Hospice Nurse Goes Thrifting for Wedding Dress

Key West is renowned for several things: it’s the southernmost tip of the continental United States, it’s the birthplace of key lime pie, and it was Hemingway’s home from 1931 to 1939. During these years, he wrote Death in the Afternoon, the Green Hills of Africa, and To Have and to Have Not. I know this not because I visited Hemingway’s house on Wednesday and got a guided tour, but because I use the Internet.

I did visit Hemingway’s house on Wednesday, if you count standing outside the high brick wall that surrounds his property and air-typing while your daughter takes your picture. We arrived in Key West around 10am. It was already steaming hot and parking was scarce. We drove by the house and could see it was overrun with tourists. I mean, who are all these people who arrive well before you at the places you want to see, even when you set out at 8am?

Apparently they were all people who were willing to purchase tickets to shuffle around Hemingway’s house in a pack following a guide. I’m sure it’s a great tour and I would have learned a lot. We’re just not the ticketed tour types. Plus as I told Jessie, reports are in that he wasn’t very nice to women. She asked how I knew this. I knew it from watching a fictionalized movie about him and Martha Gellhorn, but I improvised and said because he was married four times. Single eyebrow arch from the daughter.

Fair point. One of the things I wanted to do in Key West was shop for a wedding dress. If you have ever gone shopping in Key West, Key Largo, or indeed Miami, you will know that unless you want to get married in beach bling you are bang out of luck shopping for a wedding dress. I’m not looking to be married in white this time, or even ivory. Any color will do. But I also don’t want to be married in a paisley silk halter-neck with flounces.

And yet this was pretty much all we saw in Miami Beach on Monday. We made forays into a few boutiques on Collins Avenue. I optimistically tried on some flowing ruffly creations. They looked okay in Miami, but I knew that transported to the Hudson Valley in early October they would look exactly like what they were: beach bling. Jessie tried on some fun creations too: she looked spectacular, but she already has her dress for the wedding. We tried Macy’s. Surely the staid old department store would have something classier? Turns out Macy’s on Miami Beach is all about…paisley flounces. 

Undeterred, we hit some thrift stores on the Keys on Tuesday. I felt in my bones that I would find my wedding dress at Jolene’s Hidden Treasures and Boutique in Tavernier. The moment we walked through the door, the feeling intensified. The place was a trove of unique clothing, everything from stetsons to scarlet sequins. Jolene was bustling around in the back and called out to ask us if we were looking for anything special. My mom’s getting married, Jessie said brightly. Then we both giggled silently at each other. Jolene was on it immediately. I have the perfect dress for you! she cried, it just came in! I stood very still, waiting to see my dress.

She emerged from behind a clothing rack holding a giant white mass of gauze ruffles. It looked like a big meringue, circa 1980. Think Charlie’s Angels are all marrying the guys from Miami Vice. I smiled weakly. Actually I said, hoping I could keep the horror out of my tone, I wasn’t planning on doing the white thing this time around. Her face fell. She clearly thought she was going to see me leave with meringue dress.

We poked around for a bit and I tried on some interesting creations, but none of them were quite right. I’ll admit it: shopping for your wedding dress in a thrift store is a shade optimistic. I tried on a lovely pale green thing that swept down gracefully to the floor. But it had a thread pulled in the front and it looked a bit scruffy, even for me. Besides, getting married in pale green just seems a bit…pale.

Key West was no better. After we peered over Hemingway’s brick wall at his very shady and gracious house, we checked out a few dress shops. Sundresses with lace. Sundresses with sequins. In one store, I told the helpful assistant that I was looking for my wedding dress. What time of year are you getting married? she asked. Umm, I said, trying to think how to phrase it, kind of late next week sort of time. She looked at me pityingly and pointed to some sundresses.

So maybe I’m not getting my dress in Florida. Or my shoes, unless they’re going to be glittery flip-flops. To console ourselves, we headed to Fort Zachary, lauded on Google as the best snorkel beach in the area. There were two flaws in our plan: one, Fort Zachary was next to a naval base so our beach experience featured frequent low flying military craft and two, we forgot the snorkel gear.

