Cortney Davis is a nurse, prolific poet and writer. She is the co-editor with Judy Schaefer of Between the Heartbeats and Intensive Care, More Poetry and Prose by Nurses both published by University of Iowa Press. Author of ten books, her latest work When the Nurse Becomes a Patient: A Story in Words and Images was published by Kent State University in 2015
Muriel Murch is the author of two books, a personal narrative, Journey in the Middle of the Road: One Woman’s Path through a Mid-Life Education, and most recently a short story collection, The Bell Lap: Stories for Compassionate Nursing Care. Muriel is also a registered nurse, a radio show producer, a world traveler, and a beautiful tall English woman.
Cortney Davis: Muriel, which came first for you, the desire to be a nurse or the call to writing?
Muriel Murch: The Desire, The Call, Oh my goodness Cortney. First though I have to smile at your introduction, a tall woman, because, from a very young age, it soon became clear to my mother, who was a mere five feet and ten inches, that I would be ‘too tall’. She worried that I was going to have as hard a time as she did growing up. Surprisingly my height didn’t bother me as much as it did her. There wasn’t anything I could do about my six foot one inch height and somehow, through laughing with those who laughed at, I slowly found a way through adolescence.
When I was fifteen my father died and the question of ‘What to do with Ann’ was a very real problem for my mother. Widowed at thirty-nine it appeared that her own upbringing had not provided her with skills that she could turn into a meaningful job. However she soon found work driving for, and then organizing, the Hospital Car Service, a volunteer organization comprised of mostly retirees who drove patients to doctor and hospital appointments throughout the county. She was, of course, fabulous at it.
I was tall, gangly and bouncy and didn’t speak French therefore not good material for a debutante. I was clumsy and out doorsy and only passed through our kitchen to the nursery and so Cordon Bleu cooking school seemed a waste of time. I couldn’t spell and had failed most of the academic exams from school so secretarial college was not an option either.
At home from boarding school I spent every free moment on the farm. In order to wean me from this rough and unsuitable pursuit the good ‘Dr. Riley’, now a close family friend, began to take me with him on his rounds. I quickly became curious about the people we saw, their lives as well as their illnesses. So it was put to me that when I left school I should work as a cadet (kitchen maid in uniform) at the Royal Surrey County Hospital in Guildford. Then, when I turned eighteen, join the next incoming class of student nurses. I was far too timid to think of going to London and the big teaching (and husband catching) hospitals. A year later I may have regretted my timidity but The Royal Surrey County Hospital was the right place for me. There, I trained and worked as a staff nurse until I left for New York and White Plains Hospital, again subconsciously choosing a non-central hospital.
As to writing, I have always been a voracious reader. I learnt to read at a very young age, though became aware that even after finishing a book there were words, mostly names, that I couldn’t pronounce, never mind spell. English language, punctuation and sentence structure were, and remain, a challenge for me. I can remember when I first learnt to say the complete alphabet. I was so exited – but I couldn’t tell anyone – I was twelve years old! It was the literature classes, with their stories that were my salvation.
Hidden, and secretly, I began to write my own stories as a child. I was also captivated with old, wild poetry. I didn’t understand it all but something about the rhythm of the words comforted and uplifted me. I read a lot of poetry as a child and adolescent. But never wrote any until I was becoming menopausal!
I did write in nursing school. As well as our yearly classroom blocks we all had monthly tutorials. These were one on one session with a Sister Tutor, similar to university tutors. It was here that I learnt to read, discuss, analyze and write about a subject. I became fascinated with psychology and must have read every textbook on the subject I could find. Sister Boisher was wise enough to let me explore, occasionally handing me another book while guiding nudging and questioning the questions, and answers, I was exploring. It was for this work that I was given a prize for physiology. I had never, ever, won a prize for anything in my life before. The prize was Medicine in its Human Setting, by A. Clarke-Kennedy. That little book has been beside me ever since.
The years of young love, marriage and family only allowed for letter writing once a week to my mother and journal scribbling, often in a ‘blue book’ When times were hard, when I didn’t see my way forward on any front, it was often these wild, anguished outpourings that saved me. I hope they are all burnt now. Many years later I found that poetry could produce the same way out of pain. Most of the poetry I write today comes from the pain I see or the pain I feel.
CD: Your work has been included in several anthologies of creative writing by nurses, and nurses’ writing has gained both popularity and praise in the medical humanities arena. Do nurses have something to tell us that are unique, different from what physicians or others in the medical field might say?
MM: I do think nurses have something different to say than physicians and maybe that is because I think nurses and physicians oft times see different things when they look at their patients.
