Solomon Posen, MD
Fictional nurses continue to be predominantly female. In a brilliant essay Fiedler1 makes the point that in literature the terms "Nurse" and "Woman" are almost synonymous. As a result, male nurses, who currently constitute between 6 and 8% of the nursing workforce in the USA,2 Canada3 and Australia4 are considered a paradox and barely receive a mention in fiction except as custodians in psychiatric institutions,5,6* as muscular assistants7,8 or, Walt Whitman notwithstanding, 9 as objects of ridicule.8, 10-37*
“Sol” who temporarily “takes care” of Fred MacCann,8 the quadruple amputee, is a cheerful sadist who finds ”a lewd pleasure in the performance if his loathsome duties.” He handles Fred “like an insensate object” flinging him about “like a sack” and feeding him “perfunctorily.” When, on Fred’s request, Sol is transferred back to the psychiatric ward he becomes very abusive. ”I hope your lousy leg stumps gangrene on you up to your belly button. You broken-down, double crossing cripple.” Sol’s psychiatric charges are unlikely to be treated more compassionately. He refers to them as “the boys who see the rockets red glare, bombs bursting in air.”8
“Gary,” one of Huyler’s male nurses,10 lacks Sol’s manifest brutality8 but there are strong hints that this fat man would be more at home in a panel-beating shop than at a cardio-pulmonary resuscitation.11
A male nurse … knelt on the bed … He towered over the body, rhythmically driving the heels of his palms into Gass’s chest, again and again, the chest bending under the force of it, then springing back. The nurse was fat, wearing loose scrubs that let his pendulous belly fall out and swing, the white line of his underwear just beneath it. In that moment … there was a faint sound, like green wood broken under water. ‘I’m popping ribs,’ the man said, to no one in particular. ‘Not so hard, Gary,’ a woman said.11
Pacing is unsuccessful, further cardiac massage by the “panting and sweating“ Gary produces only further rib fractures and finally, when the patient is obviously dead, the nurse gets off the bed “heavily, with an effort.”11 Richard, another of Huyler’s male nurses12 does not display Gary’s11 obesity and brute strength. However, underneath his whimsical friendliness, he evidently enjoys teasing his patients, and occasionally exercising his power over them. “Look who’s awake,” he remarks to a patient who has been unconscious for ten days, but then unceremoniously administers another dose of midazolam because the patient is choking on his endotracheal tube.12 Two days later, when the tube has been removed, Richard’s main contribution consists of telling the patient: “You’re doing fine,” and then: “You look like someone rescued off a desert island.”12
Léon, "the sergeant-majorish male nurse with the big biceps and the bluish chin,"13 works in a hospital for neurological and psychiatric disorders where he helps lift disabled patients in and out of bed. Léon "saluted [Maugras, the patient,] raising his hand to his cap in military fashion.24 ... Maugras took an instant dislike to him.26 ... He loathed ... all men of his sort ... triumphant he-men who always seemed to be proudly flaunting their male organs."15
The male nurse in Duhamel’s Les Sept Dernières Plaies16 is also called Léon, but his personality is that of a lamb rather than a lion. He seems the first of a series of homosexual clowns, a stereotype that persists in the portrayal of male nurses to this day. Léon Bouin, a mathematics teacher before the 1914 war, has enlisted in the army and cheerfully performs all kinds of menial tasks.17 His current location is a military hospital where he is assigned to the care of Colonel Piâtre, a tyrant, who subjects his nurse to a barrage of verbal and physical abuse. Bouin seems to relish his role of sacrificial victim and refuses an offer of a transfer.17 However, one evening, the young surgeon who is telling the story finds Bouin in tears and inquires what happened:
‘He hit me.’ ‘He hit you? Where?’ Monsieur Bouin shivered slightly, more or less announcing by his body language, that his modesty had been violated. ‘I can’t possibly tell you,’ he whispered.” (“M. Bouin eut un léger frisson, presque un geste de pudeur effarouchée. ‘ Je ne peux, non, je ne peux dire,’ souffla-t-il.”)17
Norman Fussell, the male nurse in Patrick White's Riders in the Chariot,18** is another homosexual clown. Norman who
had been arranging his waves in front of the glass ... was very brisk for one so round and soft. He began to prepare himself a meal of beans on toast, which ... he ate, holding his head on one side, half out of delicacy, half because of a difficult denture. When he had finished, he informed: 'Nurse is feeling better now.' [Norman is described as a] "poofter,** [who] "could not impress a woman even if he tried.19
We do not see Norman working as a nurse. Instead he performs as a female impersonator "wearing a bunch of feathers on his head, a bunch of feathers on his arse and a kind of diamond G string wherever else. Otherwise Norman was fairly naked except that he had painted on a pair of formal nipples and was prinked and powdered in the right places."19
Robertson Davies' male nurse, “Mister Horne,”20 is yet another sexless buffoon. Whenever Mr. Horne's profession is mentioned in his presence, “he would shout 'Well, I sure's hell ain't a female nurse,' and this made him the wit of the establishment."21
During a Rabelaisian scene when Mr. Horne and the other occupants of his boarding house are serenaded, he "burst out of his door in a fury. ... Mr. Horne ... slept in his pajama jacket only, so that his shriveled and unpleasing privy parts were offered to our view."22 In a symbolic gesture, one member of the band "advanced upon Mr. Horne and flicked him sharply on the tip of his penis with one of the long supple hammers of his cimbalom. Mr. Horne danced and screamed," and as the band retreats down the stairs the proprietress remarks "in a voice pitched to reach the ear of Mr. Horne ... 'He is a man of low birth and I have him here out of pity.' "22
One of the most vicious caricatures of a male nurse is to be found in Freedman's Key Witness.23 Nurse Hopkins, a jail infirmary nurse, is "a pencil-mustached, prissy little twerp,"24 "a geek"37 who "worried a fever blister on the side of his mouth" while being interviewed by a lawyer. Hopkins is asked whether the Key Witness (Dwayne Thompson) and a female prison officer were having a sexual relationship. " 'Yes', the nurse answered in a whisper. 'Have you actually seen them having sex?' The nurse shook his head vigorously. 'No way, I wouldn't watch something that putrid.' "25
While giving evidence in court26 Hopkins draws attention to himself with a variety of nervous tics:
A hand going to his nostril with a vigorous scratch; a finger harshly rotor-rooting into an ear; the residue, wax or otherwise, wiped across his trousers; a constant blinking of the eyes and blinking of the forehead.
