"It is August 24th" by Courtney Davis

Considering patient care, a difficult thing for healthcare professionals to abandon are their preconceived perceptions of their patients. Preconceived notions can directly affect patient care, creating barriers between the professional and the patient. That is not to say preconceived notions always have a negative connotation. Sometimes initial perceptions help the doctor understand the patient at a glance before getting into a deeper analysis. Yet, these at-a-glance perceptions can often be negative. Profiling patients is a dangerous habit, causing untrue presumptions by healthcare professionals. Such thinking can lead to unwarranted hostility, disgust, or lifestyle speculations. Whether these conjectures are true or not, they create a caricature of the patient in the professional’s mind, which then works to prohibit organic conversation through the implication of stereotypes. Most people have these reflexive responses upon interacting with a stranger. However, in the health care setting, such responses can drive barriers between doctor and patient. These barriers are dangerous: they betray the patient’s trust and can coerce the doctor into misdiagnoses.

In her poem “It is August 24th”, the author-nurse practitioner Courtney Davis details an account intensified through parataxis that grapples with her narrator’s presumptions about her patient. Davis records her conversations between the narrator and her patient, a blonde, pregnant woman, stylistically with italic wording. The lack of quotations inspires a feeling of internalization, allowing the reader to conspire with the narrator, as though these conversations were hashed out in the narrator’s mind rather than spoken aloud. Davis’s narrator has malice in her tonality that she is aware of. The narrator says, “I’m leaving that tone in my voice,” (Davis 7), letting the reader fully feel the narrator’s frustrations and reservations about the blonde woman.

The patient, who had been on a coke binge that she initially hid from the nurse-narrator, still maintains a sense of clinical wonder. She has poor medical literacy and relies upon the narrator’s guidance. The patient asks, “From what?” in italics, to which the narrator crudely replies, “From an all-night party, his oily fingers?” (Davis 9-10). The nurse does not yet know the cause of the miscarriage. Medical contextualization assumes that the miscarriage was likely caused by the patient’s coke binge and drug abuse. Yet, the narrator makes crude assumptions, believing in dirty sexual activity and a wild lifestyle to be factors. The narrator analyzes the patient's uterus, “foul with bacteria” (Davis 8), from sexually explicit acts she implies of the patient. The narrator’s presumptions drive a wedge between herself and her patient. Yet, it is important to internalize that the narrator is also human. These stereotypes and assumptions are learned socially, and it is difficult to reject them. Though some of her assumptions may be true, the narrator needs to forgo these assumptions and treat the patient humanely and kindly. Fixating on these ideas interrupts her focus on patient care, highlighted by the disorganized flow of the poem.

The narrator harbors guilt over the interaction, internalized alongside her rage. These emotions remain bottled- suppressed, yet powerful. “I’m used to being polite / to every patient who looks into my eyes / as if they were my friend,” (Davis 23-25). The narrator’s internalized coping does nothing to help dispel her disgust at the grotesque disturbing scene she arrives upon- her frustrations towards the patient. Instead, she directs disgust towards herself, feeling shame at her poor handling of the situation. The narrator goes as far as to say “I’m better than her,” (Davis 30-31), further rejecting their lifestyle differences. Constantly, the narrator fails to acknowledge the humanity shared between herself and the patient, seeing the patient as a mere medical case.

The panic created by the narrator’s internal and external disgust is paramount in the poem's final stanza, which becomes chock-full of enjambment and intensified scenes. In a scene where social dynamics parallel an implication of rape, the narrator finds herself in a situation of being hunted. A man, following the narrator, stalks her, noted by the sexual undertones such the narrator infuses: “... the man / right behind me, both of us knowing / that I am a woman / like any woman– / just skin and hair and that sharp primal cry” (Davis 51-55). Again, we do not have the full story of the blonde patient. The narrator alludes to the patient having led a vivacious lifestyle, throwing caution to the wind in favor of living for her vices. Yet, now the audience and narrator are confronted directly with the threat of rape, of panic, and of fear. Was the patient raped? Was she scared during her fetus’s conception? The narrator is forced into reflection, resulting in sudden memories of “I see the woman in the clinic” (Davis 46), with “eyeliner like thumbprints / under her eyes.” (Davis 47-48).

These fragmented moments enable the narrator to connect with the patient for the first time- to see the world through her eyeliner-smudged eyes. As she feels helpless, the narrator begins to find hidden sympathy for the patient. Though she cannot mentally string the feeling into thought, it is present as she considers her womanhood, shared just “like any woman” (Davis 54). Her fear and understanding were written in a way that may be fictitious and sensational, but underscores the importance of this mutual understanding that must occur between the nurse and the patient for a mutually healthy interaction.

The sensationalized gap dividing the patient and practitioner stresses the importance of interpersonal resonance. The stereotypes that we project onto the patient are harmful in ways we may not self-realize. How we guide the patient, diagnose the patient, and show up physically and emotionally for the patient are all factors in receiving their ailments correctly. As we become caught up in the minutia of appearances and unshared life experiences, diagnosis can become skewed, changed, and incorrect, driven by what we want to be true rather than actuality. The narrator indirectly admits she has turned away from the patient, speaking the words “I know this is hard,” (Davis 35). Her words are a hollow, mechanical expression of thought that is socially demanded but not heartfelt. As she speaks them, she understands their weakness. The clinical detachment the nurse feels turns her “away from another woman” (Davis 37), deliberately isolating the patient because of her preconceived notions.

As we move through the clinical setting as professionals, our goals should be connection, not dissonance. Though it is natural to have an emotional response to people who may not be like us, we have to understand that professionally, there is a certain level of trust that must be cultivated with the patient. Working through close analysis and characterization of the narrator and patient, we understand how scenarios in the poem are mimetic examples of real-life interactions and their consequences.

- Kai Nikchevich