Tag: Seattle

A Place To Stop

 

Stop
Stop (Photo credit: Swamibu)

 

In our narrative medicine course we have moved into group presentations. On the first day of the quarter I had students sign up to be in one of eight groups to work on group projects and to do a group in-class presentation. I picked eight topics, using the list of topics (keywords) from NYU’s Literature, Arts, and Medicine
database as a guide. The eight topics I chose this summer were: Aging, cancer, death/dying, disability, drug addiction, infectious disease, mental illness, and racism. The group assignment was to research and expand upon the topic resources listed in the NYU database—to approach this as if they were doing an in-service training on the topic at their work site. I asked them to produce a one-page (front and back) handout of their favorite resources, along with two to four possible in-class writing prompts and reflective questions. Each group was given 45 minutes to present on their topic and to lead the class in discussion and reflective writing. (Note: our class sessions are four hours long, although we don’t typically go quite that long).

This past week the first two groups did their presentations (on aging and cancer) and both did an excellent job. The groups used an interactive PPT presentation, weaving in poetry, prose, artwork, comic books, YouTube videos, and movie clips. I was impressed by the range and depth of their presentations and class discussions, as well as their application of the close read drill adapted from Dr. Rita Charon’s work. Group members also shared some of their personal stories related to their health topic and did this in a moving but professional way.

 

When I was planning this narrative medicine summer course, I was resistant to the idea of building in group projects. As a student I always preferred to have individual assignments since I could then control the time commitment and the outcome. I knew that the majority of my students in this course would be busy with their nursing jobs and families as well as with school. But a colleague convinced me to use group projects, saying the students were used to them and that what they came up with was typically of high quality. I have purposefully allowed time at the end of each class session for students to meet in their groups for planning purposes and I stay around to answer any questions that may arise. Some groups have also set up online discussion boards on our course website to facilitate their group planning. (In my mind, this is the only really useful function of online discussion boards.) That seems to have worked well for them so they don’t have to meet in person outside of class.

 

Two things particularly struck me from the in-class presentations and discussions. One was the number of students who had personal experience with either a close friend or family member or a patient who was given a diagnosis of a serious cancer over the phone or in a voicemail message. We talked about how insensitive that is and what nurses can do to influence physicians, nurse practitioners, and other healthcare providers to think through how to give bad news in a more supportive way. The other thing that stood out to me in the class discussion was a comment a student made that this narrative medicine class is “A place to stop and to process these things we don’t get to process.” Other students said they agreed with what she said and talked about how nurses are so much into the care giving role, not only at work but also in their personal lives, that having a time and space to stop and reflect on how it is affecting them is a powerful thing.

 

Ah yes. There were really three things that struck me during last week’s class session. The third was that this is all heavy stuff to process and write about and how much environmental context matters—as in the actual physical classroom setting. We have a nice smallish amphitheater classroom with excellent acoustics, state-of-the-art audiovisual equipment that is easy to use, reasonably comfortable chairs and tables, and a full bank of windows looking out over a grassy marsh full of birds. I’d forgotten what a pleasure it is to teach in a classroom with windows. It also helps that it is one of the loveliest summers in Seattle’s history. Teaching this narrative medicine course in a windowless classroom in the middle of a Seattle winter would have a much different feel.

 

 

Of Poems, Hearts, and Hands

hand.
hand. (Photo credit: bambola_world)

Last week in my narrative medicine course I had two local authors come to class to read some of their writing and lead class discussions. The first guest speaker was Suzanne Edison, a poet and psychotherapist. She also leads Seattle-area workshops
on therapeutic poetry writing with parents of children with chronic illness, as well as with adolescents with chronic illness—at Seattle Children’s Hospital
and at Odessa Brown Children’s Clinic. Suzanne read poems from her two poetry chapbooks Tattooed With Flowers (2009) and What Cannot Be Swallowed (2012).  In our first class session this quarter we had done a close reading of her powerful poem “Teeter Totter.” Students had questions about some of the metaphors and lines in her poem, so last week they were able to ask Suzanne about them directly. (“Teeter Totter” also appeared in Ars Medica, Fall 2009).

