The Language of Kindness: A Nurse's Story

by Christie Watson

Nurses make good poker players, understanding the importance of not breathing in; of breath-holding so subtly that the patient does not realize, and does not see any expression other than a matter-of-fact one.

The horror of our bodies—our humanity, our flesh and blood—is something nurses must bear, lest the patient think too deeply, remember the lack of dignity that makes us all vulnerable. It is our vulnerability that unites us. Promoting dignity in the face of illness is one of the best gifts a nurse can give. I am reminded of the very beginning of the Nursing & Midwifery Code of Professional Conduct, clause 1.1: nurses must “treat patients with kindness, respect and compassion.”

The United Nations Universal Declaration of Human Rights states that “all human beings are born free and equal in dignity and rights.” Loss of respect for fellow human beings, and the removal of dignity, has in the past led to the dehumanization at the heart of genocide.

And when a person’s muscles don’t work, due to illness, medication or wastage, the nurse must act as the muscles for them, risking her own musculoskeletal system in small actions that are repeated often:

I can’t even imagine how you must feel. And I’ll do anything I can to make it even a fraction better. Take each hour with you. Each second.” I stroke his hair as I speak. “I am with you. Right here, all through the night.” It is not enough, but it’s all I have.

“There can be no doubt that all our knowledge begins with experience.”

as with most nursing, I always judge skill based on who I would want to look after my family members.

Nurses become expert at predicting who will deteriorate, based not on their numbers, but on the instincts of the nurse in charge. A strange kind of telepathy.

Working on pediatric intensive care gives a lifetime of perspective. A difficult day means that a child dies, and those caring for that child are left wondering if they could have done something differently, if they missed something—or, worse, if there was anything they did to contribute to the child’s death.

although nurses never admit it or get treated for it—cause post-traumatic stress disorder in the carers. Nurses and doctors, like patients, do not always cope, but instead simply survive.

Some recent research highlights that nurses are particularly vulnerable to moral distress. In a strange way I am glad. It is when you no longer feel pain that you suffer the worst injuries.

A bad day in PICU is looking at numbers from blood results and knowing they are incompatible with life; and a mother asking you if you would turn off the life-support machine if it was your child.

A bad day is knowing that the toddler who choked on a piece of meat at their nursery and suffered a cardiac arrest is stable now, but because their brain was starved of oxygen, it will swell over the next twenty-four to forty-eight hours and they will almost certainly be severely brain-damaged forever, unable to walk again, or talk, or smile.

A bad day is caring for a child with epidermolysis builosa, whose skin is so fragile that despite wrapping clingfilm over it, to put on a cardboard thermometer, some of the skin falls away when you touch them, no matter how gently. A layer of the child lost. A layer of the nurse lost.

A hard day at the office is cuddling a baby as he is dying, and who is alone because his new foster carer can’t leave the other children, and whose birth mum’s whereabouts are unknown. Stroking his head as he takes his last breath on your ...

For a long time after my ex and I split, I cry until my lungs can’t take in enough air, my brain is fog, my skin peels off, even my bones hurt. It is my heart that is most broken. Constant chest pain, then flickering beats in my neck, numbness. My digestive system—the bowels were understood in ancient-Hebrew texts to be the seat of emotion: grief, joy and pain—leaves me feeling completely and continuously sick; I can’t eat or taste or smell food.

Like the parents of a child who are contesting the doctors and nurses, in their decision to remove life support, she would rather we were alive and suffering, for the suffering of us dying is a far worse outcome for her.

Nursing becomes my life support. One of the greatest gifts that nursing has given me, aside from wonderful colleagues, and structure and job security, is the daily reminder that there is always someone worse off than you. A terrible and good gift.

I think about death all the time. Am surrounded by it. And don’t understand why awful things happen to good people.

nurses must “take all reasonable steps to protect people who are vulnerable or at risk from harm, neglect or abuse.”

This lack of understanding or care for nurses who are experiencing trauma is not new. After both world wars, plenty of soldiers were treated for shell shock—that is, post-traumatic stress disorder. But nurses working in the war zones were not. Research about the mental-health impact of war has always been about the men, despite hundreds of women working as nurses, next to the soldiers. In their diaries and letters these nurses describe their time in no-man’s-land, suffering broken bones, amputations and gas attacks, as well as caring for soldiers with bits of their bodies blown off; the things they saw close up, the things they smelled and touched. Shell shock was never attributed to these women, and they were never diagnosed or offered treatment.

We are taught, via the media, to be afraid of strangers. That strangers hurt and abuse children. My nursing has taught me something else: it is families who abuse their children, who kill them. Parents. Caregivers. Relatives. The people we should trust the most.

Adoption is much like nursing: having the capacity to love a stranger.

Each wave breaking against the cliff would believe it was dying for the good of the sea; it would never occur to it that, like thousands of waves before and after, it had only been brought into being by the wind.

I learn then that nursing is not so much about tasks, but about how in every detail a nurse can provide comfort to a patient and a family. It is a privilege to witness people at the frailest, most significant and most extreme moments of life, and to have the capacity to love complete strangers. Nursing, like poetry, is the place where metaphorical and literal meanings cross borders.

