When a nurse becomes a patient
By Theresa Brown
When Theresa Brown was diagnosed with breast cancer, she felt scared and deeply saddened by the thought of leaving her children without a mother. The news left Brown in such a state of shock and confusion that to this day she cannot remember sharing it with her husband. But Brown, an oncology and hospice nurse, also experienced something else: an uncontrollable anger and the occasional urge to violence toward those in the medical system she deemed insufficiently caring and inadequately responsive to her unfortunate circumstances.
In her new memoir, “Healing: When a Nurse Becomes a Patient,” Brown describes her anger when she realized a receptionist in a medical office had gone home early, denying her the chance to schedule a biopsy immediately after an alarming mammogram. About a second receptionist who rudely told Brown that the person was gone for the day, she writes: “I wanted to punch her in the stomach and as she doubled forward gasping, I slammed my fist against the bridge of her nose. I wanted hear bones crack I wanted to see blood, let her say NEWbeg for mercy.”
On the day of Brown’s lumpectomy, someone at the surgical center’s front desk told her she was “not on the list” of patients scheduled for surgery that day. The person discovered Brown’s name a few minutes later, but the thoughtless comment made Brown boil. “I confess there’s a part of me that wants to find that person again, put her up against a wall, stand right in her face, and roar in the nurse’s voice, ‘What do you mean, I’m not standing? on the list?’ †
Brown later realized that her outbursts of anger stemmed from a helplessness she felt about her illness, a despair she didn’t experience often enough. own patients in the oncology department and as a home nurse in the hospice. This is the disconnect at the heart of ‘Healing’. A caregiver receiving care suddenly understands an essential truth: empathy is essential to alleviating suffering. “I didn’t understand that indifference can become a form of cruelty when someone’s life can be at stake.” Unfortunately, Brown writes, “you can’t bill empathy.”
The American health care system, in which every test, exam, and drug are separate opportunities for revenue — and often profits — offers no tangible incentive for patience or kindness. It should therefore come as no surprise that this kind of humanity is all too rare in medicine. Brown never realized the depth of this deficit or how crazy it could be for patients until she was on the other side.
Brown uses her time as a nurse to understand the failings of the health care system, never shying away from her own failings. In an unforgettable vignette from her time as a hospital staff member, a 19-year-old cancer patient who, understandably, grumpily fell on a piece of IV waste Brown had fallen to the floor. She writes, “He was barefoot — ouch — and he swore extensively.” Brown is eager to get the patient and his evil mother out of the hospital and won’t change bandages; his mother says she will do it at home herself, but she doesn’t. A nurse manager later tells Brown that she should have noted this on the patient card. “The truth is,” Brown writes, “I never thought about it. After they left, I just wanted to be done with them. I had looked his anger straight in the eye and then, as quickly as I could, I looked me away.”
In between her harsh critiques, Brown gives a glimpse of what it might be like if medical workers looked beyond the tasks at hand and had more time and fewer tasks to manage. The cheerful, obliging staff of a radiation oncology department made Brown feel welcome: “They knew the value of kindness.”
Brown writes that universal health care, improved electronic health records and an entire non-profit system are needed to create space and time for greater compassion in American medicine. However, at less than a single page, Brown’s prescription for improvement is so short that it is inconclusive. While her prose is easy to understand, the multiplicity and length of the chapters in “Healing”—39 in all, every two to eight pages—can feel disjointed. Sometimes attempts to be smart fall short. Brown introduces a chapter on the cancer drug Tamoxifen, for example by writing about her father’s love for a Scottish hat called a tam. A chapter explaining how hospices declare patients dead begins with a meditation on pronouncing “potato” and “Des Moines.”
Brown, who survived her ordeal, left nursing to write full-time and give speeches on health care. With her newly acquired 360-degree perspective on medical care, one cannot help but be disappointed that Brown, the nurse, is no longer walking the corridors of a hospital or rushing from one hospice appointment to another, ready to find her again. wisdom to work for patients. On the other hand, even the most well-meaning health professionals can only do so much, as, Brown writes, they are trapped in a system “focused on profit and squeezing every last effort from staff who only want to do good.”