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Nursing, Writing, and Humanity: An Interview with Theresa Brown

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  • Hello
  • and welcome to the latest
  • installment of the University of
  • Pittsburgh Humanities podcast, a
  • series devoted to exploring the
  • humanities, their intersections with
  • other disciplines, and their value
  • in the public world.
  • I'm Dan Kubis, assistant director of
  • the Humanities Center at Pitt.
  • My guest today is Theresa Brown,
  • nurse, columnist, and author of
  • The Shift: One Nurse, Twelve
  • Hours, Four Patients' Lives.
  • Even if all I do is go in and flush
  • an I.V. line, I try to always just
  • reach down and just touch their hand
  • when I'm done because it's also
  • a way of saying, "I see
  • you.
  • You're not just a task, but
  • you're a person." And that's
  • probably the connection that nurses
  • need to make, which is
  • different from physicians but
  • equally as important.
  • Theresa began her career as a writer
  • in 2008 when she published an essay
  • in the New York Times about a
  • dramatic and emotional experience
  • she had with a dying patient.
  • The piece received national
  • attention and was anthologized in
  • the Best American Science Writing
  • and the Best American Medical
  • Writing in 2009.
  • Since then, she has written dozens
  • of pieces about nursing and has
  • become a leading voice for nurses
  • and nurse advocacy across the
  • country.
  • Her first book, Critical Care, was
  • published in 2010 and is widely
  • used as a textbook in nursing
  • schools.
  • Theresa's writing frequently pulls
  • back the curtain on the experiences
  • and challenges that nurses face in
  • their daily work.
  • Sometimes this reveals frustrating
  • working conditions or difficulties
  • dealing with hospital
  • administration. But just as
  • frequently, it shows the strength,
  • skill, and commitment that nurses
  • need to provide their patients with
  • the best care they can.
  • So it's no surprise that President
  • Obama quoted from Theresa's blog
  • when he was advocating for the
  • Affordable Care Act in 2009.
  • In
  • what she calls her past life,
  • Theresa received a Ph.D.
  • in English from the University of
  • Chicago and was an English professor
  • at Tufts University.
  • I began by asking her about this
  • past and about the somewhat
  • nontraditional path she took to
  • becoming a nurse.
  • As I've said many times before, this
  • is the million-dollar question.
  • Why would an English professor
  • become a nurse?
  • And there are a lot of people who
  • thought I was nuts. So I think
  • I've convinced some I'm not.
  • But essentially,
  • my dad was a professor, and growing
  • up it just seemed like a really
  • great job.
  • You could get paid to be in this
  • world of ideas and books.
  • And I loved that.
  • I got my Ph.D.
  • in English. I was teaching at Tufts,
  • and I found out that the job itself
  • for me was not the ideal.
  • I liked it. I think I was good
  • enough at it, but it just didn't
  • quite do it for me.
  • So it's kind of like, oh, now,
  • what am I going to be when I grow
  • up? And then, I became
  • a mom in the middle of that and
  • had our son, and then got pregnant
  • with twins.
  • And that just caused
  • a huge life change
  • and in hard ways because of the lack
  • of sleep and all the laundry,
  • but in really great ways, like
  • all the love and the fun.
  • And then I thought, "Oh, well,
  • this is the kind of job I want to
  • do, but what kind of job is that?"
  • And I had midwives
  • for that pregnancy, and I was
  • telling a friend of mine who's a
  • nurse, "Well, I just thought the
  • midwives had the coolest job in the
  • world." And she said, "Theresa,
  • you could do that job."
  • And it had never occurred to me
  • that I could become a nurse.
  • But then I did it.
  • Well, I want to also ask
  • you, then, about your description in
  • the beginning of your first book,
  • Critical Care. You
  • made your change from being
  • an English professor to being a
  • nurse, and it felt right
  • to you. But it took a while for
  • there to be a kind of crystallized
  • moment where you realized why it
  • felt right. And you talk about an
  • experience you have with an 11 year
  • old boy as being a moment where
  • you did have that realization and
  • talking with him at night about the
  • condition that he was in.
