Heroic Symbol: A Nurse

I first saw the picture of nurse Grace Cindric a month ago in our local newspaper, the News & Observer.

In the photo, there’s a swagger in Cindric’s stride, a steely resolve in her sunglasses and respirator mask. In a sleeve of tattoos, there’s a friendly-looking panda staring out from her arm.

The Pandemic is bringing nurses into the spotlight, showing what they do. The media is finally taking notice.

There are some positive outcomes of this virus.

‘YOU’RE A MEME NOW’

UNC nurse becomes heroic face of coronavirus fight

Drew Jackson, News & Observer, Sunday May 24 2020

One of the memes circulating on the social media platform Reddit created from a photo of UNC Hospital emergency room nurse Grace Cindric taken by News & Observer photojournalist Robert Willett earlier this week.

Reddit

After News & Observer photojournalist Robert Willett took a photo of Grace Cindric, a UNC Hospital emergency room nurse, memes like this one circulated on social media.

In blue scrubs and a floral fanny pack, UNC nurse Grace Cindric has become the hero we need right now.

In late March, News & Observer photographer Robert Willett snapped a photo of Cindric screening visitors heading into the UNC Medical Center Emergency Department, separating those complaining of coronavirus-related symptoms and everyone else.

In the photo, there’s a swagger in Cindric’s stride, a steely resolve in her sunglasses and respirator mask. In a sleeve of tattoos, there’s a friendly-looking panda staring out from her arm.

“I woke up the next morning, and it was everywhere,” Cindric said. “I first heard from my friend who posted it on Reddit; they said, ‘Fair warning, this got bigger than I expected. … You’re a meme now.’”

Since it was published, the photo has made the rounds on Reddit and Twitter, inspiring dozens of Photoshopped images depicting Cindric in heroic poses. In one a red cape billows behind her, in another she appears on the cover of a fictional video game called COVID-19.

“It was very strange at first. I was like ‘This is too much attention,’” Cindric said. “But I’ve accepted it, and I’m just rolling with it.”

A SYMBOL FOR OUR TIMES

She is the Badass Nurse. A meme, yes, but also a symbol, a face of the nurses and doctors fighting on the front lines of the coronavirus outbreak. As coronavirus cases mount in North Carolina and across the nation, as citizens panic-buy groceries and avoid their neighbors, Cindric wears scrubs like body armor, with a walkie-talkie on her belt.

To many commenting on the photo online, Cindric represents the heroism of medical professionals putting themselves between the public and the pandemic.

“I think it represents something bigger,” Cindric said. “It’s good that people are starting to see doctors and nurses out here in the middle of everything, doing this work. It’s a fun picture, it’s not terribly serious, but it represents what we’re doing. We’re all putting ourselves in harm’s way to stop this.”

Battling a pandemic is not exactly what Cindric imagined nursing would be like. The UNC-Greensboro grad has been a nurse for four years, the last two spent in UNC’s emergency room. She said she got into nursing to help the community and jumped in the emergency room for its variety.

“As an emergency room nurse, you’ve signed up to do anything,” Cindric said. “The task changes all the time, you never know what you’re walking into. … It’s a little bit of everything, and you have to kind of be a jack of all trades.”

‘COMMUNITY RALLYING BEHIND US’

Cindric said the coronavirus outbreak has escalated everything, that guidelines and roles are constantly changing, that the job she thought she knew feels like it changes by the hour. But she said she feels the community supporting their work, that people send meals and well wishes.

With the photo, Cindric said she’s feeling love and support flowing in from around the world.

“We feel the community rallying behind us,” Cindric said. “We knew the work we’re doing was important before, but we feel the respect from the community. They bring us food and send us messages. The outpouring really makes you appreciate the work you’re doing.”

JACKSON: 919-829-4707, @JDREWJACKSON

What Would Flo Think?

The last day of Nurses Week ends today on Florence Nightingale’s Birthday: May 12.

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Florence Nightingale, 1820-1910, (CR Royaume-Uni)

Would Flo be surprised that a special day, May 6, had been dedicated to nurses in 1982, and in 1990, that day grew into a full week that ended on her birthday? Would she be pleased that the World Health Organization (WHO) has designated 2020 as “The Year of the Nurse and Midwife” in honor of her 200th birth anniversary? Would she be happy to learn that this 2020 designation is significant because WHO is promoting nursing education that will increase the numbers of nurses and midwives in order to strengthen Universal Health Coverage?

What would Flo think of the modern nurses’ role in this Pandemic? Would she be reminded how she, during the Crimean War, campaigned for better care of the sick and wounded soldiers and for a higher standard of hygiene, which saved countless lives? I bet she would be proud to see that nurses are still campaigning for better conditions for their patients. And that they are speaking out for safe working conditions for all health care workers.

Continue reading “What Would Flo Think?”

Nurses Transform Lives

This wonderful article was published in Nursing Times OPINION:

In stressful times it’s important to remember how many lives nurses transform

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If you had the chance to reunite with a patient after 10 years to see the difference you had made to their life, would you do it?

This was an opportunity given to a mental health nurse, after Nursing Times helped facilitate an emotional reunion with a former patient last year.

Hope Virgo contacted us because she wanted to shine a light on the “massive contribution” a nurse had made to her recovery journey.

When Ms Virgo was 17, she was admitted to a mental health unit in Bristol with severe anorexia. She said the support of a particular nurse, Mandy Robinson, helped save her life and gave her the skills to stay well more than a decade later.

“It got me thinking about how often nurses see the longer-term impact of the care and support they provide”

When I met the pair, it was a real joy to see how excited they both were to meet again after so many years.

