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 Autobiographical Memoir

Seeing patients also animates the memoir that Terri has been working on sporadically for more than ten years. Her memoir started as a collection of stand-alone short stories that Terri wrote over a decade or so, and began to take the shape of a memoir when Terri realized that many of those stories tended to examine her relationship with her best friend and the events they had experienced together. For more than a decade, Terri has periodically immersed herself in the work of drafting chapters based on important experiences she and her friend had shared and weaving those individual chapters together into a coherent memoir, which she referred to as “a tribute to my very best friend.” Just as she did with her religious devotional, Terri intends to eventually finish the memoir and then seek out venues for publication.

Sadly, one of those experiences was her best friend’s death in an intensive care unit while Terri was working as an ICU nurse, although not in the same unit or even the same hospital. Describing the experience during one of our interviews, Terri stated, “I wasn’t family but they let me in [the room]. When I walked in the room and looked at the monitor and stuff, because I was working in ICU so I knew everything that I was looking at. … His temperature was one-oh-five, and his heart rate was through the roof, and his oxygenation was horrid and he was on the ventilator and he had pressure support and all of those other things, so I knew that he wasn’t going to live long.” In including this difficult experience as a chapter in the memoir, Terri indicated that she was “writing about [her best friend’s name] because I was trying to work through my best friend dying in ICU when I was an ICU nurse.”

She’d fallen when they’d come for her, reeling, unable to stand the blow. Eight hours at his bedside sent her frantic mind to the netherworld of numbers—20 breaths per minute, 1200 ccs of oxygen per breath—that was enough for a hemoglobin of 9 when his lung tissue was so damaged? Even an oxygen saturation of 100% meant nothing if there weren’t enough molecules of hemoglobin. How much carbon dioxide was he creating with a fever of 105, how much could he blow off with so many of those tiny air sacs lined with cotton fibers, hardened by toxins. Withered by disease? What did his blood gases look like, what were his clotting times? How was he managing without a transfusion, pressors, aggressive treatment? The thoughts chased one another through her head again and again until they tangled, merged, fused, and she surrendered at least to the ventilator’s constant whisper, the metronome of the cardiac monitor. She stood, touched her lips to his, said “I’ll be right back” to his brother, and walked slowly to the bathroom.

She recognized the ventilator alarm, understood the code, heard the steps rush past as she slid the bolt into the lock but there, in the cool, gray quiet it was the distant bustle of someone else’s day—it wasn’t her hospital; she wasn’t on the code team. So who was that banging on the door? Calling her name? Didn’t they know she didn’t work here? Couldn’t they see she was sick? Sick and cold in the dark…

Talking about the chapter, Terri stated, “A lot of that scene is from what I know about ICU. … A lot of the scene is an attempt to talk about how close our relationship was.” In the excerpt from that chapter offered at the left, Terri describes her experience standing at her best friend’s bedside in an intensive care unit. Echoing the two different perspectives of the patients she offered in the“Sonia” poem, Terri juxtaposes two different perspectives of her best friend. In the initial half of the passage, Terri describes her friend through the eyes of a nurse assessing a patient: as a collection of numbers associated with his breathing rate, oxygen volume, oxygen and carbon dioxide saturations, and clotting times, the same kinds of information that a nurse would be charting in the flowsheet, and possibly in the same order. That perspective is juxtaposed with one of the patient as her best friend slipping away, a person with loved ones.

Interestingly, Terri also offers in the passage’s latter paragraph the tension she felt in her roles as nurse and best friend. She captures a sense of the tension inherent in her roles as nurse, even though she is not a member of the code team assigned to her friend, and a best friend. She is, at once, an ICU nurse seeing a patient and a friend seeing a friend, someone in need of comfort because her best friend is dying right in front of her eyes. She is simultaneously a nurse attending to a familiar “netherworld of numbers” and a friend touching her lips to those of a dying friend. The shift from one perspective to the other is signaled by the shift from technical medical language to more poetic language.

Seeing patients as a nurse is woven into the literate activity of Terri’s memoir. Her presence at her best friend’s bedside, and her need to “work through” that experience, becomes a key part of the writing she has done about their relationship. In turn, the memoir also laminates Terri’s seeing of patients as a nurse. Terri’s comment about “working through [her] best friend dying in ICU” suggests that this section of the memoir functions as a way of cathartically giving voice to that experience, of addressing the jarring physical and emotional disjuncture of being and acting like a nurse but also a compassionate human being.

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