"I can’t tell you the number of times I’ve walked into a patient’s room and their chart tells me they should be dead and they’re not, and I don’t know why. And I can’t tell you the number of times I’ve walked into a patient’s room where the chart says they should be fine, and they are very, very much not fine, and you have to figure out why. And I don’t know that I would have ever really been able to figure any of that out without humanities education."
— Shelley DeWeerdt Hintz, RN, BSN
Today, on “The Things Not Named,” I speak with Shelley DeWeerdt Hintz, a critical care nurse, English major, and one of the best writers I ever taught, on what a nurse sees that doctors don't, why the humanities prepared her for the clinic, and what living with autism taught her about high-stakes care.
Below is an edited transcript of our conversation on Substack Live.
Transcript:
Joshua Doležal:
Welcome back to “The Things Not Named.” I’m Joshua Doležal.
Willa Cather famously said it’s the presence of the thing not named that gives high quality to literature. This year I’m asking that question of medicine. How might we all be more attentive to what goes unsaid in the clinic, in popular culture, and in the experience of illness from the patient’s side?
My guest today is Shelley DeWeerdt Hintz. Shelley’s a former student, one of the best writers I had the honor of teaching, so this is going to be a special episode for me. Shelley’s both an RN and a BSN, both nursing degrees, and also holds a master’s in public administration from Drake University in Des Moines. She’s had to recreate herself multiple times since graduating with a BA in English and writing from Central College in 2007. She graduated just a couple years after I started teaching there. And her path really goes to show how much you can do with an English major. Today, Shelley’s an adult critical care float RN, and a day that begins as a cardiology nurse may switch to ED trauma and then to surgical charge nurse all in a 12-hour shift. It sounds to me like she’s living a real-life episode of The Pitt.
Shelley lives in Iowa with her spouse, Damon, two stepsons, and several spoiled animals, including her horse, Vinny, who’s taught her everything she knows about being a human.
So welcome, Shelley.
Shelley DeWeerdt Hintz:
Hi. Long time no see.
Joshua Doležal:
Yep, yep. So The Pitt, that rings true? Or is it not like it seems?
Shelley DeWeerdt Hintz:
I haven’t actually watched it yet. I need to, but I don’t get an awful lot of downtime. I’m a very outdoors person when I’m not at work. So downtime, I’m usually trying to power down, so I usually read. I know people have talked to me about it, but I’ve seen clips, enough to know that it’s more familiar to what my day looks like than maybe other medical shows. Definitely, we’re not Grey’s Anatomy, but The Pitt is more familiar from what I’ve seen.
Joshua Doležal:
So you work three 12-hour shifts or four 12-hour shifts?
Shelley DeWeerdt Hintz:
I am weekend package, so I work every Friday, Saturday, Sunday, 12 hours. Our shifts usually start 7:00 AM and they end at 7:00 PM, but then we have a half hour we stay for a report to the ongoing team, and then the team that comes on for overnight is from 7:00 to 7:00 AM, so we basically split the day right in the middle.
Joshua Doležal:
Wow. That’s a long workday.
Shelley DeWeerdt Hintz:
It’s like three days, but then you get four days off, and there’s trade-offs. You get used to it. It’s definitely a culture shock when you first start it when you’re in nursing school, but you get used to it.
Joshua Doležal:
I have to tease you a little because the reason we’re speaking is a text I got from you after, I think, another one of these interviews where you were saying, oh, you’re talking to doctors and we nurses are the ones who really see what’s happening in the trenches. So I was paying attention, so hopefully we can hear a few of those war stories today.
Shelley DeWeerdt Hintz:
Yeah. I mean, we wouldn’t function without the doctors and they are the marching orders. They give us the list of things to do. Obviously, they’ve spent a great deal of time in practice learning, and when all else fails, we have to defer to them. But generally with rounds, especially in med-surg, they will come around, and they’ll hang out with the patient for maybe 10 minutes. They’ll give me the list of instructions for the day, and then we won’t see them again until that time tomorrow. And then everything else that happens to the patient is up to me. And so it’s up to me to notice, to change things, come up with ideas. I can message them when things are not looking okay, when I have concerns. But basically, the rest of the day is, I have to figure it out and then include them if I need help. So as much as patients believe their doctor is just, like, right there, they’re not.
