I picked up Mitch Albom’s The Little Liar wondering if I needed to read another story about the Holocaust. I almost didn’t check it out. We live in a world at war. We live in a world where starvation, strife, and civilian casualties are collateral damage of those wars. Yet war continues to be waged. I am glad I checked the book out. I read it in less than twenty-four hours. A unique voice serves as narrator in The Little Liar. It is Truth. Albom masterfully uses that narrator to explore the meaning of truth and to illustrate the horror of man’s inhumanity to man. Four characters, Nico, his brother Sebastian, Fannie, and Udo pull the reader into the story and demand the reader’s attention from start to finish. In a way, their stories have been told before, but as written, they seem startlingly fresh and compelling. In the context of what’s happening in the world, their stories are more than relevant. Rather than mar the story by retelling it, I want to share what I call the wisdom of Albom. “Never be ashamed of a scar. In the end, scars tell the stories of our lives, everything that hurt us, and everything that healed us.” “But questioning a madman is like interrogating a spider. They both go on spinning their webs until someone squashes them out of existence.” “How could fishing boats keep rolling so innocently? How could the world eat when all those prisoners were starving? How could things look so terrifyingly normal here…?” Why do world leaders create scenarios where these questions still are relevant today? Read this story. Keep asking the question. Why do we still wage war?
Compound Fracture
I am not a sommelier, but I know what wines I like. I am a retired nurse with forty years of experience in Critical Care. I believe I am qualified to discuss the broken state of our health care system. It suffers a compound fracture. Early in my career, Primary Nursing, a practice in which one nurse agreed to be active in the care of a patient throughout his ICU stay, was introduced on our unit. It facilitated a holistic approach to care. At least one nurse knew more about the patient than his diagnosis and room number and helped that patient navigate the trauma of critical illness. Primary Care did not last long. It was time consuming for nurses already working short-staffed. It was costly, as Primary Care nurses spent time away from task accomplishment addressing the total patient. Now, after a recent short stay in the hospital and a more recent health jolt, I realize things certainly haven’t gotten better. I have had MS for decades and have strived to maintain the highest level of wellness. My PCP encouraged me to go to a local MS specific clinic for care. I went every year. The providers watched me walk, checked my neuro signs, assured me exacerbations declined with age thanks to an aging immune system. I was trusting. I accepted what I was told. I kept my routine appointments. When my knee began to bother me, I didn’t think about MS. I went to a knee specialist who watched me walk, did an x-ray, saw no arthritis, injected my knee, and sent me on my way. I followed up again when the pain recurred. Another x-ray, another injection. When that shot wore off, I learned to live with the pain. Then, after suffering a Closed Head Injury due to Covid induced hypotension, I switched neuro clinics and ended up at a clinic closer to my home. I saw a new MS doctor. In two visits, he changed my life. He watched me walk. I’d seen my gait in the windows as I walked into the gym. Aging I told myself. “You have footdrop,” the doctor said. Gutpunch. MS finally left its mark, less painful than my burning paresthesias, but so VISIBLE. Yet no one had told me. I bought an ankle brace online. I’ve learned to wear it on the treadmill. My knee doesn’t hurt. My leg is more stable when I walk. Where is the breakdown? The breakdown exists because there is a lack of collaborative practice. Just like the Primary Care concept in nursing, if my PCP, knee doctor, and MS doctor had even had a phone conversation, might I have learned of my footdrop sooner rather than later. Could this type of practice ever happen? I doubt it. The other part of the breakdown: Who would get reimbursed? What would the billing code be? Who would lose money if I’d just bought a brace? How much is one phone call worth to the practitioner? To the patient? Has medical specialization destroyed the healing art by disallowing the opportunity for a patient to be treated as a whole? What professional do I see to answer these questions?
Collaboration might be needed.
Touched
I am not a sommelier, but I know what wines I like. I am not a book critic. I am an avid reader and hope someone will help me understand what I felt was the brilliance of Walter Moseley’s Touched. The cover, two hands held side by side with fingers upright and a face superimposed on them, compelled me to pick the book from the “New Fiction” shelves at the library. It is a small book. The 159 pages are 5 x 7 1/4″. The story, the words, the size made it easy to read without stopping until the last page. Then, I was left in wonder.
