Stories that Need to be Told

I almost forgot about Dennis. That’s what Carol Novembre thinks his name was. Carol and I worked together in the early 60s at Pollack Hospital in Jersey City. It was a county-run hospital. Dennis was head of maintenance. I learned a lot from him about the political corruption that went on behind the scenes. Not that I had any doubts about the kickbacks and abuse of power. I had seen the cases of liquor at the loading docks that were to be delivered to the administration suite (aka “the penthouse”).  One time when I answered the phone on our nursing unit, a voice at the other end reminded me that my “donation” of five dollars was due in order to keep my job. When I identified myself as a nurse, the male voice apologized profusely.

Dennis, a tall, lanky guy with a pocked marked face and disheveled clothes, made rounds in the hospital when he wasn’t off-site, overseeing the unofficial work of prisoners. He would bus the prisoners from the county jail to work on the administrator’s suburban house—building a fence, painting the siding, tending to the gardens in the summer. He seemed especially fond of the nurses. If he learned one of us had missed lunch, he would run down to the kitchen and  reappear with a bacon sandwich.

Reminiscing about Dennis was only one of the memories that resurfaced as I spoke to Carol last week. I had asked her if I could write about the fact that she was one of the first dialysis nurses in the country. I worry that as nurses age and die off, stories of nursing history will be lost. My stories included.

You will read more about Carol Novembre in a future post. In the meantime, here is a story I had published about one of the patients I cared for while I worked at Pollack Hospital in the mid-60s.

Pollak Hospital

 

 

 

 

 CLOSING THE DOOR

            I screwed off the cap of the Black and White Scotch bottle and I carefully measured out sixty milliliters, two ounces, into a medicine glass. The alcohol fumes gagged me every time. Then I grabbed a pack of Lucky Strikes from the carton on the shelf next to an aspirin bottle. Cigarettes and Scotch balanced precariously on a small tray. I locked the door to the tiny medication room and went in search of Charlie Hobbs.

The tobacco smoke clouded the air in the patients’ lounge. The drab room was empty except for a middle-aged man in blue pajamas staring at pieces of a jigsaw puzzle on the card table in front of him. A cigarette clung to his lower lip.

At times, I imagined myself the airline stewardess I had always wanted to be. Coffee, tea, or me? This day I was a Playboy Bunny as I bent at the knees, stretching to place the drink in front of Charlie, while his blue eyes riveted on my imagined cleavage. But Charlie’s eyes fixed solely on the amber liquid. Not once in the past four weeks had he acknowledged me, the young nurse in a starched white uniform with thick support hose and practical shoes. An unlikely dispenser of booze and butts.

Charlie had arrived with no suitcase, only the clothes he wore. The faded blue hospital pajamas and robe comprised his daily wardrobe. One of the other nurses had donated slippers. I looked down at the top of Charlie’s wild red hair. “I got to get me another puzzle,” Charlie said without looking up at me. “This here one is almost done.” He snuffed the cigarette butt into an overflowing ashtray and reached for the drink. I was glad Charlie had decided to shower that morning or else his pungent body odor would have added to the foul air.

Charlie shuffled the jigsaw pieces about by day, and watched television by night, all a maneuver, I thought, to keep human interaction at bay. No one ever visited him. Did he even have a home to go back to?

Dr. Clark’s research money supported Charlie’s hospital stay. Dr. Clark needed recruits who would agree to have a cardiac catheterization in order to see the effects, if any, that alcohol had on their hearts. Cardiac catheterization was the latest tool of the sixties. It measured heart function but carried the risk of injury and even death.

Dr. Clark scoured the downtown bars searching for men who drank excessively. On a warm summer night about a month ago, Dr. Clark had gotten lucky. Charlie seized the carrot: a roof over his head, three squares a day, free liquor and cigarettes. He agreed to live on the third floor of the county hospital for four weeks and then undergo a cardiac catheterization.

I carried the empty medicine glass on the tray back to the nursing station. How could Charlie drink alcohol at nine in the morning? Or all day long, for that matter? What would make a man so desperate that he would consent to have a procedure that might kill him?

