Tag: Nurse

Nuts: How We Treat Nurses

May is National Mental Health Month. May is National Nurses Month. The World Health Organization declared 2020 the Year of the Nurse and Midwife. This year, instead of having the typical weeklong recognition of nurses the second week of May (Florence Nightingale’s birthday being May 12th), the American Nurses Association declared the entire month nurses month.

Week one focuses on self care: “Nurse self-care is more vital than ever now as we face the COVID-19 pandemic and its accompanying stress, isolation, and anxiety.” They include links to daily self-care tips on rest/sleeping, nutrition, and exercise—and a way to sign up for a daily “hope-filled message.” Relaxation techniques. “Mindfulness while wearing an N95 Mask.” Building resilience. Safety at work with a focus on anti-bullying efforts. Obviously, these resources and webpages were designed before the COVID-19 pandemic struck our country and frontline nurses, physicians, and emergency personnel could not access sufficient N95 masks and other personal protective equipment–to be mindful and resilient in.

Self-care is important but insufficient. Access to high quality, low-barrier, affordable, confidential, and non-stigmatizing mental health treatment for nurses is an absolute requirement under any circumstances. But especially now when what we are asking our nurses to do—and all nurses, not just ICU and emergency department nurses-—is emotionally taxing and traumatic at unprecedented levels. And now, during a time of a public mental health and substance use disorder crisis, as the American Public Health Association has declared. And states that continue to have antiquated and punitive state licensing laws for nurses and other healthcare providers, requiring providers to reveal any and all mental health treatment, those state laws need to be changed so that they aren’t an additional barrier to to mental health treatment. (see: “Why don’t doctors seek mental health treatment? They’ll be punished for it” Kayla Behbahani and Amber Thompson, Washington Post, May 11, 2020)

Recommended training resources:

Northwest Center for Public Health Practice has a three-module free, self-paced online training on disaster response, including “Stressful effects of disasters on workers.”

Johns Hopkins Bloomberg School of Public Health has an excellent six-hour interactive online training program “Psychological first aid.”

Simple Ways to Help the Homeless

IMG_8789When people discover that I have not only worked with homeless people for the past thirty years but have also experienced homelessness as a young adult, the number one question they ask me is, “So what should I do when I see a homeless person on the streets—what can I possibly do to help?” In fact, while working today at the University of Washington, a longtime and well-known health journalist asked me this question. So, for her, and for all the other well-intentioned people out there with the same or similar questions, here is my list of “Simple things you can do to help the homeless” followed by a list of my favorite resources for finding out more about homelessness:

  • Respond with a smile and a kind word—even if it is “No—sorry” when you are asked for a handout for coffee, a meal, or spare change. There’s nothing worse than for a person to be ignored.
  • Carry fast-food restaurant certificates and flyers with local resources to give to the homeless when they ask for food or money.
  • Buy Real Change or whatever your local homelessness/poverty issues newspaper is—if there is one in your area.
  • Support an agency that provides services to the homeless, especially agencies that also work on upstream solutions to preventing homelessness, such as low-income housing or job-training programs. An example is Habitat for Humanity, whose vision is of a world where everyone has a decent place to live.
  • Be informed and become an advocate for local community solutions to homelessness and poverty, as well as state, national, and international ones.
  • Consider joining advocacy organizations, such as the National Low Income Housing Coalition.

The following organizations are all well-respected sources of up-to-date information and resources for individuals, groups, and communities to learn more about homelessness and what to do about it.

I personally do not give money to anyone asking for spare change. That is a choice I make, not because I am concerned people will use the money for drugs, alcohol, tobacco or anything else I may consider unhealthy choices, but because I have decided to use my money to support agencies I know and work with and which provide direct services as well as advocacy. I do make sure that I try to make eye contact and say a polite, “No, I’m sorry, I can’t” whenever anyone asks me for money. And I do intervene nicely but firmly whenever I witness someone belittling a homeless person with derogatory comments like “Just get a job!” Such aggressive, judgmental comments should not be tolerated in a civil society.