He testifies that while not actually watching the “putrid” sex act between Dwayne and the female officer he “heard” it all. “How can someone hear the sound of sexual intercourse?” he is asked during cross-examination. After first declaring that he is “not going to make the sounds she was making,” he suddenly goes on to do just that. “ ‘Oh Dwayne!’ he mimicked in a hoarse falsetto, ‘Oh Dwayne! Yes! Yes! More! Yes, yes, yes!’ He sat back down flushed and out of breath. ‘Is that what you wanted to hear?’ he asked … with delicious salaciousness.”26
“Gull” in Elizabeth Stead’s Fishcastle27 has been bitten on the penis and has to spend several days in hospital where he encounters a competent, somewhat sarcastic attending physician, and a compassionate, clownish male nurse. The doctor “had lectured him, while dressing his wounds … on the dangers of playing sex games that get out of hand. ’In your case literally!’ he had said and grinned. Very droll.”28 The kindly middle-aged male nurse is more sympathetic … “fluffing pillows with a feather duster hand and caring like a father hen.” He remarks: “ ‘Even with oral it should have a dress on, love.’ He waved a finger at him … I hope he’s as healthy as you are, is he? … He’s not one of our poor darlings, is he?’ “28
Poindexter may be the best nurse at Dooling’s University Medical Center29 but he is male and a sexless freak. ”Poindexter was a wan bespectacled homunculus who often wore at least half his surgical scrubs inside out. His face was tufted with wisps of hair that fell short of forming a beard and his glasses were so thick he looked like an exophthalmic creature from the deep.30 … He was chronically morose, perking up only when he came to work and went into a roomful of machines hooked up to a patient.”31
Among the colorless female nurses in Night Rounds32 Niklas Alexandersson, the male homosexual nursing superintendent, stands out as the only memorable character. Niklas who wears a suntan in winter, a pony tail and multiple ear-rings33 is aggressive rather than clownish. He “steals” the husband of one of the female nurses and becomes the dominant partner of the new relationship. He has a foul temper34 and, on at least one occasion, he is unfaithful to his recently acquired partner.35 Despite Niklas’ attractive exterior and aggressive personality, his homosexual behavior patterns are not far from the surface. When he quotes his current partner’s ex-wife, he puts on a falsetto voice and female body language.33 He stomps out of a room when the conversation annoys him but then proceeds to listen at the door.36 Like the gentle Norman Fussell18-19 Niklas performs on stage as a “drag-queen,” wearing “a black G-string between … [his] two firm buttocks.26
Tim Holbrook, the hero in Frede’s The Nurses37 is neither a homosexual, nor a buffoon. On the contrary, the struggles of this earnest young man highlight the widespread prejudices against men who chose nursing as a profession. Tim’s wife leaves him on account of his career choice, and the judge in the subsequent custody trial pointedly and repeatedly questions his sexual preferences.
