The Tale of Two Clinics

Reflections in the December issue of the American Journal of Nursing had an essay by Mark Darby RN, ARNP: The Way of Johnson Tower. Johnson Tower, a public housing building, sounded very much like the Senior Clinic I worked in and wrote about in my book: Stories from the Tenth-Floor Clinic: A Nurse Practitioner Remembers. Seems that the only difference between the residents of the buildings was that Mark’s building housed adults, mine was limited to residents over 60. Otherwise, both sets of folks who sought care from either of us  nurse practitioners were mostly marginalized, underserviced, and poor—and gutsy.

Mark didn’t identify the location of his public housing building but I can surmise that it was in an unsafe part of town, on the first floor and, like my clinic, had been a converted one-bedroom apartment. He says the clinic has . . . “one exam room” and is “below the building laundry. If more than four people use the washing machine, water will drip into the centrifuge.”

Mark describes four of his patients, each with their own challenges but each reaching out to help others. Getting to know patients as intimately as Mark does is facilitated by caring for the patients on their own turf. Mark and I get to know first-hand what challenges our patients face and we know the strengths they gather up to face them.

I bet Mark’s clinic, like the Senior Clinic, promoted low tech/high touch. Here is a copy of the brochure from the Senior Clinic that a friend who had worked with me sent recently. He had been sorting through “memorabilia” from over 30 years ago!

 

Senior Clinic Brochure
Circa 1987

 

A murder due to a drug deal gone bad occurred just outside Mark’s clinic. Those who planned my Senior Clinic decided to place the clinic on the tenth floor to avoid any drug seekers trashing our clinic looking for narcotics. Neither clinic would attract patients with medical insurance who had a choice of health care facilities.

I especially liked Mark’s answer when asked how he could work in such a setting. He said, “One thing I learned in NP school is that I am a nurse first and an advanced practitioner second. Nurses are supposed to look at the whole person—mind, body, and spirit—as well as the environment. I have found that the residents of Johnson Tower teach me more about being a nurse and a human being than you would imagine.” Amen I say to that.

I’m not exactly sure when my clinic closed. When I went back to Chicago in 2007 the building was no longer a public housing building but was run by the Hispanic Housing Development Corporation. It looked well cared for. I called their office soon after that visit and was told there was no longer a clinic there.

Sad.

 

Firing My Doctor

 

 

 

More Voices: Worry

 Firing My Doctor

Marianna Crane

31 May 2018

 

I didn’t decide to “fire” my doctor on the spot.

During my last appointment with her, I’d filled Dr. Green in on the details of my mastectomy. I happily reported that the surgeon had declared me “cured”–the tumor’s margins were clear and my nodes were negative. Because I had large breasts and wanted to avoid wearing a heavy prosthesis, I’d had a reduction on my healthy breast at the same time. A routine biopsy of that tissue had showed dysplasia–abnormal cells. As a nurse, I’d researched this finding and found scant evidence that it would develop into cancer. My surgeon had concurred.

As I sat on the exam table while Dr. Green stood by the sink drying her hands, I told her I’d decided not to worry about it.

Without making eye contact, Dr. Green said, “I’d worry.”

I froze.

Never one to have a quick comeback, I left the office without a word about her offhand remark. It wasn’t the comment itself that concerned me, but her apparent indifference to my feelings. Plus, what good would worrying do?

Having a potentially life-threatening illness had boosted my resolve to surround myself with people who would cheer me, not depress me. Dr. Green was a competent doctor technically but lacked sensitivity–something that I value in a patient-physician relationship. I decided to look for another primary-care provider.

After calling Dr. Green’s office to cancel my next appointment, I requested that my records be sent to my new doctor. The receptionist asked if I would tell Dr. Green why I was leaving. I agreed, and before I could get nervous Dr. Green was on the line.

I relayed the incident at my last appointment; I said that her “I’d worry” statement had left me shaken and disturbed. Whether I was right or wrong, what I wanted from a provider was someone who cared for my physical and mental needs.

Surprisingly, she thanked me. I hung up the phone feeling rattled that I had voiced such a candid assessment. Gradually, however, jubilation replaced anxiety. I realized that I had control over my life and those whom I allowed into it.

