HOLDING ON

Re-blogged from November 23, 2014

We met soon after my husband and I moved into a house in a forested community in Chapel Hill. Still working full time, I took my long walks over the weekend. As I trudged up a particularly steep hill, an older man wearing a floppy hat and listing slightly towards the right, ambled towards me. Happy to meet someone from the neighborhood, I stopped to speak with him. He told me that he was a retired physiology professor and strolled the neighborhood trails twice a day to “keep in shape.” When we parted, he touched the brim of his hat and said, “Good day.”

So dignified, I thought.images

The professor and I met sporadically until I retired. Now, each year, after the winter yields to spring, I run into him a few times a week. I know that he takes a different path in the morning and afternoon. Sometimes when we meet, he just tips his floppy hat as I pass by. Other times we stop to banter about the weather, or how fast I walk, or how slow he walks.

Once we strolled a while together as he spoke of hearing loss, memory problems, and stiffness in his joints.

“My neighbor always tells me to ‘take care.’ What do I have to take care of?” He laughed. “I’m eighty-eight years old.” He stopped to catch his breath and his smile faded

“Walking is a good way to slow the aging process.”

“Yep,” I agreed. His words unearthed my own fear of getting older. I wanted to hug him, pump him up with clichés of “use it or lose it” and encourage him to “keep on truckin.”

I did none of those things. I smiled and picked up my pace.

Somehow the professor’s longevity has become bound up in my own fear of deterioration. I want him to keep his mind sharp and his conversation snappy. I don’t want him to wear out.

Weeks pass by before I see his familiar shape again: a thin man listing to the right, trudging down the road. The signature floppy hat.

I rev up my pace. When I sidle beside him, he smiles his bucktooth smile. He dark face wrinkles and crumples his eyes into slits. He lifts his hand to the rim of his cap.

“I haven’t seen you for a while,” I say.

“Well, you know the weather has been cold and I’ve been busy with my income tax. Got to find all the information. Takes a while.”

“Guess I’ll see you more now that the weather is getting mild.” Before he can respond I add, as casually as I can, “By the way, we have been talking to each other for a few years now and I never did learn your name.”

His name is Joe. His last name is a string of consonants. He spells it out for me. I know that this is a name I’ll recognize if it appears in the obituary section in our local newspaper.

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Trotting along side of him, I note his slower pace. He looks a little thinner. He makes some comment about never being able to catch up with me. We laugh. I jog ahead as he trudges behind me.

Two days later, I spot the professor in Dillard’s department store on the arm of a white haired woman wearing a deep red jacket. Her lips match her coat. Her eyes are bright and alert. Her posture’s perfect. I approach them. He recognizes me. He smiles.

“This is my wife, Helen, she just had a bad fall and I’m holding her up.” This is probably a well-worn joke between them because they both laugh.

I tell Helen that I run into her husband frequently on either his morning or afternoon walk to different parts of the neighborhood.

“Oh, he walks the same path morning and afternoon now,” she says. “The afternoon way became too hilly for him.”

He nods. His eyes look unhappy. When did that happen?

After we chat a bit more, I say as I turn to leave, “See you on your walk later.”

“No” he answers, “This shopping trip will tire me out. I won’t be walking this afternoon.”

Again, I sense sadness in his voice, or is it my own sadness?

I circle the cosmetic counter so I can watch the professor and his wife clinging to each other as they saunter towards the men’s department. He lists towards her, their heads almost touching as they talk and walk. It disheartens me that aging is wearing him down but I’m glad to know that he has someone to hold on to.

Surviving a Knee Injury at 80

Sharing the experience of a knee injury.

Janice Radak, editor of Lower Extremity Review Magazine Online (LER), e-mailed me after I posted a story about my knee injury. Would I write 500 words about my experience? She stated that the readers of LER, such as sports medicine specialists, podiatrists, physical/occupational therapists, as well as lay readers, would gain information/insight from a person like me: former nurse, and older woman.

I wasn’t surprised Radak contacted me after I discovered that she had been Editor-in-Chief of the journal Geriatrics. The wealth of life experience older folks can share is often ignored. And since my blog is focused on the contribution of nurses to the overall health and education of the public, I’m especially glad she gave credit to my experience as a nurse.

