Staying awake and alert

September 16, 2009 -- Today the Salon web site ran a piece by regular contributor and Prairie Home Companion radio host Garrison Keillor about the four days he recently spent at the Mayo Clinic following a minor stroke. Keillor offers a wry and insightful account of his "brush with mortality," and closes with a simple plea for reform of the broken U.S. health financing system. Keillor's comments about his nursing care, though all very positive, range from the perceptive to the blatantly stereotypical. Evidently Keillor's nurses were "fabulous," "smart," "brisk," "utterly capable," and possessed of the humor and psychosocial skills needed to get patients through painful and dehumanizing experiences. But the female nurses also "have the caring gene most men don't," and Keillor senses "some human tenderness ... as if she thought, I could be the last woman to hold that dude's hand." Keillor begins his comments about the nurses by referring to an ED physician's note that Keillor presented as "awake, alert, and appropriate," then admitting that he is "even more awake and alert around attractive young women (though I try to be appropriate)." Keillor refers particularly to a "dark-haired beauty named Sarah" who not only "coaches him on self-administered shots of heparin," but also inspires him to plunge the needle in without hesitation, since "no man is a coward in the presence of women." We appreciate Keillor's kind thoughts, and we don't begrudge him his honest observations. But we have to note that he seems to be responding to the nurses' gender and physical attractiveness at least as much as their skills, and that his specific examples of care do not exactly overemphasize the nurses' advanced skills and health care knowledge. We hear about Keillor's physicians too, but nothing about their appearance. In any case, nurses of both genders improve patient outcomes because of their education, experience, and skills, not because they are nice, attractive women.

Keillor builds the piece around a short note that an ED physician wrote about him in "her report." The physician wrote that Keillor was "nice 67 y.o. male, flat affect, awake, alert and appropriate." Obviously this was a female physician, but oddly, Keillor draws no special attention to that fact, and her overall appearance remains a mystery to us. Later he refers to his neurologist, who tells him how lucky he is and explains why he will need to take powerful blood thinners. And Keillor describes one "Doctor Numero P. Uno," who is trailed by the teaching hospital's eager young physician residents. But there is nothing about the genders or physical appearance of any of these physicians.

However, here are Keillor's comments about the nurses:

The nurses, of course, are fabulous. Like many nice 67 y.o. men, I am even more awake and alert around attractive young women (though I try to be appropriate). A tall, dark-haired beauty named Sarah brings me a hypodermic to coach me on self-administered shots of heparin, and without hesitation I plunge it into my belly fat. No man is a coward in the presence of women.

Nurses are smart and brisk and utterly capable. They bring some humor to the situation. ("Care for some jewelry?" she says as she puts the wristband on me.) And women have the caring gene that most men don't. Men push you down the hall in a gurney as if you're a cadaver, but whenever I was in contact with a woman, I felt that she knew me as a brother. The women who draw blood samples at Mayo do it gently with a whole litany of small talk to ease the little blip of puncture, and "here it comes" and the needle goes in, and "Sorry about that," and I feel some human tenderness there, as if she thought, "I could be the last woman to hold that dude's hand." A brief sweet moment of common humanity.

And that is a gift to the man who has been struck by a stroke: our common humanity. It's powerful in a hospital. Instead of a nice linen jacket and cool jeans and black T, you are shuffling around in a shabby cotton gown like Granma in "Grapes of Wrath," and you pee into a plastic container under the supervision of a young woman who makes sure you don't get dizzy and bang your noggin.

Certainly, this is to some extent a vision of nurses as smart, competent, and caring. They have good interpersonal skills, using humor and helpful small talk, and they can even "coach" a lay person on giving himself shots of heparin. But then there are all the comments about the special nursing qualities that seem to flow directly from the nurses' female gender, and perhaps even their youth and attractiveness. Did the nurses teach Keillor anything in these four days about his condition, as the neurologist did? Did he have any male nurses? And did they do anything more notable than pushing him down the hall like he was a cadaver?

Consider Keillor's description of how he ended up at Mayo:  

I had appeared with slurred speech and a balloon in my head, had driven myself to United Hospital in St. Paul, parked in No Parking, walked in and was triaged right in to a neurologist who trundled me into the MRI Space-Time Cyclotron for 50 minutes of banging and whanging that produced a picture of the stroke in the front of my brain, so off to the Mayo Clinic I went and the St. Mary's Hospital Neurology ICU and was wired up to monitors.

In this flurry of events, there was certainly a good deal of skilled nursing, but nurses are absent from the description. Indeed, apart from the trundling neurologist, the health care seems to have simply occurred. Keillor says he "was triaged"--does that mean a skilled triage nurse determined that he'd had a serious neurological event and sent him back urgently so that he could get care from the right specialist? He says he "was wired" to the ICU monitors--does that mean skilled nurses hooked him up to a variety of high-tech machines, then used those machines to monitor his status for subtle changes and initiated complex treatments to ensure his health? And most important, what color was the nurses' hair?

We don't mean to be unduly harsh. Keillor was able to observe and convey that the nurses were smart and competent, at least as a general matter, and his more specific descriptions of their psychosocial skills have real value. We're also not suggesting that he should have hidden his gender-based perceptions. But we do urge him to consider whether it is really in the best interests of a health care system in which he has a personal and policy interest to reinforce the idea that nurses should be defined to such a large extent by their female gender and their physical attractiveness. If nursing is to win the resources it needs to continue providing high quality care to patients like Keillor--and the currently uninsured--it must be seen for what it really is: a serious health profession of skilled, college-educated practitioners of both genders, all adult ages, and all hair colors.

See "Nice 67 Y.O. male has brush with mortality: It was pretty clear how lucky I was to be walking out of that hospital relatively unscathed," by Garrison Keillor, posted on Salon on September 16, 2009.

You can reach Garrison Keillor at phc@mpr.org. If you do send him a letter, please copy us at letters@truthaboutnursing.org. Thank you!