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

collage 2

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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“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.