Adult Learning: Identifying Clouds, Nursing and The Freedom to Be Wrong

Clouds-Nature Journal Page ink and watercolor 2020 by Julianna Paradisi

I mentioned in previous posts I’ve taken up nature journaling as a new hobby. I enjoy it for many reasons: It promotes spending time in nature, increases meditative observation, and improves my drawing skills.

An unexpected benefit of nature journaling is that close observation of nature has revealed gaps in my knowledge of natural science. For instance, as a child I learned there were different types of clouds. I remember and can identify by sight cumulus, stratus, and lenticular, but after that, they just become pretty things to look at.

In Oregon, we have LOTS of clouds. I decided I want the ability to identify them. There are 10 major types of clouds, not including subtypes. They are identified not only by shape and color; altitude is also a factor. Altitude is difficult to judge unless there’s a mountain or tall building of known height to use as a reference point.

Despite their ubiquity, the more I research, I discover identifying clouds by type is not as easy as I’d expected.

I became discouraged about achieving my goal, until I remembered my science classes, prerequisites for nursing school. Microbiology required I learn to identify and draw various bacteria viewed on slides under a microscope. And what nurse can forget learning to identify the psoas muscle by sight in anatomy? It’s not easy to differentiate the fine borders and connections distinguishing individual muscles from what initially looks like a solid slab of tissue! At the time, both tasks appeared overwhelming, but I learned to see, receiving A’s in these classes. This memory persuades me I have the capacity to learn the different types of clouds, too.

Which brings me to another benefit of nature journaling: learning that I am not too old to learn new things, including about myself.

Perhaps, as we age, it’s not the ability to learn that is lost, so much as it’s the  fear of being wrong that is developed.

Generally speaking, nurses need to be competent, and competency is sometimes confused with being right. A nurse can be highly competent, but still make a mistake. In our worst fears, the mistake involves the safety of a patient. What saves us then is the level of accountability we bring to our practice. Nurses remain number one in the Gallup poll list of most trusted professions, not because we never make mistakes, but because of the overall accountability, characteristic of our profession. Society trusts nurses.

It appears counterintuitive, to be trusted because of how we handle our mistakes. I’m reminded of the saying,

Integrity is doing the right then even when no one is watching.*

 

I mull over these thoughts while drawing outdoors between rain showers, making ink and watercolor sketches of clouds in the rapidly changing Portland sky. Typical of Oregon weather, to the south is blue sky as the sun breaks through. Looking north, more rainclouds gather, ominously. Shortly thereafter, the heavens open, releasing heavy showers of rain. I gather my supplies, and go inside, where I ponder the names of the clouds I’ve just sketched.

And then I realize, they’re clouds, beautiful in their own right, with or without names. I am grateful for the brief moment outside, the morning’s sun break, the beauty of the day. I’ll look up the cloud names later. For now, I’ll make a cup of tea, and enjoy having the opportunity to learn something new without having to worry about being wrong.

* Various attributions, often to C.S. Lewis, but possibly a paraphrase of a Charles Marshall quote in Shattering the Glass Slipper

Julianna Paradisi (JParadisiRN) Paintings Included in Myth and Magic Juried Art Exhibition

Myth and Magic Exhibition Poster

I’m delighted to have two paintings in Myth and Magic, a juried exhibition of art presented by the Gresham Visual Arts Committee. The show runs through February 6, 2020. The venue is lovely, and I’m honored to show my work alongside so many talented artists.

For more information visit their website: http://www.greshamartcommittee.com

Venue: City of Gresham Visual Arts Gallery

Public Safety & Schools Building

1331 NW Eastman Parkway

Gresham, OR 97030

Gallery Hours: Monday through Friday 8:00 AM

to 5:00 PM / Closed holidays

The show closes February 6, 2020.

Julianna Paradisi with Her Painting at With Bated Breath : Juried Invitational Show at Gallery 114 Opening Reception

 

At Gallery 114 for the opening reception fo With Bated Breath photo credit: David E. Forinash

Many thanks to the members of Gallery 114 for hosting a well-attended opening reception for the juried group exhibition, With Bated Breath. It’s a gorgeously curated show, and it was a pleasure meeting you!

