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.

 

Where Science, Humanity and Art Converge

JParadisiRN blog began by discussing art and nursing. For the most part it remains so, through observations of the way science, humanity, and art converge, transferring these observations into blog posts.

Nursing is a tactile profession, at least when practiced at the bedside. It’s difficult to do the work of a nurse without actually touching people. Nurses learn that some skin or veins are so tough they almost repel an IV catheter, while other types are so fragile, even the paper tape used to secure a dressing or IV can easily tear it.

Nurses bathe the newborn’s firm, plump flesh, or rub lotion into the loose, wrinkled flesh of the elderly to prevent its breakdown. We measure and weigh the under and overweight, then calculate body surface area to administer the correct dose of chemotherapy.

This summer, I enrolled in an open life drawing studio. A model sits for a few hours, while artists, in meditative silence, draw the human body on paper.

Drawing is also a tactile experience: holding charcoal against toothed paper, making shapes and lines into limbs and torso, adding shadow to give them volume.

Patients and models allow nurses and artists into the sacred space of their nakedness. This privilege demands respect. Administering nursing care to a patient, or capturing the model’s likeness on paper requires concentration, skill, and love of humanity.

 

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.

Oh, Did You Want Anti-Nausea Medications with Your Chemotherapy? You’ll Have to Pay Out of Pocket for That

   Note: If you are uninsured and diagnosed with cancer, you will probably find an oncologist and a hospital that will treat you. However, although your chemotherapy cost of tens of thousands of dollars is absorbed, no one will pay for the antiemetics (anti-nausea drugs) that your doctor will prescribe for you to take at home to manage the side effects of chemotherapy. (If you know something different, please post it in the comments.) So, if you don’t have any money, your oncologist will prescribe compazine (prochlorperazine), which is cheap, and used over 20 years ago, when people banged their heads against the toilet vomiting from chemo.  There are newer, more effective drugs, like Zofran (ondansetron) and Kytril (granisetron), that control nausea and vomiting. They are expensive. Uninsured patients usually can’t afford either. They don’t complain though, because they are getting their chemotherapy for free and they know they should be grateful. So they suffer. It’s the politics of health care.

A Metaphor: Health Care Reform on Life Support

oil on wood (2008) artist: JParadisi

     The idea that the Health Care Reform bill is on life support is disappointing, but not surprising. It was admitted in a weakened state of health. It appears suspiciously a victim of domestic violence by special interest groups. The bruises on its body resemble the outline of handprints of the insurance companies it was created to protect our citizens from. Already, my patients are complaining of rising health insurance deductibles this year. It is estimated that 14 million people will still be uninsured if the Health Care Reform bill rallies and passes. It is a complex piece of legislation that confuses even those of us who strongly advocate for health care reform. I think that’s where the undecided get lost and fall to the wayside; afraid to support what they do not understand.

     In my grief over Health Care reform, I console myself  by remembering that at least it’s a step in the right direction. At least an estimated 34 million currently uninsured citizens will be insured, and people who are currently insured won’t lose their insurance if they change jobs or become ill. These are progressive and necessary improvements to the present situation. I tell myself that if we lose this moment in history, it won’t come again anytime soon. Something is better than nothing. Fight for the life of the Health Care Reform bill, don’t let it slip away.

     But I know, even if successfully resuscitated, it will not be the strong, idealistic super hero it once was. It is anemic. The bill has been bled by special interests groups and insurance companies. It’s vital organs have been damaged by poor perfusion (lack of blood supply). It is now being threatened with further leeching in order to get even a shadow of its former self passed into legislation.

     Health Care is a human rights issue. Human rights issues are intimately linked to economics. Historically, in most countries, including the United States, it is this link that causes resistance. It is the cause of resistance to Health Care Reform now. Until Health Care is recognized as a fundamental human right, and not a for- profit industry, our citizens will continue to suffer.

The Season of Lights

  

 

  

 
         

photo by: JParadisi 2009

          The other day I wondered if my blog posts are depressing this time of year when people are celebrating the holidays. Who wants to hear about medication errors and cancer when there are family gatherings and parties to attend? My concern was validated when I read oncology nurse Teresa Brown’s blog. She told a story about shaving the head of a cancer patient losing her hair from chemotherapy. In response, one commenter posted that she will no longer read Teresa’s blog because it’s too depressing.    
     Yep, that’s what I was afraid of.        

     While I understand reading about hospitalized people can feel sad, to stop there is missing the point. I believe nurses write stories about encounters with their patients because of the universal truths of humanity they relate. Whether poignant or humorous, the stories shine a light on the characteristics that connect us all as part of the human race.       

