As a new oncology nurse six months on the job, Lisa Zajac gave her patient her home address. The move was against her better judgment, or so she thought.
“They always tell you don’t give out your personal information,” says Zajac, a nurse practitioner in charge of nursing education for patient care staff at Karmanos Cancer Institute. At the time, Zajac was 22 years old and the patient wanted to send her a Christmas card. “It was January and in my mind, I thought, well, she won’t be alive by then.”
So Zajac gave her address. “But all the way home, I’m driving and thinking, ‘I can’t believe I did that.’ ”
The following day, the patient was discharged and two days after that, Zajac received a little floral arrangement at her home. By February, the woman had passed away.
“That Christmas, her daughter sent me a Christmas card. I’d only known her mother two days. And every year since, I’ve gotten a Christmas card from her daughter.”
The story is one of many Zajac, 40, tells at orientation for incoming oncology nurses to stress this point: “Don’t ever think you don’t have time to make a relationship, because you never really know. More than assessing patients and dispensing medication, nursing is about relationships. That was 16 years ago, and it’s the one Christmas card I really look forward to receiving.”
May has been designated by many national health organizations as Oncology Nurses Month. Certainly, while all nurses are extraordinary human beings, nurses who specialize in cancer treatment have a particular passion for nurturing those who are at their most vulnerable.
Today, the practice of nursing has changed dramatically.
“I can remember you went into a surgical patient room and we would say, ‘OK, you have to walk five times today,’ ” says Karen Goldman, 66, senior vice president and chief nursing officer at Karmanos. “Now, we can sit down with patients, instead of looming over them, and say, ‘I see the doctor wants you walk five times today. Let’s talk together about how you and I can make that happen.’ We’re really much more involved with the patient and the family than we ever were before.”
That is perhaps never more true than in oncology care, where the same nurse is likely to be with one patient throughout his or her cancer journey.
“On a regular surgical unit or medical unit, you get your patients better and you send them home and they go on with their lives,” says Zajac. “When our patients are readmitted, they see the same primary nurse. And when you are with them every single day, nobody knows the patient better than the nurse.”
Another story Zajac tells illustrates how small details can facilitate a relationship and provide better care. One day while introducing herself to a patient, she noticed a pile of word search puzzles. “So I said to this patient: ‘You know you are doing the hard ones?’ And she said: ‘Why would anyone do the easy ones?’ Here I was in my white lab coat and I said: ‘Well, that’s all I do are the easy ones.’ ” The patient went home and three months later, just as the patient went into hospice, Zajac received a text. The patient had dropped off a package for Zajac: it was a book of word search puzzles: all beginner level.
For all the feel good stories, however, most oncology nurses would be the first to admit the job of caring for those with a disease in which the prognosis is often dismal is tremendously taxing. As part of her doctorate degree in nursing, Zajac is studying how “compassion fatigue” among oncology staff impacts the care of patients. Her project also looks at how facilitated debriefing sessions after a patient’s death can help nurses through the grieving process to deliver continued care.
For all the intense study and preparation required of oncology nurses, it’s experience, these nurses say, that instills the understanding that “every patient, every family, every event is significant.”
“We must meet them where they are,” says Zajac. Where they are can be vastly different and unpredictable. Recently, Karmanos nurses and physicians treated a 38-year-old patient diagnosed with myelodysplastic syndrome, which has a very high mortality rate. Remarkably, the patient is now in her early 40s and is returning to work next month. Another patient — a 32-year-old woman with a more treatable cancer, Hodgkin’s disease — ended up dying. “We became very close,“ said Goldman. “I remember the moment she realized she wasn’t going to make it and she began writing out cards for her 1-year-old child so that she wouldn’t be forgotten.”
Having lost her own husband to cancer three years ago, Goldman says, “that experience has made me a better nurse and a better leader. My compassion has always been there for the patient, but my compassion for the family is now at the forefront. It’s interesting because when I ask our nurses at orientation what brought you here, they almost always say they have a family member or a friend with cancer. They are not running from it. They are running toward it.”
Just when you think theses nurses could not be more selfless or heroic, you are proven wrong.
“Our patients are our true heroes,” Zajac says. “The patients teach us to live every day with eyes wide open, to appreciate every moment of every day. We are blessed to be able to take care of them and honored to do it.”