Here is my “Perspective” on hospital chaplains and health humanities, published in the most recent issue of the Journal of Medical Humanities. The photo above is of a sketch I made of the “park bench individual” included in my poem “Waiting” included in the brief article.
Josephine Ensign (1,2,3)
Now, thirty-two years after graduating from the Medical College of Virginia/Virginia Commonwealth University School of Nursing (BS ‘84) in my hometown of Richmond, I can safely say that the single most important course I took in nursing school was not in nursing. Rather, it was a health humanities and medical ethics course taught in the School of Medicine by a hospital chaplain, Reverend Bob Young. Reverend Bob focused this course on death and dying, and he used a small weekly seminar format with a literary reading and writing group. There were approximately ten students, all first- or second-year medical students, except for me. I was in my first year of undergraduate nursing school and was struggling to avoid both failing and dropping out. I despised nursing school with its antiquated emphasis on rote memorization and rigid hierarchical hospital practice. I vowed never ever to teach or to go near a nursing school again once I graduated.
Now (again), after twenty-one years teaching undergraduate nursing courses at the University of Washington in Seattle, I can safely say that Reverend Bob’s health humanities course is the single-most influential course on my own teaching and healthcare practice. For Reverend Bob’s health humanities course, we completed a final portfolio of poems and prose we had written over the semester as reflection on the course content and on our own personal and professional lives. At twenty-one years of age I wrote some overwrought poems, including one about a baby bird dying in my hands after it had been mauled by my dog. But I also wrote several poems that, if not good by MFA standards, are poems that have stayed with me and helped guide my hands, head, and heart over the many years since I wrote them. Like this one titled “Waiting”:
Sitting on park benches
Wringing their hands
Trying to forget the ill one inside
That hospital there.
The building you just stepped out of
The one you walk by every day
That structure has become a part of the skyline
Seen from the window of a dorm room.
It is a lab, a place to practice
The proper way to give drugs
To make beds
To become a nurse.
But reflected in the eyes of the park bench individuals
The building becomes
Reverend Young gave me an A-plus for the course. But the grade doesn’t matter as much as the lasting solace his course has given me over the many years of my work as a nurse—and as a nurse educator. Thanks to all of the important hospital chaplains out there—no matter what their faith or spiritual persuasion. And thanks to everyone who works hard to put the human back in health care and in health professions education.
Josephine Ensign, FNP, MPH, DrPH
Associate Professor, University of Washington School of Nursing in Seattle
Affiliate Faculty, University of Washington Simpson Center for the Humanities,
Certificate Program in Public Scholarship
Medical College of Virginia/Virginia Commonwealth University School of Nursing (BS ’84)
Josephine Ensign email@example.com
School of Nursing, University of Washington, Seattle, Seattle, WA, USA
Certificate Program in Public Scholarship, University of Washington Simpson Center for the Humanities, Seattle, WA, USA
Richmond, VA, USA
School of Nursing (BS ‘84), Medical College of Virginia/Virginia Commonwealth University,
Open Access .This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.
(Note: parts of this Yale School of Nursing 2017 commencement speech were adapted from the chapter “Soul Story” included in my forthcoming book Soul Stories: Voices from the Margins.)
Good afternoon. Thank you Dean Kurth, and all the faculty, staff, students, and the friends and family members of today’s graduates, for this opportunity to speak to you about a topic I am passionate about: nursing. But not traditional nursing—not the Lady with the Lamp during the Crimean War—and not the white uniform-clad nurse angel of Hallmark moments. About that nurse angel, to paraphrase Virginia Woolf and her similarly stifling angel of the house: whenever you feel the shadow of her wings or the radiance of her halo, take up the inkpot or whatever modern equivalent is nearby and fling it at her. Because nurses are flesh and blood people. Nurses are not supernatural beings. We, as nurses, are human beings. Today, I want to talk to you about the real life transforming and transformational nursing of which you are all a part. I want to talk to you about radical nursing. And about the radical self-care it takes to be a radical nurse.
Radical. Not necessarily in the political use of the word. Instead, I mean radical, in the OED definition “of or relating to a root or roots—fundamental to or inherent in the natural processes of life, vital.” It is derived from the Latin radicalis, which referred to “the moisture or humour once thought to be present in all living organisms as a necessary condition of their vitality.”
What feeds and waters your soul? What draws you to the work that you do?
The question of what draws us to the work that we do as nurses is an essential one. It is a radical one. It is a question which demands from us the act of digging deep through the layers of our being, down into the root system. It demands from us the time and space necessary to examine and then continue to re-examine our answers as we move through life. It demands the use of the arts and humanities in order to explore fully. The tools necessary to do this digging are not included in your nursing science toolkit. They are included in your arts in nursing and creative writing awards program led by Dr. Linda Honan. They are included through the meditation, yoga, and other self-care opportunities you have had here at the Yale School of Nursing. They are included in the creative pursuits you brought with you into nursing and that hopefully you have continued to nurture.
