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What is in a name?
What is in a name? A. M. Woodruff
This speech Emergency I2 November
Professor Ann M Woodruff RN, RM, BA(Hons), DipEd, Med, Professor and Head Department of Nursing, Victoria University, PO Box 14428, MMC, Melbourne, Victoria 3000, Australia AccidentondEmergency Nuning(l995)
was delivered at the Nurses’ Dinner, Melbourne, 1993.
While in the US, I was a visiting fellow at the School of Nursing at the University of Connecticut. When I was introduced to the members of my first class, I was asked what model of nursing had been used at my ‘baccalaureate school’, and what was my nursing specialty? It had never occurred to me that one had a specialty in the 195Os, so I replied that it was ‘casualty’ which was equally confusing to them. Eventually I learned that it was ‘Accident and Emergency’, and now I know that is just ‘Emergency’. I am now coming to the end of my working life. Survival of nurses has been, and continues to be my concern - not nursing, but nurses. After having to name a specialty, I realised that it was in ‘casualty’ that I first came to know what nursing was all about. It was from there that I left nursing - ceased to be a nurse - for 10 years. However, in retrospect, it was also because of what I learned in casualty that I returned to nursing. Far be it from me to suggest that you revert to the name ‘casualty’ - but I do want to tell you why I prefer that name. Briefly, casualty is defined as a noun meaning ‘one injured accidentally’. Emergency as a noun means ‘a sudden and urgent occasion for action’. A casualty is a person, an emergency is a thing - an occasion for action. Nursing is about people - a casualty is a person - and casualty of my day was where I first began to suspect that people were not just patients. This was where I first came to recognise that people had a before - and an after-illness life. Of course I knew that intellectually, but it was casualty, with people in their everyday clothes, ill or injured, that made people whole to me. They had set out as ordinary people, never dreaming that they would be patients, and suddenly here they were, in pain, afraid, having taken a reverse ‘J’ curve. I remembered that my mother had always warned me to darn my socks, mend my 3.42-44
0 Pearson Proiesslonal Ltd 1995
underclothes, sew up the hem instead of putting a safety pin in it. ‘You might have an accident!’ And now here was I, one of those censorious people who would think me a tramp with a safety pin in her hem or holding up her pants, and I didn’t think that at all! It just made them real, people with a past and future like me. People whom life had suddenly overtaken - a ‘casualty’ - a person who had been ‘injured (or had become ill) accidentally’, not just ‘patients. Nursing is a mixture of skills and knowledge and attitudes. They do need for me to know how to catheterise them, but they also need me to know how to empathise with them. And casualty was where I came to appreciate ‘characters’, where I learned to suspect that perhaps people could live lives as they wanted, not as I thought they should, and still make some sense of it all. In preparation for this ‘Age of the New Morality’, it was where I really got the true message, which I had had instilled from childhood but had never really known in the true sense, of hating the sin but loving the sinner. It was also where I first found the beginnings of the courage to laugh at myself, and it was where I decided that nursing was hobbling me in some way It was from casualty that I left nursing for 10 years, and came back to it because it would be a convenient way to make a living while I studied. I thought I found that nursing had changed, but it had not changed as much as I had. I was given the option to go back to casualty but I didn’t find the same satisfaction that I had in the past. For the older me it was now emergency occasions for actions, and not so much casualty - frightened people. I found that I wanted to know how their stories ended. In her book On Nursing (1982), Margretta Styles quoted a Pittsburgh steel worker: Picasso can point to a painting, a writer can point to a book. What can I point to? Everyone should have something to point to. I found that casualty no longer gave me enough to point to. I could still point to my skills and my knowledge, but my empathy - my attitude - made me want to accompany these people to their destination, to be able to point to an outcome of nursing’s caring. So I went to a medical ward, and found that the caring of nursing could not be fully demonstrated in the hospitals of the 1970s. How should I try to change this? I opted for education of people who would be nurses, to try to develop in them the ability to recognise, to value and to constantly strive to improve their contribution to the care of people. Let me illustrate some of those lessons I began to learn in the casualty of the 1950s.
