In my latest post (and illustration) for Off the Charts, the blog of the American Journal of Nursing, I share clinical observations about oncology care, before and after the ACA was signed into effect.
First of all, I apologize to my friends and family on Facebook for the uncharacteristic political updates. Thank you to those who continue to follow me, whether or not we share viewpoints.
Since I began publishing JParadisiRN blog, I strive to maintain a balanced voice. Drama is not my thing, not as a nurse, not as a blogger (with the exception of The Adventures of Nurse Niki). Before hitting the “publish” button, I use my So What? filter, as in “Why did I write this, and so what?” It is my practice to write to the So What?
At least part of this instinct as a writer is traceable to my former role as a pediatric intensive care nurse, where I learned to report my concerns about a patient in concise, direction-oriented sound bites, in the middle of the night, by phone, to a doctor I’d just woken. For instance, if I assessed fluid overload, and suspected the patient needed a dose of furosemide, I presented the numerical values of fluid intake, urine output, central venous pressure, blood pressure, heart rate, etc, sometimes finishing the report with, “Would you like to give an extra dose of Lasix?” Most often the answer was, “Yes,” and I received an order for the desired dose before the doctor went back to sleep.
“So what, all nurses do this to some degree,” a reader might respond. They are right.
However, there’s another kind of nurse-call to a physician. It’s born of anxiety, a feeling that something isn’t right; that an otherwise stable-looking patient is on the verge of downward spiral. Their vital signs are within accepted limits, the lab values unchanged. But, standing at the bedside, “eyeballing” the patient, a subtle change is noted: they’re just a little dusky, a touch mottled. Sometimes those are the only signs warning a perceptive nurse of her patient’s declining status. It’s intuitive: The heart monitor still beats a normal sinus etching across its screen. The numerical values of pulse, blood pressure, and respirations remain unchanged. You keep a watchful eye on your patient, perhaps pulling a bag of normal saline, and a bottle of albumin to keep at the bedside, just in case.
As I grew into my PICU role, I learned to trust this intuition, my nurse’s gut. It saved more than a few lives. I joined the ranks of my more experienced colleagues, nurses who, when they call a doctor and say, “You need to get in here now,” the doctor does just that. He or she can’t explain our intuition either, but once they know a nurse has it, they listen, regardless of what the numbers say.
Here’s what: My nursing intuition is going berzerk in the current political climate. I can’t shake this feeling of impending doom. I am not an anxious person by nature; it’s my training to maintain order and calm. But I can’t shake this feeling: Where there’s smoke, there’s fire.
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’.”
Since I left oncology infusion nursing to become an oncology nurse navigator, I’m no
longer required to work holidays, as I did the previous 28 years. My husband, however, is a hospital pharmacist, and this year New Year’s Eve and New Year’s Day fall on his weekend on. There will be no staying up to MIdnight for us, because he has to be up at 5 am to provide the medications administered to critically ill patients by nurses who will also celebrate a quiet New Year’s Eve at home.
We’ve created a tradition for the New Year’s Eves that mandate we get a good night’s sleep because of our work. This year, it’s my turn to get take out sushi from the Japanese restaurant down the street. A bottle of champagne chills in our fridge. When David gets home from work, we’ll enjoy the sushi and champagne while watching a movie, reflecting on how good our life is, despite 2016 being one of the more challenging years in recent memory.
It’s not glamorous, but we enjoy it.
Wishing you and yours happiness, good health, and prosperity in 2017.
The above paintings are original works by Julianna Paradisi, and may not be used or reproduced without permission.
This year, I’ve had a few opportunities to try on the art of public speaking, a newish skill for me. The topics revolved around breast cancer, and oncology nurse navigation.
Recently, I was asked to speak to a group of inpatient oncology nurses about the role of nurse navigators for breast cancer patients, and the application to the hospital setting. Integrating the patient experience throughout the continuum of cancer treatment is a prominent part of what nurse navigators do, and inpatient nurses wanting to learn more (and earned CE) about oncology nurse navigation is exciting. It demonstrates ONNs have an impact on patient care.
For the occasion, I decided to learn a new skill: creating a Power Point presentation. I know, I know, some of you were making Power Point presentations since your first elementary school book report, but you probably can’t write in cursive as well as an older nurse, or use a real typewriter.
Here’s the stipulation: because I am also an artist, I have a thing against using clip art or stock images from the Internet to illustrate my words. If you are familiar with my blog posts for Off the Charts you already know this.
So, not only did I learn to create, and present a Power Point slide show, I used jpegs from a series of paintings I made of mountains, illustrating the presentation from the perspective of my personal practice. For many, the word navigator connotes images of the ocean or GPS, but as a breast cancer survivor turned ONN, I see myself as a sherpa, someone who has climbed the mountain, familiar with its terrain and potential for treachery. I lead patients up the mountain, summit, and then come back down. The paintings of mountains also suggest the barriers to care ONNs are tasked with removing for patients. The theme was woven into the closing remarks of the presentation.
