This week the assignment I gave students in my narrative medicine course was to apply the close reading drill they’re learning to a ‘read’ of a feature length movie. I gave students a choice of six movies around the theme of caregiving: The Diving Bell and the Butterfly, The Doctor, The English Patient, Midnight Cowboy, Rain Man, and One Flew Over the Cuckoo’s Nest. Besides doing a ‘close read’ of the movie of their choice, I asked them to reflect on the following questions: 1) What is the nature of caregiving as portrayed in the movie? 2) In the film, who is being cared for and who is doing the caring? (I should note that this narrative medicine course is a hybrid, with a mixture of in-class and online/distance learning. Last week and this week were both distance learning.) Not surprisingly, many students chose to watch and write about One Flew Over the Cuckoo’s Nest (1975) with the unforgettably villainous Nurse Ratched (Mildred) played to perfection by Louise Fletcher.

As I recently re-watched this movie, it struck me how good a nurse Mildred could have been. She is smart, sensitive, and perceptive, and could have used these attributes to be a strong therapeutic psychiatric nurse; instead, she used them to be a manipulative, destructive nurse. I kept asking myself: what went wrong with Nurse Ratched?

With all due respect to Ken Kesey who wrote the novel that the movie is based on, I offer my version of Nurse Ratched’s backstory. Perhaps it can be instructional on ways not to be a good nurse—or on good reasons for someone not to be allowed become (or continue to be) a nurse.

Backstory: Mildred Ratched grew up in rural Oregon, the first of seven children in a devout Catholic family. Her mother was a stay-at-home mom and her father was a logger. They all lived in a doublewide trailer. Her father was a heavy drinker and he regularly beat his wife. Mildred’s self-appointed (or assigned) role in the family quickly was established as caretaker and protector of her younger siblings. Her mother was timid, withdrawn, and depressed, to the point that she spent days and weeks in bed. Mildred’s father loved to shout out at the dinner table that women were only good for baby-making and housekeeping and were stupid. Mildred was a smart, precocious young girl who learned to read at age four, and then went on to excel in school. Her mother encouraged Mildred to get out of Oregon—to become either a stewardess or a nurse so she wouldn’t get stuck in a loveless marriage as she had. Her mother most strongly encouraged Mildred to become a nurse because that’s what she’d wanted to be, and nursing had the whole saintly, angelic, Catholic connotations. But Mildred dreamt of being the first in her family to finish college. What she really wanted was to become a lawyer (wouldn’t she have been an excellent lawyer with that poker face, intelligence, and ruthlessness? Perhaps she wouldn’t have been strangled by McMurphy—Jack Nicholson—and lost her voice if she’d become a lawyer).

Mildred was a freshman in high school when her father fell out of a tree at work and was paralyzed. He wasn’t eligible for L& I or other disability benefits because the hospital ED physicians established that he was legally intoxicated at the time of his fall. Mildred was forced to drop out of school to care for her father as well as all her siblings. She also started waitressing at a nearby diner. Her father died a year after his accident and then Mildred went to a nursing diploma program through the local Catholic hospital. In her last year of the nursing program she met her first boyfriend, a trucker, who found nurses sexy. Mildred got pregnant right away and immediately married. Her new husband openly cheated on her from the very beginning of their marriage. He also physically abused her. Her son was stillborn and her husband left her the following week.

Meanwhile her mother was showing signs of dementia, so Mildred moved back home to care for her mother and her siblings who were still at home. She had been working as a labor and delivery nurse, but after her own baby died she couldn’t face working in that setting, so she took a graveyard shift at the nearby state psychiatric hospital. Flash-forward twenty years and Mildred has worked her way up the ranks at the psych hospital and is now head nurse (“Big Nurse”). She still lives with her ailing mother, cares for her at night, and works days at the psych hospital. She never dated again after her husband left her. She goes to church by herself, has no hobbies, and has only a few female church friends (stuttering patient Billy Bibbit’s mother). Her only source of enjoyment in life comes from the thrill of being in charge, in power at the psych hospital.

Nurse Ratched would have rocked as a good nurse. My only hope is that the sweet young junior nurse shown shadowing Nurse Ratched in the movie (the one who goes into hysterics when she discovers Billy’s bloody body in the psychiatrist’s office) doesn’t become another Nurse Ratched.

On a related note, here are my all-time favorite movies with memorable nurses as major characters: 1) Magnolia (1999) with an amazingly good male hospice nurse, Phil Parma, played by Philip Seymour Hoffman; 2) One Flew Over the Cuckoo’s Nest (enough said about it above)…. and 3)????? I guess that’s it for movies with memorable nurses, at least for me. I do like the character of Abby in many of the ER TV series—as well as the Mississippi nurse practitioner in the “Middle of Nowhere” episode in season five (although it over emphasizes all the negative stereotypes of Southerners). Nurse Jackie is just too soap-operaish and silly for my taste. Come on Hollywood! Give us some more good and realistically portrayed nurses in movies! Maybe I need to start writing screenplays, but I envision myself as Barton Fink with writer’s block, stuck in a flaming hot hotel room somewhere…. Being stuck in the godforsaken Reno airport with a delayed flight home is nightmare enough (where this post was written). Especially since I got stopped by security and interrogated as to whether I’m any relation to naughty former Nevada Senator Ensign (the answer, thankfully, is no). Sometimes life is stranger than fiction—or movies.