Nurses: the Best of People, the Worst of People

A recent post over at Educated and Poor asking for individual experiences with nurses got me thinking. Compassionate nurses are among the best of people, but those who lack compassion can be among the worst of people. Yet I also suspect in many cases even the worst of nurses didn't start out hard-hearted. The suffering they are exposed to seems to burn out the compassion in even the most decent people. Yet it is hard for the patients in their hands to remember that.

My own worst experience with a nurse occurred when I was eight or nine. I was due for one of my regular shots, and the nurse marched in, announced "This won't hurt a bit" in a tone that, rather than being reassuring, informed me I would get nothing but a label as a crybaby if I complained. Without waiting for a response, she stuck the needle in. I was watching while she did it, and she jabbed me so hard, the shaft of the needle visibly bent. Shudder. I think it was sheer horror that helped me contain my instinct to howl in pain and outrage.

I know little about this particular nurse, but in fairness, the pediatrician she worked for was far worse, so she may have picked up the attitude at work. Although not an experience with a nurse, I'll relate one of my two worst personal medical experiences ever, involving her boss. It does illustrate the harm a complete lack of compassion can inflict. I was ten, nearly eleven, at the time. To be fair, even I didn't yet understand that my physiology was out of the ordinary in various ways. I had an ear infection, and the doctor decided to clean the wax out of the other ear. He took out whatever sort of probe they used at the time, stuck it into my ear, and began hauling out the wax.

Even with intense migraines and pinched nerves, I am not sure I have ever felt such intense pain again in my life. It felt as if a huge, red-hot knife blade was being jammed into my ear. I couldn't help screaming and crying. The doctor ignored my pleas to stop, and mocked me as a crybaby. He finished up and turned away, and I felt a tickle on that earlobe. I put my hand up to scratch it, and when I took my hand away, it was covered in blood! Blood was pouring out of my ear. The doctor glanced at it, didn't even bother to reassure me - and yes, I was panicked by this point. Feeling so much pain, followed by bleeding so badly, had me convinced I was going to die, probably horribly.

He turned to my mother, said "How was I supposed to know he had hair in his ears?", and turned back, very matter of factly, to deal with me. No apology, no admission that if he had listened to my protests he might have figured it out before doing so much harm, nothing. I ended up having to lay on one side with that ear up for almost an hour before blood stopped trickling out. And since that day, I have had trouble trusting any doctor.

However, I have seen examples of real compassion, especially from nurses. When I was nineteen, my month-old son was clearly very sick. We took him to the hospital emergency room, where they finally figured out he was having heart problems his pediatrician had completely overlooked. He was going to have to be transferred, by ambulance, to Children's Hospital in Boston. One of the nurses took the time and trouble to reassure us that he had a good chance of doing okay, and promised she would ride with him, which she did. She made a terrifying day much more bearable.

It turned out he had been born with a hole in his heart, and would need surgery as soon as he was big enough that would be possible. He was in the ICU for a while, and I was not in very good shape myself. First, any parent would be upset in that situation. Second, it didn't help my emotions that he had been named after my best friend in high school - who had died. Third, I somehow got the flu, and even after I was over it, I felt terrible. And I wasn't getting enough sleep, or eating decently, as anyone who's snatched meals from hospital vending machines and cafeterias will understand.

On top of that, I had been overprotected as a child to a degree that I was still learning how to interact with normal human beings. Looking back, I honestly think if I'd been raised by wolves I would have ended up with better social skills. I was hyper, inwardly dreadfully shy and trying to hide it by being just the opposite outwardly, and had no idea how to behave. On top of that, I was now frantic and feeling miserable. Anyone who blew my head off with a shotgun would have had more than enough justification.

One particular nurse cared for my son much of the time. Her name was Jan. She was calm, patient, compassionate, and incredibly competent. She managed to such a good job of caring for Michael even I couldn't miss it. On top of that, she had the decency and patience to do all that she could to alleviate my fears, listen to my babbling, and put up with my no doubt incredibly annoying, hyper presence. At that point, I had total distrust of anything medical: on top of my own experiences, I'd grown up listening to my father's stories of how her doctor killed his grandmother, and a vet had maliciously caused the death of my first two cats.

Despite that prejudice, despite an ingrained predisposition to assume anyone even vaguely medical was either incompetent, uncaring, or probably an outright sadist, Jan managed to make such an impression on me I trusted her. When Michael went back for his surgery, as soon as I heard she was the nurse assigned to him after the operation, I calmed right down and relaxed. Yes, there were other very decent doctors and nurses at Children's Hospital. I remember at least some of them. But she was the one who first allowed me to calm down enough to see that. Any ability at all I now have to trust the medical profession, I owe to her.

I hope all the suffering kids, all the ones who died, never managed to destroy her inside. That would be a double tragedy, because I owe her more than I can express, and I'd hate to think she suffered in any way for her caring, and also because it would be such a terrible loss to the patients she cared for and their families. Yet I do know decent nurses can burn out.

How do I know this? One of my aunts was a nurse. When I knew her, she wasn't hard-hearted, and she could be compassionate, but to hear her talk of her patients, she obviously treated them in a brisk, businesslike way. Yet later, I learned more of her history. She was an Army nurse in World War Two, and good enough to be promoted to Lieutenant. She was stationed in Britain, and was given some of the worst cases to care for. So many suffering, horribly maimed and disfigured young men passed through her care that the experience finally broke her. She had what at the time was called a nervous breakdown.

Even to the end of her life, more than fifty years later, she was never completely whole. Her very compassion proved to be the instrument of its own destruction. Who can blame anyone for that? And she did try to be fair. For years, I heard her talk of patients who complained that their IVs hurt. She made it plain she briskly assured them that was impossible, and it was all in their minds. Then, she found herself a patient. She had to have an IV, and she discovered that it caused a burning sensation in her arm that did hurt. She was honestly surprised, and apologetic, and vowed to do her best to minimise the hurt in the future.

I've also visited enough people in hospitals by now, and observed enough, to see that often, it is the system and not the individuals that causes problems. How is any nurse to do their best when they aren't allowed enough time to do so? How are they to be at their best when they are forced to work such long shifts they're exhausted? Yes, it is dreadful for the people who suffer, but it is not always the nurse's fault.

What do I conclude from all this? First of all, that nurses are a perfect example of all the best that humans are capable of, when they choose to be. Second of all, that even when they are not, they are often doing their best. Yes, they need to try to find some way to do even better, for the sake of their victims, but none of us is perfect. We owe it to all nurses to at least stop and try to discover what the problem really is, and if they really should be blamed, no matter how bitterly we might wish to blame them. And finally, for those few who really do lack compassion, who have simply found a job they can use to earn a living and don't care a bit about their patients - and, no matter how few they may be, there do seem to be a few - some way needs to be found to identify those few and force them out of nursing, for the sake of their patients and the sake of all the other nurses whose reputations they stain.