Random Thoughts on The Freedom of Speech, Nostalgia, and The 4th of July

As I write, there is a man in jail vehemently defending his freedom of speech. He chose to exercise his freedom on public transportation, a Max train, by screaming hate speech at two teenage girls, one African American, the other Muslim. His harassment of the girls so escalated that three men placed themselves between the attacker and the girls. All three men were viciously stabbed, two of them fatally. On the evening news the attacker maniacally justified the stabbings as his right to protect his freedom of speech.

Portland remains traumatized by this act of horrendous violence that made national headlines; an act of savagery that simultaneously documents the very worst, and the very best of our community.

***

I learned about freedom of speech in the public elementary school of the small town where I grew up. Our teachers taught us to temper our opinions with civility and common sense: “Freedom of speech doesn’t allow you to yell, ‘Fire!’ in a crowded movie theater,” we were instructed. Or as another teacher graphically put it, “Your freedom of speech extends to the end of your nose,” meaning you have the right to say it, but your words may earn you a punch in the face.

Untitled

Untitled by Julianna Paradisi mixed media on vellum 2016

My nostalgic elementary school memories are charming, yet they were created during a time of great national unrest. I’m probably as young as an adult can be with a bona fide memory (not one created by archival footage) of the day President John F. Kennedy was assassinated. During the years my teachers were explaining Freedom of Speech to me and my classmates, Dr. Martin Luther King was assassinated, and Robert Kennedy too. On the evening news throughout my elementary school years, we witnessed the Watts Riots, and learned four students at Kent State University were shot to death while protesting the Viet Nam war.

I learned “A punch in the face,” was a euphemism used by my teachers to explain to their students a world they struggled to understand.

***

Since the Tri Met stabbings, several random, less publicized stabbings have occurred in Portland.

I seldom drive. My chosen mode of travel is on foot. Since the stabbings, I’ve not walked the downtown as much as I used to. I’m not alone in restricting activity to reduce vulnerability to violence.

I’m told Muslim women wearing hajib are avoiding public transportation since the attack on the two girls. For some, public transportation is their only means of travel, and they’ve become isolated in their homes.

***

A few days ago, the sun rose bright, and warm. I decided to walk to a downtown department store to make a return. A block from the department store, I passed a Tri Met stop. I chose to not over think it.

In the women’s clothing department, I came around the escalator at the same time a Muslim woman wearing a hajib came around from behind a large rack of clothing. Neither of us are tall, which is why we didn’t see each other until we nearly collided. I startled, but she froze in place the way a deer crossing a road at night freezes in the sudden glare of oncoming headlights. Her beautiful, kohl-lined eyes heightened the image. But it was the tension of her body that told me she prepared for verbal attack.

I smiled, and said, “Hello.” The tension melted from her body. She smiled, and nodded. We went on our separate ways.

We were the same: two women venturing out alone, downtown, on a sunny day in the land of the free on 4th of July weekend.

Freedom of Speech, home of the brave, land of the free: This 4th of July I pause to think about what these words mean, and how they apply to my life. They’ve become simultaneously incongruous, and yet familiar.

What is the word for a nostalgia that includes memories of bigotry and hate?

This 4th of July, I honor those who fought for independence, creating America, my home, and who wrote The Constitution to protect our freedoms. I am proud to be an American. I am nostalgic for a country where freedom rings with civility and justice.

 

 

 

 

 

Letting Go of Your Hassles: New Year 2017

Rose quartz for love, clear quartz for clarity Photo: Julianna Paradisi 2017

Rose quartz for love, clear quartz for clarity Photo: Julianna Paradisi 2017

My friend who teaches Pilates and mindfulness was approached by one of her students after class. The student said, “I really appreciated your words of mindfulness, especially the part about, “Letting go of your assh*les.”

My friend, who I’ve never heard use that particular word in causal conversation, much less during a meditation, was taken aback. She could not recall saying it. She asked the student, “What did I say?”

She repeated herself, “I really appreciated you saying, ‘Let go of your hassles.”

