Healthcare Workers Are Not Okay

One day, when we are finally back to normal life, the Covid-19 epidemic will stay with us as a mosaic of images pieced together from things lived and things seen. For me, that will include a photograph of a nurse taken in March 2020, her face rubbed raw from constant contact with the personal protection equipment (PPE), which she was nevertheless lucky to have. The pandemic has shined a light on the intense, relentless, herculean efforts of the healthcare workers too many of us have taken for granted. It is this overlooked labor that Emma Glass asks us to consider in her new novel, Rest and Be Thankful. 

The narrator of this slim and haunting work is Laura, a pediatric nurse at a historic children’s hospital in London who is suffering from insomnia and the emotional strain of her job.  As time goes on, Laura becomes so worn down that doctor’s instructions mingle with Victorian ghost stories in her sleep-deprived mind. While it may be clear to the reader that Laura is burnt out, she doesn’t consider taking a break and presses on, dutifully showing up for work and caring for patients even as her grip on reality frays. 

Glass—whose first novel Peach was long-listed for the International Dylan Thomas Prize—is a practicing nurse, and she describes life at the hospital in rich, almost palpable detail. Such intimacy creates empathy for Laura and her fellow nurses, ultimately leaving the reader to ask if they falter, who is to blame?

Carrie Mullins: In Rest and Be Thankful, Laura is a pediatric nurse in London. Her job is intense, her relationship is breaking down, she’s sleep-deprived, and she starts to see weird things. I read that you were inspired by a ghost story?

Emma Glass: Yeah, the inspiration for the story came from a ghost story that I was told as a newly qualified nurse. My first job was in a children’s hospital in central London, which is where I’m working again now, actually. For the first day or two, you sit in a big lecture theater with all the newly qualified nurses and they tell you about the kind of the kinds of treatments that are done at the hospital and the history of the hospital, which is really interesting. During that presentation they told us a story about a nurse who worked at the hospital in Victorian times. She was on a night shift feeding a baby, she fell asleep and dropped the baby. The baby died and she wasn’t ever able to forgive herself, so she threw herself off the top of the stairwell of the old nurses’ home and committed suicide. The story goes that she is on patrol and if she ever encounters a nurse who’s falling asleep on a night shift, she pinches them on the shoulder to prevent them from making the same mistake that she made. There’s been lots of sightings of this Victorian nurse ghost who wanders through the hospital at night, with all the ruffling of skirts. 

CM: That’s a really intense story to tell new employees on day one.

EG: Yeah, it really struck me as odd and I had to go back and speak to some other people, just to make sure that I hadn’t imagined it because it was sort of a strange time to tell this story. But nurses are very superstitious and hospitals are very atmospheric. So that’s kind of where it started, and it shaped the book. 

I set out to write a ghost story. But of course, it never just turns out to be one thing, it turns out to be a hundred, and you sort of go along with it. And so yes, I really was intending to write a feminist perspective on emotional labor in the workplace.

CM: It’s funny you say that because I did think Rest and Be Thankful dealt with feminist themes. I actually just interviewed Avni Doshi about her novel, Burnt Sugar, in which the protagonist is also a woman who also sees things that may or may not be real.

Reading both books back-to-back made me think about how it tends to be women who question our own sanity. I think it comes from the practice of telling women they’re unstable; there is a lot of gaslighting —oh you’re just being crazy, you’re just being emotional, you’re not seeing this rationally—and that leads women to question their very sanity.  

EG: Absolutely.

CM: I felt like it was also part of your exploration of the nature of perception. For example, when Laura is on the subway, and people are looking at her, and she’s looking at them, and there’s this very poignant moment of “we can see each other but we have no idea what the other person is really going through.”

EG: One of the things that I was taught when I was training was that you’re supposed to have this professional front, you’re supposed to have very clear boundaries between yourself and the patient. It’s to protect us, but it’s never that clear-cut. How can you look after a family for twelve hours a day, five days a week, and not show them glimpses of yourself as a person? You have to look at them as more than just the illness they present with. So there’s inevitably this crossover. And yet women are still often blamed for that intensity of emotion. 

Something that I really like to explore in writing is how can you possibly have that kind of feeling over a career and not have some sort of impact or some sort of damage? When you go home, you’ve got to put that somewhere. And we do not get free psychology appointments or spaces or counseling to be able to deal with that. It’s just kind of a done deal, that that’s what we sign up to, and we have to deal with it in our own way. That’s something Laura doesn’t do very well, she doesn’t put it anywhere—it’s ever-present, to the point where she’s on the brink of madness, essentially, because there’s no room left for anything else. It’s not a healthy way to live or be and yet, particularly in the NHS, they want 30 to 40 years out of their nurses. 

