Nurses & Doctors: Make Appreciation Reciprocal

artist: jparadisi

artist: jparadisi

Few life-threatening or terminal diseases present themselves in otherwise healthy, alert, and charming hosts the way cancer does.

From the get-go, oncologists are not only captain of the ship; they hoist life preservers in the form of treatment to patients drowning in waves of shock after a cancer diagnosis.

In my opinion, oncologists’ hearts closely resemble those of nurses. This is attributed to the fact that although oncologists do not spend the same quantity of time with patients as nurses do, the quality of the time they spend is intense. They often form relationships with patients over years. It’s common for an oncologist to know close members of their patient’s family, also like nurses.

During my last episode of possible (it wasn’t) recurrence, I experienced this truth.

My oncologist and I share a professional relationship. One of the reasons he’s my oncologist is because I know he’s good at what he does. My husband likes him, too. They share an easy communication, which is another reason for my choice. If/when cancer recurs, I know they will cooperate on my care, freeing me to be the patient, not the nurse. This arrangement brings me peace of mind.

Anyway, I had suspicious symptoms, which landed me face down in an MRI. My appointment to receive the MRI results was scheduled at end of a workday for my oncologist.

David accompanied me. Dr. My Choice entered the exam room holding the films, clipping them to the light box.

“I haven’t looked at these yet,” he explained. “I thought we could see them at the same time.”

It hit me in a flash: Dr. My Choice likes us too. He is about to find out if he will tell a nurse he enjoys working with, and her husband, whether or not her cancer has recurred.

Snap! What have I done to him?

Fortunately, the films revealed I am still cancer free. The look of relief on Dr. My Choice’s face nearly equaled David’s.

Oncologists, (doctors) have feelings, too. This knowledge affects the professional relationships of nursing practice in the following ways:

  • When questioning an order, assume the doctor has good intentions toward his or her patient, same as you.
  • Avoid framing questions to a doctor with your personal inferences, such as opinions of whether or not the physician is “good” or “bad.”
  • Consider that doctors suffer from work overload, and burn out, as do nurses.
  • Remember: Being part of a team is catching one another when we fall. No one is on top of his or her game every time.
  • Protect the Rock Star Doctor (every unit has one) by double-checking their orders the same as you do for any other physician. Don’t let them fall to earth because you were not diligent in providing a safety net for their patients.

Education is the tool of our trade. It is our demeanor, which makes us professionals.

Conversations About Dying: Is “Sick Lit” Bad for Teens?

My name is JParadisi, RN and I am a recovering TV medical drama addict.

I am one of those nurses with whom other people refuse to watch TV medical dramas, because I watch them as if I’m playing Jeopardy.

I shout out the answers, instruct the handsome actor-doctor that he must intubate now, and make diagnostic recommendations. It’s a sickness. Anyone unfortunate enough to watch with me chides, “It’s only a TV show!”

Drawing by jparadisi

Drawing by jparadisi

I don’t read books about cancer or illness for entertainment either, but John Green’s young adult novel, The Fault in Our Stars, is a story about living. Told in the first person by Hazel, a 16-year-old living with stage IV thyroid cancer making its home in her lungs since she was thirteen, the novel represents childhood cancer so true to life I will not add further commentary except to urge you to read it.

The book’s poetic title, The Fault of Our Stars, is a bon mot of Shakespeare’s famous line from Julius Caesar:

The fault, dear Brutus, is not in our stars, / But in ourselves, that we are underlings.

While researching this post, I was surprised to find an article criticizing The Fault of Our Stars of being an over-sensationalized addition to the writing genre dubbed teen “Sick Lit.”

 What’s Sick Lit, and why have I, a writer of health-related information, never heard of it?

Sick Lit refers to memoirs, novels, and nonfiction books about dying from, or surviving, disease, either physical or mental. Cancer is a hot topic in this genre — I have no idea why I’ve never heard of it.

The above article’s author complains:

It’s not just the fact that these books feature terminally ill teenagers that makes them so questionable — they’re also aimed at children as young as 12.

