THE AMERICAN NURSE PROJECT

The American Nurse Project aims to elevate and celebrate nurses in this country by capturing their personal stories through photography and film. Photographer Carolyn Jones and her team traveled to every corner of the U.S. to record the unique experiences of nurses at work. The photographs and narratives shed light on what it means to be a nurse in our country, and who the women and men are who have pledged their lives to the care of others. It’s a story worth telling—it’s a story we all should hear.

http://americannurseproject.com/about/

WHAT DOES PEA SOUP HAVE TO DO WITH WRITING?

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It’s a soup day. Well, okay, it’s 76 degrees outside on this August morning in Chapel Hill but it’s dark and dreary. The sound of the rain hitting the roof makes me think of soup. Thoughts of the warm aroma of Grandma’s bean soup and the sweet, earthy taste of Mom’s chicken soup, made with the bits of the carcass we modern cooks toss away, stir up memories. Soup comforts. Soup soothes the soul. Soup awakens the senses.

Lately I have been enmeshed in editing my book. And I’m losing ground in meeting my self-imposed deadlines. I should be writing but I’m making split pea soup instead. Both efforts are not entirely unrelated. Rather than searching for inclusion of the five senses in my story, now I actualize the experience.

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I finger the firm half-moon peas searching for hitchhiking stones. The thick broth bubbles noisily on the stove. Its steam fills the kitchen with an earthy aroma. I lift a spoon-full of green soup dotted with specks of orange carrot. The velvety rich liquid satisfies my hunger and need for comfort. And reenergizes me to return to my edits.

THE WEIRDEST HOME VISIT

When I worked in the home care program at a VA hospital in Illinois, medical students sometimes came along with us nurse practitioners while we made our visits. I enjoyed showing them the reality of delivering care in the patient’s home—where we were guests—the subtle line between suggestion and decree, education and instruction, doing for the patient and letting the patient do for himself.

One afternoon, when I had a female medical student riding with me, I had trouble finding the house. In the day of no cell phones or GPS’s, I stopped at a gas station to call the patient’s wife. Was I being paranoid when she sounded like she was being deliberately unclear?

We finally drove down the well-manicured block in a rather upscale neighborhood. One house in the middle of the block was “protected” by a row of stately cypresses or if cypresses trees don’t grow in Chicago, then tall fir trees. I’m a city girl. I don’t know trees but these trees were certainly blocking out the sun and hiding the house. And yes, it was the house we were going to visit.

I had met my patient the day he was to be discharged. I don’t remember what brought him into the hospital but he was going to be sent home on Coumadin, a blood thinner, and had to have frequent blood draws to adjust the dosage. The doctors felt he shouldn’t make the long ride back and forth to the hospital and consulted with our home care team. As a nurse practitioner I could draw the blood, interpret the results and change the Coumadin dose as needed. When he was stable, I would refer him back to his primary doctor or in this case, the clinic at the VA that would follow him.

“My wife won’t like it if you visit,” he said.

“Why,” I asked.                                                                     

“Well, we have lots of cats.”

Balding and pudgy he looked a mediocre counterpart to his elegant wife who showed up shortly afterward as if she had reservations at the Pump Room: bangles on her wrists and dangling earrings, dark long hair, bright red lipstick and matching nail polish. I learned she had recently retired from a local newspaper where she had been a journalist.

No, she didn’t want a home visit. But she quickly changed her mind when I told her how often she would have to drive her husband to the VA for blood tests.

So there we were, the medical student and I, trekking behind the forestry shield and up the stone stairs of a Tudor house to a heavy door with a small window covered with a curtain. I rang the bell. I recognized the long red painted finger nails as they parted the curtain. The wife’s face, heavy with makeup, smiled. We listened to her releasing the locks.

The vestibule was dark. The whole house was dark. The only light came from a small T.V. table in the next room.

My patient sat on a sofa in front of the table. He had a urinal beside him, a glass of water on the table and a trash basket on the floor. The room seemed spacious. There wasn’t any scent or sound of animals about.

My memory of the event does not include any direct confrontation. I had always believed we nurses visit the patient in his home and are guests. Not to instill our wills. Besides the wife provided a flashlight which the student held so I could see what I was doing as I drew the blood specimen.flashlight

That had to be one home visit the medical student long remembered. I certainly was happy to have her accompany me that first time. In the weeks that followed, the patient’s wife held the flashlight and the strangeness of the circumstances began to fade. Eventually, I managed to get my patient on a stable dose of Coumadin and discharged him.

