This article was originally published in the Summer 2013 edition of Plant Healer Magazine.
I am an herbalist, nurse, and health educator who lives in the city of New Orleans. I work as an herbalist at a collectively owned herb shop, and as a telemetry nurse at a local hospital. Paradoxically, I love both my jobs. Although I had toyed with the idea of becoming a nurse before coming to New Orleans seven years ago, my experiences working in a free clinic here after Hurricane Katrina catapulted me onto that path. These days, as I prepare to move away from this city that has become such a part of me, I’ve been thinking a lot about what it means for me to have one foot in each paradigm, why it’s important, and how I can use my access to change the world. I wanted to share these thoughts with you, my herbal community.
Before becoming a nurse, I was an herbalist for many years. I came to New Orleans after Hurricane Katrina hit and spent 27 months working as an herbalist at a free clinic with other herbalists, doctors, nurses, acupuncturists, and volunteers of all stripes, helping to create an herbal medicine program alongside the primary care being offered. The result was neither idyllic nor ideal, but it did work, and the herbal program at the clinic continues today. What I learned from my experiences at the clinic would fill another essay entirely, but what’s relevant here is this: The healthcare landscape I walked into in New Orleans had been profoundly broken for generations before Katrina, leaving the people with levels of chronic illness on a scale unseen in other parts of the country. People were in dire need of basic primary care before the storm, and afterwards the need was catastrophic. It was a situation in which my skills as an herbalist were not enough by themselves, but alongside the other practitioners, we made a difference. As time progressed and the city stabilized, I often became frustrated with the inability of the allopathic practitioners, however well-intentioned, to understand where we were coming from as herbalists. For the sake of the people who utilized the clinic, I wanted the allopaths to really listen to us; to trust that although our approach was different, the results would be lasting; to see the potential for what we could accomplish together. Although we were successful in many ways, I couldn’t help but think that if I could better learn their language, I could engender more of the trust that I sensed was the key to creating a more effective relationship, and I craved more knowledge in western medicine so that I could act as a go-between and translator. The responsibility to cultivate the relationship lay with both parties; however, I didn’t sense that it was as high on the allopaths’ priority list as it was on mine. It’s not that they didn’t care, and without the hard work of a few key physicians and nurse practitioners, the program would never have been as effective as it has been. But herbalism was foreign to them, and they spent their energy working hard practicing the kind of medicine they knew. Ultimately, I decided to leave the clinic and go to nursing school because I wanted to learn more about the “other side” of medicine, to gain more healthcare skills, to be an advocate for those needing to avail themselves of the biomedical system, and to help facilitate a working relationship between the worlds. While in nursing school, I opened an herb shop with three other herbalists, one of whom was going to nursing school with me, and two of whom I had built the clinical herbal program with. Without the outlet of the herb shop as a connection to the plants, and without the support of these women, my best friends, I would never have made it though nursing school.
I didn’t have a clear vision of what it would look like to be a nurse-herbalist; it just felt like the right thing to do. But the more I’ve learned and experienced as a nurse and as an herbalist, the more I have realized how much more we could accomplish if those skilled in western medicine and those skilled in herbalism could work side by side, rather than simply from their own camps. Admittedly, those in the herbal world are eminently more willing to do this than most western medical professionals; however, there are many doctors, nurses, social workers, and public health professionals – like many of those I worked with at the clinic — who are willing and able to be allies. Building bridges between the modalities seems to me to be more than just a good idea – I believe it is vital for the health of our friends, families, communities, and world.