I can only hope that my forthrightness with Dr. Green improved her communication skills.

Marianna Crane
Raleigh, North Carolina

WAS I DREAMING? PART TWO

TEAMLast week, I attended the second and last part of the TeamStepps workshop. In another post (“Was I Dreaming?”) I described the first workshop and my surprise at how the doctors willingly and enthusiastically participated in the dialogue and group activities. What would I find this time around?

TeamStepps is a program that promotes teamwork and teaches “team strategies and tools to enhance performance and patient safety.” The audience was a group of professionals who worked in the surgical area of a large teaching hospital. I volunteer at the hospital and attended as an observer, although I did participate in some of the exercises.

The first thing I noticed when I entered the room was the empty chairs at each of the four tables. After we finished with introductions, it was clear most of the absentees were doctors/surgeons. I felt disappointed. Was their eager involvement at the last meeting just a charade?

This seminar was pivotal for implementing TeamStepps. The group in attendance—nurses, OR techs, surgeons, anesthesiologists—were to be the “coaches” who would model effective team work and help “change the culture” of the hospital. The leaders of the workshop, two doctors and four nurses, were poised to teach how to be an effective coach. Furthermore, there had been homework. Each table had been given a “discussion question” at the end of the last meeting with the expectation that the group would present a three to five minute demonstration. The occupants at my table included two nurses, one OR tech and an orthopedic surgeon who was preoccupied with the open laptop in front of him. I had already excused myself from participating in the skit.

When time came for the demonstrations to begin, those at my table seemed to be looking at the question for the first time. The other three groups appeared to be scrambling also. In the meantime, some doctors had slowly been slipping into their seats. Two appeared at our table and joined the activity. The surgeon at the end of the table had closed his laptop. Unbelievably, to me, each group, in turn, stood in front of the room and showed, as instructed, the right and wrong way to address their question.

(Our table was to communicate how the team would handle a situation when a necessary piece of surgical equipment fell to the floor and was contaminated).

In the skits, the surgeons played nurses, the nurses played doctors, OR techs were the anesthesiologists. The shows prompted much laughter and recognition of obnoxious and unprofessional behavior in the “wrong way” skit and applause for “right way” team interaction.

For the remainder of the meeting the leaders introduced peer-to-peer feedback, not easily understood by some of the surgeons who saw themselves as designated leaders and superiors and staff as subordinates. The coordinators, especially the nursing coordinators, gently suggested that the team was made up of peers regardless of occupational titles.

Like the first TeamStepps session, I was impressed with the positive vibes and enthusiasm from the audience. My world of hierarchical structure and deference paid to the medical staff was changing. I believe that this change in culture will bring a safer patient environment.

On the last page of the handout this statement stood out:

Important that staff realize this is not a passing phase—it is our model for patient safety moving forward.

 I think this model will indeed move forward at this hospital even though the ride may be a bit bumpy.

THE FALL

images

I entered a large department store on a rainy Sunday two weeks ago. My foot hit a slick spot and I became airborne. You know that awful feeling when you’re going down and there is nothing you can do about it. I drifted in slow motion closer and closer to a display table, finally making contact with my right temple, surely breaking the skin. My glasses flew off my face. I landed on the ground, half sitting and half lying. The two men who had been looking at clothing—this was the men’s department—when I first walked in started to run toward me. They could have been father and son.

“Are you alright,” the dad said.

“Let me help you up,” the young one said.

By that time I had grabbed a wad of tissues stored my jacket pocket and slapped them on the side of my head, pressing hard. I knew the laceration would bleed profusely. Thank goodness I had tissues in my pocket ready for an episode of coughing. I was recovering from a mild case of walking pneumonia.

“No, I’ll sit here a while,” I said as I reached over to retrieve my glasses. They weren’t damaged.

The nurse in me did a quick assessment. Nothing hurt. In spite of feeling a little shaky from the surprise of the accident, I was oriented and felt in control.

I pulled the tissues away from my face. They were soaked with blood. I could feel the stream of blood oozing down my skin. I quickly put the pressure back on.

“I’ll get help,” the older man said and hobbled down the long aisle. The younger fellow stood guard beside me. If we made small talk I don’t remember. In short order, two women with department store nametags rushed up to me.