Hassles. Ah yes, that makes much more sense. “Let go of your hassles.”

Since my friend told me the story, I’ve considered the hassles I want to let go of in the New Year 2017.

The usual suspects come readily to mind: Rude comments from others, drivers who take my pedestrian safety into their own hands by running stop signs, miscommunications of various species, the neighbor who parties and plays loud music until 4 am on a Monday morning when I have to go to work. I considered forgoing Twitter to avoid finding out US international policy changes before I’ve had coffee in the morning, but those tweets pop-up in the national news and Facebook immediately, so there’s no point.

While reflecting on hassles, it occurred to me that letting go of mine isn’t enough. It’s a principle of universal attraction that like attracts like. In other words, we attract to ourselves the energy we send out into the world. Simply put, the only way to let go of the hassles, is don’t be a hassle. 

To not be a hassle requires mindfulness. It requires choosing to respond to hassles (especially those manifesting in the form of other people) with care and thoughtfulness. Letting go of hassles requires empathy and compassion. It requires restraining yourself from placing a wireless speaker against the wall between you and your neighbor’s home, and turning up teeny-bopper heart-throb boy band music really loud at 6 am on a Monday morning when you get up to go to work, with the intent of preventing your hung over neighbor from getting to sleep after partying all night, which kept you up when you had to go to work the next morning.

Letting go of the hassles requires not being a hassle.

Letting go of the hassles is an ongoing job, a moment by moment, day by day thing. It requires renewing the commitment to doing what’s right everyday.

It takes practice. I don’t expect to get it right every time.

“But I’m tryin’ real hard to be the Shepherd, Ringo. I’m tryin’.”

Do Facebook Likes Help or Scam Patients?

by jparadisi

by jparadisi

I am cautious when initiating online interactions, with good reason.

Sometimes, being cautious feels uncomfortable, however. I’m talking about the Internet phenomenon of patients asking strangers for Likes, or even donations to cover the cost of their medical expenses on Facebook. Despite a high index of suspicion, like most nurses, I have a soft heart. When I see those sweet little faces of bald children asking me to help them get a bazillion Likes on Facebook, I think, “I’m a cancer nurse, how can I not click Like? What can it hurt?” But I don’t click Like, and I feel guilty.

What I want to know is: How does my Like help these children? Are they really out there anxiously waiting for me, a stranger, to Like their Facebook picture? Have their lives as cancer patients come down to this? Where’s Make a Wish? Wouldn’t they rather go to Disney Land, drive a racecar, or meet a teenage popstar? How exactly does my Like benefit them?

Worse yet, what if my Like does harm? It’s easy for anyone to click on a Facebook photograph, and to add it to a file on their computer. Then they can repost it, adding anything to the original post out of context. What if this cute little kid’s picture was used without either his or his parent’s knowledge, and is passing like a virus throughout cyberspace? Worse than that, what if the child is deceased and a family member discovers the picture unexpectedly?

Perhaps I’m reading too much into it. I only wonder, is this a valid use of social media? Then I feel guilty because some little kid with cancer wants my Like, and I won’t give it to him.

A newer version of Internet donations is crowdfunding, and uses social media platforms such as GoFundMe, or GiveForward. As an artist, I’m familiar with crowdfunding. Frequently, artists raise funds for projects through Kickstarter, but patients collecting donations in this manner to pay for medical expenses is a new phenomenon to me.

According to Crowdfunding a Cure, by Alice Park for Time Magazine, December 3, 2012: “Patients and their relatives are raising thousands of dollars to pay for surgeries, cancer treatments, and more.” The article continues to outline the waging of a successful fundraiser through social media contacts via Facebook, Twitter, and email campaigns. This being the case, it’s not unlikely that I’ll soon feel guilty deciding between emails meriting a contribution, and those that do not.

What do you think? Are you with Likes and donations? If this is the future of donations, how will it affect traditional cancer foundations’ collection and distribution of funds?

