The Adventures of Nurse Niki Chapter 6: Sometimes The Job is a Diversion from Life

The Adventures of Nurse Niki
The Adventures of Nurse Niki

The Adventures of Nurse Niki Chapter 6 is posted. It’s not a happy chapter. Niki feels disappointed by marriage. Sometimes the best plans and intentions just don’t work out, and spouses shut down.

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Many thanks to the readers following The Adventures of Nurse Niki blog, the retweets of  @NurseNikiAdven, and those who not only Like Nurse Niki’s Facebook Fan Page. The support is very much appreciated!

Nurses, They’re Making Their Lists. Does Honesty Exclude Influence?

The List by jparadisi 2012

The List by jparadisi 2012

As 2012 draws to a close, editors compile their annual lists for publication: The Top 10 Worse Movies of the Year, The Twenty Most Twittered Tweets, The Single Most Googled Christmas Gift, and so on. I enjoy lists, even making up a few of my own: Things to Do Today, lists of Goals For The Week, Month and Year.

December is a list-lover’s dream: Christmas gift lists, grocery lists of items necessary for making the best holiday meal ever, and of course, the requisite list of who’s been naughty or nice, which I will point out, are not necessarily mutually exclusive characteristics.

Unfortunately, some characteristics do appear mutually exclusive, keeping a group of people on one list, but off of another. I’m talking about The 2012 Gallup Poll results, which list nurses as the most honest and ethical of professionals for yet another year.

I don’t need Gallup to inform me of the public’s trust in nurses. Once, a retailer refused to require my driver’s license as proof of identity when I wrote him a check. “You’re a nurse,” was his explanation. “Nurses never write bad checks.”

While I don’t know if it’s true that nurses never write bad checks, one thing they never do is make it on Time magazine’s list of The 100 Most Influential People in The World. A couple of actors made the list. So did the son of Kim Jong Il. Of course, Stephen Colbert made the list; he’s on all the lists, except the Gallup’s list of the most honest and ethical professionals, which we nurses top. That may create a new list: the only list of 2012  excluding Stephen Colbert.

I digress from my point, however, which is this: why are there no nurses on Time’s The 100 Most Influential People in The World list? Not only of 2012, but ever? Florence Nightingale, who founded modern nursing by improving the plight of wounded soldiers, was not included on Time’s somewhat tongue in cheek list, The 100 Most Influential People of History.

I do not cast doubt on the ethics or honesty of those listed as Most Influential. In fact, many on the list, including Stephen Colbert, serve by bringing humanitarian needs to the forefront, and deserve recognition.

Perhaps we nurses should focus on raising leaders, imbued with ethics and honesty, towards influential goals. With health care provision in the limelight of national attention, there has never been a better time for nurses to aspire towards positions on both lists.

Velcome to My FrankenMess: When Art & Food Go Awry

Velcome to My FrankenMess. photo: jparadisi 2012

Welcome to my FrankenMess. For Halloween, I tried dipping pretzel sticks into melted icing to make them look like candy corn on a stick, à la Pinterest. This is what they turned out looking like before I gave up. I’m an artist, damn it! Curse You, Pinterest!!!

Have a Happy and Safe Halloween!

I Wish I’d Said It

There’s zero correlation between being the best talker and having the best ideas.

Susan Cain

Cheap, Fast, Or Good

Last week I was on vacation, the centerpiece being a small family reunion of sorts at the

The View is Clear From Here.

home of my mother and stepfather. My sister and her husband flew in for the weekend from out of state. They booked a flight on one of those new airlines offering cheap tickets with a la carte prices, charging you for every little thing beyond a seat on the plane. My sister joked that even the seats were cheap: they did not recline. Passengers sat in full upright position the entire flight.

On Sunday afternoon, we dropped them off at the airport.

An hour later, my sister calls saying their flight is delayed two hours. Soon it was delayed two more. This went on for six hours. Finally they were told their plane was delayed due to mechanical problems in Las Vegas. The passengers asked for the flight to be cancelled, and their money refunded so they could make other arrangements. They were told the flight would never be cancelled. Flights were only cancelled due to weather conditions, not for the lack of a jet. They were not allowed to leave the security area. They were not provided with dinner vouchers. Glasses of wine cost $15.

Sky Law had been declared.

What, you ask, is Sky Law? It’s a reference from the TV show 30 Rock, spoken by Matt Damon playing Airline Pilot Carol:

“Sky law, it’s when I turn on the fasten seat belt light and nobody’s allowed to talk until I get ten minutes of silence. I made it up, but people are stupid.”