Joshua Doležal:
Do you think the average person just doesn’t understand how much of the actual care is done by people like you?
Shelley DeWeerdt Hintz:
Yeah. I have most... Probably every week, I’ll have at least one patient who has a lot of anxiety, and so, you know, will question everything that we’re doing. Like, did the doctor want this? Did the doctor want that? Who are you? Why am I not... Or they’ll sleep through their doctor rounding, and the doctor won’t want to wake them up, and they’re going entirely off what I’ve told them and charted. And then they’ll be mad because they haven’t seen their doctor, but their doctor has gone through the chart. So there’s, every week you’ll have somebody just not quite understanding how the system operates in a hospital. It’s a little bit different in critical care. Doctors are more accessible, and they’re more frequent. But once you go to, like, a step-down unit or a med-surg unit, you won’t see them nearly as much, and they’re much less involved.
Joshua Doležal:
I want to get back to that, but maybe we can kind of double back to the beginning. So you got a degree in English, and I have actually forgotten what you were planning on doing with that initially. You were thinking about a career in writing, I believe, at the time. So help us understand how you went from the English degree to nursing.
Shelley DeWeerdt Hintz:
So I started out... As a kid, my mom was a pediatric nurse, and she let me play with her textbooks. I did all her CEUs. She brought home stethoscopes. And so I grew up in a medical family. We were always talking about it. And I had originally thought maybe I’d go to school to be a veterinarian or a nurse, but then I, I was 18 from a small town, and I was anxious, and I was far away from home, and the first semester of college as a bio major was just hard. And so I picked up an English class, which writing had always been just something I loved to do, and then I fell in love with it in school. And that was the time, you know, where everything was different in college than it is today. You were very encouraged to just follow your passion, and you would be able to find something to do, and it was going to be no big deal, and that, you know, a BA would open doors for you. So, you know, sure, go switch to English and writing. I loved it. Had a great time. Towards the end of it, the housing crisis happened. So I was going to have to get creative, but I had originally wanted to move to Des Moines with my ex-husband, and he was in pharmacy school, and I love politics and history, and I really wanted to write grants and work at downtown Des Moines, and that’s where the MPA came from. And then the housing bubble broke. So my first job, I was a collector team lead for Wells Fargo. It was...
Joshua Doležal:
I remember that.
Shelley DeWeerdt Hintz:
...not writing at all. And did that for a couple years because you got what you could get a job doing at the moment, and then moved quite a bit with my husband. Eventually ended up purchasing a pharmacy in small town Iowa. So not anything to do with writing, but it was a very, you could either teach, like, elementary school, middle school in the area, or you could have like a small business. And so my ex-husband was the pharmacy guru, and I managed everything else of that pharmacy. But so I, in order to do that, I got my pharmacy technician license.
And then when I decided to leave my ex-husband, I went to Cedar Rapids because that was where I had my horse and all my friends were. So it was 2020, it was the pandemic, and I needed to be able to pay my bills right away. And so I got a job at the hospital I work at right now as a pharmacy tech because I had that license. They needed people. People did not want to come work in a hospital at that time. So I started there and it was amazing. Like, I was bringing all sorts of meds upstairs, and they were also asking for help from non-nursing staff to help answer phones and walk patients, and it was all hands on deck. And I’m the crazy weirdo who watched all that happen and was like, I want to do that. And it sort of reminded me that I did want to do that when I was a kid.
And then when the divorce was finalized, obviously I was supposed to be getting some money from it, and it was all worked out, but I... Something in my gut told me that I shouldn’t count on that forever. And my entire world outside of work was around my horse. And I rode, I was always out there. That’s my people. And my horse is very expensive. And without the money I was supposed to be getting through the divorce, I was never going to make enough money to pay my bills and pay for my horse on a pharmacy tech job.
