I wrote and illustrated a post for Nurses Week for Off the Charts, the blog of the American Journal of Nursing. It’s title, One in 4 Million is a reference to this year’s theme.
Has there been an influential nurse or mentor in your career?
Centennial Mills Snowscape II oil, wax on panel 2019 by Julianna Paradisi from an image of the 2017 Portland snowstorm
Those of us living in the Banana Belt of downtown Portland were spared the large amount (up to 8 inches) of snow dumped onto adjacent neighborhoods and outlying towns this past weekend.
Michelle Obama cancelled her trip to the Rose City because of the weather reports predicting Snowmagedon, after Seattle was blanketed in 5 inches of snow in only a few hours. Flights between Seattle and Portland were cancelled.
On Friday night we got a dusting of powder. Saturday morning, although air temps only reached 30° F, the sidewalks were clear except small patches of ice here and there, gone by noon.
The rest of the weekend was pretty nice, in terms of weather. In fact, the sun shone gloriously most of Sunday. I got a slightly pink sunburn from an hour’s worth of it shining on my face through the window during barre class.
The Internet guffawed mercilessly at the forecasters. Twitter and Facebook popped with snarky photo memes. Portland weather forecasters are used to the heckling, similar to our local sports teams when they lose.
Unpredictable weather is a part of life in Portland, treated like a personality participating in all social events like that crazy relative everyone suspects will act out but is invited to the wedding anyway.
It was reported with great humor that all the kale in Portland grocery stores had vanished from the shelves as panicked Portlanders stocked up on essentials to sustain them during the predicted week-long siege of Snowstorm 2019.
I hadn’t planned to go to the studio on Saturday, because we had tickets to see Michelle Obama. When she cancelled Friday afternoon, I still didn’t plan to go because of the predicted inclement weather. When the snow accumulation proved slight, I still didn’t go because something inside me suspected foul play on the part of the storm: It was just an unexpected break in the weather; the really bad stuff could start any moment. These thoughts were somewhat fueled by reports and photos posted by Facebook friends attesting there was significant snow in selected Portland neighborhoods.
So I adapted. I scheduled barre classes instead of my weekend runs along the river. I did laundry. I meditated. I read my Tarot cards, and then journaled about what I thought the reading meant. I read a book. I took a nap. I made a pot of soup. I texted my husband who had to work the weekend. I told him I loved him and missed him, adorning the texts with happy faces blowing kisses emojis.
It didn’t snow.
On Sunday there were occasional light flurries of powdery snowflakes that melted on contact into tear drops falling from the railings of my deck. I took another barre class, but ventured no further from home than that.
We ate leftover soup that night for dinner.
The whole weekend was entirely anti-climatic.
I wasn’t alone in my feelings I discovered on Monday morning at work. When the topic of “the snowstorm that wasn’t” came up, and it did often, everyone said the same thing. They had been unable to reorganize their weekend plans to make use of the unexpectedly good weather. Almost everyone made soup. Lots of soup, too much soup for one family and they shared portions with their neighbors.
Disappointment was the most commonly expressed emotion. We had looked forward to being homebound by the snow that never fell.
In my mind, we were mourning our inner Lewis and Clark. A snowstorm gives us a cause to focus on as a community. But more than this, a snowstorm provides the opportunity to test our inner resilience, because in reality, Portlanders are closet survivalists. Note that stores ran out of kale, bread, milk and bacon. There were no shortages of parkas, snow boots, traction devices to put on the boots, or of generators, or snow tires, That’s because households already have these things, and every neighborhood has a neighbor with a big sturdy truck with all-wheel drive who will happily volunteer to take you to work at the hospital or wherever it is you need to be.
Oregon is home to the last of the pioneers headed west. Europeans discovered Hawaii long before Lewis and Clark arrived on the Oregon coast. In Oregon, we have travelled as far west as one can on the continent of this great country.
Those of us who came to Oregon from other places as young people came because we wished to connect with our inner Lewis and Clark; at least I did. I learned to start a fire from kindling I split myself from wood taken from the cord I stacked in the fall to get me through winter. I came because I love the change of seasons, the colors of fall, the damp, grey mossiness of winter that breaks into the brilliant smile of spring. I left the monotonous days of the state where it never rains to experience the full palette of nature.
Like my fellow Oregonians, I relish the threat of a Snowpocalypse for its gift of revelation: who I am, and what I am capable of.
And like my fellow Oregonians, I’m a little lost when the Snowpocalypse doesn’t arrive.
The Embrace oil on panel, 8″ x 8″ 2019 by Julianna Paradisi
There’s a tree I walk past often, and on my way home from work one day I decided to take a picture of it. Turning to face the tree, I took my phone out of my coat pocket.
