Note: The Nocturnists is an audio-first experience with emotion and sound design that can be difficult to fully capture in text. Transcripts are provided to support accessibility and reference, but may contain minor inaccuracies. If quoting in print, please consult the audio when possible.

Emily Silverman: Support for The Nocturnists comes from the California Medical Association.

Team The Nocturnists: At The Nocturnists, we are careful to ensure that all stories comply with healthcare privacy laws. Details may have been changed to ensure patient confidentiality. All views expressed are those of the person speaking and not their employer.

[music]

Emily: This is The Nocturnists. I'm Emily Silverman. Today I'm joined by Linda Wick, a nurse practitioner with more than 40 years of experience in nursing. Linda's path began when she was just six years old, sitting at her brother's bedside and watching nurses care for him after a devastating car accident. That early exposure to the compassion and skill of nursing set her on a lifelong journey through intensive care, nephrology, and leadership.

In this episode, Linda shares the story of reuniting with Sister Helen, one of her toughest teachers from nursing school. It's a story Linda told live on stage at Intersections, an event produced by the Center for the Art of Medicine in Minneapolis.

In my conversation with Linda, we discuss the evolution of nursing education, from the days of Benedictine nuns to today's advanced practice roles, the differences between nursing and medical frameworks of care and where they overlap, what decades at the bedside have taught Linda about resilience, integrity, and the healing power of attitude, and how a dramatic reunion with one of her toughest teachers, the nun, Sister Helen, helped her to make peace with some words that she never forgot. Before we get to the conversation, let's take a listen to Linda's story.

Linda Wick: When I was six years old, I spent a lot of time in hospitals, not because I was a patient, but because my older brother, who was 18, had been in a terrible car accident. I lived in rural Minnesota, which meant that he got taken to a larger city, Minneapolis, to be cared for. Because of my age, my mother took me with oftentimes to come sit at the hospital with him. As I watched the nurses take care of him and the doctors come and go, I quickly realized who had the real power in this system: it was the nurses.

[laughter]

They were dressed in starch white at the time, because I'm old, the white hats. They had it all going on. I would watch them take care of my brother, prevent him from getting bed sores, encouraging him when he needed encouragement, and also gave him a shoulder to cry on when they had the conversation that he might lose both of his legs because of his accident. I decided at six years old that's what I want to do. I want to be one of those women. I was a little bit intrigued by the white dresses [laughter] and the hat, but I was mostly aware of their power.

Fast forward 20 years, and I'm in college. I am living my life. I am having the time of my life, and I was the first out of seven kids to go to college in my family, so that alone felt like a little bit of an accomplishment.I went to a Catholic College, and I'm attending a class, which was skills class for those nurses in the audience. These are the days of slides. We didn't have any smart boards back in the '80s. Because it was a Catholic college, I had a nun that was teaching this class. She was in full habit, Sister Helen.

That day, we were actually learning how to put in urinary catheters. Sister Helen is standing in front of the big screen behind her with a super-sized penis [laughter], and being the quiet person I am, I burst out laughing. Sister Helen was not impressed because I started laughing and the other kids started laughing. She walks over to the light switch, and she switches it on, and she looks at me, and she goes, "Linda Nelson, do you know something about the male anatomy you'd like to share with the rest of the class?"

[laughter]

And in my head, I thought, "I probably know more than you do, sister," [laughter] but I knew enough not to say that. After class, she pulls me aside and she gives me a lecture. She tells me I'm too glib and that I am not taking this seriously enough. She ended with, "You're going to kill people." I thought to myself, "Wow, because I laughed at a nun standing in front of a penis?" Those words stuck with me. 20 years later, I was a nurse practitioner in nephrology in Duluth, Minnesota, and I was working the weekend, and I got paged.

Again, old. We had pagers, not cell phones. I get paged to the dialysis unit stat. Usually, when I got page stat to the dialysis unit, there was something cardiac going on, or somebody had dropped their blood pressure, passed out, or something. I go down there, and when you walk into a dialysis unit, you usually hear chatter. People are watching television, they're listening to the radio, they're visiting with each other, and then you hear this hum of the dialysis machines. That day, I walked in, and it was dead silent except for the hum of the dialysis machines.

