Society of Rogerian Scholars

Martha E. Rogers, Founder

My Heart is Naked by Cheryl McGaffic, with extracts from email discussion list

To read Cheryl's obituary, please scroll down, to go to Cheryl's memorial page please click here

From: Francis Biley [SMTP:sys812000@yahoo.co.uk]
Sent: Tuesday, February 19, 2002 2:09 PM
To: Martha E. Rogers Center
Subject: Reply to Bear's thread

Hi
Thanks Bear! I'm reading jack kerouac's 'On the Road' (again). In it Carlo Marx (Allen Ginsberg) says something like "America, America, where are you going in your big shiny car?". Medical intervention in the USA causes an estimated (possibly underestimated) 120,000 premature deaths per year, and a good deal more suffering, hospital admission, and, for example, 3 million admissions to long term care, annually. Martha talked about this kind of thing on her video tapes, and when they were recorded she said that if she was not so non-compliant then she would not been alive at the time of the taping. Such medical iatrogenesis costs the USA an (under)estimated $76.6 billion per year. It is therefore clear that the medical industry is creating its own marketplace. But this is an ethnocentric discussion. Is there a nursing shortage for the 70-80% of the world population, about 3,500 million people, who are not lucky enough (??) to suffer at the hands of allopathic medicine? "Bedside nursing" as Cheryl put it conveys a picture of medical model nursing that I think we are all trying to get rid of somehow. Martha said that she sees the future of nursing in the community, where we are really needed - to misquote her "why are 70% of all nurses working in the hospital, when 70% of all patients are in the community". So what do those 3,500 million people who dont have nurses do? :-) Fran

From: Cheryl McGaffic" <mcgaffic@nursing.arizona.edu>
Sent: Tue, 19 Feb 2002 16:30:40 -0700

OK Fran, I'll bite. Bedside nursing does not need to be the "medical model" that you suggested. We teach " Nurses as Care Provider for Complex Health Experiences." (an undergrad "critical care-med-surg") course from a phenomenological perspective using Benner's thinking-in action and reasoning in transition approach to nursing. Students MUST ask patient and family what the meaning of their illness experience/hospital experience is and develop interventions (or pattern appraisal using Rogerian-speak) based on the elicited meaning. We also teach highly technical skills, whether we Rogerians like it or not, are important for the continued pattern manifestations (at least in this dimension). Yes, 70% of people are in the community, but in the U.S. 70% of people die in community-based institutions (e.g. LTC, tertiary care). We have a responsibility to these people until (or even if) our health care system changes. We do not have the same health care system that is in the U.K. I believe that nurses, particularly unitary nurses, need to meet people where they are, sometimes in the community or sometimes in community based institutions. I despise (is that strong enough?) the "medical model" of health care. However, I have a much greater opportunity to provide a unitary perspective and make unitary changes if I am in the system that respects my abilities as a "critical care nurse". You also do not have guns in the U.K. I spent my morning helping one of my undergrads clean the blood and brain matter off the back of the head of a 23 year old who attempted to kill himself after killing his girlfriend. The blood and brains had been on his head for four days. We talked about how much pain he must have been in to do this (in direct opposition to the nurses who were "punishing him" for his actions by ignoring his basic needs). We held his hand. We talked to his mother who "noticed" that someone had washed his hair. This is "med-surg" nursing. I struggle daily with translating Rogers' SUHB into a language that my students can understand, and more importantly a philosophy of nursing that they can embrace. We talk (actually I talk) about integrality and what it means for us to be integral with the people we care for and for each other. The challenge for all of us, I think to teach the next generation and practicing nurses in ways they can understand and in the environment they understand. In my two conversations with Martha, I have the sense that that was her wish for us all. Otherwise the SUHB dies with us. I also think that we must also appreciate the pattern of health care in our respective countries and strive to change the pattern it from an emic perspective instead of an etic perspective. That is all I meant about including the perspectives of the "bedside nurse." We have to understand the meaning of nursing from their perspective before sharing ours. I've attached a Word file of an essay I wrote (for those who care to read), a gift for my clinical lab group that stayed in the hospital with me on 9/11. It is the Pandimensional world of teaching nursing for me. Thanks for the dialogue.

My Heart is Naked by Cheryl McGaffic

It is 2:00 am. I cannot sleep. This has happened a lot since September 11. Just like everyone around me, I go on with my daily life but in the back of my mind I know that the world has been forever changed and that my world has been forever changed. Last evening on the news a 9-year-old girl named Sarah read a letter she wrote to all the nurses who cared for those who were injured at the World Trade Center. She thanked them for their work and wanted them to know she was grateful that they were there caring for the sick and injured. I wept as I listened, for myself, for the world, for the patients I saw that day with my students.

My Heart is Naked

Sometimes I question the wisdom of continuing on in a profession that is under siege and under valued. I am aging, I am tired and some days I don’t know how I can continue to teach the newest and brightest of our profession. I started my day with Vicki who is taking care of a 74-year-old man named Fred who is critically ill with cardiogenic shock. He is receiving 6 drips, mechanical ventilation, and has an arterial line and pulmonary artery catheter. Vicki is overwhelmed. Her preceptor is overwhelmed. Fred is overwhelmed. All I see is a naked man save a pillowcase thrown over his groin with a fan blowing on him. Fred looks like my father. I ask Vicki to help me put a gown on Fred. The nurses explain that Fred has a fever and that they don’t want him covered up. I explain that he has the fever due to Systemic Inflammatory Response Syndrome. He has had this fever for 4 days; I explain the hypothalamic set point. I explain the science of fever management in critically ill adults. I explain human dignity and that most of us don’t want to be naked in a room full of strangers. The charge nurse removes the gown and places a cold fan and cold towel on Fred. Fred is naked again.