It didn’t matter. Life on the Keys has a way of working out just fine. We sizzled gently on the beach for a bit and then swam out in the aquamarine waters where the Atlantic meets the Gulf of Mexico. Jessie waxed lyrical about how Cuba was just out there. I turned to where she was pointing. There was a little pile of rocks about a hundred feet out with a single bird perched motionless on top of it. What, those rocks there with the bird? I said in a silly English accent I learned from Monty Python. We both cracked up. 

I’m heading back to New York. They have dress shops in New York, I feel sure. Macy’s in Poughkeepsie will have classy gowns that flow about my body and have never been worn by others. I’m kind of sad that I didn’t find my dress at Jolene’s Hidden Treasures and Boutique. But I have a full nine days, only five of which are work days, to find my dress and shoes. How hard could it possibly be?

Where are All the Fish?

One of the main things the Florida Keys are famous for is big game fishing. But where you have big fish you also generally have little fish, and I had read before my trip to Key Largo that the John Pennekamp state park features America’s only living coral reef. Naturally, I was excited to snorkel.

Like most airbnbs I have experienced, ours featured pretty much everything we could want, including snorkel gear. In fact, like most airbnbs I have experienced, it was decked out nicer than my own home. Especially the kitchen. How come everyone’s rental property fridges are better than mine?

The snorkel gear, however, featured only one set of goggles. I slung them into our beach bag as we left for the beach, and I asked my daughter what she was going to do while I snorkeled. She laughed dismissively. We both knew who would end up trying out the gear first.

We got to the John Pennekamp State Park in eleven minutes. Everywhere on the Keys is eleven minutes away, and you don’t really need Siri because it’s all just one long road down the narrow strips of land, with tiny side roads. So you drive from your tiny side road onto the long straight road and then you drive eleven minutes north or eleven minutes south and then you are there. I still use Siri.

The park entrance was a tropical delight, mysterious and overgrown. I half expected a T-Rex to come charging out of the trees. There was an entrance fee, but we felt it would be worth it to snorkel on a live coral reef. The beach was pretty tiny and not crowded at all. Why was it not crowded on America’s only live coral reef beach?

We set out our towels down one end, between two peculiar-looking cannons, which turned out to be Art. The sand was really hard, think concrete, and within ten seconds of lying down I had been bitten numerous times by some tiny vicious bugs that looked like swarmy sorts of ants. Big welts started to rise up on my arms and hands. Time to snorkel!

We waded into the balmy water, and Jessie applied the snorkel gear. I told her how stupid she looked and floated on my back while she launched into her hunt for stupendously colored fish. A minute after her launch, I could hear her snorkelly voice coming up through the breathing tube. Mom. There’s no fish. Just stones. 

I turned over and peered into the clear water. Stones. I saw a flash of bright yellow, but it was a leaf. Chuckling quietly to myself I floated some more, while Jessie gave up on the snorkeling and went to put the gear back on the concrete beside our towels and the swarmy ants. I thought perhaps we had a couple of clues as to why the beach was so empty. But the water was fantastic and I was in the tropics and really, what were a few nasty welts when there was also the promise of mojitos in the late afternoon?

After our swim, I lay on my towel and listened to the ebb and flow of other humans on the beach. Americans on the beach tend to spend most of the time arranging their stuff, and very little time actually enjoying beach activities, such as lying motionless on the sand or floating in the water. A large family came and plunked all their stuff down ten feet from the cannon to my right. They spend a half hour unpacking their gear and putting it all on. Eventually some of them had enough gear on to wade out into the water looking for tropical fish. I silently wished them good luck. After a few minutes, I could hear their snorkelly voices calling out how there really weren’t any fish. 

