I confess I'm besotted with "Call the Midwife," the British series on PBS, now in its second season. It's based on the memoirs of a woman named Jenny Lee, who served as a young nurse-midwife in the slums of London in the late 1950s. What's so great about it? The usual stuff that makes a British series so appealing--the writing, the period costumes...those accents! But what draws me to the show is the portrayal of Jenny and the other nurses, pedaling around London on their bicycles to deliver babies and tend to the sick and poor. The nurses are knowledgeable and technically expert in matters of health, but equally interested in every other aspect of their patients' lives. Mother not bonding with baby? Elderly shut-in seeming lonely? Back on their bikes go the nurses. The show is like a fantasy of what nursing is like.
Except it's no fantasy. Park the bikes, lose the accents and the funny hats, and the nurses with whom I work are not so very different from Jenny Lee and her comrades.
I wrote a column a while back in which I wondered aloud about whether there's a fundamental difference between doctors and nurses. I'd discussed this question with several physicians, nurses, and nurse practitioners, and we agreed that while the role of the nurse (and the difference between that role and a doctor's) is not quite as easy to define as it was in, say, Jenny Lee's day, there is something distinctive about nurses. The closest I felt I came to pinning that down was to say that the nurse is often the health professional most intimate with the patient's experience of illness. Often that involves spending more time with the patient than the doctor does--that's true in the hospital--but, more than that, it's a mindset in which nothing about the patient is outside of the nurse's realm of concern. After the column appeared, one nurse who wrote me offered this analogy to express that concept: the doctor is the "architect," she said, but the nurse is the "project manager."
I thought that was pretty good, but this week, National Nurses Week, I have the chance to pass along something better. Every year, each nurse in my practice is asked to write an account of a particularly moving interaction with a patient. It's meant to be a personal narrative, not necessarily to be shared, but this year our nursing director found her colleagues' writings so moving that she printed them out and gave a copy to every member of our practice. With the nurses' permission, I'm excerpting some of their accounts below, edited for space and with the names of patients changed to protect their privacy:
I have been a nurse [here] for just about one year. My training and experience was mainly in pediatrics. I was excited for the change but wondered how I would manage the older, more complicated patients. Over the past year I have developed a particularly strong relationship with two elderly sisters, Jane, age 99 and Elizabeth, age 94. Elizabeth has some memory problems so Jane has assumed all responsibility for Elizabeth's medical care. I was able to see what a struggle it was for Jane to get Elizabeth to the office. In September Jane called me very concerned about how she was going to get Elizabeth her flu shot. She did not qualify for visiting nurse services. I told Jane I would come to their house and give them both the vaccine. They were so grateful for that small gesture. From then on Jane and I have developed a strong relationship. She feels that she can call me for any concern she has about Elizabeth. I call from time to time to check up on them. Sometimes I think Jane just wants someone to talk to and I do my best to be a kind ear. While it might not always be a nursing related call, listening to my patients is a key part of my job.
Jim could be bit abrasive and tough. He was a man in his 70s who spoke loudly and abruptly about all the things that upset him. He seemed sad and aggravated by everything. I introduced myself and let him know that he could call me any time he needed anything. Jim called for the first time about a week later and when I returned his call he went on a tirade about how he had to wait 20 minutes. Once he calmed down I gave him my direct number. Since that day Jim has called me several times a week and I realized that this simple gesture made a huge impact on his day. This was the beginning of a beautiful friendship.
The "intangible" factors are important. I feel it is important for me to understand the patients and vice versa so I can help them plan their care. I will often ask, "How are things at home?" "Who do you live with?" "How did you and your husband meet?" I find that asking these personal questions bridges a connectedness to the patient. It bothers me that the personal touch is often forgotten. Visits are often based on the provider's agenda, not the patient's. Life is so stressful that I feel people need this more than ever and I try to provide this in every visit. There isn't a day that goes by that I do not feel a sense of privilege to be part of these patients' lives.
This week, or any week, tell the nurses you know that you feel the same way about them. Sure it's a "small gesture," but nurses know better than anyone what a big thing that can be.
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