So something just told me I just needed to do something that was going to make it so I could keep my horse even if my ex-husband flaked. And I decided to go back to school as an adult. I worked full-time, went to nursing school full-time. Don’t recommend. Not the most fun. But I got a lot of scholarships, a lot of grants because I was an adult and I was very, very low income at that point in time because of the divorce and all the craziness. And so I eventually ended up not having to pay for anything. And just slogged through it. And wouldn’t you know it, guess who flaked? Right about the same time I graduated, so. I was very happy that somehow graduated nursing school, worked full-time, was valedictorian of nursing school, which is weird. Now I can pay for myself and my horse.
Joshua Doležal:
Thanks for telling that story. You know, I’m still kind of feeling like we need to make a case for the humanities, and what you’re telling me could be the story of anybody from a small town who grew up with a good work ethic, right? Has nothing to do necessarily with English. But I’m curious if there’s anything about the humanities that added to your farm ethic that you grew up with that was useful, like being able to know yourself, teach yourself things. Maybe I’m grasping for that, but was there a connection between English and that path for you?
Shelley DeWeerdt Hintz:
There was, in that nursing school is hard and there are a lot of threads you have to tie, a lot of information you have to synthesize that they are not going to talk about in class. And you’re in class from like 8:00 a.m. to 5:00 p.m., and then it’s just, there is so much information, and my classmates, it’s notoriously one of the hardest undergrad degrees to get, and my classmates who were straight out of high school, had never gone to college before, very much struggled keeping up with it. The ability to sift through what I didn’t need to pay attention to, to like synthesize information really small and make things easier to myself, was something that I learned at Central. Being able to, like, go through large volumes of text and get the really important stuff out of it.
And I use all of that now quite a bit because I’m like the point person for all of my patients, so the doctor isn’t going to go over their discharge instructions. The doctor isn’t going to, you know, they will contact maybe a consultant a little bit, but I’m kind of the person who ties it all together for a patient. I figure out what’s missing. I figure out what they don’t understand. I figure out who, this person needs to talk to this person, and this person needs to talk to this person in order for them to be able to go, and I have to ringlead all of that. So it’s really helpful because I can sit down with a patient and synthesize an enormous amount of information and make it into something that they can actually do something with when they are not healthcare at all. They can go home and take care of themselves without me there. And so that’s a really big part of what I do, is to get them to the next step, whatever it is, and get all these different people to work together when they don’t talk to each other, see each other, all kinds of ring leading so that this one patient with 20 different sides goes from point A to point B safely.
Joshua Doležal:
So all those long reading assignments actually did pay off.
Shelley DeWeerdt Hintz:
Yeah, a little bit. Yeah.
Joshua Doležal:
What do you see as a nurse, Shelley, that you think doctors don’t? What’s a view from the trenches that doctors aren’t really aware of?
Shelley DeWeerdt Hintz:
I see the, we all see the ugly side of healthcare. We all are part of it in different ways. We all see and get very angry about healthcare disparities and insurance hell and all the different problems that are there. But I’m very with the patient all the time in a way that a doctor doesn’t necessarily see. So a doctor, I’m messaging, I’ll request, you know, like, I hope I don’t gross anybody out, but, yeah, get medical.
Joshua Doležal:
Go for it.
Shelley DeWeerdt Hintz:
I’ll message a doctor because my new patient has C. diff, and it is a never-ending cleanup, and we need a, we call them, the professional term is a fecal management system. But I need the order to be able to do that, and so they’ll put in the order and I do that. So I’m going to be the one that’s in there in PPE cleaning them up, setting them up, turning them, looking, talking to them, trying to make them feel like a human while I’m doing it, trying to make them not embarrassed about what’s happening to them. And then the doctor comes in and, you know, says, oh, your labs look great and, um, we’ve got you on Vanco and all these things and you’re doing better and da da da da da. And then moves on to the next 50 or 60, however many patients they have to see that day. And I stand there and listen and then the doctor leaves and the patient looks at me with this blank stare, like blank look because they didn’t understand anything the doctor just said. And I explain it to them. And so I’m more of the human side a little bit. I get dirty. I explain. I smell all the things. I do all the stuff. So it’s a slightly different world.
Joshua Doležal:
Can you give us an example of the disparities you’re talking about? Things that you would see that maybe doctors wouldn’t.
