Image: David Blumenkrantz

Nursing can be one of those fascinating careers that always brings with it new experiences. There can be plenty of drama, surprises and emotional highs and lows. Talking with Bernardino Ramos, the head nurse at a Veterans Affairs clinic and a veteran himself, it’s apparent that for those working in the military, the extremes can be even greater.

After earning his RN at the University of Florida, the Puerto Rican–born Bernardino started his nursing career in the civilian sector, working at Olive View Hospital in Sylmar, Calif., from 1990 to 1995. Then in 1997, at the relatively advanced age of 35, he enrolled in the Army.

“For some reason I liked the military life” is his typically taciturn explanation. After receiving basic training in San Antonio, Texas, Bernardino was deployed to South Korea as a first lieutenant, and was later promoted to captain. He worked at a facility called 121 Casualty, where they dealt with “all kinds of emergency situations.” Much of the nursing done in South Korea was not battlefield-related, and Bernardino recalls one tragic emergency occurring when a pediatrician, who was there covering for another doctor on leave, was stabbed in the street.

Two years later, Bernardino found himself stationed back in the U.S. at Fort Huachuca in Arizona, training medical personnel to deal with all manner of field casualties. Fort Huachuca is home to the U.S. Army Intelligence Center and School, and when the 911 terrorist attacks happened, as Bernardino casually recounts, “We were mobilized to move into bunkers, where we spent three days.”

In 2003, he switched from the Army to the Air Force. Stationed at Travis Air Force Base in northern California, Bernardino worked with what he described as a “flying ICU unit,” going into the battle zones of Iraq and Afghanistan to evacuate the wounded. His eyes take on a faraway look as he recalls the worst of it. “It’s traumatic—they are flying out for better care, missing body parts—no legs, no arms, no faces, abdominal wounds. So many people we don’t see. We only hear about those who are killed. These are things you don’t see in civilian life.”

Four years ago, Bernardino retired from the service. He was, in his own words, “feeling crazy. Seeing patients missing arms, eyes, legs—that is stressful, not only to them, but also to those who care for them. It took me almost a year to recover from the stress,” he admits. “It was hard to incorporate myself into civilian life.” He spent six months in therapy in San Diego while searching for an elusive job in the civilian world.

The Sepulveda Ambulatory Care Center (SACC), where Bernardino eventually found work, is one of the largest facilities in the Department of Veteran Affairs Greater Los Angeles Healthcare System. Bernardino is in charge of a specialty unit known as the Blue Team, one of 10 clinics at SACC. He directs six nurses, coordinates patient care and supervises the involvement of social workers and case managers. The Blue Team sees referrals from the primary clinic—veterans suffering from physical pain, disabilities and trauma. Bernardino explains that while the majority of their patients have historically been Vietnam vets, “now we are seeing more from Iraq.”

There are also many neurological cases, as well as those that require psychology and psychiatry. While not downplaying the physical traumas that afflict war veterans, Bernardino seems particularly interested in and knowledgeable about the emotional toll of war. “I’ve been there—as a soldier. I know what’s going on with the veterans, both physically and mentally. When you are mobilized to Iraq or Afghanistan, there is stress right there. No matter if you go for three months, six months or more, you are under fire all the time. Many soldiers who come back don’t have physical wounds, but emotional ones. We see a lot of post-traumatic stress.”

The government’s undying commitment to providing healthcare for patriots who make the ultimate sacrifice for their country comes with some drawbacks. The patient population at SACC is so big that sometimes patients are told to come back for follow-up appointments after three months. Bernardino cites medical refill lapses as an ongoing concern of his. “I work with doctors, reminding them to review prescriptions to ensure that their medications last until their next visit.”

Yet Bernardino is quick to downplay public perceptions of the VA as an inefficient bureaucracy. He also works weekends at a USC extension hospital in Orange County, and is well suited to compare civilian healthcare with government healthcare. His old soldier’s loyalty comes across as genuine as he defends the VA, insisting that while there will always be complaints, “patients here are treated like family. I think the care the patients are receiving in the VA is better than in civilian life, because there they only treat ailments. Here they treat the whole person.”

He says that some patients come in for one thing and “we find other problems, like financial or transportation issues.” The social workers deal with outside issues, which include homelessness and patients treated by caregivers at home. Bernardino says the VA arranges transportation for patients coming from as far away as Bakersfield, while volunteers help disabled veterans get around on the hospital grounds. Furthermore, Bernardino asserts that when it comes to using cutting-edge technology, the VA is up to date, making it “a leader in the field of healthcare.”

