Taking a night train tonight from London to Glasgow. A new adventure for The Bell Lap and I as we go to the Royal College of Nursing Congress and Exhibition 2016. Wisepress is featuring The Bell Lap at 11.20 am through noon on Tuesday June 21 (stand number A9). I have no idea what to expect – a big convention hall and masses and masses of people wandering about. Hopefully some folks will have tired feet and want to sit down and listen to a story or two. Thinking of Beatrice when she presented her book on the A-line subway in Buenos Aires in 2014.
It was 1995 when Between the Heartbeats Poetry and Prose for Nurses was first published by the University of Iowa State Press. Conceived and edited by Cortney Davis and Judy Schaefer, this was the first Anthology of Creative Writing by Nurses, gathered from around the world.
For many nurses it was the first time our medical writing had been accepted for publication. That summer as many of us who could, maybe twenty out of fifty contributors, came to Chapters Book Store in Washington DC for our first ever reading. This coincided – not unintentionally – with the annual general convention of the American Nurses Association. The evening was exciting, scary and thrilling. Scary because we were reading our own work and thrilling because we were hearing the words and work of other nurses. All of us facing the same direction, our voices so different and yet so deeply in tune with each another. There was an audience, listening, applauding and asking questions. One man spoke up, “Wow, this is amazing. Can’t wait for when you present this to the ANA”. We were all silent before Cortney, in her calmest most diplomatic way, (her speciality) replied, “Actually we won’t be at the convention. They don’t want us and won’t let us present the book there.” Among the audience were nurses who would be at the convention. We were all stunned, silenced and sobered that those nurses for whom we wrote did not deem our words necessary or supportive of their work.
As nurse writers we came together for that weekend forming a tight union of sorts, loosely knit, tendrils of thought, vision, each of us seeing and transforming through words, our patients in the wards, clinics and communities we serve. Since those early years we have continued to write, sending each other our books, reviewing and commenting for each other, hosting nurses writers on the radio and spoke of our work to audiences wherever we could.
Coming together was always a chancy affair but we get our moments. Two years ago The Medical University of North Carolina held its first “Narrative Bridge Conference”. Five of us, Jeanne Bryner, Cortney Davis, Veneta Masson, Judy Schaefer and myself, made it there for the long weekend;. We were billed as “The Nurse Poets” and that is what we have become. Through the years more books of poetry, prose, creative non-fiction and novels have been written and published and within the ‘about the author’ description the word “Nurse” always leads. This is who we are, this is where we speak from, whenever and wherever we can.
It was Lisa Kerr from the MUSC school of nursing who again called us together this year. Lisa wrote asking if we could come, not only to speak to the faculty and students of the nursing school but that there could be an opportunity to perform as The Nurse Poets in the annual Piccolo Spoleto Arts Festival at the Dock Street Theatre. New books had been published, among them, Jeanne Bryner’s poetry Smoke, Cortney Davis’ When the Nurse Becomes a Patient, which won an American Journal of Nursing Book Award for 2015 and my 2016 The Bell Lap Stories for Compassionate Nursing Care were all hot off the press and we were eager to share our work. I was ending a roll-out with The Bell Lap, coming down from New York and a launch at the National Arts Club with the great cartoonist, and tonight – host – Roz Chast whose book about the final years of her parent’s lives Can’t we Talk about Something More Pleasant, remains a best seller.
It was – is – fun to be on the other side of the microphone. This was a first for Roz who is more used to being questioned about her work, and almost a first for me, being more used to asking those questions. With her questions and comments, memories surprised me and in the quickness of the moment words did not always take the long route – through my brain – as they rushed from my heart to my mouth. Maybe it was not the smartest thing to recall ‘my first leg,’ after Roz’s question about my failed operating room experiences. And so we learn. Beloved friends were there and I was more than grateful to see nurses in the audience, plus a doctor or two. Paul Gross and Dianne Guernsey who co-edit Pulse Magazine “Voices from the Heart of Medicine” came in on the train, Cousin Tom rode the bus from Cap Cod and nurse colleague Gerry Colburn traveled in from New Hampshire.