But then I sort of zoned out for a while and when I next looked up, they were all out out by a distant buoy, swimming around it in a tightly packed school of humans. It looked like they were seeing some action. Turns out the buoy marked a fake wreck that had been placed near the start of the reef to give a fake home to all the tropical fish. Even though this smacked a little of a gated condo community, I couldn’t help feeling we just hadn’t persevered enough in our snorkeling endeavors. 

But by then it was perilously close to mojito hour so we packed up and drove the eleven minutes south to our airbnb, from which we could walk to Snappers, a tiki bar and restaurant on the water. Having a tiki bar within walking distance of your accommodations really is a genious move. As our hostess had written in her welcome note: “Snappers: walk there, stagger home.” I had already sampled their Key Lime Coladas, dessert in a glass. Their mojitos were just as spectacular. 

Sadly, my daughter is nine months shy of legal drinking age, so only one of us could order a cocktail. Being Irish, however, we have found a strategy to address this shockingly unfair situation. I order an alcoholic beverage and she demurely orders a juice that is the same color as my cocktail. She quickly drinks most of the juice and I tip half my beverage into her glass. That way, we both get a little buzz going and nobody needs to lose their liquor license. I look like a lush who guzzles cocktails in half the time of normal humans, but it’s a small price to pay. 

After our ten dollar mojito and some food, we decided it would be much cheaper and safer to drop by a liquor store and stock up on our own at-home mojito making kit. The airbnb fridge had tons of ice cubes waiting patiently in its pristine freezer section, but I hadn’t noticed any limes, rum, or mint. 

However, even half a mojito was enough to send us into an early evening stupor, and when we came to it just seemed like too much trouble to have to drive eleven minutes to a liquor store and another eleven minutes to get limes and mint. 

Tomorrow we are venturing south to Key West, the southernmost point in the continental US and birthplace of key lime pie. I think some writer guy used to live there too. The internet boasts of world class snorkeling on America’s only living coral reef. Maybe they’ll even have some fish. If not, we can always console ourselves with half a cocktail.

Hospice Nurse Accidentally Goes on Holiday Alone

I wanted to call this blog post Mom of Teen Finally Succumbs to Worry, but then I remembered my daughter is no longer a teen. Mom of Twenty Year Old just doesn’t have the same ring to it. Still, the point of this story is that as a mom I have always tried not to be a worrier. I’m just not the what if type. But sometimes, events stretch even my natural stores of chill. Saturday was one of those times.

I was sitting in La Guardia waiting for my flight to Miami. I was feeling a little concerned that I hadn’t had a text from my daughter saying she was boarding in San Francisco, or had landed in Miami and was shopping on Collins Avenue while she waited for me to join her. This was our plan. She was getting the red-eye Friday night and I was to meet her Saturday afternoon. What could possibly go wrong? 

Putting out of my mind all thoughts of how her car could have gone off the road or her plane fallen out of the sky, I decided her phone must have run out of juice. I texted her a couple of photos of my airport experience. No response. Then I called her. Straight to voicemail. Finally I caved and texted shopping on Collins Avenue already? check in with me. Nothing.

Now I was finally worried. I got a coffee so I could be worried and jittery. I checked my phone every 0.8 seconds. Finally…a call!

Her: Mom?

Me: Where are you?

Her: In bed. Mom, wait, my flight’s not tonight???

Her flight was not that night. It was the previous night. She had not been on it. Suffice to say that for half a minute, at Gate C44 in La Guardia airport, I lost my cool. You got the day wrong? How could you get the day wrong? Then I shifted into my calm-in-a-shit-storm mode and within fifteen minutes we had her booked on another red-eye flying out that night. She’d be joining me a day later than planned. No big deal I finished my coffee, boarded my flight and settled back to enjoy a day alone on the Florida Keys.

Travel just fills me with delight. It makes me feel like a citizen of the world. The plane banked over glittering Manhattan and I said an affectionate farewell to Central Park, the Empire State and Lady Liberty, icons of my new home. Then we cruised for three hours down the East Coast of the US. It was a route I had never taken. Miami from the air looked every bit the wealthy playground I had imagined. Collins Avenue stretched gleaming along the beach front and the cruise ships lined up at the docks like tiny white toys. 

