him to the floor and straddled him. With the side of our hand we walloped the sternum to get the heart started, then breathed frantically into his mouth. Pumped on his chest. We worked until we were exhausted. In most cases the patient died anyway with fractured ribs and a lacerated liver. Nellie didn’t want this for Joe.
Thoughts flew in and out of my mind. If the staff saw Joe turning blue, they wouldn’t give a second thought to trying to revive him. A resuscitation attempt might bring Joe “back to life,” but only briefly. Then there would be more pain and agony before his heart gave out and he died—again.
What would I want for Uncle Tony? A quiet death, or zealots in white coats beating on his chest? What should I do? Was there a choice? I looked at Nellie, her dark eyes pleading.
I heard Charlie’s voice from down the hall spewing curses. Perfect timing. Charlie would leave the hospital AMA—against medical advice—right before his scheduled catheterization. I hoped whatever he was up to would distract the staff just long enough for Joe to die.
My heartbeats kicked up a notch as I reached over and slowly shut the door. Nellie’s hold on my coat and purse relaxed and they slid to the floor. Wordlessly, she settled down in the chair next to Joe’s bed, lifted his limp hand into her lap and clutched it. I commandeered the chair by the door: the sentry blocking the enemy from entering.
I sat knotted tight while Joe’s breaths became more erratic. The lapses between his gasps for air stretched farther apart. Just when I thought he had quit breathing, he gulped for air.
Finally, the mechanical valve stopped clicking and the room became silent. I walked to the bed and placed my hand over Joe’s clammy hospital gown. I didn’t feel any movement in his chest. I didn’t feel a heartbeat. Joe’s open eyes stared at nothing. I stood there for a long minute before I smoothed down his lids.
Nellie gripped her husband’s hand to her breast and sobbed softly.
I stood over her, my hand lightly on her shoulder. While I felt relief that Joe died peacefully with his wife by his side, each footfall by the door made my heart flip. What if one of the staff would walk in and find I had made a decision that wasn’t mine to make. “ I really need to leave, Nellie,” I whispered, taking Joe’s lifeless hand from hers and placing it by his side.
Tears slid down Nellie’s cheeks. She rose from the chair and embraced me. “Thank you,” she said, her voice cracking. I felt Nellie’s tears soaking into my shoulder as my own tears fell. Then Nellie pulled away and sat back down next to Joe, taking his hand again into her lap. I wiped the moisture off my face with the back of my hand, grabbed my things from the floor, cracked open the door, and glanced up and down the hallway. No one was around. Retrieving my coat and purse, I walked leisurely toward the exit leaving Nellie waiting for the evening nurse to discover Joe dead in the bed.
The floor was unusually quiet. The medication door was ajar in the nursing station. I had no intention of poking my head inside and saying so long to the evening nurse. Just a few more steps and I would be in the clear. As I turned the corner of the white tiled hallway, Charlie Hobbs’ presence blocked me. “Hi,” he said as if we were old friends. “I’m leaving. Can ya spare a buck for bus fare?”
Charlie had on a bright green jacket I was sure wasn’t his. Noticing my eyes on the jacket, he said, “Borrowed this from the guy in the next room. I’ll return it.” I nodded even though I knew the coat would never make it back to its owner. He shifted his feet nervously as he waited for my answer.
I wasn’t anxious to break any more rules but I was glad he was leaving. Why even try to entice him to stay? That would be hypocritical. I reached into my purse guessing he would head for the nearest tavern rather than the bus stop.
“Thanks,” he mumbled. Shoving the dollar bill into the pocket of the purloined jacket, he turned abruptly. In two long strides he disappeared though the doorway under the red exit sign and raced down the steps. I followed. A cold wind chilled my stocking legs as Charlie opened the door at the bottom of the stairs to the outside world. In his haste to escape he let the heavy door slam shut behind him.
I pushed the heavy door open with my shoulder. Unlike Charlie, I had no desire to announce my departure from the hospital by slamming the door. Leaving my covert actions behind me, I griped the handle with both hands and eased it closed.
