“Though she be but little, she is fierce!”
Grow old with me, the best is yet to be.
My husband and I recently entertained guests from out-of-town. One of the fun things we did was visit Powell’s City of Books in Portland. Powell’s on Burnside is the largest bookstore in the world, a reader’s Paradise. Rooms of books sprawl from floors of multiple staircases, like levels of heaven. It is so big; the store provides maps for customers, like Disneyland. If you visit Powell’s, allow at least two hours. Like making a painting, you never finish going through Powell’s, you just reach interesting places to stop.
Of course, I bought some books while we were there. Three came from the Pearl Room, where the art books are shelved. In the Gold room, I found a copy of American Pastoral by Philip Roth. I’ve meant to read Philip Roth since I read Night Studio, a memoir by Musa Mayer about her father, the artist Philip Guston. The two Philips were friends, as painters and writers often are. That is not why I bought American Pastoral. I bought the novel because I’m reading books from the Books to Read Immediately list in How to Read like a Writer, by Francine Prose. An award-winning author, Prose teaches writing the way my instructors at Pacific Northwest College of Art taught painting: study the work of the best, and imitate what they did.
It sounds so simple: study masterpieces. This kind of observation is about getting inside the artist or writer’s head, understanding the choices they made, and why each decision contributes to the masterpiece. The next step is to take that why and store it like a tool in its box, until an opportunity for use presents itself.
That sounds simple too, except that the trick, the magic, the craft, only occurs if one wields the tool in a fresh, new way. Restating something said before needs to reveal a unique voice. That is what makes the work a piece of art: craft and a unique voice.
As I meandered through the rooms of Powell’s, it occurred to me that craft and unique voice are often missing in nursing innovation. How many times are manufacturers of IV tubing and connector systems replaced in a hospital? That is not innovation; it’s changing vendors because the current vendor contract has expired and the hospital is shopping for a new one. Real innovation is finding ways to improve, for instance, staffing in a damaged economy. It is seeing old ideas in a fresh new way. Hospitals move slowly towards change, as if lumbering freighters pulled along by tugboats in a busy harbor. Nurses resist change too. For instance, we complain about understaffing, and about losing hours (pay) when hospital census is low. Not enough nurses leaves a unit under staffed, but too many nurses means not enough working hours for everyone. Dilemma is part of the business of health care. Problems have answers; dilemmas are ongoing and need management.
Reduced paychecks due to lost shifts were particularly painful when I was a single mother with a mortgage. After awhile, the vacation paid leave dried up too. I needed cash. Therefore, I became agreeable to floating from PICU to related units, like NICU and general pediatrics. It wasn’t always comfortable going to an unfamiliar unit and taking patient assignments, but I found if I went with an open mind, spoke up about what kind of assignments were appropriate for my skill level, and won over a buddy or two from the unit, floating wasn’t that bad. I took CE courses in NICU subjects, including NALS and improved my skills. That improved my comfort level and patient safety. Social networking the old school way, I made friends in the units where I floated, and rarely lost a shift of work. Each new skill embellished my résumé; adding to my marketability. It’s a good tactic for nurses wanting to look experienced, instead of just aging, to employers.
Hospital administration plays an important role in successful floating experiences for their nurses. It is critical that they understand it takes more than a body with a pulse and a stethoscope to care for various patient populations. Years ago, I attended a meeting organized by the hospital. Its administrators asked nurses what would encourage us to float. I pointed out that while I was able to sustain a critically ill child on life support; if floated to labor and delivery I could reason that a slow heart rate on a fetal monitor was probably not a good thing, but all I would know to do about it was scream for help. The administrators listened, and created float area “bundles,” limiting the departments nurses are asked to float to by related acuity and skills. The tugboats helped navigate the freighter in this case.
I am grateful to have a career that provides so many opportunities for work. In this economy, nursing is one of the few jobs with any security at all. It also provides opportunity for creative souls.
Nurses’ Week is over, but we left out one of my favorite nurses. She did not advance nursing science. Instead, she gave the profession a human face. I love Louisa May Alcott.
She wrote Little Women. Do girls still read Little Women? I am grateful my mother considered reading the classic a rite of passage into womanhood (along with Gift from the Sea, and The Good Earth). She gave me a hardbound, illustrated copy of the novel for Christmas when I was in the fifth or sixth grade. To this day I do not know if I love Jo or Amy more. Beth scares me. Meg…she never really materialized for me.
Okay, Little Women, blah, blah blah, yeah, you read it. You like Jo too. Amy was a bimbo. Too bad for Elizabeth. Meg went on to play the sister on Family Guy, who cares? Well, darling, do you know that Alcott borrowed books from Ralph Waldo Emerson’s private library? That neighbor Henry David Thoreau was her mentor. That she was an Abolitionist and Women’s Rights activist. Do you know that before she became famous for penning Little Women in 1869, she was a nurse in the Civil War? The experience changed the course of her life, and likely shortened it. In 1863, she published her nursing experiences in the slender volume Hospital Sketches. The book has the tagline: “An Army Nurse’s True Account of her Experiences during the Civil War.”
