Works of Mercy

The following speech was delivered at the 2019 Pinning Ceremony for the graduates of the Whatcom Community College Nursing Program.

It was an honor to be their instructor and to be their keynote speaker at this unique tradition in nursing.

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Good evening family, friends, faculty and staff, and graduates –

It is such an honor to speak here again this year.  This ceremony brings me back to my own pinning thirteen years ago, and it forms a space for me to reflect on all the incredible things that nursing has allowed me to do, and all the incredible places I’ve travelled and experiences I’ve been a part of because of this profession.

I love being a nurse.  It is my calling and my life’s work.  There’s a well-worn adage floating around the universe that goes, “Choose a job you love, and you’ll never have to work a day in your life.”

And so you might be expecting my next sentence to be something like, “So I’ve never worked a day in my life.” 

That would be MARKEDLY UNTRUE.

I have definitely worked; there have been days when it felt like nothing BUT work.

And now you might expect me to say something like, “I’ve never regretted choosing this profession,” and while that is true in the long-view, there were many days in the past thirteen years where I deeply regretted not going into accounting.  Or welding.  Shining shoes at the airport, ANYTHING but nursing.

So here’s the thing that I wanted to talk to you about today.  Nursing may indeed be your calling, your life’s work, as it is mine.  But it’s not a panacea.  It’s a long-term relationship.

And like all good, solid, long-term relationships, it’s always going to require work.  Active, engaged, and mindful work.

Because once this honeymoon period is over, and you start that shiny brand new job, nursing will – invariably, inevitably – turn around and kick you in the teeth.

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As a nurse, you are on the front lines of modern medicine as it is practiced today in the United States.  We allocate our resources to those who are able to PAY for it, not to those in greatest need.

The CEOs of the major healthcare systems that may someday employ you do not have a medical degree, make more money in a month than you will make in a decade, and –  I am fairly certain – do not do peri-care or constipation management.

We are viewed as waitresses, handmaidens, servants, and go-fers.  We work for eight, ten, twelve hours, sometimes without a break to eat, sometimes without a break to pee.

We are the proverbial whipping boy for the frustrations and fears of patients and their families, and sometimes we are not just proverbial…the very first day that a patient hits you will leave a scar on your heart that will never heal.

Finally there will come a day when you will wake up and you will dread going to work.  And then you’ll start googling things like compassion fatigue and moral injury and “where can I get a degree in accounting….”

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Now, I am not trying to scare you or bring you down or diminish ANY of the well-deserved joy you’re feeling today.  I’m not trying to turn you away from nursing – as I’ve said, I love being a nurse.  I wouldn’t change my life for anything.

What I AM trying to do is have you think about a way to hang on to the joy that you feel today, the joy you felt the very first time you made a difference to a patient during clinicals.  I want you to be able to hold tight to the compassion and love and soul-deep rewards that are intrinsic to the work that we do every shift, every day, and to hang on to them for the decades of your practice to come, to never let them go.

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At the beginning of my final year of nursing school, I was given a book as a gift.  It’s a large, hardcover book full of paintings, etchings, drawings, photography and history, titled “Nursing, The Finest Art.”

And it was within the pages of this book that I first encountered the Seven Corporal Works of Mercy.  These are found originally in the Gospel of Matthew in the Bible, and although their origin is obviously set in the context of a faith community, I found them to be profound in their simplicity, and universal in their applicability.

The Seven Corporal Works of Mercy are:
-To feed the hungry
-To give water to the thirsty
-To clothe the naked
-To shelter the homeless
-To care for the sick
-To visit the imprisoned
-To bury the dead

That’s it.  That’s all there is.  When you tear down all of the artificially constructed separations and divisions that we have created to define the “us” from the “them,” when you throw them all away – throw away language, nationality, politics, dress, culture, skin color, hair color, eye color, everything but core of our existence –  it brings us back to the fact that all seven-and-a-half BILLION of us on the planet are all exactly, precisely the same, for we are – all of us, HUMAN.

And, thus, we have the same, basic, fundamental human needs.  Food.  Water.  Shelter.  Cover.  Medicine.  Compassion.  And to not be forgotten as we die.

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I use these Works of Mercy as my mindfulness, as my active work to maintain fidelity to my long-term relationship with nursing – even in the face of all the struggles and challenges along the way.

And to give you an example, I’ll tell you a story.

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Last year I traveled to Haiti to serve in a week-long primary care medical clinic in the remote and under-served southwestern tip of the country.  The group I travel with has been going to this area of Haiti for well over a decade, so people for a hundred miles around know when we’re in town, and they know when we’re coming back.

There are long, long lines in front of the clinic every day.  Patients arrive hours or days before we do – some who have walked for more than a day to see us have slept on the stairs of the clinic, waiting for it to open the next morning.  So every morning, after we leave our housing and walk down the dusty, failing, pot-holed dirt road to the clinic, we arrive at the stairs, completely congested with the well and the ill, fighting for their place in line, fighting to flag us down for attention, staring up at us from their seats on the concrete steps, sometimes even calling out for us to help them.

