As a girl in Manila in the late ’60s, Teresa Santos set her heart on becoming a nurse because she was dazzled by the starched white uniforms and jaunty caps nursing students wore. “One of these days,” she promised herself, “I will be in that group.” She trained in her native Philippines and in 1979, was hired by Cedars-Sinai in Los Angeles.
Five classmates from the same nursing college in the Philippines joined her at Cedars-Sinai: Connie Arostegui, Patricia “Peachy” Hain, Joyette Jagolino, Nora Levid and Gertrudes Tan. Over the past 40 years, the six women have been not just friends and colleagues but family. What carried them through personal and professional crises in their adopted country and back home were the extraordinary bonds they formed with one another through their work.
Together, they weathered the dramatic changes that have swept health care. Joyette, now an associate director of the Comprehensive Transplant Center at Cedars-Sinai, has worked in transplant units and seen the development of anti-rejection drugs which improved survival. Others labored in ICUs and witnessed the introduction of life-saving technologies.
But the women also saw medicine lose a measure of the human touch, they say, as more machines moved into the field. Hospitals trimmed costs and focused on efficiency. Patients went home sooner and their shorter stays left nurses little time to bond with them. As superbugs developed, the nurses worried that hospitals had become more risky.
At a time when doctors and nurses are leaving the profession and feeling burned out by the demands of electronic record-keeping and treating too many patients, the women say they remain passionate about their work. “The fundamentals of nursing haven’t changed,” Joyette said. “We care as we did 40 years ago.”
When they began their careers, there was a nursing shortage in America. Hospitals were turning to the Philippines for recruits because of the country’s rigorous nursing programs. In turn, the new hires looked to escape political and economic turmoil at home through work in America.
The fundamentals of nursing haven’t changed. We care as we did 40 years ago.”
A recent milestone—Nora’s 65th-birthday party—has the women reckoning with age. A couple of them are feeling fragile, and Connie stopped working some time ago because of illness. While Joyette views retirement as an opportunity, others can’t bear the thought of abandoning nursing.
Peachy won’t even consider leaving Cedars-Sinai. Now a senior nursing executive there, she wants to teach the next generation. After all, she said, “they are the ones who will be taking care of me when I am old and gray and sick.” Joyette, Connie, Peachy, Nora, Teresa and Gertrudes are still looking after one another. This is their story.
St. Paul College of Nursing in Manila was an all-girls’ private Catholic institution when five of the six women joined it as second-year transfer students in 1972. Classes included anatomy, chemistry, microbiology and public health.
The school, which later became co-ed, was run by nuns, and faith infused the training. Student nurses, who wore crisp uniforms and white stockings, received their first nursing caps with a special mass. Senior students worked the night shift at local hospitals but were expected to be in class the next morning.
Come Friday, the women would kick up their heels at Manila’s discos. Gertrudes loved dancing to the Bee Gees and doing the Hustle. Nora, her friend since kindergarten, often joined her. “All of us, we loved to dance, go out,” Nora recalled. Her family expected her to be an accountant but she balked. Her dad suggested nursing and she enrolled at St. Paul’s.
Connie dreamed of going to America. She planned to be an accountant like her mother but her father convinced her that nursing would be her ticket to the U.S.
After the six graduated in 1976, they asked a U.S. hospital recruiter to be hired as a group. There was no point staying in the Philippines, where a nurse’s salary “wouldn’t buy you a pair of shoes,” Peachy said. Filipino nurses were in high demand in America and the women were placed with a Missouri institution then known as the Kansas City College of Osteopathic Medicine.
If I needed someone to speak with, if I felt like crying I would call any one of them. ”
Adjusting to their new country wasn’t easy. Kansas City was a sleepy contrast with crackling Manila and the women, who were living in a converted floor of the hospital, were homesick. “The first three months were horrible,” Gertrudes recalled. “We were crying together. We missed home. We missed our families.”
One day they went to see “Saturday Night Fever.” When they returned to their dorm, they played the Bee Gees and danced in the hall, copying John Travolta’s moves and pointing toward the sky.
In late 1978, Gertrudes, who had recently married, went to Los Angeles and landed a job at Cedars-Sinai. Peachy and Joyette followed in 1979 and Peachy asked Cedars-Sinai to hire the rest. “There was such a shortage that hospitals were willing to promise the sun, moon and stars,” she said. The five began working at Cedars-Sinai, making between $7 and $8 an hour; Connie joined them in 1980.
Early in the decade, each woman found her professional niche, from pediatrics to intensive care. Except for Peachy, they also were getting married and some were starting families. They became godmothers to each other’s children.
Nora, newly married to a Cedars-Sinai colleague, was assigned to the ICU. On her first day in the unit, she fainted: She was pregnant with a “honeymoon baby” and didn’t know it. After maternity leave, she worked the night shift to be with her baby during the day.
Practices and mores at the hospital were different then. Smoking was allowed in the wards and “everybody smoked,” Peachy said. When physicians approached the nurses’ station, at times, “they expected us to stand and give them our seat,” Peachy said. If doctors were unhappy, “some would yell at us.” During rounds, Nora had to walk behind doctors, carrying patients’ charts.
That hierarchy eased in the ICU, where nurses and doctors were on a closer footing. Nora loved the work, though it was physically demanding. “We were there at the bedside to clean the patient, give them a bath, tend to their wounds,” she said. It was an opportunity to get to know the person. Later, when those tasks became the purview of aides and assistants, Nora worried that patient care would suffer. Would the lesser-trained aides catch early signs of infections or bed sores?
The intensity of the job took a toll. Nora’s marriage became strained during a period when she and her husband were working different shifts. She often felt exhausted and her children would say, “Mommy is sleeping again.”