Even though I didn’t particularly like Charlie, there were times as I placed the Scotch in front of him that I wanted to nudge him and jerk my head towards the exit sign down the hallway. Get out, Charlie. The catheterization isn’t worth all the free alcohol and cigarettes that Dr. Clark’s giving you. Get out. Now. But I didn’t have the audacity to undermine Dr. Clark’s research, no matter how conflicted I felt.

At twenty-three and a nurse for just two years, I vacillated between professionalism and irreverence. I struggled with knowing when to step back and when to dig deeper into my patients’ psyche. How to be empathic and not sympathetic. How to balance cool detachment with overbearing involvement. Charlie needed someone on his side to help him understand what he was getting into.

Nellie Mineo interrupted my thoughts as she waved to me from the doorway of her husband’s room. She looked like the Italian housewife that she was: salt and pepper hair piled in a bun on the top of her head. A well-worn cardigan sweater covered the simple cotton dress she wore. Behind her thin frame I could just make out her husband’s outline under the starched white sheets.

The Mineo’s had known the chances weren’t in their favor when they first met with Dr. Clark to discuss replacing Joe’s diseased heart valve with an artificial one. At that time Joe was so short of breath that he could hardly talk, much less continue to work in the family grocery store. Joe had been my patient during the week Dr. Clark evaluated him for surgery. The Mineo’s large, gregarious family resembled my own extended Italian family. Joe could’ve been my Uncle Tony with olive skin, dark eyes and soft smile.

An artificial valve, which clicked audibly, replaced Joe’s faulty one. I had worked overtime on the surgical unit as Joe’s private nurse the first night after surgery. At first things looked great, but soon Joe developed a cough, and then his legs swelled. Diuretics only worked for a while, and the antibiotics failed to prevent the infection from ravaging his body. Although the valve was being rejected, it continued to click on.

Joe had the first room near the nursing station. The floor was dedicated to research and held only fifteen patients. The patients stayed for a long time or returned frequently for evaluation. Not surprisingly a strong bond developed between the professional staff and the patients and their family.

Joe’s family and friends usually came and went at all hours, but this day only Nellie stood guard. When I ambled towards her, she grabbed my hand. “He looks worse,” she said, rubbing my hand in absent-minded distraction. “Promise me you’ll stop in before you go off duty today.”

Nellie and I both knew that there would be no miracle for Joe. His once muscular body shriveled into sagging skin covering a bony frame. He didn’t open his eyes to Nellie’s voice. Even a sharp pinch to his face couldn’t get a reaction. “Stop and see me before you go off duty,” Nellie repeated. I nodded. Only then did she loosen her grip on my hand.

At the end of the day, as I flung my coat over my arm, I heard a racket from the patients’ lounge. Charlie stomped past me, head down and fists clenched. “I’m outta here.”

“What happened?” I asked the nurse who jogged after Charlie.

“Charlie kicked over the card table. No reason I could see for this.” She shrugged her shoulders and continued down the hall.

Nellie watched the commotion from the other side of the hall. I walked towards her. She pulled me into her husband’s room, grabbed my coat and purse and held them tight against her body. She stared at me for a long while without speaking. From behind her I could hear Joe’s wet bubbly breaths. Even in my short stint as a nurse I recognized the rancid smell of impending death.

Nellie moved her face closer to mine and whispered, “He’s dying.” She caught a sob and swallowed hard. “I don’t want him resuscitated. Stay with us, please stay with us. Don’t let them resuscitate him. Please don’t.”  She wept quietly, clutching my coat and purse closer to her body.

What was I to do? I had never faced this dilemma before. I knew Nellie had witnessed plenty of resuscitation attempts as she lingered outside her husband’s hospital room day after day. Cardiopulmonary resuscitation was so new that all patients were candidates. At the first moment a patient stopped breathing, we leaped into action. We flung him to the floor and straddled him. With the side of our hand we walloped the sternum to get the heart started, then breathed frantically into his mouth. Pumped on his chest. We worked until we were exhausted. In most cases the patient died anyway with fractured ribs and a lacerated liver. Nellie didn’t want this for Joe.

