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Emily Silverman  

You're listening to The Nocturnists Conversations. I'm Emily Silverman. Nursing is a cornerstone of healthcare, an experience that touches all of us, whether we've been cared for in sickness or supported through one of life's pivotal transitions like birth and death. Nursing is a fundamental human act. Nurses are at the bedside around the clock, assessing our physical health, but also assessing deeper things like our resolve, our capacity to heal, the dynamics of our support systems. Despite its vital role, nursing is often undervalued and its history overlooked. But today's guest, critically acclaimed author and journalist Sarah DiGregorio seeks to change that with her remarkable book, "Taking Care: The Story of Nursing and its Power to Change Our World." Through her vivid storytelling and meticulous research, Sarah sheds light on the rich and complex history of nursing, tracing its origins from ancient caregiving practices in Neolithic times to the transformative figures like Florence Nightingale and Mary Seacole, who have helped to shape the profession. In our conversation, Sarah describes connections between nursing, religion, spirituality, and even magic, uncovering how nurses were often targeted and persecuted during historical witch hunts. We explore the idea of nursing as female coded work and the rise of men in the nursing profession today. And lastly, we talk about how nurses' assessment skills go far beyond the patient in front of them, as theyoften notice issues in their neighborhoods and communities and become important leaders in public health. But before we dive in, let's hear Sarah reading an excerpt from her book, "Taking Care." 

Sarah DiGregorio  

If you have spent any time in a hospital or healthcare setting, you've probably had an encounter with a nurse that lingers in your mind. For most of my life, I have accompanied my mother, my father, and my daughter - all of whom suffered serious chronic illnesses - to hospitals, clinics, and rehab centers, and through therapy of all kinds. To need healthcare in the United States is to seek healing in what often seems to be an inhuman labyrinth. But every now and then, someone in that labyrinth manages to see you, hear you, and offer exactlywhat you need. For me, these encounters stand out with crystal and clarity. They were moments of relief. Someone was going to help us. Someone could help us, even when that help didn't include a cure, even when there wasn't a fix, and almost every single time, the person who offered what we needed was a nurse. I've come to understand that that was not a coincidence. Sooner or later,we all need to be nursed. A nurse may have been at your birth and may be at your death. Sometimes nurses are the first and last people to touch us. Nursing is a profession, an independent scientific discipline, a practice, and a way of interacting with the world. It's also an elemental public role, one that elicits deep feelings, beliefs, and anxieties in the collective imagination. I came to this meditation on nursing as a journalist, but also as someone who grew up surrounded by the illnesses of the people I loved most. Because I'm not a nurse myself, my perspective has limitations, but I would argue that nursing matters to everyone. It draws much of its power and effectiveness from the relationship between nurse and patient. It is the indispensable foundation of all healthcare and so in that sense, nursing belongs to everyone. When I was lost in the wilds of the American healthcare system, nurses showed me and my family how to move forward. Nurses are not just there at the most profound moments in people's lives. They use their knowledge and skills to guide people through those moments.

Emily Silverman  

I am here with Sarah DiGregorio. Sarah, thanks for being here. 

Sarah DiGregorio  

Emily, thank you so much for having me. 

Emily Silverman  

So thanks so much for this book. I learned a lot about the distant history of nursing, but even the modern history of nursing things - that I didn't know so really appreciate you putting it all in one book, an incredible scope of the history that you've compiled here. And in your reading, you say you're not a nurse yourself. You're a journalist. So I wanted to ask how you as a journalist, got interested in writing a book about nurses and nursing.