Shelley DeWeerdt Hintz:
When you’re with a patient all day long for 12 hours, you kind of get to know them personally a bit. Depends on if they’re sedated or not, but you’ll talk to them. You get to know what their home life looks like, what they, you know, the reason they’re there, why they may have ended up in this situation because of some sort of economic hardship and it’s not really that they don’t care about their own health. They can’t do something. Or you get to know them and the reasons behind everything and you know them personally. So all of that information that you glean from hanging out with them and making notes on them as people, you take the really important things from it and you forward that to the doctor and tell them, like, I really think they’d benefit from whatever. And so doctors will pick up on that, but patients are really, really, really good about, like, not telling their doctors the truth. And then I have to sort of figure it out surreptitiously, and so I will interact with them in a way that the doctor might not and get information that is actually possibly more helpful than what the doctor is going to get just because I’m with them for 12 hours and I can wear those walls down a little bit in a way that a doctor can’t.
Joshua Doležal:
I don’t know if this is a fair question, but it sounds to me like there’s maybe a class divide between patients and doctors, but not between patients and you, or at least the perception’s different. Is there a kind of socioeconomic factor there that sort of gets in the way of the real medical history that’s kind of shame-based, whereas if you have a caregiver that they see themselves in, then there’s less resistance?
Shelley DeWeerdt Hintz:
I think there’s less resistance just because, yeah, I mean, they do assume that I’m probably closer to them than the gap between them and their doctor. But also there’s a sort of an assumption that, you know, well, the doctor doesn’t have to do all these things with me, and so you are going to be more of a person like me than they are. And so they try to put on a really good face for a doctor in a way that they don’t for me. So I’ll see. And they still will put on a good face for me, so it does take a lot of effort to get to what’s really going on. Sometimes it doesn’t come out right away, sometimes it doesn’t come out at all. But generally they’ll feel a little like the divide is greater between them and their doctor than it is to me. But some doctors are much better at bridging that divide than others. There are some that older ones have a much harder time of bridging that divide. Younger doctors coming out are much better at it. So we have quite a few doctors that are significantly better than others at making patients feel comfortable and opening up and talking to their level in a level of healthcare information that they can understand. But it depends on your doctor.
Joshua Doležal:
One of my guests earlier in the series was Michael Stein, who has a book that’s just an oral history basically of all of his working class patients and told in their voices, largely, which is a good example of an attempt at least to make space for that.
So before we move on, forgive me for chewing on this like a bone, but poverty, especially in a place like Iowa that has gone downhill economically even worse, you know, since I moved away, but definitely was visibly deteriorating while I lived there. How much do you think poverty plays a role in health outcomes? What are some specific examples of that that you’ve seen beyond the usual ideas of addiction or, you know, meth or something?
Shelley DeWeerdt Hintz:
Sure. I mean, we see addiction and meth, but we see all kinds of drug use. But we, being as I’m in a hospital that is very large and well-equipped, we will get a lot of patients brought to us from hospitals around the state that can’t take care of whatever is going on. So we’ll see a lot of people from other hospitals transported for care with us because the other areas of the state don’t have the money at all to take care of what is a relatively normal situation. You’ll see that, and we will see a lot, a lot, a lot of patients who do not understand how their poor diet, their just their lifestyle, which is directly tied to poverty, is making their healthcare outcomes much worse, and they aren’t able to access the same kind of services and food and medicine and everything that would lead to a much better health outcome than somebody who might live in Des Moines or downtown Cedar Rapids or, you know, have a much better economic situation. And because of where we ship all of our patients in from, I’ll have a lot of patients that are very wealthy, and I will have a lot of patients that, you know, might be coming from the Meskwaki casino area, like the reservation over there. They might be coming... They’re from all over. And there’s a definite, definite difference in healthcare, like awareness of their what’s going on and how they can help, and limited access to anything, depending on where they come from.
And yeah, there’s the... I drink only bottled water, and we’ve switched over to other sources than tap water because the cancer rates are insane. I have seen so many very young people, adults, but very young adults getting really, really bad cancers lately. So it’s a scary place to live.
