The Art of Subtraction

Fascinated, I watched as a sculptor created a face from a lump of clay. With deft fingers, he tore into the pliable medium, pulling away bits and pieces. A pair of sightless eyes, cheekbones, a nose, and finally lips appeared out of the shapeless mass. No clay was added to create the facial features. Throughout the process, clay was only removed to reveal a face in the inanimate material. Before this, I added clay to form features and appendages.

Sergei by jparadisi

Sergei by jparadisi

I realized that the art of living well — like sculpting — is a process of subtracting clutter and revealing purpose.

I struggle with clutter. At home, David politely refers to my “three-dimensional filing system.” In part, it’s because I am an artist. I find potential for creating art from the seemingly useless. I don’t expect to change dramatically.

I Googled “creativity” and “clutter.” More than 3.5 million references popped up in 0.19 seconds. A single article embraced clutter. The majority reported that clutter siphons creativity through disorganization and inefficiency. One even linked to poor health and obesity. Clearly, subtracting clutter enhances creativity and efficiency.

In my nursing practice, I strive to remove clutter and maximize efficiency in patient care. Here are a few ideas to reduce clutter and increase efficiency during your shift.

  1. Embrace technology. Using a Smartphone eliminates hunting for calculators. Apps like MedCalc keep calculations for doses, BSA, ANC, and more at your fingertips. Several apps can help your own health by logging calories consumed and burned through exercise, and we all know the benefit of removing the clutter of extra weight. Some companies offer employee discounts for Smartphone plans so check your benefits.
  2. If your institution uses electronic health records, learn to use them. Creating “workarounds” is inefficient and defeats the purpose. Electronic records save time. Charting in real-time prevents the need to reconstruct events from memory at the end of your shift.
  3. Avoid mission creep. Stick to the care plan. In the ambulatory infusion clinic where I work, patients arrive with lists of concerns having little to do with their appointment. It’s easy to start calling physicians’ offices and making unrelated appointments for them. Handle the appointment-related work, and provide resources for the rest. Don’t confuse patient advocacy with enabling dependent behaviors.
  4. Bring your lunch to work. Sit down and enjoy your 30-minute break instead of standing in line buying food. You’ll save calories, and money too. Many nurses spend $5-$15 rapidly consuming a high-calorie takeout meal in a depressing staff lounge. Wouldn’t you prefer saving the money and calories for a leisurely meal with friends or family during off hours? Just saying.

I’ll leave you with one last thought:

The cost of a thing is the amount of what I call life, which is required to be exchanged for it, immediately or in the long run.

 Henry David Thoreau

 Now, if I could only do streamline at home. Any suggestions?

 

Learn to Say No

Developing creativity requires personal time. You’ve heard it before: Learn to say no.

I was a new-ish nurse working night shifts on a busy hospital unit. Our census exploded,

The Bride by jparadisiWhat are you married to?

The Bride by jparadisi
What are you married to?

and every evening the nurse manager called all off-duty staff begging until someone accepted the overtime shift. It is difficult to refuse extra shifts when it’s your manager asking. This went on for what seemed an inordinate amount of time. Answering machines were new back then, and I resisted owning one.

One afternoon, my daughter raced to the ringing phone, picking up the call before I could. I overheard my manager asking, “Hello, is your mommy there?” As I reached for the receiver, my daughter blurted out, “You’re not going to make my mommy go to work again, are you?” Embarrassed, I grabbed the phone. On the other end, the manager apologized: “I’m sorry, I guess I’ve been calling too often. Enjoy the evening with your daughter.”

The next day, I bought an answering machine, and learned to screen calls.

Not long afterwards, something unexpected happened: The manager took her overtime-paid hours to administration, along with the record of increased census. They discovered they’d save money by hiring another FTE. The overtime calls became occasional.

Moral of the story: it’s not my personal responsibility to fix my unit’s staffing problem. I’m not advocating nurses refuse shifts during staffing crunches. In nursing, being a team player is essential. However, I found that if I work more than two overtime shifts a pay period, I get a diminishing return on the extra income because of taxes where I live. Therefore, my flexible boundary is to limit overtime to two shifts a pay period. I learned to say, “No,” to more than that.

Recognizing which problems are yours to solve, and which are the responsibility of others is the key to learning to say “no,” to coworkers, patients, children, spouses, boyfriends, girlfriends, parents, soccer moms, whomever.