Show runs through February 1, 2020. Gallery hours are Thursday-Sunday, 12 pm – 6 pm.

Julianna Paradisi (JParadisiRN) Painting Included in With Bated Breath Group Show at Gallery 114

Happy New Year!

Waiting For Clarity: Sunbreak Over The Broadway Bridge, mixed media 12″ x 16″ by Julianna Paradisi 2019

The above painting, Waiting For Clarity: Sunbreak Over The Broadway Bridge, is included in the juried invitational group show With Bated Breath, at Gallery 114, opening First Thursday, tomorrow evening, January 2, 2020 6 pm – 9 pm. The show features work by artists from Oregon, California, Washington, Wyoming, Ohio, Arizona, New Mexico, Arkansas, Texas and Montana.

I’m pleased to invite my Portland readers to attend the opening and artist reception at Gallery 114 

Show runs through February 1, 2020.

Discovering Our Inner Lewis and Clark

Centennial Mills Snowscape II oil, wax on panel 2019 by Julianna Paradisi from an image of the 2017 Portland snowstorm

Those of us living in the Banana Belt of downtown Portland were spared the large amount (up to 8 inches) of snow dumped onto adjacent neighborhoods and outlying towns this past weekend.

Michelle Obama cancelled her trip to the Rose City because of the weather reports predicting Snowmagedon, after Seattle was blanketed in 5 inches of snow in only a few hours. Flights between Seattle and Portland were cancelled.

On Friday night we got a dusting of powder. Saturday morning, although air temps only reached 30° F, the sidewalks were clear except small patches of ice here and there, gone by noon.

The rest of the weekend was pretty nice, in terms of weather. In fact, the sun shone gloriously most of Sunday. I got a slightly pink sunburn from an hour’s worth of it shining on my face through the window during barre class.

The Internet guffawed mercilessly at the forecasters. Twitter and Facebook popped with snarky photo memes. Portland weather forecasters are used to the heckling, similar to our local sports teams when they lose.

Unpredictable weather is a part of life in Portland, treated like a personality participating in all social events like that crazy relative everyone suspects will act out but is invited to the wedding anyway.

It was reported with great humor that all the kale in Portland grocery stores had vanished from the shelves as panicked Portlanders stocked up on essentials to sustain them during the predicted week-long siege of Snowstorm 2019.

I hadn’t planned to go to the studio on Saturday, because we had tickets to see Michelle Obama. When she cancelled Friday afternoon, I still  didn’t plan to go because of the predicted inclement weather. When the snow accumulation proved slight, I still didn’t go because something inside me suspected foul play on the part of the storm: It was just an unexpected break in the weather; the really bad stuff could start any moment. These thoughts were somewhat fueled by reports and photos posted by Facebook friends attesting there was significant snow in selected Portland neighborhoods.

So I adapted. I scheduled barre classes instead of my weekend runs along the river. I did laundry. I meditated. I read my Tarot cards, and then journaled about what I thought the reading meant. I read a book. I took a nap. I made a pot of soup. I texted my husband who had to work the weekend. I told him I loved him and missed him, adorning the texts with happy faces blowing kisses emojis.

It didn’t snow.

On Sunday there were occasional light flurries of powdery snowflakes that melted on contact into tear drops falling from the railings of my deck. I took another barre class, but ventured no further from home than that.

We ate leftover soup that night for dinner.

The whole weekend was entirely anti-climatic.

I wasn’t alone in my feelings I discovered on Monday morning at work. When the topic of “the snowstorm that wasn’t” came up, and it did often, everyone said the same thing. They had been unable to reorganize their weekend plans to make use of the unexpectedly good weather. Almost everyone made soup. Lots of soup, too much soup for one family and they shared portions with their neighbors.

Disappointment was the most commonly expressed emotion. We had looked forward to being homebound by the snow that never fell.

