Saturday, May 11, 2013

Oncology

Six months ago I left my beloved cardiac unit at Presbyterian Hospital and went to work in the resource pool at Shadyside. In nurse speak, that means I went from knowing quite a lot about one specialty to knowing a little about a lot of specialties. In one week I could be a neurology nurse, an orthopedics nurse, a cardiothoracic nurse, a general family medicine nurse, a pulmonary nurse, or an oncology nurse. It was intimidating at first, but I have come to appreciate the mystery of not knowing which unit I will be working on when I walk through the hospital doors. After walking across the street to get a coffee. I am a huge fan of imagining what theme song is playing as I do certain things, and the cliche image of a nurse clad in blue scrubs with a stethescope around my neck and coffee in hand crossing a street while cars stop in both directions to let me pass is just perfect for the Low Anthem. The Skylines on Fire, usually, as I air drum in my head. Part of loving what I do is my intense pride that I am part of a group that research shows is the second most trusted profession, right behind firefighters.

I am a great cardiac nurse. I have been known to grab the plastic anatomical heart model and show patients the blood flow and how their dilated ventricle affects the afterload. Or where their prolapsed mitral valve is located. Or stick my stethescope in the hands of a new nursing student and watch his face as he hears the loudest heart murmur EVER. I get real nerdy about it because I love it so much. The heart is amazing and even when it is damaged, it strives for hemodynamic stability. I will end up back in cardiology some day but right now this job offers the kind of flexibility our family needs in order for me to stay home with Purslane and Knox while they are babes.

The most difficult floor by far has been oncology. Not only is it highly specialized and oncology doctors are crazy particular about their orders being followed to the letter, cancer patients are very sick and need the best kind of holistic care. It isn't just making sure their meds are on time and correct and effective. These are people who were healthy and strong and living life just fine thank you very much and cancer showed up one day and knocked everything on its head. Shadyside Hospital has a state of the art cancer center attached to it, so the patients on our oncology floors are often relatively young, newly diagnosed. Mothers with young children. Small business owners who just started really getting going. International grad students at Pitt who don't speak much English, except in their field of academic study. Grandparents and teachers and artists and convicts. All walking around with a diagnosis on their chart and in their heads.

Not much reminds me that the world is broken like cancer. The randomness, the all consuming fight for remission, the central lines and the mouth ulcers and the radiation neuropathies. The teams of doctors and nurses coming through your hospital room door talking about options for treatment as if they were reading you the breakfast menu. It is part of our workday. For you, the patient, it is your life being summed up in language you don't understand yet. One of the older oncology nurses I work with has a button on her badge that says "Cancer Sucks". When I first saw it, I was a little shocked at the cavalier, almost sarcastic phrase. Now when I see the red words, I understand that it is as simple and direct as it gets. Cancer does suck.

I struggle with cancer patients because unlike most other patients I take care of, the results of their treatments are invisible until the day another scan is done. Or blood work is resulted. Or symptoms resolve or unfortunately, get worse. I can't offer them what is "probably" happening or even what I "expect" will happen. Every body reacts to chemotherapy differently. So as a result, much of their inpatient time is sitting around and waiting. Receiving chemo or radiation. Treating secondary problems that arose from the cancer or radiation. And because I know so little about oncology, I can't give them much in the way of experienced information. These patients need everything I have to offer as much as I can possibly offer it. They have questions, want reassurance, need to talk, have a story.

And I, as a 33 year old nurse who is only assigned to them for 8 short hours, feel amazingly ill equipped. I know what happens with heart disease. I used to joke with Grant that I would take a heart attack over a broken arm any day. But cancer is...cancer. And it sucks. But oncology nurses are AMAZING. They have special skills that allow them to give and give and come back the next day ready to fight cancer alongside their patients. I was having a particularly hard shift a few weeks ago and was in the med room fighting back tears. I just felt EMPTY. I had given everything I had and no longer felt cheerful or optimistic or caring or therapeutic. Cancer kicked the shit out of me. I was angry at God and the universe.

And in walked this sweet young nurse named Jackie. She saw me leaning against the med fridge obviously not doing a whole lot of anything and said "You alright?". That's all it took. I let the filter come down and told her and the rows of IL2 sitting on the counter exactly how I felt. She listened for a minute and then said "The way I think about it, is that when I leave here I still won't have cancer. I can go home and have a drink, make dinner, go for a run, watch a movie- whatever I want. I can make whatever decisions I want without thinking about drug side effects or whether something will mess with my treatment course or if my body is even strong enough to handle it. So I guess for a few hours the best way I can take care of these people that don't have that option...

I can give them everything I have."

I have not walked onto the oncology unit the same way since that short, life changing conversation in the med room. When I see my assignment and realize that I am on 7W, I go get a coffee (or a bigger one), check my hair in the bathroom mirror, make sure I have a Burts Bees in my pocket, and then forget about myself for the next 8 hours. That sweet Jackie gave me permission to give totally of myself- to the point of exhaustion and complete emptying. I often come home after a shift on the oncology unit so tired that I just fall into bed with Grant without a word.

I am so lucky to be a nurse.

6 comments:

  1. Christy, reading this makes me so proud to be your friend. You give so well and are such a unique, and true reflection of Christ.

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    1. Isn't community amazing? The way it fills you up and makes you able to give more. Mine is pretty fabulous. Thanks for being a part of it.

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  2. You inspire me my friend! Your candor and openness will always be a refreshing light for me. You ARE a great nurse and patients on any floor are lucky to have you. I love you!

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    1. Miss having you close by. You are so special to me.

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  3. Cancer has always reminded me that the world is broken as well. The way your body betrays you. The way all seemed well and then one day a test reveals the destruction that you didn't even know was lurking in your body. The way it randomly chooses to loosen it's grip on my mom, but steal Sam's friend in just 4 measly months. I hate it. It sucks. And, I can't wait till Jesus kicks it *ss. And until then, keep bringing hope with that gorgeous smile and kind heart of yours.

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    1. I agree completely. If I think about the randomness too much I get paralyzed. Checking bruises on Knox and Pursy, feeling lymph nodes.. sometimes being a nurse makes me a scared Mama. A mental discipline to remember God is good. Also, I love that you censored your swears. Love love you.

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