May more editors and/or journalists recognize the value of older persons and nurses.

LER archives are free and open to the public. Check them out here and read my article below.

Surviving a Knee Injury at 80

August 2022

By Marianna Crane, retired

A month after my 80th birthday, I was doing a lunge. I bent my right knee and stretched out my left leg. My foot slipped. A sharp pain stabbed my knee. My leg buckled underneath me. If there was a popping sound, I didn’t hear it. 

The next day, after an X-ray and a physical assessment of my knee, the physician’s assistant at an Ortho Urgent Care declared that I had injured the anterior cruciate ligament (ACL) and the medial collateral ligament (MCL).  

Since there had been a rash of surgeries the day before, there was a limited number of knee braces. The technician found a large brace, but if I wanted a medium, which was my size, my husband and I would have to drive to another clinic. After spending 3 hours in the waiting room, I suggested we take the larger brace. Wearing a hinged T-scope knee brace, the straps pulled taut to fit my leg, I lumbered out of Urgent Care with future MRI and orthopedic physician appointments.

I had been a nurse over 40 years, and a geriatric nurse practitioner for the last 20 of those years. Aware of the aging process, I had vowed to keep strong and flexible. Over the next 2 weeks before the appointments, I watched YouTube videos about ACL and MCL care. Performing the simple exercises made me feel in control of my progress while waiting for a definitive diagnosis. 

The MRI confirmed my ACL was partially torn and MCL fully torn. The orthopedic physician showed me MRI and X-ray pictures of my injury also pointing out age-related changes. I was to continue wearing the brace and make an appointment with physical therapy. 

The minimalist exercises I had done kept my knee flexible, which impressed the physical therapist. Her exercise plan has improved my walking and mental outlook.

The brace seems to be part of my anatomy since I wear it constantly except when in bed. Now that my leg is no longer swollen, it slides down and I’m forever adjusting the straps. I’m close to running out of space to attach the Velcro straps. In retrospect, we should have driven to the other clinic to get the correct size. I’ve been wearing the brace for over 2 months hoping it’ll continue to keep my knee stable until no longer needed. 

My knee injury isn’t a death sentence. But as a geriatric NP, I know this type of mishap could make me susceptible to deconditioning, loss of strength, and risk of falling.  At each clinic visit, the receptionist puts a yellow “fall risk” bracelet on my wrist, reinforcing this belief. However, I have witnessed tenacity and determination in my elderly patients who overcame a variety of physical setbacks. I’m grateful not to have encountered ageism at any point in my treatment. Each of my healthcare providers has indicated that I should gain back strength and mobility and return to the level of physical capacity I had before the injury.  

Marianna Crane trained as a nurse in the 1960’s before becoming a geriatric nurse practitioner in 1981. Since retiring, she has focused on writing; her work has appeared in The New York Times, The Eno River Literary Journal, Examined Life Journal, Hospital Drive, and others. Her book, Stories from the Tenth-Floor Clinic, can be found on IndieBound, Amazon, and Barnes & Noble. She blogs at nursingstories.org.

60th Nursing School Reunion or How Did We Get This Old?

. . . we take our leave after cake and coffee with tight throats, warm hugs, and moist eyes, to say our long good-byes.

WE

. . . sit at a long table facing multiple pieces of silverware, cloth napkins, sweet tea, and wine and lit by the wall sconces in the restaurant of a historic hotel in Cape May, New Jersey, delighting in the aromas of clam bisque, arugula salad, beef tenderloin and scallops.

. . . scan aging faces with familiar voices, exchanging pieces of our lives since our last reunion five years ago, attentive to each other’s tragedies and blessings.

. . . listen to the reunion organizer tell us stories sent by those not present, sad for their absence but joyful that the seven of us in advancing years made the trip, some in the company of daughters or friends.

. . . share the inner need to reconnect to the women with whom we have spent three years in our youth as we followed the call to care for others in sickness, childbirth, injury and at the end of life’s journey, transforming immature girls to strong, skilled nurses. 

