Homeless Feet Come Full Circle

IMG_6180
Josephine Ensign/ foot care at Cross-Over Clinic, Fall 1986, from Freedom House brochure.

“I did a lot of foot care at the clinic… Of course, it had its Biblical roots, but there was something about foot washing that most people found comforting and even pampering…I knew that having your feet cared for could somehow make you feel better all over…Almost all the homeless patients I saw had foot problems. They had to walk around town to get to different agencies, meal sites, and day-labor pools. They walked in the rain and the snow and the heat, usually in ill-fitting, secondhand shoes with dirty, holey socks, and carrying heavy backpacks.”~ from my book Catching Homelessness: A Nurses Story of Falling Through the Safety Net, pp 86-87.

In this excerpt, I was referring to homeless patients I cared for when I worked as a nurse practitioner at the CrossOver Clinic in my hometown of Richmond, Virginia in the mid to late 1980s—over thirty years ago. But I could be (and indeed, am now) writing about currently homeless people and foot care here in my adopted hometown of Seattle, Washington.

There is this brief part of a haibun (prose mixed with haiku) reflection I wrote after helping with a foot clinic at ROOTS Young Adult Shelter in the University District near where I work: “Tonight in the homeless shelter a 19-year-old man from Georgia says, ‘My momma always told me not to go barefoot and I didn’t listen. That’s why my feets so bad. And I have to walk everywhere on them now.’ He reaches down and gently rubs his brown gnarled feet soaking in a white plastic basin. His feet are darkly scarred and calloused: the feet of an old man.

walking barefoot/we find our way/though cruel paths scar”

(From Soul Stories: Voices from the Margins, in the haibun/chapter titled “Where the Homeless Go”).

Kendra and Ani1.jpg

And there is this description of a foot care clinic I helped with at Mary’s Place, a downtown Seattle women and children’s homeless drop-in center: “The most delightful—and tender—foot clinic patient we had that morning was the petite three-year-old daughter of a young North African immigrant mother. The child pushed around a pink plastic toy shopping cart from the shelter’s playroom, and she wore a dress, bright striped tights, black Mary Janes, and a huge pink feather boa around her neck. She came and sat on a metal folding chair while one of the students washed her mother’s feet. The little girl wanted her own feet to be given the same attention, so her mother removed her shoes and tights. Baby toes! So cute!… I wanted to scoop her up and protect her from the traumas, the abuses of the world. But, of course, I knew I couldn’t do that. It made me sad to watch her toes curl up in delight as she splashed her feet in the basin of soapy water.”

(From Soul Stories: Voices from the Margins, in a chapter titled “Walk in My Shoes.”

IMG_0678And finally there is this King5 TV news report on the University of Washington School of Nursing foot clinic I helped with a few days ago (“UW Nursing Students Host Tent City Welcome Party” by Heather Graf, January 13, 2017). Rusty, the homeless resident of nearby Tent City 3 (currently on the UW campus), told the nursing student working with him that he had never felt so pampered. Small things go a long way. They always have and always will.

Nursing Mile High Club Take 2

wierdflightattendants

Meliorism: The doctrine that the world, or society, may be improved and suffering alleviated through rightly directed human effort; a policy embodying this doctrine. (Source: OED) Meliorism, as in this statement by William James in his book (or really his collection of Gifford lectures given in Edinburgh) The Varieties of Religious Experience (1902): “The idea of a universal evolution lends itself to a doctrine of general meliorism and progress which fits the religious needs of the healthy-minded so well that it seems almost as if it might have been created for their use.” (p. 90) I recently re-read this book for an essay I am writing on science and religion, but it also has come in handy as I process the recent backsliding (yes, a religious term) in social justice progress in our country. Meliorism as a doctrine was, of course, dealt a serious blow with WWII and the Nazi atrocities as revealed during the Nuremberg Trials.

My own ‘belief’ in meliorism has been dealt a serious blow, but my resolve to work towards social justice is strengthened. And I look for evidence of progress wherever I can in order to bolster my resolve. Including in the somewhat dusty archives of this blog. “The Nursing Mile High Club” (originally published February 11, 2011) is one of my personal favorite blog posts to research and write. Re-reading it (and re-viewing the accompanying photo) makes me smile because it reminds me of how far nursing as a profession has come. Plus, it reminds me of how far my “real writing” career has come in the six years since I started this blog/website. Enjoy.

