Back to College

Although the residency that this blog sprung from ended in December, I’ve been invited back to the School of Health in Social Science for the month of May to run some writing workshops with students and continue my writing about nurses.

May is a good time to come back to Edinburgh – the light on the old buildings is beautiful, the trees are finally misting over with new green, and there are interesting talks and events happening.

Last week, I went to the inaugural lecture by Professor

Charlotte Clarke

Charlotte Clarke, the (relatively) new head of school. Charlotte’s background is in nursing, and her lecture drew on years of practical and research experience in dementia care. In the talk, she challenged the habitually negative framing of the disease, and explored how we might better support those who are losing a cognitive, linear sense of themselves, but remain as human and emotionally complex as anyone else.

Towards the end of the talk, Charlotte shared a poem she had written about an inspiring encounter with a former patient. In a short space, it illuminated the theme of the lecture with a human presence. I thought it a perfect example of the particular understanding that nurses can bring to the world through expressive writing, if they give time to it.

Here is the poem:

Ahead of His Time

1980’s

Rehabilitation ward they called it

But few ever left alive

Edward

Let’s call him that

Wordlessly seeing out his days

Silent with his fragile dignity

Early shift

Time to get Edward up

Talking – monologue

Not expecting any answer

Gardening

Edward's job in years before

Lettuce and the problem of slugs

Slug pellets, salt rings, jars of beer

Tried them all

Any suggestions?

“Don’t grow them”

A silence broken!

But instantly returns

Forever, for Edward

I don’t grow lettuce now

Such ecological wisdom

Didn’t think like that in the 80s

So ahead of his time

Few words, big lesson

That has shaped my life

Work with, not against

Thank you Edward.

First published in Gilliard J. & Marshall M. (eds). Time for Dementia. Hawker Publications, London. 2010

If dementia is something that affects your life, or you are interested in understanding more about it, I can recommend the book Keeper, by Andrea Gillies – a deft blend of memoir and scientific investigation that won the first Wellcome Prize for literature in 2009. 

This week’s inaugural lecture is by the new nursing Professor, Josephine Tonks Fawcett, reflecting on a lifetime’s experience in nurse education, which I’m looking forward to very much, especially in the light (or should that be shadow?) of the Francis Report and it’s recommended changes to the way nurses are trained. Changes seized upon and expanded by the government in recent months, as if nurses were the wellspring of hospital failure. But more of that later.

You can read my interview with the inspirational Tonks here.

The Body in Crisis

Now that I have some time to reflect back on my months at the university last year, certain events stay vivid, full of insight.

One such was The Body in Crisis event, organised as part of the ESRC Festival of Social Science in November. One of the key organizers was Susanne Kean, who I interviewed for the blog last year.

What brought me to the event was not just my interest in Intensive Care, but the fact that it would be an exploration of the experience from different perspectives, with contributions from health professionals, sociologists, academics, and – crucially – patients and their family members who had survived the critical care experience.

By the time someone is admitted to intensive care, one or more of their vital organ systems will be impaired or injured, their life will be in the balance. If they survive the experience, their bodies can take years to recover – the damage caused by muscle wastage, for instance, can last up to five years.

But as one of the contributors, Danny Kelly, reminded us, ‘We don’t just have bodies, we are bodies.’ A crisis for the body is a crisis for the mind and spirit too, especially when the person cannot comprehend what is happening, as is so often the case.

The accounts of former patients were riveting, particularly the details given by one young woman, who had been hospitalized for swine flu when she was 25, and quickly admitted to ICU, where she stayed for more than a month, her life in the balance. She brought a patient’s perspective to vivid life – the disorientation, the anxiety, the physical pain, the strange dreams and terrors that beset her – she spoke of dreaming that she had the feet of an elephant, then showed us a photograph of her in the ICU unit wearing huge blow-up sleeves on her lower legs which help with circulation and pressure sores. The mind make up its own reasoning when all around makes no sense.

The photographs that she had of her time in critical care, and scans of her first scrawled attempts at handwriting, seem to have helped her make sense of her experience, but she did not pretend that her recovery process was anything but gradual and prolonged. She had help from the Community Rehabilitation Service for six weeks, but said she was newly frightened of germs, and of coming into contact with the general public, and that the small amount of counselling she had received had helped her more than anything else. Even now, she said, two years on from her illness, things come back to her from that time.

