Category Archives: Nursing Lifestyles

Life Outside of Patient Care Areas

What Drawing Has in Common With Nursing

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Self-Portrait. Pencil on paper 2001 by jparadisi

Telling Our Stories to Benefit Others is my latest blog post for TheONC; the online community for oncology care teams. Registering for TheONC is free for oncology nurses.

Having the opportunity to write about creativity and its place in the oncology setting allows me to blog out loud the internal dialogues about painting, writing, and nursing I’ve had ever since I came out of the closet as an artist over a decade ago.  I have found these words of Goethe’s true:

“Whatever you do, or dream you can, begin it. Boldness has genius and power and magic in it.”

In my pursuit of living creatively, I frequently find magic in the convergence of science, humanity, and art. For instance, take this passage written by Peter Steinhart:

To draw anything you have to find a connection with it. You have to turn off the noise that keeps you from focusing. You have to let the object stir you to empathy or ennoblement or joy or compassion-even to fear. You must see that things are a part of your world in some special way before you can attend to them.

Now re-read the same passage, with a few simple changes:

To be a nurse, you have to find a connection with people. You have to turn off the noise that keeps you from focusing. You have to let patient care stir you to empathy or ennoblement or joy or compassion-even to fear. You must see that your patients are a part of your world in some special way before you can attend to them.

When making art, or practicing the art of nursing, it all boils down to focus and connection. Whichever you are doing today, find that focus and connection. Someone’s life will be better, because you did.

Stains

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Stains photo: jparadisi 2012

It’s a rare night that I can’t sleep. I’m trying to remove, without waking David, yellow vegetable dye stains of crumbled bits of a bunny-shaped chocolate truffle I ate yesterday, from my favorite pair of white jeans. Undergoing their third washing, they appear permanently stained. Perhaps it’s time to pronounce them, but I’m not ready to let go yet. Why is it easier to remove bloodstains from clothing than yellow Easter candy dye? Sigh.

Not a single car or pedestrian moves along the street outside. If not for David’s rhythmic breathing I might consider I was left behind after the post-apocalyptic rapture.  I’m too much of an optimist to convince myself of this, however. I remember hearing of a boy, home alone, who locked himself in a closet, fearing the rapture occurred and he’d been left behind. His parents found him crying in the closet when they came home.

The yellow dye clings to the white denim like sin; evidence of enjoying a chocolate treat (gluttony), or simple sloppiness (sloth)? I only care because I really like these jeans.

How simple is my life, that a pair of stained jeans is the topic of a post?

I wonder if any of my patients are also sleepless tonight, wrestling with pain, fear or nausea? Are they afraid of being left behind, or more afraid of what they leave behind? This thought makes me sad. I’d rather think about removing yellow candy stains from my white jeans.

Is that a sin?

Moving an Art Studio: Boxes and Baggage

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The old studio had charming, arched windows. photo: jparadisi 2012

In December, I moved my studio. Construction needs of the landlord required vacating a few art studios, including mine. Fortunately, another was available in the same building. The caveat: I couldn’t move in until December 1, and had to vacate the old studio by December 31, 2011. Between holiday busy-ness, and increased census at work, I threw everything haphazardly into boxes, dumped them equally haphazardly into the new studio, and locked the door.

After the holidays, selling art, a new writing opportunity, and knitting socks distracted me.

This is the third studio I’ve rented since making that commitment to my art. I prefer studios in romantic old buildings. These often change owners, require new construction, or are torn down altogether. Renting studios adds a Bedouin characteristic to an otherwise stable life. In true nomadic spirit, I schlep boxes of art supplies, broken pieces of junk I hope to transform into art supplies, empty yogurt cups for mixing paint, notes from art school, good work from my student days, poor work from my student days, several unfinished paintings I intend to return to, and the equivalent of a paper ton in past issues of Art Forum, Art News, Modern Painters, Women in the Arts, and Cabinet magazines.

Now it is nearly March, and I begin the onerous task of organizing a new studio.

Opening its door, I confirm no “studio elves” have magically transformed my stuff into an organized workspace. Studio elves exist; they are called interns. They work for free, but you have to be a famous artist to have one. Or, if you are rich, they are called studio assistants. You have to pay them. I cannot afford one.

