Don’t Change the Way You Look, Change the Way You See

Vegetable Still Life with View of Yaquina Bay photo: David E. Forinash 2011

Getting cancelled for part of a scheduled shift at work is often a problem during a recession, but on Friday I volunteered to go home at noon when our patient census was low. David and I planned to leave early Saturday morning for the Oregon Coast, but since he had Friday off, I packed quickly and we left that afternoon instead. Getting cancelled for half a shift felt like a gift instead of a loss in this circumstance, and my coworkers who wanted the hours were happy. The way it looks depends on your point of view.

I am in Newport, Oregon looking at a 180 degree view of the Pacific Ocean, with a blue heron nesting in a nearby fir tree. Last night I thought I heard a small dog barking, but it was the heron. What surprisingly harsh squawks from such an elegant bird! I see the heron in a new way.

Saturday morning at Newport’s Farmers’ Market we bought heirloom tomatoes, slender eggplants, a radicchio with red leaves edged in light green, and purple, yellow, and red peppers. Although we are traveling, I couldn’t resist the beauty of the vegetables, and when we paid for them even the farmer commented on the remarkable colors. Although he’d set up the booth himself that morning, he saw them from a fresh perspective while weighing them on the scale.

At the locally owned JC Market (which has a surprisingly good wine selection) I bought a bottle of Oregon Pinot Noir and a Pinot Gris. As I carried the brown paper bag through the parking lot, I saw Don’t change the way you look, change the way you see, written on a sticker pasted to the bumper of a parked car.

It makes perfect sense.

I knew a pilot who said when he entered any public venue such as a movie theatre, the first thing he did was locate all the exits in case of fire. It makes sense that a pilot would see a theatre that way. After all, how to exit the plane in an emergency is the first thing taught to commercial jet passengers.

For a long time, I viewed many opportunities through the lens of their worst possible outcomes. I believe I learned this behavior as a nurse, seeing the traumatic outcomes of choices written on the bodies of patients in the ICU. Jobs requiring an exceptional sense of responsibility for the safety of others, such as piloting a jetliner, or nursing, affect our view of life, creating habits within our personalities, which I believe are unique from most of our society. It took me awhile to realize nursing influenced my enjoyment of life, and not always in a positive way.

For instance, I used to make choices based on their potential for risk or emotional pain. “Hope for the best, but plan for the worst,” was my viewpoint. Now I look at choices for their fun value too, not only potential peril. Otherwise, I may miss seeing the movie by worrying that the theatre might catch on fire.

Don’t change the way you look, change the way you see.

Popcorn Lung?

Twice this past week, I arrived at work to the noxious odor of burning popcorn wafting throughout the infusion center. What is it with nurses and microwave popcorn? We save lives daily. We keep critically injured patients from circling the drain into certain doom. We safely medicate patients and do complex procedures, but as a group we are notorious for our inability to pop popcorn in microwaves without burning it. I can’t remember ever smelling burning popcorn in a movie theater. Statistically speaking, you’d think burnt popcorn occurs more often in a movie theater than a hospital, based on the sheer volumes of popcorn popped at movie theaters. That isn’t the case. I wonder why.

You think I exaggerate? Using the search words popcorn microwave hospital fires today resulted in 93,200 results in 0.22 seconds on Google. My favorite is this YouTube Video about a pediatric ER nurse named Stephanie:

Stephanie, you are not alone among your nursing peers. I found an unconfirmed reference online that said Seattle, Washington has made it illegal to pop microwave popcorn in its hospitals because of the fire hazard.

When I signed up for nursing, I expected exposure to many unpleasant odors, including “code browns” (poopy messes), emesis (vomit), and blood. I can handle all of them, but burnt popcorn makes me gag.  Also, fumes of microwave popcorn containing diacetyl, burnt or otherwise, may cause Popcorn Lung, according to this article (dated September 2007). I wonder if this is covered by workman’s comp?

I love microwave popcorn, and it makes a quick, tasty snack that is easy to share with coworkers. Let’s preserve this simple pleasure. If we can save lives, surely we can learn to pop popcorn without burning it.

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.


