Writing to The So What?

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.

xxx

Detail/artist: JParadisi (2009)

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.

“So what?”

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.

So what?

Ode to a Pair of Nursing Clogs

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.

My Nursing-Converted-to-Painting Clogs

My Nursing-Converted-to-Painting Clogs

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.

The Disintegrated Soles of My Nursing/Painting Clogs

The Disintegrated Soles of My Nursing/Painting Clogs

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.

 

 

 

New Nurse Niki Episode! Bruises Not Scratches

The Adventures of Nurse Niki

The Adventures of Nurse Niki

Bruises Not Scratches is this week’s new episode of The Adventures of Nurse Niki. Niki finishes the story of her “easy” day of floating on pediatrics, and ends up giving shift report to an old friend.  If you’re new to the blog you may want to catch up by starting here, Chapter 1

Don’t forget to follow Nurse Niki on Twitter @NurseNikiAdven and “Like” The Adventures of Nurse Niki on Facebook!

You Can’t Make This Stuff Up: New Episode of The Adventures of Nurse Niki

The Adventures of Nurse Niki

The Adventures of Nurse Niki

You Can’t Make This Stuff Up is this week’s new episode of The Adventures of Nurse Niki. Niki’s easy shift while floating on pediatrics takes a turn. If you’re new to the blog you may want to catch up by starting here, Chapter 1

Don’t forget to follow Nurse Niki on Twitter @NurseNikiAdven and “Like” The Adventures of Nurse Niki on Facebook!

New Episode: It’s Not All Cute Print Scrubs and Bunny Blankets

 

The Adventures of Nurse Niki

The Adventures of Nurse Niki

It’s Not All Cute Print Scrubs and Bunny Blankets is this week’s episode of The Adventures of Nurse Niki. Niki ruminates about floating from PICU to pediatrics. If you’re new to the blog you may want to catch up by starting here, Chapter 1

Don’t forget to follow Nurse Niki on Twitter

@NurseNikiAdven and “Like” The Adventures of Nurse Niki on Facebook!

The Adventures of Nurse Niki Are Back!

The Adventures of Nurse Niki

The Adventures of Nurse Niki

After a long hiatus, I’ve posted a new episode of The Adventures of Nurse Niki, Chapter 54. I almost forgot how much I enjoy writing her. Look for new developments in the life of the nurse blogosphere’s favorite fictional pediatric intensive care nurse in the weeks to come!

Don’t forget to Like the Adventures of Nurse Niki Facebook page, and follow her @NurseNikiAdven on Twitter.

All Deaths Are a Great Loss

When I was in nursing school, an “elderly” instructor (she must have been at least 60)

Bones (Redivivus) by jparadisi

Bones (Redivivus) oil on canvas by jparadisi

asked our class,

“Is the death of a young person a greater loss than the death of an old person?”

The oldest student was maybe 30. Unanimously, we agreed that the death of a young person is the greater loss. The instructor’s expression let us know she did not agree,

“All deaths are a great loss. No one wants to die. As nurses, you’ll do well to remember this.”

My first nursing job was in pediatrics. I remained in pediatrics for 15 years, and my student perception of the death of a young person being a greater loss than the death of an old person was never challenged. However, now that I am an adult oncology nurse, I have a better understanding of what our nursing instructor was trying to teach us that day.

Few people would argue that the death of an older person is sadder than that of a young person, but that’s not what my nursing instructor had asked. She asked, “Which is the greater loss?” The losses are equal, but for different reasons.

The death of a young person is a great loss because the world loses a potential Picasso, Hemingway, or Madame Curie. The parents of the youth lose the legacy of grandchildren who may have been born to their child. If grandchildren are already born, they lose a parent. The dying youth loses a full lifetime of experiences, love, joy, and sadness — the bittersweet fruit of a ripe old age. A piece of hope dies with them.