In my nearly thirty years as a radio host I was, and still am, fortunate enough to choose authors to work with. Sometimes it is the writer’s new works and oft-times it is medical in focus. I have also been able to travel and pursue the writers I really want to talk with and whose work I want to share with an audience. Many times that has meant tracking down people like yourself and other nurse writers on the East Coast. The physician I was thrilled to spend time with was, of course, Richard Selzer. I think of Selzer as being the writing mentor to all of us health care professionals who write. Since his earliest medical writing Selzer showed us the whole being of the patient, the body, spirit and soul. How did he do that? He did it by following Chekhov and Keats into writing literature. Selzer goes beyond the anecdotal; let me give you an example, or the case history, into story to bring his subjects to life. There are two physicians I would still like to have conversations with, Abraham Verghese author of Cutting for Stone and Atul Gawande who wrote Complications and Being Mortal: Medicine and what Matters in the End. Just out and being devoured on the same wavelength is When Breath Becomes Air by Paul Kalanithi. Interestingly all of these physician’s families’ come from the Indian continent and share the bonds of close family and immigration.
CD: The Bell Lap is not your first publication. What led you to write your first book, Journey in the Middle of the Road: One Woman’s Path to a Midlife Education?
MM: Since stylus first scratched papyrus the sharing of information and the efforts to stay connected have often been through letters. Journey came from those letters we wrote in boarding school and then the airmail letters of the sixties. (There is a piece about this ‘You’ve Got Mail’ on murielmurch.com) Letters were always an important was of staying connected and the letter writing habit was entrenched early in my life. In the 1980s we were in England for two years and our older children were moving on with their own lives. I wrote to each of them, one a week, make a copy of those letters without repeating myself in each letter. The idea being that eventually the family could piece all the letters together and make sense of those years.
It turned out to be a difficult time and, when we returned to California, I decided to go to college and upgrade my nursing degree from an RN to a BsN. I had visions of entering academia but it quickly became clear I was not cut out for that life style! But I couldn’t stop writing more letters. I wrote to the family, friends and my mother and some to a dear deceased uncle of my husband’s. It was very much on the lines of Dear Daddy Longlegs written by Jean Webster in 1912, a book I grew up with from my mother’s bookcase. When I graduated from San Francisco State University I took off for a month to a friend’s house in Paris with, as you can imagine, reams of pages. A sort of enforced ‘writers retreat’ but with half an eye out for their teenage son alone at home for the summer. During that time I could, and did, slash and burn, cutting the manuscript to maybe a third. Then, when I thought I had a narrative that could be of help to those who shared the common threads for women balancing family, relationships, education and desires, I somehow found a publisher and Journey came to life. The response to Journey showed that it was helpful to those who read it. Miriam Selby of Sibyl Publications eventually retired and handed back the book rights to all her authors. Roberto Santucho helped me reissue Journey as a book on demand with a new snazzy cover and new introduction.
CD: Did the stories in The Bell Lap also come from your nursing experiences? Can you tell me what your favorite story in this new book is . . . and why?
MM: What is ‘our nursing experience?’ This is a question that comes up for me every once in a while. Because, I believe, that those of us who are nurses, in a deep sense of the word, are always nursing. We are always observing, taking in the whole picture of the person before us. Do you notice that? We can’t stop watching. I think this is something all health care professionals do.
So to answer this question I would say, yes, the stories come from my ‘nursing experience’ because my life is nursing. Writing with a nurse’s eye maybe.
A favorite story. How can there be? Each story is precious until itself, each a new love affair begun from memory, a glance, a phrase an incident witnessed. Each is like a grain of sand swallowed by an oyster. It rolls around, irritating for a while before growing into something beautiful. I love them all. How can I not?
CD: Medicine and nursing are changing alongside, and because of, rapid changes in technology, scientific knowledge, and the financial demands of the business end of healthcare. But are we missing something in the way we care for patients today, in spite of all our gains? I guess I’m wondering if you think nursing has changed, and if so how that might affect the nurse / patient relationship.
MM: In the last few years almost all the articles written about new medical procedures begin with the economical implications of the changes and advances being discussed. These comments always come before the benefit to the institution and the physician, nurse, or caregiver, followed by an afterthought, oh, the benefit to the patient. Cost is imperative it seems to the running of for profit or not hospitals. It is a little scary.
The most expensive item in any administrative budget is staff and, arguably, a good patient to staff ratio is expensive in numbers if not always in pay scale. And we see cuts made all the time. Cutting nurses time and money, making them spend time documenting their accountability takes time away from the patient. Cutting down and out on senior long-term staff with deep experience and wisdom who have formed and led unit teams is a shortsighted way of saving money. Cutting those full time nurses off from their benefits leaves no team to support the patients, the ward/floor and ultimately the hospital. Nurses do not go out on strike because they love their hospitals.
