Sarah digregorio aria is the critically acclaimed author of early an intimate history of premature birth and what it teaches us about human and taking care. The revolutionary story of nursing. She is a freelance journalist who has written on health care and other topics for the New York Times, Washington Post and the wall street journal, slate insider and catapult. She lives brooklyn, new york, with her daughter and husband. David marchese is a staff at the New York Times magazine, where writes the talk column. His work has appeared in new york, rolling stone, the American Music writing spin. Gq he lives with his family. Montclair, new jersey. Welcome, sara. Thank you so much for that kind introduction, and thank you so much to all of you for being here today. It really does mean a lot to me to see you here. My community in brooklyn means so much to me. Im just really overwhelmed with gratitude today to be able to do this work and then also to be able to here with you guys. It i am i am grateful to you you so much for being here. So first im going to do just a little bit of reading and then david and i are going to chat so i also just want to say there are some nurses in attendance today. You dont have to raise your hands. But i before i ask a round of applause for the nurses, i just to say clapping is not enough yet i still would like to clap for nurses who are in attendance say thank you for. And also we should pay you better, give you a better staffing. So first of all, i just you. I came at this topic really as someone who has needed health care and someone whose family has needed care. And so me, i started from a place of kind of personal experience, emotion that i had for nurses. And this that i had when i thought my time with, my parents in hospitals and with my daughter, the hospital, you know, there are so many things that go wrong in a Health Care Setting. Right. And for me the image that comes to mind, sort of being lost in a labyrinth, being lost in a labyrinth with, you know, your most beloved people trying to get the care that they need and trying to get providers to to see you and, to hear you and to find your way through that labyrinth. And sometimes that can be so difficult, as many of you know. But when i was thinking about, you know, what goes right, you know, we all know we we know that so much about the Health Care System is broken. But what goes right and the things that that i were these encounters with nurses that were really these moments of clarity for me because i felt seen and heard and i felt that these were helping us even when that help didnt involve a cure even when there was no fix still they were nursing us and. That meant really everything. Sometimes. And so thats where i started and and also the knowledge that, you know, we dont see the nurses expertise and practice discourse and analyzed in the news or in cultural reporting as much as we should and so i thought, you know there was this huge opportunity to bring stories forward. And so thats really where i started and was a learning experience for me. And so i just also want to sort of like establish for everyone who doesnt know that nursing is an independent scientific discipline so it doesnt exist relation to medicine and physicians and it is its own discipline with, its own sort of set of both its own expertise and own perspective. And so first i just want to read to you just a little bit about how nurses themselves conceptualize their profession and how they conceptualize it as separate from medicine. And so nursing and medicine. So medicine as practiced by physicians or what we sometimes call doctors, is they are complementary and disciplines, but they are not the and one is not above the other, but in fact, ideally they are both. Theyre to serve the patient. So i just because i didnt know this stuff when i started, i just want to of read to you a little bit in nurses words how they how they conceptualize their profession. Can you all hear me okay . Wonderful. So. Nurses conceptualize profession in a multitude of ways. But ill emphasize how nursing is from medicine. In her memoir, year of the nurse, cassandra alexander, the difference between medicine and nursing like this quote they the doctors learn where the patient and demarcate where they want them to be. It is the nursing actually gets you. There are. Hands are on the pumps and ventilators. Everything we do is an attempt to heal you. And then i like this also from a different nurse quote. This is the difference between medicine and nursing, said pollack kagan, professor emerita at depaul university. Medicine is a cure. It has a small repertoire of skills. I am not demeaning it. If you need brain surgery, if you need orthopedic surgery, you need that and you want the best to do it. But then who takes care of the person . 24 seven after the surgeon goes in and does for 4 hours, physicians have a very narrow scope. They hate hearing this, but its the truth. Ask any nurse nurses are the ones who heal the patients actually help heal along with the person themselves and their family being in a mutual process with people, their and their communities. Thats what nursing is. And that is one thing that sort of came forward in to a lot of nurses and resonated with my own experience is that nursing is about a relationship like nursing cant exist without a patient so its like in that relationship tween the nurse and the patient is where the healing is and thats where the expertise of nurses is expressed is in that relation between the the patient and the nurse. And i think thats such a powerful way to think about it because. It really thats like thats the power of relationship. Thats how we can thats thats that is the power, the healing power of relationship. And that being seen by someone who has the expertise to help you. And then finally, i wanted to just bring forward what teddy potter said. So this is so you might see a liver specialist. This is me speaking or the theory, the narrator. You might see a liver specialist, a neurologist, a gastro and a psychiatrist. And each of them might carefully attend to their particular system. But good luck getting them to talk to one another or to you about the overall picture of your health, the discipline of nursing can fit those pieces back together and ways to treat the full