It’s not that I don’t see the contradiction between the worlds of nursing and herbalism. I do. The two ways of looking at health could not be more different at first glance. Despite the fact that nursing seeks to differentiate itself from the physicians by labeling itself the “caring profession,” it nevertheless swallows the western biomedical paradigm hook, line, and sinker. Although nursing recognizes the importance of a body-mind-spirit connection, it nevertheless relies, as physicians do, on a foundation of double-blind studies, molecular physiology, and genetic mapping as a guide to health – or rather, to disease. While many nurses embrace some holistic methodologies such as reiki, aromatherapy and therapeutic visualization (herbs are almost never utilized), these are looked upon as ancillary at best by the profession as a whole, and are seen as having a primary benefit of increasing a sense of well-being rather than creating lasting generalized improvement in health. Conversely, herbalism around the world, both historically and currently, is so diverse in its culture and application as to appear uncontainable in any box. We have a different vision of health, one not rooted in the treatment of disease, but in the nourishment and support of people and the earth. We look for patterns of imbalance rather than treating isolated symptoms; we rely on our senses, not test results, as our foremost guide to discovery (although we recognize that test results, too, sometimes have their use). We are scientists and indigenous healers, shamans and skeptics, activists and board members, but we do have a few tenets which bind us together, namely these: We are more than the sum of our parts. Everything is connected. Plants are alive. They take care of us and teach us. We take care of them and say thanks.
People often ask me about how I combine nursing and herbalism. I explain that my philosophy is rooted in herbalism and holistic healing, and that nursing is a very useful tool in my belt, as it is the specialty within western medicine which most reflects my love of people and my desire to help them heal. Some are excited about the prospect of combining the two; others are suspicious and judgmental. Some doctors and nurses are incredibly supportive of the use of natural and noninvasive health care; others are curious and open-minded; many, unfortunately, are mistrustful and dismissive of anything lacking the validation of double-blind studies and meta-analyses. Most herbalists are very supportive of my decision to become a nurse and seem to understand intuitively the ways in which nursing may be useful to us. Some are less understanding. Recently an herbalist traveling through town stopped at the herb shop and looked askance when hearing about my “other job” at the hospital. “So you give people pharmaceuticals,” she said, her face screaming “sell-out.” Well, yeah, that’s how it works over there. There’s no herb that’s going to fix someone who’s in atrial fibrillation with a heart rate of 200. They need a freaking cardizem drip or they could have a stroke and die. However, I could understand where she was coming from. I’ve been there. I just see, now, that sometimes it takes using every tool we have to help people get better. Just as it sickens me to see deathly ill people at the hospital languishing without help from herbs and deep nutrition (and yes, sometimes unnecessarily or ineffectively medicated), so it disappoints me when the benefits of western medicine are dismissed by those who think it has nothing to offer.
The truth is, I don’t combine nursing and herbalism in a way that is noticeable on the surface. They are two worlds between which I believe bridges must be built in order for people to become healthier, but I see no reason to homogenize them into one entity, nor do I think it is possible in practical terms. The usefulness comes more from being familiar with both terrains, so that I am able to apply my knowledge from one side of the bridge to a situation or need at the other; to make informed decisions as to when someone utilizing one modality may be in need of the other; and, frankly, to advocate for herbalism and holism within the biomedical world for the benefit of people who need it. And though I believe that more connections between herbalism/holism and biomedicalism are necessary to improve health outcomes, I am under no illusions as to the evenness of the playing field. Herbalism, as the underdog, needs my support in building trust and acceptance within the medical community, while the monolith of modern western medicine needs people working to break down both its barriers to access and its dominance over health options. My goal is the achievement of both.
I use my knowledge of holistic healing every day at the hospital. I teach people (patients, family members, and other nurses) about nutritional and lifestyle choices and I try to counteract the misinformation perpetuated in the hospital about what healthy eating means; I talk about the importance of sunlight and fresh air to healing (“…scientifically proven!” I say to them and open the blinds); I educate about the connection between, for instance, someone’s chronic gastrointestinal disorder and their severe skin condition. Likewise, I use my nursing skills at the herb shop to help me ascertain whether someone’s health challenge can be dealt with effectively with herbs or if it has progressed to the point that medical intervention is necessary. It’s not that this can’t be done without education in biomedicine – many, many herbalists are highly skilled in this discernment — but it has helped me a great deal in developing my own personal skills in this area. Because many people who come to the herb shop for help do so because they have no insurance and cannot afford medical care, this is common occurrence.