Friends offered to help, but I turned down their offers. The truth is, I want to sort through the fossils of my art life with the care of an archeologist. I’m not sure what I hope to find, but here’s some random thoughts I had while hauling bags of yogurt cups to the recycle bin:

  • Why do I have hundreds of empty yogurt cups? How much paint do I hope to mix in my lifetime? Why do I eat so much yogurt?
  • Art students draw lots of naked people. I have seen more fully naked people as an artist than as a nurse.
  • Bad paintings, like bad relationships, don’t improve over time. Get rid of them.
  • Sometimes junk is junk. Quit trying to make a silk purse out of a sow’s ear.
  • Some paintings are good even if everyone doesn’t understand them. Believe in yourself.

    My new studio is brilliantly illuminated by skylights. photo: jparadisi 2012

Obviously, this is a metaphor. Ideas and beliefs no longer serving us gather like old junk behind a closed door while we are distracted by new experiences.  We lug them home and to work where they sabotage us. They are heavy, dragged from place to place, taking up space better occupied by a richer life.

Hospitals Are Not Restaurants

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A Blank List photo: jparadisi 2012

My horoscope says today is a good day for diversion, but I disagree. This is one of those mornings I wake up with a to do list forming in my head, which means I am already behind. One of the things on the list is writing this post. Be charitable as you read it; I haven’t finished my coffee yet.

This feeling of being behind before the day begins is familiar in our home. David, a hospital pharmacist, and I work the same weekends, and this weekend we both worked the Saturday, Sunday, Monday stretch. For some reason, all hospitals I’m familiar with staff units lighter on weekends: no unit secretary, linens are not delivered, IT support is unavailable. Pharmacy has less support, meaning nursing waits for medications to arrive; everything slows down.

This mindset is puzzlement. Why would weekends be more or less busy in a hospital than any other day of the week as if they are restaurants?  I’ve worked in food service. For restaurants, happy hours and dinners are consistently busier on Fridays and Saturdays than weekdays. Restaurants catering to the business lunch crowd are understandably busier Monday through Fridays.

People do not schedule how sick they are going to be according to the day of the week.

Granted, most doctors’ offices are closed, and surgeries are usually not scheduled on weekends. I get that. However, this leads to the proviso that people who are admitted for hospitalization are too critical to wait until Monday for surgery or treatment. Trauma and sepsis do not wait until the doctor is in. They keep the weekend health care team pretty damn busy.

I’m not complaining, just pointing out a reality of life in health care, by way of explaining today, our first day off, both David and I are feeling a little frazzled. The evidence of this is on our dining room table. Rather than a place for a leisurely, home cooked meal, over the weekend it has become a catchall for the implements of our trades: his messenger bag, my tote. Both of our notebooks charge quietly, their green LED lights reflected in the luster of the table’s finish. Valentine’s Day cards, still without a permanent home, remain on the table.  Although our home is a disorganized mess, there is love.

We’re out of food though. Add a grocery store run to the to do list.

Living With Our Mistakes & Holes in Our Socks

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Knitting Two Socks at a Time on a Pair of Circular Needles. photo: jparadisi 2012

I’m learning to knit socks. If you read this blog regularly, you’ll recall learning to knit socks is one of my New Year’s Resolutions for 2012.  Since I don’t know what I’m doing anyway, I decided to learn the new method of knitting two socks at one time on a pair of circular needles, instead of one sock at a time on a single circular needle. Never mind only a few years ago I defined knitting as: making a tangled mess with yarn and sticks. Hey, I’m a girl who loves a challenge.  My audacity stems from years of the “see one, do one, teach one” on- the- job- training mentality most nurses rely on.

Fortunately, learning to knit socks two at a time is accompanied by patterns with clear diagrams and photographic illustrations. I found mine in Knitting Circles Around Socks by Antje Gillingham (Martingale & Company, publishers).

I’m happy to report I have successfully turned both heels. The most vexing problem has been confusing which of the four needle tips to use, then having to rip out and knit again previous rows after doing it wrong. I found one dropped stitch too, which is so far back at the beginning there is no way in hell I will rip out my work to redo it. I’ll simply learn to live with it.

