Philadelphia Reflections

The musings of a physician who has served the community for over six decades

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The Burdens of the Rich

The details are hazy, but sometime after graduating as a Registered Nurse my mother-in-law had a spell as a private-duty nurse for Mrs. Pulitzer, and, I suppose later, became head nurse in the University of Pennsylvania unit in France, during World War I. Let's talk about Mrs. Pulitzer, first. The Pulitzers had given the Pulitzer Prize, owned a chain of newspapers, and naturally owned several houses. Although I have to imagine there was a Mr. Pulitzer somewhere, everything was referred to as if it belonged to Mrs. Pulitzer, and Mr. Pulitzer never appeared in the stories.They had a child with rheumatic fever, who was the reason they had a private nurse. Mrs. Pulitzer devoted one afternoon a week to paying bills, which were numerous because of all the staff they employed at several houses scattered around the country, in New York, at Bar Harbor, and so on. One day, seated at her desk, she turned to the nurse, and asked her if she had any idea what a burden it all was.

My mother-in-law had always been very self-assured, and this time she drew herself up in full nurse dignity. "Mrs. Pulitzer," she said, "I don't feel a bit sorry for you." But as more than a century goes past, I have come to see the rich lady had a point. What purpose is there to being rich, if you are expected to spend large amounts of time being a clerk? There were diamonds and minks to be got out of storage for the banquets, and then put away with moth crystals. There were silver spoons to be counted, and portraits of ancestors to be varnished. The gardener seemed to dipping into the best wine, the kitchen maid didn't clean up properly, the roof in the Florida house leaked. Instead of being the rich lady with a glamorous life, she was at best acting the part of mayor of a small town. And instead of being awestruck, her hired nurse was in effect telling her she was a spoiled brat. Now, to be the head nurse of a famous hospital, helping the doughboys win the war to end all wars, there was somebody to look up to.

It wasn't the work. Anyone who has watched nurses rebel against typewriters in one generation and sit glued to the monitor with a very similar keyboard in the computerized phase of change, can recognize it wasn't the work. Not even if it means picking bloody sponges off the operating room floor, or the final degradation of digging out an impaction with others watching you do it. The hallmark, the final test, was to do it without hesitation, and never display the slightest sign of complaint. Because the point of pride was to be useful without the slightest sign of disgust. Dignity, doing something other girls recoiled at doing. The snotty little brats.

It took some time for me to recognize that the image of nursing was formed in Nursing School, so strongly that the Nursing School was really the heart of any hospital. They would come back to reunions for generations, regaling their old friends with stories of Miss This or That, the tough old head nurse with a heart of gold. The head nurse was the mother-figure, and the role model. Anything you could do, she could do better. When she dismissed you, you deserved to be dismissed. You didn't know starch until you saw her starched uniform. And cap. You could tell what school had trained her, after a glance at her cap. And when the caps went, the uniforms were replaced with green unironed operating room gowns, not the same thing, at all. The schools were replaced by money from the US Government, sought out by the nursing lobby, and eagerly accepted by the administrators of hospitals, who didn't know what they were doing. The girls didn't know any better, either, thinking what they needed was a diploma. So now we contemplate a nurse with a bachelor's degree, or even a doctorate, without the faintest idea what to do, placed in charge of practical nurses in their forties who know everything about nursing worth knowing. So they retreat into the nurse's lounge, writing volumes of notes which no one ever reads. The girls who enter the few schools left are much the same. Show me a well-run hospital and I'll show you a hospital that still has a school. Show me a hospital that recruits its nurses from a near-by university, and I'll show you a hospital which is run by administrators.

 

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