London Listening

I love coffee shops. I love hanging out and listening to conversations in coffee shops. To me, such eavesdropping provides rich information about a place and its people.

Recently, I had the privilege of returning to London for work and had ample time to hang out and listen to what Londoners were sharing with their coffee and tea-mates. Brexit was, of course, a big topic of conversation with many people saying things such as, “I’m sick of hearing about it. The world is sick of hearing about it.” But there were more fascinating comments that have stayed with me.

A young man in a black turtleneck sweater was talking with his girlfriend in a small East London coffee shop. This was close to a series of major low-income and ironically named ‘housing estates.’ As his girlfriend sat down and he had greeted her, he said, “Deracinated. That’s a new word I learned today. It means uprooted, but whether or not that is forcibly uprooted I am not sure. Deracinated sounds violent though.” He asked his girlfriend what new word she had learned and she said, “neighborliness.” He replied (with a snort), “Neighborliness is so very middle-class. People where I live are nice but they don’t really help each other. Well, they do have a community garden so that’s something. You’re all basically living on top of each other so you may as well be friends.”

Later that same day, in an upscale coffee shop in Bloomsbury, a grey-haired British philosophy professor (he was quite proud of this fact so he worked it into his conversation several times) said to an older American couple, “In America, immigrants assimilate much better than they do here–or in any other country in the world for that matter. Here, they stay with their own kind and don’t mix in very well and then they cause all sorts of problems.” (This comment had to do with the Brexit anti-immigration undercurrent.) Then, he went on a tirade about the MeToo movement—”What were you in America thinking when letting those men-haters loose to wreck havoc on innocent men who lost their jobs just for looking at women the wrong way? Toxic masculinity and preferred pronouns and all of that is pure bunk!”

Coffee shops, public parks, public libraries are all examples of what sociologist Ray Oldenburg termed “third places”—not home and not work, but rather the public square or communal living room of a community. Such third places are important for civic engagement, democracy, developing a healthy sense of place and of belonging for a diversity of people. They foster conversations across differences and can help to support mental health and well-being. In my experience, the East London coffee shop was such a third place, while the snobbish—and toxically masculine—Bloomsbury cafe was decidedly not a third place.

Let the Light In

Doorway Community Cafe

“Is there still a will in this country to make things better?” Ben Danielson, MD, director of the Seattle Children’s Odessa Brown Clinic asked this question a few days ago in a nursing course I co-teach. His question resonates with me as I firmly believe that we all have the responsibility to leave things better than we found them. It is all too easy to complain bitterly about a situation we find distasteful but not work to improve things.

That is why I am grateful for our interprofessional Doorway Project team, youth serving agencies, and the young people in Seattle who are working to bring the dream of a community cafe to reality. The photo above shows the iterative design rendering of the cafe space, along with Seattle sunshine coming through the imagined (and real) skylights from our pop-up cafe event this past week. The sticky notes have additions from participants. Their suggestions include such as a rooftop community garden, music, a small shower—and stuffed animals to hug.

Our Doorway team is tasked with the lofty goal of ending youth homelessness in Seattle’s University District. We’re doing this by working with young people who are “experts by experience”—and with the wider community—to design a community cafe space where everyone is welcome. And where young people are valued for who they are and for what they bring to the table: music, artwork, poetry, storytelling, and more.

Dr. Danielson admonished our students in class this week to “not be shy about stealing good ideas,” pointing out that things we think of as innovative have usually been done before. For the Doorway Community Cafe we are building on the model of the Merge Cafe in Auckland, New Zealand, as well as the Open Door Cafe in Edinburgh, Scotland. The work of our students and young people from the community on the Doorway Project gives me hope for the future.

When Nursing Bores Me to Tears

While there is much that I love about nursing and about being a nurse, there are times when it bores me to tears, times when I feel I have been dropped down a rabbit hole time warp, times when I despair for its future. My current list includes:

  1. When the Cult of Florence Nightingale is invoked as the one and only true vision of modern nursing;
  2. When busy (and boring) Powerpoint slides are used as props to make any and all (mostly vacuous) statements;
  3. When nurse academic-types staunchly defend an old, tired, narrow-minded, biomedical model of ‘nursing research’ as the one and only true version of research;
  4. When older, privileged white women (who seemingly are blithely unaware of their privilege) are nursing’s chosen leaders and spokespersons.

There are effective antidotes to this despair and I will share my list in a follow-up post.

Yes, Virginia, Slavery Was Real

And yes, Virginia, your deeply entrenched legacy of racism is showing. It is ugly and the way you are addressing it (I’m talking to you, Governor Northam) is exasperating and shameful.