Note: the list of resources and “Simple things you can do to help the homeless” is adapted from my forthcoming medical memoir, Catching Homelessness: A Nurse’s Story of Falling Through the Safety Net (Berkeley: She Writes Press, August 9, 2016).

Who Will Tell the Story?

DSC00528“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 battle fields 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 outcasts.

These lessons began while I was in nursing school. The modern hospital of the Medical College of Virginia 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 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 to 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.” (pp. 57-58, from my forthcoming medical memoir Catching Homelessness: A Nurse’s Story of Falling Through the Safety Net, Berkeley: She Writes Press, August 9, 2016.)

I was reminded of this passage from my book this past week as I read the NYT article “Who Will Tell the Story of Slavery?” (Lorne Manly, June 29, 2016). Manly describes the (sadly to me, oh so familiar) political dueling going on in my hometown of Richmond over the location of the National Slavery Museum. Former Virginia governor L. Douglas Wilder (our nation’s first elected African-American governor, who was more recently also the Mayor of Richmond (2005-9), wants to establish the museum in the former First African Church (now owned by the Medical College of Virginia/Virginia Commonwealth University and located next to the main hospital I describe above). But the current powers-that-be, including the current Mayor Dwight C. Jones, want to locate such a museum at the historic site of the notorious Lumpkin’s Jail, a former slave prison, dubbed ‘The Devil’s Half-acre,’ the site of which was recently located and excavated. (see the Smithsonian Magazine article “Digging Up the Past at a Richmond Jail,” by Abigail Tucker, March 2009.)

The Richmond indie bookstore, Fountain Bookstore, where I’ll be doing a Catching Homelessness author event (Tuesday October 11, 2016 at 6:30 p.m.), is located a few blocks from the site of the former slave prison in the Shockoe Bottom area of Richmond. Perhaps I’ll include a reading of this section of my book. And not keep silent anymore…

Summer Reading Challenge 2016

IMG_7812Reading through the recent NYT article “12 New Books We’re Reading this Summer (and 6 Not So New),” with the list of summer reading by their book critics and staff, I was reminded that it is time to come up with my own summer reading challenge book list with a health humanities and social justice slant. Also, I was reminded to come up with a more diverse reading list than the one offered by the NYT. I did  similar list last summer (see previous blog post, Summer Reading Challenge with a Health Humanities/Social Justice slant ( June 2, 2015), with subsequent posts on my reading progress and reviews of the books.

My Summer 2016 Reading Challenge list of fifteen books is mainly composed of books I’ve acquired over the past few months during my cross-country travels, as well as from both the Association of Writers and Writers Programs (AWP) Conference in Los Angeles and the Health Humanities Consortium meeting in Cleveland. Four of the books on my list are truly ‘new’ books and the rest are new-to-me books. Here they are, listed from the bottom up as shown in the photo above:

Happy and thoughtful and humanistic summer reading everyone!

Home is…

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Community blue tarp tapestry/ Soul Stories project. Photo credit: Josephine Ensign, 2016

Home-less-ness. Un-homed. Being without “a fixed, regular, and adequate nighttime residence.” 

Where did you sleep last night? Was it in a warm, dry, and safe place?

If you were asked to summarize the essential meaning of home to you in one word or in a brief phrase, what would it be?

As human beings we have to have rest–and sleep–in order to not only thrive, but survive. Sleep is the ultimate letting go and trusting that we will not be disturbed, that we will be okay until we awaken. The trust we have through undisturbed sleep generates hope.

What does it mean to be homeless when home was never a safe place? In such cases, it is not possible for young people to ‘runaway’ from home; they can only run towards home.

