A former registered nurse whose books include Tiny Sunbirds Far Away, winner of the Costa First Novel Award, and The Language of Kindness: A Nurse’s Story.
I once cried red tears. I had been caring for a toddler, Billy, who was suffering with meningococcal sepsis, a violently dangerous illness that can – and too often does – kill a child in hours. He’d been sniffly, with a low level fever, and off his food, but seemed to perk up after paracetamol (acetaminophen in Canada) and ibuprofen that the G.P. recommended. His mother, Kay, had noticed a few tiny pinprick bruises on his arm and assumed he’d knocked himself on something: He was at the hurtling-around age.
When Kay pulled the curtains open in the early morning, Billy’s arms were purple. His face was blotchy with a dark red rash and he was breathing in a way that she described later, reminded her of their dog during a heat wave. “It’s like he couldn’t get enough air in, sort of panting.” By the time the ambulance arrived he was no longer conscious and by the time he arrived at the hospital in London where I was nursing, he was a whisker away from cardiac arrest. It took three nurses to care for him.
The nurses I worked with that day had different experience levels and skills. One nurse was trained in Australia, and the other in India. The nurse in charge of the shift that day was from the Philippines. I’ve worked with nurses from all corners of the world, from all cultural and racial backgrounds, from all religious beliefs or none. Nurses, whether from Croatia, or Canada, or Somalia, or Scotland, have everything in common. It is a language you can only truly understand by learning it: by being a nurse, but it’s a human commonality. A nurse’s way of living. Of understanding the world. There are universal character traits that shape a nurse. Somewhere between matter of fact and kind. Nurses are tough: they have to be. But they understand life in a deeper way. Perhaps because nursing gives access to more varied disciplines than any other job that I can think of. It incorporates science, humanities, art, physics, maths, psychology, advocacy, law, politics, chemistry, philosophy, anthropology, pathophysiology, biology, ethics. Nursing is not one thing, that’s why it’s hard to get at. It is everything. But also nursing becomes a kind of faith in itself. A love and understanding of the human condition, and of what will matter to all of us, in the end.
We rushed around resuscitating Billy, sending porters back and forth from the blood bank to pick up pack after pack of red blood cells, fresh frozen plasma, fibrinogen, and every other blood product we could think of. But he wasn’t bleeding out, simply, his blood had moved from inside his cells to outside, meaning his entire body, now almost exclusively purple with joined up rash, had swollen to twice its size and his lungs were so wet he was spewing out froth – now like a rabid dog. I did not drink water that day for fear that I’d have to leave his cubicle to go to the toilet. None of us ate a thing. But I don’t remember feeling ill or light-headed. It was impossible to feel hungry or thirsty when seeing the expression on Kay’s face as she stood back watching us work on her son. The room was alive with terror. We nurses tried to concentrate our efforts not only on Billy, but on Kay, putting our arm around her shoulder, translating the information given to her by the doctors, walking a line to provide her realistic expectation tempered with hope. I went home that evening exhausted and full of prophylactic rifampicin – an antibiotic designed to prevent me and the other nurses and doctors in the room contracting Billy’s illness. We were warned a side effect of the drug was that it could make body fluids change colour. It was only when I got home, went to the bathroom and looked in the mirror that I saw my face. I was crying red tears.
Billy was there when I returned to work the next morning. Nurses never know if their patients will be there the next day, so it was a huge relief to see him. I spent another busy day caring for Billy and his family and worked with a nurse from Ireland who’d taken rifampicin before after caring for a patient suffering sepsis. She remembered noticing the redness on a tissue after wiping her crying eyes.
Billy was there the next day. And weeks later he was still there. Then a month and another. He got sick so quickly and better so slowly. There were quiet moments caring for him. I began to reflect on nursing. How we all had such different backgrounds yet cared for Billy, and all our patients, in much the same way. Nursing is practised in much the same way across different countries and cultures; the language of nursing has different accents but it travels across borders and also time. Nursing is one of the oldest professions in the world: From the earliest times, nurses, overwhelmingly women, have dedicated their lives to the service of caring for others. It is, and always has been, a universal act of indiscriminate caring. And, despite the nature of caring for patients like Billy and his family, and relying on advanced skills like the insertion of intra-osseous needles and the setting up of haemofiltration, the practice, the language, of nursing, unlike medicine, hasn’t changed all that much over the ages. Nursing predates history books, although one of the very earliest written texts about nursing is the Charaka Samhita, compiled in India around the first century BC, which states that nurses should be sympathetic. The first professional nurse in the history of Islam, Rufaidah bint Sa’ad, was described as an ideal nurse because of her compassion and empathy. In Britain nursing is often cited as born from Florence Nightingale but, of course, nursing was practised long before she lived. Canadian nurses trace their origins back to Jeanne Mance who founded the Hȏtel Dieu in 1645, still a leading hospital.
Florence Nightingale and Jeanne Mance shared commonality. They both had a privileged upbringing and refused the idea of marriage, instead dedicating their own lives to the service of others, risking much of their own lives, as nurses from all backgrounds do today; Mance cared for patients suffering the plague, and Nightingale ran to war at Scutari, where she suffered alongside the soldiers appalling conditions and being “steeped up to my neck in blood.”
Nurses all over the world provide care, compassion and kindness as well as skill and technical expertise. What a comfort that is in a rapidly changing world, when society itself has changed beyond belief. We are moving into an age where we suffer not only with, sometimes, and in some countries, curable diseases like Billy’s, but loneliness, old age, anxiety, isolation and fear. The very early nurses, in addition to having religious and technical training, were well trained in the art of caring. Surely, the art of caring is now more relevant than ever? Billy survived thanks to the technical brilliance of the doctors. But Kay survived the hardest experience any of us could ever imagine – and she would have done regardless – thanks to the caring of the nurses. Instead of being undervalued nursing and nurses should be revered, respected and elevated. Nursing matters now more than ever. It is time we sing for the heroes. Because all nurses cry red tears.
Billy did get better, and eventually went to a general children’s ward for further recovery before being discharged home. On the day of his discharge, Kay came to find me. Her face, her eyes, the light in her expression, the sheer relief is something I will never forget. “Thank you,” she said. “I don’t know how to thank you.” And we hugged for an extraordinary amount of time.
The names and details of people described here have been changed to protect their identities.