1. Dellasega, Cheryl PhD, CRNP

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In 1976, shortly after our wedding, my husband and I relocated so that he could return to school. The ambivalence I felt about leaving my critical care unit job in the city turned to dismay when the tiny hospital in our new hometown informed me that they had no openings on their two-bed ICU, or any other floor.

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In desperation, I interviewed at the Visiting Nurse Association (VNA) because I had agreed to be the breadwinner. The staff job they offered me felt like a demotion: I was an accomplished big-city critical care nurse with a superior knowledge of nursing, stuck with VNA nurses who didn't even wear white uniforms!! Nonetheless, I grudgingly pulled out my high school sewing machine and made some uniforms out of the requisite blue pinstripe fabric.


My orientation was brief-for two days I made visits with others, then I was on my own. My new colleagues could charm their way past menacing dogs and cranky spouses; I was intimidated by the thought of drawing blood miles away from the nearest hospital, or figuring out if someone was in congestive heart failure without a monitor. I missed the electrocardiograph machines and ventilators that had been my professional security blanket.


One of my first solo assignments was to visit a woman named Grace. Grace was in her early 20s (like me) and had been diagnosed with schizophrenia; she needed Prolixin injections and nutritional counseling. Her chart was brief, noting only that she was noncompliant with oral medication and had a history of violent behavior.


She was considered to be an easy patient, although also a frustrating one, because nothing ever changed in her life, no matter what the VNA nurses attempted. My team leader considered Grace perfect for a "newbie" like me.


I thought otherwise. I had no experience in mental health, and, driving down the long, dusty lane toward her isolated home, I wondered if anyone would find my body buried in a haystack should something go wrong.


Grace turned out to be so rotund that she had trouble moving around the confines of her small world: a farmhouse where weeds exploded in the front yard and chickens scratched in the dirt out back. During our first conversation I gripped her slim chart and asked every question I could imagine: "What do you like to do?" "How often do you go into town?" "What is your diet like?" "Do you have brothers and sisters?" Occasionally, Grace nodded a "yes" or shook her head "no," but mostly she just smiled. There were long stretches of silence.


After months of such visits, Grace began to talk-mostly about food. Sitting on the horsehair sofa in the parlor of the farmhouse, she would describe in detail the dinner she'd eaten the night before. Eating was perhaps her only pleasure, so encouraging a change in Grace's diet proved futile. In an effort to fill her time, I suggested a day program or a job. She smiled at the idea, exposing uneven, decayed teeth, but said nothing. I left a note for her parents offering to pursue the suggestion, but got no response. I never saw or spoke with them; they were always working on the farm. I seemed destined to offer her nothing more than a sympathetic ear.


The predictability of our visits became comforting to me. No matter how hectic my day, Grace's placid demeanor, her tiny voice, and the tick of her family's grandfather clock didn't change. I sensed she was happy to see me, too. When I arrived she was always waiting at the door. I began to understand that my willingness to be with Grace on her own terms was as healing to her as the IV medications I'd pumped into patients on critical care units. The insight that nursing was as much about relationships as about technical skills changed my professional focus completely. I decided that I wanted to get my degree and become a primary care nurse practitioner.


My last visit with Grace took place on a sticky day in August. Grace wore her usual faded housedress, Hush Puppy shoes, and gray ankle socks. When our hour together ended, she took my elbow and led me out into the humid afternoon.


A big truck overflowing with ripe watermelons was parked under a shady tree in the barnyard. The melons, from the farm, were headed to market. Grace chose one as firm and round as a basketball, brushed it free of dirt, and handed it to me.


We stood for a moment. Soon I would start classes for my bachelor of science in nursing and be reunited with old friends. Most likely Grace would remain in the remote farmhouse, spending her time eating or waiting for someone to visit. Our time together ended, as it began, with a long stretch of silence.


I climbed into my car, cradling the melon as I would a newborn infant. Clouds of dust followed my drive to the end of the lane. With one hand resting on the smooth, cool surface of her gift, I glanced in the rear view mirror, and saw Grace, standing by the truck, her hand raised in farewell.