The Language of Kindness

Q. You are an award-winning and widely acclaimed novelist, and The Language of Kindness is your first foray into nonfiction. Had you always planned to write about your experiences as a nurse someday? Can you describe how you adapted your writing process to the form, as well as any challenges you faced along the way?
 
A. I didn’t put two and two together when I approached my agent with separate ideas: to write something fictional about nursing, and to also try and write some nonfiction. I was looking for advice about which project to approach first, but, of course, Sophie (Lambert) simply shrugged and said “combine them.” It was a light bulb moment, not least because I’d spent years reading narrative nonfiction written by doctors: Oliver Sacks, Paul Kalanithi, Henry Marsh, as you describe below. My writing process was much the same as when I write fiction, bar one major factor—structure. I became fascinated with the architecture of time, partly because in nonfiction structure is key but also when writing from memory I began to understand my own writing process better. I write as I think, both fiction and non and that made a linear narrative impossible. Memories weave in and out of time. This was the most challenging aspect of writing The Language of Kindness, and I found no solution other than to allow a fairly rigid structure going from birth to death but with memories and anecdotes dancing around freely.
 
 
Q. There is a tradition of medical writing, mostly from doctors and a largely male perspective. How does your voice expand the conversation we should be having about health care?
 
A. I scoured the libraries. Spent hours in The Wellcome and The British Libraries looking for nonfiction written by a nurse. By a female nurse. And I found Notes on Nursing written by Florence Nightingale. And pretty much nothing else but rows and rows of books written by (mostly male) doctors. I began thinking about what this suggested in terms of values and gender.
                                                                                                                                                           
This is a time of great societal change. The medical model we have lived and died by is driven by money: drug companies, technology, insurance companies, and hospitals are making enormous gains from the prospect of cure in both the UK and the United States. But now as we age, as so many of our health problems are caused by emotional and social factors, cure is often not possible. Increasingly, people are sick because they are suffering existentially, not from any disease or pathogen but from loneliness, self-harm, or crippling anxiety. The things that matter are kindness and compassion. We need a conversation about the reality of contemporary health care. Nursing cannot cure. But nursing can save us.
 
 
Q. The Language of Kindness is a vital testament to the often unseen and unsung work of nurses but it is also a call for compassion in a broader sense. Are there lessons from nursing that you have carried into your civilian life? Perhaps there are lessons we would all do well to take to heart?
 
A. I am deeply ashamed of our values in the Western world. Of us valuing the wrong things: fame, celebrity, power, money, external beauty, and the cult of youth. I am ashamed of how we treat our older people, with so little respect. But the lessons of nursing do carry outside the hospital, and any one of us who has been through a serious illness, or lost someone, realizes the importance of kindness, care, and compassion. And we will all get old, or we will get sick, and then die. At that time, the only things that will matter to all of us are kindness and love.
 
Q. You write beautifully about how a nurse must be able to engage somewhat opposing modes of self-reflection and emotional immunity—how the search for meaning can crash into the senselessness of suffering. Sometimes there is simply no meaning to draw from experiencing or witnessing pain and loss. Yet you often must process these questions largely in private, presenting a strong exterior for your patients and their families. How do you reconcile these emotional extremes?
 
A. To witness suffering is dangerous. Grief is swallowed up in fragments by nurses, causing emotional trauma, the same way infections are contagious. And I’ve seen much suffering over the years: elderly people after strokes, pregnant women suffering aneurisms, others after heart attacks, head injuries, burns, or assaults, babies with meningitis, patients with sickle cell crisis, asthma, pneumonia, or heart failure, and so, so many people suffering from cancer. People who are dog-bitten, broken-boned, broken-hearted, respiratory-failing, drug-overdosing, fallen from a roof, mentally-ill, impaled on a spike, shot and stabbed. Nurses care for patients before birth and even after death, and everything you can imagine in-between. Of course, there are some patients who stay with you forever, oftentimes they remind you of your own family. Although presenting a strong exterior for patients and families used to be a concern of mine as a junior nurse, as the years wore on I realized that families want nurses to be human, to cry, to show their emotions. It is healthier for the patients and their families, and much healthier for the nurse. The Code of Professional Conduct is a list of rules that nurses must live by in order to stay registered in the UK, and one of the rules states that nurses must “remain objective and have clear professional boundaries with patients and relatives in the care at all times.” I disagree entirely. There is no objectivity in good nursing care. To nurse is to love.
 
 
Q. The nursing profession is in the midst of a crisis in both the United Kingdom and the United States. What is at risk and what—if anything—can be done to preserve and revive this essential sector of the workforce?
 
Nursing application figures are so far down in the UK that people are leaving the profession faster than they are joining. America has 3 million nurses and that is not enough. The Bureau of Labor Statistics estimates there will be more than a million registered nurse vacancies by 2024, twice the rate seen in any previous shortages. This is the worst nursing shortage ever seen. If there is no international nursing workforce strategy, then we will witness—very soon—a crippled health care system across the world. It is a public health crisis. It really is that vital. We need nurses as policy makers in government roles working at a senior level on saving nursing. There is much to be done in terms of fair pay and working conditions (for example, nurse consultants are not paid anywhere near what medical consultants are paid) and training. To attract people into the profession in the first place, we need an honest portrayal of the job available to the public. I am proud to be writing a book that finally describes the realities of nursing and to be developing a television series with Mammoth Screen to put a realistic drama about nurses.
 
 
Q. What do you hope readers take away from The Language of Kindness?
 
A. I hope to start a conversation about the state of nursing and of humanity in a broader sense. My absolute dream would be that the book changes minds and lives—that readers think about how they can be kinder to themselves and others, with the sense that time is not infinite and we will all one day rely on the kindness of strangers. As Florence Nightingale reminds us: “Life is a splendid gift. There’s nothing small about it.” This book is for nurses.