  • Can you talk a little bit about that
  • moment and what it was in particular
  • about that that caused that
  • realization for you?
  • Well, it was my last night
  • of clinical as a student.
  • So really the end of my
  • journey as a student nurse.
  • And I was
  • not working on an oncology floor,
  • but he was an oncology patient.
  • Came in with his dad,
  • and they'd been there a lot and were
  • obviously trying to make it fun
  • by eating a big bag of potato chips
  • and watching TV.
  • But it's not
  • really fun.
  • I mean, I admired the effort.
  • And then, in the middle of the
  • night, he just started to feel
  • really terrible
  • and most
  • likely was septic
  • and really low blood pressure.
  • And I ended up--
  • the nurse I was working with, we
  • ended up having to send
  • him to the pediatric intensive care
  • unit, and his dad
  • slept through a lot of it, which
  • at the time was kind of shocking
  • to me. And then afterward, when he
  • woke up, and I saw the look on his
  • face. I realized that he had
  • just been through this so many times
  • that either he was sound
  • asleep or he just couldn't face it.
  • And then, thank goodness that we
  • were there, right?
  • So that he didn't have to.
  • But the amalgam
  • of need and
  • being able to care for someone
  • and having to do
  • it on their time,
  • but also being able to help
  • them.
  • That combination
  • is what really sold me.
  • And that nursing is so
  • intimate.
  • Of course, we had to call in an ICU
  • fellow and the resident,
  • but it was really me
  • there with him. I love
  • that, that close connection with
  • people.
  • Yeah.
  • Speaking about that connection, one
  • thing that I really liked reading
  • about also in your first book
  • is you write about not only
  • how much you enjoyed the
  • process of hearing people and being
  • there for them but also you found it
  • important, despite the fact that you
  • had been counseled in
  • nursing school, not to share
  • that much-- not to disclose personal
  • details. You found that that was a
  • really important thing for you to be
  • doing, not only to be hearing what
  • people say but also to be sharing.
  • And that you talk about a-- and you
  • tell an anecdote about feeling like
  • you can't use cell phones.
  • Something like that.
  • Little details.
  • But they're important for you.
  • And that was I really thought that
  • was interesting that you can create
  • that kind of two-way street with
  • your patients.
  • Yeah. And I think it's all about to
  • use our words now, boundaries
  • and appropriateness.
  • I mean, that was the situation.
  • In fact, I call that chapter
  • Openings because the patient had
  • this huge opening in his abdomen
  • from surgeries. And it was about
  • that opening and also me finding
  • a way to communicate with him
  • because he was having a really hard
  • time.
  • But I found also that even
  • on a much more basic level, people
  • want to know that I'm a person
  • because it makes them feel like
  • they're not just a patient.
  • So in the hospital, people
  • would say, "Well, how are you
  • doing?" And they really wanted
  • an answer.
  • They didn't want me to just say,"
  • I'm fine." Now, they didn't want
  • me to say, "Oh, my God, I'm
  • overwhelmed. Our cat just died.
  • And the heater won't work."
  • Too much sharing is also bad.
  • Yeah. And they don't want
  • to hear about all
  • my pain. And that's not why I'm
  • there. But they want
  • to feel like I'm a human.
  • Because they're human then too.
  • Another thing that I thought was
  • great in terms of
  • things you learned while being a
  • nurse, and you write about this in
  • The Shift, is the importance of
  • physical contact.
  • You reference another, a physician
  • writer, Abraham Verghese, who talks
  • a lot about that.
  • And for him, he talks
  • about touch being important not only
  • in terms of making a diagnosis but
  • also in terms of getting
  • a patient to join you
  • in his or her
  • care of something.
  • Have you found that it's a similar
  • kind of importance that touch plays
  • a similar role for you?
  • I do think it really matters.
  • We don't diagnose as nurses, so
  • it's not at that level, but
  • it really establishes a sense of
  • trust and also connection.
