Marlene Kvichak keeps a bag of peppermints stashed in the car, just in case she needs a pick-me-up on one of her Jack Kerouac days.
She doesn't hitchhike, but Kvichak spends a lot of time on the road. And she never knows when she might wind up in a traffic jam, staring hungrily at the golden arches.
Shuttling from one homebound patient to another, the 39-year-old visiting nurse with the county health department has logged plenty of miles on her state-owned car and learned to navigate the back roads of North County.
She drives to three or four homes a day to check on patients, give shots and bandage wounds, change catheters, administer oxygen and provide medication. From infants with heart problems to elderly stroke victims, Kvichak visits those who are too sick or frail to leave their homes for help.
"I'm the trip to the doctor's office," said Kvichak, one of about 17 nurses, physical therapists, nutritionists and occupational therapists who make up the county's home health team. "I do a little bit of everything."
Although they arrive to provide medical care, home health workers spend an equal amount of time on something that's not spelled out in their job description.
They are sympathetic listeners. Every day, Kvichak hears complaints about everything from in-laws to stomach aches. She knows about one patient's nightmares and another's poor eating habits. She tries to remember birthdays, anniversaries and family names.
Sitting in the living room of Iris Carpenter's home in Severna Park last week, Kvichak listened to stories about World War II while preparing a vitamin B-12 shot.
Carpenter, who served as a foreign correspondent during the war, reminisced about following the U.S. Army and dispatching stories to the Washington Post, Boston Globe and other papers. But the 80-year-old grandmother, who has Parkinson's disease, also wanted to talk about her failing health and her accident three months ago.
"I smelled something burning on the stove, so I got up real fast and tripped over Rusty," she said, referring to her cocker spaniel. "I shattered my knee. I was absolutely immobile for weeks."
She receives physical therapy along with her monthly vitamin shots.
Since Carpenter has recovered much of her flexibility again and learned strengthening exercises, however, the therapist's work is almost done.
"We don't go in and stay," said Theresa Hommel, supervisor of the home health-care program. "Our goal is to teach patients to take care of themselves and help them through the first months after they're out of the hospital."
About 65 percent of the 60 patients visited by home health workers each month are elderly, Hommel said. The remaining patients include infants who need oxygen or tube feedings, young diabetics and victims of car accidents who are released early from the hospital.
Despite recent state cutbacks, the program has remained unscathed.
However, a sister state program that provides extended personal care and hygiene aid for the disabled was cut by $3 million, said Michael Golden, a spokesman for the Department of Health and Mental Hygiene. At least 3,000 people in Maryland will lose that assistance, he said.
Home nursing has been a staple service since public health departments were founded in the early 1900s, Hommel said.
Although the program was not formally established until 1966, when Medicare and Medicaid began reimbursing the service, the program marked more than 30 years in the county during National Home Health Care Week two weeks ago.