Joshua Doležal:
It’s been that way some time in the agricultural Midwest. Sandra Steingraber has a book, Living Downstream, that was published, I feel like at least 20 years ago, 15 years ago. And, you know, she is a cancer survivor, and everyone in her family was, which would seem to, you know, bolster the genetic kind of cause, except the catch is that she was adopted. So, you know, the environmental causes of cancer in the Midwest, especially around industrial farmland seems to be kind of a long history, but maybe getting worse.
Shelley DeWeerdt Hintz:
We’re also getting, this year especially, and I’m sure a lot of other states are dealing with this, but we are, all of the sort of small towns around this metro area are getting inundated with data centers. And a lot less access to water.
Joshua Doležal:
So that’s compounding the problem.
Shelley DeWeerdt Hintz:
Yep.
Joshua Doležal:
I hadn’t thought about the data center / farmland kind of one-two punch there, but that would be something to research more for sure.
Shelley, I’m curious if you’d be willing to talk a little bit, pivoting here back to your personal story, because I know that part of your journey away from college and some of the challenges you dealt with even during college, you know, there were limitations that you faced. Like I remember taking a class on a field trip and, you know, you had other plans, and I learned later, you know, years later when you were telling me some of your story that there was actually kind of a medical reason why you couldn’t come along with us.
So you were misdiagnosed for many years and then in early adulthood you had an ASD diagnosis, autism, and that really kind of changed everything for you. So can you tell us a little bit about what led up to that and why that was so important and significant for you?
Shelley DeWeerdt Hintz:
Yeah. My family, like any Midwest religious conservative Christian family, didn’t really believe in mental health care when I was a kid, teenager. I have notes in my baby book about, I was three I think and in a preschool and somebody made some noise and I ran from the preschool and they had to go chase me down because I got scared and it’s a very autistic thing to do. And my mom did as a peds nurse bring me to the doctor and for whatever reason the doctor said, oh she can’t be autistic, she can already read. Because I was three and I could read. So we’re not going to worry about it. And so she just put it out of her mind, it was never real.
But it was always, there was something about me that made everything harder than it did for other people in a way that I couldn’t figure out. Interacting with other people, like making friends, just being a normal human was just more complicated and stressful. I had all sorts of sensory issues, and I just thought I was weird. And I’m just a weird person. My grandma used to tell, you know, people that I was her very special granddaughter. Like, be gentle to her, she is fragile. Which isn’t true, but I was living in a world that wasn’t designed for me. So I was different than everybody else. And when I graduated college, I had struggled socially. Like, I was very... I hardly ever left my single room. I was very anorexic. I was very depressed and anxious, and, like, I didn’t know why functioning as an adult was different for me than everybody else, and I decided, I’m an adult now, I can go try to figure this out. So I went and started this huge process of mental health doctors and visits and meds and this diagnosis, that diagnosis, and spaghetti on the wall and da, da, da, da, da.
So I think I was... It was probably about 10 years when my psychiatrist sent me to a therapist who actually spent more time doing testing than anything else. He only was a therapist for a couple people, but like hand-selected people that were interesting. And so that’s why he sent me there, I guess. I don’t know. And after the first conversation and me talking to him about what was bothering me and why this wasn’t working or that wasn’t working, he stopped taking notes and asking questions, and he’s like, let’s just test you. And okay. And the next week we did like a modified autism ADHD test for adults, which there isn’t a really an official test for adults, it’s just for kids. But yeah, I was 100% those things. And so as soon as I got those diagnoses, he got me off all of the incorrect meds. He cleaned my entire medical chart of all these things that were not real. I went on ADHD meds and like in a week I’m like, is this what everybody else feels? Like, is this, this is what you’re supposed to feel like? It was just like that. And I’m not going to say that it fixes everything. You still kind of have to learn how to work with what you have, but it started the process of being able to leave the house and be a normal-ish functioning human. So it changed everything.
Joshua Doležal:
Thanks for sharing that. So in a way, diagnosis is a story, and you were getting the wrong story for so many years, and then wondering why.