One thing I do not do is talk about actual herbs with my patients* in the hospital. There are a few reasons for this. The most important one is that my patients are often on a breathtaking number of pharmaceutical medications. It is inappropriate to suggest herbs to such patients in this context, because it may be unsafe — I do not have enough information about their health to make informed suggestions — and even if I did, I am caring for them as a nurse, not an herbalist, and again, the two are separate things entirely. It is (arguably) not within my professional and legal scope of practice as a nurse to suggest herbs to patients; therefore, when actively working as a nurse, I steer clear of doing so. Furthermore, these people are dealing with acute, often life-threatening health situations and are not in a position to retain new and unfamiliar information, especially if it may conflict with the information they are already receiving from doctors. Many herbs are unfamiliar, some are potentially unsafe given the polypharmacy in use (not likely, but better safe than sorry), and trying to discuss them would be simply confusing and overwhelming to the acutely ill patient. It is different to talk about food – it is familiar, and short relevant bursts of information give people a measure of personal power as they recover from whatever they are dealing with (“Hey, did you know something? The sugar in that Coke you are drinking is great food for all the bacteria causing your blood infection, and it works against the antibiotics we are giving you. Those green beans on your plate will give your body some really useful vitamins and minerals with which to fight those bacteria, and help the medicine work better too”). I sometimes share the fact that I am an herbalist with my patients in the course of developing warm and caring relationships with them, which is often. In addition, I do share information about kitchen medicine with my patients and their families in certain appropriate situations (such as when they ask me) and in the context of general health. Ginger (Zingiber officinalis), Onion (Allium cepa), Lemon (Citrus limon), Thyme (Thymus vulgaris), Okra (Abelmoschus esculentus), Blueberry (Vaccinium corymbosum), Bay (Laurus nobilis), and other Southern plants at the herb-food crossroads are safe, culturally familiar, and accessible.
Back at the herb shop, I don’t hide the fact that I am a nurse, but I also don’t flaunt it. It’s often not relevant to the client’s situation, and I don’t want to muddy my role as an herbalist. There are also legalities to consider. As an herbalist, I offer suggestions based upon my experience and traditional use, in the context of supporting the structure and function of the body, and I am well within my rights to do so. I don’t want to create the impression that I am suggesting herbs based upon my education and knowledge as a nurse, because one, that’s not accurate, and two, it’s ostensibly not within the nursing scope of practice. Even though I think there is a good argument to be made in support of a nurse’s right to use herbs with her or his patients (see Martha Mathews Libster’s groundbreaking book The Nurse-Herbalist), that’s not a legal battle I feel capable of taking on right now. Instead, my nursing skills become useful when questions arise regarding pharmaceuticals, herb-drug interactions, diagnostic tests, how allopathy generally treats specific ailments, and so on. Sometimes, herbalists who are considering going to nursing school approach me with questions, and one is often the fear of legal reprisal when working as both a nurse and an herbalist. For me, the boundaries I’ve created for myself seem reasonable, and I feel that my practice in both fields is on solid legal and ethical footing.
It’s an interesting coincidence that as I am in the middle of writing this article, an issue of the Journal of the American Herbalists Guild has arrived in my mailbox, and that within it are two articles that speak eloquently to the subject matter at hand. One is by Michael Tierra (2013), who echoes my sentiments precisely: “I consider it part of our job to build bridges to the conventional medical establishment, despite the fact that this attempt at bridge building is not always reciprocated… These days, our goal should not be to prove that our way is the only way, but rather to help the people who seek our guidance and advice by utilizing all of the tools that are available” (p 20). The other is by my teacher Phyllis Light (2013) and discusses the importance of collaboration between traditional knowledge and science. “Let us begin the process of breaking down the boundaries,” she writes. “It is time to focus on what is held in common by these two systems rather than the differences. Although boundary work may take decades to reach acceptance, it must have a beginning. For the health of our planet, we must stop thinking of ‘us versus them’ or ‘science versus tradition’” (p. 27).
Let’s be blunt. I am writing for an audience of radicals, of free thinkers. I’m writing for those for whom it’s not a question of whether the western biomedical paradigm has gone wrong, but whether there is anything within it to salvage. I’m also writing for my colleagues at the hospital, who would decidedly deny being radicals of any sort; who love their patients as fiercely as I love mine and who do the very best they can with the tools they have – tools that are, in many cases, vitally and desperately needed by their patients. It’s just, simply, that I am a Libra rising. You think I’m kidding about that, but I’m not. I’m playfully serious. My point is, I have been a bridge walker my whole life. I never have fit in, not really, not anywhere. I am likable and lovable and have good friends; I am kind and fallible and I mess up and try to make amends like everyone else; but I never did fit like a key to a lock, to anywhere or anything. After years of hating it about myself and wishing I could be different — tougher, more fearlessly dedicated to the pure, unadulterated truth of whatever revolutionary righteousness I was most passionate about at any given time – I have found myself with a foot in each of these two worlds, trying to use my access in each to the advantage of those in the other. It’s an amazing position to be in.
