Nina Gaby

Essays, art, and healthcare


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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

Cheery.

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.

 

 

 

 

 

 

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More than the Sum of its Parts

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Book collage in process

Composite/collage. Synchronicity in text and image, transparency, translucency, opacity. How do we make it work?

In order to write in any sort of intimate way about mental health and addiction, I essentially make a hybrid of characteristics of an individual, spanning time, place, gender, symptoms. The point is to paint an accurate image of what without focusing on the who, on the why without the where. For obvious reasons, this allows me to shine a light on an issue without breaking confidentiality, and allows me to honor without alarm. I want the reader to understand what goes on for people in this world of addiction and psychiatric disturbance, within that understanding we might see impact or at least volition for change.

It’s a dilemma. CNF (creative non-fiction writers) will often say, if you can’t tell the whole truth than don’t bother writing about it. Others will find it good enough just to blur the lines. Others use permission contracts and footnotes. At conferences I’ve listened carefully to experts such as Lee Gutkind and Susan William Silverman, Dinty Moore and Jacquelyn Mitchard. My work has been picked apart by editors and lawyers. I don’t have an answer except that there are narratives that need to be told and images that need to be made.

I collage 3-D memoir from mixed media and think about whether transparency can truly exist. I work in porcelain and encaustic as well as words, all radiant in their translucency. I think about politics and the opacity that crushes us. I am proud of these stories I write about people I have been honored to know.

Here is my latest, a Monthly Muse contest winner from New Millennium Writings, “The Sum of its Parts.”

https://newmillenniumwritings.org/nina-gaby-sum-of-its-parts-musepaper-2018/


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Action plan. Writing about health care.

photo-66For today can I just write a blog about writing a blog? Of course I can. I’m the boss of me. Except that I started writing another piece today, one I realize could be considered controversial and should only see the light of day under deep pseudonym in the AARP magazine backpages–so I feel less the mistress of my own freedom than any thinly veiled braggadocio might suggest. That piece, the one you will likely not read, is about the atrocities of getting old in the changing workplaces of an ageist society where you are unappreciated as a still fierce force to be reckoned with. Instead the piece reads more like a Human Resource reportable incident than a blog post and do we really want to go there? If you do, message me discreetly.

So anyway, in the spirit of positivity, let’s talk about a new project instead. This March I attended the annual conference “Writing, Publishing, and Social Media for Healthcare Professionals” at Harvard. I admit it was daunting to spend time with two hundred medical experts and hearing their pitches for what could easily become the next medical blockbuster. We met with agents, editors and publicists and attended three days of lectures on such topics as “How to Get Your Message Out in Today’s Changing Media Environment,” “Narrative Writing in Healing: The Power of Stories,” and “Publishing is Changing the Way Medicine is Practiced.” Participants left the conference all charged up with action plans and brand new twitter accounts. I left geared up to do…something. During the workshops I made a pretend pitch to write a patient-centered handbook, titled something like So How Was Your Week?, which would explain, in a conversational Anne Lamott-y tone, what to expect from your psychiatric encounter. I practiced and pitched it and got good marks for my delivery to a panel of a dozen agents and editors and the aforementioned two hundred others. No agents swarmed me for a book deal, nor did I really want one. My handbook just didn’t have the punch of, say, revolutionary non-pharmacological ways to beat the common headache forever or how one surgeon brings the dead back to life or the slam dunk memoir potential of impoverished illegal immigrant cures blindness (maybe I embellished a bit here) What I really want to do anyway is find ways of talking about how we feel about doing health care, how do our stories matter in the schema of Obama-care and litigation and insurance insanity? I’ll never be an Oliver Sacks or Atul Gawande, I’m just a worker on the front lines. But what if stories like mine and those of my colleagues could shine a light on the complexities of today’s health care and create better communication with patients, families, colleagues, legislators? What if we could promote health care by making our process more transparent? What if we found words to support each other during this process? Working on the front lines can be a lonely and misunderstood endeavor. Our stories have great potential to heal and I want to talk about ways to do this.

So in the positive spirit of staying close to home and writing what you know, starting in May I’ll be working with the marketing and communication team at my local hospital to do some interviews and write some blogs and connect with my colleagues and patients to do the same. Stay tuned. In the meantime here are several collections with beautiful narrative, moving examples of the genre.

Shades of Blue: Writers on Depression, Suicide, and Feeling Blue edited by Amy Ferris, Seal Press 2015.

Mothering Through the Darkness: Women Open Up About the Postpartum Experience, edited by Jessica Smock and Stephanie Sprenger, She Writes Press 2015.

Same Time next Week: True Stories of Working Through Mental Illness, edited by Lee Gutkind, InFact Books, 2015.