Did I want an ambulance? Of course not. What I wanted was that this had never happened and get on my way looking for a pair of slippers.

I asked for some ice and time to think about what to do.

One of the women moved the jeans that were folded neatly on the display table that just damaged my face, making space for me to sit while I pondered my dilemma.

I took a selfie picture of my wound. There was no denying it would need attention. I called my husband to schlep me to yet another Urgent Care facility.

This would be my second trip to Urgent Care in less then two weeks.

Christmas Eve, after a bout of coughing and shortness of breath, I decided to head to an Urgent Care to forestall any problems I might face over the Christmas holiday. My daughter drove me to the closest one. Did I mention how I hate to admit I’m sick? I am the ultimate denier that anything is wrong. Is this a nursing trait?

The two Urgent Care units were vastly different. The one I went to on Christmas Eve was a clean, well-lighted facility with a couple of adjoining waiting rooms with comfortable chairs. A nurse introduced herself, asked what was wrong and if I had allergies and some other pertinent information that I had already put on the four pages of admitting paperwork. The repetition was reassuring. And the doctor was attentive and sat down to talk with my daughter and me as if he had all the time in the world. Both the nurse and doctor washed their hands in the sink in the room before touching me.

When we left, the receptionist wished me a speedy recovery.

The Urgent Care I went to the day I fell—nearest to the department store—had a bleak and dreary waiting room with white washed walls, scruffy linoleum and metal folding chairs. After filling out one page of admitting info, I was called into a room. The physician’s assistant came promptly and introduced herself but didn’t wash her hands or put on gloves before she touched my laceration.

“Glue,” she said. “The nurse will get your vital signs.” She left.

A young man in blue scrubs motioned to me from the hall to follow him and had me sit next to a exam table where he rolled up my sweater sleeve, took my blood pressure, stuck a thermometer under my tongue and a pulse ox clip on my finger with minimal words and no eye contact. When he sat on a chair at the end of the table to jot down the numbers, I asked his name and if he were the nurse. He was. He didn’t wash his hands either.

Oh, how I wanted to step into my long ago role of nursing instructor and berate him for not identifying himself or washing his hands. And I didn’t say anything later when the PA came back and put on gloves without washing her hands first before she proceeded to glue me up. I figured I wasn’t having brain surgery and just wanted to have my cut sealed so the bleeding would stop and I could go home.

After she was done, she stood by the exam table where I still reclined and ticked off what complications to watch out for. No smile, no handshake and she was gone. The receptionist told me I could go home.

What a contrast in Urgent Care facilities. I could bemoan my behavior at not speaking up at the last one. But you know, I really don’t care because I never want to visit another Urgent Care center again.

NURSE-BULL

During a recent trip to France, our tour group went to Camargue in the Provence region and visited a “manade,” signwhich is a Provencal ranch that raises white horses and bulls for the Bull Games. Unlike the bullfights of Spain, the bull doesn’t get killed.

Loaded in a large wooden wagon pulled by a tractor we, thirty-one tourists, were driven to the pasture where the female bulls—females who live on the manade are called bulls and not cows—grazed with their calves.

One of the ranchers seated on his white steed next to our parked wagon told us that the bulls remain outside all their lives: a natural existence. And there was no “invasive medical attention” even with the birth of the calves.rancher on white horse

The bulls didn’t receive medical attention but they did have nurses. The rancher explained, in very good English, that some bulls had a mild temperament compared to the others and were selected to be the nurse-bull. The nurse-bull had a calming influence on the herd and helped the ranchers move the other bulls in the desired direction. This sounded more like a sheep dog.

The nurse-bull in this ranch had a light brown coat and a bell around her neck.

nurse bull
nurse bull

She appeared to me to circulate among the other lady bulls with an air of superiority. Or have I been reading too many animal books to my four-year-old grandson?

Then our rancher/lecturer said another role of the nurse-bull was to accompany an injured bull in a holding area while the injured bull waited to be “put down,” She, the nurse-bull, “eases the anxiety.”

Maybe the title “nurse-bull” does reflect her actions, after all. If compassionate, calming and soothing attention doesn’t describe a nurse, I don’t know what does.