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By T. Coraghessan Boyle

From the collection Tooth and Claw (September 2005)


Originally appeared in The New Yorker (March 1, 2004)

Nursing rating 1/2 star

Rating guide:
excellent = 4 stars;
good = 3 stars;
fair = 2 stars,
poor = 1 star

Artistic rating 2 1/2 stars

It's the end of the world as we know it, and nurses are still cold martinets who personify the mindless brutality of the universe. At least, that's how it is in T. Coraghessan Boyle's story "Chicxulub," which, if nothing else, cannot be accused of perpetuating the "angel of mercy" stereotype. The story shows once again how even products of the cultural elite can casually reinforce harmful misconceptions about the nursing profession. The story, published in the 2005 collection Tooth and Claw, originally appeared in The New Yorker in March 2004.

"Chicxulub" compares the potential loss of a couple's beloved teenage daughter to the ever-present possibility that a big rock will strike the Earth's atmosphere, with catastrophic results. The father, an increasingly panicked narrator, describes the night he and his wife are called to the hospital following a serious car accident, interspersing this account with relatively controlled descriptions of large-body impacts on the Earth. One example is Chicxulub, a rock several miles across that hit the Yucatán Peninsula some sixty-five million years ago, turning day to night and extinguishing most known species on the planet.

Like such "civilization enders," the point of the story isn't subtle. Boyle wants to convey the cataclysm in a parent's life following the loss of a child, and to remind us that anything--everything--can disappear forever in a second. This tale of celestial and personal impermanence has real power, and some of the author's usual heart-stopping insight into the telling details of ordinary lives. Unfortunately, some may find the end-of-the-world theme heavy-handed, and the narrator a little overwrought, even for this context. Boyle is an unusually compelling writer and a master of short fiction, but this is not one of his best.

However, the story is a little more subtle in one respect: the depiction of the hospital environment the narrator and his wife encounter as they search for their daughter. Arriving at what appears to be the Emergency Department, the couple approach "the nurse at the admittance desk." Not the triage nurse, who might have a responsible job, who might express some slight concern, but an indifferent desk jockey who immediately personifies the big bad system that does not care. This young "Filipina" greets the distraught couple by demanding: "Name?" She has "opaque eyes and the bone structure of a cadaver; every day she sees death and it blinds her. She doesn't see us." Retrieving information with her "fleshless fingers" from her equally inhuman computer, the nurse coldly refuses to tell them anything more than that their daughter is still in surgery. The narrator comes to wonder why he "despise[s] this nurse more than any human being [he's] every encountered," this woman "with her hair pulled back in a bun and a white cap like a party favor perched atop it, who is just doing her job?" Why does he want to "reach across the counter that separates us and awaken her to a swift, sure knowledge of hate and fear and pain? Why?" This passage does offer some insight into the prevalence of violence against nurses, who constantly deal with people under this kind of stress, but we'd feel better if it didn't work so hard to build sympathy only for those who might commit such violence.

Anyway, this is only a warm-up. The desperate couple proceeds to surgery. The hospital loudspeakers are "murmuring their eternal incantations," paging "Dr. Chandrasoma" and "Dr. Bell"--incantations, of course, call on supernatural powers--"and here is another nurse, grimmer, older, with lines like the strings of a tobacco pouch pulled tight around her lips." The couple asks if their daughter will be all right. "'I don't have that information,' the nurse says, and her voice is neutral, robotic even. This is not her daughter." The narrator can't handle this "maddening clinical neutrality" and he explodes, suggesting that it's the nurse's job to know what's going on after the couple has been dragged in and told their daughter has been hurt. The nurse "drills" the narrator with a look. She steps away from her desk, revealing herself to be "short," "dumpy," and "almost a dwarf," and leads the couple to a room, saying: "Wait here...The doctor will be in in a minute." Then she disappears, and leaves them alone there for "a good hour or more."

Won't someone rescue this poor couple from the brutal bureaucratic clutches of modern nursing? Someone will, as the door finally swings open "and there he is, a man too young to be a doctor, an infant with a smooth bland face." Without revealing too much, suffice it to say that this surgeon looks at the mother, looks at the father, and expresses the only sensitive human words the couple has heard at this hospital. Then he leads the couple through what sounds like an I.C.U.--where patients are surrounded by machines and "nurses hovering over them like ghouls"--speaking in a low voice about technical aspects of various injuries. Then, as they reach their destination, he sensitively steps back, "hands folded before him."

Yes, Boyle is not trying to show us how hospitals really work, or to give a balanced view of the interactions a patient's family might have with real hospital staff. These characters and scenes help make the story go, pushing the narrative themes of human frailty and the unappeasable harshness of fate. But that won't stop readers from internalizing the subtle array of regressive distortions presented here. Of course, like anyone else, nurses who work in stressful conditions can behave badly, and it is not impossible that a patient's family could perceive their experience as described here. But is it really likely that the parents of a critical injured teenager would encounter two monumentally ugly nurses in a row, then finally get serene sensitivity from a surgeon? The story is built on extremely low-probability events, but still.

More fundamental is the whole dramatic ascent from hostile, bureaucratic nurse flunkeys to the high-powered physician who actually knows things, whose actions matter, who has apparently been working to save the couple's daughter all by himself--all this conveys a grossly inaccurate and harmful vision of the two professions. Here, the physicians may not be gods. They can't save everyone or stop comets. But they are still the objects of our "eternal incantations." By contrast, nurses sit at computers or hover like "ghouls" with white caps, guarding information and protecting themselves by brutalizing distraught patient family members: the one-dimensional bookkeepers of death.

Oh, but don't worry--this is just a story. Educated, influential New Yorker readers know that real hospital nurses are the primary advocates for the overall wellbeing of patients, a role that includes educating patients and families about patient conditions. They know nurses are autonomous, educated professionals who save countless lives, despite short-staffing and disrespect that has led many to the brink of burnout and beyond, imperiling patients worldwide. They know about the hundreds of thousands of advanced practice nurses with graduate degrees, and the nursing scholars at the forefront of health care research. How do these readers know, you may ask, since these facts are virtually unknown to the media or any other mainstream institution they've every encountered, unknown even to many if not most physicians?

We think it must be the incantations.

Review by Harry Jacobs Summers
Nursing Editor: Sandy Summers, MSN, MPH, RN
Reviewed March 5, 2004
last updated September 18, 2005

Read the story online at The New Yorker web site.

The views expressed herein do not necessarily reflect those of the Board Members or Advisory Panel of The Truth About Nursing.

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