"Thank the Nurse" (2002)
Four song EP
Country Joe McDonald
Country Joe McDonald is perhaps best known for his Vietnam-era folk-rock protest songs, especially the antiwar classic "I-Feel-Like-I'm Fixin'-to-Die Rag." McDonald has also been active in Vietnam veterans' causes, and he has a keen interest in Florence Nightingale and other nurses who have cared for wounded soldiers. Over the years McDonald has recorded several "nurse songs," which he describes as an effort to "advocate for people who seemed to be 'taken for granted' and seemed to have no voice of their own in the public." That's a sad tribute to a profession that includes "advocacy" as one of its core missions. But we can't argue with it.
McDonald put his "nurse songs" together on the "Thank the Nurse" EP in 2002. The songs are passionate, fairly catchy, and well-played, though not especially distinctive, musically or lyrically. And given their explicit pro-nurse goals, they will likely strike some as a bit didactic. Three of the four are about nurses at war, and two of these are tributes to nursing pioneers Nightingale and Clara Barton. McDonald sees nurses as heroic fighters for wounded soldiers who have been used and discarded. The nurses improve bad conditions, brave firefights, tend wounds, provide emotional support, and of course, "guard [their] patients with a .45." The last song, "Thank the Nurse," is a specific, if limited, account of what nurses do, including "saving your life." It actually suggests that nurses are more important than physicians. The songs are not free of gender stereotypes and angel imagery, and they don't fully convey nurses' clinical skills, focusing mainly on emotional support. But none suggests that nurses are physician helpers. And all give a sense of nurses' role as the last force protecting patients from death and despair.
"The Girl Next Door," the first track, examines the experience of a U.S. Army nurse sent to Vietnam without much sense of what she was getting into. According to McDonald's web site, it was written specifically for Lynda Van Devanter, author of Home Before Morning: The Story of an Army Nurse in Vietnam. The song is not unlike a 1969 Rolling Stones groove, and it's the only one on the EP that really rocks. The lyrics follow the "girl next door" to a war where she sees "death and pain" and learns to tend horrific battle wounds. McDonald seems especially focused on the female nurse's lost innocence ("The jungle ain't a place for a girl to be alone / Surrounded by the enemy with all the soldiers gone"), and the contrast between her wartime role and her traditional female qualities. The chorus bears this out:
Guarding her patients with a .45
Checking their wounds to make sure they're alive
By day she's in fatigues and at night she's in a dress
She's everybody's savior--the Army combat nurse.
This song is really more concerned with what's happening to the nurse than it is with her patients:
Back home in civilian life, Army life all done
Childhood friends can't understand why she's not any fun.
But a vision of the wounded screams inside her brain
And the girl next door will never be the same.
In the final chorus, after the line about the nurse being "everybody's savior," McDonald calls: "Who'll save her now?"
There are some outdated gender assumptions here, lyrics that seem to suggest women have no place serving in combat zones, though they also suggest that the nurse "under attack" will "do her best." McDonald has explained to us that the "at night she's in a dress" lyric refers to the nurses' being forced to dress up after their shifts to "entertain officers." But no listener who isn't a Vietnam War veteran or expert is going to get that when there's no indication of it in the song. More broadly, McDonald has noted that the gender and savior imagery is meant at least in part to reflect how the soldiers saw the nurses. But again, he hasn't created the lyrical distance that would help listeners see it only that way, rather than as a statement of his own views, or at least his omniscient narrator. And although the song refers to the "tend[ing] the sick" and the "mend[ing]" and "checking" of wounds, it's pretty vague about what nurses actually do clinically.
But the song does offer a rare and striking look at the psychological effects on nurses who regularly confront horrific trauma in settings where their own safety is threatened. This theme runs counter to the still-common notion that nurses are spiritual beings, angels (or "saviors") who don't suffer like other humans from a lack of security, time, rest, money, or respect.