On a personal level, Bernardino cites exercise as the single most important factor in relieving stress and keeping him fit for duty. An athletic 52, he starts every day with a military regimen of sit-ups and push-ups, and runs “a minimum of two miles” before showering at home and heading to work. He boasts that he still runs miles of eight minutes or less, and can still pass the Army physical with a score of 100 percent.

“That’s part of my heritage from the service,” he says, flashing a rare smile. “Exercise.” He does his best to share his enthusiasm for working out with the veterans he meets every day at SACC. “That’s what I tell the patients: ‘You learned all these skills in the military. Use your body.’ Some listen, some don’t.”

Married for 30 years, Bernardino has two children, both adults now. He’s proud to announce that his son is entering the National Guard. Since Bernardino began his career in nursing, he has added both an MSN and an FNP to his resume. He expresses optimism that the latter, which he just completed last year, will give him “the opportunity to work with veterans in a more direct way.”

See the powerful photo essay featuring Bernadino and his patients.

Image: David Blumenkrantz

Second-career nurses come from all walks of life, but few from a background so seemingly incongruous to nursing as that of Bonnie Brennan, a passionate and dedicated member of the nursing team in the ICU at Childrens Hospital Los Angeles.

A woman of many talents, the charismatic Staten Island native has a background in speech and theater, and has appeared on stage, in films and in television commercials.

For several years, Bonnie was a regular fixture in the stand-up comedy scene in Los Angeles. In the late 1990s, she worked as MC and performed regularly at the Hollywood Improv, opening for celebrity comedians like Dave Chappelle and Chelsea Handler. She has also done shows with Drew Carey, Jeff Garlin and countless others.

“I was always the class clown, even in grade school,” Bonnie laughs. “I got it from my dad, a natural performer and the consummate joke-teller. I was in awe of him growing up.”

Bonnie describes her stand-up material as “slices of life.” Relocating to Los Angeles in 1996, she was a “newly divorced 30-year-old, seemingly surrounded by 20-year-olds.” She joked about that and other topics such as her Catholic upbringing. Her compassion was already evident, and Bonnie was a regular participant in comedy shows sponsored by the Theater of Hope for Abused Women. She left the grind of the stand-up life behind when she got engaged to her second husband, a corporate executive with Robeks Juice. They have a two-year-old son named Dylan.

Bonnie recalls how her father also took her to Broadway shows, cultivating her interest in a more serious acting career. “Acting is something I’ve always done, and still do,” she explains, although since the birth of her son, there is less time for it. She tries to do one play a year. In 2008, she had a supporting role in Someday, a play produced by the Cornerstone Theater. Bonnie describes the play as being about the “trials and tribulations people go through to have children. I was passionate about it because Dylan was conceived IVF, and this play addressed that topic.”

Also a gifted writer and speaker, Bonnie has been the keynote speaker for the Johnson & Johnson Nursing Gala, and won first place honors in both the 2007 and 2009 Childrens Hospital Nursing Essay Contests. In this excerpt from her 2009 essay, Bonnie wrote about the way she was inspired to pursue a career in nursing after her experience with a home health nurse during her father’s battle with the disease. It proved to be a life-changing experience:

“While my memory of this period could very easily be one of despair, it is instead one I remember with deep gratitude…thanks to my dad’s home-healthcare nurse, Roseanne. I knew Roseanne genuinely cared about my dad’s well-being, and I was instantly put at ease just knowing that she was his nurse. She would come by on her days off just to see how my dad was doing; she would stay longer than she was required to on the days she was working; she even brought my dad Christmas and birthday gifts and, when I was back in L.A., Roseanne would call to update me on my dad’s condition and ask how I was holding up. Roseanne was more than just my dad’s nurse; she had become a part of our family. Perhaps most importantly, every time I saw my dad interact with Roseanne, he was laughing. My dad loved to laugh. I remember the exact moment I had the thought: ‘If I could give back to another family even one-tenth of what Roseanne had done for my family, then I’d really feel like I had done something truly worthwhile with my life.’ It was at that very moment that I decided to become a nurse. When I told my dad of my decision, he proudly declared, ‘I’ll be front and center at your nursing school graduation.’ As for the nurse who inspired me? Roseanne cared for my father until the day he died: April 19, 2005. Three weeks before I started nursing school.”

