The Skills of Nursing and Writing
The difficulty – and joy – of interviewing Cortney Davis, Paula Sergi, and Stacy Nigliazzo over email was that their ideas kept spilling out from the questions until there were two conversations, one in the interview and one in the email thread. We covered bed baths, Ray LaMontagne, childhood fascination with the musculoskeletal system, Montessori schools, and Cortney’s article in the American Journal of Nursing, “Nursing Humanities: The Time Has Come” – and that’s not including the actual interview.
But don’t worry: the interview ended up being so wide-ranging that we split it into three parts. I hoped to understand what it’s like to be a nurse and a writer, what it’s like to be part of a literary world and a medical setting, and the changes that these three authors would like to see in each. I was also curious about how we value nurses and nursing. Stacy Nigliazzo wrote that she “would love to redefine the role of leadership, particularly at our hospitals,” while Paula Sergi posited that “we need to somehow make a job in health care as tempting as a job in finance.” Throughout the interview, all three nurses wrote about the power of close observation. I was struck by their intelligence, skill, and tenacity. It was a pleasure getting to know them through their words.
(former) BLR assistant editor
How does nursing inform your writing? And how does writing inform your work as a nurse?
Paula: The intersect of poetry and nursing has always fascinated me. Though I now identify more as a writer than a nurse, the skills I learned in nursing school have served me well as a writer. My program emphasized skilled observation when evaluating a patient or a community. A nurse never turns this off: I find myself noticing someone’s gait, skin tone and behavior, even while standing in the grocery line. It’s become a habit: I’ll see a child who seems somehow off, maybe developmentally.
Close observation is also central to the writing process, perhaps especially with poetry, where fewer words are used: you’d better find and use the best details. Images emerge from daily life activities, and the objective details I recall often trigger an emotional response for me.
Nursing also informed my writing through the opportunity to work closely with people. As a home health nurse and public health nurse, I’ve had the opportunity to observe peoples’ lives close up. I learned to make note of the many physical details that comprise a person’s life, and I found myself wanting to record and expand on these details, to explore, develop and fictionalize these realities.
Who made the scratches on the end table, I’d wonder. Was it a child, busy at play with his cars and trucks? Or a neighbor who brought over cookies, only to drop the plate? The young wife, going into labor and grabbing the table for support? And what about those figurines above the kitchen sink? Gifts from a spouse, commemorating a special event? Family heirlooms, or a bargain from a neighborhood yard sale?
Imagination became a way for me to confront the difficult realities of aging, the illnesses and loneliness so prevalent among my elderly patient population. I was welcomed into strangers’ homes, invited to sample favorite recipes, encouraged to look at family photographs, and privileged to hear their intricate life stories.
My patients also taught me about gratitude for small things. Like most of the elderly, one lady had lost so much: spouse, siblings, friends, health, and a steady income. Her only son lived far away. But when I visited she greeted me with a smile. “You seem so happy,” I observed. “Well, yes, my dear, I am. Because today there is a blossom on my African violet.”
And then there was the woman wearing only one earring when I came for a nursing visit. I commented on the lost earring, but she smiled and said, “Oh, no, I found this one!” No writing instructor has done more to help me find meaning in the ordinary, to slow down and observe.
Working as a nurse taught me so much about human nature, how real people have positive traits as well as faults. This awareness has helped me create characters that more closely resemble real life, to avoid the pitfall of creating merely heroes or devils. Because nurses meet people who are struggling through a difficult or stressful time in their lives, we encounter frustration and loss, along with grace. When people are sick they are vulnerable and grateful for whatever you can offer: a pitcher of water, a clean sheet. When you correct someone’s sentence structure or grammar they resent you for it. But offer a cool washcloth to a feverish patient and you’re a saint. Again, gratitude abounds.
Conversely, writing has taught me to remember the truth about human nature and to be more generous with people, less critical, even with fictional characters.
Cortney: When I was a senior in high school, many of my friends were debating which nursing schools they would attend, decisions often based solely on the nursing cap that graduates would wear―the little round cupcake hat or the one with upswept wings? Becoming a nurse was, however, the farthest thing from my mind. I wanted to be an artist, immersed in paints and images rather than in caregiving and all that caregiving implied―illness, blood, suffering, and death. And so my first year in college I majored in art. My second year, when I discovered that I was attracted more to creating images with words than with paints, I switched to an English major with a concentration in creative writing.
