"A Nurse's Story: Life, Death, and In-Between in an Intensive Care Unit"
When I first read Tilda Shalof’s book, “A Nurse’s Story: Life, Death, and In-Between in an Intensive Care Unit” three years ago, it changed the course of my entire nursing career.
When I began work on my Bachelor’s degree in Nursing, I was dead set on becoming an Emergency Room nurse. My vision was completely tunneled, and no other alternative was acceptable. When I wrote a paper in my first of four years entitled “Why I Became a Nurse,” I wrote that I became a nurse because I loved the television show ER and I wanted to be just like the nurses I saw on TV. This reason was partially in defiance of what I felt was an essay topic suitable for a grade three class, and partly because I wanted to be unique. I was quite aware that what they were looking for were stories of being “called” to the profession.
However, in Tilda Shalof’s book, I found a new hero (sorry Carol Hathoway)! The author takes our hand and pulls us, with eye’s wide open, into the world of the ICU. When I first read the book, I had minimal real-life hospital experience. I had only spent about eighty hours on a medical unit giving bed baths and helping patients to the bathroom. At the time, the ICU was a completely mysterious and inaccessible place (and to a large extent, still is). There were no television shows that focused around the lives of the doctors and nurses that inhabited their halls, and I knew that my education would not include any critical care experience.
Thanks to Shalof’s accounts, I discovered that the ICU was a completely unique experience in nursing. Instead of many patients, the nurse has one patient that they focus on completely throughout the day. Shalof describes in much detail the many focused tasks that ICU nurses are continually performing: all the tubes that must be checked, the monitors that must be monitored, and the constant assessing and adjusting of treatments.
But as nurses know, the direct patient care is only the tip of the iceberg. Shalof shows us the true behind the scenes workings of the ICU: constant debates with doctors, the nursing of families, the education of new nurses, the chaos of being charge nurse. She also reaches into the depths of a nurse’s soul to expose the emotional vulnerabilities in caring for extremely sick patients, as well as the fear that comes with the possibility of making a mistake at any time.
Fortunately (and this is my favorite part of the book), Shalof completes her portrait of the ICU with descriptions and dialogs of the nurses and doctors that surround her. Each of them with a unique personality that shows differing opinions and complementary strengths. These characters are her support group and remind me (and will remind any nurse) of those that surround them in their own jobs.
Shalof does not shy away from any topic. From discussion of adoring some patients while disliking others, and certain “shitty” nursing tasks, to a mother’s possible indiscretions with her mentally handicapped Son. These stories serve as the backbone for her larger discussion of nursing as a profession.
When I first read this book I was focused on the fascinating stories and tasks performed in the ICU. But on more recent readings, I realized that the true story is the angst that the author is feeling throughout her career. She discusses foremost the fine balancing act nurses must walk between emotional connection and disconnection with each patient. This constant struggle causes turmoil and (I would say) neurosis within nurses.
Another reoccurring theme is that of how much treatment is too much. Shalof vividly describes stories in which families and doctors go too far to keep patients alive, instead of allowing them to die peacefully. The characters in the book all add their opinions to this ongoing debate that does not have a concrete solution. From this debate comes one of my favorite mottos that I have taken to heart, “We can withdraw treatment, but we never withdraw care.”
The moments that connect with me the most are her brief, yet poignant descriptions of floor nurses. Shalof describes the absolute chaos she and her patients feel when they are transferred out of the ICU with 1:1 nursing care to the floor where nurses may have up to eight patients. As a floor nurse, I can see the shock this causes a patient, and the difficulty they and their families have when being transferred. I have often witnessed their anxiety when a nurse is not present at all times. In fact, we jokingly refer to it as ICUitis, and is usually diagnosed during a night shift when the patient starts hitting the call bell every two minutes for the smallest of reasons.
Now, I said that this book changed the course of my entire career, and that is true. The moment I finished this book in my first year of nursing school, I abandoned all plans to become an ER nurse, firmly aware that I wanted to work in the ICU. I have read this book again and again and I continue to come to the same conclusion. In fact, I have just recently been accepted the Critical Care certificate program and will begin the theoretical portions this fall.
So, I tip my hat to Tilda Shalof (and all of “Laura’s Line) who has inspired me in my career and my nursing care. Shalof has since written a book entitled “The Making of a Nurse” that describes her life outside of the ICU and how it affected her career. I recommend both books with all my heart, which is why they have a permanent home on my blog (look to your left). There is not one single nurse that would not benefit from a read of this extraordinary realistic account of ICU nursing. I only hope somebody, someday writes a similar account of nursing from the perspective of a medical-surgical nurse.
June 9th, 2007 at 17:27
Interesting -thanks for writing this and for sharing your own perspective. I wrote a novel about – wait for it – med/surg nursing, and the first half is on my blog, available to all (first draft, so it has some typos and minor errors still to address). Look for Division 70 – novel-in-progress and please leave a critique.
