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.

 

Letting Go of Your Hassles: New Year 2017

Rose quartz for love, clear quartz for clarity Photo: Julianna Paradisi 2017

Rose quartz for love, clear quartz for clarity Photo: Julianna Paradisi 2017

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’.”

Art and Nursing: Exhibiting Art Within a Power Point Presentation About Oncology Nurse Navigators

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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.

 

 

 

 

Found Time for Creativity and Mindfulness: Make The Most of Waiting

Around the beginning of the year, I wrote about setting a timer for 15 minutes each day and during that time write or make something. Although the product of that commitment hasn’t been evident on this blog, I am honoring it, by continuing to write and illustrate posts for Off the Chartspaint, and an unusual way to use found time.

Part of my job as an oncology nurse navigator is meeting or checking in with patients during their course of treatment. These face to face meetings often occur before, during, or after one of their oncology appointments.

Cancer treatment involves doctor appointments, and doctor appointments involve waiting. As a ONN, I wait my turn to see the patient, although not usually in the  patient waiting room. Sometimes I’m in a MOB lobby. Often I’m invited in the back office area. If it’s a lengthy wait I go back to my office cubicle, and try to connect with the patient later.

But when the wait is about 15 minutes, sometimes I use the time drawing. Actually, it’s more like advanced doodling. Nothing fancy: I use the simple, lined notepad I bring to appointments, and a cheap, ball-point pen used to write notes. I select a random object. Flower arrangements and office plants are common subjects, but capturing enough details to visually describe a piece of medical equipment is a fun favorite. Rarely is a sketch completed before I’m called back to work.

Drawing without pressure to create product is a delightful form of mindfulness I’m fortunate to merge into my work day on occasion. The illustrations above are examples from my notebook.

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!

Hope is a Feathered Thing

Hope is the thing with feathers t
hat perches in the soul,
 and sings the tune without the words, 
and never stops at all,

And sweetest in the gale is heard;
 and sore must be the storm
 that could abash the little bird
 that kept so many warm.

I’ve heard it in the chillest land, 
and on the strangest sea;
 yet, never, in extremity, 
It asked a crumb of me.

Emily Dickinson

A few weeks ago I witnessed a miracle.

No, really, I did.

While running along the Willamette River in Portland’s Waterfront Park, a flock of seagulls (not the punk group; the kind with feathers and wings) scavenged for food several yards ahead. From the neck of one of the birds a plastic grocery bag dangled in the sight breeze like a cape.

In 2011 Portland’s city council outlawed the use of plastic grocery bags by retailers for environmental reasons. This sea gull’s plight illustrates one.

The bag was a death sentence. Besides scavenging, gulls feed by dipping for small creatures from the river, and this action will fill the bag with water. When the bag becomes heavy enough, it will sink below the river’s surface and drown the gull.

From habit, my nurse’s brain searched rapidly for an intervention. Briefly, the ludicrous image of me somehow restraining the bird and removing the bag flashed by, but before I was completely convinced of this impossibility, the birds took flight and landed on the river including the unfortunate gull with the plastic bag cape fluttering behind.

“Oh no,” I thought.” I’m going to watch the poor bird drown.” Mesmerized the way people become when they can’t avoid watching a train wreck I stopped running and leaned against the rail of the sea wall, following the bird with my gaze.

The gull bobbed on the river’s current, the plastic bag making him easy to spot. He dipped forward and placed his beak beneath the surface of the water. I saw the bag fill, then sink. Pulled down by the weight of it, the gull fought, flapping its wings wildly as it struggled to take flight.

“This is it, I said out loud, though no one else was watching.

But it wasn’t it. Miraculously, the bag slipped away from the gull and he was airborne. I watched the bag, half submerged, float down the river like a malignant cell seeking another victim.

Okay, maybe it wasn’t a miracle, but it felt like one. I had been so sure the gull was doomed.

Maybe the miracle is that I received an object lesson about embracing phenomenon, to stay hopeful, to marvel.

Because hope is a feathered thing.

If Lousia May Alcott Were a Nurse: Oh Wait, She Was.

Peds Ward by JParadisi Acrylic,charcoal, flash & pencil on vellum 2008

     Nurses’ Week is over, but we left out one of my favorite nurses. She did not advance nursing science. Instead, she gave the profession a human face. I love Louisa May Alcott.

