By Jay Neugeboren
Houghton Mifflin Company
This review takes the form of a letter from Ellen Thomson, one of our members, to author Jay Neugeboren about his book. Ms. Thomson awarded the nursing and artistic ratings.
March 17, 2004
Professor Jay Neugeboren
c/o Houghton Mifflin Company, Trade Division
Adult Editorial, 8th Floor
222 Berkeley Street
Boston, MA 02116-3764
Dear Professor Neugeboren,
I picked up your book, "Open Heart", the other day, and couldn't put it down. It attracted me for a couple of reasons. First, I am a Registered Nurse, currently working on a busy telemetry (heart monitored) floor, but I have recently applied for a position in Open Heart Recovery. The second is that 20 years ago, while en route to a hospital, via ambulance, my father's heart stopped. The crew got him to the hospital in good enough shape for him to undergo a valve replacement. I remember the same feelings of awe (do they keep "spare parts" in a closet, just waiting for people?) and sheer luck that you write about in your book.
I am writing you, though, because you have left a huge HOLE in your writing! I understand that the basic premise of the book is a meditation on medicine and friendship. However, you mention several times that your life was saved not only by the timely and insistent intervention of your friends, but also through the advent of modern cardiac care units and their attendant high-tech monitors. Yet, I am sure you would agree, we could hook you up to all the high-tech monitors known to man, stick you in a very modern unit, and how far would you get without the highly skilled nurses in that unit? Don't we, as nurses, deserve equal billing? The only time you refer to nurses is when you quote Phil's scornful comment "I mean, look at what happened when you first called and got the nurse!" Yet that same nurse came to the same conclusion, after a telephone consultation, that Doctor Katz arrived at after a physical exam, yet he wasn't afforded the same damnation. ... You yourself admit multiple times that your symptoms were anomalous; prudent clinical practice is to begin with conservative measures that may well work before proceeding directly to major interventions.
Many of your concerns about modern medicine--the lack of viewing a patient as a holistic being, over-dependence upon technology, the lack of continuity of care--caused me to choose nursing over medicine. If you take some time to read such nursing theorists as Jean Watson, Imogene King, Sister Callista Roy, even Florence Nightingale, you will see that nursing provides what you sensed was lacking in medicine. We are trained to look at the whole person, rather than a disease or organ system. The metaparadigm of nursing, the essence of it all, is person, environment, health, and nursing.
We are also trained in health promotion and disease prevention. Lillian Wald, a nurse, established the Henry Street Settlement (mentioned in your book), and public health nursing was born. Nurses have been proven to be both cost effective and cost efficient in the provision of health education and maintenance programs. A recent study linked poor staffing to an increase in sentinel events in hospitals. Nurses make a difference!
However, we are in a very difficult period as far as our profession is concerned. The need for highly trained nurses who are able to think critically and multi-task is greater than ever, yet the supply is dwindling. The majority of active nurses are now in their 40's, and there are not enough students coming up through the ranks to replace us. What will your children do when they need an intervention as you did, yet there is no staff to accommodate their needs? Nursing has been a silent profession, "getting on with the job", but we can no longer afford to be. That is why I felt compelled to write this letter--I couldn't miss pointing out the disservice you have done to my profession. You had a great opportunity to make just a small inroad into the silence, yet you missed it. I am taking this opportunity to do a little consciousness-raising. Thank you for taking the time to read my comments.
Ellen Thomson, RN, BSN
The views expressed herein do not necessarily reflect those of the Board Members or Advisory Panel of The Truth About Nursing.