Write this down and tape it to your bathroom mirror:

I am responsible for my own stuff, and that is enough.”

The caveat to this affirmation is:

If you step in it, you’re going to have to clean your shoes.”

Remember:

▪ Avoid drama.

▪ Evaluate commitments carefully.

▪ Protect your personal time.

Our ability to say no is strongly connected to the important relationships in our lives. Nurses in particular are conditioned to believe that saying “No” in order to make time for ourselves is selfish. Add the nurturing nature of a nurse to this training, and saying “No” becomes nearly impossible.

You cannot grow creatively without time to yourself. Recognizing what stuff is yours, and what belongs to others is the first step towards self-care and personal growth.

Do you think nurses have more difficulty saying “No” than other professionals? Do you think this problem is gender related? What experiences have helped you learn to say no?

New Year Resolution: Don’t Wait Until Late in the Afternoon

It was late in the afternoon when my patient arrived at the oncology clinic. The treatment

Kaboom (ceramic) by jparadisi

Kaboom (ceramic) by jparadisi

prescribed required more hours than we were open. The oncologist prioritized his treatment for that afternoon and scheduled a second appointment for the next morning to complete it. The only problem with this plan was my patient didn’t realize he needed two appointments until I told him. His eyes expressed disappointment, but it was an expletive that escaped his mouth. He immediately apologized. “I’m sorry; it’s just that I don’t have that kind of time anymore.”

I understood exactly what he meant.

It was on a New Year’s Eve when I discovered a lump in my breast. At that time, I was a pediatric intensive care nurse working 12-hour shifts and a single mother. Life as I knew it came to a grinding halt. Once chemotherapy started, my oncologist prescribed light duty.  No longer a bedside nurse, I worked on office projects for the PICU manager instead.

My oncologist was hopeful. Still, I remember hearing her say there was a 32 percent chance I would die in 10 years. I was afraid. However, as a PICU nurse, I knew life could be short. This knowledge helped me gain perspective on my predicament. I’d had a good life. If this were it, how would I spend the next 10 years?

Since childhood, I wanted to be an artist. At 15, I announced my plan at the dinner table. In his thick Italian accent, my father said, “Sweetheart, you are talented and can be whatever you want, but get a job first. You will gain life experience, and then you will have something to make art about.”

Eventually, I became a nurse.

I thought about this while my chemo-bald head perched like a cue ball on the armrest of the sofa, eyes staring at the ceiling. I still wanted to be an artist. If this was the last decade of my life, I would spend it making art. I needed to start right away, because I may not have that kind of time anymore.

After recovery, I enrolled in art school and then transitioned into adult oncology nursing. In 2009, I completed a certification in fine arts and became certified in oncology nursing.

Today I am an artist and an oncology nurse. Cultivating creativity not only adds joy and accomplishment to my personal life, but it also flows into patient care. I believe it sustains my love for nursing after 26 years of practice.

Are you setting aside your creativity until late in the afternoon of your life?

Are you waiting for retirement or for the kids to leave home?

What if you discovered you don’t have that kind of time anymore?

What would you change?

 

Returning To Hoyt Street, Everything Has changed

photo: jparadisi

photo: jparadisi

I’m standing in line at the Post Office on Hoyt Street, along with at least fifty other people waiting to mail Christmas packages. It’s been two years since I wrote the post, Miracle On Hoyt Street, describing a similar experience.

Things have changed since then. Not gradually over two years, but abruptly. On Tuesday, December 11, 2012, we Oregonians experienced our first, and hopefully last, mass shooting at the Clackamas Town Center. One of the two dead, Cindy Yuille was a hospice nurse. I did not know her.

On Friday, December 14, 2012, twenty elementary school children and six faculty members were gunned down mercilessly in Newtown, Connecticut by a twenty-year old attacker we still don’t know very much about.

What is the differential diagnosis dividing the mentally ill from the criminally insane?

Today, standing in line while waiting my turn to mail packages, Christmas songs play on the same scratchy speakers as two years ago, but this time I feel unexpectedly anxious. I realize I am uncomfortable being in a crowded public place. I look around for my old nemesis, the postal clerk who was the Newman to my Seinfeld. She is not here. Perhaps she has retired, that lucky bitch (insert smiley-face emoticon here). Then suddenly, in my imagination, the remaining clerks behind the counter resemble ducks in a shooting gallery.  It occurs to me that they risk their lives daily, standing behind that counter in a large, freely accessed lobby without security. That thought causes me to look around and find available exits, which are scant. Would my best chance of survival be to race towards one, or hit the ground and pray I’m missed? I shake my head to clear it, and glance at the booklets of stamps available for purchase. One features a picture of the cartoon character Nemo with his father. I chomp down hard on the gum in my mouth to prevent the tears from coming back as I think of fathers swimming the vast seas, searching for children who no longer exist.