It got me thinking about how often nurses see the longer-term impact of the care and support they provide.

How often do you reunite with your patients? Is this something you would want to do?

I know that for Ms Robinson, this was a rare occasion but one that she thoroughly enjoyed.

In a video created by Nursing Times, Ms Robinson said: “As a nurse – and I’ve done this job for 30 years now – I think we rarely see the kind of longer-term outcomes of how people have done.”

She said it had been “lovely” to see Ms Virgo and to know that she had made “a little contribution” to who she was now.

In response, Ms Virgo assured Ms Robinson that she had in fact made a “massive contribution”.

Ms Virgo said: “I think quite often we don’t realise that, and obviously at the time we just take you all for granted, but all the stuff that you taught me in hospital I now use all of that stuff to help me stay well.”

Observing their interaction from behind the camera I could see what Ms Virgo’s words meant to her former nurse: she was completely made up and overwhelmed.

Together they looked back on Ms Virgo’s time as an inpatient and talked about how they used to go out on runs around the hospital.

Ms Virgo told how Ms Robinson had helped her to understand how to exercise in a positive way and that it did not have to be something that was “obsessional”.

“It is vital to look back and reflect on the positives and remind yourselves of the life-changing work you do for so many people”

After the story went online earlier this week, Ms Virgo posted a link on social media site Twitter and wrote: “If you ever doubt yourself as a nurse watch this and realise the long-term impact you are having.”

At a time when the nursing workforce is under severe – and escalating – pressure, it is vital to look back and reflect on the positives and remind yourselves of the life-changing work you do for so many people.

During International Year of the Nurse and Midwife it seems more than appropriate to be shouting about the difference you are all are making.

 

 

Wonderland Book Club

QR bookclubLast Friday I discussed my book, Stories from the Tenth-Floor Clinic: A Nurse Practitioner Remembers at the Wonderland Book Club, which was held at a local independent bookstore. The audience was quite engaged and we shared discussions not only of my book but of the status of nurses, problems within the health care industry in general and in North Carolina in particular.

Here are some of the questions/comments:

  1. How do you deal with the stress of caring for patients? Do you take these problems home with you?

Me:  I have always taken home patient problems as evidenced by what I wrote in my journals. Journaling was a way I dealt with problems at work. The more difficult the patient issues, the more time I spent writing in my journal. A lot of the stories from the book have been documented in my journal. In fact, the last chapter, Playing Sheriff, was written before I found the journal from that time period. I was surprised to find the story closely paralleled the journal entry.

  1. How brave you were to write about your mother. (I’ve had this comment before. The first time, I really didn’t understand what the person was talking about)

Me:  It was difficult to write about my mother. We didn’t get along. It was especially disturbing that I was a gerontological specialist and couldn’t get along with my own elderly mother. But it was truth and I felt it was part of my story. (At another reading, I was asked what happened to my mother when she had a place of her own. I told how my mother found a boyfriend. Wish I had thought to add that to my response.)

  1. How do you deal with writing about yourself? (Asked by someone who doesn’t write non-fiction)

Me:  I look at this book as a story about someone I know. I tried to dissociate from myself so it was easier to be honest about my actions.

  1. Who was your most memorable patient?

Me:  Helen Stoltz. She lived in the apartment next door to the clinic. When I wasn’t busy, she would drop-in and sit a few minutes beside my desk and teach me about aging. Of course, she didn’t know that what’s she was doing. She talked about getting older and eventually dying, which showed me that older folks aren’t afraid of talking about death. She was ready to die. However, she was cheerful and upbeat and accepting of her life until her time came.

  1. What was the most memorable line your wrote in your book?

Me: I didn’t write it but it came verbatim from my notes at the time. The funeral director told me how to go about purchasing a grave site for the Pigeon Lady: The Greeks are tight but the Catholics will give you a break. (page 96). I’m thankful that I wrote down what he said. He was such a character—embodied with Chicago smarts and a big heart.

What I didn’t say was that “I killed all my darlings.” Therefore, there are no “precious” sentences that have survived my editing, thank goodness.

Besides the Q & A, I was happy to be able to drop some facts about nursing, such as nurses have been voted the most respected of professions for the past 18 years. And that the World Health Organization designated 2020 the Year of the nurse and midwife.

I was grateful for such an enthusiastic and supportive turnout.

 

 

 

 

 

https://wordpress.com/post/nursingstories.org/1635

 

https://www.dailywritingtips.com/say-no-to-your-darlings/

 

https://www.icn.ch/news/2020-international-year-nurse-and-midwife-catalyst-brighter-future-health-around-globe

 

https://www.nationalnursesunited.org/press/nurses-top-gallup-poll-most-trusted-profession-18th-consecutive-year

 

Just a Nurse

Reblogged from 10/25/2015

Nursing Stories

bookmrk-sm1This is from Suzanne Gordon’s Blog. Ms Gordon is a journalist and stanch supporter and promoter of all things nursing.

Recently she asked nurses to respond with their version of “Just a Nurse.” I am delighted to see their feedback. May nurses continue to tell the public what they do and how important their job is.

I would like to post all the ” Just a Nurse” submissions people have sent me.  See below.  What do you think?  I think they are all great.  Thank you so much, all of you.

