Nina Gaby

Essays, art, and healthcare


For National Nurses Week, 2018: “On Legacy and Ego Integrity vs. Despair”


(2015 submission rejected by the American Journal of Nursing)


  1. Nursing school

It was May, 2015. I’d been trying to percolate some sort of blog entry that would bring my author’s platform up to date and also commemorate National Nurses Week, Mothers Day, and my upcoming 65th birthday. Is there a quatrofecta that lets me write a four for one?


In an essay a couple years ago, published in I Wasn’t Always Strong Like This: True Stories of Becoming a Nurse, I write about when I said goodbye to the relative freedoms of an artistic life and became a nurse: “At 34, I was the third oldest person in my Bachelor’s program, several of us ‘non-traditionals’ in a group of otherwise very bright and age appropriate young women. I was the wildest, with the most energy, and I looked nothing like a nursing student, whatever they were supposed to look like.

She’s an artist,” people would whisper. “She’s old.”1


My new friend Fran was ten days older.


We met the first day of nursing school in 1984. We were both the same age, with careers, entering nursing in our thirties as a means of achieving goals we otherwise might not. We were both interested in a myriad of health and social issues. Fran was to focus on patient education, and I switched gears from wanting to be a nurse midwife to settling on psychiatry and eventually becoming a specialist in addictions and a psychiatric nurse practitioner.  That very first day Fran told me Florence Nightingale wrote about nursing as an art.


Along the way I had a baby and Fran moved to Arizona.  Then I moved to Vermont.


We established a ritual to keep us connected. Every May, between our birthdays, we would exchange “Flo.” Flo is a little plastic nurse doll we named after Florence Nightingale,  the cake topper my mother put on our graduation cake in 1986. I made a special foam-lined box, “the official Flo transport system,”so she could travel safely between Arizona and Vermont.  This year, I would be getting her around Mothers’ Day. I miss my mother, and the ritual, of which I have very few, helps me feel connected to the best parts of her as well as to my friend.


2. Legacy

Fran planned. She had a year planner, a five year planner. I was lucky if I could plan the next five minutes. She gets to retire this year at age 65. I made impulsive life changes along the way; I will never be able to afford to retire.  Fran wins awards.

In the morning, when I called to congratulate her on her three newest awards, she tried to brush them off but I wouldn’t let her get away with it. “You got a freakin’ legacyaward,” I insisted. At our age the word legacy is fraught with meaning.

We overdosed on Erik Erikson in nursing school, feverishly memorizing his Stages of Psychosocial Development along with Maslow’s Hierarchy of Needs for exams. But who thought it would ever be us we were talking about?

 So here we are, leaving Generativity vs. Stagnation, the stage of middle adulthood, for our last phase: Ego integrity vs. Despair. Late adulthood. Age 65 through death.2


We are those people now wondering what our legacy will be.  At least I am. Fran got an award to define it.

What I didn’t tell her on the phone was that when I read the news of her awards I had been sitting at my desk for twelve hours trying to master a new electronic medical record system. Everyone else in the clinic had gone home. I put my exhausted head in my hands and sobbed.  No one’s going to give me a legacy award for spending my life feeding a hospital computer system, I cried. I can admit stuff like this now, old enough to know it is a universal thing, this is jealousy and despair. This is human messiness, and we nurses know about all that.


3. Mothers Day

What she did remind me was that I had had a child. She did not have, nor were having children ever in her plan. She reminded me that I was not factoring in the 25 years of pregnancy, bed rest, postpartum depression, motherhood. Would I have gotten a doctorate if I’d not had my daughter? Probably not. Written more essays? Made more money? Would my legacy feel any different? No. I’m a direct-care clinician, on the front lines. I help people. And now my daughter, in graduate school to become an end-of–life specialist will as well, help people. I am proud of her, I am proud of my friend. And yes, I am grieving my youth and worrying about the continued integrity of my ego. I will probably sob again before the month is over.

My Mothers Day card reads:

 “No one is useless in the world who lightens the burden for another.”

