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