. . . come back to where we started, in the company of our peers, with whom we lived in the nurses’ residence of Saint Peter’s Hospital School of Nursing and graduated 60 years ago, joining hands in a circle in the school gym singing the Kingston Trio song, Scotch and Soda, before we marched into the cathedral for the bishop to bless us as new nurses.

. . . grip the bonds that may have faded but did not weaken in camaraderie as we take our leave after cake and coffee with tight throats, warm hugs, and moist eyes, to say our long good-byes. 

Bittersweet Reunion

Have you ever called a friend because you had a feeling that something awful happened to them? I have and usually it’s a false alarm. I hadn’t heard from our old friends, Jim and Sue (not their real names), in a few months. I had an uncomfortable feeling that things were not right with them. When Jim answered the phone, he told me that the day before he had visited the emergency room.

I have written about Jim and Sue before. The last time my husband and I saw them was in Charleston, South Carolina, three years ago. They visit the city each year in April. We have joined them sporadically, touring the stately homes, eating at the best restaurants, and reminiscing about the places we had traveled together.

Sue and I met when we worked together as fairly new nurses at a hospital in Jersey City. We double-dated with our soon-to-be husbands and were bridesmaids at each other’s wedding.

I documented in my post, Bedbugs and Friendships, about the last time we joined Jim and Sue in Charleston. To my dismay, Sue was showing signs of dementia. She had asked about a mutual friend three times during dinner. She didn’t remember that we had just stopped at Magnolias restaurant to make reservations for the next day.

We came home from Charleston: Ernie with bed bug bites (thankfully no actual bed bugs) and with a sadness that we were losing a dear friend. The pandemic prevented any get togethers since then.

Yesterday, over the phone, Jim told me that he had been working on his garden the day before. His feet got tangled in some vines. He fell, tumbling down a hillside. His left shoulder was fractured. No surgery needed, just wear a sling. I brought him up to date with my knee injury. I had overextended my leg while doing lunges. I ruptured the anterior cruciate ligament and tore the medial collateral ligament. I was on the mend now three months later but still used a cane outside my home.

When Jim handed the phone to Sue, I held my breath. Each time we talked on the phone, I feared that I would find her confusion to be worse. Despite a thorough work up and medication, her primary doctor has not reversed the dementia, but thankfully, halted progression. Sue seemed no different than the last time we spoke. 

Acknowledging that our aging bodies are not under our control, Jim and I, the designated trip planners, decided we’ll get together in October.

I anticipate a bittersweet reunion.

Color Apple Tree. Vector Illustration. Nature and Garden

When A Compliment Is Not A Compliment.

I’ve written many posts about ageism. What I’ve not addressed is how older persons could react to the “compliment” that we look or act so “young,” as if youth is the gold standard and “aging” is undesirable. (Notice I did not say SHOULD since I’m not giving advice but laying out my thoughts on ageism) 

Until aging is recognized as the normal trajectory of life and not as a state to be ignored or disparaged, an older person will continue to be thought of as persona non grata. Accepting the “compliment,” the older person might also accept that youth is desirable and internalize feelings of negative self-worth. 

Old is not a dirty word.

How can we oldsters redirect the “compliment” by acknowledging the fact that we are indeed old, and our old status is just part of life?

One of the best responses I have come across is Samantha White’s. Her comment is in response to Katherine Esty’s post: Ageism: The tragic spoiler of old age.


Samantha White

Jul 17

Katharine, I cling to my position that it is up to us, the elderly, to stand up and be proud of our age. I HATE it when people tell me I’m not old (I’m 84), and so I reply with, “I AM old, and proud of it! Don’t take my years away from me, I worked long and hard to GET old.” People are usually confused by my position because they thought that “not old” was a compliment.

When people tell us we’re not old, or don’t look old, we need to respond with a positive take on being old. It’s possible to do it nicely, and with pride. The real compliment is when I tell people that I have a host of age-related medical issues, and they say, “One would never suspect it!” THAT’S the compliment! I’m active and productive and upbeat. I use an upright walker that people tend to not notice, because I stand up straight and walk rapidly, rather than shuffle. I wear compression hosiery to keep the swelling in my legs and feet down, and I wear clothes that fit my body. I give life my best shot.

