What was my Memoir really about?

It has been two years since my book was published on November 6, 2018. Shortly afterward, I wrote this for She Writes Press Blog:

What was my memoir really about?

November 2018

By Marianna Crane

This guest post was written by Marianna Crane, author of Stories from the Tenth-Floor Clinic: A Nurse Practitioner Remembers.

Marianna Crane became one of the first gerontological nurse practitioners in the early 1980s. A nurse for over forty years, she has worked in hospitals, clinics, home care, and hospice settings. She writes to educate the public about what nurses really do. Her work has appeared in The New York Times, The Eno River Literary Journal, Examined Life Journal, Hospital Drive, Stories That Need to be Told: A Tulip Tree Anthology, and Pulse: Voices from the Heart of Medicine. She lives with her husband in Raleigh, North Carolina. Visit her at http://www.nursingstories.org.

The book will take as long as it needs to take to be done.

My book, Stories from the Tenth-Floor Clinic: A Nurse Practitioner Remembers, took me about seven years to complete. I couldn’t seem to rush the process. A mentor told me “the book will take as long as it needs to take to be done.” And only after I finished the book did I understand what my story was really about.  

My nursing career covered forty years. As soon as I retired I began to record those years starting with nursing school. When I reached the early 80s, a tug in my gut told me that I couldn’t go any further. During that time I was the coordinator of a not-for-profit clinic in Chicago targeting the underserved elderly. Throughout the years, I always remembered the clinic as being totally different from any other job I ever had. Located on the tenth-floor of an apartment building for low-income seniors, the open door policy allowed anyone to walk in—with a heart attack or carrying a loaf of zucchini bread.

As a new nurse practitioner (I had been a registered nurse for twenty years before I went back to school to become an NP), I narrowly viewed my role as a health care provider. I would see patients in the clinic for illnesses or health maintenance. That the elderly had multitudinous social and economic problems initially eluded me. Or was it that my lack of education in geriatrics, a new specialty at the time, that contributed to my misconceptions?

Many of my patients’ stories were captured in a journal that I kept while I struggled with the dilemmas that challenged me—patients choosing between food and medicine, or were victims of family abuse, or targeted by scam artists from the community. I often vacillated whether I had any right to step in and take over a patient’s finances or change the locks on the doors. With no road map, I fumbled along, sometimes butting heads with my staff in deciding how to intervene.

Finding the Truth in Revision

I learned that what I wrote initially in the book was not a clear map of what I wanted to convey. I just wanted to tell this story. But what story? My memory cast my co-workers in roles that inhibited my progress. With each rewrite, I softened my harsh critique of others and uncovered some detrimental actions that I had initiated. My insight became sharper when I let the story percolate in my head rather than rushing to rewrite. Reflection and patience, albeit over seven years, finally enabled me to be truthful to what happened in the tenth-floor clinic.

In retrospect, I see that having a preconceived notion of what I wanted to write had caused me to miss what was behind the real story. My belief about the stories from the tenth-floor clinic stemmed from what I remembered—my truth at that moment. The passage of time has a way of rearranging recollections. It was only after examining my place in my memoir that I uncovered what the story was really about, even if I had already lived it.

The book took as long as it needed to take to be done.

Ramblings on Expanding Nursing Practice

 

 

I asked Martha Barry who worked with me at the Erie Family Health Centers in the early 80s, to remind me if the Certified Nurse Midwives delivered babies.

 Here’s what she said:

The model for the Certified Nurse Midwives (CNM) when I arrived was outpatient care only. The CNM did all of the New OBs and sorted out the high-risk patients and cared for the other patients throughout their pregnancies, post-partum and follow-up gyn care. Prenatal care was intense case management. (We took) a lot of care and time to be sure no one fell through the cracks and got “lost to follow up.” Luckily, we could utilize the community health RNs to help find patients who did not show up for a visit. At the beginning, Medicaid was not widely available to all low-income pregnant women and especially not to non-citizens. The patients would be on a payment plan and would need to pay by “7-months” and it was a deal that included their prenatal, postnatal and delivery costs. I remember patients bringing their money stuffed in their bras to pay up at that 7-month mark. Deliveries were at Ravenswood Hospital. I wish I could remember the cost. The consulting OB physician would come to Erie for a few hours each week.

I also remember a few patients who worked at the live poultry plant and they said that although they had no health insurance, the boss would pay their delivery fees! 

I was preparing for my talk to the first class of AdvancingPractice, a one-year fellowship to develop quality care and nursing leadership at the clinic I had worked in over 30 years ago and written about in my book: Stories from the Tenth-Floor Clinic: A Nurse Practitioner Remembers.

I read Martha’s words to the group of eight APRN Fellows especially showing the generosity of the poultry plant employer. Then I told the Pigeon Lady story from my book that ends with a neighborhood funeral home director footing the bill for the wake and burial of one of our patients. He then turned around and donated that amount back to the clinic. (It’s complicated) I wanted to stress the interrelatedness of the surrounding community on the health care clinic. 