In my mind, we were mourning our inner Lewis and Clark. A snowstorm gives us a cause to focus on as a community. But more than this, a snowstorm provides the opportunity to test our inner resilience, because in reality, Portlanders are closet survivalists. Note that stores ran out of kale, bread, milk and bacon. There were no shortages of parkas, snow boots, traction devices to put on the boots, or of generators, or snow tires, That’s because households already have these things, and every neighborhood has a neighbor with a big sturdy truck with all-wheel drive who will happily volunteer to take you to work at the hospital or wherever it is you need to be.

Oregon is home to the last of the pioneers headed west. Europeans discovered Hawaii long before Lewis and Clark arrived on the Oregon coast. In Oregon, we have travelled as far west as one can on the continent of this great country.

Those of us who came to Oregon from other places as young people came because we wished to connect with our inner Lewis and Clark; at least I did. I learned to start a fire from kindling I split myself from wood taken from the cord I stacked in the fall to get me through winter. I came because I love the change of seasons, the colors of fall, the damp, grey mossiness of winter that breaks into the brilliant smile of spring. I left the monotonous days of the state where it never rains to experience the full palette of nature.

Like my fellow Oregonians, I relish the threat of a Snowpocalypse for its gift of revelation: who I am, and what I am capable of.

And like my fellow Oregonians, I’m a little lost when the Snowpocalypse doesn’t arrive.

Book Review: Sky the Oar, Poems by Stacy R. Nigliazzo

Sky the Oar by Stacy R. Nigliazzo, Press 53, 2018

Sky The Oar

poems by Stacy R. Nigliazz

Publisher: Press 53, 2018

Stacy R. Nigliazzo is a poet living in Houston, Texas. She is also an emergency department nurse. Her second published collection of poetry, Sky the Oar, like its predecessor Scissored Moon is informed by her experiences as an ER nurse.

I once had a painting instructor who read a poem to his class before each lesson. He said, You need poetry to be a painter. I would add, You need poetry to be a nurse. Nigliazzo creates poetry from the struggles of the human condition nurses witness daily.

Unlike medical surgery or ICU nurses, ER nurses treat and care for their patients for short spans of time. The poems of Sky the Oar reflect these brief, intense encounters. They are fleeting thoughts and images occurring in the internal dialogue of a poet too busy caring for the person beneath her hands to attach judgement to their plight.

Nigliazzo’s words are crisp and precise, things of beauty without sentimentalism or euphemism. The words are like shards of glass glittering in our hands, their edges sharp enough to pierce the skin. Her poems elevate these crystalline splinters of humanity for our understanding and compassion. In I Am and Nocturne, I found myself at the bedside with her. In the poem Frequently Asked Questions By My Patients, Nigliazzo captures a patient’s experience in a mere nine words.

Sky The Oar is poetry for all readers. For nurses, the slim volume is salve for the soul.

 

 

 

 

 

 

 

Down the Rabbit Hole

Down the Rabbit Hole, collage, 2017 by Julianna Paradisi

Why is it 2018 feels more like “2017, The Sequel, and not an actual New Year?

While I have one or two friends who’ve had an immediate change of luck, many more of us are experiencing 2018 as a poorly constructed, run-on sentence (or rambling blog post) with little progress or clear goals for the future.

Progress requires a release of perceived limitations, and expectations. The process of releasing creates tension similar to a snake shedding its skin, or a butterfly breaking forth from its chrysalis. Things become too tight and uncomfortable before breakthrough occurs.

Nearing the end of January, the growing and stretching feels more intense than in previous years, and I find myself sympathizing with Alice for choosing to follow a rather strange rabbit down a hole, without thought of where it would lead, or how she would return. “Don’t over think it, just do it.”

Choosing to go down the rabbit hole is not a characteristic of most nurses. Nurses like clear goals, something to steer towards, whether it’s gaining a patient’s trust by managing her pain, meeting discharge goals, or simply relieving a fever.

Measurable goals work in nursing. They’re admirable, and create safety.

* * *

Safety. What is safe?

As an oncology nurse navigator, and a cancer survivor, my patients and I grapple with this question daily: How to balance cancer prevention (safety) with an enjoyable and fulfilling life?

If you believe the answer is easily found in NCCN guidelines, and AJCC recommendations, you are most likely not a cancer survivor. Being a cancer survivor is “going down the rabbit hole.”

