PREPARING FOR REJECTION

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My book is done. Okay, so I don’t have a title—I have at least ten that are in the running—but none of them seem quite right.

In spite of that, I’m crafting a query letter to send off to agents, small presses and to anyone or anyplace else that might publish my book. Besides sweating over every word that goes into the letter, I am bracing myself for the inevitable rejection responses.

I needed to write this book about my nursing experiences back in the 80s when I was in charge of a clinic for the elderly on the 10th floor of a low-income housing project, never thinking at the time what would I do with the book once it was done.

Well, now seven years later I’m done, and educating myself on the myriad paths to publication.

Serendipitously, I tumbled on this post by Allison K Williams in Brevity this past Wednesday, September 10th. I have printed it out and taped it above my desk.

I just love the way it’s written and how it seeps under my skin and toughens it.

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What nobody tells you is that you have to be the kind of person who can hear a hundred no’s before you get to yes, and that if you are not that kind of person, selling your art may not be for you.

Here, let’s practice:No. No. No. No. No. No. No. No. No. No. No. I’ll call you back. No. No. No. No. No. We went with someone else. No. No. No. No. No. No. No. No. No. No. No. My cousin will do it for free. No. No. No. No. No. No. No. No. This did not fit our needs at this time; we sincerely wish you the best of luck placing it elsewhere. No. No. No. No. No. NO. No. No. No. NO. No. No. No. No. No. No. No. No. No. No. No. No. No. No. No. No. No. No. No. No. No. No response means no. No. No. No. No. No. No. No. No. No. No. No. No. NO. Next! No. No. No. No. No. My boss said no. My editor said no. No. No. No. No. No. NO. Sorry. No. No.

No.

Speaking editorially, we should get to ‘yes’ here, but it’s better to experience the dissatisfaction of having our expectations unfulfilled, so we can quit before dissatisfaction crushes us. Or, so we can immunize ourselves.

So we can say, I am blue. My work is blue. The blue of a thousand cerulean seas. The blue of Texas bluebells. The stunning blue of the sky from the top of the mountain. The deep blue of sapphires. The gentle blue of my mother’s eyes. The best blue.

They might want red.

And what nobody tells you is that it’s not up to you to be red, and that whether or not you want to make your blue more of a purple, or draw a crimson border around it, or pass out violet-tinted glasses to all your readers, it is a choice. Your choice. Your choice to change or stay the course, and neither of those are wrong.

It is not a cruel world full of no.

It is a beautiful world in which the one (or many) persons to whom your work–your particular, personal work–speaks are waiting for you. Waiting for you to grow, to revise, to polish, to publicize, to sell, to share. Waiting for you to make art they love and will pay for.

Go and find them.

 

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Blogging: As Many Voices as There Are Nurses

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Marianna Crane:

Jacob Molyneux, AJN senior editor, writes in the Off the Charts blog on the variety of nurse bloggers:

Originally posted on Off the Charts:

By Jacob Molyneux, AJN senior editor

Blogging - What Jolly Fun/Mike Licht, NotionsCapital.com, via Flickr Creative Commons

Blogging – What Jolly Fun/Mike Licht, NotionsCapital.com, via Flickr Creative Commons

A recent check reveals that a good percentage of the blogs on our nursing blogs list have been relatively active over the past few months. A few have been less so. I didn’t see any posts about the ice-bucket challenge, and that’s okay. Here are a few recent and semirecent posts by nurses that might interest readers of this blog:

Hospice nursing. At Hospice Diary, a post from a few weeks back is called “Dying with Your Boots On.” An excerpt:

As I drove down a switch-back gravel drive in the middle of nowhere, I pulled into a driveway and there in a sun-warmed grassy yard sitting perfectly still on a garden swing among buzzing bees and newly bloomed flowers was a fellow in a crisp white shirt, a matching white cowboy hat…

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WHAT I LEARNED

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I am writing my memoir because of what I learned when I ran a clinic on the tenth floor of a Chicago Housing Authority (CHA) high-rise twenty years ago. All my patients were over sixty years of age. I was an inexperienced nurse practitioner and new to working with older people.