On that last visit I had decided I would ask to use the rest room so I could look around for the cats. I doubted there were any.

But I lost my nerve.

SELECTIVE STUBBORNESS

The first chapter of my book opens with my grandmother telling me in her fractured English I shouldn’t be a nurse. Her garlicky breath still resonates in my olfactory recollection. This chapter has been critiqued once in a master class at an annual writer’s conference and work-shopped at least twice in writing groups.

So when I read Benjamin Percy’s essay,  “Where’s Papa Going with that Axe?”On Opening with Dialogue in Glimmer Train, I felt broadsided with good advice I didn’t want to hear.  He makes a convincing case for NOT opening with dialogue.

Then I came across Michah Nathan in the same Glimmer Train bulletin 67  who had this to say:

“Good writers develop a style that works for them. They write, they fail, and they write again. The trick is prying apart the words, the sentences, the paragraphs, and seeing how it all works. Good writers intuitively know this. They certainly don’t need me getting in the way.

So in honor of that self-immolating preamble, I give you the only useful advice I can muster: cultivate selective stubbornness.” (Read more)

I have a friend who once told me she wasn’t implementing most of the suggestions she solicited and paid for from a literary professor at a prestigious university. At the time, I thought her crazy. Her well-written book has been published. Her voice runs consistently through each chapter.

I’m not sure if I will move the dialogue from the beginning of my first chapter. Maybe not. Editing is not just applying skills and craft but following an inner faith that your story will be told in your unique voice.

It ain’t easy.

MY FAVORITE BOOKS ON WRITING

I go back every once in a while and reread the books that have always rewarded me with inspiration and encouragement. Especially now as I’m completing my book and can almost see a glimmer of light flickering at the end of the tunnel, I find I need that boost, the reassurance my work is not crap and I’m not totally delusional to think I can write.

Here are three books that jump-started my writing life and have a prominent place in my bookcase. Each time I revisit them I discover surprises I had missed before, remember old truisms now imbedded in my writing DNA and realize again the warm support as if each author is an old friend who knows me well, warts and all, and still believes I can succeed.

Natalie Goldberg. Wild Mind: Living the Writer’s Life was the first book I read about actually being a writer. I remember learning about the book in a short article in a woman’s magazine back in the ‘80’s. I went to Barbara’s Bookstore in Oak Park, Illinois, bought the book and immediately devoured it. Later I also bought Writing Down the Bones, Natalie Goldberg’s first book. But Wild Mind remains my first love. Goldberg tells the novice to lose control while writing, letting the wild mind take over, ignoring the “critic” or “editor” in one’s head. She details the life of a writer, gives permission to indulge in one’s passions for writing and gives exercises at the end of the chapters to prime the pump.

Anne Lamott. Bird by Bird: Some Instructions on Writing and Life showcases Lamott’s irreverent and awesome writing style while bringing the craft of writing into a comfort zone that anyone can attain. It’s one of the few books on writing that chokes me when I read some parts. And then she coins the phase, “shitty first draft,” which I have written plenty.  

Julia Cameron. The Artist’s Way: A Spiritual Path to Higher Creativity was my bible in the ‘90’s although I never could complete all the exercises she recommends doing to free oneself to be more creative. Although not a book centered on the writing process per se, it gave me permission to spend less time on housework and more time chasing after my muse. Cameron had a book signing in Borders Book store in White Flint Mall in Rockville, MD where a woman in the audience raised her hand. I was sure she was not a plant since she had a toddler by her side and a newborn in a carriage. She said Cameron’s book helped her get an article published. I went home and reread the book probably for the forth time but, alas, I still could not complete all those exercises.

Learning to write is an ongoing process. In future posts I will share other books that have taught and inspired me over the years.

On another note:

I was so happy to read on the AJN blog about two writing workshops for nurses.

Lastly, a plug to nurses who might live in or near New York City and who want to do more writing about their experiences, to develop a more sustainable writing practice. There’s a writing weekend for nurses cosponsored by the Center for Health Media and Policy at Hunter College and the Hunter-Bellevue School of Nursing coming up July 20–22, and it’s taught by some fantastic people. Also, we’d be remiss not to mention an upcoming weekend writing workshop (August 11–12) taught by AJN‘s clinical managing editor (and a marvelous scholar and poet) Karen Roush in Briarcliff, NY.