Recently I read an article from The Guardian, January 22 2016 “A day in the UK’s busiest maternity unit” by Zoe Williams. The article is about the Liverpool Women’s Hospital. Williams talked with the Matron Jenny Butters, Ward Manager Sarah McGrath and Dr. Joanne Topping. It is Topping who says, “ There is an amount of money we are given to do the work we need to do and it’s not enough.” At the Liverpool Women’s Hospital midwives, nurses and doctors seem to all work in a cooperative atmosphere and it sounds an enviable work situation worthy of adaption in other institutions.
During a family hospital admission we were asked, “Who is the patient advocate?” The nurse used to be considered the patient advocate and now that cannot always be said to be true. But patient advocacy is a part of what we do, what we are for the patients whom we serve. There must be cultural differences throughout the world but I think we must always hold patient advocacy as part of who we are.
One of the best improvements I have witnessed was in St. Mary’s Hospital in San Francisco at the change of nursing shifts. Somehow time was budgeted in for rounds. Two nurses visit each patient in their room one handing off a report to the other in front of the patient. I have never seen anything like this before. Even if words were spoken outside of the patients room there was this time for all three to speak together. If that happened in every hospital and at each shift change the patient care flow would be amazing.
Balancing the art and science of nursing has always been hard and today seems even more so. Sometimes I think the ‘best’ nursing opportunities, those times when as a nurse we can be mindful of procedures and yet give comfort and safety to our patients, lie in clinics and outpatient procedures. I think it is harder to be a hands on nurse in today’s hospital settings unless you are in a one-on-one situations. But really I don’t know. I do know that many, many nurses work hard at finding ways to be at their patient’s bedsides when they need it.
CD: You were born in England and educated as a nurse there. You’ve also had some nursing education in the U.S. What are the similarities and differences in nursing education here and across the pond?
MM: I think the differences started to appear when three-year diploma programs began to be replaced by four-year batcholorate B.Sc. programs in the US. There became a real division between the different levels of education, experience and job opportunities. I still saw this in evidence in the late 1980s rotating through a teen pregnancy clinic at San Francisco General. Diploma RN’s were doing the basic intake work while the Midwifery MSc RN’s were doing full exams. This was different from the late 1960s and early 1970s where four, all of us diploma RN’s, worked in a rural general practice, and we all took complete care for our patients. As times changed most of us went onto get BSN degrees.
In the UK in the 1960s we were patient bedside trained, with classroom times of four weeks in our first year, six in our second and third along with our monthly tutorials. Then this was pretty much the reverse of the American System.
In the sixties, when cardiac monitoring and resuscitation was just beginning, you could see the difference. One evening shift at the Hollywood Presbyterian Hospital a beeper rang and two of us rushed to the room. My American partner checked the monitor, I looked to the patient, and then we both began the same procedure. At that time we were also working with a Canadian nurse and we all agreed that she seemed to have been trained in the best balance of both worlds. Somehow that seemed very Canadian!
Eventually, and I’m not really sure when this happened, England brought in the same educational system as the US. Nursing schools are attached to the city universities and patient care is outsourced to the local teaching hospitals. Now I think the teaching is very similar in the US and UK.
CD: I believe that most nurses and physicians, in the course of their work, experience many moments of both fear and transcendence. What was your most frightening moment in nursing? And your most wondrous? Have you written about them?
MM: Fear and Transcendence. Good words Cortney. There are many moments that carry those emotions. A side lesson if you will of our training was to subdue that fear into right-action but we were not always ready for what incident came our way.
Write about them? No, not until now that is.
I think, for me, the first really fearful moment occurred when I was a new Staff Nurse. It was a Saturday afternoon and I was in charge of Victoria, the Woman’s Surgical Ward. Methodically I was moving through the ward tidying the patient’s beds in preparation of the afternoon visiting hours. I came to the bedside of a young woman who was supposed to have been discharged the day before and only stayed in as her parents were not back from their holiday. She had fallen off of her Vespa Scooter and suffered, what we considered, a mild concussion. But when I reached her bed she was confused and fading. Fear gripped and then released me. Rushing back to the desk I managed to phone for a doctor. Luckily, for my patient, there was a neurosurgeon in the house about to operate on a chap who had fallen off a ladder at work! The surgeon immediately came to the ward, looked at my girl and barked out, ‘Transport to Atkinson Morley Hospital Stat.’ before rushing back to the OR and his waiting patient. In minutes the Ambulance men came and lifted my girl, now unconscious, onto the gurney. I grabbed her notes and off we went. The memory of the drive through the city of Guildford on a Saturday afternoon, not watching the road, but watching her, trying to keep her with me, is still crystalline in my mind. Once we reached the Atkinson Morley Hospital my patient was whisked away. I remember the intake nurses’ focus and it was hard to tell from their expressions what the outcome would be for my girl. I stood in the emergency admitting room, at a loss, until the ambulance driver found me. ‘Come on Nurse, Let’s get you a nice cup of tea before we head home.’ And so we did.