When an old person dies, the world loses a Gandhi, Rosa Parks, or Mother Theresa. More commonly suffered are the loss of a spouse, a parent, a close friend, or confidant. We lose someone with whom we share common history and memories. Upon death, an old person takes a piece of life from those left behind. With this understanding, I sit at the bedside of elderly patients, holding their hands as they grieve out loud their cancer diagnosis and impending deaths. I grieve their loss as greatly as I did the loss of my pediatric patients.

Nurses know that every passing life is a loss and there’s peace in knowing there’s no need to judge.

Sins of Omission: Latest Episode of The Adventures of Nurse Niki Has Posted

The Adventures of Nurse Niki
The Adventures of Nurse Niki

Sins of Omission, The Adventures of Nurse Niki Chapter 28, posted today. Corey describes a typical litany of ER patients, while Niki ponders who to tell what about her and Corey’s new relationship.

The Adventures of Nurse Niki is a work of serial fiction. The blog is formatted so the most recent episodes appear at the top. New readers not wanting spoilers of The Adventures of Nurse Niki may begin at Chapter 1 and scroll up from there.  Chapters are archived by month (click on the lined square icon on the home page). New chapters post weekly on Thursdays.

Off the Charts has this to say about The Adventures of Nurse Niki:

This blog is made up entirely of first-person episodes told by a fictional nurse named Niki. Each episode is short, detailed, and engaging, and it’s easy to keep up with it on a regular basis, or quickly catch up if you haven’t yet read any episodes. Jacob Molyneux, AJN senior editor/blog editor

Kevin Ross, aka @InnovativeNurse wrote a review of The Adventures of Nurse Niki, with this highlight:

Julianna has embarked on something special for the nursing community. The Adventures Of Nurse Niki is one of the most intelligent perspectives of life as a nurse. These are the experiences of a “real nurse” if you ask me. Nurse Niki is a smart and dynamic character who works night shift in the PICU at a California hospital. A good television show or fiction novel could certainly draw out the sexiness of working in the ICU, but with Niki’s story we quickly discover that this dynamic character is also struggling to cope with life at the bedside, and as a mother and wife. Hidden within each chapter the discovery is that Nurse Niki is in fact you. She’s me. Well that is of course if I was a woman.

You can interact with Niki on The Adventures of Nurse Niki’s  Facebook page. Please don’t forget to “Like” it too. Show Niki some love! Thank YOU!! to the readers following The Adventures of Nurse Niki, the retweets of  @NurseNikiAdven (Hashtag #NurseNiki) and those who Like Nurse Niki’s Facebook Fan Page. The support is very much appreciated!

Simon’s Turn: The Adventures of Nurse Niki Chapter 21

The Adventures of Nurse Niki
The Adventures of Nurse Niki

The Adventures of Nurse Niki Chapter 21 is posted! In this week’s episode, Simon’s Turn, Niki experiences a life-changing moment.

The Adventures of Nurse Niki is a work of serial fiction. The blog is formatted so the most recent episodes appear at the top. New readers not wanting spoilers of The Adventures of Nurse Niki may begin at Chapter 1 and scroll up from there.  Chapters are archived by month (click on the lined square icon on the home page). New chapters post weekly on Thursdays.

Off the Charts has this to say about The Adventures of Nurse Niki:

This blog is made up entirely of first-person episodes told by a fictional nurse named Niki. Each episode is short, detailed, and engaging, and it’s easy to keep up with it on a regular basis, or quickly catch up if you haven’t yet read any episodes. Jacob Molyneux, AJN senior editor/blog editor

Kevin Ross, aka @InnovativeNurse wrote a review of The Adventures of Nurse Niki, with this highlight:

Julianna has embarked on something special for the nursing community. The Adventures Of Nurse Niki is one of the most intelligent perspectives of life as a nurse. These are the experiences of a “real nurse” if you ask me. Nurse Niki is a smart and dynamic character who works night shift in the PICU at a California hospital. A good television show or fiction novel could certainly draw out the sexiness of working in the ICU, but with Niki’s story we quickly discover that this dynamic character is also struggling to cope with life at the bedside, and as a mother and wife. Hidden within each chapter the discovery is that Nurse Niki is in fact you. She’s me. Well that is of course if I was a woman.

