Contents

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Preface

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pp. ix-xii

While my grade school friends read Cherry Ames, Student Nurse, pretending to save their patients while at the same time wooing the handsome physicians, I’d jump on my bike and fly down the road pretending I might escape the world. Later, when high school companions talked about sacrifice and duty while thumbing through nursing school catalogs, I declared myself an art major. ...

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The Other Side of Illness

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pp. 1-3

I heard a woman say, your operation is over. I had been a long time waking. As I swam back toward the sounds of the recovery room, I was aware of hands touching my arms and adjusting what seemed to be an endless number of new appendages—tubes and wires that snaked from my body like bare branches on a winter tree. Ah, I thought. This one must be a nurse, the owner of the voice ...

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Washing Mrs. Cardiff's Feet

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pp. 4-8

I washed Mrs. Cardiff’s feet at Saint Joseph’s Hospital, a community institution commandeered by Sister Mary Margaret, a tiny, middle-aged nun in voluminous black who moved silently through the wards, always appearing just in time to correct a near error in patient care or to catch a sloppily tightened draw sheet. At St. Joe’s—what we students and many of the nurses called the hospital—most ...

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The Evening Back Rub

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pp. 9-10

When I was a student nurse, I perfected the art of giving a great back rub, a skill I’d first learned as a nurse’s aide. In my second year of nurses’ training, when we students worked evening shift, I’d gather my equipment and push my cart from room to room, checking IVs, changing rumpled sheets, offering fruit juice with crushed ice, and giving every patient a back rub. For most patients, this quiet ...

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Being at the Bedside of the Dying

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pp. 11-14

If you work in our field long enough, no matter where you’re employed or where your ambition takes you, sooner or later you will be called on to sit with the sick, the grieving, and the dying. Some of us, those who do our nursing in places like the intensive care unit or the cancer ward, perhaps sit with the dying and the grieving more often. Never mind. Sooner or later, this task comes to us all. ...

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First Night in Charge

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pp. 15-19

My nursing program had been a rigorous combination of clinical and academic work. By graduation, I’d run a floor, taken care of ventilator patients, started intravenous lines, passed meds, participated in codes, and, in general, was ready to hit the ground running. And so, after an eight-week heart-monitoring course, I found myself in charge of a seven-bed ICU, the only registered nurse on the night shift. I had a nurse’s aide to help me, a woman in her fifties with thirty ...

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Talking to No One

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pp. 20-24

As I drove to work, a sudden snow squall sparkled and swirled in my headlight beams, illuminating the road ahead of me. Beautiful, I thought. Then I pulled into the dark mouth of the parking garage and the snow suddenly disappeared, the night closed around me. It was 10:45 p.m. In fifteen minutes I would begin my eight-hour night shift in Intensive Care. ...

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Nursing and the Word

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pp. 25-30

Before we go any further, let me remind you that I never wanted to be a nurse. When other ten-year-old girls were somberly taking each other’s pulses, playing at being nurses, I pretended that my Schwinn bike was a wild stallion. My imaginary cape flying, imaginary hoofbeats ringing out on the pavement, we galloped down Sylvandell Drive in Pittsburgh, always under the gray cloud of ...

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Beyond Scientific Explanation

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pp. 31-33

Strange things happen in hospitals, in nursing homes, at the bedsides of the suffering. Odd events become as routine to nurses as the daily tasks of monitoring and medicating patients or staying with them as they die, some struggling, others slipping away peacefully. Nurses understand that something beyond our human comprehension occurs when the last breath is expelled, the one that ...

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Weekly Rounds

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pp. 34-36

Another blustery January day, another Tuesday. Walking into the nursing home, I welcome the rush of warm air. At the same time, I recoil from the musty, antiseptic smell. I’m two years into my first job as a nurse practitioner in private practice with a group of physicians, and today’s my day to do nursing home rounds. At the end of the afternoon I’ll go back home, but right now I must go from floor to floor, seeking out our patients who linger here. After all my years in nursing, ...

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Twenty-four Hours in the Life of a Nurse Practitioner

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pp. 37-45

2:00 a.m. Something wakes me—a dream? The house is quiet, and the yellow light from my husband’s clock radio glows into the bedroom. I turn on my right side, wiggle my toes, and wait to drift away again. I tell myself I have to get some sleep. ...

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First, Do No Harm

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pp. 46-48

Milagros is an illegal alien, one of many who come to the women’s clinic. She has a valid-looking social security card, but when we check, we find that four other patients claim the same number. Last month, she used the last name Lopez. This month, she signs in as “Milagros Hernandez.” Then one of the nurses recognizes her. “Hey, Milagros,” the nurse says in rapid-fire Spanish. “Make up your mind, ...

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Hearing the Stories behind Our Patients' Words

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pp. 49-53

It was September 11, 2001, and I was sitting at home in front of my computer revising the policies and procedures for the women’s health clinic. Shortly after 9 a.m., my husband called from his office. “Turn on the TV,” he said. “A plane just hit the World Trade Center.” I turned on the TV exactly at the moment the second plane banked to knife into the glass and steel of Tower Two. As many ...

