Primary Care Profiles

Camden, New Jersey. 

No one is ever on the right side of up here. “Rock bottom” is something people hit time and time again. 

If you watched ‘Stranger Things’ and struggle to picture the “upside down – Camden comes pretty close. There are entire blocks with vacant, abandos (abandoned properties) where my patients tell me they will go to get high. There are no grocery stores – just tiny bodega shops that feature snacks, soda, kitty litter, and Santeria candles but no fresh food. Trash is stirred up by passing cars and the wind. Glossy wrappers get tangled in bushes or create garish contrast against freshly fallen snow. A lone figure drops their pants to defecate in a vacant lot when they think the coast is clear.  

Yet, our oasis stands two stories tall admist the fray. Extraordinary things happen within our walls. I’ve been privileged to be introduced to an ever evolving cast of wonderful human beings. 

————————–

Reggie* is exactly who you might imagine when you think of a chronically homeless individual. He has a long-standing mental illness that may or may not be schizophrenia. He is suspicious of me. He was last in for a doctor visit in 2012 – well before I was a provider there. He smells stale – of soil, of dried urine, and of the tang that develops from sweat never washed away. The fruity aroma that makes my nose twitch  is from the venous stasis ulcers on his legs that have swollen to 2-3 times their usual size. It is a smell that reminds me of my 5 years of hospital nursing. It’s the smell of things dying. I can see the pink-white layers of his skin. Reggie is a large man but he sits hunched in the wheelchair, observing my as I examine him. 

Reggie tells me that he only needs bandage supplies and pills to “make me pee”. He means Lasix – a rather strong diuretic we give to pull fluid from extracellular spaces back into the circulatory system so the kidneys can excrete the excess. I know that Reggie is chronically homeless but he spins me a yarn about having bought a 3 bedroom house behind one of the local hospitals. He goes into such detail about the property that I almost forget to question the verity of the whole thing. In all likelihood, he will go back to loitering around places like local food banks or the McDonald’s and get arrested for such because of the state of his skin but more so for the state of his mind. 

When caring for the homeless, the focus is on keeping the patient out of the ER, so I push the thought of IV antibiotics to the bottom of my list of therapies.  We clean and dress the wounds. I prescribe a strong oral antibiotic and a few days of Lasix. I beg him to let me draw his labs to check for signs of systemic infection and injury to his kidneys. He begrudgingly agrees. In a stern tone, one that I recognize as my mother’s voice, I tell him to return in a week for reevaluation. He leaves laden with a bag brimming full of bandage supplies, pedaling the wheelchair with his swollen feet. 

It has been two weeks, maybe three. No sign of Reggie. I search the streets for his face as I drive around the city on my way to and from work. I check the local news outlets for death notices. I imagine he’ll pop up again. Hopefully, I get to him before his infection does. 

*Name changed. 

Reverb 10 for December 27 – ORDINARY JOY

December 27 -Ordinary joy. Our most profound joy is often experienced during ordinary moments. What was one of your most joyful ordinary moments this year?

Nursing brings me more joy than I had thought. Yes, it is messy and complicated and patients can be infernally frustrating, but I still feel that it is such a privilege to be able to care for people when they are at their most vulnerable. The best moments in nursing for me aren’t in the critical moments when I’m making tough decisions about patient care or trying to keep a patient from the brink of medical disaster. The best moments for me come when I’m taking a patient history, helping someone with their medication, rocking a scared child. I feel joy when I know a connection has been made between myself and a patient. Despite the fact that nursing is such an intimate profession, it’s not very common to make a profound connection with patients because there is just so much to do in a shift. Most of my time is usually focused on just maintaining the status quo. Sometimes, though, I recognize a kindred spirit, or someone opens themselves up enough to trust in my care, or I get a “thank you” and that sustains me.

My mot joyful ordinary moment this year occurred during the days I got to care for infant A. at The Children’s Hospital of Philadelphia. He arrived on our unit at about 9 days of age – so new to the world. I took such delight in seeing him grow and achieve developmental milestones over the months that I cared for him that the other nurses teased me. There is just something so magical about seeing a human being develop that it is hard not to be mystified. I knew that I wasn’t his mother but I felt such elation the first time he made purposeful eye-contact with me. I enjoyed being his cheerleader – encouraging him during feedings, quieting him after procedures, updating the medical team on his progress. I never once saw or met his parents in the 14 weeks I was on that unit. Their absence – complicated reasons I won’t go into – ignited a little fire within me that kept my anger on a low boil for weeks. I eventually got tired of wondering who these individuals were and speculating about their parenting abilities. Instead I focused on providing A. with lots of positive energy in the time I could give him. Just because I wasn’t his mother didn’t mean that I couldn’t love him in a way, too. My nursing care improved when I focused on communicating to this little babe that he was loved and cared for and going to do just fine in the world. Once I let go of the anger, I found there was certainly a whole lot more room for the joy.

