Florence Nightingale turns 200 today, May 12th, 2020!
That’s what we in the biz would call an “Old School Nurse.”
Ms. Nightingale was a leader, an innovator, and, as I learned at the museum in London dedicated to her, was celibate and a writer too! (Sounding familiar right about now.)
You may know her for sanitation reform during the Crimean war, (‘wash your hands’, anyone??) and as the founder of the first nursing school.
But there’s another Nurse Florence I want to share with you today. She also served in the military – World War II – and retired from Skagit Valley Hospital in 1981, the year I was born. A beautiful Japanese Maple was given to her as a retirement gift. Thirty-eight years later, this tree flourishes in my front yard.
While she may not boast the same accolades as the esteemed “Lady With the Lamp,” in my view, she deserves recognition this National Nurse’s Week, amidst the global celebration for Year of the Nurse.
Florence Korber Swedeen, or “Grandma Flo,” my paternal grandmother, was a stoic woman whose infrequent smile belied the depths of love in her heart.
My opinion of Grandma Flo had not always been sterling. “Grumpy Grandma” was a term I’d let slip when referring to her. And I wasn’t wrong; a product of the Great Depression, motherless at a young age, a war servant, and subsequently divorced from a violent man who ultimately took his life, Florence was intimate with heartbreak and hard work. It wasn’t until her final year on Earth that I gained insight into how this side of her personality was carved, chipped away by one traumatic experience after another.
Despite this history, (or perhaps because of it) she spent her life caring for others. She nursed the sick and injured back to health both at work and home while raising three children whom I know she treasured. Her retirement was spent as a caregiver, moving an infirm family friend into her home, and watching my brothers and me after school (not an easy task in the least!) She baked biscotti, read us classic books like The Poky Little Puppy, and made us laugh by calling out “Dog kisses! Dog kisses!” while her chubby dog Shatzi licked our faces.
Florence K. Swedeen, RN, passed away when I was 25 years old. Before our final goodbye, she bestowed upon me a few key lessons which have significantly influenced my personal and professional life. I’d love to honor her by sharing them with you today.
Actions Speak Louder than Words
Despite the sorrowful history and often rigid exterior, Florence was inherently generous and caring. It’s just that her ability to express love out loud was limited. Her words could be considered insensitive and sharp at times, but the lack of affectionate terms were more than compensated by her loving actions. Grandma delivered kindness in the form of hot cocoa with a teaspoon of vanilla stirred in, paired with cinnamon sugar toast or homemade biscotti. She allowed me to invite friends to play cards, and didn’t get (too) mad when we cheated. Her guest room provided an overnight sanctuary when I needed a break from my brothers. At age 21, when I resolved to become a nurse, she presented me with my first Merck Manual. At graduation, my first stethoscope.
Today, I live in the house she bought before I was born. The home was not an outright gift, but she made the purchase easy for me, a very young single mom and first-time homeowner. She could have profited greatly but chose to sacrifice for my daughter and me.
It was in her final weeks of life that she summoned the voice to tell me, “I love you” every day. I’m fortunate to say I found the voice to say it back. My ability to verbalize affection is something I continue to work on.
Save the Paper!! (Waste Not, Want Not)
Christmas mornings were spent at Grandma Flo’s, eating Swedish pancakes filled with jam, whipped cream, and a side of pork sausage. Afterward, my brothers and I sat on the floor impatiently waiting for our one gift. Before we could ferociously tear into the wrapping with our chubby little fingers, we’d hear “Save the paper! Save the paper!” We’d stop tearing at the tape because she meant it!
The presents had been carefully wrapped in the same paper as the year before. If there wasn’t enough for all the gifts, no problem; she’d just use the “funnies” from the Sunday paper to cover them. The recycled wrapping was carefully folded and stored for safekeeping until another holiday or birthday required it. To this day, I have a small stack of vintage wrap kept in my garage, the paper nearly soft as satin from Grandma’s repetitious folding and re-use.
Florence was meticulous in her record keeping. When a bill was paid, an appliance repaired, or the drapes cleaned, the date and amount were written in a notebook. Every time I gave her a mortgage payment, we sat together and made careful note of the transaction. For more than a decade, I did my bill keeping in the same fashion. (Come to think of it…I may need to revisit this habit…)
Grandma Flo may sound stingy, but she was the most resourceful person I’ve known. Being from the Depression era, she found endless ways to salvage and save. The home I bought from her was built by our local high school woodshop, which she obtained at a fundraiser auction in 1978. She then refurbished a migrant worker’s home, turning it into a detached garage. Nails used for building were retrieved and placed in jars – organized by size – for later use. Grandma was frugal to a fault at times. (I had to clean out quite a few expired spices and cereals from the cupboards). But thrifty did not equate to miserly. She willingly gave when she could, cooked for those who couldn’t, paid the grandkids to do chores, and forgave debts.
I’m no Flo, but “Save the paper!” – meaning use what you have so you can give to those who don’t – remains an essential proverb in my life.
Little Things Make a Big Difference
As an ICU nurse, I’m called upon to think critically and complete high-level tasks, from troubleshooting ventilators and dialysis machines to calculating drug doses precisely, to efficiently performing CPR. A variety of life-saving, limb-sparing, healing interventions play an integral part in every shift. These often go unnoticed by patients and their families. Through Nurse Flo, I came to appreciate the patient’s perspective, and learned what it takes to help them feel cared for.
