Something incredible happened in clinic this week between a patient and my clinic nurse. It was so heartwarming I wanted to share it here.
I met Ms. S in February 2018 after she had curative intent surgery for her stage 3 colon cancer. She was seventy-four then. My clinic nurse, who has been with me for many years now, would have met her shortly thereafter. From the very beginning of our relationships with her, Ms. S was smiley and happy and optimistic and brave. She continues to shine this way today. My clinic nurse and I have always loved her energy.
In 2018, Ms. S and I discussed the use of chemotherapy to improve her chance of cure. She was agreeable. We got through most of that treatment and then switched her over to a surveillance program to monitor for disease recurrence. Sadly, we confirm metastatic spread of her cancer in early 2020. Her colon cancer started growing in her liver. Instead of walking down a smooth curative road, her life journey took the fork toward a certain shorter path. Her prognosis was consistent with the standard survival of a stage 4 colorectal cancer patient: two to three years with our best treatments used in sequence.
She embarked on palliative chemotherapy, doing it mostly her way by extending the length of her cycles so that she had more recovery time between treatments. She remained on first-line treatment until late 2021 when her cancer showed further growth. Second-line chemotherapy was started but she only lasted six months on it. Her cancer grew again.
This week, I had to tell her we did not have any standard of care treatment left for her to try. It was a tough conversation to have.
We have requested access to a drug that is not covered by our public cancer care program. If we are not granted access, the only option left will be attempting to match her to an early drug trial to try investigational agents. More will be revealed in the coming weeks for Ms. S.
To this day, Ms. S looks and feels very good. In fact, almost every time I speak with her, she comments “I feel so good” with a big, brilliant smile and a sparkle in her eyes. She always comes in with one or more of her kids, either physically present with her or on the phone. Her cancer is clearly a family disease for them.
Over the four plus years with us, Ms. S and I have formed a great therapeutic relationship. Yet, I am not sure ours is the most important relationship she has at our cancer centre. I might argue that the relationship she has with my clinic nurse is more special.
I have been very lucky over the years when it comes to dedicated clinic nurses. I believe nurses to be essential. For our patients, I wholeheartedly know seeing the same nurse each time they visit us helps with comfort and anxiety and the trust they have in our system. For me, it is so important that I trust, and can work well with, the nurse assigned to my clinic. Over time, my clinic nurse and I can get a second sense for each other’s strengths and weaknesses; knowing these things about the other makes our clinic much more efficient.
My current clinic nurse is amazing. He is the third one that has been assigned to my clinic over the years. I lost the other two, a few years apart, when they took maternity leaves. They were both phenomenal too.
My clinic nurse and I have a clever balance going on. We both have our own pace, mine sometimes on fast forward, his always on his own metric. We come together well to complete necessary tasks. He has a definite calming effect on the rate at which we must work to get everything completed. His calm is also gifted to our patients in his cadence and tone of voice when he addresses them and their care needs.
Clinic visits with us are like a sandwich for our patients. If I am the peanut butter and jam, he’s . . . well, he’s the bread. He is the most hearty and nutritious bread that you can get at the bakery – the variety that has all the yummy seeds and grains to make your taste buds dance with glee; the kind that you know is made of good stuff because you want to chew it slowly to get all the complex flavours out. He is sturdy. He keeps all the goo together.
My nurse is the beginning and end of each clinic visit for our patients. He places the first slice of bread down by going into the clinic room before me to get all the dirt on our patients – how have they been doing, what are their main concerns for today, what will they be expecting us to deliver for them during the visit. He reviews the symptom assessment forms each patient fills out before their appointment and talks through as many current concerns as possible with the patient. He recommends solutions, or alternatives to already attempted suggestions, to things like mouth sores, constipation, or diarrhea. He provides moral support and asks about the moods of our patients or about the anxiety they may be experiencing. He even throws in a joke here and there to lighten the mood, when appropriate.
My nurse then comes out of the room to inform me of the details I need to know. He fills me in on what our patient have told him and what he has said in return. When I ask him a question that he doesn’t know the answer to about something he has just reported to me, he says so. I trust him implicitly. I then go into the patient room and do my gooey doctoring.
When I come back out of our examination room after seeing a patient, I communicate the treatment plan to my nurse. We work together to get orders, scheduling, and any paperwork completed. My nurse then goes back into the room with our patient to provide further instructions, review new prescriptions, and ensure our patients do not have any further questions. Patients will often ask him about something I have just explained, perhaps feeling a little more comfortable asking him their question than asking me. By doing these things, he lays down the top piece of bread for our clinic sandwich. He does this so well. He has such a great way with our patients.
My clinic nurse also must go into each room to see the patients I have just given bad news to. He is part of the cleanup crew, so to speak, that sees more of our patients’ tears than I do. I know a lot of our patients fall apart in those rooms after I leave them to digest the news that their cancer is growing or that we have no treatment left to offer them. He picks up some of their pieces in his special way depending on the relationship he has with the patient.
I could tell Ms. S was shaken by our conversation this week. I told her there was little left to offer her. Tears came to her eyes but did not fall as she said to me, “I understand Dr. Spratlin”.
Ms. S left her clinic room before my nurse could get to her this week, but he caught up with her in the waiting room. He could tell by her demeanor she was struggling. When they locked eyes, she started to cry. Because of the respect they share, he told her he was sorry about the news she had received by leaning over to give her a comforting hug. While he did that, he spoke softly into her ear that she better be careful because all the other patients would get jealous. This prompted the loveliest laugh-cry from Ms. S. He made her laugh in one of her saddest moments – how beautiful. He did this with love and with kindness. He masterly completed her sandwich for that visit.
What happened this week between Ms. S and my clinic nurse was extra special. I know this happens all the time with him. I probably do not acknowledge him enough for the extra effort he gives to our patients. Ms. S helped me see I should do a better job at expressing my gratitude for the excellence with which he interacts with our patients.
Author Notes:
I am incredibly grateful to work in the hospital I work in. Cancer is a hard thing to deal with, especially for our patients, but it can also be emotionally difficult for the hospital staff. Our nurses are miracles. There is no better word for them. I could not do the job I do without nursing support.
If you are a physician who works with a nurse that makes a difference in your world or the world of the patients you share, I ask that you consider saying a heartfelt thank you to your nurse every now and then. They have such a tough job and they are very rarely properly recognized for all the love they provide to our patients.
If you are a patient, or the family or friend of a patient, I hope you are treated with the respect we all wish for. I know my patients get treated with excellence in the hands, and arms, of my clinic nurse. If possible, give your nurse an encouraging thank you.
We all need to feel valued for the efforts we expend in our workplace. Nurses are such a crucial component to oncology care. I am proud to call them my colleagues and friends. I honestly don’t think I know many people who care as much for patients than the nurses I have been blessed to work with. Well done team! Keep building those AMAZING sandwiches!
I am curious to know about a positive interaction you have had with an oncology nurse. How has a nurse impacted your care and/or overall wellbeing?
