Activism and Audacity in an Uncertain World: Lessons from Yale and Beyond
Patricia Butterfield, PhD, RN, FAAN
Chair, Department of Psychosocial and Community Nursing
University of Washington
Good afternoon. Dean Grey, nursing faculty, family, and friends; it is a pleasure to join you today in honoring the 2006 graduates of the Yale School of Nursing. In extending her invitation for me to speak with you today, Dean Grey gave me only one charge; that I focus this address on the topic of activism in nursing. Knowing Margaret Grey, I was not surprised that she asked me to address this topic, since she, more than many Deans, understands the role of the university in providing a forum for provocative ideas. However, in retrospect, I think that when Dean Grey asked me to speak with you, she had no idea that one of my most powerful encounters with nursing activism occurred within the confines of the Yale campus....during my first trip here on a fall day in 2002.
I had received an invitation to come to New Haven to participate in a conference titled "The Ecological and Health Effects of the Vietnam War." At the conference, I was given the role of respondent and asked to give my perspectives on a number of the sessions addressing the health effects of exposure to dioxins. At this point I must admit to you that I am a generally a "tired" conference attendee at best, and often a cynical one. I've spent quite a bit of my career thumbing through conference materials, usually after an 8 hour plane ride and a restless night at the local Marriott or Hyatt. So it was somewhat of a shock to come to the first session of the Vietman conference and have a number of my favorite myths shattered. Myths about power sharing, myths about inclusion, and a cherished myth that involved my own reconstruction of the Vietnam war. Each of these myths was shattered by a shrewd nurse, a proud veteran, and Yale alumnus named Dr. Linda Schwartz.
The first thing that surprised me about the Vietnam ecology conference was that the room was full of Vietnamese people. Wait a minute; I thought... this was "our war," not "their war." Still there they were in masse, flown in from Hanoi courtesy of Dr. Schwartz. Not just a few token Vietnamese mind you, but a large contingency of Vietnamese scientists and clinicians, standing there by the coffee and muffin table.
The second thing that surprised me was that "their" version of the war was different than mine. As a teen growing up in rural Colorado, I credited Vietnam with my own birth as an activist and small town rabble rouser. My memories were almost exclusively based on CBS evening news footage. Each Friday Walter Cronkite or Dan Rather would report the week's casualties, saying something like "106 Americans were killed and 43 were reported missing in action this week." They Dan would report the estimated number of Vietcong killed that week, providing a suitably favorable ratio of our deaths to their deaths. Even as a 14 year old, I thought "how can they know that?" "Do they go out in the jungle and count the bodies?" "Isn't that a dangerous thing to do?" A disturbing version of the war it was; actually disturbing enough to drive me into the local political scene...going door to door in Montrose Colorado, soliciting contributions for the 1972 democratic presidential nominee, a remarkably unpopular and, I can assure you, financially hopeless activity.
Through the magic of television and my own propensity as a news junkie, I became a witness to the Vietnam war from the time I was 14 until I turned 19. Despite knowing subconsciously that my version of the war was in black and white, I never really thought of it as the filtered TV version. It did not dawn on me that my version of the war was shot from a cameraman in a helicopter, looking down into the battlefield. I wasn't in the war, I was above it. So imagine my surprise when, 30 years later, I heard what it was like to be underneath the bombs, instead of above them. Convened in a beautiful auditorium at the Yale Law School, I listened as Vietnamese citizens and American veterans shared their versions of the war, and they were a lot noisier, more chaotic, and deadlier than mine.
My cyber version of the war had a soundtrack of muted helicopter noise. Their version knocked them out of bed in the middle of the night. Their version was one of mayhem and indiscriminant violence. Their version was filled with uncertainty and the need to create the illusion of normality in an abnormal time. In their version of the Vietnam war, friends died, children became orphans, and ecosystems were destroyed.
That day, for the first time, I got it. And it is funny that until you "get it," it is almost impossible to see that you were not "getting it." As a teen I had constructed and reconstructed my own version of the war. It was a relatively sophisticated version for a 15 year old teen growing up during the 70's. But as an adult, I had held on to my sanitized account of Vietnam, taking it out and brushing it off when I could benefit from some smug self-contrived sense of my self as an activist. What I learned at Yale four years ago was that my adaptation was veneer, a thin surface of reality, but without much substance underneath. I finally understood that only those who had personally experienced the war could understand the full cost of that conflict.
