News and Features
Some magazines have an identity problem, and some don't. The New York Review of Books doesn't, as you may have noticed. It's relentlessly highbrow, which is how we like it. For the most part. But every once in a while, a little bit of pop culture creeps in, hooray, and then the editors do their best to hide it. In the February 14 issue, for example, there's an ebullient review of Stephen King's Dreamcatcher, among a million other of his books, by the always bubbling and boiling John Leonard. But the cover gives no hint that this amusement lurks within. Instead, it plugs yet another review of yet another book on Anthony Blunt (Blunt and Kim Philby are to NYRB what the Beatles are to Rolling Stone: no issue complete without at least one mention, even if it has to be in the personals); a searing legal indictment of Bush's military tribunal "concept" by Aryeh Neier, the former executive director of Human Rights Watch; and, smack in the center, a piece by John Updike on Gustav Klimt in New York, the exhibit at the new Neue Galerie on Museum Row in New York.
Updike's review is fine, but it gives me the feeling, again, that there are two sides to the man: Updike the great writer, and Updike the whiny curmudgeon who hangs out in New York, goes on taxing trips to China and believes he heard the twin towers "tinkle" to the ground from his vantage point in Brooklyn. Thus the Klimt review begins with a litany of complaints about traffic flow at the museum and the placement of the bookstore and gift shop on the ground floor (where else would they be?), with the brave Updike thrusting forward like a great beaky bird through the plebes. "As stated," he writes, "the café, with windows on Fifth Avenue, was thriving; in my haste to get to the art I missed the bookstore and 'design shop.'"
I'm glad the King review is there as a counterweight to the difficult walk amid the gifts and the latte drinkers and the Austrian furnishings, but it shouldn't be a secret kept from newsstand buyers. Leonard's encompassing review includes the funny and instructive story of King buying a table at the National Book Awards for himself and John Grisham (among others), who will never be invited or granted such a prize by what Leonard, borrowing a fine word from King, calls "those shit-weasels, the anal-retentive literary establishment." Not at the table, and not on the cover.
I've always been a coward, and the events of September 11 have not alleviated the problem. I own: one roll of duct tape, a medium-sized Leatherman tool, a small flashlight, seven surgical masks, a box of latex gloves, many cans of beans and a box of Carnation evaporated milk, all bought in the aftermath of that day. I admit it's not total coverage. But then, I am not much of a survivalist. Five months after the attacks, I went through some of the post-9/11 magazines, and I now know why survivalism is not for me. A person who depends on one box of Carnation (which, I have learned from my reading, lasts only six months) should not go on living on an earth that will be filled with post-Armageddon survivalists. We could not be friends. They call knives "edged weapons."
Of course, all the survivalist and mercenary magazines are pro-gun, and they seem to think that having a gun will somehow help you in the next new world. In Terrorism Survival Guide's second issue, an article about choosing the right firearm tells families that "self defense has reached a level in this era of murderous terrorism that to be unarmed is equivalent to surrendering to ruthless evil." It's hard to imagine how a handgun would help as a skyscraper flattens to the ground, but I suppose the civil unrest that might follow could justify it. (And I did like the look and name of that Black Widow .22 Magnum, which weighs in at just over 6 ounces and is only 5 inches long and would fit quite snugly next to my Leatherman and flashlight.) As ever, Soldier of Fortune is the most interesting of the wacko military mags. Like Aryeh Neier--to whom you can safely say its writers are not too often compared--it abhors Bush's military tribunals, and its March issue contains a semi-thought-provoking piece on Johnny Michael Spann and Director of Central Intelligence George Tenet, with most of the ideas and attitudes taken from Seymour Hersh's piece on Tenet in The New Yorker last fall. Hersh and SOF: another unusual team. But then again: The World Has Changed. You can tell it has, because in the photo of a young girl and her Barbie doll in Terrorism Survival Guide's article "What Do We Tell Our Kids?", the girl is wearing a supermodern protective plastic helmet, and Barbie has on a pink tank top, lace skirt and gas mask.