When Tim first announces to his wife Valerie (a nurse) that he wants to study nursing, she is enraged:
‘Why not a doctor? I can see you quitting a good job and all of us sacrificing so you can be a doctor, but a nurse? … What will people think?’ ‘I don’t know. I always thought nursing was an honorable profession.’ ‘For a woman!’ There had been a considerable silence after that. Then, very quietly, Valerie had asked again, ‘Why not a doctor?’ ‘I don’t want to be a doctor … I would like to help people. I would also like it to be an eight-hour job. I would like to be with you and Jason and have a garden.’38
Tim implies that doctors, who do not work eight-hour shifts, spend insufficient time with their families and are unlikely to have many opportunities to work in their gardens. Unlike nurses, doctors have other items on their agenda apart from “helping people.” Valerie is unconvinced. She walks out a few days before Tim’s graduation, because she cannot bear the thought of being married to a male nurse. “ ‘What does that make me?’ she had said.”38
During the subsequent court battle for the custody of Jason,39 the judge makes no effort to hide his prejudices. In his mind “male nurse” is synonymous with “homosexual” and he is not going to entrust a young boy to a father engaged in “immoral practices.” Nurse Audrey Rosenfeld, Tim’s current girlfriend, saves the situation. In answer to the judge’s direct questions, she testifies that during sexual activities Tim “acquitted himself as a man.” Her testimony proves decisive and Tim, despite his profession, is declared capable of bringing up a child.39 The principal of Jason’s school is less tolerant: He refuses to shake the hand of a male nurse.40
The professional literature contains numerous papers deploring the stereotyping of male nurses and expressing the hope that such negative images will soon disappear. By the early 21st century, this hope has not been realised.
* In the real world, the proportion of male nurses in psychiatric institutions is greater than in acute hospitals. In Victoria, Australia, in 2004, some 30% of mental health nurses were males.4
** White, a Nobel laureate in literature and himself an overt homosexual, uses somewhat idiosyncratic spelling and syntax. He writes "pufter,"19 though the dictionary spelling of the word is "poofter" (a derogatory term for a male homosexual).
- Fiedler L (1983) Images of the nurse in fiction and popular culture. Literature and Medicine 2: 79-90.
- Buerhaus PI (2008) Current and future state of the US nursing workforce. JAMA. 300: 2422-4.
- Canadian Nurses Association (2009) 2007 Workforce Profile of Registered Nurses in Canada http://www.cna-aiic.ca/CNA/documents/pdf/publications/2007_RN_Snapshot_e.pdf (last accessed February 19 2010).
- Department of Human Services (2004) Nurses in Victoria: A Supply and Demand Analysis. State Government of Victoria, Melbourne, p. 24.
- Kesey K (1962) One Flew Over the Cuckoo's Nest. Picador, London, 1973, pp. 27-8.
- Gardner J (1972) The Sunlight Dialogues. Ballantine Books, New York, 1973, pp. 254-7.
- Simenon G (1963) The Patient. Translated by Stewart J. Hamish Hamilton, London, 236 pp.
- Brown TK (1956) A Drink of Water. In: Engle P Harnack C (eds.), Prize Stories 1958: The O. Henry Awards. Doubleday, Garden City, NY, 1958, pp. 179-201.
- Whitman W (1865) The Wound Dresser. In: Whitman W Leaves of Grass, Oxford University Press, Oxford, 1990, pp. 241-4.
- Huyler F (2004) The Laws of Invisible Things. Henry Holt, New York, 301 pp
- Ibid., pp. 177-9.
- Ibid., p. 215-8.
- Simenon G, op. cit., p. 178.
- Ibid. p. 174
- Ibid., p. 197.
- Duhamel G (1928) Les Sept Dernières Plaies. Mercure de France, Paris, 295 pp.
- Ibid., pp. 27-35.
- White P (1961) Riders in the Chariot. Penguin, Harmondsworth, 1986, 491 pp.
- Ibid., pp. 348-56.
- Davies R (1981) The Rebel Angels. Penguin, London, 1988, 332 pp.
- Ibid., p. 140.
- Ibid., p. 234.
- Freedman JF (1977) Key Witness, Dutton, New York, 532 pp.
- Ibid., p. 74.
- Ibid., pp. 284-6.
- Ibid., pp. 466-8
- Stead E (2000) The Fishcastle. Penguin Australia, Ringwood, 393 pp.
- Ibid., p. 287
- Dooling R (1991) Critical Care. William Morrow, New York, 248 pp.
- Ibid., pp. 236-7.
- Ibid., pp. 44-5.
- Tursten H (1999) Night Rounds. Translated by Wideburg LA. Soho Press, New York, 2012, 326 pp.
- Ibid., pp. 59-63.
- Ibid., p. 103
- Ibid., p. 108.
- Ibid., p. 84-5.
- Frede R (1985) The Nurses. W.H. Allen, London, 1986, 507 pp.
- Ibid., p. 104-6.
- Ibid., pp. 467-8.
- Ibid., p. 495.
SOLOMON POSEN, MD an emeritus professor of medicine at the University of Sydney, majored in English before obtaining his medical degrees (MB BS, MD) at the University of Adelaide, Australia. He is a Fellow of the Royal Australasian College of Physicians, a Fellow of the Royal College of Physicians, London, and a past president of the Endocrine Society of Australia. He lives in Sydney, Australia.
Dr. Posen taught general medicine and endocrinology at Sydney University for almost 30 years and has served on the editorial boards of several medical journals. He is the author of some 130 scientific papers (mainly in the field of calcium metabolism) and a co-author of a book on alkaline phosphatase. He is the author of a projected four-volume work titled The Doctor in Literature. The first volume, Satisfaction or Resentment was published by Radcliffe in 2005. The second volume, Private Life, appeared in 2006. The third volume, Career Choices (2010), is available on the University of Sydney eScholarship website.