Thoughts flew in and out of my mind. If the staff saw Joe turning blue, they wouldn’t give a second thought to trying to revive him. A resuscitation attempt might bring Joe “back to life,” but only briefly. Then there would be more pain and agony before his heart gave out and he died—again.

What would I want for Uncle Tony? A quiet death, or zealots in white coats beating on his chest? What should I do? Was there a choice? I looked at Nellie, her dark eyes pleading.

I heard Charlie’s voice from down the hall spewing curses. Perfect timing. Charlie would leave the hospital AMA—against medical advice—right before his scheduled catheterization. I hoped whatever he was up to would distract the staff just long enough for Joe to die.

My heartbeats kicked up a notch as I reached over and slowly shut the door. Nellie’s hold on my coat and purse relaxed and they slid to the floor. Wordlessly, she settled down in the chair next to Joe’s bed, lifted his limp hand into her lap and clutched it. I commandeered the chair by the door: the sentry blocking the enemy from entering.

I sat knotted tight while Joe’s breaths became more erratic. The lapses between his gasps for air stretched farther apart. Just when I thought he had quit breathing, he gulped for air.

Finally, the mechanical valve stopped clicking and the room became silent. I walked to the bed and placed my hand over Joe’s clammy hospital gown. I didn’t feel any movement in his chest. I didn’t feel a heartbeat. Joe’s open eyes stared at nothing. I stood there for a long minute before I smoothed down his lids.

Nellie gripped her husband’s hand to her breast and sobbed softly.

I stood over her, my hand lightly on her shoulder. While I felt relief that Joe died peacefully with his wife by his side, each footfall by the door made my heart flip. What if one of the staff would walk in and find I had made a decision that wasn’t mine to make. “ I really need to leave, Nellie,” I whispered, taking Joe’s lifeless hand from hers and placing it by his side.

Tears slid down Nellie’s cheeks. She rose from the chair and embraced me. “Thank you,” she said, her voice cracking. I felt Nellie’s tears soaking into my shoulder as my own tears fell. Then Nellie pulled away and sat back down next to Joe, taking his hand again into her lap. I wiped the moisture off my face with the back of my hand, grabbed my things from the floor, cracked open the door, and glanced up and down the hallway. No one was around. Retrieving my coat and purse, I walked leisurely toward the exit leaving Nellie waiting for the evening nurse to discover Joe dead in the bed.

The floor was unusually quiet. The medication door was ajar in the nursing station. I had no intention of poking my head inside and saying so long to the evening nurse. Just a few more steps and I would be in the clear. As I turned the corner of the white tiled hallway, Charlie Hobbs’ presence blocked me. “Hi,” he said as if we were old friends. “I’m leaving. Can ya spare a buck for bus fare?”

Charlie had on a bright green jacket I was sure wasn’t his. Noticing my eyes on the jacket, he said, “Borrowed this from the guy in the next room. I’ll return it.” I nodded even though I knew the coat would never make it back to its owner. He shifted his feet nervously as he waited for my answer.

I wasn’t anxious to break any more rules but I was glad he was leaving. Why even try to entice him to stay? That would be hypocritical. I reached into my purse guessing he would head for the nearest tavern rather than the bus stop.

“Thanks,” he mumbled. Shoving the dollar bill into the pocket of the purloined jacket, he turned abruptly. In two long strides he disappeared though the doorway under the red exit sign and raced down the steps. I followed. A cold wind chilled my stocking legs as Charlie opened the door at the bottom of the stairs to the outside world. In his haste to escape he let the heavy door slam shut behind him.

I pushed the heavy door open with my shoulder. Unlike Charlie, I had no desire to announce my departure from the hospital by slamming the door. Leaving my covert actions behind me, I griped the handle with both hands and eased it closed.

The Closing the Door was a winner of the TulipTree’s Stories that Need to be Told Contest and is featured in their 2016 anthology: Stories that Need to be Told.

 

 

 

The Physician Supports the Nurse 

I am following a physician’s blog: Suneel Dhand.

Reading his post for the first time, I had a gut feeling I would like this guy. I think he represents a new and steadily growing wave of physicians who are becoming more aware of the effects that good communication has on patient outcomes and improvement in health team collaboration.

