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A Nurse Finds Herself on the Other Side of the Equation — as a Patient

HEALING
When a Nurse Becomes a Patient
By Theresa Brown

When Theresa Brown was diagnosed with breast cancer, she felt afraid and deeply sad at the idea of leaving her children without a mother. The news sent Brown into such a state of shock and confusion that, to this day, she does not remember sharing it with her husband. But Brown, an oncology and hospice nurse, experienced something else too — an uncontrollable anger and occasional urge for violence toward those in the medical system she deemed insufficiently caring and responsive to her unfortunate circumstances.

In her new memoir, “Healing: When a Nurse Becomes a Patient,” Brown describes her ire upon realizing that a receptionist in a medical office had gone home early, denying her the chance to schedule a biopsy immediately following an alarming mammogram. Of a second receptionist who offhandedly told Brown the person was gone for the day, she writes, “I wanted to punch her in the stomach and as she doubled over, gasping for breath, smash my fist into the bridge of her nose. I wanted to hear bone crack. I wanted to see blood, have her say NO, beg for mercy.”

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 operations that day. The person located Brown’s name a few minutes later, but the thoughtless remark made Brown seethe. “I confess there is a part of me that wants to find that person again, back her up against a wall, get right in her face and bellow in the Nurse Voice, ‘WHAT DO YOU MEAN I’M NOT ON THE LIST?’”

Brown later realized that her bursts of anger stemmed from a helplessness she felt over her disease, a desperation she failed to recognize often enough in her own patients in the oncology ward and as a home hospice nurse. 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 had not understood that indifference can become a form of cruelty when one’s life could be at stake.” Unfortunately, Brown writes, “you can’t bill for empathy.”

The American health care system, in which each test, exam and drug are separate opportunities for revenue — and often profit — offers no tangible incentive for patience or kindness. We should not be surprised then that this kind of humanity is all too rare in medicine. Brown never realized the depth of this deficit or how maddening it could be for patients until she found herself on the other side.

Brown mines her time as a nurse for insights into the health care system’s flaws, never shying away from her own shortcomings. In one unforgettable vignette drawn from her time on staff at a hospital, a 19-year-old cancer patient who is, understandably, cantankerous steps on a piece of IV detritus Brown had dropped on the floor. She writes, “He was barefoot — ouch — and he swore elaborately.” Eager to usher the patient and his scowling mother out of the hospital, Brown does not perform a dressing change; his mother says she will do it herself at home, but does not. A nursing manager later tells Brown she should have noted this in the patient’s chart. “Truth is,” writes Brown, “I never thought of it. After they left, I only wanted to be done with them. I had looked his anger right in the face, and then, as soon as I could, I looked away.”

In between her searing critiques, Brown offers glimpses of how things might go if only medical workers saw beyond the tasks at hand and had more time and fewer tasks to manage. The cheerful, accommodating staff in a radiation oncology unit made Brown feel welcome: “They knew the value of kindness.”

Brown writes that universal health care, improved electronic health record-keeping and a fully nonprofit system are what’s needed to create space and time for more compassion in American medicine. However, at less than a single page, Brown’s prescription for improvement is so brief as to be unconvincing. While her prose is easy to understand, the multitude and length of the chapters in “Healing” — 39 in all, each two to eight pages — can feel disjointed. At times, attempts to be clever fall short. Brown introduces a chapter about 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 pronounce patients dead begins with a meditation on how to pronounce “potato” and “Des Moines.”

Brown, who survived her ordeal, left nursing to write and give speeches about health care full time. With her newly acquired 360-degree perspective on medical care, one can’t help feeling disappointed that Brown, the nurse, is no longer walking the halls of a hospital or dashing from one hospice appointment to the next, ready to put her newfound wisdom to work for patients. Then again, even the most well-intentioned health care workers can only do so much, given that they are, Brown writes, stuck in a system “focused on profits and squeezing every last bit of effort from staff who only want to do good.”

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