A Nurse’s Sketch Book

 

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Nearly a year ago, I wrote a post about mindfulness and found time for creativity, in which I described how I used downtime spent in waiting rooms to draw, or more accurately, for advanced doodling.

The practice continues. This year, I purchased an inexpensive set of crayons, which I keep in a desk drawer. During my lunch break, I take a minute or two to add a splash of color to the ballpoint pen ink drawings. None took longer than 15 minutes to sketch, usually much less.

These rough sketches don’t take the place of painting in my studio, but, there’s a certain satisfaction that comes with adapting to challenges of managing time, learning to juggle purpose and passion. Nursing provides purpose rooted in service, and passion (or a reasonable facsimile of art) blossoms from its branches. Like spring flowers following a severe winter, it will not be denied.

 

Modern Nurses: Audio/Video Girl

Digital Microscope ink on paper 2016 by Julianna Paradisi

Digital Microscope ink on paper 2016 by Julianna Paradisi

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.

I digress.

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 Stars of Our Lives

Mixed Media on Paper 2016 by Julianna Paradisi

The air temperature was below freezing, and because of all of the rain earlier in the week, the streets were frozen. Lots of car accidents were reported on the roads.

Because I walked to work I didn’t think too much about it, but as I progressed closer to the hospital the sidewalks, and particularly the asphalt streets became more slick with ice. I was wearing the wrong sort of boots and had to tread carefully to avoid slipping and falling.

Most interesting about the experience was that when I came to an intersection I waited to let the cars go first:

1. Because I had to walk gingerly, and slowly, and

2. Because the cars could slide too, and I didn’t want to be struck if they did.

Surprisingly, some drivers were annoyed when I refused to go first after they waved me on. One was so upset he shouted, “I was just trying to be polite to you!” from his vehicle as he passed. Intending to be thoughtful I had affronted him by not accepting his gesture of kindness, as though we were characters in an O. Henry story.

It made me think about how we are the stars of our own lives, and as such, often interpret the actions and motives of others through the lens of their effect on us. The driver didn’t understand I was being considerate too (and concerned for my safety). It didn’t occur to him that the road was as icy and slick for pedestrians as it was for those behind the wheel of a car.

I don’t know who originated it, but before reacting to someone’s words or actions it’s helpful to remember the meme, “People are not against you, they are for themselves.” I know I do it too, judge others’ actions by the effect they have on me. I hope I can become more mindful of doing it, and less self-focused.

 

Shift Observations: On Luer Locks, Voting, Taxes, and Thanksgiving

While tightening a Luer lock connector to its mate after starting an IV, I curse myself once again for not playing with Legos more as a child. Working with the catheters and tubing used for delivering intravenous medications requires combining fine motor skills (action) with the ability to see how they connect.

Instead, my childhood preference for playing with dolls foreshadowed a love of the human body in my dual roles of artist and nurse. I’m more interested in muscles, ligaments, and the miles of vasculature and nerves connecting the anatomy of a human being, than the plastic bits and pieces carrying medications into them, yet they are tools of my trade. I secure the caps and connectors snuggly, while carefully keeping their tips sterile.

Likewise, I am more interested in relationships, the way human beings connect to one another: nurses to patients, coworker to coworker, artist to model, family member to family member. Would connections between people be more resilient with some sort of psychosocial Luer lock, or would we chew at such connections with the single-minded determination of a wolf gnawing off its paw (or someone else’s paw for that matter) to escape a trap?

Someone has said,

“The building block of society is the individual, not the family unit.”

This statement conflicts with what I was taught,

“The family unit is the building block of society”

It seems to me that the problems of adult life, everything from, “At which family member’s home will we spend the holidays?” to, “Does this issue deserve my vote for funding from higher taxation?” arise from the conflict between these two statements.

Seriously, whose bright idea was it to combine Election Day, property taxes, and Thanksgiving during the month of November? Are they trying to put people in a bad mood?

Politics and holidays: at times they bring out the worst in us. Whether making decisions in the voting booth, or negotiating family holiday plans, I’m learning, with difficulty, that people are more important than the Luer locks connecting us.

Shift Observations: When It Feels Like Work

Our fatigue is often caused not by work, but by worry, frustration and resentment.