************

Nurses are a lot like flight attendants. Imagine the modern hospital as a large flying spaceship. The physicians are the pilots, or perhaps they would contend that the administrators are the pilots. The hospital patients are mostly all the passengers packed into economy class, with perhaps a few VIP hospital patients in first class patient suites. So, of course, the nurses are the flight attendants of this hospital spaceship. They keep passengers comfortable by bringing them coffee, tea or soft-drinks, they help passengers in and out of bathrooms, they answer call bells, they ensure safety by keeping bed guardrails up, and they help to avoid a mass stampede of panicked passengers/patients running for the exits.

In fact, the first flight attendants were nurses. From 1930 to 1945 Boeing  Air/United Airlines hired nurses to be flight attendants—called stewardesses then. Nurses were hired to calm passengers’ nerves in the early days of flying, and to attend to their comfort by bringing passengers food and drink, and tucking them in at night on long flights. Perhaps they gave sedatives to really nervous passengers. They wore the iconic white nurses’ uniforms, replete with the winged nursing caps left over from the nunnery roots of nursing.

But ramping up after WWII, stewardesses were mainly hired for their sex appeal, and soon became one of the most sexualized female lines of work—even more sexualized than nursing. Until the mid-1960s and the Civil Rights movement, flight attendants were all women. They were all pretty, thin, young, unmarried and un-pregnant women. They wore designer uniforms ranging from hot pants with patent leather go-go boots, to futuristic spaceship suits. Euphemistically known as “tarts with carts,” “trolley dollies,” and ‘flying mattresses,” stewardesses regularly endured pats to their derrieres as they worked the aisles, and it was common for frequent flyer businessmen to marry a stewardess. National Airlines had an infamous and financially successful “Fly Me” TV ad campaign in the early 1970s, with sultry female flight attendants declaring “I’m going to fly you like you’ve never been flown before.” The feminist NOW organization picketed their headquarters.

Currently, about 30% of all US flight attendants are male, and the median age is 44. These changing demographics, coupled with more enlightened cultural mores, successful unions, and post 9-11 increased seriousness of air travel, have all helped to raise the professional status of US flight attendants. In other countries, most notably Asian countries, almost all flight attendants continue to be young attractive females, although an enterprising new Thai airline is recruiting and hiring ‘kathoeys,’ otherwise known as ‘ladyboys,’ “third sex” male transgender people.

Flight attendants and nurses are both service-oriented professions with roots in traditional female roles. Flight attendants have a history of being much more overtly sexualized than do nurses. So how have flight attendants managed to come so much further than nursing in terms of gender parity—and in only eighty years? As I mentioned in a previous post “More than a few good men needed in nursing,” currently only 7% of the US nursing workforce is male. Although I was not able to find specific data on attrition rates by gender and profession, my sense is that male nurses have much higher rates of leaving the profession than do male flight attendants. So it’s not just a matter of recruiting, educating, and hiring more male nurses in the US, we also need to do a better job at retaining male nurses. Otherwise, perhaps they will all go join the friendly skies.

See also:  “Tracing flight attendants’ path from nurse to model to professional” blog post by Aubrey Cohen 1-28-11,  Seattle-PI‘s Aerospace News, about Seattle’s Museum of Flight’s display of flight attendants’ uniforms over the years (“Style in the Aisle”).

****

Note: 2016 statistics on gender parity for flight attendants is difficult to find, but most updated reliable sources seem to place male flight attendants at 25-30%. For nursing, the Robert Wood Johnson Foundation January 2016 policy brief “The Changing Face of Nursing: Creating a Workforce for an Increasingly Diverse Nation” states that the 2014 RN workforce was 10% men. So at least for nursing in the US gender parity—and work attire—is improving.

On Hope

img_0518
Detail from mural “Sonoran Desert:Yaqui Home” by Mario Martinez

Today was absolutely the hardest day to teach out of all of my decades of teaching. I have a class of about 150 nursing students for a course on community/public health nursing. They are a very diverse group in terms of race, ethnicity, religion, country of origin, sexual orientation, gender, and even age. Today’s topics were cultural humility and the social determinants of health equity. How appropriate. One of my students also pointed out to me how helpful it was that I had also assigned a training module on disaster preparedness, which included PTSD prevention. She found the content helpful in terms of facing the outcome of our national presidential election. This made me remember the highly effective CDC Zombie Apocalypse disaster preparedness public education videos and materials. There is a zombie-like mindset within our healthcare system, within academic nursing, and within our society that I find highly disturbing. It would be so much easier to just yield to zombie ways.