Bonnie began her nursing career at the relatively late age of 40. In 2005, she began the one-year program at Mount Saint Mary’s College. During her training, Bonnie did a pediatric rotation in the ICU at Childrens Hospital Los Angeles, and knew right away this was where she belonged. She received the Accelerated Nursing Award at Mount Saint Mary’s, and by September 2006 had been hired at Childrens Hospital. “I’ve never seen anything like the teamwork, the atmosphere and the caliber of care they provide for the families. It’s really tops in the field.”

In another excerpt from her 2009 essay, Bonnie expressed her awareness of the enormity of the life-changing decision she had made:

“And so…I began my nursing career in the Pediatric Intensive Care Unit (PICU) at Childrens Hospital Los Angeles, humbled to be working side by side with such compassionate and seasoned nurses, and amazed at the level of knowledge and skills that these women and men had acquired. Perhaps even more so, I was in awe of the seemingly effortless ability with which my coworkers practiced, and the pure instincts they possessed. Indeed, I began to wonder if, at such a late starting age, I would ever be able to practice at the same level, and more importantly…if I would ever be able to give back to another family….”

More than three years later, Bonnie expresses no regret, only an even deeper sense of humility as she grows into the life of nursing. “I measure myself against the nurses I work with. I’m truly in awe, inspired and honored to work with them.” She describes the ICU as being an extremely intense work environment, and reels off the roll call of parents’ worse nightmares that she and her fellow nurses deal with daily. “Car accidents, asthma, cardiac kids, cancer, children who are suddenly diagnosed with brain tumors, renal failure. The swine flu hit us very hard this past year,” she adds.

There are times when a sharp sense of humor serves to lighten the load, and Bonnie seems sincere in admitting she’s not necessarily the funniest of the bunch. “I notice there’s a certain personality type in ICU nurses,” she explains. “They’re some of the most intense, funny people I’ve met. Humor with the staff is a way to share a very intense workplace. There are a lot of tough moments. It’s nice to be able to step out of a moment of grief and find some humor with my coworkers, to lighten things up a little.”

Bonnie Brennan at work

As Bonnie speaks, it’s evident that she is truly striving to live up to the words she wrote so eloquently in her essay, “…if I would ever be able to give back to another family….” She knows that her work puts her into a position where, for many families, she becomes a buffer between them and the incomprehensible suffering their children endure, and in many cases, an intimate player in the real-life drama of life and death. When asked whether her background in acting helps her in these situations, Bonnie answers carefully: “I wouldn’t say acting, because that implies that you are feigning emotions.” She explains that, if anything, her training as an actor allows her to accept the gamut of emotions a nurse must experience. “As an actor you’re trained to emote, to access your emotions. I’ve cried a lot with families, and I don’t feel uncomfortable when families cry.”

There was no masking the hurt in Bonnie’s eyes as she did what she could to comfort a very special patient, a nine-year-old girl who died on December 30 after a protracted battle with HLH. Bonnie says that during the weeks she cared for the young girl, the first thing she did at the beginning of each shift was to hug the mother, and she admits that they cried a lot together. When the child died, the mother appreciated Bonnie’s efforts to such an extent that she invited her to the funeral.

While it’s obvious that Bonnie is gratified that she can indeed give back to other families, she keeps things in their proper perspective. “Ultimately, it’s not about me. I don’t want it to seem like my emotions are more important than theirs.” A quiver catches in her throat. “Now I am truly thankful for what I have. I get to go home to my healthy son. She [the patient's mother] goes home to make funeral arrangements.”

As if realizing her last statement was a bit too heavy, Bonnie flashes the million-dollar smile she now employs to comfort children and families. She’s worlds away from the stage lights and comedy clubs, and this is exactly what she signed up for. “I would never discourage anyone from changing careers and going into nursing,” she says emphatically. “It is so much more rewarding than you could ever imagine. What I’ve gotten out of the experience is so much more than I’ve given.”

See a photo gallery of Joseph and Christina's "Day in the Life"

The idea to enter the nursing profession—and to work nights—was inspired by Joseph’s aunt and uncle, who have been working as night-shift nurses since the 1980s. Joseph recalls that watching and listening to them helped instill a passion for helping others. By following their example, he and his wife have been able to work in a field that gives both of them great satisfaction while constructing a lifestyle that allows them to meet their children’s needs.