People need western medicine. It is brilliant, fascinating, and lifesaving. But while its sheer hubris prevents it from embracing other ways of thinking about health and illness, this does not preclude the fact that we must work to make it see this error and to understand that alternatives are not only beneficial, but absolutely necessary. What our culture needs is not better technology, bigger hospitals, or more nuanced medical specialties. It needs nutritious food, clean water, an understanding of the concept of vitalism, a functional and compassionate mental health care system, meaningful support of children and schools, protection and nourishment of wild, green spaces, and so much more. Herbalism understands this on a deep level because it recognizes the interconnectedness of all things and sees societal and worldwide problems reflected in the imbalances of the body. And this is why we can’t be content with simply remaining on our side of the bridge. Yes, western medicine saves lives, but it also leaves too many people with only half of what they need to reach true and lasting health. We as herbalists who dedicate ourselves to healing, and who know what it means and what it takes to do so, are sorely needed on this front. I’m not saying that I think all herbalists should rush out and go to medical or nursing school. There are many other ways to cultivate the relationship, and stepping into the allopathic world is neither necessary nor ideal for everyone. But, as Michael and Phyllis said, we can’t stop trying to build bridges and break down boundaries, however we may decide to do it. The health of our clients, our communities, and our world is at stake.
Here are some suggestions for bridge-walking:
– Know your limits. Everyone has them. You are a better health care provider every time you realize something is over your head and refer your client to someone who knows more. It’s possible that an allopathic provider may be the most appropriate referral.
– Search for western medical practitioners who are open to working with herbalists. This is easier in some places than in others. If and when you find one, cultivate the relationship and let your herbalist colleagues know so that they can refer clients who may need the attention of a physician or nurse practitioner.
– Begin a health care discussion group and invite people from as many different modalities as possible. Here in New Orleans, we have a loose monthly group which variously includes herbalists, a physician, a midwife, medical students, nurses, EMTs, and acupuncturists. Inviting students is great, because exposure to other modalities while in school may translate into a greater willingness to work outside the box after graduation. This kind of group can become an invaluable resource for information-sharing, referrals, and possibly even starting a clinic if cultivated over the long-term.
– If you do not already know where people with no money go for health care in your community, find out. If you do already know, put together a health care resource guide for clients, colleagues, and the community. This will also help you personally when you need to refer someone who has no money and/or no insurance, like many of my (and perhaps your) clients.
– Learn about the hospitals in your area, what their emergency room wait times generally are, and which ones are more appropriate to go to for different issues. That way, the next time someone calls you in a panic because their pit bull bit off their nose, you can tell them to go to the hospital with the best trauma center rather than the one well-known for women’s health care. Also, hospitals have policies regarding how indigent individuals pay or don’t pay for the care they receive. They all have to treat anyone who shows up, but only until the person is no longer in acute danger of dying. Then they can send the person elsewhere. It’s educational and perhaps helpful to learn what the deal is at your local facilities. If you investigate, you will surely learn other tidbits as well about your local hospital and health care system that you may be able to use to your clients’ advantage.
*I realize that some reject this term as paternalistic; I personally do not take umbrage with the word and use it here because the term “client” seems somehow not to fit in a hospital setting; plus, “patient” rolls off the tongue more easily than “the really sick people who I care for in the hospital.”
Light, P. (2013). Boundary Work: Creating Collaboration between Traditional Knowledge and Science. Journal of the American Herbalists Guild, Volume 11 (Issue 1), pp. 22-27.
Tierra, M. (2013). Scope of Practice, Referring out, and Building Bridges to the Medical Establishment. Journal of the American Herbalists Guild, Volume 11 (Issue 1), pp. 17-20.