Reverb 10 for December 19 – HEALING

December 19 – Healing. What healed you this year? Was it sudden, or a drip-by-drip evolution? How would you like to be healed in 2011?

People, in general. This person, in particular.

Dessert crepes at Beu Monde in Philadelphia with "Flat Jesse"

*I know you’re intrigued by the little cardboard man in the photo, but you’ll have to ignore him as he is not the subject of this post. As it is, I am probably risking life and limb posting this picture here, but it’s a risk I shall take nonetheless.

2010 has been that fragile year just after the death of my father where people walk on eggshells and constantly ask you how you are doing. It’s like the rest of the world is on a surveillance mission to see if you’re going to go completely off the deep end during the grieving process. It also seemed that, in 2010, we were continually remembering my father but never really putting him to rest because of a series of events to honor him had been scheduled throughout the year, not to mention a grand portrait unveiling in November. Because I was perpetually busy during this time with classes and clinical rotations and a two-week vacation to Maine, I didn’t really consider myself in need of any healing. Afterall, I had plenty of support from mental health professionals as well to keep a tight reign on anything that might resemble a downward spiral towards depression. It’s only in retrospect that I realize that my friendship with J provided healing because she continually reminded me why life is worth living, why it can be exciting and beautiful, how the smallest acts can renew your spirit, how faith can remind you that you aren’t alone on the planet, and that taking time to be with other people is one of the most important things you can do for yourself and others.

J is a phenomenal person. In fact, she greatly reminds me of my father in that she is a carrier of that ever annoying trait that makes her seemingly immune to passing judgment on other human beings. I, on the other hand, seem incapable of forming snide opinions of people within seconds of meeting them. These opinions, no doubt, tend to drastically change over time as I get to know others.  I am usually able to keep them in the confines of my own head, but sometimes they slip out and it’s like I hear my father’s voice come out of J’s mouth and I just want to ask “how can you like everybody!?”.

J is also one of those dependable people that are increasingly difficult to find in the world and that seemed to make all the difference in 2010. I wrote an earlier post about how much I appreciate my mother because of her dependability but, she is my mother afterall and part of that comes with the territory of bringing a wee one into the world. J, is beholden to me in no way whatsoever, yet I have been able to count on her for an inordinate amount of emotional support this year. And she has been supportive in exactly the way that I need: the strong, silent way. No loaded questions of “well, just how are you these days?” or “everything alright at home?” I didn’t have to lie about my emotional state and I didn’t get any of the overly-saccharine sympathy that I had come to detest. Every comment and question and suggest was always honest and genuine.

J and I took a lot of walks in 2010 as I, yet again, tried to recommit myself to some sort of fitness routine. It’s pretty difficult to get myself to commit to walking in the freezing cold at 9am let alone to convince someone else to do it with me. At one point, we were up to 5 miles round-trip which seemed to amaze others with whom I would share this information. Our walks provided a kind of self-renewal that I hadn’t even realized that I craved or needed. Even if I balked on some mornings, J would inevitably persuade me to lace up my sneakers and off we’d go. I always felt better at the end of the trail. It was great to accomplish something. 5 miles every week was a veritable Mount Everest for me in terms of conquering my inability to commit to any fitness routine. Beyond, the steps we logged, we engaged in lengthy chats about anything and everything of a personal, ridiculous, serious, or sad nature. It was free psychotherapy. I learned to become a better listener on these walks. I tried to learn to not get so worked up about stupid, small stuff. J tends to make me want to be a better person, so mostly, I did a lot of trying on these walks: try to not interrupt, try to not judge, try to listen for what isn’t being said.

Unfortunately, our walking schedule took a major nosedive with the fall as we geared up to finish nursing school and I struggled with two unhappy kidneys. Now, J is headed off to the wilds (or at least suburbs) of North Dakota to begin her nursing career while I remain in Philadelphia to start mine. In 2011, I will still take walks, though. If I’ve learned anything at all from my father’s death, it’s that you can still talk to someone even when they’re not next to you to hear you. I’ll just be sure to keep it in my head.

Reverb 10 for December 15 – 5 MINUTES

December 15 – 5 minutes. Imagine you will completely lose your memory of 2010 in five minutes. Set an alarm for five minutes and capture the things you most want to remember about 2010.

I’m using a 5 minute Celine Dion Christmas ballad as my timer. Does anyone else feel like her songs tend to be abnormally long?

In no particular order of importance, things I want to remember of the year 2010 before my memory gets erased by one of those Men In Black amnesia gun thingies…

 

Fiona likes to pose for her photoshoots.