Housing, ‘home-ing,’ is a form of health care. The people at the National Health Care for the Homeless Council summarize this connection with the following:

  • “Poor health (illness, injury and/or disability) can cause homelessness when people have insufficient income to afford housing. This may be the result of being unable to work or becoming bankrupted by medical bills.
  • Living on the street or in homeless shelters exacerbates existing health problems and causes new ones. Chronic diseases, such as hypertension, asthma, diabetes, mental health problems and other ongoing conditions, are difficult to manage under stressful circumstances and may worsen. Acute problems such as infections, injuries, and pneumonia are difficult to heal when there is no place to rest and recuperate.
  • Living on the street or in shelters also brings the risk of communicable disease (such as STDs or TB) and violence (physical, sexual, and mental) because of crowded living conditions and the lack of privacy or security. Medications to manage health conditions are often stolen, lost, or compromised due to rain, heat, or other factors.”

For those of us fortunate enough to be currently housed and ‘homed’ in a ‘fixed, regular, and adequate [and safe] nighttime residence’–for those of us who are able to have adequate, safe, undisturbed, restorative-of-hope sleep–let us all remember (or imagine if we’ve never experienced it) what it is like for people who go without these essential human needs. And let us use our rest, our trust, our hope to fix this ‘wicked problem’ of homelessness.

___________

Notes:

  • The blue tarp tapestry shown in this photo is from my Soul Stories project, and specifically from the ‘Way Out; Way Home’ installation art (in progress). I ask people who view/participate in this installation to contemplate the meaning of home for them. They then are invited to write or draw the word or phase on a strip of paper, the strips are then added to the blue trap tapestry wallhanging weaving.
  • The connection between sleep and trust and hope was inspired by my current research for the Soul Stories project on the role of narrative in health and healing in the context of homeless. Specifically, this concept comes from anthropologist Hirokazu Miyazaki’s essay/chapter, “Hope in the Gift–Hope in Sleep” in Anthropology and Philosophy: Dialogues in Trust and Hope, edited by Sune Liisberg, Esther Oluffa Pedersen, and Anne Line Dalsgard, (New York: Berghahn Books, 2015).
  • I want to acknowledge the generous support of the University of Washington Simpson Center for the Humanities and the National Endowment for the Humanities for funding support for my Soul Stories public scholarship digital humanities project.

Red Blanket Patients

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Very Important Patient red blanket. Photo credit: Josephine Ensign/2016

Although one of our country’s founding principles centers on equality, we know that has always been a lofty goal, and one that conflicts with our real guiding principle of rugged individualism combined with economic competition.

Money talks. Money yells. Money gets you red blanket treatment in many of our country’s hospitals. I’m sure the ‘real’ red patient blankets are much prettier than the swatch of one I knitted and embroidered for this photo, but they do exist both literally and metaphorically–and historically. Red blanket treatment’ of patients has historical roots in pre-WWII emergency medicine practice: a red blanket was placed over a patient triaged as needing rapid transfer to a place of higher-level treatment and attention. Presumably, this older type of ‘red blanket treatment’ was done based primarily on medical need and not on patient socio-economic status.

A different version of ‘red blanket’ VIP (Very Important Patient) hospital practices seems to be proliferating. ‘In the NYT Op-ed article “How Hospitals Coddle the Rich” (October 26, 2015), by Shoa Clarke, a physician currently doing his residency at Brigham and Women’s and Boston Children’s hospitals, writes of his experience during medical school (at an unnamed but readily identifiable hospital in California–as in Stanford) of being introduced to the concept of tiered care in hospitals where hospital administrators draped wealthy patients in scarlet blankets to help ensure they got better care. “This is a red blanket patient,” one of his supervising physicians reportedly said. Such red blanket patients are fast-tracked and given preferential treatment based solely on their wealth and status.

In a follow-up post related to this topic on KevinMD, a dermatology resident physician and medical school classmate of Clarke’s, Joyce Park, contends that she has never seen red blanket VIP patients getting better hospital care than other patients. In her very telling statement, “I have not seen this happen, from the level of nursing all the way up to the attending physicians” she manages to sum up the worst of hospital hierarchy-think and to come across as impossibly naive. (“The Problem with VIPs in the Hospital”, November 15, 2015.) Of course VIP patients get better hospital care, at least in terms of an increase in prompt nursing attention (and probably much lower RN to patient staff ratios), as well as more ‘discretionary’ medical and surgical interventions.