When I finally reach the counter, I thank the clerk for her good work, and wish her a Merry Christmas.

Home again, I make a special dinner to share with David when he returns from work. I say a silent prayer of gratitude when he walks safely through the door.

Over a glass a wine, I tell him about my anxiety at the Post Office. He understands, says everyone is feeling it too. He puts his arm around me, and pulls me close, while we watch It’s a Wonderful Life in the glow of Christmas tree lights.

Humbled and Humbly: A Liebster Award Nomination

You will build a body of work, but you will also build a body of affection, with the people you’ve helped who’ve helped you back. This is the era of Friends in Low Places. The ones you meet now, who will notice you, challenge you, work with you, and watch your back. Maybe they will be your strength.

…Robert Krulwich

I don’t do chain letters or emails.  I prefer ignoring them, incurring whatever god-awful threat I received them under.

However, Joni Watson at Nursetopianominated JParadisiRN for a Liebster Award.  She said some really nice things. I like Joni. We are also blogging colleagues at TheONC, so I’ve decided to play. Besides, there are talented and generous bloggers I am over due to recognize. This Liebster award is a way to say, “Thanks.”

I plagiarized the following two paragraphs from Joni’s post because they explain the responsibilities of accepting a Liebster Award:

The premise of the Liebster Award is simple; it is a meme-ish way, a chain-letter so-to-speak, for bloggers with reading audiences of 200 to 2,000 to honor one another. As I’ve followed previous blog nominations from post to post, I’ve picked up several great blogs for my own reading pleasure, so surely the Liebster Award is functioning as intended.

 

For the nomination, I must tell readers 11 things about myself, answer my nominator’s 11 prepared questions, nominate up to 11 other bloggers for the Award, and prepare 11 questions for them to answer in their subsequent posts. I’m not sure what the fascination is with the number 11, but hey, let’s roll with it!

Note: 

Joni and I share the same nurse blogger community. I wish to also tip my hat to the bloggers she mentioned, especially Dr. Dean Burke.

My Nominees:

  •    City Girl Farming: Kerrie’s genius for raising chickens, and incorporating country living into an urban environment makes her one of my favorite bloggers.
  •  Digital Doorway: Not only is Keith Carlson a talented writer, he and fellow nurse Rob Fraser are collaborators on the innovative RNFM radio.
  •  Rob Fraser RN: Has written a book on nursing social media, besides collaborating with Keith Carlson at RNFM radio.
  •   Body of Works: This new blog is a collaboration between a surgeon and an artist.
  •   Ultra Sounds: “An online forum for Creative Exploration of the Cancer Experience.”
  •    NursingCenter: Lisa Bonsall is a favorite nurse blogger.
  •     Stacy Nigliazzo: This is a website, not a blog, but if you are  unfamiliar with Stacy’s poetry, you should stop by. Her poetry is informed by her nursing.  We’ve had the honor of our work appearing together in two separate issues of the American Journal of Nursing.
  •   Art Stormer: Betsy Wills tells interesting stories while bringing the work of emerging artists to our attention.
  •    TheONC: An online community featuring blogs by some of the leading thought leaders in oncology nursing practice.
  •    SpiderHuggers.com: While not recently updated, this informative, and delightfully written blog charmingly illuminates the world of spiders.

Eleven Things About Me:

  1. If I wasn’t blogging about art and nursing, I’d blog about food, wine, and spirits.
  2. My life is influenced by the phrase, “People are more important than things.”
  3. I am left-handed.
  4. My last job before becoming a nurse was cocktail waitress.
  5. I don’t eat red meat.
  6. I hate mayonnaise.
  7. Although I got my driver’s license at 16, I didn’t really know how to drive until I was 23.
  8. I won my first art award for a charcoal drawing I made, and my mother secretly entered into a local contest.
  9. I don’t roller skate, skateboard, or ski. I don’t like slippy-sliddie sports. I like my feet close to the ground.
  10. Although I am uncomfortable with heights, I have parasailed, and loved it.
  11. I believe the secret of happiness is finding meaning daily in the experiences of our lives.