Suzanne led the class in a poetry-writing session that she has developed. First, she asked students to write about a time they had an interpersonal conflict of some sort. Then they went through their prose piece and circled four to five words that stood out to them. Suzanne had them do some other tasks in order to come up with an expanded list of words (a dozen or so). Finally, Suzanne asked them to write a poem (in any form) using all of their words. Several students wanted to share part of or the entire poem they had written, and one student commented on how powerful it was to ‘get it out there.’ Students pointed out that reliving the stressful, difficult interpersonal interactions through the poetry exercise brought on stress responses (sweaty palms or changes in heartbeat and breathing), but that writing the actual poem gave them some distance from it and left them feeling more peaceful. Suzanne explained that the poem is a way to create a container for these powerful memories and emotions. One student wrote of this
as “framing the event in the bubble of a poem.”

I prefaced this poetry-writing exercise by letting the students know that what
they wrote was for their eyes only—that I would not ask them to turn in this
writing to me. Suzanne and I had incorporated the same writing exercise last
fall in my undergraduate community health course, when I did ask students to turn in their poems to me. I got feedback from some students that they found this to be intrusive into their personal lives when they didn’t really know me. Duly noted, and very true since it was a class of 150 students (vs. 40 students in the narrative medicine course). So this time around I set the parameters upfront that they wouldn’t have to share their poems with me. Instead, the first writing prompt I gave them for in-class writing was to share a fragment of their poem, or a key word, and to reflect on what surprised them most about what came out of the poetry exercise. This seemed to work out much better. It probably also helped that this class is specifically on narrative medicine, and students expect to do more creative and personal writing in it than they typically do in a more traditional nursing course.

The second guest author was Mary Oak, author of Heart’s Oratorio: One Woman’s Journey Through Love, Death and Modern Medicine (Goldenstone Press, 2013). (see my previous post/book review “Heart’s Oratorio” from 3-24-13). She read passages from her book and answered student questions. As one of the selections she read was about her stay in the ICU and how disorienting it was, students had questions for her about this. They also asked her what motivated her to write the book and about her development as a writer. Since Mary writes about her genetic heart condition and is a mother, students also asked what the ramifications are for her children, and what that feels like now that’s she’s lived through serious cardiac complications. Much of Mary’s book is set in Seattle and she mentions specific hospitals (Northwest Hospital and University
of Washington Medical Center) and some medical personnel by name. This led to an interesting class discussion on the ethics and legalities of nonfiction medical-related writing. Several students mentioned recent ‘compliance trainings’ they’ve had to go through in their jobs as RNs in Seattle-area hospitals, where the message was that ‘they could never ever write about their work in any context whatsoever!’ They were concerned since they were asked to write about their work for class assignments (like for my course). We reviewed the basic parameters on this for academic writing: 1) no patient identifiers such as name, age, super-rare medical condition, etc.; and, 2) no specific names of providers, hospitals, clinics, care facilities—although I acknowledged this can lead to strange permutations, such as “a large Level-I Trauma Center in the Seattle area” (there is only one Level-1 trauma center in Washington State—in fact within a four state radius—and that would be Harborview Medical Center). And then I briefly discussed various legal and ethical parameters as designated by specific journals, differentiating what I was asking them to write about versus writing for publication. I got on my soapbox briefly to rant about how hospital administrators try hard to intimidate nurses (and others even lower in the food-chain) into not writing about their work—but the intimidation is real and nurses can and do lose their jobs over this stuff—and it is easy for me to rant from the relative security of my tenured academic soapbox.

Back off my soapbox, Mary read them a lovely poem by a nurse poet friend of hers, Lise Kunkel, who works in hospice nursing in New York State. The poem had to do with her hands while caring for a hospice patient. So for my last writing prompt I had students think of a significant patient-nurse interaction they had had and to write it from the perspective of their hands: Tell the story your hands could tell. Since I was really stuck back on my soapbox and hadn’t thought through the specific writing prompts I wanted to use for that class session, this one was completely made-up on the spot. I had no idea what students would do with it until I read through their writing this week.

Wow—just wow! That prompt worked, as nurses most definitely identify and
communicate with their hands. Some students wrote from the perspective of their hands: the punishing abuse from the frequent application of hand sanitizer; the uncertainty of where to place their hands during certain patient-nurse or healthcare team interactions; the patient assessment of skin warmth or clamminess or bulges where there shouldn’t be bulges—and, as one student stated, providing “a loving touch, not a medical touch.”