Suzanne Gordon

I’m just a Pediatric Intensive Care Nurse. I just manage my patients’ drips to keep to their vital signs in a stable range. I just make sure their medications are safely administered. I just make sure the physician is informed of any small but meaningful change in their condition so we can work together to prevent…

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Stories that Need to be Told

I almost forgot about Dennis. That’s what Carol Novembre thinks his name was. Carol and I worked together in the early 60s at Pollack Hospital in Jersey City. It was a county-run hospital. Dennis was head of maintenance. I learned a lot from him about the political corruption that went on behind the scenes. Not that I had any doubts about the kickbacks and abuse of power. I had seen the cases of liquor at the loading docks that were to be delivered to the administration suite (aka “the penthouse”).  One time when I answered the phone on our nursing unit, a voice at the other end reminded me that my “donation” of five dollars was due in order to keep my job. When I identified myself as a nurse, the male voice apologized profusely.

Dennis, a tall, lanky guy with a pocked marked face and disheveled clothes, made rounds in the hospital when he wasn’t off-site, overseeing the unofficial work of prisoners. He would bus the prisoners from the county jail to work on the administrator’s suburban house—building a fence, painting the siding, tending to the gardens in the summer. He seemed especially fond of the nurses. If he learned one of us had missed lunch, he would run down to the kitchen and  reappear with a bacon sandwich.

Reminiscing about Dennis was only one of the memories that resurfaced as I spoke to Carol last week. I had asked her if I could write about the fact that she was one of the first dialysis nurses in the country. I worry that as nurses age and die off, stories of nursing history will be lost. My stories included.

You will read more about Carol Novembre in a future post. In the meantime, here is a story I had published about one of the patients I cared for while I worked at Pollack Hospital in the mid-60s.

Pollak Hospital

 

 

 

 

 CLOSING THE DOOR

            I screwed off the cap of the Black and White Scotch bottle and I carefully measured out sixty milliliters, two ounces, into a medicine glass. The alcohol fumes gagged me every time. Then I grabbed a pack of Lucky Strikes from the carton on the shelf next to an aspirin bottle. Cigarettes and Scotch balanced precariously on a small tray. I locked the door to the tiny medication room and went in search of Charlie Hobbs.

The tobacco smoke clouded the air in the patients’ lounge. The drab room was empty except for a middle-aged man in blue pajamas staring at pieces of a jigsaw puzzle on the card table in front of him. A cigarette clung to his lower lip.

At times, I imagined myself the airline stewardess I had always wanted to be. Coffee, tea, or me? This day I was a Playboy Bunny as I bent at the knees, stretching to place the drink in front of Charlie, while his blue eyes riveted on my imagined cleavage. But Charlie’s eyes fixed solely on the amber liquid. Not once in the past four weeks had he acknowledged me, the young nurse in a starched white uniform with thick support hose and practical shoes. An unlikely dispenser of booze and butts.

Charlie had arrived with no suitcase, only the clothes he wore. The faded blue hospital pajamas and robe comprised his daily wardrobe. One of the other nurses had donated slippers. I looked down at the top of Charlie’s wild red hair. “I got to get me another puzzle,” Charlie said without looking up at me. “This here one is almost done.” He snuffed the cigarette butt into an overflowing ashtray and reached for the drink. I was glad Charlie had decided to shower that morning or else his pungent body odor would have added to the foul air.

Charlie shuffled the jigsaw pieces about by day, and watched television by night, all a maneuver, I thought, to keep human interaction at bay. No one ever visited him. Did he even have a home to go back to?

Dr. Clark’s research money supported Charlie’s hospital stay. Dr. Clark needed recruits who would agree to have a cardiac catheterization in order to see the effects, if any, that alcohol had on their hearts. Cardiac catheterization was the latest tool of the sixties. It measured heart function but carried the risk of injury and even death.

Dr. Clark scoured the downtown bars searching for men who drank excessively. On a warm summer night about a month ago, Dr. Clark had gotten lucky. Charlie seized the carrot: a roof over his head, three squares a day, free liquor and cigarettes. He agreed to live on the third floor of the county hospital for four weeks and then undergo a cardiac catheterization.

I carried the empty medicine glass on the tray back to the nursing station. How could Charlie drink alcohol at nine in the morning? Or all day long, for that matter? What would make a man so desperate that he would consent to have a procedure that might kill him?

Even though I didn’t particularly like Charlie, there were times as I placed the Scotch in front of him that I wanted to nudge him and jerk my head towards the exit sign down the hallway. Get out, Charlie. The catheterization isn’t worth all the free alcohol and cigarettes that Dr. Clark’s giving you. Get out. Now. But I didn’t have the audacity to undermine Dr. Clark’s research, no matter how conflicted I felt.

At twenty-three and a nurse for just two years, I vacillated between professionalism and irreverence. I struggled with knowing when to step back and when to dig deeper into my patients’ psyche. How to be empathic and not sympathetic. How to balance cool detachment with overbearing involvement. Charlie needed someone on his side to help him understand what he was getting into.

Nellie Mineo interrupted my thoughts as she waved to me from the doorway of her husband’s room. She looked like the Italian housewife that she was: salt and pepper hair piled in a bun on the top of her head. A well-worn cardigan sweater covered the simple cotton dress she wore. Behind her thin frame I could just make out her husband’s outline under the starched white sheets.

The Mineo’s had known the chances weren’t in their favor when they first met with Dr. Clark to discuss replacing Joe’s diseased heart valve with an artificial one. At that time Joe was so short of breath that he could hardly talk, much less continue to work in the family grocery store. Joe had been my patient during the week Dr. Clark evaluated him for surgery. The Mineo’s large, gregarious family resembled my own extended Italian family. Joe could’ve been my Uncle Tony with olive skin, dark eyes and soft smile.

