Nurse’s Notes

“Nursing is not for everyone. It takes a strong, intelligent and compassionate person to take on the ills of the world with passion and purpose and work to maintain the health and well- being of the planet”. (Donna Wilk Cardillo)

“The most important practical lesson that can be given to nurses is to teach them what to observe.” (Florence Nightengale)

“Do you want to speak to the doctor in charge or the nurse who knows what’s really going on?” (Anonymous)

In recent weeks, activist nurse Kaci Hickox has been the focus of a national debate about the appropriate level of isolation required of health care workers returning from Ebola stricken territories. Initially the story was that she had served as a volunteer with Doctors Without Borders in Sierra Leone as a medical team leader for a 250 personnel staffed Ebola treatment center. Upon returning to the USA via Newark Airport, under orders from New Jersey Governor Chris Christie, she was detained and then transported to University Hospital for a mandatory 21 day quarantine, despite evidence that asymptomatic carriers are not contagious until symptoms appear. At the time Hickox was asymptomatic and had tested negative for Ebola. Still she found herself confined to a stuffy isolation tent within one of the hospital’s outside buildings.

Restricted to this primitive space, allowed only a porta-potty and no shower facilities , which she described as “ Chris Christie’s private prison”, Hickox immediately contacted a civil rights lawyer and demanded her release. The outraged and surprisingly media-savvy health care worker then reached out to major media, such as CNN and Huffington Post and penned a bitter op-ed to the UK Guardian instructing all media to immediately stop referring to her as “the Ebola nurse” since, as she said, she never had Ebola. Hickox further objected to letting politicians dictate medical and public health decisions. (huffingtonpost.com, November 2, 2014).

Whatever one’s views about this incident, it serves to highlight an interconnection of political and public health issues, which may have similar or possibly very different priorities and agendas within the multifaceted complexities of our modern day information and control matrix.

While I can certainly empathize with Nurse Hickcox’s distress, especially after an emotionally and physically taxing tour of duty in Sierra Leone, it seems that she had no room whatsoever for a possibility that, admittedly bellicose Christie may have acted, at least in part, out of a genuine concern for public health.

By way of disclosure, I have just a bit of a soft spot for this occasionally likable, bully boy, populist politician known for his hard-ball tactics; since we grew up in the same community and graduated from the same high school, where this ambitious “mud-wrestling”, career politician had already been elected student council president. Ours, in my day at least, was then a progressive Republican, politically engaged, suburban community with an excellent and forward looking educational system. Somewhere back there, in my nostalgia for the fifties, I remember that our school had co-ed gym classes, female track teams and shop classes for girls, where we could learn about tools and building things. Civics, American and World History classes were mandatory, many levels of sciences from biology on up to anatomy and physiology, chemistry and physics, as well as all modern languages, with Greek, Latin, art and music as electives. Naïve as I was then, I thought most public schools were like ours.

As I said, we lived in a politically engaged community and on one memorable occasion, a very elderly Eleanor Roosevelt came to our school to promote the values of community service. Being young, I was more curious than impressed about this funny old lady with a high pitched voice whom everyone around her seemed to revere. Only with hindsight, did I come to appreciate the rare opportunity to have heard that great lady in person. As my Mother often noted, much later in her life, after having left the GOP; “Republican’s were different back then”.

And so, with Nurse Hickox’s well placed connections, applying pressure from the top down, the Garden State’s Republican governor reluctantly released her to her home state of Maine and to the jurisdiction of the also conservative, Republican Governor, Paul LePage.

Upon arrival in her home town of Fort Kent, this governor immediately ordered her to remain confined within her house, which he surrounded with law enforcement personnel. Having had quite enough of what she considered to be unlawful and unnecessary confinement, and a violation of her civil rights, Kaci Hickox took her case to court and won permission to venture outdoors, as long as she did not enter into crowded public spaces. Soon thereafter, the defiant nurse and her life partner ventured outside for some fresh air and a short, media beleaguered, bike ride.

It should not be so surprising, human nature being as it is, that response from the local community to this newly granted limited freedom was mixed. At home in Fort Kent, many residents demanded that “the Ebola Nurse” stay indoors or leave town. Several social media groups demanded that she leave the state . Her life partner claimed that he was banned from the campus of the School of Nursing at the University of Maine in Kent; over considerations of safety from Ebola but also because of multiple death threats. Other citizens, including the Chief of Police, regularly delivered groceries to the couple’s home and a local pizza parlor pitched in, as well. As the quarantine came to an end, the couple announced that they were leaving the state.

While, in some ways, this story seems straightforward enough, we now have a twist in the narrative which gives sufficient pause. As it turns out, Nurse Hickox is also a special agent, covert operative, and CDC Epidemiology Intelligence Officer, attached to the Epidemic Intelligence Office (EIS) which has close ties with the military. EIS officers wear military uniforms with shoulder stripes, stars and badges when appearing before Congress. The Centers for Disease Control and Prevention is a National Public Health Institute and federal agency under the auspices of the Department of Health and Human Services in Atlanta, Georgia. Considered by some to be the CIA of health care issues, the CDC engages in information warfare and also owns a patent on a strain of Ebola (No. CA2741523A1) which was awarded in 2010.

