.

Sermon Index

FLORENCE NIGHTINGALE: CALLED TO SERVE

by the Reverend hyllis L. Hubbell
at the First Unitarian Church of Baltimore
on the 3rd of September 2000

READINGS

From the book Zen Wisdom:

Po-chang (Hyakujo), the Chinese Zen Master, used to labor with his pupils, even at the age of 80, trimming the gardens, cleaning the grounds, and pruning the trees. The pupils felt sorry to see the old teacher working so hard, but because they knew he would not listen to their advice to stop, they hid away his tools.

That day, the master did not eat. The next day he did not eat, nor the next day. "He may be angry because we have hidden his tools," the pupils surmised. "We had better put them back." The day they did, the teacher worked and ate the same as before. In the evening, he instructed them, "No work, no food."

From the book The Wisdom of the Tibetan Lamas:

Milarepa was Gampopa's master for many years. Just before Milarepa died, Gampopa asked him for some final instructions. Milarepa replied, "What is required is more effort, not more teachings."

As Gampopa departed, knowing he would not see his master again, Milarepa shouted after him. "There is one profound secret that I would not show to just anyone!"

Gampopa looked back toward his master. Milarepa turned, bent over, and pulling up his old robes, revealed huge callouses that covered his buttocks, the results of many years of meditation sat on hard rough rocks.

"My beloved son," said the master. "This is my final instruction."

SERMON

In the early 1800s, in England, nurses were considered lower than maids. They came from the poorest of the poor communities. They were often alcoholics and prostitutes, plying their trade in the wards. They rarely had any training. There were some religious orders that cared for the sick, but they saw themselves primarily as caring for souls, not healing bodies. Doctors considered nurses unreliable, good only for the most lowly of tasks.

The common soldiers fared little better. Soldiers generally signed up because they were drunk, broke, or lovelorn. The army treated them as expendable, letting them stay drunk if that would keep them compliant. Many of the upper class officers had little use for enlisted men or their needs, considering them "animals," "scum."

Into this world, in 1820, Florence Nightingale was born. Or rather she wasnt born into this world. Florences parents were well-to-do members of the best social circles. Neither her father, W.E.N. Nightingale, nor her mother, Fanny, was expected to work. His work was to hunt and fish, look after his tenants, dabble in politics. Fannys was to throw and attend parties, go to concerts and the theater, and maintain an interest in the arts.

The first hint of something unusual in Florences nature came from her father, who was a Unitarian. He read widely and contemplated the great theological questions. He wanted his girls to receive a classical education. His idea of a proper education included Greek, Latin, German, French, Italian, history and philosophy, in addition to the music and drawing Fanny required. When he couldnt find a suitable tutor, he taught his two daughters himself.

Although she was the younger of the two, Florence was the favorite. She had thick, chestnut hair and a lovely face. She was bright, passionate, intriguing, strong-natured, and a natural leader. She loved the difficult subjects and the study and discussions with her father, while Parthe, her older sister, resented them.

But for a girl who seemed to have everything, Florence was unhappy. As a small girl, she believed that she was a monster. She avoided people for fear they would find her out. As she grew older, she became uncomfortable with the rich, easy life she led. This uneasiness may have come in part from her religious background. Fanny had insisted the girls be raised Anglican rather than Unitarian. As an adult, Florence developed a strong scientific attitude toward religion, concerned with facts and morality more than the miracles. But from the time she was a child, she also maintained a strong personal relationship with a demanding God. Her God was a god that sought justice. Her God sought individuals to be its hands. At 16, just as her mother was preparing to launch her into society, Florence literally heard God speak to her and call her into service.

Over the next decade, Florences calling began to take shape. God had not originally mentioned a specific kind of service. Who would have believed it would be nursing? Nursing was for the dissolute poor or the saintly religious not for upper-class beauties. Florence was herself conflicted. She loved to dance. She adored people, forming crushes on both women and men. They returned her passion. She had two offers of marriage from wealthy, handsome men and wonderful women friends. She and her family traveled. On the one hand, she enjoyed her life. At the same time, she was increasingly disgusted with herself for living so frivolously. She had always nursed her pets. As she grew older, she brought medicine, food, and clothes to the nearby cottages. The call to nursing began to surface. She kept putting off one of her suitors, unable to say "yes," yet unwilling to say "no." Her family was adamantly opposed to the idea of nursing. Her mother forbade her to consider it. Her sister and her mother had increasingly stormy arguments with Florence, trying to get her to change her mind. Both Florences and her sisters health began to suffer from the strain. After 9 years, Florences suitor finally demanded an answer. The answer was "no." Very respectable friends took her abroad to distract her. When that didnt change her mind, they arranged for her to spend two weeks in Kaiserswerth, a hospital in Germany with a nursing program Florence had long wanted to see. Finally, the family doctor warned Florence that for her sisters health, Florence must stay away. There must be no more upsets. Florence took this as permission to leave home. Her father granted her a generous allowance. Through her influential friends, Liz and Sidney Herbert, Florence obtained an unpaid position as head of the Institution for the Care of Sick Gentlewomen in Distressed Circumstances.