It is estimated that around 25% of ICU patients will suffer from Post Traumatic Stress. One of the things that can help recovery is the construction and absorption of the ‘story’ – the exact sequence of events of a person’s illness, treatment and recovery, the separating out of what was imaginary and what really happened. It is standard practice in the modern army for injured soldiers to be accompanied by papers outlining the sequence of what happened to them – an understanding that psychologically we need not only to understand our story, but to be allowed to go over the details again and again, to embody that knowledge.

There is some interesting research work happening at the moment around the use of diaries and patient stories within ICU settings, and from the former patients at the Body in Crisis event, especially those most recently treated, I did get that sense of people going over the details again and again, just as one does in grief, to try to make sense of a new reality.

The ability of modern ICU units to snatch life back from the jaws of death is awe-inspiring, and to be celebrated, but for individual patients who have gone to that edge and back it is always a life changing event, a victory that is wrapped in calamity.

In and Out of View - Regarding Mary Seacole

Michael Gove, the Secretary of State for Education, recently announced an overhaul of the history curriculum (of England, Wales and Northern Ireland) to concentrate on traditional historical figures such as Oliver Cromwell and Winston Churchill and to remove figures deemed to be less important, such as the Crimean War nurse, Mary Seacole.

A motley collection of historians have weighed into the debate in support of Gove, denigrating Seacole and plans to erect a statue in her memory. The Daily Mail talks about ‘The Making of a PC Myth’. On the other side of the argument a group of MPs have just tabled a motion to retain her in the curriculum, and publications like the Guardian and The Voice have been articulate in her defense.

One depressing element of the debate is that it often sets up an argument of Nightingale versus Seacole. as if there were only room in the historical pantheon for one nurse, or only enough bronze for one statue, and it sets me wondering about who history is for, and the complex and subjective mechanics by which some get remembered and many forgotten.

For those of you unfamiliar with her name, Mary Seacole was woman of Jamaican/Scottish origin who, after tending the sick in Panama, paid her own way to the Crimea, where she set up a ‘British Hotel’ with food and drink and a clinic for soldiers. She also tended the wounded on the battlefields, sometimes under fire. So popular was she among the military, that when she returned to Britain bankrupt, a three day fundraising concert was set up in her honour which 80,000 people attended and Queen Victoria supported. The press of the time lauded her, and she wore a Crimea Medal given to her by the military. By the time Mary Seacole died in the late 19^th century, her celebrity had faded to obscurity. It is only the last few decades that her story has been rediscovered and circulated.  She is the only black figure on the school curriculum not associated with slavery or the Civil Rights movement.

Not only is it harder for women and minorities to make an impact in a world they do not rule, but even those who have made an impact find it hard to stay in the public eye, their reputations subject to a constant whittling and belittling. Seacole is not truly ‘important’, say Gove’s supporters.

Important to who? She was important enough to the soldiers she cared for that they wanted to commemorate her. Vitally, she shows the historical diversity of Britain, a diversity that some make out happened only in the last few decades. She also stands for the revelation that a black women in the nineteenth century could be wealthy and autonomous enough to dispense charity and care. 

If we don’t see ourselves reflected in our history, we absorb the subliminal message that people like us achieve little.

When Gove picks out Oliver Cromwell and Churchill as examples of who is important, he is a male parliamentarian singling out other male parliamentarians, he is mirroring himself to some degree. Not to belittle anything Churchill or Cromwell may have achieved (and Cromwell achieved much bloody slaughter alongside his honours), but I have a problem with this notion of ‘importance’, as if it is something we can measure objectively.

A man born into wealth and privilege who enters politics and enacts legislation which effects the lives of millions may be doing something important, but he not doing anything exceptional. And as for the kings and queens who Gove is so keen for children to learn the names of, they may have exercised immense power, but that power came to them through the accident of birth or arranged marriage.

I am more interested in people from more modest backgrounds who confounded expectations and had an impact on their times through the exercise of their innate values and talents. Florence Nightingale was one such woman. Mary Seacole another. We need both in full view.

If you feel that Mary Seacole deserves to keep her place on the National Curriculum, you can sign an online petition here

What Nurses Wear - 2

In a previous post about contemporary nursing uniforms, I mentioned the new Scottish uniforms and wondered if patients would find it easy to discern people’s different roles from their subtly differentiated uniforms.

