“You know you’re a nurse when you wash your hands before AND after using the bathroom.” This wise saying was passed along by my first professor in nursing school, Linda Pellico. She is a teacher who brought us to tears of laughter with her bawdy stories, and tears of frustration with her high expectations and demanding assignments. One of her requirements was that we spend a whole afternoon with her at the art gallery, observing paintings; she called this project “Looking is Not Seeing, Listening is Not Hearing.” We spent long silent minutes in front of each piece before sharing what we saw of place, color, shape, and relationship. Skilled observation of the body, the story, verbal and non-verbal communication—these are often natural-born gifts, drawing someone to a particular profession. Intuition without practice and training, however, is far too imprecise a science to guide the risk-filled decisions of an advanced practice nurse.
Three years into being a family nurse practitioner, I have indeed sharpened the disciplines we practiced back in that art gallery. I can remember many of my diagnostic victories: catching an ectopic pregnancy, discovering newborn cataracts, recognizing complex hormonal disorders. Listening openly to a person’s story, looking at the body, and quickly focusing questions, can lead to a good diagnosis and a successful treatment. This is exhilarating.
In my particular work setting, however, “family practice” is heavily weighted towards the older adult with many chronic diseases: hypertension, diabetes, obesity, lung disease and arthritis are my stock in trade. I do very little “healing,” in the way that we remember Jesus healing paralytics or lepers. For these people there is not much I can do to help their bodies; I can educate them about the pathologies and their treatment choices, and I can extend their lives through tailoring medications to slow the progression of their diseases. But when they cannot quit smoking, eat well, or exercise their bodies, then I expect they will only continue to feel worse and worse, at least physically. How do I help my patients to feel better, then, if I don’t expect them to get better?
If you leave your primary care provider’s office feeling that he or she has heard you and taken your concerns and anxieties seriously, then regardless of your physical prognosis, you will likely feel better. As the care provider, my mind is buzzing with my own agenda for each visit—preventative care, like mammograms and tobacco cessation counseling, how to best address a slow rise in cholesterol or blood pressure, ranking my patient’s concerns in terms of actual risk and effects on daily living. If I can show a person that I hear her though, through my demeanor, questions, and physical exam, then she will leave feeling comforted.
Listening and hearing are my most effective treatments. I cannot fix low back pain brought on by a lifetime of obesity, nor the pest-infested apartment, the abusive relative, or the violent neighborhood. I can try to show someone that she is worthy of attention, though, that someone else cares about her troubles, and that she is a valuable person. In the long run, I don’t know if or how exactly my listening changes lives. I do know, however, that God cares for my patients more than I do, and that they can cast their cares onto me only because I can cast my cares—and theirs—onto Him.
Eden Garber is a family nurse practitioner.