Alphabet Challenge: E

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

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

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

E: Eckhart Apartment

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

I learned:

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

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

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

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

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

Olden Days of Nursing: A Pioneer of the Past Spurs Others Forward

Olden Days of Nursing: A Pioneer of the Past Spurs Others Forward

by Guest Blogger: Cynthia Freund

I talked with Marianna the other day about the book I’m writing (more about that later). She referred me to a post on her blog from a couple of months ago, a post describing the olden days of nursing. She added that she had some very positive responses to that post—and then she put the question to me, “Would you be interested in writing something about the olden days for my Blog?” I obviously fit the age criterion.

I read the post of August 4, 2020, Olden Days of Nursing: Dialysis, about a nurse working in the days when kidney dialysis first became available, the beginning of the 1960s. I know Marianna was asking me to write something about my own early experiences in nursing, and I may do that yet. But this particular post made me think of a dear friend who died a year ago, one-month shy of her 95th birthday. She, too, started one of the early kidney dialysis units, but this time at the Veteran’s Administration Hospital in Durham, North Carolina. 

In this millennial year of the nurse, I want to pay tribute to Audrey Booth, both a typical and unusual nurse—a pioneer in many ways.

From the dust bowl of Nebraska, Audrey, a curly-haired blonde, climbed on a horse twice her height to ride to-and-from a one-room country schoolhouse and onto become the Associate Dean at the University of North Carolina (UNC) at Chapel Hill. 

The interval between that Nebraska farm and UNC took her to Case Western Reserve in Cleveland, Ohio, where she earned a master’s degree in nursing. She became an expert in the care of polio patients during the height of the epidemic in the 50s, including caring for kids in iron lungs. That expertise brought her to Hawaii and Guam, and also transported her back to the mainland and the University of North Carolina (UNC). After the polio epidemic, she focused on kidney disease and, in the 60s became a leader in opening the new hemodialysis unit at the VA hospital in Durham—one of the very early dialysis units in the US.

Looking for new hurdles to jump, she joined a small select group planning the nurse practitioner program at UNC. And then, when the North Carolina Area Health Education Center Program started in the mid-70s, Audrey became the Director of Statewide Nursing Activities. (AHECs, as they are called, were designed to be centers of education and innovation, serving as magnets to attract health professionals to rural and underserved areas.) She became an Associate Dean in the School of Nursing in 1984—while continuing with all of her duties as AHEC Director. 

Throughout her career, the essence of Audrey was as a leader, a role model and a mentor. She led and taught many nurses, usually just by example. She was not well-known nationally, but she was known by hundreds of nurses—and other health professionals—in North Carolina. Many of us attribute our professional success to her leadership and guidance. 

And, as a matter of fact, it was Audrey who suggested to me that we interview the founders and influential promoters of the nurse practitioner movement in N.C. UNC started one of the very early family nurse practitioner programs. It was quite unique in its alliance with those starting a statewide AHEC Program and a Rural Health Program—a collaborative effort involving many. Audrey, and I, were involved in that pioneering effort. So, we conducted the interviews, but Audrey left the book-writing to me. 

I am about to finish that book, titled: Nurse Practitioners in North Carolina: Their Beginnings in Story and Memoir. It will be in print in the spring of 2021—and will feature many other nursing stars of the olden days of nursing.   

Audrey’s spurring me on to write this book is a perfect example of how Audrey led others—encouraging them to greater endeavors. Plain and simple: Audrey was an influencer, on a grand scale and with each individual. She was a mentor in the truest sense of that word. She was a strong voice for nursing and a strong model for women when women were still fighting for their due recognition. We indeed should celebrate all such nurses, just as the World Health Organization has done, declaring 2020 as the International Year of the Nurse and the Midwife.

Dean Emerita Cynthia Freund, MSN ’73, and Associate Dean Emerita Audrey Booth, MSN ’57, were awarded the highest honor of the North Carolina Nurses Association (NCNA) when they were inducted into the NCNA Hall of Fame on Thursday October 9, 2014. Nurses chosen for the Hall of Fame are recognized for their extensive history of nursing leadership and achievements in North Carolina.

Cynthia “Cindy” Freund, RN, PhD, worked for eight years with the newly developed Family Nurse Practitioner Program at the University of North Carolina at Chapel Hill in the early 70s. She then went to the University of Pennsylvania to start a joint program (MBA/PhD) between the School of Nursing and The Wharton School. She returned to UNC-CH and retired after serving 10 years as Dean of the School of Nursing. To her, retirement means “working without pay.” In her retirement, she worked on her book: Nurse Practitioners in North Carolina: Their Beginnings in Story and Memoir, to be published in Spring 2021.