What’s ironic with this equation is that while the improved nursing care translates to improved patient outcomes, an increase in medical surgical interventions typically translates to worse patient outcomes. When nurses go on strike, hospital patient mortality increases; when doctors and surgeons go on strike, hospital patient mortality decreases or stays the same. (See the recent multi-country research study results reported in the British Medical Journal, “What are the consequences when doctors strike?” by Metcalfe, Chowdhury, and Salim. November 25, 2015/ and “Evidence on the effects of nurses’ strikes” by Sarah Wright in The National Bureau of Economic Research.)

The reason for this difference most likely lies in the fact that more medical and surgical care does not mean better health care or better objective health outcomes. As reported in a 2012 Archives of Internal Medicine article, “The Cost of Satisfaction,” (by Fenton, Jerant, Bertakis, and Frank) a study using a nationally representative sample found that higher patient satisfaction (with physicians) was associated with increased inpatient utilization and with increased health care expenditures overall and for prescription drugs. Patients with the highest degree of satisfaction had significantly greater mortality risk. The researchers postulate that patients with more clout who can cajole their physicians into giving them more medications and more discretionary medical-surgical interventions may be more satisfied with their care by physicians, but are also more likely to die from iatrogenic causes.

Perhaps–even if you can afford VIP/concierge/red blanket patient care–you should think twice about what you are really buying. And perhaps as a country we should think about where we’re headed with such an increasingly stratified healthcare system.

Nurse Practitioners: An American Invention

Josephine Ensign (Bowdler then) at Cross-Over Clinic. From The Bon Secours Courier/St. Mary's Hospital June 1987.
Josephine Ensign (Bowdler then) at Cross-Over Clinic. From The Bon Secours Courier/St. Mary’s Hospital June 1987.

In celebration of the 50th Anniversary of the establishment of the role of nurse practitioners, I want to share an excerpt from my forthcoming book, Catching Homelessness (She Writes Press, August 9, 2016 publication date). Young people contemplating careers in nursing often ask me if I am happy I ‘became’ a nurse practitioner back in the early 1980s. My answer is always a qualified and honest, “yes, but it has not always been an easy role to work within–mainly due to the rigid medical hierarchy.” Yet of all the health care roles in existence today, if I had the chance to do it all again, I would–without any hesitation–become a nurse practitioner. We are a tough breed, willing to work on the medical margins, and we are here to stay.

Here is the excerpt from my book, in a chapter titled “Confederate Chess”:

“Nurse practitioners are an American invention, and specifically they are an invention of the American West. The nurse practitioner role was started by a Colorado nurse in the mid-1960s during President Johnson’s War on Poverty, when Medicaid and Medicare were established to extend health care to the poor and elderly. Even before this expansion of health care, there was a shortage of primary care physicians. At the same time there were many seasoned, capable nurses who were already providing basic health care to poor and underserved populations. A nurse-physician team developed the nurse practitioner role, adding additional course work and clinical training for nurses. With this, states began allowing nurse practitioners to diagnose and treat patients, including prescribing medications for common health problems.

Not surprisingly, the emergence of the nurse practitioner role met with the most resistance in states with higher physician to population ratios, and in states with more powerful and politically conservative physician lobbying groups. The nurse practitioner role was protested both within the medical and the nursing establishments. Physicians didn’t want nurses taking jobs from them, and nurses didn’t want other nurses having a more direct treatment role—more power and prestige—than they did. But the role caught on and spread throughout the country. Nurse practitioners didn’t get firmly established in Virginia until the mid-1980s when I completed my training.

