Tag: Philip Seymour Hoffman

Nurse Ratched’s Backstory

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 Her mother was timid, withdrawn, and depressed, to the point that she spent days and weeks in bed.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.

A Patient Named Noname

IMG_0787I once had a patient named Noname. She was a thin wisp of a young woman who came to the community health clinic where I worked as a nurse practitioner. This was back in the late 1990’s soon after I had moved to Seattle from the East Coast. I was still having a bit of culture shock, getting acclimated to Seattle’s rain, tree-huggers, and serial killers. When I first met Noname I was dating a man who was a tree-hugger but thankfully was not a serial killer. He was way into natural food and meditation, so I had Namaste continually playing in my head like an annoying Bee Gees song. So when I looked at the new patient name ‘Noname’ on the patient chart and entered the exam room, I greeted her as Noname, pronouncing it as if she were a cousin of Namaste. She laughed nervously and corrected me: her name was no name. As in she didn’t want to give her real name, so it was just a placeholder of sorts. It wasn’t as if she was in clinic that day for any sort of health complaint that would make her concerned for her privacy. I never did get the story of her name, of her no name.

I remembered Noname this past week as I began teaching an eight-week Narrative Medicine course at the University of Washington, Bothell. I have close to 45 wonderfully smart and creative nursing students, all in their BSN-completion program. That means they all have their RN either from diploma or community college programs and are back to take the courses necessary for their BSN. They are all working full or part-time as nurses so they have a lot of ‘real life’ experience to draw upon.For the first in-class writing prompt I used one of my favorites learned from Dr. Rita Charon and her colleagues at Columbia University’s Program in Narrative Medicine: Write the story of your name. Everyone has rich stories to tell about their names—including the patient named Noname. I find this writing prompt to be an excellent starter prompt, as well as a way of allowing people to introduce themselves in a unique way. Of course, with 45 people in class we didn’t have time for everyone to read their stories out loud, but I have had the privilege of reading all of them and it helps me to get to know the class. I pointed out that this writing prompt can even be used effectively with patients. For instance, I’ve found that it is so much better to ask a patient (with a strange to me name), “Can you tell me the story of your name?” versus the usual “What country are you from?”

After presenting them with some basics of Narrative Medicine—what it is, where it came from, Dr. Charon’s approach to close reading—we practiced close reading together using a variety of short pieces of poetry and prose and film clips. The poetry I used was from Cortney Davis (I Want to Work in a Hospital), Raymond Carver (What the Doctor Said), Rachel Haddad (Stereotactic Biopsy), and Suzanne Edison (Teeter Totter). For the film narrative/close reading I showed them clips from the movie Magnolia (1999)—specifically two clips that are available on YouTube. One clip is the regret deathbed soliloquy by Earl Partridge (played to perfection by Jason Robards), and the second clip is of the male hospice nurse (played also to perfection by Philip Seymour Hoffman) on the phone trying to track down Earl’s estranged son (played—OK—also to perfection—by Tom Cruise). I love these two clips because they portray hospice care and hospice nursing so truthfully. They lent themselves to some rich class discussion and close reading skill building.

For the last in-class close reading and writing exercise I turned to writing by one of my favorite local authors, Judith Kitchen (Distance and Direction/ Coffee House Press, 2001); Half in Shade: Family, Photography, and Fate/ Coffee House Press, 2013). I used her sample short essay F-Stop, which is surprisingly complex for such a short prose piece (available on her website). We first did a close reading of this essay. Then I showed them a photograph of a man reading to three small children around a campfire. I asked them to write the story of this photograph—to just make one up—thus pushing (or pulling?) them into the realm of fiction writing. I could tell that many of the students struggled more with this writing prompt. Some told me they had never been asked to write fiction before in nursing school. But they persevered and came up with some wonderfully rich stories.

I’ll be writing a series of posts over the next seven weeks of this Narrative
Medicine (for nursing) course. Since Narrative Medicine isn’t ‘done’ very much in nursing schools—and I think it should be—my hope is to share my experiences with others who may adapt it for their own teaching.