The Arithmetic of Nurses (VidLit 2004)

A Poem by Veneta Masson, RN, MA
     (from Rehab at the Florida Avenue Grill (1999))

Narrated by J. Chaisson, RN

Directed by Liz Dubelman

Flash Animation and Musical Score by Paca Thomas

Available at www.vidlit.com/video/the-arithmetic-of-nurses/

Nursing rating		Rating guide: excellent = 4 stars; good = 3 stars; fair = 2 stars, poor = 1 star
Artistic rating

As a poor "sick old man" struggles to speak, his home care nurse takes the measure of his decline. This is the nurse-patient interaction at the heart of Liz Dubelman's "VidLit," which combines Veneta Masson's bleak poem with Paca Thomas' flash animation and plaintive music. The matter-of-fact text, recited matter-of-factly by J. Chaisson, charts the human spirit straining to break through physical decay and social neglect. As we listen, some of the poem's words and numbers pulse, slide and bounce around the screen, while a series of black-and-white still photographs provides images of key people and themes. Some aspects of the portrayal of nursing are troubling. But by comparing society's disregard for its "sick old" members to its indifference to the nurses who care for them, the piece deftly links patient advocacy to nursing advocacy. It evokes a kind of quiet outrage.

Veneta Masson's poem is from a collection that was based on her decades of work as a Family Nurse Practitioner and director of a small clinic in Washington, DC. In "The Arithmetic of Nurses," patient Benny Smith struggles to get past the first sound of the first word he wants to say ("S-s-s"..."S-s-s"). Meanwhile, the nurse-narrator counts out the 12 cookies that are apparently all Benny will have to eat for the next 36 hours, "[u]nless someone comes." Here, Dubelman offers a portrait of a smiling middle class family of four on a bedside table, presumably the family of Benny's son or daughter. The images of Benny and the narrator are deliberately grainy, underlining the rough setting.

Benny, his "face lit up by the restless flicker of the television screen," continues trying to communicate. But his nurse is focused on the "numbers" that reflect his physical decay, as he lies in his roach-infested bed. These are the number of "minutes it will take a rivulet of urine to reach the screaming bedsores on his back," the "number of degrees his temperature will rise as infection sets in," the "number of days it will take him to let me call the ambulance," and the "number of times I must walk the long hall to this dim little room the width of a bed." With the mention of "infections," the names of possible infections begin to pop up on the left side of the screen, and rising temperature readings ascend the right side. The narrator finds some dark humor in Benny's "stiff body straddling the low bed," comparing it to a "piece of plywood on a sawhorse": "[p]ush down on the feet, up comes the head."

Finally, Benny gets it out: "S-s-s 6000 nurses on strike today...M-M-M-Minnesota!" Here we see an image of the TV showing a CNN report on the strike. The poem concludes:

Half his face breaks into a grin
For if there's one thing Benny understands
It's the arithmetic of nurses and old, abandoned men

With the final mention of "nurses," six small images of nurses appear fleetingly on the other side of a division sign from an equal number of "old, abandoned men." Most of the nurse images appear to be from decades ago. One image is of "The Greatest Mother in the World," Alonzo Foringer's dramatic 1918 Red Cross Appeal poster, which features a large, noble Red Cross nurse holding what seems to be a wounded soldier on her lap.

This VidLit's mathematical theme is compelling and clever, if perhaps a bit schematic. Masson runs the numbers for Benny's meager diet, his slow physical decline, the narrator's efforts on his behalf, and the nurses who've gone on strike. Dubelman accentuates this by arranging some of the poem's ideas into mathematical symbols and equations. Presumably the "arithmetic of nurses and old, abandoned men" also has something to do with dollar figures, with poverty and the resources devoted to nursing. Dubelman's insertion of the family photo injects a more specific idea than Masson's poem does: the notion of a prosperous family abandoning a father to poverty and illness. But it also provides a link back to the more universal concern, as if to suggest that the society that fails to care adequately for its less fortunate members is literally turning away from its own family.

The VidLit seems like an intriguing hybrid of, well, video and literature. At least in this instance, it may have more in common with a traditional music video than a film adaptation, since it adds additional media to a complete original work, whereas films do not typically incorporate the full text of their source material. But rather than the live-action "moving images" of most video, here the black-and-white still photographs provide fairly literal representations of some key images, giving the work, at times, the feel of a public television documentary. However, this VidLit also uses striking, even playful animation to focus the viewer's attention on the poem's specific textual themes. This can color or extend the meaning of the original, as with the addition of the family photo, or the way the look and the motion of the words and numbers adds a new dimension to our experience of them.

The VidLit's portrayal of nursing is not straightforward. Of course, the nurse-narrator is presented as part of society's moral infantry. She braves tenements to care for the "old, abandoned men" no one else will, even as that same society treats nurses in such a way that they feel they must go on strike. Comparing the narrator and her striking colleagues to Benny may suggest that nurses are, like him, victims of larger forces. Yet Benny is trying mightily to communicate. And so are the 6,000 nurses going on strike, an action that suggests they have the collective assertiveness to protect themselves and patients like Benny. Many recent strikes have involved nurses' efforts to ensure patient safety through measures like adequate staffing. Unlike Benny, nurses are not alone. The poem itself can be seen as a kind of patient advocacy, highlighting the pain caused by our failure to provide adequate resources to the most needy.

The "calculation" the narrator makes suggests that she has some clinical expertise. And some viewers may understand that the piece's brief presentation of some of the potential infections means the narrator knows about them. Yet most of the "calculation" lines show only that nurses chart simple physical changes, not that they necessarily provide skilled physical or emotional care to affect those changes. We do not hear about the narrator's efforts to prevent infection or bed sores.

Other elements of the poem do little to counter this image of clinical passivity. The only active thing the narrator does for Benny is count out cookies, which will not exactly persuade viewers that nurses are highly skilled professionals. The narrator also provides Benny with vital emotional support simply by listening to him. But once again, for most people this fits more with nursing's virtue script than a clinically expert one. To its credit, the piece does not employ emotional language, instead relying solely on the narrator's factual (even irreverent) account of Benny's condition and the nurse-patient interaction. However, the one specific health care action mentioned--calling the ambulance--may suggest that it is nurses' main role to watch patients until they can call for the real professionals to provide serious health care. Of course, assessing Benny's condition as infection sets in and deciding when he should go to the hospital involve skilled nursing assessments. But without more explanation or skilled action statements ("I track the infection;" "I up the dosage;" "I check the interaction"), they may seem like things that Mom could do. While the narrator may be standing in for Benny's family to some extent, it's a troubling message to send at a time when nurses must be seen as educated professionals if they are to get the resources they need. And the nurse images that flash by at the end arguably reinforce the maternal stereotype. Nurses may be great mothers, but they are not, as a professional class, the Greatest Mothers in the World.

On the whole, though, this inventive piece gives us a powerful look at nursing care on the front lines in a seemingly uncaring world.

Reviewed by Harry Jacobs Summers
Nursing Editor: Sandy Summers, MSN, MPH, RN
Reviewed July 1, 2005

The views expressed herein do not necessarily reflect those of the Board Members or Advisory Panel of The Truth About Nursing.