A Cheeky American Nurse

P1020873Immersion experiences in another country, another culture, can bring out the best—and the worst—in people. While living abroad you cannot help but make moment-by-moment comparisons between where you find yourself and where you call home. Seemingly little things: if they drive on the left instead of the right as they do at home, which side of the sidewalk should you walk on? (Answer, at least here in the UK: there are no sidewalk etiquette rules. Expect complete chaos.) To deeper comparisons such as “Why are all British nurses forced into one of four possible specialties (Adult, Pediatrics, Mental Health, and Learning Disabilities) from the very beginning of their education?”  Is this Florence Nightingale’s legacy?

As a cheeky American nurse (and nurse educator) living and working in the UK, this British approach to nurse education is something I sincerely hope that American nursing never tries to adopt. There is much to admire about the UK healthcare system, with the prime example being the existence of the NHS—although imperfect, as are all healthcare systems, it is much loved and functions so much better than the US healthcare ‘system.’ It occurs to me as ironic that while the US healthcare system is more fractured than the British NHS, British nurse education is more fractured than is ours in the US. Or at least that is how it appears to me.

This British nursing forced specialization practice is a holdover from the days (not so long ago here) of hospital-based apprenticeship, diploma-level nursing. Of course, in the US, we have also had this form of nurse “training” that is fast being phased out. In the UK, there continue to be debates about the value of a higher education degree for nurses, with some people arguing that university degrees are responsible for the apparent diminishment of empathy among British nurses. Empathy cannot be taught, but it certainly can be encouraged and modeled. I do wonder: how well can that happen in any nurse education model based primarily on traditional lectures with a class size of upwards of 700 (or more) students and multiple cohort intakes and graduations each year? That is the current reality of nurse education in the UK. Mass marketing of (or attempts to teach) empathy not only do not work—they have the opposite effect.

Notes:

  • The photograph included with this blog post is one I took in London last month at the excellent Wellcome Collection Museum. Even if you cannot visit this museum in person, check out their website for amazing online resources, including their six-part series, “The History of the NHS.” 
  • Although I am currently situated at a UK School of Nursing, I first learned about the strange (to me) structure of British nursing from two non-fiction/memoir books: 1) The Language of Kindness: A Nurse’s Story, by Christie Watson (London: Chatto and Windus, 2018 and 2) One Pair of Feet, by Monica Dickens (yes, related to ‘that’ Dickens), (Middlesex: Penguin, 1946). Monica Dickens’ book is based on her brief stint as a hospital nurse apprentice during WWII. Christie Watson’s book is based on her twenty years’ work as a pediatric nurse in London hospitals. I highly recommend Watson’s book, but not the one by Dickens unless you are a WWII buff of some sort.

Empathy: Walk in My Shoes

IMG_4999Shoes are powerful markers of a person; shoes tend to hold the presence of the person who has worn them. In The Year of Magical Thinking, Joan Didion addresses this phenomenon. After the death of her husband from a massive heart attack, she finds herself holding on to his shoes. She writes, “I could not give away the rest of his shoes. I stood there for a moment, then realized why: he would need his shoes if he was to return. The recognition of the thought by no means eradicated the thought.”*

(…) It was the red sneakers Essie was wearing that drew me to her at the women’s shelter earlier that day. This was the second time in the past several months I had run into Essie at one of our foot care clinics. She wore an orange polyester shirt with a green chiffon scarf tied around her dreadlocks, a pink pleated skirt down to her ankles, and the red sneakers. She told me she only dressed in bright, Caribbean colors: “They keep me happy. I can’t be all down in the dumps when I got these colors on.” Essie had a perpetual and slightly crooked smile, the crookedness perhaps the residue of a stroke.

The women’s shelter is located in a church basement in downtown Seattle near the main shopping district. It is a day shelter, a safe zone for women and children, that serves homeless and marginalized “near homeless” women, especially women dealing with domestic violence. The shelter has multiple case managers, social workers, and volunteer nurses who try to connect women with health, housing, and social services. The shelter workers lend the women a hand, bend an ear to hear their problems, offer a leg up the socioeconomic ladder, a toehold on life. Empathy is their main tool. Empathy is what we try to cultivate in our health science students.

Empathy is “feeling with” as opposed to “feeling for,” which happens at arm’s length sympathy. “Walking in another person’s shoes” is how empathy is most commonly described. But can we ever walk in another person’s shoes? And is it always a good thing to try?

* quote is from Joan Didion, The Year of Magical Thinking (New York: Vintage International, 2006), p. 37.

Note: The above excerpts are from my essay, “Walk in My Shoes” in my book Soul Stories: Voices from the Margins (San Fransisco: University of California Medical Humanities Press), pages 11-12.

Why Write?

IMG_3502
From the 2017 Northwest Network for Narrative Medicine Conference, Portland, Oregon

Recently, in a writing workshop on social justice issues, I was given a copy of Terry Tempest Williams’ essay “Why I Write” and in response to the reading of that brief essay, was given the writing prompt, Why do you write?

