The Patient With No Name: When Nursing Illuminates LiteratureNovember 16, 2012
By Marcy Phipps, RN, a regular contributor to this blog. Her essay, “The Love Song of Frank,” was published in the May issue of AJN. She doesn’t usually write about books in her posts, so we hope you enjoy this change of pace.
I didn’t know much about The English Patient when I picked it up recently at a library book sale—I only dimly recalled that the novel had been made into a movie I’d never seen. Since it was published by Michael Ondaatje in 1993, I can hardly blame a lack of time for my lapse. Yet I found myself glad I hadn’t read it until now, as my own nursing experiences suffused my reading of it, leaving me more deeply moved than I might have been otherwise.
The novel is set in the final days of World War II, in a bombed Italian villa that had served as a war hospital. As the story opens, the makeshift hospital has been recently evacuated, with patients and medical staff relocating to Pisa. One nurse remains, though—a young Canadian named Hana. Described as “shell-shocked” due to her experiences during the war, she refuses to leave the damaged hospital or a nameless English patient, who she insists is too fragile to be moved.
Other characters come into the story and are pivotal to the themes of loss, love, and redemption, but I felt most personally connected to Hana, the English patient, and their relationship. As an ICU nurse, I felt like I knew the English patient, a man who’d been burned beyond recognition in a plane crash and couldn’t recall his identity.
Although my hospital defers burn injuries to a nearby burn center, I’ve cared for patients very much like him—patients who, after devastating injuries, are left physically altered in ways that can’t be fixed. I often have patients who can’t express themselves in any depth, on ventilators and sedated, probably experiencing life much as the English patient—as bits of reality intermingled with flashes of memory and desire.
I’ve cared for patients whose injuries have rendered them too fragile to touch, patients in unrelenting pain, and those whose deaths are known to be inevitable. Like Hana and the English patient, I know the merciful nature of morphine—and, sometimes, the merciful nature of death.
While I don’t share the history of Hana, a war nurse who’s been exposed to more tragedy than she can bear, I can attest to the emotional toll of difficult days in nursing. I know how caring for someone who’s critically ill can overtake everything else. Sometimes it’s hard to leave the hospital at the end of the day, then strangely hard to get out of the car after arriving home . . . I do understand—instinctually—Hana’s decision to stay at the derelict hospital to care for the man she refers to several times as her “despairing saint.”
Lastly, I love the way literature and reading are used therapeutically by both Hana and the English patient. Hana frequently reads to her patient from books she’s retrieved from the bombed library, and the vivid descriptions of her reading to him by candlelight cast the act as a component of her nursing care, one as vital as the administration of medication or provision of nourishment. The English patient resorts to the healing properties of literature, as well; he asks Hana to read to him, in an attempt to draw her out of her own damaged shell.
The English Patient artfully and honestly delves into both the beautiful and the painful aspects of nursing. It also describes the nurse–patient relationship in a way that rang true to me, in prose that affected me viscerally, often leaving me breathless and with the feeling, when I’d finished it, that the story had been a fantastic dream.