Wondrous. Those moments are so special.
The quick incision for a Caesarian Section, before the pause, looking into the abdominal cavity with the baby still in the sac, the moment before the surgeon’s hands enter and lift the baby into this world.
Life passages, into and out of this world.
Caring for Naomi, an eleven your old gypsy child with Down’s syndrome who had an infected knee. The Romany family came and camped at the hospital. Naomi was a wild child but somehow she would let me tend her. I would sing, she would sing, and somehow with her arms around my neck I could dress her wound. One morning Matron came though on her rounds while this was happening. She looked over the screen that was giving us some privacy, and, as she turned away, I saw her smile. The family outside the ward saw her smile and smiled too. I think then I knew I was becoming a nurse.
More lately I think it is to look back at one’s place in the history and the progression of nursing practices. We are all stepping-stones, each unto the other. In the late 1960s and early 1970s I worked in a rural General Medical Practice. We were three doctors and four nurses. Within that practice we made house calls, did mostly home birth deliveries and cared for those who wished to stay at home through to the end of their lives. Our practice, others like it, and the lay midwives of the time all put pressure on the more normal hospital birthing procedures that were then in place. Slowly the hospitals and other doctors began to change, allowing husbands and labor coaches into the delivery rooms. The delivery rooms became labor suites, breast-feeding was encouraged and eventually The University of California opened a school of midwifery. One nurse from our practice, a third-generation midwife, was among the first four students admitted to the school.
When my mother-in-law was first diagnosed with cancer I said that, when the time came, I would go back and take care of her if that was what she wanted. Two years later the call came and I picked up our fifteen-month old son and went to New York. Her physician, who was the same age as Katharine, also made house calls. He agreed to help me care for her at home though this was a first for him in his long New York Practice. With the support of her friends and family, Katharine stayed at home through to the end of her illness. The doctor, Will Norton, was due to retire, and went on to work with Dame Cicely Saunders, becoming one of the founders of Hospice in America.
I think those things, when I look back, help me feel that yes, gosh, maybe I made a difference. Each moment was wondrous in its own way.
CD: Muriel, how are you promoting “The Bell Lap?” Let us know where you might be appearing, and where readers might find your books.
MM: Radcliffe Press first accepted The Bell Lap but just at that time Taylor and Francis Press an arm of CRC Press absorbed Radcliffe. Luckily they took The Bell Lap along with Radcliffe. So now The Bell Lap is part of a medical press and that somehow feels like coming home. I’m doing whatever I can for The Bell Lap, as I believe it has a place in the tome of general literature as well as in the classroom.
Publication date is March 16th from Taylor and Francis and CRC Press and is also be available from Amazon
Soon there will be an events page up on my website, murielmurch.com and I will be adding to that as I go along.
Events already booked on the West and East Coast of the US as well as some in the UK include:
March 15th Tuesday KWMR. FM radio 10.30 – 11 a.m. PST Turning Pages with Host Lyons Filmer
Match 26th Saturday 10 a.m. PST West Coast Live with host Sedge Thomson
March 28th or April 4th Monday KPFA FM Monday 3 p.m. PST Cover to Cover with host Richard Wolinsky
March 30th St. Mary’s Hospital, San Francisco Evening reading, Q&A and book signing. More information to follow.
April 9th Saturday KWMR Fund raising event Evening at the Bolinas Community Center. A play Reading of ‘Dr. Patel Comes to Tea.’ followed by a Q & A with host Davia Nelson from The Kitchen Sisters of NPR
May 26th Thursday an open evening at the National Arts Club in New York City. Host Ros Chas of The New Yorker and author of Can’t We Talk About Something More Pleasant?
May 31st in Charleston with the ‘Nurse Poets’ at the Piccolo Arts Festival and sponsored by the Medical University of South Carolina.
Dates still TBA
NPR Science program
KHNS Radio, Haines Alaska
BBC Woman’s Hour Book reading and interview with Jenny Murrey.
Book reading and signing Waterstones, Book Shop, Farnham, Surrey.
Book reading, discussion and signing for Primrose Hill Library with Primrose Hill Book Shop
And do ask your local bookshop to order at least two copies, one for you and one to show on their shelf!
CD: Thank you! Before we close, is there anything else you’d like to add, any subject that we haven’t touched upon that you’d like to address?
MM: If we struggle, and oft times fail, to learn lessons from history maybe at least we can learn understanding and acceptance of other people from story. Story will pull at the heart as well as the mind.
Yesterday, browsing through the library of the Royal College of Nursing, I watched young and senior nurses studying. I felt that along with their sense of purpose for themselves, their work and for their patients they maybe have been a quiet acknowledgement of the nurses in whose footsteps they tread.
In the last few years we have seen some wonderful writing, and stories from physicians and patients alike. The Bell Lap stories are for everyone who cannot write their own.