My productivity is no more than half what it used to be, because of my medical issues, and I feel myself to be on the decline physically. Even mentally, I’ve noticed that I’ve lost the ability to do math in my head (algebra, specifically). But I’ve learned to use a computer and a smartphone, which compensate for my declining mental agility, which I don’t deny. I can’t do a lot of things I used to do well (dance, ski, kayak, hike, memorize, travel, to name a few), but I do new things, such as art printmaking, and consulting. I went back to school in my 50’s and changed careers to one in which life experience is an advantage.

We need to support each other in admitting to our age and being proud of it. Thanks (to Katherine Esty) for raising our awareness and giving us this forum.


What do you think of Samantha White’s response?

Getting the Message the Second Time Around

Amazing insights to aging by Twyla Tharp.

I read the book before. My husband had been impressed with dancer, choreographer, and author Twyla Tharp’s interview on the car radio and bought her book for me: Keep It Moving: Lessons for the Rest of Your Life. It was motivational and I breezed through it. Afterwards the book sat on our coffee table. I picked it up a few days ago and randomly opened to page 123 where Twyla talks of breaking a bone while she is teaching a group of children to dance. As she demonstrates a position, her foot collapses and she cracks the metatarsal bone in her toe.

Here’s what she says:

            “This was a fairly common, unremarkable incident really, except I was sixty-nine years old and this was the first major injury of my career. Until that moment, I’ve never done bodily harm to myself. Never twisted an ankle or torn a muscle or broken a bone. An impressive winning streak, only some of which I attribute to luck.

            Perhaps something like this has happened to you. Your moment probably looked different: your reached for a book on a high shelf and felt a sharp twinge in your back. You wrestled with a tightly screwed jar and, in defeat, asked stronger hands to open it. You hesitated before jumping down from a high stool at a restaurant, worried about the shock to your knees, then chose a safer route back to earth. If so, you appreciate the significance of that first moment when your body breaks its contract with you. You can no longer entertain the illusion that you are among the immortals, those who throw themselves delightedly after perfection with childlike intensity because they can. You begin to morph into a mere mortal.

            You may not have even realized you were under the illusion of being an immortal, but while mortality can appear at thirty, forty, or fifty, be assured it happens to us all sooner or later. It is the moment when you start to doubt whether you have control over your body after all. You resign yourself to aging.” (Emphasis mine)

Tharp, Twyla. Keep It Moving: Lessons for the Rest of Your Life. New York, Simon & Schuster, 2019.

            Now it may sound ridiculous, that at 80 I hadn’t resigned myself to aging. When I sustained a knee injury soon after my 80th birthday, I did what I am best at: denial. The first two weeks afterward, I somehow “forgot” the physician assistant at the urgent care told me to always wear the leg brace. I wasn’t going to let this injury limit me, so I walked around the house without it. Only when I went outside did I put it the brace on.

            When I finally saw the orthopedic surgeon, he pointed out the injury on the MRI: a torn anterior cruciate ligament and fully severed medial collateral ligament. Looking at my knee x-ray, he discussed the arthritic changes and osteopenic bones in my knee. He reminded me that I needed to wear the brace constantly except when sleeping. Leaving the office, my husband said, “That was good news, you’ll get better in six to eight weeks.” I didn’t hear that. I was too busy focusing on the degenerative changes in my leg. I had been so proud to race up a flight of stairs, avoid elevators when possible and walk all day while sightseeing in New York City. I was in denial that my body was aging.

I asked at the end of one of my recent posts: what will I learn from this injury? I didn’t realize what a profound question that was until I opened Twyla Tharp’s book for the second time. There on her pages were examples of other aging persons who use their years of experience to forge new paths toward quality of life. I, on the other hand, was hoping to keep the status quo.

