It was August. A sunny, summer day. I walked proudly into City Hall to start my brand new job as a Public Health Nurse. I was newly minted. 23 years old. Graduated in April, passed my licensing exams in June. Excited, but terrified.
I was greeted by my supervisor, a gentle but no nonsense woman. She showed me to my desk, in a large room filled with desks for other nurses. She gave me my black bag and told me the location of my visiting district. My heart lurched. I was assigned to the part of the city was commonly and fondly known as skid row. I won’t go into all of the classist and racist reasons that the expression held, but just to say that it was common opinion.
This was not a defining moment of my career, but it began the rather defining three years of my career – and one of the defining times of my life. And it most definitely formed my values as a nurse, how I saw the world of people I was privileged to serve and care for.
My clients (as some would call them), or families as I would rather call them, were varied.
There was Rocky. He was like so many elderly men I visited who had worked all their lives, who had no pensions, who lived in rooms in old hotels, with old worn carpets, dark walls, few windows. Maybe they had a little fridge. Rocky drank too much, as did many of these fellows. I remember thinking that I would too if my life looked like theirs. He was recovering from TB. Other men I visited had been in contact with it. Or they had complicated diabetes with all of its risks. Or they just had total body decline. He had no family who were in touch, few did.
They were young Indigenous women like Mary. She had young children. She lived in a small house with peeling paint and thin, drafty windows. Mary had little of life’s amenities that I had grown up with. No fancy kitchen appliances. No comfy linens on the bed. She seldom made eye contact with me or with her children. At times it appeared to me that she was so hard on her children, when they simply acted like children.
There was Christie. She was young woman who worked as a prostitute. Christie lived in a brothel – it was a big old warehouse, dark, few windows, mattresses on the floor. There were many other young women living there, along with their children and with the pimps who abused them and took most of their money.
Vera was a middle-aged woman who had been discharged from a mental health hospital. She lived alone, with serious mental illness and the paranoia that came with it. She never left her two room apartment. She had a fixed income of social assistance that did not cover basic needs. I only got to see her once every couple of weeks, to administer drugs by injection. She for the most part saw no one else. There were many Vera’s.
I was often confused by what I saw. But I learned certain things. Everyone of the people that I visited had a story of how their life journey brought them to a place where they were marginalized from main stream society and shunned by many. None of them had enough resources to provide for their own basic needs of food and lodging. But everyone of them had a heart and a soul, and a great propensity to be warm and honest and welcoming. If given a chance.
The context of being a community health nurse is very different than one of being a nurse in a hospital or a clinic or any institution for that matter. As a community health nurse I visited people in their homes, on their turf and on their terms. When you work in a hospital you are in an institution that is organized to meet your needs, sometimes at the expense of the patients being cared for. The people you serve are called patients, they are separated from their clothing, belongings and loved ones. And they are forced to follow schedules and rituals imposed on them. Visiting and caring for people in their homes I learned that we shared the power, they did not have to let me in, they made the rules. They had to trust me before they would participate in any of the things that I and the health care system thought were good for them.
I will not pretend that I was able to gain the trust of all of the Rocky’s or Mary’s or Christie’s or Vera’s that I visited. But I did with some, more than some. And they were my biggest teachers.
I quickly learned that it was not doctors and nurses or public health units or hospitals that made people healthy, or unhealthy. It was people, and their living conditions, and the life journey that brought them there. That was the first giant values lesson I had.
I also learned that policies and the procedures of the health department did not work very well for my families. There were many rules that made no sense to them. We were focused on preventing the spread of disease and the complications of illness. They were focused on surviving one day to the next.
There were many things that I did not come to understand until sometime later. That many of my families were survivors of residential schools. Where they had been torn away from their families and homes, stripped of their identities, abused and deprived of the opportunity to experience and learn from the nurturing of their own parents. That many of my families had worked all of their lives, provided for families, but without pension systems, they were left in their old age with next to nothing. That many of my families had had negative experiences with institutions, systems, governments, health care systems, and it was impossible to trust that these systems would act in their best interests, let alone take care of them.
These experiences shaped not only my practice of nursing but my personal values. It taught me that it is social justice that underpins health and determines our destiny. That our health care system, for all it’s sophistication and science, cannot replace food and lodging. That colonization has victimized Indigenous people for generations. And many other things. And I am thankful and honored to have met Rocky & Mary & Christie & Vera.