I take diversity seriously in my teaching and strive to promote a class climate of respect for all differences, including different political views. But the profession of nursing as a whole, and especially of community/public health nursing, is built on the value of social justice and health equity. And higher education at a public university is based on inclusion and social justice. To now have a president-elect whose political platform included openly racist, xenophobic, homophobic, and beyond-misogynistic-into-sexual-assault-on-women values, takes us—takes me as a teacher—into an entirely new and uncharted territory.

Today in class I tried to acknowledge this in a transparent and respectful way—and to emphasize our responsibility to do our part to make the world, to make our country and our community a better and healthier place. We had terrific trainers from the NW Network of Bi, Trans, Lesbian, and Gay survivors of abuse who helped us address some of these issues directly. And a group of nursing students are continuing a Knitting for Change community group, an idea my UW Study Abroad in New Zealand students brought back with them last year. My co-teacher for that program was the community empowerment “Neighbor Power” expert Jim Diers. And then after class today I received notification of this recent mention I made in a Seattle-area community event of the New Zealand concept of community cafes as places to help strengthen our communities. “Experts offer ideas to help Seattle area’s homeless youth” by Neal Morton (Seattle Times, November 9, 2016).

I choose to hold on to all of these examples of the goodness and compassion in the world. I choose hope and a renewed energy to work for a socially just society.

Listen, Carefully

johann_heinrich_fu%cc%88ssli_-_silence_-_wga08336
“Silence” by Johann Heinrich Fussli, 1799-1801

My essay, “Listen, Carefully,” was published today by Electric Literature/Okey-Panky. I love the Okey-Panky tagline, “Literary oddments for busy people.” They state that my essay (or is it really a prose poem?) is a 4-minute read. It includes a link to my 7-minute digital storytelling video of my reading of the piece, accompanied by my photographs.

“Listen, Carefully” is part of my book and digital humanities project, Soul Stories: Voices from the Margins. In “Listen, Carefully” I parse out some of my criticisms of the practice of narrative medicine, as well as the rhetoric of listening—and of silence.

Rad, Nasty Women (and Nurses)

img_0300
Detail of papercut illustration by Miriam Klein Stahl, Rad Women Worldwide, p. 95

Rad, as in radical. Nasty, as in the newly reclaimed feminist term for strong, powerful, capable women (thanks to Trump’s misogynistic mansplaining over Hilary Clinton in the last presidential debate).

Books, as usual, have helped me through the latest vicissitudes of politics and of life. And one new book in particular has been my constant companion over the past several months. Rad Women Worldwide: Artists and Athletes, Pirates and Punks, and Other Revolutionaries Who Shaped History, written by Kate Schatz and illustrated by Miriam Klein Stahl (Berkeley: Ten Speed Press, 2016) is quite simply a lovely, inspiring, and comforting book. The strong black and white papercut illustrations are striking and complement the brief write-ups of the lives of forty rad, nasty women from all around the world and throughout history.

Mixed in with familiar rad women, including Frida Kahlo, Malala Yousafzai, and Aung San Suu Kyi, and less familiar women such as Enheduanna from 4,300 years ago in Mesopotamia, who is the world’s oldest known named author. She wrote hymns and poems on clay tablets using Cuneiform script, and she wrote in first person. Rad Women Worldwide also includes at least a few nurses. Irene Joliot-Curie, daughter of Marie Curie, went to nursing school in Paris during WWI and then traveled with her mother to field hospitals to train doctors in the use of their newly invented mobile X-ray machines. And the indomitable Emma Goldman worked as a nurse and midwife in the 1880s with impoverished immigrant women in the tenements of New York City. Yes! Rad, nasty female nurses unite!

