I came to oncology nursing in 1984 through what I perceived as bad luck; my goal was to get out of the field ASAP. A new RN, I was completing orientation on a medical-surgical floor when the hospital decided to renovate it into a respiratory unit and our staff would be spread throughout the 400-bed hospital. Each staff member was offered a transfer to a unit of their choice, but my lack of seniority meant I failed to get any of my choices. Instead, I found myself listening to my manager telling me about an open position on the new oncology unit.
I had been “pulled” to that unit once and remembered listening to report. I heard diagnosis after diagnosis of cancer of this or cancer of that…where was the hope? At this stage of my career it had been my experience, and naive opinion, that on a medical-surgical floor patients got to go home in better shape than when they came into the hospital; oncology patients, not so much.
The manager, responding to what was probably a look of misery on my face, quickly said, “It’s only temporary, Joyce. Keep your eyes open for a position on one of the med-surge floors. Eventually something will change.”
Eventually something did change, and it was my attitude. The “temporary” transfer to oncology nursing has lasted for over 26 years. I don’t recall if there was a particular moment when the oncology unit felt “right” for me, but found that I learned lessons from my colleagues and my patients.
As the newbie, I partnered each day with either an RN or LPN who had spent many years in oncology nursing. I remembered a few of the nurses from my one previous shift on the unit, and on the morning of my first full day I was dismayed to be assigned with a nurse whose sarcastic approach to most everything had left me with a negative impression.
This morning Beth* and I worked in unison, going over each patient’s medications and IVs, making sure lab tests had been done, giving baths, and, in between, getting patients to wherever they needed to be—radiation, CT scan, or the OR.
Our patients included Anne, the mother of one of the staff nurses, and during report we had learned she was probably not going to live through the day. Her daughter, Karen, had stayed with her mother all night and at daybreak had gone home for a few hours respite. As we approached Anne’s room to give morning care, Beth said, “Just her back, pits and mouth care, and we’ll reposition her.” I was shocked to hear a nurse use the word “pits” as pertaining to any patient’s anatomy. Considering the source, I bit my tongue; this nurse and the unit were only temporary for me.
Once in the room, I turned my attention to our colleague’s mother. Her eyes were closed and she did not respond to her name or touch, her breathing was agonal, her legs cool and mottled. As we gently bathed the minimum requirements dictated by Beth, she spoke softly to Anne, telling her Karen would be back very soon, that Karen loved her and would be with her as long as Anne needed her. Carrying on a quiet one-sided dialog, Beth gave comfort without further exhausting Anne’s meager reserves before her daughter’s devoted vigil could resume.
My opinion about Beth began to soften. In the ensuing weeks there were instances where I saw another, kinder side to the sarcastic manner she presented—Beth was actually a softy. Maybe she had developed this tough style for her own emotional protection? Wallowing in my own bad attitude, I had been too quick to judge another‘s approach in coping with seriously ill, often terminal patients. I began to appreciate that Beth was a favorite among repeat patients on the floor, and a dish of her dry humor could make a bad day palatable to patients and co-workers.
A surprising act of forgiveness
One of my most vivid memories during my first weeks on the oncology unit is of a young woman with breast cancer, admitted with neutropenia related to her first cycle of doxorubicin and cyclophosphamide. Doxorubicin at 50 mg per meter square will cause total alopecia within 2 to 3 weeks. Coming up the hall with a preoperative medication for one of my assigned patients, a call light beeped and flashed ahead of me. I glanced around the empty hallway and realized I’d have to answer the light even though I was focused on my errand. Grudgingly, I ducked my head inside the door and managed a smile, asking, “Can I help you?”
In the first bed, her curtain partially closed, a woman in her thirties sat bolt upright, one hand holding a large clump of long brunette-colored hair, while in the other hand her hairbrush was full. A lot more hair lay on the white towel over her lap. Sobbing, she couldn’t speak. Obviously she needed emotional support more than a moment’s brief help brushing out what few strands clung to her scalp.
Just then an orderly passed by the door pushing a gurney for my OR patient and he hadn’t gotten his medication yet. There was no way I could give the time sorely needed here: so much for whatever solace this nurse might have been. Giving her shoulder a perfunctory squeeze, I quickly cleaned the hairbrush and deposited its offending contents within the towel, folding it up and putting the bundle aside for now. Spotting a white paper bag on the windowsill, I lamely handed it to this devastated woman, suggesting she brush out her remaining hair into the bag, and promised I’d come back in “just a few minutes.” My gestures and comment, even to me, seemed a gross breach of any supportive actions recommended in Psychology 101. Hurrying toward my waiting OR patient’s room, I spotted the aide and asked her to locate the woman’s assigned nurse; it seemed the best I could do at the time.
About a half-hour later, having attended to my patient, I made a beeline for the woman’s room. By now her tears had dried and she was calm. Her nurse had found a pretty scarf and fashioned it in an attractive style. Pulling a chair closer, I apologized for my clumsiness earlier. In response, this gracious person reached out for my hand. I felt humbled and ashamed that I hadn’t had the kindness to take hers in mine when she had most needed someone’s time and understanding.
Embracing a new role
As the weeks passed, I found many mornings when my resolve to get off the oncology floor was not the first thing I thought about when my alarm clock went off. In the mid-1980s, chemotherapy treatments were given primarily in the hospital, particularly for lymphomas and lung cancers. Patients would return every 3 or 4 weeks for another cycle; I got to know what they did for a living, and about their families and their fears. Were they coping with this frightening interruption in their lives? Did they need the hospital chaplain or the patient advocate? I valued the relationships with my patients and their families, and I was pleased by how I could help them. Before I knew it, I truly was an oncology nurse.
After 5 years, I left the oncology unit to join a private practice where I gave chemotherapy. One afternoon, near the end of a particularly long day, I was walking an elderly, smartly dressed patient toward the infusion room when she turned to me. I must have been looking somewhat tired and bedraggled, because she pointedly said, ”You know, Joyce, a little lipstick wouldn’t hurt.“ I was taken by surprise, but how could I take offense? She was right. It was clear that her statement reflected what all patients should expect from the medical staff; our professional best. And that includes our appearance. If we look sloppy or tired, the inference is we might not do our best, and that’s scary. Since that communication I’ve always kept a lipstick in my pocket, giving my lips a quick swipe PRN. As my patient suggested, it doesn’t hurt, and maybe even helps.
Through many years and nursing experiences in oncology, I learned from my colleagues and patients, particularly about human nature and attitude. I was grateful to be open to these opportunities; they reminded me not to be judgmental, and that an uncomfortable situation can turn out to be a positive and unique growing experience.
Humble pie might not be tasty, but it may be curative.
*All names have been changed.
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