Part of my presentation was to discuss the historical context of the advancement of nurse practitioners and nurse midwives (collectively labeled Advanced Practice Registered Nurses, APRN).

One of the handouts for the class (Expanding Access to Primary Care: The Role of Nurse Practitioners, Physician Assistants, and Certified Nurse Midwives in the Health Center Workforce, National Association of Community Health Centers, September 2013) plunged me back to the time I and other new APRNs in the Chicago area were struggling to justify our right to practice to the full extent of our training.

How much had I forgotten—maybe wanted to forget. For example, back in 1957 the American Nurses Association developed a definition of nursing that would retard the advancement of nursing practice for decades: nurses were neither to diagnose nor prescribe. And some groups of nurses called us “little doctors” and didn’t support developing educational programs in nursing colleges.  

I hope the new Fellows I spoke to learned from my presentation something about the historical context of the role, the significance of the role in the community setting and the potential of the APRN career choice. 

I close with a quote from the NACHC fact sheet:

An expanded role for nursing is an idea deeply rooted in nursing’s past and from it, much can be learned for today. Indeed, nurses should take this historical opportunity to think creatively about recycling elements of past practice for today’s unique context—perhaps initiating state-of-the-art nurse-run clinics in rural and inner city areas; reaching others by telenursing; and collaborating with designers in technology firms to create Apps and other high tech solutions to bridge gaps that exist in healthcare today. To do so, they must first read and understand the impact of the historical antecedents, cornerstone documents, and legislative acts that contribute to the nursing profession’s rich history. 

 

Expanding Access to Primary Care: The Role of Nurse Practitioners, Physician Assistants, and Certified Nurse Midwives in the Health Center Workforce, National Association of Community Health Centers, September 2013, Page 9


 

 

Wonderland Book Club

QR bookclubLast Friday I discussed my book, Stories from the Tenth-Floor Clinic: A Nurse Practitioner Remembers at the Wonderland Book Club, which was held at a local independent bookstore. The audience was quite engaged and we shared discussions not only of my book but of the status of nurses, problems within the health care industry in general and in North Carolina in particular.

Here are some of the questions/comments:

  1. How do you deal with the stress of caring for patients? Do you take these problems home with you?

Me:  I have always taken home patient problems as evidenced by what I wrote in my journals. Journaling was a way I dealt with problems at work. The more difficult the patient issues, the more time I spent writing in my journal. A lot of the stories from the book have been documented in my journal. In fact, the last chapter, Playing Sheriff, was written before I found the journal from that time period. I was surprised to find the story closely paralleled the journal entry.

  1. How brave you were to write about your mother. (I’ve had this comment before. The first time, I really didn’t understand what the person was talking about)

Me:  It was difficult to write about my mother. We didn’t get along. It was especially disturbing that I was a gerontological specialist and couldn’t get along with my own elderly mother. But it was truth and I felt it was part of my story. (At another reading, I was asked what happened to my mother when she had a place of her own. I told how my mother found a boyfriend. Wish I had thought to add that to my response.)

  1. How do you deal with writing about yourself? (Asked by someone who doesn’t write non-fiction)

Me:  I look at this book as a story about someone I know. I tried to dissociate from myself so it was easier to be honest about my actions.

  1. Who was your most memorable patient?

Me:  Helen Stoltz. She lived in the apartment next door to the clinic. When I wasn’t busy, she would drop-in and sit a few minutes beside my desk and teach me about aging. Of course, she didn’t know that what’s she was doing. She talked about getting older and eventually dying, which showed me that older folks aren’t afraid of talking about death. She was ready to die. However, she was cheerful and upbeat and accepting of her life until her time came.

  1. What was the most memorable line your wrote in your book?

Me: I didn’t write it but it came verbatim from my notes at the time. The funeral director told me how to go about purchasing a grave site for the Pigeon Lady: The Greeks are tight but the Catholics will give you a break. (page 96). I’m thankful that I wrote down what he said. He was such a character—embodied with Chicago smarts and a big heart.

What I didn’t say was that “I killed all my darlings.” Therefore, there are no “precious” sentences that have survived my editing, thank goodness.

Besides the Q & A, I was happy to be able to drop some facts about nursing, such as nurses have been voted the most respected of professions for the past 18 years. And that the World Health Organization designated 2020 the Year of the nurse and midwife.

I was grateful for such an enthusiastic and supportive turnout.

 

 

 

 

 

https://wordpress.com/post/nursingstories.org/1635

 

https://www.dailywritingtips.com/say-no-to-your-darlings/

 

https://www.icn.ch/news/2020-international-year-nurse-and-midwife-catalyst-brighter-future-health-around-globe

 

https://www.nationalnursesunited.org/press/nurses-top-gallup-poll-most-trusted-profession-18th-consecutive-year

 

Wishes, Dreams and Hopes for My Book: Stories from the Tenth-Floor Clinic

ik-wens...

 

I imagine Oprah Winfrey being told by one of her many assistants about a book she should read that is set in Chicago, that focuses on a female protagonist and deals with the disenfranchised on the West Side. Oprah, immediately after reading my book, writes a glowing review in O, the Oprah magazine. Great Summer Read!