     She wrote Little Women. Do girls still read Little Women? I am grateful my mother considered reading the classic a rite of passage into womanhood (along with Gift from the Sea, and The Good Earth). She gave me a hardbound, illustrated copy of the novel for Christmas when I was in the fifth or sixth grade. To this day I do not know if I love Jo or Amy more. Beth scares me. Meg…she never really materialized for me.

     Okay, Little Women, blah, blah blah, yeah, you read it. You like Jo too. Amy was a bimbo. Too bad for Elizabeth. Meg went on to play the sister on Family Guy, who cares? Well, darling, do you know that Alcott borrowed books from Ralph Waldo Emerson’s private library? That neighbor Henry David Thoreau was her mentor. That she was an Abolitionist and Women’s Rights activist.  Do you know that before she became famous for penning Little Women in 1869, she was a nurse in the Civil War? The experience changed the course of her life, and likely shortened it. In 1863, she published her nursing experiences in the slender volume Hospital Sketches. The book has the tagline:  “An Army Nurse’s True Account of her Experiences during the Civil War.”  

     An aspiring actor and playwright, Alcott grew up in poverty.  Her father, Amos Bronson Alcott was a respected educator and philosopher lacking both business sense and money management skills. Louisa took jobs teaching and in domestic service to support her family. When war broke out among the United States, she wrote, “I want something to do.” Encouraged to write, young Alcott felt she lacked necessary life experiences. At a neighbor’s suggestion, she decided to “go nurse soldiers. So far, very good.”

     I won’t post a synopsis of the book, other than to say it contains a disturbing account of the death of a soldier whom Alcott befriended.  Her description illustrates that in the days before anesthesia, a soldier’s death was the male counterpart of a woman’s sufferings in childbirth.  

     Alcott was dedicated to the men in her charge. Her brief nursing career ended when she contracted typhoid fever. She survived, but suffered life-long chronic pain; a side effect of the mercury-based medication used to treat her. She obsessively turned to writing, becoming the main financial support of her entire family.  Little Women made her rich, but it was her nursing experiences that made her a writer. I will close this post with Alcott’s own words about Hospital Sketches:

These sketches, taken from letters hastily written in the few leisure moments of a very busy life, make no pretension to literary merit, but are simply a brief record of one person’s hospital experience. As such, they are republished, with their many faults but partially amended, lest in retouching they should lose whatever force or freshness the inspiration of the time may have given them.

To those who have objected to a “tone of levity” in some portions of the sketches, I desire to say that the wish to make the best of every thing, and send home cheerful reports even from that saddest of scenes, an army hospital, probably produced the impression of levity upon those who have never known the sharp contrasts of the tragic and comic in such a life.

The unexpected favor with which the little book was greeted, and the desire for a new edition, increase the author’s regret that is not more worthy such a kind reception.

Louisa May Alcott

Concord, March 1869

Hospital Sketches by Louisa May Alcott is available from Applewood Books.

It’s More a Guideline Than a Code

photo: JParadisi 2009

  “But what about the Pirate’s Code?” Elizabeth, (Keira Knightley), asks Captain Barbossa, played by actor Geoffrey Rush, as he reneges on a bargain she’d negotiated with him, in a scene from the movie The Pirates of the Caribbean: The Curse of the Black Pearl.  “Well,” Barbossa replies, “…the code is more what you’d call ‘guidelines’ than actual rules,” and he sails off, keeping her captive. 

      I’m reminded of this scene while reading the post by Anahad O’Connor,  What’s Your Temperature? Rethinking 98.6   in the New York Time’s Well Blog (December 28, 2009). Many commenters posted  annoyance with nurses and doctors who seem to ignore them when they explain that their temperature is usually lower than 98.6°Farenheit ( which is 37° Celsius, used in most other countries than the United States ).  As a Registered Nurse, almost every patient I see in a shift tells me their temperature normally runs below 98.6. I know. So does mine. Most of my patients run a little below 98.6, in the 97’s.  However, 98.6°F has become a cherished rule in our society, by which patients decide if they are sick.  If they are higher than 98.6°F, they reason they are sick.      