Accident
First, the clothes. Tom King of ‘nail and plate’ fame happened to be in casualty one day when a man was brought in with a particularly messy impacted fracture of the femur. The registrar seized the opportunity to get an expert opinion. Tom pulled back the blanket, and immediately launched into one of his lessons in morality. ‘Beware of the NUP’. Never trust a man who wears No Under Pants! People who were unique individuals, sinners, I had to love. Phillip Billings and the flowers and chocolates which he stole and brought to us when he wanted a bed for the night, and which we returned to the shops whence they had come. Gunner Kelly and his saddle-bridge nose and his public school blazer which he never ‘lost’ though he persistently had to be supplied with pants. Duncan McKay who had 6 toes on each of his already large feet and who was constantly losing shoes. Duncan told us that he wanted to die by the sea, and one day the ambulance people told us he had been found dead by Point Ormond on Point Philip Bay. Many more successful people cannot claim that - to have achieved their goal for the end of their lives. There was Katie Lofts of the fading red hair and the moth eaten fur coat. Katie proudly told us that she at last had a proper room which she shared with a fellow wanderer. He had a steady income playing the piano in a Fitzroy wine saloon. Katie gave me my first lesson in reciprocal compassion. On a particularly busy casualty night of pension day, Katie was wheeled in, in a very delicate condition and with a very sore head. We had had a woman in casualty all day who had just lost her baby through a trivial domestic accident. The mother was totally deranged, and had kept up a constant wail for her baby: ‘My baby, my baby, I want my baby’. Our early compassion had become sorely taxed, and we were feeling guilt stricken about our growing irritation. However, Katie knew that life dealt everyone a lousy hand at times, and that eventually everyone had to cope with it on their own. At the top of her very loud voice she shouted ‘Oh, bugger your baby, I’ve got worries of me own!’ That has become our stock response to anyone telling a sad tale. Casualty gave me an ability to laugh at myself. One hectic Saturday night I had a call from the front desk. A taxi driver had a man on board whom he was anxious to be rid of, and there was no orderly free to assist. I took a wheelchair and, with the grudging help of the driver, hauled the man across the dimly lit back seat of the taxi and dragged him into the chair. Holding him in place by the rough and ready method of grasping the back of his shirt collar, I steered him around to the back-of-casualty desk. I asked the resident if she could free a particular cubicle for me to put him in. Her
and Emergency
Nursing
43
horrified gaze at last caused me to look at his face. He was as dead as a dodo! While she was commencing a fruitless open-heart massage (that was the only way, then) I (irrationally convinced that I had strangled him) decided that the least I could do was to try to salvage his soul. This was a religious hospital, and if the person was a Catholic or if his religion was not known we called a priest for the last rites. But it had to be either of those options and we had to make every endeavour to find out what, if any, religion the person owned. Racing to the casualty desk I found that a friend had arrived. Without any preliminaries, I excitedly asked the friend ‘What is your friend’s religion? ‘The poor man immediately wailed ‘He Finnish’. People in those days often confused nationality with religion, so I doubled back down the corridor and asked the first person I saw - the Malaysian registrar - ‘What religion are the Finns? ‘The poor registrar, confronted by this demented nurse, admitted that he didn’t know but suggested that the friend may have suspected that the man was dead-finished! It caused me to examine some things in a new light. The woman dying of gas gangrene following a backyard abortion, receiving the last rites and punctuating the solemn words of the priest with ‘Oh me bum, me bum’s hurting! ‘It caused me to ponder the efficacy of our poor and inadequate attempts to alleviate humanity’s total experience of suffering. It was a harder life - cut-downs, glass cannulae and rubber tubing, duck ponds, ATS instead of toxoid, open heart massage, no triage and no critical care units. But