My question is: Are books about their peers dying of cancer harmful to teenage readers?

In my opinion, they are not. No matter how adults try to protect children from the harsh realities of life, we cannot.

Many children have parents, siblings, or classmates living with cancer or other terminal illnesses. By deeming books that realistically portray the challenges and social stigmas accompanying childhood cancer, is society protecting children, or avoiding its collective discomfort with the topic?

Do you think children should be exposed to stories of childhood cancer and terminal illness? In what ways do you think it’s harmful? Do you think this topic should be banned for children under certain ages? Why?

Nurses Can Offer Reassurance When Cancer Changes Relationship Roles

Many relationships thrive after cancer, but how?

painting by jparadisi

Self Portrait by jparadisi

I think they transcend.

In a way, a patient is lost to loved ones during cancer treatment. Roles within the relationship change. The big, powerful husband adored by his wife of many years is now too weak to get in or out of their car without assistance, let alone do his longtime chores around the house. The wife and mother who makes Martha Stewart look like an amateur has not only stopped preparing gourmet meals, but can’t tolerate the smell of cooking food either, forcing Dad to pick up deli stuff, or order pizza to feed their hungry children.

Everyone has to adjust when a family member has cancer. The roles have changed.

  • There’s a new chapter in the family medical history. The cancer patient is the unwilling author of a family cancer history. Genetic counseling is an option, but family members may not want to know the results. It depends on their comfort level with the sword of Damocles dangling above them.
  • Partners become caregivers. Suddenly, there are extra duties around the house. Some learn to help with ostomy appliances or continuous infusion pumps. It’s common to teach spouses to flush PICCs. I often assess my patient’s status by the level of distress expressed by the spouse.
  • There is an uninvited guest who never leaves: fear of recurrence. David and I married after my cancer treatment. It’s a cute story; maybe I’ll post it one day. A few years ago, my surveillance labs came back with abnormal liver function results. My doctor ordered an ultrasound. Watching the monitor while the tech swabbed my belly with a wand, I said to David, “Look, Honey, I’m not pregnant!” I laughed, the tech laughed, but I will never forget the look of pain in my husband’s eyes as he uncharacteristically admonished me, “This isn’t funny.” I felt guilty for his fear, for letting someone fall in love with me when the cancer could come back. It turned out, an antibiotic I had taken a few weeks before caused the elevated LFT results. There was no cancer, but our uninvited guest remains.

Nurses cannot make these things disappear for our patients. We can, however, be sensitive to their needs, and reassure that they’re on a well-traveled path. Remind them that the most important thing they can do to help themselves is to talk about the pressures they feel as the cancer patient, or as the partner with increased responsibilities. We can also encourage them to develop strategies against their common enemy as a couple. Finally, we can be prepared to provide information about community resources available to support them.

And hope for the best.

How do you help patients and their families adapt to changing roles during cancer treatment?

Alopecia And The Pirate

As I write this post, some scientists are searching for ways to prevent male baldness through genetic manipulation. Others are conducting similar research to cure cancer. Is hair really as significant a part of our identity as we are sold to believe?

My hair began falling out the 14th day after the first chemotherapy infusion. In preparation, I bought a wig, styled and colored the same as my real hair. Like a feral animal, it perched on its stand, awaiting an opportunity.

When I saw the first ungodly huge handful of fallen hair I was too stunned to cry. Instead, I mumbled, “F***,” repeatedly, like a demented chicken.

It didn’t fall out all at once. Each morning for a week, I’d step out of the shower holding gobs of hair in my hands to prevent clogging the drain. After blow-drying what was left on my head, I’d take a pair of manicure scissors, like a naughty three-year-old, and try to even it out and disguise the bald patches. When I no longer could, a coworker’s husband shaved my head while she collected the locks, tying them into small bundles with blue satin ribbons. Image

After a time, I stopped wearing the wig. I preferred to cover my baldness with a red bandana, pirate style.