Because if we don’t attend to the work of that question—of what draws us to the work that we do— it often becomes an Achilles’ heel, tripping us up, making us lame. If we are not careful, the root of our passion for our work can become the biggest source of professional burnout.
I know this from personal experience. I have burned out—flamed out—rather spectacularly at least once in my career as a nurse. I now know my own particular set of warning signals for when I am beginning to get crispy, and I have worked out an action plan consisting of a short list of self-care that for me includes creative writing, and “real” books (not textbooks), and libraries, and more time in nature and with my family and friends.
I’ll tell you a condensed version of my cautionary tale about my first and worst experience with burnout. I wasn’t able to really think about this episode of my life until more recently as I began to write about it—creatively and reflectively.
A few years ago, I was in New York for a week to attend the narrative medicine workshop at Columbia University. I was there to learn ways to incorporate the stories of health, healing, and the human condition into my work. After the workshop was over, I spent a Sunday walking the length of Manhattan in flip-flops, which was a very silly thing to do since I ended up with a badly infected blister on the bottom of one foot.
But as I walked through Manhattan, I pondered questions that had been flashing through my head like an existential version of the NASDAQ sign in Times Square. Why am I attracted to the suffering of others? Why have I spent the past thirty years working as a nurse with homeless and marginalized people? Would I be happier—and able to afford a better pair of shoes—if I was drawn to work as a shoe buyer for Saks Fifth Avenue? The latter question occurred to me as I hobbled past the wrought-iron festooned display windows of Saks’ flagship store.
In one of our last narrative medicine workshop sessions we were asked to, “write about the last real thing that happened to you.” My last real thing had occurred the week before, during my work in Seattle. I teach health policy to nursing students at the University of Washington. Together with colleagues in the Schools of Medicine and Dentistry I help train and precept groups of medical, nursing, and dental students in the provision of basic foot and dental care for homeless people. The week before my New York trip, we had done one of these Teeth and Toes clinics at Seattle’s largest homeless shelter.
The shelter is in the downtown core of Seattle, at the bottom of the original Skid Road, which earned its name from the frontier town’s cedar logs, public inebriates, and Gold Rush prostitutes that all rolled downhill together into the mudflats and salt waters of Puget Sound. Entering the building, I was hit by the smell of a horse stable, something hay-sweet mixed with urine. The smell took me back to my work at the Cimmerian warehouse of the Richmond Street Center in Virginia, where I began my work with homeless people in the 1980s, and where I rolled down my own version of Skid Road and was homeless for six months.
Later that evening, as I inspected various scars or open wounds on the homeless clients’ feet, my mantra to them became, “What happened here?” Some people had simple replies, such as, “I was in a bad car accident a year ago.” Others were more complex. One patient was a woman dressed in a stained orange t-shirt, her short red hair flying away from florid, puffy cheeks. She stared at the ceiling while mumbling to herself, as if in prayer, her hands held in front of her neck, fluttering. I had the impression she was trying to catch hold of her exposed and scattered soul. Her only reply, while still looking at the ceiling and twitching her hands even faster, was, “I get nervous with too many questions.”
What happened here? is a question I asked myself about my own spiral into homelessness. At age twenty-five I was a respectable Southern preacher’s wife and a newly graduated nurse practitioner, running a health care for the homeless clinic in downtown Richmond. In a photograph of me from this time I’m kneeling on the floor of the clinic, my long straight hair falling in my face, and I’m washing the feet of a bearded Vietnam veteran homeless patient. I mostly worked alone in the clinic, tending to the health needs of thirty or more homeless patients each day for more than three years. I have no photo of myself towards the end of those years when I became a severely depressed divorcee without a job, living in my car and in abandoned sheds. There is no coherent story of this time, no map recording my journey, no facile answers to the question of what happened, only a mosaic of metaphors: rolling down Skid Road, falling into the rabbit hole, exposing my scattered soul, eating myself with rage—and flaming out. In retrospect, I see that my descent was partially caused by an extreme case of professional burn out, something nurses are especially prone to.
The term “professional burnout” comes from Graham Greene’s novel A Burnt-out Case, set in a Colonial British Congo leprosy clinic staffed by an atheist physician and Catholic nuns as nurses. The physician explains that a burnt-out case is a leprosy patient whose disease has burned itself out: the patient no longer has active leprosy but has the scars such that he or she is unable to re-enter normal life. In a conversation with the Father Superior of the village, the physician tells him of the issue of a leprophil: a person who is attracted to the suffering of lepers—who loves suffering and poverty and illness—a form of schadenfreude. He states that leprophil nurses “…would rather wash the feet with their hair like the woman in the gospel than clean them with something more antiseptic.” He likens leprophils to people who love and embrace poverty. The leprophil “makes for a bad nurse and ends by joining the patients.” The physician tells the priest that a patient can detect when someone loves their disease, their poverty, their suffering, instead of loving them as a person.
