Outlaws and Insights: On Reflective Nursing Practice

The faces of illness and death can make us small. As nurses, we become large again at the intersection with others as they experience their own watershed moments. The simple mechanics of doing our jobs allow us to look through windows that open, wide and brief, into others’ lives, providing us great insight into our own. I learn much about interiority in this way.

My own seasonings as a nurse and as a person are inseparable. A defining point occurred in a dilapidated New England farmhouse with a screen door that flapped in the wind. Inside, torn floral linoleum covered a crooked floor. Greasy dishes were piled in a rust-stained sink. The house smelled of chain-saw oil and stale urine. An antique hospital bed, crank missing, was in the center of the room. Clint was young, only forty years old. He existed under the radar of authority. To live outside the law, his wife informed me while I did his Hospice intake interview, required that one must be honest. This family considered themselves outlaws; this family was unflinchingly honest.

Three months later, I pronounced his death. Friends and neighbors gathered in the dooryard, keeping a crude but comforting vigil. It was one part festival, one part wake, and one part street theatre. Singular customs like these distinguished every landmark in the lives of this unconventional, eccentric community.

Clint’s three weary brothers were at his bedside before he died. These were big, tough men, not afraid of much,  yet morose with this dying happening so close to them. They strode through life, hard-drinking, hard-living desperados. Now they stood before death. Quiet. Stunned.

Their armor had failed.

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But these men knew survival. The success, or failure, of hunting season determined the difference between a fat year for the family and a lean one. They told stories of the long, cramped surveillance from narrow deer stands in the numbing November cold. They could follow a buck’s trail in the woods for miles. They interpreted scrapes and smells. Their heavy bodies were graceful, feet planted carefully to avoid the snap of a twig. They predicted an animal’s behavior and its route. They tracked trails of blood, patches of hair caught on woody shrubs, and hoof prints on damp brown leaves.  The brothers waited for good shots:  a clean kill demonstrated mastery of the craft and respect for the animal, avoiding a slow and painful death. They knew all this deeply. Close to the bone. They read signs and followed inner guidance.

They knew that in his own way Clint had lived and died well.

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The brothers left, after Clint’s heart stopped, charging the women with the care of the body. A feeling of tribe is associated with doing this work with others, at home.  The air in a room changes when death arrives. A hush is discernible. When death is institutionalized, there is usually a lack, a void.  Respecting the stillness, we women worked quietly together.

Into this pause, this threshold place, sudden gun shots exploded just outside the screen door. I jerked around and saw the three brothers in braced postures, the butts of their rifles gripped hard against their shoulders. Calloused hands, steady, prepared to shoot again. They aimed over the impenetrable far woods, and for a second then a third time the deafening shots pierced the stillness. They slowly lowered their guns. Quiet conversation resumed. The other women and I turned back to our work.

This ragged 3-volley salute from hunting rifles was a raw and eloquent prayer of grief and honoring, a spontaneous eulogy born of one family’s particular way of being in the world. Rich meaning and tradition are elements of every culture.

_________

Nursing often requires doing constant impossibles. Contemplative nursing practice exists as  the underpinning to all dimensions of all care that we provide, wherever we provide it. Reflection and compassionate service hold the potential for us to change lives and to be changed ourselves. Pilgrims, all of us. Together in this land of living and of the dead.

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Reflections on Nurses, Writing. Blogging 101, Day 4

I live in Vermont, home of the Bread and Puppet theater group, which shares magic, social and political commentary, and affordable art with its guests. One summer, the troop led us into a hushed red-pine forest. We sat on the ground at long, makeshift banquet tables laid with bright cloth and 582289a3d3123309b4a0d36b24c096b0coffee cans painted with flowers and arcane symbols. Our puppeteer-hosts served, in silence, chilled water from clay pitchers and chunks of homemade bread.

Like fresh bread and cool water, writing nourishes when it is shared.

I work as a nurse.  Nursing, too, is a practice that must be shared in order to exist. As a profession, or a calling, right livelihood, or just a paycheck,  by simple definition it cannot stand alone. The very mechanics of doing our jobs allow us to look through intimate windows opening briefly into others’ existences. Our jobs intersect with theirs at intrinsic turning points as they experience birth, life, and death.

That intersection is a crossroads where mysteries live, where events below the surface manifest in language we have become clumsy with. Nurses write to translate, to interpret.

The dichotomy between the technical and the personal asserts itself repeatedly in this profession. How do we maintain the pace required to provide dramatic, cutting edge interventions while preserving compassion and healing intention? That call to serve and to heal sparked the beginnings of the nursing profession—and eventually it sparked the creation of technology.

The ancient healers—magicians, witches, shamans—have been replaced. Today we survive infections and trauma that, before the arrival of modern medicine, were deadly. These improved outcomes are miracles and that come with various requirements. We must be technicians we well as nurses, often responding not to the person but to machines that measure and image the body’s mysterious inner workings. We are accountable to federal, state, and local regulations that assure safe, quality patient care. We seek an evidence-based practice. We have advanced practice and advanced degrees. I’m not suggesting that any of this is wrong. I am saying that often as nurses we have little time for providing the elements of care that called us to our profession in the first place. And I am saying that sometimes those same elements have been erased by a system that has embraced corporate culture and practices.

Yet time exists in layers, and so still there are the small, secret pockets where the legacy of healing emerges again and again.

And in those pockets, nurses are writing to survive that great split between science and magic. We are writing to avoid being destroyed by the heavy pendulum with its great momentum, swinging powerful and erratic between the polarities of what is possible in health care and what is possible in healing. For they are not always the same thing. Although our world so much needs both, there is an unfortunate and deep divide between the two. Nurses are among those who try to bridge that chasm, underscoring our profession’s commitment to interact with the person, not the disease.

Nurses use a process which includes assessment and documentation. There is this, too: we notice, observe, witness, map, and chronicle. It’s the pursuit of writers, yes, and it’s also what nurses do, from our own particular places in the universe.

Nursing happens. It doesn’t pretty things up. It is intimate with birth and blood, shit and insanity, illness and death. It’s built from primitive stuff, the humus of life, raw energy that demands acknowledgment.

Warm bread, shared, silent, in a summer forest in Vermont is one sort of offering. Another is giving voice to our experiences of life, through our words on the page.

These things are good medicine. We offer them up.