A compassionate homage to life on the wards
Memoir: The Language Of Kindness, Christie Watson, Chatto & Windus, hardback, 336 pages,€17.99
An unflinching honesty about the human cost of the ancient but undervalued profession of nursing defines this compelling and universally relevant memoir.
Christie Watson left school at 16 and moved in with an older boyfriend. That didn't last long. She then worked at a video store, lasted two weeks at agricultural college and one week doing a course in travel and tourism, until someone suggested that she become a nurse because they'd provide her with accommodation while training. On her first day, she fainted at the sight of blood. The supervisor admitted that it happened a lot, but suggested "you might want to rethink your career".
Watson went on to work as a registered National Health Service nurse in the UK for 20 years before giving it up to become a full-time writer, winning the Costa First Novel Award for her debut, Tiny Sunbirds Far Away.
The Language of Kindness, her first work of non-fiction, is a memoir about her time on the wards. What she saw. What she felt. What she learned from patients. Subtitled 'A Nurse's Story', it's a neat bit of marketing by the publisher to bring this out during the 70th anniversary of the founding of the NHS, and Watson doesn't try for one second to hide her polemical intent.
The author wants to celebrate nursing and the people who do it, in the belief that those whose calling is to care for others at their darkest, most vulnerable moments are "a measure of our humanity" but that nursing remains, unjustly, "the most undervalued of professions". Her memoir is written in the present tense, to give it immediacy. This can be an irritating technique if clumsily used, but it works here brilliantly well.
Throughout, the author conveys the vivid sense of events happening in the here and now. She describes the weekend nights on A&E wards, as "party people fill the corridors, wild eyed and twitching" and the hospital is filled with the "dog-bitten, broken-boned, respiratory-failing, seizing, drug-overdosing, horse-kicked, mentally ill, impaled, shot and stabbed".
The grinding poverty on display reminds her of the artist Hogarth's portrayals of 'Gin Lane' more than two centuries ago, as "the room smells of body odour and the metal of old blood".
As a nurse, Watson mainly worked with sick children in the Paediatric Intensive Care Unit of her local hospital, and it's here that many of the unbearably poignant stories she has to tell begin. She talks about some of the worst days, "watching a child turn purple, then black, from the outside in, and lose digits, arms and legs", or "looking at numbers from blood results and knowing they are incompatible with life".
She remembers washing the hair of a child who's died in a house fire, so that the family won't be assailed by the smell of burning. "Patients like Jasmin stay with me for ever," she notes. "I carry the smell of smoke."
There are, too, moments of pure terror. Once, she accidentally cuts the breathing tube of a teenager suffering from muscular dystrophy, leaving him seconds from death. It is her estranged husband who reconnects it. For all their problems, "I forgive my ex his bad days, of which there are many. I know too well what is involved. I hope he forgives mine, too."
Later she's assigned to a hospital in a poor area of east London, arriving with "squeaky and shiny" new shoes and a pocket full of pens.
Within two weeks she has scabies, impetigo and nits, and her work consists of giving bowel washouts to children suffering from constipation caused by poor diets. It is, she says, "like living in a Dickens novel… everything smells of feet and beef flavouring". Many of the children have behavioural difficulties which make them difficult to manage. She is bitten by one young patient and needs to have a hepatitis booster.
Friends who work in offices complain of their difficult days, but "I have decreasing sympathy for normal problems…. I think about death all the time."
She finds that she's emotionally shutting down, not feeling as she thinks she should but, when her marriage irrevocably breaks down, "nursing becomes my life support".
This book is peppered with historical and philosophical reflections on the role of nurses in medicine, going back far beyond Florence Nightingale to ancient India and the mediaeval Muslim world, but it's the personal observations of the emotional toll that the job takes on Watson and her colleagues that hits home hardest.
Some of the names have been changed, and incidents amalgamated to further protect identities, making this a work of imaginative reconstruction as much as it is straight reportage, but the pages never lose their authenticity.
A school nurse tells her that she misses the innocent days of twisted ankles. "School nursing now is about gang rape… it's about self harm and anxiety disorders, prevention of online grooming by paedophiles, and drug advice."
Watson herself must stay professional as she deals with families that she knows have harmed their children.
She admits to being constantly tired, and sometimes bored or feeling out of her depth, and no one ever got rich from nursing, as her own financial struggles attest; but her radiant belief in nursing never wavers.
As her own father dies of lung cancer, she notes how, when all oncologists and radiologists have gone, it's the nurses who remain, providing round-the-clock care. It's they who sit for hours, as she did, with families, offering comfort, answering questions.
"Nursing," she writes, "is not so much about tasks, but about how in every detail a nurse can provide comfort to a patient and a family."
It is, she concludes, "an indiscriminate act of caring, compassion and empathy… it is a privilege to witness people at their frailest, most significant and most extreme moments of life, and to have the capacity to love complete strangers".
Kindness is a word to which she frequently returns. It's the core of her philosophy.
She understands compassion fatigue, and how the job can wear you down, accepting that even the best nurses have bad days. "I have felt spent, devoid of any further capacity to give," she confesses. She also concedes that chronic underfunding of healthcare takes it toll.
All the same, she insists that "there is no excuse for bad nursing care… I am horrified if ever I see a bad nurse".
It's that combination of fierce compassion and unflinching honesty about the human cost of nursing which makes this such as a compelling and universally relevant book. It couldn't be more topical, or timeless, and the fact that it's written with an elegant grace that makes it a joy to read doesn't hurt either.