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?”


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.




Art & Nursing in The Clinical Setting: An Interactive Experience

Recently I had a unique experience as an artist and nurse.  At the hospital, I was stopped by someone I vaguely thought was a former patient, or perhaps a family member or supportive friend of a former patient, I really don’t remember.

Lung Ta (Wind Horse) oil stick on vellum 2007 by Julianna Paradisi

Lung Ta (Wind Horse) oil stick on vellum 2007 by Julianna Paradisi

This person, however, not only recognized me, but knew I painted the art hanging in the infusion clinic where I once worked.

“You sold the horse print.The one over the reception desk.”


“I really liked it. It was good. It was a print, right?”

“Thank you. Well, actually no. It was an original painting. I used oil sticks to make it.”

“What are oil sticks?”

“They’re similar to oil pastels, but big, like cigars. In fact, painting with them feels like how I imagine painting with a big, greasy cigar might feel. But they air dry over time, unlike oil pastels.”

“That sounds really messy, but your painting looked neat and precise.”

“Thank you.”

Mt Hood Triptych #2 oil on canvas 2016 by Julianna Paradisi

Mt Hood Triptych #2 oil on canvas 2016 by Julianna Paradisi

“I really liked it.”

“Thank you. So what do you think of the painting of Mt Hood I made to replace it?”

The the expression on her face gave her away, so I threw her a bone.

“Not so much, right?”

“It’s okay. I liked the horse.”

“I really appreciate your comments,” and I meant it.

As an artist I’ve stood through many gallery openings and art receptions. It’s rare for anyone to ask about what inspired the art, or how it was made. No offense intended to anyone, but a common experience for artists at gallery receptions is being approached by people wanting to talk about themselves or their art, not yours. They didn’t come to view the art.

I’m enchanted by this woman who spends her time in an infusion clinic considering the artwork on its walls; becoming fond of a particular painting, and wondering how it was made. She wasn’t there to view the art either, but she did. Not only that, but she had access to the artist, who is a nurse going about her nursing duties, until this brief respite, when the two of us discussed the art.

I do not believe such things happen very often to artists or nurses. I am grateful it happened to me.


About Roadblocks and the Path of Least Resistance

untitled collage by jparadisi

The other morning, wearing shorts and running shoes, I sat on a tree stump in the shade waiting for a freight train to pass. It was already 80ºF and I should have started out earlier. The train blocked the running path to the bridge leading to a trail along the river. Sitting on the stump, waiting on a train, I started thinking about roadblocks. It has been a week full of roadblocks.

There are different kinds of roadblocks. One kind is temporary and forces you to go around or wait until it passes to continue whatever you were doing. While annoying and time-consuming, this sort of roadblock doesn’t cause you to cancel your plans, just adapt them. You either find another route, or wait for the roadblock to pass, like the freight train. The day before, I was this type of roadblock for a motorist wanting to pull into a parking slot at the same time I was walking through it to my car.  I didn’t know I was a roadblock, because he didn’t use his turn signal. Jumping out of his way, I saw the pink breast cancer ribbon magnet he had on the door of his car. It is ironic to survive cancer and get run over by a driver who supports finding the cure.

Another kind of roadblock causes a complete change of plans.

Yesterday I hung chemo for patients whose cancers are roadblocks in their lives. Even with good prognosis, a cancer diagnosis means that everything in your life becomes secondary to your treatment plan. Jobs, vacations, and holidays are arranged around cancer treatment. Patients ask their oncologists for “time off’ if there is a special event, like a child’s wedding to attend. Oncology nurses instruct stem cell transplant patients to avoid close contact with their young grandchildren, their pets, even fresh fruits and vegetables for a period of time during their treatment.

For me, the most annoying thing about cancer was the lack of control over my time. Cancer is a formidable roadblock. I remember trying to schedule oncology appointments during the first couple weeks of my new identity: cancer patient. I told the patient scheduler I preferred afternoon appointments. She said the doctor would see me at 9 am. I said,  “I run in the mornings; 9 am doesn’t allow enough time.” She said, “not anymore you don’t sweetie, we’ll see you at 9.”  I empathize with people who have chronic conditions requiring frequent medical appointments. Imagine your own body being your roadblock.

