My Nurse Mentors

So, never lose an opportunity of urging a practical beginning, however small, for it is wonderful how often in such matters the mustard seed germinates and roots itself.  ...Florence Nightingale(1820–1910) {1}

This article originally appeared in All Nursing 2003 

 

Introduction

 

  My professor of English Literature at the Johns Hopkins University in Baltimore, Maryland endorsed, “The mark of a genius is humility.” While I am certainly no genius I would like to humbly submit this tribute to my nurse-mentors who took their time to train me. These are but a few. Memory fades with the years. My journaling should have been more conscientious.  Here are only a few of those wonderful nursing caregivers that I can recall and now I would like to honor.

 

Adhesive Tape

In my junior year of medical school at the Washington University School of Medicine in Saint Louis, Missouri I had to learn and I did learn to start intravenous fluid lines. When I mastered getting the needle into the vein in one smooth, swift minimally painful stick I still could not tear adhesive tape so I could not easily secure the needle in place. I suggested to my then somewhat condescending intern that I carry scissors and I was haughtily told in his sneering, condescending tone of voice, “No doctor carries scissors. You have just got to learn to tear adhesive tape or you can not be a doctor!”

 

Well, for sure I wanted to be a doctor so I strained and struggled until finally a nurse made the time to teach me the following, “Hold the adhesive tape between the thumbs and forefingers of each hand; then put your knuckles together; then put your thumbs on your knuckles, and then separate your wrists!” And that was it. Instantly I became an expert. I trotted about happily volunteering to start additional intravenous fluid lines confident in my newfound ability to tear adhesive tape. Nothing could have been simpler. It is my shame that I do not recall her name, but her method of tearing tape remains with me to this day. And now, in this writing, I thank her. I thought of her respectfully and I thank her each and every time I tear adhesive tape.

 

Spirituality

 

In my senior year of medical school I was admitting a patient with his upper gastrointestinal bleeding. The intravenous line with normal saline was established. Blood was drawn for type and cross match. His nasogastric tube was in place. As the nurse and I were smoothly working as a team admitting the patient a Roman Catholic Priest entered the room. I was dumfounded. I turned to the nurse and as I began to voice my dismay she firmly took my arm and started for the hallway. I realized that my arm was going out of the room and if I wanted to keep my arm I had better follow it and follow her. In the hallway she gently but firmly explained that, “In the care of any and all seriously sick patients, including but not limited to Roman Catholic patients it is correct and appropriate to provide the sacrament known then as the last rites or extreme unction now known as the sacrament of the sick or equivalent in the event of any acute illness that might unpredictably further deteriorate and progress to the demise of the patient!” Not being myself a Roman Catholic: and, not having had myself any instruction in spirituality in my medical school years, I listened carefully and learned much.

 

Through my years I have always inquired if my patients or their families or significant others want a visit by clergy. When the answer is, “Yes doctor,” I have telephoned imams, and/or priests, and/or ministers, and/or rabbis personally and directly and I have documented these telephone calls to clergy in the chronological record of medical care of my patients. In time I have endeavored to educate my marginally literate hospital ancillary personnel who have written in ink in the chronological records of patient care thus, “Priest visited and gave the patient the last rights (sic)!” In time I have become more acquainted with the process and I have accepted my community theater role of Padre` Perez (wearing both my wig and my medieval eighteen-inch wood cross) that provided me the opportunity to administer the last rites on stage, that I chanted (and can still chant even now) in classical Latin accompanied by a bassoon for Don Quixote de la Mancha in our fifteen performances of our Jonesborough Repertory Theater performance of “Man of La Mancha!”

 

Nevertheless, giving credit where credit is due, my initial understanding of the importance of clerical visitation of critically ill and potentially critically ill patients came from a dedicated, educated, kind, gracious nurse. Again I take this opportunity to thank her and again I apologize respectfully to her for not even remembering her name.

 

Mitzi

 

In my internship, I was privileged to meet and learn from the best of the best of my nursing mentors. She was a married Asian-Pacific-Islander with a pre-school child. Her dedication was such that she chose to leave her family each afternoon to work the evening shift of our emergency room. And that is where I was fortunate to meet her. I do remember her name but I withhold it out of respect to protect  her privacy and confidentiality. Her chosen “abbreviation and/or anglicanization” of her name was, “Mitzi.” It was the name she went by. It was the name we used in the hustle and bustle of our emergency room. We knew her by no other name. She was the best of the best.

 

When a patient with acute left ventricular failure with pulmonary edema would arrive in our emergency room gasping for breath Mitzi would say, “Oxygen doctor?” We would answer, “Yes.” Then Mitzi would give the oxygen and say, “Intravenous morphine doctor?” We would answer, “Yes.” Then Mitzi would administer the intravenous morphine and so on and so forth. Similarly with: diuretics, rotating tourniquets, the 12-lead electrocardiogram, and acute hospitalization. We had no intensive care unit but we had Mitzi and our patients did well.

 

All of the staff physicians recognized the skills of Mitzi. If and when a patient would come in with ankle trauma the bone-and-joint specialists would endorse, “Have Mitzi look at the x-ray and then call me.” To the best of my knowledge and recollection, Mitzi was never honored or otherwise officially recognized by either our medical staff or our house staff. Mitzi was never given any awards, plaques, dinners out, letters of appreciation, letters of commendation and so on and so forth. Why not? Could it have been that the physicians, both attending staff and house staff were ashamed of admitting just how much they learned from Mitzi and just how much they depended on Mitzi?

 

And what became of Mitzi? Did she receive the outstanding care that she taught us to provide when she herself became unwell? Mitzi was herself hospitalized with unrelenting, never-ending, round-the-clock chest pain. In those dark ages, now decades ago, imaging was in its infancy. The chest x-rays were reported as negative. The laboratory data was unrevealing. I can still see and hear the chief-of-medicine, speaking in his deep voice and surrounded by his acolytes, waving his hand in the hallway outside her room and endorsing, “Aside from the small probability of malignancy...”

 

Matters came to a crisis when some well-meaning provider wrote on Mitzi’s scut sheet (list of things to get done), “Get a psychiatry consult,” that, in those days of stereotyping mental health professionals and stereotyping mental illness (has that changed?) deeply wounded Mitzi. In those dark days before patient’s rights, Mitzi was not supposed to see her scut sheet which was to be tossed (shredded?) and not to be, never ever to be, a permanent portion of her chronological record of medical care, but Mitzi, being perceptive, and knowing about scut sheets, albeit gravely ill, somehow did get to see her scut sheet.

 

Finally she demanded and got a medical oncology consultant who performed a needle biopsy of the inner lining of her chest and documented pathologically a spreading malignant cancer, primary site undetermined. At last Mitzi, under a sentence of virtually certain death, now knowing the reason for her relentless chest pain, achieved a measure of peace. Was it the irony of her life that she who not only gave so much to the treatment and care of untold numbers of patients and trained untold numbers of interns when she was ill she was dealt with in a strange manner? Mitzi lives now in my memory. May she rest in peace and may her memory always be for a blessing.

Please accept my appreciation for my meager and imperfect endeavor to voice my humble and respectful appreciation of all of my nurse-mentors.

Thanks Mitzi! God-bless!  God-speed!  God’s-Grace!

 

REFERENCES:

1. Cohen, I.B. “The Triumph of Numbers: How Counting Shaped Modern Life,” W. H. Norton, 2006. Chapter 9 is devoted to Florence Nightingale.  

            

               

  

 

 

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