Heal the World?

Aka “The screams of the children keep me awake at night*”.
I was tempted to use the quote as this entry’s title, but it’s just too macabre. Exposition about its origins further on.
I work in healthcare, which is currently struggling due to a combination of national cuts and the gremlins that exist in any new building. On top of this I have a tendency to speak my mind, and do so plainly away from the public. This was the case recently when I voiced an opinion that differed from the group. Let me explain:

We were having to cancel patients recently for a variety of reasons (no beds, no time, the patients themselves being in frail health) and many people professed regret for those cancelled. I can see the frustration. You come to the hospital, starved and thirsty and scared, often afraid of dying during the procedure, only to sit all day restraining the panic until some nurse comes to haul you away to surgery.
Only this time it doesn’t happen. You get told the operation will be cancelled and you go off home to eat and fume. And make arrangements if you’ve had to take time off work. And hold the panic at bay if the operation was cancerous in nature. Because a two week wait for the next available operating slot can be a long time. And it was into this shared sympathy, regret and sorrow that dropped the bomb of my own opinion.
“I don’t feel sorry for them”.
Yes, in hindsight I could’ve voiced my opinions better. But that’s me. Blunt, crass, forthright, apparently it’s a blessing.

Silence. Then derision. Then outright criticism.
“You shouldn’t be a nurse!!!!!” being the most stinging.
I smiled my counterpunch. Smiling enables you to swallow a lot of ire I find. Personally for me, not so much to enrage people further, but on a more placating level and projecting an aura of mental incompetence or a difficulty in understanding it can diffuse more situations than it ignites. Or at least that’s what I find, I could be in the minority.
I wasn’t going to be led into a slanging match then, but reading those six words for the first time might make anyone gasp. The implication one of cruelty and neglect of the most vulnerable and suffering few conjures images of some of the worst instances of humanity’s dark history. Indifference and apathy, oppression and injustice, all of it forming the extreme nightmarish scenario that saturated the UK headlines several years ago, primarily in the Mid Staffs hospital. Stories of preventable death, dehydrated patients and exhausted demotivated staff forming a perfect storm that resulted in 1700+ deaths.
And a huge promotion for the Hospital CEO. Seriously, he was promoted to the NHS national committee (I’m not making this up, sadly).

But that is not me.
I’m not a heartless, manipulative healthcare worker hiding behind a uniform. Every patient that comes into my theatre – intentional possessive preposition – will receive the utmost dignity, care and compassion that is within my heart and mind to give. Absolute, without question. But until that time I don’t know them, and subsequently until that time they are not my concern.
Does this make me a bad nurse?
For not feeling compassion towards people I don’t know nor have never met?

It is a professional balancing act, one tied up with the code of candour as well as conduct, of the English health service. The Trust I work for states that you must care for any patient that you come into contact with; regardless of race, religion, sexuality, etc. the only two exceptions are the sensitive issue of abortions, where several religions consider such an act a mortal sin (abortion is legal in Britain, illegal in Ireland and a bit of a grey area in Northern Ireland) and the lesser known, or lesser occurring scenario where a family member is the patient. Put simply I am NOT allowed to assist on the surgery of a member of my family. I’m not even allowed inside the theatre. The rationale being the understandable emotional distress of having your family operated on, be it trauma or elective would be too much for many, myself included.

But these are the people you are closest to, who birthed you, raised you, taught you. Surely there would be no greater compassion than for your own blood, wouldn’t there? Yet you must not intervene. You must feel more compassion for strangers than kin. As if compassion is something that can be taught in a classroom, such criticism levelled by many senior nurses at the new blood entering the profession through the implemented degree scene back in 2000. A generation more adept to write a sociology paper than assist an elderly patient to the bathroom. Not possessing the real fortitude of previous generations, those who went into nursing as a vocation, when nursing was considerably more on-the-job orientated in its training and the ability to care for someone, to sit and talk to them was of greater emphasis than it is now.