As I did, a young man stopped and asked if I was going to photograph the tree. When I said yes, he asked what it was I saw. I looked at him closely before speaking. His question, his wool jacket, the way he stood told me what I wanted to know.
I asked, Are you a photographer?
He was.
If he’d asked, I would have told him I’m a painter.
The setting winter’s sun outlined the silhouette of the tree. I showed him how its bifurcated trunk created the illusion of an embrace.
At first he couldn’t see it: Show me the nose.
Pointing with my finger, I outlined nose, brow and lips for him.
He looked intently, the way artists and poets do. After a pause, he said, I have a friend. She talks to trees.
I told him once I heard a grove of trees singing. Two weeks later, they were gone, having been cleared for a housing development.
He told me he will never not see the embrace of this tree.
He went on his way. I took the picture of the tree, and from it, several days later, made this painting with its story of a random encounter.
Crow, Magnolia, and Moon by Julianna Paradisi 2019 pastel on tea-stained paper
Last Fall I watched a murder of crows scavenge through a city park, mingling with a flock of pigeons. One crow ambled closely behind a singular pigeon, comically mimicking its head-jiving gait.
It was molting season for the crows. Their normally sleek, iridescent black chests were marred by bare patches evoking the image of clowns dressed in rags. The indignity of their molting got me thinking about enduring molting as a process of transformation. Birds molt their feathers. Snakes shed their skins. These are transformations of self- renewal.
Some creatures undergo complete metamorphosis, however. Water-bound Tadpoles transform into amphibians, growing legs while their tails wear away to nothing along their journey towards becoming frogs.
Then the metamorphosis of caterpillars into butterflies came to mind, and it occurred to me I had no idea how a caterpillar transforms into a butterfly within its shroud of chrysalis.
When I was going through cancer treatment, the image of a butterfly was often suggested to me by others as something to consider. In fact, butterfly imagery is popular among survivors for its message of transformation from lowly caterpillar into a beautiful winged creature with the ability to fly.
While I liked this imagery, the truth is, with my bald head and surgery scars, I identified more with the imagery of an egg: something smooth, round, and hairless holding within it the dramatic creation of a transformed life.
After watching the crows for some time, I went home and looked up on the Internet the process of how a caterpillar transforms into a butterfly. It was startling to learn it isn’t like some quick-change artist act on America’s Got Talent.
It’s a pretty gruesome process. Caterpillars don’t spin a cocoon around themselves like silkworms do. They molt their outer skins and the chrysalis bursts forth containing their innards. Until recently, scientists believed the caterpillar was then digested by enzymes within the chrysalis into a soup-like yolk, with cells programmed to become the legs, eyes, wings, etc developing into their assigned organs.
Chrysalis (sketch book) by Julianna Paradisi 2018 Ink on paper
It was difficult for scientists to accurately study the metamorphosis of caterpillars into butterflies because they had to cut open a chrysalis or x-ray it to see what was happening inside, thereby killing the embryonic butterfly and preempting further development.
The advent of micro-CT enables scientists to see inside a chrysalis without killing the caterpillar/butterfly, and study the metamorphosis without destroying it. It turns out the caterpillar does not actually self-digest into a soupy yolk, but its parts shift in size and form within the chrysalis, molding into a butterfly. At maturation, the butterfly takes breaths into its thorax, until its wings swell with air and the chrysalis bursts open, releasing it.
Last Fall, I began drawing and painting crows, attracted to the idea of transformation and how it applies to my life. I’ve completed a twenty-year cycle, a mini-lifetime within my lifetime since cancer treatment. It’s time to begin something new. I’m not quite sure what. I sense a shedding of old ideas and roles like the molted feathers of a raven, and an internal metamorphosis like the shape-shifting of a butterfly. I’m developing a stronger sense of self, a lighter heart, and healthier boundaries.
There is evidence butterflies retain the same aversions to noxious stimuli they were exposed to as caterpillars right before the metamorphosis, implying sentient awareness. I wonder if caterpillars have awareness of the end of life they as they knew it while molting their final skin, and the chrysalis envelops them like a grave? Do caterpillars understand what’s happening to them, or do they “die” like we humans do, without concrete evidence of what happens when we no longer inhabit our bodies?
Does a caterpillar in its chrysalis dream of an afterlife with wings?
The little dish of crystals I keep on my desk. I made the little dish from clay. Photo: jparadisi 2018
Late on a Friday afternoon I sat on the floor of a shared office space in semi-lotus position, dismantling the fax machine to clear a paper jam. I needed to fax a copy of one more cancer survivorship care plan to a primary care physician’s office to meet my weekly quota before going home. If you work for an accredited cancer institute, and particularly if you’re an oncology nurse navigator like me, the phrase “survivorship care plan” is enough to cause heart palpitations, and maybe make your palms sweat. If the phrase doesn’t hold meaning for you, count your blessings.
