Alumni
Nursing
Portland Magazine
June 9, 2020
A nurse makes home visits during the pandemic. What does she see? Body, Mind, Emotion, Spirit, Dream.
By Sallie Tisdale
Illustration by Mia Nolting
SHE IS OVER NINETY, hard of hearing, easily confused. And here we come, hidden behind masks, shields, and gloves. She smiles sweetly, whispering, “You are all so kind to me.” She strokes my arm, reaches up to the doctor for a hug. He deflects her, gently. “You are so kind,” she says again. “So kind.”
My life hasn’t changed all that much in the last few months. I work as a writer and part-time as an RN in palliative care. I stay home and write, and it’s my pleasure, not a hardship. I go to work and listen to lungs and bowels and worries. I’ve been a nurse for more than thirty years, and I’ve been in nursing homes, a college infirmary, a bare-bones clinic in Uganda. I’ve worked with developmentally disabled adults and stem-cell transplant patients on an oncology unit. Now I work with fragile, chronically ill people. The old woman lives with her family still, and we will do what we can to keep her comfortable and in her home for the rest of her life.
I hear more worries now. The stakes for medically complicated patients are always high; they are higher now. We are doing everything possible to avoid sending our clients to the hospital. We sit six feet apart for the morning meeting, in the big day center that no one can use now. I’m in charge of supplies, and I spend time every shift counting gowns, goggles, and disinfectant wipes.
Many of our appointments are virtual now. The vaunted promise of telehealth doesn’t account for cognitive decline, poor vision, the tremors of Parkinson’s disease, or a caregiver who doesn’t speak English. It doesn’t account for a thousand other realities, but we try. We still must see several people a day, what we call “eyes-on” visits. Eyes on, hands on, because some things must be done this way. The visits are slow and cumbersome and—why don’t more people mention this?—really irritating. The doctor hates the face shield. We all hate the face shields. “Might as well be in a scuba suit,” he complains. “I can’t see anything, and how can they see me?” I give him a red child’s cowboy hat to wear on top and remind him to pull up his mask.
When I taught first-year nursing students, I would ask them to give me a short definition of what a nurse does. Most of their answers were lists of tasks: start IVs, give medications. What I wanted to hear, what I eventually would say, is that a nurse sees the whole person. Every member of the team does, of course, but not to the extent the nurse does. We see the whole in each part; our job is explicitly to care for every part of a person at once: body, mind, emotion, spirit, dream.
My clients are more scared now. They are missing all kinds of important care like dental visits and hearing aid repair; they are lonely and bored, and some of them are really scared. We’re beginning to see mental health effects from this fear and loneliness, more complaints of nausea, insomnia, aches and pains and racing hearts. Part of seeing the whole is remembering how much our minds and bodies interact. The old woman stroked us, I think, in self-defense. She smiled and called us kind to mollify these big strange people with no faces.
How does a nurse do her job? The nurse adapts. I read about my sisters and brothers on the COVID-19 wards, and I ache with empathy, for what I can only imagine their days are like. I think of them and feel useless, guilty. They are working so much harder than I am, at such risk. Many have been censured by management and abandoned by our leaders, and they keep going back. So I joined the antibody research project. (Here’s a surprise: I enjoy getting my blood drawn now, because the phlebotomist touches me.) I fill out a skills inventory, in case they need to draft more of us into those units. Respect, my peers, respect.
I’m used to gowns and gloves, to the faint sensation of the invisible that reminds us of contamination. It’s a deep body memory, this donning and doffing, what you can touch, what you can’t. I have to make a home visit to a patient with a fever. That means full protective equipment. The policy—today’s policy, new policies all the time—dictates that I can’t bring equipment into the house. But the in-home caregiver doesn’t have a blood pressure cuff, so what do I do? There’s no body memory for this process. After the visit, I step out the door and slowly take off my equipment in a precise order and put it in a garbage bag the caregiver holds, just inside the door, the space between us our agreement.
Nurses adapt. I find ways.
Yet I am the least anxious among my friends. I get to go to work, a privilege we rarely appreciate. I get to talk to rational people and read the newest epidemiology research. That means I can parse my way through the barrage of news, ignore the conspiracies and falsehoods. I’m scared sometimes, but I’ve been scared before—a needle stick during the AIDS crisis, a patient with drug-resistant tuberculosis coughing during my exam. I’ve been scared before, and I will be scared again, but I have a job and it is meaningful and I get to touch people sometimes. My feet stay on the ground.
There are more surges ahead. Waves to come, already building. Sooner or later, all of us will be exposed, and someday there will be a vaccine. Which comes first is anyone’s guess. We are members of a species encountering a novel pathogen, and that has inevitable consequences. The world is a whole thing. We are small parts in a matrix we can’t begin to measure. Small, incredibly precious parts. But biology does not fret about individuals, no matter how precious. I made a copy of my advanced directive and emergency contacts and carry it with me now wherever I go.
There will be an after. Another world, another time. I want to see this whole Earth. However you conceive of that which is larger than yourself, look for that now. I am writing this in the spring. Lakes of cherry blossom spill across the sidewalk like pink rain. The dogwood trees are filled with white petals. Daffodils and lettuce, robins and lilac, calling to each other. What the Earth transmits to me now is a reminder: I am a part of all that has been. I am part of all the possibility of life ahead.
Sallie Tisdale ’83 is the author of nine books, most recently Advice for Future Corpses. Her essays have appeared many times in Portland Magazine.
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