Heebs and the Rest of Us
There's a new niche magazine: Heeb, the New Jew Review. Intended to stir up controversy, this sparky and slightly inane newcomer will reignite the old, old controversy over what it means to be Jewish. If it means skateboarding and deejaying and graffiti-writing, I've blown it completely. But there are some great things in here, too: a wrong-minded but amusing meditation on the use of Jews in The Simpsons; a lovely homoerotic paean to Allen Ginsberg, with a moving photo of the great one in his bathrobe, cooking; a twisted essay on Pizza Hut's new Twisted Crust pie, which the writer insists is a reference to the swastika (Hakenkreuz, in German, or twisted cross); someone's old bubbe reviewing the latest pop music ("Oh, I love that beat!"). Heeb takes only a minor interest in the major crisis facing Jews today--there's a short bit (in a department called Underground Oslo) on the Old City Peace Vigil, a small interfaith group that is bravely keeping up a protest in the shadow of the Western Wall. Everything in this eye-catching magazine is irreverent, but only a teaspoonful is important. Still, it's a rare pleasure to see my people not take themselves too seriously. Oh, and it has a centerfold of Neil Diamond. Not nude, but the mutton chops are swell; he's like a luscious pinup from another lifetime.
In my last column, I called the expansion of profiling that has occurred since September 11 "equal opportunity." I meant it ironically, but a surprising number of people took me literally. So I want to make clear that I don't consider this upgraded frisking any kind of opportunity, nor do I think that its expansion is really the same as equality. I am also aware, as was pointed out to me, that there are people in the world who might appreciate a good cavity search, confident that this is all for their benefit. And while I understand that we have all become subject to "nothing more than" the same ministrations that visitors to maximum security prisoners go through, the fact that some think this is the best of all possible worlds strikes me as fatuous.
The billions of dollars currently being pumped into police and surveillance budgets represent an unprecedented investment in a heavily patrolled world. Such an extraordinary buildup will inevitably exacerbate questions about the limits of state force; it will require the greatest vigilance to prevent our turning into not just a police state but one big global military base. Specific categories of us will probably continue to bear a special burden--black women in airports are, according to some figures, searched more than anyone else because I, as Typical Black Everywoman, meet the description of a drug courier better than you--as in You, profiled Nation reader and Typical Ungendered White Person.
Blacks and Latinos are the profiled shape of the "war on drugs," even though the majority of actual drug abusers are young white people like Governor Jeb Bush's poor daughter, Noelle. The "war on terror" promises to be even more sweeping. For the time being, our new international, militarized police force has increased its scrutiny, from black women in airports and black men in cars, to include Middle Eastern men anywhere, Asian people who look vaguely Filipino, as well as ample Minnesota housewives actually armed with sets of silver fondue forks.
Is this better or worse? I think it's a misuse of data, often creating a false sense of security. The kind of profiling that seems to inform the majority of stops and searches is usually based on statistical relations so vague as to be useless. Such profiling, premised on diffuse probabilities about looks and dress, ethnicity or nationality, class or educational status, begs for more analysis. Otherwise it can be defeated on the one hand by guards and gatekeepers whose interpretation of looks or class status is skewed by selective and subjective prejudice and on the other hand by travelers committed to the art of disguise.
The attacks on the Pentagon and the World Trade Center were carried out by deeply rational and well-trained operatives whose tactics defied easy profiling. They looked--and were--well educated; they dressed professionally. The fact that the FBI actually had information that some of them had been involved in terrorist networks counted less in the real world than that they looked good. After all, it is true that in a very large sense sleek, well-dressed professionals commit fewer crimes than the hungry, grumpy lower classes. I have this painful recurring dream of the security guards at Logan on September 11, carelessly waving all eighteen men through, while strip searching long lines of black women having bad hair days.
I worry that we're doing the same thing with shoes: Richard Reid was able to board an airplane because he played against the expectation embedded in profiles. He looked odd enough to have been stopped and questioned, but ultimately looks had little to do with what made him dangerous. Although they were suspicious, security officials did not discover his criminal record, surely better evidence of his propensities than whether he wore a ponytail. He was finally allowed on board; he was a British citizen, and British citizens were not the subject of any profile. They searched his bag but not his shoes, because shoes were not at that point the subject of any profile. Now that we know thick-soled sneakers can be turned into weapons of mass destruction, airports spend a lot of time removing and examining them. It's likely to catch copycats, I suppose, which is not a problem to be ignored, but does anyone really believe that Al Qaeda would use shoes again? In other words, while there is, after Richard Reid, a marginal relation between shoes and bombs, the actual odds of it ever happening precisely like that again are slim to nonexistent. Indeed, what distinguishes professional operatives who calculatedly sow terror is that they take the time to play against type.