* * *

Being an artist and writer demands a willingness to go down the rabbit hole; a comfort level with uncertainty.

The challenge of life is learning to live somewhere on the continuum between safety, and recklessness.

Hank Stamper, the burly central character in Ken Kesey’s epic novel, Sometimes a Great Notion, about Oregon’s logging industry, argues towards recklessness:

“Hank would have been hard put to supply a reason himself, though he knew it to be true that Lee’s presence at the Snag tonight was important to him…maybe because the kid needed to see first-hand what kind of world was going on around his head all the time without him ever seeing it, the real world with real hassles, not his fairy book world of his that him and his kind’d made up to scare theirselfs with.”

* * *

Progress begins by asking questions.

What is safe? What is reckless? Should a predictable outcome dictate the beginning of a new enterprise?

An explorer would answer, “No.”

Alice returned from Wonderland, having viewed strange, new perspectives, and with a bunch of great puns. I assume she counted it a good experience, because she went back for a second trip Through the Looking Glass.

Here’s to going down the rabbit hole, and leaving 2017 behind.

 

 

 

 

 

Cancer Survivorship: Breaking The Myth of “Nurses are Bad Patients”

The Queen of Cups I collage by Julianna Paradisi 2017

Are nurses are the worse patients?

Upon completion of treatment for breast cancer, my surgeon remarked, “You got through treatment really well. In the beginning, I didn’t think you would.”

The comment struck me as odd, but I was curious. “Is this because I cried when you diagnosed me?”

“Yes.”

Thoughtfully, I replied, “I cried because I understood the diagnosis. I understood it would change my life.”

In return I received a patient smile.

The first plastic surgeon I chose was forthright in his opinion of me as a patient, however, “You nurses are the worse patients.”

I asked, “Are we your worse patients, or your most educated ones?”

He promptly discharged me from his care.

* * *

I received excellent treatment for breast cancer. My survival and good health are proof. But there were gaps in the emotional support I received.

It’s been nearly two decades since I had breast cancer, and all those years I accepted the label of being “a bad patient;” the one that asked questions, the one needing proof the  medical recommendations were best practice.

Then I became an oncology nurse navigator, with patients who are nurses. They have taught me I was not a bad patient, just a nurse-patient, set apart from non-nurse patients. And there are subsets of nurse-patients I help: those bringing an oncology background to their diagnosis, and those who don’t.

Nurses assume accountability for their care

Nurse-patients with oncology backgrounds manage their cancer diagnosis differently than their colleagues without. I suspect this is because they bring their own toolbox: They work with oncology surgeons, medical oncologists, and radiation oncologists. They personally know and handpick their treatment team. They’re still scared, but the support they seek is more pragmatic: how-to’s for managing treatment, work, home, and family life.

Nurses without an oncology background wonder if we are referred to top-notch practitioners, and receiving state-of-the art options, contributing more stress to our cancer diagnosis. We tend to get second, and sometimes third opinions about treatment recommendations. We are more likely to travel to nearby cities (and sometimes other states) with larger, nationally recognized cancer programs for consultations. We may delay starting treatment to fit in the extra consults. Our family and friends may not understand why we won’t simply “do what the doctor says.”

Here’s my unproven hypothesis explaining why this happens:

The Hot Seat: Nurses are compelled to advocate for themselves

Nurses, in our role of patient advocate, are educated to question doctors. We are accountable for catching, and preventing mistakes.

In my nursing education, this training happened early in the morning before our clinical days, in a potentially brutal ritual dubbed, “The Hot Seat.”

In “The Hot Seat” one by one, nursing students gave report on the patient (s) they were assigned that day: diagnosis, age, treatment plan, and goals for outcome. Our instructor cross-examined each student about everything: medication indications, dosage, side effects, and lab values to monitor. She inquired about imaging, and anticipated needs the patient may have at discharge. The more questions a student answered correctly, the more difficult the questions became. The fewer answers a student mustered, the hotter the seat became.

Nurses know unasked questions lead to harm

In The Hot Seat we learned critical thinking means always ask the next question. It’s the question you forgot to ask that leads to harm.