Before Christmas, a relative of mine was admitted to a hospital in the Central Belt, and we were given a small leaflet to help us understand how the ward ran and what to expect. It contained valuable information such as phone numbers and guidance on how to find out what was going on. It also outlined who was who on the ward:

The senior charge nurse, it said, would be wearing ‘a navy blue tunic.’

Check.

Under the charge nurses would be ‘a team of qualified nurses wearing cornflower blue tunics.’

Hmm. A while since I’ve seen a cornflower. Is that a dark or light blue?

‘And clinical support workers in pale sky blue tunics.’

Right, so their blue is a pale one, which means cornflower is probably darker – but not as dark as navy… I think.

‘You may see many other health professionals… such as dieticians, occupational therapists, physiotherapists … wearing mediterranean blue tunics.’

Mediterranean? Mediterranean?

Perhaps some colour swatches might help.

I notice there’s no mention of what doctors or consultants wear, or where to find them. Yet while my partner’s father spends weeks waiting to be discharged, nearly all of our enquiries lead to their invisible persons, and the need for them to sign something or decide something before anything can move forward or resolve.

Another sartorial indignity I came across during the year is the Do Not Disturb apron. The motivation behind it is no doubt a sound one, to minimise mistakes in drug rounds by minimising interruptions, but as so often with good intentions, it is debatable whether it achieves its ends, or whether turning nurses into red warning signs/ sandwich boards does anything to foster a caring and humane atmosphere on the ward.

Nurses I have talked to say that many colleagues don’t ‘obey’ the edict on the apron, and talk to them about whatever is pressing, apron or not. A study reported in the Nursing Times found that these tabards reduced interruptions on average from six to five. Not quite as effective as their inventor must have imagined. 

Plastic People

 I recently attended a lesson at the clinical skills centre at Little France  – I wanted to see students working with simulation models – dummies, in other words. The point of clinical skills is to get some hands-on experience in a scenario as similar to life as design ingenuity and latex technology can get you. And these days, that’s startlingly close.

The room was the size of a small ward, even had curtains and rails to divide the space into a three bedded unit. That’s not what you notice first, though, since you’ve just stepped into what looks like a charnel house. There are single arms everywhere, resting on bloodstained pads (as a dog owner, I recognise these as ‘puppy pads’ a central but largely useless part of canine toilet training – I’m glad they've found another purpose).  In the old days, apparently, you practiced your syringe skills on oranges. Now we have disconcertingly lifelike arms with veins you can inject into or draw from. The blood is a jollier, more fluorescent red than the real stuff. Each arm has a bag of it attached by tubing, giving the impression that someone has just stepped away from trying to revive it.

Around the edge of the room, a selection of anatomically detailed lower torsos sit on the countertop. I wipe the unbidden image of an Amsterdam sex shop window from my mind. The class I'm attending is a speedy overview of pregnancy and childbirth given by the cool-headed Carol Brown, who has brought many of these female parts with her, some in a box branded with the name of Adam, Rouilly, who specialise in such things. The box is printed with the jaunty strapline Limbs and Things. A lone male bottom is incongruously stranded amongst the female parts, very obviously waiting to have his prostate felt. Carol puts him aside.

She props up an entire pregnant female torso, and with a whisk of her wrist pulls down the outer skin to reveal an amazing sight: a full-term baby inside a see-through sac with placenta attached. There is pump to control the inflation level inside the sac, so that manual examination of the belly will be as near life as possible. Some speakers are fitted to reproduce foetal heartbeat sounds. It is both ingenious and oddly beautiful.

The first year students and I practice internal examinations, then deliver the model of a baby through a skeletal pelvis, then a fleshed-out dummy. Between tries, students absentmindedly cuddle or rock the plastic newborn. I even learn something about neonatal resuscitation. Although the lesson is intended as an overview, so persuaded am I by the experience of hands on dummy-nursing, I go away with a delusional idea that if someone went into labour in the aisle of Sainsburys, I might be of some help. A little learning, as they say.

Adam, Rouilly’s website is absolutely fascinating, with an overlay of weirdness for the casual visitor. The list of simulation models makes it clear that this kind of virtual practice concentrates on the more intrusive tasks – injections, intubation, catherisation, internal examinations, suctioning.  Ideally, nursing and medical students can use them to come to terms with the basic mechanics of the thing, so that, when it comes to dealing with living patients (I was going to say breathing patients, but some of these models do breathe) they can focus on the person as much as the task.