Shelley DeWeerdt Hintz:
I thought I was schizoaffective. I thought I had schizophrenia for, like, three or four years because I had like verbal stims in my head where I would, you know, like tics, and they diagnosed that as a schizoaffective thing. And no, it was just a mental stim that autistic people can have, and it wasn’t that I actually had schizophrenia. But I thought I did. And it really messed with my self-esteem.
Joshua Doležal:
Oh, so living in that story was disempowering, destabilizing in ways that living with autism hasn’t been?
Shelley DeWeerdt Hintz:
No. It’s, uh, oh, your brain is just wired a bit different, and instead of looking at things this way, you can look at it this way. Instead of, well, everybody does it this way, why don’t you try it this way, and you’ll be able to handle it. And it helps, and it gave me an entire roadmap to look at myself and my life differently, approach my challenges differently, and instead of seeing myself as flawed, seeing myself as different. And it was a way to accept myself better and, yeah, changed everything.
Joshua Doležal:
What do you think most people don’t understand about what it’s like to live with, or on the spectrum, live with ASD?
Shelley DeWeerdt Hintz:
It’s so varied. So my house is very autism friendly. So there’s me, my husband, probably on the spectrum, one of our stepsons, probably, and then the older one is a disabled adult. He’s level three autism, and then a whole bunch of other acronyms. So he only communicates with like Looney Tunes statements, and he gets all kinds of services, and so we run the full range in this house. And it’s such a varied situation where like it could be helpful for somebody and useful in certain situations on one side of the spectrum and incredibly debilitating on the other side. And you can be anywhere on that range. And it goes very hugely between Rain Man and it’s just there’s so much to it. So there’s no way of...
Joshua Doležal:
Yeah, I may be reducing it too much. But when you’re working in healthcare, you’re in an environment that is, you know, just kind of flooded constantly with sensory stimulus. I would think of that as a really kind of excruciating environment, you know? And yet it’s a place where you’re able to survive for 12 hours at a time. So how do you deal with that in ways that you weren’t able to in the environment as a college student? And also, is it ever an asset to you to have, you know, lived with some of these experiences when you’re dealing with patients?
Shelley DeWeerdt Hintz:
What’s helpful in the healthcare setting for me is that all these noises, I mean, they overwhelm all of us. We all get all these alarms. We are all stressed out about it, and it’s nice that everybody understands when you’re just, like, alarm fatigued. But what’s helpful in that situation for me is that this is the sensory overload that I have chosen and put in a box. It is not a surprise. I know what I’m going into. I know what the alarms mean. They’re useful to me. They’re not random. They mean something. They’re communicating. And so they’re exhausting, but they’re also easier to manage in a weird way than sensory outside of the hospital, because they’re kind of a comforting, well, that noise I’m hearing is a good noise, and that noise I’m hearing over there is a bad noise.
But like, you get a box that you’re very comfortable with and the world outside of the hospital doesn’t have that box, if that makes any sense. You don’t necessarily know what the noises mean, what the sounds mean, what the... It’s all, you gotta figure that out. So it’s a strange juxtaposition, I guess.
But in healthcare, it’s actually helpful for me because first of all, as a critical care nurse, I look at a patient less as a human and more as an incredibly complicated puzzle. And it’s a gift and a curse sometimes that I can look at a patient and compartmentalize them in a way that non-neurodivergent people struggle with. I can walk into a patient, a trauma situation, somebody spiraling the drain really, really quickly, and a newer nurse or someone who knows that person is going to have a lot more of a struggle compartmentalizing and dealing with that situation, whereas I will be able to walk into it and instead of seeing a human, seeing that you feel compassion for, which you do, but my brain immediately goes to this, then this, then this, then this. I need to fix that and that and that and that. And it’s easier for me to put my game face on, which is a very ADHD thing to do, but to like lock in and start making choices what needs to happen, and be able to push the thought of a human to the side in a way, because I always struggle to connect with my patients and because I’m not the most socially adept.
But in that situation, that’s what they need. They need me to lock in and deal with a problem. And I can deal with a problem. I’m not necessarily the best person to comfort you. I admit that about myself. But if you’re dying, I’m the person you want in the room. So I can do that.