So I worry when I hear about plans to expand profiling as we now seem to practice it. I worry when I hear about plans to have our thumb prints taken, our irises scanned, our DNA plotted. How can we be putting all this work into appearances when appearances bear no necessary relation to intent? The risk of this is not just one of diminished dignity or privacy. The problem ought to have been made clear to us in the wake of "accidents" like Amadou Diallo. The problem ought to be apparent in recent news stories about the CIA having flown an unmanned surveillance craft over a street in Afghanistan. It had a night vision camera on it that caught in its scope a group of men conversing who fit a profile because one of their number was unusually tall, as is Osama bin Laden. After some consultation at the remote site where the CIA officers and their telemonitors were located, the CIA decided to bomb the group. The men were killed, but as of this writing, the CIA admits it still doesn't know who the men were. Civilians on the ground claimed that the men were townspeople scavenging for scrap metal.
This death by actuary. This profiled guilt. This trial by night vision drone. Our superlative technology permits us to listen, scan, survey and X-ray anybody and everybody in the world. But a sea of data alone won't help us if there is no higher wisdom in the final analysis. Good "intelligence" means more than eyes and ears--there must be a heart and a brain, or we will never achieve the global stability we all so desperately desire.
The McLaughlin Group is about to "celebrate" its twentieth anniversary. We might as well "celebrate" the discovery of anthrax.
The show flatters itself--and its corporate sponsor, GE--that it is providing some kind of public service. It's even offered on PBS in many cities, and its website features such faux educational trappings as classroom guides and discussion-group questions, along with $50 golf shirts. And while ratings have dropped steadily and precipitously for the past seven years, that is due largely to the fact that it has very nearly taken over our media world. Entire cable networks are devoted to its ethos, and even the old reliables of respectable political discourse--like NBC's Meet the Press and CBS's Face the Nation--are dancing to its dissonant tune. Before McLaughlin, public affairs television programs were often dry and pompous, but with the exception of the painfully pompous Agronsky and Company, they were devoted to the proposition that reporters--like everyone else--should appear on news programs only when they've learned something of value of which most people are unaware (hence the word reporter). The McLaughlin Group transformed this essential qualification from specialized knowledge to salable shtick. Not only television but journalism itself has never recovered.
As evidence of how little education, expertise or good, old-fashioned shoe-leather reporting matters in this universe, consider McLaughlin himself. Before building his television empire, he earned his fame as a Jesuit sex lecturer. He ran a hapless Senate race in 1970 in Rhode Island as a McGovernite Republican--yes, you read that right--but still managed, with Patrick Buchanan's assistance, to land a job in the Nixon White House. There, in priestly garb, he defended the Unindicted Co-Conspirator as "a moral man, thirsting for truth." Nine days before Nixon's resignation, McLaughlin predicted that Watergate would soon be viewed as a "mere footnote to a glorious administration."
Aside from talk-radio and religious writings, McLaughlin's most significant brush with journalism was a brief stint as Washington editor of National Review, where he would sign his own name to the work of the NR's interns and research assistants. But the show turned him into a superstar in Reagan's Washington. He bullied and humiliated fellow panelists and terrorized his young staff members, at least three of whom felt themselves to be victims of his sexual harassment. According to the court documents of the lawsuit Linda Dean filed against him, McLaughlin told her that he "needed a lot of sex" and "would take care of every material desire" she had, as he fondled her "intimately and against her will." Dean was fired, but her lawsuit resulted in a private settlement. (I guess this would be as good a place as any to plug the second edition of my book Sound & Fury: The Making of the Punditocracy from Cornell University Press.)
The genuine journalists whom McLaughlin casts as foils on his show tended to hate his guts but could not walk away from the unmatched buck-raking opportunities it spawned. While McLaughlin appearances paid a pittance, they came with invitations from corporate sponsors to recreate the show at conventions for five figures a pop. Mediocrities like Morton ("Ronald Reagan is a kind of magic totem against the cold future") Kondracke and Fred ("I can speak to almost anything with a lot of authority") Barnes quickly developed celebrity cults. The more ambitious among them--like Kondracke, Barnes, Robert Novak and Chris Matthews--eventually used their newfound status to jump-start their own carnival-barking careers on rival networks. The warhorse Jack Germond stuck it out for fifteen years, at considerable cost to his self-respect as an honest reporter but considerable benefit to his income. (When Germond learned that the program would be distributed internationally, he replied that the panelists could now rejoice in "dumbing down the world." McLaughlin promptly benched him.)
In addition to debasing the culture of journalism, the McLaughlin monster also aided its corporate sponsors and conservative friends in shifting the foundation of political debate into the heartland of Reagan country--where it remains to this day. The group set up a center of gravity in which two right-wing ideologues, Buchanan and Novak, were "balanced" by the wishy-washy neoconservatism of Kondracke and the bourbon-laced, no-nonsense nonpartisanship of Germond--a down-the-line reporter with no political axes (or axises) to grind. McLaughlin acted--and I do mean "acted"--as referee. The net result was to bestow respectability on views that had only recently been the exclusive property of the caveman right and to marginalize liberalism beyond "responsible" debate.