It was summertime, and I was at downtown Portland’s Pioneer Square, when a young man wearing a pirate’s black hat, white blouse with buckskin laces, black britches, and boots approached me. He clutched an authentic-looking sword. This was years before Johnny Depp made pirates sexy. Despite fatigue and chemo brain, I understood: “Oh, no, this guy sees my bandana. Pirate guy thinks he’s found pirate girl.” There was no place to run.

He spoke to me. “Ahoy! Me beauty, how art thee this fine afternoon?”

“I art fine, thanks,” I replied. “Why are you dressed like a pirate? Is that sword real?”

“Aye.”

He belonged to a club, of sorts, of people who dress like pirates and act out sword fights. I puzzled over what he wanted until he reached into his blouse and pulled up a goddess pendant dangling from a leather thong around his neck. He brought the goddess to his lips, kissed it, and then pointed to the carved turquoise goddess I had worn on a silver chain since my diagnosis.

“My fair Muse hails from Hungary, where she symbolized the female spirit of war and led her people to victory. I see you wear the Goddess yourself.” Doffing his hat, he bowed before swaggering back into the crowd.

He had approached because of the necklace, not the bandana. He hadn’t noticed that I was bald — or had he? Did I just have an encounter with an eccentric or a very kind man dressed as a pirate offering encouragement?

He left me smiling. There is more to each of us than what we look like.

This post was originally published by TheONC.

New Year Resolution: Don’t Wait Until Late in the Afternoon

It was late in the afternoon when my patient arrived at the oncology clinic. The treatment

Kaboom (ceramic) by jparadisi

Kaboom (ceramic) by jparadisi

prescribed required more hours than we were open. The oncologist prioritized his treatment for that afternoon and scheduled a second appointment for the next morning to complete it. The only problem with this plan was my patient didn’t realize he needed two appointments until I told him. His eyes expressed disappointment, but it was an expletive that escaped his mouth. He immediately apologized. “I’m sorry; it’s just that I don’t have that kind of time anymore.”

I understood exactly what he meant.

It was on a New Year’s Eve when I discovered a lump in my breast. At that time, I was a pediatric intensive care nurse working 12-hour shifts and a single mother. Life as I knew it came to a grinding halt. Once chemotherapy started, my oncologist prescribed light duty.  No longer a bedside nurse, I worked on office projects for the PICU manager instead.

My oncologist was hopeful. Still, I remember hearing her say there was a 32 percent chance I would die in 10 years. I was afraid. However, as a PICU nurse, I knew life could be short. This knowledge helped me gain perspective on my predicament. I’d had a good life. If this were it, how would I spend the next 10 years?

Since childhood, I wanted to be an artist. At 15, I announced my plan at the dinner table. In his thick Italian accent, my father said, “Sweetheart, you are talented and can be whatever you want, but get a job first. You will gain life experience, and then you will have something to make art about.”

Eventually, I became a nurse.

I thought about this while my chemo-bald head perched like a cue ball on the armrest of the sofa, eyes staring at the ceiling. I still wanted to be an artist. If this was the last decade of my life, I would spend it making art. I needed to start right away, because I may not have that kind of time anymore.

After recovery, I enrolled in art school and then transitioned into adult oncology nursing. In 2009, I completed a certification in fine arts and became certified in oncology nursing.

Today I am an artist and an oncology nurse. Cultivating creativity not only adds joy and accomplishment to my personal life, but it also flows into patient care. I believe it sustains my love for nursing after 26 years of practice.

Are you setting aside your creativity until late in the afternoon of your life?

Are you waiting for retirement or for the kids to leave home?

What if you discovered you don’t have that kind of time anymore?

What would you change?

 

JParadisiRN Blog: 2012 in review

The WordPress.com stats helper monkeys prepared a 2012 annual report for this blog.

Here’s an excerpt:

4,329 films were submitted to the 2012 Cannes Film Festival. This blog had 20,000 views in 2012. If each view were a film, this blog would power 5 Film Festivals

Click here to see the complete report.

