“Everything that we see is a shadow cast by that which we do not see.”~ Martin Luther King, Jr.
My nursing education began in a patriarchal era, a time when doctors made unilateral decisions regarding healthcare. The patient did as they were told. Because of course, Doctor knows best. But my education was not limited to the classroom, or to pronouncements from those steeped in the biomedical tradition. Some of my educators were outspoken women, women with attitudes and personalities, that helped me to see what it meant to be a nurse, one who wasn’t scared to put the doctor in his (mostly male at that time) place. But I also learned from patients.
In that patriarchal way of thinking, what to tell a patient about their prognosis, especially if it were a bad one, depended on the gender of the patient. A man, usually the breadwinner of the family, needed to know if he had a terminal disease, he had to put his affairs in order. A woman, well, first let’s tell her family (i.e. her husband) and let them decide what she should know. My lesson regarding the deep injustice of that practice came from a 60-year-old woman with lung cancer. I entered her room to find her angrily complaining about the ‘bloody doctors’ who had broken the news of her diagnosis to her husband, who had fallen to pieces at the word cancer. “They should have told me! I would have known how to tell him! Look at him! Now I have to take care of him instead of concentrating on my health!”
Bioethics teaches those being educated in the health sciences about concepts like autonomy and justice. Nursing students are taught of their role as patient advocates. The patient has the right to be involved in healthcare decisions, should be a partner in their treatment plan. And the nurse should speak on their behalf if it appears that something other than that is taking place.
While my patients were teaching me about the subjective experience of being ill, of facing life and death issues, I was also being taught how to see the same issues objectively and a little dispassionately. And although the nurse needs to be empathetic and compassionate, by being able to see the bigger picture, she (or he) may be able to help a patient through to the other side of a low moment. I remember how much I hated my husband, when during labor, as I would angrily tell him I was never getting pregnant again, he would quietly state: ‘You said that the last time’. And although (of course) that angered me, it also helped to remind me that I had made it through before, and I would make it through again. Of course, the beauty of labor is that there is usually a lovely baby at the other end of it, and memories of pain and distress fade away.
At times when life seems to present us with what appear to be unsurmountable problems, a little perspective is called for. Nursing students live from exam to exam, see their life in terms of grades and points. Nursing instructors try (often in vain) to help them to see that it is concepts and experiences that are important. The knowledge, the skills, the sensations of being a nurse cannot be crammed into your head to pass a test. Patients are not multiple-choice questions (just pick c!). This can be the biggest challenge for an instructor: to help the student see beyond the immediate prize of an exam score, to the long-term rewards of recognizing, applying and synthesizing concepts taken from the classroom to the bedside.
That was not the only lesson that my patients have taught me over the years. I also learned that the behavior exhibited by a person who is under duress, whether it is because of health challenges or a particularly stressful set of life’s events, is just an exaggeration of that person’s true self. We often hope that when we act out our friends will excuse our tantrums, that they will understand that we are under stress and ignore our rude outbursts. But while we are focused selfishly on our own troubles, we may be totally unaware that someone else is quietly going through something far worse.
This week we were rocked by another symptom of a sick society, a society suffering from undertreated mental illness, armed with an insane number of murderous weapons. The words of JFK should guide us: “Our problems are man-made, therefore they may be solved by man.” But we must have the right people in place to do the right thing. So long as those who have the ability to change our laws are influenced by profits and power, we cannot hope for the right decisions to be made.
One morning a few weeks ago, I listened to the words of the poet Tupac Shakur, and was moved to tears at his words of encouragement to ‘Keep your head up’. This morning I am hearing those words, accompanied by the sampled lullaby of Nina Simone telling us that ‘things are going to get easier.’ Let us hope that things will indeed get brighter.
Have a wonderful weekend, Family! And to all who think they cannot possibly make it through a particularly rough time, just remember, you said that the last time!