Why are people drawn to work with the lepers, outcasts, and homeless of the world? Is it, as the priest states in Greene’s novel, dangerous to ask what lies behind the desire to be of use, for we “might find some terrible things”? This virtuous work or calling or vocation or zeal, whether religious or secular, can feed the Hungry Ghost ego. It can become one’s identity; it can become addictive and destructive. I know this because I became my work and through it I became homeless.
The lesson here is: please do not become your work. That goes for all of us, whether we are graduates or teachers or administrators. In order for all of us to work together to help make our world a better, healthier place for everyone—which itself is a radical idea—it requires radical nurses who practice radical self-care.
Nursing is the largest healthcare profession worldwide, yet continues to have the least direct influence on health policy. Within nursing we have people working in four categories: 1) direct service providers; 2) advocates who help make systems work better for people; 3) organizers who bring people together to change or create new systems; and my personal favorite, 4) rebels—people who speak truth to power and who agitate for radical change. The key is to recognize your own strengths, where you are most comfortable working at any given time in your career—but to also see the value in the range of roles played by different people. Because an effective social change movement and an effective, compassionate, and equitable healthcare system, require people—require nurses—working together in all of these roles.
The Yale School of Nursing may be small, but its graduates have an outsized positive impact on the healthcare system, here in the US as well as globally—and even in terms of planetary health. Graduates: you don’t have big nursing shoes to fill, you have your own shoes, your own important career paths to blaze.
MY HOMETOWN OF RICHMOND, Virginia is a city anchored to its past by bronze and marble Confederate shrines of memory, by an undying devotion to the cult of the Lost Cause. I was born and raised in the furrowed, relic-strewn Civil War battlefields on the city’s tattered eastern edge. A captive of its public schools, I was taught official Virginia history from textbooks approved by the First Families of Virginia. But I came to understand the shadowed history of my state by caring for its homeless outcasts.
These lessons began while I was in nursing school. The modern hospital of MCV curled around the former White House of the Confederacy like a lover. My clinical rotations were nearby in the crumbling brick former colored-only hospital, which then housed indigent and homeless patients as well as prisoners. Most of these patients were black, so I called it the almost-colored-only hospital. The prisoners, shackled to their beds and accompanied by brown-clad armed guards, were from the State Penitentiary located across town. One of my patients was a death-row inmate. When I spoon-fed him his medications, I was simultaneously afraid for my own safety and ashamed of being an accomplice to murder. I knew I was nursing him back to health only to return him so he could be killed by the state. I wanted to talk to him, ask about his family, about his life in and outside of prison, but the stone-faced armed guard loomed over me. I knew from experience not to discuss my ambivalent feelings with my nursing instructor. She considered these to be inappropriate topics. I wanted to finish nursing school as fast as I could, so I kept silent. (From the chapter “Relics” in Catching Homelessness: A Nurse’s Story of Falling Through the Safety Net, pp. 57-58).
These words—my own words— have come back to me this week as I followed the news of contested sites of memory, of whitewashed Civil War memorials literally being fought over once again in places like New Orleans and Charlottesville, Virginia—and perhaps soon in my hometown of Richmond, Virginia. In Charlottesville, white nationalists waved lit torches and chanted “You will not replace us” in front of a statue of General Robert E. Lee in a city park. (source: Associated Press, Washington Post, “Torch-wielding group protests Confederate statue removal” May 14, 2017). New Orleans has begun the removal of four Confederate monuments in the city, starting with the Battle of Liberty Place monument commemorating the Crescent City While League’s violent fight against desegregation of the city’s police force—in 1876 during Reconstruction. (source: Christopher Mele, New York Times, “New Orleans Begins Removing Confederate Monument, Under Police Guard” April 24, 2017).
Richmond, as the former Capital of the Confederacy, likely has the largest collection of statues to Confederate “war heroes” of any city. I took my driver’s test on the then still cobblestoned streets of Monument Avenue, a five-mile long stretch of tree-lined divided grand boulevard punctuated by traffic circles around five towering statues of civil war heroes. A sixth and very controversial statue was added in 1996 at the far western end of the avenue—of native Richmonder Arthur Ashe (1943-1993). Besides being an international tennis star, Ashe was also a civil rights and HIV/AIDS activist, and a champion of urban health equity work. His memorial statue on Monument Avenue portrays him standing, holding books in one hand (he was also an excellent student and UCLA college graduate) and a tennis racket in the other hand. In the statue, he faces west, away from the Confederate statues. When Ashe was growing up in segregated Richmond, he was barred from playing tennis in the city’s whites only parks—and, ironically, he also would have been barred from even walking down Monument Avenue, a whites only residential area.