My Heart is Naked

I move on to the next unit to see Jeanette. Jeanette is always calm. Her patient has just developed SVT at a rate of 140. He has endocarditis. He is hypotensive. Her preceptor is coming unglued. I suggest we put him back in bed and place oxygen on him. I have to walk the length of the unit to find an oxygen adapter. I am short of breath. He almost passes out. The preceptor leaves us because Jeanette and I are handling this. The preceptor is a float nurse and has to go assist with a cardio version. I can see on this patient’s face that he is afraid. We stay with him. I hold his hand. Jeannette speaks to him in their native Navajo language. He converts on his own to sinus rhythm. Jeanette is sensitive and she comforts him. Jeanette is a healer. The preceptor later asks me "what Jeanette did" that caused the man’s SVT. I remind her that the patient is on a cardiac unit being monitored and that Jeanette responded appropriately and well. I worry that our profession will eat Jeanette alive because she is kind and quiet and genuinely cares for people.

My Heart is Naked

I see the rest of my group. I go to the library to get an article on the state of the science of fever management. I share it with Vicki and her preceptor. Fred is still naked. I take two students to work with Jennifer’s patient. He has a tracheostomy, chest tubes, a midline wound from a gunshot wound x 8 related to gang violence. He is 21 years old. I remember him from last week when he was in the ICU. Now he is "better". Now his eyes look vacant, he is almost catatonic in his responses. I ask him if he feels sad. He blinks twice for yes. We talk about what has happened to him. He cries. We do his dressings, his trach care, we clean his mouth, and we rub his back. Tracy, his nurse and a former student of mine thanks me. Tracy wipes the tears away and wipes his brow. She now has six patients, five are as sick as this young man. Faith is crying in the supply room because she feels so badly about this young man whose life has been irrecoverably altered. Faith tells me that she will pray for him.

My Heart is Naked

There is a patient who is actively dying of cardiomyopathy. She is my age. I see her two young daughters in the waiting room. I ask Rosie, who is 14 how she is doing. She says, "Not too good, my mommy is dying." We talk about death. We talk about her mommy. Three of my students have cared for this patient and her daughters during the past 7 weeks. I go get Phyllis who bonded with the girls and her mother. I tell her she could go say goodbye if she wants to. I talk to the nurses who are also grief stricken. I encourage them to support the girls and to talk with them. I go in to see the patient. Phyllis is there stroking the patient’s brow. Phyllis will be an awesome nurse. Rosie tells me her mother is seeing angels now. She is talking to their grandmother who died several years ago. I explain "nearing death awareness" to them. Phyllis and I say goodbye, I know that this patient will be dead by tomorrow. Phyllis and I cry on our way to post conference.

My Heart is Naked.

We review a case study about Multi organ dysfunction syndrome. The students are tired. They have worked very hard. They have done very well. Tomorrow is their last day of clinical. I lead them through a guided meditation on healing. Some weep. Others talk about how much they have learned about themselves this semester. They are wonderful. They will all be great nurses. I finish checking them off on their skills after post conference. I meet with another student to help her with pathophysiology. She brings me home baked chocolate bread because she heard that I was sick and that she was worried about me. I am deeply touched by this deliberate act of kindness.

My Heart is Naked

Cheryl's Obituary

Cheryl Mallernee McGaffic Cheryl Mallernee McGaffic was born Cheryl Denise Mallernee on Easter Sunday, April 6, 1958 in Phoenix, Arizona. She married Walter Arden McGaffic on January 8, 1983, also in Phoenix. She lived most of her life in Arizona, with brief sojourns in upstate New York and Boston, Massachusetts. She died October 28, 2002 at the University of Arizona College of Nursing in Tucson, Arizona. She is survived by her husband, Walter McGaffic of Tucson; her parents, Jack and Doris Mallernee of Sierra Vista, Arizona; her brother and sister-in-law, Steve and Candy Mallernee of Peoria, Arizona; and many relatives, friends, and colleagues. She earned both a B.S.N. and a Ph.D. in Nursing at the University of Arizona. Her doctoral thesis was based on the spiritual aspects of death and dying; this was to become her primary career focus. She was a nursing professor at the University of Arizona at the time of her death. Cheryl's academic and educational accomplishments were many, and she was involved with numerous professional, community, and social organizations; but those accolades were not what mattered most to her. The defining aspects of Cheryl's life were her connection to God and her relationships with people. She felt a profound interconnectedness to her family and friends, to her students and colleagues. This was the center of her personal view of life, the essence of her spirituality. Her special interest in the spiritual aspects of the end of life touched many and encompassed the spectrum of bereavement. She had a special gift of reaching those in grief. It was part of who she was. She made career choices consistent with this gift: she embraced the most hopeless and desperate patients, as evidenced by her work in oncology, in the ICU, with AIDS patients, and as a volunteer chaplain. Most recently, she was on the verge of change in her professional life. She loved teaching and cherished education; however, prior to her death she contemplated the pursuit of a Divinity degree or vocation as a hospital chaplain or Episcopal deacon. The circumstances of Cheryl's death might seem a mockery of her passionate spirituality. This is not the case. Her belief in God and her love for us were not and never could be taken from her. Still, she has so suddenly been taken from us. We miss her. Cheryl's family would like to extend their most heartfelt thanks to all who have offered their support, prayers, and love. We apologize to those we have not thanked personally; it would be impossible to thank everyone individually, because the outpouring of love has been infinite.

Author unknown, with thanks to Tracy Edwards.