Notes from nurses past: Edmonton RN turns to history for COVID-19 guidance

Registered nurse Nick Beil, with the help of his health-historian cousin, turned to the stories of nurses from the First World War and the Spanish flu for perseverance through the COVID-19 pandemic.

Nick Beil recruited his cousin, a health historian, to compile reflections on 1918 pandemic and WWI

Nick Beil, with the help of his cousin Suzanna Wagner, started to include nursing quotes and reflections from the 1918 pandemic and First World War in his weekly updates to staff at the Grey Nuns Community Hospital. (Submitted by Nick Beil)

The Grey Nuns Community Hospital was facing a deadly COVID-19 outbreak when registered nurse Nick Beil turned to his colleagues from a century ago for advice on how to persevere through a catastrophic pandemic. 

Nothing in his two decades as a nurse compares to what the emergency department has come up against during the pandemic. The south Edmonton hospital has been contending with outbreaks on three units since late October. 

At least 21 staff have tested positive for COVID-19 in connection to the outbreak, Covenant Health confirmed this week. Numbers provided by AHS don't include the total number of patients that have tested positive, but as of Friday there were three active patient cases. Sixteen people have died in connection to the outbreak. Across Edmonton, acute care facilities are routinely running over capacity, burdened by rising hospitalization rates.

"There is nobody in the generations of nursing that are working right now that has that ability to draw on something of this magnitude and this severity and say with any determination that it will be OK and we will get through it," said Beil, a program manager for the hospital's emergency department. 

"I had to reach out to someone from the past."

With the nurses from the First World War and the 1918 Spanish flu pandemic long since passed, Beil would need a medium to bridge the historical gap. So in early November, he turned to his cousin, Suzanna Wagner, who finished her master's degree at the University of Alberta in the spring researching the history of nursing in the war and the 1918 pandemic. 

The health historian compiled a list of quotes and reflections from that time, which have since become a feature of Beil's weekly updates to staff. Of the many parallels between then and now, a renewed appreciation for nurses ranks among the most noticeable, Wagner said. 

"I see in this pandemic an appreciation for nurses that is suddenly appearing where I hadn't seen any before," she said. 

Beil says those messages have resonated with staff.

"It is emotional because they are gritty and it really does speak to how times then are probably very similar to times now for the nursing population for what they're going through in their personal and professional lives," Beil said. 

'To lend a hand is to play the game in the fight spirit'

One quote came from the Edmonton Bulletin front page in October 1918, as the pandemic first hit Edmonton. Around 55,000 people in Canada and more than 4,000 in Alberta eventually died from the Spanish flu, with women carrying the brunt of the relief efforts as nurses and volunteers. Headlines then warned of nurse shortages and overburdened health-care staff. 

"We all have to take our chance. Let's up and do it with a smile, thinking of the help we can render to others," reads the anonymous quote on the newspaper's front page. "To funk and be scared is to run a certain risk of being hit: whereas, to smile optimistically and to lend a hand is to play the game in the fight spirit." 

Nurses and teachers working as volunteer nurses during the Spanish flu epidemic at an isolation hospital in Lloydminster, SK, in 1918. (Glenbow Archives)

Another reflection Beil shared via his cousin came from health historians Esyllt Jones and Magda Fahrni who say that in the absence of a cure for the 1918 influenza, nurses became all the more important. 

"Although influenza was a blow to the prestige of medicine and public health, it was a boon to the reputation and pride of nursing. In its aftermath, nursing leaders correctly pointed out the value of quality nursing care, which in the absence of effective medical intervention was especially important," the authors wrote in the 2012 book Epidemic Encounters. 

It affirmed for Beil the lasting importance of nurses to provide care and compassion even in the most trying circumstances. 

"The really meaningful side of what nurses can provide hasn't changed," he said. 

'The trenches of health care' 

Other quotes, this time taken from the First World War, provide insight into the practical exhaustion of the job in moments of crisis.

One nurse working on an overcrowded hospital ship evacuating soldiers from the frontlines was asked whether she ever got downhearted. "Yes, but only over one thing. I want 12 hands instead of two, and a relief brain when my overworked article becomes deadly tired," the nurse is quoted as saying in the 2014 book In The Company of Nurses by Yvonne Ewen.

Surviving 'The Spanish Lady' (Spanish flu)

Digital Archives

18 years ago
Residents of a small Alberta town recall their deadly brush with 1918's Spanish flu. 6:09

The war-time reminders are fitting now, Beil says, when much of the language around COVID-19 echoes a military confrontation, with frontline workers battling the pandemic.

"Emergency nursing has long been known as the trenches of health care, so that is ringing true today," he said. "The seriousness and the necessity to respond quickly and effectively is really there and the pressures are on us as nurses." 

Suzanna Wagner, a health historian who completed her master's at the University of Alberta this year, studied the history of nursing during the 1918 Spanish flu pandemic. (Jordon Hon/University of Alberta)

Wagner says she is heartened to see her research reach health-care workers. She says it can serve as an example of the ways academics can find new ways of making their work relevant to a wider audience. 

"It's incredibly rewarding to hear that this work is having an impact on people especially when it's so needed," she said. 

As for what nurses will make of this moment 100 years from now, Beil says he can't be sure. In an emergency room, the future is often measured in minutes, not years. 

"One of the things I'm hopeful for is that some of the more poetic nurses among us will take an opportunity to create some reflections of their own and pass that on," he said.