After I read his blog today: Doctor, I am just double-checking that you spoke with the nephrologist before I give that? September 4, 2018, I was moved to write this comment:

Thank you for this very timely and important post. We older nurses have many unfortunate memories of altercations with physicians who were more concerned over their status than the welfare of the patient and the benefits of team collaboration. With a renewed interest to improve the patient experience and prevent medical errors your post shows what physicians can do to improve communication with co-workers, especially nurses.

Here is Dr. Dhand’s post:

(I highlighted what he said that so impressed me)

I was recently seeing a rather complicated medical patient in the hospital. We were treating both a heart and kidney condition, and things were not going so well. To spare anyone non-medical who is reading this the scientific details of the bodily processes involved, we were essentially balancing hydrating, with the need to get rid of excess fluid. After seeing the patient, I spoke with the nurse, went over the clinical dilemma, and mentioned that I would speak to the kidney specialist before making the decision—and would perhaps order an additional medication if appropriate. I went back to my desk, entered a note onto the computer, spoke with the nephrologist, and we decided to go ahead and order the medication. A few minutes later, the nurse came back to me and asked: “Dr Dhand, I saw your order and just wanted to double-check that you spoke with the nephrologist before I give that medication?”.

The way the question was asked, may have come across to some as slightly condescending. I could tell some of the other doctors in the room were surprised with such a direct question. After all, I’m a reasonably experienced physician—why would I order a medicine I didn’t want to give? And how dare I be asked so bluntly if I’ve double-checked with another colleague, after I’ve already said that was part of the plan? Did this nurse not trust me?! It wasn’t even a particularly strong or toxic medicine, but one that we use everyday on the medical floors.

I paused for a bit, and said: “Yes, I’ve double checked, and it’s fine to give, no problem”. The nurse, sensing this question may have come across in the wrong way, then said: “Oh, I just wanted to check because you said you were going to speak with the nephrologist…and I looked at your note, and you didn’t even mention the medication”.

Indeed, that was correct—I wrote my note just before I had the conversation.The nurse was spot on. Whether or not the question could have been phrased differently is irrelevant, and I actually found the fact that this nurse sought to clarify the issue with me, highly impressive. I passed on that compliment. Not to mention the fact that the question was based on the conscientious act of actually reading the physician’s note!A more junior doctor colleague in the room afterwards commented on how what was asked to me sounded like a bit of an affront. Actually, I said it was the opposite, and explained why. There’s no room for ego in healthcare, and that’s frequently how mistakes happen, and what the nurse did was outstanding.

That interaction interested me, because as someone who teaches communication, I know I myself would have handled that situation very differently 10 years ago. Indeed, many doctors would have snapped right back at the nurse or taken offense that they were being so directly questioned. Perhaps even with a sarcastic response. “Of course I have, do you think I would have ordered the medication if I didn’t want it?!” “Yes I’m a doctor too, and wouldn’t order a medicine for no reason (you dare question me like that!)”. Imagine if that had happened, what the effect would have been on the nurse of being chewed out, possibly leading to not double-checking an important clinical issue in the future if they felt like something wasn’t right. A bad thing to happen to a well-meaning professional! Many doctors I’m afraid to say would have responded very differently to how I did, and chosen the latter approach during a hectic day when they already felt overloaded with questions and issues. I’m sure if you ask almost any nurse, they will tell you about countless times when they’ve been needlessly talked to in a terse manner by doctors. That’s not to say these don’t represent a small minority of interactions, but certainly enough to remember.

The one thing I feel most proud of as I’ve (hopefully) matured over the years, is how I handle situations like that. I may have always had a relatively calm demeanor, but I was definitely much more of a hot-head around the time when I finished medical school. Not confrontational, but definitely more somebody who could get into needless conflict over things like this. For anybody not working in the high-paced and frequently emotionally charged healthcare arena, you may not realize that run-ins, disagreements and personality clashes are part and parcel of the job (frequently between physicians too). They happen every day, everywhere. I remember after one negative interaction I had with a colleague many years ago, I was talking to another group member, and was given some great advice. She said: “You know what Suneel, always remember the saying: Great Minds, Don’t Mind”. That saying, Great Minds, Don’t Mind, has always stuck with me. It’s so very true, in all aspects of our lives, and something I strive for every day. The very best of us don’t take offense, become hyperreactive, or needlessly be petty and escalate situations, when we could easily interpret something as a personal insult. Especially when we are all doing our best for our patients at the frontlines of healthcare.