 Twyla’s book is so different from the usual books and articles I read on “successful” aging that focus on scientific studies. Twyla mixes common sense, creative motivation, and lots of interesting anecdotal stories about famous folks, mostly in the arts, such as writers, dancers, painters, music composers, singers, musicians; some still alive, some long dead but all demonstrating a lesson that moves us to be better as we age. (I must confess my eyes glazed over the description of how the professional boxer and heavy weight champion, George Foreman, affected a comeback at 45 years old.)

What Twyla does best is to show how to circumvent the limitations of aging by abandoning old stereotypes. She says that “. . . chasing youth is a losing proposition.”  Forget the past, reinvent yourself. Keep reaching. Keep moving.

What did I learn? I learned that successful aging is not trying to keep constant the same level of ability. In using the wisdom we older folks have accrued, we can refine the path we take as we go forward on our aging journey. This journey is ours to define and enjoy.  

Culinary Medicine

Medicine looks at food as treatment for health problems.

I have long thought of food as medicine. I stumbled on a certified medical specialty called Culinary Medicine from an online health newsletter. There is a formal educational track that leads to certification as a Culinary Medicine Specialist. Registration is open to Physicians, Nurse Practitioners, Nurses, Physician Assistants, Dietitians, Pharmacists and Diabetes Educators. Sites for study include 60 academic centers across the country. The curriculum not only addresses foods that help to treat specific health problems across the life span but also deals with socioeconomic barriers such as food insecurity.

Culinary Medicine

Definitions and goals

“Culinary medicine is not nutrition, dietetics, or preventive, integrative, or internal medicine, nor is it the culinary arts or food science. It does not have a single dietary philosophy; it does not reject prescription medication; it is not simply about good cooking, flavors or aromas; nor is it solely about the food matrices in which micronutrients, phytonutrients, and macronutrients are found.

Instead, culinary medicine is a new evidence-based field in medicine that blends the art of food and cooking with the science of medicine. Culinary medicine is aimed at helping people reach good personal medical decisions about accessing and eating high-quality meals that help prevent and treat disease and restore well-being.

A practical discipline, culinary medicine is unconcerned with the hypothetical case, and instead concerned with the patient in immediate need, who asks, “What do I eat for my condition?” As food is condition-specific, the same diet does not work for everyone. Different clinical conditions require different meals, foods, and beverages.

Culinary medicine attempts to improve the patient’s condition with what she or he regularly eats and drinks. Special attention is given to how food works in the body as well as to the sociocultural and pleasurable aspects of eating and cooking. The objective of culinary medicine is to attempt to empower the patient to care for herself or himself safely, effectively, and happily with food and beverage as a primary care technique.”

La Puma, John. “What is Culinary Medicine and What Does It Do?” Population Health Management, February 1, 2016.

Here are some recipes from the Culinary Medicine site.

I thought you might enjoy a physician’s blog that includes Culinary Medicine information: Dining with a Doc-The Celebration of Food as Medicine.

Will Nurses Take the Lead in National Health Care Improvement?

The pandemic has educated the public about the nursing profession and the state of our health care system by:

  1. Showing the dedicated, skilled, and committed men and women as front-line professional nurses working to make a difference in the life and death of their patients—at times with great personal risk.
  • Exposing the discrepancy in access to health care services between the haves and the have nots.

In response the findings above, The Future of Nursing 2020-2023: Charting the Path to Achieve Health Equity believes that because nurses “work in a wide array of settings and practice at a range of professional levels . . . (t)hey are often the first and most frequent line of contact with people of all backgrounds and experiences seeking care, and they represent the largest of the health care professions . . . that (N)urses can reduce health disparities and promote equity, while keeping costs at bay utilizing technology, and maintaining patient and family-focused care into 2030.” Nurses can achieve this by not only taking a prominent leadership role in the national health care system but at all levels of health services.

            The National Advisory Council on Nurse Education and Practice (NACNEP) with the endorsement of The Future of Nursing Committee developed nine recommendations for accomplishing this goal. You can read about them here.

Listen to this 5-minute audio, The Future of Nursing, which gives an excellent overview of the project.

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The public is often unaware that nurses work in such a wide variety of settings. Nurses’ knowledge and competence in the broad area of health care services and the fact they are the largest group of health care workers, validates their ability to take on leadership roles from the state and federal to community levels. 