An aspiring actor and playwright, Alcott grew up in poverty. Her father, Amos Bronson Alcott was a respected educator and philosopher lacking both business sense and money management skills. Louisa took jobs teaching and in domestic service to support her family. When war broke out among the United States, she wrote, “I want something to do.” Encouraged to write, young Alcott felt she lacked necessary life experiences. At a neighbor’s suggestion, she decided to ”go nurse soldiers. So far, very good.”
I won’t post a synopsis of the book, other than to say it contains a disturbing account of the death of a soldier whom Alcott befriended. Her description illustrates that in the days before anesthesia, a soldier’s death was the male counterpart of a woman’s sufferings in childbirth.
Alcott was dedicated to the men in her charge. Her brief nursing career ended when she contracted typhoid fever. She survived, but suffered life-long chronic pain; a side effect of the mercury-based medication used to treat her. She obsessively turned to writing, becoming the main financial support of her entire family. Little Women made her rich, but it was her nursing experiences that made her a writer. I will close this post with Alcott’s own words about Hospital Sketches:
These sketches, taken from letters hastily written in the few leisure moments of a very busy life, make no pretension to literary merit, but are simply a brief record of one person’s hospital experience. As such, they are republished, with their many faults but partially amended, lest in retouching they should lose whatever force or freshness the inspiration of the time may have given them.
To those who have objected to a “tone of levity” in some portions of the sketches, I desire to say that the wish to make the best of every thing, and send home cheerful reports even from that saddest of scenes, an army hospital, probably produced the impression of levity upon those who have never known the sharp contrasts of the tragic and comic in such a life.
The unexpected favor with which the little book was greeted, and the desire for a new edition, increase the author’s regret that is not more worthy such a kind reception.
Louisa May Alcott
Concord, March 1869
Hospital Sketches by Louisa May Alcott is available from Applewood Books.
This fall, I’m reading the first 4 books of the Cherry Ames series, by Helen Wells, for the first time. Cherry Ames, if you don’t know, is an 18 year-old student nurse, who’s intuitive style of patient care and indomitable spunk lead her through a spree of madcap adventures in the halls of fictional Spencer Hospital, eventually ”winning” her cap and the coveted black stripe of a graduate nurse, during World War II.
Unlike Cherry, I did not want to be nurse as a young person, and I wasn’t particularly interested in books about nursing. From junior high on, I felt heroines like Cherry Ames were kid stuff. In high school, I read Kurt Vonnegut, John Irving, Ray Bradbury, Robert A. Heinlein, and James Thurber. Characters such as Michael Valentine and Garp held more intrigue for me.
I felt pretty much the same way as an adult reading Cherry Ames. In a world of Nurse Jackies, Cherry’s declarations that,
“The patient always comes first. Save the patient at any cost to yourself. That was the nurse’s creed.”
“Nursing had always been Cherry’s dream. She knew it was the finest way a girl could serve people, and Cherry loved people and wanted to help them. Nursing was the way to put her idealism into practice.”
come across as cheesy cliques. At least, that’s what I thought until last Thursday, November 5th, 2009, when the Fort Hood shootings occurred, and the stories of heroism during the crisis became publicly known.
The first story of heroism I heard was that of civilian officer Sgt. Kimberly Munley, the first responder on the scene, who simultaneously shot the assailant as he fired upon her. She put herself (as the clique goes) in the way danger to save the lives of others.
On Tuesday morning, I watched The Today Show. Meredith Vieira’s guests were 19 year-old Pfc. Amber Baher, and her mother. Amber is a soldier, credited with applying a tourniquet on the bleeding wound of one of her “battle buddies,” then carrying him to safety, while she herself was shot in the back. “I don’t know if it was adrenaline, but my own personal safety wasn’t really what mattered to me,” Bahr told Meredith. “Making sure that my battle buddies were safe was my No.1 priority.”
Another soldier, US Army Reservist Dorothy “Dorrie” Carskadon (who has family here in Portland) was injured during the shooting, reportedly while assisting one of her comrades.
I am deeply moved by each of these stories of individuals choosing to save the lives of others, at any cost to themselves. By their actions, they put their idealism into practice. These women, these soldiers, exemplified, on American soil, the values and commitment of our past and present veterans overseas. This type of courage happens everyday, on battlefields far from home. “Their lives’ work is our security, and the freedom we all too often take for granted.”
In healthcare, we borrow military language. We wage a war on cancer. We battle disease. Severely broken bodies in trauma units are FUBAR. Today, I went to work, hoping I would also borrow a small amount of the courage and idealism displayed by our soldiers.
I need to reconsider my opinion of Cherry Ames.
I’m reading The Complete Stories of John Cheever (Knopf 1974). He is mentioned in a Seinfeld episode (The Cheever Letters) and in the current economic crisis, I find his voice to be as contemporary and fresh as it was in the 1930′s and 40′s when he wrote about the the effects of the Great Depression on that era’s society. Some of his sentences are breathtakingly beautiful in their clarity and use of language.
Here’s an example:
Fiction is art and art is the triumph over chaos (no less) and we can accomplish this only by the most vigilant exercise of choice, but in a world that changes more swiftly than we can perceive there is always the danger that our powers of selection will be mistaken and the vision we serve will come to nothing.