Volume 44 Number 1
Norma N Gill: a symphony of resilience and reform in Enterostomal Therapy
Naomi Houston
Keywords stomal therapy, history, Norma, Gill, Enterostomal Therapy
For referencing Houston N. Norma N Gill: a symphony of resilience and reform in enterostomal therapy. WCET® Journal 2024;44(1):40-43.
DOI
10.33235/wcet.44.1.40-43
Submitted 18 January 2024
Accepted 10 February 2024
Abstract
In the midst of Akron, Ohio’s industrial prowess and profound social unrest, Norma N Gill emerged not merely as a pivotal figure in Enterostomal Therapy (ET) but as a beacon of hope and innovation amidst personal and societal struggles. This narrative seeks to weave the threads of Gill’s life, her personal battles with health, and her unwavering faith, into the broader tapestry of a society grappling with racial inequality and social injustice. While her professional collaboration with Dr Rupert Turnbull has been celebrated in medical annals, it is the intersection of her work with the societal dynamics of her era that this exploration seeks to illuminate. By delving deeper into Gill’s life and work, we aim to shed light on how her personal experiences and societal context merged into her ground breaking contributions to medicine and stomal therapy, thereby offering a nuanced understanding of her enduring impact.
Introduction: the harmonisation of personal struggle and societal change
Norma N Gill, often heralded for her transformative work in stomal therapy,1-5 lived a life that was a symphony of personal struggle, societal change, and professional innovation. Her story, while deeply embedded in the medical advancements she pioneered, is also a narrative of how personal and societal challenges can forge a path of resilience and reform. Set against the backdrop of Akron, a city that was a crucible of industrial innovation6-8 and deep-seated racial and social issues,9,10 Gill’s journey from personal health crises to becoming the ‘Mother of Stomal Therapy11’ is not just a medical tale but a social and human one. This exploration seeks to intertwine the threads of Gill’s personal and professional life, providing a richer, more nuanced understanding of her contributions to Enterostomal therapy and medicine within the context of the societal challenges of her time.”
Norma N Gill
Akron’s imprint on Norma Gill’s journey
Akron, Ohio, during the 1950s, was a city where the brilliance of industrial innovation and the shadows of social unrest coexisted. Renowned for its significant contributions to the rubber industry and airship construction,12-14 Akron was a beacon of American technological advancement. The Goodyear-Zeppelin Corporation, stationed in the city, crafted airships that symbolised the pinnacle of contemporary technological progress.
The USS Akron flying over its namesake city, ca 1931-1933, via Ohio Memory
However, beneath the surface of industrial success, Akron was also a cauldron of deep-seated social and racial tensions.9,10 African Americans, many of whom had migrated north seeking enhanced opportunities, encountered a stark reality of marginalisation and systemic discrimination. They were subjected to significantly lower wages compared to their white counterparts10,15 and were stripped of basic human dignities.15 Akron, simultaneously a stronghold for the Ku Klux Klan, was a reflection of the deeply embedded racial prejudices of the era.16,17
This racial tension was not isolated but part of a larger, nationwide issue stemming from the historical roots of the slave trade. Even after the abolition of slavery in the 19th century, its legacy continued to permeate the United States, giving rise to the ‘Negro Question’ – a discourse aimed at addressing the systemic inequalities faced by African Americans.18 Intellectuals, including John Stuart Mill and Albert Einstein, contributed to this discourse, with Einstein poignantly stating in a 1946 New York Times Magazine article: “It is easier to denature plutonium than to denature the evil spirit of man”.19
An Akron sign
In the neighbouring state of Indiana, Jim Jones manipulated the desperation for racial equality, culminating in the tragic deaths of over 900 individuals.20 This event underscored the complexities and perils of racial and social issues, illustrating how the pursuit of equality could spiral into catastrophe.