Dale Carnegie

Derail photo by jparadisi 2012

I had one of those patient assignments I couldn’t get control of. The care plan refused to move forward in its time frame, despite fervent pushing. There were unexpected variables: The patient possessed few usable veins; those she had were challenging, and time was lost starting her IV. The infusion wasn’t available when expected. Once it started, the vein blew. No harm occurred to the patient, but another vein had to be found, another IV had to be started, all at the cost of more lost time. It became clear the patient was not going to be on time for a scheduled procedure in another office. This happens once in a while in the ambulatory setting, mostly because the parties doing the scheduling are unaware or overly ambitious about what can be done in a limited amount of time.

I called the RN at the office scheduling the procedure, explaining our patient would be late. Then I returned to my post, watching her IV, willing it to stay open and unobstructed. The expression on my face must have been intense: I didn’t notice our nursing student enter the unit until he came to me and asked, “Tough day?”

This student returned to school to pursue a career in nursing. His commitment, work ethic and accountability are rare. Despite raising a family, and going to school full-time, he finds things to do above and beyond expectations. He’s smart and funny too, with a natural ability to get along with our crusty, all female staff. He’s going to be a great nurse.

“Yeah, it’s a tough day,” I replied. Remembering how hard this nursing student works I realized, instead of whining, I had the opportunity, a choice, to show some professionalism. I explained some of the factors making the assignment difficult. Without thinking, out of my mouth came the words, “Solving the problems is what I do as an RN. This is what I’m paid to do. When things go wrong, that’s when my education kicks in full throttle. I’m here when the work is slow, for the times when things get tough.”

The student smiled and said, “Yeah, that’s what makes it a profession. It’s like when I had my company, the job was easy until there was a problem. That’s when it felt like work.”

He’s going to make a great nurse.

Shift Observations: The End of The Dinosaur

photo: jparadisi 2012

With the care of an archeologist sifting for fossils, I hold his right arm for a second time, turning it to and fro, sliding my fingers up and down searching for a vein suitable to accommodate an IV catheter.  I’ve already looked once, and now return after a fruitless search of his left arm. Decades of chronic illness, medications, and simply old age have done their work, leaving my patient with a spindly network of fragile veins shifting loosely under his skin.

“Everyone should be born with a spigot,” I think silently to myself. “Why doesn’t this patient have a port?” I know the answer without consulting his physician: he is very old, and his illness will likely overcome him. The IV infusion I will eventually administer will not save his life, only limp him along a bit longer.

Outside, cold grey clouds shower a mix of horizontal rain and snow beyond the window of the infusion clinic. An unseasonal storm threatens what promised to be an early spring.

With a slight shiver, my patient asks if I believe in a climate change so powerful it could wipe out life on Earth. Before answering, I take in the wrinkled, reptilian-like skin of his forearm, which I continue to study. Without looking up, I respond to his question, “You mean, like the Ice Age that killed the dinosaurs?” He nods.

Magically, I feel a small, but plump vein. The IV goes in slick as oil on the first stick. I can’t believe our luck. “Yeah, I believe in climate change, but this storm will not be our extinction.”

Shift Observations: That First IV Start After Vacation

photo: jparadisi 2012

Why does that very first IV start on the first shift back from a vacation always cause just a little apprehension?

My patient waits silently while I collect the supplies I need: a sterile IV pack, the angiocath, a normal saline flush. I tear a few small strips of tape and stick them to the edge of the bedside table, easily within reach, ready to secure the IV once it’s in the vein.

How many IV’s have I started over the past twenty-five years? Why does the first one after a vacation always feel like the first one ever?

My gloved fingers palpate the chosen vein one more time before I swab it clean, leaving a glistening sheen and contrasting shadow along its hill, a cairn on his forearm.

Collecting my thoughts, I focus on the vein until they are as sharp as the needle I use to puncture his skin and thread the catheter into the vein. A flash of blood tells me I’m in. Using one of the strips of tape, I secure the IV, then cover the site with a transparent dressing. It flushes easily.

I release my breath, which I realize I was holding.

I’m back.

Shift Observations

photo: jparadisi

Three nurses at lunch break in the staff lounge, focus intently on their phones. A fourth nurse enters.

She asks, “What would we do without our smartphones?”

Silence.

One nurse looks up, smiles, and says, “Talk to  each other?”

A longer pause, then shrieks of laughter.

All heads return to their phones.