Marty awakens from what he believes was a centuries-long sleep a changed man. He believes he has been recruited and altered to play a part in the eradication of the human race. From there, the reader faces many questions. Is the narrator reliable? A few pages in, it no longer matters. Immersed in an alternative reality, the possibilities of which include science fiction to schizophrenia, the reader confronts the quintessential questions of humanity. Is Marty/Martin/Temple the infection of or the cure for humanity? For me this dilemma expanded and applied to everyman. Are humans the destroyers or saviors of this earth? Do we, as a species, have the inner strength to resolve differences and amass the resources to save ourselves? Reminiscent of The Overstory, Touched returns more than once to the concept of the oneness of the environmental and human ecosystems.
I found the ending haunting and provocative. After being reprogrammed by Marty’s intervention, a man leaves Marty’s home to get away from the sound of a howling dog. The man fears it will keep calling for his attention. I interpreted that the man feared changing back to what he had been, a hateful, racist thug, thus positing the age-old question: are humans doomed to repeat past mistakes?
Neither expert nor editor, I’ll only mention things I found interesting about the writing. Mosley’s use of names insist I examine my own moral compass. Marty’s wife, Tessa, has had relations with a man named Truth. Marty’s last name is Just. His alter ego is Temple. Mosley describes the color of people using various shades of browns and grays. I have a mentor who talks about muscular sentences. I found Mosley’s writing sparse, yet muscular. The biggest compliment I can give any author is to say I will reread this book before returning it to the library. I have been Touched.
Quiet Horror
I am not a sommelier, but I do know what wines I like. I am not a movie critic. I have friends who critically analyze movies, their production, stories, costumes, and acting. Not me. Having said that, I do not take lightly writing about The Zone of Interest. It still haunts me. I read the novel by Martin Amis before watching the movie. Usually, books satisfy me more than the movie productions of them. Not so in this case. The opening scene portrayed a family outing. Men wore swimsuits like the one my dad wore when he took me to the local pool and taught me to swim. Women and children sat on blankets spread across the grass. A river lazed in the background. What it didn’t show, but what I knew from reading the book, was this all took place in the shadow of a death camp. It registered for me as quiet horror. No audible dialogue, just the establishment of an atmosphere that was down to earth while being obscene for someone who knew the secret of the setting. Throughout the movie, ordinary people did their jobs, followed orders, created innovative machines, even fought to remain in the penumbra of Auschwitz, with little reference to the people who suffered and died. In one scene, women quibbled over who would take what from a collection of garments confiscated from prisoners. I couldn’t help but see vultures picking over the flesh of dead animals. What gut-punched me the most was a scene, not from the 1940s, but a modern scene in which uniformed workers cleaned the floors of a what seemed to be a Holocaust Museum. Again, no dialogue, just people doing their jobs as if they either did not know or had become immune to the context. Encased in glass, a mountain of shoes stood in the background. Another quiet horror. I remember my shock and grief when I saw a similar display at the museum in Washington, D.C. It made visible and real the number of lives taken during the Holocaust. I often think of The Zone of Interest in a world at war in so many places. I must wonder if, because of our responsibility for mundane tasks and day to day survival, do we become immune to the quiet horror of man’s inhumanity to man? The Zone of Interest helps keep me from becoming so.
A Slice of the Pie
I retired from bedside nursing over five years ago. In that time, every medical journey with my body demonstrated to me how broken our health care system is. Medical specialization is one culprit in the fragmentation of care. When I go to my cardiologist, I am the heart with Sick Sinus Syndrome. When I go to my electrophysiologist, I am the dual chamber, MRI friendly, pacemaker. When I go to the dermatologist, I am skin. When I go to the joint specialist, I am the knee not wanting to have surgery, not the septuagenarian with MS who works out six days a week and walks funny. When I go to the MS doctor, nothing more need be said, except that I am blessed. For the most part, my disease is invisible. Maybe that is why it doesn’t come up often in a plan of care.
