August 7, 2008

Cortney Davis, RN, MA, ANP

NURSING AND THE WORD

First of all, I have to confess right off that I never wanted to be a nurse. When other ten-year-old girls were reading “Cherry Ames, Student Nurse,” I was riding my bike, pretending that my Schwinn was a bay stallion and together we were galloping down Sylvandell Drive in Pittsburgh, always under the gray cloud of steel-mill smog that hung in the sky. When I was twelve, my father, a public relations writer for Blue Cross, was transferred to New York City, and so we pulled up stakes, said good-bye to the smog and moved to Connecticut. I continued to ride my bike but alas, most of my new friends, just like the friends I’d left behind, thought about nothing but becoming nurses. They donned candy stripers’ uniforms and gave of themselves at St. Joseph’s Hospital while I signed up for Saturday art classes at the local museum. After high school graduation, my candy striper friends debated the size, shape and overall appearance of nursing caps—the main criteria for deciding which nursing schools they’d attend—and I went off to Gettysburg College where I wrote poems, wore black net stockings, played the guitar and grew my hair down to the middle of my back. The thought of giving someone a bedpan or even a bed bath gave me the creeps. But life has a way of sending us where we never thought we’d go.

Move forward several years: I’m married with a baby daughter and my husband and I aren’t meeting the monthly rent. His cousin, a nurse’s aide, suggests that I become a nurse’s aide too: on-the-job training, flexible hours, uniforms provided and, best of all, decent pay. Feeling somewhat up-against-the-financial-wall, I enrolled in the six-week course, got my blue uniform (eerily similar to a candy striper’s garb), bought white stockings and white Clinic shoes and went to work four evenings a week from 6 to 11:30. When I returned at midnight, all was quiet—the baby in her crib, my husband snoring in our bed.

My very first night on my very first shift, I was introduced to the world of nursing in ways I’d never expected. I walked into a room to take an elderly man’s vital signs and found him cold and dead in bed. For several minutes I sat watching him, awed at the sight of this human being whose soul had recently departed, leaving his body a fragile husk. Before telling the nurse, I held the old man’s hand, suddenly filled with sorrow that he had died alone. I touched his yellowed fingernails. I leaned close and memorized his face. Later that same night, a patient’s husband called me an “angel of mercy,” and a woman told me how afraid she was, waiting for the results of her biopsy. While I gave her a backrub, she wept. After, as I was putting away the lotion and tidying up, she caught my hand and told me how grateful she was for my care. The hospital, I quickly learned, was a different world, one where people suffered and died. In the hospital, there was an undercurrent of mystery, sensuality, spirituality—here, love and caring were primal, like the love between a mother and a child, with all that relationship’s fears, longings, difficulties and joys. When I gave my weeping patient a back rub, my hands soothing her skin, I felt the same difficult-to-define selflessness that I felt caring for my baby girl. Little by little, I began to like my job.

I understood that in the hospital, during all those intimate and critical moments between nurse and patient, the caregiver becomes the transparent giver, and the patient is the very real receiver. Often sick or dying, a patient, like an infant, is helpless to do anything but exist in the moment. As a nurse’s aide, I found great joy and great peace in the smallest but most important interactions: offering a cold glass of water to a thirsty patient; holding a lonely old woman’s hand; listening to a man talk of his life, almost over; rubbing lotion on a frail woman’s legs, the only pleasure left her. When I returned home at the end of my shift, everything was more precious. Everything reminded me that this other world—the suffering hospital—existed always, twenty-four hours a day. If I woke at 3 a.m., I knew that while I nursed my baby, somewhere a nurse might be feeding a patient or giving a patient pain medication or saving a patient’s life. When I walked through the hospital doors in my squishy shoes and my neat blue uniform, not knowing what I would find, my heart opened, like a hand.