An artificial valve, which clicked audibly, replaced Joe’s faulty one. I had worked overtime on the surgical unit as Joe’s private nurse the first night after surgery. At first things looked great, but soon Joe developed a cough, and then his legs swelled. Diuretics only worked for a while, and the antibiotics failed to prevent the infection from ravaging his body. Although the valve was being rejected, it continued to click on.

Joe had the first room near the nursing station. The floor was dedicated to research and held only fifteen patients. The patients stayed for a long time or returned frequently for evaluation. Not surprisingly a strong bond developed between the professional staff and the patients and their family.

Joe’s family and friends usually came and went at all hours, but this day only Nellie stood guard. When I ambled towards her, she grabbed my hand. “He looks worse,” she said, rubbing my hand in absent-minded distraction. “Promise me you’ll stop in before you go off duty today.”

Nellie and I both knew that there would be no miracle for Joe. His once muscular body shriveled into sagging skin covering a bony frame. He didn’t open his eyes to Nellie’s voice. Even a sharp pinch to his face couldn’t get a reaction. “Stop and see me before you go off duty,” Nellie repeated. I nodded. Only then did she loosen her grip on my hand.

At the end of the day, as I flung my coat over my arm, I heard a racket from the patients’ lounge. Charlie stomped past me, head down and fists clenched. “I’m outta here.”

“What happened?” I asked the nurse who jogged after Charlie.

“Charlie kicked over the card table. No reason I could see for this.” She shrugged her shoulders and continued down the hall.

Nellie watched the commotion from the other side of the hall. I walked towards her. She pulled me into her husband’s room, grabbed my coat and purse and held them tight against her body. She stared at me for a long while without speaking. From behind her I could hear Joe’s wet bubbly breaths. Even in my short stint as a nurse I recognized the rancid smell of impending death.

Nellie moved her face closer to mine and whispered, “He’s dying.” She caught a sob and swallowed hard. “I don’t want him resuscitated. Stay with us, please stay with us. Don’t let them resuscitate him. Please don’t.”  She wept quietly, clutching my coat and purse closer to her body.

What was I to do? I had never faced this dilemma before. I knew Nellie had witnessed plenty of resuscitation attempts as she lingered outside her husband’s hospital room day after day. Cardiopulmonary resuscitation was so new that all patients were candidates. At the first moment a patient stopped breathing, we leaped into action. We flung him to the floor and straddled him. With the side of our hand we walloped the sternum to get the heart started, then breathed frantically into his mouth. Pumped on his chest. We worked until we were exhausted. In most cases the patient died anyway with fractured ribs and a lacerated liver. Nellie didn’t want this for Joe.

Thoughts flew in and out of my mind. If the staff saw Joe turning blue, they wouldn’t give a second thought to trying to revive him. A resuscitation attempt might bring Joe “back to life,” but only briefly. Then there would be more pain and agony before his heart gave out and he died—again.

What would I want for Uncle Tony? A quiet death, or zealots in white coats beating on his chest? What should I do? Was there a choice? I looked at Nellie, her dark eyes pleading.

I heard Charlie’s voice from down the hall spewing curses. Perfect timing. Charlie would leave the hospital AMA—against medical advice—right before his scheduled catheterization. I hoped whatever he was up to would distract the staff just long enough for Joe to die.

My heartbeats kicked up a notch as I reached over and slowly shut the door. Nellie’s hold on my coat and purse relaxed and they slid to the floor. Wordlessly, she settled down in the chair next to Joe’s bed, lifted his limp hand into her lap and clutched it. I commandeered the chair by the door: the sentry blocking the enemy from entering.

I sat knotted tight while Joe’s breaths became more erratic. The lapses between his gasps for air stretched farther apart. Just when I thought he had quit breathing, he gulped for air.

Finally, the mechanical valve stopped clicking and the room became silent. I walked to the bed and placed my hand over Joe’s clammy hospital gown. I didn’t feel any movement in his chest. I didn’t feel a heartbeat. Joe’s open eyes stared at nothing. I stood there for a long minute before I smoothed down his lids.

Nellie gripped her husband’s hand to her breast and sobbed softly.

I stood over her, my hand lightly on her shoulder. While I felt relief that Joe died peacefully with his wife by his side, each footfall by the door made my heart flip. What if one of the staff would walk in and find I had made a decision that wasn’t mine to make. “ I really need to leave, Nellie,” I whispered, taking Joe’s lifeless hand from hers and placing it by his side.

Tears slid down Nellie’s cheeks. She rose from the chair and embraced me. “Thank you,” she said, her voice cracking. I felt Nellie’s tears soaking into my shoulder as my own tears fell. Then Nellie pulled away and sat back down next to Joe, taking his hand again into her lap. I wiped the moisture off my face with the back of my hand, grabbed my things from the floor, cracked open the door, and glanced up and down the hallway. No one was around. Retrieving my coat and purse, I walked leisurely toward the exit leaving Nellie waiting for the evening nurse to discover Joe dead in the bed.

The floor was unusually quiet. The medication door was ajar in the nursing station. I had no intention of poking my head inside and saying so long to the evening nurse. Just a few more steps and I would be in the clear. As I turned the corner of the white tiled hallway, Charlie Hobbs’ presence blocked me. “Hi,” he said as if we were old friends. “I’m leaving. Can ya spare a buck for bus fare?”

Charlie had on a bright green jacket I was sure wasn’t his. Noticing my eyes on the jacket, he said, “Borrowed this from the guy in the next room. I’ll return it.” I nodded even though I knew the coat would never make it back to its owner. He shifted his feet nervously as he waited for my answer.

I wasn’t anxious to break any more rules but I was glad he was leaving. Why even try to entice him to stay? That would be hypocritical. I reached into my purse guessing he would head for the nearest tavern rather than the bus stop.

