Nurse Ratched:
The Reality Show
In October of 2000, the Marshalltown (Iowa) Community Theater gave five performances of One Flew over the Cuckoo’s Nest, Dale Wasserman’s dramatic adaptation of Ken Kesey’s acclaimed 1962 novel. Six years later in Marshalltown, Life was imitating Art … in a most disturbing fashion.
In 1975, Cuckoo’s Nest was made into a film starring Jack Nicholson as Randall P. McMurphy, a brash, free-spirited rebel who has been admitted to a state hospital in Oregon for those deemed wards of the state. The antagonist against whom he is pitted is the tyrannical Nurse Ratched, a woman more dictator than nurse. With an iron hand, she supervises a staff of doctors, nurses and orderlies who either share her lack of sympathy for the hospital’s vulnerable inmates, or else lack the personal courage and professional integrity to to voice any meaningful protest against her authoritarian regime.
Although McMurphy, in a titanic battle of wills, asserts his independence and rallies the patients together to take on the oppressive Nurse Ratched, he is ultimately defeated by her arsenal of enforced medication, shock treatments and (in the last resort) lobotomies.
Regrettably, this grim work of fiction now appears to be playing out as a real-world drama on the west end of Marshalltown at the Iowa Veterans Home. The December 2006 issue of the “IVH Stars’n’Stripes,” that institution’s resident newspaper, published an op-ed piece by the paper’s managing editor, Loren Martens, titled “Respect and Dignity.”
In his article, Martens objects to what he views as the frightening ramping up of a program of ostensibly “random” breathalyzer and urinalysis tests required by some residents of Heinz Hall, the dormitory housing the IVH’s most self-sufficient residents. This has been a source of tension between staff and residents for several years, and by Martens’ unsettling account, one resident is now required to take regular breathalyzer tests because alcohol was once found in his room, even though he has never manifested any drinking problem.
Another resident, claims Martens, must submit to mandatory urinalysis because a friend of his is “under suspicion”! And in the ominously ambiguous language favored by bureaucracies everywhere, residents have been informed that failure on their part to comply “will result in some consequences.”
Martens descries what he sees as the administration’s view that it is appropriate to force medical care upon unwilling residents. “The senior Drug & Alchohol Counselor [DAC] for Heinz Hall has told me in no uncertain terms,” states Martens, “that even though she feels it is OK to allow residents to die as a result of refusing medical treatment, it is not OK to allow residents to refuse treatment for addiction — even when there is no diagnosis of addiction, there have been no behavioral problems, and the resident’s health and welfare have not suffered.”
All this uncannily — and uncomfortably — echoes a passage in Cuckoos’s Nest:
Nurse Ratched: “If Mr. McMurphy doesn’t want to take his medication orally, I’m sure we can arrange that he can have it some other way. But I don’t think that he would like it.”
[an inmate standing behind McMurphy smiles]McMurphy: “Heh, you’d like it, wouldn’t you?” [regarding the pills] “Here, give it to me.”
According to one resident, who understandably wished to remain unnamed for fear of retribution, the aforementioned DAC is scarcely a paragon of clinical objectivity. “She carries a lot of baggage on this issue,” he asserted. “My understanding is that her father was an alcoholic, so any time she sees a man with a bottle of beer, that’s a problem in her book.”
In the past, other Heinz Hall residents have complained that this DAC, upon learning that a resident may have stepped out to have a cold beer on a hot summer day at The Spot (a neighborhood tavern located just outside the IVH’s front gate) has attempted to construe this as a drinking “problem,” with subsequent efforts to forcibly enroll the resident in an alcohol rehab program. “This is outrageous,” complained one veteran. “I’m 53 years old, and I’m not allowed to have a couple of beers like any other adult in this country?! What’s really ironic is that I don’t even drive — I walk back to my room. So what’s the ‘problem,’ anyway?”
While the DAC is not at the top of the administrative hierarchy, it has been remarked by residents (and acknowledged, off the record, by staff) that, to a large extent, the DAC operates in her own bailiwick. Other staffers are seen to be generally unwilling to take exception to her perceived expertise, perhaps out of a misguided sense of solidarity and reluctance to undercut her authority, or (more likely) the civil servant’s classic instinct for self-preservation, which frequently manifests itself as a cowardly reluctance to “make waves.”
Another Navy veteran, himself a former IVH resident, has suggested another explanation. “It’s a self-serving way to justify her employment by inflating the statistics,” he said. “If she can ‘document’ a large number of alcohol abusers, it makes her look all the more indispensable and enhances her own job security. What I wonder,” he continued, “is just how much all these uncalled-for tests end up costing the state’s taxpayers.”
The people of Iowa, a prototypical Midwestern state, combine a deep strain of patriotism with an innate sense of common decency. This combination has repeatedly manifested itself in their sense of obligation toward military veterans. Iowa, of course, has an agrarian tradition, and Iowans — like farmers generally — are a frugal lot.
Nonetheless, Iowans have shown their determination, as urged upon their elected officials, to do the right thing by our country’s veterans — and they’ve also shown that they’re willing to put their money where their mouth is. They have generously funded the IVH with millions of dollars over the years to build, maintain and improve what is considered one of the best veterans residence facilities in the country.
As seen on the official IVH Web site [click here to view], there is no reluctance on the part of administrative officials to give copious lip serve to their self-declared mission: “Caring — our only reason for being.” However, this looks more like self-congratulating sanctimony in light of the heavy-handed ramrodding documented in Martens’ piece. In theory, the stated values of the IVH include compassion and respect; in practice, evidently, we are witnessing what lawyers like to term an “arbitrary and capricious” exercise of power.
We wonder how pleased Iowans would be to learn that their hard-earned tax dollars were being used to bully the veterans of the IVH, men and women who once showed the full measure of strength and fortitude for their country. Sadly but inevitably, in many cases some are now weakened and vulnerable individuals who find themselves dependent by dint of infirmity, indigence and other personal misfortunes of time and chance. Indeed, Iowans everywhere might be inclined, like us, to join with Mr. Martens in asking: “Is that really treating residents with respect and dignity?”