Sarah DiGregorio  

It's been sort of a long road to this book. You can pick up the story in several different ways. One was that I started to write about healthcare about 10 years ago. I've been a journalist all of my adult life and sort of pivoted, as we say now,to healthcare journalism after the birth of my daughter in 2014. And then my first book was about premature birth, and that book was inspired by her birth and also my own birth. And when I started to think about what I wanted to write about for my next book, I was thinking about the experience of being in healthcare settings - what that feels like, what that looks like for both patients and for family members and also for clinicians. And I was thinking about, well, what am I not seeing of that experience represented? There are a lot of things that are wrong with our healthcare system, and certainly there's a lot of reporting on that as there should be. There's a lot of reporting on, I would say, technological advances, again, as there should be. But what I didn't see represented for the general public was really the vast majority of anyone's experience in a healthcare setting, especially in an inpatient setting, is receivingnursing care. And I knew from having been in those settings that the nursing care can make all the difference, maybe especially in cases when you have a chronic illness, or you have an illness that is going to limit someone's life, and yet people still need care, even when there's no cure available. And so I started to think about these moments of kind of clarity that I had had with my family members, where I feel like so much of being in healthcare systems is about feeling confused and feeling that you need to put on a suit of armor and take your notes and figure out how to get this doctor to talk to that doctor, and how to make sure that this pharmacy has that medication and the intense relief when someone can actually provide you with some clarity and also make space for your whole self. So I was thinking about what that was and what that meant. And I started out thinking, you know, maybe I should write about connection in healthcare, or sort of a more humanist approach to healthcare. And my editor and I were talking and going back and forth. And she was like, "I don't think that's really, it's not specific enough. Like, what do you mean?" And I actually had a dream one night, and I woke up and I was like, "No, it's nurses. It's nurses!" I have all these questions about how they do what they do, the way that gender and race and class intersect with this role, and the way that people think about nurses in various ways. I think it really is kind of like an archetype for people. It's very elemental. It brings up a lot of feelings for people when they think about nurses - about what it feels like to be vulnerable, who might care for you, who might have power over you, all of that. And I thought, "Oh no, there's so much here, and I want to investigate this." And I realized that nursing in general had been so neglected as a topic worthy of deep consideration for a general, non-healthcare audience.

Emily Silverman  

So where did you begin? Did you hit the books and start reading about history, or did you start with field work? I think one of the aspects of the book that I lovethe most was like you're actually getting out there and meeting people and talking to people and reporting back. How did you find your sources? How did you even begin to put this together? 

Sarah DiGregorio  

My contemporary nurse sources for this book. They came from reading research, from reading books, but also from just reaching out to nurses and saying, "Well, would you talk to me? Or do you have, hey, do you have anyone that you know who works in an ICU setting?" And nurses often know each other,and if you can become trusted by them, and often I could because I was writing a book, you know, I could offer that they be anonymous. It's it's very difficult to get nurses, clinical nurses, to speak on the record with their names, because a lot of times their  employers don't permit that. So what I started out doing was calling and speaking with nurses who were working during the pandemic, and I would interview them for maybe 45 minutes at a time every couple weeks to understand what was happening. Because I had the sense that I would - if I waswriting about nursing, and we didn't know how any of this would end, or when itwould end or if it would end, I needed to know what was happening to nurses. And then I also, at the same time, started deeply reading the history. So I started by, you know, I read quite a bit about Florence Nightingale. I read aboutMary Seacole, and I spidered out words from there, thinking about the ancient roots of nursing, even prehistorical roots. It was a very weird experience because, also, I was home with my daughter, who was in kindergarten. I think maybe the chaos in the world and the way that nursing and care work was so foregrounded, it gave me a little bit of permission to just read and talk and go. Idid not really understand how this book would be structured until at least a year into my work.

Emily Silverman  

You mentioned the reading of the history, and I love the part of the book where you say that caring or nursing is a fundamental human impulse. And often we look back at the moment in history that defines early humans as the moment where we started using tools, or we started using fire and things like that, but the evidence of human beings caring for each other, nursing each other is an equal marker of being human that we should also pay attention to. And I just thought that was really beautiful. And was wondering if you had any examples of nursing from antiquity. You talk about ancient Egypt, you talk about Neolithic times. Any favorite examples of old, old, old, old, old, old, old, old, old nursing that you want to share?