Sitting before the fax machine in semi-lotus position, trying very hard not to break its plastic drawer while reaching for the piece of paper stuck in its maw, I considered the difficulty of practicing mindfulness in the controlled chaos that is health care. At that moment, I felt more akin to George’s father on Seinfeld, Frank Constanza, screaming “Serenity now!” than to the Dali Llama.
How is it I have the nursing skills to manage a patient’s airway on a ventilator, but am defeated by a piece of office equipment?
The stress is worse for nurses working at the bedside: For instance, how many times does the ED call to admit a patient to a nursing unit only to be told the unit doesn’t have a bed? I don’t mean a room, I mean literally, a physical bed? The admission is delayed while some poor night shift nurse traipse through hallways into the bowels of the hospital in search of a bed.
There are medication shortages to contend with, including the lowly bag of saline, diphenhydramine, and flu shots. These scenarios are not new to nurses. They are common occurrences we problem solve during the course of a shift, while managing the health and safety of our patients, documenting for compliance standards, and meeting accreditation mandates such as survivorship care plans.
Some days I’m more successful maintaining mindfulness at work than other days. That’s why mindfulness is a practice. Practicing mindfulness requires compassion not only for others, but for ourselves. In fact, it’s my opinion that a lack of self-compassion and self-care contributes to a general lack of compassion towards others, fueling a hostile work environment. I keep a small dish of crystals on my desk at work to remind myself to stay in the moment.
As I sat on the floor in front of the fax machine, late on that Friday afternoon, a coworker returned to our office. She asked what I was doing, and I vented my frustration. She got down on her knees, and took a turn at dismantling the fax machine to get it working. She was successful. I faxed the care plan to the physician’s office, meeting my quota for the week. I got out on time to take my barre class, where we practice breathing and mindfulness.
Gratitude and compassion are the two hands of mindfulness.
Down the Rabbit Hole, collage, 2017 by Julianna Paradisi
Just over a year ago I had the opportunity to show some of my paintings and speak to a live audience about the challenges of being an artist, healer, and breast cancer survivor. Artists, Healers, and Breast Cancer Survivors: A Window into Their World was also the name of the show.
My talk took listeners through the primary events of my diagnosis, treatment, and transitioning from cancer survivor to artist and writer. When I completed treatment I was told there was a 32% chance I wouldn’t survive the next ten years. I considered then, if these were the last ten years of my life What was it I wanted to do?
I came up with three things:
And then a funny thing happened on my way home from the medical oncologist’s office: I lived.
In March 2019 I celebrate twenty years since my diagnosis and treatment for breast cancer.
As I heard myself speak to the roomful of other cancer survivors and colleagues, I experienced the sudden realization I have reached my goals. Although all three need continual care and practice, the time has come for me to think about what comes next. What new goals should I set? How do I become a better version of myself?
After all I’ve been through in my life I should have been better prepared. When you decide to ask the questions, you need to be ready for the answers. Asking life challenging questions with intention is Going Down the Rabbit Hole, Part II. 2018 has been a year of renewed discovery, self-reflection, and a little bit of rocking the boat. It’s been a year of fabulous highs and a few painful lows. Just like surviving cancer, I am stronger for it.
As 2018 comes to an end, I face 2019 with renewed intention and focus.
I’ll be writing more about the process.
Quickened Towards All Celestial Things
graphite, acrylic, oil on wood 20″ x 20″ 2018
Manicure by Julianna Paradisi 2014
It’s an honor to have my post and illustration, A Brief Meditation on Love, Loss, and Nursing, originally published on Off the Charts, the blog of the American Journal of Nursing, featured in the February issue of AJN
Click on the link above to read the issue online, and find look for Best of the Blog, A Brief Meditation on Love, Loss, and Nursing, in the table of contents.
Down the Rabbit Hole, collage, 2017 by Julianna Paradisi
Why is it 2018 feels more like “2017, The Sequel,“ and not an actual New Year?
While I have one or two friends who’ve had an immediate change of luck, many more of us are experiencing 2018 as a poorly constructed, run-on sentence (or rambling blog post) with little progress or clear goals for the future.
Progress requires a release of perceived limitations, and expectations. The process of releasing creates tension similar to a snake shedding its skin, or a butterfly breaking forth from its chrysalis. Things become too tight and uncomfortable before breakthrough occurs.
Nearing the end of January, the growing and stretching feels more intense than in previous years, and I find myself sympathizing with Alice for choosing to follow a rather strange rabbit down a hole, without thought of where it would lead, or how she would return. “Don’t over think it, just do it.”
Choosing to go down the rabbit hole is not a characteristic of most nurses. Nurses like clear goals, something to steer towards, whether it’s gaining a patient’s trust by managing her pain, meeting discharge goals, or simply relieving a fever.
Measurable goals work in nursing. They’re admirable, and create safety.