Every specialist gets a bit of me; no one cares for the “all of me,” I realized this when after working with the same Physical Therapist for several weeks, we discussed my Multiple Sclerosis, which suggested this wasn’t considered when the orthopod submitted orders to treat my bobbling knee. The therapist didn’t know I had it.
Flash back twenty years and my diagnosis of pulmonary embolism. Although I saw a hematologist, the risk of clotting problems associated with autoimmune disease was never mentioned.
I have a dream for my health care providers. Once a year, I’d like a Zoom meeting, God forbid we could do it in situ, where each one helps put the pieces of the puzzle that is my body together and makes recommendations for my health maintenance. I would come with a list of questions about what the interface of body systems and health problems means for the coming year. I would come hoping I would be recognized in toto.
Has Medical Specialization and the Business Model in Health Care Given Rise to Google, MD?
As a nurse, my family sought my advice over the years. I never practiced medicine without a license and stuck mainly to my specialty, Cardiovascular Nursing. If people asked me about pregnancy, I used the line “I don’t know nothing ‘bout birthin’ no babies.” I learned more about labor and delivery from Call the Midwives than I did from a clinical rotation forty some years ago.
With time, my advice took second chair to a new pundit, the internet. My mom asked me things, I advised, she argued. She would quote something she “Googled.” When a close relative developed cancer, she prepared for long distance care at a Cancer Treatment Center she read about until I reassured her that for her type of cancer, therapy at home would be more than satisfactory.
I agreed with the doctors at work who disdained Dr. Google or Google, MD. But then I had easy access to talented professionals amenable to “curbside consults.” I felt light-headed at work one day. I mentioned it to a colleague, a cardiologist. I had a stress test within a week.
Now that I have retired, I experience patienthood in an entirely new way. It started with a little light-headedness. No. Not a little. A lot. Bad enough to call 911. The red ambulance rolled up with lights flashing. I never felt so relieved as I did when the gurney rolled into the foyer of the fitness center. By the time they did a blood pressure, a blood sugar, an O2 sat, and looked at my EKG, I felt better, well enough to go to the bathroom and drive myself home.
I did what I would have told anyone. I went to my PCP the next day. He drew labs and did an EKG. My heart rate was, hold it, take it in, thirty-six. My heart had been bradycardic for years, but a rate below forty scared me. I’d been to a cardiologist before, so I called his office to schedule an appointment. When you imagine your heart might slow to a stop, you don’t want to wait around.
This is where the fun began. Despite the fact that I had seen this doctor and had a near “syncopal” episode, I hadn’t seen him often enough, so I was considered a new patient and couldn’t get an appointment for a month. Imagine me going to sleep at night with my index finger palpating my carotid artery to make sure my heart was still beating. Yup. That was me.
Thanks to Facebook and a few good friends and the fact that health care professionals treat each other like family, my appointment got moved up. I only had to wait a few days. My heart had to behave for a little while longer. However, I was warned that the doctor was extremely busy and that sixty patients were scheduled in the office that day. Whether you’re a nurse or a lay person, when it is your heart that is thinking about quitting, retiring from the rat race, going on hiatus, you don’t give a damn about anyone else’s problems whether it’s a cold sore or an office trying to make a buck.
When the doctor with whom I had worked for years walked in, I knew he recognized me, although he wasn’t sure from where. Yeah doc, I was the one who took care of all your very sick, high risk patients who agreed to participate in the trial of the procedure that revolutionized aortic valve repair. I worked hard with the unknowns and celebrated successes that changed the horizon for cardiac interventions. Guess what? I don’t give a damn about all that. I want you to NOT diagnose me in a five-minute office visit and exam. I want you to let me know you know all of my history, my MS, my anti-phospholipid syndrome, my meningioma, my very bad reflux, my hiatal hernia, the fact I have engaged in some sort of physical training since I was six years old. not just my heart history. But he chose the five-minute route. So, I went home and chatted with Google, MD.
Dr. Google mentioned sometimes a hiatal hernia can cause the exact same symptoms I was having, which was a relief, except it made me wonder if I should visit my GI doctor. I wondered if my meningioma was getting bigger and causing increased intracranial pressure and bradycardia. See my neurosurgeon? I wondered if I had thrown a clot to my lung again. Oh, did you not know about that? It’s on the paperwork, initially labeled incorrectly with someone else’s name. Call the pulmonologist. I had already done that.