If only nursing mistakes were as inconsequential. Who wouldn’t go back in time and fix the med error, rephrase the statement that made you sound dumb in front of coworkers, or treat differently the symptom, which turned out more significant than you realized at the time? Wouldn’t it be great if we could rip out our mistakes and knit them again like stitches dropped from a pair of needles?

We can’t.

Instead, I am aware of the importance my words carry when patients come to me with concerns or fears. I answer the same questions multiple times over the years of my career, but for the patient, their fears are new.  For everyone, I hope to get it right the first time: the right amount of compassion, the right understanding of the meaning of their words, the right kind of wisdom needed for a particular moment. If I get it wrong, coming across as abrupt, disinterested or intensifying fear rather than calming it, there is no going back to rip out stitches from the fabric created by my words and actions. They hang in our memories like dropped stitches; leaving an unsightly hole.

Nursing is more complex than knitting two socks with four needles. Often, there’s no way to go back and fix our mistakes. Sometimes the best we can do is learning from errors, acquire the necessary grace, and live with the resulting holes in our socks.

*Update: I finished knitting my first pair of socks last night.  See photo.

My First Pair of Knitted Socks! photo: jparadisi 2012


Staycation

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Reflections on the Willamette River photo: jparadisi

I am on staycation this week. It means I scheduled a week off from the oncology infusion clinic, and spending the time here in Portland, where I live.

I admire nurse colleagues their ability to schedule travel vacations months in advance. They bring brochures of exotic places like Machu Picchu, Sidney, Tuscany, Spain, etc. to work, having booked cool hotels and fabulous dinner reservations. One coworker planned an extensive road trip, driving solo, through national parks. Besides being courageous, she has a sense of humor: she purchased an “inflatable man” to occupy the passenger seat of her car during the trip. Then she gave “Joe” away as a white elephant gift at our staff Christmas party. Better than a gnome.

My staycation reflects a lack of planning on my part. A few days after Christmas, I realized my mind wandered when I listened to small talk, the small talk my patients generate adapting to their role, connecting with me, making the experience pleasant for all of us. My sudden inability to concentrate on more than actual patient care signaled to me I let too much time lapse between vacations. There wasn’t enough time to coordinate David’s work schedule with mine, nevertheless, I needed a midwinter break sooner than later. Our scheduler received my request for vacation time that week.

So, how am I spending the time off? I booked a fallback Pedi Mani, then met a girlfriend for Happy Hour at a new tapas bar the first day. Over the weekend, David booked a two-night stay for us at a hotel on the Willamette River. The off-season rates were great. We saw the French film Le Havre, leisurely dined at restaurants we’ve only talked about, and slept in. I’ve booked a spa day for myself, complete with green tea service, and lunch later this week.

After that, who cares?

Learn and Live

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Hawthorne Bridge photo: jparadisi 2012

American Heart Association, are you messing with me?

I was a wee bambina sitting at the dinner table the first time I heard the acronym CPR. My father, a volunteer firefighter for the small town where we lived, certified that afternoon. I remember him saying, “It’s a terrible thing to need to do, but everyone should know how to do it,” and his words are true. Everyone should know CPR.

I got my first CPR card in high school, recerting off and on until becoming a nurse. Now, I recert (renew) every two years. All hospitals I have worked for in two different states require Registered Nurses to have current BLS certification. There is no grace period. If the card expires, the nurse cannot return to work until he or she has renewed their certification.

I love The Heart, however, few things swizzle an experienced nurse’s placid pool of confidence more than CPR recertification, aka, BLS (Basic Life Support). I know this, because I renewed my card last week. Everyone in the class expressed anxiety. Anxiety occurs because, every two years, we have to relearn breath to compression ratios, and how many compressions per minute. For one rescuer or two? Is the victim an adult or a child? The ratios are different for each. And what the hell is that little rhyme you’re supposed to repeat while changing positions with the other rescuer because you’re getting chest pains yourself from the exertion of doing (how many, again?) chest compressions? Don’t forget, you’re trying to save a person’s life while doing this.

Our instructor assured us changes occur only every five years, but it seems different every time. Not only for staff I work with: once, I was running behind two women runners on the Hawthorne Bridge, and overheard them talking about CPR, and how confusing all the numbers are to remember. I sprinted to them, asked if they were nurses. They were. We ran together for a while, commiserating over this albatross of our working lives.