The group's ideological legacy is hardly less significant than its deleterious impact on the civility of our discourse. I wonder how valuable it was, on a scale of one to ten, to George W. Bush in the late fall of 2000 to have a conservative punditocracy parroting James Baker's arguments before his case reached the Reagan/Bush-packed Supreme Court. And I wish I could predict whether Bush would have been able to shift the budget debate away from his showering trillions in tax breaks on the wealthy toward the alleged trade-offs between money for the war on terrorism versus that for health, education and the environment, without the spawn of the McLaughlinites marching in lockstep--like a parade of Stepford Wives--to the drumbeat of the Republican right wing. The ultimate public service of The McLaughlin Group has been to make it nearly impossible for anyone to speak to public issues on television except to repeat the most banal, and frequently conservative, clichés--albeit accompanied by snappy and self-serving wisecracks. Why not genuinely honor this signal achievement on its anniversary and start making calls to PBS and its local affiliates demanding that they stop wasting our precious contributions and tax dollars to broadcast it? Will it work? No predictions, there, I'm afraid, given the size of GE's sponsorship. But I promise you'll feel better about yourself.
Barbara Coe is not your typical sixty-something silver-haired-senior-in-polyester.
It's the largest profession in healthcare. It's the largest female profession in America. But despite its tremendous importance and impact, most people know very little about contemporary nursing. Public ignorance of the present-day profession, however, pales in comparison with ignorance of nursing's history. How many of us know that the development of nursing as the first secular profession for respectable women was a major feminist achievement? Or that Florence Nightingale was not, in fact, the "founder" of modern nursing? Or that nurses played a key role in developing the American hospital system, as nursing historian Sioban Nelson has documented in her recent book Say Little, Do Much? How many of us know about the role of nursing in the development of public health and care of the chronically ill and poor? Most important, how many of us recognize that society's persistent devaluation of nursing--reflected today in the prejudices of many newly liberated female physicians, health policy experts and journalists--is a legacy of longstanding, socially enforced subordination to medicine?
Katrin Schultheiss, an assistant professor of history and women's studies at the University of Illinois, Chicago, is one of a handful of non-nurses who understand what the profession has to teach us about the complex process of female emancipation, as well as about the development of modern healthcare systems. She recounts the tortuous history of how the "professionalization" of nursing in France coincided with anticlericalism and the secularization of the field. Although her story focuses on the forty-year period from 1880 to 1922 and takes place in one country, the gender dilemmas Schultheiss explores have hampered nurses' ability to care for patients in healthcare systems around the globe, including in the United States.
Her tale begins with the advent of France's Third Republic and follows political reformers who attacked clerical authority as they tried to modernize the healthcare system. Until that time, nursing outside the home was typically provided by convent-trained nuns. Modern hospital reformers recognized that nursing required more nurses with more systematic education, but therein lay the problem. Since knowledge is power, the acquisition of knowledge was inevitably a challenge to authority.
Physicians, as men, did not welcome women on their terrain. As members of a developing profession--one that did not then command the prestige it enjoys today--doctors were also adamant about defending their field "from irregular or illegal practitioners."
Even doctors who recognized the need for a more educated nursing work force and who wanted to laicize the care of the sick would not countenance the education of nurses if, in the process, nurses attained the kind of knowledge and stature that would allow them to demand greater authority and autonomy in both the workplace and society. So even lay nursing had to be constructed in altruistic terms that stressed not nurses' knowledge but their virtue. As Schultheiss writes, "As long as nursing was clearly understood to be a custodial, maternal, or charitable occupation, and as long as nurses were regarded as the social, economic, and educational peers of the patients, rather than the doctors, there would be no ambiguity about who held medical authority within the hospital."
In Paris, nursing nuns, while obedient and devoted, presented a problem to medical reformers. "The very existence of an autonomous community of women called into question the hierarchy of power within municipal institutions," Schultheiss notes. Happily, secular authorities found lay nurses, as one reformer commented, to be "infinitely more subordinate than the religious nurses and more scrupulous in the strict execution of doctors' orders."
While anticlerical reformers touted the benefit of lay nurses, the French public was attached to the nuns who had provided what out-of-home nursing care had existed since the seventeenth century, and even before. Of course, Schultheiss points out, even support for religious nurses was cast in gendered terms. Proponents of the nuns insisted that nursing should be left to a special group of religious women because it would corrupt lay women for their real work--which was mothering. "A woman is either a bad mother or a bad nurse," was their motto. To convince the public to support secularization, reformers had to "feminize nursing--to turn nursing into a general feminine virtue that all women could possess."