When I trained, in the middle of the last decade, the accepted ward ratio of nurses to patients was one in five; one nurse to five patients on the day shift. Now on many wards, thanks to the cutbacks, retirements or outright resignations the ratio is now one in eight. Eight. Even Supernurse couldn’t adequately look after eight patients, all with complex individual needs, all with their own private forests of paperwork and still have time for the personal touch the tabloids forever hark on about. But we give our all, our best, our selves. We burn with desire to help, to heal, to give some people who are approaching the end a little more comfort on this earth.
We burn.
And many of us burnout.
Children’s nurses have the highest reported rate of burnout in nursing as a whole, and with good reason. Seeing children and infants suffer tugs at the deepest heartstrings, and in time they will eventually overstretch.
One of my favourite films is Martin Scorsese’s ‘Bringing Out the Dead’, with Nic Cage playing the burnt out paramedic working the night shift in New York. Over the course of three nights we learn about Cage’s character ‘Frank’ and how his failing is not his inability to save his patients rather the inability to surrender that burden of guilt he feels over those he couldn’t save. The ghost of one girl, Rose haunting him throughout symbolising such self-torment, and towards the end admonishing him saying that she didn’t ask him to shoulder the guilt of her death, that was something he chose to do himself, that salvation lies within himself, not in the gratitude of those he saves, or the guilt of those he doesn’t.

Seen from the other direction many strangers, when hearing my profession utter words to the effect of: “Oh, I couldn’t do your job”.
I’ve never understood why exactly people admit to this particular failing. Nursing hasn’t been my sole employment so far in my life; you don’t hear customers confessing to coffee baristas their admissions of reverent pride over their morning espresso. Also the prevalence of parents rules out any revulsion of close contact with bodily fluids, though theatre nursing is an acquired taste even within the profession; the heavy dose of gore and poor patient interaction making surgical work an anathema for many. My own belief is that the majority of people recognise the mental burden healthcare entails. To care for strangers; the sick or injured, the frail, stricken or dying is a challenge not everyone is enamoured to possess. They have it, but do they have enough to give to themselves, their families and then still keep giving?
There is no shame in such fragility.
To be as strong and as hard as iron is just as much a curse as it is a blessing.
You weather the storm, but you are not invulnerable.
The job will not save you.

One of my closest friends is a former mental health nurse. An intelligent, articulate compassionate lady with over a decades experience she left the NHS around 5 years ago, giving me some bittersweet advice about the organisation:
“Don’t sell your soul to them… they won’t thank you for it”.

It is sadly true. Unless you’re one of the few nestled amidst the golden spires of management your payoff at the end will be marginal at best. Especially now for my age group, who will have to wait until we’re 70+ to officially retire. And what state will I be in? Two orthopaedic nurses retired in the last five years have ended up as patients on their own table, shoulders worn down from hauling the heavy ortho surgical sets day after day.

So I see all this laid out before me and it is hard to cut pieces of my self off to give to those I’ve never met. If this makes me a bad nurse to some then so be it, but I’ve always marched to my own drum concerning things in my life, and my conscience will police my actions better than any manager can. And I can only do my best within the framework such a remit allows, and everything else can turn to ash in the wind.

* The quote comes from the diary of an SS Officer that Philip K Dick discovered in an Californian University’s archive. Dick would use the quote as inspiration to create his idea of a replicant, a robot that was perfectly human but lacking the emotions to live as the real thing, when he wrote his novel ‘Do Androids Dream of Electric Sheep’, later to be turned into the classic movie ‘Bladerunner’. The idea that a human could witness such suffering first-hand but not even acknowledge it (let alone intervene on the victims behalf), and instead be more worried over his lack of sleep, fascinated Dick, leading him to wonder if a percentage of humanity was born without the fundamental characteristics of compassion and connection for strangers, something that many people possess even if they aren’t consciously aware of the fact.

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