So you can imagine my chagrin, last week when our instructors explained the changing numbers confuses so many health care professionals and lay people, they were not even attempting CPR outside of hospitals, for fear of doing it wrong. This led the AHA to research hands-only CPR. They found:

• Hands-Only CPR (CPR with just chest compressions) has been proven to be as effective as CPR with breaths in treating adult cardiac arrest victims.
• The American Heart Association has recommended Hands-Only CPR for adults since 2008.
As of June 2011

I support the American Heart Association listening to our concerns. I applaud its continual research, which saves lives. Everyone should know CPR.

All the same, does this mean, these past twenty-five years I’ve been a nurse, whether it was one or two breaths between compressions has never really mattered?

American Heart Association, are you just messing with me?

To find a BLS/CPR class near you, click on this link.

Next Career, No Body Fluids

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XXXL Pajama Pants pencil and pastel by jparadisi 2012

“Next career, no body fluids.”

That’s what I tell myself.

I admire hospital management their ability to wear cute dresses and pumps to work or, if they are male, slacks and sweaters. Oh, and jewelry: modestly dangling earrings and longish necklaces. I knew the most talented and charming surgeon who got away with it too, mostly because she’s so damn good at what she does. I once saw her come from the OR wearing green surgical scrubs, a string of black pearls around her neck, and pumps covered in paper surgery booties. I was so impressed I splurged on a string of black pearls for myself, and wore them to work with green surgical scrubs too. Imitation truly is the best form of flattery.

I digress.

I don’t wear cute dresses, few necklaces, or modestly dangling earrings to work because I do direct patient care.  A pediatric nurse quickly learns dangling jewelry is a handhold for infants and children to grab, snapping them or ripping an earlobe. Adult patients suffering dementia put a nurse and his or her jewelry at risk too, and long necklaces tangle into stethoscopes.

The other day, in the adult ambulatory clinic, I started an IV. Unexpectedly, a gush of blood erupted, running warm down my pant leg as if it were the slope of a volcano. I couldn’t get my leg out of the way because I was trying to keep up a calm facade for my patient (“Everything is just fine, just fine.”) while frantically taping the IV in a successful effort to maintain it. When I saw the blood on my pant leg, it looked like I had stabbed myself.

I remembered the last time my clothes were soiled this badly at work. I was a new PICU nurse and a child threw up ALL OVER my pink scrubs.  A nursing supervisor acquired clean scrubs from the OR dressing room for me, and I finished my shift.

I work in an outpatient setting now. There are no kindly nursing supervisors willing to go to the OR for fresh scrubs. I had to think of something else.

In ambulatory care, patients wear their own clothes. Our linen closet is not stocked with an array of gowns or pajama bottoms; however, I managed to find a pair of XXXL pale blue drawstring pajama bottoms stuffed behind the fitted bed sheets. They were so gi-normous, I had to hike and tie the drawstring waist at my bust line. The pant legs were three times wider than both my legs put together. You can imagine how ridiculous I looked (if you can’t, I drew a picture for you above) even with a white lab coat buttoned over the ensemble to hide it. My coworkers were busy, and unaware of my dilemma. When one noticed, all she could say was, “Uh oh.”

Clearly, I needed another plan. Fortuitously, David had the day off, and was near where I work. I called for help, and he brought a pair of pants for me from home. I changed, and resumed patient care.

Apparently, I need a preparedness plan for my clothing at work. Do any ambulatory care nurses have one?

Next career, no body fluids.

A Social License Part II

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Occupy Portland Encampment (first week of November 2011) image: jparadisi 2011

“Oh, that’s too funny! Well, thanks for letting us know. See you in a few days.”

Those were the words of the charge nurse at the infusion clinic, when I called to let her know that, because of jury duty, I would miss the next day’s shift too.

The jury was selected. The judge outlined the case and instructed us in our responsibilities as jurors. Then we were dismissed for lunch.

The trial began when we returned. It was expected to last through the late afternoon of the next day. If the jury reached a decision quickly after the closing arguments, our job would be done. If not, a third day would be required to complete deliberation.