Book tour in Chicago

Saturday, June 1, 2019

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

Frank Lloyd Wright Home and Studio, Oak Park, Illinois

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

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

 

THE CHOICE

This was published in September 2018 in The Olli Writers Group Anthology

anthology 

On our first night in a hotel room in Estoril, Portugal, the thumping in my chest jolted me awake. Still groggy from jet lag, I tried to go back to sleep but the pounding demanded attention. I pressed my hand over my heart, feeling what seemed like a bird batting its wings to escape my ribcage.

Besides a touch of anxiety, I felt fine. No chest pain, no shortness of breath, no dizziness, no nausea. Then my bladder chimed in, upstaging my clinical observations.

Slowly, I rose and sat on the side of the bed, careful not to disturb my husband who was asleep beside me. Thinking I might pass out, I sat quietly waiting to topple. When that didn’t happen, I shuffled in the dark, feeling my way along the wall, to the tiny bathroom.

Successfully back in bed without tripping, falling, or fainting, I couldn’t help but let the jet lag overtake any further analysis.

The next morning, I awoke to the same sensation in my chest. More alert than the night before, I diagnosed the uneven heartbeat as atrial fibrillation. A geriatric nurse practitioner until my retirement three years ago, I had treated many patients with this condition—its occurrence increases with age. A fact I couldn’t ignore. A-Fib, as it’s called, isn’t life threatening and often stops on its own.

I remembered that the day before, as my husband and I explored the neighborhood around the hotel, we had walked past a medical clinic. Through the large glass window, I saw several people sitting in a waiting room, some reading magazines, not unlike our clinics back home. I had no desire to seek help there. I didn’t speak the language, and who knew about medical practice in Portugal? Besides, I was counting on this event ending soon.

Getting ready for the day’s adventure, my husband slipped a sweater over his head as I laced my shoes. “By the way,” I said, trying to sound causal, “I’m having a little irregular heart beat. It’s nothing serious and I suspect it’ll end on its own. I just want you to know, that if by chance I pass out, get the tour director to call an ambulance and tell the medical folks what’s wrong with me—A-Fib.” Before my husband could become worried, I added, “I’m sure I’ll be fine.”

My husband of forty years trusted me, the knowledgeable nurse, to accurately assess my situation, and nodded. I figured he would be happy to be spared an interruption in our itinerary.

We rode the elevator down to the lobby, queued up with our tour group, and boarded the bus to Cabo de Roca. I grabbed a window seat. The vibrant, coastal city gave way to dry grasses clinging to rocky cliffs. I slid down in my seat and discretely put my fingers to my neck, checking my carotid pulse. The irregular rhythm ticked off around one hundred beats per minute. Not too rapid to worry me—yet.

After a couple of hours, the light blue sky became cloudless as we ascended into the thinning mountain air. Would the high altitude affect the rhythm of my heart? Would my pulse become so erratic that my blood stagnated, forming a clot that would migrate to my brain and spawn a stroke? My husband remained deep in his book. Or was he consciously ignoring me? The medical clinic near the hotel began to seem inviting, but very far away.

The bus turned into an empty parking lot. We arrived before other tourists. My husband was the only one who headed over to the one-story building that stood at the far end of the lot where one could obtain, for five euros, a certificate validating that one had stood at the westernmost point of continental Europe. The others headed to the bathrooms or the gift shop.

I stepped off the bus last. I felt something strange. Or, rather, I felt nothing. Had my heart stopped? No, it just felt that way with the fluttering finally gone. My chest was silent. My pulse was regular. The air smelled cool and crisp. Released from potential calamity, I dashed off to find my husband. No further health alarms marred the remainder of the trip.

When we returned to the States, my internist insisted I wear an Event Monitor: electrodes attached to my chest at one end, and at the other end to a plastic box that would hang around my neck for a month. When I noted any flip-flops from my heart, I was to depress the start button and the monitor would record the “event.”

One night during the first week, after I wrestled with the monitor to find a comfortable position in bed, I settled into sleep. My heart, booming loudly in my ears, jarred me awake. I pressed the record button. The monitor gave off a high-pitched sound and began taping. As instructed, I lay still. When the whining stopped, I stumbled into the kitchen to call the toll-free phone number.

The nurse talked me though the process of sending the recording across the phone lines. I hung up, relieved that she hadn’t told me to go directly to the hospital, as had happened with my friend, Norm, after his first submittal. “Get to the emergency room, NOW,” the nurse told him. The next day, a cardiologist installed a pacemaker in his chest.

I reassured my husband, who woke up during the taping and rushed after me, concern covering his face. We ambled back to bed—him to sleep and me to await any further malfunctioning of my heart.