Born in Akron in the 1920s, Norma N Gill was not a mere observer of these societal complexities. At 18, she married Edward ‘Ted’ Gill, a supervisor at the General Tire rubber factory, and seemed destined for a life centred around her community. However, her faith, deeply influenced by her Baptist grandmother, who also had a colostomy, became a pivotal force in her life. Norma’s faith was not merely doctrinal; it was experiential, marked by profound spiritual insights and visions, highlighting her sensitivity to the human spirit.21
Norma Gill navigated through significant personal challenges that further sculpted her life and career. After the passing of her first husband, Edward ‘Ted’ Gill, in 1974, she found love again, marrying Herbert G Thompson in 1983, whom she met at a class reunion. This new chapter in her personal life coincided with her unwavering commitment to her professional and community endeavours.21
Norma was actively engaged in discussions around the ‘Negro Question’.18,21-22 The racial disparities and social tensions she witnessed were not merely intellectual debates; they were tangible, daily issues in her community. This emotional tension within Norma inspired her to envision a sanctuary where African Americans could practice their faith, free from the racial prejudices of her era. Norma aspired to establish a church where people of all races could find faith, offering a compassionate and ground breaking response to the racial biases that afflicted her community and her time.21
The unveiling of suffering: Norma Gill’s battle with illness
In May of 1948, Norma Gill’s life trajectory took an unexpected and harrowing turn. She was diagnosed with ulcerative colitis, a chronic, inflammatory bowel disease that wreaks havoc on the innermost lining of the colon and rectum. The diagnosis cast a long shadow over her future, introducing her to a new reality where her daily life was punctuated by 15 to 20 urgent trips to the bathroom, disrupting her ability to care for her family and manage household duties.21
The medical solutions of the time presented their own challenges. Cortisone and ACTH, the prescribed medications, were newcomers to the market, and doctors grappled with determining the correct dosage.21 The financial burden was also significant: Gill needed six tablets daily, which cost $37.80 per week or $1,965 annually. In 1950, when the average family income was $3,300, this medication alone devoured nearly two-thirds of her family’s earnings, compelling her to mortgage her home and seek assistance from her community.21,23
Despite the medications, Gill’s health spiralled downwards. Profuse bleeding from her colon ulcers left her in a state of perpetual weakness. At one point, she required a blood transfusion of more than twice her normal blood volume. Her hands blistered and swelled, adding another layer of difficulty to her responsibilities as a mother. Amidst this health crisis, she discovered she was pregnant with her third child. Despite the challenges, something deep within her spirit told her that this pregnancy had a purpose, and she chose to continue it.21
Picture of Pyoderma Gangrenosum to give some idea of the incredible state Gill would have been in
From desperation to a glimmer of hope
After giving birth, Gill’s condition deteriorated dramatically. Nights were particularly challenging; she often had to crawl on her hands and knees to care for her baby, as her husband worked nights and her mother couldn’t stay over. Her 11-year-old daughter took on significant responsibilities, including preparing the baby’s formula and giving her a bath.
Soon after, Gill was afflicted with Pyoderma Gangrenosum (PG), a rare and painful autoinflammatory disease characterised by large, necrotic skin ulcers.24 The ulcers were debilitating, appearing on her legs, face, trunk, and abdomen. On her face, they were so severe that she later required plastic surgery. On her legs, the ulcers were so agonising that flesh would fall off the bone, exposing nerves and emitting a horrible smell of decaying tissue. The pain was so intense that she resorted to wrapping her legs in towels overnight to collect the fluid oozing from the ulcers. However, the mornings brought even more agony: removing the towels caused her such pain that tears would stream down her face.21
In the midst of this torment, she turned to God for help. Seeing the future looked so bleak as she really felt she was dying, she made a vow that if she did survive, she would dedicate her life to serving others. Life was very difficult: she lived one day at a time.21
Through meditation, she found a way to distance her mind from the relentless pain. She later realised that what she was practicing was Transcendental Meditation (TM). TM involves the repetition of a mantra in a specific manner, allowing the mind to settle into a state of deep rest and relaxation. This technique has been shown to reduce cerebral blood flow to painful stimuli by 40-50%, thereby providing relief.25
A pivotal moment: crisis and transformation in Norma Gill’s journey
In December 1953, eighteen months after the birth of her daughter, Norma Gill encountered a crisis that would become a turning point in her life. Emergency services, struggling to detect her pulse and observing her skin turning a cyanotic shade, rushed her to her local hospital. Doctors worked through the night, stabilising her condition, and after four intense days, she was sent home for Christmas. However, her ordeal was far from over. Gill, sensing the fragility of her time, sought spiritual guidance through prayer. In 1954, perplexed doctors in Akron referred her to Cleveland Hospital.
