The PBS television show Call the Midwife recently began its second season. The show, set in the East End of London in the 1950s, is based on the bestselling memoirs of the late Jennifer Worth -- a former district nurse and midwife.
Call the Midwife, and upcoming National Nurses Week (May 6-12) has made me, as a registered nurse, reflect on my own nursing practice, and in particular on one former patient -- "Edith" -- who has made an impact on me, and has for nearly 30 years affected my work as a nurse, as an academic nurse researcher, and as a professor.
Edith was my patient in the late 1980s, on an inpatient psychiatric unit where I worked as a staff nurse, in my first few years of nursing practice. I can picture her as if it were yesterday. She was in her late 60s, about five feet tall with grey, curly hair. She wore purple-and-black floral tops, black elastic-waistband pants, and black rubber-soled shoes.
Yet, my most disturbed and seared memory is the look of fear expressed through her eyes and the tension in her facial muscles.
Edith was psychotic. She was confused. She often did not know where she was or how she got there or what was happening to her. But she knew me. I can still hear her voice in my head, calling me, yelling for me -- "Mona... Mona... Mona."
She is my ghost. Some days, my muse.
I think of her and the care that I gave her those weeks, so many years ago.
Often, Edith sat in a wheelchair in the hallway near the nursing station. She didn't talk much. But she wanted to be near people -- I think to assure her that she would be safe, that no one, or no thing, would get her. Her fear, her screams, were often unsettling. She was scared and I tried to calm her.
Sometimes I took Edith for a walk up and down the halls. I would have to crouch over, she would hold onto my arm, and then shuffle with me down the hall. We didn't talk much. Neither of us did. On our walks, she would pat my arm and sometimes stop walking, look up at me, and just look into my eyes. Her facial muscles a bit more relaxed, her fear somewhat subsided, perhaps finding comfort yet searching for answers (what is going on with me?). Maybe wordlessly thanking me for being with her.
Edith touched me. I have thought about her often over the years. I have wondered what happened to her in the months and years after she left the psychiatric hospital. I don't recall where she went after her hospitalization. Maybe she went home. Maybe she went to a nursing home, or maybe she went to a state psychiatric hospital for longer-term care. I don't remember.
What I do remember is that she wasn't much better when she left the hospital. Not really that much improved. She was still psychotic. Medications did not seem to help her.
Perhaps the human connection did.
In the years since I cared for Edith, I became a researcher -- a "doctor nurse," as I'm sometimes called, because I have a Ph.D. in nursing. I study how people make meaning from their experiences and I study therapeutic nurse-patient relationships, inpatient psychiatric nursing care, non-pharmacologic interventions for emotional distress, and the experience of psychosis. Maybe I am interested in these research areas because I want to do better for people like Edith.
During the time and place when I cared for Edith, patients were in the hospital for two weeks or more. Today, the average length of stay is 7.5 days. Still, nurses provide intimate and intense personal care, in a compressed and time-limited context.
In the current U.S. health care climate, nurses have less time to do more. Patients are sicker and inpatient nurses are fewer, and therefore have to work faster, and get to know patients quicker.
Patients in the hospital are still afraid. Nurses still calm their fears.
Now, nearly 30 years later, thoughts of Edith and her psychosis, her time with me (and my time with her) on an inpatient psychiatric unit, my attempts to understand her and care for her, have affected my work today. I struggle with this question: How can we do better?
I'm absolutely sure that other nurses have patients who have similarly affected them deeply. To be sure, other health care professionals have as well.
Maybe it's because I could not help Edith. Maybe it is because I did.
Today, I don't walk down the halls of inpatient psychiatric units with patients patting my arm, or hear my name being called out from patients who are afraid of their voices, visions, or disorganized and confusing thoughts. I'm no longer directly responsible for the care of Edith and those like her.
But they are with me. Perhaps Nurses Week is a good time to remember patients who, like Edith for me, have changed us and inspired us to examine our practice, our world, and ourselves.
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