To make it work, they’ve made a commitment to being healthy—getting plenty of rest, exercising as a family and eating well. And one other thing: “Ultimately, it’s all about teamwork,” says Joseph. He and Christina must coordinate all of their time and effort, and that requires a special closeness. They share the same level of love and commitment for their family as well as their work. The couple met in nursing school in the Philippines and were married there in 1999. “She was my first girlfriend,” Joseph says with a shy smile. “He promised me I would be the last,” Christina adds. They moved to the United States in 2002, and are raising two children: Matthew, five, and Andrea, nine.

Before joining Kaiser, Joseph worked for six years at West Hills Hospital, where Christina now works two nights a week in med-surg. Like any loving mom, she has photographs of her children at her place of work, in this case taped to the door of her locker in the break room. Colleagues praise Christina for her professionalism and compassion.

Joseph also still works at West Hills on occasion, on a per diem basis. “It’s very rewarding to be a nurse,” he explains. “To see your patients get better or feel better is the most rewarding part for us.” For the past three years, Joseph has worked three to four nights a week—sometimes as Charge Nurse—in the Telemetry Unit at Kaiser Permanente Woodland Hills. It’s obvious from his bedside manner, and the way his patients perk up when he enters their rooms, that he is respected and appreciated. Lillian DeLillio, a cardiac patient in the Telemetry Unit, lights up when asked about Joseph. “He’s a great nurse! He’s compassionate and always there when you need him.”

Both parents stress how much better the night shift is for being involved with their children’s education. “I like it better than the day shift because you still have time to take care of errands and other things. I’m home when [the kids] get home and can help them with homework,” Christina explains. “At school they have a yearly science project, which is a big part of their grade. Every year we have to prepare for it, create a model and help them put it all together. When parents get home at 7:00 or 8:00 p.m., the libraries are closed and you’re too tired to help.”

Another advantage of the night shift, Joseph explains, is that it’s actually easy to get assignments, mainly due to the sleep factor. “Most nurses prefer the day shift,” he says, “but we’ve gotten used to the odd scheduling, so it’s not so hard for us anymore.” Life for a night-shift nurse is marked by routine, often punctuated with long stretches of inactivity. In the Telemetry Unit, Joseph checks the heart rates of all the patients every four hours, and must be ready to attend to any and all cardiac-related issues. Christina explains that in med-surg, “shift change is the busiest time. Endorsement time is at 7:30, and then at 8:00, we check our patients’ vital signs. At 9:00, we distribute their medications. It slows down around 10:00 p.m., unless new patients are admitted late. The middle hours, 11:00 to 3:00, are usually very quiet. That’s when staff can retire to the break room for rest and coffee. Then at 4:00 a.m., things pick up again: bed baths, checking vital signs again and medications at 6:00 a.m., in preparation for the shift change at 7:00.”

There are areas where working the night shift is inevitably problematic. The couple hasn’t had a regular “date night” for years, Joseph admits. “It’s more often a lunch date on the days we’re both off and the kids are in school.” On those occasions when they’re both home in the evenings together, they’re more likely to watch a movie as a family. They try to work alternate nights as much as possible. When their schedules collide, they leave the kids with Christina’s sister. In spite of their best intentions, however, things don’t always go smoothly, as Christina explains. “Because Joseph’s schedule is so hectic, he sometimes forgets which shift he’s supposed to be on, and which hospital. A couple of times he came to work here at West Hills, only to discover that he wasn’t supposed to work that night after all! He returned home, and the kids were so happy to see him.”

The telephone is an important tool for keeping communication open. For example, Christina explains, her son always wishes his dad were there to put him to bed, so she calls Joseph at work so he can say goodnight to his children. “I try to call after 9:00 when his busiest time is over. Sometimes on the nights when we both have to work and we leave the kids with my sister, I’ll call them around 8:30 to say goodnight.”

The couple has sound advice for other nurses coping with the intense physical demands of working nights and raising children. Joseph runs on a treadmill in their home and has a gym membership that he tries to find time to use. The family also rides their bikes together around the neighborhood.

Keeping work and life together on the night shift also requires getting sufficient rest and keeping sleep schedules under control. “We try to get as much rest as we can, because at work there are nights when it’s really busy,” says Joseph. He says he tries to sleep eight to ten hours in the daytime on his days off. After coming home from the kids’ school in the morning, he watches a little news on television, then tries to sleep from 10:00 a.m. to 4:00 or 5:00 in the afternoon. “If I wake up early, I’ll go pick up the kids from school. If I worked the night before and then have the next night off, and my wife is working, I’ll pick up the kids and let her catch up on her sleep,” he says. When Joseph and Christina both have the day off and know they’re also going to be able to stay home that evening, they’ve trained their body clocks to become daytime people on demand.