The Closing the Door was a winner of the TulipTree’s Stories that Needto be Told Contest and is featured in their 2016 anthology: Stories that Need to be Told.
This is my 262nd Blog post. It’s a significant number for me. I spent the first twenty years of my life in a two-bedroom apartment in a three-story brick building in Jersey City, New Jersey: 262 Summit Avenue.
Most of the buildings on the block were three stories with an apartment on each floor. I could name everyone who lived on the block. Few people moved. Multigenerational families stayed in close proximity. My grandparents’ place was a two-block walk away.
We children couldn’t do anything wrong without a neighbor correcting us or telling our parents. In the summers we played outside until evening darkened the skies and the streetlights came on. In the colder weather, when the chill kept folks indoors, the older women sat by their windows as if afraid they would miss something.
Across the street, taking up most of the block, sat the massive New Jersey National Guard Armory. The National Guard soldiers came for weekend training. Blaring brass bands cut above the street traffic. It was only when I reached my teens that seeing all the young men in uniform kept me close to home.
In summers, the Armory hosted the Rodeo and big-name performers: Frank Sinatra and Jimmy Durante. My friends and I, probably around ten or eleven years old, had managed to sneak through a side door and wander around before the Rodeo started, watching the workers set up the stands for the audience and the pens for the animals. During the show, we edged up so close to the action that we could hear the cowboys’ grunts, as they desperately tried to stay on the backs of the bucking horses or angry bulls.
We listened to Frank Sinatra from the shadows along the walls. A spotlight followed his lanky body on the stage as he crooned into a microphone. We felt invincible.
In retrospect, it seemed easy for my friends and I to slip into the Armory. I don’t remember ever once getting kicked out. Perhaps the workers chose to look the other way.
My best friend, Carol, lived at one end of the block and I lived on the other. I’ve written about her in a post: Taking the Bus. We met when we were four or five years old, attended the same grammar school and high school. After she married, she and her husband moved to south Jersey. Two years later, I married. We moved to Newark, then near DC, making other moves until we eventually settled down in North Carolina.
After many years of exchanging Christmas cards, Carol and I now live 20 miles from one another. When we get together, we rehash our childhood memories on the 200 block of Summit Avenue. The city street that was the Village that raised us.
Making applesauce sort of represents living life to the fullest. I think prayer is sometimes about asking God to let us do what we can and enjoy ourselves. Picking apples and making applesauce has made me do that.
I called Marv soon after he received the diagnosis of Stage IV Small Cell Lung Cancer this past January. I don’t recall if I have ever called him in all the 40 plus years his wife, Lois, and I have been friends. Now in the past few months, I had called him twice.
After his diagnosis there was a sense of urgency. The doctors had told him the cancer was very aggressive so when Marv declined treatment, I figured I better talk to him right away. How long would he be around? I needed to tell him how I appreciated his encouragement and support of my friendship with Lois.
Lois and I met in Chicago. Two nurses with two young children each: a boy and a girl, and both ready to break out of the stay-at-home-mom mode. Together, in the late 70s and early 80s, we completed undergraduate and graduate nursing degrees. In 1992 I moved from Chicago.
We didn’t need to get permission from our husbands to spend time away from home or to spend money on plane tickets when we rendezvoused over the years. But it was Marv’s encouragement and support of our long-distance friendship and warm reception and hospitality during my visits that I wanted to acknowledge. Since Lois didn’t cook, or wash dishes for that matter, it was Marv who made the dinners, baked the banana bread, and served Lois and I as we continued deep into our conversation—as women are inclined to do.
That phone call melted into tears for both of us. Maybe the rawness of Marv’s diagnosis and the awareness of impending death were too close to the surface. I was glad I had called to say thank you.