It was a great evening and gave me the needed boost and courage to fly down to Charleston and join the band – not yet a rock band – The Nurse Poets.
Four of us had made it and it was grand to be together. Jeanne had driven for two days from Ohio. Cortney flew from Connecticut, Veneta from Washington DC and I from London, via New York. At breakfast we celebrated with coffee and grits. We quickly shared our stories, families, the agonies of book promotions and knowing as all women of a certain age do, that we will continue to balance these lives until illness, infirmity or death claim us.
At noon, under Lisa’s guidance, we spoke at MUSC nursing school for more faculty than students but how eager they all were, how they knew the importance of story, the lives led before and beyond the illness of the patient. Then an afternoon break before being driven past the Emanuel Church where flowers are still laid out daily in remembrance of last years tragedy to an early supper of fine southern food. (Where oh where do I get the real recipe for Green Fried Tomatoes?)
Then we walked to the Dock Street Theater where the audience was already gathering for our evening performance. The theatre is nestled in a small courtyard, intimate and perfect for poetry readings. The seats filled quickly and chairs were added along-side the cloisters until there was standing room only. We sat, warm but not hot, under the evening sky. Our time was tight, and so were we. Introductions by Barbara, the organizer of the festival. then Lisa, organizer of us and then, following each other in alphabetical order, we were on. Each of us brought our full-to-overflowing hearts to the mics and poured out our words. Jeanne watching family, Cortney and Veneta their clinics, and I from the wards and communities before returning to nursing school with an excerpt from The Bell Lap.
The audience rose to applaud these words that came from our hearts and our memories. Why did they love us so? We were good 🙂 yes but was it just the words, or was it the knowledge that with these words they know we have seen them, as people before patients. We have marked and held them in our hearts and returned them to themselves, thus received and healed, if not cured. Giving this audience an understanding that as these words have come from the wards to them they may also return to the new young nurses of today.
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.
We laugh when AARP first shows up in our mail box on our fiftieth birthday. But over the years we come to read more articles until devouring the magazine from cover to cover. This April’s bulletin issue features Jessica Migala’s article High-Tech Ways to Stay Healthy which looks at the new world of medical app options for both patients and doctors.
In Stuck in the Past: Why are Doctors still using the Stethoscope and Manila Folder? Michael R. Splinter, Executive Chairman, Applied Materials, Inc., asks ‘Why Physicians haven’t adopted more modern Technology?’ He suggests that physicians should get rid of the Stethoscope and the Manila Folder. But I would ask him, along with Medscape Editor, Dr. Eric Topol and others, in the interest of good physicianship, for want of a better word, to hold steady and reconsider, first the sturdy stethoscope with all its uses and then, memory.
Mike Newall’s 2007 film Love in the Time of Cholera opens in the year 1880. Early in the film, Fermine Urbino, having rejected her suitor Florentino Ariza, suddenly, mysteriously falls sick. Her anguished father calls for the young doctor, Juvenal Urbino, who hurries to the bedside of his friend’s daughter. A lady’s maid hovers nervously in the background. Approaching the bed Dr. Urbino takes in Fermine’s glistening, feverish forehead. His hand reaches down to check her pulse. Then, bending low over the bed, and in haste for a rapid diagnosis (and screen drama), rips open Ferimine’s bodice to reveal her breasts, which rise, quivering under such an assault. Putting his ear close to her heart he leans low to hear its rapid, beating pulse while struggling to contain his emotions. But we all know what is going on and – because the film is a little slow and predictable, and most viewers have read the book – what will happen.
We may miss these dramatic bodice ripping moments but it is an undeniable fact that the invention of the stethoscope in the early 1800s made diagnosis of certain illnesses better, and faster.