  • And it's
  • also a way of saying, "You know, no
  • matter what's going on with you, if
  • you have a terrible rash, if
  • you're in pain, if
  • you
  • don't smell very good, because we
  • need to get you cleaned up.
  • You know, I am not
  • afraid of your body." And
  • I think it's really important to
  • say that to people.
  • Yeah. I remember a talk
  • from Abraham Verghese where he
  • talks about there's a
  • belief that a patient has that the
  • doctor will always be there
  • for him and do what the doctor
  • can to care for this patient.
  • And the touch is the thing that kind
  • of seals that.
  • Yeah, I think that's right.
  • Yeah.
  • And with nurses too.
  • It's that even if-- I think I wrote
  • about this in the shift. Even if all
  • I do is go in and flush an I.V.
  • line, I try to always just
  • reach out and just touch their hand
  • when I'm done because it's also
  • a way of saying, "I see
  • you.
  • You're not just a task, but
  • you're a person." And that's
  • probably the connection
  • that nurses need to make.
  • Which is different from physicians
  • but equally as important.
  • Yeah, I'm reminded
  • of some of when you
  • talk about in nursing school, you
  • learn not to disclose too many
  • things, but you learned how
  • important it was to do that.
  • You talk also in some of your
  • writing about the fact that you were
  • not prepared in
  • nursing school to do some of the
  • things that have been the most
  • important parts of your work.
  • Talking about death, I'm thinking
  • about in particular. This isn't
  • something that you're prepared for.
  • Have you found that you did
  • need to learn a lot
  • on the job? I suppose it's
  • inevitable that you will have
  • to do that. But could you have been
  • prepared better for those things?
  • Is it a problem with nursing
  • education that these things aren't a
  • part of the education process?
  • Yeah, I think so.
  • I mean, I went to Pitt. So
  • I actually feel like it was a really
  • great program, and I got what
  • I needed. But yeah.
  • And I think medical students too.
  • Particularly on the subject of death
  • and dying, they're starting to
  • learn more about it.
  • And I'm guessing that nursing
  • schools are, too, although I don't
  • know about that.
  • So it might have just been that
  • everybody was so busy
  • hiding from that topic, and now
  • we've brought it out from under
  • the shadow.
  • But yeah. There's definitely
  • actually all kinds of things about
  • communication that
  • would make the first job easier
  • if we learned more about
  • them. What do doctors want to hear
  • from us? How is it best to talk to
  • another nurse?
  • We learn a lot about talking to
  • patients, but we don't learn about
  • talking to each other.
  • Yeah. I mean, it's interesting.
  • I also wanted to ask you a little
  • bit about working in
  • hospital settings. Because
  • one of the things I found that was
  • really interesting in The Shift
  • is you talk about one of your
  • patients there, a patient named
  • Sheila, and
  • the time that you spend dealing--
  • she's been misdiagnosed in the book,
  • and you spend some time
  • talking with her.
  • And she's very concerned.
  • Her family's there.
  • They're very concerned.
  • And you write about the time that
  • you spent talking with all of them
  • about her condition.
  • And then, you say afterward that
  • even though it may be the most
  • important thing you do during your
  • shift, it goes unrecorded.
  • Right.
  • But you also spend a lot of time
  • talking about how much work you have
  • to do to record so many other parts
  • of your job. Yet this is the thing
  • that made me want to ask is it
  • the case, then, that hospitals are
  • not incentivizing
  • the most important part of the job
  • that you can do as a nurse?
  • Wow. What an amazingly smart
  • question.
  • Yes, I think that is true.
  • No one's ever put it like that
  • before.
  • Yes. And yet still,
  • the expectation is that we will
  • be empathic and we will be there for
  • people.
  • But then, there's so many more
  • task-oriented things that we get
  • evaluated on that
  • it really is not
  • incentivized.
  • Hate to use that word, but it's the
  • right word, I think.
  • Yeah.
  • We're expected to do
  • the human things that actually
  • nurses love doing, but we're not
  • judged for doing those
  • things unless you really, really
  • screw it up.
