Meeting the need

On their way to becoming nurses, Ann Pope and Elisha Nitschke washed the feet of homeless men and women. They climbed stairs and knocked on apartment doors. They listened, really listened, to stories of hardship, mental illness and addiction.

During 11 weeks with haunted and eccentric people who live downtown, the student nurses shed their illusions and sounded the depths of their capacity to care.

“This week I have learned to meet my clients where they are, not where I want them to be,” Nitschke, 24, wrote in a journal that is part of the coursework.

Pope and Nitschke, like hundreds of other fourth-year students who’ve taken the class before them, learned the frustration of trying to help people who passively shrug off change, Professor Carol Allen said.

“Not until the students get discouraged do they start to really get it,” Allen said. “We work with small wins, and we celebrate small wins.”

The street nursing experience is an optional part of the curriculum at Spokane’s Washington State University Intercollegiate College of Nursing. Some students try it and learn they’re not cut out to work with people on the fringe.

Most go through a progression of emotions.

“At first, they feel a little scared, a little ‘I don’t know what to do,’ ” Allen said. “Then they feel excited that they can make a difference. Then, about halfway through the class, when they’ve seen the same person 35 times and he’s asked the same question 14 times and nothing is changing, some students get depressed, some get angry and some say, ‘Why the hell are we down here?’

“Then they start to get it.”

They achieve a small win – someone keeps a promise to visit a health clinic – and they celebrate. A small thing becomes huge.

‘One bad decision’

The street nursing experience started in the early 1970s when the school’s instructors started taking students into Spokane’s downtown hotels for a portion of a psychiatric nursing class. Today, two courses – psychiatric nursing and community nursing – include the downtown setting as one of several choices of required “clinicals,” that is, coursework that brings the students into the real world to work with real patients.

Students have other choices, if they don’t want to work downtown. Their choices include apartments for the elderly, the Salvation Army’s SAFE house and the Peaceful Valley Community Center. Seventy to 80 students each semester work in various community settings.

And each semester, a dozen students choose the downtown challenge, visiting their assigned agencies and single-room occupancy hotels in teams of two.

Pope and Nitschke visited Shalom Ministries, which offers hot meals at Central United Methodist Church, 518 W. Third Ave., and the Collins Apartments, 204 S. Wall St. For 11 weeks, they spent Tuesdays and Wednesdays from 8 a.m. to 3 p.m. chatting and listening.

Pope, 25, from Moses Lake, is the single parent of a 4-year-old son. Nitschke, an East Valley High School graduate, is married and has a 2-year-old son. Both said the downtown experience has taught them important lessons.

Pope won’t forget seeing a childhood acquaintance, now a young woman, trading dirty syringes for clean ones at a downtown public health program that aims to slow the spread of HIV and hepatitis C among intravenous drug addicts. The acquaintance was “a little girl I had played with from church when I was 6 years old,” Pope said.

“It would be so easy to be homeless, and that just really drilled it home,” she said. “One bad decision could put you there if you don’t have a good support system.”

Downtown visits

Sex and drugs are currency for some downtown residents. One afternoon, on their last day visiting clients downtown, Pope and Nitschke saw two teenage girls go into the room of an older man they knew in the Collins Apartments. The student nurses knocked on his door. The man cracked the door and asked them to come back later.

“These girls are folding my clothes,” the man said gruffly.

They said goodbye and moved down the hall.

Another apartment door opened and Bruce Hagerty, a jazz drummer with an advanced degree in criminal justice, welcomed them. The students wedged themselves into the few inches between Hagerty’s bed and his sink. There was barely enough room for the three of them in the 12-foot-by-14-foot room.

When the students first met Hagerty, he was distraught over a recent divorce and sneaking vodka into the building. But the longer they knew him, the more he stayed sober and the more he revealed his dry sense of humor. He still wore his wedding ring and kept his framed marriage license on the wall, but he was getting care at the VA Medical Center and figuring out how to get back into music.

The nurses told Hagerty they saw two girls entering his neighbor’s room.

“Those girls were misdirected. They’re supposed to be here with me,” Hagerty joked. “No, I don’t want any women now. I’ve had my fill. I don’t think I’ll ever get over Ginny.”

Nitschke told him: “I hope you do.”

Saying goodbye

Upstairs, the students dropped in on Kim Kambich-Arnold, a disabled veteran and former bartender. She was getting ready to go out and laughing about how much makeup – she called it “paint” – she would need to apply. A bowl of lollipops sat on a table by her door, and a friend’s cartoon drawings hung on the refrigerator. She attempted suicide a few months ago by taking a bottle of aspirin.

They told her they were worried about the girls in her downstairs neighbor’s apartment.

“He trolls for homeless women,” Kambich-Arnold said. “I would talk to him, but I don’t need the stress in my life.”

The students visited Sherry, whose life revolves around her schizophrenic brother, Timmy, a disheveled bear of a man who is also her next-door neighbor at the Collins.

Sherry, who didn’t want her last name used in this article, is convinced her diabetes is a punishment from God. She doesn’t like to check her blood-sugar levels by pricking her finger. She once worked at Goodwill but lost the job. She’s not ready to find another job, she said, because she has to work on her emotional problems and her low self-esteem.

They didn’t ask Sherry about the neighbor with the girls in his apartment.

“This is our last day,” Pope said.

“So what happens to you now?” Sherry asked. Several others had asked what was next for the students, to their surprise.

“Everyone wants to know what happens to us!” Nitschke said happily.

She explained that next she would help deliver babies at a Spokane hospital and that Pope would help at an eye clinic. In January, they would take licensing exams and become nurses.

Pope will go to Bellingham to join her fiancé. She would like to be a public health nurse and work with the homeless and mentally ill, but she realizes cuts to public health budgets have made those jobs difficult to find. She will have better luck finding a job at an outpatient surgery clinic.

Nitschke plans to move to Seattle with her family and look for a job as a labor and delivery nurse. The Spokane downtown experience will help her work with the homeless, pregnant women she knows she’ll encounter.

“We have to write a letter to the next students,” Nitschke said. “We’ll tell them to come bug you.”

‘So much caring’

The students reported to the building manager their concerns about the resident who was entertaining young women in his room. They would never know the end of that story, but they had learned to let go and move on.

Allen, the nursing professor, said the students sometimes make one more leap in learning as they finish the class. They start thinking about how they can make change on a broader scale. They start thinking about political action, like holding community forums and writing legislators.

“They learn that the buildings downtown contain people with stories and needs,” she said. “And they learn there are things they can do for those people.”

Later, Pope said she often thinks about the people she met downtown. “I think about them, especially when it’s cold. I wonder where so-and-so is. I wonder if they’re warm.”

Weeks after Nitschke and Pope’s last day at the Collins Apartments, their clients remembered them.

“They weren’t the typical teeny-boppers,” Hagerty said. “When they opened their mouths, there wasn’t the sound of a vacuum, like when you open a coffee can.”

Kambich-Arnold said, “They’re humble. They’re bright. They have so much caring. I was doing the mom thing and telling them to be nice to themselves, too. When I was bartending, I learned you can’t bring this stuff home with you.”

Sherry said she couldn’t imagine what the students might have learned from her. She seemed genuinely perplexed by the suggestion.

“Those nurses did good by coming around and checking on me,” she said. “I kind of didn’t like it, but it was for my own good.”