Katie Jarvis talks to the first woman to write about nursing since Florence Nightingale, ahead of her appearance at the Stroud Book Festival
Christie Watson has seen it all. As a nurse in A&E, she saw (the list is too long to repeat in full) heart attacks, brain aneurisms, diabetic ketoacidosis, encephalitis, malaria, liver failure, ectopic pregnancies, burns, assaults. She treated people who were dog-bitten, drug-overdosing, mentally ill, impaled, shot and stabbed.
Once, she dealt with a head half-sawn off.
As a 16-year-old carer – before she started her nurse-training – she regularly helped a 58-year-old man use the toilet, wiping him afterwards; helping him pee into a bottle.
In theatre during an operation, the ECMO machine (that carries a person’s circulating blood) split, soaking everything and everyone with horror-film gore.
She’s been to parties (cigarettes, booze and even (sometimes; for some) weed can help) where the main point is to banish the sights of the day: a baby born with encephalocele: the brain outside its head. (The mother held it; the father couldn’t look.)
Within two weeks of working in paediatrics on Hackney Road, she caught scabies, impetigo, nits; she was bitten by a child and had to have a hepatitis booster – followed by an eye washout when hit by explosive diarrhoea. (Later, in the way Girl Guides collect badges, she was awarded a dose of ringworm, to boot.)
One time (the details are changed but the situations true), Christie is sitting with parents, listening to a doctor telling them their premature baby has died. A few seconds later, a nurse knocks to have an urgent word. Crying has been heard from the sluice room where the baby lies in a basket, awaiting a porter to the mortuary. A short while later, the baby ‘dies’ again – this time for good. Grief, twice-fold.
Sometimes, Christie feels nothing. Emptiness. Burn-out.
Sometimes, the tears pound to be released from her eyes like madmen in Victorian Bedlam. Such as when she looked after Tommy, nine years old, who turned his face from the sun each dawn. For many months, she sat by his side, nursing him through her 12-and-ahalf hour shifts. Tommy was paralysed from the neck down following a road accident; his tracheostomy meant the only sounds he made were rasping breaths as he sobbed.
“I wonder what he was like before,” she asks. (She often tries to imagine the lives of patients before they were patients.)
Christie washes Tommy, rolls him, monitors him, medicates him, feeds him with giant bags of fluid that nourish through a tube in the stomach.
But. “…it is his mind that needs nursing most of all.”
She talks to him; listens to him; reads him Harry Potter when he can’t sleep.
On his 10th birthday, the nurses decorate his bed with tinsel, and stick cards along the edges.
His parents pile presents on his bed until Tommy is wide-eyed with wonder. When he finally falls asleep, exhausted, his mum turns to Christie.
“He wanted a bike,” Tommy’s mum says, in pain that defies description. “I always promised him that he’d get one on his tenth birthday.”
These are some of the stories a nurse can tell; a nurse such as Christie used to be for 20 years until turning to writing.
They’re the kind of stories you might not have heard before. Because Christie Watson’s wonderful memoir about nursing – The Language of Kindness – could well have been called The Language of Silence.
Books by doctors abound. When Christie Watson began her book, she looked everywhere for ‘nurse’ literature. She had to go back as far as Florence Nightingale before she found any. I’m amazed, I say to Christie Watson. Truly, startlingly amazed. Amazed that I’ve never noticed it before.
I mean - you know. We all come into contact with professional nurses, at some point in our lives. We all thank god for them.
But I’m also talking beyond the hospital block; beyond the GPS’ surgery. Because we all nurse – we nurse our children; our parents; our partners. We make soup and tempt with small spoonsful when loved ones are ill. We all – every now and then – languish in bed, too ill to get up; too unwell to want to, hoping someone will nurse us in return.
Nursing is everywhere. Yet, as I’ve devoured books by doctors - Reaching Down the Rabbit Hole: A Renowned Neurologist Explains the Mystery and Drama of Brain; Do No Harm: Stories of Life, Death and Brain Surgery – I’ve never noticed what wasn’t there. Anything by nurses.
The absence in plain sight.
“And I have to say,” Christie admits, when I phone her for our interview, “I feel embarrassed myself that, as a writer and as a nurse, it didn’t even occur to me for many years.”
Before The Language of Kindness, you’d have found Christie’s books in the fiction section – her novel, Tiny Sunbirds Far Away, was written while on maternity leave and won the Costa First Novel Award; she followed it with a second, Where Women are Kings, in 2014.
“A heart cell beats in a Petri dish. A single cell. And another person’s heart cell in a Petri dish beats in a different time. Yet if the two touch, they beat in unison. A doctor can explain this with science. But a nurse knows that the language of science is not enough” – The Language of Kindness: A Nurse’s Story, by Christie Watson ‘We’re in a situation where so many of the patients on children’s wards are teenagers who are selfharming’
When she first considered writing about nursing, her thoughts turned back to fiction. It was her agent who put her on the right track. “She suggested non-fiction about nursing, which seems like such a no-brainer now; but, at the time, it hadn’t really occurred to me. And then I looked around for stories written by nurses and I couldn’t find any.”
It speaks volumes about what we value, I guess. But why exactly do we fail to attach value to something so immensely precious? To caring for each other.
“I think it’s primarily because nurses are women – 89 percent of nurses in the UK are women - and it does say a lot about our value system. Even the skills at the heart of nursing - compassion and care and kindness – are still seen as feminine traits: seen as less important than the bombastic, medical, technology model that we’ve always lived by.
“And that, I truly believe, is because we’re living in a gendered society that values men above women.”
Soft skills. That’s the implicitly dismissive term that’s often employed.