Since Monument Avenue in Richmond is a designated national park and indeed, is the only national park to consist of city street, it is unlikely that any of the Confederate statues will be removed anytime soon. But perhaps it is time to rename the street Memorial Avenue. This idea comes from University of Richmond professor of philosophy Gary Shapiro in his NYT opinion page essay “The Meaning of Our Confederate ‘Monuments'” (May 15th, 2017). Shapiro points out that records of city planners of the Confederate “war hero” statues on what would become Monument Avenue, “show that they meant to legitimize and dignify the white supremacist regime that had taken hold in Virginia.” He quotes philosopher of art Arthur Danto who states, “We erect monuments so that we shall always remember, and build memorials so that we shall never forget.”
Instructive and remarkably prescient here are words of Henry James, in his travelogue book The American Scene, in the chapter “Richmond” about his visit to Richmond in the late winter of 1905. A late snowstorm prevented him from traveling very far from the center of Richmond, but he describes his walk to the then newly developing Monument Avenue and the statue of Robert E. Lee (erected in 1890). James reflects on his visit to Richmond and writes:
“History, the history of everything, would be written ad usum Delphini—the Dauphin being in this case the budding Southern mind. This meant a general and a permanent quarantine; meant the eternal bowdlerization of books and journals; meant in fine all literature and all art on an expurgatory index. It meant, still further, an active and ardent propaganda; the reorganization of the school, the college, the university in the interest in the new criticism.” p. 374 Henry James, The American Scene (London: Chapman and Hall, Ltd).
My own then budding Southern mind, educated in the Virginia public schools of Battlefield Park (named for the Civil War Battle of Cold Harbor) Elementary School, Stonewall-Jackson Junior High School, Lee-Davis High School—and then VCU/MCV nursing school—was negatively affected by that still-lingering, ardent, white supremacist propaganda. Through my father I am related to Varina Davis, First Lady of the Confederacy. That legacy, and the work that I have done and continue to do to actively resist racism, is something I do not want to forget.
The American Nurses Association has declared this National Nurses Week (May 6-12, 2017) theme as “Nursing: The Balance of Mind, Body, and Spirit” to accompany their designation of 2017 as “The Year of the Healthy Nurse.” To help nurses celebrate the week, a host of businesses are offering “freebies” to nurses, including 1,000 calorie cinnamon rolls. I have nothing against high-calorie baked goods, but to celebrate nurses I recommend books and inkpots. Books, as in real books by real nurses (my current favorites listed below). And inkpots? I explain that in the following excerpt from my upcoming commencement address to graduates of the Yale School of Nursing:
“Thank you for this opportunity to speak to you about a topic I am passionate about: nursing. But not traditional nursing—not the Lady with the Lamp during the Crimean War—and not the white uniform-clad nursing angel of Hallmark moments. About that nurse angel, to paraphrase Virginia Woolf and her similarly stifling angel of the house: whenever you feel the shadow of her wings or the radiance of her halo, take up the inkpot or whatever modern equivalent is nearby and fling it at her. Because nurses are flesh and blood people. Nurses are not supernatural beings. We, as nurses, are human beings. Today, I want to talk to you about the real life transforming and transformational nursing of which you are all a part. I want to talk to you about radical nursing. And about the radical self-care it takes to be a radical nurse.”
I have always bristled at the mention of nurses as angels and included this pet peeve of mine in a previous blog post from January 10, 2016: “Sick Nurses.” So I was delighted to run across a poem, “Killing the Nurse in the House,” by nurse and poet Cortney Davis. I had the pleasure of reviewing her forthcoming collection of poems, Taking Care of Time(Michigan State University Press), which won their Wheelbarrow Books Poetry Prize. This is the endorsement I wrote: “Searing and unsentimental, the poems of Cortney Davis serve as haunting and truth-telling companions. Whenever I am in need of inspiration or of reconnecting with compassion and with all it means to be human, I return to Davis’s ’stories tamed on the page.’ Although, as in her poem ‘The Snake Charmer,’ Davis knows her poems connect us with the wild, untamable places of our lives.” Taking Care of Time avoids the overly religious (to me) themes that have appeared in some of Davis’ recent writing. It will have a permanent place in my home library once it is published.
