"The unique gifts that nurses receive"

December 21, 2005 -- Today the Globe and Mail (Toronto) ran a moving op-ed by Calgary maternity nurse Raewyn Janota. It describes the skilled, sensitive care Janota recently provided to a couple whose baby was stillborn. In taking readers inside this wrenching example of her practice, Janota underlines the importance of her work and shows why, even during the current crisis, career seekers should still want to do it. The piece might have included a bit more about the "gift" nurses receive in knowing that they save lives and improve outcomes in more tangible ways. But the piece is still a powerful look at some key aspects of nursing. We thank Janota for writing it and the Globe and Mail for publishing it.

Janota contrasts the usual joyful scene of a birth with the somber atmosphere in the room of this couple, whose baby died close to term, after what seemed a "normal pregnancy" in which they "did everything right." Twenty-four hours after learning the baby was dead, the "heroic mother laboured many hours, knowing that at the end there would be nothing but heartbreak." At one point Janota notes that she "can do nothing for this couple but stay with them."

But Janota's own piece shows that's not really true. Janota tells us what she did. She handles the baby gently so as not to damage his skin, wraps him and lays him in his mother's arms. She clears equipment and ensures the mother is stable. She helps the parents "examine their baby." She assesses how the family is coping with the situation. It's obvious that she has a keen understanding of the emotional dynamics involved. She guides the grandmother, who is holding the baby, to the lost-looking father. She seems to know when to appear, and when to withdraw. She describes taking the baby to another room, taking foot prints, a tiny lock of hair and photographs a social worker will develop.

Then she slips out of this scene, which may seem sentimental, to note that a woman once told her that, as a maternity nurse, she was not a "real nurse." Janota's answer?

Strange how oblivious most people are to what nurses do. We teach healthy living in the local high school, work on street teams in jeans and sweatshirts, do research that impacts health care delivery around the world. And then there is the diminutive patient in front of me. His life was taken before it began, but my colleagues and I will start his family on the road to healing. It's not running an adrenaline drip, but it is all very real.

Saying a prayer for the baby--silently, since the baby's parents have no religious affiliation--Janota returns him to his parents. She asks the mother whether she would like to leave before or after Janota takes the baby "downstairs" (avoiding the word "morgue"). She promises the crying parents that she will not leave the baby alone, and that she will "carry him away in my arms." By this time Janota's own tears prevent her from speaking.

After the parents have left, Janota bundles the baby (and his paperwork, of course) and carries him to the morgue. She "place[s] this tiny fragment of humanity in a cold cot," then returns to the unit to do more paperwork. "Documentation of death is complicated, but for the sake of the baby and his parents, I can't get it wrong." Later, Janota drives home, "drained of emotional energy." Seeing her own son's sneakers, she considers that the dead baby will never have any sneakers. "His mother will never receive a glued and crumpled Mother's Day card, nor will his father ever lace up his skates. I hug my son."

We often hesitate to endorse accounts of nursing that are heavy on the emotional aspects of the profession, because they tend to play into the public's vision of nurses as unskilled handholders. Here, in addition to Janota's general descriptions of the tangible differences nurses make, the piece might have made some reference to the lives she and her maternity ward colleagues have saved. And she might have stressed the benefit nurses receive simply in knowing that they greatly improve patient outcomes. Less attentive readers may come away from this piece just thinking what nice people nurses are.

But how many people could really negotiate the kind of scenario Janota describes here? How many could feel the family's pain enough to help them, but keep the presence of mind not to hurt them, do all the sensitive technical work that surrounds this kind of event, and do it on a regular basis, all without become uselessly mushy, or numb, or cold and hard? This kind of care requires serious emotional skill, and great strength. And of course, it's fair enough to stress that nurses are regular witnesses to the full intensity of the human condition, from birth to death--something most jobs do not offer.

Six months later, Janota receives "a moving expression of gratitude from the baby's mother." Janota notes that many families "take happy outcomes for granted and complain about the details." But despite their "unimaginable pain," these parents "found room in their hearts for those of us who witnessed their suffering."

This, Janota argues, is "what makes nursing real." Nurses leave "bits" of themselves wherever they work, "but in return, we receive so much more." She notes that nursing is now "struggling to renew itself. We are aging and no one wants to replace us." She admits that if she was a "business executive or a fashion designer or a city planner," she would not have to work "12-hour night shifts in ugly purple pyjamas," and she might be "a little less lined and grey."

But I wouldn't experience the exhilaration of hearing an infant shriek his protest after a particularly perilous birth journey. I wouldn't have colleagues who know more about supporting each other than an executive could possibly learn from a lifetime of management seminars. And I wouldn't have known this baby and his beautiful family.