we had some advantages. When people were dead they were dead. No apical beat - no respirations. We were spared many of today’s ethical dilemmas. Sister Patrice was the nun in casualty in my early days. She had bilateral ptosis which gave her an oddly imperious gaze. She was the only one who could rouse Stanley Doran from his catatonic state, when brought in after apparently dying in front of a rookie policeman. ‘STANLEY DORAN-GET UP!’ gave all present some hint of how the onlookers must have felt when Jesus raised the daughter ofJairus. There were the ‘regulars’ - and, in an odd way, we all shared a kind of kinship. We, together, made casualty a ‘place’. A place which cared for those who were ‘irregulars’, for whom there was no connection with this strange place. At one of our annual hospital concerts there was an item which demonstrated our love/hate relationship with our ‘derelicts’. It told, in a humorous way, of our grudging admiration for the triumph of the human spirit. It was sung to the tune of ‘The Legion of the Lost’. M&A was Mist Morph. and aspirin, HDA was Haust Dom Alb. - the White House
44
Accident
and Emergency
Nursing
Mixture - an extemporaneous evil mixture of aluminium hydroxide, paraldehyde, linctus physeptone, vitamin B, and anything else which came to hand. ‘Patsy’ was the afore-mentioned Sister Patrice. Down the alleys of Fitzroy we come Staggering blindly along Each with his bottle of finest rum Singing a dare-devil song
Lurching down the lanes with our thirsts slaking Lurching into Cas with our heads aching Collapsing on a bunk with the ‘flu faking Rum, rum, the curse of every one So M & Am HDA, still we come To Patsy’s gay dispensary Paraldehyde and APC!
We think a Patsy, mingled with despair We think of Patsy, in her waiting lair St Vincent’s derelicts they call us St Vincent’s derelicts are we Drunkards all, and gay lads Forever we’re on the spree
REFERENCE Styles M 1982 On nursing: Mosby, St Louis
toward
a new endowment.
This speech Emergency I2 November
Professor Ann M Woodruff RN, RM, BA(Hons), DipEd, Med, Professor and Head Department of Nursing, Victoria University, PO Box 14428, MMC, Melbourne, Victoria 3000, Australia AccidentondEmergency Nuning(l995)
was delivered at the Nurses’ Dinner, Melbourne, 1993.
While in the US, I was a visiting fellow at the School of Nursing at the University of Connecticut. When I was introduced to the members of my first class, I was asked what model of nursing had been used at my ‘baccalaureate school’, and what was my nursing specialty? It had never occurred to me that one had a specialty in the 195Os, so I replied that it was ‘casualty’ which was equally confusing to them. Eventually I learned that it was ‘Accident and Emergency’, and now I know that is just ‘Emergency’. I am now coming to the end of my working life. Survival of nurses has been, and continues to be my concern - not nursing, but nurses. After having to name a specialty, I realised that it was in ‘casualty’ that I first came to know what nursing was all about. It was from there that I left nursing - ceased to be a nurse - for 10 years. However, in retrospect, it was also because of what I learned in casualty that I returned to nursing. Far be it from me to suggest that you revert to the name ‘casualty’ - but I do want to tell you why I prefer that name. Briefly, casualty is defined as a noun meaning ‘one injured accidentally’. Emergency as a noun means ‘a sudden and urgent occasion for action’. A casualty is a person, an emergency is a thing - an occasion for action. Nursing is about people - a casualty is a person - and casualty of my day was where I first began to suspect that people were not just patients. This was where I first came to recognise that people had a before - and an after-illness life. Of course I knew that intellectually, but it was casualty, with people in their everyday clothes, ill or injured, that made people whole to me. They had set out as ordinary people, never dreaming that they would be patients, and suddenly here they were, in pain, afraid, having taken a reverse ‘J’ curve. I remembered that my mother had always warned me to darn my socks, mend my 3.42-44
0 Pearson Proiesslonal Ltd 1995
