Balanchine’s Corps

My favorite ballet is Serenade. It was choreographed by George Balanchine in 1935 and I love everything about it. The music (Tschaikovsky’s Serenade for String in C, Op. 48) is beautiful, the costumes simple but lovely, the movement is simplistic in parts, earning its overwhelming complexity through the symmetry of the dancers in such fine and detailed movement. In other areas it is fast, with foot work, jumps and turns at Balanchine’s classically challenging rapid pace. Other pieces of the movement are free with large beautifully leaps using the space of the whole stage. The choreography shows the dichotomy of power and grace in ballet.

For me, Serenade represents so much of what I love about Balanchine’s work. There is no story you have to follow, you can create one for yourself as you watch. If you prefer you can love it only for its beauty, without the distraction of a hypothetical plot.

In a video interview on New York City Ballet’s website Ashley Bouder, a principle in the company discusses the things that make her love the ballet. My favorite point she makes is that Balanchine “let the corps dance”. So many of the classic story ballets of the past were focused on parts performed by principles and soloist. The corps, the dancers in the background, made up the majority of the company, yet on stage they simply waved flowers in unison, performed as live scenery, or armies of fairies. Their roles were small, their parts nearly invisible, their recognition as being a part of the ballet almost nonexistent.

Given my background, I have often related the world of heath care to that of the ballet. If you think about it, they have some significant similarities. The average ballet company is made up of principles, soloists, and the corps. The principles dance the leading roles; the swan in Swan Lake, Giselle in Giselle, Copelia in Copelia, and the Prince to accompany her each time. The soloist perform smaller but technically complex roles. Their roles have titles in the program. Their parts stand out as an important piece of the ballet you have seen. The many members of the corps make up the largest group in the company. Their roles are smaller, sometimes unrecognized. In some ways, as an audience member, you don’t notice that they are there, but you would notice if they were not.

Nurses are the corps.

We make up the largest group of health care team. Our roles are significant and necessary, yet we are often recognized only for waving flowers, and often, we think that this is enough. In the responses to my Just a Nurse post, I was surprised by how many people, both nurses and outsiders, responded to say how kind and caring nurses are. That we are angels, gifts from above, we go above and beyond for our patients. Don’t get me wrong, so much of this is true. I like to think that most nurses are kind, they care about their patients, not just for them. They are willing to take a minute to do something extra, to lend a hand or give a smile.

But this isn’t because they are nurses, it is because they are people. I have known many kind doctors, respiratory therapists that are caring, housekeepers that go above and beyond. I have seen surgeons change ostomy bags that were leaking, residents help change dirty linens, nurse managers change soiled diapers. I have seen members of almost every job in the health care system take an extra moment to lend a hand or share a smile.

As nurses though we are often only comfortable taking credit for the fluffy things we do, and to be honest, it’s a big problem. Don’t get me wrong, the fluffy stuff is important, but it isn’t alone, and it isn’t fair for it to take all of the credit. Let me tell you a story.

The other day I had a sick patient. She was on a ventilator, experiencing failure of multiple organs complicated by a complex history and multiple acute factors. I cared for her a few days in a row, alternating back and forth with the same night nurse. The patient had multiple problems, but in sign out one night my coworker and I both discussed a pressing issue: what to do with her thick, curly, beautiful hair. So, we established a plan. She would shampoo it with her nightly bath and leave it in a loose pony tail. In the morning I would get to do one of my favorite things, I would set aside some time and braid her hair.

So that is what we did. In the morning I made a crown around the top of her head, pulling all of her hair into it. I used all of the gather hair to create one braid off the side of her head. I’ve perfected this braid over the last couple of years. It gets all of the hair off of the bed but without leaving any thick areas on the scalp to put pressure on an immobilized head, risking a pressure sore. At the same time it looks pretty and whimsical, momentarily distracted from the really sick child it sits atop.

Later that morning the mom visited. Over the course of her visit she and I watched as her daughter had some slight vital sign changes. I had been watching her closely and had tried adjusting a few things. Eventually, I found what I thought to be the cause of the changes and discussed it with one of the doctors caring for her with me. We developed a plan, and sure enough, the patient’s numbers improved. Later in the day, when the mom got ready to leave she thanked me for my observations and the plan I had helped to develop. She thanked me for my clinical assessment skills, my ability to implement a plan, to carry it out, and evaluate its effectiveness. Essentially, she had thanked me for doing what nurses do.

I accepted her thanks awkwardly, and as she walked away I glanced over at her daughter’s beautifully braided hair and realized something rather surprising. If she had thanked me for the braid I would have had no problem accepting. I would have engaged her in discussing how and why I had braided it. I would have been comfortable telling her I loved this part of my job, having a few quiet moments to do something special for my patient. Instead, when she thanked me for my clinical skills I didn’t engage her, I awkwardly brushed off her thanks, humbly and uncomfortably walking away.

This is something else I observed from many if the comments on the Just a Nurse post. So many of you (nurses and others) expressed that nurses shouldn’t need thanks or recognition. That the privilege we have to do our job should be enough. That knowing we made someone feel better should be enough. But what if it isn’t? Or rather, what if it shouldn’t be? What if it would benefit everyone if we were willing to take credit and say “you are welcome”?

I have been reading “From Silence to Voice” by Bernice Buresh and Suzanne Gordon on my commute to and from work. It is a worthwhile read, I highly recommend it. At one point they discuss their observation of the same issue. They wrote:

“Why would nurses diminish their agency? Why would nurses believe that backstage players should not be allowed to come to center stage and take a bow? Why would nurses resist taking credit for their accomplishments even when the credit is given to them?”

What follows is a fascinating evaluation of the historical and societal factors that have impacted this. I will let them tell you about the past, I will focus on the future.

Maybe it is time that you and I learn to accept thanks when it is given to us. Thanks for more than the fluffy caring.

Balanchine let the corps dance.

As that corps, we need to learn to take a bow.

For more information on the book mentioned above visit http://www.silencetovoice.com/
For my non nurse readers, I promise to be back with more non-nursing posts this week.

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