 

The re-dedication of the Dr. Bernett L. Johnson Jr Sayre Health Center. The last day of my Penn BSN program. Getting offered a nursing job on the exact unit where I want to be. Walks in Fairmount park with J. Every Advent Soup Night. Dancing like a fool with my fellow nursing students. Viewing dad’s portrait at HUP. All the sentiments I’ve heard from those at HUP and Penn who remind me that he’s not forgotten. Naps with my cats. The beauty of Maine in August. Finding a new friend in A. Talking with patients at United Community Clinics. The privilege of getting to hold so many precious children at CHOP. Movies on Black Friday with mom. Baking bread. Picking fresh fruit. Making jam. Visiting the new PurlSoho space. Introducing J to NYC. Hugs from Phyllis and HUP’s COO, Mr. Black. The funny way it looks like our dog Hudson is smiling or laughing. Birds at the bird feeder. Nursing potlucks in all their epic glory. Hugs from B that make it hard to breathe.

Of course, there would be so much more, but my holiday iTunes playlist is on to Sarah McLachlan.

 

December at Valley Green Inn, Fairmount Park, Philadelphia

Wreath and Candles for Advent Soup Night.

Bali, Queen of the Covers

The Bubbles in Arcadia National Park, Bar Harbor, Maine

Dad immortalized in oil paint at HUP

Reverb 10 for December 7 – COMMUNITY

December 7 – Community. Where have you discovered community, online or otherwise, in 2010? What community would you like to join, create or more deeply connect with in 2011?

To whom much is given, much is expected. I have discovered community in those nursing colleagues that share my desire to contribute to the field of nursing in a meaningful way by providing care to vulnerable populations – racial and ethnic minorities, women, the homeless, the addicted, the incarcerated – that face myriad health care disparities because of their liminal status in society. When record numbers of health care providers are jumping the primary care ship for high paying specialties, we are committed to providing comprehensive primary, preventative care in an effort to foster healthier individuals, families, and communities. I am lucky to have found such wonderful people who share my passion for nursing. I am continually inspired by the patients that I am privileged to care for and collaborate with.

I have also discovered community in my neighborhood. This is the 4th year that those who live on our block have met for our weekly Advent Soup dinners. As one of our neighbors likes to say, “we have created a sub-culture” in an era where few families and communities take time to share a meal, let alone take the time to do it 4 weeks in a row. What is truly remarkable about this neighborhood tradition is that only a handful of us are Catholic. These gatherings transcend religious and spiritual belief, though, and challenge us to slow down, to revel in the anticipation of the changes that are to come. We have used this season of Advent, known as a time of preparation in the Catholic faith, to gather and reflect upon the year we are about to leave behind and the year that is to commence. We discuss our hopes and disappointments, our fears and longings; we laugh a lot over bread and homemade soup. We reflect on how we have been able to create an oasis of peace, love, and friendship during a hectic season. I am infinitely grateful for the fact that I only have walk up and down my block to find, not only true friends, but family.

 

At the risk of seeming gluttonous, I don’t know if I could really ask for more in 2011, except that my relationships continue to grow and deepen and that life never fail to present me with the opportunity to come to know others who cross my path.

Reverb 10 for December 4 – WONDER

December 4 – Wonder. How did you cultivate a sense of wonder in your life this year?

I spent 14 weeks completing my last clinical rotation for nursing school at the Children’s Hospital of Philadelphia. CHOP, as it is unfortunately known, is a bit like Willy Wonka’s candy factory – few individuals are privileged to enter into a world where sheer medical magic takes place.

It seems that the world is divided into two groups: those that love and those that loathe children. The latter dismiss tiny humans as sniveling, whining, parasitic-like creatures who are infernally irrational and suck the joy out of life for those of us over 4 feet tall. We’ve all seen the caustic looks directed towards the exasperated parent in the grocery store or airport as they try to wrangle and uncooperative child into submission.

I am always amused by how quickly we forget that we were once children. Undoubtedly, we were all ill-behaved children at some points. I am frustrated by the fact that we expect children to act as though they are abstract-thinking adults. I am incensed by how quick we are to blame parents and consider them poor caregivers or disciplinarians*.

*I will concede that, yes, there are some rather maladjusted children, but this is not the norm. I will also concede that there are rather terrible, ill-prepared and ill-equipped parents.

Children are amazing, wonderful, mystical little creatures.

They understand much more than we ever give them credit for.

They are empathetic to a fault.

They are resilient and able to adapt rather quickly to change.

They have intelligence and wisdom beyond their minimal years on earth.

They feel everything acutely and completely.

They give wholeheartedly.

They love unconditionally.

They accept willingly.

I have had the benefit of having been able to care for infants and toddlers and teenagers and 3 hours per week of a behavior and development lecture to make me fully aware of the wonder of children. Others, though, might see the same things I do if they slowed down to accept children for who they are – a constantly changing constellation of thoughts, ideas, organic biological and psychological processes. They are works-in-progress; construction zones that say “please pardon our mess” as they bumble their way toward adulthood.

When someone tells me that they don’t like children, I am inclined to suspect that their dislike has less to do with any actual child and everything to do with themselves. That’s what makes me really wonder.