The Making of a Nurse
By Tilda Shalof
Toronto: McClelland & Stewart, 2007
328 pages; CDN$34.99 cloth
I wasn't sure what to expect when I picked up Tilda Shalof's latest book, The Making of a Nurse . I'd heard her speak eloquently on CBC about the book and the personal journey behind it. But having read many "hospital" stories since developing my childhood obsession with what went on behind all those closed doors, I admit to wondering whether this book would offer anything new to an experienced nurse now gently surfing the downside of the CIHI age wave. I suppose the fact that I read the first half of the book in a single sitting during an unplanned airport layover puts to rest any question about whether the story captured my full attention.
Shalof's book traces her life from childhood to the present, along the way weaving anecdotes - of her days in school, her professional interactions with colleagues, patients and their families, her travels and her own inner struggles - into a rich history of her love of nursing. It's been a while since I read a book that captured and triggered so many feelings and memories, good and bad, about the life and career that we nurses have chosen.
Intimate in one moment, funny in another, wrenching in the next, her story will be compelling and engaging to any reader. But it will especially resonate in the minds of nurses and, indeed, anyone who has spent time working in the healthcare system. Shalof's writing style makes for an easy read - frank, straightforward and clear. The book - part diary, part confessional and rich with reflection - moves along quickly, shifting easily between the present and her memories of meaningful moments across her life and career.
I was left feeling slightly voyeuristic as Shalof described her most personal feelings about moments spent with parents, friends, patients, partners and children. Who among us has not felt a romantic rush for a colleague in the exhausted dark of night before pulling back to harsh reality? And carrying the enormous burden of caring for a loved one, who has not had fleeting thoughts of wanting to flee? Most of us don't talk about those kinds of things publicly. I was impressed with Shalof's mature, unapologetic and easy honesty.
After reading her book, I wish I had gotten to know Tilda better when I first had the chance a quarter-century ago. We shared teachers and classrooms for three years in a large group of nursing undergraduates at the University of Toronto. June 2008 will mark 25 years since we also shared graduation. She talks in the book about the grind of getting through the theoretical and classroom side of nursing school, our collective desire to be with patients, and learning the language of nursing diagnosis - a still silly and politically dangerous game in which professional nurses are supposed to pretend they don't really diagnose and treat real pathologies every minute of the day.
I was a back-row student, surrounded by like-minded souls, snapping gum, sneaking out the back for cigarettes (a lot of us still did that in those days, and in the good company of some of our teachers - it was a different world) and just wanting to be working full time with patients. I could not get out fast enough, and I'm sure more than a few of my professors shared that sentiment.
Twenty-five years later, I find now that I had a kindred spirit sitting right across the room. I wonder whether I would have treated Tilda differently had I made an effort to know the pain of the home life to which she returned after those lectures? I was shocked to read her account of living on the street and her journey back to a different life. Was this the same "nice girl" across the room in nursing school all those years? Was she really sitting in her boyfriend's car back then, listening to Marvin Gaye sing "Sexual Healing," and avoiding class? Reading that, I have to say, I liked her even more.
The reflection above is typical of what I found myself doing repeatedly throughout the book. Shalof's story had me reliving my own, remembering small moments of personal pride juxtaposed with those when I felt sorry about something I had said. I relived joyous moments of sitting on beds laughing in the dark with sick patients who were too scared or bored to sleep - and the terrible opposite, collapsing against the linen cart in a supply room too crushed by sadness to do anything but weep alone.
I was struck by two recurring themes in the book. One is intensely personal - the child caring for the parent, the young girl forced to grow up too fast and the shocking frankness with which Shalof describes her mother's descent into what must have seemed like madness. I wonder how many nurses came from such homes, or were the oldest child, or just feel (and then sometimes resent) a great personal sense of need to fuss, care, watch, monitor and rescue. Is it bred into us or thrust upon us? And why do some do it with such easy joy while others seem to have made an art of the "sour puss," as my dad would say when we were pouting as kids.
The other recurring theme is on the professional side, and it's about the yin and yang of nurses and the Zen of nursing. Without the saccharine tone of some similar tales, Shalof puts words to the joy that nursing at its best can be, even in moments of crisis, anger or great sadness. Most significantly, she makes plain how much nursing matters - it's beautifully done.
On the other hand, she shares tales in a matter-of-fact way of the rigid, sometimes cynical and rules-driven colleagues on whom nurses rely most closely as trusted teammates, managers and teachers. After reading the book twice I came away asking myself again what it is about this self-described caring profession I love that attracts and retains such extremes in the personalities and beliefs of some of its practitioners.
Shalof prompted me to think again about those sorts of questions because she brings the irrefutable credibility of a hands-on, working career nurse - it would be pretty hard to deny the truth in anything she says. She experienced nursing much as I did, for better and worse. For me, her narrative was so real that I could feel and smell and hear every sensation in her stories. I wondered anew how it is that the Shalofs of the world are able to sidestep the fatigue and the bullies among us to mount enough curiosity and joy that they still look forward to a night shift in the ICU after 25 years of practice.
Without bitterness, she dances around one of the constant dilemmas underlying professional nursing practice: the expectation that the RN will function with the knowledge and autonomy of a neurosurgeon in one moment, then stand back, hands off (or worse, "brain off") in the next - all driven by timing, location and the needs of other people. In her accounts of the events of busy ICU shifts, one can sense the pressure and enormous responsibility thrust upon nurses, often without the benefit of the accompanying authority to act. And she quietly, bravely acknowledges the opposite problem of nurses who won't stand up when they need to. The real story of The Making of a Nurse is the constant tussle with these kinds of vexing dilemmas nurses face every day.
Recently, I looked out into the audience at what much of the world will always know as Toronto General (coincidentally, the setting of the book), where I was giving a guest lecture, and there was Tilda. She'd come in on a day off to say hello and re-connect. Her loving spirit was just like the one coming off the pages of her book, after the lecture insisting on helping me as I dragged a small suitcase of AV equipment with me, calling me a taxi and even offering to take the cab with me to help me get set up at the next venue. Ever the good nurse, "helping those who would help themselves if they had the necessary strength and will." I thought about how exhausted I felt that day. It must have shown.
I watched Tilda wave at me through a light drizzle on Elizabeth Street as my cab drove away, and I felt a great rush of pleasure in the unexpected reunion with my old schoolmate-turned-author. "Good on you," I thought. Good indeed. One of my cherished mentors, the late Anna Jean Rouse, chair of the undergraduate program when Tilda and I were in school, would have been beaming. She always made me feel like she loved the "back row" students and the mavericks best, and I hope she would feel her faith was well placed. The Making of a Nurse puts beautifully into words a journey millions of us have shared, but that few of us can summon the language to describe. A great read, highly recommended. More, please!
About the Author(s)
Reviewed by Michael J. Villeneuve, RN, MSc
Scholar in Residence, Canadian Nurses Association
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