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Torrid Monday afternoon…

Value creation is something very strenuous; it means choosing roads not often taken, taking action, and giving a different meaning to every action taken

Becoming a nurse for me had, in a mostly unconscious way, a totalizing impact on my experience not only professionally but especially individually. The studies, vicissitudes and episodes indelibly affect my professional actions and personal attitude.

I do not believe that I have ever had a vocational drive toward this profession; and I do not wish to call it a profession, a trade, a job, and less than ever a science. I will call it Art, as she who founded it called it ,Florence Nightingale, a Florentine by birth but an Englishman by passport, who really in the Crimean land in the very distant nineteenth century started an extraordinary work of art, nursing.

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Many highly esteemed colleagues have experienced perhaps a deeper and more direct approach to the idea of caring. I started from not very moral and very prosaic(!) motivations, but a common thread has always marked my path and it has been and still is the hunger for humanity. To know, meet and bring out the humanity in me as a caregiver and to welcome the humanity of those who despite themselves must rely on my care.

At the beginning of the nursing course I expected so many answers to this hunger for humanity, my certainty at the beginning of the course was that since we would be concerned with caring for people, the focus of our actions could only be to plumb the depths of humanity…..I felt instead that I was drowning in a sea of technicalities that for reasons, so, of peer understanding are also necessary , provide scientifically proven answers but stop at a rational explanation, return nothing bring out nothing. Even before the report we talk about the communication modes/techniques with which we can defend ourselves as practitioners in order not to end up in burn out or worse than ever in the presence of a magistrate. With knowing, vaguely pedantic manner and a taste for the obvious, we talk about “suspension of value judgment,” the person in front of us needs care and we must care for them regardless of their background, status, census, skin color, eye shape, religious faith… Very valid and obvious principle! Continuing education? By the sprinkle! Results? Incomprehension, tension and instrumentalization. Little mention is made of listening, active listening, the real kind; listening to an elderly person who starts from the postwar period to recount episodes that determined in the present her coming to the hospital, to the Pakistani mother who nurtures her modesty by asking for a somewhat secluded place to breastfeed her newborn daughter; the exasperation of a 20-year-old son witnessing his mother’s passion in the terminal stage of cancer illness; almost imperceptible nuances that give cues as to the best way to be able to relate to each person we face; and modify senses we attach to words, contexts, accents, tones, sensations. Kaleidoscopes. Creating multiplicities of symmetrical structures in a relationship that has nothing symmetrical about it.

My lifeline in this stormy sea? The Human Sciences, sociology and anthropology began to quench my curiosity. The discovery and becoming aware that the world of health and illness is not a watertight compartment in the intricate system of the hospital, ward or district, these are not the places of Care! The place of Care is the person! As a biological entity, certainly, but also with the history of one’s own experience, one’s own perceptions of symptom, illness, pain, healing and Cure. My long wanderings began there: at the first anthropology class in the first year of my bachelor’s degree; in that instant the determination to internalize certain notions and the firm will to put them into practice, the goal the creation of value. Value creation is something that deviates from the search for absolute truth. By definition, absolute truth does not exist; there is value creation. Bringing out value in every gesture, thought and action. I consider “value” most important because it measures the subjective impact a given event has on a person.

Value creation is something very strenuous; it means choosing roads not often taken, taking action and giving different meaning to every action taken. Mind you, there is no heroism in this, but the power of courage is. A courage that can be met with cool detachment even hostility.

“In the confusion of suffering, do not forget that joy is the cause and not the effect of our victory.”

D. Ikeda

Victory is sharing a patient’s laughter in the recovery room twelve hours after surgery. Victory is maintaining harmonious relationships with the team. Victory is being able to ask a patient, “How do you feel?”

The power of that moment becomes decisive. What is the meaning we can give to our Care? The time we share with the people we care for is an infinitesimal fragment in the universe of each person’s existence, cared for and caregiver. Hence the power of the moment, of the need to establish and cultivate, however briefly, a heart-to-heart bond that no technicality can sublimate.

These impressions are part of my feeling, the way I live my Art; certainly to this day, working in a high specialty branch requires precise technical knowledge and attention to procedures and protocols, but I never detach myself from the modalities and thoughts I will report below because they are nourishment and sap for my naive humanity.

