A Nurses Story | Chapter 5 of 27

Author: Tilda Shalof | Submitted by: Maria Garcia | 1443 Views | Add a Review

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As a veteran emergency physician, I have worked alongside my nursing colleagues for more than thirty years. You can’t work in a big-city Emergency Department without learning how to get along with health professionals. You learn how to ask nicely for an internist to squeeze in a final consult at 6 a.m. – knowing they hand over in an hour – and how to get a reluctant respiratory therapist to give your patient with asthma a nebulizer of salbutamol instead of an inhaler.

In the same way, you figure out which nursing colleagues stand tall in a crisis. You learn that in the resuscitation room, where patients’ lives are on the line. It also helps if you get to know the nurses you work with on a personal level – their likes, their dislikes, what kind of sense of humour they have, and the tender no-go places in their hearts. After more than twenty years as an ED physician, I thought I knew well the nurses with whom I work. Then, I read Tilda Shalof’s extraordinary book A Nurse’s Story, which was first published in 2004. At that time, the only books about medicine that I had read were books that told stories from the point of view of physicians. A Nurse’s Story was the first book I read that told stories from their perspective. Through Shalof’s deft and soulful writing, I met the nurses who worked on “Laura’s Line” in the intensive care unit. Shalof created vivid portrayals of the members of the team – Justine, the union rep, Frances from Newfoundland, and Laura, who set the tone with her sharp remarks.

Not surprisingly, I immediately took to Shalof – the sensitive one. How many times had colleagues accused me of being too sensitive? Like me, Shalof probably came to realize that sensitivity is not a weakness but a strength. Sensitive health professionals are among the best observers of the culture of modern medicine, as ably demonstrated by Shalof in A Nurse’s Story.

The book gave me a close-up view of what it’s like to care for patients hovering on the brink of life and death. There’s a saying among critical care doctors: if you’re a patient in the ICU, and you’re not getting better, than by definition, you’re getting worse. The doctors who work in the ICU play a critical role in making the diagnosis. But make no mistake: it’s the nurses who keep you alive. Shalof made that clear with story after story of nurses who have an incomparable ability to think critically and multitask when a patient is crashing.

Since then, through my own book The Night Shift: Real Life in the Heart of the ER, I have discovered how to tell stories that get inside the heads and the hearts of my colleagues who work in emergency medicine. But I give kudos to Tilda Shalof for helping to lead the way. When I first read her book, I was envious of Shalof. Why hadn’t I written a book like that? The book also made me feel anxious and insecure. Where did Shalof find the time to write the book? More important, how did she develop her ability to master prodigious detail to tell those stories?

Two years after this ground-breaking book was published, my show, White Coat, Black Art, aired on CBC Radio. A Nurse’s Story was a template for the show, which was tagged as “medicine from my side of the gurney,” and it had a strong influence on my approach. In particular, I admired Shalof’s refusal not to candy-coat the experience of working as a frontline nurse in critical care. She presented working life in the ICU – warts and all. Her characters were real people – at times elated and at times difficult and grumpy to work with.

More important, her book exposed longstanding problems in health care that need to be discussed. Since my early days as a freelance medical reporter for the Toronto Star and the Globe and Mail, I have had a passionate interest in medical errors and patient safety. On White Coat, Black Art, I have explored patient safety many times. I have to tip my hat to Shalof for devoting an entire chapter to medical errors in the ICU. I have seen many authors point the finger at others; what I admired greatly was Shalof’s willingness to talk about her own errors – those that caused harm as well as near misses. Her brave confessional is a good example of using one’s own mistakes as a steppingstone to making health care safer. Talking about it is essential to removing the shame associated with human error in medicine that precludes discussing errors openly.

The book owed its success to several factors, including Shalof’s bracing honesty and her willingness to tackle edgy contemporary subjects. This book was firmly in my mind when I did my TEDtalk “Doctors Make Mistakes. Can We Talk About That?” Back in 2004 it was rare for health professionals to write openly about their jobs and specifically their all-too-human mistakes. The fact that my TED talk has been viewed close to a million times convinces me that talking about one’s own errors is both authentic and helpful in helping to create a culture of safety.

A Nurse’s Story is set during the time of Severe Acute Respiratory Syndrome (SARS), a coronavirus that appeared mysteriously in Guangdong province in China and then arrived (via ill passengers) at several hospitals in Toronto and Vancouver. As a frontline ER physician at Mount Sinai Hospital in Toronto, I remember all too well an outbreak that some feared would become an airborne pandemic and would wreak havoc on the community. Ultimately, as we know all too well, SARS caused a disproportionate amount of illness among health care professionals who provided intense respiratory care of ill patients. Many of the most urgently ill patients were respiratory therapists, anesthesiologists, and (not surprisingly) critical care nurses. It is in chronicling the impact of SARS on her nursing colleagues where Shalof’s book truly shines. A Nurse’s Story gave voice to nurses who were apprehensive about an illness with no cure and a potentially grave prognosis. Shalof validated the anger many nurses felt about being urged to come to work while uninformed about the risk to themselves and their families.

Many lessons were learned from the SARS outbreak. Just one example of a resulting change is in the ER where I work, which now has three rooms for isolating patients with airborne respiratory illnesses, instead of the one isolation room it used to have. Another is the willingness of nurses to speak up about shoddy care and decision-making that puts them at risk. With the emergence of a new coronavirus that has been dubbed Middle East respiratory syndrome (MERS), we will watch and see how good a job the authorities do to protect nurses on the frontlines.

A Nurse’s Story was well received in Canada and in the United States. The book’s literary success leads me to wonder what impact it has had on the culture of medicine. That is a hard thing to gauge. My own opinion is that books like A Nurse’s Story and The Night Shift don’t change culture so much as reflect a change in the culture towards more openness and self-reflection. I doubt that A Nurse’s Story or The Night Shift changed relations between nurses and doctors on a larger scale. Knowing the tendency of nurses in a hierarchical structure to bully one another, I suspect Shalof was rewarded for her courage with a little disdain and a lot of envy.

No matter. It hasn’t stopped her from exploring the nooks and crannies of modern medical culture. And it hasn’t stopped me either. My new book The Secret Language of Doctors is a deep exploration of the culture of medicine as evidenced by the pejorative slang health professionals use to talk about patients, clinical situations, and colleagues we don’t like.

For me, the best part of revisiting A Nurse’s Story was realizing just how fresh and relevant it still is. I suspect it will still be in the decade to come. Knowing that writers like Tilda Shalof are out there giving readers an inside look at the world of medicine buttresses my own determination to do the same.

Brian Goldman, M.D.,
author of The Night Shift and The Secret Language of Doctors


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Great book, nicely written and thank you BooksVooks for uploading

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