Sarah DiGregorio  

There is an example of a skeleton that was found at an archeological dig in what is now Vietnam. It was a Neolithic village, and when archeologists uncovered this one particular skeleton, he was buried differently than the other people in his community. He was on his side and in the fetal position, and the archeologists looked at the bones and realized that the vertebrae were fused, and that this young man had been born with a congenital condition in which his vertebrae were fused, and so as he grew, he kind of curled, and he became progressively paralyzed until he lost the use of his arms and legs. And even after he became paralyzed, probably around 12 or 13, he lived for another 10 years. And so one of the archeologists on the dig found the story told by these bones to be incredibly revealing of how this community interacted, how it was organized. And we are talking about the community so long ago. They didn't even have metal right? They didn't have metal tools. This is how far back. What I think is amazing about this is that we can think of ourselves as a species for whom it's totally natural for us to go to war, kill each other, enslave each other or and we can think of ourselves as a species for whom it is completely natural to organize skilled care for the vulnerable with the reality that all of us are vulnerable in different times of our lives. It's not like a binary. It's not like some people are vulnerable and other people aren't. So we just leave those vulnerable people behind, and we all keep going into this progress, right? It is necessary for a functional, flourishing human society, for us to have ways to take care of each other when we need it, because we all need it at some point or another. And so if you think about community experts who knew how to help someone give birth, community experts who knew how to ease someone's transition to death, someone who knew how to set bones, people who knew how to use herbs and other materials for infection control. These are things thatpeople have been doing for each other. This is a kind of expertise that people have cultivated in communities all over the world forever. And you know that, because we wouldn't have made it here if they hadn't, right, how could we possibly have and there's just a lovely bit of writing from an archeologist, Lorna Tilly, and I think she really encapsulates why this is important. She wrote, "Our past contains important lessons for our present, if we are willing to pay attention. An archeological focus on health related care completely overturns the notion that society has evolved by embracing a winner takes all survival of the fittest approach to health and welfare policy. A defining hallmark of the human species is our capacity to support each other in times of need."

Emily Silverman  

It feels somewhat intuitive to say that a lot of the early healers were intertwined with religious or spiritual traditions. You say in the book that in many communities and societies there was a charismatic mix of medicine with religious magic. That had some downsides later on, but maybe you can talk a bit about that, the fusion, I guess, or the co-emergence of religious practices with healing and nursing and caring practices. 

Sarah DiGregorio  

I believe that there are, that there is still, perhaps a little bit of a mix of magic inour medicine. There certainly have been in all parts of the world a relationship between religious and spiritual beliefs and practices and healing. And it does feel intuitive, right? Because in many cultures, the idea of caring for and what you need to be well was both spiritual or mental, or involved the spirit world, or however that was conceptualized, and that that had very concrete realities in the body as well. So in many cases, it wasn't really thought of as being separate. I think about in particular, there were many orders of nuns in Renaissance Italy, and these were incredible places where women really were able to build and pass down expertise in ways that they weren't able to in othersettings. So when a novice would come in and they would learn the different herbal remedies, they would learn how to grow these things or how to trade for them in the marketplace. They would learn how to create these tinctures. But also, perhaps you would give someone who was pregnant an amulet that had been prayed over for a safe delivery of her child. And you might also give her, for instance, a tincture of mint for nausea. So there are things that we know often have therapeutic properties and always have. I mean, there are things likehoney for infections, turmeric, things like that. And also it was very much intermingled with this idea of, and I hate to use the word wellness because it's just so loaded and kind of toxic these days, but what it means to be well. So thenuns would also carry chicken broth for convalescence. They would give spiritual advice as well as these sort of herbal remedies. That kind of sort of melding was very, very common in lots of different cultures throughout the world.

Emily Silverman  

I'm thinking about what you said that maybe there is still some magic in the healthcare we deliver today, and I'm remembering a story that someone told me once, it was a study where they injected an irritant under the skin of a bunchof people that cause kind of an allergic reaction in the skin, and they randomized them to two groups, and one of the groups just got like an antihistamine medicine, and the other group got the antihistamine medicine, but also a doctor or a nurse or a healer or whatever to say, "this medicine is gonna make you feel better. It's gonna make it better." And the second group got better faster, which shows that we are part of the medicine. 

Sarah DiGregorio  

That's exactly what I'm talking about, that there is an element of connection in all of healthcare. You can find different ways to quantify it, I guess. But I feel in the end, it's not quantifiable. It is the element of human connection in healthcare. It's not like it's going to cure incurable cancer. That's not what I mean, but I do mean exactly the kind of thing that you're talking about. How dopeople feel and in the end of the day, does it that's what matters. How have you made them feel? And that is healthcare, that sense of human connection.

