Southern Exposure

Ruminations of a Native Son


Greater Washington. DC., United States
February 06
Compulsive writer (mostly memoirs and sociopolitical rants), musicologist, hermeticst, fiscal conservative, radical centrist, agrarian socialist; Charter member, Factualist Party; born and raised in DC, healthcare professional, retired businessman, civic and political activist on two coasts, civil rights movement veteran. An empiricist's worst nightmare, I believe in everything but I don't believe everything, including many things I believe in. Turned down by US Army in 1966 for medical reasons, thrown out of Col. Hasan's Black Man's Army in 1967 for being "too militant." Scion of a family only Tennessee Williams could have dreamed up. There's more. There's always more.


APRIL 11, 2012 11:59PM

The Ghost of Gladys Spellman

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Recently a Facebook friend asked me how I manage to avoid burnout in nursing, and how is it that I am able to say "I love all my patients, even the ones I can't stand."

An interesting thing happened the day I was planning to write this: I got sick. I live alone. I am often reminded I am a senior citizen, to which of course I reply with a crotch-grab, "I got your senior citizen right here." It is not denial. It is a Dorian Gray thing, I suspect. At any rate, getting sick while living alone delayed my writing, but it also put a finer point on the issue of the questions. I'm glad I live alone when something like that happens. My house is a shambles after 36 hours of chills, fever, nausea, splitting headaches, etc. Yeah, a "man cold." I'm glad there was no one here to pick up after me. That would be more than wrong. 

In the morning I will rent a bulldozer.

But I digress: The burnout factor is something I live with and have lived with ever since this second career found its roots in my 30 years of fire/EMS service, when I saw the same thing happen to, first, "aid men," then ambulance corpsmen, and finally EMTs and paramedics. A lot of them, like a lot of nurses, seem to go cold after a while, to just be going through the motions, or worse, to resent the very people for whom they are caring. 

I am reminded of the night a car came screeching up onto the apron of my fire station. A young woman in the passenger seat was gasping desprately for air, doing what we call "posturing", screaming and sobbing that she couldn't breathe. A classic first panic attack. Our ambulance, as it often was then, was out of service again, so we called for a medic unit since it was technically a "trouble breathing." I began talking to the young woman, talking her down (I've done this countless times, and they first look at me like I'm insane, but eventually they catch on and start to calm down). Medic unit arrives, paramedic goes to patient side of car, recognizes what's going on, and begins to berate and shame the patient for being "hysterical." I tapped him on the arm, nodded for him to follow me to the  other side of the medic unit (where I'm sure he thought I would tell him this was a frequent flyer), grabbed him, slammed him against the ambulance, and said "Motherfucker, you're at my house now, and if you ever speak to one of may patients that way again you will be getting flown to the trauma center."


Which one of us was burned out?

But again, it is digression, because what really guides me now, even with all those years of preparation, all that time regarding those patients as "mine" as in "my sister," or "my mother," etc., I wind up working at a hospital that contains the Gladys Spellman Specialty Care Unit. This is a very large wing with 90% of the patients on ventilators, either hopelessly mired in end-of-life issues or having sustained permanent brain damage. Sometimes it's someone from a nursing home who caught pneumonia and is now living in an unattractive sort of mechanical homeostasis. 

I am a critical care technician. My home base is intermediate medical care (IMC), the best place probably to work in my hospital (yes, I am aware I speak of all these things in possessive terms. That is not an accident), though I really prefer the ER. But I have a sweet deal here as a PRN ("as needed" or per diem) worker; I make my own schedule. The quid pro quo is I don't know what unit I'll be working on a given day. And at least once a month all us PRNers have to do a turn in the Spellman unit. It is the name of that unit that makes my approach to caregiving the opposite of burnout. I've said, and I believe, I couldn't do that every day. But when it's time, I go and do it anyway, and I love those patients too, who cannot speak to me, at least verbally, or who may even lack awareness. Hope does spring eternal. Sometimes it pays off, too. Statistically not very often, but they are still people, people lying in their own waste, people sometimes physically falling apart, bedsores, sloughing skin, unseeing eyes - or as often those eyes that see in such a panetrating way that I am locked into them, and we converse in a way that defies words, just as the suffering of being trapped inside one's body must be the most horrific sort of nightmare, and yet I can come and join them in the experience for a while, and I do. I don't look away, I look in. This prevents burnout. The conventional wisdom is "don't get emotionally involved." My acquired wisdom is that the only way to avoid burnout is to join your patient, no matter what's going on, whether he or she in in a hospial bed, ER cubicle, lying on a sidewalk, trapped in a wrecked car, at the t0p of an antenna tower...