The general public thinks of Florence Nightingale first as the Lady with the Lamp. A nurse devoted to her patients. But it was in her first position that we get glimpses of her broader calling and gifts. Nightingale was a born administrator with a head for detail, leadership abilities, a voracious interest in facts relating to healing, and an instinctive knowledge of how to get things done. Her requirements were exacting and novel. Her vision of the work of nursing was clear. Nurses should never have to quit the floor where they could watch the patients. She wanted to pipe hot water to every floor so nurses didnt have to leave the floor to fetch it. She wanted them to install a lift to bring in the patients food. The patients should all have bells that ring at the nurses door, and "a valve that flies open when the bell rings and remains open so the nurse can see who has rung."

In 1854, the British Army intervened to support the Turks in a conflict with the Russians that came to be called the Crimean War. An army base was established in Scutari, a large village on the Asian shore of the Bosphorus. The British Army was badly prepared. They crammed in 30,000 men, with only 21 wagons, no hospital transport, litters, or carts. A cholera epidemic broke out. More than 1,000 cases were sent to Scutari. Amputations were performed without anesthetics. The wounded lay on the ground or on straw mixed with manure. Surgeons worked by moonlight because there were no candles or lamps. Another 1000 cholera cases were sent back to Scutari. The hospital at Scutari was a former Turkish artillery barracks that had been turned over to the British. What was described to the British government as a hospital, however, "was bare, filthy and dilapidated. There was no labor to clean it; there was no hospital equipment to put in it." There were no beds. No kitchen. No food. No cups or buckets to bring water. No operating table. No blankets.

These horrors were not new to the military. But previously the public had not known about them. William Howard Russell, of the Times, was the first war correspondent to send back reports from the front. The aristocrats from the high command abhorred the newspapers, but ignored Russell, underestimating his power. Russell reported with furious indignation back to the mothers and fathers of the sick, wounded, and dying soldiers, thrown aside like garbage to rot. The new invention, the telegraph, brought the news home the next day.

The public howled. The government heard. Sidney Herbert, Florence Nightingales friend, had become the Secretary at War, as his post was called. He was now responsible for the sick and wounded. Herbert turned to Nightingale for help. He asked her to find and train 40 nurses to take with her. He assured her that he had sent ahead all the supplies that she would need.

It was unheard of to use nurses in military hospitals. Nightingale wanted only the very best, women whom she could count on not to disgrace themselves through alcoholism and prostitution. She wanted women who, if they were from religious orders, were willing to do nursing work and not proselytize. She was able to find only 38. She required authority from Herbert to be in absolute charge. Discipline was going to be necessary if she was going to change the face of nursing. She was quite aware that her success or failure would be very public and could improve or damage the face of nursing for another 50 years.

When the nurses arrived, six rooms were allotted for 40 people. There were no tables, no food, little water. Fleas and rats scurried through the rooms. There were no brooms. The doctors ignored Miss Nightingale and her nurses. They did not trust them, and refused to request their help.

A flood of sick men in November, however, overwhelmed the doctors to such an extent that, in desperation, they began to call on Nightingale and her nurses. Compounding the disaster, a hurricane came through and destroyed a large ship "loaded with warm winter clothes and stores for the troops." The hospital floors were covered with vermin. The water pipes to the privies were backed up so that liquid filth covered the floor of the lavatory chamber. The stench was nauseating. Nightingale estimated that at one time 1000 men were suffering from diarrhea but there were only 20 chamber pots.

One of her first breakthroughs with the doctors came because she was willing to take it upon herself to clean the wards. She purchased 200 scrub brushes. She watched over the orderlies to make sure they regularly emptied the large wooden tubs that held all the waste. She washed the mens clothes because the local laundry brought them back crawling with more lice than when they had had when they left. The men had given up sending their clothes out, preferring to live with their own lice. Despite Herberts assurances before she left, Nightingale had brought along supplies. And supplies she needed. Because of the imbecility of the system of administration, ships loaded with blankets and fruit and medicine, sat in the harbor for weeks and months while men lay on the floor in the cold of winter, dying of dysentery and scurvy. Food was thrown overboard several times on the grounds that no one had specifically requisitioned it, while men were dying of starvation. In December, enough blankets sat in storage to give three to every soldier, but the men lay half-naked on the muddy ground because the blankets they had previously been issued had been lost in the battle or destroyed in the hurricane. Regulations did not allow them replacements. The system of supply had broken down.