After that first phone call and when Marv didn’t die in a matter of days or weeks as the doctors had suggested, I called him a second time. It was about six months after the first phone call. He had written a book of his life and made fifty-five copies to pass along to family and friends. I read it almost all in one evening. I knew some of Marv’s stories already, but his life on the farm and the details of his self-started business was new to me. I was especially taken with the way he wrote—as if we were sitting in his living room in Sioux Falls, or back in Chicago, just sharing his recollections.
That second phone call was more uplifting. We laughed more. Cried less. I told him how much I liked the book, especially the story about him making applesauce.
The first Fall after Marv and Lois moved from Chicago to Sioux Falls, he noticed that many people didn’t pick the apples from their trees. The apples just fell and rotted on the ground. He knocked on doors asking to harvest the apples, not for profit, but to donate them to the homeless and churches, and to make applesauce.
It was right around apple picking season that I visited Lois and Marv in Sioux Falls. With a refrigerator and freezer stuffed with applesauce in zip-lock bags, Marv sent Lois and me into the neighborhood to give away the first samplings of his culinary concoction to neighbors that Marv and Lois had barely met. The friendly neighbors graciously accepted our offering.
Marv was a successful business person, a loving husband, dad, and grandfather. Like all of us he was also a complicated human. But it was Marv, the person who picked the apples and made applesauce, whose memory is the warmest in my heart.
I have served on the Family Patient Advisory Council at my local hospital in Raleigh, North Carolina since it’s inception a little over two years ago. I became the first Chair and now I am the Senior Chair.
This last week, the hospital funded my travel to Chicago to attend the Patient Experience Conference 2018 where the Chief Nursing Officer, Manager of Service Excellence, also a nurse, and I gave a presentation: Operationalizing Patient Advisory Council: Going Beyond the Boundaries.
I felt privileged to discuss the successes and challenges of our group and pleased, as a retired nurse, that I am using my background in health care services to facilitate change. In this case, to promote and improve the patient experience.
Patient experience encompasses the range of interactions that patients have with the health care system, including their care from health plans, and from doctors, nurses, and staff in hospitals, physician practices, and other health care facilities. As an integral component of health care quality, patient experience includes several aspects of health care delivery that patients value highly when they seek and receive care, such as getting timely appointments, easy access to information, and good communication with health care providers.
Understanding patient experience is a key step in moving toward patient-centered care. By looking at various aspects of patient experience, one can assess the extent to which patients are receiving care that is respectful of and responsive to individual patient preferences, needs and values. Evaluating patient experience along with other components such as effectiveness and safety of care is essential to providing a complete picture of health care quality. – Agency for Healthcare Research and Quality
At the conference, not only did I learn about the patient experience movement and its growing numbers of supporters, I came away excited about the direction of health care.
After the conference, I met my friend Lois. Our friendship spans 40 years. We had one day of sleet and one day of sun in our quest to revisit old haunts and discover renovations to Chicago’s old buildings. At Navy Pier we asked a mother and daughter to take our picture. It turned out the daughter was starting nursing school with the intent to become a nurse practitioner. At this serendipitous meeting, Lois and I shared sage advice about the rewarding aspects of a nursing career.
Back home in temperate North Carolina, I look back at my time in Chicago and feel privileged to have attended the conference and had the added perk to have spent time with Lois.
Recently rummaging around in my office closet for my watercolor materials, I came across an old envelope with a faded 5 X 7 picture inside. Years ago I had planned to frame it. Obviously, I forgot all about it. Most of what is stored in the closet fits into the category: out of sight, out of mind.
This closet is stuffed with past journals, yearly calendars dating back more than 20 years, greeting cards, and evidence of my artistic endeavors: pastels, watercolors, acrylics and scores of papers for each medium, along with canvases, and a variety of paint brushes. However, the significant items sharing the confines of the closet are the photographs spilling out of albums, in shoeboxes, and in dilapidated wooden frames.
Over our many moves, I boxed my memorabilia without weeding anything out but only adding to the collection, always promising myself that I would organize the stash.