  • You know, somebody complains. And
  • I was just at a conference,
  • actually, where people were talking
  • a lot and a lot about that.
  • But thinking
  • that small fixes can make a big
  • difference. And I
  • don't think so.
  • I think we've put our values
  • on the wrong things, and there's got
  • to be a change in
  • that way.
  • Do you have any thoughts about some
  • kind of big-picture changes that
  • might move us in a
  • direction where some of these
  • human and very important parts of
  • being a nurse could take center
  • stage more than they currently do?
  • I think there's two issues.
  • One is now documentation
  • has gotten to the point where it
  • seems like we're supposed to record
  • everything.
  • Every little detail in triplicate
  • from multiple dropdown menus.
  • And it's extremely time-consuming
  • and alienating and
  • doesn't lead to supporting
  • nurses giving whole care
  • to the patient. So there's that.
  • But that, I think, springs from a
  • kind of lack of trust in the value
  • of actual human
  • connection.
  • And I see as an analog to
  • this what's going on in education.
  • We can't just trust that if we have
  • good teachers and normal-sized
  • classrooms and standard
  • equipment, that they'll do a good
  • job. There has to be all this
  • evaluating and standardization
  • and looking at metrics. And
  • I'm not saying there's no value to
  • any of that, but
  • when you're talking about
  • human-to-human interaction, you've
  • got to trust at some level
  • that you
  • pick the right people. And they can
  • pull that off, and they can achieve
  • from that interaction what they are
  • meant to achieve.
  • And maybe you can't measure
  • that,
  • or you need to think really, really
  • creatively about how to
  • measure it.
  • And we're not doing that.
  • Yeah.
  • In The Shift, you write about two
  • articles by a psychiatrist, Leonard
  • Stein, The Doctor-Nurse Game.
  • You say these are two of the best
  • articles you know of.
  • He wrote in 1967 about it and then
  • again in 1990, revisited
  • the issue. Said there had been some
  • changes. Can you talk a little bit
  • about those articles and why they
  • mean so much to you?
  • Yeah. And I
  • love it that those articles are just
  • so old school.
  • There's no data, but what they're
  • saying rings totally true.
  • So he calls it The Doctor-Nurse
  • Game in the sense of a psychological
  • game, not like a game like Monopoly.
  • The communication is always loaded
  • in some way.
  • So in the earlier version of the
  • article, he says nurses
  • have to act as if every idea
  • is actually the physician's idea.
  • So
  • I make a phone call saying, "Mrs.
  • Jones is vomiting.
  • Do you think that Zofran would be a
  • good idea?" A standard
  • antiemetic drug.
  • And everything has to be presented
  • like that. And then.
  • In the revision of The Doctor-Nurse
  • Game, he says that
  • now nurses are "stubborn
  • rebels." We're going from
  • an era where women especially
  • were more compliant to the-- women's
  • movement starting, right?
  • We're having political protests.
  • So the nurse is now a stubborn
  • rebel, and the same
  • phone call would turn into, "Well,
  • Mrs. Jones is vomiting.
  • Are you going to do anything about
  • that?"
  • Very different tone.
  • Yes.
  • And what I like is I will admit
  • that I've done both those things and
  • more.
  • I have wheedled, I have argued.
  • And what's sad is
  • that it seems like there's not
  • that many situations where I can say
  • a doctor and I just talk to each
  • other as colleagues and equals.
  • That there's always
  • a feeling of, okay, how am I going
  • to get what I want
  • here? And even more
  • than that, how am I going to get
  • this person to share
  • his or her knowledge with
  • me so together we can make the best
  • decision?
  • Well, you mentioned the bullying
  • being another topic. I did not know
  • that this was as big an issue
  • as it was before reading your work,
  • but you talk about your experience
  • with it between nurses.
  • And after
  • learning a little bit about it from
  • your work, I kind of looked into it
  • and realized there's a vast amount
  • of literature, and that is a big
  • problem within the field.