That is the power of a transformational experience. And in my case, the stage for my transformation was set by the insightful efforts of Dr. Linda Schwartz and the Yale School of Nursing. Today, Dr. Schwartz is the Commissioner of the Connecticut Department of Veteran's Affairs, the first woman and the first nurse in Connecticut's 140 year history to hold this position. I am pleased to announce that Dr. Schwartz is with us today, and I'd like her to stand and be recognized by all of you.
But as we all know, Dr Linda Schwartz is not the only nurse, nor the only Yale graduate to set the stage for others' transformations. That brings me to a discussion of those in attendance today. First, I wish to honor the contributions of family and friends to the success of today's graduates. I stand here as one of you, flying into New Haven late last night directly from my son's graduation. We left for the airport directly from his commencement at Notre Dame, where he received an undergraduate degree in physics. So I too stand here as a family member, understanding the sense of pride that family and friends take in the achievement of those they love.
Now I would like to speak directly to those of you who are graduating today. I have struggled with several months with the notion of my "charge" to you. You already carry the expectation of clinical competency with you, and that alone is no small feat. Your employers, as well as your family members, expect you to be able to move nimbly within the worlds of pharmacology, pathophysiology, and epidemiology. In those worlds, patients' conditions change by the hour and sometimes by the minute. Why is it not enough to go boldly into the clinical world, armed with a PRD, motivational interviewing skills, and low cholesterol dietary instructions? Why is it not enough to heal the sick? The answer is simple; in today's world clinical skills are necessary but not sufficient for the practice of nursing. They are not a sufficient response to the global burden of disease. They are not a sufficient response to a health care system characterized by a maldistribution of resources to need. And they are not a sufficient response to questions about the sustainability of our planet.
What is needed today is a sense of outrage, a sense of urgency, and a sense of audacity. I resisted the temptation to give you my laundry list of things wrong with health care; and it wasn't easy to keep from unloading all my special issues on you. Because I know that you have your list of things to work on. It was not easy to refrain from inserting platitudes and superlatives into this address. I've been coming to such events for 25 years, sitting out there, tinkering inside my head with the subtleties of the perfect imaginary commencement address. I also thought about the address given when I received my doctoral degree from Oregon Health & Science University. What I learned from thinking about that day was that sharing my pet causes would not be very memorable for you either; anymore than hearing then Oregon Governor John Kitzhaber talking about living wills and advanced directives at my commencement. The only thing I actually remember about his address is my mother's comment as we left the auditorium, when she turned to me and said "I think your Governor wants to knock off all the old people like me so he can save a few bucks." Ah, the nuances of a detailed policy discourse, shattered to bits by a grandmother's "cut to the chase" vernacular.
I know you have your own list of things to fix. Do not lose that list. Although it seems like an obvious time to get to work on fixing thing, there are many distractions that will keep you from getting to your list. Some distractions are obvious; among them are the pesky reality of getting a job, the pervasive fear of not passing the certification exam, and the looming college loan repayment schedule. However, the most dangerous distractions are the most subtle. It can be easy to lose enthusiasm for the power of an ideal in the face of others' cynicism. Life can seem more comfortable once you resign yourself to playing it safe, moving comfortably into the world of waiting rooms with aquariums. It is tempting to tell yourself that you've been in school for a long long time and there is nothing wrong with making some money for a change. Frankly, I do not think there is anything wrong with making money either, and after a Yale education, my guess is that your families think so as well. But, please ... keep your sense of activism and outrage close at hand. Do not insulate yourself from the raw feelings of your ideals. Although activism efforts are sharpened by the power of thought, they originate from compassion and reflection.
It is difficult not to pander to you. But today is too important not to speak candidly and from the heart. Today I am asking you to remember the example of Dr. Linda Schwartz, and how she re-wrote my life view of war in a 2 day conference, all without leaving the comfort of a Yale auditorium. Bypassing my business suit and somewhat composed exterior, she struck a direct blow to my comfort zone; in a way that completely reset my clock. By doing so, she helped reset my assumptions about justice, imperialism, the pretense of authority, and the importance of speaking truth to power.
To the graduates of 2006; I know that you, as well as Linda, hold the power to transform lives in your hands. You are the very best of what our profession has to give. We are living in an uncertain time and we need your talents, insights, and new ideas unleashed. I ask you today to act with an unguarded heart on behalf of our nation and our planet. Congratulations and welcome to the struggle.
