l“Look,” the charge nurse says, “don’t hate me

because of what I gave you.” I shrug and smile.

She is impossible to hate—kind and funny

and unbending in a storm. “I did it because I

honestly thought you would do well by her,”

she says. The charge nurse regards me earnestly,

and then her phone rings and she is too busy

to explain. I take off down the hall, my mind

fl ipping through its fi le of diffi cult patients past.

What could it be this time?

Though I’ve been warned, nothing pre-

pares me for the mountain of woman—all 453

pounds of her—that I discover in the room.

She is sitting tall on the bedside and roaring in

pain as I step into the room. The nurse I am to

replace attempts to hold her in position for an

epidural. On the other side of the bed, two anes-

thesiologists contemplate the patient’s enormous

backside. I momentarily freeze at the room’s

entrance—some inner voice delivers me a sharp

admonishment not to stare. I take a deep breath.

“Hey!” the anesthesia attending calls. “Could

you give us a hand?” Her eyes bug out sugges-

tively above her mask. The patient’s cries dis-

solve into a low, steady moan as her contraction

passes.

I step all the way into the room and intro-

duce myself to the patient. I’m energetic and

enthusiastic, putting on my best “nurse act.”

“And I will be your nurse until 11!” I say, cheer-

ily as always, but louder, while taking a better

look now, embracing the situation as my own,

at least for the next eight hours.

The patient’s eyes are squeezed shut. Her

face is blotched and tear-stained under its tent

How long would

it have taken

for us to see

beyond Trudy’s

body—and the

hardship dealing

with her weight

presented—to

the woman

and mother

underneath?

432 © 2007, AWHONN http://nwh.awhonn.org

(continued on p. 430)

Editor’s note: To protect confidentiality, the author has changed patient and staff names and some identifying features.

Katherine Robbins, RN, BSN

JudgingTrudy

Katherine Robbins, RN,

BSN, is a labor and

delivery nurse at UMass

Memorial Medical Center

in Worcester, MA.

DOI: 10.1111/j.1751-486X.2007.00211.x

430 Nursing for Women’s Health Volume 11 Issue 4

of permed hair. She trembles, leaning hard

on the shoulders of the nurse I’m relieving,

dwarfi ng her. I place my hand on my colleague’s

back and whisper into her ear, “Are you OK?”

She nods and grimaces. We don’t even consider

swapping places so that she can go home, as

is customary. The situation calls for way more

help than we have as it is.

The anesthesiologists have Trudy (the name

we’ll call her) lifted almost as far up as the bed

allows. This adds to the effect of Trudy’s enor-

mity. She appears infl ated—a weeping Macy’s

Thanksgiving Day Parade balloon bobbing up

near the ceiling. The anesthesiologists are having

trouble placing her epidural, for reasons they eu-

phemistically refer to as “obscured landmarks.”

In other words, the patient’s back is so fat that

the doctor can’t feel her vertebrae through the

skin—the anesthesiologists are shooting in the

dark. I squeeze around to their side of the bed to

help. What they need is a longer needle, which

they have me rummage through their cart for.

Unfortunately, no such needle exists.

Poor Trudy begins to moan louder again

as another contraction hits. I can see that the

anesthesia docs have tried at least fi ve times to

penetrate Trudy’s spine. Over the monotone of

Trudy’s voice, the attending advises her resident

to wipe away the “heme”—her code word for

the rivulets of blood springing from each punc-

ture mark. They poke her back some more with

thumbs and forefi ngers, searching for the right

spot. They dig hard into Trudy’ skin—so hard,

I can see, that they have forgotten this person is

not yet, in fact, anesthetized.

“Ow, that really hurts!” Trudy calls out. The

simple, normal clarity of her voice shocks me.

She is not some crazy, oversized animal but a

perfectly rational soul responding to inappro-

priate care. I’m suddenly ashamed of myself for

forgetting this, for being sucked into the vortex

of judgment than surrounds her case. “Maybe

we should just forget it,” Trudy says. “I don’t

need it anyway.”

“I don’t know, you were just fi ve centime-

ters. You may have a way to go,” Louise, the

day nurse, says. “Hang in there, we’ll get you

comfortable.”

“Well, I’ve got to go try to fi nd a different

kit,” the anesthesiologist announces, failing to

hide her frustration. “We’ll be right back.” She

leaves the room abruptly, with another bug-

eyed glance at me on her way out that says she

doubts she can place the epidural at all.

“Another one, another one!” Trudy rocks

back and forth in front of Louise. “Oh my God,

this is bad. It’s a bad one!” She starts to shake,

and then sob, turning her face up at the ceiling.

