I Wasn’t Strong Like This When I Started Out

The Jewish Healthcare Foundation enlisted Lee Gutkind, the editor of Creative Nonfiction magazine, to choose these twenty-one essays in this new collection from the two hundred submissions sent in response to a call for manuscripts. Gutkind, who in the past two decades has written five books about the medical world, reveals in the introduction that he has a clear memory of the doctors and patients in his stories but not of the nurses, who remain semi-invisible to most of us, even though there are over 2.7 million of them working in the United States. The purpose of this book is to bring nurses out of the shadows and shine a light on the difficult work they do, as well as to educate readers about the demands of this challenging occupation.

The Jewish Healthcare Foundation enlisted Lee Gutkind, the editor of Creative Nonfiction magazine, to choose these twenty-one essays in this new collection from the two hundred submissions sent in response to a call for manuscripts. Gutkind, who in the past two decades has written five books about the medical world, reveals in the introduction that he has a clear memory of the doctors and patients in his stories but not of the nurses, who remain semi-invisible to most of us, even though there are over 2.7 million of them working in the United States. The purpose of this book is to bring nurses out of the shadows and shine a light on the difficult work they do, as well as to educate readers about the demands of this challenging occupation.

The writers featured here are all nurses or former nurses, some nurses in training establishing their place in the medical hierarchy, and others having left the field, looking back across time to reflect on the vast changes made in the profession. While each writer focuses on a different aspect of nursing, using their patients and experiences as examples, the reader will notice several common themes. Gutkind identifies the overarching theme: “No matter how difficult nurses’ lives or how secret their suffering, becoming a nurse entails movement into another dimension of strength and character and persistence; it is a path of irreplaceable and often unacknowledged service to society and humanity.”

These writers share rare glimpses into the joys, sorrows, and challenges facing nurses every day in hospitals, home care sites, doctors’ offices, and nursing homes all across the country, stories that have mostly been kept secret, because of privacy laws and because nurses prefer to spare their families the pain and suffering they’ve witnessed and “leave the pressure and the scars of their profession behind them when they leave work at the end of a shift.” These stories reinforce the notion that nurses are the ones who keep the medical care system running, or as Karen Wolk Feinstein, president and CEO of the Jewish Healthcare Foundation and the Pittsburgh Regional Care Initiative, writes in the foreword: “Good health care is built on good nursing.”

Several of these writers explore the wavering line between compassion and detachment. As Laura DeVaney, an RN on a radical head and neck unit in Indianapolis, writes in “Becoming a Nurse,” “there’s a difference between empathy and sympathy, and a good nurse solely empathizes. I haven’t figured out how to be that kind of nurse, yet; honestly, I’m not interested in learning.”

In “Healing Wang Jie’s Bottom,” L. Darby-Zhao recounts being called to a poor family’s home in rural China to treat the middle-aged matriarch’s Stage IV bedsore, after a motor vehicle accident left her paralyzed. Darby-Zhao raises funds to buy the woman a wheelchair. Twelve years later, the woman periodically calls Darby-Zhao to catch her up on the latest family news, because “In her eyes, I am still her nurse.” Josephine Ensign, who develops a close personal attachment to a dying AIDS patient, writes that she was taught to remain emotionally distant from patients, but admits: “It sounds good in theory, but there’s no way to teach the location of that boundary to someone else, or to know where it is for yourself.” She attends her patient’s funeral, all the while worrying that by doing so she’s crossed a professional line.

As a matter of course, death is a rite of passage in this world. The most poignant and heartbreaking passages in the collection are those that describe the deaths of babies. One young nurse cares for a dying infant, whose parents are unable to hold him. The nurse cries as she holds the baby, before and after his death and as she carries him to the morgue, explaining that she’d thought it would be unfair to let him die alone. In “Becoming,” Lori Mulvihill recounts caring for a newborn with anencephaly, who lives only a few hours. After the baby’s death, Mulvihill describes hugging the parents and crying with them, reflecting, “I am present for a sacred moment; present, physically and emotionally” and “I am a witness to overwhelming love and loss.” Home hospice nurse Kimberly A. Condon feels embarrassed for sobbing when an infant she’s caring for dies in his mother’s arms, but later she concludes, “I had been absolutely present with them in that agonizing, priceless moment. It was the best I could do.”

The book’s title comes from the essay “I See You” by Tilda Shalof, in a paragraph that summarizes her description of a good nurse: “Most of all, you need moral courage because nursing is about the pursuit of justice. It requires you to stand up to bullies, to do things that are right but difficult, and to speak your mind even when you are afraid. I wasn’t strong like this when I started out. Nursing made me strong.” I’m encouraged, as I’m sure most readers will be, to have these smart, compassionate practitioners as patient advocates who stand up to doctors, administrators, and the health care bureaucracy in order to care for their patients, and I hope through the power of these stories they’ll no longer feel invisible.