FINALLY SHARING OUR STORIES?

nurses make a difference

Nurses Week starts tomorrow, May 6, which is known as National Nurses Day and ends on Florence Nightingale’s birthday, May 12th170px-Florence_Nightingale_by_Goodman,_1858

While I feel nurses deserve appreciation for their work 365 days a year, who am I to disregard an opportunity to spotlight actual nurses and their contribution to health and healing.  

I have previously blogged about The American Nurse Project, which shares photographs and narratives of nurses at work. The story of each nurse is moving and educational—telling the reader what nurses really do. Check this site, which singles out a few of the contributors.

For example, Jason Short (#6) states, “I have found that once you get a taste for helping people, it’s kind of addictive. You want to empower yourself to be more and more helpful.” So he’s back in school to become a nurse practitioner.

american nurse project

And Mary Helen Barletti (#13) who says, “How often does anybody get to come home from their job and know they saved someone’s life? Or, if I couldn’t save them, I stood at the bedside of a dying patient with my arm around the daughter who was losing her mother.”  She, also, has empowered herself to be more helpful by pursuing “additional education in Reiki healing techniques and in the spiritual needs of the dying.”

It’s probably no coincidence that a new book of stories written by nurses has been published just in time for Nurses Week: I Wasn’t Strong Like This When I Started Out: True Stories of Becoming a Nurse: edited by Lee Gutkind.true stories of becoming a nurse

Again, like The American Nurse Project, real nurses tell their stories. They are harrowing and mesmerizing stories, spattered with guts and blood and antagonism toward the health care system’s bureaucracy but reflective of the real world nurses live in when they commit to helping their patients.

Lee Gutkind states in the Introduction, “Nurses tend to keep their experiences to themselves—-.”  Amen, brother.

However, we may be seeing an uptick in the willingness of nurses to share their stories.

It’s about time.

COLD CLINICAL FACTS

revising & revising

Four women in my Wednesday evening non-fiction workshop graciously agreed to be my beta-readers and look over my manuscript during a two week break, following suggestions outlined by our leader, Carol Henderson. What Carol stressed, among other things, was not to get bogged down with spelling and formatting but look for flow, bumps and where you fall asleep. How does the narrator come across? Make a note where things are not clear.

The four women are talented writers. Their stories deep, interesting and well told. I consider myself lucky to have willing and skilled readers. Their feedback, positive and negative, can only improve my book. They have heard my stories, isolated, standing alone, without any connection to what had happened before or followed next. Now for the first time they would have the whole picture of my creation.

Stein On Writing
Stein On Writing

The “corrected” manuscripts (Sol Stein, Stein on Writing, says corrections are better done on hard copy.) sat for a couple of days before I ventured to look at them. I had already cleaned my office, cleared my desk and now isolated myself for a day to read.

Had I thought my readers would unanimously tell me that my book was so wonderful that no changes were needed, I would have been delusional. But honestly, I didn’t expect that. I was ready, so I thought, to honor the suggestions. What I wasn’t ready for was the strong agreement among their observations.

With tunnel vision, I had selected stories about patients I had cared for that had “haunted” me over the years—unforgettable because they were complicated and sad. I wanted to show what we nurse practitioners were up against. As an observant professional, I described the sights, smells and  “nasty images” so well that my readers felt, at times, overwhelmed. Plus, I appeared “too clinical.” Could there be less intense patient interactions wedged between the mayhem? Where was my softer, feeling side, they asked? Where indeed?

After the initial shock of realizing I had many more painful hours at my keyboard—writing for me is slow and tedious—adding inner reflections and lightening up, I wondered how much my long-standing role as the professional nurse for over forty years played in this evaluation.

I can see one of my older patients, a short, slight man, sitting on the edge of the examination table. As I monitor his high blood pressure I observe a suspicious discoloration around his left eye. He admits his granddaughter had hit him. He adamantly refuses any interference. I don’t remember my exact response except I’m sure it culminated with a stoic nod of my head.

stature with tearAfter long years of stuffing my emotions in my lab coat pocket, I’m usually surprised by the visceral reaction I have when I resurrect these tales. How much deeper do I need to go to allow the sentiment that I didn’t know I was withholding flow from my vignettes?  How strong are the barriers I constructed to dampen my own despair when I couldn’t correct a problem and will I be able to shatter them after all these years?