The thing about roadblocks is sometimes they force you to take a detour, leading you in a direction you may not have otherwise gone. Instead of pondering “the road not taken,” you find there is no other choice but the path of least resistance. When your life is no longer supported by its foundation, sometimes you’ll find a fresh perspective for rebuilding it.  Lying on the sofa, fatigued from chemo and staring up at the ceiling, you might discover a longing for time to make art and time to deepen your personal relationships. You might decide to sell or give away almost everything you own, and simplify your life to make those wishes real. Everyday decisions are regarded carefully, and considered for whether or not they bring joy. Sometimes a roadblock is the very thing needed to stop what you are doing and check if the life you are living serves you. A roadblock can change your life in positive ways too.

The freight train passed, and I resumed my run. I continued on the path I’d intended from the beginning, because the train wasn’t a significant enough roadblock to cause me to do otherwise.

Privacy and Grief


Sometimes a Surgical Mask Feels Like a Gag by jparadisi 2010

One of the difficult things about working in an outpatient infusion clinic is not knowing the outcomes of many of our patients. They come to us for treatment from a multitude of physician’s offices, all over.  Cancer patients come at regular intervals for weeks, sometimes months. Many arrive with life-threatening disease looking for one last remission, or simply enough time to see a child graduate from high school or the birth of a grandchild.  We listen as they tell us about the disappointments and the blessings of a cancer patient. We meet their families and loved ones. When they complete the course of treatment, they stop coming in. Most of the time we never know what happens to them.  HIPPA privacy laws limit our ability to find out. This is very different from my previous work in pediatric intensive care units, where nurses celebrate a child’s long anticipated discharge home or attend at the child’s death, and grieve along with their parents. Either way, I knew what the outcome was and dealt with the accompanying emotions. I knew how to respond to families I ran into at a grocery store.

It happened again a few weeks ago. Drinking a cup of coffee I found her obituary in the morning paper. She was one of those special patients who were easy to love. Her prognosis was grim, but her attitude was good; she was a fighter. From a grainy newsprint photo, she looked out at me. She had hair in the photograph and I realized I’d never seen her with hair, but the eyes were the same, clear and full of laughter and hope. She’d been dead for few weeks by the time the obituary was printed.

HIPPA laws prevent me from looking up her family’s address and sending a card or flowers. The obituary did not include instructions to send donations to a favorite charity or anything like that. So I’ll send one off to one of mine, in honor of a patient who touched my life. Her name will not be mentioned, and her family will not know, but I will feel better.

Pick Me

Absence (installation 2009) by JParadisi

I am five years old, lying on a mat on the floor in a darkened room. Peeking out of the corner of tightly squinted, but not quite closed eyes, I watch Mrs. Sundeman, seated at a child-sized table, place gold stars on our morning’s work. She sits on a child’s chair. With the side of my face pressed against the mat on the floor, her black shoes with stout heels are in my direct line of view. I peer up towards her face, willing her to see I am a good napper. “Pick me, pick me,” I chant silently. “Please pick me.” I force myself to lie still on the uncomfortable mat.  It’s naptime in kindergarten, and I want to be the best napper so Mrs. Sundeman, the teacher will pick me to have the magic pencil. Then I will choose, one by one among the sleeping children, who will get off the mats first by tapping them on the shoulder with the magic pencil. With the magic pencil, I choose who returns to play and who stays on the uncomfortable mats.

I am not chosen. It is not enough to lie still with squinted eyes. Mrs. Sundeman prefers children who dream unconsciously to those who like me cannot lie still without thinking. I do not know how to lie still and not think of something. Even with my eyes tightly closed, I see swirly lines and arabesques in brilliant colors against the black backdrop of my eyelids. My thoughts are full of ideas for pictures I will draw and I struggle not to tell the child lying closest to me, because we are not supposed to talk during naptime.

I am an adult now. I am a Registered Nurse. I hang bags of chemotherapy on IV poles and attach it by tubing to the IV sites of cancer patients looking at me hopefully as if I am administering Jesus in a bottle. They come in hoping for a cure, but many would be satisfied with simple remission, allowing them another birthday, another holiday, another anniversary with their families. I can hear their silent chants, “Pick me, pick me.” I smile at them while setting the pump. I ask if they are comfortable in their lounge chairs. I bring them warm blankets and pillows.

She lies in a lounger. Her cancer refuses to go into remission, and we both know. She no longer chants “pick me, pick me.” I gently hug her body of skin stretched over fragile bones. I never had the magic pencil. I never will. I am not the one who gets to pick, and for that I am grateful.