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

Living With Our Mistakes & Holes in Our Socks

Knitting Two Socks at a Time on a Pair of Circular Needles. photo: jparadisi 2012

I’m learning to knit socks. If you read this blog regularly, you’ll recall learning to knit socks is one of my New Year’s Resolutions for 2012.  Since I don’t know what I’m doing anyway, I decided to learn the new method of knitting two socks at one time on a pair of circular needles, instead of one sock at a time on a single circular needle. Never mind only a few years ago I defined knitting as: making a tangled mess with yarn and sticks. Hey, I’m a girl who loves a challenge.  My audacity stems from years of the “see one, do one, teach one” on- the- job- training mentality most nurses rely on.

Fortunately, learning to knit socks two at a time is accompanied by patterns with clear diagrams and photographic illustrations. I found mine in Knitting Circles Around Socks by Antje Gillingham (Martingale & Company, publishers).

I’m happy to report I have successfully turned both heels. The most vexing problem has been confusing which of the four needle tips to use, then having to rip out and knit again previous rows after doing it wrong. I found one dropped stitch too, which is so far back at the beginning there is no way in hell I will rip out my work to redo it. I’ll simply learn to live with it.

If only nursing mistakes were as inconsequential. Who wouldn’t go back in time and fix the med error, rephrase the statement that made you sound dumb in front of coworkers, or treat differently the symptom, which turned out more significant than you realized at the time? Wouldn’t it be great if we could rip out our mistakes and knit them again like stitches dropped from a pair of needles?

We can’t.

Instead, I am aware of the importance my words carry when patients come to me with concerns or fears. I answer the same questions multiple times over the years of my career, but for the patient, their fears are new.  For everyone, I hope to get it right the first time: the right amount of compassion, the right understanding of the meaning of their words, the right kind of wisdom needed for a particular moment. If I get it wrong, coming across as abrupt, disinterested or intensifying fear rather than calming it, there is no going back to rip out stitches from the fabric created by my words and actions. They hang in our memories like dropped stitches; leaving an unsightly hole.

Nursing is more complex than knitting two socks with four needles. Often, there’s no way to go back and fix our mistakes. Sometimes the best we can do is learning from errors, acquire the necessary grace, and live with the resulting holes in our socks.

*Update: I finished knitting my first pair of socks last night.  See photo.

My First Pair of Knitted Socks! photo: jparadisi 2012


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.