I look across the room, and I can see the blood pooled on the floor. I can see the blood on the nurse's scrubs, and I can see the blood on the patient. When there's that much blood, you can smell it, and I knew I was in trouble. I walk over, I look at the patient whose fistula had eroded, and so her artery was pumping blood. Luckily, the nurses quickly put pressure on it, but you lose a lot of blood pretty quickly when it comes out of an artery. There's Sister Helen. We look at each other, we lock eyes. She knew exactly who I was.

Oh boy. I click into my clinician mode, and I reach over and I say, "This is going to be fine. You're going to have to go to surgery. Let me start asking you some questions." I start asking the typical clinical questions that we ask before somebody goes to surgery. When did you last eat? Are you allergic to anything? Have you ever had a problem with anesthesia before? We call the vascular surgeon, and we get her on a gurney, and we have to walk her a block and a half through the sky walk to get her to the OR.

As we're walking, I'm holding her other hand, and I said, "Sister, this is going to be fine. We've had this happen before. We have an excellent surgeon. You have to go to surgery, but you're going to be just fine." She looked at me, and she said, "I know I will. I've got God on my side." We get to the OR, and I hand her off to the OR nurses. As I'm walking out, there's the surgeon scrubbing to go into the OR, and I'm like, "All right." We called him Dr. D because he had a really long last name.

I said, "All right, Dr. D, here's the deal. That was my nursing instructor in there, and she used to tell me I was going to kill people. The last face she saw going into the OR was this one?" [laughter] He laughed and said, "Linda, we've got this. Don't you worry, everything is going to be fine." Sure enough, everything was fine. She didn't need a unit of blood. The next morning, I went to see her on rounds, and I said, "Oh, sister, Helen, so glad everything went fine. How are you doing?" and we're chatting.

She said, "I knew I was going to be okay when I saw your face." I was a little bit shocked. I said, "Sister, you used to tell me I was going to kill people." She laughed. She goes, "Oh, I told everybody that." [laughter] Good to know. She told me again that she was proud that I'd went on to be a nurse practitioner, and thanked me for my care. I walked out, sat down to chart my note. I started thinking how grateful I was. First of all, grateful for Dr D that he knew what he was doing, grateful for instructors like Sister Helen, who really taught me the skills and the humanness of nursing, grateful that I get to be with people at the most vulnerable times of their life, and also grateful that my brother, at 74 years old, still has both his legs. Thank you.

[applause]

[music]

Emily: I am sitting here with nurse practitioner, Linda Wick. Linda, thank you so much for being here today.

Linda: Thank you for having me.

Emily: Linda, I loved your story. It had such a humorous energy to it, even though there were some dramatic scenes, I guess you could say gory scenes even. I guess I was wondering first, how was it for you to perform that story on stage in Minneapolis?

Linda: It was really a great experience, partly because I was given a professional story coach, and that was really a fabulous experience. I do a lot of public speaking, so speaking in front of a crowd is not a big deal for me, but to have a professional coach really helped me get the story fine-tuned was great, and all the stories that night were so fabulous. I really appreciated the professional story coach.

Emily: I was wondering if you could back up and tell us about growing up. It sounds like you got the idea to go into nursing when your brother had a car accident and you were in the hospital with him and seeing how the nurses were taking care of him. I was just wondering if you could bring us back to that time.

Linda: Sure. It was 1968 in rural Minnesota, and my brother, who was 13 years older than me was in a terrible car accident. At the beginning, it was touch and go, whether he would live or not, but his legs were crushed between a stationary vehicle and a moving vehicle. He first spent time in Fargo, North Dakota, and then they sent him down to the University of Minnesota because they didn't have the expertise that they needed.

I lived on a dairy farm with my family, and my mother took me and my younger sister, who was four years younger than me, to Minneapolis to spend time with my brother. I was a curious and active kid, so I am shocked that they let me in back then, because visiting was very restricted back then in the hospital; kids were not allowed, but I think he'd been in the hospital for so long that they bent some rules to let me in and entertain my brother.

He was in traction. If people know what traction is, his legs were held up with wires, and he had wires through his legs to hold his bones together. He was pretty immobile. Sitting in the hospital, I'm sure I drove the nurses crazy, because I asked 100 questions, "What is this? What is that? What does it do? Why are you doing that?" At the same time, I was observing what was happening, and the nurses spent the most time with my brother. The doctors would come in, ask him some questions, write some notes.

