Friday, July 1, 2016

The Shift

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