Here is a list that Nurse.Org has compiled of some settings outside of hospitals where nurses work:

Top 20 Non-Bedside Nursing Jobs from Nurse.Org

1. Nursing Informaticshttps://nurse.org

The need to analyze and control health care costs has driven a surge in informatics as a nursing specialty. Effective nursing informatics can help to rein in health care costs at hospitals and other medical facilities. Plus, informaticists can also help bedside nurses care for patients more efficiently by improving systems. 

2. Nurse Case Manager

“More and more reimbursement for healthcare delivery is linked to readmission rates,”  said Cheryl Bergman, professor at the school of nursing at Jacksonville (Fla.) University.“ A nurse case manager helps manage the holistic care of patients to decrease readmission thus, keeping patients out of hospitals.”

3. Cruise Ship Nurse

A beyond-the-bedside job search could land you in a position that resembles an ongoing vacation. In normal, non-pandemic times, cruise ships come and go from the nation’s Southern port cities every day. These ships have to bring healthcare providers like cruise ship nurses on board to care for their passengers.

4. Legal Nurse Consultant

“Some law firms hire expert nurses for particular cases (such as surgical nurses if the case involved a surgical claim),” Bergman, of Jacksonville University, says. “The pay per hour is often set by the nurse and could be very lucrative ($300 an hour) for reviewing the legal documents with additional fees if called for deposition.”

5. Nurse Educator

Nurse educators can shape the future of patient care, both at the bedside and throughout the nursing profession.

6. Healthcare Risk Manager

Risk managers work to ensure patient and staff safety, respond to claims of clinical malpractice, focus on patient complaints, and comply with federal and state regulations.

7. Certified Diabetes Educator

The Centers for Disease Control and Prevention says 21 million people in the United States have been diagnosed with diabetes while another 8 million have this condition but don’t know it yet. That’s a lot of people who will need help controlling their blood sugar in the next few years.

8. Flight Nurse

Bedside nurses who enjoy critical/emergency care may enjoy the challenges of flight nursing. Flight nurses help transport critical patients via helicopter or airplane. 

9. Forensic Nurse

Forensic nurses help solve crimes and collect evidence. They can also help a coroner determine a cause of death. 

10. Nurse Health Coach

Are you the kind of bedside nurse who enjoys developing one-on-one relationships? Have you ever found yourself, weeks after a discharge, wondering how a patient is getting along? 

11. Nurse Administrator

If you want to get away from direct patient care at the bedside but think you would love the business side of healthcare, nursing administration may be the perfect new career for you.

12. Telehealth Nurse

Telehealth nursing uses mobile phones, tablets, and computers to provide remote healthcare and medical education. 

13. Nurse Writer

Nursing school requires excellent communication and writing dozens, if not hundreds, of papers about healthcare. This is why some nurses may want to turn their skills into a new writing career.

14. Correctional Nurse

Just because some patients are incarcerated doesn’t mean they don’t need medical care, mental health care, or emergency care.

15. School Nurse

If children have always been your favorite patient population or you just need a change of pace from working with adults, then becoming a school nurse may be an excellent fit for you!

16. Public Health Nurse

As opposed to bedside nurses who work one-on-one with patients, public health nurses promote the health of an entire population.

17. Infection Control Nurse

If you like working in the hospital setting and enjoy conducting research, you may want to consider becoming an infection control nurse

18. Nurse Recruiter

Nurse recruiters help healthcare, and medical companies fill staffing gaps. This allows hospitals and health facilities to provide safe and effective patient care and ensure that the business’s operations continue to run smoothly.

19. Medical Device or Pharmaceutical Sales 

If you want to use your clinical expertise to help patients live healthier lives working in the corporate world, medical or pharmaceutical sales might be an excellent opportunity for you!

20. Utilization Review Nurse

Utilization review nurses ensure that patients receive the care they need while also preventing unnecessary or duplicate services. They work with patients, families, and healthcare staff to make sure that everyone is on the same page regarding the care plan. They also work with insurance companies to ensure coverage for the services provided. 