 

 

 

 

 


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Blogger Block? Me?

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Valid excuses abound for my lack of follow through to my commitment of blogging twice a week to develop a presence. A “platform” as the new vernacular insists. How hard could that be for someone with boundless opinions on everything and insatiable energy for anything to do with the written word?

Yes me. Caught in a wash of the ennui that has always made me pity others. Me, of the “just do it” mentality. Legions of exhausted wordsmiths, I humbly join you. Hands folded, the laptop keyboard about as inviting as the treadmill in the corner that I am also avoiding. I can get mildly energized by the metaphor of laptop and treadmill, thinking I’m on to something, but it passes. I go get a yogurt, throw laundry in the washer. I have prepped for writing, I remind myself. I spent yesterday, a work day from home, writing up a pile of overdue psychiatric evaluations for my day job, got some discharge notes done, took a nap, and yes I will admit this to you, caught up on the Young and the Restless. All that so I could write today.

Or at least try to untangle the loop-de-loop that my anthology project has become. An interested agent needs me to include in my proposal some writers of household name stature before a publisher will even look at it. Household name writers don’t write on spec so I need a publisher. Generous women willing to help, waiting for more info. I wait for the universe to toss me some secret tool to unravel the loop or at least get more of my pleading emails answered.

I list all the reasons I can’t write today, all the reasons I am planning to go to a matinee with a friend instead. Why I spent last weekend eating fried seafood along the coast of Maine instead. A double sabotage, nothing pokes a hole in the energy reserve like overly oxidized trans fats. Actually I am doing a lot of stupid things to avoid how I feel about some really bad things that are going on, things I should be writing about. Like that my cat had to have her leg amputated this week. Like that a friend has been given two to seven days to live. Another friend has relapsed. Another friend’s dog died. A family member has had a serious exacerbation of a chronic illness. I’m worried about my daughter. I can’t keep up with the need for my services at work, and Obama-care isn’t helping with that. I cannot write about what’s important in mental health care right now because the state that I live in has an even broader interpretation of confidentiality laws than the feds. I have a sore throat. Headache for weeks. Cataracts. My house is a mess. Where does the list end, where does it cease to be valid? At any rate, I have to share the yogurt with the cat, it’s the only thing she’ll eat. And then I’ll post this, knowing you will understand.


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The Most Horrible Person in the World Goes to a Writer’s Conference

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My coffee this morning is in the “Write Like a Motherfucker” mug that my friend that I’m jealous of got me from the last writer’s conference we went to, before this one. It was a gift and she gave me a gift because she did not know yet what a horrible person I am. I either write like a motherfucker or not at all. Because we are all going to die. But I am getting ahead of myself.

I will spend this morning writing for my blog that nobody reads. See where this is going?

I have been having a small, personal festival over the past week. A pity party we might call it at work. I work with addicts and we toss around phrases like that all the time. Usually I hate them, the phrases that is, I love the addicts. They are my tribe and I can help them with my expertise, my script pad, my humor, my success stories. I am at least competent there. I teach them Cognitive Behavioral Therapy, “CBT”. And like the Paul Simon song “Rewrite” or the Vivian Gornick book about situations and stories, just change your story line, man, and you’ll feel just fine. How’s that going for you, I ask myself. Not so hot, I answer, as the list of complaints against the self rolls merrily along.

“You self actualized too early,” a old boyfriend cited Maslow to me in 1975. He looked just like Woody Allen, I swear, which was pretty cool back then. “It’s a set up.” I didn’t know any better, and my first career as a clay artist came easy, every gallery I approached wanted my stuff, I sold every piece I made, they clamored for more, and I ended up with vases in the permanent collection of American Craft at the Smithsonian. Then I went to a hotshot university for a nursing degree, won awards, got a free Master’s Degree, great jobs doing good work, and as much as I complain now, “poor me I did 45 hours of work in three days…” well that means I get four days off to write! It’s not that I didn’t learn my craft (one morning I threw 500 one-handed bowls, Japanese style, on the potters wheel and would not let myself keep a single one, I suffered harshly through Organic chemistry and worse through Research methods) but at least I was in charge of where it was all going. Even my sobriety came easy. I just stopped drinking. Yeah the withdrawals could have been life-threatening, but I didn’t know it then. I even cold-turkeyed cigarettes after smoking a pack a day of Marlboros since the age of 13. I am a lucky girl. One might say determined. Yes, that too.

