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In Honor of the Nurses [published in TOI January 1, 2021]

Not many of us could have predicted when the World Health Organization declared 2020 as The International Year of the Nurse and the Midwife that we would come to know in visceral ways how essential nurses and midwives are to health and healing. Not many of us could have foreseen the extent to which their lives — and their deaths — would reveal the state of healthcare systems and societies across the world.

As the daughter of a nurse who, like nurses and midwives everywhere, exalted both in the wonder of human biology and the love of human beings, I want to pen a few words in the final moments of this tumultuous year in the hope that we take seriously what we’ve learned about them, about ourselves, and about our larger communities.

Even when forewarned, humans have never been particularly adept at preparing for disasters perceived as vague and far-off, whether earthquakes, climate change or plagues.  Perhaps we’ll do better next time. But this year — as nurses and midwives, among other health and public health professionals, struggled to protect patients, themselves, and their families — the novel coronavirus (SARS-COV-2) made visible how very true this is. To various degrees around the world, we have seen how fragmented and understaffed health systems, depleted stocks of basic protective gear, longstanding neglect of public health infrastructure, and toxic social environments translate into avoidable disease and death.

As COVID-19 became the leading cause of death in the world, we learned how social divisions leveraged by populist leaders can make a bad situation far more lethal, turning people against one another and making simple, protective public health measures the subject of conspiracy theories. In some places, basic decency dueled with a distorted sense of ‘freedom’ and too often lost. This is perhaps most true in the United States where COVID-19 cases and deaths are disproportionately and shamefully high.

Nurses and midwives are our eyes, ears, and hearts when we are vulnerable. They triage, provide emergency care, monitor, and ameliorate pain levels, remain alert to emerging symptoms, and summon other team members when needed. This year they did all of this without the natural accompaniment and support of their patients’ loved ones. They did this even when required to care for many more patients than is safe. Women birthed without their partners. Patients died without their families. Throughout, nurses helped bridge the human space between pregnancy and birth (as beautifully described in the blog of an Israeli midwife), between sickness and health, and between sickness and death.

We learned that nurses and midwives run towards the fire on our behalf, even when they aren’t safe, even when their job stress is magnified by failed policies and longstanding inequities. Social media afford many first-person accounts. We have months to go, but they are telling us that while they are proud of their work, 2020 has been harrowing, exhausting, injurious and life-changing.

A couple of weeks ago my mother fought back tears when she heard a nurse describe the death of her 28th patient to COVID-19. She told me that as a hospital nurse in the 1950s two patients died on her watch. Both were in their 80s; both deaths were anticipated. Still, she recalls their deaths with a gnawing sense of failure. How, she wondered, would so many deaths weigh upon the souls of today’s healers?

Despite broken systems, nurses and midwives, together with other health and public health workers, have had to figure out how to prepare for and manage illness and death on a scale not seen in a hundred years. Foregoing sleep and family time for months, they’ve cared for too many patients, made difficult moral decisions when supplies ran short, stood up “surge hospitals,” organized quarantine centers, and set up testing and vaccine sites.

So as we turn towards 2021, here’s hoping that when the long-term impact of these months on those we charge with protecting our health becomes more apparent, we stand up on their behalf with needed services and with a commitment to fix our healthcare systems, our larger communities, and ourselves.

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Previous Blog: COVID-19 reveals long-standing hospital underfunding. August 4, 2020.

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