Miami airport is pristine. The shopping is informed by Cape Canaveral and water sports. There was a long line for the rental cars and I was the only white person in it. As I drove my vehicle out of the parking garage, I was feeling like Intrepid World Traveler, able to navigate any system anywhere. Then I turned the corner towards the exit and my phone went dead. Oh no! Now I have no map, no Siri, I don’t know where I’m going…WHAT THE HELL??? A moment later, the dash screen lit up with google maps and the directions to my airbnb. The phone had just gone momentarily dark while connecting to bluetooth. Yessssss! Am intrepid world traveler again, handily overcoming all obstacles in my path! 

A mile down the highway, I’m taking in the endless palm trees and the sunshine and the new greens and blues when splat! splat! splat! It’s 91 degrees and sunny, but it’s raining. Not only that but the raindrops are the size of dinner plates and I’m turning the wipers up to top speed and back down because one minute it’s raining hard and the next it’s not raining at all. Different. Meanwhile, cars are zooming past me on all sides. Floridians drive really fast, and they weave. A lot. I’m still a fairly polite Californian driver, but a year of trips into New York City from the Hudson Valley have taught me to handle aggressive driving. When you drive into NYC from Hudson, there’s a certain point around Yonkers where the road etiquette switches sharply from sedate upstate to insane city. It’s like a gear shift. Comes in handy when you find yourself heading south from Miami on a Saturday afternoon.

Once outside the suburbs the scenery changes fast: it’s flat and low and there are no trees, only what look like mangrove swamps. There’s a sense of the ocean on both sides though you can’t always see it. And everything slides subtly back into the 1950s: the buildings all pastels and rounded corners, the famed highway with its bridges and shabby turquoise wall dividing the lanes. I can feel Hemingway’s prose rising to describe the place. He no longer dreamed of storms, nor of women, nor of great occurrences, nor of great fish, nor fights, nor contests of strength, nor of his wife. He only dreamed of places now and the lions on the beach.

After I check in to my airbnb, I wander down the gravel road to Snappers, a tiki bar and seafood restaurant on the water. Table for one. A Key Lime Colada and some fresh shrimp. I’m sitting five feet away from the ocean that stretches off east to the Bahamas and south to Cuba. Finding myself accidentally having dinner alone in the balmy air of Key Largo is just about the best way I could have imagined to recharge my depleted Covid hospice nurse self. There are no lions on the beach that I can see, but I’m okay with that.

Everyone has to miss a flight at least once in their lives, it’s a rite of passage to adulthood. And it taught me a valuable lesson: if you find yourself accidentally on holiday alone, always treat yourself to a Key Lime Colada. On second thoughts, make that two. 

Nursing in the Time of Covid

This morning I was working out in our basement, which gives me ample time to contemplate the accumulated rubbish of our year here. There’s the broken microwave, a barstool that doesn’t fit anywhere, and my old sturdy UCSF faceshield. Also a pair of thick plastic goggles that, when I wore them way back at the start of Covid, made me sort of feel like I was snorkeling in Hawaii. Without the warm water or tropical fish of course, and yet with a chance of drowning.

The sturdy faceshield made me think back on the early days of Covid, and I realized that the pandemic is now old enough for me to have a kind of nostalgia for the beginnings of it; a sort of warped yearning for the weirdness of the early days, the sharp awfulness, the quiet. I remembered putting that faceshield on in the windy parking lot of a California nursing home back when I got dressed in my PPE according to the instructions on a flimsy sheet of paper. The parking lot was cold. The wind kept threatening to whip my instructions away. My plastic bag blew down from where I had secured it, ready to hold my dirty PPE when I was done. 