Emily Silverman  

And it's not hard to imagine how the way you feel would have neurohormonal, immunological implications.

Sarah DiGregorio  

Yep, absolutely. I mean, the same way that you know the swing from the idea that family members are visitors to the idea that family members are integral parts of the care and that people do better when they have their family members around. What is that? We know that those things are true. You can describe them in the literature. But what is that? 

Emily Silverman  

Talk about these demonologists in the 1300s who took the idea of the nurse anddistorted it into this idea that the midwife, the wise woman, the herbalist, the nurse, the folk medicine practitioner, were witches and were quacks, and you know that actually involves some serious violence and persecution. I want to touch on the story of the amazing character of Paula de Eguiluz, but before we get into her personal story, maybe you can just tell us about what happened with witch hunts and nurses.

Sarah DiGregorio  

This is a bit of a complicated story, because the figure of the midwife and the nurse and the wise woman figure was heavily leaned on by the Inquisition to ginup fear, to create a sense of otherness. And to say, you know, these women are dangerous. They're doing things like killing your baby to feed it to the devil. Really, it was very complicated for the Inquisitors to do this, because although there was quite a bit of writing about this in demonology circles, about the danger of midwives in particular, and how dangerous they are, midwives were really important in their communities. If you think about living in a village, and there is an older lady who has delivered all the babies, are you really going to want to burn her at the stake? Probably not, right? You'd be kind of screwed. So there was a lot of use of the image of the midwife to gin up fear, to sort of accuse people. It's not clear from the historical record if in fact, midwives were executed disproportionately. They certainly were executed in it and they were executed for their work, but were they executed disproportionately? It's not clear that that's true. In the Middle Ages, the first Western medical schools in Europe were founded. And so suddenly you had this idea of, well, actually, we have these physicians, and they're the ones who have the information. You all don't have any information because you didn't get it from the books and the other learned men the well to do people at these universities. And so this was a really centuries-long effort on the part of, I would say men in power. I would say the new medical model, trying to gin up fear about these women who had for the most part, been responsible for the healthcare of their communities. And so oftentimes there would be an accusation of a baby who died that was the midwife who had sacrificed the baby to the devil. Or, you know, there was even an implication that women were supposed to suffer in childbirth. In the Christian tradition, it's the punishment for Eve's sins that you'll bring forth babies in pain. And so if a midwife had ways to mitigate that pain, was that a form of heresy? And so there were all these kinds of efforts to suppress these very grassroots, very time-honored kinds of expertise. And the real violence of itwas mostly born by midwives and nurses who were otherwise marginalized as well. So when the Spanish colonized parts of the Americas, they brought with them the Inquisition, and it was indigenous systems of healing, healthcare, midwifery, nursing, were brutally, brutally suppressed. People were executed for witchcraft in those contexts quite often. And so that's where the story of Paola comes in. She was a formerly enslaved woman who rose to prominence in Cartagena, in what is now Columbia, for her healing. So she was super popular. I mean, rich people, everybody came to her for this kind of very distinctive Afro-Caribbean healing. And the Inquisitors kept trying her for witchcraft, and they kept locking her up, and she would keep going back to doing what she was doing after she had been whipped and imprisoned. And in fact, the Inquisitors even forced her to nurse for free in their hospital, which was a tacit acknowledgement of her skill. They also she also provided care to Inquisitors themselves. They asked for her to come to their houses and to help them. She was the rare person who was able to somehow use the Inquisition against itself.She learned how to confess. She said, Oh yes, the devil came to me as a well-spoken white man, and she would confess and then repent. She became so popular that at one point they were parading her through the streets in this sortof ritual humiliation. But she was being cheered by the crowd. She was being cheered, and she was supposed to wear these very dowdy clothes, but instead, she dressed herself in corals, and it's an incredible story, and it's a great example of a story that has been totally written out of nursing history. And actually, I became aware of it. I want to make sure I cite this book. It's an anthology called "As if She Were Free." It is stories of marginalized, powerful women throughout history, and that's where I came across her story. When you think about the history of nursing, are you thinking about her? No, but we should be.

Emily Silverman  

I want to talk about Florence Nightingale and Mary Seacole. We all remember Florence Nightingale, but Mary is an amazing character who people don't know as much about.