Eventually my sister and her husband made it home, but not until 2 am the next day. Between the food tab, and missed time at work, any savings from the inexpensive airline tickets was forfeit.

You can get it cheap, or you can get it good.

After vacation, I returned to work to find my coworkers complaining about how another department’s lagging is causing treatment delays, appointments to overlap, and general dissatisfaction among the nurses, and patients. These complaints from nurses and patients seem sucked up into the Bermuda Triangle of hospital administration.

You can get it fast, or you can get it good.

The airline industry has been cutting back services and raising their prices for a while now. Pop up airlines offer lower prices at the expense of customer service: fewer flights, possibly less crew. Perhaps it takes longer to access a new plane and flight crew when the unexpected occurs, creating long flight delays.

I suspect the delay in service to our patients may be connected to recent layoffs. Although I’m not aware they directly affected this department, layoffs mean that those of us remaining with jobs that impact patient care are doing more work with fewer resources. It takes longer to provide services when a department is unexpectedly short staffed, or hospital census rises unexpectedly.

Once again health care imitates the airline industry. You can get it cheap, or you can get it fast. It’s still possible to get it good, but you can’t have all three.

Diplomacy, Apologies and Boneheads

Bone Head watercolor and charcoal 2012 by jparadisi

Diplomacy is as necessary to successful nursing as IV skills, medication administration accuracy, and critical thinking. In fact, diplomacy is a subheading of critical thinking. Further, apology is a subcategory of diplomacy. During a recent shift at the infusion clinic, I had plenty of opportunity to practice both.

Nurses are well familiar with these shifts: They start looking like a doable workload. Then nothing goes as planned and you and your coworkers spend the entire shift chasing after it like a pack of grey hounds trailing behind a rabbit on a track. Unexpectedly, the rabbit jumps the track: Medications are not delivered on time from pharmacy. The patient needing a nurse inserted PICC is vein-less, requiring radiology placement and transport to their department; this delays the patient’s antibiotic treatment. The home infusion company is late delivering the continuous chemotherapy infusion for another patient left twiddling his thumbs waiting. IV pump alarms ring longer than anyone can bear, and nothing is on time per the electronic medical record. Meanwhile, the phones never stop ringing! 

These factors cost patients lengthy waits. During such shifts, I say, “I’m sorry” to patients all day long. For the sake of diplomacy, I can’t explain the bonehead roadblocks I’ve endured while trying to move their day forward as efficiently as possible. Diplomacy also prevents me from telling the bonehead roadblock he or she is a bonehead roadblock. I remind myself everyone, including me, makes mistakes, and to show a little love to the bonehead on the other end of the phone, because my turn will come.

My last patient of this shift doesn’t understand my explanation of why her care is delayed. Her sister eyes me suspiciously from a chair. I know she thinks I’m the bonehead. I stay the course, however, and it all works out. The patient eventually received safe treatment.

At the end of these shifts, it’s the outcome that matters. No one really cares who’s the bonehead.

Shift Observations: The End of The Dinosaur

photo: jparadisi 2012

With the care of an archeologist sifting for fossils, I hold his right arm for a second time, turning it to and fro, sliding my fingers up and down searching for a vein suitable to accommodate an IV catheter.  I’ve already looked once, and now return after a fruitless search of his left arm. Decades of chronic illness, medications, and simply old age have done their work, leaving my patient with a spindly network of fragile veins shifting loosely under his skin.

“Everyone should be born with a spigot,” I think silently to myself. “Why doesn’t this patient have a port?” I know the answer without consulting his physician: he is very old, and his illness will likely overcome him. The IV infusion I will eventually administer will not save his life, only limp him along a bit longer.

Outside, cold grey clouds shower a mix of horizontal rain and snow beyond the window of the infusion clinic. An unseasonal storm threatens what promised to be an early spring.

With a slight shiver, my patient asks if I believe in a climate change so powerful it could wipe out life on Earth. Before answering, I take in the wrinkled, reptilian-like skin of his forearm, which I continue to study. Without looking up, I respond to his question, “You mean, like the Ice Age that killed the dinosaurs?” He nods.

Magically, I feel a small, but plump vein. The IV goes in slick as oil on the first stick. I can’t believe our luck. “Yeah, I believe in climate change, but this storm will not be our extinction.”

Thank You, Even If It Might be Random

Argonauta: My Back to The Beach mixed media on paper by jparadisi

If the only prayer you ever say is “thank you,” that would suffice.

Meister Eckhart

Thank You.

My oncologist called yesterday afternoon with the test results: I do not have cancer. I do have gi-normus bilateral implant ruptures, which need surgery. David and I saw the MRI results at the oncology office. The ruptures are so huge that the woman who used the word “explode” was actually right. The oncologist validates that my symptoms could definitely be the result of a spontaneous rupture this big. I’m waiting for the scheduler from the plastic surgeon’s office to call.

