Thursday, November 2, 2017

Downey VA Introduces the Shoe Shine Nurse

 Downey VA Hospital, the agencies largest psychiatric facility, had an aloof contingent of highly
educated,  office-sitting nurses dedicated  to grinding  out an assortment of directives, memos, and program notes to lowly staff nurses for implementation.. These administrative hot shots even had their own building complete with plush Karastan carpeting, air conditioning and fancy  pictures on the walls. A far cry from the dingy, smoke filled  wards with cyclone fencing and bars on all  the windows where staff nurses practiced. These office bound nurses never ventured far from their comfortable habitats, but their word became law out on the wards.

Here is a real gem of a memorandum  from one of those office sitters with ample, well padded backsides that I recently  discovered in my basement junk pile  archives of old nursing paraphernalia, "Adjunctive therapy is utilized for phenomenologically promoting a patient's  self actualization when neutrality and anomia of traditional therapy are compromised. An  additional tool to augment the psychotherapeutic milieu." That one's a real head scratcher, but I guess, the general idea is to engage the patient in an activity program so he can find something to do.

Examples of adjunctive therapy include: psychodrama where the patient acts out a scripted scenario under  staff direction, token economy where the patient earns rewards and privliges as outlined by the staff, exercise group involving that old 1..2..bend and grunt routine, and work details such as the "spoon factory" where listless patients dutifully inserted plastic spoons in plastic bags for 8 hours at a stretch.

These adjunctive therapy all share a common thread and that's top/down delivery. A group leader instructed patients in a rigid, authoritarian manner.This did little to establish trust or facilitate communication.

Something different was needed here to demonstrate trust and caring. As I surveyed the ward, I noticed most of the patients were wearing scuffed and dull leather shoes. The ubiquitous athletic shoe was decades in the future. Low and behold, off in a distant corner, a little used and neglected  shoe shine bench sat gathering dust.

Suddenly an epiphany popped into my head. The next day on the way to work, I stopped by the local Ben Franklin store (remember those?) and purchased a few tins of Florshiem paste shoe polish. After gathering  a few worn out T-shirts, I was in the shoe shine business.  That evening after the head nurse departed I initiated my shoe shine therapy program. I pulled that old relic of a shoe shine bench away from the wall, dusted it off  and barked out, "OK fellas step right up. Let Nurse Fool shine your shoes. Let me buff them up to a brilliant shine in nothing flat."

Patients were reluctant at first, but after encouragement from the attendants,  a few disheveled  patients stepped forward and propped their lusterless shoes on the bench for an enthusiastic shine by my deft hands. At first I chatted with them about the condition of their shoes to get them talking. The role reversal and lateral delivery of care was off putting at first, but the shoe shine did help to build trust.

Caring and trust were in short supply at Downey VA, but at least I tried.


  1. Trying is something to be proud of.

  2. I've always had a special place in my heart for folks that had schizophrenia as I think they are a very neglected group of patients. There was not a single board certified psychiatrist working the wards at Downey. Building 66 where I worked was staffed by a retired internist.

    Sad, but there are no ice bucket challenges or Jerry's kids for schizophrenics.

    Thanks for reading my foolishness and your comment.

  3. Thanks for that OFRN. A needed story on any day in America.

  4. I have so many Downey stories in my head, but fret that my lackluster writing skills might dishonor the patients that are so memorable to me.

  5. I enjoy reading your posts. Unfortunately, I told my patients that if I remember you it's probably not a good thing. So many sad stories taking up space in my brain.

  6. Angel, how true. I think every nurse has a graveyard of sorts in the back of their head. The really sad ones never seem to leave and are indelibly etched in your long term memory.