The Shift: One Nurse, Twelve Hours, Four Patients' Lives
Theresa Brown, RN (Algonquin Books,
2015)
The oncology/hematology ward in a
Pittsburgh teaching hospital is a good place to learn what nurses do.
The Shift is a first person account of a nurse's day there, at the
minute-by-minute level of alcohol swabs and sterile saline solution;
Theresa Brown drives her narrative by such details, but she also
makes time to think about some larger features of the environment,
and the systems that sustain it.
The patients and staff Brown discusses
are composites, for obvious reasons, but I found it easy to forget
that and enjoy their stories. From the fussy patient who wipes her
own room down with bleach, to the cheerful one who stocks miniature
Hershey bars for the nurses, to the barely conscious old man, they
stand in for their respective tribes. Brown navigates between empathy
and detachment, and divides her time between providing care and
keeping records of it. If it isn't recorded, it isn't done (and can't
be billed for.) "We need a menu that includes the option: spent
time comforting patient with life-threatening diagnosis. But nothing
that empathy-intense gets included in our required paperwork."
Of course, she's not only dealing with
patients and their families. Nurses constantly interact with each
other. The bureaucracy may require that they sign off on each other's
calculation; prudence may dictate that they call for help to move a
patient, and sometimes all the call bells go off at once. Being able
to rely on one another makes a huge difference; of course, it also
means more interruptions. Thirty uninterrupted minutes for lunch,
which is the legal mandate, just doesn't happen most days.
Brown's fellow nurses are probably the
easy part, because they at least understand what each other is trying
to do. The hierarchy of the hospital includes doctors of all levels
of experience. The most senior may be the least seen, other than
morning rounds, when they are surrounded by fellows, residents, and
interns, all doctors at different stages of their training. And
then–"These poor medical students: They worked so hard to get
into med school and then in the hospital no one gives them the time
of day, in part because they have no real purpose, at least on our
floor. They're supposed to be learning and I'm sure they are, but as
far as we nurses know they can't do anything."
Officially, nurses listen to doctors and not the other way around,
but many a young doctor has had his day saved by a timely word.
Brown has answers for some things I've
always wanted to know. How can nurses stand to wake up a patient who
may really need the rest? Why does discharge take so long? Why do
they move a dying patient out of the oncology ward? We won't
necessarily like the answers, but it's helpful to see how they are
embedded in the systems at work. In the end, nurses are the point of
contact between systems and human beings, and we're lucky so many of
them are as smart and humane as this.
In this one twelve-hour shift, Brown
learns from, teaches, and advocates with a dozen or more other
professionals. "As is so often the way in the hospital, we
barely nod at each other and move on. Nurses and doctors–we come
and go from our patients' lives and each other's with the anonymity
of mail carriers, the efficient intimacy of the guy who reads the gas
meter in the basement. That initial impression is what matters. Can I
work with this person? Can I trust him?" Mostly, which may be
all we can really expect. People are usually doing their best. And
thank heaven for them.
Any Good Books
July 2016
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