A simple enough (and in some ways too simple, as in a middle school level) writing assignment, but one that I happily took on. Beside my desk at home hangs an excerpt of George Orwell’s 1946 essay, “Why I Write.” In this essay he includes a list of “four great motives for writing” and they include (here in abbreviated form):

  1. “Sheer egoism. Desire to seem clever, to be talked about, to be remembered after death, to get your own back on grownups who snubbed you in childhood, etc., etc.. It is humbug to pretend that this is not a motive, and a strong one.
  2. Esthetic enthusiasm. Perception of beauty in the external world, or, on the other hand, in words and their right arrangement. (…) Desire to share an experience which one feels is valuable and ought not to be missed.
  3. Historical impulse. Desire to see things as they are, to find out true facts and store them up for the use of posterity.
  4. Political purpose—using the word ‘political’ in the widest possible sense. Desire to push the world in a certain direction, to alter other people’s idea of the kind of society that they should strive for.” pp. 312-313 in, A Collection of Essays by George Orwell, London: Harcourt, Inc. 1946.

So here is my prose poem, “Why I Write”:

  1. I write because my fingers are ink-stained. I write because if I don’t, my pen will explode.
  2. I write to make sense of the world. I write to court chaos.
  3. I write until the rivers of my mind run clear. I write until glyphs are superfluous babble-brook praise.
  4. I write unless there are enough reasons not to. I write unless it is unsharable, and then it stays inside, inscribed, worm-tracing scars.
  5. I write journals, research proposals, reports, patient chart notes. I write poems, blog posts, essays, chapters, books, and marginalia.
  6. I write personal mission statements. I write to humanize health care for patients, providers, and communities.
  7. I write my name. I write my different names beneath the kitchen cabinet of my childhood.
  8. I write because I was here. I write because I am here.
  9. I write to remember. I write to forget.
  10. I write. I am a writer.

I opened this post with a reference to the social and environmental justice writing of Terry Tempest Williams. I close with one of my favorite passages of her writing that I stumbled upon this summer. It is from her book An Unspoken Hunger: Stories from the Field (Vintage, 1995). It reminds me of why I write; it reminds me of the importance of women writers in our world:

“As women connected to the earth, we are nurturing and we are fierce, we are wicked and we are sublime. The full range is ours. We hold the moon in our bellies and fire in our hearts. We bleed. We give milk. We are mothers of first words. These words grow. They are our children. They are our stories and our poems.” p. 59

 

 

Find and Defend Our Quiet Places

P1020274
Summer 2017 solar eclipse in Seattle.

Summer is an excellent time of year to focus on finding and defending our quiet places—not so much hammock, family reunion, and beach time (although those are important), but quiet places necessary for reflection and evaluation.

Reflection and evaluation are both terms we banter around and oftentimes use lightly and imprecisely. So, turning to the clarifying Oxford English Dictionary:

Reflection; Senses relating to mental activities

a. The action or process of thinking carefully or deeply about a particular subject, typically involving influence from one’s past life and experiences; contemplation, deep or serious thought or consideration, esp. of a spiritual nature.

Evaluation

1. The action of appraising or valuing (goods, etc.); a calculation or statement of value.

But turning to a different source, from Maori community activists Tamati and Veeshayne Patuwai (husband and wife powerhouse duo), I learned that in Maori the terms for evaluation and reflection are combined. Several years ago when I visited them at Mad Ave* in Auckland, New Zealand, they told me that the Maori word for evaluation means, “To go to a still pond, reflect, be still, look closely, and then tell the truth—first, to ourselves and then to others.”

No matter what our work, professions, families, and communities may be, pause a moment to consider how much better we’d all be if we could find and defend our quiet places. And then tell the truth, first to ourselves and then to others.

__________________

*Mad Ave in Auckland, New Zealand has been instrumental in finding creative, asset-based youth and community-building solutions in an area of North Auckland that had received the negative label of “Mad Ave.” They have the terrific tagline “Activating Community Potential by Any Means Necessary.” Here are some photographs of their work that I took in September, 2015. Community wellbeing through haiku, monster makery, stream restoration, music-making, and public art. That suspended metal bird sculpture in the community/town square is an indigenous version of our Western phoenix rising from the ashes.

 

Summer Reading Challenge 2018

IMG_4854This is the third installment of my annual summer reading challenge with a social justice (and feminist) slant. These ten library books include ones related to my current research and writing project, Skid Road: The Intersection of Health and Homelessness, as well as works by women authors I am delighted to discover. Here they are in the order (bottom up) they appear in the photograph. Happy—and meaningful—summertime reading!

