After escaping an apartment fire eight years ago, this nursing student realized it wasn't the heroics of the firefighters that touched her most. It was the support of her community. She compares these "small but immeasurably meaningful gestures" to the the work of primary care in this touching story of self she developed at last month's second annual Gregg Stracks Leadership Summit.
By Laura Roberts, R.N., B.S.N.
Eight years ago, I was living in a second-story flat with my then-boyfriend-now-husband Jeff in Madison, Wisconsin, where I was starting my second year of college. We’d been living together for a few months and had put a lot of love into setting up our little space. We’d scoured the local Salvation Army for the funkiest floral-print couches. We’d painted the living room walls pumpkin orange, hung his zombie and skateboard art alongside my cheerful bird paintings, and filled a new fish tank with a couple of googly-eyed goldfish. The place was eclectic and cozy and felt like home.
On a Tuesday night during my second week of classes, we turned off the lights, locked the doors and went to bed around 11:00. A few minutes after 2:00, I woke abruptly. Though I was half-asleep and blind without my glasses, I knew something was wrong. I woke Jeff and we sat up in bed and looked out the window and saw flickering orange lights dancing in the glass of our neighbor’s window. It took a minute to understand that the popping sounds we heard were coming from our living room. The flames we saw in the neighbor’s window were in fact a reflection of the fire in our own apartment.
We sprang out of bed and opened the bedroom door. Thick smoke immediately surrounded us. Through the haze, we saw ceiling-high flames consuming the living room and kitchen, melting the orange paint and devouring the floral couches. The heat was oppressive and the apartment was filling with smoke, but as I turned toward the back door Jeff ran toward the living room in search of his beloved cat. I dragged him out the door as the living room ceiling started to crumble.
The hair on his arms had been singed off. Both of us were smeared with ash. We left the porch door open in the hope that our cat would escape. Neighbors streamed out of their houses and sirens roared as fire trucks arrived. The firefighters eventually extinguished the blaze, leaving our apartment a blackened, dripping ruin. A fire marshal lingered for hours to determine the source of the blaze, concluding that our old mini-fridge had overheated and was likely to blame.
After the firefighters extinguished the fire, they let us back in to look around for salvageable belongings and to search for the body of our cat. The space was still smoking and everything was black. Plastic appliances had melted into grotesque shapes, metal pans and knives had rusted, and once-invisible cobwebs had become thick black ropes in the ceiling corners. The carpets, soaked by hoses, were squishy. Soot covered every surface. Everything we owned was destroyed except for our sweet cat, whom we were overjoyed to find cowering outside.
Those first few days after the fire were some of the most illuminating of my life. I learned a lot about my own strengths and weaknesses. I learned about true priorities. And I learned how important small kindnesses can be. The apartment management put us into a new place by that afternoon, and as we sat on the hardwood floor in a daze, Jeff’s friend Jamie showed up. I hardly knew her but she took my hand, ushered me into her car, and drove me to Target to buy underwear because I had none. A few days later my coworker Teresa—whom I had worked with only a few times—showed up at my new apartment with a bag full of clothes for me, because she had heard about the fire and we were about the same size. The firefighters had heroically put out the blaze, but those small gestures were the first steps to reassembling my world.
Primary care is like those gestures. It is not as overtly exciting as firefighting or emergency surgery in an E.R. trauma bay, but thoughtful, caring primary care provides patients with the smaller pieces that add up to a healthy and satisfying life. Primary care addresses the small but vital barriers to solving the bigger problems. In my work as an RN in acute care, I see patients who are terrified that they will lose limbs to their diabetes but don’t have the resources or knowledge to acquire and administer the insulin they were prescribed. I see patients who have gone months without taking their beta-blocker because they hate how it makes them feel but have no idea that there are other options. In primary care we have the opportunity to coordinate care, to listen to patients about their needs and barriers, to connect patients with resources to help them obtain medications and make it to appointments, and to work with patients to find a treatment plan that fits with their lifestyle, their needs and their goals.
These actions may not be as interesting as the procedures and interventions that make medicine seem so exciting from the outside, but I chose to pursue a nursing career in primary care because I believe that these immeasurably meaningful gestures help patients build a healthy and satisfying life on a foundation of thoughtful, individualized, patient-centered care. Just as I could not start to rebuild my life without underwear and clothes, a patient cannot benefit from specialized medical care without first overcoming basic barriers to access, communication and clarification of individual goals.
Yet as I make my way through my family nurse practitioner program, imagining a career of changing lives one small gesture at a time, I am repeatedly discouraged by the realities of the American health care system. I meet patients who haven’t seen a provider for years due to lack of insurance or access. I observe rushed ten-minute patient appointments with hardly enough time to scratch the surface of a patient’s true needs and concerns. I see conflict and mistrust between physicians and nurses, specialists and internists. And consequently, I see patient after patient slipping through the cracks as once-manageable health problems become insurmountable.
These experiences give me pause. I don’t want to just march into a struggling health care system and willingly fall victim to the existing constraints and challenges. Yet despite these discouraging experiences, I’m not willing to just walk away from primary care. I feel strongly that—like clothes and underwear after a fire—primary care is the foundation of a healthy and satisfying life. Rather than walk away, I decided to work toward change. Primary Care Progress has offered me that opportunity. And after I joined, I discovered that I am not alone in my frustrations or in my convictions.
At last month’s Gregg Stracks Leadership Summit, I met primary care trainees from across the country that are committed to investing their collective energy and unique perspectives in rewriting the story of primary care. At the summit we spent two days learning how to harness our passion to mobilize our communities and effect real change, and I came away energized and eager to get to work.
I am now back at the University of Southern Maine School of Nursing, where my chapter, like chapters across the country, is rolling up its sleeves and taking action on campus, in our community and as a part of a national movement. Primary Care Progress has given me a channel for my energy and passion for primary care, but perhaps more importantly, it has given me hope. My frustrations and fears have been replaced by optimism and a strong conviction that by working together we can improve interdisciplinary education and practice, bring justice to care delivery and access, and establish primary care as the backbone of a thriving American health care system.
Laura Roberts, R.N., B.S.N., is a second-year family nurse practitioner student at the University of Southern Maine. She works full-time as a cardiac nurse at Mercy Hospital in Portland. She looks forward to a career in primary care and preventive medicine.
Read other posts about the Gregg Stracks Leadership Summit.
Read other stories of self.