When court resumed, thirteen jurors took their seats. The thirteenth juror, an alternate, would hear the entire case, and then be identified before deliberation. The alternate would only participate in deliberation if another juror became ill or had an emergency preventing him or her from serving. Looking at each face in our group, I wondered which one of us would be kicked off the island (Survivor reference). Was it me?

The only other potential juror, beside me, who had been called out, had not been selected for duty. It was her opinion that cases seeking medical damages resulting from a car accident, such as this one, are always based on greed. She was rejected as a juror because she could not set aside her opinion to hear the case.

The plaintiff suffered neck and shoulder pain since her car was rear ended three years ago at a stop light by the defendant. She was suing for pain and suffering. The defendant was driving his sister’s car at the time of the accident, because an intoxicated driver totaled the defendant’s car two days before he rear-ended the plaintiff.  The defendant had been on his way to school when the accident occurred. He was not intoxicated nor using his cell phone. His foot slipped off the brake. It was a low impact collision. The sister was not in the car at the time of the accident, but was included in the suit because the car belonged to her.

That first day, I wanted to side with the plaintiff. I have seen serious injuries occur from seemingly insignificant impacts. I imagined the plaintiff sitting at her desk job in pain everyday. I listened carefully to her lawyer’s lengthy circumlocutions about her suffering, and the testimonies of her primary health care provider and chiropractor on her behalf.

I left the courthouse at the end of that first day believing the case was motivated by fear: fear of disability and loss of income, fear of a healthcare system that will likely fail the plaintiff when she needs treatment in the future. I felt disheartened.

At the end of that first day I left the courthouse. The defendants‘ lawyer would present their case the following day. Across the street, the people of Occupy Portland gathered among their tents and makeshift shelters.

I felt the onset of a melancholy I cannot identify in the chill of the autumn air.

Next: A Social License Part III

A Social License: Part I

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Occupy Portland Encampment. Early morning, first week of November 2011. image: jparadisi

I arrived at the courthouse shortly before 8 am. There was a long line of people standing on the sidewalk in the frosty morning air of 32° F.

“Is this the line for jury duty?” I asked the man standing in front of me.

“Can’t you tell by our smiling faces?”

Three weeks ago, I reported for jury duty, the first time in my life. In order to appear, I had to take the day off from work at the oncology clinic.

Across the street, Lownsdale and Chapman squares were crowded with tents and makeshift shelters of the Occupy Portland movement. I noticed that no one was up yet at the encampment. It must have been a cold night for the protestors.

Slowly, the line passed through the security checkpoint. I placed my tote bag on the x-ray scanner conveyor, and then I set off the metal detector passing through it, so I removed my belt and shoes, placing them on the conveyor too. The third time, I walked through without setting off the alarms. “This is just like going through the airport,” I remarked to the woman behind me. “Only, I’m not in Maui when it’s over.” We both laughed.

In a large room crowded with 161 other people, I settled into a black vinyl chair, wishing I’d brought a respiratory mask, because of all of the sniffling and coughing in close proximity. Ah, humanity!

At 10:30, my name was called, and I joined over a dozen people taking the elevator to the 5th floor. We entered a courtroom into the presence of a judge, the defendants, their lawyer, the plaintiff and her lawyer. We filled the pew-like benches and the jury box. The judge explained the process of selection.

I was confident I would not be selected. A lawyer once told me they never choose nurses or doctors for juries, because we are motivated by rule of law. In our professions, we follow policy and procedure, tend to interpret the law as policy: if you violate the policy or law, you are guilty. Lawyers prefer more wiggle room than that.

The case concerned medical damages suffered in a car accident. I was not surprised when the plaintiff’s lawyer called me out, “Ms. Paradisi, you are a nurse. Fellow jurors often perceive nurses as experts and leaders. Are you prepared to listen thoughtfully and not guide the deliberation process with your own prejudices?”

“I am aware that people give weight to the opinions of nurses in health care matters. I know what I know. My background is oncology, and pediatrics. I am not an orthopedic doctor.”

We were excused from the courtroom while the lawyers and their clients agreed upon the jurors.

Holy Moly, I was selected as a juror!

Next: A Social License, Part II