 

Just to reinforce what older nurses experienced when we were considered the handmaidens of the physician, I’ve included this previous post of mine: Don’t Question the Doctor,February 19, 2017, describing my good friend Lois Roelofs’ altercation with Dr. Jericho:

 

One afternoon while making rounds, I dashed in to see, Mr. Barnes, my last patient, in 236-1, the triple ward next to the nurses’ station. He smiled when he saw me. “I’m going out for dinner tonight. Dr. Jericho is picking me up at five.”

“Oh? I didn’t know. He didn’t tell us at the desk,” I said, scanning his Kardex card in the vertical file positioned on my left arm. “I’ll check on it.”

Back at the nurses’ station, I checked the doctor’s order sheet for Mr. Barnes. Hospital policy dictated that patients could leave hospital grounds only with written orders from their attending physician. Dr. Jericho was not the attending physician; he was a personal friend. And there was no written order.

I faced a potential explosion. Dr. Jericho’s capacity to be short-tempered was well-known to the nursing staff.  We’d each had our experiences. None of us liked it, but we felt powerless to do anymore than endure. And I didn’t need the problem right then: I wanted to give report on time and get home on time, once.

I dialed his office. “Hello, Dr. Jericho, this is Mrs. Roelofs on Hall Two. Your friend, Joseph Barnes, told me you were picking him up for dinner.” I swallowed hard and took a breath. “I see no written order covering this leave. I’m calling to see if you’ve run this by his attending, Dr. Acorn.”

He barked into my eardrum. “I don’t need to check anything out with anybody. Do you hear me? It’s none of your business….who is this again? What’s your name?”

“Mrs. Roelofs. Head nurse. Hall Two.” I forced my voice to sound strong.

“I’m coming right over to clean your clock,” Dr. Jericho yelled into the phone.

My head and heart spun wildly into one big tuft of fear that settled in my throat. I raced to a friend working on the ward at the other end of my floor. We schemed to hide me on that ward when Dr. Jericho arrived. Then we stationed lookout nurses. Minutes later I got the message. I ducked into Room 214, a five-bed room on East, and hid behind curtains drawn around a vacant bed. When Dr. Jericho arrived, my cohorts told him I was off the floor on an errand. He strode into my nurses’ station across from Room 201, parked himself on my desk chair, and bellowed, “I’ll wait.”

When I was a student nurse a few years before, I had scrubbed to assist Dr. Jericho in surgery. He became irritated with something and kicked a metal wastebasket across the room. Anesthesia saved the patient from being startled off the operating table. However, my nerves, as a novice, vibrated with the intensity of the metal clanging against steel and tile. Now my nerves were vibrating once again.

Suddenly, my friend peeked around the curtain, wearing worry on her face. “He won’t leave until he sees you. He’s camped out. Slicked back hair, black suit, green paisley tie, and all. You better come.”

I returned to the utility room on my ward with its steel cabinets, stowed commodes and IV poles, soaking instruments and thermometers, and corner hopper – a large square toilet-like bowl for rinsing bedpans. Standing in the doorway to the adjacent nurses’ station, I said as confidently as possible, “Dr. Jericho, I’m back. I understand you want to see me?”

Dr. Jericho launched to a standing position. “You bet I do. Who do you think you are to question what I’m doing? To tell me I need a doctor’s order to take my friend out for dinner?” His words torpedoed through the nurses’ station and up the ramp to pediatrics.

He stomped toward me. I backed away, inch-by-inch, until I was flush with the hopper. One more step and I’d plop into hopper water. I was trapped. Only the smothering smells of disinfectant separated us. “It’s my responsibility to see that hospital policy is followed, sir,” I said. My breath stopped momentarily.