June 9th, 2007 at 20:40
Thanks for letting me know! I will check out your novel ASAP. YAY!
June 11th, 2007 at 08:16
I thought it was you when I saw your comment at Emergiblog! Fun, I’ll add you to my fave list. Did you see that Shalof has a new book out?
June 11th, 2007 at 08:48
Answering my own question…. Always read to the end…
June 11th, 2007 at 15:20
Jen! Good to see you on the blogosphere! Consider yourself added!
June 11th, 2007 at 15:36
Sean- thanks for the recommendation. I will definitely be ordering a copy of “A Nurse’s Story”. I got to spend a day of my clinical rotation at Mass. General Hospital on their Cardiothoracic ICU floor and I instantly fell in love with the idea of working in critical care.
June 11th, 2007 at 18:25
Wow — so far I have my own category! Sh*t, I gotta update that thing…
June 11th, 2007 at 18:31
Hey Sean, you have until Tues night to submit this entry and/or the one below about ya know good communication? where you have trouble telling the docotr? and stuff? to
http://nurse-ratcheds.blogspot.com/
for “change of shift”. They’re both very good. I think you should.
Jen
June 11th, 2007 at 20:30
I’m way ahead of you Jen!
June 12th, 2007 at 06:35
As always it seems!
June 13th, 2007 at 18:49
I was looking at that book…. but have to wait to start getting paid first. But it is on my list!
June 15th, 2007 at 12:55
I worked for about 18 years as an ICU nurse. I learned from the best at a trauma unit. It was a teaching hospital and the one thing I came away with was this. You have to be right. You HAVE TIO BE RIGHT!If you are not right the patient will suffer and your credibility will too. I worked all over the country as a traveling nurse working only in critical care areas. MICU,SICU,PICU,CICU,NICU, and trauma units. I would not trade the experiences I have for anything. I know that I am a good nurse and can work anywhere. Nowadays, I am a home health nurse and I love it. Do I miss the unit? Sometimes, but the reason I left was because I could not absorb any more grief and sorrow. I was like a sponge that was saturated. Where as before I could stand and watch people cry their eyes out at the bedside I was crying right there with them. Now you say so what? Well, that is the deal right there, I was not able to dissassociate myself from the pts. anymore. I was saddened by their plight and couldn’t hide it. I hope you enjoy your experiences as an ICU nurse and know that you are a special kind of nurse (the best in my opinion) I have a nurse friend who still works in the unit. She calls it medicine by numbers because of the high tech nursing and the mulititude of drips. Good luck!It is the safest place to be a nurse the ratio is only 1:1 or 2:1 SWEET!
June 15th, 2007 at 16:58
Thank you very much for sharing your insights Poody. It’s nice to hear from someone who has “been there.”
I hope to hear from you again. Let me know if you have a blog out there somewhere.
Sean
June 18th, 2007 at 11:43
Hello! Good Site! Thanks you! tfuealjgny
June 22nd, 2007 at 12:50
Dear Sean,
I love your blog. Reading it, I hear the voice of a strong nurse, speaking out, sharing his stories, telling it like it is, taking a stand, and representing to the world some of the best qualities of our profession – in short, I love it!! I am thrilled also to know that you enjoyed my book and that it had such a positive effect on you. I love critical care nursing too, as you know, and I am sure you will enjoy it and find it endlessly challenging and stimulating. I also have a sense that the kind of nurse you are will find yourself at home in in any/every specialty. All I can say is we are lucky to have you and oh yes, keep on writing. I am completley in agreement with your views on our Canadian health care system that you wrote about most recently.
Best, Tilda Shalof
June 29th, 2007 at 18:47
Tilda,
I am more than honoured that you visited my blog. Thank you for all your kind words!
Sean
January 15th, 2008 at 13:21
[...] I read Tilda Shalof’s book, “A Nurse’s Story: Life, Death, and Inbetween in an Intensive … When I read this book I felt an entire shift in the way I felt about nursing. I began to gain an [...]
March 5th, 2009 at 15:33
i don’t think that was a good idea between people and the nurses. when some people died and they put blame on the nurses, because that’s just their job. hell no!! that’s not the right thing to do. with the people who has trying to help us with the sicknesses that we’ve got………..
April 18th, 2009 at 13:50
hey Sean, thanks for recommendation.some people can not understand cause
regarding to metter of death of patient and they love to put blame on nurses.No man!! people should think about that.we care the people.
June 1st, 2009 at 05:46
[...] The Intensive Art A Nurse Story Life Death and In Between Posted by root 7 minutes ago (http://nursesean.com) If you are not right the patient will suffer and your credibility will too i worked all over the country as a traveling nurse working only in critical care Discuss | Bury | News | The Intensive Art A Nurse Story Life Death and In Between [...]