     98.6°F is an average body temperature. This means there is a range of some degrees below and above that are considered a normal body temperature. It’s a guideline, and only one factor in the assessment of whether or not a patient has an infection (viral or bacterial). Many adult patients present with an infection without reaching a temperature of the textbook rule 101°F.  There are a few more guidelines I want to consider: What is the patient’s blood pressure, and how does it compare to the patient’s blood pressures in the past? When I suspect infection, I’m often more concerned with a drop in the patient’s blood pressure, than an increase.  Is the pulse (heart rate) higher or lower than usual? Is the patient complaining of pain or achy? Is she dizzy? Is there a rash or swelling anywhere? Finally, what is my overall impression of the patient? Does she look sick to me? If vital signs are borderline normal, but my gut tells me the patient is ill, I’ll call her doctor to discuss the findings. I’ll actually tell the physician, “The numbers are normal, but she is symptomatic (has symptoms) and she looks sick to me.” You’d be surprised how many doctors order blood cultures, a chemistry panel, CBC, a urine analysis, and prophylactic antibiotics based on a phone call like that from a nurse, especially in oncology. 

     My point is  to illustrate why, when you tell your doctor or nurse that 98.6°F is high for you, it seems we aren’t listening to you. What we are doing is looking and listening to you, to decide what the best plan of care might for you.  98.6°F is only a guideline, not a code. 

Disclaimer: It is not the intent of this blog to dispense medical advice. If you have concerns about fever, infection or other personal health issues, please consult a licensed medical practitioner.

On Art and IV’s

 

I want to discuss what it’s like to be an artist and a nurse. The visual art pieces are the easiest for me to post: I take a photograph of one of my images, down load it from the camera and upload it onto the blog. Poof!  I am the curator of my own Internet gallery. I can explain the images, or not, or use them for illustrations of random posts. I can take refuge in the worn statement “It’s just paint.”  Like a fish that surfaces then dives back into its watery depths, I find safety in the intentional layers of interpretations. My viewers tell me what the images represent to them. I don’t have to speak at all.

Writing is more problematic. Putting thoughts down in words feels like a greater commitment to what is said and more concrete than the commitment required by a brushstroke. Perhaps, because I write nonfiction, it seems more self-revealing.  However, every mark, be it a word or a brushstroke, reflects a choice made by its author, so perhaps there’s no difference at all.

I suppose that I could make up the stuff that I write. Why not? I mean, what I like about painting is that I can take a subject, then represent it any way that I want to. I like it when the image creates more questions than it answers. For me the object of writing is to examine truth and that requires an attention to detail.

On the days my focus is nursing, I spend a lot of time at work writing down objective information in carefully coded medical terminology. There’s no room in a medical record for speculation or inference, no magical realism. Events happened as written or not at all. Period. The writing is blunt and impersonal. Words in a medical record are merely tools to convey information; they are not supposed to be lovely or melodic on the tongue. There is nothing poetic about charting, and the information is private.

I have an affinity for privacy. My father was a schoolboy in Nazi-occupied Italy during World War II.  He grew up knowing that telling tales or speaking about private matters could cause someone’s arrest or even death. In turn, I was raised in a very small town; gossip spread quickly, and at a young age I intuitively knew that private matters needed to stay unspoken beyond the dining room table.  In my family’s church, sins were only shared in the quasi-anonymous shelter of a confessional. The current generation’s willingness to post the most intimate details of their lives on the Internet is incomprehensible to me.  However, the same need for self-expression bangs determinedly at the door of my soul, and the private persona of the nurse gives way to the voice of the artist inside of me, despite all I have been taught.

I’m not the only person I know who feels like this. At work a few weeks ago, I did a curbside in the hallway with a surgeon regarding a patient we share. The surgeon also writes, and once our patient concern was settled, we briefly caught up on our artistic pursuits. The doctor felt diffident about writing, and I admitted to the same. Then the surgeon went back to the OR and ran a scalpel through the soft tissues of a patient.  I returned to my own duties and slid an IV needle, slick as butter, into the vein of another patient, then infused medication intended for their treatment but, potentially harmful just the same if given incorrectly.  Neither the surgeon nor I felt that either procedure was as difficult as the self-exposure and disclosure of the act of writing, and I find that amusing.