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Reader's Digest: "Life, Death & in Between -- A Nurse's Story"

March 2005 -- This month's issue of Reader's Digest (Canada) included as a "Book Choice" an engaging excerpt from Tilda Shalof's A Nurse's Story (2004), which describes the nurse's years working in a Toronto hospital ICU. The excerpt gives the magazine's many readers an honest and thoughtful look at the development of a nurse and some of the key aspects of bedside practice, despite occasional lapses into unhelpful angel imagery.

The excerpt traces Shalof's career trajectory from her Cherry Ames-inspired dreams of becoming "one of those compassionate, generous people who did generous things" to her current status as an ICU veteran. She describes how she gradually gained the confidence and expertise to be part of what she calls the "elite squad" of nurses staffing a major hospital's ICU, offering a number of telling insights and anecdotes along the way.

On one of Shalof's first days at a general medical ward in the 1980's, a senior nurse who saw her floundering with an array of tasks she had only read about mocked her for being a "university grad," saying the unit needed some "real nurses." We're trying to imagine such a sad, self-loathing comment coming out of the mouth of a senior physician or lawyer. Still trying.

Shalof also frankly explains her struggles to handle the pressure, responsibility and strenuous nature of the ICU. In briefly describing a code, she clearly shows the critical tasks that four nurses and a physician performed to bring the patient back to life. This short passage is an excellent antidote to the usual mass media depiction of codes, in which only the work of physicians is of any consequence.

The author also offers insights born of experience with some of the toughest health issues society confronts. She touches on the difficulties associated with the restructuring of the 1990's, which led to cutbacks and nurse layoffs, and the 2003 SARS crisis, which threatened and burdened nurses far more than any other class of health care workers.

She tells the story of one aged patient with multi system failure whose son would not let her go, insisting on heroic measures which in all likelihood caused the patient needless suffering. Shalof's attempts to advocate for the patient to a resident and the patient's son were unsuccessful; the son suggested she was the "Angel of Death."

Shalof also frankly confronts the difficulty of maintaining her "dignity" as a serious professional while frequently attending to patients' most personal needs, such as one patient's case of fecal impaction. Without calling undue attention to how difficult this was, she conveys the strength nurses must possess--a strength that is not recognized in the usual tired remarks about bedpans--to care for patients in these ways and not convey disgust. She might also have noted that in many cases these less than pleasant tasks are clinically complex, as well as being important parts of the nursing assessment, which often saves lives.

At times Shalof tells us what she feels is the essence of the profession she loves. Though parts of her piece show the clinical skills required to be a nurse, they are de-emphasized in the passages that describe what nursing is, which place a heavy emphasis on spiritual, comfort-oriented qualities. Shalof writes that nursing is "about pain relief, hygiene, comfort, spirituality and kindness." A respected mentor teaches her to "focus on the things that are at the heart of nursing's domain": "comfort, dignity, nourishment, promoting well-being." Those are all good things, but what about saving lives and improving outcomes? What about patient advocacy and education? Some elements on Shalof's list do require advanced education and clinical skill, but things like "comfort" will not strike most readers as the hallmarks of a serious profession without more explanation. Instead, these statements may play into the "angel" stereotypes that have fostered a lack of real respect for nursing. Shalof closes the piece by stressing that what nursing has taught her "above all" is that "compassion is the greatest wisdom." That's hardly novel as a spiritual precept; it's the fact that nursing seems to be mainly about spiritual precepts that concerns us.

That brings us to one of the saddest scenes Shalof describes, one that does not occur in the ICU, but at a restaurant where some of the ICU nurses to whom Shalof has long been close are talking about the future. There is a clear sense of burnout. One nurse has decided to quit nursing and apply to law school. Another, Laura, the leader of the crew because of her formidable intellect and skill, announces that she is off to medical school:

People are always telling me I'm wasting my talent as a nurse. I tell them it takes a lot of intelligence to be a nurse, but they don't get it. Well, I've had enough! I'm going to be a doctor. I'll make decent money and maybe get some respect.

We know that this "ER" scenario is not common, even though skilled nurses' patients and families often encourage them to become physicians (see our FAQ: "You could be a doctor!"), and that nurses are many, many times more likely to attend graduate school in nursing than medicine. Shalof herself appears to have remained in the ICU, passing along her hard-earned wisdom to new nurses there. But Laura's comments, though understandable, seem to signal a tragic illness in the profession--an illness with external and internal causes.

The Center commends Ms. Shalof and Reader's Digest for this generally good piece. See more information about the book (including how to purchase it) A Nurse's Story by Tilda Shalof.

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