It has been a daily practice of mine for many years to read an essay, some encouraging words, even a few lines from various sources before my day shifts to high gear. Not much different from a few sit ups or teeth brushing; just tending to self care. One reader billed as A Guide to Daily Living, is a compilation of quotes by Mother Teresa. Not always in agreement with The Mother as to the exact nature of our worldwide soul sickness and poverty, I did have a surprising moment of tear-filled identification on reading this entry.

I was traveling by train to Darjeeling when I heard the voice of God. I was sure it was God's voice. I was certain He was calling me. The message was clear I must leave the convent to help the poor by living among them. This was a command, something to be done, something definite. The call was something between God and me…In those difficult, dramatic days I was certain that this was God's doing and not mine and I am still certain.

My decision to enter nursing school in 1967 had a similar 'calling.' I was a senior in high school and the prospect of becoming a teacher, a business woman, (in those days read: secretary or
businessman), or stewardess, or even the thought of enduring college was unbearable. My high school was hosting a career day. I had never been an aide or candy striper or volunteered to take care of anyone, except a neighborhood baby or toddler. Still, I entered the classroom marked Nursing. A very lovely, blond woman in a navy suit was describing a city hospital residence not far from my home, in which I could live for three years, yet, be able to go home every weekend. A few hundred dollars would cover the cost of room, board, books, uniforms, and I would even get a nine dollar monthly stipend. After completing my studies I would be qualified to take the RN licensure exam. But, the piece de resistance was the olympic sized swimming pool students were more than welcome to use.

Not exactly burning bush material, but, I entered that place over thirty-five years ago, and from that first day of sights and smells on the 'ward' I knew this is where I was meant to be, this is what I was born to do, this is who I am. Victor Frankl, psychiatrist and concentration camp survivor, would assert that this is where I have found my meaning and purpose, this is the primary motivation of my life.

I would never exchange those early years of preparation, despite my belief in advanced education and practice. I have had the ability to obtain two undergraduate degrees and my MSN, but I remain at the bedside. For the past fourteen years that bedside has been the ambulatory chemotherapy unit at LlJ. Oncology was not my first love; first came critical care. I worked in a prominent Manhattan medical center. World renowned and famous people were among my patients, but, as I already knew, we all put our pants on one leg at a time. It was and continues to be why I stay close to the delivery of care. It is in the quiet exchange of story, a person's story, that the still small voice can be heard, where grace, elusive and fleeting, lingers. Where a stranger expresses to another the joys, fears and queries of this vast place of unknown, of disease; where some intangible becomes textured and woven, and meaning and purpose gets redefined because in part the stranger listening becomes 'my nurse.'

Firsts are never forgotten, and Jimmy will always be my first. A sixth month old, already with an enviable afro, was being treated for pneumonia, having been the victim of parental abuse, had experienced multiple beatings and an attempt on his life by flushing him down a toilet. He was rigid as a carving stone, and uttered very little. Picking him up for feedings was a challenge in balancing a heavy unyielding mass of flesh. Day after day of holding, of humming, of warm milk, of stroking, of me, of any kindness, and he brightened, melted a fraction, curled, cooed, snuggled, if only a bit.

Jimmy was not the lesson. His mother on one occasion came in and saw me with her son. On hearing her voice Jimmy froze, wailed, and almost fell out of my arms as he stiffened. I was resentful and murderous at this disheveled, nose running, high heeled, trench coat wearing thirty something female. How dare she, how dare she do this to MY Jimmy. I only saw her on one other occasion, the last day of my rotation as a student on that pediatric ward. She came briskly up to me as I was heading toward the exit. I can't remember if she spoke any words, but I do know she could hardly look at me, and with her head bent she extended her hand to me as if clutching a football and placed into mine a stuffed brown bear with a note attached. All it said was, 'Thank You Jimmy.' There was no stopping the flow of tears, and I ran out of the building.

It is easy to be nice, loving, even magnanimous to the Jimmys of the world; the perks in that are many. It is much harder to see 'Jimmy' in the woman on crack giving birth to yet another who will be orphaned, or in the drunk, falling down and abandoning his life and his wife and children, or in the lover who 'forgot' to tell his girlfriend of his IV drug history and her strange cancer is not cancer at all but AIDS. It is hard to hear vile words instead of thank you after a long day of wiping up a steady stream of bodily fluids, the stench of which comes home in your nose, and lingers a few more hours past quitting time. This is the part that can't be taught in school; this is the part Jimmy's mother teaches.

Tom the sculptor, his body covered with Kaposi's, once strong and muscular. now wasted and shriveled, helped me let go of prejudice held long ago when forming my beliefs about homosexual love. Charlie gave me a needed laugh and taught me about courage in the face of dying when he yielded to yet another bone marrow biopsy and yanked down his shorts to reveal a shamrock tattoo with the names of his 'girls,' --wife and two daughters -- plastered on his left cheek.

Edward, author, scholar, and the most refined debonaire gentleman I have ever known, sat with a colleague and me one day in September last, two months before his death, and having treated us to cappuccinos, laughed at and mimicked our 'Queens' accents. He just more or less 'shot the breeze' with us, affirmed yes, his pants legs only go on one at a time, too, and that he was afraid, but we were his friends and rather than we bask in his presence, he, so famous a soul, seemed to delight in ours.

So much more can be said about the patients who asked about a staff nurse's sorrow at yet another failed pregnancy, the death of a nurse's mother, a recent divorce suffered by another, a diagnosis with grave consequences in another, and the health and mental challenges for the child of yet another nurse. All known because in the therapeutic revelation of information by the nurse, the nurse-patient bond gets formed, the stories get uttered and the healing is transformational in both parties.

I had the 'good fortune' to loath the idea of college in 1967, and want to swim after classes in a nurse's residence. I learned over and over and continue to love to hear the stories that teach me each day what it means to be a nurse. As Mother Teresa said, "Learn your lessons, not out of a book, but in the rough and tumble of life, among real people, in a setting you will never forget."

I forget, sometimes, how to calculate a Carboplatin dose. I forget, sometimes, the per meter dose of Taxol used weekly. I know where to find the answers, I look them up. My friend and colleague MP and I often reminisce about all the people, all of our patients who have died. She says when we go, we will be very busy visiting all of them. When the days are hard and tiring she says to ask for some help from all those 'friends' already gone. I do. It helps. I continue to start the day with some essays, words to nourish my soul, it helps; but, mostly I remember the stories, the stories I don't forget. Mother T also said, "We are not channels, we are instruments. Channels give nothing of their own, they just let the water run through them. In our action, we are instruments in God's hand… " Yes, that one, I can agree with her!

—Patricia G. Marsella, RN
Long Island Jewish Medical Center