Nursing wasn’t my original plan.
Last September, I sat on a plane from New York to Portland, Oregon, attempting to draft a TED talk. Trying to summon inspiration, I pulled up a photo on my laptop. The original—my mother’s 1975 nursing school portrait in a silver frame—is sitting across from me today. Clad all in white, she’s wearing a cap and the toothy grin that appears throughout the pages of our family photo albums.
The origins of my mother’s healthcare career were a world apart from mine, and they reflected the times. One day, my grandmother was driving to work in Omaha, Nebraska, when she heard a radio commercial for a nursing school. The Vietnam War had just ended, she was recently divorced and working overtime managing an apartment complex, and she decided her daughter—my mother—who was flailing amidst waitress jobs, was a perfect candidate.
My mother enrolled at Clarkson College, and my aunt Sheri applied for a secretary position at the adjoining hospital. My favorite story, which the three women repeat at every holiday gathering, is about the time Sheri received orders for a STAT liver tray and called down to the hospital cafeteria. The attending physician overheard her say, “I’m not sure what kind of liver! Chopped?”
My mother graduated a few years later, but her time in the white uniform was brief. It was the 1970s, and nurses were expected to get up and offer their seats when male physicians came into the room. Unwilling to be held back by patriarchy, in a move that I will forever admire, she left to become a physician herself.
Pregnant with me during her residency, she started practicing in her late 30s and became the first woman to join a formerly all-male obstetrics practice that was located in the Midwest. She delivered thousands of babies over the years. Meanwhile, I grew up somewhat miffed by the world of medicine. To me, it meant Dictaphones at the dinner table, late nights on call, and my mom’s car pulling out of the driveway at 3 a.m. because someone was fully dilated. By age 18, certain I wanted to be a journalist, I headed off to Reed College in Portland to major in English.
Majoring on majors
I must have declared 10 majors before landing on psychology. I was captivated by the cellular workings of the mind and the cutting-edge research underway at Reed on psychopathology, addiction, and the neural circuitry of reward and memory. I spent my summers working in the department labs and initiated a behavioral neuroscience study for my thesis. Reed is the only institution in the United States that allows undergraduate students to conduct their own animal research, and I took the responsibility to heart, though it didn’t come naturally to me. With Nora Volkow, director of the National Institute on Drug Abuse (NIDA), as my idol, I examined the role of specific neurotransmitters in regulating behavior in the context of polysubstance use and addiction.
After graduation, I continued on in research, applying for a Fulbright Scholarship in Scotland and eventually to PhD programs. Data analysis in the lab, however, started to become an isolating endeavor for me. Rodent brains, despite their uncanny similarities to ours, are a simulacrum of their human counterpart. When I tried to extrapolate the research to determine its implications on real people in complex, messy environments, I became disillusioned.
I moved on to research in a developmental brain-imaging lab at OHSU Hospital, where I spent afternoons with 12- to 18-year-olds doing neuropsychological evaluations. The longitudinal research, funded by the National Institutes of Health, looked promising for its ability to illuminate pediatric mental-health trends based on at-risk environmental factors during critical windows of brain development. In short, chronic trauma or stress during key phases of the brain’s rewiring has tangible effects on structural formation and, thus, on health and behavior later in life. Now, we have beautiful functional-MRI images to prove it.
One day, a teen came into the lab after school. Her mother, a hospital employee, had volunteered her for the study. I asked the routine opening questions and gave the speech about confidentiality and its one exception (the possibility of a participant hurting him- or herself, or someone else).
I was carefully trained on asking this question and on what to do if I encountered a participant in danger, but the situation had never come up. Later in the evaluation, when the girl exhibited signs of suicidal ideation, I quietly left the room to call my superior and then returned to keep the girl company until a psychiatric professional arrived. For years, I wondered what happened to her. It gradually became clear to me that I was in search of a profession that was more connective.
A few months later, I transitioned from academia to healthcare and began working with older adult clients in a residential setting. It was a newly created position, and I was granted substantial creative autonomy to help make the community at large healthier. I began a poetry workshop with a fellow Reed alum, started a support group for families of residents with Alzheimer’s and Parkinson’s disease, and launched a brain education series and canine therapy program.
I found myself in nursing school
Daily, I provided one-on-one counseling and care coordination for individuals and families facing a diagnosis of dementia. This was the first time I was introduced to the profession of nursing. I worked collaboratively with nurses to navigate insurance, healthcare systems, family dynamics, and change-in-condition situations. And so, taking a path that was both methodical and serendipitous, I found myself in nursing school, following in my mother’s footsteps after a decade of rebelling against them.
