Heroes or Humans
Nursing is at the intersection of compassion and knowledge. It involves seeing a patient as more than the blurbs that are distant and impersonal on their medical chart, but rather as a person who is more than their diagnosis. It is officially recognized as “the promotion of health, prevention of illness, and the care of the ill, disabled, and dying people”, which means we meet people where they are in the acceptance of their illness and the wishes they have. Nurses need to balance the responsibility they have to provide care that is quality and to follow the Code of Ethics, with the occasional need to both be human and be a compassionate companion for a patient. In a career that can be emotionally draining and requires significant compartmentalizing, the way nurses cope and manage is of particular importance.
Throughout my time in school, people have made offhand remarks about what an admirable career nursing is but quickly add that they could never do it for whatever reason: “too much blood”, “ugh, I just can’t do needles”, “I just don’t think I could handle the 12-hour shifts”. The part often overlooked is the short four years that precede becoming a nurse, affectionately known as nursing school. Those years are a clever and cruel combination of college and trade school intertwined. If someone were to ask why I couldn’t be a nurse, my answer without hesitation would be nursing school. It is an odd contradiction, that the very thing meant to prepare and build confidence as a future nurse is also the single thing to strip away and reveal how flawed we are and how many things in life are unfair. Our classes are composed of units that teach us how to perform trauma assessments and how to tell someone they are dying, but are juxtaposed the next week with discussions about healing and how to properly bathe a newborn. All the while, the expressions on the professors’ faces say the same thing: we’ve seen it all. These are the faces of women who have seen babies born at 23 weeks die in their mother’s arms with the tubes and wires that seem to spring from every possible place; these are the women who performed 45 minutes of CPR on a 17 year old boy after he tried to swim while day drinking with his friends; these are the women who hold your grandparent’s hand as they begin to forget where they are and who they are; these are the women who ultimately return home each day with baggage far greater than can be seen on the surface, but still put smiles on their faces and assume the role of doting mothers and wives. This is the future that all of us face, which perhaps is what people really mean when they say “I just couldn’t do it”.
Back in March, I was on a hospital floor the day the world seemed to permanently freeze in time. The nurses were discussing the invisible spores that were apparently invading every door knob, car key, and grocery bag. They weren’t worried, though, they were naïvely making light of the situation that the country was finding itself in. I remember one nurse complaining about the amount of work that was headed their way- “hypochondriacs” who thought they felt the foreign tickle in the back of their throats. If only they knew. Walking in that morning, I passed the ambulance bay that had been cordoned off with yellow caution tape and news crews that were shoving boxy microphones into the faces of anyone with scrubs. The mood was eerie and it felt like I was on the precipice of the world collapsing, it just hadn’t quite happened. Then it did- the email from the Dean of Nursing arrived. Describing a pre-professional program, very few ever understand the unique pressure students face, but this email gives the heart of it: Be Professional. The email was a reminder that we were to remain on campus through the closure and take this threat in the face without blinking- ultimately it was a moot email due to lockdowns and miscommunication between the school and the hospitals. The implication is still that nursing students are expected to grow up and grow into a career in the same four years- mistakes can cost an entire career instead of merely more prestigious internship. Some studies have found nursing students have higher stress levels than medical school students- an odd finding considering the trajectories and hierarchies of both positions. Although a doctor has more jurisdiction than a nurse, medical school teaches “foundations” that make up nursing school. Four years of college plus four years of medical school allows time for learning, growing, and adjusting. Nursing school is not for the faint of heart- it challenges, changes, and makes students face their weaknesses every day.
Just like last semester, every Thursday after an alarm has gone off, I load into a packed Toyota Highlander with five other girls who are equally exhausted and spread thin. Together, we bemoan the lectures we need to watch before our class and gossip over the latest Covid test results. Each of us has lined up with hundreds of others that week to be stuck up the nose with a glorified Q tip and had our secretions sent out for sampling- it’s just a part of our lives. We have reported our symptoms to four different trackers, hand sanitized until our hands look chapped and burned, and donned our N95 masks all for a ten-minute drive. However, the place at the end of the ten-minute trip is what truly drives our actions, a neighborhood hospital. It stands large and intimidating, only a few miles away from campus, but it feels like a separate world. It represents neat sterility: nothing is warm nor particularly friendly about it. Together in the Highlander, we slow to a roll alongside the T tracks and make our way into the parking garage. Each of us takes our last sip of water for the next 9 or so hours, then masked up we begin the walk we make every week.