“Thanks,” he mumbled. Shoving the dollar bill into the pocket of the purloined jacket, he turned abruptly. In two long strides he disappeared though the doorway under the red exit sign and raced down the steps. I followed. A cold wind chilled my stocking legs as Charlie opened the door at the bottom of the stairs to the outside world. In his haste to escape he let the heavy door slam shut behind him.

I pushed the heavy door open with my shoulder. Unlike Charlie, I had no desire to announce my departure from the hospital by slamming the door. Leaving my covert actions behind me, I griped the handle with both hands and eased it closed.

The Closing the Door was a winner of the TulipTree’s Stories that Need to be Told Contest and is featured in their 2016 anthology: Stories that Need to be Told.

 

 

 

Revisiting “The Artist’s Way”

A friend recently lamented that she wished she was more creative. “I am so left brain,” she said. “Everything I do is regimented. I would love to lose myself in some artistic project.” She had retired about three years ago and needed some help in reinventing herself after a successful nursing career.

That night—I do my best brainstorming while sleeping—I remembered The Artist’s Way, a book I still had in my bookcase but had not looked at in years. And I also recalled that Julia Cameron was featured in the New York Times not too long ago. Eureka!

I re-read the first few chapters and realized that I, too, would do well to follow Cameron’s instructions, which I first did over 20 years ago. I no longer do morning pages nor am I taking myself on artist’s dates. And, guess what, I have not been working on my second book.

I discovered that Cameron wrote a new book in 2016: It’s Never Too Late to Begin Again: Discovering Creativity and Meaning at Midlife and Beyond. I plan to buy the book at my local independent bookstore in order to rejuvenate my artistic skill. And begin writing that second book.

I’ve attached the article from the NYTs below for those of you youngsters who missed the hype caused by the Artist’s Way.

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Julia Cameron Wants You to Do Your Morning Pages with “The Artist’s Way.”

by Penelope Green

February 3, 2019

SANTA FE, N.M. — On any given day, someone somewhere is likely leading an Artist’s Way group, gamely knocking back the exercises of “The Artist’s Way” book, the quasi-spiritual manual for “creative recovery,” as its author Julia Cameron puts it, that has been a lodestar to blocked writers and other artistic hopefuls for more than a quarter of a century. There have been Artist’s Way clusters in the Australian outback and the Panamanian jungle; in Brazil, Russia, the United Kingdom and Japan; and also, as a cursory scan of Artist’s Way Meetups reveals, in Des Moines and Toronto. It has been taught in prisons and sober communities, at spiritual retreats and New Age centers, from Esalen to Sedona, from the Omega Institute to the Open Center, where Ms. Cameron will appear in late March, as she does most years. Adherents of “The Artist’s Way” include the authors Patricia Cornwell and Sarah Ban Breathnach. Pete Townshend, Alicia Keys and Helmut Newton have all noted its influence on their work.

So has Tim Ferriss, the hyperactive productivity guru behind “The Four Hour Workweek,” though to save time he didn’t actually read the book, “which was recommended to me by many megaselling authors,” he writes. He just did the “Morning Pages,” one of the book’s central exercises. It requires you write three pages, by hand, first thing in the morning, about whatever comes to mind. (Fortunes would seem to have been made on the journals printed to support this effort.) The book’s other main dictum is the “Artist’s Date” — two hours of alone time each week to be spent at a gallery, say, or any place where a new experience might be possible.

Elizabeth Gilbert, who has “done” the book three times, said there would be no “Eat, Pray, Love,” without “The Artist’s Way.” Without it, there might be no adult coloring books, no journaling fever. “Creativity” would not have its own publishing niche or have become a ubiquitous buzzword — the “fat-free” of the self-help world — and business pundits would not deploy it as a specious organizing principle.

The book’s enduring success — over 4 million copies have been sold since its publication in 1992 — have made its author, a shy Midwesterner who had a bit of early fame in the 1970s for practicing lively New Journalism at the Washington Post and Rolling Stone, among other publications, and for being married, briefly, to Martin Scorsese, with whom she has a daughter, Domenica — an unlikely celebrity. With its gentle affirmations, inspirational quotes, fill-in-the-blank lists and tasks — write yourself a thank-you letter, describe yourself at 80, for example — “The Artist’s Way” proposes an egalitarian view of creativity: Everyone’s got it.

The book promises to free up that inner artist in 12 weeks. It’s a template that would seem to reflect the practices of 12-step programs, particularly its invocations to a higher power. Butaccording to Ms. Cameron, who has been sober since she was 29, “12 weeks is how long it takes for people to cook.”

Now 70, she lives in a spare adobe house in Santa Fe, overlooking an acre of scrub and the Sangre de Cristo mountain range. She moved a few years ago from Manhattan, following an exercise from her book to list 25 things you love. As she recalled, “I wrote juniper, sage brush, chili, mountains and sky and I said, ‘This is not the Chrysler Building.’” On a recent snowy afternoon, Ms. Cameron, who has enormous blue eyes and a nimbus of blonde hair, admitted to the jitters before this interview. “I asked three friends to pray for me,” she said. “I also wrote a note to myself to be funny.”

In the early 1970s, Ms. Cameron, who is the second oldest of seven children and grew up just north of Chicago, was making $67 a week working in the mail room of the Washington Post. At the same time, she was writing deft lifestyle pieces for the paper — like an East Coast Eve Babitz. “With a byline, no one knows you’re just a gofer,” she said.