Sarah DiGregorio  

If you asked someone off the street, "what's the history of nursing?" They would say Florence Nightingale. Florence Nightingale sort of invented nursing. I always like to say it's not really about Florence Nightingale. It's more about us and what we want the story to be. So Florence Nightingale was a nurse. She was a single woman in the 1800s in London. She worked at a hospital for well-off ladies. And first of all, the idea that she somehow invented nursing - and I'm not saying that she was not important to how nursing evolved - however, she did go to Germany to train with a very venerable order of German Deaconess nurses. So she went, essentially, to nursing school. She was already participating in a very long tradition. What really brought her into the limelight was the Crimean War. The reason for the Crimean War, a very complex geopolitical situation, that involved the balance of power in Europe doesn't really matter, but what happened was that. What happened was that there was a war against the Russians in Crimea. The British decided that they needed an official nursing corps to help their soldiers, to render care for their soldiers in thiswar. Previously, what they had been doing, was essentially other soldiers, nursed soldiers, but it was considered a terrible assignment. They weren't very good at it. It wasn't very organized, and they had pretty bad outcomes. And actually, the French army had a division of nurses, and had had one for over 100 years at this point. So when Florence Nightingale was tapped to create sortof a nursing force for the British Army in Crimea, this was a first for Britain, but itwasn't a first even in Western Europe. But Florence Nightingale is asked by the British government to hire a bunch of nurses and go to Crimea and try to get this stuff together, you know, because it was a disaster. And so she went about hiring nurses. And this was a really tricky political maneuver, because first of all,most of the higher-ups in the army did not want them there. Did not think that women belonged in a war zone, did not think that women should be working in a war zone, and she was tasked with hiring Protestants and Catholics in a very class-conscious kind of way. And so she was supposed to show unity in this nursing corps. She was supposed to show professionalism in an environment that was sort of waiting for her to fail at every turn. So she really relies on that very Victorian class, race, conscious hierarchy that she was part of. I mean, she was certainly a well-to-do person from a very prominent family. So she hires her nurses, and concurrently, there is a nurse from Jamaica. She's actually Jamaican and Scottish, and she grew up in Jamaica. Her name is Mary Seacole.She worked, actually, for the British government in Jamaica when there was a yellow fever outbreak on the island. And she had learned what she knew from her mother, who was also a nurse or a healer, however you want to say it. She actually sometimes called herself a doctress. And Mary Seacole was very patriotic. She really thought of herself as British. She thought of herself as a British citizen, because at the time, Jamaica was a colony of Britain, and her father had been Scottish. She heard of this war, she heard of the terrible need for nurses, and she thought, well, I have to go, because I am a really experienced nurse. So she goes, and she shows up to volunteer herself to Florence Nightingale and Mary Seacole is Black. And she essentially goes from one office to another, and she sits there and she waits and she waits. She waits all day for someone to come out and see her. Finally, someone at the recruiting office came out and said, "Miss Nightingale is busy, but we are not hiring nurses." But Mary Seacole actually knew that that wasn't true, and so she has this moment that she recounts in her autobiography, of standing on a crowded street in London and realizing, just like that, realizing that they hadn't hired her because of the color of her skin. She had come there with quite a lot of optimism, and she was quite used to working in mixed racial communities, and she was aware when she was experiencing racism, but there was something about being a nurse and being called to help her country that she felt so keenlythat this rejection really came as a shock, that they wouldn't want her expertise.And so what she ended up doing was, going to Crimea on her own, setting up a shop there, where she sold food and she sold supplies, but she also rendered care really directly on the battlefield for soldiers who were injured, who were dying. She gave first aid all the time. People came to her. They needed treatment for frostbite. They need treatment for broken bones, for infectious diseases. She rendered this care for free, while also trying to fund herself by having this thing she called the British Hotel, which was not a hotel, but it was essentially a general store and restaurant. Meanwhile, Florence Nightingale, of course, had gone and had cleaned up the military hospitals that were serving the soldiers fighting in Crimea, and it was only after a Sanitary Commission came and cleaned out the sewers that she saw the mortality really drop, and that was because they were using dirty water. And of course, Florence Nightingale becomes lauded as this incredible heroine who really created this new idea of nursing as a female-only profession. So I think that there has been a little bit hackneyed kind of Florence Nightingale versus Mary Seacole narrative. It's an easy thing to do, and I try to push back on that a little bit, because Mary Seacole has been called things like big air quotes here "the Black Florence Nightingale." She was Mary Seacole. She knew how to provide the care that she knew how to provide, and she was quite experienced, and she provided a different kind of care, right? She was doing a lot of what we would now maybe call palliative care, a lot of comforting of the dying, a lot of infection control, a lot of first aid. Whereas what Nightingale was doing was really structural. She was thinking about, how does a military hospital need to function in order for it to be safe? You know, how are we going to implement infection control in this very crowded environment, but she was doing that, and she was extremely class conscious. She saw people from the from lower incomes as fundamentally lesser, and that there was a natural, again, bigger quotes, "a natural order of things," which was that the lower classes would do one kind of work, and the upper classes would do another kind of work, and women who were not white really didn't even figure into this at all, except for that, she was a big believer in the project of the British Empire, which she thought of as bringing quote, unquote, "civilization to uncivilized people." So when Florence Nightingale became lauded and became the archetypal, the original nurse, what that meant for the way that people thought about nursing, it has really lasting implications, and it really matters, even today, I think. You know, nursing is disproportionately white in the United States, and very much based on this big archetypal story of Florence Nightingale, this idea of a nurse as an angel, a nurse as always, always a woman, really does come out of her story. And she cultivated that. She thought of it as essentially female work.