This was back when PPE was being rationed out weekly in ziplocks. Back when Covid was tearing through the nursing homes and the deaths went unrecorded as Covid deaths, but we all knew. Back when I would come out from a visit and take off my gear slowly, carefully, according to the instructions on that flimsy sheet, and tie it all up in a plastic bag and walk it around to the trash bins in back of the nursing home and get in my car and carefully sanitize my hands and then tear out those little saniwipes and wipe down my keys, my phone, my steering wheel, the gearstick. Mostly I was thinking how crazy this all was and how could I possibly get sick with all the precautions I was taking. Sometimes I was crying from fear.

And here we are today: Covid was kind of over for a minute, but not really. Restrictions were lifted, but they’re back. Numbers were down, numbers were vastly underreported, numbers are flying up, numbers are inflated. Covid’s over, Covid’s here to stay. Option e: All of the above.

So how does a hospice nurse respond to the current moment? We follow the protocols that are handed down to us. They change every few weeks. I have three documents, decision trees about what to wear to a visit, depending on whether a patient is vaccinated, whether their family is vaccinated, whether they have been in the hospital, out of state, had visitors from out of state, if so which state. It’s dizzying to just write about. My trunk is full of different kinds of masks.

When someone is suspected of having Covid, or of having been exposed, they become what is called a PUI - a Person Under Investigation. So CIA! I personally think the term was invented by an FBI agent-wannabe. Then there are UVPs: unvaccinated persons. They don’t necessarily have symptoms or exposure, but we have to wear a special kind of mask for them anyway. Nothing says get the goddam vaccine like our special kind of mask.

And yet hospice goes on being hospice. People go on dying in the ways that they always have, and some new ways: because whatever you can say about death, you cannot say that it is predictable.

Last night before I went to bed I checked my work phone. I do this when a patient is close to death. With some of them, I cannot help myself, I check my phone before bed, when I wake in the night, and first thing in the morning. Last night I learned that my patient, a 45 year old mother of two, had died just after 8pm. There was a flurry of texts among her day team and the night staff. The death was excruciating, fast, brutal and chaotic. When I visited yesterday morning, her family did not even want to admit that she was dying, yet I could see that she only had hours to live.

She was from a different country, the family spoke another language, and they had very different rituals around death. It was a crash course for me in their culture, about which I knew little. To communicate with them, I had to use the language line on my phone. I spoke in English to a translator, they spoke to the family, the family answered, the translator told me what they said. Any conversation so parsed  would be tedious. I stood in their kitchen, it was my second time in their house. My side of the conversation went something like this:

Please tell them she is very close to the end of her life.

Please tell them I am so very sorry.

Please tell them that giving her food now will cause her more distress. 

Her body cannot tolerate food any more. Her body cannot tolerate fluids.

Please tell them I know this is terribly hard to hear.

The translator made my words into unintelligible sounds. The family listened, wide-eyed. They cried. They had many questions but really they were all the one question: what can we do now?

Please tell them that the best thing they can do for her is sit by her bed, touch her, tell her that they love her.

They did this. I gave her some pain medicine, and I left them there by her bedside. Outside her house I sat in my car for five minutes to gather myself and then I drove to my next patient. In the old days I might have taken a half hour to recover from this visit. But my caseload is so high, there is no time between patients for anything but trying to stay caught up with the mountainous workload.

The night nurse said that when the patient died, her mother threw herself on her body and cried hysterically. I tried to imagine lying across the body of my daughter.

Hospice goes on being hospice in the time of Covid. Mostly, people keep dying of the things they have always died of: cancer, heart disease, poor choices. Despite the virulence of the Delta variant, being vaccinated made a huge difference to the fear factor of my job. Boosters are on the horizon. And with vaccination rates slowly climbing, I’m wearing fewer and fewer paper gowns.

Nineteen months in though, burnout among healthcare workers is increasing. Nurses are quitting the field. I love my work, and I am clear I don’t want to do anything else. But I’m about to have nine days off, my longest vacation in two years, and I’m going to clear the trunk of my car of all traces of PPE. It can go in the basement with my sturdy plastic faceshield and the spiderwebs. And my work phone. I might put that down there too. Right after I change the outgoing message to I’ll be out of the office until September 27th and I won’t be checking voicemails…