In her reporting, Ms. Cameron observed an epidemic of green nail polish and other “Cabaret”-inspired behaviors in Beltway bars, and slyly reviewed a new party drug, methaqualone. She was also, by her own admission, a blackout drunk. “I thought drinking was something you did and your friends told you about it later,” she said. “In retrospect, in cozy retrospect, I was in trouble from my first drink.”

She met Mr. Scorsese on assignment for Oui magazine and fell hard for him. She did a bit of script-doctoring on “Taxi Driver,” and followed the director to Los Angeles. “I got pregnant on our wedding night,” she said. “Like a good Catholic girl.” When Mr. Scorsese took up with Liza Minnelli while all three were working on “New York, New York,” the marriage was done. (She recently made a painting depicting herself as a white horse and Mr. Scorsese as a lily. “I wanted to make a picture about me and Marty,” she said. “He was magical-seeming to me and when I look at it I think, ‘Oh, she’s fascinated, but she doesn’t understand.’”)

In her memoir, “Floor Sample,” published in 2006, Ms. Cameron recounts the brutality of Hollywood, of her life there as a screenwriter and a drunk. Pauline Kael, she writes, described her as a “pornographic Victorian valentine, like a young Angela Lansbury.” Don’t marry her for tax reasons, Ms. Kael warns Mr. Scorsese. Andy Warhol, who escorts her to the premiere of “New York, New York,” inscribes her into his diary as a “lush.” A cocaine dealer soothes her — “You have a tiny little wife’s habit” — and a doctor shoos her away from his hospital when she asks for help, telling her she’s no alcoholic, just a “sensitive young woman.” She goes into labor in full makeup and a Chinese dressing gown, vowing to be “no trouble.”

“I think it’s fair to say that drinking and drugs stopped looking like a path to success,” she said. “So I luckily stopped. I had a couple of sober friends and they said, ‘Try and let the higher power write through you.’ And I said, What if he doesn’t want to?’ They said, ‘Just try it.’”

So she did. She wrote novels and screenplays. She wrote poems and musicals. She wasn’t always well-reviewed, but she took the knocks with typical grit, and she schooled others to do so as well. “I have unblocked poets, lawyers and painters,” she said. She taught her tools in living rooms and classrooms — “if someone was dumb enough to lend us one,” she said — and back in New York, at the Feminist Art Institute. Over the years, she refined her tools, typed them up, and sold Xeroxed copies in local bookstores for $20. It was her second husband, Mark Bryan, a writer, who needled her into making the pages into a proper book.

The first printing was about 9,000 copies, said Joel Fotinos, formerly the publisher at Tarcher/Penguin, which published the book in 1992. There was concern that it wouldn’t sell. “Part of the reason,” Mr. Fotinos said, “was that this was a book that wasn’t like anything else. We didn’t know where to put it on the shelves — did it go in religion or self-help? Eventually there was a category called ‘creativity,’ and ‘The Artist’s Way’ launched it.” Now an editorial director at St. Martin’s Press, Mr. Fotinos said he is deluged with pitches from authors claiming they’ve written “the new Artist’s Way.”

“But for Julia, creativity was a tool for survival,” he said. “It was literally her medicine and that’s why the book is so authentic, and resonates with so many people.”

“I am my tool kits,” Ms. Cameron said.

And, indeed, “The Artist’s Way” is stuffed with tools: worksheets to be filled with thoughts about money, childhood games, old hurts; wish lists and exercises, many of which seem exhaustive and exhausting — “Write down any resistance, angers and fears,” e.g. — and others that are more practical: “Take a 20 minutes walk,” “Mend any mending” and “repot any pinched and languishing plants.” It anticipates the work of the indefatigable Gretchen Rubin, the happiness maven, if Ms. Rubin were a bit kinder but less Type-A.

“When I teach, it’s like watching the lights come on,” said Ms. Cameron. “My students don’t get lectured to. I think they feel safe. Rather than try and fix themselves, they learn to accept themselves. I think my work makes people autonomous. I feel like people fall in love with themselves.”

Anne Lamott, the inspirational writer and novelist, said that when she was teaching writing full-time, her own students swore by “The Artist’s Way.” “That exercise — three pages of automatic writing — was a sacrament for people,” Ms. Lamott wrote in a recent email. “They could plug into something bigger than the rat exercise wheel of self-loathing and grandiosity that every writer experiences: ‘This could very easily end up being an Oprah Book,’ or ‘Who do I think I’m fooling? I’m a subhuman blowhard.’”

“She’s given you an assignment that is doable, and I think it’s kind of a cognitive centering device. Like scribbly meditation,” Ms. Lamott wrote. “It’s sort of like how manicurists put smooth pebbles in the warm soaking water, so your fingers have something to do, and you don’t climb the walls.”

Ms. Cameron continues to write her Morning Pages every day, even though she continues, as she said, to be grouchy upon awakening. She eats oatmeal at a local cafe and walks Lily, an eager white Westie. She reads no newspapers, or social media (perhaps the most grueling tenet of “The Artist’s Way” is a week of “reading deprivation”), though an assistant runs a Twitter and Instagram account on her behalf. She writes for hours, mostly musicals, collaborating with her daughter, a film director, and others.

Ms. Cameron may be a veteran of the modern self-care movement but her life has not been all moonbeams and rainbows, and it shows. She was candid in conversation, if not quite at ease. “So I haven’t proven myself to be hilarious,” she said with a flash of dry humor, adding that even after so many years, she still gets stage-fright before beginning a workshop.

She has written about her own internal critic, imagining a gay British interior designer she calls Nigel. “And nothing is ever good enough for Nigel,” she said. But she soldiers on.