“Who are you to tell me what hospital policy says? You, young lady, are never to question me again. Do you understand?”

His words slapped my face like sleet on a winter walk. I could have punched him – he was close enough – but I thought better of it. “Yes, sir.” I held back a salute that he seemed to demand. He turned, clicked his heels, and marched out, as if on a military drill.

My meds nurse, LPN, and aides crowded into the small nurses’ station. “What happened? What’d he say? I’ve never seen him so mad. At least not this week.”

“Oh, the usual Dr. Jericho stuff. Nothing new.” I said, trying to sound nonchalant with a heart rate of over a hundred.

Reaching for the desk phone, I glanced at a list of phone numbers and dialed Mr. Barnes’ attending physician. He gave me the order. Why hadn’t I called him in the first place?

I determined never to let a doctor’s behavior intimidate me again.

Caring Lessons: A Nursing Professor’s Journey of Faith and Self, Lois Hoitenga Roelofs, 2012, pp 49-50

411isrlw3gl-_ac_us320_ql65_

 

 

Don’t Question the Doctor

My friend Lois and I were talking on the phone the other day. We both graduated from diploma nursing schools in the early 60s. It was a time when the nurse was considered the “handmaiden” of the physician. We played the Doctor-Nurse Game* and even stood up when a doctor entered a room. Feeling powerless to confront their authority, not surprisingly, caused us to harbor much resentment towards the medical profession over our long nursing careers.

I told Lois that my volunteer work at a local hospital has exposed me to the improved interactions between nurses and physicians. Of course, having more female physicians has leveled the playing field somewhat and the emphasis on “team” encourages the professionals to respect and work together to care for the patient. I have fresh insight into the challenges physicians face in the health care delivery system that restrict their practice and autonomy. While I do feel more sympathetic toward physicians, I cannot forget the unbalanced relationship nurses once endured.

 

Here is an example from Lois’ book, Caring Lessons.411isrlw3gl-_ac_us320_ql65_

One afternoon while making rounds, I dashed in to see, Mr. Barnes, my last patient, in 236-1, the triple ward next to the nurses’ station. He smiled when he saw me. “I’m going out for dinner tonight. Dr. Jericho is picking me up at five.”

“Oh? I didn’t know. He didn’t tell us at the desk,” I said, scanning his Kardex card in the vertical file positioned on my left arm. “I’ll check on it.”

Back at the nurses’ station, I checked the doctor’s order sheet for Mr. Barnes. Hospital policy dictated that patients could leave hospital grounds only with written orders from their attending physician. Dr. Jericho was not the attending physician; he was a personal friend. And there was no written order.

I faced a potential explosion. Dr. Jericho’s capacity to be short-tempered was well-known to the nursing staff.  We’d each had our experiences. None of us liked it, but we felt powerless to do anymore than endure. And I didn’t need the problem right then: I wanted to give report on time and get home on time, once.

I dialed his office. “Hello, Dr. Jericho, this is Mrs. Roelofs on Hall Two. Your friend, Joseph Barnes, told me you were picking him up for dinner.” I swallowed hard and took a breath. “I see no written order covering this leave. I’m calling to see if you’ve run this by his attending, Dr. Acorn.”

He barked into my eardrum. “I don’t need to check anything out with anybody. Do you hear me? It’s none of your business….who is this again? What’s your name?”

“Mrs. Roelofs. Head nurse. Hall Two.” I forced my voice to sound strong.

“I’m coming right over to clean your clock,” Dr. Jericho yelled into the phone.

My head and heart spun wildly into one big tuft of fear that settled in my throat. I raced to a friend working on the ward at the other end of my floor. We schemed to hide me on that ward when Dr. Jericho arrived. Then we stationed lookout nurses. Minutes later I got the message. I ducked into Room 214, a five-bed room on East, and hid behind curtains drawn around a vacant bed. When Dr. Jericho arrived, my cohorts told him I was off the floor on an errand. He strode into my nurses’ station across from Room 201, parked himself on my desk chair, and bellowed, “I’ll wait.”