Schultheiss's story also introduces us to a peculiar hybrid form of religious nurse--the "hospitalières" of the Hospices Civils of Lyons. These women were secular nuns, congregationist sisters "who undertook a lifelong commitment to serve the sick and poor under harsh physical conditions and with virtually no monetary compensation, but who remained under the direct authority of the secular administration." According to Schultheiss, laicizers supported them because they were easily controllable and because their sense of devotion was easily manipulated by civil administrators who didn't want to pay the real cost of nursing care.
In this section of the book, class also enters the story: If civil administrators were to get nursing care for little or nothing, women's educational standards--and thus their salaries--had to be low. Whether they were secularizers or not, reformers recognized that more highly educated women of a better class would eventually demand more pay, and more say.
Finally, Schultheiss takes us to Bordeaux, where we meet Anna Hamilton, a reformer and devotee of Florence Nightingale. With connections to the international nursing reform movement, Hamilton wanted to open a nursing school that would produce a "new nurse," recruited from the so-called better classes. This new nurse, she insisted, would deliver better patient care than nursing nuns. Hamilton's critique of the nuns, Schultheiss explains, was not based on anticlericalism. Rather, Hamilton argued that the nuns had "distanced themselves from direct patient care" while creating obstacles to the creation of "a single medical hierarchy grounded on universal principles of hygiene and scientific health care."
Hamilton was able to gain support for her project from Paul-Louis Lande, a physician who became mayor of Bordeaux, because she firmly linked the "professionalization and feminization of nursing." Doctors in Bordeaux, Schultheiss writes, recognized "the need for improving the training of hospital nurses, but rejected all aspects of reform that expanded the nurses' autonomy or authority beyond the narrowest limits."
Hamilton accepted these limits, asserting that "it is extremely ridiculous for a nurse who possesses neither the knowledge nor the rights nor the sex of the doctor to try to imitate his way of interacting with the patient and to try to use his language." Thus, in France, as in England and the United States, the nurse-doctor game began with the acceptance of the notion that nurses could not--or should not--possess medical knowledge and that they therefore could not--and should not--use medical language.
Schultheiss ends her story after the First World War. The war produced such a huge need for nurses that the debate over the virtues of lay versus religious nurses effectively ended. When more than 100,000 nurses culled from every social class enlisted to serve "la Patrie," this "demonstrated that women's special aptitudes could be attached fruitfully to the state." However, even during this period and afterward, nursing was valued not for its knowledge but for its virtue. It had become, the author concludes, "a twentieth-century version of republican motherhood."
French nursing carries that legacy to this day. Last year, when I was strolling down the Boulevard St. Germaine in Paris, a book displayed in the window of a children's bookstore caught my eye. It was called Je Sais Qui Me Soigne ("I Know Who Takes Care of Me") and is part of a series on citizenship and the professions. Nurses make a brief appearance in the book--as doctors' servants who have, as the text reads, "just enough schooling to follow doctors' orders."
For nurses struggling to put their education to use for patients, rather than for physicians, the ability to escape, at least temporarily, medical domination has always made home care attractive. Which brings us to Karen Buhler-Wilkerson's part of the story. In No Place Like Home, Buhler-Wilkerson, a professor of community health and director of the Center for the Study of the History of Nursing at the University of Pennsylvania School of Nursing, traces the development of home care from the opening of the first US home-care agency--the Ladies Benevolent Society, founded in 1813 in Charleston, South Carolina--through the present.
In Charleston, as elsewhere, respectable society ladies started home-care agencies because they felt "obligated to improve the conditions of and provide for the comfort of the poor," who were, in turn, "expected to manifest their gratitude to the rich," who established these agencies. But they did not deliver the care. Nurses did.
No Place Like Home does a great service to these ordinary nurses who are often dismissed as know-nothings by some nursing elites today. Buhler-Wilkerson details the complexity of caring for victims of tuberculosis or managing patients during typhoid epidemics. She also documents the persistence of the issues with which home-care agencies still struggle today: how to navigate doctor-nurse relationships; how to choose appropriate patients for home-care services; how to deal with gender, race and class prejudice; and how to secure long-term services for the chronically ill.
From the early days of home care, doctors were concerned about nurses invading their territory. In Boston, for example, doctors "confided to lady managers that 'the constant danger with trained nurses is that they shall usurp the doctors' position and prescribe for patients.'"