She will tell you that she has good boundaries. But like many successful women, she brushes off her achievements, attributing her unlooked-for wins to luck.

“If you have to learn how to do a movie, you might learn from Martin Scorsese. If you have to learn about entrepreneurship, you might learn from Mark” — her second husband. “So I’m very lucky,” she said. “If I have a hard time blowing my own horn, I’ve been attracted to people who blew it for me.”

Penelope Green is a reporter for Styles. She has been a reporter for the Home section, editor of Styles of The Times — an early iteration of Styles — and a story editor at the Times magazine. @greenpnyt • Facebook

A version of this article appears in print on Feb. 3, 2019, Section ST, Page 1 of the New York edition with the headline: She Guides Your Process. Order Reprints | Today’s Paper | Subscribe

With “The Artist’s Way,” Julia Cameron invented the way people renovate the creative soul.

 

 

 

Can nurses really speak out too much?

This article caught my attention from the Nursing Times (a monthly magazine for the nurses of the United Kingdom). I had to do some homework to learn about The Queen’s Nursing Institute and its function.

Healthcare policy is a key activity for The Queen’s Nursing Institute. The QNI works to influence decision makers across England, Wales and Northern Ireland on health care policy including primary care, public health, nursing education, regulation and skill mix and issues such as services for homeless people and reducing health inequalities. To do so QNI contributes to stakeholder meetings, responds to national consultations, takes up issues raised by local projects where it appears they may have wider significance, and provides examples and information to policy-makers.  Wikipedia

At the annual conference of the QNI held in London last week, Dame Donna Kinnair, chief executive of the Royal College of Nursing, was told by government representatives that “nurses voices are too loud.”

Read her response below. 

 

 

Let’s Shout Together for Community Nursing

27 SEPTEMBER, 2019 BY  KATHRYN GODFREY 

Nurses at the annual Queen’s Nursing Institute conference held this week in London were told about the government response to hearing the views of nurses.

Dame Donna Kinnair, chief executive of the Royal College of Nursing, told delegates that she had been told by government representatives to bring her membership “under control” so that the voice of nurses would not become “too loud”.

“Nurses do need to speak out about key workforce issues such as safe staffing”

This conversation occurred at a government meeting, but Dame Donna reassured the audience that she would ensure the nursing voice would be heard and in fact “amplified”.

But can nurses ever speak out too much? As a profession they have traditionally been known for getting on with their essential work and not shouting about policy and resource issues. It is therefore good to hear that there is concern that their voices are getting louder.

Nurses do need to speak out about key workforce issues, such as safe staffing as well as more specific issues that affect the patients that they care for. For example, patients who are incontinent are often not provided with adequate supplies of pads to manage their condition. It is big issues like staffing and more specific issues like incontinence resources that affect the care nurses can give and the quality of life patients experience.

Nurses who do speak out can feel like they are speaking in a vacuum and that it is hard to get their message to the decision makers.

Now Dame Donna is asking nurses to share their experiences with her so that she can amplify and communicate to government the concerns of all nurses.

She said: “What I want to do is make sure your voice is amplified through my voice and I can’t do that unless you share your voices and stories with me.

“So that every time I look around, every time I speak to a minister I have got the basics of that conversation, so I am truly representing how nurses feel,” she told attendees.

“This is a crucial time for nurses to raise their voices and have their points heard”

“My pledge to you is that I will continue to amplify your voices and in return I ask you to share your voices and your stories with me, so that we can collectively be a unified profession.”

These are difficult times. We hear little other than Brexit in the news, which means key issues for the health and welfare of the population are being neglected. This is a crucial time for nurses to raise their voices and have their points heard.

The new advertising campaign We are the NHS is timely. The video about nursing is an excellent showcase for the many and varied jobs nurses carry out. It is a great illustration of how highly skilled and essential a workforce nurses are, the glue that holds the NHS together. So the more we hear from them the better. Let’s hope that those who need to listen don’t put their fingers in their ears.

nursing times

I wish our fellow nurses across the pond every success in making their voices heard.

Nurses Give Their Expert Advice on Understanding the Broken Health Care System

I have been on the lecture circuit. My topic is Empowering the Patient: How to Navigate the Health Care System. Two presentations down and two to go with another in the negotiating stage.

I’m fine-tuning the presentation based on the feedback I have received from my audience each time I give the talk. Sana Goldberg’s recently released book: How to be a Patient: The Essential Guide to Navigating the World of Modern Medicine has added an extra layer of emphasis on the importance of nurses’ influence in the health care system.

She writes:

 

I believe nurses are best poised to change the future of healthcare.

Today, registered nurses spend more time physically present with patients than any other healthcare professional, and as a consequence we see and hear a lot. We maintain a vantage point markedly different from that of the MD, the scholar, the journalist, and the policy maker. We are intimately familiar with the complexity and multiplicity of the patient experience, as well as the systems in health care that fail to acknowledge it. We witness the system’s barriers regularly, and in turn we come up with creative solutions to side step its most vexing realities.

(Sana Goldberg, How to be a Patient: The Essential Guide to Navigating the World of Modern Medicine, page XXIV)

Doesn’t that last sentence remind you of Teresa Brown’s New York Times Op Ed essay that I posted just last week? Side stepping vexing realities is another way of describing the “workarounds” that Brown described.

I’m using another book written by a nurse for my talk. Finish Strong: Putting Your Priorities First at Life’s End by Barbara Coombs Lee, who besides being a nurse is a lawyer and President of Compassion and Choices.

Both books are well written and easy to read and full of great information that older readers will find helpful. And, of course, I am pleased that they are written from a nursing perspective.