Emily Silverman  

It's a theme that comes up again and again in these chapters. The idea, like yousaid, of the nurse as the angel or there's a moral dimension to the work, which there is. I mean, like we said at the very beginning of the conversation, caring is a fundamentally human thing. It is a loving thing. It's an act of care. But I'm wondering if you have any thoughts about that idea and the fact that it keeps coming up in different times and places? What is it that causes that?

I do think it's kind of a fundamental complication of care work. Nurses that I have spoken to, while they may have individual sort of interior motivations around what they do, it is not something that I think in the modern sense, should be primarily conceptualized as something that people do out of the goodness of their hearts. It is an independent scientific discipline. It is work. It is expertise. And I do think that there is a very deep human element to the work that really taps into our feelings around caring for each other and also being cared for. There's an intimacy to the work that really can't be denied or elided, Ithink. And it is being done often when we're at your most vulnerable, and so it might tap into people's feelings about their parents, about their about right, what it means to be cared for? 

Emily Silverman  

Yeah

Sarah DiGregorio  

And that's not always, people don't always have good feelings about that. People don't - often do not enjoy being vulnerable. I do think that there is an element of timelessness to this - can be very complex, very complex. And you do want the people who are entrusted with watching over your ability to breathe and eat and stay warm and have your wounds tended to directly with their hands on you, you do want those people to not be bad people. I mean, you know, no, you know, we're all full, complicated human beings. The idea thatsomeone would not take advantage of their position, the idea that someone would be doing it because they feel for you. I think that that is a complication at the heart of nursing. I'm not sure that there is a way around it. 

Emily Silverman  

There was a recent article in the Wall Street Journal, and the headline of the article said, "The Hot New Job for Men: Nursing." And the article talks about how the number of male nurses in the United States has nearly tripled since the early 2000s and it attributes this in part to the decline in the traditional male-dominated industries like manufacturing and additional opportunities in the realm of nurses. So now we have our ends, but we also have NPs, and we have nurse anesthetists, and it can be lucrative in some corners of the medical marketplace. And actually it talks about how a lot of the men in nursing do end up being taken up into those more lucrative corners of the marketplace, but I just thought that was really striking. I mean, there's so much about gender and nursing, and you mentioned in your book the famous movie, "Meet the Parents."The joke, the running joke in "Meet the Parents," is that Ben Stiller's character, who is courting the daughter of this intimidating father, is a male nurse, and they just keep making fun of him over and over again throughout the film that he's a nurse, and why isn't he a doctor, and so on and so forth. So what is the conversation right now about gender and the nursing workforce? 

