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27 2 Doctor and Nurse When Wald brought together professionals from different disciplines to conduct her study, she envisioned them working as a group of equals. She also expected teamwork to be a vital component of the facility she planned to establish. As she frequently noted,the staff operated as a team at St.Christopher’s,the London hospice that was her model. Moreover, many of the contemporary political movements she supported sought to disrupt hierarchical social arrangements. Wald was especially eager to alter the traditional relationships between doctors and nurses.By 1969,the balance of power between them had begun to shift. We saw in the last chapter how Wald’s mentor Peplau had argued that nurses could claim unique expertise by focusing on their personal relationships with patients. The expansion of high-­ tech medicine enabled nurses to enhance their status in another way. During the 1960s, ICUs and coronary care units increasingly contained new technologies such as defibrillators , feeding tubes, and respirators. Especially during the many hours when medical staff was unavailable, nurses in those units assumed responsibilities doctors previously had considered part of their exclusive domain.1 As Wald explained,“The hospital is larger and more complicated and filled with equipment that requires many staff members with special skills and particular interests who are involved in a single patient’s care.”2 She thus hoped to 28 Prelude to Hospice be able to work closely with many doctors at Yale New Haven Hospital (YNHH). She soon realized, however, that very few hospital physicians understood the goals of her research and the role she expected to play. As a result, she decided that rather than relying on the entire medical staff to refer patients to her, she would select participants only from the rosters of the two doctors on her team. Because Wessel was a pediatrician and had very few terminally ill patients in his practice, her decision meant that Goldenberg, a breast cancer oncologist and surgeon, became the primary doctor in the study. Approximately three hundred patients visited his breast cancer clinic each year.3 Wessel noted that Wald worked best with Goldenberg. Their common experiences of being Jews at Yale may have strengthened their relationship. I have noted that Sherwin Nuland was surprised to find that the chief resident of Yale’s surgical program in the early 1950s was the “very obviously Jewish-­ looking”Goldenberg . Anti-­ Semitism at Yale had greatly diminished by 1969, when Wald and Goldenberg began to work together. But when Wald attended the Yale School of Nursing in the late 1930s and early 1940s and when she returned first as a professor and then as a dean in the 1950s, she too may have been considered an outsider on an overwhelmingly Christian campus.4 Wald also must have felt that she had made the right choice because Goldenberg’s views about hospital care for dying people seemed closely aligned with her own. In December 1968, he lambasted house staff who acted “almost as if there’s something evil about being sick”and seemed to consider it a waste of time to care for dying patients. “This upsets me a great deal,” he remarked.5 At a conference with hospital staff the following year, he explained that “aloneness” was often the most serious problem of people at the very end of life: “If there’s someone there just to be able to say a word or two, then I think we have met one of the great needs.” He acknowledged that doctors often had to make a “conscious effort to screw up this courage and go into the room and just sit there for five minutes and talk to the patient and answer whatever Fig. 2. Ira S. Goldenberg (Credit: Yale University, Harvey Cushing/John Hay Whitney Medical Library) 30 Prelude to Hospice questions the patient may have and give whatever support seems most appropriate.” Nevertheless, he urged his colleagues not to avoid that task. He also demanded absolute honesty. “I have very, very strong feelings myself about lying to patients,” he stated. “I think it is wrong.”When patients ask if they are dying, physicians should answer truthfully, though they might want to add “indeed we’re all going to die at some point,it’s inevitable”and “we’re going to keep you comfortable, we have medications available.” Nurses who realized that patients had not been told what was happening must “button-­ hole the doctor involved, sit down and talk them...


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