Or a politician working the crowd at the mall here in Laurel in 1980. Gladys Noon Spellman was one of the most loved, respected and accomplished Democratic Senators ever. She was talking with constituents, hugging people, shaking hands, making the rounds, one of those typical political moments, when the Sword of Damocles fell and her heart stopped beating. No reason. She just hit the floor.

The local rescue squad arrived, performed CPR, delivered her to what is now "my" hospital, but while her heart resumed beating, her brain did not wake up. She was transferred to the flagship hospital of the county system, back in the town where she'd lived, raised a family, taught in the local elementary school, become an advocate for educators and education, ran successfully for the County Council, was appointed by President Lyndon Johnson to the Advisory Committee on Intergovernmental Relations in 1967 and was awarded the highest honor that could be bestowed by county officials nationwide when she became the first woman elected president of the National Association of Counties in 1972. 


 Former Happy Acres Elementary school, where Ms. Spellman taught.

When it became clear Ms. Spellman was unlikely to come out of her coma, other patients with similar problems were placed in the same area. Gladys Spellman died eight years after that ordinary night in 1980. By then a unit had formally been created at the big hospital to care for people who, for the most part, weren't going to come back, who were stuck in limbo. Steny Hoyer won Ms. Spellman's seat when it was finally declared vacant in 1981. Two years ago the unit was moved to my hospital, because there was an underused wing. 

Gladys Spellman was just an ordinary person who did extraordinary things. She walked among us, she fell among us, she was rescued - or perhaps not - by fire-EMS personnel on the floor of the now-moribund Laurel Mall, she was treated in the intensive care unit of the big hospital, and now the unit is at my hospital and that wing of the 4th floor bears her name. 

It also bears her legacy. Every one of those people, in fact every person who comes through the doors, usually beginning with the ER, is an ordinary person with a story. Most of them get better and go home. Some do not. Some linger for months or years. Even those who go back where they came from are sometimes bitter. Wouldn't you be if you were 80, as a recent patient of mine, and knew when you were well enough you'd be returned to the nursing home you'd been living in prior to the hospital's god-awful atmosphere? (And I say that having spent some time in hospital beds as a patient - it is not the greatest place for a sick person to be). This gentleman was difficult. None of the med-surg staff (where I wind up more than half the time normally because of a shortage of help) liked him. He was very insistent about one thing in particular: that his door be open far enough to allow air to circulate (the 4th floor is hot year 'round. I do not know why) but closed enough that he could sit on the edge of his bed and use the urinal without being exposed to passers-by. He had, in his mind, the perfect alignment of that door, and he had been cursing people for several days for not placing it just so. 

I also once failed to get it right, and he yelled at me and cursed me. I apologized, moved it slowly, saying "Tell me when it's right, okay?" which he did. A while later I came back and he was sitting on the edge of his bed. He said "I'm sorry I cussed you" in a very contrite tone. I told him it was okay, I understood. He raised his voice then, saying "No it isn't! It's not okay! I was wrong. Don't tell me it's okay. I know better than to act that way!' I stood, silent, for a moment, thinking what, if anything, might be the right thing to say. 

"I'm sorry," he said again, in a soft voice. 

"Thank  you, sir. Apology accepted."

Then one of those things happened that I cannot explain and almost never mention to anyone: I felt something; a physical touch on my shoulder, and a sense of voice where there was no audible voice, saying "We get a little testy sometimes."

I knew that touch from more than 30 years ago. I knew that voice that only existed inside my head. 