CM: That line strikes me as incredibly difficult to maintain. My younger son had neurosurgery at ten weeks old and when I was staying overnight in the PICU, I relied on the nurses so heavily for emotional support. Like every time I had to use the bathroom, I’d turn to the nurse stationed in the room and say, “I’m just going to go to the bathroom, okay?” in this kind of desperate way. I really needed her to say, no problem, in other words, you’re okay to go for five minutes, he’s okay, it’s all okay.  To be a receptacle for that kind of emotional intensity every day must be incredibly difficult.

EG: It is and it’s part of the job, and it’s actually part of the joy, having those glimpses into other people’s life. There’s an inherent trust when someone comes in and says, I’m taking care of you and your child today.

Where Laura is working is based a little bit on my experience of nursing children who were immunocompromised and had very, very serious illnesses. One patient was nursed in a single room for eight months and the parents were there all of the time. And, you know, it’s that whole thing about reassuring someone going to the bathroom, even saying to the parents, we’re here if you guys want to go out for dinner.

In Rest and Be Thankful, I go to the very dark places where things don’t always work out so well, but often it’s happy stories: we treat illnesses, we make people better, they get to go home, and you get to share in that joy. When you say you’ve been discharged today, and the kid’s so excited because they get to go home and see their brothers and sisters, and the parents are grateful, because if it wasn’t for something that you have done, their situation would be really different. To be in the room when a doctor says your child is disease-free, there’s nothing that beats that. So with all of the sadness and the pain, there is a happy side of things as well

CM: I really appreciated how the book pushed the reader to consider those two sides of the coin, like the chapter heading: “It was better than I thought/It was worse than I thought”—I loved that. In fact, the whole exercise of putting myself inside the life of a nurse was refreshing because we don’t often see those jobs represented in literature. When you consider what literature can do—invite us into lives that we haven’t experienced and imagine what they would be like—it’s actually kind of shocking how many books are about a writer dicking around versus people doing essential jobs.

EG: Ha, yes. I wanted to show the real skill that goes into nursing work.  I’m not sure how nurses are perceived in America, but in the U.K., there is still this perception that it’s a vocational role and you really don’t need much intelligence or learning to be a nurse. Often that perspective comes from, dare I say, male doctors. I wanted to shed some light on the fact that it’s really hard work, and you have to have a level of expert knowledge.

CM: It’s crazy because if you’ve ever stayed in a hospital, you realize you interact with nurses 90% of the time and doctors about 10% of the time. The nurses are doing all this technical work, and you show it well in the book: how physical it is, the smells, the textures. Your writing is almost tactile. You know, when a mother in her grief vomits on Laura, and she just stands there, and it’s in her pockets. And that leads back to the question of how long can someone handle such an intense job?

EG: When people started talking about it being a novel about burnout, I really didn’t realize that that’s what I had written until I found myself in a position where I was burnt out. I just started a new job back at my old hospital, and I’ve had four weeks to kind of think about what we’ve just all been through and what we’re all still going through, but I genuinely do not know how I coped doing the work that I was doing in the middle of the pandemic. Plus, you know, life doesn’t stop, people still get hit by cars, children are still at risk of different things.

It’s only now I can see burnout as something that is terrifying. It’s something that we need to have an awareness of, to prevent people from getting to a point where they’re not able to function any longer. And of course, it’s not just nurses suffering from burnout, it’s everyone, it’s everywhere, because we don’t have the same opportunities to free ourselves from our situations, we don’t have the diversions, and that’s really hard.

I think what I’m showing is that burnout is an everyday scenario for people working in those highly pressurized environments, and what I hope it will do is to open people’s eyes, and perhaps people will be a little kinder now. We still get shouted at by angry parents and angry family members and we have to just stand there and, to an extent, take it because we know that the person is in a highly emotive situation, but it wears people down.

I think there are more nurses leaving the profession now, which is really sad. That’s something that I have also thought about more than once, that perhaps there is not enough support, and certainly not enough understanding of what it’s like. One of the heartbreaking things that I’ve seen through the pandemic is how there was a lot of support in the first days for the NHS [National Health Services, Great Britain’s public healthcare system] and for nurses and lots of outpourings on social media—you know, thank you to heroes, although I don’t really agree with that term—the thank yous and the donations and the kind thoughts that have gone to health care workers, and then there’s always somebody in the comments that says, quit your whining, you are paid to do that job, get on with it. And that’s true, we are paid to do it, we’re not forced to be there. But at the same time, I hope that there’s a little more understanding and kindness towards people who are in these kinds of positions.

CM: Absolutely, and to me that’s part of what a book like yours can do—open people’s eyes and generate sympathy. And to that person in the comments, I would hope if they end up in the hospital, they don’t get a nurse who’s just doing the job for the income. 

EG: Me neither.

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