My current favorite “Real Books by Real Nurses” (and yes, I do include my own and yes, I do realize that this is not a very diverse group of authors and welcome suggestions of books I may not know about):
The opening keynote speaker was Scott Montgomery, a geoscientist and lecturer in the UW Jackson School of International Studies and author of numerous books, including The Chicago Guide to Communicating Science(University of Chicago, 2003). For his talk, titled “A Story in 25 Images,” he practiced what he preaches by using PPT for showing a series of images to accompany a story (with a traditional narrative arc) of his journey as a communicator of science. Most of his images were abstract geology sorts of themes, but the ones that included human images portrayed only white men in suits. Yes, I was wearing my critical feminist academic bonnet, and yes, there were many women and persons of color in the audience. One young female attendee pointed out in the Q&A session that women within the academy face significant barriers, not just to entering science fields, but also to have non-traditional, public-facing and public-engaging scholarly work—barriers faced by men as well but to a lesser degree. And this is not only a gendered, but also a “minoritized” (her term and one that I like) issue.
The middle part of the day’s workshop consisted of panel discussions and break-out sessions focused on various issues of working with the media in all its varied forms—from TV and newspapers to podcasts, blogging, and other types of social media. I moderated a lunchtime round table discussion on academic freedom and public scholarship, two overlapping topics close to my heart. I didn’t share this in the session, but I have had to fight to defend my academic freedom in terms of this blog over its now seven year history. And public scholarship, such as what I do in my work on health and homelessness? It would seem that it is not deemed “nursing science,” whatever that term even means. But hopefully that is a cohort effect that will change for the better.
I was part of the final panel, “Navigating the Path from Research to Public Policy,” along with Dr. Simone Alin from UW Oceanography and NOAA; Washington State Senator Rueven Carlyle;Sally Clark, former Seattle City Councilmember and current Director, Regional and Community Relations, External Affairs at UW; and Tim Thomas, with the Urban@UW Homeless Initiative. The moderator’s question to the three of us panelists who are researchers was, “Can you tell us a little about how you’ve been involved in informing policy-making through your research.” Indeed, I can and I did, including a mention of my medical memoir, Catching Homelessness: A Nurse’s Story of Falling Through the Safety Net, which is research-informed and is written as a policy narrative—policy narrative being defined as ” a new genre of writing that explores health policy through the expression of personal experiences” by the editors of the Narrative Matters section of the health policy academic journal Health Affairs. Narrative Matters needs better inclusion from nurse writers, but that is another story for another day.
When Harborview Hospital in Seattle opened its doors to patients in 1931, advertising posters portrayed the striking fifteen-story Art Deco building as a shining beacon of light, the great creme-colored hope on the hill overlooking the small, provincial town clinging to the shores of Puget Sound. “Above the brightness of the sun: Service” is what one poster proclaimed; in the bright halo behind the drawing of the hospital, were the smiling faces of a female nurse and her contented-looking (and either sleeping or comatose) male patient with a bandaged head.1
Harborview Hospital—King County’s main public charity care hospital—was built at the top of Profanity Hill, on the site of the former King County Courthouse and jail. Profanity Hill got its name from the steep set of over 100 slippery-when-wet wooden stairs connecting downtown Seattle to the Courthouse. One wonders if it also got its name from being at the top of the original Skid Road—now named Yelser Way—where in the early days of Seattle, freshly felled logs, mixed with a considerable number of public inebriates, skidded downhill together into the mudflats of Puget Sound.2 The term ‘skid road’ soon became synonymous with urban areas populated by homeless and marginalized people.
Counties are the oldest local government entity in the Pacific Northwest, and King County, which includes the City of Seattle, was formed by the Oregon Territorial legislature in 1852. From the beginning, the King County Commissioners were responsible for such things as constructing and maintaining public buildings, collecting taxes, and supporting indigents, paupers, ill, insane, and homeless people living in the county.3 Seattle, with its deep-water shoreline and rich natural resources, was built on the timber and shipping industries, which soon attracted thousands of mostly single and impoverished men to work as laborers. These industries, mixed with ready access to alcohol in the always ‘wet town,’ led to high rates of injuries. Serious burns came from the growing piles of sawdust alongside log or wood-framed houses heated by wood fire and coal. Then there were the numerous Wild West shootings and stabbings. As in the rest of the country at that time, wealthier families took care of ill or injured family members in their own homes, with physician home visits for difficult cases. The less fortunate relied on the charity of local physicians and whatever shelter they could arrange.
David Swinson ‘Doc’ Maynard, one of Seattle’s white pioneer settlers, was Seattle’s first physician and, in a sense, he opened King County’s first charity care hospital, an indirect precursor of Harborview Hospital. A colorful and compassionate man, Doc Maynard built and operated a 2-bed wood-framed hospital facility in what was then called the Maynardtown district—now called Pioneer Square—a Red Light district full of saloons and ‘bawdyhouses.’ Although she had no formal training, Maynard’s second wife, Catherine, served as the hospital’s nurse. Their hospital, which opened in 1857, closed several years later, reportedly because Doc Maynard insisted on serving both Indian and white settlers. Also contributing to the hospital’s demise was the fact that Maynard disliked turning away patients who could not pay for his services. Around this same time, Doc Maynard assumed care for King County’s first recorded public ward: Edward Moore, “a non-resident lunatic pauper and crippled man.”2 The unfortunate patient had to have his frostbitten toes amputated, and then once healed, was given an early version of ‘Greyhound Therapy’ and shipped back East.
