Trajectories of Persons and Practices: Sociohistoric Perspectives of Disciplinary Development. The Case Study of Terri Ulmer

Chapter 6 | Learning to See Patients:
Resituating the Development of Professional Vision in Healthcare

Seeing Patients with Poetry

Seeing patients also animates much of the poetry Terri has written. If Kate’s childhood literacies centered on creating fan fiction and fan art, Terri’s childhood was textured with writing poetry. As an adolescent who, as she described, “had a lot of alone time,” Terri started writing poetry and short stories when she was in her early teens. As she explained, “I’ve always gotten these strong images, these visual images in my head. And because I don’t draw as well as I’d like, I just ended up writing about them.” Since that time, writing poetry has been a continual part of her literate life. The hundreds of poems she has written over the past forty years have addressed the joys as well as the hardships she has experienced and the many people she has encountered.

As Terri enrolled in courses to pursue a Licensed Practical Nurse (LPN) degree in the early 1980s and started working as a health care professional, many of her poems focused on her work as a nurse. Terri frequently referred to these poems collectively as “see me” poems because they all tend to center on looking beyond patients’ diagnoses, symptoms, and treatments in order to acknowledge their humanity. “One Nurse’s Prayer,” the earliest of her “see me” poems that Terri could recall, was written during her LPN coursework. According to Terri, she wrote the poem “in response to a particular discussion at LPN school. The very first instructor I had … was really smart and she was very compassionate, and she was very, she talked about being an advocate for the patient. Her point was that if you can’t see the whole patient, you can’t be a good patient advocate. That’s where, I think, my approach to patients came from, was her insistence that you see that patient as a human being.”

One Nurse's Prayer

Help me remember as I start each day
I’ve chosen to serve with my life in this way
Help me to listen and comfort and care,
Your perfected love, my actions to share.
Help me to faithfully serve those you send,
Those broken and twisted with your love to mend.
Help me to see them through your loving eyes,
To hear them and know how to quiet their cries.
Help me remember, dear Lord, how to give,
To be an example, to know how to live.
Help me remember as I walk this road
Your love has the strength to lighten each load

Written in the form of a prayer using rhyming couplets, “One Nurse’s Prayer” (see left) is Terri’s plea for God’s assistance in doing the physically and emotionally demanding work of a professional nurse. Echoing her professor’s comments, the poem’s six rhyming couplets, each beginning with the phrase “Help me,” invite God’s help with listening to, seeing, and comforting the persons under her care. In the fourth couplet, Terri specifically asks for help “to see” patients “through your [God’s] loving eyes.”

After earning her LPN license and as she began working directly with patients, Terri indicated that she kept this poem among her belongings at work and would read and re-read it often, especially during stressful moments. While serving as a director of nursing in a palliative care unit in the mid-1990s, for example, Terri stated that, “It [the “One Nurse’s Prayer” poem] would be in my desk. … I would look at it frequently, because sometimes the unit got pretty bad [and] I would get extremely frustrated.” Terri used this poem, then, to buoy her through the stressful work of caring for the elderly and to bolster her resolve to be a caring and compassionate nurse. Terri also indicated that she shared her poem with the other nurses she worked with in the hope that it might buoy them through the difficult work and temper their own frustrations. While working as the director of nursing, Terri indicated that “I gave it to the nurses who were working with me,” Terri stated, “They got a Christmas present and it [the poem] was stuck down in there. … I would like give them silly stuff too, you know, like limericks on Valentine’s Day or something.”

As she continued working directly with patients, Terri’s “see me” poems shifted from pleas to recognize patients’ humanity to expressing the experiences of specific patients she encountered. Of the persons at the center of the dozens of poems in this vein that she wrote, Terri stated, “They are particular patients, but they are a composite as well. So part of it comes from particular patients, but it is for all of the patients like that.” Terri indicated that she often wrote these poems at home after her shift. It was often the case, though, that she drafted them on the job. As she explained,

Sometimes if the imagery was really powerful I would write it down then [during a shift], just get out a piece of paper. I have them [pieces of paper containing lines for poems] stuck everywhere with single lines on them because it, the image, was just so powerful and so strong and the way that it came to me I liked so much. I’ll just have these little slips of paper in my pocket.

Terri indicated that the poems about patients were a way to assuage her frustrations about how patients were regarded. The dozens of her poems based on her encounters with patients, Terri explained, “came from seeing the same thing over and over and over again. And responding again to that depersonalization that just seemed to be so rampant.” Elaborating, Terri explained,

I was dealing with my anxiety about what we were doing to patients, how we were looking at them. So that’s my attempt to navigate and find a place where the outcome looks at the whole patient, considers everything, and everybody walks away better for the interaction. … It is attempting to find that human beating heart in the middle of all the beauracracy.

With so much focus on their illnesses, Terri stated, “They [patients] become their diagnoses, they become their disorder, their illness, whatever it is. And this [the poems] is an attempt to say no, you know, there is more here. Just because you are looking at what is on the pages of the chart.” Terri’s reference to “the chart” suggests that writing poems focused on particular patients provided her with a way of countering the depersonalized representations of patients offered via the flowsheet and other institutional documents, and how they were regarded and perhaps treated based on those representations. Rather than offering a prayer to see those in her care as “whole patients,” as she did in “One Nurse’s Prayer,” Terri instead began offering representations that enacted that insight, representations of them as whole patients.