Upon arrival, the medical team was confronted with a shocking sight: Gill’s body was so swollen she couldn’t wear shoes, and she exhibited an enlarged liver, iritis, and bone issues. After four weeks of intensive care, she began to stabilise and was introduced to colorectal surgeon Dr Rupert Turnbull. Despite her abdomen being enveloped in ulcers, scar tissue, and scabs, Turnbull identified a suitable spot for an ileostomy. Gill found a touch of humour in this, as she genuinely couldn’t identify a clear patch of skin for the stoma. Nevertheless, the surgery was successfully performed.21
Pathway to healing: navigating the road to recovery
Post-operation, Gill embarked on the path to healing, albeit with complications along the way. Dr Turnbull was particularly concerned that Gill’s weakened physical state and prolonged use of cortisone would compromise the sutures, making them unlikely to hold. To aid her recovery, Gill was advised to consume a protein-rich diet, especially since parenteral nutrition was not available at the time. Despite initial healing, Gill faced another challenge: her abdomen was so laden with scar tissue and ulcers that her surgical appliances would not adhere, leading to leakage issues. The solution was a Dempsey Mattress with a hole, allowing her to lie face down so her ileostomy effluent could drain into a pan, aiding the healing of her abdominal skin. She remained in this position for two weeks, sitting up only to eat.21
A new chapter unfolds
After enduring nine weeks in Cleveland Hospital and navigating through additional surgeries, including the removal of her rectum and the repair of a surgical hernia, Gill found herself on the pathway to recovery. Her vitality gradually rekindled, sparking a fresh perspective on life. While the specifics of her future endeavours were unclear, one element was unmistakable: a deep-seated desire to aid others blazed within her. How she would extend this help was yet to be determined; she left that decision in the hands of the ‘man-upstairs.’21
Turning pain into purpose: Norma Gill’s revitalised mission
Embarking on a volunteer journey at a local city hospital, where she initially distributed mail, Norma Gill began to rebuild her life with a newfound purpose. A referral from her dermatologist opened doors to local surgeons, and soon, her reputation for assisting patients in their struggles, much like her own, began to spread. Gill found herself aiding 28 Akron physicians, providing not only a service but also a beacon of hope to those navigating the complexities of post-surgery life.
In 1958, during a visit to her gastroenterologist, she was encouraged to reconnect with Dr Turnbull. When queried about her activities, she responded with a light-hearted jest that she was venturing into ‘his line of work.’ This reconnection not only marked a significant step in her professional journey but also symbolised a personal triumph over the adversities she had faced. Gill was not merely surviving; she was thriving, turning her pain into a catalyst for change and support for others navigating similar paths.21
The advent of modern enterostomal therapy
By the age of 38, a decade after her initial diagnosis of ulcerative colitis, Norma Gill was invited to join Dr Turnbull as his dedicated Ostomy technician. Their collaboration was more akin to a partnership, with regular consultations on complex cases and stoma management challenges. They approached each obstacle with the determination of detectives piecing together a puzzle.26 Together, they liaised with manufacturers to enhance ostomy equipment and embarked on a mission to educate the broader medical community about this burgeoning field. Their combined vision was transformative, emphasising that ostomy surgery should be viewed as a gateway to an enhanced quality of life, rather than a life marked by despair, isolation, and stigma.27
From community efforts to formalised training
In the early stages, ostomate support was primarily driven by the community, often taking the form of self-help groups. These informal gatherings, where patients exchanged advice and coping strategies, gradually evolved into the United Ostomy Association and later the International Ostomy Association. Recognising the growing demand for specialised training, Gill and Turnbull took the initiative to establish a school for Enterostomal Therapists in 1961. Due to the overwhelming interest, initial admissions prioritised those with personal or familial experience with stomas, a criterion that remained in place until 1972.28
Spreading the mission: the establishment of global professional bodies
Norma Gill’s pioneering work didn’t go unnoticed and began to captivate surgeons across the globe, leading to the replication of her services and the establishment of similar educational institutions in various locations, such as Grand Rapids, Michigan, and Harrisburg, Pennsylvania. The necessity for a professional entity became evident, culminating in the creation of the American Association of Enterostomal Therapists in 1968 during the United Ostomy Association conference in Phoenix, Arizona.21 This organisation would undergo several evolutions, eventually becoming the International Association for Enterostomal Therapy and later giving rise to what is now known as WOCN (Wound Ostomy Continence Nurses).29
An enduring impact: Norma Gill’s legacy
Norma Gill’s tangible impact is not only visible in the institutionalisation and global spread of the field of ET nursing but also in the next generation of practitioners, exemplified by her daughter Sally, who also embraced a career as a ET nurse. A decade after her initial contributions and the formation of the United Ostomy Association, the Department of Colon and Rectal Surgery at the Cleveland Clinic employed eight full-time Enterostomal Therapists, highlighting the growing recognition of this specialised field.30 Today, the profession boasts a global presence, with formal training programs and professional associations dedicated to stomal therapy, ensuring that Gill’s influence and dedication to improving patient care live on.