Joshua Doležal:
Yeah. Interesting. I’ve read somewhere, I can’t remember the source, that there’s a predominance of neurodivergent people in science, and I would imagine that carries over into medical science. And the context of this was a nice phrase, which is instead of saying that vaccines cause autism, it’s more likely that autism causes vaccines because of that high representation of people with autism in research in particular. So there seems to be this misperception almost of... And it’s, I’m not trying to downplay the challenges you’ve gone through, but it sounds like this is really an asset in certain ways, in certain contexts. But the public story is that this is a disability. And I’m curious how you respond to that term.
Shelley DeWeerdt Hintz:
In the neurodivergent community, disability is really, that’s a hot word. You can make people very mad. And I think it goes back to the spectrum thing. I know that the name Asperger’s was not a good name. There were reasons why we shouldn’t have used that word. But putting people just as autism spectrum is a very hard concept for laypeople to understand because, well, they have autism, and you have one picture of autism, and the name sort of makes that harder. But autism is so many different things and so many different patterns, and every single autistic person is different. You meet one, you say you’ve met an autistic person, you’ve met one autistic person. You haven’t... It is such a... Where something might be very helpful in certain situations and they might only experience difficulty with XYZ, it might not function as a disability for that person because of what job they’ve chosen and the circumstances of their childhood where they got all the care they needed, and they got all the special ed and they’re really, really great at math and their parents could afford to send them. So like it’s not a problem for that person. But then you have someone like my stepson who until he was a teenager, like they had to put the locks on backwards so that he didn’t leave the house in the middle of the night and he goes to a dayhab. He’ll never work. He’s never like, he’s... We watch Blue’s Clues. My other books, we’ve got Blues and like... And he will never experience certain things. And so for him I would consider that a disability. Like, it limits his ability to participate in the world. And we do the best we can to open that for him, but it’s hard. And so for some people and in certain situations, it can be an asset, and in some people in certain economic situations, that same trait might be a disability because they don’t have access to the same things.
Joshua Doležal:
It’s really well expressed and nuanced. Thanks for taking a deep dive into that.
So let’s circle back to English here at the end. Shelley, I assume that you’re still a reader and make space for books.
Shelley DeWeerdt Hintz:
Oh, yeah. I have a great maybe hope of... We’re working on saving up for a house, working on the down payment, which is a very high bar, but I have high hopes of having a writing room again someday. And getting back into it.
Joshua Doležal:
Well, you have a Substack that has been kind of paused for a while. I assume because of your work schedule. So hopefully you’re at least making some time for reading, and I’m curious if you feel that there’s kind of a feeling, you know, I think among administrators and maybe even some students or parents sending their students into pre-med programs that the real stuff that you need to know is all STEM-based, you know, science and math, and that reading is kind of a nice to have but not a need to have for, you know, for medical training in particular. But I’m curious, if you were teaching young people interested in nursing, what would you want them to know before they entered the clinic? Would books be part of that? Or would it be, you know, mainly the STEM path that everyone thinks it is?
Shelley DeWeerdt Hintz:
For nursing school, you have a great deal of pre-reqs you have to do before you’re even allowed to do nursing. And I don’t know that without the ability to read well, to synthesize information, to study in a very complicated way, you’re never going to make it. Like, you will drown in the information. You will never have enough time to process it all. And so reading is a necessary... Like, AI is never going to make that happen for you.
I saw a whole lot of students try to use those tools to try to make everything easier, and it only would really give them this sort of surface level understanding of the topic, and then nursing is not surface level. Every patient is a complex mess of bits and pieces and numbers, and one thing will mess something over here, and you need to understand how to manage a huge web of information to make the right decisions for them.
It’s not cut and dry. There is no... Nursing tests do not have right answers. They do, but they don’t. They have the best right answer, and anybody who’s been in nursing school knows the horror of, this is the right answer, and this is the right answer, but which answer is more right? And without having some humanities background, you will never be able to figure that out. It will make no sense. You have to be able to understand nuance and lots of information and the reason why something is better than others.
Joshua Doležal:
And real quick, would there be any books that would prepare people well for nursing? Particular kinds of memoirs or novels that would be appropriate?