Most of the paintings depict Mount Hood, the dominating peak and iconic symbol of Portland, Oregon, my home.
I gave the presentation with a sense of creative satisfaction in finding another way to merge art into my nursing practice.
This week I got a flu shot, free of charge from the hospital. I bared my deltoid muscle, allowing a nursing student to practice her immunization and injection skills. She did a pretty good job. It barely hurt. Those are penguins on the adhesive strip she covered the tiny bead of blood from the needle prick with, in the photo to the right.
I hardly thought twice about getting a flu shot this year, which hasn’t always been the case. In fact, in the past I opposed mandatory flu shots for nurses; arguing against someone else making rules about my body. While I was never threatened with job termination for refusing flu shots, some hospitals did make nurses refusing them uncomfortable with policies mandating they wear respiratory masks in patient care areas during flu season, or producing notes from their primary care provider explaining the nurse’s choice to avoid it; stuff like that.
What changed my mind about flu shots? I don’t know it has actually changed. What’s changed is my attitude: I don’t feel it’s worth the fuss anymore. It’s not a battle I choose to fight. I don’t know if this is a sign of maturity, or aging, but it’s lost its importance in the greater scheme of my life.
This year, and the last, I got a flu shot, and then I went back to work.
What about you? Are flu shots still a hot topic for nurses like they were in 2009, during the height of the H1N1 virus epidemic?
Recently I had a unique experience as an artist and nurse. At the hospital, I was stopped by someone I vaguely thought was a former patient, or perhaps a family member or supportive friend of a former patient, I really don’t remember.
This person, however, not only recognized me, but knew I painted the art hanging in the infusion clinic where I once worked.
“You sold the horse print.The one over the reception desk.”
“I really liked it. It was good. It was a print, right?”
“Thank you. Well, actually no. It was an original painting. I used oil sticks to make it.”
“What are oil sticks?”
“They’re similar to oil pastels, but big, like cigars. In fact, painting with them feels like how I imagine painting with a big, greasy cigar might feel. But they air dry over time, unlike oil pastels.”
“That sounds really messy, but your painting looked neat and precise.”
“I really liked it.”
“Thank you. So what do you think of the painting of Mt Hood I made to replace it?”
The the expression on her face gave her away, so I threw her a bone.
“Not so much, right?”
“It’s okay. I liked the horse.”
“I really appreciate your comments,” and I meant it.
As an artist I’ve stood through many gallery openings and art receptions. It’s rare for anyone to ask about what inspired the art, or how it was made. No offense intended to anyone, but a common experience for artists at gallery receptions is being approached by people wanting to talk about themselves or their art, not yours. They didn’t come to view the art.
I’m enchanted by this woman who spends her time in an infusion clinic considering the artwork on its walls; becoming fond of a particular painting, and wondering how it was made. She wasn’t there to view the art either, but she did. Not only that, but she had access to the artist, who is a nurse going about her nursing duties, until this brief respite, when the two of us discussed the art.
I do not believe such things happen very often to artists or nurses. I am grateful it happened to me.
This year I took a summer vacation, one of the joys of which was time painting in the studio.
I’ve migrated to three different studios over the years, but a single constant in each was my old pair of nursing clogs, converted to painting shoes.
In their earlier life, they spent ten years traipsing across a PICU, and even flew in a helicopter a time or two while transporting sick children in Oregon to Portland.
When I transitioned from PICU to adult oncology, they retired. In their new-found leisure, they started a second career as my painting shoes, where we continued to do good work together.
Anyway, over the weekend I returned to the studio and painted, changing out of my street shoes into the old, faithful clogs. They felt funny. In fact, one foot was suddenly closer to the floor than the other. I looked down, and entire sections of the right foot clog’s rubber sole had disintegrated and fallen off in chunks. As I moved about, the left foot clog did the same. I stared at them in disbelief. I had not foreseen their imminent demise.
I did not have a second pair of studio shoes to change into, so I continued wearing them while painting, standing and walking, balancing on what remained of the core of their sole. We made one last painting together. I tried remembering the last patient I’d nursed while wearing these clogs, but could not.
When I finished painting for the day, I washed my brushes, and swept up the trail of black, crumbled rubber left behind on the studio floor. Removing the old, familiar clogs, I put on my street shoes, and placed the paint spattered, destroyed clogs into the garbage.
Move on. They’re just an old pair of clogs.
Besides, there’s another pair, retired when I left the infusion clinic for the oncology nurse navigator job, waiting in my closet at home to take their place in the studio.
Preparing materials for tumor conferences is part of my role as an oncology nurse navigator. It involves, among other responsibilities, reviewing the cases, printing copies of the agenda for the attendees, managing the sign-in rosters, and providing updated lists of available clinical trials. It also requires powering on the projector, the screen, and setting up the digital microscope necessary for the pathologist and radiologist to project slides of the tumor cells, and the MRI or Cat can images on the large screen for discussion.
Suddenly, and unexpectedly, I’ve become Audio/Video Girl. Other nurses of my generation will appreciate the humor in this.
