Backstory

 

Photographic Memories, 2019

I look at photos often. Sinking into a memory can be an emotional roulette of sorts. I see more than the single moment captured. Like a song, each photo brings with it the before and after. I cannot separate the photo from those book ends. The girl in this photo is so young. She is smiling-of course. She was taught young to not make a fuss, to smile like a good girl. Her eyes are closed, perhaps to block out a little of the embarrassment she feels at being the center of attention in a busy restaurant on Christmas Eve. It could be she is embarrassed about the fuss around her birthday or was it the attention of the classmate who happened to be sitting one table away, changed with time but familiar around the edges. High school was four years past and that was where she wanted it to stay- over. His face, watching as they sang “Happy Birthday” in front of 200 strangers made her stomach hurt but good girls smiled. Always.

I look at this girl, who in four short years had seen devastating heartbreak and violence and am filled with both sadness and a fierce pride. She is on the cusp of a new and beautiful life of healing and joy, but she didn’t know this yet. I wish I could whisper to her now, let her in on the secret that not all love hurts and not all damage is damaging forever. I wish I could tell her that I know she is alone among those who should know her the best. They will never share those secrets she keeps but that will be ok. Others will share them gracefully. I could tell her not one bit of that matters now, but I know her. I know it mattered then. Appearances mattered.

            I wish I could lean in quietly, whisper above the small pearled earing, pitch my voice just above the holiday din; and tell her that scar tissue makes a beautiful teacher.  I would tell her that her broken heart will not only heal but it will bloom and grow into a heart capable of holding space for others who are broken and hurting. She will leave this snap of time shortly, leave the mixing of perfume and candles, bourbon and steak; and step into the winter night. The air will feel cleansing, the anonymity of the street comforting. She will move through the next few months of life as she always does, doing what should be done until one night, when the dark cold takes on personality.  Everything will change the night death comes to wake her and set her on the road of life building.

I couldn’t have known that Christmas Eve that destiny has a maudlin sense of humor. Life changing moments hardly seem that at the time. I had been so sure I was broken beyond saving, that I had nothing to give anyone. I was destined to be mediocre at best. But time had more to teach. In that photo I was toeing up to the start line for the rest of my life. A little more than a month later I would find myself in another moment in time, no photo to capture the shift except the one imprinted in my brain. That night had been filled with routine with only ordinary motions and then time stopped.  When time began again everything was different in a million little and unmentionable ways. 

He had been walking home in the early February darkness. The black hoodie and jeans hid his tall, lanky body in the early northeast morning.  He was struck at 55 miles an hour, in the freezing dark.  His head hit the top of the sedan’s windshield, his face the glass and his legs the bumper. He shouldn’t have lived but he did. For better or worse, he lived through that night.  The actions taken by my EMS team that night was part of the 0.1%, a tiny slice of time when prehospital care made a life-or-death difference. This man lived because of us, because of me and my training. That night was a conjunction of time and space, when training met instinct, uncertainty of trauma met steely determination. It was the night a “nice girl” became a determined woman.

I look back to that moment. In our family we call it “Route 2.” My now husband had been senior medic on that call and witnessed the change that came over me that night.

“That was the night you were ready to move on,” he often tells me and anyone else who will listen, “You called the shots that night, stood up and took charge, you stopped being a good girl became a leader.”

Twenty-four years, four children, 23 years of marriage and a year from my FNP I look back to that photo as when my paradigm shifted irrevocably. It wasn’t an earthquake in the status quo of my thinking, more of a small and insidious crack that slowly loosened old programming.

Why does a woman being a “good girl” still have a place in our society? What does this mean for the profession of nursing and medicine? Can we be effective practitioners if we are first concerned with being liked? The girl in the photo wanted nothing more than to be referred to as good, dependable and nice. This woman is concerned with different adjectives. Compassionate has replaced nice. Competent and effective has replaced dependable. Morally sound and consistent has replaced good.

I was recently struck by a comment on social media about a female politician. “She just isn’t likeable,” said a political commentator. I was struck by this comment. We don’t hear about “likability” being an issue for men. Politicians don’t say someone is unelectable due to a lack of likeability. In healthcare, we don’t say men aren’t likable. We say they have a poor bedside manner quickly followed by “but I don’t care because he is a good provider.”  We don’t tend to label male providers difficult or opinionated when they disagree with one another. We call them strong, educated, confident. At worst a male provider may be called arrogant. Women providers are seen through a less positive lens when they exhibit the same qualities of confidence and assertive discussion. Why?  

As women, providers must work against old, long entrenched, expectations still shared by colleagues and patients. Be a lady. Smile. Don’t make a fuss. Look nice. Speak softly. We cannot serve our patients if we are constantly preoccupied with being likable. How do we function within a theatre that still expects, perhaps subconsciously, that we women providers give competent care while not rocking to boat? We can’t. We must be unafraid of who we were and proud of who we are now. I am lucky.  My training allowed me to work with providers of all genders who empowered me, mentored leadership, humility and encouraged my journey. Times are changing and I can be a part of that change for those who come next.

I can’t undo the programming for that girl in the photo. She is in the past, frozen forever at 22, smiling and stuck in so many ways I can’t change. But I am not her now. I have learned to balance assertive with respectful. I have learned to care less about likability and more about competence, effectiveness, compassion, and endurance. To make big decisions with patients about health care one needs confidence and humility of equal proportions. I can’t claim to be an authority on what it takes to be a recovered “nice girl.” I will be forever learning how to navigate roads laid by outdated paradigms of our world.  Yet I know I am eons away from that girl in the photo. I am not her and she is not me. She is the core of who I am, a germinal center locked in time. I wouldn’t be me without her.  I often wish I could let her in on the conspiracy- you don’t have to be a "good girl" to strive towards doing great things.