THE SHIFT

One Nurse, Twelve Hours, Four Patients' Lives

Theresa Brown, RN

A moving story unfolds in real time as practicing nurse and New York Times columnist Theresa Brown reveals the individual struggles as well as the larger truths about medicine in this country. She lets us experience all the life that happens in just one day in a busy teaching hospital’s oncology ward. In the span of twelve hours, lives can be lost, life-altering treatment decisions made, and dreams fulfilled or irrevocably stolen. Every day, Theresa Brown holds these lives in her hands. On this day there are four.

There is Mr. Hampton, a patient with lymphoma to whom Brown is charged with administering a powerful drug that could cure him–or kill him;

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A moving story unfolds in real time as practicing nurse and New York Times columnist Theresa Brown reveals the individual struggles as well as the larger truths about medicine in this country. She lets us experience all the life that happens in just one day in a busy teaching hospital’s oncology ward. In the span of twelve hours, lives can be lost, life-altering treatment decisions made, and dreams fulfilled or irrevocably stolen. Every day, Theresa Brown holds these lives in her hands. On this day there are four.

There is Mr. Hampton, a patient with lymphoma to whom Brown is charged with administering a powerful drug that could cure him–or kill him; Sheila, who may have been dangerously misdiagnosed; Candace, a returning patient who arrives (perhaps advisedly) with her own disinfectant wipes, cleansing rituals, and demands; and Dorothy, who after six weeks in the hospital may finally go home. Prioritizing and ministering to their needs takes the kind of skill, sensitivity, and, yes, humor that enable a nurse to be a patient’s most ardent advocate in a medical system marked by heartbreaking dysfunction as well as miraculous successes.

This remarkable book does for nurses what writers such as Atul Gawande and Abraham Verghese have done for doctors, and at shift’s end, we have learned something profound about hope and healing.

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  • Algonquin Books
  • Paperback
  • May 2016
  • 272 Pages
  • 9781616206024

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About Theresa Brown, RN

Theresa Brown, RN, works as a clinical nurse and is a frequent contributor to the New York Times opinion pages as well as on the Times Opinionator blog. She has also been a contributor to the popular “Well” section of that paper and writes for CNN.com and other national media.

Brown received her BSN from the University of Pittsburgh and, during what she calls her past life, a PhD in English from the University of Chicago. Before becoming a nurse she taught English at Tufts University.

Today, her focus is medical oncology and end-of-life issues. She lectures nationally, is a board member of the Center for Health Media and Policy at the Bellevue School of Nursing at Hunter College. Brown was a panelist for the TEDMED’s Great Challenges of Health and Medicine initiative and is also involved in the Robert Wood Johnson Foundation’s “Flip the Clinic” initiative and an advisory board member for Scrubs Magazine.

She lives with her husband and three children in Pennsylvania.

Praise

Compelling and compassionate human drama. If you want to understand how modern medicine ticks, fasten your seat belt and spend a day in the hospital with Theresa Brown on The Shift.” —Danielle Ofri, MD, PhD, author of What Doctors Feel

“The Shift takes an intimate look at the practice of modern medicine from the point of view of a professional on duty at the patient’s bedside. It’s an engrossing human drama composed of interlocking stories of patients and their families, doctors and nurses, aides, chaplains, social workers, and others who take care of sick people in a modern-day hospital. The Shift is one nurse’s story, but it contains elements of every nurse’s experience.” –Wall Street Journal

“…this meticulous, absorbing shift-in-the-life account of one nurse’s day on a cancer ward stands out for its honesty, clarity, and heart. Brown…juggles the fears, hopes, and realities of a 12-hour shift in a typical urban hospital with remarkable insight and unflagging care. Her memoir is a must-read….” —Publishers Weekly (starred review)

“Theresa Brown’s The Shift … should be required reading for all incoming medical and nursing students — or anyone who is a patient or visitor in a hospital. …her story is riveting in the exacting way she recounts the way her day unfolds.” Pittsburgh Post-Gazette

Discussion Questions

What do you think of the “one shift” structure of the book? Why do you think Theresa Brown chose this structure?

Candace Moore is a “difficult patient” but also an “empowered patient.” How did you feel about her? In our present health care system, do you think empowered patients always risk being seen as difficult?

Sheila Fields was badly misdiagnosed. Did this strike you as an unfortunate but pardonable result of human error? Or did it seem to result from lack of flexibility in the health care system as a whole?

It takes a long time for Dorothy to be discharged from the hospital. Did this bother you? Quality initiatives in health care have found that after patients are discharged they often have problems understanding the instructions for taking care of themselves at home. Can you think of ways to improve the discharge process?

The rapid response done on Mr. King is sad for the staff and holds little of the drama that such situations typically evoke on medical TV shows. What are the human costs, and benefits, of working in a profession that cares for such fragile human beings?

Should nurses work shorter shifts, or do the advantages of having one person responsible for a patient for twelve hours outweigh the disadvantages of increased nurse fatigue and greater likelihood of mistakes?

Sheila ends up being sick in a way that no one saw coming, and Mr. Hampton does fantastically well in a situation Theresa Brown anticipated going badly. How does the William Blake poem quoted in The Shift capture the complexities of both situations?

To see a World in a Grain of Sand

 

And a Heaven in a Wild Flower

 

Hold Infinity in the palm of your hand

 

And Eternity in an Hour

Ray Mason is a fake name for real-life stem-cell-transplant patient Doug Weaver. Imagine having your own health care experience, or that of a loved one, written about. What would you like or dislike about it?

Nurses and physicians have a history of fraught relations, yet the team of nurse-surgeon-resident caring for Sheila works well together in large part because they all know each other. What does this suggest about creating ideal work environments for RNs and MDs, as well as ideal care environments for patients?

Would you want Nurse Brown’s job? What kind of person do you think makes an ideal nurse?

If you—as a patient, family member, or health care professional—could change one thing about our present health care system, what would it be?

After reading The Shift what have you learned that might help make your care or a loved one’s care in a hospital better?