Still, my two lives were very separate. At home I let my long hair fly loose, I wrote poems about my growing daughter and soon about my new pregnancy and new son, and I still played my guitar, not the folk songs of my college days, but lullabies. In the hospital, I became someone else—a braver someone, a more humble someone. For some reason, it seemed that those two worlds wouldn’t or shouldn’t become one.

Move forward again: my husband and I aren’t getting along, perhaps the strain of so little money and so much work, the loss of our youth and our dreams and the tight corners of our tiny four-room thin-walled apartment. My son gets sick and has to be admitted overnight. My daughter needs eye surgery, twice. My husband takes our car and his clothes and moves to Texas, first stopping in Mexico to obtain a divorce. A position opens up in the O.R. for a surgical tech, which means more on-the-job training and a better salary, and so I sign on. A year later, masked and gowned, I’m slapping instruments into the surgeons’ hands.

In the O.R., just as I was on the floors, I’m surrounded by human misery and human transcendence. A drunk man bleeds out at midnight as the surgeons and I frantically race to remove his lacerated spleen; patients, almost anesthetized, turn to look at me and stare into my eyes, the only part of me they can see, and I hold their gaze; when I walk out of the OR, my mask down, red marks on my cheeks from the mask’s pressure, nervous family members watch me. They ask if I was in the room with the one they loved, their child, their wife, their mother. In the O.R., colors and sights and sounds swirl around me. The colors of the opened body are lovely—the glassy pink intestine, the deep red of muscle, the pearly white of tendon and bone. At home, my poems become more sensual, more aware of sounds and smells, the smallest nuances. Yet still, my two worlds revolve around one another, spinning in tandem, like electrons, but they never collide.

Fast forward once again. I’ve taken the advice of the surgeons who’ve said to me, “You’re good; you should become a registered nurse,” and gone back to a local community college to do just that. My previous college credits lighten my load, I take some courses at night and then arrange to work evenings to free my days for my clinical experience. I become friends with one of the other students and, in order to survive financially, she and her son move in to my four-room apartment. We both work part-time, different days and shifts, watching each other’s children and then, exhausted, we study until 3 a.m. We begin dating the two brothers who live on the second floor. By the time we graduate, I’m engaged to one of the brothers, and my friend and I can run a busy floor, care for ventilator patients, give injections, pass meds and resuscitate a coding patient with our eyes closed. I step right into a night job in Intensive Care, and she becomes a psych nurse in a tough rehab unit. Our days of financial scraping at last behind us, my kids and I have our apartment back, and my blossoming paycheck fills the refrigerator and buys everyone new shoes.

My boyfriend and I get married. We move to a house about an hour away, and I take another ICU job in a bigger hospital. Within a year, I’m promoted to head nurse on the brand new 20-bed oncology unit. Click forward again, through hundreds of days and hundreds of patients, all of them sick or dying of cancer. On the oncology ward I witness the most intense suffering and the most intense caring imaginable: I was a good nurse before; on this ward, I become a real nurse. Then one day one of my favorite patients dies unexpectedly. Her doctor and I are in the room with her and, after she’s wrapped and taken to the morgue, I sit dazed at the nurses’ station. Battling leukemia for several years, this young woman was my age, and her kids were the same ages as my kids. Her death, more than any other that I’d witnessed—and there had been so many—shook me to my soul. All my years in caregiving, everything that I’d seen and done, all the patients who lived or died—all those memories and moments seemed to overwhelm me. I almost quit nursing, asking myself, why bother? How can what I do possibly make any difference? Again and again, I’d run head-on into the cold stone wall of suffering and death, but this time I was unable to shake off my grief and simply go on. I couldn’t, didn’t, heal my patient. Now, how would I heal myself?