  • Yes.
  • You write a little bit about it
  • being related to this hierarchy
  • issue and where kind
  • of nurses fall on that hierarchy.
  • Being
  • lower down on the totem pole, as you
  • say, when things go wrong,
  • you take it out on other nurses.
  • Have there been any changes since
  • you've been in the field in this?
  • Are there promising
  • attempts being made to address the
  • issue?
  • Well, first of all, the issue being
  • a lot more public.
  • So I see that
  • as a huge change, and
  • people acknowledging it as a
  • problem.
  • I've given talks on this, and people
  • ask me, "Do you know a place
  • where this really works?
  • What can we do about this?"
  • The best talk opportunity
  • I had was to talk
  • to a group of not
  • malpractice lawyers but people who
  • do risk assessment for health
  • care systems.
  • And it was one of those few moments
  • where I felt like from my mouth to
  • God's ears because
  • I could say to them, "You know,
  • you should really care about this
  • because this is what
  • can cause an event that
  • actually ends up leading to a huge
  • malpractice suit." And there
  • had just actually been one announced
  • in Pittsburgh. I won't go into the
  • details. Like right before I gave my
  • talk, which was perfect because the
  • whole issue was a
  • middle-of-the-night communication
  • between a nurse and a doctor.
  • And I said, "You know, you can look
  • at this, and you can say,
  • 'Seems like this nurse didn't know
  • how to do her job.' And that may be
  • what happened.
  • Or it may be that there's
  • a whole history of bad communication
  • between this physician and this set
  • of nurses.
  • And someone
  • ended up having a really, really,
  • really bad outcome as a result
  • of that." So that's what I hope
  • is that people are
  • starting to understand
  • that letting
  • these bad boy doctors -
  • and it usually is bad boys -
  • behave the way they are is really
  • detrimental to the system overall.
  • And the other point to make is that
  • people always say, "Well, it's these
  • doctors who are the big earners."
  • Those doctors are not earning
  • all that money for the hospital
  • and themselves by being
  • jerks and abusive.
  • It's in spite of that.
  • So that can't be an
  • excuse.
  • And when I talk to people who
  • work with physicians who have
  • these issues, they say, "Actually,
  • you know, the doctors don't really
  • like how they're behaving either.
  • I mean, it's not like these are
  • sociopaths.
  • They're just really overwhelmed
  • and stressed, and they
  • have issues, right?" But
  • for them, the opportunity to learn
  • a different way to be
  • tends to come as a relief.
  • And if it doesn't, then they
  • leave. They just find another job.
  • So you've spent, I think,
  • most of your career
  • as a nurse working in a hospital
  • setting. But recently, you've
  • changed, and you provide in-home
  • end-of-life care now.
  • Is that right? So you're outside the
  • hospital setting?
  • Yes.
  • Has working in
  • that-- has that change allowed you
  • to focus more
  • on doing some of the things that you
  • feel are most important in nursing?
  • That is, having a personal
  • relationship, providing personal
  • care to someone, and
  • doing some of those things that you
  • value most about being a nurse.
  • Yes. In particular, being able to
  • have uninterrupted conversations
  • with people, because honestly, after
  • working in the hospital and writing
  • The Shift, I was being sort of
  • stuck. And one day in the hospital,
  • I was feeling a little bit burned
  • out with just the level of
  • interruption and never being able
  • to focus on one
  • person at a time.
  • And I love it that I can
  • do that.
  • It's amazing.
  • My phone might ring
  • once.
  • It's very different from the
  • experience you describe in The
  • Shift.
  • Yes, yes.
  • And even then, I can usually say,
  • "I'm at a patient's home.
  • Can I call you back?" So
  • I love
  • that. And it's given me back
  • a sense of why I
  • got into this job.
  • There's also times when I miss the
  • hospital, and I feel nostalgic,
  • but I've loved
  • that aspect of the work.
  • And I also love, oddly
  • enough, that people
  • are in charge in their own homes.
  • The classic
  • example of someone who's on oxygen
  • who still smokes,
  • which is dangerous.