While I have always encouraged my fellow nurses to write their stories, I wonder how common it is for us to deny the deep connections we forge with our patients and the influence they have on our psychological well-being? Maybe this is why so many of us resist documenting what we do?

Or slant the telling with cold, clinical facts?

THE TIME IS RIGHT

A friend deliberated whether she should visit her father for his 95th birthday. She was swamped with commitments. Since he was unaware of his birthday as well of his surroundings and didn’t even recognize his three daughters, there was no urgency to travel to another state.

However, she cleared her schedule and made the trip, as did another sister and a niece. Both lived out-of-state also.

As it turned out, on his birthday, he had a choking episode with difficulty breathing. He stopped eating and died three days later, surrounded by those he loved who otherwise would not have been there had they not come to commemorate the day he was born.

This story reminded me of a patient I cared for back in the early ‘90’s when I worked as a nurse practitioner in a home care program. I had made a first visit to an elderly man in the western suburbs of Chicago who was referred by his doctor because he had terminal cancer (I don’t remember his diagnosis). But I do remember his sunny apartment. He and his wife sat on the sofa, holding hands, his wife’s face streaked with tears. She had just been informed she had breast cancer. The patient calmly told me he wanted to help his wife through her ordeal. He would call me when he was ready to be admitted.

Sure enough, a couple of months later, he called telling me he was “ready to die.”  In another sunny living room, the patient and his wife held hands as they sat side-by-side on a floral sofa in his daughter’s home where they had relocated. His appearance had changed little since I last saw him. His wife had had successful treatment of her cancer and now his responsibility ended. The serenity of that visit remains vivid in my mind as he, his wife and daughter discussed his impending death.

After he disclosed he was having pain, we agreed I would return the next day bringing morphine with me. When I arrived the following afternoon, he was comatose. His daughter called later that evening to say her father had died.

Was it a coincidence my friend’s father died during the time his family gathered around him? Did my patient let go when he knew his wife no longer needed his support?

Calla lilyMaggie Callanan and Patricia Kelley, both nurses, co-authored Final Gifts, a book that speaks to the dying experience. They use the term “nearing death awareness” which “is a special knowledge about—and sometimes a control over—the process of dying.” In a chapter called “Choosing a time: the time is right, they describe how some dying people “choose the moment of death.”

Vignettes of both sudden and lingering death portrayed in Final Gifts show us “what is needed in order to die peacefully” and how “those close at hand can help bring that person peace and recognition of life’s meaning.”

I read this book years ago. Having read it again, I only appreciate all the more how much of a contribution Callanan and Kelley make toward our knowledge and understanding of the dying process. They do this by telling their nursing stories.

I encourage you to read this book.

What stories can you share about your experience with “nearing death awareness?”

LOVE OF FOOD

As I continue editing my book (I’m a tiny bit behind schedule), I am adding more food references. Food has always had a hold on me. Growing up in both Italian and Polish traditions, the fabric of my childhood was knitted with gustatory delights. Food meant comfort and caring.

italian-familyOne repast I’ll never forget was the first time my husband-to-be visited my Italian Grandma’s second floor apartment in Jersey City. At our traditional Sunday mid-afternoon meal, italian-feastthe men ate first. After the men, the children were served. Lastly, the women sat, ate and then washed the dishes—a paternalist, ethnic ritual I rebelled against at the time, only now to look back with pure nostalgia.

Grandma and my aunts, Ann, Jennie, Pam and Anna and their sister-in-law Chris, served. That day, I sat with the men beside Ernie, American hot-dog and hamburger aficionado, at the table in the cramped, hot kitchen. There wasn’t a dining room. He had seconds of the bean soup and the pasta with tomato sauce and slathered butter on Grandma’s freshly baked bread. He had an awakening when the meat course arrived. crusty-italian-bread_1I remember Uncle Mickey commenting on Ernie’s voracious appetite. Salad and cheese followed. Ernie’s intake dwindled.