When I was a student nurse a few years before, I had scrubbed to assist Dr. Jericho in surgery. He became irritated with something and kicked a metal wastebasket across the room. Anesthesia saved the patient from being startled off the operating table. However, my nerves, as a novice, vibrated with the intensity of the metal clanging against steel and tile. Now my nerves were vibrating once again.

Suddenly, my friend peeked around the curtain, wearing worry on her face. “He won’t leave until he sees you. He’s camped out. Slicked back hair, black suit, green paisley tie, and all. You better come.”

I returned to the utility room on my ward with its steel cabinets, stowed commodes and IV poles, soaking instruments and thermometers, and corner hopper – a large square toilet-like bowl for rinsing bedpans. Standing in the doorway to the adjacent nurses’ station, I said as confidently as possible, “Dr. Jericho, I’m back. I understand you want to see me?”

Dr. Jericho launched to a standing position. “You bet I do. Who do you think you are to question what I’m doing? To tell me I need a doctor’s order to take my friend out for dinner?” His words torpedoed through the nurses’ station and up the ramp to pediatrics.18064403-angry-doctor-in-glasses-with-notebook

He stomped toward me. I backed away, inch-by-inch, until I was flush with the hopper. One more step and I’d plop into hopper water. I was trapped. Only the smothering smells of disinfectant separated us. “It’s my responsibility to see that hospital policy is followed, sir,” I said. My breath stopped momentarily.

“Who are you to tell me what hospital policy says? You, young lady, are never to question me again. Do you understand?”

His words slapped my face like sleet on a winter walk. I could have punched him – he was close enough – but I thought better of it. “Yes, sir.” I held back a salute that he seemed to demand. He turned, clicked his heels, and marched out, as if on a military drill.

My meds nurse, LPN, and aides crowded into the small nurses’ station. “What happened? What’d he say? I’ve never seen him so mad. At least not this week.”

“Oh, the usual Dr. Jericho stuff. Nothing new.” I said, trying to sound nonchalant with a heart rate of over a hundred.

Reaching for the desk phone, I glanced at a list of phone numbers and dialed Mr. Barnes’ attending physician. He gave me the order. Why hadn’t I called him in the first place?

I determined never to let a doctor’s behavior intimidate me again.

Caring Lessons: A Nursing Professor’s Journey of Faith and Self, Lois Hoitenga Roelofs, 2012, pp 49-50

 

 

* Doctors and nurses: new game, same result

Mark Radcliffe, deputy features editor

BMJ. 2000 Apr 15; 320(7241): 1085.

“In the beginning the relationship between doctors and nurses was clear and simple. Doctors were superior. They had the hard knowledge that made ill people better. The nurses, usually women, were good but not necessarily very knowledgeable. They were in charge of folding pillowcases and mopping brows. . . .

In 1967 Dr Leonard Stein first outlined the doctor-nurse game. He said that the interactions between the two were carefully managed so as not to disturb the fixed hierarchy. Nurses were bold, had initiative, and were responsible for important recommendations. While being bold, however, they had to appear passive. In short, nurses were able to make recommendations as long as they made it look as if they were initiated by doctors. So the nurse was responsible for the wellbeing of her patients and the nourishment of the doctors’ sense of professional self.”

What is a Student Nurse?

Carol Ann, a friend of mine from nursing school, recently came to visit. She and her husband live in California. They cruised the Panama Canal over Christmas, drove to see friends in Clearwater, Florida, toured both Savannah and Charleston and traveled to Raleigh, North Carolina to stay with us for a few days. Immediately, we began to reminisce about our school years. I pulled out the Lumine 1962img_0075 yearbook so we could scan our younger selves when we lived in the nursing residence with 42 other young women. For three years, the Gray Nuns of Montreal instilled in us the essence of nursing along with the skills and art of the profession.

Of course, much has changed since then (I will write more about this in later posts). At the time, we nursing students staffed the hospital on the evening and night shifts where a senior student nurse filled the charge position and second year students worked under her. None of us were paid for this “experience.”

The following essay printed in our yearbook describes the student nurse—all young women. I don’t know the author, Barbara Garrity, nor do I agree that student nurses wore white before they graduated.

Many of you older nurses will recognize the out-dated attitudes of the time and most of you youngsters may be scratching your heads wondering could a student nurse be a real person.

