The Heart's Truth

Essays on the Art of Nursing

Cortney Davis

• Publisher: The Kent State University Press
• Year: 2009
• ISBN:
  9781612775586
• Topic: Medizin
• Subtopic: Krankenpflege

"Cortney Davis has an uncanny ability to give voice to the profound act of everyday nursing and its power in transforming the lives of people. Somehow, she sees the shadows and ghosts that fill our bodies and souls and makes sense of them, showing us that the divide between patient and provider is an artificial one that can get in the way of true understanding. The Heart's Truth reminds us of the power of reflection and narrative and challenges us to reclaim these ways of knowing in the interest of healing our patients—and ourselves." —Diana J. Mason, PhD, RN, FAAN, Editor-in-Chief, American Journal of Nursing

What is it like to be a student nurse washing the feet of a dying patient? To be a newly graduated nurse, in charge of the Intensive Care Unit for the first time, who wonders if her mistake might have cost a life? Or to be an experienced nurse who, by her presence and care, holds a patient to this world? Poet and nurse practitioner Cortney Davis answers these questions by examining her own experiences and through them reveals a glimpse into the minds and hearts of those who care for us when we are at our most vulnerable. The Heart's Truth offers the joys, frustrations, fears, and miraculous moments that nurses, new and experienced, face every day.

In these finely wrought essays, Davis traces her twin paths, nursing and writing, inviting readers to share what she discovers along the way—lessons not only about the human body but also about the human soul. Rich, intimate, and never shrinking from the realities of illness, the grace of healing, or the wonder of words, The Heart's Truth will inspire student caregivers, intrigue readers, and affirm those who have long worked in nursing, a profession that Davis calls "odd, mysterious, humbling, addicting, and often transcendent."

Twenty-four Hours in the Life of a Nurse Practitioner

OCTOBER 7

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.

6:05 A.M. The alarm goes off and a cold chill creeps through the covers. My husband yawns and gets up. I get up too, shivering. Today is one of my twelve-hour shifts in the women’s health center, the hospital-based clinic where I’ve worked with the poor and underserved ever since leaving private practice. Twelve hours means three clinic sessions without a break. Already, I’m tired.

6:10 A.M. Standing in the shower, it takes me a minute to get oriented. I shampooed yesterday. I shaved my legs yesterday too. Funny how a woman will say, as she slides down into the stirrups for her Pap test, I hope you don’t mind that I didn’t shave. I say I don’t even notice.

The bathroom steams up quickly. Light filters through the blinds, and suddenly I feel awake. And happy. The day will begin, and the day will end, a cycle over which, I remind myself, I have little control.

I say a quick prayer in the shower. There’s something about this warm space that seems primal and exposed, as if here my soul might be as naked as my body. At the same time, I wonder if God objects to a woman who prays naked, soaping and scrubbing while she asks Him to protect her family, her friends, her patients.

Dry off. Get dressed: Black Victoria’s Secret bra and black panties. Black slacks and an olive green slinky top. A slick of mascara and a line of brown pencil under my lower lashes. Professional on the outside, but inside I feel a little sexy. More like a poet—what I am on my days off—than a nurse practitioner. So this is what middle age looks like, I think, staring into the mirror.

7:00 A.M. While I eat breakfast, I reread a favorite book of poems, Sloan Kettering, by Abba Kovner, who wrote as he was dying of throat cancer. The poems are spare and wonderful. Suffering and blessings, endings and beginnings.

7:25 A.M. Out the door. If I’m lucky, if traffic hasn’t picked up, if the school bus is behind, not in front of me, I’ll arrive at the hospital by 7:50 A.M. As I drive through our neighborhood, I feel, viscerally, the seasons shift. The feel of the air has changed, reined in after the fullness of summer. In the sky, streaks of blue struggle to emerge from clouds. On the radio, the news, distant and personal at the same time: shootings, accidents, the ever-present clash of country against country, ideology against ideology. I try to imagine myself as victim, as patient. I remind myself to be kind.

7:53 A.M. I run up three flights from the parking garage to the women’s health clinic, thighs burning. Have to do more exercise. Have to take care of my body. But when I enter the hospital corridor, everything—the rest of my life—is put on hold.

I clock in and walk into the back conference room I share with eight residents, another nurse practitioner, nurses, and secretaries—a room in which I have no desk, no chair, nothing but a drawer. I put my pocketbook into it, pull on my lab coat.

This morning is our monthly staff meeting. Afterward, I’ll post myself in the hallway where I’ll stand all day in between seeing patients. I check the schedule. Sixty patients due between 9 A.M. and 4:30 P.M. And another fifteen patients in the evening.

8:10 A.M. Waiting for the others to arrive, I call M., the coordinator of the hospital’s Breast and Cervical Cancer Screening Program, and we talk about the latest abnormal Paps and mammograms. She shows me five reports, each one evidence of a problem that will require surgery, chemotherapy, or radiation. M. and I chat, both of us aware that these reports will change five women’s lives forever.

