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Columnist Steve Lopez pays tribute� to nurses who saved his life

Steve LopezSeptember 1, 2012 -- Today the Los Angeles Times ran a good tribute by prominent columnist Steve Lopez to the nurses who recently cared for him after his heart stopped following knee-replacement surgery at the University of Southern California's Keck Hospital. The piece has its share of generic help 'n' comfort imagery, referring to the nurses with phrases like "dedication and compassion," "noble profession," and "uncelebrated soldiers." Those tend to reinforce the angel image of nursing, masking the fact that nurses are college-educated professionals who save lives and arguably undermining nurses' claims to the tangible resources they need. Fortunately, the column does a lot to counter that impression, not least of which is the sub-head's statement that "an alert nurse's quick action save[d] the columnist's life." In addition to explaining how that happened--CPR by a post-op nurse--Lopez discusses the professional and personal histories of three nurses who cared for him, in the process giving readers a sense of nurses' professional training and skills (e.g., counseling patients and "translating doctor-speak") as well as their gender and cultural diversity. Lopez even notes that one of the nurses is about to start a master's degree program to become an "acute care nurse practitioner." So on the whole, despite some lingering sense that nurses are lofty spiritual beings, Lopez's "note of gratitude to nurses" really is a fitting tribute to the profession. We thank him and the Los Angeles Times.

The column is headlined "A note of gratitude to nurses." But apart from the excellent subhead--which includes the text "An alert nurse's quick action saves the columnist's life"--the piece starts and ends with messaging that doesn't necessarily do much for nursing. That same subhead concludes:  "and opens his eyes to his medical team's dedication and compassion." Lopez explains that his heart "cut out in post-op after knee-replacement surgery," and that he had "one foot in the grave for somewhere between 15 and 30 seconds," but a "nurse immediately began chest compressions, and I was back, unaware that I had flat-lined." Afterwards, "doctors and nurses were at my bed night and day asking questions, running tests, huddling to figure out what had happened to me." A few days later, he notes, "doctors concluded" that he had a preexisting irregular heart rhythm, so he got "a bonus piece of hardware -- a pacemaker." Lopez sends "many thanks to the docs, who were great," but he wants to thank the nurses too. Unfortunately, his generic thank-yous tend to focus on nurses' virtue and compassion:

Nurses quietly go about their work in a noble profession, uncelebrated soldiers toiling through the days and nights in service to the sick, the injured and the dying. . . . You walk into a hospital a little nervous or scared, and perhaps feeling alone. Strangers take you in and offer good counsel and comfort, often under difficult circumstances.

Fortunately, the heart of the column is Lopez's description of three nurses who played important roles in his care, and these short profiles give readers get a glimpse of who nurses are, what they really do, and why it matters. The piece includes a group photo of the three nurses, who all wear solid red USC scrubs, looking professional. And in discussing each nurse, Lopez makes a point to state that he or she is a "registered nurse" or "RN."

Andrew Fabella, RNThe first nurse Lopez describes is Andrew Fabella (right), the "one who knew exactly what to do when my heart stopped, because he'd done it so often in a career that began in 1999." Lopez notes that Fabella, who presumably works in post-op, came to see him several times afterwards, "tracking me down in the intensive care unit and then in cardiology to see how I was doing." Fabella reportedly told Lopez that "caring for the sick is a point of pride among Filipinos." Lopez concludes the short section on Fabella with a reference to his save:

"It makes you feel good at the end of the day to know you brought somebody back," said Fabella, whose wife is also a nurse.

That's a good quote, not only because it reinforces the idea that nurses save lives autonomously--they don't need physicians to tell them what to do--but also because it's a frank acknowledgement of the satisfaction nurses get in return, which actually subverts the angel stereotype. Nurses are not divine beings, but skilled humans doing critical work; humans naturally feel good when they do something really important for other people. And note the fairly subtle way that Lopez mentions Fabella's wife, which belies the stereotype that men in nursing are necessarily gay. Lopez has an independent reason to mention Fabella's wife--it's relevant and interesting that she is also a nurse--but it also makes a demographic point about nursing.

Liz Guillen, RNThe next nurse Lopez describes is ICU nurse Liz Guillen. Lopez explains that he was "getting a little grouchy" by the time he got to the ICU, what with the long knee recovery looming, the uncertainty about what was wrong with his heart, and the "joy" of having just had the Foley catheter removed. But Guillen, addressing this last issue, told him that it would "be a little easier each time," and more generally, she "was a constant comfort in telling me what to expect or translating doctor-speak." Lopez notes that Guillen

now has one full-time nursing job, a part-time nursing job, and she'll also be a full-time student at Cal State L.A. next month, when she begins a two-year master's course to become an acute care nurse practitioner.