I often wonder what people think as they pass by hospitals, if anything at all. Most, I assume, think of misfortune and thank a higher power for not being there as they move along with their days. I have always thought of the spectrum of emotions that are contained in such a square building: nothing looks different from the outside, but walk the halls and it’s clear. The maternity ward is bright, filled with colors and light; a promise of new life and excitement. It is one of, if not the only one, that is filled with excited and happy humans. The nurses here are kind and good at letting the new parents bond with their newest family member. Take a short walk down the corridor, make a right turn, and go down on floor: the hospice unit. Life is made up of equal and opposite forces: life and death. Most see it as a linear progression, either measuring distance from birth or distance to death. However, as with most neat administrative tasks, the hospital delineates them and places the two units in in such close proximity that it is nearly a sick joke. It serves as a reminder that life is not linear nor predictable, but it is actually messy and can be threatened at any point along the lifespan. A hospital from the outside looks organized, neat, simple, but from the inside it begins to feel more complicated and breaks down in unexpected ways.
The unit we’re on looks non-descript and smells heavily of bleach, with a dash of very sour, rank, gag-inducing poop from someone infected with C. diff. It is 6:30 in the morning when we walk through the fire-safety door, painted a beige that sucks any hope for a quick and speedy recovery. We scurry into the back room where an overused microwave, lacking TLC, sits next to an equally tired looking coffee maker (what an irony). The nurses bustle around us in an array of scrub colors, ranging from an optimistically cheerful floral to a subdued all black set, which sets my mind off on a tangent thinking of the Grim Reaper. They all look haggard and worn, ready to escape home to sleep just the way we were a few hours ago. As we all grab our stethoscopes and slip on the role of “your student nurse today from Boston College” like a safety blanket we have all hung onto for a year now, we try to avoid catching the eyesight of our professor who views us a woefully incompetent. Like I said, we have all embraced the safety of being a student nurse, which means we cannot be held responsible for the mistakes we make. Nursing students practice under their clinical instructor’s nursing license, which is always under the risk of being revoked if a student makes a mistake.
Unfortunately, we catch her eye as it becomes difficult to blend in when we look like that “blood clot” in the hallway. We get rounded into the conference room to discuss our patient assignments for the day, but it gets difficult to hear as a bed alarm makes the most horrifying sound to alert the staff that a patient has either fallen out of bed, forgot they were not supposed to leave bed, or purposely left the bed out of impatience for waiting to see a nurse. Our feet all hit the ground and the seven of us burst through the door frame like a group of drunk people stumbling out of an Uber on a Saturday night, and try to locate the room. Nurses are running towards the room at the distant corner of the ward, where the sun is rising right through the windows. If someone was to pause, they would see a beautiful rosy pink that turns a blood orange as morning begins to stretch over the world. The hospital is built several floors above anything nearby, so the only distraction from the skyline are the trees that are beginning to turn that fiery red that New England is famous for. The light will eventually bleed into the rooms where each patient sleeps, perhaps reminding them that another day has arrived where it may be better than the last. There is no pausing however, because the bed alarm means feet on the ground that had better be moving towards the flashing light above the room that signals distress. Luckily, this morning’s alarm was from a patient who dropped a notepad and wanted to retrieve it; she was 31 and recently diagnosed with breast cancer that had spread to the brain. Her prognosis was meek and meant she wouldn’t likely live to see her daughter turn one, nor would she celebrate her 7th anniversary with her husband, and her parents would be burying their daughter against the tide of the natural life cycle. She is also my patient for the day, and I embrace the challenge of caring for her with a tough smile.
