1. Mysko, Madeleine MA, RN

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I entered my three-month rotation at Seton Psychiatric Institute through a leafy drive, a pastel tunnel of old trees and flowering shrubs. I was 19 years old and eager to leave behind my dark and creaky nurses' residence in downtown Baltimore. So Seton was a welcome escape, with its sloping lawn and the distant, treeless hill where the home for elderly nuns gleamed.


Even the "chronic ward"-as it was called in 1966-had a wholesome, scrubbed charm, not unlike a nursery suite tucked under the eaves of a Victorian mansion. On the top floor of the hospital, it was a low-ceilinged space checkered by light from a row of dormer windows.


The patients on the ward had severe dementia, confined mostly to chairs or beds. We student nurses were kept busy, where it was back to the very basic principles and practices of nursing-wash basins, toothbrushes, towels, and sheets. The psychiatric interviewing techniques we had learned on the acute care wing seemed to no longer apply. On the chronic ward, we were more concerned with getting our patients to open their mouths for the spoon.


On the first day of our chronic ward rotation, each student was assigned a patient. Mine was a large woman with a broad face and pale blue, empty eyes. Her shoulder-length hair was the color of an old linen tablecloth, much like my own grandmother's hair.


She never spoke, never made a sound. Feeding her breakfast was a long and miserable affair over a bowl of thinned oatmeal. "Would you like another taste of your oatmeal?" I asked. "How about a sip of your juice?" I even mentioned the weather. After a while I gave up this one-sided conversation, putting my energy into helping her finish the meal. Sometimes she opened her lips when I prodded with the spoon. Other times she did not.


I felt more comfortable providing morning care, which required only diligence and a firm hand on the wash-cloth. I threw myself into it, taking my time, for she was my only patient and I didn't know what else to do. When at last I emptied the wash basin, I could say with satisfaction that she was clean. Even the few teeth in her mouth were clean, for I had managed to swab them thoroughly.

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I decided I ought to do something about her hair. I brushed and brushed, delighting in the simple busyness of it. Beyond the windows of the chronic ward, the morning was as pretty as a Disney fairy tale, but I was looking forward to the afternoon, when my boyfriend would arrive and take me out for a ride. I got out the comb, made a sharp part down the center of the woman's hair, and brushed and brushed again. The woman beneath the brush was as unresponsive as a mannequin.


I wonder now where I found the ribbons. Perhaps they weren't ribbons at all, but strips of bandage gauze? Whatever they were, I used them-tied into two prominent bows-to anchor her hair in stiff ponytails on either side of her head. When I was finished, I took her by the shoulders, righted her, and stepped back to appraise the effect. She gazed past me with her dull blue eyes and listed to the side again. She looked like a very old baby doll.


A Sister of Charity was in charge of the chronic ward. Silently, from around a corner, she appeared, sweetly saying hello to my patient and to me. Then she lightly pressed a finger to the shoulder of my starched bib and asked me to follow her.


"Why did you tie her hair in bows?" she asked. Nearly 40 years later I still remember her words. "She's a grown woman. Why did you fix her up like a little girl?" She was smiling as she spoke, her eyes kind but ineluctable.


I was stung, embarrassed. I don't remember how I responded, but I do remember seeing at once what those two perky bows really meant: I had made that woman into nothing more than my project for the morning.


Over the years, memories of that afternoon with the Sister of Charity on the chronic ward have returned to me many times. If she is gone now, I hope that at the time of her dying, the nurses called her sweetly by name and arranged her hair with the dignity she deserved.