This metastory was composed by Carey Clark. It is a fictionalized reflection that is drawn from 13 of the stories submitted for the study.

Nurse #65X89 jumps onto the fly-fast transporter so as not to be late for her shift position at the Central-Technical Hospital, Western Division (CTHWD). Catching a glimpse of herself in the window, she notes that her dark-navy uniform is clean and crisply pressed as per regulation code for technical nurses, section 46723 and her black shoes are clean and pre-sanitized as per regulation code for technical nurses, section 62894. During the quick transport to CTHWD the nurse has an opportunity to check her instant regulation code update messages and check in on her offspring via tele-video technology. She gives up her prime seat on the fly-fast as a doctor enters the cabin, as per regulation code for technical nurses, section O784-089, which details the hierarchical positions of doctors and nurses within the work setting and in the public sector as well.

While checking in on her child via tele-video technology, nurse #65X89 feels a strange twinge in her heart that she is not quite able to place. It feels awkward and almost overwhelming, kind of painful …and maybe even a little pleasant too…and she hopes she isn’t coming down with something that might require a technical treatment such as a high dose injection of super-immune booster. She’s heard it is painful and she has not experienced much pain in her life.

Once at CTHWD, nurse #65X89 walks through the instant sanitizer, holding her breath as a combination of modern methods are used to sanitize herself and her clothing, even the meal replacement bottle she brought with her for the requisite mid-day rapid nourishment. She then enters her pod and notes that today she will only be in charge of 33 patients… a light load. Perhaps she’ll have time to catch up on her technical skills update today.

Through the plexi-glass she gets report from a very old nurse, # 94Z82. #94Z82 has been around forever…she must be 45 or 50 years old by now… and she is always trying to talk about the old days, when nurses attempted to work together as teams and they “enjoyed” some sort of physical-mental-emotional-spiritual interaction with their patients. #65X89 can’t imagine how that would have been, actually having to interact with the sickest of the sick, and maybe even their families too. #65X89 looks at #94Z82 quizzically when she states how bad she feels for the man in bed c-3 who is actively dying. #65X89 thinks to herself that it must be time for #94Z82 to retire…she must really be burning out if she is truly de-evolving to caring about a dying patient. As per regulation code for technical nurses, section DZX872, #65X89 writes up #94Z82 for possible signs of de-evolution and obvious implications of caring behavior. The system just has no room for this inappropriate behavior and it’s not what the patients expect or want anyway. The public wants good, practical, expert, physical, technical medical care. The days of holistic care were long ago abandoned, when nearly 15 years ago an infamous group of doctors and insurance agents had managed to prove, with a great deal of physical practice-based evidence, that all holistic techniques are ineffective.

The patients are all lined up in her pod, lying on computer-web based beds that report and record all of their vital signs and bodily needs. The doctors can walk around above the pod on the glass ceilings and observe the patients and technical nurses below, cuing in direct orders as they make rounds every few hours. Most of the orders go directly to the machines and the nurse monitors the machines functional ability. The beds are equipped with the ability to administer medications, turn patients, provide nutrition, clean waste away, perform wound treatments, measure blood values, run various tests, and record all pertinent patient information. Occasionally the nurse offers the patient a word of support as dictated in the regulation code for technical nurses, sections A5cpt- A5dpt and she may assist them in using the tele-video to contact their relatives. For instance if they are crying or in pain, she is allowed to tell them, “everything will be fine, you are receiving the best technical-medical care available”. If they are dying she is allowed to say, “you are free to pass on” one time every five minutes.

Sometimes the technical nurse even has to enter the pod to trouble shoot the equipment or remove a dead body if the web-based bed misses the conveyor belt. If something seems to be wrong with the patient that the machines can’t fix, or if one of the patients needs to be coded (what an ancient word that is, but some folks have enough money to try and stay alive. Why they would want to is another question…), the doctors can immediately be summoned so that they may give the nurse direct orders from the glass ceiling overhead. Nurse #65X89 is ever so grateful to know these demi-MDs are available to her and the pod patients at any moment. How could she solve or think through the physical needs of these patients on her own?

After all of the patients have had their adequate nutritional supplementation, nurse #65X89 again checks in on her offspring via the tele-video and that strange feeling returns to the area of her heart. #65X89 feels a sense a warmth in her chest and her stomach and a sense of …longing?… to hold her offspring’s hand. How strange. She’ll have to look these symptoms up on the extranet. She even notices how her offspring’s hair is sparkling in the sun as she runs in the play-yard, how her tiny hands dig deep into the sand, how she turns and waves to her, the joy in her voice as she states, “I am learning my new set of age 4 regulation codes today, life-giver!”.