In 1816, while studying medicine in Paris under Dupuytren and Jean-Nicholas Corvisart-Desmarets, René Laennec began to experiment with ways in which to hear the body better. His first instrument was a plain wooden monaural tube.
By 1851 it had evolved to a binaural instrument with flexible tubing. He named his instrument the stethoscope from the Greek words Stethos (chest) and Skopos (examination). Laennecs’ new invention was far more accurate in hearing heart and lung sounds than the old method demonstrated in Love in the Time of Cholera. But it had its detractors. Christopher McManus writes in his Right Hand, Left Hand, that Thomas Watson MD, was known for not only using his new stethoscope but sitting and watching the patient and saying he found the stethoscope ‘more of a hindrance than a help and that although he could not do without it, he did without it as much as he could.’
A young Scottish physician, John Forbes, moved to London in 1840 while his old friend James Clark was the young Queen Victoria’s physician. Queen Victoria loved all things Scottish and was fascinated with modern medicine. So it was not surprising that in 1841 she chose this studious doctor for her family and the Royal Household. Scottish physician or not, Forbes brought with him the new French instrument, the stethoscope.
Not until almost a hundred years later, in the 1940s, did Rappaport and Spraugue design the stethoscope with two sides, one for the respiratory system and the other for the cardiovascular system which remains the basic design used today.
What the Stethoscope does now, beyond listening to the regular or irregular trills and lub-dubs of the heart, and searching through the dull silence or fretful peristalsis of the abdomen for the calm gurglings of a bubbling stream, is to permit the physician to bend low, in homage to the body. His other hand may search to feel for a pulse away from the apex beat, ‘the Watson Pulse,’ of the heart’s aortic pounding, catching the dance of the two partnered beats. Maybe his fingers brush the abdomen before he takes courage and palpates the flesh, quadrant by quadrant.
In Argentina it is customary to ask permission, ¿Permiso? before crossing the threshold and entering a home. Today the physician needs an excuse to touch the body and the stethoscope gives that permission and allows the patient to accept this touch. Then he can slip the scope into his pocket and bending closer again percuss the lungs, tapping and listening over and around each lobe that embraces the heart.
As nurses we have permission to touch the patient, and time to be intimate. Washing, turning and tending the body are among our arts. They hold their place as skills alongside checking monitors and charting observations. Touch can comfort and bring safety, relaxation, even healing, and healing can pave the way to curing. Maybe nurses used touch more when we moved from bed to bed in the large open wards of long ago where patients saw and connected with the suffering of one another and were helped by that sharing. In our efforts to incorporate ‘individuality’ and privatization into every aspect of our lives, illness has become shuttered away in lonely single and semi-private rooms, where patients lie secreted and alone.
In Buenos Aires, I have had occasion to see a few physicians over the years I have visited. Nothing big, just mindful checking in and up. The office of Doctor Garavaglia, the General Practitioner, is typical of them all. His big desk faces out from the back wall and the two chairs sitting comfortably in front of it are inviting rather than intimidating. There are two bookcases holding literature as well as medical texts and a screen in the corner to give privacy for undressing and the examination couch if the patient should need it.
In each office, the visits begin with conversation, discussion about our mutual families, for that is but courtesy. Before Doctor Garavaglia asks what brought me to him, what he can do for me, he pulls out a card – no bigger than the old Kardex cards we once used. My name is written on the top, my passport and phone numbers also. And there, in cryptic hand, go a few notes. But then he puts down his pen, and listens as I talk, occasionally nudging me this way or that. For as he listens and watches me, how I talk is as meaningful to him as what I say. I speak of our daughter and he reaches into a drawer, pulls out her card and glances at it. In a moment he has her relevant history in his recall, which he – naturally – shares with me. When, a year later, I return he pulls my card from the same drawer. ‘Ah yes, I remember’ updates are made on the card, then it is put aside. ‘¿Cómo estás? Estas bien, verdad?’ He means it. It is good to see you. And we talk once more.