After espresso, my uncles left to smoke cigars in the front parlor. Ernie staggered behind them as Grandma smiled with delight over how much he had eaten. A good appetite was paramount to sainthood.

My book covers a time in the early ‘80s when I worked as a nurse practitioner in a clinic on the west side of Chicago. I could walk to a Polish deli for the foods of my childhood on my mother’s side: kielbasa, kielbasapierogi and babka. (A good appetite at a Polish table also ranked next to godliness.)

I found a hole-in-the-wall Mexican Restaurant. There I fell in love with a soup crammed with a hunk of corn and a whole chicken breast. Mexican Chicken SoupIn that blue-collar neighborhood, I often stopped at a take-out stand specializing in greasy fries and Chicago red hots. All part of my immersion into community nursing. I was eating my way into appreciation of my clientele’s way of life.

Now as I write, I’m relishing the memories.

HAPPY NEW YEAR

 Highlights of 2012

  Watching grandsons growgrandsons

                                   

                                                                                                           

                                                                                                                                                   

                                                                                                                                                           

                                                                                                                                                 Touring France in spring                               Paris

 

Writers Museum

 

 

 

 

Ireland in fall

   

    

anniversary1                             

Celebrating 46 years  

                                                       

                                                                                                                           Perfecting deep-dish Chicago pizzachicago pizza jan. 2012

 

 

 

 

 

Having my story “Invisible” accepted for publication by “the Examined Life Literary Journal.

 

 

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

*Two other nurses contributed to this issue of The Examined Life

 

 

 

VANISHED Part 3 of 3

A couple of weeks after our hallway discussion, I spotted them exiting the elevator. Margaret pushed Josie in the wheelchair with one hand while lugging an IV pole with the other, rushing to the back door of the building and out to the parking lot in a obvious effort to avoid me. The bottle that hung from the pole had a milky beige color that could only be a supplemental feeding. Josie had a tube in her stomach. A conduit to deliver nutrients to keep her alive.

As much as Margaret had badgered me for recommendations, it was clear she no longer needed, or wanted my input.

I never saw either of them after that day. Soon rumors circulated that Josie had died. No one knew what happened to Margaret.

wc

VANISHED Part 2 of 3

When the clinic first opened last year, Margaret would saunter in holding Josie’s hand, pulling her along. While Margaret’s stringy hair and disheveled clothes reflected an indifference to her own appearance, Josie always looked neat. Like a treasured, well cared for doll. Her deeply wrinkled face blank but her blue eyes held a sparkle. She didn’t talk but nodded her head and smiled when spoken to. Who knew what she understood?

Margaret took good care of Josie because as long as Josie lived, Margaret had a roof over her head. Some of the residents in the building complained about Margaret’s erratic behavior, but it never became such a problem that she faced eviction.

“Can ye weigh Josie this mornin’?” Margaret asked.

Since Margaret refused to enroll herself or Josie in our clinic, I kept a record of their visits in a manila folder in the top desk drawer. There was a sheet for each person who, like Margaret and Josie, wandered in occasionally for a weight or blood pressure check.

The last time Josie stood on the scale, I moved the beam until it balanced at 90 pounds. Josie began to teeter. I grabbed her arm just in time before she tipped over.

“Josie was ninety-two when we weighed her last week,” I said.

“Mother of God!. She’s a bag of bones. I can’t get her to gain an ounce.” Margaret shoved Josie’s shoes on and yanked her out of the chair. She pulled and picked at her with one hand as she gripped her elbow with the other. Josie’s expression remained flat. I listened to Margaret fussing at Josie as they headed toward the elevator.

I didn’t mind weighing Josie although Margaret never uttered a “thank you” or “Is this a good time for us to stop in?” Since Margaret was known for mood swings and bursts of anger, laying eyes on Josie every so often gave me a chance to check for any signs of abuse.