Although not included in this book, some of the other rad, nasty female nurses I admire are the following:

  • Dorothy Day (I highly recommend her autobiography, The Long Loneliness, a rich and thought-provoking book.) I love her statement, “Writing is an act of community.” 
  • Mary Seacole, a Jamaican-British creole nurse who worked in the Crimean War and was shunned by none other than Florence Nightingale. Seacole published her memoirs under the lovely title, The Wonderful Adventures of Mrs. Seacole in Many Lands. It is a rollicking good read.
  •  Ruth Lubic, nurse midwife and amazing nurse leader/pioneer. She founded the NE Washington, DC Family Health and Birthing Center using her MacArthur (“Genius”) award money. I love this video interview with her, where she opens with this statement: “I told the staff, when I walk in this door, I want to feel love.”

Notes to My Younger (Nurse) Self

IMG_6180
Josephine Ensign/ foot care at Cross-Over Clinic, Fall 1986, from Freedom House brochure.

Recently, I had the opportunity to talk with a journalist for the career advice blog site, Glassdoor. The interview was published as “11 Things I Wish I Knew Before I Became a Nurse” (by Eileen Hoenigman Meyer, August 31, 2016). Here are some of my favorite parts of this interview as interpreted and written by Meyer:

“I wish I knew how crazy the healthcare system is. I was young and idealistic. But maybe if I would have known I wouldn’t have chosen this path,” Dr. Ensign says, laughing.

While Dr. Ensign initially had “no intention of teaching,” she’s mostly impressed with her students who she refers to as “change agents.” She even found herself in a former student’s care during an unexpected trip to the ER, the ultimate test of trust for a medical educator and an experience she wrote about in her essay “Medical Maze.” Dr. Ensign expresses optimism about her students’ role in the future of medicine, but also concern for them in a challenging industry. She says, “In school students get a vision of utopia, but they don’t get enough support for how to deal with it when they run into barriers-how to stay true to themselves.”

Notes to my current (Nurse educator) self:

Continue to figure out ways to ‘teach fearlessly’ (upcoming blog post, stay tuned), to improve nursing education away from the production of “functional doers” towards the nurturing of “change agents.” (See previous blog post, “Undoing Nurses as Functional Doers” November 24, 2010.) 

My Homeless Shadow

IMG_1542“Most of us live homeless, in the neighborhood of our true selves.”
—Rachel Naomi Remen

__________________________

A few years ago, while working with Public Health– Seattle & King County on a medical respite project for homeless youth, my own homeless shadow resurfaced. I was in downtown Seattle at the YWCA women’s shelter, waiting inside the front lobby for the rest of our group to arrive. We were scheduled to have a tour of the facility to see how they ran their medical respite program. I’d taken the city bus and had purposefully dressed down in jeans, a sweater, and a raincoat. It was late afternoon, raining out- side, and I saw soliciting, pimping, prostituting, and drug dealing happening on the sidewalk in front of the shelter. The members of my medical respite group were buzzed in the front door. At the same time, a homeless woman resident walked up to me and asked, “Did you stay at a hotel last night on Aurora instead of here again?” Aurora Avenue is one of Seattle’s main prostitution areas. I looked up at her in alarm. “I’m sorry. You must have me mixed up with someone else. I’m not staying here, I’m just visiting.”

The people in my group overheard this interchange. Later, they teased me about it, saying how preposterous it was. I was a university professor, for God’s sake! There was no way I could be homeless, much less a homeless prostitute. But I couldn’t shake the feeling that my cover had been blown, that I’d been found out, that my homeless shadow was showing. You were homeless—why? What was wrong with you? Those are the questions people ask me—or want to ask me—whenever they discover I was homeless. Coming out of the closet about my own homelessness was never an option for me. It could derail my career, hurt my family, and marginalize me even more. It was largely why I had moved across the country to Seattle, to escape the memories of having been homeless in my hometown of Richmond, Virginia. But standing there in the YWCA shelter, I recognized the irony—and the hypocrisy—embedded in my reaction to the woman’s question. Here I was an outspoken advocate for people who were homeless, while secretly judging them, and by extension, judging myself.

Homelessness is exhausting and soul sucking. Homelessness has marked me. Like the star-shaped surgery scars on my belly, the body harbors secrets. Homelessness is a type of deep illness, a term coined by sociologist Arthur Frank for an illness that leaves you feeling dislocated, an illness that casts a shadow over your life. That shadow never completely goes away. At some point it was time to acknowledge my homeless shadow, time to remember.

Note: This is an excerpt from my recently published medical memoir, Catching Homelessness: A Nurse’s Story of Falling Through the Safety Net (Berkeley: SheWrites Press, August 9, 2016).