Theresa Brown’s 2015 book The Shift explored the question of what it means to care for others. In her new memoir, Healing: When a Nurse Becomes a Patient (Algonquin Books), Brown chronicles her experience with breast cancer from diagnosis through treatment and deepens this question into: How can we make the healthcare system more compassionate?
Theresa Brown, RN, author of HEALING: When a Nurse Becomes a Patient. Photo by Heather Kresge
That question is one many clinicians deeply consider and grapple with on a daily basis. No stranger to that kind of reflection, the author takes us into the moments when it became more than a passing thought. Brown is an experienced nurse and thinks she knows what to expect when diagnosed with breast cancer. These expectations are immediately upset, and she begins to view her work as a nurse, as well as the healthcare system as a whole, from a new perspective. She recalls times she inadvertently failed some of her patients before she fully realized what it was like to be one. She appreciates how important it is to see a hospital patient as more than just their illness or condition, writing that before her diagnosis, “In my blinkered view, hospital patients were patients only,” and that she didn’t “fully appreciate how burdened my patients were by their illnesses.” She learns the hard way, through their absence in her own care, the things that patients need most: timely information, calm and organized guidance through the maze of the healthcare system, and someone to take the time to listen.
Woven through the story of her diagnosis and treatment are stories of the patients she took care of as a registered nurse, ranging from when she was a new oncology nurse to her recent work in home hospice care. She illustrates her points with stories from an eclectic variety of sources —from King Lear to the Bible, including Lewis Carroll’s “Jabberwocky,” Audre Lorde’s The Cancer Journals, Susan Sontag’s Illness as Metaphor, and Joseph Heller’s Catch-22. She argues against cancer metaphors, in particular the language of war and of positive thinking that makes breast cancer both more frightening and a condition that demands a brave face, writing that “if we stripped cancer of its encumbering metaphors, it would be less scary, less oppressive.”
The medical memoir now stands as a literary genre of its own, and Healing adds to that canon, skillfully blending personal reflection and engaging stories with a big-picture perspective. In other words, we benefit and gain empathy from her experience. Brown takes inspiration and guidance from significant thinkers and writers and brings them to the reader for the same inspiration and guidance. Incorporating them broadens the scope of Healing to include ways in which our healthcare system fails patients, pointing out that our system is neither as good as we think it is, nor as good as the systems in other industrialized countries. Her argument is most interesting when she brings her nursing perspective to her own experiences as a patient. The problem, she argues, is not technology or the complexity of care: “Science and technology are not deforming health care, making it unwieldy and impersonal, greed is. . . . It is a failure of compassion, which is not surprising since over the past few decades, health care has changed from people-centered to profit-centered.”
Some would argue that the caring and compassion which she found lacking after her own diagnosis are intangibles that cannot be measured. But in this profit-centered system, she concludes the only way to build in more compassion is to provide “scientific evidence that caring makes a difference”; in other words, by showing that compassion is profitable because it has “measurable beneficial results.” To argue for compassionate care, she cites studies that show that compassion improves outcomes. Yet she also acknowledges the intangible:
We discuss physical failure in health care in terms like decompensation, morbidity and mortality, multiple organ dysfunction syndrome, and the patient ceased to breathe. But what about the soul, or whatever one calls that singular essence that makes each of us who we are?
Brown’s fluid, accessible prose renders the emotional ups and downs of her experience with cancer moving and poignant. With its examination of the healthcare system from both a nursing and a patient perspective and its analysis of a wide range of writings on the subject, Healing aligns well with Intima’s mission to enhance healthcare through communication, empathy and understanding between clinicians, caregivers and patients. The book will appeal to anyone who has or will have an encounter with the healthcare system, in other words, just about everyone.—Priscilla Mainardi
Priscilla Mainardi, RN, attended the University of Pennsylvania and earned her MFA degree in creative writing from Rutgers University. Her work appears in numerous journals, including Pulse - Voices from the Heart of Medicine, the Examined Life Journal, and BioStories. She teaches English Composition at Rutgers in Newark, New Jersey and has served on the editorial board of Intima since 2015. Mainardi is the Fiction Editor of Intima.