For most people who have spent even a short stretch as a patient in a hospital ward, the nurse is the most important person in their lives. Doctors and residents often spend a few perfunctory emotionally distant minutes, usually in the early morning, and family and friends come and go until, in many hospitals, they are barred completely in the evening hours.
The nurse isn't just an avenue to medication, a wash or help in the middle of the night when the IV machine inevitably shocks one out of sleep with a shrieking alarm. They are a desperately needed reminder of one's humanity in an isolated and antiseptic world, filled only with the omnipresent hissing and electronic language of its machinery barely drowned by the banal drone of daytime television.
The focal point of a patient's need to express pain or fear, or to obtain solace, the nurse becomes akin to a friend who is missed when, after eight or 12 hours, the diligent care they provide becomes the responsibility of another.
Chicago-based nurse and cartoonist MK Czerwiec's book Taking Turns: Stories from HIV/AIDS Care Unit 371 takes the reader on a journey from the point of view of a nurse who worked in the HIV/AIDS care unit at what was then Illinois Masonic hospital in Chicago's Lake View neighborhood from 1994 until the unit's closure at the turn of the century.
In an interview with AGNI magazine online, U.S. poet Marie Howe discussed the manner in which her work as a writer changed after her brother John succumbed to HIV/AIDS.
"I wanted, after that, to make an art that was transparent, that was accessible to people who don't usually read poetry, to my brothers and sisterswonderful, intelligent, smart people who want to read poetry if they know what to read," she said. "Regular people. And I wanted it to be the kind of talk that people talk in sick rooms, where it is very direct and very understated."
The accessibility Howe describes is infused into every page of Taking Turns.
A story is told, in beautifully rendered comic-strip form, that begins in 1993 with a discouraged Czerwiec, who has followed in her mother's footsteps of nursing after degrees in English and philosophy resulted in a miserable job chained to a photocopier.
Yet, only three years into nursing school at Rush University, Czerwiec tells her instructor she is ready to quit after a patient elicits haunting memories of her father, who suffered a stroke when Czerwiec was only 17 and slowly deteriorated over the next seven years before suddenly passing away during her first semester in nursing school.
The instructor suggests that Czerwiec work with AIDS patients on the 7th floor of Rush.
"At that moment," Czerwiec writes, "despite being 13 years into the AIDS pandemic, despite over 270,000 deaths from AIDS in the U.S., nearly 7,000 of them in Chicago, I knew very little about AIDS that hadn't been on TV or in the newspapers."
"My instructor was right," she adds. "I would learn from AIDS what I needed to know to be a good nurse."
The emotional honesty of the comic book is quintessential to the visceral experience of Taking Turnsfunny, terrifying and heartbreaking.
As much as it informs the reader about the devastation of HIV/AIDS, the book allows the reader to see the disease through the eyes of a person who is literally on the front lines. Its intimacy opens those heavy ward doors into every corner of Unit 371, which became Czerwiec's world, from a journal of her dreams to the last moments of a patient's life surrounded by family and friends who tell him that it is okay to let go.
In discussing the creation of the book with Windy City Times, Czerwiec related a history rich with irony.
"My mom had been a general medical nurse in Chicago during World War II and she had these tremendous stories because, like all other professions during that time, nurses took on a lot more roles," Czerwiec said.
Initially, she resisted her mother's inspiration.
"I really wanted to have a place in the arts," Czerwiec recalled. "I loved literature and philosophy. I thought I was going to be a writer, but I realized, after graduation, that I wasn't going to get a job as a writer. My mother had gone back to nursing school in her late 60s. I was so proud of her for doing that. So, we went to nursing school at the same time. We would study together and help each other with our papers. It was fun."
Yet, Czerwiec's initial days in Unit 371 turned fun into a trial by fireexperiences she privately journaled.
"At first, it was really overwhelming," she said. "Because the learning curve was so steep. There was so much responsibility, so much to learn. I felt like I was constantly screwing things up. In an inpatient unit, we were just scrambling to get people over these opportunistic infections but we knew they would be back and that we would probably see them decline until they passed away."
Raw emotion was piled onto the rigorous precision of the job. As an out lesbian, Czerwiec was a part of the community she was serving.
