1. Darby, Mark MSN, BSN, RN, ARNP, FNP-C


An NP is reminded by clinic patients and their community that caring is a two-way street.


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Fresh from graduation as a family NP, I obtained a job at Johnson Tower, a public housing tower built in the '60s. Over 200 small brick apartments were stacked on one another like blocks of Legos.

Figure. Illustration... - Click to enlarge in new windowFigure. Illustration by Janet Hamlin.

I was warned that Johnson Tower was where "all the crazy people" went. Or that if I wanted a drug, any drug, I just had to go to a particular floor and say the dealer's name. Indeed, last year a man was murdered over a drug deal gone bad not 15 feet from the front door of our clinic.


It is a clinic with one exam room below the building laundry. If more than four people use the washing machine, water will drip onto our centrifuge.


People have asked me, "How can you work in a place like this?" One thing I learned in NP school is that I am a nurse first and an advanced practitioner second. Nurses are supposed to look at the whole person-mind, body, and spirit-as well as the environment. I have found that the residents of Johnson Tower teach me more about being a nurse and a human being than you would imagine.


There is Mr. Isaiah, an elderly man on disability who sits at the front door greeting people and acting as unofficial security guard. He knows all the residents and their families, and calls police when there is a disturbance. He protects everyone, even those he does not like. As he says, "You are supposed to care about your home, no matter where it is."


There is Janine, a young woman who despite intermittent claudication will walk all day picking up recyclables, not for money so much as to care for the earth.


There is Doug, 385 lbs. and on too many opioids for low back pain, who told me he would like to lose weight if he could only find someone to listen to him and "not treat him like he was just fat." So we worked together, focusing on exercise, stretching, and weight loss. He is down 100 lbs. and counting. And no pain meds.


There is Bobby, a 30-year-old schizophrenic with type 1 diabetes. He works nights in a bakery, walking two miles from the closest bus stop to his job. He makes just enough to pay his bills, afford his medication, and a little extra. He is meticulous about managing his diabetes. He knows his psychiatric medication forward and backward. He tells me what it was like when his mental illness was not controlled. I had seen such patients when I worked inpatient psych and had always thought people like Bobby would be incapable of leading a productive, happy life. Boy, was I ever wrong. Every so often, he brings doughnuts for the clinic's front desk staff, medical assistant, or me.


Every Thursday noon, a church comes to the tower. They hold a prayer service and serve a meal in the dayroom. Many residents come for the meal alone, but some come for the prayers and the companionship. Many pray for me and the clinic. They have adopted us-so much so they make sure that the clinic staff are given a meal. I always think I'm supposed to care for them, but they care for me as well.


The drug-related murder occurred just outside the clinic door, in the early morning several hours before the clinic was to open. The police were only letting residents into the building, but they let me cross the tape they had used to rope off the area to check on the clinic. As I walked in the front door, there was Mr. Isaiah sitting in his chair. He said, "It's still my home, and it needs protection." The building manager told me that they would need to use a high-pressure hose to clean the area because there "was a lot of blood." We thought about closing the clinic that day. But I decided that no, we needed to be there.


The week after the murder, Janine came down to the clinic carrying a cross made of flowers. She asked me to follow her out to the murder site. She gently placed the cross against the fence and tied it there. She stood back and lowered her head to pray. As we went back into the building, she said, "No one should have to die alone, no matter what the cause."


All these people, despite their circumstances, teach me more about generosity, perseverance, and hope than I could learn anywhere else. People say, "How can you work in a place like Johnson Tower?"


I am a nurse. Where else would I be?