The woman in the bed in front of me looks tired and worn, but not sad. She is entering the second week of her stay in this ward, which is not the vacation away from home people usually want. Most adults crave even just an afternoon away from their children and away from the responsibilities that anchor us to reality, but none would envy the way this woman has accomplished both of those tasks. She is young, so young that her blonde hair is still natural, her skin looks as smooth as satin, but it’s the deep, bruised eyebags that give away her health. Clara, we’ll call her, is hospitalized for complications of breast cancer that has metastasized to the brain; she has 3 months left to live, according to the doctors who crowd her room each morning at 10 and each afternoon at 3. She has an unexpected break from caring for her infant daughter, because Coronavirus precautions have limited visiting hours and cracked down on who can enter her room. Around her room are photos of her wedding, her college graduation, from her baby shower, but mostly there are photos loved ones. They are haphazardly taped to the wall, hanging among the signs that warn both staff and visitors alike that Clara is on precautions because of risk for infection. The signs on the wall are not the only break in Clara’s reality; there’s an IV pump that continually provides Clara with normal saline to keep herself hydrated, but her arm is bruised and sore as a consequence; behind her bed is not the stack of books she has at home, but instead the array of instruments that are used hourly to assess her vital signs; it isn’t the cry of her daughter waking her up at night, but it’s the nurse who comes to check in on Clara and asks if she needs more pain medication. Clara has an altered reality, but somehow remains strong and radiant from deep inside.
If there are such things as kindred spirits, Clara and her nurse exist as each other’s. Em, her nurse, is also young and new to the world of buzzing alarms and fluorescent lights that do not have an off switch anywhere. Together, they help each other learn and bring comfort to the other. Although Em is not always Clara’s nurse, she happens to be right back with her the day I meet them both. Em looks like brunette version of Clara: tall and lanky, green eyes, round and rosy cheeks, and a smile that immediately puts me at ease. When Em introduces me to Clara, it is easy to see the relationship and banter they have established with each other; I learn that Em had a date last night from a cheeky question. People wonder what relationship is “professional” with a patient, but a more pressing question is how Em handles having a patient like Clara.
Compartmentalizing, like I mentioned before, is key to having a successful career in medicine. The best and worst times of peoples’ lives dovetail in a hospital, which adds to the mystique of what a hospital that appears so uniform on the outside can contain. Similarly, while nurses can look put together, professional, and detached from situations, the lasting weight of a day’s work can be carried for years internally. I will forever remember the story my advisor recounted my freshman year while I sat in her office terrified of the degrees on the wall that told me she was Smart with a capital S. She became more human and less of a word as she told me the story about her first patient who died. Her eyes went a little glassy and I could tell that I had lost her to this memory that was lodged years back in time, but seemed to surface so easily. She told me she came home after working the 12-hour night shift and sobbed sitting on the ground next to her oven. Her breath shortened a bit and speech quickened, signs of emotional distress, as she described the profound loss and failure she sensed that night. She was young, just about Em’s age, when it happened. She told me in secrecy that it had made her want to leave the field, that the pain she experienced was juuuuust enough to push her over the edge. Her confession was no secret to me; nearly 20% of nurses leave the field in their first year and 33% within two years. It might be a wild thing to do- leave the field after studying it for four years and passing the licensure exam. However, it better serves to remind that nurses carry the work they have done for a lifetime. My advisor, after returning back to her typical and well-controlled emotions, told me that although it was something she would never forget, it was also something she would never experience again. She handles compartmentalizing by understanding that there would never be a “first patient” again when it came to death, and that each day requires just a little bit of detachment from your job.
The reality of Em and Clara’s relationship is that it will end, just like all things ultimately do. Clara has terminal cancer, something that was once just a funny lump in her right breast had spread. She says it had felt like a funny little bump, which she first attributed as a sign her period was arriving soon (another month, another failed attempt at pregnancy), but then she became pregnant (3 years down the line and multiple fertility doctors later!) and attributed it to that, but then it became larger. That lump, nearly invisible, spread to her brain through the lymphatic system which is supposed to protect from illness and infection. By the time it was diagnosed, it was either the cancer or the pregnancy that would have to go. Clara tells me all about the pleading with her husband, their daughter had been a dream for so many years and was their miracle they had created. She would be the lasting relic of their marriage, the best thing they had ever done together. There had been snotty tears, sleepless nights, breakdowns at the sight of a baby stroller with two parents sleep deprived, yet radiant with that content look that only happens occasionally in life. Clara is brave in the pursuit of her treatment, which is primarily palliative care. She is not receiving any chemotherapy nor any radiation to destroy her cells that had turned against their host. She is passing through each day in varying amounts of pain, which the cocktail of painkillers and opioids she takes help mask, but also sedate her sarcastic, but often happy personality.