Addendum: I received an e-mail from hospice nurse Lise Kunkel with a link to one of her published poems, “Reading Aloud to Dad (for Jiggs)” in Oncology Times, 3-10-09, vol 31(5),p. 34. She also told me the name of the poem that Mary Oak read to my class last week: “The Hands of a Hospice Nurse.” She uses some of her poems in trainings she does for hospice volunteers through the Care for the Dying Cooperative in NY State. Lucky volunteers and lucky patients….

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.

Shocking News: Nurses Can (and do) Read and Write

Who would have thought the world would come to this? A world in which there are IMG_1009so many nurses who are not only reading real books, but also writing real books, or essays, or poems, or short stories—so many nurses with the audacity (and ability) to obtain writing credentials, MFAs, writing certificates, and bona fide publications in non-nursing literary magazines and anthologies for God’s sake! Shocking indeed.

That was one of the main takeaway messages I got this week from listening to a podcast interview with Lee Gutkind on RN.FM radio. Lee Gutkind is the founder and editor of the literary magazine Creative Nonfiction; he is also the editor of the recently published anthology I Wasn’t Strong Like This When I Started Out: True Stories of Becoming a Nurse, edited by Lee Gutkind (In Fact Books, 2013).

In the radio interview, Gutkind states that the anthology was something he had wanted to do for a long time. Whenever he pitched the book idea to publishers they rejected it, saying it was a bad idea because nurses don’t write and nurses don’t read. So with the support of the Jewish Healthcare Foundation he published it himself under the new imprint of the Creative Nonfiction Foundation. Gutkind admits that he was surprised by the volume of submissions to the anthology, that the submissions “were so much better than we expected,” and “how many had writing degrees, writing experiences, as well as being nurses—it was encouraging to us.”  

The book was first released in early April, quickly sold out, and is now into its third printing. (Amazon says it is out of stock/due in 1-3 months but they should have it in stock much sooner than that. Elliott Bay Book Company has the book in stock and can ship it to you. They hosted our reading of the book this week/is what photo is of). Jane Gross, in her May 20th NYT book review ‘Semi-invisible’ Sources of Strength, wrote of the anthology:

It is beautifully wrought, but more significantly a reminder that these “semi-invisible” people, as Lee Gutkind calls them in this new book, are now the “indispensable and anchoring element of our health care system.”

I would argue that nurses always have been the ‘indispensable and anchoring element in our health care system’ and that most laypersons have long recognized this fact. Perhaps what is different now is that people higher up in the rigid health care system hierarchy are being forced to recognize this. The forces contributing to this shift are fascinating and complex, but have to include the growing proportion of BSN prepared nurses in our country’s workforce. Both Jane Gross and Canadian nurse author Tilda Shalof (whose essay Ms. Gross quotes from) are dating themselves by focusing on the outdated rift between diploma/Associate’s degree (ADN) and four-year university-educated nurses in tertiary care settings. Ladies: in the U.S. that battle is over. As the authors of the Institute of Medicine’s 2010 The Future of Nursing: Leading Change, Advancing Health report states:

The formal education associated with obtaining the BSN is desirable for a variety of reasons, including ensuring that the next generation of nurses will master more than basic knowledge of patient care, providing a stronger foundation for the expansion of nursing science, and imparting the tools nurses need to be effective change agents and to adapt to evolving models of care. (p. 4-9)

Currently, 50% of the U.S. nursing workforce are BSN prepared; the Future of Nursing report has set the goal to increase that to 80% by 2020. What a BSN education includes that an ADN education does not, are grounding in liberal arts (including literature and writing), leadership development, and public health/health policy competencies (more complex systems-level thinking)—all essential ingredients for more nurses to be readers, writers, and change agents in our health care system.

Something that I found disturbing in the radio interview and discussion was how much the two nurse radio hosts stayed stuck in the tiresome tropes of  “nurses as an oppressed profession,” (and specifically that they are oppressed by physicians) and that nurses “empower patients.” “Empowering” someone else is a slippery slope ethically and even practically, and nurses are not the only members of the healthcare team to advocate for patients. As to nurses being oppressed—oppression is understood to mean the unjust or cruel exercise of power. Yes, there are still ‘unjust cultures’ within hospitals that negatively impact nurses (as in the case of Kim Hiatt here in Seattle), but to extrapolate that to the statement that all nurses are oppressed is not only incorrect, it is unhelpful. Unhelpful to the image of nursing and unhelpful to the improvement of our health care system.

