Every Thursday morning, Barbara Nelson stocks her pocket with a stick of gum.
After Nelson, a staff member of the Visiting Nurses Assn., checks five-year-old Brian Andrews' heart and lungs and weighs him, Brian goes for Nelson's right pocket and gets his reward.
During this particular check-up, Nelson will find that Brian has lost two pounds since her last visit to the small, cluttered trailer in a local mobile home park.
Nelson asks Brian what he had to eat for dinner the night before. He doesn't answer. His mom tells Nelson that Brian had a hamburger, potato chips and, after attending the Douglas County Free Fair, half of a peanut butter sandwich.
Brian just smiles and chews his gum.
NELSON, a registered nurse who's been working for the VNA for eight years, visits Brian weekly to assess his growth and development. She has been seeing the skinny, brown-eyed boy since he was just a little less than a year old.
After leaving the home, Nelson explains that Brian is physically and developmentally delayed. He was in the Head Start preschool program this summer, and Nelson doesn't know yet whether Brian will start school in the fall.
On this Thursday, Nelson will visit five clients and travel about 50 miles throughout the county. As a VNA nurse, she provides in-home health care, from changing dressings and catheters to taking pulses and blood pressures. The VNA's goal is to help people maintain independence.
Nelson's youngest client is Brian. Her oldest client is 94.
FROM BRIAN'S home, Nelson gets back on the road, about 8:20 a.m., to travel to an old farm home about 12 miles south of Eudora. There, she will see 87-year-old Walter Pooch, whose right leg was amputated because of an infection.
A farmer for many years, Pooch is bitter about his amputation.
Pointing to Nelson, Pooch says, "If she'd been taking care of me, I wouldn't have this dumb artificial thing."
Pooch, who lives in the home his parents bought in 1901, was fitted for his artificial limb three years ago. It's still a little too long, which makes it impossible for him to move around without his walker. Pooch tells Nelson that he is seeing a doctor to get the prosthesis cut down a bit more.
Nelson checks Pooch's other leg. It's swollen, but for the second time in a row it doesn't show any open wounds.
A DIABETIC with heart problems, Pooch has poor circulation in his left leg. To combat this, Pooch wears a pneumatic boot on his leg. The blue boot fills with air to improve his circulation.
Still ornery, Pooch jokes that he's going to give Nelson a bad check for the money he owes her. Nelson picked up some medicine for Pooch and forgot to get a check from him before doing so. Knowing Pooch and his wife of 64 years, Vera, Nelson realizes she won't be getting a rubber check.
Nelson fills Pooch's "Med Minder," a red plastic box that sorts out his pills by day and time. She writes down what prescriptions need to be refilled. That's because after all of her visits, she'll call in her client's prescription needs.
AFTER SHAKING Pooch's hand, Nelson gets back into her silver Cutlass Supreme to head to the home of Lester and Helen Schwalm. It's about 9:25 a.m.
She has called on Lester Schwalm off and on for eight years, consistently since 1985. He's bedridden with Parkinson's disease and is cared for primarily by his wife, who is going in for surgery this week for cataracts.
Nelson has stopped by the Schwalm's meticulously cleaned home mainly to see what type of arrangements Mrs. Schwalm has made for the care of her husband while she's recovering from surgery. Nelson is worried that Mrs. Schwalm will continue to lift and stoop, but Mrs. Schwalm promises Nelson that she'll leave her 83-year-old husband's care to other family members and friends while she's convalescing.
Knowing how hard-working Mrs. Schwalm is, Nelson isn't entirely convinced, but she empathizes with her.
BACK IN THE car, Nelson admits that her work can be emotionally stressful.
About 10 a.m., Nelson is ready to head for the Whitmore home.
Dale and Lucille Whitmore stay in two hospital beds that have been set up in the front room of their home. Dale, 73, has lung cancer and was brought home from the Veterans Administration hospital in Topeka so he could spend his final days with his family.
Kathy, their daughter, takes time out to explain how the VNA has helped the family cope with what she termed a crisis. In addition to Nelson, home health aides visit the Whitmore home to help with personal care and cleaning. A physical therapist also helps Lucille, a 67-year-old diabetic who has heart problems and is losing her sight.
Until three weeks ago, Dale cared for his wife. Kathy Whitmore is frank about her father's condition. She knows he'll probably die soon.
"HE CAME home to die, plain and simple," she says. "We brought him home on a Wednesday and her home on a Thursday. . . . Daddy has taken care of Mom for three years. We didn't know exactly what we were going to do. If these people weren't here, we'd go totally nuts."
Worried about her parents' medical bills, Kathy asks Nelson to explain a VNA bill to her. About 11 a.m., Nelson calls the VNA office at 336 Mo. and finds out that the home health care visits are covered by Medicare.
It's a load off Kathy's mind. VNA clients may pay for their visits with their private insurance, Medicare or Medicaid. There is also a sliding scale based on the client's income that allows clients to pay reduced fees.
After easing Kathy's financial worries, Nelson then fills her second "Med Minder" of the day and 14 of Lucille's syringes with insulin.
AT 11:30 a.m., she's off to visit Ruth Stroud, who's 79 this year. Stroud was released from the hospital, where she was being seen for heart problems, about four weeks ago.
Nelson is happy to see that Stroud is doing well. Stroud tells Nelson that she has a doctor's appointment the next day and asks whether she should go in her friend's car, which isn't air-conditioned, if it's hot. Nelson reassures Stroud that if she has to cancel her appointment, she can schedule another one for a cooler day.
"I don't want to fold up like a flower," Stroud says, smiling.
Nelson then checks a sore spot on Stroud's side but finds nothing serious.
There's a knock on the door, and Stroud produces a dollar bill. It's time for Stroud's lunch, which is delivered to her home.
Nelson jokes about eating Stroud's meal and then bids her goodbye. It's off to a fast-food restaurant, where Nelson can get a hamburger.
AFTER LUNCH, Nelson visits three VNA clients who've been hospitalized. One man asks Nelson if it's a professional call. No, Nelson answers, it's a friendly visit.
At 1:15 p.m., she heads to the VNA office to do her paperwork for the day. She calls in prescriptions and makes notes about her client's progress.
Six hours later, Nelson is ready to go home. She explains that she's on call that night, which means she'll staff any necessary evening visits.
Despite the emotional and physical stress of her job, Nelson says nothing could compare to her work with the VNA.
Before joining the not-for-profit agency, she was involved in a variety of jobs, from working as a school nurse in Topeka to serving as a public health nurse in Columbia, Mo.
SHE ENJOYS working in home health care because of the diversity of the job and the sense of cohesiveness at the VNA.
"I've already told my husband that if he wants to move, I'm not going to work," she says. "This is my last job. Nothing could compare."