Does any one remember watching film strips and movies in grade school classrooms? Did your hand shoot up when the teacher asked for volunteers to set up and run the projector? Mine did, but it was always a boy who was chosen. Eventually, I stopped raising my hand.
Years later when I became a pediatric intensive care nurse, I discovered an aptitude for tubes and wires, or rather I learned to get one fast. The ability to troubleshoot a ventilator until a respiratory therapist could fix it became handy too. I realized the level of skill I’d developed when as a single mom I set up my stereo system (you who grew up with bluetooth streaming have no idea how easy you have it), and a desk top computer with printer/fax using a dial-up modem. In case you are to young to know, we could not use our computers and phones at the time in those days.
Learning to set up the electronic equipment for tumor conference was a lot like how I learned almost everything as a nurse: someone showed me how to do it once, and then I was on my own. However, as mentioned, I have developed an aptitude for technology: during the demonstration I snapped pictures of the wire connections with my phone, creating a visual reference guide to use later.
I was anxious the first time I set up by myself. While lifting the digital microscope which I imagine costs a hefty portion of my annual salary from its cart to the conference table, I distracted myself from my fear of dropping it by imagining twenty doctors staring at me because it didn’t work. Tumor conference would be a disaster if I failed..
The microscope and projector worked. Relieved, I glanced at the doctors, men and women, seated around the table. Some of the male faces resembled grown up versions of the boys in grade school my teachers chose to run the projectors. Some of them probably drive cars electronically more complex than the audio video equipment I had just set up.
To be clear, I am treated respectfully as part of the multidisciplinary team at tumor conference. I’m proud to be part of this valuable service offered to our patients. I am happy with my life choices. However, I wonder what might be different if girls were chosen equally with boys to run the projectors when I was young?
The following post is the second of a series resulting from preparations for a forthcoming breast cancer conference panel discussion on survivorship.
When I was diagnosed with breast cancer I was a pediatric intensive care nurse working twelve-hour shifts, a long-distance runner, practiced weight-training, and a gardener. After the diagnosis, these activities came to an abrupt halt. Surgical procedures meant no running for weeks at a time. Weight training was limited by restrictions. Chemotherapy meant avoiding infectious patients, let alone managing critically ill children with my chemo-brain. Gardening was okay, but only so long as I didn’t get cuts or wounds that could become infected due to a lowered WBC.
Surrendering an active lifestyle in exchange for the other side of the bed was not an easy adjustment, and I held out for as long as possible. During treatment I didn’t have the energy to participate in these activities to the same levels as before. I continued running after my first chemotherapy infusion until one day I completed 1 1/2 miles and then completely bonked. I had to walk back home that 1 1/2 miles with bone deep fatigue. Grudgingly, I gave up running while on chemo.
For some, physical activity is a go-to method of stress relief. For many cancer patients, when this tool is needed most, it is unavailable. It requires developing new tools for managing stress.
It’s important for nurses and health care providers who are not physically active to understand that a lack of physical activity actually creates stress for patients who are. It’s one reason your adolescent and young adult patients often become sullen. Physical activity is part of their mind-body connection.
The median age of breast cancer diagnosis is 61, so It follows that many hospital-based exercise classes for breast cancer survivors are structured with the intent of increasing physical activity and function for older, sedentary survivors. While beneficial, these classes may not meet the needs of the physically active, regardless of their age. Breast cancer patients who beg to continue swimming, running, bicycling, and even skiing are not uncommon. Here’s some exercise tips for physically active breast cancer patients:
- Review your level of physical activity with your medical oncologist and surgeon before resuming or starting an exercise program. Surgery remains the cornerstone treatment for breast cancer, and physical restrictions apply post-operatively to promote healing. Mastectomy, reconstruction, and lumpectomies require different periods of recuperation. Some chemotherapy regimens used to fight specific types of breast cancer have potential to affect the heart. Those with metastatic disease may have other restrictions. Forgoing your activity of choice is difficult, but it’s important to remember that taking the time to heal is an investment in overall wellness.
- Consider alternative forms of exercise. Walking is commonly prescribed during treatment. Meditation labyrinths are a great way to get some exercise and practice mindfulness at the same time. Some hospitals, spiritual centers, and churches have them. Ask about stair climbing-I used a Stair Master (once cleared by my surgeon), and did not have the energy to run outdoors. Running machines are another option: If you get tired, you can stop without having to get back home.
- If you are medically cleared to use a gym make sure to bring antibacterial wipes to wipe down the machines before use, if they’re not provided: If you are receiving chemotherapy, you are more prone to infections from opportunistic germs. If you take a yoga class, (another commonly recommended activity for breast cancer patients) bring your own mat, and wear plastic flip-flops to avoid fungal infections from the studio floors.
- Remember, physical fitness is not what you do in the short-term, it’s an accumulation of activity throughout a lifetime. Going through breast cancer treatment tests your body; it’s working hard. Support its healing through good nutrition and adequate rest.