Back then, we had paper charts. Write their notes on the chart, hand it to the nurse, and walk out. The nurses were the ones that implemented whatever treatments the doctor had prescribed. They were the ones who prevented my brother from getting any bed sores, which is pretty amazing given how immobile he was.

My brother was 18 at the time, so he was an 18-year-old, cocky kid, and the nurses were the ones that put him in his place when he needed it, and also were compassionate to the situation that he was in. I just watched all that and thought, "Wow, this is what I want to do. I saw how much they helped my brother and my mom, and entertain me." I always say my nursing career started when I was six years old at the University of Minnesota hospital.

Emily: Then, not too long after that, you land in nursing school. Tell us about nursing school. Where was that, what year was it, and what was that like?

Linda: Oh gosh, I'm going to have to admit my age now, but-

Emily: Forgive me.

Linda: -I started college in 1980 in Duluth, Minnesota, at The College of St. Scholastica. The College of St. Scholastica is well known for their nursing program. It's been a long-standing program of theirs that has done very well. I lived with physical therapists. I just want to have a shout-out to physical therapists, because their coursework was way more difficult than mine, I just want to say. Nursing school, the first couple years, are just your basic sciences and stuff, which I just absolutely loved.

Then got into the nursing program and did our clinicals, and had to learn all the skills that nurses have to learn. That would have been 1983 and 1984. Back then, the College of St. Scholastica is a Benedictine college, and so the majority of our teachers were nuns. I did not grow up Catholic. I grew up in a very small rural town. We didn't even have a Catholic Church in our town. The kids that I went to school with were Catholic went to a neighboring town to go to church.

This was all very fascinating to me, and I was, again, super impressed with how amazing these nuns were. They were smart, they were driven, they had done amazing research. Some of them were like your mother, and some of them were like a tyrant. [laughter] I'll never forget in chemistry, one of the first weeks, Sister Agatha said we were going to have to memorize the Periodic Table of Elements. That was going to be an expectation for that class.

Wanting to know how I could plan my time, I went up to after class and said, "When exactly are we going to be expected to know that? Like in the next this semester, or by the end of the year." She said to me, "If you don't know it now, you're in the wrong class." I'm like, "Wow." [laughter]

Emily: Oh gosh.

Linda: We went from that to these wonderful nuns that would-- If we ripped our clothes or something, and we needed something repaired, there was a nun that did that. That brings me to Sister Helen. Sister Helen Claire that was our skills instructor, and she was tough. She didn't really look or appear to have much of a sense of humor. My girlfriend, Ann, and I, we thought everything was funny and a little bit ironic. She didn't really like us very much, it felt like, because we were cracking jokes and goofing off and being typical 20-year-olds, I guess. That's what college was like. I loved every minute of it.

Emily: Having gone through medical school, for us, it's four years, and the first two years generally are more classroom-based, listening to lectures and that kind of thing, small groups, maybe problem-solving, but definitely feels more like college. Then the second two years are more like throwing you into the environment, letting you practice, taking a history, doing a physical, and then perhaps the most intimidating task, which is presenting your work. This moment on rounds, where it's your turn, and you step forward, and you deliver your presentation in a very specific order, and it's sort of ritualistic.

Then, at the bottom, you get to your assessment and plan, and that's where you're supposed to show off your clinical reasoning skills. A lot of the back half of med school is just doing this over and over and over again and over again and over again. I was just wondering, what are the rituals or skills, maybe less skills, like a bed bath, like you said, but other types of skills incorporating some of that knowledge? I would just love to hear more about nursing school, because we have a lot of physicians on the podcast but don't have as many opportunities to speak with nurses. We'd love to hear more about that.

Linda: Yes. It sounds very, very similar in that we had to do what we called SOAP Notes back then. I don't know if you are familiar with that term. You are quite a bit younger, but--

Emily: We do. We also have the SOAP note.

Linda: [laughs] That was very much how we were taught, the subjective information, the objective information, your assessment, and your plan. I think what was different between the medical side of things and the nursing side of things was, let's say somebody had strep. I'll just use something easy like strep throat. The objective part would be a positive strep test, and your assessment would be strep throat. The plan would be, treat with antibiotics. Nursing would be the objective. They have a sore throat.