      This is the season of lights.       

     Florence Nightingale, the founder of modern nursing, walked the hallways of an army hospital during the Crimean war, shining the light of her lamp on wounded soldiers while making her rounds. To her patients, she was known as The Lady with the Lamp.       

     Nurses, at our best, bring light to patients, by listening to their stories while delivering expert care. Treatment, especially cancer treatment, can feel like a season of darkness one must travel through to find the light at the end. Some patients will never leave the dark season of a chronic illness, and for them, nurses are there to hold the small lamps of hope needed to guide them along their journey.       

     This is the season of lights. During the darkest time of year, our society strings lights from our homes and businesses. We string lights around the trees outdoors, and those we bring into our homes. We light the Menorah during the Festival of Lights. We light our way through the season of darkness, and remind ourselves that nature’s light will return.       

     Nurses tell the stories that guide us through long shifts with fearful patients. The stories bring us back for the next shift and the next, until a string of these stories lights our careers, and our lives, until each of one of us finds our unique purpose in the darkness.       

     This is the season of lights.        

            

        

            

          

     

Mistakes are Judged by their Outcomes

     It’s been a long time now, since I was on my knees, praying that the  young woman lying crumpled in front of me on the street would keep breathing. Her face was a bloody mess of tangled, curly brown hair, broken teeth, and road rash.  I noticed she had blue eyes and freckles too. Her twisted bicycle lay next to her.  I didn’t see a helmet anywhere.

     A few minutes earlier, on that summer evening, my husband and I sat at a table in a restaurant, after attending an artists’ reception for a show I was exhibiting in. As the server touched the plates holding our food to the table, I heard someone outside yell “Oh God!”, then a crashing sound. My attention focused to the window facing the street, where I saw a large, shadowy object fly over the roof of at least two cars, before landing on  the larger boulevard, which faced west. The sun was slowly setting, and was at eye level with the horizon. She had run a stop sign from a side street to the boulevard, and was hit by an oncoming motorist , who couldn’t see her silhouette in the setting sun.

     A surgeon I know once remarked that if  medications for cancer treatment keep improving, she might be out of a job. I had told her not to worry; there will always be trauma patients. It’s human nature, people make mistakes.

     I kneeled over the young woman, who was unconscious, counting her respirations, and assessing their quality, making sure she got enough oxygen until the paramedics arrived. A crowd gathered around, and I heard people whispering, “That guy over there, he hit her in his car.” I remember wondering what the driver might be feeling.

     I’d forgotten that I was kneeling in the middle of a lane of a busy city street. When I did remember, I looked behind me. There was David, ready to scoop me up from harm’s way if another motorist came too close. But that wasn’t necessary, because, behind David, thirty or forty Portlanders made a human fence, protecting us from traffic, and beyond them, another two Portlanders directed traffic until the police arrived, keeping the human fence safe too. It’s one of my favorite memories of this city that I live in: Each one of us doing our part to keep each other safe.

     People are human. They make mistakes in judgement sometimes. Mistakes are often judged by the severity of their outcomes, regardless of intent. Crimes are committed by intent. The bicyclist ran a stop sign. All I know is that I wanted her to keep breathing until the paramedics arrived. I wanted her to live.

    It seemed like forever, but it was probably about fifteen minutes before the paramedics could get their rig through, and take the young woman to a hospital. She was regaining conciousness when they loaded her on a stretcher into the ambulance. I watched for the story on the news and in the papers, but I never found out what happened to her in the end.

Sounds Like a Job for Health Care Reform

     A patient called to cancel his appointment for a monthly infusion necessary for the rest of his life (or until a pharmaceutical company comes up with a new medication). He’s been getting it for a few years now. The infusion made it possible for him to go to college. He cancelled his appointment, because he can’t afford the treatment at this time. He is temporarily not covered by health care insurance.

     Upon college graduation, his insurance carrier changed. He missed several treatments while his new insurance carrier took months to review his prescription and medical history,  weighing those against the cost of the medication (it’s expensive).  Eventually, the insurance company gave in, and he resumed the monthly treatments.

     Things continued smoothly, until recently. He took a new job. Isn’t that the point of a college education? Anyway, now he has to wait six months for his new insurance coverage to begin, before he can request to have his treatments resumed, after it is yet again approved for authorization by the new insurance company. The medication is too expensive for anyone but the very wealthy to pay for out of pocket (and even they might balk). So now this patient tries to maintain his health without the medication, so he can continue to work and keep his latent health care benefit.

     If only there was a less expensive health care option available…