What do you think?

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WHAT IS A STUDENT NURSE?

By Barbara Garrity

Student nurses are found everywhere, underneath, on top of, or slithering past patients’ beds. Doctors yell at them, head nurses criticize them, residents overlook them, mothers worry about them, and patients love them.

A student nurse is courage under a cap, a smile in snowy white, strength in starched skirts, energy that is endless, the best of young womanhood, a modern Florence Nightingale. Just when she is gaining poise and prestige, she drops a glass, breaks a syringe or steps on a doctor’s foot.

A student nurse is a composite. She eats like a team of hungry interns and works like the whole nursing staff put together. She has the speed of a gazelle, the strength of an ox, the quickness of a cat, the endurance of a flagpole sitter, the abilities of Florence Nightingale, Linda Richards, and Clara Barton all rolled into one white uniform.

To the head nurse, she has the stability of mush, the fleetness of a snail, the mentality of a mule and is held together by starch, adhesive tape and strained nerves. To an alumna, she will never work as hard, carry more trays, make more beds, or scrub on more cases than her predecessors.

A student nurse likes days off, boys her own age, the O.R., affiliations, certain doctors, pretty clothes, her roommate, Mom and Dad. She’s not much on working 3-11, days off with class, alarm clocks, getting up for roll call, or eating corn beef every Tuesday.

No one else looks forward so much to a day off or so little with working 3-11. No one else gets so much pleasure from straightening a wrinkled sheet or wetting a pair of parched lips. No one else can cram into one little head the course of a disease, the bones comprising the pelvis, what to do when a patient is in shock, how to insert a Cantor tube (usually at 3 A.M.) plus the ten top tunes of the hit parade.

A student nurse is a wonderful creature; you can criticize her, but you can’t discourage her. You can hurt her feelings, but you can’t make her quit. Might as well admit it, whether you are a head nurse, doctor, alumna, or patient, she is your personal representative of the hospital, your living symbol of faith and sympathetic care.

The Olden Days of Nursing

“I would be in a sweat if I tried to maneuver out of that tight parking space without power steering,” I said to my 15-year-old grandson who is currently taking driver education.

We had left the grocery store with a bottle of apple juice and two bags of pretzels. The parking lot was small and crowded.

“What is power steering?” he said.

Yes, how would he know what power steering was, much less what driving was like in the “olden days?” For all he knew, every car always had a GPS, automatic windows, and power steering.

This made me wonder how many would remember what nursing was like back in 1962 when I first graduated? Some of the antiquated rituals we performed may be better forgotten.

However, this is what I remember:

Adjusting flow from IV bottle
Adjusting flow from IV bottle

Hanging a glass bottle with intravenous fluid on an IV pole. Calculating how many drops per minute were needed so it would run over the prescribed time, and then counting the drops for a full minute. I would rip off a piece of white adhesive tape, writing the date and time the IV was started and my initials, and attaching that to the IV tubing. I checked the IV often throughout my shift, making sure it was dripping at the correct rate. There wasn’t an alarm to alert me when the bottle was dry.

 

 

"Pouring meds"
“Pouring meds”

Standing in a small medicine closet with a bunch of 2 X 3 medicine cards—each hand written—with the patient’s name, and drug, dose, and time of administration. I poured each drug from the patient’s medicine bottle or from a large stock bottle into a small paper soufflé cup. All the soufflé cups sat crowded on the small tray that I carried into each patient’s room. God forbid I tipped the tray and spilled the contents. (The nurse in this picture has a cart on wheels—an advantage over my small tray.)

Preparing an enema in the utility room by opening a packet of orange-colored Castile liquid soap and mixing it into the porcelain bucket that held warm water. Did I test the temperature with a thermometer or put a drop on the inner aspect of my wrist? More than once I had forgotten to clamp the tubing and received a good soaking.

Rusted, white enamel enema can being sold on Easy for $25--could be used as a "flower-pot."
Rusted, white enamel enema can being sold on Etsy for $25–could be used as a “flower-pot.”

Do any nurses of a certain age reading this want to add to the list?