Killers, tea and sympathy
November 2004 -- Two very different items in this month's Reader's Digest focus on nurses: Max Alexander's generally fair cover story on serial killer Charles Cullen ("The Killer Nurse"), and an excellent one-page item in the Health section by Hanne Dina Bernstein, RN, about her seemingly simple but life-saving care for a leukemia patient ("Tea and Sympathy").
The piece on Cullen (p. 163) is a lengthy chronological account of his troubled personal background and work life. Earlier this year, Cullen pled guilty in New Jersey to having killed 13 patients with drug overdoses, and by his own account he may have killed 27 more. The article is generally fair, setting Cullen's actions in the context of his history of family tragedy, troubled relationships, mental illness, and substance abuse. It briefly describes a few of the reforms that may be needed to help prevent nurses from being able to commit acts like Cullen's and still be able to move from facility to facility, as he did, with virtual impunity. The piece could have explored the policy implications in more depth. Cullen reportedly claimed that his actions were mercy killings, and the press has generally done little to explore whether that claim has any basis.
To its credit, this piece explains that many of Cullen's victims were not mortally ill or even in pain. It quotes San Francisco State University School of Nursing director Beatrice Yorker, "an expert on killer nurses," who argues persuasively that most people like Cullen are sociopaths seeking power or excitement, much like a firefighter who sets fires. This kind of insight has been distressingly rare in the press accounts of the Cullen case to date.
Of course, the magazine did use the blaring headline "The Killer Nurse" on its cover and the internal subhead "Why No One Stopped the Angel of Death," which obviously perpetuates the harmful "angel" stereotype. We realize that the contrast between this stereotype and Cullen's actions is part of what makes the case so striking (and sells magazines). But we would still hope that magazines could resist it, and that the fact that nurses (like physicians) are in a relationship of professional trust with vulnerable patients would create enough contrast. In addition, the piece might have noted that Yorker is actually an expert on physical assaults in hospitals generally, including Munchausen Syndrome by Proxy. Labeling her a "killer nurse" expert might imply that there is an entire academic disclipline centering on an epidemic of "killer nurses."
The piece could also have done a better job of setting Cullen's conduct in the larger context of appropriate nursing care. It might have briefly explained how and why nurses normally administer potentially dangerous drugs, and that whatever Cullen's motives, there are legitimate questions about whether some patients are receiving adequate pain management in end-of-life care. But at least it does not (as some pieces have) express surprise that a nurse could get hold of potentially lethal drugs, as if that was beyond nurses' abilities or was the province of physicians. Nor, unlike some pieces, does the article suggest that nurses are or should be supervised by physicians.
Small items in the issue's "RD Health" section (pp. 193-94) join the torrent of American media inviting readers to seek primary care from physicians, which has the effect of excluding the nation's 210,000 nurse practitioners, who are at least as qualified to address such issues. "A Healthy Routine" describes the benefits of seeing the same "doctor" each time a patient is sick, and "Is Dad in the Know?" tells readers how to get fathers more involved in their kids' visits to the "doctor." Needless to say, all expert quotes are from physicians, and none are from adult or pediatric nurse practitioners.
The final "RD Health" item (p. 197) is a piece by Hanne Dina Bernstein that appears to be a reprint from the American Journal of Nursing. At first it seems like it will play into traditional nursing stereotypes: its title is "Tea and Sympathy," and its subtitle is "A nurse helps her patient heal with conversation, compassion and a simple cup of tea." And unfortunately, for those who read no more, these headings may well confirm the stereotypes. But the piece itself is a striking example of a seemingly simple yet brilliant nursing intervention. It describes Bernstein's efforts to reach an emaciated patient who has just undergone a bone marrow transplant for leukemia. The patient is clearly depressed, refusing soup, grimacing at his medication, refusing a newspaper. Bernstein leaves and goes to pour herself a cup of tea, but instead she takes the whole pot and two cups back to her patient's room, asking the patient if she might have the tea there and declaring: "I would like to watch the news." The patient allows this, though he is "clearly taken aback," and he closes his eyes. However, some time after Bernstein turns the TV on, she notices that he is watching. She tells him that she has brought an extra cup, if the patient would like some tea; the patient allows that he might have half a cup. They watch TV till the patient begins to fall asleep, and she starts to leave, but the patient asks whether she will be in tomorrow. She will, and the next night the patient has "two cups of tea and a piece of toast--his first solid food in a month." The following night the patient tells Bernstein about his job and his family, who live too far away to be able to visit, coincidentally near where Bernstein's own parents live. The fourth night the patient gets out of bed, and a few days later, he has left the hospital, able to recuperate closer to home. Several months later, while Bernstein is shopping on a visit to her parents, she hears a "booming voice" greet her. It is the now vigorous patient, who gives her a hug and introduces her to his wife: "This is Hanne...She saved my life with a cup of tea."
Indeed she did. The story may bring a tear to readers' eyes, but we hope at least some will also realize the depth and importance of what Bernstein did, and that she and her nursing colleagues are not just nice people serving tea. Bernstein quickly saw that the patient was depressed, alone, not eating--all of which could spell decline in a frail, critical patient. Her intervention seems simple, but is subtle, powerful and multifaceted. Despite initially feeling (as Bernstein puts it) "defeated," she politely barges back into her patient's life with a tray of tea, asking to watch the TV news in his room. The patient is surprised and doesn't seem interested. Yet he doesn't say no, and soon the TV has him hooked. Now she offers tea, and he accepts. She has him. She has used a combination of her own presence and the TV news, which is usually an account of human folly presented on the addictive electronic constant of American life, to remind the patient of his connection to other humans--and of course, of all the troubles of other humans. Not coincidentally, she has started him on the path to physical recovery with a cup of tea, even though he has just refused soup. Immediately, she builds on this, arranging to do the same thing the next night. He starts eating and gaining strength. Of course, almost anyone could physically do these things. But not just anyone would think to do so, nor be able to bring if off so expertly. What average person would think to insist on "watching the news" in the room of an obviously tired and depressed post-operative cancer patient? Compassion? This is science--though ironically, if it were portrayed on a drama on that same TV set, it would almost certainly be done by a physician character. (Stop laughing; it's true.) It is just the kind of nursing intervention that is so often overlooked in a society obsessed with invasive, high-tech medical treatments. And it is the kind of intervention that is under threat in a short-staffed care environment in which many nurses are unable to find time to do something with a patient that may not seem worthwhile to the uninitiated, but which may end up--in a very real sense--saving his life. Of course, many of the magazine's readers will not get all this, and we wish there was a way Bernstein could have gotten it across more directly without it seeming self-serving or ruining the emotional power of her story. But it is there, and Bernstein and the magazine deserve credit for putting it there.
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