JParadisi RN’s Blog Listed in Top 50 Nursing Specialty Blogs

Cat Nurse I by JParadisi 2010

JParadisi RN’s Blog made it on another list. When Health Freezes Over created a list of 50 nursing specialty blogs and JParadisi RN is number 22 (and #5 of eight oncology blogs).

Thanks to DANA, who posted the list on March 3, 2010.

It Ain’t no Sin to be Glad You’re Alive

Bathing Sparrow (sorry it's hard to see) photo:JParadisi 2010

After weeks of daily rain, the sun was shining in a brilliant blue sky and the weatherman promised the warm weather would last all weekend.  My coworkers were feeling fine too: in the staff lounge, two of them sang “If I can’t have you, I don’t want nobody baby” and I joined in as the third Bee Gee, before traipsing to blood bank to retrieve a couple of units for a transfusion. On the way, I passed a surgery tech wearing cap and scrubs, who started dancing in the hospital hallway to the tune of his ringing cell phone. We both laughed when he caught me watching. I was still smiling when a woman stepped out of the elevator, looking haggard and sad. She was not hospital staff, and her sorrow reminded me that many people in the hospital were not having a good day at all. I quickly doused the smile and flipped on my professional demeanor switch.

It’s part of the job when you are a nurse. It’s not enough to like people and have excellent skills. Nurses need the ability to separate their personal lives from their jobs. Don’t bring your own drama in, and don’t take the drama of others out. This is a valuable survival technique for longevity in health care. I’m pretty good at it, but occasionally worlds collide.

Like this morning. My oncology patient mentioned she sure missed having a glass of wine once in awhile. We joked about it before I went into the room of my next patient. Filling out the admission record, I asked the required question: “Do you drink alcohol?” I was unprepared for the ferocity of my patient’s reaction, as she explained emphatically that she does not drink alcohol, and it ought to be illegal to drink it. I stopped the admission process, sat down on the rolly stool in the room, and listened to her. When she finished, her glaring eyes dared me to contradict her. I quietly asked, “Have you or someone you love been harmed by someone drinking alcohol?” She had. Or rather, her son was in an automobile accident caused by a drunk driver. Now he is ventilator-dependent and confined to a wheel chair for the rest of his life.

Joking with one patient about an anticipated glass of wine as a reward for going through chemo is supportive. Bringing the topic up with another patient is traumatic. Nursing requires the ability to respond thoughtfully to either patient, sometimes within the span of a few footsteps.

While warming myself in the sunlight on a bench in a neighborhood park after work, I thought about all of this, reminded of how good it is to be alive and healthy. At the end of even difficult shifts, nurses leave the hospital behind while the patients stay there and endure.

Next to the bench, a sparrow bathed itself in a tiny pond. I watched him scatter water droplets that glittered like diamonds in the bright sun, thoroughly enjoying himself on a beautiful day. He wasn’t paying attention to me. He wasn’t thinking about patients, car accidents, cancer, or a glass of wine. He was just enjoying the moment.

…it ain’t no sin to be glad you’re alive.” (Bruce Springsteen)


Meandering Through Powell’s Bookstore and in My Head About Art and Nursing

     

Powell's City of Books photo: JParadisi 2010

 

     My husband and I recently entertained guests from out-of-town. One of the fun things we did was visit Powell’s City of Books in Portland. Powell’s on Burnside is the largest bookstore in the world, a reader’s Paradise. Rooms of books sprawl from floors of multiple staircases, like levels of heaven. It is so big; the store provides maps for customers, like Disneyland. If you visit Powell’s, allow at least two hours. Like making a painting, you never finish going through Powell’s, you just reach interesting places to stop.   

     Of course, I bought some books while we were there. Three came from the Pearl Room, where the art books are shelved. In the Gold room, I found a copy of American Pastoral by Philip Roth. I’ve meant to read Philip Roth since I read Night Studio, a memoir by Musa Mayer about her father, the artist Philip Guston. The two Philips were friends, as painters and writers often are. That is not why I bought American Pastoral. I bought the novel because I’m reading books from the Books to Read Immediately list in How to Read like a Writer, by Francine Prose. An award-winning author, Prose teaches writing the way my instructors at Pacific Northwest College of Art taught painting: study the work of the best, and imitate what they did.   

     It sounds so simple: study masterpieces. This kind of observation is about getting inside the artist or writer’s head, understanding the choices they made, and why each decision contributes to the masterpiece. The next step is to take that why and store it like a tool in its box, until an opportunity for use presents itself.   