But – and it’s not a huge but, because I can see the good of all this. But. Look at the picture below.  As the mannequins become more sophisticated, could it be that healthcare professionals might start to compare us unfavourably with these plastic people – uncomplaining, unopinionated, can’t use the internet, don’t mind waiting for hours, extremely high pain threshold. The students have time to discuss things amongst themselves as these attractive ladies wait in wistful silence, putting the patient back into patients.

All photographs courtesy of Adam, Rouilly

Story workshops with nurses

If you scrutinise the photograph (left), you may notice that an essential part of running a writing workshop for nurses is baiting the trap with a selection of finger food. There is no better way to lure busy team members in the middle of their working day.

Along with Dr. Deborah Ritchie of Nursing Studies, I ran four lunchtime sessions for mental health nurses at the Royal Edinburgh Hospital, under the theme ‘Telling our Stories’. Our immediate aim was to generate fresh accounts of mental health nursing today. Not only for the pleasure and satisfaction of the exercise, but because the voices of nurses are so often missing in debates around healthcare. In the long term, we are interested in seeing how these kind of creatively generated stories could be used to inform research, planning and advocacy.

We were assisted by the wonderful arts organisation, Artlink, who run a range of creative activities for patients at the hospital. They kindly loaned the big kitchen at their Glasshouses base so that we could get away from the usual training room atmosphere and have a space that was more homey and informal.

A big thanks to all the nurses who took part, none of whom had done creative writing before, but who rose fearlessly to the challenge, producing work that was moving, funny, sometimes frightening and filled with a tough-hearted dedication.

The following was written by staff nurse Jo Dunlevie in response to a challenge to find metaphors or images that would capture the transition between work and home. It’s a fine piece of imaginative writing.

Work

Unfunny clowns in dangerous big shoes

Stomping animals growling in the dark

Bright lights, Loud horns

Blinking light to dark

High wire ooh's and Ahh's

A moment away from a fall

A Disaster, head off in the lions jaws

Home

Slow steady smiles

Big laughs and tiny giggles

Quiet steady light, and the smell of growing things

Friendly voice, nudging concern

Big sighs and lashes on sleeping cheeks

Soft fall of turning pages

And the Dum de dum of life in Ambridge

Good Nurse, Bad Nurse - read it here

I have just posted the text and photos from my public talk here (just click the Good, Nurse, Bad Nurse tag, above). It's quite a chunk of text to read onscreen, so those of you with fatigued eyes might wait for the audio version that we're planning to put online at Nursing Studies if the gods of technology allow it.

Above is one of the illustrations from the talk that I came across during my research. It was a campaign based in Oregon to shift perceptions of male nurses. Hmmm....

Other Voices, Other Blogs

One of the many undone tasks that I carry around with me like so many virtual baglady encumbrances is the assembling of a blogroll for this site. Look to the right hand column and you’ll see that today my load is lighter.

These blogs and sites cover a wealth of ideas– from the ever-changing and ever-stimulating blog of Durham’s Medical Humanities department to the individuals who have set up blogs to reflect their personal interests and opinions (or vent a little spleen as in the case of The Grumpy RN) .

I’ve been putting out calls for nurses who write, not only through this blog, but also through guest posts at The Scottish Book Trust and writer’s magazine Mslexia. As I hoped, plenty of people have got in touch to alleviate my ignorance and point me to nurses who do write or sites that reflect the nursing experience.

I especially enjoyed Dovegreyreader, a blog by part-time community nurse Lynne Hatwell which has become very influential among publishers for its thoughtful book reviews, but also contains entertaining accounts of her nursing career. Annie Coops, both a nurse and a diabetes patient, uses her site to reflect on her experiences of caring received and caring given, while Nursing Writing, set up the University of Connecticut school of nursing is home to a range ‘scholarly and professional’ writing by nurses.

These and more riches – available at a click of the finger.

Sometimes, when I think of all the voices, all the opinions the web allows us to access, I have to go and lie down in the dark. Other times, it’s a giddy thrill.

Good Nurse, Bad Nurse

Just to let you all know that I'll be giving a public talk at Edinburgh University on October 2nd. It's an occasion to mark the residency and to talk about the different and often distorted ways that nursing is reflected in our culture.

Here's the blurb:

‘Good Nurse, Bad Nurse’

Featuring a cast of drunkards ,saints, harridans, angels, sexpots, wimps  and mavericks, Nicola White, Leverhulme Writer in Residence at Nursing Studies Edinburgh, explores how nursing  has been portrayed in literature, film and popular culture and asks what part nurses play in their own stereotyping.