But the true roots of Harborview Hospital began in 1877 in the marshlands along the banks of the Duwamish River on the southern edge of Seattle. There, on an 80-acre tract of fertile hops-growing land, the King County Commissioners built a two-story almshouse, called the King County Poor Farm. They built the Poor Farm in order to fulfill their legislative mandate. Not wanting to run the Poor Farm themselves, they posted a newspaper advertisement asking for someone to take over operation of the King County Workhouse and Poor Farm, “to board, nurse, and care for the county poor.”4 In response, three stern-looking French-Canadian Sisters of Providence nurses arrived in Seattle by paddleboat from Portland, Oregon. The Sisters began operation of the 6-bed King County Hospital facility in early May 1877.
In their leather-bound patient ledgers, the Sisters of Providence recorded that their first patient was a 43-year-old man, a Norwegian laborer, a Protestant, admitted on May 19th and died at the hospital six weeks later. The Sisters carefully noted whether or not their patients were Catholic, and in their Chronicles, they recorded details of baptisms and deathbed conversions to Catholicism of their patients. The hospital run by the Sisters of Providence had a high patient mortality rate, but the majority of patients came to them seriously injured or ill. Also, this was before implementation of modern nursing care: the Bellevue Training School for Nurses in New York City, North America’s first nursing school based on the principles of Florence Nightingale, opened in 1873.
In their first year of operation, the Sisters realized that the combination of being located several miles away from the downtown core of Seattle and the unsavory name ‘Poor Farm’ was severely constraining their success as a hospital. So in July 1878 they moved to a new location at the corner of 5th and Madison Streets in the central core of Seattle, and they renamed their 10-patient facility Providence Hospital. The Sisters designated a night nurse to serve as a visiting/home health nurse and they accepted private-pay patients along with the indigent patients, whose care was paid for by King County taxpayers. The Sisters of Providence agreed to provide patients with liquor and medicine, both mainly in the form of whisky, a fact that likely helped them attract more patients.2
The Sisters’ list of patients included mainly loggers, miners, and sailors in the first few years, later mixing with hotelkeepers, fishermen, bar tenders, police officers, carpenters, and servants as the town grew in size. Many of their early patients were from Norway, Sweden, and Ireland, echoing the waves of immigrants entering the United States. Diagnoses recorded for patients included numerous injuries and infectious diseases—including cholera, typhoid, and smallpox—along with ‘whisky’ as a diagnosis, which later changed to ‘alcoholism.’ Their patient numbers grew, from just thirty hospital patients their first year, to close to two hundred patients by their fifth year of operation. The Sisters expanded their hospital to meet the increasing patient population.
Growing religious friction between the Catholic Sisters of Providence and the county’s mainly Protestant power elite, contributed to the King County Commissioners assuming responsibility for re-opening and running the King County Hospital in 1887. The King County patients were transferred from Providence Hospital back to the old Georgetown Poor Farm facility. Then, in 1906, the King County Hospital was expanded to a 225-bed facility at the Poor Farm site. It remained there until 1931 when the new 400-bed Harborview Hospital on Profanity Hill was opened. The old Georgetown facility, renamed King County Hospital Unit 2, was used as a convalescent and tuberculosis center until it was closed and demolished in 1956.5 The area where the King County Poor Farm was located is now a small park surrounded by an Interstate, industrial areas, and Boeing Field.
Harborview Hospital, now named Harborview Medical Center, still stands at the top of Profanity Hill, although the area is now officially called First Hill and nicknamed Pill Hill for the large number of medical centers now competing for both real estate and health care market share. Harborview Medical Center is owned by King County, and since 1967, the University of Washington has been contracted to provide the management and operations. Harborview Hospital has served as the main site for the region’s medical and nursing education. Since 1931, it has been the main tertiary-care training facility for the University of Washington’s School of Nursing.
Harborview Medical Center continues to fulfill its mission of providing quality health care to indigent, homeless, mentally ill, incarcerated, and non-English-speaking populations within King County. It is the largest hospital provider of charity care in Washington State. In addition, it serves as the only Level 1 adult and pediatric trauma and burn center, not only for Washington State, but also for Alaska, Montana, and Idaho, a landmass close to 250,000 square kilometers with a total population of ten million people. Harborview Medical Center has nationally recognized programs, including the pioneering Medic One pre-hospital emergency response system, the Sexual Assault Center, and Burn Center. In addition, Harborview provides free, professional medical interpreter services in over 80 languages, and has the innovative Community House Calls Program, a nurse-run program providing cultural mediation and advocacy for the area’s growing refugee and immigrant populations.