Two Nurses Tell Their Stories in Literary Journals

Two nurses write about hospice services in literary journals. Great reads!

The Sun is one of two literary journals that I have unsuccessfully submitted to over the years. The other is the Bellevue Literary Review.

Close to 20 years ago, I drove to The Sun’s offices, parked in front of a single-family house on Roberson Street in Chapel Hill, and placed my submission, an essay doubled-spaced on hard copy, folded, and slipped into a legal-size envelope along with a cover letter and self-addressed-stamped-envelope, in the mailbox by the front door. I drove back to my home some five miles away and waited.

Imagine my pleasant surprise to find that each journal has recently published an essay by a nurse. And the topic is similar: hospice.

I can’t display sour grapes because I have long promoted nurses telling their stories. And since I have worked as a hospice nurse, I know that hospice care is poorly understood and underutilized.

Every Baby Needs to be Rocked by Barbara Woodmansee, The Sun, May 2022

Barbara Woodmansee is a hospice nurse who is stationed at a local hospital awaiting referrals from the staff. She has been told to keep a low profile. Her essay tells of seven hospice admissions. They give an overview of the types of patients hospice manages and the variety of services that the hospice program provides. Woodmansee shows how hospice intervention makes a difference in a patient’s last days along with the roadblocks she faces in providing care. She also tells us of a personal experience that inspired her to be a hospice nurse.

One of Woodmansee’s patients, Carrie, is a woman in her early 20s who developed COVID after delivering a heathy son. Her immune system has failed, and she has “multisystem organ failure; sepsis has debilitated her heart, kidneys, liver, and lungs to the degree that she has no reserve left to fight her infection.”

Woodmansee is present in the hospital room where the patient’s family gathers while life support is withdrawn. “Once the ventilator is removed, Carrie’s entire family stands at the bedside, each with a hand on her body—all except for her mother. Ann has taken Carrie’s infant son to the car. When her daughter dies, she is holding the baby.”

Woodmansee notes that “COVID has made me even more aware of my inability to support everyone affected by a patient’s death: the dying person, the family, and the staff who are trying so hard. One of the important gifts we (hospice nurses) give to families in hospice is our presence, but we have to move so much faster now, with so many new barriers between us, both physical and psychological. Worst of all, we’re getting used to it.”

With that, Woodmansee shows what nurses feel and the relentless circumstances they have had to deal with the COVID pandemic. Her essay also shows the personal investment a nurse makes to each of her/his patients.

On The Brink by Barbara West, Bellevue Literary Review, Issue 42, 2011 BLR Prize Winners.

Barbara West, an on-call hospice nurse, deals with an unclear after-hours emergency. She visits the double-wide trailer occupied by an elderly sister and brother. What she finds is the brother, slumped over in a wheelchair close to death while the caregiver/sister seems bent on ignoring reality.

After West attempts to lift the brother from the wheelchair to the bed, a loud sound emits from his body, and his breathing stops. She says, “If you work in hospice long enough, you’re bound to be accused of murder at some point. It could be over the phone, in a moment of passion from a guilt-ridden, out-of-state, family member. Or in person, simply because you’re the one at the door at that pivotal moment. Or maybe because you’re the white nurse with a Northern accent, the face of the American health care system that denied Daddy access to dialysis back in Oklahoma. For the first time in my career, I wondered if I might now have actually done what I’d previously only been accused of.”

West misses the interdisciplinary team that is available during usual working hours. Now on a Friday night, she alone must address all the issues other team members would. And it is when she notes their skills, the reader is made aware of the rich services a hospice program can deliver. But we also realize that, in the absence of other team members, nurses can assure that appropriate care is given.

The humor threaded through this story softens the sharp edges that West overcomes in steering the brother’s death to an acceptable closure. But the reader sees what discomfort West carries within her. She seeks reassurance from a coworker that she handled this case correctly. We learn that memories, both pleasant and uncomfortable, long remain with nurses when making judgements they must make on their own.

May we see more nurses writing their stories outside of nursing journals for the public to enjoy and be enlightened and to realize that nurses do make a difference.  

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