Hope that you get the chance to come along - it's free but ticketed and you can book HERE

Public talk, October 2^nd.  Doors open 6.30pm, talk starts 7.00pm, Teviot Lecture Theatre, Doorway 5, Medical School, Teviot Place, Edinburgh, EH8 9AG 

Dancing Nurses Vanquish Evil

Add caption

No self-respecting blog about nursing and culture (and possibly they number more than one) could ignore what happened on Friday night. The Olympics opening ceremony boggled eye and brain. It was an ambitious attempt to re-imagine what British things were worth celebrating without recourse to forelock-tugging, corporate branding or celebrity glitter. Some crass mouthbores slated it as socialist. As if there was some sinister bias revealed in the motto that ringed the stadium before the appearance of Tim Berners-Lee - THIS IS FOR EVERYBODY.

At the centre of the pageant was the unexpected partnering of children’s literature and the NHS as represented by 800 puff-sleeved dancing nurses and dozens of ecstatically bed-bouncing children. The dark spirits of Lord Voldemort, the Childcatcher and other fictional villains were driven back by co-operative goodness and some airborne Mary Poppinses. And they weren’t hired actors pretending to be nurses; they were actual nurses and other healthcare workers who had volunteered their own time to rehearse weekend after rainy weekend. To learn exits and entrances and jitterbug kicks for the joy or satisfaction of just taking part. Watching it was to zigzag between thinking, this is madness and this is brilliant.

The reasoning behind the juxtaposition was that J.M Barrie, author of Peter Pan, gave all the rights for the work to Great Ormond Street Children’s Hospital, and it was fitting too that his words were read out by JK Rowling who has passed a great deal of her wealth on to projects such as a new research clinic for neurodegenerative diseases at Edinburgh’s Royal Infirmary. Literature is good for your health.

Removing healthcare from the day-to-day and setting it in this fairytale wonderland, addressed to the whole world, allowed us to see it for a moment in a new light. I mostly consider myself immune to the emotion of national spectacles, if not downright repulsed. The Jubilee, for example, had me running for the literal hills.  Yet I found myself vulnerable to the sheer optimism and egalitarianism expressed by ceremony writer Frank Cottrell Boyce, one of the creative team behind the ceremony.

But maybe I’m coming down with a case of age-related tenderness.  I’d be interested to hear what others thought about those dancing nurses. Chuffed or queasy?

nurse performers return home post-ceremony 

An Art?

Gabriel Orozco 'My Hands are My Heart' 1991

Last week I attended a study day for intensive care nurses and AHPS (yet another acronym to digest – for those who don’t know, it stands for Allied Health Professionals - physiotherapists and speech therapists, for instance)

At lunchtime I got talking to some experienced ICU nurses. We’d been discussing a presentation we’d been given about agitation in ICU patients, and how careful monitoring of sedation levels was needed to find the right balance between wakefulness and unconciousness. As I understand it, sedation that is too deep can hold back a patient’s recovery, while too little can make it difficult for a patient to tolerate the invasive breathing tube, not to mention the various lines, drains and cannulae.‘Of course,’ one woman remarked,  ‘A lot depends on the nurse.’

When I asked what she meant she said that older or more experienced nurses were more likely to have developed strategies to calm a patient. Really good nurses had the ability, she said, to create a tranquil atmosphere, just through the quality of their presence. ‘Are you saying it’s an art?’ I asked. ‘Yes,’ she said, clear as a bell, ‘It’s an art.’

It is so much easier to talk about clinical techniques, about monitoring and measurements and checklists than it is to talk this way, about art and intangibles, how nursing can work on a level that I can only, godless heathen that I am, describe as spiritual.

In my reading I come across accounts by individuals who have suffered life threatening illnesses and who write about the importance of certain subtle interactions to their recovery. Richard Selzer, an American surgeon and writer receiving treatment for Legionnaire's Disease in an ICU wrote of the skilled nursing care he received, calling it ‘transformative’. He describes being carried back to bed by a male nurse after a bath as the moment when his ‘molecules rearranged themselves’ ‘It is the true moment of cure,’ he writes.

David Rier, an Israeli sociologist, was admitted to an intensive care unit with a virulent form of pneumonia. Unusually for an ICU patient, he was alert or semi-alert much of the time and the notes and observations he made provide an insight into patient experience in the ICU that is rare in its thoroughness and which changed his own thinking about medicine. In his fascinating account, he credits a large part of his recovery to the atmosphere of the ward.

