nursing

The Story of the Mystery Patient

~ Frank Hudson ~ 2 Comments

As I mentioned as January ended, this February has been challenging for me to keep up with this Project and it’s associated tasks. I still hope to have new pieces soon. In place of a new encounter and performance with a poem or other text, let me do one of those posts where I pretend this is a normal blog

I know nothing other than what I read in the news about the situation in Ukraine — and that news with Ukraine now is, in short, mostly about what is feared to be an imminent invasion. I’m sure this Internet is full of folks with takes and information and policy positions if you feel the need for that, but instead I’m going to tell you a little story from my youth.

Back in the 1970s I was working the overnight shift in an urban hospital’s Emergency Department. Overnight, those 11 PM to 7 AM shifts, are probably not good for one’s health or social life, but I rather liked them. Staffing is much lower, and there was in my day almost no administrative or support presence. No crowd of attending MDs looking for proper deference to their priorities, no administrators to set or enforce policy in between meetings. Therefore, hierarchies were radically flattened at night, and I got to see and participate in a lot of different medical things.

My ED then was staffed with myself, a registered nurse (RN), a clerk who typed in information to print up a chart and the handy labels that would be pasted on lab requests/samples, and a family practice resident*  Just down the hall from our suite of four treatment rooms was a door with a buzzer where anyone from the ambulance patients we’d expect after incoming radio calls, to those who’d called their doctor and clinic and were told to drive to the hospital for further evaluation that couldn’t wait until morning would appear. And then too, the walk in.**

I worked nearly 20 years in hospitals, most often in Emergency Rooms. This stock photo looks about the right vintage.

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On the night I remember, the buzzer rang and there was an older man at the door. He had apparently walked up alone, and I usually was the one who went to the door to see what was the matter. And that was the issue from the start: he was speaking some foreign language, and he seemed to have only a scattered understanding of English and almost no English words to reply with. He looked to be in his seventies, had no obvious injuries, no severe distress. He moved slowly, but was walking.

Our door had a big lit-up Emergency Room sign, we could only assume he’d come in for treatment, but for what? You might assume that any 1970s urban hospital would have multiple language interpreters on hand, but that was not the case in ours then. And frankly, we wouldn’t even know what interpreter to call because we couldn’t figure out what language the man was speaking. Some words sounded a bit like German to me, so we called up a nurse working that night who spoke some German to come down. The RN and I hooked our mystery man up to the cardiac monitor, and the resident MD did a quick exam to see if we could figure out why this man had come to us. I think I may have even done an EKG on him, with no obvious issues found.

We looked for an ID in his clothes once we’d put him in a hospital gown and on a stretcher. There was none.

The nurse who spoke some German arrived. She got to her first preliminary question, which might have been “What is your name?” “Or why are you here?” and the mystery man exploded. At least some of the reply was in German. And our volunteer nurse interpreter said his angry words were that Germans had killed his family. How much German did he know? Made no difference, he wasn’t going to answer questions when asked in German.

I next got a bright idea. One of that class of residents was a young doctor who had a great facility in European languages, speaking at least a half-a-dozen of them. He wasn’t on call, and it was 4 AM, but I thought we should call him in. Given the infamous hours that residents worked in those days (maybe still do) that was asking a substantial favor, but he agreed to come in early. I was busy with something when our multilingual resident MD arrived. At one point he thought maybe Russian, and tried that. Later, I heard that once again the mystery patient became angry. Our resident didn’t know the man’s native language, but he got back something that was similar to our German speaking nurse — Russian was not a welcome language to our mystery patient.

Our multilingual resident was a smart guy though. One of the old-guard attending doctors on the hospital’s staff was Ukrainian American and had written a book dealing with Ukrainian culture in Ukrainian, a copy of which was on the shelf in the hospital’s medical library. Our resident showed that book to our mystery patient he later told us, and there was a quick realization that that was his language. After the regular day got underway, the older Ukrainian American doctor found that the man was one of his patients who was somewhat confused and had wandered to the hospital thinking that his doctor might just be there in the middle of the night.

So, as I said at the start, I know nothing about Ukraine — but I do think of that man who appeared in the night at the door of my Emergency Department and demonstrated how little I knew of him and what his country had been through.

Long guns, a poetic example.

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What to bring forward for a musical piece today? How about this one about war and violence that combines a line or two of language expression from Afro-American singer Howlin’ Wolf with second generation Swedish immigrant Carl Sandburg’s poem about countries that pack those long guns. Player gadget below for some of you to play it, or you can use this highlighted link otherwise.

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*Family Practice was the improved modern evolution of the old school “General Practitioner,” and the program that our hospital had treated that generalism like any other specialist residency to give the doctors who went through it a great deal of practical experience in things they would encounter. Almost every one of the residents I worked with there and then were fine people, who would come in some degree of unsure in the Emergency Room and leave after three years as the kind of doctor that I would want for myself or my family. Doctors and regular medical educators ran that program, but experienced nurses were so important in that too. Each June brought in new residents who really needed the steady hand of nurses at night to guide them in practical medical logistics and solutions.