Harborview remains a shining beacon on Profanity Hill, rising above the skyscrapers of downtown Seattle. At night, it is literally the shining beacon on the hill, with blinking red lights directing rescue helicopters to its emergency heliport, built on top of an underground parking garage on the edge of the hill. Sharing space with Harborview’s helipad is the narrow strip of green grass of Harbor View Park, with commanding views of Mount Rainier to the south, and of downtown Seattle and Puget Sound to the west. In the wooded area below Harbor View Park, extending down to Yesler Way, along the old Skid Road, are blue tarps and tents of the hundreds of homeless people living in the shadows of the hospital. Construction is underway to add a new public park, mixed-income public housing, and a new—and hopefully less slippery—pedestrian walkway connecting downtown Seattle to the Hospital on Profanity Hill.
Note: This was published in the “Famous Hospitals” section of Hektoen International: A Journal of Medical Humanitiesin Spring 2015. Since researching and writing this essay, I have continued research (including conducting oral histories) for my project “Skid Road: The Intersection of Health and Homelessness.”
Late one November night in 2000, I drove myself to the ER at the UW Medical Center. I had left my twelve-year-old son sleeping at home. Still a single mother, I had called my boyfriend to come over and stay while I was gone. My legs had been tingling and getting progressively benumbed over the past week. The numbness started in my toes and now reached my butt and groin region, plus my toes were turning blue. I had no idea what was wrong. The weekend before I had run up the 2,400-foot Mount Constitution on an island in the Puget Sound. It had been cold on the mountain, but I hadn’t fallen or gotten frostbite. I was forty and in decent shape, was rarely ever sick, and had no primary care doctor. I worked as a nurse practitioner at a nearby community health clinic; I was used to diagnosing and treating other people’s health problems, but not my own.
“Take off all your clothes except your underwear and put them in this bag. And tie the gown in the back,” the ER nurse said, as she handed me a cotton gown and white plastic bag marked ‘University of Washington Medical Center: Patient Belongings’ in purple. Why did I wear black thong underwear to the ER? I thought, as I gazed down at my mottled blue toes.
My personal mantra at the time was, I can do this; I can do anything! I didn’t see the danger in that saying. I worked three jobs, trying to pay off school debts and save for a down payment on a house, as well as for my son’s future college education. I had been running on the tenure track, applying for and getting research grant after research grant, publishing a string of papers, collecting teaching and peer evaluations. The faculty had recently met to decide whether or not to grant me tenure. I didn’t yet know the outcome. If I did not get tenure, I would lose my main job. So there in the ER I did as I was told, stripped to my underwear, donned the gown smelling strongly of bleach, and then endured a series of tests and examinations. At some point, although I don’t remember when, a plastic hospital ID band was strapped to my left wrist over the spot where my silver bracelets had been.
Covered by a white sheet up to my chin, I was now lying flat on my back on a black plastic-encased gurney, perhaps one that has recently delivered a dead body downstairs to the morgue.Can I feel my legs? Are they still there or have they been amputated? Or is it just that they are frozen, because I’m so cold? What time is it and why are we going through all these hallways?
The air around me was cold—refrigerated morgue cold—and filled with the low murmuring of disembodied voices, accompanied by white noise whooshing of the building’s ventilation system. Overhead, flashing, blindingly bright rectangles of fluorescent ceiling lights marched along in single file. I began counting them, memorizing the pathway so I could find my way back out again. Lines of closed doors whirred past on either side. No windows. No wall clocks. I can’t feel my legs.What time is it? I tried to lift my head up off the thin pillow to look at my legs, to look for a clock, but I was too tired. Have they given me medication to knock me out?
A burly male orderly was behind my head, pushing my body on the gurney through the hallways. I could see long nose hairs in his cavernous nostrils and smell occasional wafts of stale coffee breath. He didn’t speak. As we passed people in the hallways, white-coated and blue scrub-wearing staff members, they all stopped briefly, turned sideways, backs against the walls, in order to let us pass. They furtively glanced down at my face, but their eyes always flitted away, never making eye contact.