Today: JParadisiRN On Doctors Radio Channel on Sirius XM 10am PT/1pm ET

Today @ 10 -1030 PT & 1pm ET  I discuss challenges of dating after a cancer diagnosis on Doctors Radio channel Sirius XM. I’ll be speaking from the points of view of both an oncology nurse, and as a cancer survivor.

Oh yes, there will be a blog post in the future about this one!

You Can Find Me Here: New Posts for TheONC

Resurrection Chair by jparadisi

It’s been a busy lately, and when it’s not, I’m  out enjoying the sunshine. Nevertheless, I’m keeping up with new blog posts both here, and for The Oncology Nursing Community (TheONC).

In case you missed it, last week for TheONC, I wrote When a Partner Doesn’t Do in Sickness and In Health, about the painful reality of partners leaving cancer patients at diagnosis or during treatment.

This week, I discuss helping patients cope with cancer in Helping Patients Build a Cancer Toolbox.

TheONC.org is a new online social forum for oncology nurses and cancer care teams where they can leverage their collective knowledge, nurture professional growth and emotionally support each other in a secure environment, as registration is required.

Moderated by oncology nurses and key opinion leaders, TheONC features discussions and commentary covering key issues ranging from symptom management and palliative care to managing ethnic and cultural diversity.

Other resources in the community include:

  • A Library of resources including patient education materials and presentations by community members
  • Clinic Close-Up, where members can view video-based interviews with experts from large group practices, private practices, and academia covering a variety of topics
  • News items relevant to clinical practice
  • An interactive Quiz feature where nurses can test their diagnostic knowledge on a regular basis
  • A Calendar of national and regional events and meetings specific for oncology nurses and cancer support team members

TheONC is like having a weekly national oncology conference conveniently online. A wide range of topics have already been discussed, including Stem Cell Transplant, pediatric oncology, survivorship, nursing while going through cancer treatment, and much more. Once you’ve registered, posts can be saved for future reference.

Follow TheONC on Twitter @The-ONC, and Like us on Facebook.

A Get Well Card for Warren Buffet

photo: jparadisi

As an oncology nurse, if I listened to the family members of an affluent, elderly patient debating at his bedside his right to receive cancer treatment, insisting he is too old, I would suspect elder abuse, and call for a social service consultation. Yet, this very scenario is occurring throughout the media in response to Warren E. Buffet’s announcement last week that he has stage I prostate cancer and will undergo eight weeks of daily radiation treatment, beginning in July.

The hullabaloo is in regards to guidelines established by the U.S. Preventive Services Task Force (USPSTF) recommending that men over age 75 not receive prostate cancer screening, aka the simple PSA blood test. 81 year-old Buffet not only received the PSA test, but when the results came back raised, he under went a prostate biopsy, which is also a no-no for a man his age per USPSTF guidelines. This is how his prostate cancer was diagnosed.  USPSTF recommendations for treating slow-growing stage I prostate cancer consist of a digital rectal exam (DRE), and PSA test every 3-6 months, with annual prostate biopsy (see link above). Mr. Buffet’s choices for cancer treatment drives at least one oncology urologist batshit. By the way, the USPSTF is the same task force that presented new mammogram guidelines in 2009, sending women’s health groups to arms.

I’m no expert on prostate cancer, hell; I don’t even have a prostate. But if I did, I would consider it my right to choose how to treat it if it were diseased, assuming I am presented with appropriate choices. There are a few things I do know: Warren Buffet is one of the good guys. An outspoken advocate of fair play, he proposed The Buffet Rule a $47 billion tax increase on the nation’s richest households, which the House voted down earlier this month. He is also one of 81 billionaires pledging to give away more than half their personal wealth to philanthropy when they die.

Do I believe Warren Buffet deserves special health care privileges because he is powerful, wealthy, and generous? No. I believe everyone has the right to their informed health care choices, and have those choices respected by their providers, families, and friends, without scrutiny. A cancer diagnosis and treatment is difficult enough without this added burden, whether the patient is unemployed, homeless, or the third richest man in the world.

A man with the power and affluence of Mr. Buffet is most likely unconcerned about the opinions of the media, and even less with mine. But for what it’s worth, Mr. Buffet, from an oncology nurse in Portland, Oregon, I wish you the best throughout your cancer treatment, and send positive thoughts for a speedy recovery.

