Thursday, August 14, 2008

A Visiting Nurse and the Puzzle of Humanity

Last night, I was doing some visits for the visiting nurse agency who recently employed me. On my fourth and final visit, I had a revelation of sorts.

I drove about twenty minutes to reach this patient's home, winding through lovely country roads, past old farm houses and pastures. Reaching his neighborhood of middle- and upper middle-class homes, I was struck by how out of the ordinary this situation seemed to me. For the last eight years, almost all of my home visits have been to poor, inner-city neighborhoods, trailer parks, or lower income neighborhoods with modest single family homes. Not since I was a visiting nurse back in the late 90's had I actually visited a patient whose home reminded me, perhaps, of my own parents' home back in the day.

The home smelled of garlic, tomato sauce and stewing summer squash from a large garden in the back yard. An above-ground pool bubbled outside, and we sat on a relatively new overstuffed sofa, our feet on plush carpet, a rambunctious four-month-old yellow lab entering and exiting the room every few minutes. My patient's wife buzzed around the kitchen and dining room, setting the table and trying to usher the dog away from my bag of bandages and supplies.

My patient and I talked about his work with a medium-sized company, his recent surgery, and how his wound had been healing. Like sitting with a benign uncle in a comfortable living room (with the exception that I was actually dressing a surgical wound), we chatted about dogs, our adult children, and a few other random subjects.

At the end of the visit, I put away my supplies and washed my hands, readying to take my leave as dinner was reaching the well-laid table. It was such a familiar scene---familiar in a visceral way, but unfamiliar in terms of the home environments into which I've been accustomed to walking in the course of my nursing career.

I felt no judgment of my patient and his lifestyle. In some ways, it smacked of American middle-class privilege, but I had no idea of knowing from this brief encounter what this man and his family might think about the poor. Perhaps they give money regularly to progressive social causes and volunteer at the local food bank. Maybe one of his children works for a left-wing NGO or humanitarian organization. Maybe they support the Republican National Committee. Who knows?

Before, during and after this visit, the main focus of my awareness was on class, privilege, and the fact that I have so rarely had the opportunity to visit patients in such comfortable and middle-American surroundings.

I'm not sure how I feel about this demographic shift, although I still do visits to rooming houses and low-income buildings in our area. Having mostly eschewed my work in the nearby inner city, I am now evaluating this new manifestation in my professional life and how it effects me on an emotional, spiritual and psychological level.

Choosing currently to work as a visiting nurse in our much less ethnically diverse collegiate area (which in turn is surrounded by middle- and upper-middle class neighborhoods, small towns and semi-rural suburbs), I am acknowledging my certain sense of "compassion fatigue" and burnout that I experienced working with the poorest of the poor in the city for the better part of a decade, and my slow adjustment to a new class paradigm.

For almost ten years, my professional identity (and to some extent my personal identity, as well), was wed to the notion that I worked in service to the poor, advocating and fighting for them to receive the best quality health care that I could coerce and squeeze from the system. Stepping out of that environment---at least temporarily---I'm struck by the stark differences of class and privilege that I witness, and I simply acknowledge to myself that yes, this is assuredly different.

So, patients come and patients go. They are all of one class or another, all born into some situation or another, their class, race and social status beyond their control. I am simply noting the differences, evaluating my response, and cultivating an awareness that allows me to sit with each person, look them in the eye, and meet them face to face, hopefully without judgment or preconceptions.

Nursing brings one into contact with the diversity of humanity. This diversity of humanity is a wonder to behold, and in one's relationship to that wonder, one can also find a many puzzles to ponder.


Anonymous said...

What is the level of support per patient in the new area?

Is it possible that in the old place you were expected to do a lot more with a lot less?

Maybe another subtle sign of privledge?

Keith "Nurse Keith" Carlson, RN, BSN, NC-BC said...

Oh yes. In the inner city, communities of color struggle to get their needs met.

Recent studies by the Pew Center for Research show that Hispanics---whether they speak English or not---are more likely than any other group to be shut out of the healthcare system. (Stay tuned for a new post on Digital Doorway about those findings.....)