Nurses know the importance of asking questions. When we seek treatment outside of our specialty areas from doctors we do not know, we manage the stress by asking, “Why?”

My understanding of this means that nurses are some of my favorite patients. I remember what I needed to know to ease my stress during cancer treatment, and I offer it to my nurse-patients. Once they understand how oncology treatment works, they often become so independent in caring for themselves I rarely hear from them.

And I’ve certainly never discharged one from care.

 

 

 

Back From The Digital Future: My Return to Paper and Ink Books

Tiny Lending Library ink on paper by Julianna Paradisi 2018

My adult life I’ve had an unreasonable fear of being without a book to read. The anxiety is triggered when I travel, particularly by air. I trace its beginning to childhood when, on a family vacation to visit my grandparents in Italy, our plane was delayed in Germany for hours due to bad weather. Eventually, all passengers were shuttled by bus from Frankfurt to an airport in Stuttgart, continuing our flight to Rome.

I was in the fifth grade, stranded in a foreign airport with nothing to occupy me for twelve hours. My personal Hell was exceeded only by my parents’: they had to manage my boredom along with my six year-old brother’s, and toddler sister’s, also stranded. Fun times.

From then on, I travel with whatever book I’m reading, and if nearing its end, at least one other book, or more, depending on the planned length of stay. I know books are sold at airports, but I’m unwilling to take a chance on their selection. Problematically, my books take up space, and add weight to my luggage, interfering with my desire to travel light.

The invention of digital readers changed this. I live near one of the best independently owned book stores in America, and I apologize to all small, independent book store owners, but the ability to download books to a slim, lightweight device, and buy more books from virtually anywhere I travel was a game-changer, until last year.

Last year, the hospital  where I work installed a Tiny Lending Library in its Healing Garden.

In case you’re unfamiliar with Tiny Lending Libraries, they’re a thing, with their own organization, and website. The movement began when people built cases, or sometimes simply placed boxes filled with books in their neighborhoods, inviting their neighbors to “take a book, and leave one behind.”

Besides the satisfaction derived from the printed page of a book, the experience of handling a used book left by someone wanting to share it provides a connection to the neighborhood, and the people who live there.

At work, I stop to see what’s on the shelves in the Tiny Lending Library if it’s not already being examined by staff or neighbors. The selection changes often. So far, I’ve borrowed six books, and left twice as many.

Once again, there’s a stack of unread books on my nightstand. I carry the one I’m reading with me to work, in case I have time on my lunch break to read a page or two. Eventually, it will take its place in the Tiny Lending Library.

I wonder how many of the books from the Tiny Lending Library make their way into hospital rooms, carried there by family or friends visiting a patient who is stranded by illness or injury, and worried about not having enough books to read?

 

 

 

Applying Nursing Process and Knowing When to Quit

The Queen of Cups II
Collage 6.5″ x 4.75″ by Julianna Paradisi 2017

It was several more days later   before I ripped out the knitted sleeve I wrote of in my last post. I blame part of my reluctance on nursing process: Nurses are trained (to the point of reflex) when confronted with a problem or undesirable outcome to devise further interventions to create the desired outcome. Likewise, I attempted to apply nursing process to the problem of the knitting mistake.

I measured the sleeves of my favorite sweaters, discovering I habitually wear sleeves an inch or so longer than the pattern I’m using prescribes. Then I did some math, and calculated I could still make all the required increase stitches, if I were willing to accept a longer sleeve, but it would be a very close call between longer and too long. As an artist, and nurse, I felt compelled to take the challenge. Artists like to work with process too.

The hard part about nursing process, however, is knowing when to call it quits: How far backwards is one willing to bend to make something work? This can also apply to dysfunctional relationships or work environments. Carrying out interventions beyond the limits of healthy boundaries quickly becomes denial and co-dependence.

In the end, I conceded the sleeve was too long. I ripped out every stitch, turning my head away so I didn’t have to look, the way a patient undergoing a procedure with only local anesthetic does while the doctor takes a scalpel to their skin.

The deed is done. There’s no more anxiety about the outcome. I did what I had to do.