* * *
Safety. What is safe?
As an oncology nurse navigator, and a cancer survivor, my patients and I grapple with this question daily: How to balance cancer prevention (safety) with an enjoyable and fulfilling life?
If you believe the answer is easily found in NCCN guidelines, and AJCC recommendations, you are most likely not a cancer survivor. Being a cancer survivor is “going down the rabbit hole.”
* * *
Being an artist and writer demands a willingness to go down the rabbit hole; a comfort level with uncertainty.
The challenge of life is learning to live somewhere on the continuum between safety, and recklessness.
Hank Stamper, the burly central character in Ken Kesey’s epic novel, Sometimes a Great Notion, about Oregon’s logging industry, argues towards recklessness:
“Hank would have been hard put to supply a reason himself, though he knew it to be true that Lee’s presence at the Snag tonight was important to him…maybe because the kid needed to see first-hand what kind of world was going on around his head all the time without him ever seeing it, the real world with real hassles, not his fairy book world of his that him and his kind’d made up to scare theirselfs with.”
* * *
Progress begins by asking questions.
What is safe? What is reckless? Should a predictable outcome dictate the beginning of a new enterprise?
An explorer would answer, “No.”
Alice returned from Wonderland, having viewed strange, new perspectives, and with a bunch of great puns. I assume she counted it a good experience, because she went back for a second trip Through the Looking Glass.
Here’s to going down the rabbit hole, and leaving 2017 behind.
The Queen of Cups I collage by Julianna Paradisi 2017
Are nurses are the worse patients?
Upon completion of treatment for breast cancer, my surgeon remarked, “You got through treatment really well. In the beginning, I didn’t think you would.”
The comment struck me as odd, but I was curious. “Is this because I cried when you diagnosed me?”
“Yes.”
Thoughtfully, I replied, “I cried because I understood the diagnosis. I understood it would change my life.”
In return I received a patient smile.
The first plastic surgeon I chose was forthright in his opinion of me as a patient, however, “You nurses are the worse patients.”
I asked, “Are we your worse patients, or your most educated ones?”
He promptly discharged me from his care.
* * *
I received excellent treatment for breast cancer. My survival and good health are proof. But there were gaps in the emotional support I received.
It’s been nearly two decades since I had breast cancer, and all those years I accepted the label of being “a bad patient;” the one that asked questions, the one needing proof the medical recommendations were best practice.
Then I became an oncology nurse navigator, with patients who are nurses. They have taught me I was not a bad patient, just a nurse-patient, set apart from non-nurse patients. And there are subsets of nurse-patients I help: those bringing an oncology background to their diagnosis, and those who don’t.
Nurses assume accountability for their care
Nurse-patients with oncology backgrounds manage their cancer diagnosis differently than their colleagues without. I suspect this is because they bring their own toolbox: They work with oncology surgeons, medical oncologists, and radiation oncologists. They personally know and handpick their treatment team. They’re still scared, but the support they seek is more pragmatic: how-to’s for managing treatment, work, home, and family life.
Nurses without an oncology background wonder if we are referred to top-notch practitioners, and receiving state-of-the art options, contributing more stress to our cancer diagnosis. We tend to get second, and sometimes third opinions about treatment recommendations. We are more likely to travel to nearby cities (and sometimes other states) with larger, nationally recognized cancer programs for consultations. We may delay starting treatment to fit in the extra consults. Our family and friends may not understand why we won’t simply “do what the doctor says.”
Here’s my unproven hypothesis explaining why this happens:
The Hot Seat: Nurses are compelled to advocate for themselves
Nurses, in our role of patient advocate, are educated to question doctors. We are accountable for catching, and preventing mistakes.
In my nursing education, this training happened early in the morning before our clinical days, in a potentially brutal ritual dubbed, “The Hot Seat.”
In “The Hot Seat” one by one, nursing students gave report on the patient (s) they were assigned that day: diagnosis, age, treatment plan, and goals for outcome. Our instructor cross-examined each student about everything: medication indications, dosage, side effects, and lab values to monitor. She inquired about imaging, and anticipated needs the patient may have at discharge. The more questions a student answered correctly, the more difficult the questions became. The fewer answers a student mustered, the hotter the seat became.
Nurses know unasked questions lead to harm
In The Hot Seat we learned critical thinking means always ask the next question. It’s the question you forgot to ask that leads to harm.
Nurses know the importance of asking questions. When we seek treatment outside of our specialty areas from doctors we do not know, we manage the stress by asking, “Why?”
My understanding of this means that nurses are some of my favorite patients. I remember what I needed to know to ease my stress during cancer treatment, and I offer it to my nurse-patients. Once they understand how oncology treatment works, they often become so independent in caring for themselves I rarely hear from them.
And I’ve certainly never discharged one from care.