Conclusion
‘The unyielding spirit of Norma N Gill: a legacy of resilience and change’
Norma N Gill, a beacon of perseverance and innovation, leaves behind a legacy that seamlessly blends medical breakthroughs, personal tenacity, and societal transformation. Her odyssey from battling ulcerative colitis and pyoderma gangrenosum to spearheading significant strides in Enterostomal therapy, narrates a story that extends beyond the confines of medical history, permeating the human and societal dimensions of her time. Gill not only revolutionised ostomy care but also epitomised a belief that ostomy surgery should pave the way to an enhanced quality of life, a belief forged from her own tribulations and the societal hurdles she encountered. Her life and endeavours stand as a poignant reminder that amidst the throes of personal and societal adversities, an individual can indeed forge a pathway of hope, innovation, and lasting impact.
Conflict of interest
The authors declare no conflicts of interest.
Funding
The authors received no funding for this study.
Norma N Gill：肠道造口疗法的复原与改革交响曲
Naomi Houston
DOI: 10.33235/wcet.44.1.40-43
摘要
在美国俄亥俄州阿克伦繁荣的工业和深刻的社会动荡中，Norma N Gill不仅是肠造口治疗（ET）领域的关键人物，也是个人和社会斗争中代表希望和创新的灯塔。本文试图将Gill的生活、她个人与损害健康的疾病的斗争及其坚定不移的信仰编织成一幅更广阔的画卷，展现一个正在努力解决种族不平等和社会不平等问题的社会。虽然她与Rupert Turnbull博士的专业合作已载入医学史册，但她的工作与她所处时代的社会动态之间的相互交汇才是本文将要探索和阐明的内容。通过深入研究Gill的生活和工作，我们旨在揭示她的个人经历和社会背景是如何帮助她对医学和造口治疗作出突破性贡献的，进而细致入微地了解她产生的持久影响。
引言：个人奋斗与社会变革的和谐统一
Norma N Gill因其在造口治疗方面的变革性工作而广受赞誉1-5，她的一生就是一首个人奋斗、社会变革和专业创新的交响乐。她的故事与她开创的医学进步密不可分，同时也了个人和社会的挑战如何铸就一条坚韧不拔的改革之路。阿克伦是一座工业创新的熔炉6-8，也是一个种族和社会问题根深蒂固的城市9,10，在这座城市的背景下，Gill从面临个人健康危机到成为“造口治疗之母11”的经历不仅仅是一个医学故事，也是一个关于社会和人性的故事。本文进行的探索旨在将Gill的个人生活和职业生涯串联在一起，在她所处时代的社会挑战背景下，使人们对她在肠造口治疗和医学方面的贡献有更深刻、更细致入微的了解。