Sarah DiGregorio  

That's an amazing headline. Well, you know, the idea of nursing as gendered, again, is so complicated, because in reality, if you go all the way back, nurses were often men. The first nursing school that we know of was in ancient India, and it was only for men. The idea that men are new to nursing, or that men didn't nurse in the past, is not true, and in many ways, again, this goes back to this cliched idea of the image that we all have of the white nurse who's always a woman. She's pretty and she's sort of a ministering Angel. That image has never, ever been really true, and men have always been nurses. But it is also true that 90% of nurses now are women. When I started out writing the book, I was not that interested in the underrepresentation of men in nursing. I was more interested in how we think about female-coded work. But actually started to realize that the idea that caring work is female work has, of course, served tokeep women down, but it has also served to sever men from a really essential part of their humanity. That's the element that I came late to, is the idea that actually men are harmed by this, and actually we are all harmed by the idea that some things come naturally to some kinds of people and not others. That isnot true and never has been true. You know, the care suffers. It's a certain kind of impoverishment that only certain kinds of people end up in certain kinds of care work. Because everyone does deserve to see themselves as carers, as goodat that, as capable of that. The more nursing can be open to people who have been disproportionately shut out of it, the better. At the same time, I want to say always, it's like always both and, you know. There's nothing inherently wrong with an association with maternal caring, because maternal caring is, in my opinion, one of the most powerful forces in the universe. If individual nurses find that to be generative for them, I think that's great. I don't want to like run from that or say that it's wrong somehow, but I just the idea that nursing is doneby one kind of person with one kind of caring is not good for anybody.

Emily Silverman  

I loved the chapter about nurses and their communities. The way that they're kind of having their finger on the pulse of the community in ways that other healthcare practitioners might not. And we saw this during COVID but we've also seen this in a lot of other times and places. And to end, was wondering if you could just talk a bit about nursing at scale, like nursing almost as blending into public health?

Sarah DiGregorio  

When people ask me, what I imagine, I always imagine, I live in New York City, so we have like, bodegas on every corner. I always imagine, like, what if there was a nurse in every Bodega who was, like, knew everybody in the neighborhood and could take your blood pressure and ask how your kid's coughwas, and what would that be like? How would we live differently if that were thecase? So I do think that nurses are uniquely situated to be in the community, because they are not physicians, and so they are not primarily concerned with the processes of disease and surgery and cures and things like that, but they are often very good at things like prevention 

Emily Silverman  

and hospice. 

Sarah DiGregorio  

Hospice, yes, health literacy, noticing problems in the community and then knowing who to call in. I think about nurses as being so good at like air traffic control. So there was a school nurse that I spoke to in New Jersey who said thatshe saw a lot of kids with stomach aches, an uptick. And she was like, what's going on? And she would ask them all the questions, like, what did you have for breakfast? Or, like, what's going on at home? And she figured out that a lot of these kids were having anxiety because there was worsening violence in the neighborhood, and they were coming to school really anxious, and they were having stomach aches. Because no child is like, I'm feeling anxious because there was a shooting on my block last night. They come to school and they're like, I have a stomach ache. And so this nurse figured this out, and she was able to then pull people in, right? So it's that what I think is so powerful about nurses working in the community is that spotting patterns, like being able to use the tools of assessment on individuals to then notice bigger patterns and to say, "Oh, I see a problem here. Well, who needs to be involved in this? Like, what are we going to do?" That nursing way of thinking is assess, plan, implement, and then evaluate, right? So thinking, I know I do assessments, I notice a problem. I need to make a plan. Who needs to be involved? Is it shopowners and pastors and the principal and the teachers and the parents. And it's not that there's then an easy fix for violence in the community, but it is like, who's going to be there to notice that these kids are scared? And who is going to be there to say, "okay, who needs to know about this? And what do we need to do?" And then, is it working? Do we need to try something different? And so I think about nursing and community a lot like that. I do think that that is one of the most powerful kinds of nursing, because it's noticing patterns. Because it's knowing people.

Emily Silverman  

I have been speaking with Sarah DiGregorio. Sarah is the author of the book "Taking Care: The Story of Nursing and its Power to Change Our World." Really enjoyed the book and this conversation. Thanks so much for coming on the show.

Sarah DiGregorio  

Oh Emily, thank you so much for having me. I really appreciate it.