  1. Race and Medicine in Nineteenth and Early-Twentieth-Century America, by Todd L. Savitt (Kent, Ohio: The Kent University Press, 2007).
  2. Tuberculosis and the Politics of Exclusion: A History of Public Health and Migration to Los Angeles, by Emily K. Abel (New Brunswick, New Jersey: Rutgers University Press,
  3. Imperial Hygiene: A Critical History of Colonialism, Nationalism and Public Health, by Alison Bashford (New York: Palgrave Macmillan, 2004).
  4. Body and City: Histories of Urban Public Health, edited by Sally Sheard and Helen Power (Burlington, Vermont: Ashgate Publishing Company,  2000).
  5. Good Woman: Poems and a Memoir 1969-1980, by Lucille Clifton (Brockport, New York: BOA Editions, Ltd., 1987.
  6. Woman’s Place: A Guide to Seattle and King County History, by Mildred Tanner Andrews (Seattle: Gemil Press, 1994).
  7. Whose Names Are Unknown: A Novel, by Sanora Babb (Norman, University of Oklahoma Press, 2004).
  8. How to Suppress Women’s Writing, by Joanna Russ (Austin: University of Texas Press, 1983).
  9. Half a Yellow Sun by Chimamanda Ngozi Adichie (New York: Anchor Books, 2007).
  10. Purple Hibiscus, by Chimamanda Ngozi Adichie (New York: Anchor Books, 2003).

Stories Matter

IMG_2227

“Stories matter. Many stories matter,” states author Chimamanda Ngozi Adichie in her powerful TED talk “The Danger of the Single Story.”  Adichie points out that listening and clinging to a single story—about a person, a place, a situation—creates stereotypes, and, in her words, “the problem with stereotypes is not that they are untrue, but that they are incomplete. They make one story become the only story.” She goes on to say, “The consequence of the single story is this: it robs people of dignity; it makes our recognition of our common humanity difficult; it emphasizes how we are different rather than how we are similar.”

I thought about Adichie’s wise words earlier this week as I moderated a hospital-based panel discussion on service provision and community advocacy to end commercial sexual exploitation and sex trafficking. The panel and the day-long training for health care providers included personal stories of survivors of sexual exploitation. None of the survivors remotely resembled Julia Roberts in the “modern Cinderella story” movie Pretty Woman, which reinforces the common stereotype of the high-class and empowered hooker. Instead, the survivors told stories of trauma and violence which both preceded and accompanied sexual exploitation.

In my introductory talk about why this topic matters, I linked to an important storytelling video geared towards healthcare providers on The Life Story website, “Medical Emergency.”  I appreciate how this particular video weaves together the stories of women in their own voices. Advocacy is not about speaking for those less fortunate, less powerful, but of using our own power and privilege to amplify their voices, their stories. Our job as healthcare providers, as compassionate citizens, is to step back and listen respectfully.

Another powerful story came to me today via a colleague who sent me the link to this NYT Op-Docs Season 6 video “We Became Fragments” directed by Luisa Conlon, Hanna Miller, and Lacy Jane Roberts. Through their video, they step back, listen, and then amplify the voice and words of Ibraheem Sarhan, a young Syrian refugee now living in Canada. I love how this short video highlights the importance of competent and compassionate, trauma-informed teachers and healthcare providers. When one of Ibraheem’s teachers gives an in-class assignment to write about their family, the teacher gently points out to Ibraheem that he doesn’t have to write about his family if it is too painful a topic. The teacher must know that a bomb in Syria killed Ibraheem’s mother and siblings and left him with a shattered leg. Ibraheem tells us that when people ask him about his visible leg injury, “they don’t know how much my heart burns when I tell my story.”

Stories matter to the teller and to the listener. What we need more of in this world is for all of us to increase our capacity to listen to a multiplicity of stories and within those stories to recognize our common humanity.

 

 

Worksite Metaphor

IMG_2562This past week I spent time cleaning my office at work, recycling (shredding) the detritus of an academic life: tenure and promotion materials,  teaching evaluations, student papers, and my own papers. I do this periodically to ensure there is never too much of me—of my identity—at work, not from a pathological paranoia, but rather from a desire to maintain healthy boundaries. Or at least that is what I tell myself.

But during the cleaning and sorting I found a hand-written draft of a prose poem that I wrote many years ago during a workshop I taught on narrative medicine. It was in response to a close read and discussion of Jane Kenyon’s poem “The Sick Wife” and her husband Donald Hall’s poem “The Ship Pounding.” As Carol Levine writes in “Two Poets: One Illness,” the poems “…offer a rare view of the same illness from the perspective of the patient (Jane Kenyon) and her husband and caregiver (Donald Hall), both distinguished poets.” (Journal of General Internal Medicine, March 2010, 25(3): 275-275.)

In Hall’s poem he uses the metaphor of a ship to describe his experience in the hospital when his wife was sick. He concludes with describing the hospital as “the huge vessel that heaves water month after month, without leaving port, without moving a knot, without arrival or destination, its great engines pounding.” I used as an accompanying writing prompt for workshop participants to write a description of their own metaphor for their particular work site. What is your metaphor for your own work site? Here is what I wrote (and found while cleaning my office—and have now shredded):

Dusty, moldering storage closet

door with stuff behind

forgotten cast-offs

old files labeled for people and departments and programs that died long ago

textbooks for subjects that are no longer taught

a ceramic statue of Florence Nightingale holding her lamp

beside a bowl of nectaries

people who have retired but won’t leave

people who should retire 

computer parts, old landline phones, stenographic paper

which is what exactly?

My office—bare–no books

A few seashells

I can leave, clear out in a moment

Not closed inside a storage closet.