Three weeks later, I mailed the monitor, wire, attachments, and unused batteries back to the company. I wouldn’t miss the nightly struggle to sleep with a rigid box digging into my ribs. Or the monitor’s beeping at inappropriate times during the day. Or most of all, the constant surveillance for any twitch in my chest.

The only two episodes I had during the month were not atrial fibrillation but sinus tachycardia: a regular, rapid heart rate, usually benign. Wearing the monitor for a month seemed too much of an inconvenience for such a paltry yield.

No doubt there will be other assaults to my aging body, mildly annoying or life threatening. The trick is to know the difference: whether to stay back and seek medical care or take a chance and get on the bus.

 

The Perks of Serving on the Board

 

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

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.

My Book is on Amazon

Stories from the Tenth-Floor Clinic: A Nurse Practitioner Remembers 

Paperback – November 6, 2018

by Marianna Crane (Author)

Running a clinic for seniors requires a lot more than simply providing medical care. In Stories from the Tenth-Floor Clinic, Marianna Crane chases out scam artists and abusive adult children, plans a funeral, signs her own name to social security checks, and butts heads with her staff―two spirited older women who are more well-intentioned than professional―even as she deals with a difficult situation at home, where the tempestuous relationship with her own mother is deteriorating further than ever before. Eventually, however, Crane maneuvers her mother out of her household and into an apartment of her own―but only after a power struggle and no small amount of guilt―and she finally begins to learn from her older staff and her patients how to juggle traditional health care with unconventional actions to meet the complex needs of a frail and underserved elderly population.

 

Review

“Marianna Crane writes with compassion and insight about what it’s like to serve on the front lines of the medical profession―treating the most vulnerable among us. Her vivid account is moving and enlightening, a valuable contribution to the literature of social justice.”
―Philip Gerard, Professor, Department of Creative Writing, University of North Carolina, and author of The Art of Creative Research

“Nurse practitioners are well known for their willingness to be primary care providers for the ‘underserved’―those people who are waking bundles of multiple chronic and acute illness and myriad ‘social determinants’ of poor housing, little income, and almost no family or friends to call a support system. Society prefers that such patients remain invisible, because acknowledging their existence is too unsettling. It is my fervent hope that Stories from the Tenth-Floor Clinic will find a wide audience of readers who are willing to meet and care about the people nurse practitioners allow into their lives every day.”
―Marie Lindsey, PhD, FNP, health care consultant and founding member and first president of the Illinois Society for Advanced Practice Nurse

 

About the Author

Marianna Crane became one of the first gerontological nurse practitioners in the early 1980s. A nurse for over forty years, she has worked in hospitals, clinics, home care, and hospice settings. She writes 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, Stories That Need to be Told: A Tulip Tree Anthology, and Pulse: Voices from the Heart of Medicine. She lives with her husband in Raleigh, North Carolina.

 

Note: Still waiting for the cover to be designed.

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.

A Broken Man Who is Hard to Forget

Richey rolled himself in a manual wheelchair into the exam room of the spinal cord clinic for the first time on a warm spring day in April. He managed to lift his quivering right arm to shake my hand. I was the new nurse practitioner in charge of his care. He had some ability to walk but he used the wheelchair to maneuver the halls of the VA. Luckily, he could schedule a hospital van to drive him back and forth to appointments. Having a spinal cord injury proved to be an advantage in the system.

Richey’s dirty blond hair stood in tuffs on his head. Dressed in jeans and a T-shirt, he could have passed for eighteen but in reality he just turned thirty, had an ex-wife, two preteen girls, and a few years of homelessness under his belt.

“What are all these scars on your abdomen?” I had asked.

“All the fights I had growing up,” he said. “Always in fights.”

When I met him he was living with his brother, his brother’s wife, and their young daughter. His brother was planning to leave for Iraq and his wife would move in with her family, so Richey decided to move back with his mother.

“Don’t do that, you’re crazy,” Richey’s brother told him. But Richey figured that his mother tried her best when they were growing up. He would give her a second chance. Plus, he said he would be near his ex-wife. He wanted to reunite with his girls.

Richey couldn’t get out of his own way to avoid trouble. He had a long history of drug abuse and alcoholism. He saw evil intent in everyone he dealt with. He could worm his way into a confrontation by just looking at a person. No one respected him. Not one person was supportive.

Richey hated our physician but he seemed to tolerate me. Most of the spinal cord patients flattered me because I had the prescription pad. They had pain and needed medication. Like all my patients, Richey signed a contact to submit to random urine testing. The first sample tested positive for marijuana along with cocaine.

“Knock off the cocaine,” I told him and added that I would look the other way with weed. Most of the spinal cord patients liked marijuana because it helped with spasms and improved their appetites.