Sound complicated?

“For this kind of job, teamwork is very important,” Joseph emphasizes once again, with a smile.

Lillian Goodman, 78-year-old nurse, health career educator and administrator gives one of her classic answers: “The idiotic saying, ‘a job well done.’”

Then seriously, she adds, “There should be a lot of satisfaction from a career in a field that has an impact on society. I would say that along with teaching, [nursing] is one of the few fields where you could say that.”

For Lillian, it seems her own expansive career in nursing has brought her decades of satisfaction and continues to do so. Her journey through life began in a small town in New Hampshire, where she was raised. “In the era I grew up in, there were three ways to go,” she recalls. “You got married, you became a teacher or you became a nurse. I had an incredible high school biology teacher, Mr. Flaherty, who was also the football coach. He inspired me tremendously to think about scientific questions. My mother’s stories about growing up amidst the Armenian Genocide, along with Mr. Flaherty, pushed me toward nursing.”

In 1949, Lillian enrolled at Elliot Hospital in Manchester, N.H. “We were what was in those days called ‘diploma school nurses.’ We trained, worked and lived there.” With self-deprecating humor, she shares an embarrassing memory from those formative days. “When I was a student nurse at Elliot, I was on evening shift. It was very busy—the charge nurse went to dinner and put me in charge. I was very excited and anxious, and we had a new admission, a very young, good-looking man. I was 18, he was 18 and I was so nervous! I said, ‘Excuse me, sir. I have to take your vital signs.’ I picked up his arm and started taking his pulse, and everyone started laughing. I asked, ‘What’s so funny?’ He said, “You took my brother’s pulse, not mine!’”

From those youthful misadventures, Lillian went on to earn her OB-GYN and RN licenses in 1952, and went to work at the Margaret Hague Maternity Hospital in Jersey City. Three years later, she found herself in California working as an OB Supervisor at Kaiser Permanente Sunset. In 1957, she married a physician and started a family, taking nine years off to raise her two children. When she returned to the workforce, it was as an OB-GYN and med-surg nurse at Holy Cross Hospital in Mission Hills.

At a certain point, Lillian recalls, she became interested in teaching, and obtained a vocational credential and a B.A. in Liberal Arts from Redlands College. By the early 1970s, she had embarked on a new phase of her career, as the director of a private vocational nursing school, training LVNs. In 1978, she joined the Los Angeles Unified School District (LAUSD), supervising high school and adult education health career programs for LVN, CAN, EMT, MA, X-ray and dental assistants. Along the way, she picked up her M.A. in Education Administration and an administration credential. By the time she retired after 27 years of service, she held the position of Director of Vocational Nursing Program/Health Careers Specialist.

With more than 60 years of experience in the field of healthcare, Lillian is outspoken about changes that she has seen in the system over the years. “Hospitals are now owned by large corporations,” she laments. “It’s not [supposed to be] a product. Efficiency models shouldn’t be the criteria.” Of her many passions, nursing remains first, and Lillian expresses concern that the field is under threat. “We need to put more money into educating nurses. At the community college level, there are waiting lists so long that potential nurses give up. We also need the pay to be commensurate. Nursing needs to be a viable profession.” To this end, she feels that negative practices such as older nurses eating their young are anachronistic, and can be addressed and minimized through “professional development and education for the more experienced and seasoned nurses to interact with the new nurses.”

Next: How Lillian teaches…

As members of the Persian Jewish minority in her native country of Iran, Niaz and her sister faced a future of fundamentalist religious persecution. Her mother, Mahnaz Shadnai, was a nurse, while her father, Homayoun “Benny” Farzadfar, ran an orphanage with the Red Cross. Shadnai recalls that while she was happy in Iran, “I didn’t like the way my daughters were treated.” In 1998, they immigrated to the United States for what Shadnai hoped would be “freedom and educational opportunity” for her girls. They settled in California, where they had some relations. “It was hard,” Niaz recalls. “The heartache my family and I went through to get here felt endless. We didn’t speak the language and my parents had no jobs.”

