In our transparency-seeking, report-card-issuing, memoir-happy climate, not much about medicine goes unexamined these days. One exception, oddly, is an aspect that used to be at the center of attention: the ever-titillating relationship between doctors and nurses.
From Cherry Ames to Dr. Kildare, the folks in the stiff, white uniforms once waltzed around providing vicarious fun for all. A few serious academic analyses from those days confirmed the intensely stereotypic sexual gamesmanship and complicated power plays underlying even trivial doctor/nurse interactions.
Now, of course, all that has changed, with nursing established as a powerful and educated profession, with gender stereotypes erased, salary disparities shrinking and job descriptions overlapping.
But has it really changed? Do we know for sure? In theory, doctors and nurses are now heading for a happy paradise of equality, collaboration and mutual respect. Human nature being what it is, though, one wonders if we are not first condemned to weather a Reconstruction-type era of confusion and ongoing mutual abuse, as all parties struggle to regain their footing.
In the meantime, not many bulletins are coming in from the field. You can bet that no doctor out there is planning to publish a manuscript entitled "Reflections on Nurses" any time soon. I am assuming my colleagues concur that such a project would be best left for retirement incommunicado somewhere on a distant Pacific atoll, where the mailman never calls.
It is hard to say which would prompt more angry letters: outlining some of the bad nursing care the present system enables, or searching for exactly the right words to describe the miraculous best. "Saintly," "selfless" and "devoted" all have condescending paternalistic overtones. "Professional" is just too cold. There is a limit to how many times you can use "fabulous" in one piece of writing. Better to keep quiet, we say, cowards all.
But nurses are made of sterner stuff. In "Reflections on Doctors," they have produced something quite extraordinary in recent medical writings: a compilation of 19 brief essays musing on the current relationship between the species. The book comes from Kaplan Publishing, whose guides take aspiring professionals from SAT preparation to licensure, and it is apparently intended to prepare incoming nurses for the terrain.
It does so not by theory but by anecdote: these contributors hail from the trenches rather than the executive offices or classrooms, and while some are writers by avocation, few can muster anything in the way of literary style. Still, their casual stories deliver a remarkably wide perspective on their subject.
Karen Klein recounts the two occasions in the course of a career when she refused to take a doctor’s orders. The first time netted her a heartfelt apology when her judgment proved correct; the second time, for an equally correct judgment call, she got only a bloody handprint on the back of her uniform as the irritated doctor gave her a shove in the direction of the job she refused to do.
A heavily symbolic handprint, that, and in self-consciously literary hands it could have been fashioned into quite the metaphor. This nurse only hopes the doctor "got the help he needed."
Other stories are similarly matter of fact. Cara Muhlhahn, a nurse-midwife in New York City, describes a complicated cord-around-the-neck home delivery:
"Yay! One more unnecessary Caesarean avoided because of excellent clinical management and great collaboration with doctors." Paula Sergi, a public health nurse, writes about the workaholic doctor she wound up marrying, "the person behind the woman who attends social functions alone."
Anna Gregory, an occupational health nurse, ruefully reflects on her looping career arc: as a nurse she increasingly took on "the doctor’s job"; now, training as a doctor, she worries that when she finishes "all the docs will have been replaced by nurses."
In war-torn Kosovo, a team of hip young female women’s health doctors and nurses groan when an elderly Albanian pediatrician joins their team, only to become captivated despite themselves by the old crone’s clinical prowess.
Each story represents a step in understanding the inherent differences that separate the professions. While working as a rehabilitation nurse, Mindy Owen stumbles on a big one in caring for a quadriplegic teenager, the victim of a car accident. She becomes transfixed by a picture of the boy with his old basketball team, and shows the photograph to the boy’s doctor. "Never do that again," he snaps. Only then does she realize that the doctor takes the photograph as a reproof, a message that because he cannot "fix" the patient, he has failed.
Nursing is intensely reality-based; medicine, often, not so much. "It was the first time I really understood the philosophy of some physicians," the nurse writes, "and the definition of failure to a doctor."
These nurses despise the lazy and arrogant doctors they come across (one wonders if the modern empowered nurse elicits worse behavior from these characters than did the old subservient model). They adore the paragons who spend endless hours with chronically ill patients and then happily play Santa Claus at the Christmas party.
Mostly, though, they write in shades of gray, describing interactions and relationships that are colorless, courteous, businesslike. You might actually call them dull. You wouldn’t get a minute of good television out of them. You might, however, get some good medical care.