The Nursing Dilemma of Medical Marijuana

Medical marijuana is legal in Oregon, where I practice. In one sense, this seems to be an enlightened act of legislation for patients who cannot tolerate conventional medications or simply prefer an herbal approach to managing pain and/or nausea. Its use is particularly prevalent in among oncology patients, and those with chronic pain.

Still, it’s a nursing conundrum. The issue is that marijuana remains illegal at the federal level. Because of this, many hospitals are reluctant to allow prescription marijuana on their campuses. Although a 2009 Justice Department memo recommends that drug enforcement agents focus their investigations away from “clear and unambiguous” use of prescription marijuana, it also says users claiming legal use but not adhering to regulations may be prosecuted.

In light of this, hospitals take the conservative approach: Attending licensed medical practitioners are prevented from prescribing medical marijuana for hospitalized patients, and create policies prohibiting the use of medical marijuana on their campuses.

For pharmacists and nurses the problem is this:

  • Pharmacists can only dispense medications prescribed by licensed medical practitioners. The federal government classifies marijuana as a Schedule I drug, which means licensed medical practitioners cannot prescribe it.
  • Nurses administer medications only with an order obtained from licensed medical practitioners.

Nurses may have run-ins with patients and caregivers unfamiliar with this policy, and a patient’s home medication routine may be disrupted.

Though it does not happen often, I had the experience of treating a chemotherapy patient expecting to smoke marijuana between infusions to control nausea and vomiting. Initially caught off guard, I struggled to find a way to manage the situation.

The campus did not permit smoking, tobacco or otherwise. When I reviewed the hospital policy, it confirmed that the medical marijuana was not an exception. I explained this to the patient, who was understanding, but skeptical.

Reviewing the premedication orders, the oncologist had done a good job of covering nausea and vomiting with conventional medications. I asked the patient to give it a try. Always having a plan B, I promised that if the medications didn’t work, I’d call the oncologist and, if necessary, the department manager.

Fortunately, the conventional medications worked. The patient enjoyed a hearty lunch and held it down. For the future, I recommended the patient smoke marijuana at home before appointments, and afterwards if indicated.

Several states have enacted medical marijuana laws. Do you work in one of them? How does this affect your nursing practice?

 

Thoughts on Cairns, Advanced Directives, and DNR Orders

Cairns are ancient, human-made stacks of rocks indicating a landmark or memorial site.

Cairns by jparadisi

Cairns by jparadisi

Modern-day hikers use cairns as directional markers for those following their trail. Not long ago, I came across a group of cairns while walking along the Willamette River. Most likely, they were merely an artistic expression, but only the person who left them knows for sure.

In a way, Advanced Directives and DNR orders are healthcare cairns, marking directions for end of life journeys. Also like Cairns, without an understanding of the patient’s intent, their meanings become open to interpretation, and subsequently, misinterpretation.

Misinterpreting Advanced Directives and DNR orders is a common occurrence among physicians and nurses.

A series of surveys by QuantiaMD, an online physician learning collaborative, found that nearly half of health professionals misunderstood the components of living wills — 90 percent of those surveyed were physicians.¹

The survey findings provided characteristics of a patient who had a living will, and asked respondents to identify the patient’s code status. Of about 10,000 respondents — 44 percent incorrectly identified the patient as having a DNR, and 16 percent did not know the code status. About 41 percent correctly identified the patient’s status as a full code.¹

The majority of survey respondents wrongly said patients with DNRs should receive significantly less medical care and interventions than designated by such an order. A DNR means that a patient should not be resuscitated if found with no pulse. About 20 percent said they would defibrillate a patient who had a clear DNR order.¹

Much confusion stems from the lack of a national standardization of end of life directives, and their communication to a patient’s healthcare providers. One article describes a hospital using yellow armbands to indicate that a patient has DNR orders.²  Oncology nurses will especially appreciate the problem created for that hospital’s oncology unit, where many patients arrive wearing yellow Livestrong bracelets in support of finding a cure, not as a declaration of DNR status!