Why nursing? I often asked myself, and people continued to ask me even after I became a nurse practitioner. It was as if any sane, intelligent, modern woman could not want to be a nurse. I had stumbled into nursing while a master’s student at Harvard University, studying medical ethics and taking courses in the School of Public Health. I was gravitating toward a public health degree, but was advised by one of my professors to go to either medical or nursing school first in order to get direct health care experience. I didn’t like the approach of mainline medicine, but also had a negative stereotype of nursing. The only nurses I knew worked in my rural family doctor’s office. They were stout, dull-witted, and wore silly starched white caps, overly-tight white polyester uniforms, and white support stockings that swished as their fleshy thighs rubbed together. But in graduate school at Harvard I sprained my ankle, and went to the student health clinic. I was seen by a kind and competent provider who spent time explaining what I should do to help my ankle recover. I was impressed and thought she was the best doctor I’d ever seen. Then she told me she was a nurse practitioner and explained what that was. My negative stereotype of nurses was challenged.”

Gratitude for Mentors

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Dr. Lorna Mill Barrell (1931-2014), a nursing mentor of mine, after lunch in the Jefferson Hotel, Richmond, Virginia in 1996.

We now have the ‘science of gratitude’ to back what we’ve already known: gratitude is good for us, both individually and collectively. That we have a national holiday named for gratitude is something that–despite the complicated colonization and empire-building historical roots–I am thankful for.

Over the past four months, I have had the privilege of interviewing a variety of people in the Seattle area who work (or live) at the intersection of health and homelessness. These interviews are part of the oral history component of my ongoing Skid Road project, exploring the historical roots of ‘charity’ health care in King County, Washington (the county within which Seattle is located). One of the first open-ended interview questions I pose to people is, “Who or what has most influenced your work and life?”

People I interview typically pause for a moment after I ask this question, they gaze at some corner of the room as if seeing pleasant ghosts, and then they launch into detailed descriptions of people and events essential to who they are as people and to the work they do. Most people identify one or two key people in their lives who provided a sort of moral compass steering them in the direction of compassion–for their own humanity, as well as for other people. Parents. Teachers. Counselors or therapists. Professional mentors. They can easily tell a specific story of lessons they learned from these key people. And due to my use of snowball sampling–asking them to identify people I should try to interview–I have been able to complete oral history interviews on several generations of mentors.

These interviews have led me to reflect more deeply on the people in my life I am grateful for, people who have influenced who I am and what I do. I am also reminded of the wisdom of Rachel Naomi Remen, MD and her healing work with physicians, nurses, and other caregivers. I often introduce my students to her Heart Journal daily practice. For this, she advocates a 10-15 minute quiet time at the end of the day where you review your day, then write the first things that occur to you when you ask yourself three questions: 1) What surprised me today? 2) What moved me or touched my heart today?, and 3) What inspired me today?  Attention and gratitude.

As a nurse and a teacher, I remember two people who have had the most influence on my work, my life. One is Lorna Mill Barrell, RN, PhD who came into my life when I was seriously considering dropping out of nursing school. It was in November of 1983, my final year of the BSN program at MCV/VCU, and I had just been informed by my community health clinical instructor that she was giving me an ‘F’ on my final clinical rotation project paper. “I don’t see how this has anything to do with nursing,” she wrote across my project paper’s title, “The Health of Richmond’s Homeless Population.” I contested her grade and that’s how I met Lorna, who was the chair of the department my instructor worked in–she was my instructor’s boss.

I remember Lorna’s welcoming and nonjudgmental attitude towards me when I came into her office to meet with her about my grade. I’m sure I came across at first as indignant, haughty, and angry. At the time, I wasn’t just contesting my community health grade, I was also contesting my desire to be a nurse at all. She offered to read and re-grade my paper. Thanks to her intervention, I not only passed community health (she changed my paper grade to an ‘A’), but she helped convince me to finish nursing school and go straight into their master’s program for becoming a nurse practitioner. She was my thesis advisor and the co-author of my first published academic journal article. Within a year of graduating and starting my first job as a nurse practitioner working with homeless and marginalized patients at Cross-Over Clinic, Lorna hired me to teach a community health clinical course.

