Wednesday, May 09, 2012

"The Nurse's Story" by Carol Gino

In honor of National Nurses Week, I am offering a review of "The Nurse's Story" by author Carol Gino. As with all book reviews on Digital Doorway, I have received no payment from either the author or the publisher in exchange for this blog post. I have only received a copy of the book from the author in order to facilitate the review process. 

In 1982, Carol Gino published "The Nurse's Story" to great critical acclaim. Praised by Kirkus Review, The LA Times, author Mario Puzo, The Denver Post, and a variety of critics, readers and publications, "The Nurse's Story" remains one of the seminal stories of nursing and nurse burnout ever published. 

In this fictionalized account of the beginnings of her own nursing career, Gino tells the story of Teri Daley, a nurse in the New York area who enters the profession with great enthusiasm and fervor, using self-righteous determination to fight against the disparities and inequities that she so clearly sees permeating the American health care system of that era.

As much as “The Nurse’s Story” tells the story of one nurse’s experience, it is a cautionary tale for all nurses, allowing the reader a glimpse into how a nurse can move from passion to burnout in the course of a few short years.

Faced with death, suffering and pain in patients ranging from the very young to the very old, Teri gives her all to fend off the inevitability of death, becomes overly involved in some patients’ lives, breaks the rules, and eventually suffers the consequences of her intense work, not to mention her own stretched professional boundaries.

Reading Ms. Gino’s book, I am reminded of the beginnings of my own nursing career, when I sometimes chose to continue to pay friendly visits to patients following their discharge from the home care agency where I was employed. In “The Nurse’s Story”, the protagonist receives telephone calls at home from some patients to whom she has given her personal telephone number, a regrettable choice that I also occasionally made in those early years. Blurred boundaries can lead to blurred feelings and confusion between one’s professional life and personal life, and Gino very deftly illustrates Teri’s ongoing struggles with her boundaries as she navigates a particularly challenging professional and personal journey.

These issues of boundaries and the love between patients and nurses are called forth eloquently in Gino’s deservedly well-respected book. In the Author’s Note prefacing the 1997 edition of “The Nurse’s Story”, Gino writes:

I believe with all my heart that nursing is a calling, and that especially in this time of corporate agendas in the health care system, with all the changes that will be invented and enforced, the most important thing to remember, and the most healing component of that system is still the ‘caretaker’, the nurse who is willing to risk loving her patients---because then healing will take place no matter what the outcome. I also know now, without a doubt, that caring for others is the greatest gift of all….and when done with love and compassion, it heals the healer as well.”

The notion of burnout figures largely in “The Nurse’s Story”, both implicitly and explicitly. Whether it’s during Teri’s nursing education or her days on the wards or working private duty, we’re aware that Teri’s personal and professional lives are suffering due to her dedication to the work that is wearing down her defenses. Explaining the symptoms of burnout, Teri’s nursing school professor states:

You stop being able to work to your full capacity. You get depressed more often than usual and for longer periods of time. You start to somatosize, you get sick more often because of the stress. Sometimes you get more irritable, have insomnia, and when you do sleep you have nightmares. You lose your objectivity, and one day you find that in order to spare yourself work or pain you sacrifice your patients.”

When the professor is asked why anyone would want to come back to nursing after taking a break or going back to school, she responds: “For the same reason you chose it in the beginning: because there is nothing else that is as essential, as valuable. And by comparison to nursing, everything else pales.”

And when it comes to death and suffering, Ms. Gino’s protagonist lays it on the line:

In the silent space between a stopped heart and the call for help lies everything I really am. That’s where I practice my morality; that’s where the strongest of my beliefs is tested.”

The Nurse’s Story” presents us with a heroine who desperately wants to serve, to heal, to assuage suffering, to share her love and compassion with her patients. Although sometimes flawed in her modus operandi, Teri’s caring heart is exemplary, and Ms. Gino uses Teri as her own tragic figure, a figure who comes to recognize her own subterranean fears, and channel them into a career where caring and healing hold center stage.

At one point towards the end of her story, Teri shares the following:

Throughout my years of nursing, most people had told me that no physical pain, including that of terminal cancer, had caused them as much suffering as isolation. Loneliness is one of the big killers, as are ignorance and fear. The only effective weapons, the only big guns we have to fight with, are intimacy, knowledge and compassion.......And my nursing had always been my most intimate connection. Sharing someone’s sickness…someone’s death…having someone really dependent on me, had connected me more than anything else. After I’d hugged and kissed hundreds of sick and dying bodies, helped wrap and care for another hundred dead ones….I’d really been touched.”

The Nurse’s Story” is required reading for every nurse or aspiring nurse, and for any individual who would appreciate having a glimpse behind the (bedside) curtain to see what can---and does---occur when a nurse confronts her pain and embraces the learning that emerges from that hero’s journey. 

In 1982, Carol Gino gave a gift to nurses and those who want to understand them. And that gift is as relevant today as it was when “The Nurse’s Story” first began enlightening readers with its brutal honesty and its truthful, heartfelt storytelling.
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