This is my home now—
this hard, narrow bed
and the stiff, cold chair there
by the strict, choking closet
that holds my “things.”
I hear them talking you know,
hear the hardness
in their hearts—it hurts,
here, in my “home.”
I hear the old man
cursing in the hall,
a nurse shushing him
while one roommate mutters
incessantly and the other
tries to rise
on aching, creaking bones
that stood oh! so many years
to cook and clean and fetch,
mend and hold and carry.
I wanted the bed by the window
but I have curtains—
when I was small, I used to sleep
in the hayloft
so I could wake to the sun—
I can’t make it to the porch alone
now and everyone’s too busy
to take me
but sometimes
they forget to pull the curtains
and I see the sun,
the clouds, trees, grass, flowers,
and I know
the world goes on
outside this room,
my vision, this home.

Many of Terri’s poems about specific patients are narrated from the patients’ perspectives. The poem titled “204” (at right), is based primarily on a patient named Maggie who was under Terri’s care at one of the hospices she worked for. According to Terri, the poem was originally titled “Maggie,” but Terri thought that she could better express the depersonalization she was addressing by using Maggie’s patient number rather than her name in the title. In the poem, Maggie contrasts her experiences as a patient with her experiences outside of the hospice by juxtaposing descriptions of what she feels (the hard, narrow bed; the stiff, cold chair; the strict, choking closet; her aching, creaking bones) and hears (the nurses’ comments; the cursing old man and the nurse attempting to quiet him; the roommate “muttering incessantly”) in the institution, with descriptions of her life before coming to the hospice (a young woman who “used to sleep in the hayloft / so [she] could wake to the sun”). Talking about what initiated the poem, Terri stated,

Everybody is compartmentalized. Everybody is sorted and categorized. There is this whole person, and what we have are the numbers and the figures. And what she [Maggie] has is this now, this room, but she had a life before and she was a whole person, she had a family and she had friends, and there were things she did, and she is reduced to this now. And that is what most people see when they see her, whatever little niche she fits into. She is a whole human being, and so part of dealing with the bureaucracy requires that I reduce her to where she fits into a niche, and I can’t. I can do that for them [the hospital, the physicians] but when I go home she is still Maggie.

Combining these two disparate perspectives in a single poem allows Terri to view Maggie as a whole person rather than merely as a patient number.

Other poems in this vein are narrated from the care provider’s perspective. “Sonia” (see below), for example, was written during a period when Terri worked as a wound care nurse at a rural convalescent home. Terri served as the weekend supervisor every third month, and the poem was written about a patient named Sonia who passed away during one of those weekends. The opening representation offered in “Sonia” is what the narrator sees as a nurse treating Sonia, a dying patient moaning in response to the narrator’s “mauling, probing, insulting” attempts to treat her wounds. That representation is juxtaposed to a second one the narrator encounters in the photos placed about her room, images placed by Sonia herself or her family or friends in an attempt to render the comfort of familiarity. Those images, including those of “children”—perhaps of Sonia herself as a child or perhaps Sonia’s children or possibly grandchildren—represent her as a “dignified vibrant woman / vigorous” and “alive.”


By the time I came
speech had left you
moaning at my touch,
helping hands mauling,
probing, insulting. Pieces of you
assail me, photos
of a dignified vibrant woman,
vigorous, alive, amid
images of Mother Teresa,
Christ, children,
and yet,
I am your companion
for death's vigil.

Talking about the poem, Terri stated that it was “about how nurses attempt to reduce life to very small dimensions as a way of making it more manageable.” Elaborating, she stated,

So you could take an incident report, or you could take the nursing notes, because it would have charted in the nurse’s notes what explicitly was the condition that I found her in, and what her vital signs were and whatnot because she was a hospice patient so she was dying. We knew she was dying. So all I would have documented would have been her level of consciousness, her response, and her vital signs, her response to me, and then whether there was any family present or not. Those are the things that would have been appropriate to document in her chart. But, what I saw when I walked in the room was [that] this is a woman who had this rich life as depicted in the pictures around her bed.

In the poem, the narrator offers two different perspectives of Sonia simultaneously. By holding both of these representations in focus at the same time, Terri is able to regard Sonia as a whole patient rather than merely as the information documented on the chart.

These poems and Terri’s comments about them illuminate the laminated character of Terri’s charting of patients and her engagement with poetry. Terri’s seeing of patients as a nurse animates her writing as a poet. The discussion in one of her earliest nursing classes gives rise to Terri’s “One Nurse’s Prayer” poem. Her later encounters with patients give rise to “204,” “Sonia,” and dozens of other poems, and those persons and their surroundings are semiotically remediated in the lines of the poems. In turn, the “see me” poems also mediate her seeing of patients as a health care professional. Sometimes, these texts are in the form of material inscriptions present in her workplace. Terri reads through the copy of her “One Nurse’s Prayer” poem she keeps in her office to buoy her through the challenging work of palliative care. During her shift, or immediately afterwards, Terri quickly jots lines of poetry based on her encounters with patients. In other instances, those texts take the form of the “memorial texts” Witte (1992) mentioned (p. 265). Whether material or memorial, those texts laminate Terri’s seeing of patients as a nurse in powerful, and powerfully material, ways. Reading back through her “One Nurse’s Prayer” poem would encourage Terri to regard her patients through God’s eyes. Having seen Maggie and Sonia through the lens of the poetry, it would be difficult for Terri to regard them solely through the lens of the flowsheet and other institutional documents, to see them solely as patient numbers, numbers on a chart, diagnoses, and illnesses. Those poems invite Terri to see the persons under her care as “whole persons,” “whole patients,” to view them as people with rich lives beyond their hospital rooms. Those poems, in other words, invite Terri to adopt a perspective that works in conjunction with and perhaps to some extent challenges the perspective offered up by the flowsheet, the incident reports, and the other documents and texts more commonly associated with her positions as a health care professional.

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