At the turn of the twentieth century, with the founding of the Henry Street Settlement on the Lower East Side of Manhattan, Lillian Wald and her colleagues developed public health nursing--"to improve standards of living" of the poor. One of the great innovations of the Henry Street Settlement was the establishment of a "First Aid Room." This was a kind of community clinic where immigrants could gain easy access to nursing care for routine health problems. Doctors, however, soon complained that "nurses were carrying ointments and even giving pills outside the strict control of physicians." Even outspoken nurses like Wald's colleague, socialist Lavinia Dock, feared a confrontation with powerful physicians. By 1911 questionable cases were no longer treated in the First Aid Room. "Later publications," Buhler-Wilkerson writes, assured the public that "the real Henry Street Settlement nurse will make the doctor feel that she is exerting every effort to have his treatment, not hers, intelligently followed."
An equally fascinating subject tackled by Buhler-Wilkerson is the impact of racial prejudice on nurse-patient and nurse-doctor relationships. In both the North and the South, lady managers as well as nurses fretted about whether it was appropriate for white nurses to care for black patients or black nurses for white patients. When insurers, notably Metropolitan Life, entered the field at the turn of the last century, managers considered the same imponderables. Race invariably trumped the needs of care and even of doctor domination of the nurse-physician relationship. For example, Buhler-Wilkerson tells us that the respectable ladies of Richmond, Virginia, who ran home care in that city, decided it was "'eminently' satisfactory for white nurses to care for black patients on the 'same footing' as white patients--but drew the line at white nurses 'taking orders from colored physicians.'"
The advent of health insurance also had a critical impact on the home-care agencies. Wald convinced Metropolitan Life to cover home-care services in 1909. Met Life wanted to reduce the high mortality rate of black life insurance subscribers--thus delaying payments on their life insurance policies. Home-care nursing's preventive approach initially seemed to make good business sense. By the 1950s, public health nursing and medical advances had paid off: Fewer people were dying of infectious diseases, and more acute illnesses were treated in the hospital. This meant that the bulk of home-care patients were chronically ill. To reward public health nursing for its success, Met Life curtailed its home-care program. "Providing care for those who failed to recover quickly was, from an insurance perspective, a poor investment," Buhler-Wilkerson states bluntly.
Since the fate of nursing is tied to the fate of the patients nurses serve, the situation has not improved much, as first Medicare and Medicaid and now managed care have "rediscovered" home care. Indeed, today the promise of the home as a place where nurses and their patients can escape the negative consequences of medical paternalism and give or receive higher-quality care has remained largely unfulfilled.
In Devices & Desires, Margarete Sandelowski uses a different lens--the world of medical technology--to explore the issue of gender and nursing. This brilliant book shows just how much the "charitable, devotional and altruistic" image of the nurse conceals. From the discovery of the thermometer to the development of intensive heart and fetal monitoring, Sandelowski documents doctors' dependence on nurses for their reputation for scientific and technical mastery. As Sandelowski shows, nurses have been critical in administering medical technology, monitoring the information it provides and interpreting that information to physicians, not to mention "educating patients about new devices, getting patients to accept and comply with their use, and alleviating patients' fears about them."
An eye-opening segment describes the use of the first thermometer, rather than the hand, as a diagnostic tool in the mid-nineteenth century. In it, we learn that the thermometer we take for granted today was originally an unwieldy, dangerous instrument that had to be carefully manipulated so as not to injure the patient. Because diagnosis and treatment involved taking the patient's temperature numerous times a day, busy physicians assigned the task to nurses. This involved, however, far more than simply recording data. The nurse, Sandelowski writes, "had to know what caused various temperatures to occur and the nursing measures that would lower or raise temperature to normal levels."
While physicians were the ones to insert the first unwieldy and equally dangerous intravenous devices, nurses were the ones to make sure the patient's arm remained immobile and that the patient could tolerate the discomfort of IV therapy. Nurses are the ones who developed the intensive-care unit--to provide intensive nursing care--and who track and interpret data from fetal monitors. As the primary users of much medical machinery, nurses are often more knowledgeable about equipment than doctors. Indeed, "the benefits of machine monitoring could not be fully harnessed without nurses who understood and could act immediately on the information monitors generated." While the public does not recognize this fact, the author tells us that medical equipment manufacturers certainly do. This is why nurses continually work with physicians and manufacturers to create design improvements and to insure that "expensive machinery [is] fully utilized."
What is amazing about this story is how little nurses have benefited from their technological mastery. Sandelowski shrewdly diagnoses a classic Catch-22. While it is true that nurses' status is somewhat enhanced by their technical proficiency, the recognition they receive does not match their actual accomplishments. That's because physicians quickly label the technical activities nurses engage in as "simple enough" for a nurse to perform.