  • Right? And my supervisor,
  • we were talking about this at a
  • meeting, and she said, "Sometimes
  • all you can do is say to them,
  • 'Could you please just turn the
  • oxygen off while you're smoking.'"
  • Like they're not going to stop
  • smoking, and they need the oxygen.
  • And I really love
  • that. That there's a negotiation,
  • like, well, you know?
  • Well, I don't always feel like
  • taking this pill, like, okay.
  • Well, let's talk about of these
  • three pills, which one is the
  • most important for you to take every
  • day? Because in the hospital,
  • it's you'll do this, and you'll wear
  • this, and you'll eat this, and
  • you'll go here, and you'll stay
  • there.
  • And it's very hard on people.
  • So maybe patients-- maybe your
  • patients get to be themselves a
  • little bit more when they feel like
  • they're in a place they can have
  • some more autonomy.
  • Yes.
  • Yes.
  • Yeah, that's interesting.
  • Well, I want to ask you a little bit
  • about writing as well.
  • When you started as
  • a nurse, you did not think, "I'm
  • going to write about this." That was
  • something that you did because of
  • a certain experience.
  • I wonder, can you talk a little bit
  • about what that experience was and
  • what prompted you?
  • Why that particular experience led
  • you to need, really, to
  • write about it?
  • Yes, I was still a pretty
  • new nurse, and I had
  • a patient who was set to go home
  • that afternoon and start coughing
  • up blood. And then, start
  • basically
  • spitting up blood or almost like
  • spewing up blood and
  • dying. And we
  • called the code and ran the code,
  • but she
  • wasn't going to make it.
  • And she didn't make it.
  • And
  • I couldn't get past the experience.
  • I mean, I went back to work, but I
  • felt very haunted,
  • and I thought, "Well if I can write
  • this down,
  • it will be contained." And
  • that doesn't really work.
  • I feel like basically what I've
  • realized is you never get over
  • something like that, but you make
  • peace with that.
  • But it's just a part of
  • who you are as a health care
  • provider.
  • And when I talk about it, I see
  • a lot of nods in the audience.
  • So I think it's a pretty common
  • experience.
  • That first sudden, violent
  • death.
  • But I liked what I wrote, and
  • so I thought, "Well, aim high.
  • I'm going to send this to the New
  • York Times." And actually, a friend
  • of my brother's is
  • on the editorial staff, and I
  • sent it somewhere else to the
  • magazine. I never heard from them,
  • but he said, "You know, this is
  • really good. I hope this is okay." I
  • sent it to the Science Times, and
  • they liked it.
  • And they took it.
  • So very, very excited.
  • Took six months to actually get into
  • print.
  • But then, when it came
  • out, it got a huge,
  • huge national
  • reaction, which I'm not
  • saying as a way of bragging.
  • I really didn't expect it at all.
  • And I started hearing from editors
  • and agents saying,
  • "This is a voice. We never hear the
  • voice of a bedside nurse,"
  • which was so incredibly
  • empowering to me.
  • And you've written more or less
  • continuously since then.
  • In the times I mentioned earlier,
  • all of the attention that you got
  • for the piece you wrote about
  • doctor-nurse relationships in 2011,
  • I think. You mentioned in one
  • interview I read that you actually
  • had to talk to an administrator
  • after that. So that's one
  • kind of, I guess,
  • repercussion of being a public
  • writer and being a nurse.
  • How has that
  • experience been for you all along
  • the way? Are you looked at with some
  • kind of suspicion?
  • I can imagine that being one way
  • that people would relate to you.
  • But what's that been like in
  • general?
  • Yeah, there's definitely been
  • suspicion.
  • There were nurses who loved what I
  • did, and there were
  • a few nurses who,
  • for different reasons, didn't.
  • And I sort of worked with
  • talking to them and saying, "Oh, I
  • was thinking about writing about
  • this, and you were
  • in it." And they
  • were always fine with it.
