It is commencement season, a time of new beginnings and setting forth on new adventures. This week is also Nurses Week, a week set aside each year to honor nurses. I have been reflecting on my nearly four decades in the nursing profession...what I imagined as a young nurse setting sail into the world of healthcare and where I have found myself so many years later.

Several of my nursing colleagues and I have been thinking about our stories or narratives as nurses -- where have we been, where are we going, what has shaped us and what gives our work meaning? #WhyINurse

So, in the spirit of this reflection and with immense gratitude to those who have allowed me to learn from their lives and teaching, I share the commencement address I gave several years ago as I completed my graduate work at the Tufts University School of Medicine. Several years later, I am happy to say that I am still discovering my way to Ithaca. My wish for each of you is for your journey to be long and circuitous as well. ~Pam

Commencement Address

Tufts University School of Medicine: Pain Research, Education and Policy Program

To the faculty, administration, fellow graduates, and especially to my wonderful family; I am both incredibly honored and extremely humbled to stand before you today.

It has been 32 years since I last wore a cap and gown and I am reminded today of that spring day so long ago in Ann Arbor, Michigan. In 1979, the adventure on which I was embarking appeared so clear and direct, much like Homer’s Odysseus as he set off from Troy enroute to Ithaca. But as with Odysseus, we often find our journeys far more complicated than we ever anticipated…meeting not only with trade winds and gentle seas but also with violent storms and towering waves that can batter us and throw us off course. And so it is for the patients we meet each day in healthcare. They, too, are voyagers on their own Homeric journeys, each filled with unique, authentic stories waiting to be told. It is up to us, in healthcare, to elicit, acknowledge, and honor these stories, to bear witness to their individual journeys and to help them navigate through difficult passages.

When we first enter the world of healthcare our mission seems clear and direct – we want to quickly fix what we see as broken, to cure what we see as diseased. While this is a noble mindset, we often miss the opportunity to heal when we blindly set out in this direction. What I have learned is that often we cannot cure, no matter how desperately we try, but the potential for healing is always possible. This statement may seem incongruous to what we see as the measurement of medical success. But, as we look broadly at what healing really is… isn’t it all about reducing pain and suffering…about living and dying with dignity, grace, and a sense of purpose? We meet our patients at many points on their journeys and I see our work as assisting them in gathering the necessary tools of healing to find safe passage on their voyages.

During the course of my studies here at Tufts I have discovered many tools of healing. The Pain Research Education and Policy program was not on my navigational charts when I set off in 1979, but I am so grateful that I found my way here. Through my work with inspirational faculty mentors, especially Dr. Bradshaw, Dr. Glickman-Simon and Dr. Carr, as well as Dr. Gualtieri in the Health Communications program, I have explored pain not only as a physical manifestation of injury or disease, but also as a complex pattern of psychosocial and cultural components that contribute to a sense of suffering. Addressing the suffering has a direct impact on reducing the sensation of pain. The Pain Research, Education and Policy Program has allowed me to explore the intersection of modern medicine, technology, ancient healing practices of the body and mind and spirit, and the innate human desire to survive adversity. It has given me a voice in advocacy and scholarship by helping me to articulate the meaning of pain and suffering for individuals and society. For this I will always be grateful.

Some of you may be familiar with the poem, Ithaca, by Constantine Covafy. It is a poem that has kept me company on my journey and I would like to offer it to you as a metaphor for this commencement, as each of us sets forth on new journeys and adventures:

When you set out on your journey to Ithaca,
pray that the road is long,
full of adventure, full of knowledge.
The Lestrygonians and the Cyclops,
the angry Poseidon -- do not fear them:
You will never find such as these on your path,
if your thoughts remain lofty, if a fine
emotion touches your spirit and your body.
The Lestrygonians and the Cyclops,
the fierce Poseidon you will never encounter,
if you do not carry them within your soul,
if your soul does not set them up before you.

Pray that the road is long.
That the summer mornings are many, when,
with such pleasure, with such joy
you will enter ports seen for the first time;
stop at Phoenician markets,
and purchase fine merchandise,
mother-of-pearl and coral, amber, and ebony,
and sensual perfumes of all kinds,
as many sensual perfumes as you can;
visit many Egyptian cities,
to learn and learn from scholars.
Always keep Ithaca on your mind.
To arrive there is your ultimate goal.
But do not hurry the voyage at all.
It is better to let it last for many years;
and to anchor at the island when you are old,
rich with all you have gained on the way,
not expecting that Ithaca will offer you riches.

Ithaca has given you the beautiful voyage.
Without her you would have never set out on the road.
She has nothing more to give you.

