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Title: The Shift: One Nurse, Twelve Hours, Four Patients’ Lives
Author: Theresa Brown, RN
Publisher: Algonquin Books
Publication date: September 22, 2015
Price: $15.59; hardcover, 272 pages
If health care were looked at through an architect’s eyes, nurses would be the girders holding the structure together. They work 12-hour shifts caring for the needs of sick people, doing intimate things with the bodies of total strangers that would make most laypersons queasy.
In her new book, The Shift: One Nurse, Twelve Hours, Four Patients’ Lives, Theresa Brown, RN, a practicing nurse and columnist for The New York Times, invites readers into the heart of her daily experiences on a cancer ward. And she compresses that experience into one shift. Every day, Nurse Brown and her colleagues care for critically sick people, at once being tough and tender and super efficient. By the end of this enjoyable medical story, readers of The Shift will be well acquainted with several patients with cancer and the durable hard-working nurses who care for them.
Ms. Brown earned a PhD in English and taught writing at Tufts University before trading academia for hospital scrubs at a Pennsylvania teaching hospital. She explains that nursing was her true calling, although she describes it more as a rewarding job than an enjoyable one. She lets readers know that her career change was motivated by compassion and care.
Moving and Wacky Moments
She is a capable writer, at times turning out lovely descriptive sentences. She also has a keen ear for dialogue, deftly capturing the conversational voices of nurses and doctors as well as their patients, in all shades of emotion.
What illuminates Ms. Brown’s story are the moving and sometimes wacky moments that make life in a hospital terrific fodder for storytelling. In one scene, a patient says a weepy goodbye before surgery, knowing there is a fair chance that she won’t survive the risky procedure. Ms. Brown offers her a hug; the patient, instead, kisses Ms. Brown squarely on the lips.
Writing Style Critique
Good writers sometimes fall into the trap of searching for allegory for allegory’s sake, ending up with chunks of well-written narrative, which can be an uncomfortable fit into the storyline. For instance, Ms. Brown’s prologue is titled “A Clean, Well-Lighted Place,” which is, of course, the title of one of Ernest Hemingway’s best-known short stories. In the story, a lonely old man sits sipping brandy in a café late at night. A young waiter wants to close the café and go home to his wife, whereas an older waiter has empathy for the dawdling patron, explaining that for an old man, going home to one’s room was not like sitting in a clean, well-lit café. It is a story of loneliness and mortality.
Ms. Brown explains Hemingway’s story and then inexplicably writes, “There will come a time when each of us will need a clean, well-lighted place that stays open all day and night, offering shelter from life’s storm—this is a hospital.” Really? Hospitals save countless lives, but it is about the last place anyone wants to go. They are noisy and uncomfortable with middling to bad food, patients groaning through the night, and a place where, according to the Institute of Medicine, about 99,000 Americans die each year from nosocomial infections. The analogy just doesn’t hold water, surprising for a PhD in literature.
And because real life, even in a busy hospital setting can also be more dull than fiction, the story sometimes reads like a very busy person’s to-do list, executed in real time. Without a main narrative purpose, its insights can also come off like a collection of clichés, as when Ms. Brown notes of the ward’s survivors: “Their lives will continue to spool out as they each weave the fabric of their own unique existence.”
Hierarchal Struggles
The author becomes closely involved with her patients and makes no bones about questioning a doctor’s orders when she feels they aren’t in her patient’s best interest. To that end, in a pointed critique of yesteryear’s patriarchal medical culture, Ms. Brown notes that vestiges of that Ivory Tower occupied by white male doctors still exists. “Hospital nurses get hired and fired independent of MDs, but from what I see and hear, at a fair number of hospitals no nurse would be protected if an important doctor really wanted her gone. Doctors are our shadow bosses, the people whose orders we put into action, whose patients we share the care of, even though MDs don’t explicitly supervise us. No wonder we both end up playing games when we communicate at work.”
Hierarchal struggles exist in every stratum of life, from marriage to career. Ms. Brown makes some sweeping generalizations about doctor-nurse relationships, derived from personal experience. No doubt male chauvinism still exists in medicine. However, although Ms. Brown is a dedicated nurse working on a cancer ward, her experience does not capture the incredible respect that oncologists and oncology specialist nurses have for each other as they work side by side caring for their cancer patients.
Making Patients Come Alive
For readers of The ASCO Post, the hook in The Shift is that the story’s central location is a cancer ward. Ms. Brown weaves the clinical scenarios of four cancer patients into her narrative, and her common touch and genuine humanity—despite some cornball antics—shine through as the patients come alive on the pages.
We meet Richard Hampton, a lymphoma patient in his late 70s. She does a superb job describing the rigors of Mr. Hampton’s cancer care and his vital family support systems. However, when Ms. Brown discovers, after a brief secretive conversation with an intern, that Mr. Hampton has been prescribed rituximab by the attending physician, this back and forth ensues:
“Are you his nurse? Asks the intern, his voice soft and low.
I nod and say my name.
“So, it looks like they’re going to give him Rituxan today,” he says.
“Rituxan?” I ask, raising my eyebrows.
His features collapse, and his face goes blank. “We’ll discuss it on rounds.”
This is not a professional oncology exchange. It adds intrigue where none should exist. Cancer care is not a spy movie. The lay audience looking for a somewhat entertaining hospital story should try The Shift, but readers of The ASCO Post perhaps may want to give it a pass. ■