Fast forward a few years and I am married with a baby daughter, and my husband and I are having trouble meeting the rent. His cousin, a nurse’s aide, suggested that I take the training in order to help out, working evenings when my husband could be home to babysit. Reluctantly, I enrolled. I learned to take blood pressures and dip urines and empty drainage bags and give back rubs; then my first night on the job two things happened. A man called me an “angel of mercy” and I was introduced to death. Entering a room, cheerfully, ready to take an elderly man’s vitals, I found him lifeless and alone. In the quiet moments I spent with him before alerting the nurse, I felt something awakening within my heart. This was important work. This was where the intersection of the mundane and the transcendent met. This was where the true metaphors originated. This was the world in which everything I’d learned about writing came to fruition.
I loved what I was doing, and I loved the intimate and physical being with and caring for patients. There was and is something other worldly about the extremities of life, birth and death, healing and suffering. After I’d gone back to school to become an RN, when I worked in Intensive Care and Oncology, my passion for writing and my love of nursing intersected, and I began to write about the intensely human moments that occur between patients and their caregivers. When a patient and a nurse are alone in a room, together they create a sacred space.
Because I was a writer first, my writing informed my nursing by making me ever aware of the importance of close observation, of the nuance in a patient’s gesture or expression, in the metaphors, similes and images that patients use so precisely in speaking of their suffering. I’d learned as a writer the need to listen intently for what might be called the subplot, the underbelly of the surface narrative―the story behind a patient’s story that might remain unsaid but should never go unheard. Nursing encompassed and met, face to face every day, all the human elements of great literature. Writing and nursing merged, becoming, for me, a way to consider how we care for, or fail to care for, one another in all ways. Writing about nursing became, for me, a way to encounter the numinous in the everyday details of caregiving. Somewhere along the way I discovered that accompanying patients to their deaths or to their healings was as great an accomplishment as writing the perfect poem. Offering a back rub to a suffering patient was putting into action the impulses that occur in writing: the desire to connect, the need to reach out and go beyond the self, the knowledge that if even one person is touched by what you offer, you have succeeded.
And nursing has informed my writing, of course by providing the “subject matter,” if you will, of my poems, non-fiction and fiction. I find it interesting that when I’ve been with a patient, writing is farthest from my mind. I’ve never been caring for a patient and suddenly thought, “I could write about this,” and so run into the back room to scribble an idea or a line. It’s only later, when the moment has passed, that I might recall an event in all its fullness. Nursing has gifted me with a vocabulary of the senses―of the sights, sounds and colors of caregiving (nurses are trained to describe precisely, to notice and compare!), and of an awareness of the body, its gorgeous strengths and tender weaknesses. Nursing has taught me to listen for the key images, for the sounds of the human voice and how speech can hide or reveal. Nursing has taught me to stay with a suffering patient or with the piece of writing that later might honor that patient’s life. And most of all, nursing has taught me to praise, because as a nurse, I’ve witnessed miracles.
Stacy: I grew up in my grandfather’s house. He was a surgeon and his work influenced practically every aspect of our home life. I remember flipping through medical textbooks before I could read to look at pictures of various body parts and diseases, most of which were photographs of actual people with black bars fixed over their eyes. There was a three-dimensional model of a human heart in my bedroom with a pop-out left ventricle. I received nearly all of my childhood vaccinations on the living room couch.
Years later, after the sudden and unexpected death of my mother, I chose to enter the field of nursing. This decision was my watershed, my renaissance. The poems quickly followed.
For me, writing and nursing are inseparable—each informs the other. After ten years at the bedside, I still find myself perpetually inspired, especially by the little things. I’ll never forget the patient I once cared for who arrived via ambulance immediately after leaving another facility against medical advice. She was angry at first, but eventually warmed to me. At the end of my shift she held my hand and slipped a friendship bracelet from her wrist onto mine as a thank-you for my care.
On another occasion, I witnessed the death of a six-year-old boy after more than an hour of CPR, and held his mother gently as she crumbled at his bedside. Later that same day, after the boy had been moved to the hospital morgue, another patient was moved into the same treatment room: a young mother with a little boy in her lap. He was coloring a stack of blank progress notes. I asked, “How old are you?” He held up six fingers.
What I find most telling about these experiences is that they are truly timeless. Writing continually informs nursing by preserving our stories. One need only to read Walt Whitman’s “The Wound Dresser” (also a gifted nurse) to see there is no need for a time stamp within the context of illness, grief, and healing.
I would also assert that nurses and writers are equally watchful and precise—always looking for what others perhaps don’t see while anticipating three or four strides down the road. I’ve been told that my writing conveys compassion, but with detachment. As a nurse, this duality is also necessary. While I was comforting the mother of the previously mentioned boy who died, I was also serving as the primary nurse for two other patients, one of whom was being admitted for critical care. Of course, I was emotionally devastated, but there was work to be done. This is where writing becomes necessary. At the end of the day, the page is where we pour out our hearts. It is our sanctuary.