5 of the patients die quietly under the influence of mega doses of morphine and ativan (the age-old standbys, for sure not as expensive as the insta-death shot but they still get the job done) and wouldn’t you know it that 3 of them fall off the conveyor belt. #65X89 enters the pod to remove the debris before the next shift comes on and as she lifts one of them a small voice barely cries out, ‘please, help me…I am not dead yet’. Nurse #65X89 stops in her tracks as she realizes suddenly that he, the patient, is still alive. She has never been this close to one of her live patients, literally holding him in her arms. He gasps and whispers, “please nurse, help me…I am not dead yet and I want to see my daughter just one more time. I love her so much…please nurse, please…”

Jane wakes with a start, covered in a cool sweat from the nightmare. Her heart is pounding and she can’t believe the strangeness of her dream, the portrayal of life and nursing as so very different from how she knows it in the year 2020. She centers herself, starts some spiritual-clearing energy exercises even as she micro-brushes her teeth, and then rushes to auto-record the nightmarish-tale of Nurse # 65X89 in her self-care journal. That one must have come from the collective unconscious of what could have been in the year 2020 if nurses hadn’t finally organized themselves and their practice when the peak of the nursing shortage slammed the healthcare world in the year 2010. She is sure that her holistic nurse-support group will be interested in this one! Definitely an energy treatment is in order to integrate this experience within her system.

After performing Chakra Connection, taking her daily exercise, and aligning her energy fields one last time, Jane prepares for work. She dresses in purple scrubs with red shoes, because she thinks the interesting color scheme will give her patients and her colleagues at the wellness center something else to smile about as they contemplate what the color scheme says about her emotional outlook today. Jane consumes her energy drink on the short walk to the wellness center and she is enveloped in the warmth of the sun, the flowers in full-bloom, and the children playing freely in the community-learning center next to the wellness center. She looks forward to her healing work with patients and their families, as well as her consultations with nurses and doctors who are still trying to adjust to the inclusion of the new holistic-spiritual-energetic healing modalities that are now used in conjunction with physical medicine. The new way of providing healthcare encompasses the best of both of the world of holism and reductionism. Jane recognizes that the mass exodus out of large hospitals and back into the community, back to treating the patients and their families in their own neighborhood setting, has been a challenge for many of the older, traditionally trained doctors and even some nurses.

Jane also recognizes that the dream she had this morning may have been a reality if it wasn’t for the 2010 nurses’ ability to organize and take their professional practice back into their own hands and out of the hospital-based hierarchical system. The old HMO- based system was one where the health and healing of patients, families, and even nurses themselves all too often came in last place as the nurses fulfilled their duties in truly technical skills: passing medications, charting, and learning each MD’s preferred style of technical-medical care. Why, some nurses even took their stress and insecurities out one another as they clearly failed to recognize their interconnection to one another and the cosmos at large. Many nurses left the system or traveled from place to place in search of more meaningful and less stressful team-based work. Who could blame them after the demanding experiences of nursing school, where words like caring and holistic were tossed around but never fully supported or facilitated by the educational system?

Yet, during the years 2003-2010, many nurses still learned to thrive off the one thank you a day from a patient, the rare hug from a family member, and the occasional instance of teamwork between doctors and nurses. These rare moments of joy still occurred even as the profession crumbled under the increasing demands of medicine, administration, and regulatory bodies. Finally the National Nurse Walk-Out Day occurred in 2010 on May 12 in honor of Florence Nightingale’s birthday and nurses immediately found themselves in the position of moving out of a place of subordination and into a space of power over their own work and their own lives.

Those that loved highly technical care could still return to the few hospitals that were left, but with increased wages, the ability to include holistic practices within their technical duties, and with greater partnership relationships with each other and the MD’s. The rest of the nurses chose to re-invent their practice within their own communities: some provided more traditional primary care and some specialized in anything from energy work, to guided meditation to art therapy, or herb-ology. The main difference was that now the nurses were practicing together, independent of the patriarchal system that had kept them subordinate for so many years. This new kind of practice and the fusion of healing, caring, and curing had been dubbed “the middle way”.

Jane thinks through her day ahead as she washes her hands at the entrance to the wellness center and the healing sounds of string-based instruments envelop her. First, a guided meditation class to teach, then a talk about nutrition at the learning community next door, followed by a few energy appointments and spiritual counseling in the afternoon. She has also scheduled herself plenty of breaks and time for regeneration of her own system, as demonstration of self-care is now a requisite if nurses desire to maintain their professional licenses. Most of all, Jane starts her day with the knowledge of her interconnection with others, knowing that she can make a difference in the life of Others around her even as she experiences self