underclothes, sew up the hem instead of putting a safety pin in it. ‘You might have an accident!’ And now here was I, one of those censorious people who would think me a tramp with a safety pin in her hem or holding up her pants, and I didn’t think that at all! It just made them real, people with a past and future like me. People whom life had suddenly overtaken - a ‘casualty’ - a person who had been ‘injured (or had become ill) accidentally’, not just ‘patients. Nursing is a mixture of skills and knowledge and attitudes. They do need for me to know how to catheterise them, but they also need me to know how to empathise with them. And casualty was where I came to appreciate ‘characters’, where I learned to suspect that perhaps people could live lives as they wanted, not as I thought they should, and still make some sense of it all. In preparation for this ‘Age of the New Morality’, it was where I really got the true message, which I had had instilled from childhood but had never really known in the true sense, of hating the sin but loving the sinner. It was also where I first found the beginnings of the courage to laugh at myself, and it was where I decided that nursing was hobbling me in some way It was from casualty that I left nursing for 10 years, and came back to it because it would be a convenient way to make a living while I studied. I thought I found that nursing had changed, but it had not changed as much as I had. I was given the option to go back to casualty but I didn’t find the same satisfaction that I had in the past. For the older me it was now emergency occasions for actions, and not so much casualty - frightened people. I found that I wanted to know how their stories ended. In her book On Nursing (1982), Margretta Styles quoted a Pittsburgh steel worker: Picasso can point to a painting, a writer can point to a book. What can I point to? Everyone should have something to point to. I found that casualty no longer gave me enough to point to. I could still point to my skills and my knowledge, but my empathy - my attitude - made me want to accompany these people to their destination, to be able to point to an outcome of nursing’s caring. So I went to a medical ward, and found that the caring of nursing could not be fully demonstrated in the hospitals of the 1970s. How should I try to change this? I opted for education of people who would be nurses, to try to develop in them the ability to recognise, to value and to constantly strive to improve their contribution to the care of people. Let me illustrate some of those lessons I began to learn in the casualty of the 1950s.
Accident
First, the clothes. Tom King of ‘nail and plate’ fame happened to be in casualty one day when a man was brought in with a particularly messy impacted fracture of the femur. The registrar seized the opportunity to get an expert opinion. Tom pulled back the blanket, and immediately launched into one of his lessons in morality. ‘Beware of the NUP’. Never trust a man who wears No Under Pants! People who were unique individuals, sinners, I had to love. Phillip Billings and the flowers and chocolates which he stole and brought to us when he wanted a bed for the night, and which we returned to the shops whence they had come. Gunner Kelly and his saddle-bridge nose and his public school blazer which he never ‘lost’ though he persistently had to be supplied with pants. Duncan McKay who had 6 toes on each of his already large feet and who was constantly losing shoes. Duncan told us that he wanted to die by the sea, and one day the ambulance people told us he had been found dead by Point Ormond on Point Philip Bay. Many more successful people cannot claim that - to have achieved their goal for the end of their lives. There was Katie Lofts of the fading red hair and the moth eaten fur coat. Katie proudly told us that she at last had a proper room which she shared with a fellow wanderer. He had a steady income playing the piano in a Fitzroy wine saloon. Katie gave me my first lesson in reciprocal compassion. On a particularly busy casualty night of pension day, Katie was wheeled in, in a very delicate condition and with a very sore head. We had had a woman in casualty all day who had just lost her baby through a trivial domestic accident. The mother was totally deranged, and had kept up a constant wail for her baby: ‘My baby, my baby, I want my baby’. Our early compassion had become sorely taxed, and we were feeling guilt stricken about our growing irritation. However, Katie knew that life dealt everyone a lousy hand at times, and that eventually everyone had to cope with it on their own. At the top of her very loud voice she shouted ‘Oh, bugger your baby, I’ve got worries of me own!’ That has become our stock response to anyone telling a sad tale. Casualty gave me an ability to laugh at myself. One hectic Saturday night I had a call from the front desk. A taxi driver had a man on board whom he was anxious to be rid of, and there was no orderly free to assist. I took a wheelchair and, with the grudging help of the driver, hauled the man across the dimly lit back seat of the taxi and dragged him into the chair. Holding him in place by the rough and ready method of grasping the back of his shirt collar, I steered him around to the back-of-casualty desk. I asked the resident if she could free a particular cubicle for me to put him in. Her
and Emergency
Nursing
43
horrified gaze at last caused me to look at his face. He was as dead as a dodo! While she was commencing a fruitless open-heart massage (that was the only way, then) I (irrationally convinced that I had strangled him) decided that the least I could do was to try to salvage his soul. This was a religious hospital, and if the person was a Catholic or if his religion was not known we called a priest for the last rites. But it had to be either of those options and we had to make every endeavour to find out what, if any, religion the person owned. Racing to the casualty desk I found that a friend had arrived. Without any preliminaries, I excitedly asked the friend ‘What is your friend’s religion? ‘The poor man immediately wailed ‘He Finnish’. People in those days often confused nationality with religion, so I doubled back down the corridor and asked the first person I saw - the Malaysian registrar - ‘What religion are the Finns? ‘The poor registrar, confronted by this demented nurse, admitted that he didn’t know but suggested that the friend may have suspected that the man was dead-finished! It caused me to examine some things in a new light. The woman dying of gas gangrene following a backyard abortion, receiving the last rites and punctuating the solemn words of the priest with ‘Oh me bum, me bum’s hurting! ‘It caused me to ponder the efficacy of our poor and inadequate attempts to alleviate humanity’s total experience of suffering. It was a harder life - cut-downs, glass cannulae and rubber tubing, duck ponds, ATS instead of toxoid, open heart massage, no triage and no critical care units. But we had some advantages. When people were dead they were dead. No apical beat - no respirations. We were spared many of today’s ethical dilemmas. Sister Patrice was the nun in casualty in my early days. She had bilateral ptosis which gave her an oddly imperious gaze. She was the only one who could rouse Stanley Doran from his catatonic state, when brought in after apparently dying in front of a rookie policeman. ‘STANLEY DORAN-GET UP!’ gave all present some hint of how the onlookers must have felt when Jesus raised the daughter ofJairus. There were the ‘regulars’ - and, in an odd way, we all shared a kind of kinship. We, together, made casualty a ‘place’. A place which cared for those who were ‘irregulars’, for whom there was no connection with this strange place. At one of our annual hospital concerts there was an item which demonstrated our love/hate relationship with our ‘derelicts’. It told, in a humorous way, of our grudging admiration for the triumph of the human spirit. It was sung to the tune of ‘The Legion of the Lost’. M&A was Mist Morph. and aspirin, HDA was Haust Dom Alb. - the White House
44
Accident
and Emergency
Nursing
Mixture - an extemporaneous evil mixture of aluminium hydroxide, paraldehyde, linctus physeptone, vitamin B, and anything else which came to hand. ‘Patsy’ was the afore-mentioned Sister Patrice. Down the alleys of Fitzroy we come Staggering blindly along Each with his bottle of finest rum Singing a dare-devil song
Lurching down the lanes with our thirsts slaking Lurching into Cas with our heads aching Collapsing on a bunk with the ‘flu faking Rum, rum, the curse of every one So M & Am HDA, still we come To Patsy’s gay dispensary Paraldehyde and APC!
We think a Patsy, mingled with despair We think of Patsy, in her waiting lair St Vincent’s derelicts they call us St Vincent’s derelicts are we Drunkards all, and gay lads Forever we’re on the spree
REFERENCE Styles M 1982 On nursing: Mosby, St Louis
toward
a new endowment.