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Ingrid Forsberg ~

It's 10:00 am on a Monday in June. I'm the nurse practitioner on duty in a convenience care clinic housed in a corner drugstore in urban Chicago.

Sunlight is pouring through the huge storefront windows when my first patient of the day walks in. He's in his late twenties, muscular, crew-cut. He looks like someone who's used to being in charge.

Right now, though, he looks anxious. He's pale, with dark circles under his eyes. His eyes scan the store, looking for something.

I know immediately that he's looking for me.

Not every medical professional loves the idea of convenience care clinics (CCCs, as they're known). Some believe that sick patients should be seen by a doctor in a full medical facility, not by a nurse practitioner in a walk-in clinic.

But for some patients, these clinics are the difference between getting some medical care or getting none. In this neighborhood, the nearest doctor's office is booked weeks in advance, and a basic visit to the nearest ER costs more than $1,000.

The man makes his way toward my sign-in desk, trying to look like he's not in a hurry. He examines some items in the pharmacy aisles, then moves on, his hands in his pockets.

Finally, he crosses the last ten feet to my desk.

"Hello," I say. "Are you here to be seen?"

He nods.

"Could I have your name, please?"

"Jim. Jim Cornwell."

I bring him into our exam room and step out for a moment.

When I rejoin him, he's sitting on the exam-room table, looking more comfortable. The doctor's-office feel of the setting often has that effect on people.

"What brings you here today, Jim?"

"I've had the flu...I thought it was the flu. But it's not getting better. I've got--a rash--now. That's new."

I nod, looking him up and down. He's thin, with the look of recent weight loss.

This is Boystown--a predominately gay neighborhood that has given support and a sense of belonging to many people who've come from areas where being gay has been a frightening experience. Boystown is a place where they can express their sexual identities freely.

I see a few cases like Jim's each month. They arrive with common symptoms; runny nose, sore throat, fever, body aches, fatigue and, in some cases, a rash. Often, as I begin the exam with patients like Jim, I feel as if I can sense the thoughts and wishes going through their minds: Why did I come here? It's got to be just a common cold....

I collect a throat swab from Jim for a strep test. When the result is negative, it's time for the good news--and the bad.

"You don't have strep throat," I say. "Unfortunately, we don't have the equipment to run other tests to find out what's causing your symptoms. But can you tell me...are you sexually active?"

He nods slowly.

"Based on your history and symptoms, it's unlikely that you have just a common cold," I say. "There are some sexually transmitted diseases that begin with symptoms such as yours. HIV is one of them. If you're currently sexually active, especially with new partners, getting tested for HIV should be your next step."

Silence.

"It can cause these kinds of symptoms--and much worse, if untreated. There are treatments that, properly managed, can keep you healthy."

He listens. Nods a little every now and then.

"Getting treatment can also make it safer for you to have partners," I continue. "The risk of passing on HIV, if you have it, is much less while you're being treated."

He stares into the space ahead of him.

"I have a list of free clinics nearby that do the testing," I say. "Would you like to have it?'

He nods. "Please."

I get the pamphlet and explain the options as gently as I can, treating him as I would treat my own son. That's a role that nurse practitioners often fall into--being a surrogate parent for young people who might be far from home, and afraid.

I try to take the fear out of it, to communicate acceptance and warmth. Many people avoid being tested for sexually transmitted diseases for fear of what they might learn, or how they might be judged. They find it less frightening to wait and see. As a nurse, I tell them that's rarely a good idea.

One of the hardest parts of working here is that I can't know what happens to these patients after they leave.

Watching Jim walk out, I know that I'll probably never see him again. I have to relinquish him to the great unknown--the place for all of those people I see long enough to care about, then never see again.

Fast forward two years.

No longer working at the CCC, I'm pursuing my doctorate in nursing practice. An e-mail arrives:

From:Ann

Subject:Your former patient

My heart begins to race. Ann was my colleague at the CCC.

Jim Cornwell asked for you today. He came in with a cold--but he kept asking where Ingrid was!

He's in treatment for HIV now--he says that was your idea. He says if he hadn't seen you, he doesn't know how bad things might have gotten.

He says you saved his life.

I thought you'd want to know.

As I read this, my heart soars and breaks for Jim, both at once. He's received a serious diagnosis--but, thanks to the latest antiretroviral drugs, he can expect to live a long and healthy life.

We never know when our actions might change a life. Mundane symptoms can mask life-threatening illness; the smallest words can change the course of treatment. This is a gift--but it can also be a burden when you don't know what the outcome will be, or if you'll ever see the patient again.