     That sounds simple too, except that the trick, the magic, the craft, only occurs if one wields the tool in a fresh, new way. Restating something said before needs to reveal a unique voice. That is what makes the work a piece of art: craft and a unique voice.   

     As I meandered through the rooms of Powell’s, it occurred to me that craft and unique voice are often missing in nursing innovation. How many times are manufacturers of IV tubing and connector systems replaced in a hospital? That is not innovation; it’s changing vendors because the current vendor contract has expired and the hospital is shopping for a new one. Real innovation is finding ways to improve, for instance, staffing in a damaged economy. It is seeing old ideas in a fresh new way. Hospitals move slowly towards change, as if lumbering freighters pulled along by tugboats in a busy harbor. Nurses resist change too. For instance, we complain about understaffing, and about losing hours (pay) when hospital census is low. Not enough nurses leaves a unit under staffed, but too many nurses means not enough working hours for everyone. Dilemma is part of the business of health care. Problems have answers; dilemmas are ongoing and need management.    

     Reduced paychecks due to lost shifts were particularly painful when I was a single mother with a mortgage. After awhile, the vacation paid leave dried up too. I needed cash. Therefore, I became agreeable to floating from PICU to related units, like NICU and general pediatrics. It wasn’t always comfortable going to an unfamiliar unit and taking  patient assignments, but I found if I went with an open mind, spoke up about what kind of assignments were appropriate for my skill level, and won over a buddy or two from the unit, floating wasn’t that bad. I took CE courses in NICU subjects, including NALS and improved my skills. That improved my comfort level and patient safety. Social networking the old school way, I made friends in the units where I floated, and rarely lost a shift of work. Each new skill embellished my résumé; adding to my marketability. It’s a good tactic for nurses wanting to look experienced, instead of just aging, to employers.   

     Hospital administration plays an important role in successful floating experiences for their nurses. It is critical that they understand it takes more than a body with a pulse and a stethoscope to care for various patient populations. Years ago, I attended a meeting organized by the hospital. Its administrators asked nurses what would encourage us to float. I pointed out that while I was able to sustain a critically ill child on life support;  if floated to labor and delivery I could reason that a slow heart rate on a fetal monitor was probably not a good thing, but all I would know to do about it was scream for help. The administrators listened, and created float area “bundles,” limiting the departments nurses are asked to float to by related acuity and skills. The tugboats helped navigate the freighter in this case.   

        I am grateful to have a career that provides so many opportunities for work. In this economy, nursing is one of the few jobs with any security at all. It also provides opportunity for creative souls.

Stay Tuned…Next New Post on June 7th.

     I haven’t abandoned JParadisi RN’s Blog, I gave myself the week off for good behavior. I’ll resume posting on Monday, June 7th. Same goes for Die Krankenschwester.  Go do something fun too. Break free!

Best,

JP

And for Memorial Day…

     *Originally published on Veteran’s Day, November 11, 2009.

    

photo: JParadisi 2009

 This fall, I’m reading the first four books of the Cherry Ames series, by Helen Wells, for the first time. Cherry Ames, if you don’t know, is an 18-year-old student nurse, whose intuitive style of patient care and indomitable spunk lead her through a spree of madcap adventures in the halls of fictional Spencer Hospital, eventually “winning” her cap and the coveted black stripe of a graduate nurse, during World War II.  

     Unlike Cherry, I did not want to be nurse as a young person, and I was not particularly interested in books about nursing. From junior high on, I felt heroes like Cherry Ames were kid stuff.  In high school, I read Kurt Vonnegut, John Irving, Ray Bradbury, Robert A.  Heinlein and James Thurber.  Characters such as Michael Valentine and Garp held more intrigue for me.

     I felt pretty much the same way as an adult reading Cherry Ames.  In a world of Nurse Jackies, Cherry’s declarations that,

The patient always comes first. Save the patient at any cost to yourself. That was the nurse’s creed.”

And,

“Nursing had always been Cherry’s dream. She knew it was the finest way a girl could serve people, and Cherry loved people and wanted to help them. Nursing was the way to put her idealism into practice.”

come across as cheesy cliques.  At least, that’s what I thought until last Thursday, November 5, 2009, when the Fort Hood shootings occurred, and the stories of heroism during the crisis became publicly known.