Eleven Questions From Joni

1. What is your most favorite blog post you’ve ever written?

I’m still trying to write it.

2. When you’re not blogging, what do you do for fun?

Running, it’s when I do my best thinking. Painting, writing, cooking, knitting, spending time with family, road trips.

3. What’s your favorite book of all time?

It’s a tie: To Kill a Mockingbird, and A Tale of Two Cities.

4. Pets or no pets?

Currently, no pets, but I’ve had everything: snakes, birds, fish, turtles, pollywogs, kitties, and puppies. The last pet was David’s, my nemesis, Lucas.

5. How many healthcare professionals do you have in your family?

Four. I’m the only nurse.

6. What’s your ideal weekend?

Relaxing with David, and spending time with the kids without time pressures.

7. What’s your best organization tip for work or life in general?

Choose your goals, then work backwards to find out what steps you’ll take to reach them. If you can’t figure out the steps, you haven’t spent enough time researching your goals.

8. As a child, what did you want to be when you grew up?

I had a hard time choosing. As a teenager, an artist and writer. My father encouraged me to get job first, so I’d have something to write about.  I stumbled into nursing accidentally. It turns out to be an excellent fit.

9. What or who made you laugh today?

It’s always David.

10. If you could be friends with one literary character, who would it be?

Antoine De Saint-Exupery’s The Little Prince.

11. What joke makes you laugh every time you hear it?

This is sacrilegious, because I really believe Capt. Sullenberger and his crew are heroes, but I laugh every time I watch this Matt Damon clip from 30 Rock. “Where’s my ticket to the Grammy’s?” It kills me!

Eleven Questions for my Nominees:

  1. Who was your childhood hero?
  2. What book (s) have you read more than once?
  3. If you could do one thing in your life over, what would it be?
  4. In one sentence or less, how would you describe yourself?
  5. What is your favorite way to exercise?
  6. Name one person from any era, dead or alive, you would like to meet.
  7. What is your secret talent?
  8. Do you ever dance to music when no one is watching?
  9. What is your all-time favorite TV show?
  10. What TV show theme song you know by heart?
  11. What is one ability you wish you had, possible or not?

JParadisi RN Guests on RadioMD.com Staying Well Monday October 15 10:20 am PT/ 1:20 pm ET

Ravens by jparadisi

Today, Monday October 15 at 10:20 am PST/ 1 pm EST, I’ll be a guest on Staying Well hosted by Melanie Cole, MS on her radio program, Staying Well, broadcasted on the national internet station RadioMD.com. Melanie and I will discuss the effects of cancer on relationships. Readers of this blog know I am not only an oncology nurse, but also a thirteen-year survivor of breast cancer.

Topics include maintaining relationships during cancer treatment, how to talk to your children about your cancer, and tips for having the best quality of life during treatment.

I hope you’re able to listen: Staying Well on RadioMD

One More Skill On My Resume

Years ago, I had a coworker with the best attitude about learning new skills. At every in-service, sort of like Kenneth Parcell on 30 Rock, he would smile a toothy, freckled face grin, and say, “Hey, it’s one more skill to add to my résumé.”

In May 2010, I wrote Not All Days Are Magically Delicious, a post in which I describe my frustration while learning to apply a wound vac to a patient’s wound. In case you don’t feel like reading the post:

A wound vac is a small mechanical device in a fanny bag, worn by the patient 24/7. Black sponge is packed into the wound and covered with an adhesive, transparent film. A suction tube connects the dressing to a canister attached to the wound vac. When the wound vac is turned on, it sucks all the air out, compressing the sponge tightly into the wound. There is barely any sound as the machine “vacuums” the wound’s drainage into the canister. The suction stimulates healthy tissue, often reducing healing time dramatically. If an air leak is present, there is a loud sucking noise when the machine powers on, and the sponge will not compress. This means it needs more transparent covering to seal it. If that fails, the entire dressing comes off and redone, which is not very comfortable for the patient. (Excerpt from Not All Days Are Magically Delicious by JParadisiRN, May 2010)

For that post, I even made a little painting of a wound vac so you can see what I’m talking about:

Wound Vac by jparadisi 2010

Well, I’ve come a long way in two years. I am happy to report I have changed many more wound vac dressings since writing that post, and each time the machine starts up with the sponge fully compressed and without that awful sucking noise, the very first time. The trick is realizing that you can never apply too much drape (it’s like self-adhesive Saran Wrap). Doing so prevents those wicked little air leaks. I can now spot the problem areas before powering on the wound vac.