With Jim, and others like him, knowing that my care made a difference is life-changing. I may have changed Jim's life by telling him what he needed to hear, but he also changed mine by coming back and sharing his story with my colleague.

I still think of Jim whenever I'm not sure whether my work is making a difference, or whether I'm doing enough.

Remembering him, I feel reassured that, often, doing enough means simply being there for someone who's in trouble.


About the author:

Ingrid Forsberg, an assistant professor in the family nurse practitioner program at Rush University College of Nursing, has been a nurse practitioner since 1978. "It wasn't until the explosion of convenient care clinics in supermarkets and drugstores that the public knew much about our profession. I've felt interested in writing about my experiences for some time, but now, with nurse practitioners enjoying greater recognition, I decided that this story had to be told. I've also been reading Kitchen Table Wisdom by Rachel Naomi Remen, which has led me to recognize the power of storytelling in health care."

Story editor:

Diane Guernsey

Comments   

# Eston C Clare 2018-02-13 00:52
Thank you, Ingrid. Poignant stories like yours reaffirm my journey towards becoming a healthcare professional at this stage of my life (Mid 40s). Thank you for the book reference as well, I can't wait to read it. May God bless you.
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# Ronna L. Edelstein 2018-02-11 15:53
Ingrid, you make a positive difference every day in your profession--whe ther or not your receive empirical evidence of that, such as the email about your patient. Nurse practitioners like you are essential to the health care system; I believe mine knows more about me than my primary care physician does! Continue to do what you do, because you are a gift to all those who interact with you.
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# Jef Gamblee 2018-02-10 10:41
Good story, well crafted, well told. Thanks
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# Pris Campbell 2018-02-10 03:41
Kitchen Table Wisdom is one of those books I wish everyone could tead and this narrative falls right in with the spirit of that book. You showed both compasion and good clinical skills with a man who could easily have fallen through the cracks. Do keep writing.
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# Erika 2018-02-09 22:12
My mother, who lives at home and just turned 100, has been cared for by Barbara, a wonderful nurse practitioner, for several years. Though my mother is fairly far gone in senile dementia, Barbara treats her with respect and great kindness, not to mention excellent medical care. Moreover, Barbara is sympathetic and compassionate with me, understanding both the practical and the emotional issues I deal with. I can't imagine why anyone would not want a nurse practitioner for their primary medical care--not if Barbara is any example of the profession.
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# David Coulter 2018-02-09 21:44
When I was a medical student, I worked nights as a medical technician at a local community hospital. When I got a call to the ER, I had to go there, draw the blood, go back to the lab, run the test and then report it to the ER. One night I was asked to see a man who had a history of chronic alcoholism. I drew his blood but also talked to him about why his alcoholism was so bad for his health and encouraged him to get sober. His labs were fine and that was the end of it, or so I thought. Several months later I encountered his sister, who said, "You are the medical student who convinced my brother to stop drinking! He has been so good ever since! Thank you!"

Never underestimate the positive impact we can have, even when we are young.

David C.
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# marianna crane 2018-02-09 21:29
Ingrid,
I truly loved your story. As a retired nurse practitioner, I am writing my stories--mostly from my practice in Chicago. I know we NPs make a difference but the public rarely hears from us. You are educating and showing how we practice. You also show that your are a caring and knowledgable practitioner who makes a difference. Keep on writing and publishing your work.
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# Dr. Louis Verardo 2018-02-09 20:12
What a great story. You did what you trained for, and you made a difference in your patient's life by doing your job well. It doesn't get much better than that.

You are a good clinician.
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# Laurin Bellg 2018-02-09 19:26
This is stunning prose, Ingrid - so simple and honest - and a truly heart-felt story. It made me cry; I loved it. I felt like I was present in the CCC room with you and this patient, and the recipient of your deep compassion - as was Jim. I too love Kitchen Table Wisdom by Rachel Naomi. I am also a Rush
Alum (Critical Care, 2002) and a fellow author on medical matters, so I encourage you to continue to write, write, write and compile this as a published collection. It's that good. What you write has that feel of Chicago-land that I remember and offers such rich content. You seem to be the one to tell it now and pass it on. Please, keep writing. (I'll be in Chicago speaking about my book in March if you would like to connect)
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# ingrid forsberg 2018-02-25 15:05
Would love to connect with you in March. send me a note with details. Thanks for your kind remarks. Ingrid
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