Norma N Gill
阿克伦在Norma Gill人生旅程中烙下的印记
20世纪50年代，位于俄亥俄州的阿克伦是一座工业创新的辉煌与社会动荡的阴影并存的城市。阿克伦因其在橡胶工业和飞艇制造方面做出的重大贡献而闻名12-14，是美国技术进步的灯塔。Goodyear-Zeppelin Corporation驻扎在这座城市，他们制造的飞艇代表了当代科技进步的巅峰。
美国海军阿克伦号战舰飞越同名城市，约1931-1933年，通过俄亥俄州记忆网获取
然而，在工业成功的表面之下，阿克伦也是一个社会和种族紧张关系根深蒂固的大熔炉9,10。许多非洲裔美国人为了寻求更多的机会而移居北方，他们遭遇了边缘化和系统性种族歧视的严峻现实。与白人同行相比，他们的工资要低很多10,15，并被剥夺了人的基本尊严15。阿克伦同时也是三K党（Ku Klux Klan）的大本营，反映了那个时代根深蒂固的种族偏见16,17。
这一种族紧张关系并非独立兴起，而是源于奴隶贸易历史根源的全国性大问题的一部分。即使在19世纪废除奴隶制之后，奴隶制的影响仍在美国蔓延，进而产生了“黒人问题”Å\Å\旨在解决非裔美国人所面临的系统性不平等问题的论述18。包括约翰·斯图亚特·穆勒和阿尔伯特·爱因斯坦在内的知识分子为这一论述做出了贡献，爱因斯坦在1946年《纽约时报》杂志的一篇文章中意味深长地指出：“改变钚元素的性质，比改变人类邪恶的心灵更容
易”19。
阿克伦标志
在邻近的印第安纳州，吉姆·琼斯利用人们对种族平等的渴望操纵人心，最终导致900多人惨死20。这一事件凸显了种族和社会问题的复杂性和危险性，揭示了对平等的追求是如何演变为灾难的。
Norma N Gill于20世纪20年代在阿克伦出生，她并非只是这些复杂社会现象的旁观者。18岁时，她嫁给了通用轮胎橡胶厂的主管Edward ÅeTedÅf Gill，似乎注定要过上一种以她的社区为中心的生活。然而，她的信仰深受她浸信会祖母的影响（她的祖母也接受过结肠造瘘术），成为她生命中的关键力量。Norma的信仰不仅仅是教义；而是充满体验性，具有深刻的精神洞察力和远见，突出了她对人类精神的敏感性21。
Norma Gill经历了重大的个人挑战，这些挑战进一步塑造了她的人生和事业。1974年，她的第一任丈夫Edward ÅeTedÅf Gill去世后，她重新遇到了爱情，于1983年与Herbert G Thompson结婚，两人在同学聚会上相见。在她个人生活开启新篇章的同时，她坚定不移地投身于专业和社区事业21。
Norma积极参加围绕“黒人问题”的讨论18,21-22。她目睹的种族差异和社会紧张局势不仅仅是知识分子的争论，而是她所在社区实实在在的日常问题。Norma内心的这种情绪张力激发了她的灵感，她设想能够建立一个避难所，让非裔美国人可以在那里实现自己的信仰，摆脱她所处时代的种族偏见。Norma渴望建立一个所有人种均能找到自身信仰的教堂，对困扰她所在社区和她所处时代的种族偏见做出富有同情心和突破性的回应21。
揭开苦难的面纱：Norma Gill与疾病的斗争
1948年5月，Norma Gill的人生轨迹发生了意想不到的重大转折。她被诊断出患有溃疡性结肠炎，这是一种会对结肠和直肠最内层造成严重破坏的慢性炎症性肠病。这一诊断结果给她的未来蒙上了一层阴影，使她不得不面对新的现实，即她的日常生活中每天都会面临15至20次紧急如厕的困扰，这损害了她照顾家人和处理家务的能力21。
当时的医疗解决方案也面临着挑战。处方药可的松和ACTH是市场上的新药，医生们一直试图确定它们的正确剂量21。此外，经济负担也很重：Gill每天需要服用六片药片，每周花费37.80美元，每年花费1,965美元。在1950年，当时的家庭平均收入为3,300美元，仅这一种药物就占据了她家近三分之二的收入，她被迫抵押了房屋，并向社区寻求援助21,23。