 

One of the radio hosts recommended that Gutkind offer a nurse writer conference—as a way to bring nurse writers together, to foster a community of nurse writers. Gutkind replied by encouraging listeners to e-mail him if they are interested in such a conference (information@creativenonfiction.org or under ‘contact form’ at www.Leegutkind.com).

Elliott Bay Book Company ‘Becoming a Nurse’ Event/June 11th, 7pm

The following is from the Elliott Bay Book Company (Seattle) Events page for June. I believe I have Karen Maeda Allman, bookseller and director of Author Events at EBB to thank for the kind description. As a writer who uses their bookstore as a gathering space, she is referring to the fact that I am part of Waverly Fitzgerald’s monthly Shipping Group at the EBB cafe. Thank you Waverly and all my fella’ Shippers for all the support over the years!

I want to add that we may (hopefully) be joined on June 11th by Nina Gaby, psych nurse practitioner, visual artist, and writer from the Boston area. Her essay “Careening Toward Reunion” in the Becoming a Nurse anthology is quite dogeared in my personal copy. I seriously want to meet her… If you are in the Seattle area on June 11th, please come join us for some nurse power time at Elliott Bay.

JOSEPHINE ENSIGN, EDDIE LUEKEN & KARLA THELLEN

Start: 06/11/2013 7:00 pm

It’s a particular pleasure for us when writers who use our bookstore as a gathering space have new work to celebrate, as will happen a few times this spring and summer. Tonight, Josephine Ensign, who has contributed so much to our community as a nurse and teacher of the next generation of nurses, appears with colleague Eddie Lueken and Karla Thellen for a group reading from their new anthology, I Wasn’t Strong Like This When I Started Out: True Stories of Becoming a Nurse (edited by Lee Gutkind, InFact Books). Nurses are the backbone of the healthcare system and these stories reveal something of the experiences of nurses at all stages of their careers. Here is illuminating reading for those aspiring to join the profession as well as for those who benefit from their work.

I Wasn’t Strong Like This When I Started Out: True Stories of Becoming a Nurse (Paperback)

By Lee Gutkind
$15.95

ISBN-13: 9781937163129
Availability: On Our Shelves Now
Published: In Fact Books, 3/2013

Location:
The Elliott Bay Book Company
1521 Tenth Avenue
Seattle, WA 98122
United States

Becoming a Nurse: The Events

becominganurseThis week Jane Gross in the NYT wrote a nice review of the new book I Wasn’t Strong Like This When I Started Out: True Stories of Becoming a Nurse, edited by Lee Gutkind (In Fact Books, 2013). The title of the book review is  ‘Semi-invisible’ Sources of Strength, referring to the fact that nurses are often the un-sung, un-heard, un-seen cast members in the grand drama that is modern medicine. Semi-invisible sources of strength: I suppose then that nurses are to health care what the backbone is to the human body? Lumpy and bumpy, semi-visible through the skin, at times painful? OK, I’ll stop with the analogy.

In the days following the NYT book review, True Stories of Becoming a Nurse quickly became one of their top sellers. In the past day it has been in the top 20 on Amazon. Fascinating to see the book filed under “healing,” “spirituality,” and “personal transformation,” as if it belongs in Whole Foods next to the crystals and incense and socks made of recycled bamboo. Thanks Jane Gross for writing the review and thanks NYT for including it. That Ms. Gross focused her review on the old old and seriously tiresome rift between diploma-trained and university-educated nurses in tertiary care settings is unfortunate—but understandable given that she was writing the review as a testament to her diploma-trained RN mother. I get it; I’ll move on to more important topics.

Our University of Washington (with support from 4Culture)-sponsored Becoming a Nurse book launch on April 18th at Suzzallo Library in Seattle was a great success. We had a total of five nurse author panelists who read from their anthology essays. Many, many thanks to the four panelists (Kim Condon, Eddie Leuken, Lori Mulvihill, and Karla Theilen) who paid their own way out here to attend the event. I only had to ride my bike two miles in the rain to get to the event—several of the other panelists flew in from across the country). Many, many thanks as well to the mighty team of UW Health Science librarians (Tania Bardyn, Lisa Oberg, Joanne Rich, and Janet Schnall) for organizing, hosting, and recording the event. The video recording of the readings is here . Note that the audio quality is much better than the video but you can see our general shapes as we read!. You can’t see the wonderful audience but they packed the room—standing room only. Thanks all you supportive audience members!