Occasionally Margaret said, “I may let you take care of me.” She hinted she had some god-awful condition. However, it became apparent she had no desire to leave the doctor she had been seeing. Frankly, I was glad not to have Margaret as a patient. And she frequently suggested she would register Josie at our clinic, too. None of this materialized. I believed Margaret collected advice from health care providers, testing one theory against another and choosing which one she favored at the moment.

—to be continued.

VANISHED Part 1 of 3

A feverish Chicago summer ebbed into autumn. No telltale falling leaves signaled the change of seasons on this block of concrete walkways surrounding the massive twenty-story apartment building. I yanked open the heavy door. Inside the foyer, through the grimy glass doors, I noticed Margaret parking Josie, in her wheelchair, in front of the elevator. When Margaret saw me, she ran to unlock the 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 and broken teeth. Her face was impassive in spite of her hearty welcome. My eyes skimmed over her quickly. She was empty handed and the pockets in her cardigan sweater, and in the cotton dress it covered, weren’t bulging. She sometimes stashed the ice pick under Josie’s lap blanket. Margaret chose not to come to the clinic for health care so I didn’t know what medication she was taking to control her paranoid schizophrenic personality, or if she took medication at all. Her aggressive outbursts occurred randomly. I had heard secondhand stories where she had brandished the ice pick. So far as I knew, she hadn’t hurt anyone. I kept my guard up with Margaret and worried about Josie.

When she came from Ireland ten years ago, Margaret was much younger than sixty, the cut off age to live in this senior building. So she petitioned the Chicago Housing Authority to allow her to live with her aunt. Margaret’s attention had kept Josie out of a nursing home.

Up to a month ago, Margaret literally pulled Josie behind her as she rushed around going nowhere. When Josie became unsteady on her feet, Margaret put her in the wheelchair and bundled her up as if to fend off an infiltrating enemy.

“How are you doing today?” I said to Josie’s pixy face as she peeked from the blanket shroud. She blinked. My neck muscles relaxed. I fantasized Margaret would push Josie around in her wheelchair after Josie was dead and none of us would catch on until Josie started to stink.

Something had to disturb Margaret more than usual for her to wait for me this early in the morning. “Josie won’t eat.” Margaret said abruptly to the ceiling, avoiding my eyes. “I put food in her mouth and she spits it out.”

We had been around this topic before. Margaret wanted to believe Josie was just fine, thank you. Any advice I gave could be met with a disagreeable outburst. “You could try to give Josie small feedings and soft food like pudding, ice cream or Jell-O.” I held my breath while Margaret fussed with Josie’s blanket. “You can’t force Josie to eat, if she doesn’t want to,”

“Glory be, she not eating enough to keep her body alive,” Margaret shrieked.

Just then, the elevator doors opened with a loud scraping sound, emitting the usual stench: urine and beer. A reminder that last Friday was the first of the month when social security checks were placed into the mailboxes. Many of the old timers who lived in the building cashed their checks and spent the weekend in an alcoholic stupor.

Margaret changed the focus of her frustration as she pinched her nostrils with her fingers. She yelled in a nasally voice, “It is an insult to the good people in this building that the drunks cavort and carry on so, pissing in public places.” Her demeanor could have been misinterpreted as an attempt at humor, but I knew better.

An elderly man stepped off the elevator and nodded his head in greeting as he maneuvered around Josie’s wheelchair. Margaret whipped the chair about, through the doors that the man graciously held open and both women faded into morning fog. I suspected Margaret would wheel Josie into the clinic later today, asking, again, why Josie wouldn’t eat.

—to be continued.

UNCONVENTIONAL NURSING

 

 

NAKED IN THE LABOR/DELIVERY ROOM

Written by Ruth DonoghueRuthie

Time: December in the early ‘90’s.

Place: Nursery in a Catholic hospital where 5,000 babies pass through in a year.

The call came from unit secretary.

A nurse was requested as soon as possible to pick up a baby in delivery/labor room three. (Every newborn baby was sent to the nursery to be bathed, examined and observed).