So I go to this writer’s conference in Mississippi. Where everyone is charming and I’m anxious because of the red/blue problems, I have preconceived ideas. I remember visiting my aunt in Nashville every summer. I am the daughter of a liberal Jewish very northeastern set of parents, my father a writer whose short story about southern graft got him on Alfred Hitchcock and then a screenplay bastardized into the cult classic Hot Rods to Hell. I remember my aunt and her friends, whenever they were ready to dish mercilessly about someone, would start with… “Well bless her precious little heart….”. At the conference I am very mad at myself for not writing an essay for the Creative Non Fiction contest “Southern Sin,” but then the winner of the contest reads his essay on Friday evening and I am very glad I didn’t even try. He was brilliant. During the conference the friend I am with, talented and young, finds out she won a teaching award. She has just gotten several pieces published. Everyone clamors for her memoir proposal. She reminds me of me, how must it have felt for my friends back when I was winning everything. But I don’t care. I am jealous. Then I get an e-mail that a piece that I’ve just submitted to Rumpus (the Write Like a Motherfucker people) has just been rejected and I can’t sleep. Then Facebook announces that my best friend from nursing school has just gotten an amazing thing (not at liberty to describe) AND she has just developed her own App for patient education. I have done none of those things. I hate myself and everybody else. I am not consoled by my own publication list. I am not consoled by the godfather of the genre of creative non fiction telling me I’m a great writer, the proof being that he selected my piece to go into one of his collections. I am not consoled by listening to the esteemed conference panel discuss the years they put into their success. One panelist reminds us to write because we are going to die. I’m going to die a whole lot sooner than the friend I am jealous of.

But I am buoyed by the charm and sweetness of the southern way, it’s like an immersion into CBT, just being nice, it feels good. And so I bounce along, my horribleness known only to me. Till now. One gentleman who I’d call pretty “red” talks about marbling, the red and the blue, we’re marbles. He literally embraces my conflicted northern self. I want to move down there, maybe I’d become a better person. But it’s muggy most of the year and my mascara and my masquerade would wear thin quickly.

So now you know. And this writing thing, well it is hard. I was set up, as the old boyfriend warned. But there’s no choice. So after a week of heavy partying (pity, that is) and too much TV, I’m still at it, bless my precious little heart.


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“May I never see in the patient anything but another creature in pain.” Oath of Maimonides 1135-1204: Trauma Informed Care and Compassion Fatigue, Is there a connection?

What is to give light must endure burning.”
Viktor Frankl 1905-1997

It is National Nurse’s Week and I am preparing a presentation for our nursing staff on the phenomenon of vicarious traumatization, the subject I tackled in my last blog and most recent essay “Don’t Touch the Mustard; Notes on Being in Lockdown With my Daughter.”

Vicarious trauma is a contagion, it is what happens to nurses and other caregivers who spend time helping others move through illness and crisis. We absorb the pain that surrounds us. Its sister, compassion fatigue, is the “debilitating weariness brought about by the repetitive, empathic responses to the pain and suffering of others” (LaRowe 2005) and “very much the landscape for today’s professional” (Showalter 2010).

My hypothesis for this presentation is this-If we look at trauma differently, will we respond differently? I am briefly commenting on this in honor of nurses everywhere who risk burnout, fatal weariness, and with concern for our healthcare system which suffers from the turnover that this fatigue costs all of us.

Trauma Informed Care

“A thorough understanding of the profound neurological, biological, psychological and social effects of trauma and violence on the individual” (Jennings 2004).

“Trauma is a disease of disconnection.”
Bessel van de Kolk Lecture, October 2011

Traditional treatment demands “compliance,” how would it be different to ask for “collaboration?” Would a change in a power differential actually ease the burden on the caregiver? Or is the potential for connection threatening? This is a question begging far more time and energy than is possible for this caregiver and blogger right now.

Can symptoms be looked at as adaptive rather than destructive? Normal responses to abnormal experiences?

For traumatized patients, all behaviors were directed towards survival. Over time they may have become “dysfunctional” with high incidence of substance abuse, psychiatric symptoms, and repetition compulsion. If we intervene with a clear understanding that these symptoms were lifesaving behaviors, we can respectfully help suggest alternatives. The same alternatives that might help any one of us.

Should we say- what happened to the patient rather than what is wrong with the patient? If we practice this with others, might it be easier to look at ourselves with more compassion?

Viktor Frankl also suggests that we honestly assess whether in the same situation might we do the same thing that we see our patients doing? This would go far in reducing the ‘us and them’ mentality that often gets in our way.

And then there is humor. Wish I had more time. Suffice to say it is the rare situation, with patient or colleague, that doesn’t get a whole lot better with humor. Or food. Another subject for another blog.

I need to get this on Powerpoint. In the spirit of collaboration, I will use more questions than answers. And bring lunch.