I learned that older folks were generally accepting and forgiving.

old-man-drinking-whiskey-and-smokingI learned that a few drank too much, hired prostitutes, carried guns in their purses, and chewed tobacco.

I learned that some sold their medicine for street drugs or money and some were abusive and some were abused.

I learned that not all families wanted to care for their older members and that family members, who suddenly showed up when someone was dying, might not be family.

I learned that most of them enjoyed sex.

I learned that loneliness was the most pervasive condition among the group.

I learned how to plan a funeral, hand over firearms to the local police precinct, how to put folks in a nursing home, transfer them to an emergency room, and commit them to a psychiatric hospital.

I learned to listen to a person’s story before I examined her. And that making a home visit told me more than I could ever learn from an office visit.

I learned that I didn’t need the support from a highly educated and professional staff but from people who were caring and didn’t walk away from a problem.

I learned that a sense of humor was a requirement when working with the elderly.

And I learned that some of my patients were impossible to forget.

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TIME TO MAKE SOUP—AGAIN

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I resort to making soup when I’m facing a deadline with my book. I’ve documented what has become a ritual in a post I wrote exactly two years ago.

I’m planning to start a total review of my manuscript before I hand it off to the line-by-line editor. (Yes, the end is in sight!) But, before getting started, I’m going to take a break. I don’t call this procrastination but honing in on my creative skills by using a different outlet—making soup. Warm, fragrant liquid that perfumes my kitchen, soothes my anxiety and wakes up my senses.

While writing my book I have made the following soups: broccoli and cheddar, lentil with frankfurter, black bean, potato and leek, chicken noodle, gazpacho and my favorite, butternut squash.

Today I am tackling French onion.

The recipe that I will try for the first time comes from Jacques Pepin. He uses chicken stock (instead of beef) and incorporates egg yolks and port after the soup is cooked. I will forgo the eggs and port.

After going through the mechanics of cutting, frying, toasting, stirring, shredding and ultimately tasting, I will feel ready to plug away at my writing with renewed enthusiasm.

It works every time.

 

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Onion Soup Lyonnaise-Style

Jacques Pepin

From the Lyon region of France, this onion soup is much thicker than the usual kind. It’s often served as a late-night dish. When I was a young man, I often made it with my friends at two or three A.M. after returning home from a night of dancing. The soup is strained through a food mill and put in a large tureen or casserole that goes into the oven. Once it is baked, egg yolks and port are mixed together in front of your guests and poured into a hole made in the center of the cheese crust. Then the whole soup is mixed together — both the crust and the softer insides — and served in hot bowls. It looks thick and messy, but it is delicious.

Serves 6 to 8

15–20 thin slices (1/4-inch-thick) baguette
3 tablespoons unsalted butter
2 medium onions, thinly sliced (about 3 cups)
6 cups homemade chicken stock (see recipe below) or low-salt canned chicken broth
1/2 teaspoon salt, or to taste
1/2 teaspoon freshly ground black pepper
2 cups grated Gruyère or Emmenthaler cheese
2 large egg yolks
½ cup sweet port

Preheat the oven to 400 degrees.

Arrange the bread slices on a cookie sheet and bake for 8 to 10 minutes, until browned. Remove from the oven and set aside. (Leave the oven on.) Melt the butter in a large saucepan. Add the onions and sauté for 15 minutes, or until dark brown.

Add the stock, salt, and pepper. Bring to a boil and cook for 20 minutes. Push the soup through a food mill.

Arrange one third of the toasted bread in the bottom of an ovenproof soup tureen or large casserole. Sprinkle with some of the cheese, then add the remaining bread and more cheese, saving enough to sprinkle over the top of the soup. Fill the tureen with the hot soup, sprinkle the reserved cheese on top, and place on a cookie sheet. Bake for approximately 35 minutes, or until a golden crust forms on top.