No matter how much nurses participate in the diagnostic process, of course, physicians have maintained a legal and linguistic stranglehold on "medical" diagnosis. Even as "physicians were increasingly expecting them to perform de facto acts of diagnosis," Sandelowski writes, "nurses were in the bizarre position of having to be mindful of symptoms without speaking their mind about them."
Nurses were supposed to be able to distinguish between normal and abnormal conditions and to look for reasons for any abnormal findings. But nurses were never to use the words "normal" or "abnormal" in reporting or recording patient conditions, and they were to refrain from offering their opinions on etiology or diagnosis.... Nurses were to say (report and record) only what they saw, unlike physicians, who maintained the right to say what they knew.
This has produced the peculiar phenomenon--even today--of the nurse who recognizes that a cancer patient has diarrhea or a mentally ill patient is hallucinating, but who is not allowed to use the actual medical word because that would suggest that she, or he, is making a "medical diagnosis."
As she describes these phenomena, Sandelowski never paints nurses as innocent victims of nasty, overbearing physicians. In their perennial attempt to find "a socially valued place and distinctive identity," Sandelowski argues, many members of the profession have, albeit unwittingly, adopted common gender stereotypes that perpetuate the oppression of nurses.
One segment of the profession, Sandelowski contends, has bought into the notion that the complex practical, technical work that ordinary nurses perform is indeed simple and know-nothing.
Typically conceived of as nothing more than the physician's hand, and persistently caught in the Western cultural dichotomy between merely manual and highly prized mental, or intellectual, work, nurses have struggled to show that nursing is largely brain work. In the process, however, they have inadvertently complied with the prevailing cultural practice of denigrating the very "body-knowledge" that is the forte of the nurse.
This is particularly evident in the nurse-practitioner movement, which so many elite nurses now promote. "The key factor differentiating nurse practitioners from other nurses," she writes, "is both the use of medical instruments and the use of instruments in ways previously denied nurses." But, she points out, in our bottom-line-driven healthcare system "the role emerges as largely economically and 'medically-driven'.... The traditional image is maintained of nurses as the extra hands and eyes of physicians willingly and cheaply filling voids and bridging gaps in health care."
Other segments of the profession, Sandelowski argues, have opposed nurses' emotional and social work to their technological activities, arguing that technology is somehow an inauthentic nursing activity, while "caring" is both authentic and an essential "antidote to technology." Sandelowski shrewdly insists that in opposing "nursing/touch and technology," the profession has been "identified both with and against technology and thus, in an ironic way, with and against itself."
While it is not the purpose of these books to offer advice about dealing with the many problems nursing confronts, they implicitly point to one incontrovertible solution: We can appreciate what nurses do in the present only if we understand how their work has been constructed in the past and what they have contributed--and can contribute--to our healthcare system.
Understanding and analyzing nursing's decades-long struggle for "a socially valued place and distinctive identity" is not an academic exercise. It is central to reversing the chronic underfunding of the nursing services most of us will eventually depend on in hospitals and other healthcare institutions, and also the undereducation of the nursing work force at almost all levels of practice. And it is critical to any solution to the severe nursing shortage, which, if not quickly and effectively addressed, will have disastrous consequences as the population grows older and sicker.
On East Capitol Street a few years ago, I was in a taxi when a car pulled suddenly and dangerously across our bow. My driver was white, with a hunter's cap and earmuffs and an indefinable rosy hue about his neck. The offending motorist was black. Both vehicles had to stop sharply. My driver did not, to my relief, say what I thought he might have been about to say.
The Texas company has been a scandal in other countries for a long time.
It may look as if domestic politics no longer exists in the new America--the one in which there is no money for anything besides guns and prisons but we don't care because we are all bowling together against the Axis of Evil. But that's not true. As long as there is a fertilized egg somewhere in this great land of ours, there will be domestic politics. George Bush may not be able to bring about the Kingdom of Heaven on Earth for the religious right, who gave him one in four of his votes. He may even realize that a serious victory for religious conservatives--significantly restricting the legality of abortion, say--would hurt the Republican Party, because California has more people than Utah. But he is doing what he can to keep the fundamentalists happy.
It must be frustrating for him--just when we're all supposed to pretend to love our differently faithed neighbor even if we know he's bound for hell, Christians keep saying weird things. First there was Jerry Falwell's remark that God let terrorists blow up the World Trade Center because he was fed up with "the pagans, and the abortionists, and the feminists, and the gays and the lesbians...[and] the ACLU"; Falwell apologized, only to express the same thought a bit more obliquely on November 11 at a Florida church: "If the church had been awake and performing that duty"--proselytizing the ungodly--"I can tell you that we wouldn't be in the mess we're in today." God, says Falwell, "even loves the Taliban"--it's just liberals he can't stand.
