Finished reading RN by Jane Carpineto. She follows three nurses who represent different aspects of the profession over several months and documents the highs and lows of hospital nursing. It was written in 1992 and I was struck by how little had changed. Here's a few excerpts that jumped out at me:
"There's something weird about this profession.... None of your friends on the outside see death as an everyday occurrence. For them, it's an extraordinary event."
" I think you're right... that the best and brightest are leaving this profession. A few of them become private home-care nurses. They feel they'll be more respected that way, even if they make less money. I'm envious of the autonomy they have."
"You know what I hate most? It's when people say, 'Oh, you're a nurse, isn't that nice. They don't say that to doctors."
"It's funny how they want us to take even more of our time to write down how much of our time our tasks take."
She remembers the personal power she felt almost two years ago when she entered the medical world as a genuine medical professional, and she can recall that inner voice that told her that she had been granted a special invitation into others' private lives. Some people had been grateful for her presence, had turned to her in need and desperation, while others had withdrawn from her as time and illness advanced. Like Arthur, they increasingly had used her as the target for their frustration. The more control they lost, the more they tried to control her, the more distance they put between themselves and her. Eventually they couldn't remember her name. Then she would find herself withdrawing, too. Mustering sympathy became more difficult.
"I don't see them (doctors) with the patients very often. They're always in the charts. The patients ask me so many questions that I can't help feeling there's a communication breakdown somewhere. It seems like there are about sixteen people between the patient and the doctor."
On the whole, though, the SICU nurses, in concert with their peers elsewhere, express the same standard complaint; too much to do, too little time to do it, too few people to get it done.
"The trouble with academic types... is that they lose their trench perspective. Teaching skills and doing skills are different. The more they move into teaching, the further away they get from doing. You get to resent it when the CNS (clinical nurse specialist) comes up to you after four hours of horror in the trenches and suggests that you should try doing something a different way."
Staff nurses see the caretaking functions of nursing, the very functions that attracted them to the profession in the first place, eroding day by day due to an onslaught of managerial and fiscal priorities. And they don't like it.
At the end of a day, most professionals, businesspeople, service workers, and artisans will have gone about their daily affairs without so much as a glimpse or thought of death, but nurses will have thought, seen, and felt its constant presence by the end of every day. No one, not even physicians, will have been exposed to it so unremittingly.
Often it is the climate of emergency and high pressure that is apt to precede death, more than the death itself, that takes a toll on them. They have learned to accept the inevitability of death, to regard it more as destiny than tragedy. They mourn it, but they don't personalize it. They understand that disease can be a force more powerful than human ingenuity and modern technology combined.
"I struggle more these days with feelings of futility than with feelings of grief."
The closer she comes to the suffering of others, the further she travels from her own. Usually the only conscious reason she voices for choosing to be a nurse is her desire to be helpful to suffering people, but that is partly an illusion. What she doesn't know and doesn't say is that continuous caregiving is a selfless activity that affords her an extra layer of protective coating against experiencing her own personal pain.
No matter what strategies we as a society devise to counter it, the truth is that capitalism and caring for the sick are incompatible marriage partners.
Exhaustion and stress were such intrusive visitors to her daily life that they sometimes made her feel that she had nothing left for caring.... Too few nurses, not enough money, more and sicker patients, and who cared anyway? Do politicians care? Do hospital administrators? Some of them, perhaps, but not enough to make a difference. Do voters care? Do patients care? ...it looked as if not caring was spinning so far out of control that if nobody else was going to care, why should they? But put the nagging questions to sleep for awhile, and in the morning these nurses care again. Can't get away from it. It always comes back, this caring business; like it never really left, just felt like it did. It's in a nurse's bones and blood.
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