The other mentor I draw on as inspiration for my current work is another MCV/VCU teacher–from the medical school though–who I only remember as Chaplain Bob. During my first semester of the BSN program, fresh out of a brief stint in a MDiv medical humanities program, I convinced him to let me take his medical school elective course on death and dying. He approached this topic in our small seminar-style class, from a health humanities perspective, having us read and discuss Tolstoy’s The Death of Ivan Ilyich, among other works of art and literature. He also encouraged us to write our own poetry and short stories. I took that assignment seriously and wrote a chapbook-length collection of poetry. Chaplain Bob gave me an ‘Aa’ (not entirely sure what that grade really is) for the course, but he also enthusiastically encouraged me to continue my creative, reflective writing. I kept that chapbook. And here, impossibly at age twenty-two (meaning–not that it is great poetry but that is impossibly so long ago) , I wrote:

The Process

Sitting by the hour/ listening to the drone: “The Patient. The Client./And don’t forget the Significant Others./ By all means, keep in mind the Nursing Process.”

“We’re training you to be/ Professionals./ We want you to think/ Independently./ Here, take this test/But don’t think too much/just fill in the dots/the computer will understand.”

We learn to forget,/ to not feel, to not know./ It will hurt too much,/ and it certainly won’t help /us to be professionals.

and…

Waiting 

Sitting on park benches/writing 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 that 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/ one room/one bed/one person/one fear/one hope.

____   To all my mentors, named and unnamed (and in Bob’s case, half-named): thank you. Remember to pass it on.

 

 

 

Carrying Stories: Beyond Self Care

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Girl with Balloon, street art by Banksy. This one found at intersection of K-Road and Queen Street in Auckland, New Zealand. Photo credit: Josephine Ensign/2015.

What to do with difficult stories? Stories of refugees, victims of mass shootings, of hate crimes, of rape, of torture victims, of people dying alone and unnoticed ?  It all gets overwhelming and depressing to hear or read these sorts of difficult stories, to carry them in our hearts, to bear witness to so much suffering in the world.

Of course, for many fortunate (perhaps unfortunate?) people, there is the option of tuning out these stories, turning off the news, unplugging from any non-vacuous form of social media. Taking a break from difficult stories.

But what about all the other people who cannot or choose not to disconnect? What about people whose work involves listening to these stories on a daily basis? Frontline health care providers who work with people experiencing trauma (physical, emotional, sexual). First responders. Counselors, mental health therapists, lawyers. Human rights activists. Researchers working on social justice issues. What can they do to, if not prevent, at least deal effectively with, vicarious or secondary trauma? And for those of us who teach/train/mentor students in these roles, how do we prepare students to be able to carry difficult stories while maintaining well-being?

In a previous blog post, “Burnout and Crazy Cat Ladies,” I explored the issue of ‘too much empathy’ and of pathological altruism, linking to some of the (then/2011) current research. After writing that post and some related essays, I began incorporating a new set of in-class reflective writing prompts for soon-to-be nurses in my community/public health course. I used these in a class session I titled “Public Health Ethics, Boundaries, and Burnout.”

The first writing prompt: ‘What draws you to work in health care? What motivates or compels you to do this work?’ And then later in the class session– after discussing professional boundaries (how fuzzy they can be), individual and systems-level risk factors for burnout, and asking them to reflect on how they know when they are getting too close to a patient, a community, or an issue–I gave them the follow-up writing prompt: ‘Referring back to what you wrote about what draws you to work in health care, what do you think are the biggest potential sources of burnout for you? And what might you be able to do about them?’

Feedback from students about this in-class reflective writing exercise and the accompanying class content on boundaries and burnout, was invariably positive. Many of them said it was the first time in their almost two years of nursing education that anyone had addressed these issues. I understand that patient care, electrolyte balances, wound care and all the rest of basic nursing education takes priority, but it makes me sad that we don’t include this, to me what is fundamental and essential, content.

“…people who really don’t care are rarely vulnerable to burnout. Psychopaths don’t burn out. There are no burned-out tyrants or dictators. Only people who do care can get to this level of numbness,” Rachel Naomi Remen, MD reminds us in her book, Kitchen Table Wisdom: Stories That Heal (Riverhead Books, 1996). Something to remember when we are feeling overwhelmed by difficult stories.