Richey wasn’t too different than the spinal cord guys I cared for—“broken men” I called them. They had no incentive to look back and try to figure out what happened to turn them into the non-functioning adults they had become. They had no insight, no imagination, and no drive to make changes.

Richey’s problems revolved around his perception of not getting any respect. The receptionist in the x-ray department didn’t respect him so he didn’t get the x-ray I had ordered. The night nurse didn’t respect him so he left the rehab center I had worked so hard to get him into. Maybe she was mad that he broke the rules by wandering outside after hours, peeing in the bushes, falling down afterwards, and unable to get himself up until he was found in the morning. His mother didn’t respect him so he left her and went to Florida to live with an estranged sister who didn’t respect him so he went back to live with his mother who I found out used drugs and let him drive her car that he was physically challenged to drive in the first place. I suspect that if a policeman had stopped him, that policeman wouldn’t respect him for driving without a license.

His ex-wife didn’t respect him for having an affair. Nor did she respect him when he drove home with his ladylove in the front seat on the day she, his wife, was in the hospital giving birth to their first daughter. During that drive Richey flipped the truck over, his girlfriend was fine but he fractured his spine.

I have long forgiven myself for not being able to help Richey recognize that his actions caused most of his problems but I still think about him after all these years.

Letting Go of the Life We Plan

“We must be willing to let go of the life we planned so as to have the life that is waiting for us.”
― Joseph Campbell

I didn’t plan to write a book but that’s what happened. I had always wanted to be a writer and, even as I worked as a Nurse Practitioner, I took writing classes, went to workshops and kept a journal documenting patient stories that one day I would expand and publish. But writing a book was never on my agenda.

I like to think I followed Joseph Campbell’s advice and stayed open to the many possibilities that came my way. And I may have, but not intentionally.

I am pleasantly surprised to find myself a soon-to-be published author.

With the New Year almost here, I reflect on the serendipitous events that supported my literary efforts, including meeting other writers that inspired and encouraged me, finding supporting mentors and willing beta readers.

Somehow what I needed at the time found me.

In 2018, as I journey along the publishing road, I plan to stay open to all the new adventures awaiting me.

Thanks to all of you who follow my Blog.

I wish you happiness, health and contentment in the New Year.

 

Excerpts From My Book

 

My book will be published on November 6, 2018 by She Writes Press.

I have changed the title over the course of writing the book so many times that I can’t give you a count.

The latest one, and I do hope the final one, is Stories from the Tenth-Floor Clinic: A Nurse Practitioner Remembers.

She Writes Press asked me to select three of what I felt to be the most powerful excerpts from my book (75-150 words each).

I thought I would share them with you:

When Margaret saw me, she ran to unlock the inner door before I got a chance to grab the key from my purse. Had she been waiting for me? My neck muscles tightened.

“Top of the morning to you,” Margaret sang out in her Irish brogue, exposing black, broken teeth, and a wooden expression in spite of her hearty words.

I looked for the ice pick Margaret reportedly always carried. She was empty-handed, and the pockets of her cardigan sweater weren’t bulging. Sometimes, it was said, she stashed the ice pick under Josie’s lap blanket.

*********************************************************************

“I’m going to do the dishes,” she said.

“No, you won’t. Ernie and I will do the dishes after our company leaves,” I repeated.

Annie wandered in and stopped by the stove, eyeing Mom and me with nervous concern. I wished she wasn’t present to witness our confrontation. But I was determined not to let Mom wash the dishes. The sound of water and the rattle of pans would be heard in the living room, not conducive to an after-dinner conversation with our guests. They might presume we wanted them to leave.

Mom stood facing me with one sleeve rolled up to her elbow. I held my stance.

From my peripheral vision, I watched Annie shudder, her feet rooted to the floor.

Then I peered into Mom’s angry eyes. Where did this rancor come from?

*********************************************************************

(After I told Grandma I was going to nursing school)

“Hey, whana you do? You cleana da bedpans? Huh?” She came close. Garlic breath warming my face as her waving hand grazed my ear. “Thata no gooda work. No gooda.” Her braided bun loosely fastened by hairpins wobbled as she shook her head.

Her feet, with stockings rolled down around her ankles, planted themselves firmly by my chair. The pizza she made just for me, her first granddaughter, lay warm and fragrant on the Blue Willow plate in her hand. She slid the plate in front of me.

Grandma knew as well as I that in the ’50s there were few job choices, much less careers for a woman. Those in her Italian neighborhood lived in multifamily clapboard houses. They cooked the meals, raised the children, and played a supporting role to their husbands.

Grandma expected me to get married after I graduated from high school and start making babies.