In 1985 the hospital banned smoking. Other changes followed as the feminist movement of the ’70s took hold and nurses demanded fair treatment. Over time, white uniforms gave way to scrubs, which were seen as more egalitarian.
By the early- to mid-1990s, there was upheaval in the workplace that the women once considered their immutable home in America. Like hospitals across the country, Cedars-Sinai was squeezed by managed care, and patient rolls plunged. Peachy remembers that hospital rooms were turned into offices. There were layoffs and hundreds of positions were eliminated, according to reports at the time. But the women hung together and all six held on to their jobs.
The decade was particularly tough on Gertrudes. In 1991, she resigned from Cedars-Sinai, took her three young children and went to Manila to be with her husband, who had left the household. She returned about a year later: The marriage had ended.
Devastated, she turned to the group. “If I needed someone to speak with, if I felt like crying, I would call any one of them,” she recalled. Her friends’ husbands took her twin sons to the ballpark. Cedars-Sinai hired her back and eventually even restored her seniority. It was as if she had never left.
During the late 1990s, Peachy helped start an effort to improve doctor-nurse relations, and persuade physicians that nurses “weren’t only there to take orders” and instead were “integral parts of the care team.”
All of us, we loved to dance, go out.”
The women’s parents, many still in the Philippines, had grown old. In 2001, Connie learned that her mother was desperately ill and longed to be by her side. But she arrived in Manila to find her mom in the hospital, near the end. After her death, Connie was despondent and leaned on her husband and the group to get through her grief, she says. The women rallied around her, as they did with any member in distress.
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A couple of years later, at 53, Connie suffered a major stroke and became a patient at Cedars-Sinai. She learned to speak and walk again but no longer was able to work. She took early retirement from the hospital.
By then, Cedars-Sinai was past its 1990s retrenchment and in expansion mode. The hospital’s transplant program was flourishing and it performed record numbers of heart transplants. Hollywood donors such as Steven Spielberg helped fund a pediatric research center, while Barbra Streisand both contributed to and raised millions of dollars for a women’s heart center.
Life on the wards also was changing. With efficiency the watchword, patient care became heavily dependent on new technologies. As insurers and Medicare pushed for rapid discharges, doctors and nurses felt frustrated by the swifter pace. Patients were discharged so soon, it was hard to form meaningful ties with them. “When I began as a nurse, I was able to spend more time with patients,” Peachy said. “I got to know their families, their pets. We were not only rushing, rushing, rushing.”
She yearned for simple tasks such as changing a patient’s IV. Long ago, she recalled, “there was no pump to help infuse the medication; I would count the drops per minute.” The time spent doing this brought her closer to the patient. Now, a nurse presses a few buttons and can leave the room. It feels as if “it is the machine we are watching instead of the patient,” Teresa said.
When I began as a nurse, I was able to spend more time with patients. I got to know their families, their pets. We were not only rushing, rushing, rushing.”
Patricia ‘Peachy’ Hain
Today, almost half the nurses at Cedars-Sinai are Asian, many of them Filipinos, the hospital said. Peachy, an executive director of nursing, oversees 900 nurses and aides while Joyette has become an associate director of the hospital’s Comprehensive Transplant Center. Teresa’s daughter studied nursing and works in her mom’s old unit, where everyone calls her “Little Teresa.” Gertrudes and Nora, who were in kindergarten together, work near one other in the anesthesia pre-op evaluation center. Gertrudes’s twin boys became nurses. “Mom, you were our role model,” they said.
The women achieved the American Dream through their work at Cedars-Sinai, each setting down roots and buying a home in the U.S. Even Kansas City, Mo., where they felt homesick as fledgling nurses, has become more lively. A spokeswoman for Kansas City University of Medicine and Biosciences, which operated the hospital where the women worked in the 1970s, said the city has undergone a renaissance in recent years. “I wish that they could come back and see how it is now,” she said. “Kansas City is a great place.”
Gertrudes said the women should buy a condo where they can live and care for each other when they are elderly. Her friends are considering it. Teresa loves the idea, saying such a setup would be “like the Golden Girls.” Last month, they gathered at Gertrudes’s home to celebrate Nora’s 65th birthday. When 1970s hits started playing, the women got up to dance. Forty years after training together, they could all still do the Hustle. Connie, cane in hand, held onto Peachy as they brought out their best John Travolta, moving to the music and pointing to the sky.
The Philippines: An Incubator for Nurses
There are several hundred nursing colleges in the Philippines. The country has emerged as “the largest single source of foreign nurses to the United States,” according to a study by Patricia Cortés, an associate professor at Boston University and Jessica Pan, an associate professor at the National University of Singapore. Their research, published in the Journal of Human Resources in 2015, found that foreign nurses “in particular Filipinos, tend to work in more demanding settings, and maintain less desirable schedules.”
Nurses from the Philippines are in high demand in the U.S., researchers say, in part due to their rigorous training.
Percentage of foreign nurses in the U.S.
from the Philippines
Sources: Census Bureau data via Patrica Cortés, Boston University
Their drive and work ethic help them earn more money, Dr. Cortés said, but they are also simply “very good” at what they do.
The intensive four- and five-year nursing programs in the Philippines can produce nurses who are better educated than some of their American counterparts, Dr. Cortés said. They take on tough assignments, working in hospitals—rather than doctor’s offices—and can often be found in the ICU, “where you want the most skilled nurses.” They tend to be recruited by the larger, better hospitals and often take on undesirable shifts, such as nights.
“The very best of Filipino women decided to go into nursing,” Dr. Cortés says. “They would have been doctors” if they had been able to pursue medical careers in the Philippines. Instead, she noted, they went into nursing, knowing they would be able to find work abroad, ideally in America, and earn substantially more than they would have at home as physicians or lawyers.
Write to Lucette Lagnado at firstname.lastname@example.org