And as the years passed I became more reluctant to tackle the task. Maybe the constraints I have placed on the act of clearing out do more to deter me than support me. I will need two days since I will pull everything out of the closet, not returning anything until I have handled it and made the decision to toss or save. Did I say I needed only two days?
I can see myself sitting on the floor surrounded by these old pictures, fingering each while nostalgia washes over me. I will be revisiting places I lived, missing family members who have long since died, dealing with changes that the passage of time had not only had on me but my spouse and children. Yes, I know how this all will affect me and I am not anxious to deal with such an emotional task.
Getting back to the picture.
We rented a house on Sister Bay, Wisconsin after I read about the area in the Chicago Magazine: the best place to see the fall colors and beautiful sunsets. Since we were “poor”—my husband was in graduate school and we were living on my salary as a part time nurse—I wrote the owner of a rental home asking for a discount. Since we didn’t go during the annual Fall Fest, the owner agreed. Our children loved that we were steps from the bay. They explored the large room on the second floor with rows of single beds and at least two cribs. We took out the rowboat on that first visit, catching the winds of an abrupt storm and just made it back to shore without capsizing. We rented bikes to survey the fall colors. Our favorite breakfast restaurant had a goat grazing on grass that grew on the roof.
We rented the same house over the years, without the discount. Each time the owner had made improvements: a porch, a wrap around deck, bedrooms replacing the one large room on the second floor, and finally he declared “no children. “
On our last visit, my mother came with us. Late one afternoon she must have picked up my camera on the deck and took this picture of my daughter and me. She also captured my son sorting stones on the narrow strip of beach. My husband probably was grilling hamburgers on the other side of the deck. Perhaps after another magnificent sunset, we went inside for dinner. Perhaps afterward, my son would show us the best stones he picked at the water’s edge to take back home.
Perhaps sorting through the old pictures won’t be too daunting after all.
Next Sunday, November 5th, will be the 20th anniversary of my mastectomy. Afterward, my surgeon draped her arm over my shoulders and said I was “cured” as she escorted me out of her office on Connecticut Avenue in Washington, D.C.
Each November 5th , I would make a big deal of the anniversary date of my surgery, or my second birthday, as I called it. I went someplace special. Like a superstitious baseball player, I ran through the same ritual when I came to bat. I wrote down what I was grateful for in my journal, contacted friends and family, telling them how much I appreciated their concern and attention when I was in the throes of cancer crazy and then scheduled something I would do all alone.
The first year, I took Amtrak from Union Station in Washington, D.C. to New York City and ambled up Fifth Avenue on a glorious fall day. In Central Park, I ate a hot dog with mustard and sauerkraut and listened to a skinny old guy dressed in a bright blue suit with a vest and spats, who sat on a bench across from me, playing a ukulele and singing songs my mother and I had listened to on the small radio on top of the refrigerator when I was a kid and she cooked supper. Wait till the Sun Shines, Nelly. Over There. Don’t Sit Under the Apple Tree with Anyone Else but Me. Filled with nostalgia of my childhood and gratitude for my life, I licked the mustard off my fingers and walked back down Fifth Avenue to Penn Station and back home. I repeated some version of this for the next nine years.
However, when my ten-year anniversary rolled around, I decided I would no longer engage in this superstitious ritual. I no longer needed to hang on to the label of cancer survivor, or replay each detail of the cancer journey as a holy event.
On another glorious fall day, I traveled from my new home in Chapel Hill, North Carolina back to DC for what I called the last celebration. First, I had lunch with Cathy, a nurse who was diagnosed with breast cancer around the same time as I. While I had stage 0—no infiltration, she has stage III. She sat across from me in McCormick & Schmick’s front dinning room, a seafood taco salad front of her. She had lost 30 pounds, intentionally, and looked professional with her soft beige jacket, long green velveteen skirt and government ID hanging around her neck. During radiation treatments she had worn a strawberry blond wig. Rather wild for a woman in a religious order.