The EP's second and third tracks are more folk-oriented songs that provide surprisingly compelling history lessons about 19th century nursing pioneers Nightingale and Barton. As they do so, Grateful Dead guitar god Jerry Garcia backs McDonald with some of his fluent guitar runs.
"The Lady with the Lamp" describes the suffering of the British soldiers in the Crimean War, and at least in a general sense, what Nightingale did to help them. The chorus:
The Lady with the Lamp
You know she understands
The Lady with the Lamp
She's the soldier's friend
Seemingly told from the perspective of a gravely wounded soldier, the song describes "the hell of war"--"A soldier's life is just give and give / And then they ask for more." It also includes a few lines that could be seen as references to Nightingale's advocacy and work for the soldiers: "Walking on the picket line where my comrades fell / Holding up the thin red line in the shot and shell." Though some today might read the "thin red line" to refer to battlefield health care, McDonald has explained that it is a reference to the red-clad British soldiers themselves, taken from a contemporaneous poem.
Eventually the narrator gets to his own condition: "Now I'm in this cold and lonely room / Wondering if I'll live at all." He asks his nurse for a cup of tea ("I've such a terrible thirst"), for some final company ("I feel it's come to the worst"), and to convey his last words and belongings to the family he will never see again. But the song is not just a lament or a tribute; it has a target:
First they use us
And then they throw us away.
Only Miss Nightingale
Knows the price that we pay.
I'm guessing Country Joe, Navy veteran and veterans' advocate, is not just talking about distant history here.
After the reference to Nightingale as the "soldier's friend" in the final chorus, McDonald sings: "She will hold his hand / Stay with him till the end." Of course, a number of these descriptions of care are consistent with relatively unskilled hand-holding. We don't get much sense of what Nightingale and her colleagues actually did to improve the outcomes of patients who did not die, nor of Nightingale's lasting public health achievements. In this sense, the song is something of a missed opportunity. But the portrait of the nurse as patient advocate and emotional supporter is strong. In particular, the song strongly aligns Nightingale with the soldiers' interests in desperate times. As McDonald has noted to us, she improved the way dying soldiers were treated, keeping them company at the end, making sure last words and belongings were sent home, and keeping records of death, though the song does not make clear that she actually pioneered these key changes.
"Clara Barton" is also pretty general, but it's stronger in its portrait of a nurse engaging in large-scale patient advocacy. And there's no hand-holding. Instead, McDonald goes right to Barton's lasting public health influence and her role as a female pioneer:
Every time in the world that someone receives first aid
You can thank Clara Barton for the life that is saved
She lived out her life in a world ruled by men
Every time they knocked her down, she got back up again.
This is a simple but powerful statement of what Barton did in founding the American Red Cross, an organization that has obviously had a huge impact. And the remark about Barton's determination despite being female is much better than the references to women in "The Girl Next Door." Then McDonald turns to some things that Barton did for Civil War soldiers.
Civil War veterans with tears in their eyes
Told how she braved the battle just to save their lives
She never ran from the shot and the shell
Bringing aid and comfort in the midst of hell
And even then at the war's very end
When the prisoners were lost and without friends
She helped families to find those that they loved
A professional angel sent from up above.
We appreciate the reference to life-saving, and to helping reconnect families following the war's end, which is no trivial thing. It might have been nice to get something more concrete than "aid and comfort," a phrase that may implicate some of the unskilled hand-holder concerns. And even though Barton was not a trained health worker like Nightingale, as McDonald has explained, the reference to a "professional angel sent from up above" still suggests that nurses are noble spiritual beings, rather than skilled health workers who need decent working conditions. And no, simply including the word "professional" does not fix it.
"Clara Barton" also reveals the platitudes and filler in some of the EP's lyrics:
Thank the Lord for Clara Barton and long live her name
The American Red Cross is her claim to fame
When you see a Red Cross worker in a time of blood or war
Take a moment to remember and thank the Lord--Clara Barton!
