What Prostitutes, Nurses and Nannies Have in Common

I met a hot grad student while waiting for the BART from Oakland to San Francisco and we made plans to meet up after running our errands in the city. We had dinner, which he paid for despite my insistence, and made out in the park. After deciding that my place wouldn’t work-staying with friends-and his place wouldn’t work-early-bird roommates-he offered to get us a room at a luxury hotel overlooking Union Square. I’ve never found big spenders sexy, and when he paid for the room, my attraction to him drained away. And we had sex anyway, and I had a good time, and I woke up in the morning realizing that though I wasn’t much of a domme, I’d make a terrific escort.

The emotional labor of a waitress doesn’t need to produce physiological changes in her, but the labor of a prostitute should. That is, I had no idea if and how I was going to get wet. When I showed up at the apartment of my first trick, who turned out to be an attractive young cellist, I had too much on my mind to bother conjuring up a fantasy to get me there. I was surprised to find that I didn’t need one: I have always walked through a client’s door with all the necessary bodily fluids for the task at hand. When work is going well, it’s all pretty Pavlovian. I’m not particularly turned on by the idea of turning tricks, and I don’t need to be; I like meeting people and I like sex, and when I throw a pair of heels into the equation, everything else falls into place. I was with a client the first time I ejaculated-I don’t think he believed me when I told him-and though it was several years before I was able to make a private habit of squirting, my job provided me with excellent training in turning off my head and letting my body do its thing. After all, ejaculation is a much more tangible professional reward than “smile and the world smiles with you.”

3. Bringing up baby: a unique approach to birth control

I never wanted to rely on sex work as my sole source of income. It can be volatile, work comes and goes, and I was afraid of having a long and unexplainable gap in my resume. I took a job as a nanny for a lovely family, and when they moved out of the city, I was passed along to a family that lived in their building and another across the street.

Nannying was an old standby: my first paid job, when I was eight, was as a “Mother’s Helper” for a family a few doors down from mine. I didn’t consider it strange that I was being paid to look after two girls, friends of mine, who were not much younger than I was; I was clearly the most serious kid on the block. I’d already been babysitting my brother and myself for some time then, after complaining to my parents that the babysitter they’d hired was making me watch Beverly Hills, 90210 with her when I wanted to read by myself. As a teenager, I worked for a painfully uptight, rich family; snooping around on their computer during naptime one day, I found a letter of complaint they’d written to a cleaning service regarding a scratch left on their marble floor. I hoped my small presence in the lives of those children would prevent their growing up into tyrannical WASPs like their parents.

I loved working with kids, it was fun for me. I was never especially good at being a kid, and taking care of other people’s children was an experience in what it might have been like to be the kind of kid who is. It also induced-when I was in my late teens-that eerie biological drive that some women get in their thirties: the irrational, overwhelming need to get pregnant. If it weren’t for my strong will and desire to avoid STDs, I’d probably be helping a near-tween with her homework right now. Taking care of children when I was little more than a child myself had felt “natural,” and initially, so did nannying as an adult; I wanted a child and knew it wasn’t time, and this was close enough.

When I started taking care of Olivia and Jeannie, they were five months old, and I was with them until they were four; in that time, I went from feeling warmth toward them to feeling kinship with them to feeling exhausted by them, especially Jeannie. Nannies are made to feel they are part of the family, and in some ways, they are, but they achieve that by closely observing the emotion work done by a child’s parents and mimicking it through their emotional labor. To achieve that familial feeling, to endear herself to her employers and her charges, a nanny has to work according to her employer’s emotional methodology, not her own. Olivia’s parents and I shared similar views and methods of childrearing; initially, I thought Jeannie’s parents and I did as well, and my connection with Jeannie and her family felt as genuine as my connection with Olivia and hers.