The family persevered and started life anew. Niaz remembers entering third grade and quickly mastering English. She graduated from high school in 2006, then enrolled at Los Angeles Pierce College to take her nursing prerequisites, where she earned a spot on both the Dean’s and President’s list of honor roll students. Meanwhile, her father had opened a dry cleaning business, while her mother became a med-surg nurse, a position she holds today at Kaiser Permanente in Woodland Hills, Calif.

Yet they had barely settled into their new lives when disaster struck. Three years after their arrival in the United States, Niaz’s father was diagnosed with colon cancer. The initial bout was successfully battled into remission, but a few years later the cancer reappeared, this time in the liver. At the age of 18, Niaz found herself helping care for her ailing father, who would pass away in December 2006. As heart-wrenching as it was for her at the time, today she can look back at the experience as transformative. “For the duration of my father’s sickness, I was faced with wonderful healthcare providers, such as nurses like my mother, and others who took care of my father. The experience I went through made me even more passionate and sure about nursing. It was those healthcare providers who made my experience with my father’s death, the hours leading up to it and the moment it happened, as good as they could be, and nothing can be more significant than that.”

As a young girl in upstate New York, Pattie Jakel felt the calling. At the age of 15, she found herself caring for her grandmother, who was stricken with colon cancer. Years before that, around the seventh grade, Jakel took one of those career aptitude tests, which—no surprise to her—revealed that her interests pointed toward nursing. “The man [who administered the test] was condescending,” she recalls now. “He told me, ‘All little girls want to be nurses—you’ll change your mind.’” Luckily for the countless patients and colleagues who have either been under her care or have worked with her during an emotional and challenging 27-year career, the man was wrong.

Earning her RN from Hartwick College in 1982, Jakel found work as a traveling nurse as part of a program instituted in the 1980s to combat a nationwide nursing shortage. She spent three years working in nine cities, in regions of the country as varied as the deep South, New England and the west coast. Her sojourn came to an abrupt halt when she reached Los Angeles. “I stopped because I fell in love,” she recalls. She met her husband, a French architect, at Kaiser Permanente in Woodland Hills, where his business partner was hospitalized with cystic fibrosis. “[His partner] played matchmaker…he died a year before [my husband and I] were married,” she remembers wistfully.

Nineteen years later, Jakel is still married to the architect and is the proud mother of two teenagers. They’re a very physically active family, enjoying recreational activities such as snowboarding. Jakel recently spent eight days in New York with her daughter Mackenzie, who won several awards at a dancing competition. Her children join her in volunteer work at a no-kill animal shelter, located not far from their home in West Hills, Calif.

Nursing and family have been the focal points of Jakel’s life, and she has found a way to balance words and deeds. On top of her many years on the floor in scrubs, she has been an outspoken advocate for nursing. “I have one talent in this world,” she modestly proclaims, “and that is being a good public speaker.” Jakel makes regular presentations at national and local conferences, teaches oncology classes for nurses in training at UCLA and volunteers for the American Cancer Society and the Leukemia and Lymphoma Association, educating parents and volunteers. She’s also coauthoring a chapter for a book being written for primary care physicians on the challenges of caring for geriatric cancer patients in the home.

Jakel left nursing for a nine-year period to work on a NIH-funded research project, where she was involved in studies on cancer, Alzheimer’s, memory, methamphetamine addiction and cocaine addiction. Due to spending cuts, her position was eventually eliminated. Jakel was stung by this turn of events, especially as it happened a week after receiving her 20-year pin for service. “The administrators had no idea what I was doing,” she says. “It showed me I needed to be more verbal. I had to tell them that I had patients I had worked with for nine years that I needed to say good-bye to, like one woman with brain cancer.”

Today, Jakel is the CNS in a 26-bed Oncology Unit at Santa Monica-UCLA Medical Center and Orthopaedic Hospital. Following her around for a day, it’s obvious that she has earned both the respect and friendship of her staff, blending professionalism with a lighter, personal touch. During a typical morning shift, she jokes as she looks over statistics with Terry Taylor, the ACP who is on the verge of retirement. Roaming the halls, Jakel makes frequent stops for consultations with nurses, orderlies and resident doctors. As expected, not everything runs as smoothly as she would like. She rubs her forehead in frustration when given some bad news about a mistake almost made in a patient’s medication. She knocks on the door of a patient she describes as particularly elderly and frail, to make sure he hasn’t had an accident. “Falls are a huge issue,” she explains. “Medicare will not cover falls, bedsores, things like that. The hospital is responsible if someone hits their head, gets a hematoma and dies.” Emerging from the patient’s room, she continues, “The first line of defense is the family, to remain at the bedside, but sometimes it’s hard to get family members to stay here. It’s like a break for them.”