In case you missed the UW Suzzallo Library Becoming a Nurse event, we will have another Becoming a Nurse reading next month (Tuesday June 11th, 7pm) at Elliott Bay Book Company in Seattle. I will be reading along with Eddie Leuken and Karla Theilen). All three of us will read excerpts from our anthology essays, as well as new work.

This Friday (May 24th) at 6:30pm I’ll be reading at the Northwest Folk Life Festival in Seattle as part of the 2013 Jack Straw Writers Program. (6:30-7:30pm SIFF Cinema/Narrative Stage). Kathleen Flenniken, poet laureate of Washington State will be the host/KUOW sponsors the event. I’ll be reading from new work from my collection of poetry and prose I’m working on called Soul Stories: the stories feet can tell about the journey of homelessness. In the essay I’ll read I ask myself (and partially answer) the questions: why am I drawn to the suffering of others? Why have I spent the past thirty years working as a nurse with homeless and marginalized people? Wouldn’t I be happier if I was drawn to work as a shoe buyer for Saks Fifth Avenue? Questions I am sure many nurses and others in helping professions ask themselves.

 ___________________________________________________

The following is the press release for the book.

I Wasn’t Strong Like This When I Started Out: True Stories of Becoming a Nurse
Edited by Lee Gutkind
Featuring new work by Theresa Brown, Tilda Shalof, and others.

 

As editor Lee Gutkind points out in the introduction to I Wasn’t Strong Like This When I Started Out, “there are over 2.7 million working RNs in the United States (not to mention our many LPNs and LVNs), compared to about 690,000 physicians and surgeons. There are more nurses in the United States than engineers … or accountants and auditors … And, yet, many of us take the work these men and women do for granted.”

 

This collection of true narratives captures the dynamism and diversity of nurses, who provide the vital first line of patient care. Here, nurses remember their first “sticks,” first births, and first deaths, and reflect on what gets them through long demanding shifts, and keeps them in the profession. The stories reveal many voices from nurses at different stages of their careers: One nurse-in-training longs to be trusted with more “important” procedures, while another questions her ability to care for nursing home residents. An efficient young emergency room nurse finds his life and career irrevocably changed by a car accident. A nurse practitioner wonders whether she has violated professional boundaries in her care for a homeless man with AIDS, and a home care case manager is the sole attendee at a funeral for one of her patients. What connects these stories is the passion and strength of the writers, who struggle against burnout and bureaucracy to serve their patients with skill, empathy, and strength.
Pub. Date: March 2013, ISBN: 978-0-393-07156-6, 5 ½ x 8 ¼, Trade Paper, 278 pages,
$15.95, Distributed by Publishers Group West

 

Lee Gutkind has explored the world of medicine, technology and science through writing for more than 25 years. He is the author of 15 books, including Many Sleepless Nights: The World of Organ Transplantation, and the editor of five anthologies about health and medicine, including At the End of Life: True Stories About How We Die.

In Fact Books is a new imprint founded and edited by Lee Gutkind, editor and founder of Creative Nonfiction. In Fact Books titles help create an understanding of our world through thoughtful, engaging narratives on a wide variety of topics and real-life experiences. All titles are distributed by Publishers Group West. For more information, please visit http://www.infactbooks.com.
For interview requests and other media related questions, please contact:
Hattie Fletcher at fletcher@creativenonfiction.org or (412) 688-0304.

 

University Bullies

The U-District, looking northeast from Queen A...
The U-District, looking northeast from Queen Anne. UW Tower is the tall building in the center, with the Hotel Deca (originally the Meany Hotel) to its left. The Interstate 5 Ship Canal Bridge is in the foreground. (Photo credit: Wikipedia)

Urban universities seem to have a long history of being bullies in the communities in which they reside. There’s the fact that universities are big businesses, with all the power that money brings. Then there’s the influence of the widely held belief that universities are a public good and are, therefore, above reproach. People typically don’t want to be seen as blockers of progress, as being against the building of classrooms, scientific labs, and hospitals—and all the additional jobs that go with them. But are universities good for the health of their own communities?