Request the nurse be naked.

I believed this was a religious event, since it was permitted in the Catholic hospital where I worked. It was a time when we were trying to be more understanding of other religions and promoting better relations. Recently our department had finished seminars on religious and lifestyle diversity. Any employee not willing to extend understanding would be sent for counseling. Since I was close to retirement, I volunteered to take the call.

I grabbed two surgical masks, stapled them together and applied them as a bra. Disposable mother mash pants served as bottoms. A heavy starched doctor’s coat was applied for traveling.

Upon arrival the whole family—mother, baby, grandma, grandpa, father and sibling—was present, smiling and naked. The doctor had managed to skillfully leave.

The thermostat was set at 90 degrees. I removed my doctor’s coat. Nobody noticed.

They allowed me to place their beautiful baby in a blanket. I quickly donned my heavy doctor’s coat and departed, pushing the baby in the crib.

It was an accomplishment because now I wouldn’t have to go for sensitively counseling in contrast to some others.

On a cold January day, a month later, in the hospital elevator, I encountered a couple, lightly dressed, carrying a baby in a blanket only. Smiling, happy and healthy. They didn’t recognize me.

TRICK OR TREAT AT THE FRONT DOOR; HEARSE AT THE BACK

I have been pestering my classmates from nursing school (we are about to celebrate our fiftieth anniversary next month) to write their stories so I can post them on my blog. Maybe pestering is too mild a word. Regardless, I have succeeded. Two women have sent me stories.

The first comes from Joan Moore. 

This is her story when she worked for a Hospice in Central New Jersey in the late 1990’s.

THOUGHTFULNESS IN THE FACE OF GRIEF

Written by Joan Moore

One of the most important aspects of hospice nursing is that a nurse is available 24/7 for the patients. This means every nurse on the team is required to take a turn being “on call”.

I’d like to share one of my many on call experiences.

My weekend started quietly. It was a Saturday in October. Halloween. In that neighborhood when Halloween falls on a weekend, the kids start trick-or-treating in the early afternoon. I received my first call at twelve noon. Molly, a much-loved fifty-year-old with ovarian cancer that I had admitted two months previously, had just died. I offered my condolences and said I would be there in about twenty minutes.

I drove past many happy, costumed children on my way to the house. When I arrived, Molly’s brother-in-law was sitting on the front porch with a big bucket of candy for the neighborhood children. Inside, Molly looked very peaceful surrounded by her sister and three dear friends.

Hugs all around and emotional support. I explained what I needed to do to pronounce, per protocol, since it might seem silly to onlookers as I took a blood pressure and listened to lung and heart sounds on a person who just died. Then I called the doctor to inform her and the funeral director who told me he would probably arrive in an hour.

Since it was Halloween and children all around, the family told me to ask the director if he could please drive the hearse around the back of the house so as not to cause any commotion in the neighborhood. Conversation then revolved around Molly and good stories about her.

As I was about to render post-mortem care—washing and dressing the body—the body-language of the women told me that this was a task they wanted to do. They lovingly bathed Molly and dressed her. One laughingly remarked about Molly’s favorite sweater—it had silver threads running through it. She said, “I wonder what will happen when she’s cremated? Would she be all sparkly?”

The funeral director arrived and drove around the back of the house. Molly’s brother-in-law remained on the front porch giving out candy. It’s always difficult to watch as your loved one is taken out of the house for the last time.

I left, happy that my beeper never went off during this visit. I was available to listen and care. I wondered what the rest of my calls would be like. Turned out I was able to manage with only supportive phone calls and didn’t have to go out on any visits.

An epilogue to this—unbeknownst to me—one of the women was a nurse and a good friend of my supervisor. Monday when I went back to work she pulled me aside and told me that the family appreciated my silently watching over them while they rendered care. There is nothing more wonderful for a nurse to hear that you really helped.

 

Next week: Ruth Donoghue’s story: NAKED IN THE DELIVERY/LABOR ROOM

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