8:15 A.M. Finally, everyone arrives: our supervisor, our medical director, the hospital’s chief of OB-GYN (the only man here), our nurses, our secretaries, and the other nurse practitioner. First we praise the clinic’s good work: more patients seen; charts more complete. The director restates her commitment to care for the underserved. It all sounds good, but the reality is we don’t have enough providers or translators. There’s pressure from administration because the clinic never generates enough money, and without money, resources are strained. Outside, a throng of women and children wait in the hall, all of them poor, most of them undocumented, each woman depending on us.

9:00 A.M. From now until noon, I lose track of time. Minutes here are measured only in patients and their stories. Our eight exam rooms fill up. I stand in the hall with L., the other nurse practitioner. There is one resident here too, a first year just learning her way around. She won’t be much help.

My first patient, Sandra, is here for her initial pregnancy visit. She tells me she lost her first pregnancy at four months. “Will it happen again?” she asks. Calculating by her last period, she should be twelve weeks along, and we should hear the fetal heart. But when I place the doptone on her belly, there is only silence. I spend minutes searching. “Perhaps you’re less pregnant than we think,” I say. Then I track down the portable ultrasound machine.

On the ultrasound, I see a small fetus in my patient’s uterus. It seems, every once in a while, to move, but I don’t see the rapid fluttering of a fetal heart. There is a pregnancy within my patient’s uterus, one much earlier than twelve weeks. It takes me fifteen minutes to arrange for Sandra to have an ultrasound in Perinatology in order to document, for sure, if there is a living pregnancy, if everything is okay.

The next patient is at the end of her forty weeks of pregnancy. Strong fetal heart. Baby’s head down in the pelvis, ready and waiting. Nice, I think, to have this normal, easy visit. Maybe this will change the day’s luck.

Then another pregnant woman, this one in the country for almost a year, comfortable with our American ways but still shy about practicing her limited English. She’s thirty-six weeks pregnant and, after two previous C-sections, wants a third. “Otra niña!” she tells me, frowning. Another girl. I explain that we women can only reproduce girls. The father donates the chromosome that determines the baby’s sex. My patient beams. This third girl is not her fault.

10:40 A.M. I’ve lost count of how many patients I’ve seen. I glance at the clock as I run to the bathroom for the first time. I’ve had nothing to drink since breakfast, no water, no tea, nothing. A patient waits in every exam room. We are really behind, some of it my fault. I took too long with my first patient, the one who’s now upstairs having her ultrasound. Washing my hands for what seems the millionth time, I wonder if her pregnancy is okay. I’d asked her to come back and let me know.

I quickly see more OB checks, Pap tests, infection checks—then a seventeenyear-old who is twenty-six weeks pregnant, abandoned by her boyfriend and recently dropped out of school. She’s depressed, losing weight, out of money, and at odds with her parents. I call the social worker. Some patients know how to navigate the system and get help. Others, like this teen, are lost and vulnerable. But, by the time the social worker finishes her intervention, the patient is smiling. The high school will take her back. After delivery, she can bring her infant to the school’s babysitting facility; she can get state assistance. Her life begins to look a little better.

11:45 A.M. Lunch: peanut butter and jelly on whole wheat. Milk. A little Kit Kat bar from the bowl on the secretary’s desk. I eat junk food at work that I’d never eat at home: chocolate kisses, jelly beans, a large Pepsi, and, sometimes, the wonderful almond pastry that the coffee shop sells for $2.85. On a busy day, I eat because I’m stressed. On a slow day, I wander between patients, searching for comfort food.

The clinic is not an easy place to work, and the lunchtime atmosphere is often edgy and negative. The nurses complain about the secretaries and the secretaries complain about the nurses. Whoever is out of the room is fair game. We talk about the previous clinic director who resigned (probably couldn’t stand the craziness, we say) and the chief resident who’s never around. Then we get up and walk back into the hallway.

12:30 P.M. Our afternoon resident is stuck in a difficult surgical case. Her ten patients will be added to our schedule. Much grumbling from the nurses who must now handle three full-to-the-brim columns of patients, a name in every fifteen-minute slot. Grumbling from L. too. She and I are the only providers here to see all these patients.

The first chart of the afternoon belongs to a pregnant woman who thinks her water has broken, although, for now, she has no contractions. As I walk into her room, I hear a secretary’s voice rise up from the front office. “No more add-ons!” she shouts. “We don’t have any more room!”

I’ve learned that the only way to get through the day is to keep moving forward. If I focus on one patient at a time, I can be completely there. But if I let myself think about the number of patients waiting or the evening clinic or the fact that I won’t pull into my driveway until 8:45 P.M.,, then I’ll be overwhelmed with that anxious, it’s-all-up-to-me feeling, forgetting what I understood this morning—that I have little control. I can only take care of myself and the patient I’m with. Right now, it’s this woman and, yes, her water has broken and she’s about to go into labor.

