How Can You Bear to Be a Nurse?

I was recently at a conference where Mary Mallison's classic 1987 piece, from the American Journal of Nursing, was presented. I had forgotten how wonderful it is. This probably won't have a lot of meaning for those who aren't in nursing, but for nurses it is so meaningful.

How Can You Bear to Be a Nurse?

How can you be a nurse? How can you bear the sight of blood?
Wait until you slide a catheter into a tiny vein just before it collapses. The flashback of blood you see will make you sing.

How can you be a nurse? How can you bear the sight, the embarrassment, of urine?
Wait until your new postpartum patient can't void, and her uterus is rising. Your persistent maneuvers finally work, making a catheter unnecessary. Urine then looks glorious.

How can you be a nurse? How can you bear to touch that alcoholic who hasn't had a bath in weeks?
Wait until you've repeatedly given ice lavages to that alcoholic and his esophageal varices have finally stopped bleeding. When he actually recovers enough to amble onto your unit to visit, dirt and all, you'll be happy enough to hug him.

How can you be a nurse? How can you bear to watch someone die?
Wait until you've worked for weeks helping a dying woman repair a decades-old conflict with her children, and at some point along the way you see the guilt fall from their shoulders and peace enter her eyes. Watching such a death can be an exaltation.

How can you be a nurse? How can you bear the sight and smell of feces?
Wait until you've been anxious about the diarrhea that nothing has stopped in an AIDS patient. Finally, your strategies work and you see and smell normal stool. You'll welcome that smell.

How can you be a nurse? How can you bear to watch children suffer?
Wait until you've rocked and soothed a suffering child into peaceful sleep, and you feel the child's relief washing over you like a blessing. Then you won't need to ask.

How can you be a nurse? How can you bear to look at searing trauma, at burned people?
Wait until you see healthy granulation tissue that has been given a chance because your sensitive nose detected an infection before it could take hold. That healing will look beautiful to you.

How can you be a nurse? How can you bear the stream of abusive words heaped on you by psychotic patients?
Wait until you've prodded and pulled a silent, withdrawn catatonic back over the lifeline, and she releases a string of expletives. Could Mozart sound better?

How can you be a nurse? How can you bear the sound of babies crying?
Wait until your combination of vigilance, bulldog advocacy, and gentle handling has given a preemie's lungs the time they needed to develop, and you hear his first lusty cry. You'll laugh out loud!

How can you be a nurse? How can you bear to care for frustrating, confused Alzheimer's patients?
Wait until you've devised a combination of strategies that provide exercise and permit safe wandering and you see a lift, almost a spring, in a patient's shuffling gait. You'll feel the lightness of Baryshnikov in your own step that day.

How can you be a nurse? So many of your patients are so old, so sick, these days. How can you bear the thought that, in the end, your care may make no difference?

Wait until you've used your hands and eyes and voice to dispel terror, to show a helpless person that his life is respected, that he has dignity. Your caring helps him care about himself. His helplessness forces you to think about the brevity of your own life. Then and there, you decide yet again to reject the pallid pastel life. No tepid sail across a protected cove for you. No easy answers. So you keep choosing to be a nurse. You have days of frustration, nights of despair, terrible angers. Your highs and lows are peaks and chasms, not hills and valleys. The defeats come more than often enough to keep you humble: the problems you can't untangle, the
lives that seep away too fast, the meanings that elude your understanding. But you keep working at it, learning from it, knowing the next peak lies ahead. And gradually you realize your palette is filling up with colors. You see more shades of meaning. You laugh more. You realize you are well on your way to creating a work of art, maybe even a masterpiece.

So that's why you've remained a nurse. To your surprise, your greatest work of art is turning out to be your own life.

Reading the OED

Ammon Shea has a new book out, entitled, "Reading the OED." Yep. He spent a year reading the entire OED, and he has highlighted some of the "most obscure, hilarious, oddly useful, and exquisitely useless gems he discovers along the way." If you remembered from one of my early submissions here, it was Shea who introduced me to the early citation of "epicaricacy" (Bailey's Dictionary). The other dictionaries defining "epicaricacy" merely listed the definition, and therefore one had to wonder about the legitimacy of the word. It was Ammon Shea who led me to the 1700's Bailey's dictionary that contains the word. I have seen "epicaricacy" in black and white. So Shea is a linguistic hero to me.