     The first story of heroism I heard was that of civilian officer Sgt. Kimberly Munley, the first responder on the scene, who simultaneously shot the assailant as he fired upon her. She put herself (as the clique goes) in danger’s way to save the lives of others.

     On Tuesday morning, I watched The Today Show. Meredith Vieira’s guests were 19 year-old Pfc. Amber Baher, and her mother.  Amber is a soldier, credited with applying a tourniquet on the bleeding wound of one of her “battle buddies,” then carrying him to safety, while she herself was shot in the back. I don’t know if it was adrenaline, but my own personal safety wasn’t really what mattered to me,” Bahr told Meredith. “Making sure that my battle buddies were safe was my No.1 priority.”

     Another soldier, US Army Reservist Dorothy “Dorrie” Carskadon (who has family here in Portland) was injured during the shooting, reportedly while assisting one of her comrades.

     I am deeply moved by each of these stories of individuals choosing to save the lives of others, at any cost to themselves.  By their actions, they put their idealism into practice. These women, these soldiers, exemplified, on American soil, the values and commitment of our past and present veterans overseas. This type of courage happens every day, on battlefields far from home. “Their lives’ work is our security, and the freedom we all too often take for granted.”

     In healthcare, we borrow military language. We wage a war on cancer. We battle disease. Severely broken bodies in trauma units are FUBAR. Today, I went to work, hoping I would also borrow a small amount of the courage and idealism displayed by our soldiers.

I need to reconsider my opinion of Cherry Ames.

Workplace Violence: What’s Bizarre is Accepting it Happens

Use the Call Light for Help photo: JParadisi 2010

     Blogger Theresa Brown, RN’s post for the NY Times,  Violence on the Oncology Ward  struck a chord within me. My own experiences with violence directed at nurses started while I was a nursing student during a clinical rotation over 20 years ago. Standing in the courtyard of a large urban hospital under a bright noonday sun, someone grabbed me from behind by the hair while screaming obscenities in my ear. My head was jerked backwards against my shoulder so violently that the only thing I could see was a classmate and a passerby running towards me to fend off the attacker. After the two rescuers pried the fingers that were beyond my grasp loose from my hair, I saw that the attacker was a diminutive woman dressed in filthy rags. I stood stunned as she walked down the sun-drenched sidewalk, still shouting obscenities. When I reported the incident to my clinical instructor, expecting her to warn the rest of our class to be careful, she told me disinterestedly that “It was just a crazy person, it doesn’t count.” I realized that both the “crazy woman” and myself had been dismissed.      

     Years later, in another hospital, a patient came to his appointment with a butcher knife in his back pocket. That hospital has a no tolerance policy for weapons of any kind, and security was quick to take the knife surrendered voluntarily by the patient so he could receive care. After security left, the patient looked coolly into my eyes and said “I don’t know why you’re worried about the knife, I could beat you to death with my crutch if I wanted to.” The security officer returned, and the patient was escorted off campus.      

      He took himself to the emergency department, and told his story to a nurse there. This nurse called my department. Listening to the story, he commented “That’s bizarre,” after every statement I made. I finally asked him “What’s bizarre?” and he said, “That you feel he threatened you, after security took the knife.” No longer a student nurse, I asserted myself: “He did threaten me.” The ER nurse said, “I find it bizarre. That kind of thing happens all the time over here.”       

     “What’s bizarre,” I told him, “is that you accept it happens.”      

     Studies of workplace violence suggest that accepting  inappropriate behavior in the health care environment creates a setting conducive to more serious forms of violence. Verbal or physical threats, and carrying any weapon or item that can be used to cause death or serious physical injury are only two examples of inappropriate behavior. 

     I wonder if a sense of duty to the patient blurs what is acceptable behavior for some nurses? Despite his threatening behavior, I arranged another method of care for my patient with the knife, because he needed treatment.  

     I don’t know if enacting legislation mandating tougher penalties for workplace violence committed against nurses is the answer. It seems to me that everyone needs protection from violence. What I do know is that violence towards nurses is still accepted by many in the profession as an inevitable part of our job description, and I strongly disagree.