Officer Hickox has been remarkably quiet since being outed, amongst suspicions that she functioned as a “crisis actor” in a carefully scripted medical theater event. It is well known that the CDC is against travel bans from Ebola affected countries as well as opposing mandatory quarantines for civilian travellers and returning health care workers. In contrast, our military is enforcing a 21 day mandatory quarantine for all personnel returning from West Africa. At this point, it is difficult to determine any clear agenda within this media driven hall of mirrors. (theflippentruth.wordpress.com, 10/31/2014).

Meanwhile, the appearance of Ebola patients in American hospitals, as a potentially lethal threat to health care workers, prompted nation-wide protests after several nurses caring for infected patients contracted the virus. While various spokespersons for hospital management, tried to spin these infections as “lack of proper protocols”, the nurse’s refused to accept these “blame the victim” tactics. The real problem, they maintained, is a total lack of preparedness for possible Ebola cases, as symptomatic of a more generalized erosion of patient care standards. They remain adamant in their advocacy for community based, “patients before profit” as opposed to an increase in corporate dominated “profit before patients” health care facilities, which remain chronically under staffed.

As a result, National Nurses United, our nation’s largest professional nurse’s union, launched a two day strike by some 20,000 nurses in California, and plan a larger national strike to involve over 100,000 nurses in 15 states as well as the District of Colombia. Nurses are protesting insufficient protection in caring for Ebola patients which should require full-body Hazmat suits that leave no skin exposed and which are equipped with face shields and sufficiently powered air-purifying respirators. Moreover, they are very reasonably demanding hands-on training for proper donning and doffing of protective gear, waste disposal and other isolation unit protocols.

Most nurses involved in these protests, will not walk off their jobs, choosing instead to hold information rallies and candlelight vigils at various locations, including areas just outside of the White House. This move toward action, by this profession, is something relatively new in the realm of social change. Until recently, members of healing and helping professions, such as nursing and teaching, would not consider unionizing or doing anything so radical as a strike. As a result, legitimate demands for much needed change have often been marginalized.

Prior to the foundation of our modern nursing professions, care for the sick and injured was mostly provided by the military and members of various and mostly celibate, religious orders. Various elements of those traditions which involve duty, discipline, obedience, humility, overwork, “a calling”, uniforms according to rank, idealism and self-sacrifice; have persisted up until our modern era. Early founders such as Florence Nightingale, who wrote Notes on Nursing in 1859 and Clara Barton who founded the American Red Cross, were among those strong, visionary women who contributed to early models for professional education and training. Hospital based trainings came to the fore during the early 1900s with an emphasis on clinical experience. These low tuition, diploma programs, attracted women from middle and working class backgrounds, and provided hospitals with cheap and even free labor. Early on, these three-year programs were residential, at a time when most candidates were female and subject to regimented, nearly cloistered, dormitory regulations. As such, there were strict curfews, severely monitored room regulations with regular inspections, and emergency-only and limited holiday passes. Violators were either expelled or subject to some form of penance, usually having to do with confinement, and extra duty.

These, almost nun-like, student nurses, were expected to be young, remain single and celibate; and those who were “caught out” with a pregnancy were summarily dismissed. Each hospital issued its own color coded, stiffly starched uniforms, and branded cap designs often resembling those of Victorian parlor maids. In most of these programs, these caps had to be earned during a probationary period and then awarded during some version of a candlelit ceremony, with family members in attendance. Uniform regulations were such that hair must be worn well above the collar, caps were never to be worn outside hospital premises; make-up needed to be subtle and colored nail polish forbidden. These and other regimented protocols were strictly maintained during an era when most doctors were male. When a physician or male medical student entered a room, student nurses were instructed to immediately rise to their feet in a show of respect and deference, in keeping with their role of “hand-maidens” to these physicians.

As the profession slowly evolved and achieved some distance from those long standing, quasi-medieval, rigidly religious and military origins, more and more gradually enlightened nursing schools became college-affiliated and eventually offered various levels of degree programs, ranging from Associate of Arts on up to a Ph.D. Health care educators finally realized that is was not necessary for nursing students to reside in nanny controlled residences, nor to be female, single or celibate; and that pregnant and older women were often excellent candidates as well.

While many students still wear school uniforms during their clinical rotations, most graduate nurses have forgone those formidable, off-putting, stiffly starched caps and whites; and prefer go about their duties in more relaxed, practical, colorful, and patient friendly, scrub-suits.

Despite these welcome and much needed improvements, the nursing profession is now in crisis with at least one in five graduates leaving the field. Their current strikes, protests, and vigils are evidence of this disturbingly widespread dis-satisfaction with lack of safety and necessary supplies, unsatisfactory working conditions, low pay, poor benefits, understaffing, stressful physical demands, mandatory overtime and irregular hours. Other excellent nurses have left after refusing what they consider to be unsafe compulsory vaccines, especially for pregnant women, as a condition for employment. These varied and valid concerns raised by the nurses and other health care personnel should warrant the immediate attention of all of us who expect and are in need of quality health care.

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