Whether you are a nursing student returning to school, or a seasoned nurse struggling with new technology, don’t give up. Keep at it. One day, that piece of equipment you struggle to manage will be another skill you can add to your résumé.

A Social License III: Nursing Synchronicity

“It all depends on how we look at things, and not on how they are themselves”

Carl Jung

I love the moments of synchronicity Jung calls “significant coincidence.” Like when I need a topic for my nursing blog, and find it in a non-nursing setting, like last Friday, while shopping for a pair of pants for work in a department store.

She was unlocking the dressing room door for me, when the sales clerk, a young woman maybe twenty years old, asked if she could find other articles of clothing for me to try on. I told her I was shopping for work pants. She retrieved several pairs for me to try, then asked what kind of work I do. I told her I am a nurse.

“What kind of nursing?” she asked.

“Oncology,” I answered.

“Do you give chemotherapy?”

“Yes, I do.”

Nursing is a social license, meaning the public perceives us on duty even when we are not. Nursing strikes a chord in people concerned about their loved ones.

“My mom was a nurse,” she said.

For a moment, I don’t know what to say. Does she mean her mother changed careers, or does she mean she’s dead? It’s one thing to ask about a stranger’s possibly dead mother in a hospital, altogether something else to begin such a conversation in the public setting of a busy department store.

She throws me a bone: “My mother had cancer, so she isn’t working, but she’s in complete remission. She’s done with chemotherapy. It was hard, because she doesn’t live in this city, and I was here, going to college. She didn’t want me to miss college because of her cancer. Her nurse friends were really nice, not fake nice, really nice. They did a lot for her.”

I told her I am also a cancer survivor, and that you can’t have better friends than other nurses when you are ill. I told her I’m sure her mother wouldn’t want her to shipwreck her own life because of her cancer. I told her it was good she continued her college education.

Was it merely coincidental this young woman’s mother is a nurse, and a cancer survivor like me? Or did the encounter hold a deeper meaning? I don’t know, but I left the department store with the warm feeling I get when I feel a connection to another human being.

Maybe synchronicity is never significantly coincidental. Maybe synchronicity is the simple human need to reach out to each other in a meaningful way, and especially to a nurse.

Stains

Stains photo: jparadisi 2012

It’s a rare night that I can’t sleep. I’m trying to remove, without waking David, yellow vegetable dye stains of crumbled bits of a bunny-shaped chocolate truffle I ate yesterday, from my favorite pair of white jeans. Undergoing their third washing, they appear permanently stained. Perhaps it’s time to pronounce them, but I’m not ready to let go yet. Why is it easier to remove bloodstains from clothing than yellow Easter candy dye? Sigh.

Not a single car or pedestrian moves along the street outside. If not for David’s rhythmic breathing I might consider I was left behind after the post-apocalyptic rapture.  I’m too much of an optimist to convince myself of this, however. I remember hearing of a boy, home alone, who locked himself in a closet, fearing the rapture occurred and he’d been left behind. His parents found him crying in the closet when they came home.

The yellow dye clings to the white denim like sin; evidence of enjoying a chocolate treat (gluttony), or simple sloppiness (sloth)? I only care because I really like these jeans.

How simple is my life, that a pair of stained jeans is the topic of a post?

I wonder if any of my patients are also sleepless tonight, wrestling with pain, fear or nausea? Are they afraid of being left behind, or more afraid of what they leave behind? This thought makes me sad. I’d rather think about removing yellow candy stains from my white jeans.

Is that a sin?

New Creativity Blog Post Up at TheONC

This week’s blog for TheONC is The Art of Subtraction: More Thoughts on Clutter. The topic is based on my experience of watching a professional sculptor make a likeness of a model’s face, by removing clay, not adding. The experience opened up my eyes to a new way of living a creative life.

I am the guest at the baby shower who always wins that game where you shove a bunch of bubble gum in your mouth, chewing and chewing until you get a big, pink glob, which you are required to mold into the shape of a baby. The best sculptor wins. Here’s my secret for winning: put a tiny butt crack in the back of the bubble gum baby; it is irresistible to the woman judging it.