It was a cold, gray, late autumn afternoon back in the days when I routinely rose at 4:15 AM in order to be ready to make home visits in "the projects" while the local rabble rousers still were sleeping off the effects of the previous night. Starting that early meant I often was home by early afternoon and never making calls after dark unless I was "on call" and covering an emergency. That day had been rainy, with that penetrating dampness and cold that sets one's bones to shivering, and I was more than glad to go home to a warm house and slip into my favorite jeans and a soft, cozy sweatshirt. But then the phone rang.
"Corazón" needed a visit, that day. I had picked up a second, part-time job not long before, and Corazón, an elderly Mexican woman, was one of my early patients with that new company. I don't remember now what problem had arisen, but it was unlikely that anyone else in that very small and minimally staffed agency was available to see her. Darkness was gathering, meaning that I'd been going non-stop for twelve hours or more, and the prospect of taking the car out of the garage, driving the three or four miles to her home through late afternoon traffic, and then doing whatever it was that Corazón needed only left me feeling all the more tired. But I would go, I said to the caller, even though I cannot bring myself to change into proper work clothes once again, I told myself. Throwing on a coat, grabbing the necessary supplies, and beckoning my German Shepherd into the back seat, I set out.
Corazón lived with her son, "Joe," a big, imposing man with an air about him that suggested he was chronically dubious about everything. Behind eyes that seemed to think and feel much more than he ever said, he always had been receptive and courteous, but reserved, and as I drove I was a bit concerned about appearing too casual and therefore disrespectful in duds more suited for a night on the couch or a trip to the dog park than to a home visit to provide professional healthcare. But on that day at that time that family was lucky not to receive a nurse in a robe and pajamas, as my director said a few days later when I recounted this story to her. I climbed the front stairs and rang the bell.
Joe responded, and I launched into my explanation that I'd just learned Corazón needed me and had opted to respond quickly instead of taking the time to put myself together in a more professional-looking package.
I don't know that the first sentence was out of my mouth before Joe's face softened, all of the tentativeness and skepticism I might have sensed in our earlier encounters evaporated like a drop of water on a hot grill, and with a huge smile he ushered me into the home. Likewise, Corazón's smile when she saw me lit up her cramped little bedroom more than all the lamps in the home ever could have done. It was unsettling, the sensation one has when tempted to turn around to see if people are looking at and talking to someone else.
Understand that my normal dress for home visits is practical and not fancy or pretentious. If I need to climb on a bed or sit on the floor I do it, and any of a number of possible accidents could result in the need for a sudden change of clothes, so nothing requiring a trip to the dry cleaner or other high maintenance fussing is in my work wardrobe. Washable dresses, skirts, and slacks fill the bill and, one would think, hardly are off-putting.
But something about seeing me on the front porch in the cold dusk with jeans poking out below my coat and sweatshirt sleeves edging over its cuffs put Joe at ease more than ever before, and moments later, Corazón, too.
Throughout our remaining days together Joe's polite cautiousness and undertone of skeptical reserve never reappeared. Not once. It was so much easier to work in that home with the barriers dropped and only authentic connection remaining. And then came the moment when everything stood still.
After reviewing her latest test results Corazón's doctor told me her vital organs were failing irreversibly and there was nothing to be done that would save her. It was time for the family to make a decision about hospice care. All these many years later I don't remember for sure, but I hope the doctor had had a similar conversation with Joe. Corazón was bedbound at home, however, so the doctor would not have been able to talk directly with her.
I remember arriving at the home and talking with Joe about his mother's prognosis and the need to consider hospice care, and noting gently that someone needed to tell her and learn her wishes. Without missing a beat Joe responded, "You tell her." I asked him to consider whether this message might best come from a family member, priest, or even the doctor by phone, but Joe was firm: "You tell her." In Spanish, my second language, in which I yet was less than fluent at that time. "Really?" I asked. "Yes," he said firmly.
In over forty years as a nurse I don't believe there's been another time when I was the first and only person to tell someone that his or her body was failing, medicine could not change this, and she or he was going to die. There's the usual "We will keep you comfortable and help you to have as much good time as you possibly can" addendum, and then the "You will have medical and nursing care and the help you need as long as you live; now we need to decide how that is best to be provided" preliminary to the hospice discussion. But the whammy is the "There's nothing more we can do; I'm sorry" message. In Spanish.
As so often is the case, despite not having been told Corazón already knew, and she comforted me. I didn't see her for much longer after that, as she did enroll in hospice care. But before we parted ways, she made me a bracelet, in the colors of the Mexican flag, which to this day is one of my prized possessions.
I have thought off and on over the years since then that what turned the tide from perfectly adequate and polite encounters to something more profound was my happening to turn up in a sweatshirt and jeans on that one cold, dark late afternoon. Since then, although I have my respectable suits, white coats, and "business casual" garb and do wear them, I've turned up on many a doorstep in jeans . . . and even a bicycle helmet. And I've wondered if sometimes our "professionalism," or at least its symbols are ironic barriers to the authentic connections with those we serve and seek to influence intimately. I'm not advocating widespread dressing down; surely there is reassurance to be had when our doctors look like doctors and other professionals do the same, and how we dress affects how we conduct ourselves in the workplace. But that latter? That's the rub. We need to be mindful, I think, of any tendency to act out the role associated with the clothes we wear, because any acting is a way of being that is less than authentic. And it is compromised authenticity that others sense and from which they pull back.
These days I wear a white coat a good bit of the time, but make a point when I don it to be sure I'm not hiding behind it, and that in my speech, my demeanor, my smile, my being I am as fully present and real as I can be. Because no matter what our business and professional costumes may be - white coat, suit, clerical collar judicial robe, whatever - what most matters and assures the best outcomes is the sort of connection that comes with such things as
Blue Jeans.
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