I’m thinking about the university campus-community where I currently live and work: the University of Washington and the U-District. In the past two decades I have seen the university steadily creeping westward through the heart of the U-District neighborhood, building palatial new student dorms, new research and technology buildings, branch medical centers, and even taking over the hulking Tower of Saurumon—oh wait, it’s really called the UW Tower. This is the former SAFECO insurance company building, which at 22-stories is the tallest building in Seattle outside of the downtown business core. You have to be here to understand just how much of a commanding presence this building has for the surrounding neighborhood. There is no place to hide from it. Fittingly, back in the 1960’s or 70’s, the SAFECO tower had a 96-foot long reader board with flashing light messages such as “Big brother is watching you.” Now the top of the tower just says “UW” in big purple letters (the ‘is watching you’ part is, perhaps, understood.)

There is a new U-District revitalization group working on ways to reduce crime, increase (legitimate) businesses, and make the U-District healthier and more livable. The group has representatives from the University of Washington, the U-District business groups, residents of the U-District, and at least one community service provider who works with homeless people in the U-District. I have a personal interest in the success of this group since I own a home near the University, I bike to my office at the University, I dine and shop in the U-District, and I do some volunteer work at a U-District homeless shelter. Mine is a cautionary optimism about the success of the revitalization group. My caution comes from looking at the community-campus ‘revitalization’ that has happened recently in the city I moved to Seattle from: Baltimore.

I lived, worked and went to school in the East Baltimore area where Johns Hopkins Hospital is located. As a neighborhood, East Baltimore certainly had its problems—mainly deeply entrenched poverty, stemming in large part from historical racism. It was a majority African-American community. But it was a community in the true sense of the term, and I found from working with the residents that there were amazing sources of community resiliency and pride. These sources of community resiliency could have been built upon for the mutual benefit of the ‘real’ community and of the Johns Hopkins community. Although there are small examples of this happening, they are all dwarfed by the following facts:

In 2002, spurred on by an Irish-American Baltimore City mayor, Johns Hopkins University partnered with the city and state governments, and with the Annie E. Casey Foundation to begin a 20-year $1.8 billion East Baltimore revitalization effort. Approximately 90 acres of residential area just north of the Johns Hopkins Hospital were bought up, 800 families were displaced, and their houses torn down. These houses are slowly being replaced by life sciences buildings, student dorms, and high-end townhouses and apartment buildings.  Various sources of Johns Hopkins University publicity for this project that I’ve reviewed, gleefully state that the ‘urban blight’ has been wiped out and that crime in the area has been reduced by 87% since 2002 (well duh, you need people to have crime, right?). None of the reports mention what has really happened to the 800 displaced African-American families, nor what they think of this seemingly non-participatory (or bullying) university neighborhood ‘revitalization’ project. (see “The changing face of East Baltimore” by Greg Rienzi, Jan 1, 2012/JHU Gazette.)

I hope that my own university and community can do better than this….

For a brief and fascinating history of UW/U-District relationships, see the Washington State Historylink file “Seattle Neighborhood: University District Thumbnail history.” Who knew that the world’s largest single university building, the UW Health Sciences Building, came about because the UW football team won the Rose Bowl in 1960? Now I know why it’s so important for the UW to be building a new $261 million Husky football stadium.

 

Hospital Quality: A Different View

Paul Farmer (of Partners in Health fame) has an easy-to-apply formula for DSC00749quickly assessing the quality of hospitals or clinics anywhere in the world. He says that given the resources of the country, he looks at the quality of the hospital/clinic bathrooms and the gardens surrounding it. Based on just those two items, he claims he can accurately assess overall hospital/clinic quality—and afterwards correlate it with more ‘objective’ measures of quality and safety. Try out his quality assessment at your own hospital/clinic work-site, and maybe as a New Year’s resolution try to influence improvements.

My office at work is in the world’s largest university building: the Warren G. Magnuson Health Sciences Building at the University of Washington. The building has close to 6,000, 000 square feet of space and is composed of over twenty wings whose hallways are connected, but in a haphazard, disorienting way. The building is an Escher-esque sort of place, with faceless people wandering the hallways and strange concrete staircases going everywhere and nowhere. Ten thousand or so people work (or are hospital patients) in this building. At any given time at least half of the people are lost. I am usually one of them. The building includes a hospital and four health science schools—medicine, nursing, public health and dentistry. The fifth health science school—social work—was lucky and is far across campus in its own (very small) building.

The Health Sciences Building is sandwiched between three busy streets and one busy ship canal. Many of its courtyards are completely covered in concrete, with only a few stalwart and scraggly rhododendrons popping up in places. The bathrooms are tiled and painted a sickly yellow-beige that reminds me of public high school gym locker rooms.