Yet those same soft skills are the ones Christie details in pages where the ‘softness’ forces you to push aside the book in horror; to try to take your mind off Jasmin, dying from injuries sustained in the fire that killed the mother so desperate to rescue her and her brother from their bedroom. Before Jasmin’s distraught aunt comes to visit, Christie and her colleague gently wash the tragic girl’s smoke-saturated hair, tipping away the soot-blackened water so the acrid smell recedes just a little.
Or as she helps massage the joints of a corpse to stop discolouration or pooling. (A corpse with a photograph of dearly-loved children by his side.) “Nothing worse than pooling, for the family.”
Or as Christie holds her breath, trying not to show revulsion as a man with an abdominal blockage vomits his own faeces.
“It is,” she writes, “a privilege to witness people at the frailest, most significant and most extreme moments of life...”
To have the capacity to love complete strangers. That’s the hardest skill of all.
The other interesting thing about going back to Florence Nightingale (Christie’s book encompasses history, philosophy, science, technology, political thought; a panoply of vision) is how much technology has changed; but how much besides remains horribly the same.
Christie was offered counselling just twice during her nursing career – in the same way nurses such as Florence’s (no matter what they experienced) were simply expected to be “a bit tough”. And while soldiers of the world wars were diagnosed with shellshock, that condition was never officially recognised in those who tended them.
Perhaps that’s why the suicide rate amongst female nurses is currently the highest occupational suicide rate of all.
“It’s the best job in the world but it’s definitely the hardest job in the world,” Christie says. “I don’t think there’s anywhere near as much mental-health support or clinical supervision as there should. I’m absolutely sure I’ve had post-traumatic stress symptoms – not disorder but symptoms. And I’ve certainly had flashbacks to really horrific, traumatic events. I don’t imagine any nurse working in the
frontline in the NHS, or otherwise, has not seen things they wish they could un-see; been involved in situations that are extreme human experiences.”
Some things haven’t changed over the years; that’s true. But others have – and not for the better.
Such as the huge rise in mental illness that Christie writes about – particularly among teens. (“I’d rather have cancer than a serious mental illness,” a mental-health professional says to Christie.) One in 10 children now has a diagnosable mental illness.
“I think we’re facing a really big and difficult problem,” she tells me. “When I started nursing, it was children with asthma, diabetes; they’d come in with various conditions: you knew what it was; you gave them the treatment and they’d go home. So lots of the children’s nurses – bright, chirpy young women – started out, like me, thinking, ‘This will be a lovely job – I’ll be cuddling babies!’
“Now we’re in a situation where so many of the patients on children’s wards are teenagers, often girls, who are self-harming; or boys who are having their first psychotic episode.”
Not that we can separate body and mind any more. The time has come to ditch the terms adult nurse, children’s nurse, mental-health nurse, she says.
“Because we are such a jumbled-up mixture of everything. You can’t cut people into slices. So much of what we see in hospitals is physical and mental illness at the same time that we need training in everything.”
And perhaps – I suggest – perhaps from a patient point of view, there’s a feeling that a lot of this is of our own making. Orthorexia (a ‘recent’ condition centred around an obsession with healthy foods); alcohol, obesity, stress, smoking; all could be banished if we just put our minds to it.
But. Isn’t it too simplistic to blame people for things that, in theory, they look as if they could avoid?
“I used to have a bit of that myself. But patients teach you so much – far more than nursing books. We had a patient who used to come in with drug and alcohol problems. He had long-term serious mental-health issues; he had vascular disease; he had really badly managed diabetes because he wouldn’t manage it. He was in and out of hospital, and all the nurses and doctors – all of us – had the potential to get very frustrated with him.
“But it turns out he had been looking after his mum, at home, who had dementia for years and years; he had kept her out of hospital and he’d kept her out of a nursing home.”
That’s the thing about healthcare professionals. They walk in other people’s shoes; they see their lives.
“If you follow these people home, you’ll understand much more than you see at face value in hospital.” Christie Watson talks about many things. About how Filipino nurses – amongst the best she’s worked with – are horrified to come to the UK and see elderly patients with empty chairs at visiting time.
She talks of how a black new-born in America is twice as likely to die as a white new-born. “Right now. Today.”
About the fact that we’re 40,000 nurses short; and until we have nurses on the wards, we can forget all those big conversations we’re having about AI and other advanced technology.
There are good things, too. Surprisingly simple things. “Like social prescriptions – so, for example, prescribing somebody poetry. I was speaking to a GP recently who said he often prescribes gardening as a way to help somebody’s mental health. That’s a great thing.”
Death cafes are another positive. “Everyone deserves a good death. And the only way we can achieve that is to talk about it.”
Yes, some things are changing for the better. And, even with the negatives, it’s still a job to beat all jobs.
Christie’s currently working on a script to bring The Language of Kindness to TV. And she knows – to her great delight – of two other books (one by a nurse; the other a midwife) due out soon. The silence is being broken.
And the message reverberating through that silence is clear. Value shouldn’t just be attributed to objects with pound-signs on them. Value shouldn’t just be attributed to glitzy new wonder-drugs or to great leaps forward in medical science – wonderful as they are.
“That’s the thing about nursing,” Christie Watson tells me. “It doesn’t try and cure people. It’s not based on cure: it’s about helping.
“Even when cure is not possible, that’s when nursing becomes really important.” The Language of Kindness: A Nurse’s Story, is published by Chatto & Windus
Christie Watson will be speaking alongside Sam Guglani (writer and consultant clinical oncologist in Cheltenham) on what it means to devote your life to the care of fellow human beings. ‘The Caring Kind’ takes place at Stroud Subscription Rooms, 2-3pm, on Sunday, November 11: stroudbookfestival.org.uk