Small differences began to pile up: how and what Jeannie should eat, how her achievements should be noted or celebrated, how her misbehavior should be addressed. My labor no longer felt effortless; I was made to feel I was a part of the family, but I no longer believed it myself, and the dissonance between how I should feel toward Jeannie and how I did feel (frustrated, annoyed, and strained) began to wear at me. I adjusted my work accordingly, and outwardly disguised that dissonance through a more labored performance; the stress and frustration of that adjustment moved into my private life. When Jeannie was a toddler, my desire to have a child began to fade; by the time I stopped working as a nanny, it was gone completely.

4. A resentfully kept woman

Richard was my primary source of income for a couple years. I didn’t agree to exclusivity with him, I just got lazy about posting ads when I had a steady income from one client. He was also seeing two friends of mine, the one I’d met him through and another he’d met since, and, to great frustration on my part, liked to think of himself as a patron of the arts, not a client.

My involvement with Richard raised a host of problems and was never “easy money.” To maintain his illusion, he didn’t just leave a pre-established “donation” on my table. He exerted his control of the fantasy by asking me to enumerate my needs whenever I’d see him: this much for rent, this much to repair my bike, this much to frame some drawings. This very quickly became a nuisance. Though he ultimately paid more for my time than an ordinary client would at my hourly rate, I started to feel like a child asking for her allowance, not an adult woman with groceries to buy, bills to pay, and bus cards and cat food and new underwear and the rest.

I don’t doubt that my resentment showed, and I wasn’t entirely surprised when he told me he was thinking about retiring in the fall and would need to end our arrangement soon. I continued seeing him until he came over to my apartment for a session one afternoon and after taking off his coat, announced that he was going out of town for the month and this would be the last time we’d see each other. He fingered me on my couch while I silently raced through questions of how quickly I could get myself back in business and avoid eviction. When I stopped him, he reassured me that of course he’d give me enough to get by, as if a loose reassurance of an unnamed severance pay is enough to calm someone who’s just been fired. To him, this was a breakup, but the kind of breakup of his own making, the kind where you get to have sex and take a cute shower together before you go. I was getting laid off and asked to fake a few orgasms for my former employer.

A year later, Richard called and asked me to take him back. He’d made a terrible mistake, he couldn’t stop thinking about me, would I be able to forgive him. In our time apart, his delusions about the nature of our arrangement had strengthened, while my distaste for his delusions had settled into a stale memory. Nuisance or not, I’d just moved and spent everything I had and then some in the process, and started an intensive nursing program that had me shelling out endlessly for expensive textbooks. He came over, and in a metaphor straight from a made-for-TV movie, the slats on my bed cracked under the combined weight of our bodies and my annoyance with finding myself back where we’d started from.

I’m still seeing him, but I’m faking it. Through his delusions, Richard isn’t upholding his end of the bargain: knowing that he’s a client, albeit a “special” one; without that knowledge in place, I no longer feel obligated to uphold my end: giving a performance that feels genuine. It’s not an ideal working relationship.

5. Don’t say “Nurse Ratched”

Five years ago, I was writing a somewhat uninformed column about public health for a free underground newspaper and wondering if anyone cared, and decided I needed to make a professional shift — not away from sex work, but toward writing about health care for an audience that went beyond my friends and theirs. I wanted to write about the way marginalized populations experience health care, and that interest sent me to nursing school; I thought that by becoming a nurse, I would gain credentials that would improve and validate my writing. I forgot to think about the job itself, whether actual clinical nursing would appeal to me and whether I’d be any good at it; I’d thought through being a nurse-writer, but not a nurse-nurse, until I got thrown into the work itself and had to find out.

Samuel Fuller’s prostitute-turned-nurse in “The Naked Kiss.”

Like most nursing students, I started my first day of patient care with a panic attack on my way to the hospital, convinced that my patients would see me as an incompetent fraud interfering with their health care. Nurse educators are eager to point out that nurses have been rated the most highly trusted professionals in the U.S. for as long as they’ve been included in the Gallup poll on professional honesty and ethics (with the exception of 2001, when firefighters were bumped up the list by 9/11).