My office is in the ugliest wing of the world’s largest university building. My office has a fault line running through it. There is a 6-inch wide grey rubber seam that bisects my office in two—it runs up one wall, across the ceiling, down the other wall, and across the floor. This rubber seam is the building’s earthquake shock absorbers. I often wonder what it would be like to stand on the fault line during an earthquake. Would I be safer there than ducking under my fake-wood desk? My office also has a door that goes nowhere. Supposedly it allows access to various pipes and electrical wires in the concrete-encased outer phalanges of the building. This door is perpetually locked and I have hung a silk scarf over it to make it seem less weird. I tell students it’s where old faculty members go to die. I often want to crawl in there and take a nap.

The particular part of the Health Sciences building I work in, the T-wing, was built in the late 1960’s and is a prime example of Brutalism. It is also a prime example of why Brutalism is not an architectural style suited either for Seattle weather or for being attached to a hospital. Outside and inside it appears to be made of crumbling, damp and moldy concrete. In one staircase I use there are arm-sized stalactites forming on the ceiling and liquid is perpetually dripping from their pointed ends into a black and green puddle in one corner of a stair landing. It has a bizarre beauty. Over Winter Break the stalactites were removed and the ceiling painted over. I find that I miss them.

University of Washington Medical Center does fairly well on most quality measures included in Medicare’s Hospital Compare. Under ‘patient satisfaction survey’ they include an item on cleanliness of bathrooms. (Gardens aren’t included). If you haven’t used this website before, I encourage you to do a search of hospitals in your area. They have recently added a section on hospital readmission rates.

Nursing Out of the Closet

Today at 12:01a.m., the government of my hometown of Seattle began to issue IMG_0672same-sex marriage licenses. Last month Washington Referendum 74 for marriage equality passed with 54% of the state vote (and 82% of the vote in Seattle). The Seattle couple given the honor of being the first same-sex couple in Washington State to receive a marriage license was Pete-e Petersen (age 85) and her partner of 35 years, Abbott Lightly (age 77). They are both retired nurses. Ms. (Captain) Petersen was a Korean War Air Force nurse who ran a M*A*S*H-type hospital and then went into public health nursing. She became California’s first nursing home ombudsman for the State Department of Health under then Governor Ronald Reagan.

In interviews with Petersen and Lightly, they talk about the prejudice, stigma, and threat of losing their nursing jobs if they didn’t ‘pass’ as being straight women. It wasn’t until they moved to Seattle after they both retired that they felt safe enough to come out of the closet and live openly as a lesbian couple. In a televised interview with the couple early this morning, they both said they didn’t think they’d live to see the day when they could get an official marriage license and get married.

I’ve been reflecting on nursing, and especially nursing education, in terms of LGBTQ issues. I remember my very closeted lesbian nursing instructors from the 1980’s, and the still closeted lesbian nursing professors I know. In nursing school I got absolutely no educational content on LGBTQ issues, except being told that gay men were vectors of HIV/AIDS. Most nursing education today is not much better, although hopefully we teach that HIV/AIDS comes from a virus and not from gay men.

I think back to a time in the 1990’s when I was running the women’s clinic at a Baltimore LGBTQ community clinic (the photo here is of me with friends, at the March on Washington for Lesbian, Gay and Bi Equal Rights and Liberation/April 1993). I was advised by colleagues to not publish a paper I’d written based on my experience providing health care at the clinic(co-authored with my wonderful Johns Hopkins professor/expert on women’s health, Elizabeth Fee). This wasn’t based on their concerns for patient confidentiality, but was based on their firm belief that publishing the paper would label me as deviant and could negatively impact my future career in academic nursing. Since I was a single mother, I needed a job, so I ditched the paper.

Carla Randall and Mickey Eliason, both present or former nurse educators, write about similar experiences in their recent article “Out Lesbians in Nursing: What Would Florence Say? (Journal of Lesbian Studies, 16:65-75, 2012). They point to the fact that historically nursing was dominated by “lesbians, nuns, and spinsters.” They contend that lesbians currently constitute the largest minority group within nursing. (I would add that is only likely for the older cohort of nurses. The largest ‘minority’ group for the younger cohort of nurses is men/ a healthy addition to our profession). Randall and Eliason state that none of the national or international nursing organizations include sexual orientation or gender identity in their nondiscrimination policies. Most other health professions organizations—including the American Medical Association—have issued statements specifically addressing non-discrimination for LGTBQ patients and health care professionals. They also point to results of a study they published in 2010 in Advances in Nursing Science where they reviewed all articles in the top 10 nursing journals between 2005-2009. They found that only 0.16% of the articles included LTGBTQ issues. Longtime nursing educator and activist Peggy Chinn has also published about her experiences of homophobia within nursing education. Her 2008 article “Lesbian Nurses: What’s the Big Deal?” was published in the journal Issues in Mental Health Nursing. Interesting choice.