A few weeks after my patient died, not knowing what else to do, I dug out my old poetry notebook. In a short, simple poem I wrote out what it was like for her to die—how her family hadn’t gotten there in time, how alike our lives were, how thin the line was between her as a patient and me as her nurse, and how final her dying was. Writing about her death, I felt a sudden, inexplicable joy. I had, in words, captured her last moment forever. She would be, in this poem, forever in my life. But I had also, in the writing, let her go. I had forgiven her for dying and forgiven myself for not being able to save her, for not being able to save most of my patients. In the poem, I came to terms, in some mystical way, with my own mortality. She and I were so much alike. I had been there for her last breath; someday, some nurse would be there for my last breath. From that moment on, my work in nursing became, more and more, the subject of my poems. My poems became like nurses, healing me and at the same time documenting my patient’s lives in transformative ways. Poems taught me that I did make a difference in my patients’ lives.

Any nurse understands that much of what he or she does, their best work, is done in secret. A nurse and a patient are often alone. There are meds and treatments to give, catheters to be changed and IVs to unplug, heart rates to monitor and pump settings to adjust. But all these are only excuses for nurses to have contact with their patients—to talk to them, to touch them, to listen to them, to be with them. Nurses and patients share a thousand invisible moments; it is those important moments that both nurse and patient remember.

I remember once when I was the patient, rushed in for emergency surgery. What I recall most vividly from that time is the way the nurse held my hand while she asked me her hurried questions. She didn’t let go, steadying me, until they rolled me away on the gurney to the O.R.—that human contact held me together. A friend of mine remembers how a nurse, in the middle of the night, came into his hospital room where he lay, sweating and restless with fever. Silently, the nurse gathered water and washcloths and stayed with him, cooling his forehead, his neck, his arms. They never spoke, but he told me that he’d never felt more caring for, more loved, in his life. When he bumped into her months later at a local store, he burst into tears.

His tears were like my poems. They gave witness, gave voice to the way the nurses held onto to us, supported us by doing nothing heroic or technical but by performing compassionate deeds that no one else witnessed, moments that weren’t recorded in the chart and that didn’t show up on the hospital bill. Like my friend’s tears, my poems about my nursing interactions with patients make those invisible moments visible and real. Poems capture those times and hold them in place; at the same time, they allow us to burrow beneath the surface of the moment, transporting us beyond the individual experience to universal truths about life, suffering and death. In a word, when I learned how poetry is like nursing and how nursing is like poetry—how both can change the world, how both can heal and touch the deepest part of us—I was hooked. Ever since I wrote that simple poem about my dying patient, I haven’t had one career, I’ve had two.

Writing and reading poetry, with its attention to detail and language, helps me be a better nurse. Because I have learned how to read poems on two levels, slick surface and deep metaphor, I can hear the story behind the patient’s words. Because poems are, the good ones anyway, mysterious and transcendent, I have learned to be alert to the many holy moments that occur in caregiving and to accept them without embarrassment or doubt.

Being a nurse helps me be a better poet. Because I am alert to the body’s messages in health and disease, I can allow my poems to be sensual, replete with sights and sounds and noises and smells, with cries of suffering or songs of joy. Because, as a nurse, I am engaged in the very human activity of caring for others, I can pour that reality into poems, grounding what I do in the real world and, at the same time, allowing what I do to be creative and open to imagination. In poems, I can change the endings that I cannot change in the hospital. In the hospital, I can encourage patients to talk to me, creating, in a sense, their own poems, a space in which to place their lives and their fears.

In my best poems, in my best nursing moments, poetry and caregiving merge, doing the important work of paying attention, accepting, releasing and healing.

from Rattle #28, Winter 2007

____________

Cortney Davis is a nurse practitioner living in Redding, CT. Her recent poetry collection, Leopold’s Maneuvers, won the Prairie Schooner Poetry Prize and the AJN Book of the Year Award. Her memoir, I Knew a Woman: the Experience of the Female Body, was awarded the Center for the Book non-fiction award. Co-editor of two prize-wining anthologies of poetry and prose by nurses, Between the Heartbeats and Intensive Care, Cortney has received an NEA poetry grant, three CT. Commission poetry grants and two Pushcart Prize nominations. (www.cortneydavis.com)