Nurses, a Knowledge of the Night
The only true benefit of this profession is the relationship. By that I mean to bring well being to someone. If only by washing a behind eh, I mean… and above all to wash a behind with humanity, that’s what is rewarding because we are poorly paid financially. So we are repaid by the self-gratification derived from the thank-you of someone that we have provided with something. Yet the more you objectify, the more you depersonalize the invalid the more you treat them as an object the less they will give back to you in terms of benefits, the less that they will be satisfied. Well if we received nothing in return we could not stand that either.
Those are the candid words of Anne Perraut Solivières a night nurse. Witness to a gap between the idealized image of the work of a nurse and the reality in the modern hospital of today, she sought to do some research in order to better understand her situation. Disappointed by the quality of the studies that she found she decided to take matters in hand and put pen to paper her self. Out of which has come her new book “Nurses, a Knowledge of the Night” – a unique blend of life-experiences and specialized analysis.
-The first problem is one of division. We have always split the care of the patient, according to specialty, by organ, by surgery, by doctor and by… Today we divide in administrative terms according to budget by short term care, by therapy, rehabilitation, and palliative care since we have also treated and organized death as a disease. So what I am getting at is how can we keep the person in view when he is blown apart, shattered or cut apart like a sausage in little pieces? This is the result of medical and technocratic visions, which are today united in preventing us from seeing the individual and to have a picture of him, in short to have a normal relation with the person, even if he has a stomachache. What I mean to say is that I don’t care about his stomach! And once again today every method of interaction conspires to draw attention away from it. There are presently specific data sheets, so what I mean is that I am going to make a note that the patient had a stomach ache and what I did and so on but one does not really care at all. We no longer know who had a stomachache. The patient becomes more of a pain or he becomes a problem. The system is very… it is completely perverse because we divide and we are less able to observe the whole picture. It isn’t possible.
No one would deny the financial problems at the heart of the difficulties of the health system today. It remains to be seen if we are looking in the right place.
-It’s because medicine has become more and more costly. Technology in the first place is very expensive and medical technology is particularly expensive. The least piece of software, it is…well it’s terrible. It is really extremely costly and so we are faced with a real economic set of problems. But at the same time we don’t really talk about the choices. For the cost of a state of the art examination that will be very expensive and that will benefit one patient how many old people could we watch over or help etc.? These are choices. I am not able to say what choice we should make but I would like my contemporaries to ask themselves what it is that they want, and then of course there are demands that are totally justified. For example to bring our hospitals back up to standard. But what are these standards? What I mean is what is it that we are standardizing? It is true that there are extremely old hospitals and to repair them, to bring them up to code, is going to be very costly but that, all of that contributes to health care but it is not care itself. The only place where we don’t spend our time and where we have allowed the situation to deteriorate is the human aspect. We are in the process of bringing the buildings up to code, the technology up to standard, to apply standards to ourselves. Have I seen him? Have I talked to him? In the end I spend more time writing that I have talked to him that actually talking to him. What does this all mean? We have reached a kind of absurdity. Everyone agrees that they find it absurd. I mean everyone who is involved on a day-to-day basis in these professions and yet it continues.
Mrs. Perrault Soliveres explains that large investments in new technology necessarily mean a less human approach.
-When you install a new piece of equipment, you have to make it pay for itself so we are in a for profit system. Which means that in that kind of system the human aspect is not the primary reason for it’s being unless the individual is considered as a consumer and for me the patient cannot be a consumer. A customer is someone who makes a choice: I want to buy this; I want to buy that… Well either I need it or I don’t need it. Illness operates according to another set of rules.
The misfortune of caregivers is being far from the powers that form the policies that they must implement:
-It is the doctor who decides. It is he who stipulates; well what I mean is that it is the doctor who sets the tone in fact of what should happen. The nurse she always has the option of objecting but she has an obligation to carry out the prescriptions of the doctor. If the nurse is overworked what do we see? What I mean is if she has not carried out one of the instructions, there will be hell to pay. If she takes the time for example to wash the hair of someone who has not had it washed for I don’t know how long we don’t look at the fact that she has cared for a patient. We will say to her: she hasn’t done what was prescribed. That is what is always obligatory. That is what the priority is and that is what if you will reduces the time, the human time as it gives more importance to technical procedures.
-How do you expect that self-esteem, I mean a sense of professionalism to develop in a context like that? So very quickly people are worn out and find the situation unbearable, they find the sick people unbearable, too demanding and the situation impossible and in fact it is. So if you will people like me…. I am a militant and therefore I have always been fighting and I have given myself the weapons to do it but young people who are just getting started with only their limited training who find themselves confronted with a terrible shortcoming in all areas, philosophical… Really what I mean is we live with shortages and therefore with a terrible frustration. And young people today don’t want any frustrations. They don’t want it. We have learned to live with it. Frustration was a part of our culture but all that is over now. Well we can say it is ended… it is probably not ended well it is certainly not ended in fact but in any case they don’t accept it any longer. So they leave. They leave right in the middle of training, with training hardly just completed at the end of a year. They find that it is unbearable and the leave. They say: nothing can make me put up with that, because it is unbearable for almost the entire population. Otherwise we would not close off suffering and death in hospitals. Why does everyone go to die and leave his or her unhappiness in a hospital? It is because society does nothing to deal with it anywhere else. And we, as caregivers are part of society. And young people are part of a society that more and more is in a state of denial of a culture that we have, as best we could, included in it. And so they find themselves face to face with intolerable things because they are in fact unbearable. Why is it that people get into these professions? They do it because they want to help others, to have a positive self-image. Helping others is a very good way to feel good about oneself as well. But when one cannot do that any longer, well you say to yourself I am nothing, I can’t go on, it is too hard, you see.
The answer? Mrs. Perraut Soliveres favours a true revolution in the way we approach medicine:
-It would require in my opinion precisely on one hand that… that medicine stops training people exclusively in technology and in… really I would say in the belief that science has the answer to everything because that actually it is not even very scientific, but rather in a science of medicine. People should be trained much more on the problems of society, in the human sciences with their larger… philosophy etc. What I mean is you have to get back to a training that is multidisciplinary and not exclusively scientific. In fact it is primarily scientific and it is science that dominates everything else. We add a sprinkle: we do three little hours of sociology and philosophy over here. But I mean what we really do is to treat human science like we do medicine. It is not the same at all. What would be needed is to restore… Actually, I will tell you, it’s very revolutionary: it’s completely turning the system around, to first put people in contact with the world that they will be caring for, to get to know it, to understand it. In the first place! And then later go on to find the training that they will need to work in that profession. The selection would be then made not on physical chemistry; the selection would then be made on the ability to listen to others. There is a part of medicine that is extremely technical, very state of the art and it is very important. I mean research, and all that is vey important but eighty per cent of medicine is not that. Eighty per cent of the needs of the patient are not found in the latest technologies etc. They are needs that if you will are not even sometimes necessarily medical. They are the needs of society. These are needs… for example if people do not have a home and if they live on the street, it’s not up to medicine to fix that, but it is medicine that is left to salvage the situation. But there is a health policy that should emerge from it. But you get the impression if you will that people are shocked by the degradation of living conditions.
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