Three Nurses on the Front Lines By Suzanne Gordon Little, Brown. 328 pp. $23.95
This is a beautiful, profound and profoundly important book. Heeding its counsel would do more to improve our nation's health care, decrease suffering and control costs than all the blue-ribbon panels, commission reports, management studies and utilization reviews that the nation could possibly undertake. Suzanne Gordon's message is simplicity itself: Sick people need skilled, humane and insightful care that keeps their interests paramount. Registered nurses have historically provided that care, but now their ability to fulfill their crucial role faces the greatest jeopardy in the history of the profession.
Once in a very long while, a book crystallizes the disquiet that people feel about some grave issue, places it in a human context that everyone can understand and galvanizes us toward a new way of thinking and acting. "Life Support" belongs in the august company of Rachel Carson's "Silent Spring," Michael Harrington's "The Other America," Betty Friedan's "The Feminine Mystique" and other pivotal works with the power to shift the nation's consciousness. I only hope that a society almost pathologically averse to facing the realities of human illness and mortality can come to its senses before great damage is done.
We all know that something terrible ails our health care system, that it does not respond to our people's human needs, that it neither safeguards our health nor comforts us in disease. Through the courage, dedication and determination of physicians, it can perform spectacular, heroic acts of rescue and repair, replacing hearts and immune systems, rebuilding bones, restoring sight and hearing, overcoming infertility, salvaging unbelievably tiny infants, halting infections that once would have killed. But it simultaneously allows, even encourages, hopelessly sick people to die in needless agony, relatives and patients to bear terrible burdens of unwarranted guilt and anguish, and many sufferers to lose all dignity and sense of self.
These failures arise, Gordon's piercing narrative shows, from the medical model of illness, which now dominates American health care essentially to the exclusion of any other. In this model, she explains, "You go to a doctor. He or she gives you a diagnosis and treatment plan. You follow it and hopefully you are cured. But," she goes on, "illness is a process, not an event -- one that requires care both before, during and after the medical encounters that punctuate it." Feminist critics have argued that medicine embodies an action-centered "male" way of seeing and being that will soften into a more humane "female" mode when women gain equality in the medical profession.
But Gordon sees more deeply. "It is not the gender of physicians or nurses that makes them attend to the patient's experience of illness. What matters is how a particular discipline -- medicine or nursing -- defines its mission. If its mission is to defeat disease, then the patient may also be defeated in the process," a truth known, if only unconsciously, by anyone who has ever watched an incurably sick loved one caught in the grip of high-tech treatment. "If," on the other hand, "the mission is to acknowledge and deal with the reality of illness, then the patient's chances of emotional survival increase."
Nursing took on the mission of expert, highly observant, humane caring in the crucible of the 19th-century battlefield. Generations before doctors could do anything concretely useful for the great majority of their patients, Florence Nightingale demonstrated that skilled attention to a wounded or sick soldier's needs for nourishment and fluids, warmth or cooling, cleanliness and sanitation, understanding, encouragement and peace of mind could spell the difference between life and death for thousands upon thousands of men. For generations afterward, excellent nursing was essentially all that doctors could prescribe for most disorders. But then the first antibiotics, followed by a torrent of other advances, finally gave doctors real weapons against some very important diseases, and the medical model won out, with consequences that Gordon vividly and movingly describes.
Having reached this point in a laudatory review, a reviewer is required by convention to reveal some flaw in the book that, while not drastically diminishing its overall merit, nonetheless demonstrates his or her own superior discernment or knowledge. But in this case I can find none. "Life Support" is pure gold, as fine an example of health writing as I have ever read. In a market crowded with medical books shrieking frenzied alarms or whining near-paranoid complaints, it speaks precisely and modestly, meticulously and compassionately. It shows a wisdom earned the old-fashioned way, through suffering experienced and reflected upon, through deep empathy and open-minded observation, through taxing thought and thorough research, through devotion and humility. "Life Support" deserves to be both an instant bestseller and a perennial standard. It needs to be read by every medical student, practicing physician, medical educator, health care policy maker, insurance executive, hospital administrator and health journalist; by every American who will ever either be or know a patient; and by every one of us who will die. I cannot praise it highly enough.
The reviewer's most recent books are "The Growth of the Mind" and "In Her Own Right: The Institute of Medicine's Guide to Women's Health Issues."