When I walked into my first patient’s room, it was clear that she trusted me, and that displaying any of my own anxiety would violate that trust, so I put it away. She was an older woman with severe osteoporosis, and she had been given an enema that morning in preparation for a colonoscopy. As soon as my colleague Angela and I had introduced ourselves, she was asking for the bedpan, though then and for the rest of the day she’d realized she needed it a little too late. She was in severe pain, confused, and embarrassed, and Angela was clearly disgusted and terrified. Later in the day, when we helped her with her bed bath, Angela mumblingly asked the patient whether she would prefer to clean her own “area,” knowing that she was almost completely immobile and in need of a particularly thorough washing under the circumstances; the patient responded with more confusion and embarrassment.

Much of the work nurses do depends on translating authoritative knowledge into therapeutic communication; because nursing education has to prepare students for their eventual board exam, it often focuses more on absorbing and applying a vast catalog of knowledge and technical skills than on how to feel and show empathy, how to do effective patient teaching, and how to take care of your own emotions along the way. Outside of the caring professions, empathy isn’t usually something that needs to be taught; when it’s a part of your labor, though, it’s more vulnerable and complex. When we learned how to do bed baths in class, we’d gone through the minutiae of every step (clean the eye from inner to outer canthus-common NCLEX question!) until we reached perineal care; for that, we were instructed to watch an instructional video at home. Considering that our instructor displayed her own discomfort with the matter, it’s reasonable that Angela and others would be particularly unprepared for that kind of patient care.

After years of childcare and years of sex work, I’m at ease with recognizing that genitals are sometimes sexual but not always, and I’m not disturbed or embarrassed by anyone else’s body or bodily functions. I’m also accustomed to working harder to put my clients at ease when they’re uncomfortable or unwell. A nurse can’t treat a patient for Body Image Disturbance—the experience of being afraid, upset by, or disconnected from your physical appearance when it’s affected by changes in health status—if she’s disturbed by a patient’s missing limb or incontinence and unable to disguise her own discomfort.

Industry speed-ups in the form of high nurse-to-patient ratios clearly impede measurable aspects of the nursing process like patient assessment; it’s less clear how they impact nurses’ ability to provide effective emotional labor. When emotional labor works, it does so for the client and for the worker herself. Performing the nontechnical aspects of nursing require more time spent with patients, something nurses are often not afforded. As student nurses, we’re assigned a single patient for a five hour shift, and even that can be a struggle with some clients. This week, I found myself floundering as I treated a patient who was dealing with the agitation and confusion of alcohol withdrawal; my anxiety over trying out new technical skills on a less than cooperative client in a limited timeframe overwhelmed my ability to provide effective emotional labor. I went home feeling guilty about the patient teaching I should’ve done, the ways I should’ve responded to make him more comfortable, and have held onto that guilt all week.

I’m adept at professional caring, and used to finding new ways to care for myself as I do it. I’m also used to seeing that labor made invisible; when it’s most effective, emotional labor seems effortless. When it stops working, there’s no prescribed fix, and because emotional labor is difficult to measure, it can be hard to figure out where and why it’s broken to begin with. It’s often easier to stomach your feelings than it is to bring feelings into a labor dispute, easier to tell yourself to buck up than to take a needed break, easier to switch off at work than to quit your job.

When individual care workers are tapped out, the market consequences are likely minimal, and no one is going to give a TED Talk about an innovative new technology of care; the struggles of care workers have to be acknowledged as labor issues and social issues, not problems of capital. Care workers don’t just perform a service with a beginning and an end, don’t produce something you can buy and put in a drawer, but the empathic gestures of emotional labor, commodified as they are, are fully integrated with the emotion work we all do when we chat with a stranger in the grocery line, hold someone’s hand when they’re sick, or laugh at a bad joke. Whether we care freely, with effort, or for a wage, we can and should expect our own empathic gestures mirrored back at us.

Further reading:
Some Things to Consider When You Think You Want to be a Prostitute
Trafficking in Wrongs: Why Californians Need to Vote No on Prop 35 and Why the Rest of Us Should Care
An Interview With the Man Who Pays Me to Burn His Feet With Cigarettes While He Masturbates
They Still Have Rights: The Search for Humanity and Justice for Sex Workers