human being which can improve outcomes in concrete. As potter explained, this is teddy potter, who is a professor of nursing at the university of minnesota. She said, our mind body, were all whole people. And when you see your physician, you not feel like your needs are being met. Yes you may have received responsible care. It not negligent. It wasnt malpractice, but it missed what you actually need. And so its seeing the whole over and over and over again and thats what nurses do. So i just want to kind of like establish that because you know, the way that nurses conceptualize their profession was not something that i was super familiar with when i started writing this book, even as someone who has, you know, written about health care extensively the past and finally, before we talk, before david and i chat, i just want to read to you a little bit from the first chapter. And its really about why i think so important that we understand ourselves as understanding nursing as something that has existed in human societies and is actually one of the things that has made us human. So nursing is a thread running through all human history. Nurses were at the events that defined our world. They were key to the success of the byzantine and roman and indian empires. They were instrumental in the founding of the worlds major religions. They were tried as witches. They were forced underground, but they never stopped passing down what they knew, even when it was dangerous they were arrested for providing birth control, jailed for trying to vote. They act on their expertise, even when enslaved, they broke down. Jim crow. They went where they were needed. They fought for everyones right to a good death. They brought their knowledge to the halls of government. Human societies simply could not have developed and functioned the way that they have without nursing. So if you imagine that nursing arose in relatively recent times as, a profession dedicated to assisting physicians, hospitals, you have a backward nursing came first. Historians and anthropologists often point to pivotal moments that distinguish the evolution of early humans. When we started making tools or decorative objects or using fire to cook or when we cooperated by sharing food. But what about the impulse to staunch someones bleeding. What about helping someone give birth . What about sitting up with someone who is dying . These are interactions define humans as much as the use of tools, fire and agriculture. 4000 years ago in a neolithic Stone Community in what is now bucklin village vietnam a baby boy born with a rare congenital condition in which neck vertebrae are fuzed. As he grew, the boy curled his spinal column became progressively compressed. He was paralyzed from the waist down with very little use of his upper body, his head twisted to the right, and he could not feed himself chewing, swallowing were probably difficult. Nevertheless, even after becoming almost completely immobile as a teenager, he lived until his midtwenties, someone or many someones must have nursed him intensively. They brought him food and water, fed him, bathed him. They would have had to help him with positioning and tend to his skin to prevent pressure sores and infections without nursing care. He would have died within days. When the young man died, he was buried in the fetal position because of the curve in his spine. When archeologists found him in 2007, they noticed he was the only one in the community buried in this way. Then he saw the neck vertebrae and the extreme then they saw the fuzed neck vertebrae and the extreme slender ness of his leg and arm bones that comes with paralysis. Lorna tilly, an archeologist on the dig, had previously worked in nursing and the young mans body, spoke to her. She started to piece this case together. Other evidence of prehistoric nursing tilly became captivated by what these bones were saying. But when she looked back at previous archeology studies, she found that while survival from illness or injury was sometimes there was often little to no analysis or even acknowledgment of prehistoric nursing care that would have made this survival possible. Informed her work in both archeology and health, she developed a model called the bio archeology of care a framework for understanding how our earliest ancestors nursed each other in anthropology news. Tilly and her coauthor argued for the importance of understanding ourselves way. They said, quote our past contains important lessons for our present. If we are willing to Pay Attention and archeology will focus on Health Related care, completely overturns the notion that society has evolved by embracing a winner take 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. So i think this is so powerful because there are different that we can think of ourselves right . Can think of ourselves as peak as a species for whom it is natural to try to dominate each other and get one over on each other or. We can think of ourselves as people are really. We are meant to care for each other and we are meant to to organize ourselves that way. And i just, i, i want leave you before i Start Talking to david from one quote from actually the last page. That is my favorite thing i think ever written about nursing. It comes from mark lazenby, who is the dean of the professor or sorry, hes the dean of the university of california, Irvine School of nursing. Hes he said nursing is a profoundly radical profession that calls society equality and justice to trustworthy and to openness. The profession is also radically political it imagines a world in which conditions necessary for health are enjoyed all people. Thats my favorite thing. It imagines a world in which the of health are enjoyed. The conditions necessary for health are enjoyed by all people. So thank you. Listening. And now im going to talk to david david. Hi, sarah. Hi david, congratulations. Youve written a great book. Thank you so much. I want to start by asking something that sort of in the context two things you just said that have to do with sort of the breadth and hugeness of the subject of nursing. Were you know, you youre writing about something that defined could be defined both, as you know, relationship and and also in terms of care, the thing that makes us human now if you had said you were pitching