I thought of Kafka’s Metamorphosis’ as I lay flat on that hospital gurney being wheeled through numerous hallways, then wheeled into an extra-wide elevator lined with rubber bumpers, and then upstairs to the neurology floor of the hospital and checked in by a sweet young nurse who greeted me as Dr. Ensign and I realized she had been one of my students in a health systems course taught the previous spring in a large auditorium I think I was rolled past on this gurney on my way up here—but that can’t be right. I had started thinking in run-on sentences. This young nurse, my student, handed me a tiny plastic cup filled with lilac-colored liquid. I looked at her, trying to remember if she was the sort of student I could trust to give me the right medication. Then, I swallowed the sick-sweet syrup with a metallic aftertaste. I awoke in a darkened room with a spotlight directed at my right arm, some young man thumping my veins and then drawing tube after tube of dark red blood.
After three days of hospital MRIs, X-rays, spinal taps, more blood draws, nerve-conduction tests on my legs, and totally annoying flashing light tests in my eyes, the grey-bearded senior attending neurologist appeared in my hospital room, accompanied by a fluttering group of neophyte short-white-coated medical students. He told me that the good news was that they had ruled out a spinal tumor, but that the bad news was that I had autoimmune transverse myelitis, meaning my body was allergic to itself and was causing a swelling of my lower spine.
“We’ll have to wait and see what it develops into. It can take a year or so before it progresses enough to make a definitive diagnosis,” the neurologist said, peering at me over his rectangular wire-framed glasses.
So I went home and waited. I desperately wanted a diagnosis, a unifying name for the bizarre collection of symptoms that kept sneaking up and sprouting into new signs—the concrete objective markers—and the symptoms—the soft subjective could be all in my head; could be just female hysteria. Symptoms such as my favorite: malaise, a general feeling of being unwell. Malaise, from the Old French mal= bad and aise= ease, space, elbowroom. I was in a bad space. I had not understood what it felt like to be in a body that betrayed me. I thought a diagnosis could bring me back into my body, bring me back into a good space.
The numbness slowly resolved, although my toes continued to turn blue, as did my fingers. Then, all of my joints began to swell. I spent the next year going to various specialists and sub-specialists, one of whom drew fourteen tubes of blood all in one visit, in order to run a panel of obscure and insanely expensive tests, of which the results were inconclusive. Another specialist drew my blood, extracted the serum and injected it into my forearm in order to measure my body’s allergic reaction—to myself. I tried complementary medicine and went to an acupuncturist who had been an internal medicine physician but had burned out on working within the medical system. He told me the story of his final days in medicine: “I told the administration that I wouldn’t take it anymore and I walked out,” he said. “Now don’t move because I’m going very close to your heart,” he added as he jammed a large needle into the middle of my sternum. A large purple bruise bloomed on my chest for weeks afterwards, taking my mind off my blue toes and swollen joints.
I was grateful for my university-sponsored health insurance, but was tired of all the medical encounters that seemed only to lead to more medical encounters. What I dubbed my ‘mystery illness’ morphed into a diagnosis of mixed connective tissue disorder (MCTD), which is really something that can’t make up its mind between being lupus, or rheumatoid arthritis, or the totally freaky-scary scleroderma, where your skin and internal organs thicken and petrify while you are still alive. MCTD is a rare autoimmune disorder that attacks the fibers providing the framework and support for the body. Rare, as in I’m special? Or as in I’m cursed? I thought, as a specialist explained my diagnosis, my dis-ease, my mal-aise. As he told me my diagnosis, my world closed in, like the bedroom doors closing on Kafka’s man-turned-beetle.
Today my medical chart still lists a diagnosis of MCTD, but none of the freaky-scary petrifying stuff has occurred. I no longer run the medical circuit in search of more tests, more tubes of blood, more diagnoses, more jabs to the heart, more promises of a cure. I live with it as you would live with a curmudgeonly, truth-telling friend. It tells me when I’m falling back into the inhuman I can do it; I can do anything! mindset. I listen to my body, even as it continues to get lost in the impossible hallways at work. Most of the time, I embrace the stalactites, the career limbo of nursing ambivalence, and the bewildering staircases. Recently, I cleaned out my university office and recycled all my papers, academic books, and grant reports. I prepared to slow down my tenure track conveyor belt, step into a sabbatical, search for that tranquil courtyard that doesn’t exist on any map.
I chose a soft, calming color for the walls of my office. Then, after the maintenance crew had re-painted the walls, I realized I had picked a version of hospital green. I’ve decided to live with it, and to see what fine details of life it reveals.
It is a year or so since I wrote this essay. My office at the University of Washington is painted the same hospital green. While on sabbatical last year I continued to search for that tranquil courtyard and I am happy to report that I found it—outside my own home. I have survived another (and last) academic conveyor belt bid and have been promoted to full professor. And it is based on this sort of ‘real’ (to me) writing, on public scholarship, on my work in health humanities and social justice. My UW office is now filled with shredded promotion material in preparation for making a paper mache academic mask that I will hang on my hospital green office wall. I firmly believe it is these sorts of things that are helping keep me sane and healthy.