You get my drift. In a perfect world, maybe all involved in my care could conference call and coordinate a plan. Since all my health care problems reside in one body, mine, maybe it would be helpful to consider them all before proceeding. Thanks to medical specialization and the business model of medicine, that will never happen. To be the best advocate for myself, I will draw from my experience, consult Dr. Google, and hope I make the right decisions.
On turning 68 in 2019
My 68th birthday looms. It creeps towards me, tenacious, heat resistant like the ground cover in my shrubs. I tear up clumps of the succulent green with baby’s breath like flowers and throw it in the dirt. In a week, it is spreading, thriving, a lush carapace for soil turned to dust by the sun.
This year I am grateful I am upright, as I am every year. My gait deviates a bit. My right leg swings out to the side when I walk; the right foot wobbles before it hits the ground. That’s MS for you. If stopped by a cop, I refuse to try and walk in a straight line, because I’ll always look drunk. I’m prepared to refer him or her to the clinic, to the doctor, where I log intermittent moments of my journey and hope to have enough time left to create a few more.
I am grateful for a partner who gives me space for my obsessions, who loves me for who I am, who still holds my hand when we sit on the sofa together.
I am grateful for the fact that the moment I sit before a blank page and type just a few words, something awakens. My mind pinballs from the present to the past to the present to the future. I create sorceresses and serial killers and murder victims. I reencounter patients and students and lovers I’ve sequestered in that biological computer known as my brain. I read books and see what I’ve missed in my stories. I revise and think to myself “Who needs drugs when the mind is immersed in the magnificent process of creating?” I want to be TC Boyle and JC Oates and Margaret Atwood and Cormac McCarthy and Octavia Butler and Wallace Stegner and Andy Warhol and Van Gogh all rolled into one.
I want to see my son perform on The Ellen Degeneres Show. His songs come up on my play list when I’m working out and my pace quickens. I can’t believe how talented he is.
Mine is a wonderful life.
Then reality abrades its noxious way into my consciousness and I mourn. I mourn for what I see as the erosion of all the progress women my age thought we made in the early 70’s.
I remember reading Our Bodies, Our Selves and began to see and understand my body as my own, divorced from the “body politic” and not distorted by “the Gaze.” I celebrated a sense of visibility and having a voice that was and would be heard. I chose a career with a “living wage.” I smugly thought, if I have children, they will be proud of what my generation accomplished for my gender. Foolishly I rested on my laurels thinking the fight was over, the battle, no the rights, had been won. Forever.
As 68 gets ready to bulldoze over 67, I mourn the current socio-political climate, which, like my ground cover, proliferates and spreads. What it spreads is not pretty or protective. It spreads ignorance, prejudice, and hate. I mourn the roll back of resources and funding that will guarantee women reproductive health and personal freedom. I mourn that money and connections allowed a sex trafficker a lighter punishment and enabled him to commit the same crime again, reaffirming that women and girls in this country are nothing more than cheap merchandise. I mourn that the top elected official in this country voiced his sense of entitlement when it comes to women’s bodies, a “man” who so misunderstands sexual assault that he deflects allegations of it with “She’s not my type.” I mourn that it took two daring sports figures to get people to face the injustices and inequities that plague our so called free and democratic society. I mourn the fact that I fear the physical environment in which my grand-children will live and grow.
My birthday wish: Let me do one thing that will make the world a little bit better.
Multiple Sclerosis-The Monster
My feet woke me up this morning, burning hotter than a pig on a spit. I knew not to expect blisters. The sheet billowed when I yanked it off with the flourish of a matador. MS. I have referred to it as “my MS.” I hate acronyms. They reduce the horrific to the mundane. MBC. Does that make Metastatic Breast Cancer any easier? Only for drug companies advertising treatment. COPD? Does that make it easier to breathe when you have Chronic Obstructive Pulmonary Disease? I have Multiple Sclerosis. It doesn’t deserve a nick name. If I refer to it as MS, you might think I am talking about a Masters degree. Although I have one of those, “my MS” refers to the disease which has been my master, as both a blessing and a curse, for forty years. I haven’t talked about it much. Call me a private person. But after joining a writers’ group on Facebook, I found out two things. The first? Nothing is off limits. The second? Talking about living with a monster may help someone else living with one, whether it is an abusive partner, a child in trouble, or Multiple Sclerosis. Be advised. This is not a forum for whining or self-pity. I worked until retirement, work-out six days a week, enjoy good eye sight, and seem to be a thinking human being. Many are not so lucky. That does not mean I haven’t faced the monster on a daily basis and trembled in its shadow. More to come.