  • But then, there were times when,
  • even when people were de-identified
  • or they just they felt kind
  • of exposed, even though no one would
  • know who they were.
  • And the hard thing for me was that
  • people wouldn't necessarily
  • come to me directly and say,
  • "Here's how I feel," which
  • I can see that that's hard.
  • But when you're all working
  • together, just I wish people had
  • done that, but whatever.
  • But since leaving
  • that job, I found more hospitable
  • employers.
  • And the challenge
  • for me is to just make it clear that
  • I'm there to work.
  • I'm not there to be super nurse
  • or Theresa
  • Brown, the author.
  • And people get that, and they go
  • with it. So they'll kind of say,
  • "Oh, you're that writer, right?" And
  • we sort of talk about it.
  • And then I'm like, "Okay, so what
  • about this patient?"
  • Yeah. I imagine if you did have
  • people come up to you and talk to
  • you, whether they agreed with you or
  • not, that would be
  • a really productive experience for
  • you. But instead, it's a shame that
  • that's not more of the reaction that
  • you get from your colleagues.
  • Yeah. I would have appreciated
  • that. Yeah. Like, let's
  • have a conversation about this.
  • But I don't know if it's
  • the power of being in print that
  • makes people feel intimidated
  • or especially talking
  • about end of life.
  • That was not
  • always popular in oncology
  • because a lot of oncologists just
  • feel like you shouldn't
  • talk about that.
  • You shouldn't talk about hospice.
  • You just should never bring
  • it up. And
  • I would love it if that would
  • change.
  • So that created tension.
  • People felt like I just shouldn't be
  • going there and writing about it.
  • Yeah, yeah.
  • It's interesting because you said
  • death-- you write this in maybe
  • both of your books, but death is so
  • present in your work.
  • And then, also when you're writing.
  • For that to be something
  • that is-- that
  • there's some kind of a taboo against
  • talking about it. Seems like that
  • would be one of the most important
  • things that you could prepare
  • yourself for.
  • Yeah. Well, that gets back to the
  • question you asked at the start
  • about are we prepared to talk to
  • patients about death and not
  • really. I mean, I even remember, as
  • a student, having
  • a patient who the husband
  • had made the decision to put
  • his wife in hospice.
  • I don't remember why, but it was
  • this patient that ended up doing a
  • kind of write-up about.
  • And my instructor said, "Well,
  • you're just basically sending this
  • woman to the funeral home." I
  • said, "You know, no.
  • This is the husband's decision.
  • It's very well-founded." And I
  • actually ended up
  • talking to him a fair amount about
  • it.
  • And that was kind
  • of the start of saying, "Oh, I can
  • do this." It's not you don't
  • know you can do it because we don't
  • get a lot of opportunities in life.
  • Yeah.
  • There's a fascinating study
  • that you've referenced, and that is
  • also, I think, I read in Atul
  • Gawande. His latest book from
  • Massachusetts General Hospital, of
  • patients who accept hospice
  • care, not only having less suffering
  • towards the end of their lives but
  • actually living longer.
  • Yes.
  • Yes.
  • It's not you're saying sending this
  • person to the funeral home.
  • It's quite the opposite, in fact. The
  • numbers show.
  • Right.
  • And that's one of the big
  • misconceptions we have to struggle
  • against in hospice that
  • people think the goal
  • of hospice is for people to die.
  • And it's not.
  • It's for people to live the
  • absolutely best life they can
  • until they die.
  • And certainly, if there was someone
  • on hospice with a certain kind of
  • cancer and an amazing treatment
  • came out. And they wanted to
  • try it, and they could stand
  • it, I'd be the first person to say,
  • "You should definitely do that."
  • We want everybody to live as well
  • as they can, but we
  • are all going to die.
  • It sucks, but it's true.
  • That's the effort to prolong
  • life at all costs.
  • It seems like there's
  • a strange kind of goal
  • of immortality somehow behind that.
  • Once you accept mortality,
  • then you can get all kinds of
  • positive results from that.