I now feel terrible for this woman. So does Lou-

ise. She does need an epidural. We both begin

the earnest stroking and cooing instinctive in

labor nurses: It’s OK. Hang in there, honey.

I know it hurts, I know, I know.

And then it happens: The unmistakable

grunt of imminent birth.

“I have to PUSH!” she exclaims.

“OK, OK,” Louise, says. She calmly turns to

me and says “She’s been doing this right along.

I just checked her. She’s only fi ve.”

Louise has a good 20 years of experience

on me, so I listen. But my gut tells me that

Trudy is about to have a kid. “Let’s get you lying

down, honey,” Louise says. We lower the bed

and guide Trudy in a massive fl op onto her side

and then help her heave herself onto her back.

She releases a giant sigh. “Remember not to

push. Really try not to push, sweetie,” Louise

says. “Blow,” she demonstrates, pursing her lips

toward imaginary birthday candles. “Like that.”

But Trudy won’t look at us.

“We better check her,” Louise says. Then

another contraction hits. Trudy saves her breath,

this time, for full-out, purple-face pushing. In

anticipation of the exam (which Louise plans to

perform), I reach two gloved hands up and over

Trudy’s closest thigh, and pull to position her leg.

Trudy shrieks. “Sorry—” I start to say, thinking I

have hurt her. But then I look down between her

legs. Lo! There is the pinkest, slickest little head

pushing, pushing out. Out slides an exquisite,

blinking face. The baby is a redhead, rose-lipped

and beginning to cry already, though her body’s

still inside. I reach down to catch her and quickly

check for any loops of umbilical cord. And then

Trudy miraculously pulls back her other leg to

make room for the body to squirt the rest of

the way out into my hands, onto the sheets. The

baby is perfect and tiny between Trudy’s thighs.

She begins to wail, right on cue.

“Uh—we’ve got a baby here!” I yell out.

Louise scrambles to my side and reaches over to

touch her, this baby girl.

“You did it, Trudy!” she cries. “Brittany’s

here!”

And it’s all been

trumped—Trudy’s

size, our mis-

directed efforts

at controlling her

labor, her heme-

streaked backside,

our lapses in

humanity—by the

grace of this new

baby.

(continued from p. 432)

Trudy starts to giggle, and then full-

out laugh, and then Louise and I join in,

too, fi nding ourselves just on other side

of panic—relieved and incredulous.

The baby is already waving startled

hands around, blinking at us. We madly

grab for the sterile delivery cart, a cord

clamp, warm blankets, and, in Louise’s

case, some gloves. Somewhere in the

shuffl e, an OB resident had entered the

room—which was good (great even!),

despite the fact that neither Louise nor

I had had time to call for one. This one,

a second-year resident, reaches a gloved

hand around me to clamp the cord.

Louise, it seems, has procured a glove,

but not a pair. She, too, has one hand

on the kid, sort of.

“Where’s my other glove?” The

resident barks.

“Where’s MY other glove?” Louise

calls back.

The baby cries. Trudy sighs and tells

us over and over how much better she

feels. Louise and I look at each other

and simply start to laugh again. The

baby is healthy and Trudy is out of

her misery. We even have a doctor in

the room, though we aren’t sure how

or why she appeared. We lift the baby

up for Trudy to see, and now she, too,

is laughing, and then crying. And it’s

all been trumped—Trudy’s size, our

misdirected efforts at controlling her

labor, her “heme”-streaked backside,

our lapses in humanity—by the grace

of this new baby. We dry the perfect

baby and give her, at last, to Trudy.

How long, I wonder, would we have

tortured Trudy had she not preciped in

the bed? How long would it have taken

for us to see beyond Trudy’s body—and

the hardship dealing with her weight

presented—to the woman and mother

underneath?

How do nurses avoiding judging?

And how does judging infi ltrate our

practice, erode our effectiveness? We

are, after all, only human. Perhaps, our

judgments defend us from the over-

August | September 2007 Nursing for Women’s Health 431

whelming nature of what we face daily:

people in pain, families in crisis, people

abusing each other or their unborn

children, poverty, addiction, feces,

vomit, blood, stillbirth, cussing, body

odor and much, much worse.

I used to cringe at judgments

presented in report: She’s a doll; You’ll

love them; They’re a little simple; She’s a

real bitch; Careful, they’re both lawyers.

Nurses, as chronic overachievers, tend

to feel that report is incomplete

without the sort of “personal touch”

these judgments represent.

Lately, though, I’ve come to feel

that nursing’s truth and beauty lie

in the inevitable dissolution of these

judgments. The way that the Trudys

of our bizarre hospital world turn our

expectations inside out—show us our

own strengths and weaknesses, and

show us grace and possibility where

only the workaday world of tasks and

petty judgment had prevailed. NWH

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