Ordinary men and women, every one. From the crazy drunk to the drug seeker to the needy and demanding sickle cell crisis patient, to the frightened one with chest pains who is feeling that sense of imminent doom, to the panicky patient who will be talked down eventually, to incredibly demanding to those who seem to have given up and those beyond having given up. On giving report to my relief at midnight in the Spellman unit: "Everybody alive and breathing? Good." 

They are all mine when I am there, and Gladys Spellman walks those halls with me, and in the words of Dan Fogelberg, "Death is there to keep us honest and to constantly remind us we are free."

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AJ, I've not finished reading this post, deeply meaningful to me. But I must stop because it overwhelms me with gratitude. I am not complaining. Thank you. I thank you as a representative from the receiving end, for all those who cannot. You are a rare gem, and shine with the ability to put into words what makes you so, inspiring the rest of us. I thank you as a reader and as a person seeking... answers. I will return to finish when my I have found a way to hold this vastness already in my arms. With love and gratitude.
Thank you dear Maria, for inspiring this post and for your words. Take your time. Thank you so very much.
Maria said much of what I would have -- and she herself is remarkable. You are special -- and I have sensed it from reading this and from reading so many of your writings. And having had the privilege of meeting you, I now know even more how authentically empathic you are. I wish you joy.
Thank you, Lea, for reading and for your very kind words. I tend to think of myself as eccentric in this business, but when I read what you and Maria have said here I feel more like I am just where I am supposed to be. Joy is sure to follow that.
I returned to finish reading. AJ, it is my wish that I have the privilege of meeting you one day. There is good writing, which you demonstrate. Then there is goodness, which you are. Reading this, I am once again blessed with the reminder that all my suffering was worth it. It has afforded me an appreciation of what you do, of the kind of selflessness required. Let none of this go to your good head. Which has nothing on your humble heart. May it always remain so. I speak from the other, voiceless, end.
PS - request for next post - "I knew that touch from more than 30 years ago. I knew that voice that only existed inside my head. " Description of what happened more then 30 yrs ago.
Maria, I would very much like to meet you someday as well. We'll work on that. I'm truly left at a loss for words, knowing of your personal ordeal, which has served to help put my own in sharp perspective, though having been briefly on that other, silent end, nowhere near the sort you suffered, I did have a hard time waking up after emergency open heart surgery. I heard things, just couldn't respond. A nurse, possibly burned out, remarked later when I was conscious, "We thought you'd pulled a Spellman on us." Welcome back to the world!

Not to worry about my head getting bigger. I have an aversion to that, though I do believe it gets harder with time. :)

You know, I can tell you very quickly what that touch and voice thing were, where they came from, and yet you have still inspired another post regarding that sort of phenomenon. In this case it was a very vivid flashback to 1970 (well over 30 years!) when Gladys and I found ourselves on opposite sides of a volatile political issue that would affect the local fire and rescue service. I got rather passionate at one point, perhaps even vitriolic, but it wasn't aimed at Ms. Spellman personally. When the discussion was over I approached her to apologize for the heatedness of the debate and she put her hand on my shoulder, said "We get testy sometimes," Winked, patted me on the back and said "You have a future in politics." I'll never forget that.

That said, there is more to the "ghost" thing and I should write about it. Now you've made me feel safe in doing that, and so I will. Thank you for your inspiration yet again.
Thanks, L'Heure...
Wow! The concept that some people are "called" to their profession rings true with every word.