You can interact with Niki on The Adventures of Nurse Niki’s  Facebook page. Please don’t forget to “Like” it too. Show Niki some love! Thank YOU!! to the readers following The Adventures of Nurse Niki, the retweets of  @NurseNikiAdven (Hashtag #NurseNiki) and those who not only Like Nurse Niki’s Facebook Fan Page. The support is very much appreciated!

Innovative Nurse (Kevin Ross) Reviews The Adventures of Nurse Niki

Last week, I had the pleasure of being a guest of nurse bloggers Keith Carlson and Kevin Ross (or, as I refer to them, ) on RNFM Radio. We spent a fast hour discussing the lifestyle of nurses, and The Adventures of Nurse Niki. I had a fabulous time, and one of the take-homes I went away with is the idea to hash tag forthcoming episodes of The Adventures of Nurse Niki on Twitter #NurseNiki, so regulars readers can discuss them on Twitter. Great idea, Kevin & Keith, thanks!

The Adventures of Nurse Niki

The Adventures of Nurse Niki

Following the interview, Kevin (who turns out is a huge Nurse Niki fan) wrote this awesome essay The Adventures of Nurse Niki: The Daytime Drama You’re Not Reading. The title doesn’t reflect Kevin’s wonderful review of Nurse Niki, or his thoughtful expose of the life of nurses, which is actually the most important part of the review. Here’s an excerpt from Kevin’s post:

Julianna has embarked on something special for the nursing community. The Adventures Of Nurse Niki is one of the most intelligent perspectives of life as a nurse. These are the experiences of a “real nurse” if you ask me. Nurse Niki is a smart and dynamic character who works night shift in the PICU at a California hospital. A good television show or fiction novel could certainly draw out the sexiness of working in the ICU, but with Niki’s story we quickly discover that this dynamic character is also struggling to cope with life at the bedside, and as a mother and wife. Hidden within each chapter the discovery is that Nurse Niki is in fact you. She’s me. Well that is of course if I was a woman.

Niki’s struggles are really no different than yours. She’s trying to find work-life balance and has the same inner turbulence that never seems to allow for the seat belt sign to be turned off. Niki’s hope was to work for awhile as a nurse and then be able to stay home with her daughter when she was born. She so desperately wants to feel that same connection with her husband that she had with him in college, but how can she possibly put her day in perspective for someone who isn’t exposed to the same emotional trauma that a nurse endures day in and day out? Sound familiar?

Our well laid out plans rarely seem to work out in the way we picture them, and so far it certainly hasn’t for Niki as she deals with the conflict of the same characters we all try to play each day in our own lives. What we believe work-life balance should be is really what I like to call controlled chaos. With a house full of boys around here we often find ourselves having to put up barricades and call in the crowd control teams to herd what seems like a bunch of cats out the door for their next soccer practice or school performance.

Just like many of us either currently or in the past, it’s never just a 12-hour shift and only 3 days a week. Nursing is not a part-time job by any stretch. When you work in high acuity settings like these it seems as if you never leave, even with a couple of days off in between your shifts. It’s really a constant you can depend on. Your co-workers become your family. The frightening difference is that they are the ones who understand you the best, and so the plot thickens.

In case you missed it, The Adventures of Nurse Niki Chapter 16 posted last Thursday. I don’t want to spoil it for new readers, but this is a chapter you’ve waited for.

If you haven’t discovered The Adventures of Nurse Niki, the blog is formatted with the most recent episodes first. However, you can conveniently begin at Chapter One by clicking here. Previous episodes are also archived by month on the main menu.

Don’t forget to Like The Adventures of Nurse Niki on Facebook, and follow her on Twitter @NurseNikiAdven #NurseNiki. Let’s do this!