While I can never imagine what being diagnosed with cancer, let alone terminal cancer, I can understand the pain that accompanies the increasingly lonely days that Coronavirus has drawn over us. The hospital ward is empty, there are no balloons or flowers that brighten the rooms, no families bustling in to see their loved one who got all washed up for the visit, and no handholding or kisses goodbye. Death is around us always, whether it is with the seasons or with an aging grandparent. These days, death feels even closer and even larger than it once did. I cannot make empty promises about having one last goodbye or having that one last hug or seeing her daughter in Clara’s case. Physical touch is gone and quality time is limited due to exposure restrictions. The reality for Clara is that her husband and daughter will be able to visit on a special circumstance when she is “close to the end”. In medicine, there are signs that give a timeframe about how far death is. You will see them withdraw, start to breathe more slowly, their blood pressure will begin to drop and their hands may get a little cooler, and finally you may hear the “death rattle” which is the gurgling noise someone makes as they begin to lose the ability to swallow saliva- each of these corresponds with a day to just minutes from death. Rules are bent easily when family comes in for the last goodbye- her husband will be able to give his young bride one last kiss, just like he did on their wedding day. Their daughter can crawl into bed with Clara and fall asleep, just like she did for the 9 months she was inside Clara’s womb. Together they can have one last picture taken by Em, which will be hung on the wall in Clara’s room until she passes. Clara will be heavily sedated to keep the pain at bay, but it also dulls the humanity in her.
While I wonder how Clara will approach her last few days and how her family is going to adjust to having an angel watching above rather than living in the present, I more often wonder how Em and her fellow nurses handle loss as a constant threat and often arrival. The toll that being empathetic, compassionate, and seeing people at their worst has on mental health is not small. A study from the United Kingdom found that the suicide rate among female nurses is 23% higher than the national average. Related to healthcare professionals, a survey done in China in February of 2020 found that 50% of the respondents reported symptoms of depression, and those in Wuhan where the coronavirus first broke out experienced more severe symptoms. As much as nursing has to do with the care of others, it is equally important for those nurses to care for themselves. Several studies have demonstrated the effectiveness of weekly meetings to discuss work stressors, measures that can help improve mental health, and tactics for staying physically healthy. Although nurses are being called heroes in present times- they are human at the core and require the same support networks. The nurses I have looked up to as professors and preceptors have shown me the toll that caring and being responsible for someone’s health has- which is why it is not and was not as shocking to hear that such a high number of new nurses leave the field. Hospitals contain parallels of life and death constantly- whether it is with the layout of the building, the status of a patient’s life, or the beginning and end of a career that was well-earned. Nursing is compassion, empathy, strength, and skill- these are also the makings of a human being. Nursing is not heroic- it is human at its most core requirements. A pandemic does not make the job more meaningful than what it was in the times before.
References:
Sampson, Marlene et al. “The MINDBODYSTRONG Intervention for New Nurse
Residents: 6-Month Effects on Mental Health Outcomes, Healthy Lifestyle Behaviors, and Job Satisfaction.” Worldviews on evidence-based nursing vol. 17,1 (2020): 16-23. doi:10.1111/wvn.12411
Hancock, Christine, and Natalie Marsat. “How Is COVID-19 Impacting the Mental Health of Nurses?” Health Europa, C3 Collaborating for Health , 28 Aug. 2020, www.healtheuropa.eu/how-is-covid-19-impacting-the-mental-health-of-nurses/102404/.
“One in Five Nurses Leave First Job Within a Year.” RWJF, 26 July 2019, www.rwjf.org/en/library/articles-and-news/2014/09/nearly-one-in-five-new-nurses-leave-first-job-within-a-year--acc.html.
“Why Is Nursing School so Stressful?” Loyola Chicago ABSN, Loyola Marcella Niehoff School of Nursing, 30 Aug. 2020, absn.luc.edu/blog/why-is-nursing-school-so-stressful-4-stressors/.
About the Author: Adeline Hayes is a college student in Boston, originally based in both Maine and D.C. She enjoys exploring coffee shops and writing about things close to her life. She derives satisfaction from making the field of Nursing both seen and heard through her voice.