I am a Virginian. I was born and raised in Richmond, Virginia; was (moderately) educated in its Hanover County public schools (Battlefield Park Elementary School, Stonewall Jackson Junior High School, and Lee Davis High School—need I say more?); and, I received my nursing degree from the Medical College of Virginia. Oh yes, and I was married and had my son there. I was a Virginia resident for the first thirty years of my life. I worked with former white (and blatantly racist) classmates of Governor Northam.

This past week I have had colleagues and even (non-Virginian) family members ask me if this whole “blackface and KKK garb” at college/medical school parties and even in yearbooks was really that widespread in the 1980s. Of course it was. Does that make it okay? Of course not. Everyone knew how hateful and racist it was.

Governor Northam is showing his true white male supremacist color in how he is handling the ‘outing’ of the blackface/KKK garb photo on his medical school yearbook page. Promising to read Ta-Nehisi Coates, as if that will provide the ‘magical negro’ cure for his own racism? Digging his heels in (because he can) and proclaiming, “I’m not going anywhere” and that he “has grown” over the past week of controversy? How he is acting now is the true measure of the man—and of the state of racism in our country.

Stories Beget Stories

Stories beget stories, so be careful of the ones you tell—or listen to or share.

This past week I was a participant in the StoryCenter‘s webinar “Defining Compassion in Nursing” based on the Nurstory digital storytelling project founded by Dr. Sue Hagedorn from the University of Colorado School of Nursing. I was intrigued by the title of the webinar as well as by the opportunity to learn how digital storytelling is being used in nursing education and advocacy.

Digital storytelling (DS) refers to short video segments (typically 3-5 minutes in length) personal narratives that incorporate digital images, music, and voice-over narration by the person making the video. They are typically created within a workshop-based process that includes a Story Circle to share, critique, and refine stories-in-progress. Developed in the early 1990s by media/theater artists Dana Atchley and Joe Lambert and promoted through their StoryCenter (formerly the Center for Digital Storytelling), DS has been used for public health research, training, and policy campaigns (such as the powerful Silence Speaks global women’s health/human rights campaign); community building (such as the now archived BBC Capture Wales program); literacy programs; and reflective practice with health science students. DS is increasingly used as an innovative community-based participatory method that is especially effective at informing program planners and policy makers about the lived experiences of marginalized people.

Besides the fact that not all stories can or should be told in a nice, neat, linear 3-5 minute format, there are numerous ethical issues to consider. A brief overview of some of the ethical issues with DS is included on the StoryCenter website under “Ethical Practice in Digital Storytelling.” And, with their permission, here is an excellent overview by Kelsen Caldwell (formerly in the University of Washington School of Medicine, Health Sciences Service Learning and Advocacy group) of ethical considerations of storytelling in health advocacy work with communities: “The Ethics of Storytelling.”

I have worked with groups of people experiencing homelessness, as well as with health science students working on community-based service-learning projects that include homeless people, and have helped them to make some of their own DS videos. I completed a participatory digital storytelling video workshop in August, 2015 with a group of homeless youth through the Zine Project Seattle (sadly, no longer in existence). With their permission I share links to two of their videos here: “Harm Reduction is Good” and “Tug of War.”

“Soul Stories: Homeless Journeys Told Through Feet” is a DS video I made to accompany a show of my photographs and poems/prose that then became the book, Soul Stories: Voices From the Margins (2018). Also from this book, I made “Listen, Carefully” (at 7 minutes a bit long for a DS). In a StoryCenter workshop at the University of Washington, Bothell campus during the summer of 2016, I made my “Homeless Professor” digital storytelling video which was based on a portion of my medical memoir, Catching Homelessness: A Nurse’s Story of Falling Through the Safety Net (2016). My very first DS video I made was “My Story of Community Health Nursing” that I continue to use in teaching population/community health nursing. In reviewing these DS videos, I am struck by their staying power and relevance for me. Although technically rough in places, they tell stories I want to share.

I have concerns about how empathy and compassion are defined by nursing and how we as nurse educators have our own unpacked, unexamined, uncritically looked at stories of what nursing should and should not be. Who gets to decide what is a “proper” nurse story of compassion? Shouldn’t it more properly be Nurstories instead of the singular Nurstory? That said, after viewing all of the DS videos on the Nurstory website, I am struck by how powerful and even subversive several of them are. Rawaih Faltatah’s “Circle of Care” is an ode to her older sister, a nurse, and the effects of her caring and compassion on her own life and choice of a career in nursing. A more difficult to watch and listen to, yet subversive and important DS video is “Invisible Touch” by Kate Clayton-Jones.