A Nurse Tells it Like it Is

A nurse has called attention to our dysfunctional health care system in the OP-ED section of the New York Times. (Our Jury-Rigged Health Care System by Teresa Brown, New York Times, September 6, 2019)

Brown has hit a nerve as evidenced by the 969 comments to date supporting her stance.

Her article discusses how nurses (and physicians) use “workarounds,” that is, they circumvent onerous rules to make sure patients get even basic care.

I found the piece a frightening expose.

May more nurses speak out about our ineffective and unsafe health care system in order to educate consumers and institute functional policy changes.

 

Our Jury-Rigged Health Care

 By Theresa Brown 

  • New York Times, OP-ED Friday, September 5, 2019

 

The nurses were hiding drugs above a ceiling tile in the hospital — not because they were secreting away narcotics, but because the hospital pharmacy was slow, and they didn’t want patients to have to wait. I first heard about it from Karen Feinstein, the president and chief executive of the Jewish Healthcare Foundation, who reported it at a board meeting several years ago. I wasn’t surprised: Hiding common medications is a workaround, an example of circumventing onerous rules to make sure patients get even basic care.

Workarounds are legion in the American health care system, to the extent that ECRI (formerly the Emergency Care Research Institute) listed them fourth among its list of top 10 patient safety concerns for health care organizations in 2018. Workarounds, the group writes, are an adaptive response — or perhaps one should say maladaptive response — to “a real or perceived barrier or system flaw.”

Staff use workarounds because they save valuable time. According to Anita Tucker, a business professor at Boston University, system breakdowns, or what she calls “operational failures,” and the workarounds they stimulate, can “consume up to 10 percent of a nurse’s day.” Most hospital nurses are stretched to their limits during their 12-hour shifts. No nurse has 90 minutes to lose to a slow pharmacy or an inefficient hospital bureaucracy.

I saw the common sense that can underlie workarounds when my hospital floor instituted bar code scanning for medication administration. Using a hand-held scanner to register bar codes on medications and patients’ hospital bracelets sounds smart. But then some medications routinely came without bar codes, or had the wrong bar codes, and we nurses weren’t given an easy way to report those errors. Patients’ wrist bands could be difficult to scan and the process disturbed them, especially if they were asleep. The lists of medications on the computer screen were also surprisingly hard to read, which slowed everything down.

But the biggest problem was that the scanning software did not work with our electronic medical records — so all drugs had to be checked off in both systems. This is a huge problem when dealing with patients like those receiving bone-marrow transplants, who might get 20 drugs every morning — some of which are delivered through IVs and come with nonstandard doses. What was already a lengthy process suddenly took twice as long.

Some nurses responded to the arrival of the bar code system with workarounds, including refusing to use the scanner, or taping copies of patient bar codes to their med carts. I tried to adhere to the rules, but if I was especially busy or couldn’t get a medication to scan, I would chuck the whole process.

However, because bar code scanning has been shown to reduce errors in medication administration, the hospital officials wanted it to be done consistently. They produced a public list of all the nurses on the floor. Each nurse was labeled green, yellow or red, depending on the percentage of medications he or she administered using bar codes. Family members, doctors — anyone could see how a nurse was graded.

Over time the list worked, but the sting of it also endured. We were being punished for taking time for patients, even if it meant bending the rules. No one among the managerial class seemed to understand that nurses care a lot about patient safety. The unheard concern was that a green light for bar code scanning meant a patient could fall into the red zone for something else.

Workarounds in health care always involve trade-offs like this, and often they are trade-offs of values. Increasingly, the entire health care system is built on workarounds — many of which we don’t always recognize as such.

Consider the use of medical scribes, who complete doctors’ electronic paperwork in real time during patient visits. The American College of Medical Scribe Specialists reported that 20,000 scribes were working in 2014, and expects that number to climb to 100,000 in 2020.

I have heard doctors say they need a scribe to keep up with electronic medical records, the mounting demand of which is driving a burnout epidemic among physicians. Scribes allow doctors to talk with and examine patients without having a computer come between them, but at base they are a workaround for the well-known design flaws of electronic medical records.

As a nurse, when I first learned about scribes, I was outraged. On the job, nurses hear repeatedly how health care companies can’t afford to have more nurses or aides to work with patients on hospital floors — and yet, money is available to pay people to manage medical records. Doctors who use scribes tend to see their productivity and work satisfaction increase, but the trade-off is still there: Scribes demonstrate the extent to which paperwork has become more important than patients in American health care.

The Affordable Care Act, which I support because it has made health care available to millions of previously uninsured Americans, is also an enormous workaround. The act expanded Medicaid, protected patients with pre-existing conditions and offered subsidies to make private insurance more affordable. Obamacare, though, was never intended to make sure that all Americans had affordable care; it works around our failure to provide health care to all our citizens. In its own way, the Affordable Care Act is as jury-rigged as using ceiling tiles to stash medications.

The United States spends more per person on health care than any other industrialized country, yet our health outcomes, including overall life expectancy, are worse. And interventions like bar code scanning are a drop in the bucket when it comes to preventable medical mistakes, which are now the third-leading cause of death in the country. Our health care nonsystem is literally killing us.

As the workarounds accumulate, they reveal how fully dysfunctional American health care is. Scribes are workarounds for electronic medical records, and bar code scanning is a workaround for our failure to put patient safety anywhere near the top of the health care priority list. It’s a values trade-off that the nurses on my floor instinctively understood.

Theresa Brown is a clinical faculty member at the University of Pittsburgh School of Nursing and the author of “The Shift: One Nurse, Twelve Hours, Four Patients’ Lives.”