And if you find her poor, Ithaca has not deceived you.
Wise as you have become, with so much experience,
you must already have understood what these Ithacas mean.

And so, as you set sail from this commencement for your Ithaca…I wish you a long and prosperous journey, the privilege of listening to many stories, and the wisdom of healing.

Thank you and Bon Voyage.

"I don't do death" a physician once told me. The culture of modern medicine asks us to embrace the promise that cure is always possible and death is a failure of the health care system or the inadequate skill of a physician or nurse. It is my hope that together we can change our current culture of medicine by expanding our expectation that our students, residents and fellows are trained with the same rigor in high touch medicine as they are in high tech medicine -- so all healthcare professionals "do death" AND "do life" with compassion and skill. It has been a year since I wrote the following essay for Cognoscenti (WBUR) . Today, I again returned to the Massachusetts General Hospital for the 2014 Pediatric Memorial Service, so please indulge me in this redux. I welcome your thoughts and comments. ~ Pam

Each year, early in October, a letter arrives with the return address of Massachusetts General Hospital, 55 Fruit St, Boston, Mass. I know immediately what the envelope contains and I pause and reflect for a few moments before I open it. Inside is an invitation to return to the place where my son, Nick, was treated for a deadly form of cancer when he was 14. We, as a family, also spent many days, weeks, months in this place: crying and laughing; watching fireworks magically unfurl in the dark sky over the Esplanade from windows on the 18th floor of the Ellison Building; waiting in the subterranean operating room holding areas in the warrens beneath the hospital; exploring the empty hallways late at night like the actors in “A Night at the Museum”; holding impromptu guitar jams in Nick’s hospital room; and ringing in the new year with noisemakers, shrimp cocktail and sparkling cider with hospital staff who drew the short straw and had to work on New Year’s Eve.

Perhaps learning to step into the full spectrum of life and death is the meaning that the children who didn’t survive bring to the practice of medicine.

Nick died 12 years ago, so why do I still return to this place each year? It is because Nick, like the other children who were cared for in this huge, often anonymous institution are not forgotten — they are remembered and honored year after year with the annual Pediatric Memorial Service. In this medical mecca, children are not supposed to die. We are fortunate to have some of the best and brightest medical institutions in the world at our doorstep. Reports of miraculous new cures abound in the media, but there are some children who are not the success stories that are highlighted in hospitals’ marketing materials.

They are the children who didn’t survive. Those of us who receive an invitation to return to MGH each year for the Pediatric Memorial Service are a disparate group. Some of our children died when they were adolescents, some when they were in early childhood. Some died from a chronic illness, some from an acute infection or disease, and others suddenly by an accident. We come from different walks of life and professions. We speak different languages. Yet, on this day, year after year, alongside the staff who cared for our children, the barriers are lifted and we are all together as human beings, remembering the stories, sharing a hug, speaking our children’s names, and trying to find meaning in loss. Collectively, we understand the unique grief of losing a child.

Early in my professional career as a nurse, I heard a young physician say, “I don’t do death.” I’m not sure what this statement really meant — perhaps that somehow his superior knowledge could forestall death permanently? — but beyond its arrogance, it spoke of fear and hopelessness. As a society we are very isolated from pediatric death. We are fortunate that in the span of a few short decades we have seen a dramatic decrease in childhood deaths due to vaccines, antibiotics, and advances in medical treatments.
But this decrease has created a void in our health care professionals’ ability to know how to deliver care when finding a cure is no longer an option. Our medical and nurse training programs don’t “do death” well either, especially around societal taboos.

A physician at this year’s memorial service gave me hope for the future when she commented that her role as a doctor is to walk the journey with her patients and families and this includes the full spectrum of life and death. We look to our healers to cure us with the modern arsenal of medicine at their disposal, but when a happy ending is no longer possible, shouldn’t it also be their role to help guide us through the fear of the unknown and unthinkable, especially in pediatrics? Perhaps learning to step into the full spectrum of life and death is the meaning that the children who didn’t survive bring to the practice of medicine. Our kids have become the teachers, no matter how short their lives may have been. Their legacy is to continue to teach the healers how to walk alongside those who are confronting the unimaginable and unbearable with grace, humility and humanity.

So, I guess I keep coming back to walk through the doors of the Massachusetts General Hospital year after year to remember, share a story, and to say thank you for honoring these great teachers who keep medicine honest, healing and humble — the kids who didn’t survive.

http://cognoscenti.wbur.org/2013/11/05/pediatric-death-pamela-katz-ressler

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