The hospital staff soon learned that Nightingale was the one to go to if they needed anything. Money had been raised by the newspaper, which she used to buy supplies locally. Nightingale made it a practice never to let a man die alone. She once calculated that she had been present at more than 2000 deathbeds. She barely slept. She would make night rounds with a lamp, stopping by one man, then another. One soldier wrote, "What a comfort it was to see her pass . . . She would speak to one, and nod and smile to as many more; but she could not do it all you know. We lay there by hundreds; but we could kiss her shadow as it fell and lay our heads on the pillow again content."

But nursing, she felt, was the least of her duties. Procurement and administration were what saved lives. Her reports and proposals, her research and statistical analyses, were what were to change the military health care system permanently. Secretary-at-War Herbert received more than 30 reports from Nightingale, reports crammed full of detailed, practical suggestions for reform. Although we cannot and should not forget the image of the woman with a lamp, it was Nightingale's tireless lobbying for hospital reform, the depth and detail of her reports, and her forceful analysis she that saved thousands of lives in England as well as India and the U.S.

She returned home to public acclaim barely a year later. Songs were written about her. Longfellow immortalized her. But she wasnt interested in adulation. She was afraid it would hurt her mission, causing jealousy among those she hoped to sway. The status of nursing was no longer her primary concern. Now she needed to protect her soldiers. She was haunted by her memories. "I stand at the altar of the murdered men," she wrote in a private note ... " and while I live I fight their cause." On the edges of her private notes, on the margins of letters, on scraps of paper, over and over again, she wrote, "I can never forget."

Over the next 16 years despite illness that brought her close to death several times, despite exhaustion, despite frustration, she charmed and she bullied, she wrote and she spoke in an attempt to bring about hospital reform. Her plans were brilliant, showing an unprecedented grasp of the big picture, supported by masses of evidence supporting the need for radical change. Her letters are often dated "sometime before dawn." Always, there were more reports to prepare. When her friends in high places themselves grew sick and weary, she flogged them on, refusing to believe them too ill to do the work that must be done to change the system so that this could never happen again. Change happened over time, but slowly, all too slowly, and never enough. The government defended its own. The overhaul she called for meant disgrace and forced retirements for highly placed officials. Governments changed. Still, she persevered. In the end, her efforts led to major reforms in the military hospitals, both at home and in India and the United States. She had stood by her beloved soldiers to the end. She had not forgotten or deserted them. She greatly influenced workhouse reform, removing the mentally ill, the sick, and the children. The status of nurses, once her chief interest, was now changed forever. Training was available. There were more jobs than there were applicants for them. A new era in nursing had arrived. In 1882, the founder of the International Red Cross credited Florence Nightingale as the inspiration for his work. Finally, she brought some dignity and respect to the little people of this world to nurses, to women, to the common soldier, to the poor in workhouses, to the masses of poor in India. "No food, no work."

Tomorrow is Labor Day, the day we celebrate the workers of the world. Florence Nightingale was one of those laborers. One who worked almost without ceasing, led by a vision, haunted by memories. She worked not for food, but for a demanding God. I spoke a few months ago about the virtues of perfection. But they include a final lesson: letting go of the need for results. Florence Nightingale never learned that lesson. Her God was a demanding God. Nightingale herself only softened after much of her power had disappeared and her own work was largely over. Yet, by driving herself, by driving those around her, Florence Nightingale changed the world. Her work saved thousands, perhaps hundreds of thousands, of lives in the generations since. We are all called to serve. Young and old, rich and poor, whatever our gifts, we are all called to make some difference in the lives of others, in caring for our planet. Serve to the limit of our capacity. Ease a burden. Create beauty. Bring justice. Sometimes we do not hear that call.

Sometimes we hear it all too well.

The work is long. The work is hard. But the secret is more effort. More calluses. More tears. More work. Yes, there is a time for joy. A time for rest. A time for renewal. But the soul is renewed by work. The earth is renewed by labor. May we be laborers of the spirit. The world needs saints. The world needs us.

Let us be on our way.



Sources:

Hubbs, C. Florence Nightingale New York: Twayne Publishers, 1997.

Woodham-Smith, C. Florence Nightingale New York: McGraw-Hill, 1951.