Posts Tagged ‘cancer’

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The ‘Inexhaustible Well’: Notes from a Trauma Nurse on Mortality

April 19, 2012

UW Digital Collections/via Flickr

By Marcy Phipps, RN, a regular contributor to this blog. Her essay, “The Love Song of Frank,” will be published in the May issue of AJN.

Years ago, long before I was a nurse, I read The Sheltering Sky, by Paul Bowles. He speaks of the tendency of people to take life for granted, and says that in the unpredictability of death there lies a presumption that everything is limitless:

“Because we don’t know when we will die, we get to think of life as an inexhaustible well. Yet everything happens only a certain number of times, and a very small number really. How many more times will you remember a certain afternoon of your childhood, an afternoon that is so deeply a part of your being that you can’t even conceive of your life without it? Perhaps four, five times more, perhaps not even that. How many more times will you watch the full moon rise? Perhaps 20. And yet it all seems limitless.” 

Lately, especially at work, that quote has edged forward and lingered with me. The ICU I work in is primarily devoted to trauma, but there’s been a recent shift in patient demographics. Last week I took care of only one trauma patient—an athlete who’d had a bike accident—and then three patients with cancer in varying stages.

The patient I’m most haunted by is a 65-year-old woman who had arrived in the ER with pain and weakness and would be leaving the hospital with a stunning diagnosis of stage IV cancer, and with numbered days. When I last spoke to her she’d just met her new oncologist and was waiting to be transferred out of the ICU.

“I’m going home,” she said. “I’m going to be with my family and sit on my porch. I’m having a glass of wine.” Read the rest of this entry ?

Posted in patient perspective, writing and nursing | Tagged , , , , , , , | 7 Comments »

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Web Roundup: Comparing Online Health Info, Questioning a Breast Cancer Treatment, Guilt in Any Gender

February 9, 2011

Many women with early breast cancer do not appear to need removal of their lymph nodes, as is often recommended, according to a federally funded study released Tuesday.

lymphedema

Read the full Washington Post story about a new study published in JAMA (abstract is here). This story is being covered in most major news sources today, and it may signal a significant treatment shift for some patients. (One of the possible adverse long-term effects of lymph node removal is lymphedema. Here’s a page with links to the two-part article we ran about the condition a while back, as well as a related blog post by senior editor Sylvia Foley that looked at what people had been writing about their experiences with this condition.)

Speaking of advice about your health and about treatments, the health care journalism blog Covering Health alerts us today to an article at the NY Times comparing health information found at the WebMD and Mayo Clinic sites. Do you prefer the glitzy, highly produced one with lots of corporate sponsors, or the nonprofit? You know which one gets more visitors . . .

And speaking of patients, as we should, what about those who are transgendered? Does it confuse or challenge you to care for such a patient? There’s a very sensitive and painful post at the blog Nursetopia about caring for a transgendered patient who has terminal cancer and a bad case of guilt. Here’s an excerpt:

Yes, Ms. D. was transgender. She was in the middle of her transformation, and I honestly felt sadness when I did care for Ms. D. Not because she was transgender and I was uncomfortable. No, I was saddened because Ms. D. thought her cancer diagnosis was a plague from God for her transgender sins.  It was heartbreaking to hear – from her and from her nurses. No matter her nurses’ and physicians’ medical model cancer explanations, she would not be swayed. God was punishing her with lung cancer. He had to be. Her cancerous lungs were right beneath her silicone breast implants. No amount of discussions from healthcare providers or clergy convinced her otherwise.

For the perspective of another transgendered patient, here’s a Reflections essay called “Intake Interview” that we published a couple years back. Like the blog post mentioned above, it reminds us that patients often don’t undertake such changes lightly, or without very real personal cost.

Lastly, this month’s Reflections essay, “The Wisdom of Nursery Rhymes,” is by nurse, blogger, and artist Julianna Paradisi. It’s about a moment in which two very different pediatric cases intersect, unexpectedly giving the author a glimpse of hope in the midst of much that’s tragic or brutal in life.—JM, senior editor/blog editor

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The Shape of a Woman: Two Poems in ‘Art of Nursing’

February 4, 2011

By Sylvia Foley, AJN senior editor

Abstract ice patterns by net_efekt, via Flickr

“I think about the woman / wilting // on the pillow of the steering wheel,” begins Stacy R. Nigliazzo’s poem “Sketch,” featured in this month’s Art of Nursing department. As the title suggests, the poem sketches out a scene, the immediate aftermath of a car accident. The driver appears dead; the paramedics “offer her up, prostrate / in white splints,” while the physician records the time. The narrator—who might be an ED nurse (perhaps Nigliazzo, an ED nurse herself)—describes what she sees. And as she does, we feel the terrible burden of her witnessing: the victim’s eyes brim “like black bowls that can’t be filled.” When the victim has been taken away, we’re left with almost nothing, only some coins and “buckled lines / in the shape of a woman.” It’s a short, spare piece that conjures up far more complicated matters, like where the dead reside, and how the living might go on.

