Down the Rabbit Hole

Down the Rabbit Hole, collage, 2017 by Julianna Paradisi

Why is it 2018 feels more like “2017, The Sequel, and not an actual New Year?

While I have one or two friends who’ve had an immediate change of luck, many more of us are experiencing 2018 as a poorly constructed, run-on sentence (or rambling blog post) with little progress or clear goals for the future.

Progress requires a release of perceived limitations, and expectations. The process of releasing creates tension similar to a snake shedding its skin, or a butterfly breaking forth from its chrysalis. Things become too tight and uncomfortable before breakthrough occurs.

Nearing the end of January, the growing and stretching feels more intense than in previous years, and I find myself sympathizing with Alice for choosing to follow a rather strange rabbit down a hole, without thought of where it would lead, or how she would return. “Don’t over think it, just do it.”

Choosing to go down the rabbit hole is not a characteristic of most nurses. Nurses like clear goals, something to steer towards, whether it’s gaining a patient’s trust by managing her pain, meeting discharge goals, or simply relieving a fever.

Measurable goals work in nursing. They’re admirable, and create safety.

* * *

Safety. What is safe?

As an oncology nurse navigator, and a cancer survivor, my patients and I grapple with this question daily: How to balance cancer prevention (safety) with an enjoyable and fulfilling life?

If you believe the answer is easily found in NCCN guidelines, and AJCC recommendations, you are most likely not a cancer survivor. Being a cancer survivor is “going down the rabbit hole.”

* * *

Being an artist and writer demands a willingness to go down the rabbit hole; a comfort level with uncertainty.

The challenge of life is learning to live somewhere on the continuum between safety, and recklessness.

Hank Stamper, the burly central character in Ken Kesey’s epic novel, Sometimes a Great Notion, about Oregon’s logging industry, argues towards recklessness:

“Hank would have been hard put to supply a reason himself, though he knew it to be true that Lee’s presence at the Snag tonight was important to him…maybe because the kid needed to see first-hand what kind of world was going on around his head all the time without him ever seeing it, the real world with real hassles, not his fairy book world of his that him and his kind’d made up to scare theirselfs with.”

* * *

Progress begins by asking questions.

What is safe? What is reckless? Should a predictable outcome dictate the beginning of a new enterprise?

An explorer would answer, “No.”

Alice returned from Wonderland, having viewed strange, new perspectives, and with a bunch of great puns. I assume she counted it a good experience, because she went back for a second trip Through the Looking Glass.

Here’s to going down the rabbit hole, and leaving 2017 behind.






It’s That Time of the Month Again: JParadisiRN’s Post for Off the Charts

Yes, it’s that time of the month again. Before you go thinking JParadisiRN is giving out Too Much Information, let me say that I’m referring to my latest monthly post Who Will Watch the Watchers? Consider Nurses for Off the Charts, the blog of the American Journal of Nursing.

In this latest post I contrast nurses’ accountability to protect the privacy of our patients while maintaining their privacy under the oversight of HIPAA, against the current debate over personal privacy versus national security, and who should have oversight of the NSA and the information they collect.

Read the post at Off the Charts and leave a comment. We’d love to know your opinion!

New Series, Color-Coded For Your Safety Published on Die Krankenschwester

Four Shades of Grey from Color-Coded For Your Safety, by JParadisi and posted on Die Krankenschwester

Color-Coded For Your Safety is my latest series of images posted on the blog, Die Krankenschwester, which I also author. The series considers identity. Color-Coded for Your Safety consists of nine photographs of flip-top caps collected from medication vials, which are commonly used in hospital pharmacies. Color-coding medication vials is a visual aid created by pharmaceutical companies (medication manufacturers) assisting pharmacists, nurses and physicians to identify the medications they administer to patients. The goal is to prevent patients from accidentally receiving the wrong medication. Each cap color represents a different medication.

The Season of Poverty and Thanksgiving

Street Art (unknown artist) photo: jparadisi

You know it’s going to be a long shift when you open your first chart of the morning, and the doctor’s orders are written on a Post-It.

I admit it: I’m feeling kind of overwhelmed this week. November begins what I fondly dub “The Season of Poverty.” I’m not really impoverished. It just feels that way in November, as soon as the property tax bill arrives, followed by Thanksgiving, a couple of family members birthdays, then Christmas, then more family members birthdays clear through the end of February. *  Before spinning out of control, I remember Maslow’s Hierarchy of Needs and regain my perspective. Holiday anxiety is a luxury.

In the midst of this angst, something happened last week and I keep replaying it in the YouTube of my mind.

I was walking on a downtown street, minding my own business, when seemingly out of no where a man walked up to a metal street sign and, with his bare fist, slammed it with such violence I thought he was going to bend it. Shouting obscenities, he hit it again and again, barely a few feet in front of me. I froze where I stood, looking for the nearest exit to safety, as the man came forward in my direction. From behind, a woman wearing dirty clothes said, “Ma’am, come here, behind this chain,” as she lifted the chain blocking off a driveway. Grateful, I did as directed, waiting until the man I was afraid of passed by.

That’s it, nothing more. But I keep thinking about the concern this woman showed for my safety. If someday she seeks help in the emergency department of a hospital or becomes a patient, I hope she receives the same concern and courtesy she gave to me. She didn’t judge me by my clothes for not belonging in her neighborhood. She did not think that I deserved to suffer violence for being in the wrong place at the wrong time. She simply extended safety to me.

Happy Thanksgiving.

*Dr. Dean Burke offers financial advice to nurses at The Millionaire Nurse Blog.

You can show your concern for the homeless in Portland, Oregon by donating to Sisters of the Road.

Who’s Flying the Plane?

We've Gotten Off Track photo: JParadisi 2009

       Perhaps a change of nomenclature is needed in health care.  Physicians should be called Pilots, and nurses renamed First Officers, like in the airline industry, which the health care industry often compares itself to. The term doctor’s orders would change to instructions. Instead of a nurse requesting orders from a doctor, the First Officer would ask for further instructions from The Pilot. The name changes promote the team approach that more accurately describes patient care. 

     Gallup Poll: Power Elite Believes Nurses Should Have More Say in Policy, Management  posted by Shawn Kennedy on the American Journal of Nursing blog, Off The Charts  quotes that “69% of ‘people who run things in this country’ see nurses as having little influence on health reform.”  The poll ranks nurses at the very bottom of the list of groups influencing health reform, under patients, who lag behind physicians. Listed as the most influential  are  government, insurance and pharmaceutical executives. In other words, the people flying the plane do not control the plane. Decisions about health care policy are made by people who are not on the plane. Sometimes the decision makers aren’t even at the airport. 

         That’s not to say that physicians and nurses should dictate health care policy without thought or consideration of cost for treatment or alternative options. In the short story Voyagers, I write about recognizing the need for administrators, whose jobs keep hospitals solvent and regulated. However, demoting nurses, doctors, and the patients themselves to the bottom of the list of influential voices in health care policy, while allowing corporate administrators to have the most influence, seems a crippling case of the tail wagging the dog.