A Ghost of Christmas Past: Dec. 1973
The year I graduated from nursing school I knew very little about nursing except what to wear.
My white uniform, designed with a bib of crisp pleats across the bust, tented into an A-line skirt. The hem fell exactly to the middle of my knees. White stockings and utilitarian shoes worthy of a convent exemplified my look of a novitiate. Infection control and the influx of men into the profession eventually rendered the winged-white caps obsolete. I pulled my long blonde hair into a pony tail, stuffed it into a crocheted “snood’” and secured it with bobby-pins. For convenience I always stuck a few pens in my mound of hair, Geisha hair sticks by Bic. I never wasted time looking for a writing tool. My favorite offered three colors of ink, red, blue, and green, to accommodate each of the eight hour shifts in a day.
Three hospitals provided services to my small college town in the Midwest. A five bed surgical intensive care unit became my basic training camp. Monitoring EKGs and frequent vital sign checks were considered state of the art. On days when less than three patients required this vigilance, I functioned by myself in this new, specialized area of the hospital. I documented changes in EKGs, electrolytes, vital signs, and pain control, and established standards of care. I initiated calls rather than depending on a “head nurse” or supervisor to speak for me. Intensive care necessitated eliminating time delays and the middle man; I answered directly to doctors and the demand for accountability fell on and appealed to me.
Of course I worked my first Christmas on the job. Christmas 1973 gifted me with insight into my career choice and the ever-present threat to ICU patients known as death.
My patient looked like Alan Bates, the actor. Roguish, with curlicues of black hair slick with sweat and oil, the man reclined in a rickety framed gurney. He angled his elbows on the metal frame like a king holding court He strained the cloth restraints that secured his hands to the side rail. With each effort, his biceps bulged and trembled. Shaking his head side-to-side, he uttered incomprehensible sounds and marked his territory with a circle of spittle. My immaculate uniform meant nothing to a man wallowing in a reality fragmented by the effects of alcohol withdrawal and hypotension.
I fantasized about Alan Bates ever since the movie Women in Love, where I watched Mr. Bates and a young, though semi-portly Oliver Reed romp in the first nude male wrestling scene to appear in a mainstream film. The full frontal male anatomy fascinated me. How could I imagine in five years that career experience would reveal every variant of the mysterious penis and turn it into nothing more than a delivery conduit for the precious measure of renal perfusion, urine?
I nicknamed him The Professor. I can’t remember his real name. Today HIPPA would demand I protect it. He epitomized my ideal of an English professor complete with perfect, albeit, slurred diction and a penchant for whiskey. I imagined him fully functional, both cavalier and cerebral in a tweed sports coat with leather patches on the elbows. College girls flocked to his classes, his office, even his apartment. And I, fresh enough, inexperienced enough, thought like all novices with addiction, that a little love and attention could cure alcoholism and all the underlying problems that caused it. I’d say the right things, and The Professor would quit smoking, quit drinking, eat right, and publish a book dedicated to me. I also thought medicine could save him from the massive gastro-intestinal bleed channeling life from his body. In one day I learned what little power altruism, innocence and science wielded.
It was just he and I. The day nurse dashed away as soon as she finished report. Short and to the point: “ 34 year old white male. Bloody emesis with clots in his stool. Found unconscious at home by a neighbor. Two units of blood given in the ER. No family. Sinus tach on the monitor.”
There it was. The security of what I then believed was the pinnacle of technology. In just a few years to merely monitor the EKG would be comparable to using a squirt gun against a light saber.
“Dr. Reisman said there is nothing more to do.” Today it seems there is nothing we can’t do. There are no rules about when to stop.
