Excerpt from “Random House interview with Cortney”

 

RH: What made you become a nurse and then a nurse practitioner?

CD: I first entered the medical world as a nurse’s aide. I’d never wanted to be a nurse, but I couldn’t turn down a job that offered me the chance to work part-time evenings, earning extra money while my first husband stayed home with our daughter. As an aide, I was introduced to patient care, to the sorrows of illness and the joy of recovery. I liked the hospital with its wards and quiet hallways. When I became pregnant with my son, I continued to work until the day before my delivery.

When my first husband and I divorced, I enrolled in a surgical technician program, eager to learn more. I loved being allowed to look into the open abdomen to see how the organs fit neatly into the envelope of the belly and into the chest to see how the lungs and heart moved within their thin sacks. After a while, I began searching for a nursing program, trying to find a way to return to school while continuing to work to support my two children.

In 1970, I entered Norwalk Community College’s Associate’s Degree in Nursing program, working days and catching up with my basic nursing courses in evening classes. When it was time for clinical rotations, I worked as a student nurse all day and nights as a nurse’s aide. After graduation, I worked in Intensive Care—it was there, in that environment of life and death drama, that I became a good nurse. A few years later, I became the head nurse on a new cancer unit. If Intensive Care taught me to be a expert nurse, this ward taught me to be humble. My experiences with dying patients and with those who fought for their recoveries will stay with me always.

In 1976, I entered Cornell University’s Nurse Practitioner Program. Nurse practitioners were a new concept at that time. When I graduated, I was one of only a few thousand nurse practitioners in the US—now there are more than 80,000 of us. Early on, doctors worried that we might steal their patients by offering healthcare at reduced rates or by spending more time with patients. Today, the NP role is better defined; in most states, we prescribe medications and work as colleagues with other nurses and with physicians. Many of us still work in undeserved areas and in clinics, stressing health maintenance and education as well as diagnosis and treatment.

For the past ten years, I’ve worked in women’s health. There’s nothing half-way here, no way to avoid the complexities of the body or the heart. I learn something new every day. Most important, I’m privileged to witness the entire range of human emotions, from intense grief to great joy, and to make a difference in the lives of patients whose stories amaze me.

RH: Your work as a nurse certainly influences your work as a poet and writer, but does your writing influence your work in nursing?

CD: Because the phrase “write about what you know” makes sense to me, I often incorporate my nursing experience into poems or prose. There’s also an awareness that carries over from my writing into my interactions with patients in a very insistent way. I pay closer attention to a patient’s language, to how someone tells their story, and I pay closer attention to the implications behind that story—what a patient doesn’t say but reveals with her eyes, her silences. The sensitivity that underlies the writing impulse makes it easier for me to enter, metaphorically, a patient’s skin and intuit what she’s experiencing. And that influences my nursing in a profound way, adding an extra dimension to caregiving and making my patients’ lives a part of mine.

RH: Many of the relationships you have with your patients in your books, I’m thinking of I Knew a Woman: the Experience of the Female Body, are very close. Is this kind of personal healthcare at risk in our age of HMOs and managed care?

CD: Caregiving is, by its very nature, intimate. Sometimes this closeness develops over time, sometimes it results from the urgent nature of a particular patient’s situation. Managed care requires an incredible amount of documentation and long hours spend obtaining pre-approval for tests or admissions. The higher a caregiver’s stress level, the less likely it is that she will be able to take the time required to forge close bonds with a patient. Patients also must often change providers whenever they change insurance plans. In addition, many HMOs dictate what tests may or may not be done, regardless of a provider’s recommendation or a patient’s wishes. Most patients don’t understand how managed care works until they or someone they love needs something or someone that their insurance denies.

RH: What, in your opinion, is the biggest crisis in women’s health right now?

CD: One of the biggest, I believe, is that many tests we take for granted, like Pap tests and mammograms, are unavailable to many women, both in the U.S. and other countries. A second part of this crisis might be the failure of medical science to develop more and better tests for women that might discover curable conditions in time. A third part might be the lag time in circulating healthcare information to women, especially in other countries—like the information that cervical cancer is curable if discovered in time, and all that’s needed to do that is a simple yearly Pap test.

If I had to name runners-up in the contest for the biggest crisis in women’s health, I’d say the lack of knowledge women have about their bodies.

RH: When do you work on your writing?

CD: Wednesday is usually my “writing day.” On a good day, I write from about 8 in the morning to 7 or 8 at night with a break for lunch. I might be writing or revising new poems or doing secretarial chores like sending out poems or prose for publication. Sometimes my writing day falls apart and I have to go to the dentist. Sometimes I opt instead to spend a day with my writer friends. And I can stretch the definition of writing to include reading, visiting museums, hiking, or listening to music. It all helps fill up the well.