David was out on a bike ride when the oncologist called. I emailed all my family and friends with the good news before he came home, so he was the last to know. The expressions that flashed across his face when I told him I had the results went from tension, to fear, to joy in the span of a moment. I didn’t cry then, but tears are in my eyes as I write this post. I could see how worried he was, and I felt bad about being the cause of his concern. A part of the worry about recurrence is fear of becoming a burden to this man I love so much. I’m not the only cancer survivor I know who asked herself before she married if it is a fair thing to do to to someone you love. I counsel others that “cancer people need love too,” but I know how they feel.

When I went through surgery and chemotherapy twelve years ago, I made two wishes. I wished to become an artist, and I wished to fall deeply in love and be loved deeply back.

David and I worked together as pharmacist and nurse for ten years before we dated. I didn’t know him personally until I was working light duty during my cancer recovery. During that time, we sat on committees together, and developed a friendship. He knew about my treatment, all my coworkers did. He saw me lose my hair, saw me bald, and saw my hair grow back. Somewhere through all of that, he fell in love with me. I didn’t realize it at first. I mean, we’d worked together for ten years. What kind of man falls in love with a bald, breastless nurse? A damn fine man. The best person I have ever met, and that’s saying a lot, because I know lots of really good people.

We started dating a year after my recovery, and married three years later.

Two weeks ago, while we sat in the waiting room before my MRI, I took off my wedding ring for David to hold while I had the test. Out of his jacket pocket, he pulled the original cardboard box that held the small, velvet jewelry box our wedding rings came in. His ring was already inside the box. “They need to stay together,” he told me. If the tech hadn’t come to get me that moment, I would have cried. In fact, I did cry a little on the MRI table thinking about how good my life is, and how much would be lost if the cancer had recurred.
Thank You.
I don’t know why I am a lucky one. I’ve stopped wondering why I’ve been blessed with such a positive outcome when so many others are not. I am no more special than any of my patients or friends who have succumbed. Most of the time it feels like a poker game and all any of us can do is pick up the cards we are dealt. Maybe it is that random, I don’t know. But if it’s not, Thank You.

It May Help Someone

US West Communications photo: jparadisi

I apologize to my friends and family members who are reading about my current health issue for the first time on this blog. Finding out about what’s happening in the lives of the people you love through social media is akin to a HIPPA violation, but there you have it. It’s not that I don’t care, or don’t miss communicating with you directly, it’s that when an unexpected health problem occurs, hours of time are spent on the phone navigating the system for appointments, waiting for return calls, requesting diagnostic information, notifying work, canceling or rescheduling activities previously planned, and fulfilling as many other commitments as possible before surgery. I did call my mother first, because Mom finding this stuff out on the blog is a HIPPA violation where I come from. At times, I wonder if I should blog about this at all, but from the beginning I’ve felt that these posts may help someone.

One of the phone calls I made led to a strange encounter. I was prepared for most of the questions the woman asked, but a few seemed odd. For instance, when she found out that my implants have ruptured, she asked if it’s a common occurrence. I wasn’t sure what she meant. Common for me? Common for breast cancer survivors, or for implants in general? I told her implants have an expected lifespan of ten years, but I don’t have actual statistical data. She asked if it hurts. No, not now, just uncomfortable. There was a pause on her end of the line, then she asked the most outrageous question: “Is there a nicer word to use than ‘explode’?” Offended by her insensitivity, I sharpened a smart-ass remark and aimed it at her carotid. Then I thought better of it. In my best teaching voice, I said, “Use the word ‘rupture’; if you say ‘explode’ to a breast cancer survivor, you might make her cry.”

I was unprepared for the woman’s response: “I know, I’m going through it myself.” Incredulous, I asked her, “You have breast cancer?” She said, “Yes.” She told me she finished chemo and is going through reconstruction.

I dismounted my moral high horse. I considered the anxiety my story would have triggered in me when I was going through reconstruction, or cause someone else who is experiencing it now. She has a difficult job.

With genuine concern, I told her I am sorry she had breast cancer too. I told her that despite my current predicament, I am glad I chose reconstruction. I told her that being alive makes this problem entirely worth it.

And I mean it.

I Wish I’d Said It

I gather stories the way a sunburned entomologist admires his well-ordered bottles of Costa Rican beetles. Stories are the vessels I use to interpret the world to myself. I am often called a “storyteller” by flippant and unadmiring critics. I revel in the title.

-Pat Conroy