Earlier this year a report came out of Brigham Young University stating that ‘Loneliness and social isolation are just as much a threat to longevity as obesity.’ Republished in Science Daily it was then picked up by The Week on April 3. Thus is university research trickled into public consciousness. This ancient universal truth helps account for the modern obsession that we hold to e-mail, Facebook, Twitter and Instagram. These are all ways of staying connected within a real or virtual community that sometimes feels far way and out of reach.
In the days of long hospital stays, back in the early 1960’s, before rehabilitation centers and convalescent homes were big business, patients stayed in hospital until they were deemed ‘All right to go home.’ The tasks of daily living, such as being able eat, toilet, and digest alone and finally, in the last few days of ambulation, prepare and serve from the drinks trolley through the ward. In those years visiting hours were quite restricted. Patients and families could see each other only as the hospital hours, the family work schedules and public transportation allowed. It was often difficult to be at the bedside of a loved one through the days of a long illness. Cards and letters from the outside were very important.
Like other hospitals up and down the country, the post was delivered twice a day to The Royal Surrey County Hospital. It arrived at the front desk and was handed to the hospital porter on duty. Our head porter was named Frank and each morning Frank took the post and sort it into departments; Patients, Clinics, Matron and finally Nurses. Frank would put the different piles in his bag and, leaving the front desk in the hands of the lady telephone operator, set out on his rounds.
I suspect that this walk-about for Frank was as important to him as Matron’s morning rounds were to her, and, in their way, an essential part of the hospital running smoothly. Everyone looked forward to Frank’s arrival, a signal that maybe ‘you’ve got mail.’ Frank’s cheery face would be welcomed with a reciprocal smile everywhere he went. Frank went from Matron’s office to the Bursar’s, the departments, the nurses’ dining room, and then to each of the wards in turn, bearing cards and letters for the patients. In the wards, Frank would hand the post over to the Ward Sister who, depending on how busy she was, would begin to sort and give them out as soon as she could.
But Frank also had a fatherly interest in us nurses and, once we were no longer students but black-belted, silver-buckled Staff Nurses, he watched the patterns that formed in the letters we received. He seemed to know which letters bore serious intent, what passion was in the strong hand writing on the envelope. We would watch him too when he came to the wards. Sometimes he would pretend not to see us but he noticed weight loss and dark, hungry eyes. After he had handed over the patients’ letters to Sister on Victoria Ward he would look for me. If I was with a patient, he found a reason to wait. If I was by the morning coffee trolley he could come to me.
“Good Morning Frank. How are you today?”
“Well. Thank you Staff.”
My eyes would ask the question and his eyes would twinkle a response as, almost every day, he would pull his right hand slowly from his overall pocket and hand me a square white envelope, covered in airmail stamps. He never left these letters in the dinning room for other nurses to find and tease me with. The Royal Mail was then as fast as our young heart beats.
“Thank you Frank.” Did I blush? Maybe so, as I took the envelope from his hand into my deep uniform pocket. It rested patiently, beside scissors and tape, until I found a quiet moment to read alone.
I should have known then it was hopeless. I was supposed to be booking a flight to Malaya to work in the Leprosy Hospital of my friend Bushba’s uncle. Instead I was looking into Flights to North America.
Five months later I joined nurses from all over Ireland, England, Scotland and Scandinavia. We were that generation’s import of cheap labour. The next wave of immigrants from the old world to the new. That was fifty years ago.
This pattern of writing has stood us in good stead. Often we have been apart and whenever that happens we write to each other every day. Over the years The Royal Mail gave way to faxes and eventually to e-mails. There are bundles of letters in old boxes in the barn, files of faxes in trunks in the attic and years of emails stored on computer drives.
This week he flew away again as I stay behind to do what needs to be done. God willing I can join him before summer settles in. But until then we will take time to give and receive each other’s hearts and minds, sharing words together.