February 19th, 2005

Toledo doorway

Thinking thoughts.

tablecolor posted about following a nurse for a day. And it reminded me of a recent conversation.
I like nurses. Nurses and social workers tend to like me. This gets things done - this means that when a patient comes tearing into the hospital at 7 cm dilation screaming for an epidural and the doctor in question is in no way associated with the group I'm working with, they ask me if I want to get involved. "We'll check with the doc when we call him." Nurses do things. Nurses know things. And a good nurse will make your life wonderful.

I was talking with an office nurse. And she expressed, as everyone seems to, that I did not look old enough to be a medical student. People tell me this all the time. People think I'm still in high school. Does it bother me? It bothers me when they assume I must be a nursing student and then they get the condescending "isn't that cute" tone of voice. And she looks at me. "Remember that," she says. "Remember what it feels like to be looked down on for being a nurse."

There is a shortage of nurses in the world today. One of the reasons, or so convention has it, is that young women who want to go into medicine are being redirected. For so many many years, the only route into medicine for a woman was to become a nurse - unless one were very smart, a little pushy, and ready to take heat. Now my class is over 50% women. Young women are being encouraged to become doctors. And sometimes being told you're too smart to be a nurse.
A good nurse, O Best Beloved, is a patient advocate, an educator, a living monitor, a decision-maker, a triage artist, and a general manager of patients. She [I will use she; nursing is still predominantly female, though I know several excellent male nurses as well] knows what needs to be done. She checks documentation. She catches your mistakes. A good nurse means that an OB-GYN can see an entire office worth of patients while three women are laboring in the hospital next door, and still be there to deliver the baby without making anyone wait overly long. And a good nurse is a smart nurse.
Perhaps it is family medicine that makes me perceive things this way; I am accustomed to arguing that you want smart generalists and intelligent gatekeepers. I am accustomed to hearing you're too good come across my own ears. I am accustomed, O Best Beloved, to taking my profession with a grain of salt. I am a believer in well-trained physician assistants, nurse-midwives, and LPN's. I do not subscribe to the idea that medicine is a sacred guild of professional men. I am a middle-class white girl from the Midwest. My parents are teachers. I served burgers at Wendy's to earn money in high school. And I have sweated and bled and fought no more and no less than anyone else in my class to get to where we are.

My gmail account has a saying from the Apocrypha, from the book of Sirach, as its signature:
The Lord created medicines out of the earth,and the sensible will not despise them. Was not water made sweet with a tree in order that its power might be known? And he gave skill to human beings that he might be glorified in his marvelous works. By them the physician heals and takes away pain; the pharmacist makes a mixture from them.
God's works will never be finished; and from him health spreads over all the earth.
- Wisdom of Jesus ben Sirach, 38:4-8
And he gave skill to human beings that he might be glorified.
Show me a physician without a good nurse, O Best Beloved, and I will show you a human being who is not living up to that potential of skill. Show me a medical student who takes time to make friends with the nurses, and I will show you a medical student who has that hidden "edge" that makes all the difference.
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