Enrolled in an accelerated BSN program, I did the things I suspected one would do in nursing school. I assisted with codes, gave flu shots, and made up mnemonics to memorize classes of antibiotics. I got my first stethoscope—a ceil blue model—and learned how to discern subtleties in lung sounds and circulation. I also did things I never anticipated, such as working with transgender Iranian refugees who struggled to access hormone therapy and insurance. I went to the state capitol and discussed gun loopholes with my district representative. Even as a student, I frequently met people on the worst days of their lives.
Most surprising to me was that the program was a natural progression from my liberal arts education and the subsequent experiences toward which that education propelled me. Nursing invited me into moments that challenged my understanding of the world and piqued my curiosity in the same ways Reed College had.
According to the “literature”
Organically, nursing became a vessel through which my naïve pursuit of truth continued to interface with the world outside the academic bubble. And the relationship was reciprocal. As one of my nursing professors—Kristen Beiers Jones, MSN, RN, also a Reed graduate—says, “Nurses who read The Sorrows of Young Werther are better nurses, and humans who are at the bedside of the ill will appreciate Goethe so much more.”
Introduced to the challenges we face in healthcare delivery today, my perspective was inherently different because I had the advantage of being a novice thrust into a new mode of thinking. Studying romanticism, poetry, and many other abstract liberal-arts topics forced my thought processes to be—for better or worse—unfettered by the pragmatism that drives many nursing-school conversations. As I moved through the program, I found that my previous education had turned me into a magpie for problems others weren’t drawn to. The things my undergraduate education celebrated—discourse and the ability to express ideas even when they run against the status quo—are valuable commodities in today’s world of nursing.
My first degree equipped me with the tools and intellectual courage to wrestle with ethical dilemmas—to refrain from disassociating in moments of moral distress or giving a stock answer when patients ask me the difficult questions. As an institution that celebrates diversity and upholds tolerance, my undergraduate alma mater also prepared me to enter the mindset of a nurse who repeatedly learns that one does not know what is best for others; one can only attempt to meet others where they are.
At the corner of Mind and Behavior
My interest in the nexus of mind and behavior has never wavered, and I feel most empowered approaching that intersection as a nurse. Our profession is an art and a science that fosters curiosity as much as tenderness. Nursing redefined my understanding of privilege and meritocracy and taught me about modes of systemic oppression in the world at large that nurses must continue to address. Generational and historical trauma—and their impact on care and access—are among the biggest challenges we face in 21st-century healthcare.
I am motivated by the concept of community-based health neighborhoods and nurses’ roles in shaping them over the coming decades. Advocacy—something at the core of every nurse’s practice—is an invaluable skill in the present healthcare climate. Millennials entering the nursing profession must strive to deliver care that is patient-centered, trauma-informed, and culturally competent amidst systematic efforts to keep it economical as the population and its comorbidities expand infinitely. I believe our greatest task, however, lies in our ability to teach. When nurses are effective in empowering people to advocate for themselves and their communities, we have a better chance at saving a broken system.
Learning to unlearn
I am employed at Unity Center for Behavioral Health in Portland, where I continue to work across a diversity of populations. Chimamanda Ngozi Adichie teaches that there is no single story, and this perspective—that the human experience is complex—drives my colleagues and me. As nurses, we must actively work to unlearn our biases, to see things as they are and not, as Anais Nïn observes, as we are. The self-reflection and presence this perspective demands are what I love most about my chosen career of nursing.
During my days at Reed, I was always filling notebooks with quotes, a habit I picked up from my mother. I recently found one by Jewish poet Hayim Bialik that captures my thoughts on the intersection of nursing and the liberal arts. He observes, “There takes place, in the material of language, exchanges of posts and locations: one mark, a change in the point of one iota, and the old world shines with new light.”
On days when I am discouraged by the challenges we face in healthcare, I don’t have to look far into my past to find an idea, story, or experience that makes the problem shine with new light. Perhaps it is not cutting-edge research or ingenuity that will save the healthcare system, but humanity. In the meantime, the field of nursing welcomes every insight, approach, and background that will help get us there.
Sana Goldberg, BSN, RN, was inducted as a member of the Honor Society of Nursing, Sigma Theta Tau International in May 2016. In addition to her employment at Unity Center for Behavioral Health in Portland, Oregon, USA, Goldberg continues to nurture her writing and communication interest as founder of Nightingale, an online magazine dedicated to promoting health equity through health-, arts-, and policy-related content authored by nurses and other healthcare professionals.