“The staff’s cheerfulness, and the personal attention they lavished on me, gave me a strong sense of security. As mentioned earlier, this conviction that everything was under control and would turn out all right remained with me through most of even the most critical phase of my illness. But given my weakness, not even the staff’s smiles and attention could have sustained this security had they given me the full, discouraging story they were giving to my wife,” Rier is of the opinion that at his most ill, bad news would have killed him.

“These points are crucial” he writes, “because I am convinced that this cocoon of optimism helped save my life.”  David A. Rier The Missing Voice of the Critically Ill (in Sociology of Health and Illness vol 22, 2000)

The non-clinical aspects of care – human interaction, empathy, encouragement, nurture – are often referred to as ‘soft skills’. It’s not a good phrase. Within a society so devoted to the hard and fast and innovative, it is belittling and dismissive. Yet what evidence there is points to these intangible exchanges as essential to recovery and healing.

What Nurses Wear

“Nursing is made up of little things; little things they are called, but they culminate in matters of life and death” Florence Nightingale

I have become all too aware of the breadth and complexity of nursing today. With some 57,000 nurses and midwives working in Scotland – in hospitals and within communities, not only practicing care but advocating, researching and teaching, I look for points of connection, those little things that catch my attention and provide a way in to writing and thinking about nursing today. Writing too is made up of little things, an accumulation of words where everything can turn on a small, telling detail.

child's nurse costume

Lately I’ve been thinking about what nurses wear. The design of nurses’ clothing has always been driven by a certain functionality yet when you compare nurse uniforms of 100 years ago to the current uniforms being adopted in Scotland, the changes are radical, boggling even.  It’s not just about the development of easycare materials, but reflects a literal loosening up of the constraints that working women were subject to, and more particularly the roles that nurses occupy.

painting by William Hatherell ©IWM (ART 5234)

Around the time of the first world war, many nurses wore long white veils and floor length gowns and aprons. It’s no accident that they look like nuns, it’s a deliberate reference to the origins of organised nursing within the convent hospitals of Europe. Over the years the veils got shorter, and sat in elaborate shapes on the top of heads. The white aprons remained too, making nurses visual sisters to maidservants and waitresses. 

from the 1970s TV series, Angels

Capes and big belts lasted into the seventies, but in the last couple of decades, we have seen a shift to the simple, androgynous ‘scrubs’ type of clothing influenced by the US. By the end of 2012, all nurses in the NHS in Scotland will be wearing the uniforms modeled below, with different roles and hierarchies denoted only by subtle colour coding. The impetus behind this is to help patients identify who is who, but from the outside perhaps it’s not that obvious. The materials and cut are chosen with regard to washability and hygiene rather than aesthetics. That much is obvious.

new national uniforms © Scottish Government

In my posting about nursing in Malawi, you’ll see that nurses there, as in many developing countries, still wear caps and dress-like uniforms, but in North America and Europe, skirts and hats have disappeared. If you go to buy a nurse outfit for a child, however, it will have a little white hat, as well as a blue dress and apron, and assorted accessories – a stethoscope and upside-down fob watch. If your child is a boy, you won’t find a male nurse costume. Popular imagination is on a time lag as regards what a nurse looks like.

Male nurses never wore little white caps. For a while they looked like dentists. This new simplifying of the uniform is also a way of acknowledging that things have become more egalitarian –nurses may be male or female, surgeons and health care assistants can be dressed similarly, and increasingly care is delivered by teams of differently skilled people working together –ideally with the patient as the focus, not the internal hierarchies.

This is Elsie Stephenson in a photo taken during her nurse training in the 1930s. Elsie went on to be the first head of Nursing Studies here in Edinburgh. Her outfit is so crisp, so constraining at chin and neck and waist it practically makes me itch to look at it. The neatness of a nurse's uniform in that era was an outward manifestation of the discipline and attention to detail that were seen to be central to a nurses’ being. That and an unquestioning obedience. It wasn't so different to being in the army.

Scrubs, on the other hand, are clothes that you can throw on and not think about. But it does make me wonder if anything is lost in this casting off of the traditional idea of what a nurse looks like. And I'm interested to know - does anyone have nostalgic feelings for the nurses’ cap and uniform or is it a case of good riddance and don't look back?