1:00 P.M. My patient from this morning, Sandra, returns grinning from Perinatology with a copy of her ultrasound. Her pregnancy is fine but six weeks earlier than her last menstrual period would suggest. I admire the ultrasound picture: a tiny fetus with a yolk sac next to it, like a chick in an egg.

Patients arrive in fast succession. One is a woman whose last baby was delivered by C-section. This time, she wants to try a vaginal delivery, but we don’t know what kind of uterine scar she has. Even if her belly scar is horizontal, there’s a chance the internal uterine scar could be vertical, increasing the risk of uterine rupture. I tell her we have to request her old records, and, after her exam, we walk over to Medical Records where we get passed from one clerk to another, then to another office in another building. There, they tell me to request the records myself. I make a mental note to do this later. Back in the clinic, one of the nurses, D., tells me I have the patience of a saint. I disagree. I feel like exploding.

Patients all around me. A postmenopausal woman complains she’s not able to hold her urine. The chief resident is supposed to see her to discuss surgery, but the resident arrives late and then lingers too long in the conference room. The patient storms out, angry. Sometimes, patients find the clinic overwhelming or humiliating—the noisy, multilingual chatter; the loud TV; people joking outside the exam rooms; rotating providers; the reality that the clinic is for the poor, the underserved.

In the next room, there’s a thirty-four-year-old woman who’s found a small lump in her right breast. It feels like a cyst, not a cancer, but I’ve learned to be cautious. I send her for a breast ultrasound, telling her that any mass, even one that seems benign, has to be investigated. I think of my friend, J., who just finished radiation for a breast cancer that came out of nowhere—a few microcalcifications on a mammogram, no lump, no family history. A biopsy found ductal cancer, early, well-contained, and treatable.

2:15 P.M. A pregnant diabetic is next, someone who should be seen by a senior resident, but there’s no senior resident here so I pick up her chart: blood sugars out of control, a bladder infection. Her belly measures larger than her thirty weeks, and she still hasn’t gone for diet counseling. I examine her, make phone calls to the dietician and visiting nurse, increase the patient’s insulin dose, write a script for an antibiotic, and, of course, the resident appears just as I’m finishing up. Behind schedule again.

2:45 P.M. When I pick up this chart, I groan out loud. The nurse has written “patient severely depressed” in her note. This means, I know, a long and complicated visit. There are patients in every exam room and even overflowing the waiting area. Babies cry, women gossip in different languages, secretaries shout, nurses stand in the doorway and bellow patients’ names at the top of their lungs: NA-O-MI PHIL-LIPS! AN-TON-I-A SAL-A-ZAR! Leaning against the wall, I review the chart: a twenty-nine-year-old woman from Nepal. Postpartum seven weeks and crying all the time. Not suicidal. Husband translating.

The husband holds their newborn son while my patient huddles on the exam table, glassy-eyed, the sheet tied around her like a shroud. She keeps saying something in a reed-thin voice, but her husband won’t interpret for me. I ask a question, he answers me. I stand with my hand on his wife’s shoulder, trying to break down the wall he is building by his refusal to be our go-between. Finally I almost shout at him, “She keeps saying the same thing over and over. If I don’t know what she’s saying, I can’t help her!” He looks at his wife and shakes his head. “She says she needs someone to take care of her.”

I spend half an hour with them, going nowhere. I exam her and, physically, she’s fine. But she’s always crying, not sleeping, and barely caring for their newborn. When her husband looks at her, she flinches. To me, she has all the hallmarks of an abused woman but no obvious bruises. What does she do all day? Is she ever allowed to ask or answer questions herself? I consult with the social worker who takes my patient to crisis intervention. On the way out, the patient’s husband holds her arm, tight.

3:30 P.M. Just when I’m sure there can be no more surprises, I pick up the chart of a thirty-five-year-old woman who is forty-one weeks pregnant, one week overdue, and here for her first prenatal visit. Maybe she has no money and so thought if she couldn’t pay, she couldn’t be seen. Maybe she doesn’t understand the benefits of prenatal care. Maybe she wondered if the baby was ever going to arrive and so finally came in to see us.

She’s my one and only English-speaking patient of the day, so at least I can go more quickly through the first-visit requirements: history, physical, lab tests, Pap, cultures, ultrasound, and all the testing and teaching that, normally, are spread out over forty weeks. And I have to discuss this patient with the chief resident. If we let this woman’s pregnancy go on any longer she’ll be at risk for a host of problems, including fetal demise. I want to scold her, what were you thinking? but don’t. She goes off to the lab, request slips in hand, and says she’ll come back in two days for induction of labor. I wonder if she’ll show up. Then I remind myself to be kind.

4:00 P.M. The weekly high-risk conference begins in our back room. I’m still seeing patients so can’t attend, although I’m supposed to. The residents who have been invisible all day suddenly appear. The door closes, and the residents and the Perinatologist discuss all the high-risk obstetrical patients, most of them seen by L. or me. She and I grumble once again in the hallway. We both just want to sit down.

4:55 P.M. Our evening clinic begins in five minutes, but I have to grab a snack before I can see one more patient. In the coffee shop, I get ...