God's Little Looney Bin

I have a patient who I see regularly for my second job as a per diem Visiting Nurse. Interestingly, her mother-in-law, who lives with her as well, was a patient of mine seven years ago when I was a full-time Visiting Nurse. Arriving early in the morning before my day-job begins, I am welcomed into their home like a beloved guest. Although the redundancy and sameness of the visits can sometimes feel monotonous, their collective and individual sweetness keeps things fresh, and I see it as yet another opportunity to be loving and accepting of others.

This particular patient is not very educated and has lived a very sheltered life. However, she is also a deep thinker and humanitarian in her own way, and getting to know her over the months reveals a complexity of thought in a person who, if I met by chance socially, I honestly might not take the time to get to know. Be that as it may, these professional therapeutic relationships are a way to open one's heart to those who one might not encounter otherwise.

When I first arrive around 7:30am, I open the unlocked front door and enter the dark living room. My patient sleeps in a hospital bed near the front window of the cramped room, and her husband sleeps in another hospital bed along the adjacent wall. An oxygen tank for my patient hums next to her mother-in-law's tank, the line for the elder woman's O2 running up the stairs. I call my patient's name softly, take off my coat as she stirs in her bed, her husband snoring loudly across the room. As I turn on the light, she wakes and sits up, rubbing her eyes like a child.

In the course of our weekly thirty minutes together, we converse about many things as I unlock the box holding her meds, take her vital signs, listen to her lungs, and do a cursory but thoughtful assessment. Sometimes telling me stories I've heard before, I listen with interest and inject humor into the conversation which makes her laugh and cover her mouth to hide her crooked and decaying teeth. My strange sense of humor is not lost on her, and she'll often remember things that I said previously and repeat them to me weeks later, laughing as if I had just said it again.

This past week, we talked about the recent violence in the city over the Christmas holiday, the people who take advantage of the poor, the social service agencies that, one by one, are coming under scrutiny and revealing systemic corruption at the expense of the needy. We also often discuss the environment, Global Warming, animals close to extinction, vegetarianism (she refuses to eat meat), and culture in general. She also talks a great deal about her health, her mother-in-law who she loves, her husband's health. She waxes poetic about my wife and me, and I try to wave off her heaps of unabashed praise.

Once in a while, she will say something that sticks in my mind, a gem that I write down in order to not forget it. Recently, after ruminating about the ills of the world together, she summed it all up by saying that perhaps this world was just "God's little looney bin" and we were all just permanent residents. I then told her about a line in one of my favorite films---My Dinner with Andre---wherein Andre describes New York City as a modern prison in which the residents are not only the inmates but also the guards, and that everyone has forgotten that they are free to leave at any time, and almost no one does. My innocent but thoughtful patient loved that image, and covered her mouth as she giggled.

Going upstairs each week, I greet her elderly mother-in-law if she is awake. The television is always tuned to the channel showing Catholic mass in Spanish. She lies on her bed, doing her Rosary, looking out the window. Our conversations are generally the same: I ask her how she is, she complains of various symptoms, I tell her a little anecdote, and I leave quietly, not before she blesses me, my wife, my son, and my dog. Working with Latinos, I have often experienced such blessings, some of which can go on for up to five minutes, although hers tend to be about a minute long. I give her a big kiss and hug, carefully go down the cluttered stairs, hoping to not be sucked into another long conversation with my patient before taking my leave and continuing my day.

Back downstairs, this kind but simple woman who receives few visitors will keep talking as I leave the house, and I often need to persistently attempt to bring closure to the ongoing conversation as I close the door behind me. Three years older than me, she always tells me how much she enjoys my visits, that she had fun, and looks forward to my next visit, which is usually only once a week.

Examining these visits, I can see that my dispensing of meds and taking of blood pressure is really only circumstantial to her. The important thing to her is the human interaction, the give and take of conversation. For me, it is a service, yes, but it is also honestly a way I keep just a little extra money flowing into my bank account. Community nursing often feels more like social work, and patients will embrace you not only as a clinician, but also as a friend. Those roles are fine, as long as boundaries are maintained and expectations are low.

Here in "God's Little Looney Bin", I flit from home to home, play a small but often vital role in someone's life, add comfort and kindness along the way, and hopefully encourage new habits of prevention and self-care which increase quality---and perhaps even quantity---of life. It is a curious and quite personal calling, and is never bereft of surprises. Looney bin or not, it's what we have, and whether I be inmate, guard, or both, I'll give it my all until it's time to say goodbye.