A few of the great words in this book follow. Remember, "epicaricacy" won't be among them because it has never been in the OED:

"Pavonize" - To behave as a peacock might - Shea says: "Which either means to flaunt one's appearance in a vain fashion or to peck at the ground in the hopes of finding bits of food and to clean one's hindquarters with one's mouth."

"Xenium" - A gift given to a guest - Shea says this about that word: "It is a very delicate balance to strike, this business of giving a gift to someone you do not want to offend and yet whom you also do not want to encourage to stick around too long. Unless you are one of those unbalanced individuals who actually enjoys having company, I would recommend xenium such as a pair of used socks, something that says 'Here is a gift - please go away.'"

Or how about "Forplaint" - Tired from complaining - Shea says this: "It can indeed be tiring to constantly remind the world at large that it does not quite live up to your exacting standards. We should recognize those among us who are forplaint and thank them for their selflessness in trying to better our world with their ceaseless haranguing and nitpicking."

Oh, for you logophiles, it's a fun book!

Words are beautiful

I am at a conference this week where we are exploring reflection, along with preflection and inflection, in thinking about our communication. It has been so interesting and has focused a lot on language and the beauty of words. Here is a poem that really stimulated our reflection:

The Way It Is

There's a thread you follow. It goes among
things that change. But it doesn't change.
People wonder about what you are pursuing.
You have to explain about the thread.
But it is hard for others to see.
While you hold it you can't get lost.
Tragedies happen; people get hurt
or die; and you suffer and get old.
Nothing you can do can stop time's unfolding.
You don't ever let go of the thread.

- William Stafford

What does your thread of life look like? Draw it, and record important people who have influenced you along the way.

I am beginning to understand poems that are written in prose format. They don't need rhymes or a particular rhythm to be beautiful. It is how you put those words together. This one is thought-provoking and truly beautiful.

Epicaricacy in the news

I suppose, considering the name of this Blog, I should write about "epicaricacy" every so often. I found this use of it on a very unlikely Web site...Flickr, a Nikon/Digital discussion board. As is usual on a lot of forums, there is some snarkiness there. Here's the comment with "epicaricacy":

"Your verbose and confusing choice of vocabulary does gently massage my tendencies towards epicaricacy, I do like to think of all the peeps ur diverting off to wiki just so they can understand you. Keep up the good work with the big words what people can't say or spell good; solipsists being my personal favorite. Philosophical theory combined with good old soap box ranting, love it!"

One wonders if he even knows what it means. He surely didn't use it correctly, at least from my perspective.

Time to Reflect

The chapter on collaboration is in, and what a lot of work! While I write a lot in my job, and even outside of my job, I never find it easy. A writing course would be helpful, though do I have the time for it?

Especially with scholarly work, I always wait for the most recent report or study that would be "perfect." That of course enables me to procrastinate, without feeling guilty (or too guilty). I am happy with my chapter, though, as it not only reviewed the literature, which is all I would have done in the past, but it also builds upon my experiences, including conference presentations of major initiatives, in the area. This latter part makes it much more engaging than other chapters I've written, and it gives the reader a chance to reflect on real situations or initiatives, using the principles I've presented of course. Oh, and I did start with a limerick (we'll see if the editor keeps it!), and here is what I finally submitted:

Since nursing’s a teamwork vocation
With theory and care its foundation,
Is it too much to ask
In this admirable task
That we focus on collaboration?

I wonder if "arduous" is better than "admirable," but I have time for that. The Brits say "admirable" with 3 syllables, but I suspect many Americans say it in 4. Still, I like the concept of "admirable" more than that of "arduous."

I found this lovely poem in the most recent issue of JAMA that I thought I'd share with all of you. It is good to have a little time! (Richard English would eschew it, claiming it's merely prose.)

Water

To a modest pond filling
with Spring's runoff
we walk together -
same path each year.

Today you use a stick for balance.
Halfway there, too far,
you must stop
your back tired.

The trail home crosses a small
stream, no more than a rivulet,
gentle slope to soft bank
steep for 80 years and one stick.

At your request I take your left hand
helping you through emerald grass
to this quiet water -
my Eünoè your Lethe.

You cross and walk away carefully
- each step itself redeemed.
I turn back to the pond
now filling faster.

Michael Wynn, DO
Salem, Oregon