Turning to the younger—and thankfully more open-minded/supportive of LGBTQ human rights—generation, I am inspired by the young nurse activists who are helping to bring positive change to nursing education and nursing practice. Some are my own students (one of whom contributed to my ‘resources’ list below). Two others are Fidelindo Lim and Nathan Levitt, who both work and teach in NYC. They co-authored a thoughtful “Viewpoint” essay in the American Journal of Nursing (Nov 2011) “Lesbian, gay, Bisexual, and Transgender Health: Is Nursing in the Closet?” In their essay they conclude:

“Homophobia, stigma, and discrimination lead to health disparities and reduced access to care. If we are to remain faithful to our profession’s mission and the public’s trust, we must take a proactive approach to addressing the health needs and safety of LGBT patients, some of whom are nurses themselves.”

There’s a wonderful interview clip of Nathan Levitt, a transgender male, talking about his own experience with health care when he sought breast surgery. His surgeon required him to first see a mental health therapist to “see what’s wrong with you.” When he got to the therapist’s office, she told him she’d just completed one of his cultural competency trainings on LGBTQ health, and that obviously he was the expert on this, not her (video-clip interview available on The American Nurse Project site.) Education and enlightenment can have a boomerang effect.

Additional recommended readings/resources:

Get Your Words Out

English: This is an image I took in Saigon, Vi...
English: This is an image I took in Saigon, Vietnam last year (2008). (Photo credit: Wikipedia)

I promised my current cohort of community health nursing students the information in this blog post, but I wanted to offer it to other people—nursing or otherwise—who are interested in getting their writing in print (both traditional and virtual publication).

Here’s my advice for getting your health-related creative writing published. In follow-up posts I will provide specific resources for where to get published, as well as some ethical/practical writing guidelines specific to narrative nonfiction (true stuff written in an engaging, literary way). This information is mainly for writers of short-form (typically 6,000 words or less) fiction and non-fiction, and poetry. It doesn’t include advice for academic journal writing or book-length works. The following recommendations are based on my personal experience (mainly publishing narrative nonfiction in literary journals), as well as the collective wisdom of the wonderful people in my Seattle writing group—The Shipping Group.

  • Submit your best work. The most important self-editing advice I ever got was to read my own writing out loud to myself (to my always attentive and appreciative Corgi/don’t try this with cats as they bore easily). You can pick up a lot of things that don’t ‘sound right’ by reading your work out loud.
  • Have your writing (essay, poem, etc) vetted by other people besides your significant other/spouse/co-workers who may not be objective enough to provide you with kind but honest feedback.
  • If you are a student, take advantage of the writing support resources at your school for editing and feedback (mainly for essays, but they should also have resources for writers of poetry and short fiction).
  • Find a local (or virtual) writing group to provide support. Indie bookstores and public libraries are good sources to find local writing groups.
  • Balance the advice of ‘submit your best work’ with the equally important reminder that some people take this too literally and never submit their writing.
  • Do your homework to make sure your writing piece fits the current submission criteria for the journal/blog, etc you are targeting. Read their submission criteria descriptions. Read samples of their published work. Ask their contact person for clarification if you are unsure of something. The contact people are generally really nice and helpful so don’t be afraid of them!
  • Begin a daily practice of repeating the mantra, “Rejection only means I am submitting my writing. Rejection only means I am submitting my writing….”
  • If something you submitted gets rejected one place, immediately submit it somewhere else.
  • If something you submitted gets rejected, but the editor writes you a personalized note of encouragement, take it seriously. That means they took time to tell you something specific that was positive about your writing.
  • Celebrate any and all of your publications. Writing itself is a radical act. But since most writing is intended to have an audience, achieving that communication link with a wider audience through publication is truly a radical act. So celebrate your accomplishment.
  • Keep writing…..