Terminology also contributes to confusion. Many physicians and nurses wrongly interpret DNR (Do Not Resuscitate) to mean Do Not Treat. Reviewing a patient’s Advanced Directives, DNR orders, or POLSTs (physician orders for life-sustaining treatment), and making them readily available to a patient’s healthcare team, helps prevent unwanted treatments, while providing comfort care per the patient’s wishes.

In March 2012, The ANA Center for Ethics and Human Rights revised their position statement, “Nursing Care and Do Not Resuscitate (DNR) and Allow Natural Death (AND) Decisions,” defining the responsibilities of nurses following end of life orders.

What are your experiences with end of life orders? What is your institutions’ policy?

References:

It’s That Time of the Month Again: JParadisiRN’s Post for Off the Charts

Yes, it’s that time of the month again. Before you go thinking JParadisiRN is giving out Too Much Information, let me say that I’m referring to my latest monthly post Who Will Watch the Watchers? Consider Nurses for Off the Charts, the blog of the American Journal of Nursing.

In this latest post I contrast nurses’ accountability to protect the privacy of our patients while maintaining their privacy under the oversight of HIPAA, against the current debate over personal privacy versus national security, and who should have oversight of the NSA and the information they collect.

Read the post at Off the Charts and leave a comment. We’d love to know your opinion!

Boston Marathon: Tears of Relief and Tears of Sorrow

Like the rest of us, I grieve for the victims of the Boston Marathon bombings, and am thankful for the rapid response of the health care providers who were suddenly thrust into a scenario resembling a war zone.

I found out about the attack moments after the bombs went off, by turning on the TV. I had come home early from the clinic, because our census was low. Earlier in the morning, I told my coworkers that my cousin was running the Boston Marathon. Now I wondered where was he? Were he and his partner safe?

You can imagine my relief when he quickly responded to my text, “I’m ok.”

I called my Mom, to let her know too.

Soon afterwards, my cousin posted the same message on Facebook. Dozens of friends and family expressed relief.

I am grateful for the safety of my family. My heart breaks for those who were not as fortunate, and are suffering still. My thoughts and prayers go out to the victims, their families, and the teams responding to this senseless emergency.

Becoming More Like Medicine: Study Suggests Frequent Dental X-rays Increase Risk of Meningioma

photo by jparadisi

In recent years, I’ve had problems with dentists. Okay, it’s more like I have arguments with my dentist, who thinks I am the problem. We argue about the frequency of dental X-rays. I have maintained there is no reason to take bitewing X-rays every six months, and possibly ever, unless indicated by pain or symptoms.  Bolstering my side of the debate, I remind the dentist that I am a cancer survivor and yet, my doctor does not send me in for an X-ray when I develop a cough. In fact, I haven’t had a chest X-ray since my cancer diagnosis, and that was over a decade ago. Why do I need dental X-rays every six months?

With an exaggerated expression of patience, as if speaking to a difficult child, the dentist explains, “Dentistry is not like medicine. We do things differently.”

“Differently, as in you don’t use research to develop clinical standards?” I ask.

Next thing you know, I’m sitting through a very uncomfortable dental cleaning. What’s the name of that comedian who does the bit about dentists? He starts with,

“I go to the dentist, and he asks me if my gums bleed at home. I tell him no, but I don’t stick steak knives in my mouth at home either.”

 

I bring this up because the American Journal of Nursing published an article by Carol Potera, Older Dental X-rays Linked to Meningioma.

According to the article, adult patients diagnosed with meningiomas are nearly twice as likely to have had bitewing X-rays yearly, or even more frequently, than adults who are tumor free.”

It goes on to say that modern dental X-rays

“use much lower doses of radiation than those received by participants in this study,”

however, the study authors write:

“Efforts to moderate exposure to (ionizing radiation) to the head (are) likely to be of benefit to patients and health care providers alike.”

Finally, according to the article,

The American Dental Association, in its latest guidelines, asked dentists to weigh the risks and benefits associated with the use of dental X-rays at preset intervals.

Intuitively, I’ve known for a long time that frequent, routine dental X-rays are not a good idea. Now there is research to prove it.