Shelley DeWeerdt Hintz:
I loved reading before I went into school. Basically any book that gets into, like, the nitty-gritty of something, any essay that... Let’s see. There was books about what it was like in New Orleans during Katrina. I forget the name of the hospital, but there was that. There was just books about cancer treatment and how awful, like all sorts of healthcare books that are technically fiction or essay material that don’t sugarcoat things is really helpful. But I think there’s something very, very helpful about being in a critical, any sort of writing literature class where you have to critically think. And I don’t necessarily know that STEM classes are going to teach you how to do that kind of critical thinking. They will definitely teach you how to decide what to do if you have in front of you the patient’s labs and their vital signs and things like that.
But I can’t tell you the number of times I’ve walked into a patient’s room and their chart tells me they should be dead and they’re not, and I don’t know why. And I can’t tell you the number of times I’ve walked into a patient’s room where the chart says they should be fine, and they are very, very much not fine, and you have to figure out why. And I don’t know that I would have ever really been able to figure any of that out without humanities education.
Joshua Doležal:
Yeah, it’s probably a both/and there. Well, we’re almost out of time, but I see we have one listener question finally. So Julia is asking, from your perspective and experience, what are some of the biggest challenges today facing health and health services in rural communities?
Shelley DeWeerdt Hintz:
I’m going to say absolute just lack of access. They don’t have anything. We have a great deal of telemedicine that is very helpful. Patients are able to go to clinics and talk to a doctor virtually. That’s very helpful. But access to adequate in-home healthcare services, having to drive forever for physical therapy, there’s a food desert. There’s a, you know, they can’t afford a ride to their appointments. Just they don’t have access to things. They don’t have a bus they could get on. They don’t have... There’s nothing there to help these people take care of themselves even if they wanted to. And on top of that, the population in Iowa is aging at such a rate that there isn’t enough people to adequately provide those services because people don’t graduate, and they don’t want to stay. We nurses are... Iowa’s the only place in the US that pays worse for nurses than Iowa is Guam, so we’re the forty-ninth lowest. And so a lot of people will graduate, and they will either work at the university because you can see everything there, or they will leave. We’re close to a bunch of states with much better systems. So there’s just not, what people need just doesn’t exist in the places and quantities that they need it.
Joshua Doležal:
Yeah. Well, there’s this kind of American idea that, you know, you retire to an acreage in the peaceful countryside, and if that means a two-hour drive to the hospital in your later years, that might not actually be the romantic picture it seems.
Shelley DeWeerdt Hintz:
Yeah. There are, we love to be outside and hike, and we go on drives all the time, which is tough with the gas prices. But we love to just look around. Iowa’s beautiful. I love to travel, and there are so many places I would consider more beautiful, but there is a very uniquely Iowa beautiful. And so we are out there, and every year I see more homes that are empty and farms that are empty and towns that two years ago were busier, and that’s empty, that’s gone.
Joshua Doležal:
Yeah. Well, I wish you all the best in your work and for this house and for your writing room. Fingers crossed you’ll be back at your desk writing the memoir that I can’t wait to read.
Shelley DeWeerdt Hintz:
I hope to get a chance. That’s my retirement plan, is I’m going to write and I’m going to have butterflies and hummingbirds in the backyard.
Joshua Doležal:
Well, we’ll wish for that to come true. Shelley, thanks for joining me today, and thanks everyone for being here.
The Recovering Academic is made possible by the support of readers and listeners just like you, so thanks again. Next week I’ll speak with Dr. Sandeep Jauhar about his latest book, My Father’s Brain, which is a memoir about his father’s struggle with Alzheimer’s. Dr. Jauhar is a cardiologist and the author of several books, Intern, Doctored, and Heart: A History, and that conversation will be live on Thursday, June 25th, at noon Eastern.
So that’s the thing not named for today. Thank you, Shelley, for joining me, and see everyone again next week.
The Recovering Academic explores the messy intersections of medicine, culture, and storytelling. I write three new essays a month, hold live interviews, and produce a podcast about the things medicine leaves unnamed. It's all free to read, and it stays free because readers choose to support it. I also give 5% of what I earn here to local charities.