You are to be congratulated, sir; for finding time to write this after, cold, flu and hyper-ventilating ladies!
I'm not getting any younger, and if I end up in a like position, I can only hope you are working that night.
enjoyed accompaning you on this 'walk' through the joys, pain reality of life.
Thank you. I have spent twenty + years in healthcare being told that to become too close to a patient is the wrong way to do nursing. Thankfully, that is changing in nursing education. Nursing is the art of caring for someone within the science of the human body. Miracles happen everyday and living in the moment that your patient is experiencing is the only way that I am comfortable in my own skin as a nurse. I love grumpy, crotchety old men, frustrated young adults and even the people that others pull their hair out over. I have over 2 ft of hair, I can spare a bit.
This is one of those posts which reaches deep into the soul. Aging is difficult, but confronting illnesses and incapacitation is profound. People who are skilled and have the right mixture of empathy and compassion serving others in this kind of situation are no less than saints on earth. I am glad that Ms. Spellman placed her hand upon your shoulder. That too gives hope that in the next life we can still effect things that matter. Your message from her, and your life speaks to a telling reality, we must do our very best, frustration is present, but our better natures must win out. It is that nature that gives meaning and purpose. I think my sister, who passed, a life long nurse too, was a person of great compassion too.
Yes, the whisper from the past is a very interesting follow up to do one day and i look forward to reading that too! Politics would be so lucky to have you, even if it is to influence policy from the arena of the ward, with the credible and powerful voice of action on the ground. My wish is all care givers should learn from you. And this piece you have written touches others; i see the shares it inspires on fb by people who read and are moved but do not comment here or press like buttons. I want you to know that the reach of this kind of sharing exceeds feedback - and we will never know the profound butterfly effects of it. So glad you wrote this.
Director of Studies: Thank you so much. For me, it's less a sense of being called than of being grabbed and pulled in. I can't imagine not doing it. The couple of days spent lying in bed shivering and coughing really helped bring this into sharper focus for me, so it was opportune.

Social Maggie: Should that ever happen, and I pray (in my way) that it never does, I will be there. It may not look like me, but trust me on this...

kenneth houck: Thanks for coming along. Much appreciated.

songbird1o1: You've said in a paragraph what it took me several hundred words, two photos and a music video to express. Thank you for your wonderful comment. Yes! It is only by living in that moment that one's patient is living that it is truly an act of caring. I couldn't do it any other way, and I'm quite sure that's what causes most burnout, just trying to keep one's distance while wading through the human detritus to get to the human in that bed.

SheilaTGTG55: I honestly believe there are two things necessary to nursing as opposed to functioning as a sort of custodian: One must be prepared for "miracles" for lack of a better word, open to them in fact, and willing to understand the symbolism without caring much what brings them about; and Two: Be prepared to dive into the deep end of the garbage pit of life, to find the human soul in there and if nothing else, just hold its hand. Your sister was no doubt a saint, in the truest sense of the word. Thank you for your wonderful and rather wondrous comment.
Maria: Once again, thank you. I trust your perceptions and this case is no exception. If I've accomplished what I set out to, then I'm gratified. Your words reassure me that I have.
I loved reading this, so tender. Thank you for being of the same ilk as those who cared for my Daddy when I could not be there, small town Ohio, excellent. He had voice, and eyes, and he related with them quite well, and it is lovely to know what that was received like. Thank you for this glimpse into the Interior of a world that is exterior to those in your Care.
The Songbird: Thank you for your lovely and touching comment. I'm happy if I managed to shed some light on the other side of that relationship, as I have been on both sides, which I believe maybe has made me a little better at what I do. My best to you.
This is my first reading of this post; I missed it last year. I'm reminded of people I've known who have been patients in end-of-life care, and of people whose words I've heard when they haven't been physically present, the most profound of which was the voice of a much-loved friend who had died; he said clearly, "Don't waste it." He meant, "Don't waste this second chance. Don't waste this opportunity. Don't waste this life." I'm not sure whether Gladys Spellman is a ghost or a spirit, and I'm drawing a fine distinction. If I ever find myself in the Spellman unit, I hope I have a healthcare provider who has even a fraction of your insight, compassion, and skill. Rated.
Susan, First, thank you for your lovely comment. I use the term "ghost" in a slightly different way than that concrete notion, but more a presence that no longer owns a form, but continues to exist. Ghost, spirit, the distinction is, for some of us, a very fine one. "Don't waste it," also is quite eloquent, in that these...ghosts, spirts, people? tend to be economical in the use of words, for reasons that make sense to me, and which strip away all the extraneous baggage so they are understood perfectly by the one hearing - or feeling - them.

Your last sentence touches me very deeply, and makes me think again of that ghostly advice: "Don't waste it." Eternity runs above time, Paul Tillich tells us. But time is what we have to work with until we don't

Thank you so very much.
I hope I have someone like you around when I finally break down..
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Thank you, Algis, and may that be a long, long time in coming.