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Could you survive as an NHS nurse? 

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Carry on, nurse: The opening ceremony of the 2012 London Olympics celebrated the NHS
Carry on, nurse: The opening ceremony of the 2012 London Olympics celebrated the NHS Credit: Getty

Peter Dorward reviews The Language of Kindness: A Nurse's Story by Christie Watson

My next to last patient yesterday was, as it happens, a nurse. She was in a terrible state. Although highly trained – a specialist in intensive care – due to “short staffing” she was “on the bank”, so never knew at the start of each 12-hour shift whether she would be caring for 30 bed-bound, screaming, demented elderly, or running a critical acute medical ward, or slopping moisturisers on dry skin in dermatology outpatients. She’s 28 but looks 10 years older. She picks at a patch of eczema on her right palm. Stress habit.

“I don’t even feel competent to do my job. How could I? I don’t know what the job is half the time. The only thing I know is that when it goes wrong, it’s my fault. And do you know the worst of it? I scarcely care anymore. It’s like I’ve forgotten how to be nice.” Casting around for some kind of halfway honest response to this, I found myself saying: “I just finished reading this brilliant, inspiring book, about nursing. It’s called The Language of Kindness by Christie Watson. You might like to try it…”

On the face of it, this is an autobiography, describing a journey that I think must be a common one: a callow teenager who is bright and sensitive but doesn’t get the point of study emerges from a jumbled adolescence and learns, through nursing, to love, to care.

It’s a tender and beautifully written account of how this process – learning how to be kind – challenges, teaches, sometimes harms, and then completes a person. Watson, who won the Costa First Novel Award for her 2010 Tiny Sunbirds, Far Away while still a nurse, is extraordinary in her capacity to remember and evoke the terrifying cluelessness of a 20-something who finds herself ill-equipped for the high-stakes world of caring for the sick.

At times, this process of assimilation is funny: she showed the carry-out-chicken guy around a surgical ward, mistaking him for the consultant. More often, her stories cut to an emotional truth. She formed a connection with a schizophrenic Caribbean man who played chess on “an antique board that smells of the sea”, and was beguiled by his mystifying reflections on art, surrealism and dreams, then horrified by the violent climax of his tragic illness. Of watching her first delivery, she writes: “I am crying and crying… I can’t stop… I try not to think about [the patient’s] skin. The thinness. The tearing…”

Christie Watson, former nurse and winner of the 2012 Costa First Novel Award Credit: John Lawrence

Binding the narrative together are accounts of her teachers, those instructors in this nuanced “language of kindness”. There’s practical Sue from Skegness, a psychiatric charge nurse with nicotine-stained fingers and bright purple eyeshadow, who “speaks the smell of cigarette smoke”. There’s heroic Anna, whom Watson “follows around like a lost puppy… She does everything, from cleaning a dirty toilet rather than wait for the cleaner… to arguing with the neurosurgeons about treatment plans”.

And there are the uncelebrated, invariably underpaid minor characters: Bola the cleaner, who sings hymns as she does the washing up and feeds the tired staff bullets of dried spicy fish from a foil-wrapped stash in her hand-bag; or Malin the play-therapist, who prepares children facing neurosurgery for anaesthetic.

There are monsters, too – the nurses and doctors who have lost the capacity to care, or never had it. They are almost as important to learn from, but Watson doesn’t linger with them: it’s not the story she wants to tell.

Her accounts are never mawkish or cloying. They are intense, at times overwhelmingly so, but Watson’s prose is measured, her words respectful, her metaphors apt. There’s no fakery here, no false feeling. Which tells us something important, I think, about Watson’s language of kindness, and how to speak that language well.

In the latter part of the book, the learner has become the expert. In passing, of a child dying after a house fire, she writes: “Jasmine is not the first child I have christened.” Imperceptibly, she has made that transition to becoming the model others look up to. It is now she who instructs a student in the tender art of “laying out” a body, explaining that “sometimes it helps to talk, out loud, as if the child is still here…” But she fears that she has lost the capacity to cry. As she demonstrates to her student the importance of the temperature of the water used to wash the child’s body, “my face is so dry, it itches”.

Underlying everything, quietly stated (this book, even at its most polemical, never moans), is the high cost of kindness to its practitioners. In the last chapter, we find that, after all this long learning, Watson is leaving nursing. We don’t quite know why.

There are allusions, latterly, to burnout, compassion fatigue, the sheer grind of soldiering on in a system that at times seems to hate you. But this book is never bitter. It’s full of longing, for more compassionate times. It reads like a love letter to a profession whose values are threatened, even dying – but it’s always kind.

Peter Dorward is a GP and author of The Human Kind: A Doctor’s Stories from the Heart of Medicine (Bloomsbury, £16.99)

The Language of Kindness is published by Vintage at £14.99. To order your copy for £12.99, call 0844 871 1514 or visit books.telegraph.co.uk