This verse doesn't pull its weight. Without the extraneous words, it might have explained some of what Barton or the Red Cross has done, specifically, like save millions through blood donations, give primary care to refugees, or feed earthquake victims.
The last song, "Thank the Nurse," explains a little about what nurses do to save lives and improve outcomes. And it includes surprisingly favorable comparisons to physicians. Because the song is an explicit "thank you" to nurses, it has less of a story to tell, and so it is less organic. The chorus:
Thank the nurse that's nursing you
The one that nursed you through
Thank the nurse that's nursing you
For saving your life...saving your life...saving your life
This is a bit awkward and general, but the verses are full of specifics about nurses' vital 24/7 care:
Doctors diagnose and physicians prescribe
Surgeons can operate but they don't save your life
When a fever's burning, who helps you through the night?
Gives you medication, checks your vital signs
When you wake up in recovery, who's right there by your side?
With a smile and reassurance, restoring your self-pride
Well the doctor is important, that you can't deny
But when you get down to it the nurse keeps you alive
The one who cleans your body and bandages your wounds
The one who makes your bed, gives you medicine and food
Helps you through contractions until the pain subsides
Encourage you to make it, till you see that baby smile
When you're sick and convalescing you're seldom in the mood
To pay attention to the one attending you
So sick with rack and worry you think you'll lose your mind
You survive the accident but all your friends have died
When the orderly is sleeping and physician can't be found
No need for apprehension--the nurse is makin' rounds
These lyrics do convey some of nurses' vital sentinel and support roles. However, there is still a heavy focus on psychosocial care that most people are unlikely to associate with great technical skill. The nurse "helps" you, stays by your side, smiles and offers reassurance, encourages you, cleans you, makes your bed, "gives" you medicine and food, and makes rounds. Certainly the song has many suggestions that nurses keep you alive, and maybe listeners will get some sense of how in the references to fever, hygiene, wound care, and checking vitals. The steadfast psychosocial care that dominates the song is also important. But these lyrics don't tell people how much skill it requires, or that nurses also provide advanced physical care. No one will listen to these lyrics and think: "Wow, I never considered how much thinking nurses have to do, and how much scientific knowledge they have to master. It's a good thing they get years of college-level education."
Although "Thank the Nurse" gives no direct sense of patient advocacy, it also does not link the nursing it describes to physicians. Nurses seem to be doing all of these things as part of their own duties, rather than at the direction of physicians. This at least implies autonomy.
Then there are the physician lyrics. These are almost shocking, insofar as they actually suggest that nurses are more important. Physicians diagnose, prescribe, and operate, but often they "can't be found," and--the coup de grace--they "don't save your life." This is going a bit far. As key parts of the health care team, nurses and physicians both save lives, often by working together. But we have to admire McDonald's willingness to contradict one of the most cherished assumptions of his society, that physicians save lives and nurses are their helpers.
Although the songs on "Thank the Nurse" are not perfect, they are rare examples of American popular music directly aimed at showing how important nurses are to patients facing their darkest hours, particular in war. At a time when the mass media still commonly suggests that physicians provide all important care to those wounded in the Iraq war, Country Joe's heartfelt tribute to nurses is as timely as ever. So thank the musician.
Reviewed by Harry Jacobs Summers
Nursing Editor: Sandy Summers, MSN, MPH, RN
Reviewed September 24, 2006
Revised May 18, 2007
Also see an article on the history of Country Joe's interest in nursing and Nightingale in a NurseWeek article "Ode to Nurses" from 2001 that contains a link to a recording of Nightingale's voice --one of the first voice recordings done by Thomas Edison. She says on the recording: "When I am no longer even a memory, just a name, I hope my voice saves...the great work of my life."
We urge more nurses to tell the world about the great work of their lives.
You can send Country Joe messages at email@example.com or:
Country Joe McDonald
P.O. Box 7064
Berkeley, California 94707-0158
The views expressed herein do not necessarily reflect those of the Board Members or Advisory Panel of The Truth About Nursing.