Jakel stops to mentor Monique Acosta, an RN, and Monica Coles, a nursing student. The conversation turns to a 19-year-old patient who recently died from gastric cancer. As they speak, a condolence card is being passed around and signed by everyone in the unit. “Ashley was an angel, and that’s a word I don’t often use to describe patients,” says Jakel. “She was so sweet and so brave, she never once complained….”

Dr. Michael Marra, a professor of Asian Languages and Culture at UCLA, is in the advanced stages of Leukemia. In a soft voice, he describes the treatment he is receiving as “stunning, just stunning,” praising the compassion he has found. “You’re in the dark tunnel now, “ Jakel tells him. “We’re going to get you through it.” She listens intently as Marra shares his views on life and death, which have been influenced by his interest in Eastern philosophies. “What is life? Life is something beautiful that you experience, and then it’s gone. There’s nothing strange about it.”

Their conversation turns to issues of quality of life and mercy. Jakel tells him that she has worked with elderly patients who, in the advanced stages of illness, are ready to die, but whose families influence them to do everything possible to prolong their lives. “We don’t let people die anymore. I struggle everyday with people well into their 80’s.” Marra shakes his head sadly. “It’s a natural process,” he says quietly.

Jakel estimates she has seen “hundreds of deaths in 27 years” on the job. “It doesn’t get easier; it gets different,” she says. “I have other areas where I can put my emotions now. I still cry. When Ashley died, I cried for days.” She shares stories about work with her children, believing it will help make them more compassionate. At the hospital, this open expression of feeling for her patients is not lost on her young mentees, who quickly discover that in the life-and-death world of oncology, tempering one’s compassion with the steely resolve to persevere is perhaps the greatest skill they can develop.

Pattie Jakel

See Pattie Jakel’s anything but typical day in our photo gallery.

Yet it took a near-death experience for Walsh to gain a full appreciation of the true nature of her calling. In 1998, she was diagnosed with polycystic liver disease, and found herself wearing the same beeper she had seen on patients in the ICU. Her experiences as a patient and the treatment she received post-op allowed her to see nursing “from the other side of the bed rail,” as she puts it. “That gave me a greater sensitivity toward anybody who’s in a vulnerable health condition.” In a voice tinged with emotion, she recalls one particular night in 1999. “They were transporting a patient who had just suffered brain death to the operating room to procure the organs.” At that moment, the enormity of the situation hit home, and she remembers “going off to a private place and crying my eyes out.”

Doctors had difficulty finding a suitable liver for Walsh, and she ended up hospitalized at the University of California, Los Angeles, where she waited three excruciating weeks until an eleventh-hour transplant was arranged. It was during her post-operational convalescence that Walsh really got a taste of how patients view their own healthcare. Simple things, which she admits she herself did as a nurse, became aggravations as she lay in recovery. “One thing that really made me furious was the way hospital employees would walk by, pop their head in my room and toss old gloves or empty coffee cups into my trash can. I still get pissed when I think about it…my whole world had shrunk to that little cubicle, and I felt like that was my trash can! To this day, I respect the patients’ space.”

Other transgressions were more serious. She recalls the intense pain she felt when having a drain removed, and the dread she felt when the time came to remove another one. The bedside manner of the doctor and nurse left her cold. “They basically ignored me, talking about his weekend and other trivial stuff,” recalling that even as she cried in pain, they never once looked at her or asked if there was anything they could do to make her more comfortable. “I had fallen into that mindset where ‘you have to be a good patient,’ so I didn’t say anything. It was extremely impersonal and rude. I thought about how many times I had been in a patient’s room involved in personal chatter—so that experience really brought that home to me.”

It has been more than eight years since the transplant, and other than having to closely monitor her immune system, there is little outward sign of what Walsh went through. Today she is more physically active than ever, an avid hiker and jogger who participates in long-distance runs. Like all good teachers, she is able to synthesize her own life lessons into her work. “I’ve shared these personal examples as a staff developer, during training sessions,” she explains with a smile. “It really seems to raise the level of interest. I guess no matter how long you’ve been involved in this kind of work, you can never, ever overestimate the importance of compassion.”