Stories We Don’t Tell—And Should

Which stories within health care are told, are shared widely, and which are not? Who holds the talking stick power to tell their stories and have them listened to? The ethics of storytelling about health, illness, and healthcare experience is an important and overlooked aspect of medical and public health ethics.

One current event case in point: The NYT editorial board published a compelling piece this past week, “How to Inoculate Against Anti-Vaxxers.” They highlight the fact that the World Health Organization has added vaccine hesitancy (or outright refusal) as one of the top ten global health threats for 2019. And they point to the outsized power of the singular (and scientifically inaccurate) stories of anti-vaxxers who use emotionally-charged personal anecdotes of the “horrors of vaccination” to persuade people not to vaccinate themselves or their children.

Not included in this opinion piece is the fact that this is a significant health equity issue since the overwhelming majority of anti-vaxxers are affluent white people (a story that needs to be told). Hence, the current event here in the Pacific Northwest of Portland, Oregon (the whitest city in the US) being the epicenter of a large measles outbreak—because Portland is a hot spot of anti-vaxxers. Washington State Governor Jay Inslee has declared a public health state of emergency over the measles outbreak that has spread from Portland into southwestern Washington State and now up to Seattle.

Something else that is not talked about—a story not told—is the fact that so many naturopaths and other alternative/complementary medicine practitioners are actively anti-vaxxers themselves and pass this on to their patients.

Nurses play an outsized and important role in educating people—especially parents—about the benefits of vaccinations. As the NYT article points out, the vast majority of parents who are vaccine hesitant are open to conversations with healthcare providers about the risks and benefits of specific vaccines. Taking the time to listen to their concerns and answer their questions—using motivational interviewing techniques—can help lead to a healthier future for everyone. Nurses and other healthcare providers can tell true stories of all the uneventful vaccinations that led to healthy children.

Feminist Nurse: Not An Oxymoron

Nurses Build Trust Not Walls. Women’s March on Seattle, 2017.

One of my first patients was a suffragette poet. She was 102 in 1981 when I cared for her in a Presbyterian nursing home in my hometown of Richmond, Virginia. I was a recent Harvard Divinity School drop-out working full-time as a nursing assistant, wrestling with the decision of whether or not I wanted to be a nurse. I was—and still am—a feminist. I was not sure I could be both a feminist and a nurse. Nursing seemed anti-feminist, steeped in the traditional subservient roles to which women were relegated.

I’ll call her Lillian because in my memory she stands out as steely kind and sharply intelligent as I imagine Lillian Wald, the founder of public health nursing, to have been. As a young woman “my” Lillian had met and worked with Susan B. Anthony. “My” Lillian had marched in suffragette demonstrations in Washington, DC and had written suffragette tracts and poetry and lobbied hard for passage of the Nineteenth Amendment in 1920 that finally granted women full voting rights. She never married and spent the rest of her life as a Presbyterian missionary in various African countries. Being a missionary was one of the few acceptable roles for single women at that time, along with nursing and teaching. (The drawing below is from my paternal grandmother’s 1919 college journal showing the “choices” she was considering for her life—ranging from Old Maid to Bride.)

In my research this past week I ran into an article written in 1904 in Seattle by a man named Honor L. Wilhelm. In between his serialized stories of his honeymoon to Victoria, BC, and guest articles on Native Americans, he wrote a piece titled “The Girl Alone” that made my feminist blood boil. He stated, “Motherhood is the acme of womanhood. The girl alone is a sinful, selfish, miserable, abhorred, ugly, wretched, hideous creature, whom to know is to shun and to meet is to pass by. She is an outcaste and a social parasite.” (p. 74, The Coast: Volumes 7-10, 1904)

The elderly suffragette poet I was fortunate to have had in my young adult life helped convince me that in becoming a nurse I did not have to trade in my feminist ideals and identity. I mainly worked evening shift at the nursing home. Late at night, once I had completed all my work, I sat beside her bed while she told me stories of her life and read drafts of poems she was working on. She gave me a hand-written poem which I treasure—a talisman of feminism.

A year later when I went back to school for my bachelor’s degree in nursing, I had no feminist nurse professors or role models. The sole feminist nursing student I knew dropped out of school in disgust after our first semester. I wish I had known about the work of feminist nurse Peggy Chinn and her colleagues who had just started Cassandra: Radical Feminist Nurses Network. Dr. Chinn’s work continues, including through her NurseManifest Nursing Activism Project. And the next generation of feminist nurse activists have started the Radical Nurses group.

March on. We still have so much work to do to help make our world a safer, healthier, more equitable place for all.