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Nursing & Writing Roundtable: Part II

What do you wish you could change most about the literary world?

Stacy: I would love to see more of a mentor-based community for emerging writers. Too often, vanity and elitism get in the way, and those who could do great things are unfairly discouraged. Were it not for the encouragement and direction of established writers early on (Cortney Davis being one of them) I might have quit before ever really getting started.

Cortney: Although, on the one hand, I might come up with a list―too many inferior self-published books, too many MFA programs turning out too many “writers,” technology ruining the market for actual, physical books, and the way anyone with a blog suddenly becomes an author. On the other hand, I have to acknowledge that in every era the way we express ourselves changes, and yet literature survives. While I might mourn the explosion of self-published books, I remember that Whitman and so many other writers we honor today wouldn’t be known without self-publishing. While I might mourn the proliferation of MFA programs, the churning out annually of hundreds (or thousands) of “writers,” I know that among the graduates is another Dickens or Plath or Shakespeare. While I might despair at Internet ezines and blogs, I rejoice that the written word is now available to anyone with access to a computer, tablet, or smart phone. I might also mourn the fact that in order to publish a book of poetry, one has to pay an entry fee and win a contest. Yet I have faith that eventually the best poet will emerge. Even if his or her poems aren’t to my taste, entry fees bring the money that is necessary to produce the beautifully printed books we enjoy today. So, perhaps I wouldn’t change a thing but rather wait to see what comes next.

I’m grateful that my education in writing began with a college program which offered the basics of writing but never declared that all graduates would be “writers.” I’m grateful that my real education in writing was simply living and then writing―hours and hours of sitting at my desk trying to translate what I saw and felt into language that was alive, physical and sometimes even risky. I’m grateful that my impulse to write was fed by nursing, by that intense, important arena that offers every emotion and every human situation on earth.

Paula: I wish our culture could be more aware of and appreciative of all art rather than being so focused on money as the motivation for career choices. I wish that we could recognize and reward creative children and young people more than we do.

I’d welcome more opportunities for collaboration between and among writers. The experience of co-editing three anthologies taught me how books benefit from two different philosophies, life experiences, and visions. It gave me the confidence to be ambitious with projects because I so admire the talents of my collaborators, Pam Gemin and Gerry Gorman.

What do you wish you could change most about the medical world?

Stacy: Without a doubt, I would love to redefine the role of leadership, particularly at our hospitals. I once had a graduate student shadow me in the emergency department (my director was out that day, so she followed me instead). She was about to complete her terminal degree in hospital administration, but had never worked in a hospital before—not even as a volunteer. I relished the opportunity to show her how things really work, as opposed to just on paper. By the end of the day she was stunned. “I totally underestimated how hard nurses work,” she said. I think all administrators should be required to don scrubs and walk the wards in our shoes from time to time.

I would also encourage providers of care to share their stories through creative expression (music, painting, stories, and poetry) as a means to de-stress, foster empathy, and fight compassion fatigue. I applaud the growing field of healthcare humanities and hope to see it continue to expand in the future. Columbia University now offers a master’s degree in narrative medicine, so I think we’re on the right track.

Cortney: In June, 2013 I entered the hospital for routine one-day surgery. Due to a surgical mishap and a series of unexpected complications, I was a critically ill patient for twenty-six days. I learned, first hand, the many changes that have occurred in both medicine and nursing. Just as technology has altered the way we approach, create, and read literature, so technology has changed the way we exist as patients or caregivers, both enhancing and diminishing those roles.

My sheets were changed not daily but only when soiled. I was in the hospital for two weeks before I was able to attempt to wash myself (with a pre-soaped no-rinse washcloth). Gone (at least in the hospital in which I lingered) was the bed bath, the foot soak, the back rub. When my skin became red and rashy, the solution wasn’t an air or foam mattress pad and skin care but un-bleached sheets, thin ones spread over the plastic mattress. I was offered a visit from the “massage woman” who would schedule a visit to rub my back and shoulders.

I am forever thankful to one nurses’ aide who got me up into the bathroom and washed me as I stood naked holding on to the sink, soaking both of us in the process, but finally after three weeks I felt clean. The doctors―often new ones every day―came and went with their notes and laptops, asking “How do you feel today” but often not waiting for the answer. Nurses arrived pushing their rolling computer stands. The day I was finally discharged, one of my very good nurses was let go, part of a general lay off. She’d been there for almost 20 years, and she remembered what good nursing care once entailed and, like me, she mourned its passing.

What would I change? I would bring back the tender bedside ministrations that I learned were so important to patient care, and the minute observations that Florence Nightingale once taught her students. I applaud the current trend of teaching literature to medical students as a way to foster empathy, but I know that the pressures of learning “medicine” and the requirements of technology might eventually overwhelm compassion. I admire the hospitals that have instituted “Schwartz Rounds,” monthly meetings in which staff members might discuss their emotional reactions to the many difficult or wonderful moments that occur at the bedside―and I wish that there were similar opportunities for patients to discuss their emotional reactions to illness. I’d encourage both patients and caregivers to respond to their illnesses or their anxieties creatively, through writing, art, or storytelling. I know that there are nurses and physicians and programs and hospitals that offer excellent patient care. I wish there were more.

Just as literature enters, every era, new territory, so do medicine and nursing. As we “old school” nurses age and retire, I hope that what is best in nursing―the deep, intelligent observation of and sensitivity to a patient’s needs―and the best in doctoring―the deep, intelligent attention not only to a patient’s illness but to all that makes each patient a valued individual―might survive.

Paula: It would take a shift in our culture to bring the changes I’d like to see. We live in a country whose value system has gone awry: having money is how we describe success. I feel more optimistic about this lately, as I become aware of an increased consciousness among some young people. I wonder how to communicate to young people the tremendous opportunity of a life in medicine or nursing, how satisfying it can be. We need to somehow make a job in health care as tempting as a job in finance.

I believe that the Affordable Care Act is a step in the right direction, despite its flaws. I think Walt Whitman would agree.

I’d like to see continued emphasis on preventative care, where we’ve recently made progress.

I’d welcome more affordable training for medical students as a way to motivate more people to study fields that bring in less money, like internal medicine and pediatrics. But these are not original ideas.

I’ll go out on a limb here and call for doctors to salvage their role in health care, to reflect on the tremendous undertaking they’ve chosen. How can we support doctors and nurses beyond repeating the sound bite of “patient centered care?” To deal with the load of paperwork and more pressure than ever to be productive, to increase patient loads?

I don’t offer these suggestions flippantly. I speak from personal experience, having been married to an internist for thirty years. I’m thinking about my husband’s habit of visiting a patient in the home or making a social visit to them in the hospital. He’s aware that his role is to support the failing beams of his elderly patients and their families. If you’re a patient of his, you’ll get a return phone call from him, though it may be after nine PM.

He attends wakes and funerals whenever possible, even if it means cutting short his few hours of free time. He’s invited to birthday parties and anniversary parties and attends them.

It’s true that we live in a small community with only one hospital, and that he doesn’t have to travel long distances. He also has a specific set of skills and a personality that makes him especially good as an internist: a lot of energy, a love for people, a strong work ethic, and tenaciousness in making a diagnosis. And he gets frequent rewards in the form of comments and thank you notes from patients and their families.

Part III