 

I hope more writing workshops open in the future for nurses in other locations around the country. But, in the meantime, check out the books I mentioned above and just start writing.

What are your favorite books on writing?

Long Lost Story

Just last week I came across a folder in an old box on the bottom of a closet. There I found accordion-pleated sheets of paper where I had written about the Donovan family in single space dot-matrix some twenty years ago. Bill Donovan had lung cancer with metastasis to his bones and brain. He died on a cold December day in Chicago.Winter in Chicago

I still have my Day Timer—who is old enough to remember those? I kept statistics on my patients: address, phone number, date of birth, diagnoses, if and when they received a flu shot and the date they either were discharged from home care or died. I wrote sporadically about my more difficult or worrisome patients in journals, which I kept all these years. I knew someday I would write my nursing stories.

But I never did forget Bill. I just didn’t remember enough detail about him and his family to add him to the book I’m working on. But now I’ll flesh him out along with his three daughters, a live-in girl friend and a hired caregiver, Stanley, who emigrated from Poland where he claimed to be a medical student and who withheld Bill’s medication on the grounds he, Bill, could die from the morphine.

Now you couldn’t make this stuff up.

The Murder Building

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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 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.

Unsolved Mystery?

This happened long ago. I worked for a hospital-based home care program. We, nurse practitioners, received referrals from physicians who had exhausted all options to prolong the patients’ life. We visited the patient in his home and helped the family care for him until death. Traditional hospice services were not an option as yet.

My patient was in his 60’s or 70’s and had a ditzy wife. Just like Edith Bunker on the old All in the Family T.V. show. She looked like Edith with dark hair, a whiney voice and hands that kept flying in the air as she talked. Edith and I sat in the corner of the living room with its high ceilings, dark woodwork and antiquated furnishings talking about her husband. I think he had lung cancer. I can see him wandering around in the turn-of-the-century apartment, seemingly unaware of his wife and me. While Edith jabbered on, I thought about how much information I should give her. Could she handle her husband dying at home? Thankfully, time was on my side. Her husband didn’t look close to death. I could parse out information slowly.

I began by telling her about our program, giving her our twenty-four hour phone number. I would make another visit soon and go into the dying process in more depth and review potential problems. She seemed so scattered, but she cried occasionally giving me the feeling she realized the gravity of her husband’s condition.

At the end of my visit, Edith walked me to the hallway outside the apartment. For some reason, as I perched on the top stair, I told her to pick out a funeral home. “You’ll have to do this eventually. Call them and tell them your husband is on our program and our doctors will sign the death certificate.” Maybe I thought it would give her something to do before I made a follow-up visit.

Before I made that visit, I received a message from the funeral home that Edith’s husband had died over the weekend and that a service had been held just for the family.

A few days later, I made the mandatory bereavement visit. Edith’s daughter and her husband were with Edith in the kitchen. The son-in-law, GI Joe crew cut and heavy shoulders, stood by the sink washing dishes. The daughter, a replica of her mother, but with some extra padding, sat on one side of Edith with a box of thank you notes in front of her. The couple came from out of state and would stay only for a few more days. When Edith introduced them, they nodded without smiling as if I were a diversion they hoped would soon leave. While I sat at the table talking with Edith I could feel their ears on high alert. Was the son-in-law washing the same dish over and over again? I was distracted by the tension I felt in the room while Edith babbled on.

While I drove back to the hospital, I replayed Edith’s words. I heard her squeaky voice tell me her daughter and son-in-law drove a long distance from out-of-state. “But,” she said, “As tired as they were, they thought of me.” Did I notice her daughter’s back suddenly straighten up?  “My daughter said I needed a break. ‘Let’s go and get your hair done,’ she told me.” Edith patted her head full of tight curls reinforced with a heavy application of hair spray. Her smile showed she basked in the attention they had showered on her. She left for the beauty salon with her daughter while her son-in-law stayed to watch over her husband. “When we came back,” she said, tears flowing down her cheeks, “my husband was dead.”

I had other patients to see that day and quickly put the visit out of my mind.