  • That otherwise, you wouldn't
  • be able to do. Quality of life being
  • one of them.
  • Right.
  • Right. And just do you want to end
  • your life in
  • an ICU hooked up to machines?
  • You can't talk to your family.
  • And if somebody wants that,
  • that's fine.
  • But do people understand
  • that they're making a choice,
  • and they could be at home?
  • They could have the people they love
  • around them. They could actually
  • have conversation.
  • And usually, if you present it like
  • that, people
  • will choose that.
  • And then, it's how do we help them
  • make the most of that time.
  • Yeah.
  • Well, one other question about your
  • writing I wanted to ask is about
  • your style.
  • As someone who was an English
  • professor, I'm sure you're aware
  • of style. The writing style.
  • You paid a lot of attention to it in
  • your past life.
  • How did you come to the style you
  • currently use? Have you thought
  • about it a lot over the years?
  • Was it something you worked on a lot
  • before you sent your first piece
  • out? And how has it changed since
  • you've been writing over the years,
  • or how do you think about that?
  • Oh, I think
  • the truth is I don't think about
  • it. It's just what
  • I do.
  • It's sort of what goes on in my
  • head.
  • That kind of spare
  • style.
  • And when I try to get too
  • flowery or metaphorical, it usually
  • just is like embarrassingly bad.
  • Those must be in early drafts.
  • So I
  • think what I've learned is what I'm
  • good at.
  • Interesting
  • detail, which I hope it's
  • interesting to other people, but
  • I'm also very spare with commas.
  • And so, the copy
  • editor went through and added
  • a whole bunch of commas.
  • And then, I went through and took
  • some of them out
  • and then got a note back
  • saying, "Well, we
  • went along with the comma decisions
  • to accommodate the writer's spare
  • style."
  • So the point being that
  • even at that level, it was important
  • to me to have a sense of
  • flow and control over the sentences.
  • That's just the way it
  • comes out.
  • Yeah.
  • I was kind of thinking about it as
  • I was reading and knowing your
  • background. And I had thought about
  • it in terms of the-- some of the
  • words that came to mind were
  • measured and kind of respectful in
  • a way. And then, I read a passage
  • of yours talking about the kinds of
  • relationships you have in
  • friendships you form with other
  • nurses, and you talk about it being
  • no-nonsense.
  • And it seemed to me that it was kind
  • of the way that you were writing
  • was, in a way, kind of like
  • respectful of the work that you were
  • doing as a nurse.
  • And that it had that no-nonsense
  • kind of character to it.
  • Oh, that's interesting.
  • Yeah. Yeah.
  • I mean, I love Joseph Conrad.
  • I love Faulkner.
  • I love their incredible writing.
  • But I think the styles
  • that really speak to me are
  • Hemingway, Raymond Carver.
  • I mean, I just
  • love that spareness.
  • And apologies for mentioning all
  • women. Flannery O'Connor also has
  • that.
  • I mean, all men.
  • I'm sorry. Mentioning all men.
  • Yeah.
  • Well, it's really the very-- it
  • creates a very moving work
  • for me when I read.
  • Definitely.
  • My last question is, what are your
  • plans for your writing from here on?
  • Do you have anything-- I mean,
  • you're going to keep, I hope, writing
  • for The Times. But other than that,
  • are there other projects you have in
  • mind that are larger than that?
  • There will be a third book.
  • It's sort of a light
  • on the back burner of my brain, and
  • that's about as far as
  • it's gotten.
  • It might be something about
  • end-of-life and hospice, but
  • there are so many books about that
  • now. I need to make sure I have
  • something that's
  • new enough to be worthwhile to
  • say.
  • But yeah, I will keep at it.
  • Well, we look forward to more of
  • your work. And Theresa Brown, thanks
  • so much for joining us.
  • Thank you.
  • That's it for this edition of Being
  • Human. Stay tuned next time when my
  • guest will be Jeff Williams,
  • professor of English at Carnegie
  • Mellon University and author of How
  • to Be an Intellectual.
  • Thanks for listening.