And so we wade up the concrete stairs, through the crowd, like a line of ants, and slip into the building and start preparing the clinic for the busy day ahead.

This was how it went for the first two days.  But, on the third day, the third morning, something changed.

As we arrived to the stairs, instead of jostling each other to save their space in line and allow us to pass, the crowd suddenly parted.  The noisy chatter of the people went silent.  And for the first and only time that entire clinic, people didn’t ask for help for themselves.  Every single person in the crowd reached out and pointed. 

They pointed to a tiny patient, cradled in her mother’s arms, sitting silently on a step, staring at us.

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Hydrocephalus is a condition where the fluid that constantly circulates around our brain and spinal cord is unable to drain appropriately, and begins to back up and collect in the ventricles, the great caves deep inside our brain.  If left untreated, the collection of fluid begins to push against the inside of the brain…and then the brain is pushed against the skull…and in an infant, the plates of the skull are not fused yet – that’s how a baby can make it out of the birth canal  – and so in this case the skull begins to expand, the the skin of the scalp begins to stretch like an inflating balloon.

In developed countries with high-tech medical systems, like the United States, hydrocephalus can actually be seen on obstetric ultrasounds and diagnosed before the baby is even born, and treated successfully with a surgery early in life.

But Haiti does not have a high-tech medical system.  Haiti does have a medical system – but it is not one that can diagnose a hydrocephalic baby before it is born into the world.

And it is not one that can provide the necessary surgery to take the pressure off a tiny brain, and allow a tiny, innocent human to have the chance to live anything resembling a normal life.

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The child with the giant distended, distorted hydrocephalic head was the very first patient we saw that clinic day.  She was nearly two years old, and the size of of an eight-month-old.  Her head was so large, so swollen from the excess fluid inside her skull that she could not stand, could not walk, and could not even lift her own head.  She was developmentally delayed, minimally verbal.  But she looked at us with her wide, dark eyes, and followed our movements as we examined her.

At the end of the exam, the nurse practitioner told that mother that we could not help her beautiful, precious daughter.

And that was the moment that I saw – and was taught, yet again, by this child and her mother – the power of the Seven Corporal Works of Mercy.

To feed the hungry, to give water to the thirsty – this child was well-nourished, well-hydrated, her skin smooth, the fine fuzz of her hair soft and clean, her eyes bright and curious.

To clothe the naked – she was dressed in a tiny, beautiful dress, one that she probably normally wore to church, and had been dressed in specifically for our clinic.

To shelter the homeless – even though this child required constant, un-ending care, she was loved and treasured and sheltered and protected by her mother.

To care for the sick, and to visit the imprisoned – her mother had brought her to us.  She had carried her gravely disabled child to our clinic, waited in the hot morning on the concrete steps for us to arrive, cradling her daughter in her arms, praying that the doctors and nurses from America could do something.  Anything.

Sometimes a prison is not a jail cell, not window with metal bars.  Sometimes imprisonment is being born into a body that needs a little help – and having that body be born into a country where no help can be found.

And the seventh corporal work of mercy is to bury the dead.  Since this is rarely a literal need in our time, it can instead be interpreted as a need to bear witness to the suffering before us, to give it a name, and to speak it out of the shadows, and into the light.

The injury to this child by the fluid trapped in her skull was too great, too severe.  Even an immediate evacuation to the United States and immediate surgery by the most talented surgeon at the most advanced Children’s Hospital in the country could not undo the damage done by this insidious, tenacious disability.  She would be this way for the rest of her life – and, eventually, it would cause her death.

But her life had been one where the human underneath had been honored, and thus it was one of love.

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Her mother sat with us for moment, then picked up her child, thanked us, and carried her out of the clinic, down the concrete stairs, and started her long, long walk home.

I do not know if this little girl will be alive when I return to Haiti next year.  But I do know that she and her mother are etched upon my memory, and on my soul as a nurse.  They have reinforced the fundamentals of how I practice in this profession, and I will never forget them.

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We live in a country and in a time where we can do incredible, miraculous things with modern western medicine.  And yet the hugeness, and the inequity of it all, can feel suffocating.

By comparison, the Corporal Works of Mercy were developed when we as humans could do almost nothing against disease.  And yet in these simple, universal actions, you can find the space to breathe again, because it returns you to the center of who we all are.

When you chose nursing, you chose an opportunity to care for the human underneath the disability, underneath the different language, underneath the different lifestyle, the human below any construct we could possibly devise that engenders separation.  You have chosen to work without regard to any of that – and thus, your work springs from a place of love.

It is an honor and a privilege and a burden that very few in this world choose to carry, and you are to be commended for doing so.  You will give so very, very much of yourself to your patients and their families, and the dividends of that giving will multiply and be returned to you in endless, incredible ways.

Your lives will never be the same.  They will be challenging, infuriating, heartbreaking, magnificent, joyous.

I said this last year, and I’m going to say it again as I close here – nursing is a profession of joy.

And I am thrilled beyond measure that all of you are joining me.

Congratulations to you all.

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