The assessment would be, how do we control the pain of their sore throat? What other options can we use for pain, like gargling and things that nurses can do, because we know that the physicians have taken care of treating it with antibiotics? Gargling with salt water or maybe taking some ibuprofen or whatever. That's just a simple example of thinking about the things that nursing can control versus things that that medicine controlled, and then how they worked together to help the patient.

When I went on to be a nurse practitioner, that's where those two things overlapped, and I always use this Venn diagram of this is what medicine knows. This is what nursing knows. Then there's an intersection with nurse practitioners that we know some of the medicine and some of the nursing, and then that's where we come together. At first, I really struggled with those SOAP Notes, because I'm like, "They have strep throat, they need an antibiotic. What are you talking about? What do I have to pretend that there's something else going on?"

That's where nursing really made me picture, you know? No, this is the things that nursing has to do. They have to help control the pain. They have to assess if your treatments worked. Do you have to try something else? Sometimes, that's something else is calling the physician and saying the pain meds aren't working. Does that make sense?

Emily: Yes, there's so much face time with the patient in nursing, and such intimacy with the patient and their body in a way that probably physicians can never fully understand. Just like you said, the bathing, the turning, the maintenance of the tubes and wires and lines. I'm just wondering what you have learned about people in the body over your years of practice as a nurse like and how to make people feel better.

Linda: What a great question. I think what's amazed me the most is that two people can have the exact same diagnosis and have very different outcomes, and all the nuances that play into those outcomes. As we know, lifestyle and social determinants of health. One of the things that struck me about people's illness course is their attitude and how I saw that make such a difference for people in terms of their outcome. I'll use my own dad as an example.

My dad was diagnosed with lung cancer. I remember sitting in the office with him and the pulmonologist, and it was right behind his sternum, so it was inoperable, and they were going to do radiation, and this was back in the '90s. My dad asked, "What's my prognosis?" The pulmonologist said, "With this type of cancer, the size of your tumor, probably six to eight months is average. Everybody's a little different." I remember my dad because he felt fine, other than this cough.

I remember my dad looking at the pulmonologist, and he said, "I'll be here more than eight months. I'll see you back in a couple of years." The pulmonologist is like, "Great," and he did, and he lived two and a half years with that diagnosis. I really think it was my dad's attitude. He was just like, "I'll let you know when I'm ready to go," and he wasn't ready. That really made a huge difference. I saw that in patients as well every day. I think the things I learned about the body was there's nothing that shocks me.

I worked in the ICU, I saw the grossest of the gross things in the ICU, both surgical and cardiac. There's nothing that shocks me about looking at anything on the body. I think what's most amazing is how the body heals itself in ways that people don't understand. I was fortunate enough to work in cardiology when we first started doing angiograms, if you can imagine. I'm old, I told you I'm old.

One of the things in cardiology that a lot of people don't realize is when you have blockages in your heart arteries, your blood vessels will grow new little blood vessels called collaterals around those blockages. When we first started seeing that, when we were doing angiograms where we shoot dye through those arteries, it was amazing. We didn't have a way to see that before. Those collaterals keep people alive. Your body is able to heal itself. Yes, the body healing itself is just, it's amazing.

[music]

Emily: I wanted to come back to the nuns and Sister Helen. We recently did a wonderful interview with the writer and journalist Sarah DiGregorio. She wrote a book called Taking Care, which is about the history of nursing. She had some stuff in there about the relationship between nursing and religion, actually, and how, I think, in some parts of the world, nursing as a profession and practice grew out of religious communities. I was just wondering if you had any thoughts about that connection and working with the nuns and parallels there?

Linda: Oh, absolutely. As you probably know, the Mayo Hospital was built by nuns in Rochester because of a huge-- I believe it was like a huge tornado or something that went through the area, and they needed a place to put the patients to take care of them. It was the nuns that built St Mary's Hospital in Rochester. That was the start of the Mayo Clinic. Yes, that's the history of why nurses wore white, why nurses wore caps. It's all based in that history of the religious orders that became nurses.