My other fantasy is that an older woman who lives in Los Angeles, reads my book, which has been recommended to her by her nurse daughter or nurse son. She loves it so much that she passes it on to her best friend. Her best friend also loves it, and just so happens to be married to a well-connected TV producer, and soon my book is slated to premier as a new Netflix series.

And then reality sets in as I read the following quote.

“I did not get there by wishing for it, or dreaming about it, or hoping for it. I got there by working for it.” –Estée Lauder

Bummer.

 

 

Indie Book Awards, Washington DC

I spent an awesome weekend in DC attending the Indie Book Awards and sightseeing with family. The weather was near perfect.

Friday June 21, 2019

IMG_2645

IMG_2401  I attended the INDIE Book Awards with my husband. My book “Stories From the Tenth-Floor Clinic” won Finalist in General Non-Fiction category. 

Finally, I met Brooke Warner and Lauren Wise from She Writes Press in person. SWP won a well deserved award: 2019 Publisher of the Year.

brooke & laurenpublisher of the year

 

Some authors won multiple awards, hence a cacophonous sound of clanging metal medallions hanging from their necks as they walked off the stage.


on stage

 

IMG_2409
Book Table

Leave a book; Take a book.

I was lucky to grab the Grand Prize Winner: “Beloved Mother” by Laura Hunter. Laura was about my age. However she “has published sixteen award-winning fiction pieces . . .”

Saturday June 22, 2019

In the morning we checked out the Wharf, a collection of mixed use spaces, including a marina, office, residential, retail, as well as parks on the District’s Southwest Waterfront.

Afterwards, we visited the Hirshhorn Museum  where I struggled with comprehending contemporary art until I came upon this piece that could be viewed from a nursing perspective.

hirshhorn
Hirshhorn Museum

 

IMG_2643

This leg looked so realistic. Finally I could make sense of contemporary art! Well, maybe.

 

 

 

 

 

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Firefly restaurant for dinner.

 

Sunday June 23, 2019

A latte and croissant at Firehook Bakery near our hotel before heading home on Amtrak.

pastry 2

 

Not being one to enjoy formal celebrations (I didn’t attend either my undergrad or graduate ceremony), I’m glad that I traveled to Washington DC for the INDIE Book Awards. I’m so proud to be part of the community of authors that night who were celebrated for their achievements, whether they won a Grand Prize, or like me, one of the many Finalists awards. It’s a night I won’t forget.

Now on to my next book.

The Eric Hoffer Award

I am pleased to announce that Stories from the Tenth-Floor Clinic: A Nurse Practitioner Remembers is a 2019 Eric Hoffer Award Finalist.

Back to where it started: Chicago

I flew into cold, snowy Chicago last week to discuss my book at the main facility of Erie Family Health Centers. This felt like a dream as I stood behind the lectern gazing at the audience that, believe it or not, included a few familiar faces from some thirty years ago. I had been invited to read from my book: Stories from the Tenth-Floor Clinic: A Nurse Practitioner Remembers.I was discussing EFHC’s humble beginnings to this group of employees seated in the conference room on the third floor of an impressively designed modern building.

The main clinic that I remember was housed in a community center. Children’s laughter in the after-school program and the sound of the ball dribbling on an indoor basketball court easily penetrated the partitioned walls of the exam rooms. The dedicated staff experienced delayed pay days when revenue came up short. The clinic where I worked, a short walk from the main center, had mismatched chairs in the waiting area, second hand medical equipment, and roaches in the cabinets. In spite of the physical shortcomings, EFHC cared about the patients, the community, and its staff.

EFHC not only survived its humble roots but thrived and expanded. The non-profit organization now has 14 health centers, and more Advanced Practice Nurses (nurse practitioners and midwives) than doctors and is recognized as providing the highest quality of care by the US Department of Health and Human Services. The Chicago Tribune named EFHC as one of the top workplaces in 2018.

I am honored to be part of EFHC’s history.

 

Retired Nurse Practitioner & Author Marianna Crane presents her memoir,
Stories from the Tenth-Floor Clinic
On February 20, Marianna Crane, retired Erie nurse and author, met with our nursing staff to discuss her memoir, “Stories from the Tenth-Floor Clinic,” which movingly recounts her experiences as a nurse caring for the underserved elderly at Erie in the 1980’s.
We had a full room, a great discussion about the nursing profession, and over $300 were raised for Erie’s patients through the sale of her book!
Please join us in continuing to support Crane’s work! Keep up with her on her blog and website, Nursing Stories.
Buy the Book!
Proceeds from the sale of Crane’s memoir go towards providing quality care for Erie’s patients.
Crane with Dawn Sanks, Director of Health Center Operations at Erie West Town
Crane with Dr. Lee Francis, President and CEO
A full room!
Erie Family Health Center | 312.666.3494 (city) | 847.666.3494 (suburbs) | www.eriefamilyhealth.org
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