The narrator of “Connection,” the poem by Camille Norvaisas that’s featured in January’s Art of Nursing, has undergone a double mastectomy. She is shockingly direct in her stated desire. “I want to feel the same / as my nipples, so cold, / in some jar in a sterile lab,” she tells us. She’s trying to comprehend a literal disconnection: once her breasts were part of her; now, “referred to as tissue,” they lie on a stainless steel table somewhere awaiting dispassionate study. The poem hums with sensation, real and imagined. Somehow it manages to be both fierce and stoic in its lament.

Have a look at these poems, sit with them a while; poems tend to reveal more upon rereading. (Art of Nursing poems are always free online—just click through to the PDF files.) And if you’re interested in submitting your own work to Art of Nursing—we consider visual art, short-short fiction (750 words max), and poetry—feel free to send me an email (sylvia.foley@wolterskluwer.com) for more information.

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Posted in art and nursing, healing/holistic, nurses, nursing perspective, patient perspective, writing and nursing | Tagged , , , | 2 Comments »

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The Puzzle of Snowflakes: Treatments May Be Uniform, But Patients Are Not

January 4, 2011

Julianna Paradisi blogs at JParadisi RN; her artwork appeared on the cover of the October 2009 issue of AJN, and her essay, “The Wisdom of Nursery Rhymes,” is upcoming in the February issue.

My patient sits in a chair, watching a DVD presentation about caring for his new, surgically inserted, tunneled catheter. In a few weeks, this catheter will be used for his stem cell transplant. I am teaching him how to flush it and change the dressing. He’s from out in the sticks, too far away from the clinic for our nursing staff to provide the care for him. He doesn’t have family or friends for support. After the DVD, I bring out a chest manikin and dressing kit to demonstrate the sterile dressing change. As I explain the technique of donning sterile gloves, he stops me with a challenging glare.

“I can’t do sterile.”

I stop what I’m doing to explain the dangers of infection if the dressing isn’t sterile. Like a car stuck in a snowdrift, he remains unbudged. “I can’t do sterile,” he insists. I puzzle over what to say next. My coworkers flurry by in their white lab coats. I’m wearing a white lab coat, too. My patient is lost in a health care blizzard. He doesn’t see snowflakes. He only sees snow. Read the rest of this entry ?

Posted in art and nursing, healing/holistic, nursing perspective, patient perspective, writing and nursing | Tagged , , , , , | 5 Comments »

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Taking A Stand Against Terminal Illness — Self-Delusion, or the ‘Good Fight’?

April 6, 2010

By Shawn Kennedy, MA, RN, AJN interim editor-in-chief

This week, The New York Times published an article about a young palliative care specialist who, when advised her cancer had progressed to the point where she should consider palliative care, rejected the notion and proceeded to pursue all available options. She was only 40 years old and said she was not ready to die. While the aggressive treatments (which she had plenty of money to pursue) gave her about another year, the article explains that her final days were spent heavily medicated for pain from the tumors throughout her body—even as she continued to request brutally painful procedures with little chance of prolonging her life.

That was her choice, and she knew what she was choosing. But that doesn’t always happen; too often, people really don’t know what it may cost them to take a stand against the inevitable. (For an engaging and comprehensive look at the issue and its implications for nurses, see Life Support Interventions at the End of Life: Unintended Consequences in the January issue of AJN.)

This month, AJN’s Reflections essay describes a scenario when full disclosure of the likely results of pursuing treatment wasn’t forthcoming from health providers. It tells of one nurse’s dilemma in balancing her role as family member and as a nurse during the last days of her mother-in-law’s terminal illness. At issue is how to explain to family members, who are “misinterpreting survival as recovery,” the likely outcome of aggressive treatments.