Over the years I have thought about that bereavement visit. I felt so lucky I was distracted and didn’t register the implication of those words: alone with son-in-law and dead when wife returns. I didn’t think the patient was anywhere near death when I first saw him. Sure he could have had any number of problems that would cause system failure and death. However, if I never mentioned contacting the funeral home, Edith would have had to call 911 after her husband died. Without enrollment in our agency, a sudden death in the home would necessitate an autopsy. I would have no grounds for suspicion if the autopsy showed death from natural causes. But there was no autopsy. So I continue to exercise my vivid imagination and rehash possible scenarios. In one, I see Edith’s daughter and her husband nod to each other as the daughter takes her mother out of the house. The son-in-law waits a few minutes after they leave. He walks into the bedroom where Edith’s husband sleeps, takes the extra pillow off the bed, and presses it over the man’s face bearing down with this strong arms until he is sure his father-in-law is no longer breathing. After carefully replacing the pillow on the bed, he pulls a pack of Marlboro’s from the front pocket of his khaki’s. He ambles into the living room, settles into an overstuffed chair, lights up and waits for his wife and her mother to return.

I’ll never know what really happened

There Are Some Patients We Never Forget

When you have been a nurse as long as I have there are patients who take residence in your memories and resurface frequently. They could almost be family except they have a short history in your life. What they were like before or after you knew them usually remains a mystery.

Mr. G was a cantankerous, legally blind, brittle diabetic I had taken care of in the late 80’s. His house was the worst on the block: paint peeling off the frame, rickety wooden stairs and overgrown weeds. Thankfully he lived close to the  police station because I had to drive there one day when Mr. G didn’t answer the door. He was convulsing on the floor as I peered through the window. I had to beg the police to break down the basement door to enter because Mr. G often complained to me how many times they had axed into the front door and how expensive it was to repair. He frequently had hypoglycemic reactions.

Mr. G. gave himself insulin injections using low vision equipment to measure out the dose. His much younger wife worked full time, leaving him lunch, usually a sandwich, piece of fruit and a drink on the dining room table. He had confided in me that he thought she was having an affair with her boss. Having an active imagination (I’m a writer aren’t I?), I wondered if his wife was trying to kill him. Maybe the house, inside and out, was in deliberate disarray leading to a potential life-threatening accident. I don’t remember the other scenarios I entertained as I drove to and from his home.

When I left my job to move to another state, my friend, co-worker and fellow nurse practitioner, Jane Van De Velde, took over his care. He died on her watch. She recently emailed me with remembrances about him.

“But I really remember his memorial service. It was so touching, all the people who attended and spoke so highly of him. I was literally brought to tears. I got up and spoke about how wonderful it was to see another side of someone–the strong, healthy, community-involved and well-respected side. We saw him at end of life when he was so very ill and depressed and visually impaired.”

Jane adds, “There are some patients we never forget.”

Amen

Radio Interview

I was listening to my long time friend, fellow writer and nurse, Lois Roelofs being interviewed on the Laura Dion Jones Show from Illinois on WRMN 1410, last week. With my I-Pad up to my ear, I settled in a comfy chair in the living room of my daughter’s home in Raleigh. For the next half hour, my four-year-old grandson repeatedly circled my chair, lunged at the dog, and jumped on his eight-year-old brother who was playing Mario Kart and protested loudly. Besides ignoring my grandsons, I ignored the ringing phone and hoped no one would press the doorbell.

Lois wrote a book: Caring Lessons: A Nursing Professor’s Journey of Faith and Self. Lois not only promoted her book but also discussed the special characteristics of the nursing profession. She told Laura’s audience that nurses are not just caring but use manual dexterity along with cognitive and social skills in their interactions with patients. “It’s an intellectually vigorous profession.” And the ultimate multitasking profession, I might add. Anyone who has been hospitalized will appreciate the benefits of a being cared for by a competent and compassionate nurse.

Lois and I met years ago in a baccalaureate-nursing program. We share the same irreverent sense of humor and the love of nursing. And the belief nurses have an important message to share with the public—how and why we make a difference. Lois does a good job during the interview to make this point.

Listen for yourself. Brew a cup of tea. Click and fast forward into the broadcast to 3:05 minutes and hear Lois promote her book and the nursing profession.

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