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Body Teaching

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pp. 54-58

Last summer, two of the new interns who joined our team in the women’s health clinic were men; otherwise, all our care providers are female. Because our clinic is located in a teaching hospital, there’s also a stream of students passing through regularly. Medical residents spend a mandatory week or two with us, usually grudgingly, to sharpen their pelvic exam skills, and nervous medical students ...

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Tattoos

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pp. 59-62

... We look up from our charts. Alex’s face is splotchy and he looks very young. “What?” Linda asks. Alex is in his first year of OB-GYN residency—not exactly brand-new but not very experienced either. Next year he’ll blossom, suddenly becoming more self-confident and realizing how much he’s learned. Linda, a third-year resident, and I glance at each other. I’ve been a nurse practitioner in ...

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Breaking Bad News

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pp. 63-68

I’m just about to flip open the patient’s chart to find out why she is here when I see a note stuck on the front of the folder. “Positive for chlamydia,” is scribbled in the secretary’s handwriting. “Here for treatment.” ...

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Becoming Flora

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pp. 69-73

She was the last patient to arrive that August Friday, an urgent add-on at the end of the day. The secretary’s note, a terse fragment, oozed condemnation—“Patient 22-weeks pregnant, thinks her water broke a few nights ago but didn’t bother to call”—an attitude I was all too ready to pick up and run with. It had been a long busy week, and I was tired. Tired of standing, tired of listening, tired of doing ...

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Raped

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pp. 74-75

Alicia sits on the exam table before me, freckles scattered here and there across her nose. Her mouth is bowed. She is twelve, with dark brown hair, pale brown eyes, and a resigned, empty stare. ...

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The Heart's Truth

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pp. 76-77

A young woman, who I will call Susan, had been coming to our hospital clinic for years complaining of a deep pelvic ache that interfered with her intimate relations with her husband. She’d had cultures for infection, Paps, ultrasounds— even an exploratory laparoscopy that discovered no adhesions, no cysts, nothing to explain this troublesome pain. ...

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Watching ER

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pp. 78-80

We nurses share in our patients’ joys—the successful operation, the negative scan, the day of discharge—but our days also include crash C-sections, unexpected infections, sudden trauma, and other personal and familial grief. Unlike the smoothly coordinated workings of the TV show ER (“We have to crack the chest! Quick, the knife! Rib spreader! There, we’re in!”), our jobs consist of ...

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Feeding the Deer

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pp. 81-82

Only three months after my granddaughter’s life-threatening illness, my father died. An only child, I instantly became an orphan. Five months later, I found myself in surgery, undergoing an unexpected, major emergency operation. After I recovered, my mammogram, like a bad joke, came back abnormal, and once again I returned to patient status for a biopsy. Even the benign outcome ...

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When Their Rhythms Become Mine

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pp. 83-85

Working as a nurse practitioner, serving uninsured women and teenagers, I’ve gotten really good at doing first exams. I even have something of a reputation: fifteen-year-old girls come in for an appointment and say, “You did my friend’s first exam and she said it wasn’t too awful.” Some of the nurses steer the first exams my way as well. When she hands me a chart, a nurse might say, “I’m glad ...

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I Believe in Grief

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pp. 86-87

... Once I would have rushed to comfort these people. Uncomfortable myself with their grief, I’d want to ease their sadness with my cheer and consolation. I’d hug a patient and tell her to “try to get pregnant next month.” I’d reassure the widower, telling him, “Your wife had a long life.” I’d enter the burned child’s room in Intensive Care with a smile rather than encouraging the mother to weep ...

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Human Feelings, Human Experiences

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pp. 88-91

I think a lot about the meaning of words. Years ago, listening to the news, we heard the phrase “shock and awe” used to describe the massive, initial bombing of Iraq, a display of might and power meant to shock Saddam Hussein into surrender. Then, when his soldiers didn’t immediately give up, some announcers talked about how “shocked” they were by Iraqi resolve. ...

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Conscious Suffering

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pp. 92-96

... I’m so sick I’m in bed in my pajamas and fuzzy robe. So sick I haven’t made it downstairs to turn on my computer and must instead write in my scribbly hand on a yellow legal pad and hope that, later, when I’m able, I can decipher these scratchings and type them into words. ...

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Afterword

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pp. 97-98

When I was not quite a year old, my mother’s dormant tuberculosis flared and my father, just home from Italy at the end of World War II, was suffering from terrible nightmares—what we’d now call post-traumatic stress disorder. My parents decided I’d be better off in a healthier environment and so sent me to live with their best friends, a couple with two children of their own, a boy and a girl. ...

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Acknowledgments

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pp. 99-100

My appreciation to the editors of the following journals, anthologies, and texts in which versions or sections of these essays first appeared: ...