At serving time, bring the soup to the table. Combine the yolks with the port in a deep soup plate and whip with a fork. With a ladle, make a hole in the top of the gratinée, pour in the wine mixture, and fold into the soup with the ladle. Stir everything together and serve.

FEAR OF GETTING OLDER (FOGO)

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FOGO

 

It isn’t often that I applaud a drug company. In fact, I can’t remember if I ever have.

Here’s to Pfizer for creating an initiative to stimulate dialogue about getting older, which was described in the New York Times business section this past Wednesday (Elliott, Stuart. Pfizer to Inject Youth Into the Aging Process. The New York Times, 16 July 2014: B9. Print).

Pfizer has set up a website, getold.com, with links to Facebook and Twitter. The main audience is those in their 20s and 30s. Topics revolve around the affirmative aspects of aging, like “Why sex can be better when you’re older” and a story of 90-year-old who runs marathons. Okay, I admit a bit sensational but the emphasis is on the positive.

I only hope Pfizer’s effort to portray the elderly in a flattering light will help diminish ageism which is so prevalent in our society.

Thank you Pfizer.

I challenge you to take the FOGO quiz.

I HAD A DREAM

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Mercury Sphygmomanometer

 

In preparation for moving I discover the darndest things as I unpack dusty boxes stored in the attic untouched for years. This time it’s a mercury sphygmomanometer, packed in its original carton along with a “limited warranty” card that should have been filled out within ten days of purchase. Looks like I didn’t even open the box but put the blood pressure machine away for the day I would open my independent practice.

 

That would have been in the early 80s after I became a gerontological NP

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after I worked in Chicago with inner city, underserved elderly

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after I became frustrated with the lack of resources and left to become an administrator of an HMO

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after I knew I didn’t want to be in administration

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after going back to work as a nurse practitioner once again

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after moving to three different states

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after finally retiring from nursing . . .

I forgot my dream.

Do You Ever Hold Your Patient’s Hand?

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Marianna Crane:

I have found a nurse, Amanda Anderson, who is telling the public (via her blog: This Nurse Wonders) what nurses do. She is writing about her job, her observations, her feelings and the environment that nurses function in day-to-day.
She is writing her nursing stories.
I applaud her.

Originally posted on This Nurse Wonders:

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At work the other day, I witnessed something small that has taken up a big part of my thoughts since.

Some point in the shift, the phone rang, and I answered to a voice asking for the dialysis nurse. Common occurrence, as nurses come to the unit to dialyze patients regularly, and often nephrologists or other dialysis nurses call to give them orders or requests.

The dialysis nurse in request was one I’d observed before, though never worked directly with. I had already painted her in my mind as old, union-centric, and jaded. Once, I listened quietly as she talked loudly to another nurse about contract negotiations and the unfairness of nursing. To be short, I expected little from her; a burnt deadbeat.

But when I went to the room where she dialyzed a patient, I saw something that shamed my quickly-laced assumptions right out of me. There she sat, in…

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THE HEALTH WAGON

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In the last post I wrote about Sandeep Jauhar’s essay in the New York Times, Nurses Are Not Doctors. Dr. Jauhar doesn’t condone independent nurse practitioner practice and he suggests that in order to expand the number of primary care physicians their salaries should be increased.

Somehow that last statement has hounded me. Not so much for the obvious reason that excessive physician salaries drive up health care costs but because I wouldn’t want my primary provider’s impetus to be money versus a genuine concern for his/her patients.

Okay, my reasoning is rather black or white. But I invite you to watch the 60 Minutes episode, The Health Wagon (try to ignore the Viagra ad). You will come away with an appreciation of the work nurse practitioners do to address the unmet health care needs in our country. Clearly they are not motivated by money. (The NPs practice in Virginia and can “diagnose illness, write prescriptions and order tests and x-rays”)

If you wish to bypass the video, visit The Truth About Nursing to read an overview of the program. Plus this is a great blog to follow if you want to keep up with nursing issues.

