The Heart's Truth: Essays on the Art of Nursing

The Evening Back Rub

9 The Evening Back Rub 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 ritual brought relief from boredom and loneliness. For me, it became a private interlude during which I could listen to patients tell their stories or admit their fears. While my hands massaged their backs, patients could escape, at least temporarily, the hospital’s stark walls and the day’s long hours. This is how it went. After taking a patient’s blood pressure and checking the pumps and monitors that hummed monotonously in the background, I’d draw the curtain, crank up the bed so I wouldn’t have too far to bend, and help the patient turn on her side. Next I’d fanfold the sheet to expose her back, the muscles tense, skin red and ridged from the pressure of the bedclothes. Sometimes, a patient’s ribs stuck out like ladder rungs. I’d snap open the bottle of lotion and pour a little pool of it into my palm, warming it in my hands until the scent of almonds drifted into the air. Alone with my patient in the half dark, I’d slather the lotion from shoulders to buttocks, gently swirling my hands in long strokes until the entire back was slick and soft. After a minute or so, the patient might begin talking, and I’d gradually increase my fingers’ pressure until I was rhythmically kneading the skin, increasing blood flow and urging the patient’s body to let go, to trust me, to relax. I’d learned that a good back rub lasted ten minutes—ten minutes’ attention to the flesh and soul. Alas, nurses rarely give back rubs anymore. Time once devoted to patients is now spent requesting off-formulary medications or arguing with insurance companies about why Mrs. Smith should stay in the hospital for one more day. Now, instead of offering ten minutes of human interaction during which a nurse’s hands might become a conduit of healing, we rush in and toss the patient a 10 the heart’s truth prepackaged, prewarmed washcloth. Those little bottles of almond lotion, once tucked into every patient’s bedside stand, have just about disappeared. A lot has changed since the days when I wore my blue students’ uniform and patients recuperated in the hospital for weeks. Today I wear street clothes and a lab coat and only the sickest patients qualify for admission—and even they are sent packing after a few days, heads still spinning, bellies aching. No longer able to heal according to their own rhythms, patients are hurried along “critical pathways,” insurance companies’ predetermined timetables for recovery; we nurses, once our patients’ advocates and masters of the evening back rub, mourn all that’s changed and all that’s lost from our noble profession. Some of my nurse-friends have left their jobs to find happier occupations. I read that, these days, fewer young women and men opt to pursue bedside careers. As for me, I’ll hold on to the memory of the evening back rub, that once-upona -time when a suffering patient could be comforted and I had time to linger and listen. Now when I greet a patient—before I verify her insurance plan and check to see which treatments she may or may not receive, and before I determine how much time I’m permitted to spend with her—I place my hand on her arm for a while and we talk. Just for that moment, the years roll back and there is nothing and no one between us, as it should be. ...