Dear nursing intern,
I understand your frustrations with our field. It can be disheartening to walk a line between health and disease everyday when so often times the lives placed in our hands are lost. Few in our field have escaped the misplaced blame of distraught families after a cruel twist in fate steals a life in its prime, and we, the professionals responsible for saving that life, fail. How vain our struggle seems sometimes when despite our best efforts good people die and bad people survive, how helpless it feels to know the selection is done by a force greater than ourselves, and we can not compete with it.
You are not nearly as helpless as you feel. Science has come a long way since the ancient medical practice began. Currently I am in a history class that has taught me more than anything else that modern medicine has evolved from ancient craft to a contemporary science through an explosion of knowledge that has happened particularly within the past 100 years. This is especially true with women’s medicine because the female anatomy was not seriously studied, let alone understood until the eighteenth century.1 Considering all the resources at our disposal now, and the cost of having them has breathed a fresh breath into an old passion. People had to stumble in the dark for years to find out what we know now, and so much of that we take for granted. I am telling you this for encouragement. I personally found a great peace with the medical field and its hardships through this class.
You see, I have learned that today we are lucky. Patients can finally trust the science of medicine to help them more often than hurt them and to be founded on knowledge based in fact rather than experiment. Meanwhile, for those of us entering he medical profession we have the benefit of accessing a knowledge that has already been built and communicated, one that is constantly advancing. This is the importance of history, people do not study history to dwell in the past, or to look with hindsight at all the better outcomes that may have resulted had things been done differently. Rather, history offers a place to grow from. We owe history, and all of its mistakes, for our future, and all of our successes. Our technology allows us tools for more precise work, and noninvasive diagnostic tests for more accurate identification of pathology. We are so better equipped, mentally and physically, than our predecessors.
The first nurses were midwives, exclusively female, knowing only what they had been told and had observed. They were probably just as nervous as you but not nearly as prepared. Their remedies were herbal concoctions that had been passed down. Their methods of delivery were crude and dangerous.2 Can you believe that for so many centuries people did not even understand the importance of hygienic? Midwives didn’t even wash their hands after delivering a baby before moving on to the next patient. Can you believe that up until the 1900’s no one made the connection that the food you eat influences health and growth?3 A concept as basic as nutrition was foreign for that long. Only in recent years have historians realized that the high infant mortality rate among African Americans during the years of slavery may have been due to an inadequate nutrient intake, since slaves relied on a high-calorie, low-protein diet.4 But it makes perfect sense that it took so long for that connection to be made.
Throughout most of history people were ignorant about the mother/child relationship during gestation and after birth. This was clearly demonstrated by the fad of wet nurses, where a child was sent way to be cared for by a random woman who got paid for these childcare duties, one of which included breastfeeding.5 There was no concept of the benefit of breast milk, or the importance of mother’s milk, or even that fetuses and nursing infants ingest mostly whatever the mother ingests. Now that concept is so prevalent that some topical medications must be cleared by a doctor before applying while breastfeeding. Had physicians known the fragility of that barrier wet nursing would have never gained popularity. However, now that we do know we are able to use it to our advantage by increasing a fetuses odds at health by providing the mother gestational vitamins, such as foliate, and direct her from harmful behavior such as drinking.
Another aspect of the health field to have undergone much improvement within recent decades is abortion. Although self-induced miscarriages have been done all throughout documented history, the often-barbaric ways in which they are carried out almost always risked the mother’s life as well. Otherwise, they all posed a risk of sterility, just as the abortifacts used by slave women such as pennyroyal and cedar berries.6 We have all heard awful anecdotes of desperate teens using clothes hangers, poison, or throwing themselves down stairs, especially during the years when abortion was illegal in America. However, there was a time when girls would pay people claiming to be professionals for an abortion, and these early physicians would do the very same things. In one book for the history class I mentioned there is a fictional account describing an abortion. Graham Swift goes into gory detail in his novel Waterland when premarital sex leads to the unwanted pregnancy of one of his characters. Without much choice she approaches the local medicine woman who ties her up and uses a straw-like contraption to suck the fetus out. As a result the character contracts an infection that nearly kills her, and leaves her barren for life.7 Imagine this happened in real life as little as fifty years ago! Imagine how much more fortunate we are today, our youth receive a sexual education in school and offered easy access to contraceptives and pregnancy options.
Science is a domino effect. In order for the dominos furthest down the line to be reached, some dominos in the beginning must fall. Well, in order for milestones in medicine to be met, someone had to start somewhere. This goes without saying that the advancement of medicine has come with a price. For most of the history of medicine people didn’t know what they were doing. Success, health, even survival was completely dependant upon trial and error. In order for the past century to be this successful a lot of dominos had to fall. There were many firsts and many failures. But I have come to a better understanding through my history class that these often-frowned upon steps were necessary to getting the medical field where it is today. Dr. J. Marion Simms eventually came to be called the father of modern gynecology, but only because he experimented so many times to critique his methods. He performed thirteen operation on one female slave he had purchased for experimentation during a course of only four years.8 Does he deserve honor and recognition? I’m not sure, but I am sure that because of what he taught thousands of women have benefit. My history class has opened my eyes by challenging me to consider the past before automatically accepting fact as truth. By doing so I have come to realize the true significance behind the progression of our field. I can hardly imagine how many deaths were caused by diseases that today we can easily treat or even prevent with vaccines. Yet, in order to attain those life-saving vaccinations there had to be a first to be inoculated. Perhaps sometimes the end does justify the means. Anesthetics were not used until the 1840’s, but does that mean in the interest of human suffrage that not medical procedures that caused pain should have been done until after those years? Where would we be then? Regardless of whether or not you agree with controversial dominos that fell during the history of medical progression, undoubtedly experimentation and suffering occurred, and can not be reversed or undone now. My history class sheds light on many aspects of humanity that are shameful. However, if there is to be any justification at all it is that people have died to make this world a better place. Remember that always while nursing, everything we know is more valuable than I had ever comprehended before this class. It will give more meaning to your work; even seemingly mundane tasks such as patient charts and documentation will become less trivial when you think about a time before they existed and how difficult it must have been to manage without them.
Now for a word of warning: don’t confuse technology today with a lack of need for evolution. Scientists get cocky when lulled into a false sense of comfort about all the things they know. The truth is that in some respects we have hardly progressed at all. For example, it is easy now to discredit the popular scientific belief of the 1800’s that African Americans are biologically predisposed to be inferior to Caucasians and how it was “proven” using skull measurements.9 Perhaps that seems less ridiculous when consider that today, despite all our progress; racial and social discrimination still manifests itself in the medical field. For instance, did you know that presently African Americans have the worst health status of all U.S. ethnic groups?10 Still the average life expectancy for black people is almost six years less that that of while people. No surprise since compared to whites black people have a higher incidence of stroke, cancer, heart disease and diabetes! These are not old statistics, inequality in the medical field occurs today. By age seventeen 40% of black children have never been to a dentist!11
That is the final lesson my history class has taught me: that nurses, the medical profession, and humanity as a whole, still have a long way to go. However, no profession that offers great incentives comes without sacrifice. Nursing requires sacrifice, yet rewards one’s dedication three fold. Alas, the loss of a patient is a difficult feeling to imagine, but so is the feeling of saving a life, or even having played a small role in the process. Helping people is the main cause for nurses, it is our motivation. And mind you, not just for the sake of the present. You see, just as the medical pioneers of the past have taught us vicariously, so too is it our job to contribute the experiences of our time to the future. So try not to feel too discouraged. I promise all the hardships are worthwhile in the end.
Sincerely,
Kiri Conneely
RN