a book editor im going to write about a subject like a relationship or the thing that makes us human. I think they would have said too big of a book and but only that but sort of chronologically the subject of nursing, the way you lay it out goes from prehistory to now so its kind of a huge subject and youve written youve synthesized it so smartly and and what feels like comprehensively. And i wonder if you can talk about sort how you saw your way into into the subject given how kind of unwieldy it could be. Yeah. Now thats a really good question because it is unwieldy and it felt unwieldy the whole time to be honest, i where i started was when i pitched the book a cultural history of nursing which you know didnt exist for a general audience. And so, you know, there is a pretty obvious gap in the book market. There. So many interesting stories tell and i started out by thinking that needed to tell it chronologically like okay i want to tell a comprehensive history of nursing from prehistory to today and im going to somehow make that readable and i you i quickly realized that that that was impossible like impossible like you cant as you say, nursing is like it is a huge topic. And, you know, i could not write a comprehensive history of nursing. So i started to about that a little differently. And i realize what i really wanted to write about was not a history of nursing, but a history of the power of nursing and the history of the trend like transformative nursing and ways that nurses have changed the world and what nursing has meant because you there are certainly like really important nurses that i cover quite and if you really going to write you know a comprehensive of now you wouldnt do it that way. And so i started think about well what am i really interested in im interested in nursing in peoples lives and thats why i ended up doing away with the with the like kind a logical approach and i started to think about it in terms of how nurses interact with people, different points in their life, course. And so thats why i, you know, i ended up organizing it around and nursing and community and then nursing and addiction care, nursing at the end of life, nursing care. And that ended up being like a much much easier way for me to get my around it also because then instead of the whole book chronological, i could think about domain that was talking about i could think about weaving in history to that but also bringing in contemporary nurses who were doing you know transformative work. So i let myself i let myself i let the idea that i could possibly write a comprehensive book about nursing, let that go. And and thats sort of i landed with this book and what you just said about thinking about the or contextualizing it in the sense of in peoples lives brings to mind for me theres a in there from monica macklemore where she described whos a nurse and she describes nursing as sort of being about transition about helping people through Life Transitions which is such an interesting way of thinking the job and certainly one that i think the layperson would not have arrived at by themselves. And im wondering if you can talk about sort of how you saw that play out, how that definition was brought to life for you. Yeah, i love that. She said, because youre right, its really its not necessarily an intuitive way to think about it. She was making a distinction between, you know, people think when you think of nurses, perhaps as a layperson, you might think like, oh, the nurse comes in, does a task for me. So the nurse is going to check my Blood Pressure or if im in labor, the nurse is to check my the fetal the fetal heart rate. Theyre going to check reading. And she was the distinction that those strata that they use that nurses use to do their work, that all of these sort skills and tasks that they have, those are strategies but that the real of nursing is that they are guiding people through these transitions. So some of the transitions are like the most profound life that we have. So for instance, if youre giving birth or youre being i mean, thats a transition from being not being a parent to being a parent from being in the uterus, being out in the world, dying. Obviously, a major both for the person dying, also for the family and in the book about hospice care, you know, helping manage the transition, i saying goodbye to their loved one. So there are skills that nurses have to do that work. But then what they are really doing is managing that transition with the family and whatever that means. And i think, you know, one of the more simple transitions is even just like a from an illness to a well state or from, you know, a state you have just been, say, diagnosed a chronic disease that maybe doesnt have a cure a lot of the nurses i spoke to were helping people manage a transition to sort understanding their new body, understand how to take care of themselves with this sort of new reality. So youve just been diagnosed with diabetes or, you know, some other condition that cant be cured, but that you do need to sort of transition your life to live with that. I remember when mira first came home from, the nick you we had a visiting nurse. To me i know notes that maybe make sure i didnt like really lose it but she was there the way mira so you know that for me like her coming day was helped me tremendously in managing the from an icu setting to being parent at home which. I dont even know like if you said to me how she do that, i dont know. Like i dont know what she just really kind of like came in and was like, well, let me weigh the baby. She was like, how are you . Oh, hows going with the pumping . Oh, that sucks. You know . I mean, like, she was just really but she made she normally it for me and she wasnt shocked by me, my baby or anything that had to us. She was like, yep, this happens. Its going to be okay. And i think that thats yeah, i mean, this like that kind of transition where theyre guiding through those things and given how both misunderstood nursing is and how underappreciated is, did you find that there was there were commonalities in the sorts of things the nurses you were reporting on really to convey to you . Like what did what was your sense of what they wanted the world to know or just a journalist to know about what they do. Yeah, i thought about