Charles Dickens3

1  Gaby, N. (2013). Careening Towards Reunion. In Lee Gutkind (Ed), I Wasn’t Strong Like This When I Started Out: True Stories of Becoming a Nurse   Pittsburgh, P.A. : In Fact Books.

2 “Erikson’s stages of psychosocial development” Wikipedia.

3Dickens, C. (originally published in 1865, 2013).  Dr. Marigold.  On line publisher at OverDrive: A Word To The Wise.


 Addendum 2018: Fran got yet another award for which I congratulated her on yesterday, and I’ve quit and started several jobs since the original writing of this, and have finally settled in a medical clinic as their psychiatric provider and feel as though I’ve come home. As I sent the box with Flo carefully tucked inside to Arizona, I told the story to the postman and started to cry. He had a similar story of his own.








How Lucky to Have a Friend that Reads

imageA main difference between me and my friend and colleague Char who died is this: the day she came in to clean out her office it took her two minutes and only a couple copy paper boxes. She dumped a pile of books on me, nursing education books from 1983 that she’d been carting around, and old DSM-maybe the Third Edition? And some outdated clinical diagnostic tools. “I don’t want those, don’t give them to me, you know I’ll keep them forever, they are heavy and I don’t want them!” She did anyway.

She also didn’t cry. She was leaving her office for the last time. The week before she had received “findings” after a trip to the doctor. “Findings” in our parlance as medical professionals means there is something really there, not just the “curbside” diagnoses we all give each other in the hallway. Mine, for Char, was “old lady gallbladder.” My prognosis, “they’ll suck it out of you and I’ll come over while you’re recuperating and we’ll read together and then you’ll come back to work and we’ll fight and gossip like always.”

Shortly after 5AM the morning after her doctor’s appointment she messaged me, knowing I’m always up, she knows my craziness well. “Call me,” it said. “NOW?” I messaged back. “In 10 minutes,” she said.

A very long 10 minutes later I called, she had “findings” that were more serious than just a rotten sac of sludge and the next thing we knew her office, next to mine, was empty.

As we had ended our conversation at 5:30 AM she said, “I don’t care. As long as I can read I don’t care.” Of course she said a lot of other things but the one thing I could do was get her plenty of books. I also promised to shepherd two handwoven vestments that were of vital importance but they found their eventual homes.

(My friend reads. How lucky I am, I think, to have a friend who reads. Reads stuff I like. Reads stuff I write. Only she is gone long before my own book will come out.)

I soon go about the business looking through my books. Can I give her David Rackoff’s essays? He died from cancer last year. He writes about his therapist dying of cancer. My friend is a therapist. Can I give her Jennifer Egan’s A Visit from the Goon Squad? David Shield’s collection The Inevitable? Victoria Zackheim’s Exit Laughing? Mary Roach’s Stiff? What about all the David Foster Wallace stuff? Didion? The Road? The Hours? another friend’s memoir of her husband’s ALS? My holocaust collection?

What’s wrong with me? No wonder I’m depressed. Look at my reading material. I find a Hello Kitty tote and decide on Rackoff, Egan, some other blackish stuff just too good to pass up and my friend is just too smart to suddenly not read good stuff. She would be offended if I suddenly showed up with a filter, treating her in good taste. Rainbows and unicorns. A journal for your journey. Savor every second.

The next day she shows me to her “visitors” chair in her bedroom. We are still not used to this. I am a little dressed up. I dump out the books, apologetically. “They are a little dark, of course. But brilliant.” “Of course,” she says. “Can I be irreverent?” “I guess so.” It would be a mistake to think that impending death is going to change my friend’s intellect or her humor. “So it’s OK that I won’t be bringing you journals with unicorns and rainbows.?” “I would hit you upside the head.” “Good.”

The last time we were out together, noodles and a movie in Hanover, NH on a perfect late fall day, she had a plastic sack of books she needed help moving from her car to mine. “Don’t give me any crappy books,” I warn. “I think they are just more of the ones you lent me.” The Rackoff is in there. The Egan. “I loved those,” she said. Then there’s a bunch of crap she slipped in that I don’t want and I keep my mouth shut. I put it in a pile on the stone fence of the parking lot after she slowly drives away.