Nursing is—or should be—an indiscriminate act of caring, compassion and empathy. It should be a reminder of our capacity to love one another. If the way we treat our most vulnerable is a measure of our society, then the act of nursing itself is a measure of our humanity. Yet it is the most undervalued of all the professions.

The words “natural death” are bandied around hospitals as if it’s a pleasant thing to die naturally. But it is not. A natural death from cancer looks unnatural, horrific. People begin to go off, smell, rot, their veins bloated and twisted, and they sweat until they leak fluid, like cheese left in the sun after a picnic. A natural death can be the cruelest torture, and palliative radiotherapy, although also torturous, is sometimes a kinder cruelty.

We do not need war and tragic road accidents to remind us of the horror of life. We have cancer.

“Love is the only thing that matters. I’m talking about you and me, here: the love that you share with your wife, or husband, or lover, and your son and daughter, and then—perhaps the most precious love of all—with your grandchild. I’m talking about a love so deep you’d give up your life to defend it. A love so high you can glimpse heaven, enough to believe in it. Maybe some of you have seen it already. Maybe some of you are as lucky as I am. That’s all I have to say. Fall in love. That’s the only thing that matters, in the end. Love each other.”

The true measure of any society can be found in how it treats its most vulnerable members.

Nursing is simpler than I thought. It doesn’t really need theorizing. Nursing is helping someone who needs help.

“Older people should be properly valued and listened to, and treated with compassion, dignity and respect at all times.”

It is hard to be kind when you are undervalued by society, by your employers and by the media. It is hard to always be kind when you are exhausted and working continually in an unsafe environment.

In one study up to 85 percent of emergency-room nurses were suffering from compassion fatigue. This is different from burnout, which is a long, slow process and is shown to be a kind of depression. Compassion fatigue is common when caring for people who have suffered trauma. The nurse repeatedly swallows a fragment of the trauma—like a nurse who is looking after an infectious patient, putting herself at risk of infection. Caring for negative emotions puts her at risk of feeling them, too. And taking in even a small part of tragedy and grief, and loneliness and sadness, on a daily basis over a career is dangerous and it is exhausting.

Another nurse has repeated cystitis and has been told it was because she didn’t go to the toilet when she needed to. There are times when you literally don’t have time to go to the toilet; days when you purposefully don’t drink water, as you know you won’t have time.

I buzz and wait until the receptionist lets me in with a bright voice. I walk along the spotless corridor, past the patients’ relatives, mostly Middle Eastern men wearing designer trousers and sliders. Of course many patients choose to stay at home, often being cared for by Western nurses and doctors in the Middle East. Plenty of nurses have worked in places like Saudi Arabia, spending a year or two making money there, to clear debt or save for a small deposit for a flat back home. You can earn better money, most of which is tax-free, and live in a place where you have minimal costs. I could never do it. On returning, a friend told me, “As a female nurse, you get ignored by the men, disrespected and not listened to. Sometimes spat on. It’s a complicated business, gender and culture in other parts of the world. You learn a lot, and not all of it good.”

As Florence Nightingale observed: “If a patient is cold, if a patient is feverish, if a patient is faint, if he is sick after taking food, if he has a bed-sore, it is generally the fault not of the disease, but of the nursing.”

There must be another life, here and now…This is too short, too broken. We know nothing, even about ourselves.

“One of the key aspects of a nurse–client relationship, as opposed to a social relationship, is that it is temporary,” Peplau said.

To give that much of oneself is dangerous. Grief can only be swallowed so many times before it damages.

Good nurses, though, will risk the danger and hurt in order to help.

The NMC Code of Professional Conduct states: 20.6 Stay objective and have clear professional boundaries at all times with people in your care (including those who have been in your care in the past), their families and carers. But there is no objectivity in good nursing care. Jo was a brilliant nurse. She understood that to nurse is to love. Even after death.

Nurses spend a long time with dying patients—those between worlds, between words—and with those recently dead, when they are not yet mortuary-dead and their lungs still contain air, the room still holds the smell of their nightdress and the sound of their voice. Particles of them float; dust in the light.

I reach my arm across her and hug her gently. “It’s okay to cry. Good, actually. It shows the family you really care.” I will my own tears to come, but they are too deeply buried inside me. “Cry,” I tell my dry eyes. “Cry!”

Like many of my colleagues, I always talk to dead people. It makes them somehow less dead, allowing nurses to perform the things they have to do without breaking down in grief, or feeling their own mortality biting the air. Talking to dead people keeps them alive. There is an atmosphere in the room after a person has died, which you can sense if you have felt it before, like an argument—something hanging in the air.

The best nurses treat each and every patient as if they are a relative or loved one. And caring for dying patients is the most creative aspect of nursing.

Nurses have to honor the spirituality of their patients, however it is expressed, sometimes forcibly suppressing their own beliefs.

Caring for the person is, and should be, increasingly holistic, but occasionally caring for the person’s mind means that their body will die.

Don’t ever underestimate the capacity of a human being who is determined to do something.

There is a theoretical risk that if someone is touching the patient, or even a bag of fluid attached to them, when the shock is delivered, they could end up in cardiac arrest.