A Blue Mason Jar Full of Post-It Notes Goals for The New Year

Blue Mason Jar of Dreams photo: jparadisi 2011

Every year I write my New Year’s resolutions on Post-It notes, filling a blue, vintageMason jar with them after reviewing the ones from the year before. I write the date on each Post-It note.  If a previous year’s resolution wasn’t met, and still holds merit, it remains in the Mason jar with the new ones.

Previous years’ resolutions in the jar:

  • “My health: that I may remain cancer-free” (1999)
  • “The continued good health of our families” (1999) I updated this one to “our families” in 2004, the year David and I married.
  • “David’s and my continued good health and happy marriage” (2008)
  • “To show a financial profit as an artist.” (2008)
  • “Gallery representation”(2008)
  • “Publish more stories in 2011” (2010)
  • “A book deal for my manuscript” (2010)
  • “The blog will have more than 1,000 visitors/month (2010)
  • “Lose ten pounds” (2011)

Most striking about the hopes and dreams on this list is that none of them are actually resolvable. They are ongoing. Sure, publishing my manuscript into a book would be great, however, knowing me, the next year I would resolve to write another book, one that won an award or topped the charts, or something like that. Artists are rarely satisfied with any level of achievement. We are always looking up the ladder at the next rung:

  • Gallery representation leads to the desire for critical recognition, increased sales, collectors, fame.
  • Publishing stories leads to writing more stories, longer ones, for larger audiences.

In general, human nature is much the same:

  • Health and happiness leads to the expectation for more of the same.
  • I lost ten pounds last year. For 2012 I expect to keep them off.

Resolution is the wrong choice of word. For me, setting New Year’s Goals is better phraseology. Most of the improvements I wish for in life take time and perseverance to achieve, and more hard work to maintain. To my way of thinking, New Year’s is a time to review the larger goals of my life, and see if they are still worth steering towards. If so, then I ask myself what small adjustments can I make this year to further them? These adjustments are written as goals on the Post-It notes, dated, and placed in the jar.

The most important part of opening the Mason jar each year is reading the hand written Post-It notes, and saying a small prayer of thanks or another expression of gratitude for the advances, which occurred over the past year towards each goal. There is no lasting joy in achievement without gratitude. This year, I am thankful for:

  • A clean bill of health when we were afraid my cancer had returned.
  • Editors who published my paintingsessays, and blog posts.
  • David and I lost weight. He avoided a prescription for blood pressure medication.
  • I was represented by Anka Gallery. I met wonderful people there and made lasting friendships.
  • I sold some paintings.
  • JParadisi RN blog has grown beyond my previous goals.
  • I have met inspiring people through blogging. Special thanks to: Dr. Dean Burke, Joni Watson, Brittney, Sean, poet Stacy Nigliazzo, and artist Matt Lamb.

So what’s on Post-It notes this year? What goals am I steering my life towards in 2012?

  •  Remain cancer free
  • The continued good health of our families
  • David’s and my continued good health and happy marriage
  •  A financial profit as an artist
  • Finish the Vessels of Containment painting series and start the new series
  • Gallery representation
  • Write and publish more stories in 2012
  • Increased writing income
  • The blog will continue to grow
  • Keep off those ten pounds

Here’s the cool thing about writing down goals: The Examined Life (Socrates). Today I see  each goal I’ve written down is focused on an unknown future. I haven’t written a single one, which applies to my present reality. So, until my dreams come true:

  • I will continue to develop my skills as a nurse so my patients remain safe in my care.
  • I will strive to be a better team player at work.
  • I will phrase criticism in a constructive manner.
  • I will remember that everyone has a difficult job. That’s why they call it work.
  • I will say Thank You at least once daily. It’s wrong to wait an entire year to give thanks for everything that is good in my life.

I wish to thank my family and friends (new and old) for your support of JParadisi RN blog. May your New Year be filled with Health, Love, Happiness, and Prosperity.