A Reminder

A NURSE MAKES HOME VISITS DURING THE PANDEMIC. WHAT DOES SHE SEE? BODY, MIND, EMOTION, SPIRIT, DREAM.

B Y SALLIE TISDALE

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 this magazine.

B Y NINA RAMSEY

BECAUSE WILDERNESS CAN BE a balm for the pain in every human heart.

Because we can quiet our minds and our voices and listen to the sounds of the trees, the rivers, the wind, the rain.

Because my father and his father hunted mallards, and we wept as we watched drops of water bead up and run off the iridescent blue and black feathers of a dead drake. As my father, as his father before him, tried to demonstrate his own awe of the wild, by cutting through and slicing apart and examining the wonder of layers of duck down, all we could think about was death.

Because John Muir said, “The clearest way into the Universe is through a forest wilderness,” and what can that possibly mean? Did all life begin in the universe? In stardust and intergalactic duff? Were we born in the death of a sun?

Because we don’t yet know what it might mean if there were no longer any wild places left on our aching, polluted planet Earth.

Because standing in the tree well of a giant sequoia or at the base of a two-thousandfoot granite wall, glittered with feldspar and quartz, reminds us we are but a small speck in a much greater whole.

Because humanity needs to hand over its hubris.

Because the only way into the wilderness web of life is to inhabit the wild. Kick over leaf litter to find the brilliant society of sowbugs, snow fleas, earwigs, centipedes, leopard slugs, soapberry bugs, and panda snails. Find a trail of porcupine quills leading to a porcupine skull and know there has been a fisher about—a rare, threefoot-long member of the weasel family and killer of porcupines. Climb a snowfield to find the horns, hooves, and clods of fur—all that is left of a bighorn sheep— surrounded by bear tracks. How else are we to realize that we are one of many forms of earthly life and nowhere near the top of the food chain?

Because at one o’clock in the morning, we hear barred owls and wonder at their linguistics—the inflections, the syntax, the short-short-short, the long, and the gobbling vocalizations. Their warning calls and their morning songs.

Because we, as well, are capable of warning calls and morning songs.

Because in the wilderness, we can get wild ourselves. Skinny-dip. Climb into the Douglas fir’s sticky-with-pitch branches (pitch that is a medicinal balm for skin irritations). Butt-glissade down a snowfield. Howl at the moon. Klack back to common ravens. How can we tell how feral, how wild, how uncivilized we are if not in the wilderness?

Because we can clean our teeth with a twig and wipe our bottoms with a leaf.

Because peeing on a boulder in a subalpine meadow makes a good salt lick for deer, mountain goats, and bighorn sheep. But peeing in the dirt in a subalpine meadow can bring ruin to feathery mosses, yellow buttercups, purple lupine, white avalanche lilies, and orange columbine as the ungulates will tear them apart to dig up all trace of you.

Because young wild animals, like human children, play. Marmot pups wrestle. Yearling deer leap and buck. Bear cubs chase each other up trees. Young goats head butt, bleating; they run up a snowfield and leap down that snowfield.

Because where else can we experience the fear reactions that are hard-wired into our primitive lizard brains? A crashing in the bush and our hearts stop—a grizzly bear? A cougar? A long thick stick in the dirt seen out of the corner of our eyes and our blood freezes—an adder? A rattlesnake?

Because mother love exists across species. A pronghorn antelope doe cries over her dead fawn and refuses to leave it. An elk cow chases down a coyote getting too close to her calf. That mother elk’s deadly hooves could have crushed that coyote’s skull. Did the coyote need that elk calf to feed her hungry, growing pups?

Because we consider coyotes and listen to their howls in the dawn, which reminds us of their wolf cousins, which reminds us of our dogs, as all descended from wolves; which reminds us to wonder what would have become of our primitive human societies had we not been helped by the generosity of the wolves, who remembered humans were a reliable source of food, and so gave themselves over to domestication. How would we have survived?

Because the conservationist Aldo Leopold wrote, “Only the mountain has lived long enough to listen objectively to the howl of the wolf.”

Because 64 million years ago, dolphins evolved from the sea to the land, where they lived as creatures similar to wolves but with hooves, before returning to the sea and evolving back into dolphins but with gigantic brains. What did they learn as landdwellers that drove them back to the sea?

Because it is an atrocity to domesticate a dolphin and name it “Flipper.”

Because we must resist our compulsion to humanize wild animals and claim dominion over the wild. Resist digging canals and damming rivers. Resist carving our initials into the bark of a hemlock tree. Resist blasting into Earth’s crust to extract silver, copper, iridium, gold. Resist giving names to the Rufus and Anna hummingbirds that frequent our feeders—Rusty, Greenie, Brownie, Jade; Buzzbomb, Peabody, Scarface, Bill.

Because poet of the wild John Haines wrote, “I need to concede a considerable area to what I don’t know and can’t know, and perhaps don’t wish to know. Only to understand in a way I do not quite understand.”

Because we all, at some time in our lives, feel like a voice in the wilderness.

Because wilderness need not be branded as uncultivated, uninhabited, inhospitable, a banishment to a no man’s land out of which we must spend years wandering. If in wilderness we feel ourselves to be in the heart of the world, we might experience a deep sense of belonging.

Because included in the lyrics of a hymn by Maltbie D. Babcock, which Lutheran children sing at Luther Land, a Bible camp in the woods, “This is my Father’s world, and to my listening ears, all nature sings, and round me rings the music of the spheres.”

Because in the silence of wilderness, the nocturnal hoofbeats of a mule deer sound like a procession of club-footed clowns. How can a creature so delicate be such a clodhopper?

Because we can test our strength and our endurance. Slogging twenty miles in sixteen inches of wet spring snow. Breaking camp in five minutes when a storm approaches. Hiking twelve miles of a high elevation section of the Pacific Crest Trail while suffering from positional vertigo.

Because in wilderness, we can closely observe the boom-and-bust nature of the predator-prey cycle. In the Cascade Mountains, pine martens will correct an overgrowth of golden-mantled ground squirrels. Without coyotes in our suburban neighborhoods, we suffer an overgrowth of rabbits and rats.

Because we need to understand the endless, slow grind of geological time—fossils 240 million years old; igneous rocks forty millions years old; layers of geological time demarcated in sandstone canyons.

Because wilderness will live on long after our species is extinct.

NINA RAMSEY is a psychiatric nurse practitioner and writer in Seattle, WA. Her work has appeared in the North Dakota Quarterly, Farralon Review, Signs of Life, and Portland.