**There was an indoor hockey rink across the street that had a fairly full set of bookings that ran until midnight. Yes, we needed to keep a lot of suture kits in stock.

From Our Breasts, Frances Cornford’s “The Old Nurse”

~ Frank Hudson ~ 1 Comment

I’ve been planning on presenting this eerie ghost story by English poet Frances Cornford for awhile now, but I wanted to take care with the musical setting while working on our recently completed countdown of the most popular pieces here from this past winter.

Heidi Randen was interested in doing this as a guest reader, and it’s her voice you’ll get to hear today. She’s also the guest blogger for this piece, so before I say our customary few words about the music let me turn it over to Heidi.

 

From Our Breasts, Frances Cornford’s The Old Nurse

By Heidi Randen, guest writer for Parlando (and Frank’s wife)

Like the subject of this poem, I am an old nurse. When my husband shared these sad, sweet, ghostly, gothic verses, they resonated with my experience of nursing in the biological and professional sense. I breastfed our kid and have worked as a Registered Nurse in hospital and clinical settings with very old and very young people.

Frances Cornford wrote this poem in the 1920s when professional nursing was still a new concept.  Florence Nightingale pioneering nursing in the field during the Crimean War would have been about as far back in the collective memory as the Korean War is to us now.  Nightingale started the world’s first professional nursing school in London in 1860. This occupation would have been as relatively novel as computer programming or palliative care are today.  In an English village in the 1920s, an old nurse would most likely mean an old wet nurse or an old nursemaid.

Wet nursing is a humble and humbling profession:

Against my breast I felt a small and blunt-nosed head.

To breastfeed is to be reduced to a mammal, a one-person dairy operation.  To share your milk with an infant in need who is not your own is an extravagant act of human kindness, yet it carries great stigma. In my family’s American immigration story, relatives on my mother’s side repeat the line: Our family was so poor that your great-great grandmother had to work as a wet nurse in the Netherlands.

Breastfeeding is like still being a little pregnant.  Your body is not wholly your own, still providing shelter and sustenance for another.  This is also the case in professional nursing.  When I worked in the hospital, I would often forego sleep, meals and bathroom breaks if it was a particularly busy shift.  This self-sacrifice is why nursing is still considered a calling and is listed as the most trusted profession in the United States and the United Kingdom.

From Our Breasts 1080

The circle of life: the woman who breastfed me and who suffers from Alzheimer’s, being helped long by the person I breastfed, my kid who talks about going into nursing when they grow up.

 

In my experience talking with fellow nurses, neonatology, pediatrics, oncology and hospice are considered extra special callings.  It takes greater emotional mettle to get close to babies and children in pain, to help people with serious or life-limiting illness and their families.  Put any of those specialties together: neonatal hospice or pediatric oncology and you are exponentially special, perhaps super-human.

But nurses are very human.  We see things that are unbearably sad.  And there is nothing sadder than a dead baby.  It seems like the worst violation of the order of things.  But it is not.  To me, the worst thing in the world is when people are left alone in sadness and fear.  Like the woman in the poem, the nurses of the world—in all senses of the word—hear crying over the sound of storms, seek out those in distress and provide comfort.  The satisfaction of this experience is expressed tangibly by the poet:

And a sob-quivering body slowly growing calm
And toes like round cold buds that warmed inside my palm.

Like the subject of this poem, I too see dead people and they don’t frighten me. The longer you watch human beings move through all their stages, you see that the end of life has much in common with the beginning of life.  This became most apparent to me in the space of one day when I visited a friend in the hospital with a newborn and a friend dying in hospice.  The mystery of where that baby came from was the same as the mystery of where my friend was going.  To nurse is to help for a little while on another’s journey, then—like the old nurse at the end of the poem—to be alone again with this mystery after they leave.

The Old Nurse as published in Cornford's Autumn Midnight 1923

The page from Cornford’s “Autumn Midnight” collection where the poem was published in 1923. Woodcut by Gwen Raverat

Heidi didn’t mention this when she wrote this earlier this year, but of course now we are asking nurses and others to put their bodies on the line with our current Covid-19 crisis.

Here’s those few words on the music. My original starting idea was to use singing bowls as part of the arrangement, but I have only one available, and while I could manipulate the single pitch after recording, I wanted them to play intervals and triads and decided to go another route. I used some gongs and bell for the piece’s intro, but much of what sounds like the singing bowls is an electric guitar being sustained to feedback levels and then being fed through a modulated reverb. I also made use of one of my favorites, the Mellotron cello sound, because that instrument’s uncanny aural valley always sounds spookier than the real thing to me.

The player gadget to hear Heidi’s performance of Frances Cornford’s “The Old Nurse”  is below. If Cornford intrigues you, I’ve presented two of her poems with original music earlier this month.