Grandma suffered a persistent infection affecting her heart, which eventually led to a stay in a nursing home. It was meant to be a temporary respite; a place to receive IV antibiotics, physical therapy, and then return to her apartment.
She would never get the chance.
Dutiful granddaughter and brand-new nurse that I was, I visited her at the nursing home daily. While there, I had three crucial responsibilities:
- Brush her dentures with the special brush
- Run a washcloth in hot water for face-washing
- Ensure the bedside table with water, chapstick, and tissues are within reach
This 3rd and final step was the most vital of all. The staff neglected this, leaving the table too far away to reach every time they left the room. This lack of awareness meant Flo had to call them back in the room, which made her feel guilty, or lie in bed staring at the items but unable to wet her mouth, take a sip, soothe her eyes or lips. Hypothetically, a 3rd option would be to get up and risk injury from a fall, which leads to death quite often in the elderly.
Think of it: a sweet old grandma, frail, alone, thirsty, and tired. Unable to reach her sip of water.
I do think of this, every single time I care for a patient in the hospital, and every time I train a new cohort of nursing students at the college.
Grandma Flo taught me the meaning of compassionate nursing care. The little things – basic hygiene, fresh water, clean linens, a fluffed pillow – can be the exact thing a patient remembers you for. It can be the thing that instills trust, respect, and gratitude in your patient and their family, and only takes an extra minute to complete.
I carry this legacy by reminding myself that each patient I care for is someone’s family member, and leading my students in this way as well.
Death Deserves Dignity
On January 11th, 2007, at 7:30 am, as I drove home after a long night shift at the hospital, I received the call.
“Your grandmother was unresponsive this morning when we checked on her. We sent her to the hospital.”
My first lucid thought was, “They had better know she’s a DNR!”
My second was, “She’s gonna be so pissed if she wakes up.”
You see, Flo was a member of the Hemlock Society (now merged into an organization called Compassion and Choices) and shared her pragmatic, (while sometimes grim) outlook on life and death with me from a young age. Grandma Flo was more than prepared for her passage into the Great Unknown when it was her time. She was adamant there’d be no heroics or prolonging the inevitable. She’d long since filled out advanced directives and selected her final resting place.
Prior to her move to the nursing home, when I visited her during any hospitalization, she would give these instructions: “Make sure the nurse on duty knows I’m a DNR!”
DNR means ‘Do Not Resuscitate.’ Specifically, it means if one’s heart stops naturally, there will be no chest compressions or ‘mouth to mouth.’ The medical team will not shock the heart back to life or put in a breathing tube. There will subsequently be no life support, no ventilator, no feeding tubes.
Choosing the right ‘code status” is a profoundly personal decision influenced by health literacy, cultural norms, beliefs, and values. An informed choice takes into account quality, age, and stage of life, as well as expected outcomes post-CPR. What many don’t understand is how rarely CPR – even by trained professionals – leads to a healthy, happy long-term outcome.
Grandma Flo didn’t avoid these difficult conversations. She didn’t whisper about death as though it was a taboo secret. She spoke of it plainly and succinctly, and this clear communication was a gift to our family.
I’ll never know what exact medical condition caused her to become unresponsive that morning and later pass away because we declined tests or treatments in the emergency department other than pain medicine for comfort. Flo would have wanted it that way. I know, because she told me this many, many times.
Eight hours went by as I lay in bed with Grandma Flo, listening to her respirations fluctuate from fast, to slow, to almost imperceptible, until there were no more breaths to follow. Respecting her wishes for a natural death felt rational, ethical, and deeply loving.
I certainly wasn’t mature enough to recognize it all the time, but these lessons shape me as a Registered Nurse and educator. They inform my decisions, interventions, and advocacy for patients.
I hope by sharing just a glimpse of the impact Grandma Flo had on me, you can glean lessons to incorporate in your own life.
For example, perhaps this year, you’ll hang on to some newspaper comics and turn them into gift wrap!
And if you want to know more about how to navigate important conversations about end-of-life decisions, I recommend Fivewishes.org
Grandma Flo – what would you think of our current situation, a global pandemic, worldwide nurses on the frontlines?
What WWII stories would you be persuaded to share? Would you tell me about the tragedies you witnessed, the patients’ hands you held as they passed away, the lives you saved?
Would you help me make sense of my role in nursing today?
In a way, I’m glad you’re not here to endure the fear our world is experiencing. You did your time. Besides, you would be such high risk, I wouldn’t be allowed to come brush your teeth, wet your washcloth or make sure your personal items were close by.
Thank you for teaching me, for seeing the best in me, for loving me in the way you knew how.
I promise never to leave the bedside table out of my patient’s reach.
Cheers and Gratitude,
Are you a nurse with a story?
Would you like to be featured for my series “Year of the Nurse Spotlight?”
I’d love to hear from you!
Please email me Tiffany@recoverandrise.com
Make sure to follow me @scrubbedcleanrn
Find more about my work as a Life and Recovery Coach at www.recoverandrise.com