Lopez notes here that his hospital stay gave him a "window into a multicultural L.A. world in which there's so much striving and self-improvement among solid citizens who are too busy to worry about a lousy economy." Wrapping up, Guillen notes that she loves her work, and Lopez says she "appreciates the challenges each patient presents and the constant learning experience."

The profile of Guillen thus underlines the great potential nurses have for evolution and growth, not just in getting graduate degrees and becoming advanced practitioners, but in practicing every day at the bedside. In addition, it's very helpful to hear that part of what nurses do is "translate doctor-speak"--which means both that nurses understand technical jargon and that their care model involves making sure patients actually understand what is going on, which of course improves outcomes greatly. The one thing that gives us pause is Lopez's reference to Guillen as a "constant comfort," which really understates what she's doing, but in the context of explaining critical care information (as opposed to fluffing pillows) it seems all right.

Lopez spends the most time on nurse Israel Gonzales, who cared for him in cardiology. At the outset, Lopez makes sure to thank cardiology "RNs Anna Kim, Joshua Manikowski, Eugenia Chong and Carmen Cossio," who "were all pros." Lopez explains that Gonzalez attended UC Riverside "on a partial cross-country scholarship and left with an MBA," then started a Web company with his father. Lopez gives some detail on how Gonzales still ended up a nurse:

"I wanted to take care of my family," said Gonzales, who grew up in the midst of gang activity in Chino but followed his parents' advice to focus on education and spirituality. As a kid, he said, his parents took him to rallies for social justice and to Native American spiritual ceremonies. Gonzales helped care for his dying grandmother several years ago, and when an aunt fought breast cancer, he learned that some of his relatives carry a gene mutation that has been linked to hereditary breast and ovarian cancer. He decided he wanted to be available to other relatives as they age, helping care for them as well as advise them on exercise and diet. He was also motivated by a report projecting a critical shortage of Latino nurses.

So even as the Web business continued, Gonzales went to nursing school and "got tapped for a highly competitive residency program at Keck in 2011, and earlier this year was named rookie nurse of the year at the hospital." Gonzales says he might put his skills together some day to start a health care company but for now is happy as a nurse, telling Lopez simply that he likes to help, at which Lopez remarks, "and he did just that for me." Lopez also includes a couple quotes from Gonzales's mentor:

You can teach anyone the skills, but if they don't have the compassion, it's just a mechanical process," said RN John Alexiou, the mentor who nominated Gonzales for the award and advised him that "if you treat every patient as if they're family, you'll never do the wrong thing."

Unfortunately, this last bit isn't very helpful. Of course compassion is important, but the last thing nursing needs is for people to believe that "you can teach anyone the skills" and that what nurses do is "just a mechanical process." Maybe that's not really what Alexiou meant to convey, but you can't teach just anyone to be a nurse, and we really doubt anyone would minimize physicians' clinical skills in that way. It seems to us that nurses have long been socialized to embrace the compassion-related aspects of their practice as what distinguishes them, what makes them special, but the profession's ongoing struggle for resources and social respect shows that this has not been a helpful long-term strategy. The public needs to know that nurses save lives and improve patient outcomes. The remark about treating every person like family is helpful in suggesting nurses' responsibility to advocate for patients as if they were family members. The Truth has incorporated this concept in its I Am Your Registered Nurse poster. Of course, this commitment to patients is not adequate by itself, since advanced knowledge and skills are also required to inform and guide nurses' advocacy.

Fortunately, the remainder of the information about Gonzales is much better. The detail about the MBA and the web company is very helpful because it shows that nursing attracts very able people and that's it's a good use of their talents. In a similar vein, Lopez's note about the "highly competitive residency program" is great, since it tells readers that there is such a thing as professional achievement and advanced training in nursing, and in particular that there are nursing residency programs (although of course they receive only a tiny fraction of the funding physician residencies do). And the background about how Gonzales came to be a nurse is great too, not just in revealing the nurse to be a tenacious person who escaped "gang activity" to become a skilled professional, but also in what it reveals about nursing. It shows that nursing includes giving advice on "exercise and diet," which shows that nursing is a thinking profession with a holistic focus. And in noting that Gonzales was motivated in part by the shortage of Latino nurses, the piece points to the importance of cultural diversity and sensitivity in the profession. Nurses do work closely with and for a wide variety of patients, and it's critical that they understand those patients and that the profession reflect the "multicultural" nature of the society it serves. From the profiles and nurses mentioned in this column, the nurses Lopez met at USC seem to do that. And the fact that two of the three nurses profiled (and four of the eight nurses mentioned overall) are men serves the same diversity goal.

So we'd like to send our own "note of gratitude" to Steve Lopez and the Los Angeles Times.

 

See Steve Lopez's column "A note of gratitude to nurses: An alert nurse's quick action saves the columnist's life and opens his eyes to his medical team's dedication and compassion," which was posted September 1, 2012 on the Los Angeles Times website.

You can write to Mr. Lopez at steve.lopez@latimes.com.