I picked up my stethoscope to start my assessment and stopped a moment to shift gears. Looking around it disappointed me to see no one had decorated the unit for Christmas. Through an expansive fifth floor window, low hanging clouds rolled over the trees and houses. Smokey mist covered every building and obscured the lights and decorations heralding the season. Loneliness accompanied the focus required for my work.
I approached The Professor with caution. His gown gathered in folds across his abdomen and groin. The monitor electrodes glared white against a thicket of chest hair. Small halos surrounded each electrode where the hair had been shaved. A small slash of dried blood marked a path down his chin. He sat in a smear of maroon with a clot the size of a plum mashed against one rail of the gurney. His writhing agitation caused his blood pressure cuff to slip down his arm to the restraint. I could see his pulse on the monitor and count his respirations. I needed to check The Professor’s blood pressure.
There is nothing more gag-inducing than stool from someone bleeding in the gut. It blends the smell of fresh blood, rotting meat, and swamp gas.
When I started to examine The Professor, I didn’t know this. The odor surrounding him forced me to breathe through my mouth. I stepped closer and started a standard script. “I’m Cindi and I’m going to be your nurse today. I need to listen to your chest, heart, and abdomen.” I said abdomen because he was a professor. A whiff of his body odor reassured me I could have said “gut.” After holding my stethoscope between both hands to warm it, I placed the diaphragm on his chest. I heard the familiar squeaks and crackles of smoker.
“I need…I need…”
I heard his voice drone as the sound traveled through his chest and the diaphragm of the stethoscope, up the slick black tubing, and through the ear pieces into my head. I pulled back. “What is it that you need?” Pompous satisfaction. I was making progress with the man. He trusted me enough to ask for something.
“I need…” A blast of red erupted from his mouth and landed in an abstract design of spatter on my uniform. I looked at the chrome paper towel dispenser and saw nothing on my face, but from mid chest down I easily could have been mistaken for a gunshot victim or a Pollack. I washed and dried my forearms and returned to The Professor. Before AIDS and public awareness of the dangers of hepatitis, it never dawned on me to be afraid of exposure to body fluids.
The Professor’s head dropped against his shoulder. His heart beat twenty beats per minute faster to compensate for the loss of blood from his system thus maintaining his blood pressure. I sped up his IV fluids and paged Dr. Reisman.
When waiting for a physician to return a call, when it feels like all the responsibility is on you, time shows no mercy. My heart pulsed in my temples. Sound amplified. The Professor’s sonorous breathing seemed to roar through the unit.
The monitor warned of irregular heartbeats. Unable to hear a blood pressure, I palpated one with the systolic throb recognizable at 45. The phone rang. I reported the events of the past ten minutes and hoped some new medical development had evolved in that time.
Dr. Reisman was as new to his medical practice as I was to my nursing practice. When we worked with patients and each other, two pairs of fresh eyes explored changing professional roles, planning care with new knowledge and inspiration, reshaping old traditions. I represented a new breed of nurses with my four year degree. Just starting his practice, he seemed to approach me differently than the older, well-weathered MDs. Or perhaps he simply heard the uncertainty, the disbelief, and, yes, the desperation in my voice. “I’m on my way.”
The Professor rallied and resumed thrashing about the gurney. His heart rate remained high. A pallor circled his mouth. With a violent twist of his head, he resisted the green plastic prongs for supplemental oxygen. He repeated the move when I tried to wipe his mouth and wash the blood from his chin.
A small man with thick, pre-maturely silver tipped hair and an earnest demeanor, Dr. Reisman arrived. I noticed the five o’clock shadow of his beard. He noticed my uniform. “Did this just happen?”
I nodded.
“There really is nothing more we can do.” Dr. Reisman stroked his chin and walked over to The Professor.
“Can you hear me? You are really sick. At this point we can’t get you better. Is there anyone we can call? Is there anything I can do for you?” He rested his hand on The Professor’s forearm.
The Professor stared across the room and said nothing. Guttural sounds rumbled in the back of his throat. Watching a man’s demise, tethered to a bed in my ICU, gobsmacked me.
“Call me when something happens. I’ll be in the ER.”
