"Glasgow nurses," The Times columnist Melanie Reid recalls being told, "have hearts like swinging bricks." A hard substitute for a heartbeat - but in many ways appropriate.
Nurses play a foundation role in healthcare: not hardness but strength, not wreckage but construction. They are the patients' Alpha and Omega, with a longer 'to do' list in between.
Nowhere is that more clear than in the stripped down, washed concrete operating rooms of hospitals across low-resource countries, where surgery is up to a thousand times more dangerous than in higher-income settings, and minimal resources mean that nurses often provide everything from a hand on the shoulder to spinal anaesthesia.
They care daily for those they know don't stand a chance - but should.
"It's tragic. Tragic for the patient and tragic for the nurse," explains Margaret Bugyei-Kyei, a senior anaesthesia assistant in the U.K. whose career began in nursing, in Ghana.
"You are going to let a patient lose their life for no reason - you could have saved them easily with the right equipment, access. So you withdraw; your spirit is demoralized."
May 12th is International Nurses' Day, celebrated each year on the birth date of that doyenne of modern nursing, Florence Nightingale. The profession has come a long way in terms of science and structure, but the challenges of surgery in a low-resource setting can sometimes seem all too close to those of 19th century Crimea. "The Lady with the Lamp," as Nightingale was affectionately called, had kerosene; nurses today have mobile phones, or head torches, which they are well-used to angling into a body cavity to light the surgeon's way, as electricity cuts out in the operating room again and again.
There's no space for ego or recklessness in that gesture, or in the bulk of tasks that nurses perform - and maybe that's why the profession has been so quick to speak up for safety as a priority. They understand that it requires "diverse people actually work[ing] together to direct their specialized capabilities toward common goals for patients" - to act as pit crews, not cowboys, as Lifebox Foundation chair Professor Atul Gawande told the graduating class at Harvard Medical School back in 2008.
Cowboys strut and lasso with mixed success, but safety is consistent, a "system property," as the International Council of Nurses notes - and follows through on. The ICN and fellow nursing organizations around the world were some of the first professional groups to endorse the World Health Organization's Surgical Safety Checklist. This communications tool is proven to reduce risk and complications in the operating room by more than 40 percent, but it's a challenging framework to introduce consistently and collaboratively (there are checks for counting swabs and monitoring blood oxygen levels, but none for strutting or lassoing). Nursing engagement is essential for it to work, and their reach is immense.
"As the largest group of health professionals, who are the closest and often the only available health workers to the population, nurses have a great responsibility to improve the health of the population as well as to contribute towards the achievement of the Millennium Development Goals," write Judith Shamian and David C. Benton, of the ICN.
With those goals due to expire next year - and a gap of up to 29 percent in supply and demand of the frontline healthcare workforce projected in the next 20 years - acknowledging the role of nursing has never been more important.
But small gestures anchor large-scale change, and that's where nurses excel too. Take an average day at a district hospital in Rwanda, where a young woman is being stitched up after an emergency Caesarean section. Her baby has been yanked out, wailed and wrapped up, and is warming under the only heat lamp. The tiny team - one surgeon, one nurse anaesthetist, one nurse (acting as scrub nurse, circulating nurse, surgical assist) - got him free not a moment too soon, and they have another case on the way.
The woman is naked, cold and exhausted; she traveled hours on dusty roads to get here, but in such a constrained environment even clean cotton drapes are at a premium. Before she wheels the mother away from the operating room, the nurse pulls off her own surgical gown. She turns it around so that she can drape the clean side, warmed from hugging her scrubs throughout the procedure, across the patient's body. Covering the indignity of the incision, blocking off the draft. The clothes off her own back.
Lifebox is proud to work with nursing communities around the world and today we just wanted to say thank you.