We all like to talk about Florence Nightingale as the first nurse, and she certainly jump-started the profession of nursing, but the nuns really took it on, because they saw the need and are very much based in their religion about helping the poor and taking care of the needy. I think a lot of nursing over the course of my career has moved away from that, but it was still very much a part of my education. Because I went to a Catholic college and because most of my teachers were nuns, the honor it is to be with people at a time when they're so vulnerable, and that it's Spiritual.

That really was embedded in part of our education, that it's a spiritual experience to be with people. We get to be with people at the beginning of life. We get to be with people at the end of life, and everything in between. That was very much a part of my education, because I went to a Catholic college. Yes, the nuns across the world really advanced the nursing profession and made it professional, versus just skill-based. It was the nuns at St. Scholastica that started a four-year nursing program versus just the two and three-year hospital-based programs that used to be in existence. They were like, "No, there's way more science here that these people need to know to be expert at what they do." The nuns were a big part of that.

Emily: In the story, you describe this moment when Sister Helen says to you, "One of these days you're going to kill someone," or something like that. It reminded me of how sometimes in our life, people say things to us, and often, this is when we're young, and we remember it for decades. I was just thinking I still remember being in middle school, and there was this group of girls who really liked to bully this other girl, and they made up this mean song about her, and they would sing it all the time.

I still remember the song and the words to the song. I think the reason it stuck with me was just because it was so mean, it was so cruel. I'd like to think that we have a lot of happy memories too, but often we remember things that hurt us, and they stay with us. I was wondering about this moment when she said this to you, and whether that was something you really carried with you over the years, or whether it's something that you just happen to remember later, or how that affected you.

Linda: Oh, it really did affect me. I remembered it. Yes, I remembered it many times during my career, when I would be working nights in the ICU and something didn't seem just right, and you'd want to go, "Oh, it's going to be okay." Then I would think, "You're going to kill people. No, this isn't okay. I need to escalate it." I'd rather be yelled at for escalating something that's not a big deal than overlook something that I'm concerned about.

One of the other things Sister Helen Claire said to us is integrity is what you do when nobody's watching. Much of what you do as a nurse, you could make a mistake, a very honest mistake, and you wouldn't have to tell anybody. Nobody would know. I certainly made mistakes. I'll never forget my first drug error. You ask any nurse, and you have a room through 1000 people, and you say, "How many of you remember your first drug error?" We all raise our hand, because it's like such a stab in the heart.

I remember my first drug error that I made. As I was going to call the physician to tell them what I had done, all I could think of was, "She was right. She was right. I'm going to--" It wasn't a major drug error, but it was a drug error. Those words really did stick with me, as evidenced by the fact when I saw her lying in her chair at dialysis and blood everywhere, I was like, "Oh, why is it me? Why is it her? I don't want this to be happening right now." [laughs] Yes, I think, I think words are powerful, and you say something that you just think is not a big deal, and that person remembers that the rest of their life.

Emily: Tell us about becoming a nurse in nephrology. Dialysis is such an intensive intervention. I remember when I was a hospitalist going down to the dialysis suite. Sometimes I would need to go down there to interview a patient or exam. I just remember walking in and the machines and the turning gears and the tubes with blood going in and blood going out. It feels almost sci-fi, very high tech. The needles that they use to get access are big needles. Before we get into the moment where you and Sister Helen reunite in the dialysis suite, I was wondering if you could just talk about being a nurse in Nephrology and what that's like.

Linda: Sure. After I became a nurse practitioner, we had been in the Minneapolis metro area, and then we moved to Duluth, and it was 1995, and the medical community in Duluth wasn't really sure what to do with a nurse practitioner. It was a rather new profession, although it's actually an old profession, but they didn't understand what to do. I got hired first in internal medicine, and I learned a ton, but the physicians weren't really super excited to work with nurse practitioners.

The nephrologists had already had a nurse practitioner, and they wanted another nurse practitioner. They came and talked to me about working in nephrology, and I said, "I don't know anything about nephrology. All I know is from when I worked in the ICU, is when we had somebody that was on dialysis. You just got out of the way when those nephrology nurses showed up with the dialysis machines and gave them whatever they wanted. That's all I know." They're like, "We'll teach you." I had to learn it all.