“Well, I believe that if I didn’t get breast cancer, I would be still be living in the religious community. It was having cancer that lead me to evaluate where I was and why. It took two years from the first questioning to finally leaving,” Cathy said as she snapped off a piece of the taco shell, and scooped up some beans and fish into her mouth. I wasn’t surprised she left—she always struck me as an independent person—more of a free spirit than a follower who vowed obedience to an organized religion.
“Remember when we talked about whether or not cancer had changed us? You said you were still the same, right?”
“Yeah,” I said, “ I wished I would have become a better person, more caring and polite. But I am the same big mouth from Jersey City. Clumsy and rude.”
Cathy laughed even though she had heard this before.
“Are you happy?” I didn’t know why I asked her—she looked content.
Her eyes widened. “I thought I was going to die.”
Maybe a cancer diagnosis does change you. Not overtly. Some foreign emotion tugs at your gut: an awareness that only rises when it’s important. I didn’t do anything great. I just lived more honestly. Taking responsibility for my own thoughts and actions, I needed less approval from others.
After lunch Cathy went back to work and I headed to the National Cathedral on Wisconsin Avenue.
While my “lesions” were investigated and various treatments were discussed, I frequently made a detour on my way home after work to the Chapel of the Good Shepherd. Small, with seating for seven worshipers, the chapel was tucked away off the courtyard on the crypt level of the cathedral. There I would sit with my fears, always alone. The cool concrete walls, dim lightening, and silence calmed me. I focused on the stature of Christ, a lamb cradled in his arms, his hand burnished smooth by the touch of visitors seeking miracles. I always left infused with strength to face whatever was coming.
This time, when I entered the chapel, I wasn’t alone. To my left, a young woman with long dark hair silently sat with her legs drawn up and her bare feet on the bench, her shoes placed neatly on the floor in front of her. Her dress didn’t classify her as homeless. Her brow was knotted in worry and her cheeks were wet with tears. She didn’t acknowledge me but kept her eyes fixed on the statue of the Good Shepherd. My own mission seemed insignificant in the presence of her agony.
After a few minutes I left. But not before patting the Good Shepherd’s hand. “Thanks for being there when I needed you,” I whispered.
Now approaching my 20th anniversary I know that a “cancer” diagnosis has forced me to appreciate that there are no guarantees in life. I need to take chances. I don’t see any choice but to dive into my dreams.
As I look back on my life that has been rich and challenging, I remember that young woman and wonder what was so awful in her life at that moment. I hope, like me, she went back to the tiny Chapel of the Good Shepherd, her problems resolved. And before she left, she touched the back of Christ’s hand thanking him for being there when she needed comfort and then got on with her life.
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.”
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 Times, The Eno River Literary Journal, Examined Life Journal, Hospital 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.
I have been thinking for a long time about the fact that we older nurses are dying off. We will take with us our memories of nursing history. I have always loved to hear from other seasoned nurses about how they size up their nursing careers as they look back. What was important at the time, what were they happy to see disappear, and how do they assess current nursing practice and the future of the profession?
So I decided I would weigh in, occasionally, by spotlighting a nurse of a certain age, i.e., sixty and older, whether this is through an article I have read or by interviewing someone, or through my own stories.
This post is prompted by an article: Diane Saulecke, “There from the Start: A Hospice Nurse Looks Back,” American Journal of Nursing, 7, July 2017, 56-57.
The article features Dianne Puzycki, an 82-year-old nurse, who began to work with the hospice movement when it first started in the early 70s. She still works “the night shift at Connecticut Hospice once a week. ‘I want to be part of it as long as I can,’ she says, ‘It’s become part of my life, my philosophy.’”
After graduating from nursing school in 1955, she started her career at Memorial Hospital (now part of Memorial Sloan Kettering Cancer Center) in New York City. There she cared for patients with cancer, many of them young women.
“At that time, we didn’t talk about death and dying,” she says. “We weren’t allowed to talk about that. It really haunted me for years.”