******

Here are some excellent resources:

 

Dorothy Day and Nursing

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From Creative Commons

Dorothy Day is known for her work in social justice, and especially for her co-founding and longtime work with the Catholic Worker Movement. Earlier in my career I worked with the Richmond, Virginia-based Freedom House, modeled after Day’s houses of hospitality. Freedom House, like Day’s original house of hospitality in the Lower East Side of NYC, included a shelter, soup kitchen, laundry and clothing services, counseling and friendship. The staff members of Freedom House lived in voluntary poverty as a mark of solidarity, and as a way to become un-insulated from the realities of poverty and homelessness.

I also knew that Dorothy Day had been a journalist and had been involved with the women’s suffrage movement. She picketed the White House in 1917 as part of the Silent Sentinels’ nonviolent civil disobedience, and was arrested and jailed for her part in the peaceful protest.

But, I had no idea that Dorothy Day was also a nurse. I discovered that fact recently when I read her autobiography, The Long Loneliness (Harper and Row, 1952). In 1918, as WWI and the influenza pandemic raged on, Dorothy wrote to a friend: ‘I hate being Utopian and trying to escape from reality . (,,,) What good am I doing my fellow men? They are sick and there are not enough nurses to care for them. It’s the poor that are suffering. I’ve got to do something.”

So she went to work as a nurse–or a nurse-in-training– at the Kings County Hospital in Brooklyn. She writes of this time: “From the beginning I enjoyed the work. (…) My experience there reassured me as to the care one received from the city. It was a care given to citizens, not to paupers. And it was all free.”

In her autobiography, she describes specific patients and hospital wards that were particuarly memorable to her. Two female patients dying near each other in a ward, one a woman of fifty and the other a girl of twenty-two. Of the younger patient she writes, “There was the smell of death around her, I kept thinking, and there was no one to bring her flowers to deaden it.” She moved to a fracture ward. ‘This ward broke me, the work was so hard. (…) One afternoon when I had been cleaning up filth all day, and the perverse patient had again thrown her bedpan out on the floor dirtying my shoes and stockings, I left the ward in tears and sat in the washroom weeping uncontrollably at the ugliness and misery of life.” Day claims that she had a sympathetic nursing supervisor who took her off the difficult ward, “… transferring me to medical where there were fifty patients with influenza.” (I’m not so sure I’d call her supervisor sympathetic.)

We forget how devastating the 1918 flu pandemic was: “This was the time of the ‘flu’ epidemic and the wards were filled and the halls too. Many of the nurses became ill and we were very short-handed. Every night before going off duty there were bodies to be wrapped in sheets and wheeled away to the morgue. When we came on duty in the morning, the night nurse was performing the same grim task.(…) It was hard not to be careless at this time when every day ten or twelve new patients were carried in or walked staggeringly only to fall unconscious as soon as their clothes were taken from them.”

Of burnout and emotional numbing in her work a a nurse, Day writes this: “Nursing was like newspaper work. It was impossible to suffer long over the tragedies which took place every day. One was too close to them to have perspective. They happened too continuously. They weighed on you, gave you a still and subdued feeling, but the very fact that you were continually busy left you no time to brood.” She writes of finding solace and peace outside in the hospital grounds: “I just sat for a brief rest and watched the sparrows and starlings looking for crumbs from the apron pockets of the old women. ”

Dorothy Day worked as a nurse at the hospital for a year, until after the influenza epidemic was over. “Then a longing to write, to be pursuing the career of a journalist which I had chosen for myself, swept over me so that even though I loved the work in the hospital, I felt it was a second choice, and not my vocation. My work was to write and there was no time for that where I was.” She concludes this chapter of her life by writing, “…I had been a good and sympathetic nurse. I knew that I loved the work, and that if I had not had the irresistible urge to write, I would have clung to the profession of nursing as the most noble work (…).”

Nurse Dorothy Day, along with suffragist/activist/radical hospitality Dorothy Day: an inspiration.