Marianna Crane - Stories from the Tenth-Floor Clinic: A Nurse Practitioner Remembers

STORIES FROM THE TENTH-FLOOR CLINIC

Copyright 2018 Marianna Crane

All rights reserved. No part of this publication may be reproduced, distributed, or transmitted in any form or by any means, including photocopying, recording, digital scanning, or other electronic or mechanical methods, without the prior written permission of the publisher, except in the case of brief quotations embodied in critical reviews and certain other noncommercial uses permitted by copyright law. For permission requests, please address She Writes Press.

Published 2018
Printed in the United States of America
ISBN: 978-1-63152-445-5 pbk
ISBN: 978-1-63152-446-2 ebk
Library of Congress Control Number: 2018943324

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To my patients

A s a new nurse practitioner in the mid-80s, I worked in the emerging specialty of gerontology. I often grappled with how best to serve those who sought my carepoor, elderly, inner-city high-rise residents who didnt have access to adequate health services and often had to choose between food and medicine. Their multiple struggles, and my quest to provide them with the care and dignity they deserved, plagued my thoughts and dreams until I began to give voice, through writing, to our shared experiences.

To tell my story, I reread my journals, researched data, and interviewed others with whom I had worked at the time. All names have been changed to maintain confidentiality and consistency, except for those of members of my immediate family.

I hope you will enjoy getting to know this diverse group of individuals as much as I have.

T he slap of bare feet on linoleum caught my attention before a tall, wild-haired man in boxer shorts and a sleeveless undershirt appeared in the doorway.

Dropping my pen on the desk, I shoved the chair back, ready to bolt from the roomexcept that he blocked the way, breathing heavily, and leaning against the door jamb. He wasnt angry. He wasnt carrying a weapon. He looked so unsteady that I probably could have pushed him over with one hand. My surging adrenalin began to subside. After all, this was a clinic.

What can I do for you?

I feel lousy. He staggered into the room and plopped down on the chair next to my desk. His long, hairy legs splayed out in front of him, his arms dangled, and his head dropped to his chest. The stink of sour sweat and urine rose from him.

Just then Amanda Ringwald poked her face in the doorway, worried eyes roaming from me to the man and back. I nodded indicating that it was okay for her to go back to her desk. I had everything under control. What could she do anyway? Eighty-four years old, Mrs. R was a fixed body at the reception desk in the waiting room. She greeted patients, answered the phone, and muddled messages.

Whats your name? I asked the man.

He turned his head toward me. Bright yellow colored the sclera of his empty eyes.

Peter Zajac. He gulped. I live down the hall. 1002. He sucked in another deep breath before he added, Im sick. The scent of alcohol rode on his breath.

I recognized the name. Suddenly I recognized the man. More than once I had watched him stumble past the clinic door in a drunken stupor on the way to his apartment.

Tell me whats wrong, Mr. Zajac.

I feel lousy.

He didnt look critical enough to call 911, so I ran through the usual review of systems from head to toe: headache, nausea, shortness of breath, chest pain. On and on. He shook his head no at every question. Do you drink? I asked.

Some.

Let me check you over, I said, rolling the antique blood pressure machine across the linoleum. I listened to his heart and lungs, poked at his belly looking for pain and fluid, and checked his legs for water retention. I found his blood pressure low and his heart rate a bit fast.

Considering his jaundiced eyes and past behavior, my best guess was alcohol toxicity. He might have been hypoglycemic as well. Couldnt hurt to give him some orange juice to bring up his blood sugar.

I zipped past Mrs. R on my way to the kitchen that doubled as our supply room. Sun streamed in from the window behind her, transforming her wispy white hair into a halo. I took out a container of orange juice from the refrigerator, poured some into a plastic cup, and forced a smile in her direction before scurrying back to the exam room.

While Mr. Zajac held the cup to his lips with shaky hands, I recalled that his daughter had walked into my office a few days before. Dropping in without an appointment must run in the family. I was unpacking some items from my last job when I noticed her standing next to me. The tuning fork in my hands slipped and clanged as it hit the floor.

Just stopped in to say hello, she said, pressing a handbag under her arm, her middle-aged face devoid of makeup. She told me her dad lived down the hall. Im happy that the clinic has opened on his floor. I bet youre busy with all the sick old-timers who live in this building.

Yes, I said, when in fact we werent. Not yet, anyway. The Senior Clinic hadnt been open long, and then only for a few hours a weekthat is, until I came on board as the full-time coordinator.

Mr. Zajacs daughter chattered on. What was her point?

Dads killing himself with booze, she finally said, her lips quivering.

Although I had more boxes to unpack, I couldnt kick a sobbing woman out of my office. I put my arm around her shoulders, steered her to a chair, and listened to the saga of a daughter depressed over her fathers self-destructive behavior.

I cant confront your father and tell him to stop drinking. I only wish it was that easy. He needs to walk into this clinic and ask for help.

And so he did.

I eased the empty cup out of Mr. Zs hand.

Thank you, he said, his voice stronger. He pulled back his shoulders, sitting straighter in the chair. Was it my imagination or did he seem a bit better? No doubt he had been a handsome man once. I tried picturing him in clothes.

As I mulled over what to do with him, I remembered that his daughter had told me he went to the Veterans Administration Clinic. The vise gripping the back of my neck slowly released. His daughter was righthes killing himself with booze. I could send him back to the VA where he would be admitted to the detox unit. My last job had been over there, so I knew the ER nurses. It would be simple to arrange for an ambulance if he agreed to be hospitalized.

I pulled up a chair and sat facing him. His body odor was less repugnantor was I adjusting to it?

Mr. Zajac, I have something to tell you. Listen carefully.

Yes, he said, watching my face.

Youre a sick man. We need to find out whats wrong with you so you can get better. I dont have the equipment in this clinic to help you. You should be in a hospital where they can do the tests to find out why you feel so lousy. I decided not to mention the detox unit. The hospital staff could deal with that.

Youre already a patient at the VA, right? He bobbed his head. I could call them and get you admitted. Is this okay with you? I held my breath. His brow wrinkled and his jaw, covered with gray and brown stubble, began to rotate like he was chewing his cud, actions I hoped meant he was considering my suggestion.