I remember those restrictions well. The diagnosis of breast cancer was withheld from my beloved Aunt Lena. I was in the first year of nursing school but never visited her in the hospital. One evening, when I was talking to my mother on the phone, I asked, “How is Aunt Lena?” “Just fine,” my mother said. That’s when I knew she had died. My mother would give me the bad new when I next went home to visit.
Puzycki mentions that she heard both Cicely Saunders, a doctor who founded the first hospice, and Elisabeth Kübler-Ross, who opened up discussion on dying through her 1969 book On Death and Dying. The early 70s were heady times in health care as discussion heated up regarding the previous taboo of being honest with patients by telling them their cancer diagnosis.
Kübler-Ross’ book was the subject of a workshop for the medical staff at the time I worked for a community hospital in the early 80s. To this day I remember one of the surgeons storming out of the classroom after loudly protesting, “my patients don’t want to hear that they have cancer.”
Being present for patients and “picking up on the little things” is to Puzycki the key to hospice nursing. And she says that seeing the compassionate actions taken by her colleagues, especially the younger ones, makes her feel hopeful about the future of the profession. She recently saw, for example, a fellow nurse lean down and kiss an elderly patient on the head. “I said, ‘That’s a good hospice nurse.’”
AJN Facebook Readers on Influences, Public Attitudes to Nursing, Practices of Yesterday
by Betsy Todd, MPH, RN, CIC
What do you remember from early in your career that would never be seen or done today?
We “nurses of a certain age” remember!—and we’re amazed at how far our profession has come. As one nurse commented, in response to early nursing practices that seem primitive today, “Oh my goodness, how has humanity survived?!”
There were, of course, our caps, white dresses, white hose, and white shoes. One nurse recalled that we always wore our school pins on our uniforms. These seem not much in evidence these days, but were always a source of pride and connection (and sometimes, lighthearted rivalries) back in the day.
In addition, nurses pointed out that the scope of practice has certainly changed. Nurses mixed soft soap for enemas, mixed weak solutions of Lysol (!) for vaginal douching. Wound care has, shall we say, evolved. Nurses recalled packing wounds with eusol (chlorinated lime plus boric acid—“cleaned wounds by removing patients’ flesh with it!”), Savlon (chlorhexidine combined with a chemical later used for disinfecting floors), Milton (a bleach solution), or sugar mixed with Betadine or egg whites. Some remembered “vigorously rubbing talc onto bums to relieve pressure” or “Maalox and heat lamp for sore butts.”
Are automated medication dispensing systems (for example, Pyxis machines) and bar codes part of your daily routine? Several comments described pouring meds from stock bottles on the unit or mixing chemotherapy solutions in the medication room. There were no medication carts, just medication trays with cups and handwritten cards for each patient (different colored cards for b.i.d, t.i.d., etc.).
“Point of care” lab testing didn’t include quality checks. One nurse remembered “burning urine samples in a glass tube over a Bunsen burner to check sugar levels.” DeLee suctioning of newborns—“I ended up with a mouth full of stomach contents more than once”—or pipetting blood and urine samples for the lab via mouth suction were also routine.
Many comments reminded us of tools rarely seen in today’s hospitals. There were time-taped IV bags, glass syringes and IV and chest tube bottles, mercury thermometers, crank beds and egg-crate mattresses, “gloveless everything,” and no hand sanitizer.
Routines and work practices of years ago may be hard to imagine today. Nurses recalled smoking during report, and patients smoking in bed. Patients were admitted “just for observation,” or a day or two prior to surgery. Each shift charted in a different color of ink. Nurses recalled time to talk with patients, and actual “acuity-based staffing” (“RIP,” as one nurse commented).
Another nurse summed up a certain sadness as she described some lost aspects of patient care:
“morning care before breakfast, clean sheets every day, evening care with back rubs, trash emptied, fresh water and being aware of the patient’s environment. [We] took time to assess the patient by the RN and listening. The care was impeccable because of the nurses who controlled the patient experience.”