Monday afternoon scorching, I walk slowly to the hospital. I have jumbled thoughts, many times not being able to focus on anything at all; by dint of asking questions, the brain short-circuits. The expression on my face says, ” damn even today yet another afternoon of routine, punctuated by activities, gestures always the same, always the same words.” I give in because I have no other choice. I enter the department, greet my colleagues , and mechanically the sequence of gestures begins: ordinary stuff in a department where extraordinary activity is carried out. Wearily abandoned in chairs and resigned to the approach to the day, the phone rings, the alert from the delivery room arrives. Suddenly the maneuvers speed up, the routine is relegated to the empty seats on the bleachers, to watch this game between life and death for the operators there are only armchairs left. I make a run to the on-call doctor, warn that we need to be ready for an “asphyxiated term birth” who is being hand-ventilated post emergency endotracheal intubation performed in the delivery room. The doctor curses and mutters something, I tell her that the colleagues have already arranged everything. Faces are stiff, excited moments, instruments are being prepared. Nurses on duty in the delivery room quickly enter the ward with the mute cradle. The creature was born to black parents but only a livid gray coloring emerges from the slender little body, not a moan not a movement. The silence is surreal; indiscretions leak out about the birth, responsibilities, accusations. The colleagues who accompanied the baby to our ward are mute and despite the urgency of the moment have the blank stare of those who mentally repeat the sequence of the havoc they witnessed. I feel stunned, I am kept away from the maneuvering area, too inexperienced, I would be in the way, and then there are other parkins to take care of. The tension grows the operations become more and more convulsive. He has to be transferred to a level three center here we are not technically able to take care of his short and already troubled life. Enter the father who crosses the threshold of the ward and I get the impression that on the door is written what Dante finds written on the door of hell “lasciate ogni speranza o voi ch’entrate“; fortunately not for everyone that is the case but for that little universe that was a descent into hell. The doctor on call searches within herself for the strength to communicate to this concerned parent the essence of a harsh reality; she lines up a sequence of procedures, drug names, and clinical conditions that require transfer and super-intensive care and further investigation. The father tries to come up for air and portray this dreadful picture to himself; it turns out that he is a surgeon, the air is even thinner. Meanwhile we are told that the mother is in intensive care for hemorrhage resulting from extreme exertion in the delivery room; not paying attention we learn that after two miscarriages this was the first pregnancy the couple had managed to carry to term. No one in the delivery room had questioned whether any form of consent should have been sought for some of the gory procedures to which mother and child were subjected. With my hands tucked into the incubators to care for our little guests, I couldn’t help but watch the father’s astonishment as he looked at that body furrowed by tubes and that skin violated by holes. Ice bags to bring hypothermia to have neuro protection of residual brain function. I got tears in my eyes. I pictured the delivery room …

certainly strong is my imagination and my emotional involvement exaggerated, but I still do not understand; to avoid rationalizing also because there is no rationalization such as to wash away the indignation and disquiet. The transfer team arrives: with bated breath we proceed to prepare, the father is denied the opportunity to accompany the baby because procedures, protocols and regulations prohibit it; he is distractedly offered alternatives, then a young doctor offers to accompany him in person to the pediatric center. One struggles to breathe. The din and haste are replaced by silence and hope.

I consider every form of life valuable,

the snow, the strawberry, the fly.

I consider value the mineral kingdom, the assembly of stars.

I consider value the wine while the meal lasts,

an involuntary smile, the weariness of those who did not spare themselves,

two old men who love each other.

I consider value what tomorrow will be worth nothing,

and what is still worth little today.

I consider value all wounds.

I consider value to save water,

repairing a pair of shoes,

keeping quiet in time,

rushing to a cry,

asking permission before sitting down,

feeling gratitude without remembering what.

I consider it valuable to know in a room where north is,

what is the name of the wind that is drying the laundry.

I consider value the wanderer’s journey,

the seclusion of the nun,

The patience of the condemned, whatever guilt it may be.

I consider value the use of the verb to love

and the assumption that there is a creator.

Many of these values I have not known.

Erri de Luca

(Opera sull’acqua e altre poesie, Einaudi, 2002)

Alessandra Trinci

Sources and Images

 

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