THE BLOG
02/20/2013 09:29 pm ET Updated Apr 22, 2013

How to Make a Bed

Until I became a nurse, no one had ever asked me to sign a book contract. I had been writing for decades, read thousands of books, and even worked in publishing for 10 years. Who knew that nursing would be my break?

And I was writing fiction. I hadn't produced anything particularly medical and I hadn't pillaged hospital files for plots or characters. The coincidence of the two milestones, graduation and publication, could be seen as the serendipitous joining of timing and maturity, but I don't think so.

Nursing demands vigilance about people. The sights and smells that a patient offers, their movements and their offhand comments all contribute crucial information to understanding what they need. Training and experience heighten one's ability to see what needs to be seen. Learning to pay attention to these details is a lesson in the economics of description.

Imagine a routine interaction with a patient: the daily bed change. You're not dispensing meds, you're not taking obs. The primary task is to spread the sheets, position the cotton blanket so the holes or permanent blotches are out of sight, fold them all neatly, and then tuck. Did you really study anatomy, health promotion, nutrition, pathophysiology, pharmacology and psychology for this? Yes. So hit the linen cart with enthusiasm, then glove up: You don't know what you'll find.

Let's pick a fairly typical hospital specimen -- female, 85. She's been on the ward for two days. You have several beds after this one, so those facts may be all you know when you enter. Before you even look at her, check the room for flowers or photos or treats brought in by visitors. Or is this one more of a loner? Look for other goodies from the real world, a blue velour bathrobe folded over the edge of a chair (belonging to her deceased husband, perhaps?) a few novels on the end table (mysteries? Brit lit?), or is there just one virtuous apple saved from dinner? What does it mean if you see none of these things? Is she underloved or simply unencumbered?

This room is hospital bare, except for the presence of the patient who occupies the bed that you need to make. A meal, its delights still hidden under plastic covers, sits untouched on the tray table. Is she sitting up in full but tasteful makeup, watching the news and dutifully sipping water from a blue tumbler? No, she is pale and dozing, with one hand resting on the metal bar that keeps her from rolling out of bed. There is a clean gauze bandage on her forehead and the purple hint of bruise under her eye. A fall? A brawl? Did she sleep through breakfast or is she not eating?

When you say, "Good morning [whatever her name is]", her eyes open. She is not irritated to be woken; she doesn't appear disoriented or in pain. In fact, she smiles and glances at the folded sheets in your hands. She makes her own judgements about you. Without delay and without looking for a hand, she vacates the bed, leaving it flat, as if she'd never been there. She transfers herself to an adjacent chair with a wince, favoring her right leg as she goes. Although you didn't ask, she volunteers, "I'm better today." Once settled, does she glance out the window at the nearby rooftops while the help does the necessary bed-making? Does she engage you in eager chat? Or, does she skeptically investigate the breakfast offering on her tray table? No. She opens a bedside drawer and peers in.

You are on the other side of the bed, bunching up her used sheets and deciding if they can be reused, so you can't see what she is reaching for. Picture what it might be -- a tortoise-shell compact with rose-scented powder like your grandmother used to have, an ipad in a blue leather case, a copy of Dog Fancy. Or maybe a phone, so she can call her daughter, her lover, her bridge partner -- a few lines of overheard dialogue could reveal so much more. Each possibility provides another clue.

Meanwhile, what evidence do you find on the papery white cotton bedding? Any visible bodily stains or smears? No clinical signs here, just one balled up tissue, also colorless. Now inhale. At first whiff, there is something strong and almost sweet. Jean Naté Body Splash or concentrated urine? No, there's nothing floral or offensive in it. Take another sniff. The fragrance clarifies to a fruity chemical: it's from her breath, ketones. Sure enough, over at the drawer, the patient has scored a diabetic fix, a handful of jellybeans. She pops them in her mouth and sinks back against the seat, closing her eyes to let the glucose hit the blood.

One clinical hypothesis emerges -- an independent woman, maybe lives alone, becomes undernourished, her blood glucose level drops, so does she, and bam, she ends up in the hospital with stitches, maybe a fracture. This may not be the case, but it's possible. You would supplement the patient's record with your observations. The right questions would follow. Nursing teaches you to filter through the distracting details to find the significant ones -- the ones that work to tell the story. A dozen other details may be surmised from the above, some that might advance a plot, some that might round out a character. The trick is knowing where to look.

A nursing degree may not be the straightest route to a book deal. (And note: there is a far more established history of doctor-novelists than nurse-novelists, but that's a topic for another day.) It has, however, refined my field of vision. Reading people correctly is a crucial skill for working on a ward. For an author intent on building a character fact by fact, a tightened view of the physical world it is just as vital.

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