I admired tailored slacks and polished shoes as Dr. Reisman stood at the elevator. In a time when patriarchal practice dominated medicine, Dr. Reisman showed me a glimmer of the collaborative practice of the future. That day I sensed something about the potential of my profession that would come to fruition many years, many patients, and many challenges later.
“Doc.” The Professor sputtered in a coarse whisper. “Doc, can I just have a cigarette?” His head lolled to one side. The monitor warned of disaster.
When I looked up at the small black screen, three to four beats of wide amorphous conduction, the kind that drop cardiac output and blood flow to the brain, interrupted the rapid, but regular white P-QRS pattern of tachycardia. The Professor lost consciousness. The irregular rhythm looked like a child’s drawing where a tiny hand zig-zagged a crayon across a piece of paper. More and more clusters of chaos appeared. Finally chaos reigned.
Without a regular heart rhythm, the heart failed to perfuse. Within minutes The Professor stopped breathing. A white line, as clear and sure as a jet stream, crossed the monitor screen. The monitor screamed its proclamation of death with a continuous high-pitched alarm.
What happened after The Professor died, I don’t remember. I knew the mandatory procedural rituals performed after a patient’s death. In 1973 plastic body bags didn’t exist. I assume I wrapped The Professor in a sheet. Today I sing Native American chants to patients as I prepare their bodies to be taken away. There was no singing for The Professor. I had much to learn about what was right and proper and comforting to me when working with the dead.
Nor do I remember what I did that Christmas night when I got home. Until I owned a house with a fireplace, I made one out of construction paper and corrugated cardboard painted like bricks. The felt Christmas stocking my mother made me hung by the faux-fireplace on a tiny nail. Mom decorated the stocking with symbolic cut-outs. Beads and sequins sparkled on a candle, a train, a ball, and other various mementos of childhood. There was no nursing cap; that identity had not entered my being when Mom created the stocking.
For many years, the memory of The Professor’s last words, the loneliness of his death, and my feeling of inadequacy stayed with me. I saw myself, like a candle in an infinity box, as a myriad of nurses expanding in many directions, burdened with the responsibility for another person’s life, alone to experience the loss of a man who, at first glance, seemed a person of looks and intelligence and potential, but who was simply a man I tried to help and failed.
I could have changed jobs, gone to work in the newborn nursery or a doctor’s office. I could have quit nursing altogether. The Professor would have no second chance, but I continued nursing in search of my mine.
Part 1: The Golden Age of Nursing
I graduated with a BSN in Nursing in 1973. My four year degree was the exception, not the rule, at the time. I received no extra pay or recognition. As with so many careers, training really began my first day on the job.
I learned about the demands of the relatively new hospital concept called “intensive care.” There was no internship, no syllabus, just flying by the seat of my support hose and white down-to-the-knee uniform. I pulled my hair into a bun and stuck my pens there, a sort of nurse’s kanzashi, to keep them handy. Charting consisted of half a page of lines and dots for vital signs and no more than eight lines for patient notes. Back then I documented drug infusions by flow rates, drops per minute, not dosages. I can’t remember how we documented medications. Self-edification drove my critical care learning. I enrolled in EKG classes, had the privilege of spending two days listening to Dr. Marriott explain the most complex arrhythmias, attended respiratory care seminars, and took advanced physiology to have the academics to support my practice.
Along the way I mastered how to finesse shaving a man with a heavy beard, how to navigate delicate family matters like a wife bumping into a girlfriend at the bedside. I learned a farmer rested better if I read him the bean futures or told him what I’d paid for a dozen eggs. I watched a learned professor die from his addiction to alcohol. I worked in a small unit where the patient was barely an arm’s length away. What happened to my patients I carried home, tucked in a portfolio of images, smells, and sounds. No escape, no mercy. I took every day personally.
Looking back on a forty-three year career, I evaluate myself and my profession. I ask, as Dr. Paul Kalanithi posited to himself in his book When Breath Becomes Air, did my life, my work, matter? I grew up in the Golden Age of Nursing. Before JCOH. Before computers. Before order bundles, protocols, and health care framed itself, first in a corporate model, now in a hotel management model. Before what was documented became more important than what actually happened.
I mourn its passing.