This piece struck home for me. As a chemotherapy nurse, all too often I witnessed patients with end-stage cancer wanting to undergo treatment that might promise, at most, a few additional months of life—but certainly not the life they’d had or wanted.  Read the rest of this entry ?

Posted in Uncategorized | Tagged , , , | 4 Comments »

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‘What’s Not to Like?’ A British Nurse, Recently Treated for Cancer, Weighs In on U.S. Health Reform

March 26, 2010

Here’s a little perspective on health care reform in the U.S. from AJN’s contributing editor on international health. Jane Salvage, RGN, BA, MSc, HonLLD, FQNI, is a visiting professor at the Florence Nightingale School of Nursing and Midwifery, King’s College, London, and recently spent a year on the Prime Minister’s Commission on the Future of Nursing and Midwifery.

At 10 Downing Street

Just two weeks ago I learned I had a stage 1 endometrioid adenocarcinoma—a cancer in the lining of my womb. In many other countries today, and in the UK until recent years, this would eventually have killed me. But here I am today, happily home after a hysterectomy, probably cancer-free, thanking my lucky stars and our British National Heath Service (NHS).

My life has been saved by an army of people, from nurses and doctors to lab assistants, many of whom I’ll never meet. All my high quality care was free at the point of delivery, efficiently funded from my taxes instead of boosting the profits of insurance officials or millionaire surgeons. And I am pleased that my taxes have also subsidized the care of the demented, impoverished old lady in a nearby bed, even though her hollering and howling kept us awake most of the night.

What’s not to like? A great deal, you’d think from the nonsense talked about our UK NHS during your U.S. health reform debates. Last September, visiting the Robert Wood Johnson Foundation Initiative on the Future of Nursing, I stayed at the same Washington, DC, hotel as a group of anti-reform protesters. They seemed full of hate, for the world as well as for President Obama, and their ignorant, implacable opposition astonished and scared me.

Just before I went into hospital earlier this week, I cheered at the news of the passing of Obama’s health care bill. By the time I came out less than 30 hours later, the Republicans were already busily trying to sabotage the reforms, as they will continue to do. Fellow nurses, don’t let them do it. Fight them all the way. You need all the help you can get—let us know what we can do.

And please don’t believe the lies told about the NHS on Fox News by minor right-wing British politicians who have zero credibility back here. To be sure, there’s plenty that needs fixing in our system, and we’re working on it. I’ve spent the past year on the Prime Minister’s Commission on the Future of Nursing and Midwifery in England, identifying problems but also widespread good practice. We suggested some ways forward in our final report, launched on March 2. Drafting this report and then unexpectedly becoming a patient myself—seeing things from the other side of the fence—has reminded me, in a humbling way, of the greatness of our NHS. For all its faults it remains a brilliant system, and you’d be hard put to find a British nurse, doctor, or patient who isn’t a staunch supporter.

If ‘socialist  health care’ means supporting your family and fellow citizens and ensuring no one dies of undetected cancer or bankrupts themselves having treatment, I’m all for it.

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Posted in health care reform, international nursing, nursing perspective | Tagged , , , , , | 8 Comments »

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Financial Strain and Childhood Cancer: What’s Your Definition of ‘Freedom’?

September 14, 2009

By Peggy McDaniel, BSN, RN  

I recently read a stirring blog post in the NY Times from a fellow nurse, about a cancer patient she’d treated who was an insurance salesman but whose last months were dominated by a desperate attempt to manage his mounting medical bills, bills which left his wife with a second massive burden on top of her grief at his death.

by frozenchipmunk, via flickr

by frozenchipmunk, via flickr

Like Theresa Brown, I am an oncology nurse. In my work in pediatric oncology, I have also seen families ravaged by cancer treatment—physically, emotionally, and economically. Young families that fight to save their children often end up bankrupt, or with a ruined marriage from the emotional strain of dealing with a loss coupled with financial strain. Financial concerns are ever present. 

Theresa’s article really hit home. I hope you take the time to read it. As I was listening to President Obama’s health care reform speech last week, I heard him mention Senator Kennedy’s experience as a parent of two children diagnosed with cancer. When it comes to the pain and suffering that children experience during treatment, the Kennedy childrens’ experience and that of children without reliable insurance were probably quite similar.

I would guess, though, that the experience was very different for the parents. Read the rest of this entry ?

Posted in children's health, health care reform, nursing perspective | Tagged , , , , , , , , , , , | 2 Comments »

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