I worked with wonderful physicians who spent the time mentoring me and teaching me, and learning all about acid-base balances and BUN and creatinine ratios and all the stuff that isn't very exciting, unless you're a nephrologist. I always called my nephrology partners the biggest nerds I knew, but I would want any of them to take care of me, because they were really smart. Learning about dialysis was a huge learning curve, but once it made sense to me, it made sense. When I worked in the ICU, one of the intensivists used to say, kidneys are your friends, and boy, are they ever. You don't want to lose your kidneys. I don't know if that answered your question, but that's that was my foray into nephrology.

Emily: You get called for an emergency in the dialysis suite, and you walk in and there's a patient laying there, bleeding from their fistula, so bleeding from their arm. Like you said, the artery is connected to the vein, so there's a lot of blood flow because it's connected to the artery. There's blood everywhere. You notice that it's Sister Helen, all these years later, the stern nun who told you that you were going to kill patients. What went through your mind in that moment?

Linda: My first thought was, "Crap. Why does it have to be Sister Helen, and why does it have to be this situation?" Then, after working all those years in the ICU, chaos and and high stress are kind of my jam. I immediately go to this place of, what do you need to do? I knew she needed to go to surgery quickly. I introduced myself, and then got a little bit of the history from the nurses, and went right to, "Have you eaten anything? Do you have any allergies? Have you ever had a problem with anesthesia," all the stuff we need to know before we take somebody to surgery.

The whole time, I could tell by the way she looked at me that she remembered me. The other part of me was I have to reassure her that I know what I'm doing. I have to reassure her she's not going to die. I didn't say those words, but I just talked very calmly and said, "This is taken care of, the surgeon on call. I'd call the surgeon; it's really good. He's going to take good care of you. You're going to be just fine." I know this is scary because there was a lot of blood, but that's what went through my mind was, "Why her? Why now? Why this situation?" Anybody else wouldn't have had that immediate anxiety that I got when I saw it was Sister Helen Claire.

Emily: Then you reminded her of what she said to you. You said, "You told me I was going to kill patients." Then she said, "Oh, I tell everyone that." [laughter] Did that lift anything for you, or what did that do for you?

Linda: Yes, it did. It did lift things for me. I realized that that was just her way of making us be more serious about the profession we were entering and that we were goofing around in class and having a good time, although, at the time, seemed like a way to get through. She was trying to set us on a path that made it like, "What you do is important, and you can make mistakes that kill people." When she said, she said that to everybody, I'm like, "Okay, it wasn't just me. That's good to know." [laughter] I realized why she said it. At the same time, I think there was probably a different way she could have instilled the need a little more--

Emily: Instilled in that sense of responsibility.

Linda: Yes, a little more responsibility.

Emily: Yes. It's a great story, and I really appreciate you sharing it with The Nocturnists Satellites and with the Minneapolis Community, and for coming on the show to speak with me about it today. Is there anything else that you'd like to share with The Nocturnists listeners before we end. I

Linda: I just want to thank you. This was such a fun thing for me to do, and The Nocturnists did is such a great job. With what's happening in healthcare right now, I just want to encourage people that have that drive and passion to still go into nursing, still go into medicine. It's the most wonderful profession. I've never regretted one day of it. There's hard days, for sure, there's upsetting days, but it is really an honor and a privilege to be involved with patients in the way that nurses and physicians are throughout their course of their life. I just want to encourage people to please don't let what's happening in healthcare discourage you from entering the profession.

Emily: I have been speaking with nurse practitioner and storyteller Linda Wick. Linda, thank you so much for coming on the show.

Linda: Thanks for having me.

[music]

Emily: This episode of The Nocturnists was produced by me and producer and head of story development Molly Rose-Williams. Our executive producer is Ali Block, and Ashley Pettit is our program director. Original theme music was composed by Yosef Munro, and additional music comes from Blue Dot Sessions. The Nocturnists is made possible by the California Medical Association, a physician-led organization that works to ensure the doctor-patient relationship remains at the center of medicine.

To learn more about the CMA, visit cmadocs.org. This episode of The Nocturnists Conversations is sponsored by the Physicians Foundation, which supports physician well-being, practice sustainability, and leadership in delivering high-quality, cost-efficient care. The Nocturnists is also made possible by donations from listeners like you. In fact, we recently moved over to Substack, which makes it easier than ever to support our work directly. By joining us with a donation of $2, $5, or $10 a month, you'll become an essential part of our creative community. I'm your host, Emily Silverman. See you next week.