And then there's Attorney General John Ashcroft, who burqaed the semi-nude statue of the Spirit of Justice because he felt upstaged by her perky breast at press conferences, and who thinks calico cats are emissaries of the devil, when everyone knows it's black cats. Ashcroft is in trouble with Arab-Americans for offering this proof of the superiority of Christianity to Islam as quoted by conservative columnist Cal Thomas on his radio show on November 9 (and belatedly denied by a Justice Department spokeswoman): "Islam is a religion in which God requires you to send your son to die for him. Christianity is a faith in which God sends his son to die for you." Not to get too wound up in theology here, but if the Christian God sent his own son to die doesn't that make him, according to Ashcroft's definition, a Muslim?
Fortunately, the fertilized egg can be rolled onstage to distract us from such knotty questions. In keeping with the strategy of rebranding antichoice as prochild, the Bush Administration plans to use the CHIP program for poor children to provide healthcare to children "from conception to age nineteen," a neat way of defining zygotes as kids. The women in whom these fine young people are temporarily ensconced will remain uninsured--perhaps they can apply for federal funds by redefining themselves as ambulances or seeing-eye dogs. After all, somebody has to get those fetuses to the doctor's office. As for the 8 million uninsured postbirth children, not to mention the 27 million uninsured adults, who told them to leave the womb?
But wait, there's more. In a highly unusual move, the Justice Department has weighed in on the side of Ohio's "partial-birth abortion" ban, which has been on ice thanks to a federal court ruling that found it did not make enough allowance for a woman's health, as required by the 2000 Supreme Court decision in Carhart v. Nebraska. The Ohio law would permit the operation only to save her life or avoid "serious risk of the substantial and irreversible impairment of a major bodily function." Gee, what about considerable risk of moderate and long-term impairment of a bodily function of only middling importance? Should the Ohio state legislature (seventy-five men, twenty-four women) decide how much damage a woman should suffer on behalf of a fetus? Shouldn't she have something to say about it?
To please fanatical antichoicer Representative Chris Smith of New Jersey, Bush is holding back $34 million from UN family planning programs. To return the favor, Congressional Republicans have revived the Child Custody Protection Act, which would bar anyone but a parent from taking a minor across state lines for an abortion. The parental-notification-and-consent laws of a pregnant teen's home state would follow her wherever she goes, like killer bees, or the Furies--and unlike any other law.
Bush is also stacking with social conservatives commissions that have nothing to do with abortion per se but raise issues of sex, gender and reproduction. The cloning commission, called the Council on Bioethics (fourteen men, four women), is headed by bioethicist Leon Kass, a former opponent of in vitro fertilization who's associated with the American Enterprise Institute. There's room around the table for antichoice columnist Charles Krauthammer; antichoice law professor Mary Ann Glendon, the Vatican's representative at the UN conference on women, in Beijing; and social theorist Francis Fukuyama, who wrote in a New York Times Op-Ed that the thirty-years-overdue introduction of the pill in Japan in 1999 spelled the downfall of the Japanese family, because now women will just run wild. But there are only four research scientists, and no advocates for patients with diseases that the cloning of stem cells might someday help cure. Similarly, the newly reconfigured AIDS commission is said to be stacked with religious conservatives and will be headed by former Representative Tom Coburn, whose claim to fame is his rejection of condoms, which sometimes fail, in favor of "monogamy," which never does.
Finally, there's the nomination of Charles Pickering for the Court of Appeals for the Fifth Circuit. Rated unqualified by the Magnolia Bar Association of Mississippi. Pickering, an ardent segregationist when it counted, opposed the ERA, has been a lifelong opponent of legal abortion and won't discuss his antichoice record in Senate hearings. The Fifth Circuit includes Texas, Louisiana and Mississippi, states where the right to abortion is already compromised by conservative legislatures; in l999 Texas tied with Michigan for most new antichoice laws enacted (seven). Traditionally the federal courts offer hope of redress for victims of state laws--in this case, some of the poorest women in the country. What are the chances that Pickering will champion their rights and their health?
My money's on the fertilized egg.
Is the Enron story one of outrageous mendacity or stupefying ignorance?
Black pathology is big business. Two-thirds of
teenage mothers are white, two-thirds of welfare
recipients are white and white youth commit
most of the crime in this country.