NURSES DON’T WANT TO BE DOCTORS

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For the life of me I don’t know why the New York Times published Sandeep Jauhar’s essay, “Nurses Are Not Doctors,” in the Opinion Pages on April 30, 2014. His essay argued that nurse practitioners shouldn’t practice independently.

As a nurse practitioner it’s obvious that I wouldn’t agree with his opinion but his case was lame. He cited only one study, which was published in 1999. It showed that primary care patients seen by nurse practitioners had 25 percent more specialty visits and 41 percent more hospital admissions than those seen by physicians. Not only was the study dated, it was limited in scope. Come on Sandeep Jauhar. Come on New York Times.

Jauhar further suggested we need more primary care physicians (true) and his solution to encourage graduates to go into primary practice rather than specialize was to increase salaries. Read Shikha Dalmia’s article in Forbes, August 26, 2009: The Evil-Mongering of the American Medical Association, in which she discusses the effects of excessive physician salaries and the historical basis for the physician shortage, which only shows how ludicrous Jauhar’s suggestions were.

Finally, he concluded that nurse practitioners are essential but only “as a part of a physician-led team.”

Angered by the slanted and self-serving article with a title that I had hoped never to view again in my lifetime, and the fact that I thought this essay so beneath the New York Times to print, I wrote a Letter to Editor:

As a retired nurse practitioner, I am disturbed by Sandeep Jauhar’s Op-Ed piece: Nurses Are Not Doctors (April 30). Over the years doctors have criticized nurse practitioners’ practice. “If they want to be doctors, let them go to medical school” has been the American Medical Association’s mantra in spite of the fact nurse practitioners have never claimed that they wanted to be doctors.

What disturbs me is Dr. Jauhar’s focus on limiting NP practice at a time when our health care system has been shown to be inadequate. US life expectancy at birth, 71 years, is ranked 35th. Slovenia ranks 33rd. (WHO, 2013) We need to look at models where physicians, nurses, nurse practitioners, physician assistants and other health care workers can contribute their collective skills to deliver superior health services to all Americans. Rather than propose primary-care doctors get paid more and be designated the leader of the team, I would suggest he, along with the AMA, encourage the expansion of collaborative practice with the end result being accessible, cost effective and appropriate health care for all.

My letter didn’t get published. However, the ones that did and were supportive of nurse practitioners were authored by those more credentialed than I. They made excellent points in debunking Jauhar’s disparaging comments. And the 852 comments on line appearing over the next 17 days, until the comment section was closed, tipped in support of NP’s. (I didn’t check all 852 but did a sampling of the responses.)

Finally, let’s accept the fact that nurses are not doctors and don’t want to be and further agree to allow NP’s to practice “to the full extent of their education and training.”

Now let’s see if the New York Times publishes an essay from a nurse practitioner’s point of view.

Storytelling for Policy Advocacy

Marianna Crane:

Josephine Ensign takes nursing stories to a higher level–to promote policy advocacy. Read on–

Originally posted on Josephine Ensign's "Medical Margins" Blog:

PoppyStoryTime When I tell people that my work focuses on narrative advocacy, they mostly look at me funny and ask, “What’s that?” It is a more concise way of saying ‘storytelling for policy advocacy.’

A common definition of narrative is a story with a teller, a listener, a time course, a plot, and a point. Storytelling is as old as campfires and cave-dwelling. (The photo here is of my father telling Appalachian ‘Tall Tale’ stories to his grandchildren). Storytelling is how we learn about our world, about ethical living, about history, about ourselves. Within the healthcare arena patients and family members tell their stories to nurses and doctors and other members of the healthcare team. It is still a truism that something between 80-90% of the information needed to make a correct medical or nursing diagnosis comes from the patient’s history, from their story.

Storytelling and story-listening are not only important…

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