虽然服用了药物，Gill的健康状况还是直线下降。结肠溃疡导致的大量出血使她长期处于虚弱状态。她一度需要输血，输血量是她正常血量的两倍多。她的双手出现水泡、肿胀，这对她履行作为母亲的责任又増加了一层困难。在这场健康危机中，她发现自己怀上了第三个孩子。虽然面临种种挑战，但她内心深处的信念告诉她，这次怀孕一定具有某些旨意，因此她选择了继续妊娠21。
从绝望到看到一线希望
分娩后，Gill的病情急剧恶化。夜晚的生活尤其具有挑战性；她经常不得不手脚并用地爬着照顾孩子，因为她的丈夫需要上夜班，而她的母亲又不能在她家过夜。她11岁的女儿为她分担了很大一部分责任，包括为婴儿准备配方奶粉并给她洗澡。
不久之后，Gill患上了坏疽性脓皮病（PG），这是一种罕见且十分痛苦的自身炎症性疾病，其特点是皮肤出现大面积坏死性溃疡24。她的腿部、面部、躯干和腹部均出现了溃疡，使她的身体日渐衰弱。她脸上的溃疡非常严重，以至于后来需要进行整形手术。此外，她腿上的溃疡也令她痛苦不堪，肉会从骨头上脱落，暴露出神经，散发出难闻的组织腐烂气味。由于疼痛剧烈，她不得不在晚上用毛巾裹住双腿，以吸收溃疡部位渗出的液体。然而，早上会面临更大的痛苦：取下毛巾让她痛不欲生，泪流满面21。
饱受病痛折磨，她开始向上帝求助。预见自己灰暗的未来，她真的觉得自己正在慢慢走向死亡，于是她发誓，如果她真的活下来，她将献身于为他人服务。生活非常艰难：她过一天算一天21。
通过冥想，她找到了一种让心灵远离无尽痛苦的方法。后来，她意识到自己练习的是超然冥想（TM）。TM包括以特定方式重复咒语，让心灵进入深度休息和放松的状态。事实证明，这种技术可将通往疼痛刺激的脑血流量减少40%-50%，从而缓解疼痛25。
关键时刻：Norma Gill抗病旅程中的危机与转变
1953年12月，在女儿出生18个月后，Norma Gill遭遇了一次危机，这也是她人生的转折点。急救服务人员努力探测她的脉搏，观察到她的皮肤变成了紫绀色，急忙将她送往当地医院。医生们彻夜工作，使她的病情趋于稳定，经过四天的紧张治疗，她出院回家迎接圣诞节。然而，她的苦难远未结束。Gill感受到了她所处时代的脆弱，她通过祈祷寻求精神指引。1954年，阿克伦的医生束手无策，将她转诊至克利夫兰医院。
医疗团队抵达后，看到的情况令人震惊：Gill的身体十分肿胀，甚至无法穿鞋，她还表现出肝脏肿大、虹膜炎和骨骼问题。经过四周的重症监护，她的病情开始稳定，并被介绍给结直肠外科医生Rupert Turnbull博士。虽然她的腹部布满了溃疡、瘢痕组织和结痂，Turnbull还是找到了一个合适的部位进行回肠造口术。Gill感到有些苦涩，因为她确实无法为造口找到一块完好光滑的皮肤。尽管如此，还是成功进行了手术21。
愈合之路：引导康复之路
术后，Gill踏上了康复之路，但并发症不断出出现。Turnbull博士特别担心Gill虚弱的身体状况和可的松的长期使用会影响缝合，使缝合线无法固定。为了帮助她康复，医生建议Gill摄入富含蛋白质的饮食，尤其是因为当时还没有肠外营养可用。虽然伤口已初步愈合，但Gill仍面临着另一项挑战：她的腹部布满了瘢痕组织和溃疡，手术装置无法粘附，导致出现渗漏问题。解决办法是使用带孔的Dempsey床垫，让她面朝下躺着，这样回肠造口术的流出液便可以排到一个盘状器皿中，促进腹部皮肤的愈合。她在两周内一直保持这种姿势，只有吃饭时才坐起来21。
开启新篇章
Gill在克利夫兰医院住了九周，又经历了包括直肠切除和外科疝气修补在内的多次手术后，她发现自己已经慢慢开始恢复。她逐渐恢复活力，对生活有了新的认识。虽然她未来工作的具体内容尚不清楚，但可以明确的一点是：她内心深处渴望为他人提供帮助。她将如何提供这种帮助有待思考；她把这个问题的决定权交给了“楼上的男人”21。
化痛苦为目标：Norma Gill的重振使命
Norma Gill在当地一家市立医院开始了志愿者之旅，最初她在那里负责分发邮件，后来，她带着新制定的目标开始重新规划自己的生活。从皮肤科医生转诊使她认识了许多当地外科医生，很快，她帮助像她一样的患者摆脱疾病困扰的名声开始传播开来。Gill发现自己为28名阿克伦医生提供了帮助，不仅为他们提供了服务，还为那些在复杂的手术后生活中摸索前进的患者树立了希望的灯塔。