"There was so much loss," she added. "It becomes so personal. You just keep showing up and doing the best you can. There was caregiving fatigue. I would try to clear my head with my writing and then, at some point, I started painting these very simple images on boards and I would make memorials to people who I had cared for who had died. It wasn't until towards the end of the inpatient unit's life that I stumbled into making comics as a really helpful way to help me process care experiences."
To Czerwiec, her patients became "part of the family."
"We were people taking care of our own community so there was all this boundary crossing," she said. "Connected care was the kind of environment the unit wanted to foster. But there's a cost to that connection when your patients are passing away."
But what happens when that loss encompasses an entire unit?
Taking Turns vividly illustrates the aftermath of a night in 1999 when "just before a colleague and I [Czerwiec] were instructed to close the unit after transferring out our one patient."
"There wasn't the need for an inpatient dedicated unit because our patients were getting better after new drugs came out, started being used in combination and started working," Czerwiec explained. "It was right about that time that Advocate took over Masonic so, in that transition, they decided to admit AIDS patients to the oncology unit."
"We had become a strong community," she added. "I felt guilty because we were supposed to be super-happy but, on the other hand, this community of volunteers and caregivers that was so important to me was gone. It was like when a war ends and everyone goes home. You want the war to be over but there's still a sense of loss."
After the unit closed, Czerwiec was in a state of mourning and at a loss as to what to do next.
She returned to her creation of comic strips. It was there that she "discovered the voice I had wanted all the way back when I was going to be a writer."
In order to ensure she represented the "stories that help us heal" and the patients she served with absolute authenticity in her work, Czerwiec returned to school.
In 2009, she received her master's degree in medical humanities and bioethics from Northwestern University.
"A movement was starting up called graphic medicine," Czerwiec explained. "People were working at the intersection of comics and healthcare.
In less than a decade, that movement has grown from a website founded by physician, comic artist and writer Ian Sullivan into what the 2017 Graphic Medicine Conference calls a "community of academics, healthcarers, authors, artists and fans of comics and medicine."
"It has long been known that comics are 'not just for kids," Sullivan writes. "Over the past decade this underrated medium has begun to receive recognition and acclaim from literary critics, academics, and broadsheet reviewers. Often drawing on direct experience, the author builds a world into which the reader is drawn. Amongst the growing number of autobiographical works, titles dealing directly with the patient experience of illness or caring for others with an illness are to be found."
Czerwiec found a calling which she describes as "finally bringing the creative and the clinical experience together."
"Graphic medicine became my job," she said. "It is such a thrill and incredibly satisfying to be teaching, lecturing and, at the same time, working on my book. The thing that makes comics work is the marriage between a minimal amount of text and an image. It feels like it comes really easily to me. I think everyone has the ability to draw. We just don't always access it."
It is an ability Czerwiec encourages from the Northwestern students who attend the drawing medicine seminar she created.
"They are so instinctually creative," she said. "Their drawings reveal their concerns, fear, worries, moments of joy and humiliation. They process a lot about the clinical encounter just by drawing it."
In creating Taking Turns, Czerwiec said she felt a need to "go back, carefully look at and process" her experiences on Unit 371.
"I felt like there was a period where we weren't talking about [the AIDS crisis], how difficult it was and how many people were lost," she added. "I wanted people to talk about it and reflect on it. In the context of healthcare, I want people to think about what is exportable from the kind of care that was provided in this very unique place. What can we export from that in terms of how we provide care and how we teach young people to provide care today?"
It is therefore only fitting that the discussions and the stories Taking Turns will inevitably reap begin with a single quote from Howe.
"The unendurable happens. You know, people we love and can't live without are going to die. We're going to die … it's unendurable … . Art holds that knowledge. All art holds the knowledge that we're both living and dying at the same time. Art can hold it."
Taking Turns will be released by Pennsylvania State University Press on March 15. A book launch featuring Czerwiec will be hosted by Art AIDS America at the DePaul Art Museum on March 30, 6:30 p.m., 935 W. Fullerton Ave.
For more details, visit ArtAIDSAmericaChicago.org/event/taking-turns-stories-hivaids-unit-371.
For more details on MK Czerwiec, visit ComicNurse.com .