1958年，她去咨询胃肠病医生时，医生鼓励她再次联系Turnbull博士。当被问及她从事的活动时，她轻描淡写地开玩笑说，她正在涉足“他的工作领域”。这次重逢不仅标志着她在职业道路上迈出了重要的一步，也象征着她个人在与逆境斗争中取得了胜利。Gill不仅生存了下来，她还不断变得强大，将自己的痛苦转化为变革的催化剂，并为其他与类似疾病斗争的患者提供支持21。
坏疽性脓皮病的图片，有助于您了解Gill当时所处的难以置信的状态
现代肠造口治疗的问世
Norma Gill 38岁时，也就是在她最初诊断为患有溃疡性结肠炎十年后，她应邀加入Turnbull博士的团队，成为他的专职造口技师。他们的合作更像是伙伴关系，会定期就复杂病例和造口管理难题进行商讨。他们以侦探不断挖掘真相解开谜题的决心来克服每一个障碍26。他们一起与制造商联系，改进造口设备，并开始践行新的使命，向更广泛的医疗界宣传这一新兴领域。他们的共同愿景具有变革性，强调应将造口手术视为提高生活质量的途径，而不会带来充满绝望、孤立和耻辱的生活27。
从社区努力到正式培训
在早期阶段，对造口患者的支持主要由社区推动，通常采取自助小组的形式。在这些非正式聚会上，患者们相互交流建议和应对策略，因此这些聚会逐渐发展为造口联合协会，后来又发展为国际造口协会。Gill和Turnbull认识到对专业培训的需求日益増长，并于1961年主动采取行动成立了一所造口治疗师学校。由于该项目受到广泛关注，最初的招生优先考虑那些个人或家族有造口相关患病经历的人员，这一标准一直沿用到1972年28。
传播使命：建立全球专业机构
Norma Gill的开创性工作并非无人在意，而是开始吸引全球外科医生的关注，导致人们开始效仿她提供的服务，并在密歇根州大急流城和宾夕法尼亚州哈里斯堡等地建立了类似的教育机构。成立专业机构的必要性显而易见，因此，在1968年在亚利桑那州菲尼克斯召开的联合造口协会大会期间，成立了美国造口治疗师协会21。该组织几经演变，最终成为国际造口治疗协会，后来又产生了现在的WOCN（伤口、造口、失禁专科护士）29。
持久的影响：Norma Gill的遗留产物
Norma Gill的实际影响不仅体现在ET护理领域的制度化和全球传播，还在下一代从业人员身上有所反映，她的女儿Sally就是一个很好的例子，她也选择了ET护士这一职业。在她做出初步贡献并创立联合造口协会十年后，克利夫兰诊所的结直肠外科聘用了八名全职造口治疗师，表明这一专业领域日益得到认可30。如今，这一专业在全球范围内具有广泛的影响力，制定了专门针对造口治疗的正规培训计划并成立了专业协会，确保Gill的影响力和改善患者护理的奉献精神得以延续。
结论
Norma N Gill不屈不挠的精神：坚韧与变革的遗留产物
Norma N Gill代表着不屈不挠、勇于创新的精神，她的遗留产物是医学突破、个人坚韧和社会变革完美融合的结果。她从与溃疡性结肠炎和坏疽性脓皮病作斗争，到引领造口治疗取得重大进展的成长过程，描绘了一段超越医学史局限、渗透她所处时代的人文和社会层面的深刻故事。Gill不仅彻底改变了造口护理，还传达了造口手术应为提高生活质量铺平道路的信念，这是她从自己所遭受的磨难和所遇到的社会障碍中锤炼出的信念。她的生活和努力深刻地提醒人们，在面临个人和社会逆境时，每个人都可以开辟出一条充满希望、创新且具有持久影响的道路。
利益冲突声明
作者声明无利益冲突。
资助
作者未因该项研究收到任何资助。
Author(s)
Naomi Houston
Clinical Nurse Consultant Stomal Therapy
Nepean Blue Mountains Local Health District, NSW Australia
Nepean Hospital, PO Box 63, Penrith, 2750
Email naomi.houston@health.nsw.gov.au
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