With Blurry Eyes and Open Ears: My Toughest Day as an Oncology Nurse

There are a handful of responses that follow when you reveal to someone that you work as a nurse in oncology.

“Oh wow, I don’t know how you do it,” or “It takes a special kind of person to do that work,” or “That must be so depressing.”

And while all these statements ring true on some level, my response to them in my head is usually, “Yeah, I don’t know how I do this every day,” or “Well, there are many jobs I can’t imagine doing,” and lastly, “It’s not always depressing.…Don’t you see how many new immunotherapy commercials there are these days? That’s what I’m helping do.”

The feelings outlined above are 2 clear sides of the proverbial coin. And, I believe, both are felt throughout the course of a nurse’s shift. Our range of emotion can go from despair to delight in a matter of moments. We are someone’s advocate and support as they enter the final stages of life, providing comfort, spiritual solace, and emotional encouragement to both the patient and their support people. All the while, we are gearing up to be a cheerleader for someone who is on day 1 of their cancer journey in the room next door.

The range in our emotional toolbox is wide and often spread thin. I have worked in oncology for 22 years. I found myself here simply because it was the first day shift position offered to me and happened to have excellent nurse to patient ratios. There was no moving reason why. No story of a sick family member that steered me to oncology. Day shift and the best potential working conditions were my priorities when starting out. Now, 22 years later, my priorities are making my patients feel their most human while in my presence, knowing the basis for all we do is to improve, and not always extend, someone’s life, and to revel in the small miracles life offers us.

At 6:45 AM some 17 years ago, I had no clue at the start of my shift how I was about to be tested. Turns out it was in ways well beyond my 26-year-old self could imagine. While my friends were off to their jobs in the corporate world, waking up when I was clocking in, I was about to face the most emotionally challenging day in my career.

At the time, I was working at Brigham and Women’s Hospital in Boston on a mixed oncology step-down unit. I took report on the 4 patients in my care that day from the exiting night nurse. As she gave me report on a 42-year-old man who had been decompensating overnight, I couldn’t help but think, “Why hasn’t she called a rapid response and gotten this guy out of here?” Hours later, I would think, “Thank God this didn’t happen in an ICU setting. It would have been so much harder for the family.”

I entered a semiprivate room and was greeted by a relatively healthy-looking man with an advanced lung cancer diagnosis who had been admitted with new shortness of breath in the setting of tumor burden despite extensive chemotherapy treatments. He was tachypneic to the thirties and accessory breathing. He was on oxygen via nasal canula but still winded with speaking. He was flanked by 2 friends, both of whom were teary-eyed and appeared to be in more emotional distress than the patient.

Of note, one of the patient’s friends was indeed a celebrity in the sports world, especially looked up to here in Boston, where sports figures are looked to as gods. The patient revealed these 2 men were his best friends and now served as his family following his recent divorce. The patient then told me his parents were deceased, and his siblings were involved, but lived several states away. He went on to say that his 12-year-old son was the center of his universe. This is when he smiled, and I can still see the way his face lit up as he told me about his son. It will forever be something I can recall easily.

After quickly assessing the patient, I asked what his biggest concern was and what he thought I could do to help him. He replied, “just keep me alive so I can see my son tomorrow.” He was scheduled to have his son for the weekend and was planning to go to a Red Sox game. After several more minutes of hearing his hopeful weekend plans, I noticed the patient becoming more winded and lethargic. I called for help from a coworker who I admired for her ability to remain effortlessly calm during any crumbling situation. She stepped in and immediately validated my concerns. She calmly told my patient that we were concerned with is breathing and wanted a more specialized care team to come and evaluate him. Our rapid response code was initiated.

Before the team could arrive, the patient lost consciousness. The visitors were removed from the room and were visibly shaken. The patient was stabilized on a non-rebreather mask, evaluated by respiratory and taken urgently to CT, where he was found to have a large saddle pulmonary embolism despite being on anticoagulation. The attending physician, chief resident controlling ICU beds, responding resident, respiratory therapy, nursing and nursing leadership untangled the knotted mess of items that needed to be considered to keep this man alive.

The largest item on the table, to clarify code status. The patient was a full code yet had no further treatment options to reduce the burden of disease. Radiation therapy was not an option for palliation, and the patient was already on anticoagulation. It was decided that all efforts would be made to educate and encourage comfort care for the patient.

The conversation I witnessed at the bedside that day was through blurry tear-filled eyes, but ears that were open more than ever before. The attending physician, with kindness, respect, and due diligence, took his time to explain the amount of effort and care that had been given while also highlighting the harm there might be in doing more. The patient responded in a way none of us expected a 42-two-year-old man to do. He agreed that his journey was coming to an end. He had felt this way when he walked through the emergency department doors. He simply stated, “I need to see my boy and have him with me. There are things I need to tell him before I go.” What he said next shocked me and jolted me back to reality. He asked, “Will you be here when I go?” To this day I will not forget the profound impact those words uttered by a human I had just met a mere 3 to 4 hours prior had on me.

And that was it. All hands were in motion. His friends arranged for a car service to pick up his son from school after the hospital social worker reached out to both his son’s mother and his son’s school psychologist. Nursing leadership worked with admitting moving patients so that this man could stay on our floor, in my care, as my only patient, in a private space. He would be able to be with his best friends and son and to impart his final lessons and words of love.

A morphine drip was started and titrated for comfort and air hunger; just enough so that he would still be awake to see his son. And then in walked a 12-year-old boy with his mother, and my thoughts all floated, suspended in my head. How was I going to help this boy watch his father die? Would I be able to walk that fine line of keeping him comfortable while the family trusted I was not hastening the inevitable? Would I be able to hold my composure?

The patient died peacefully with his son, his ex-wife, and his 2 best friends by his side 10 hours into my 12-hour shift. I can proudly say all his son’s questions were answered honestly and deliberately. As I performed postmortem care with a clinic assistant, we both cried, and I silently prayed to the God that I believe in. While the day’s events were incredibly stressful and draining, somewhere in my mind I knew there were deep lessons to be grateful for here within these walls.

The answers to all the questions that had run through my mind as this patients’ son entered his room still run through my mind in any emotionally challenging situation. The difference, 17 years later, is that I now know it is OK to show your human emotions within a certain context. Someone is dying; this is human. The humane response may be to show that you are affected by their leaving this world. You are allowed to be human here as well.

I am thankful I have been given the opportunity to be tested in oncology. I am grateful for the nurses who have supported and taught me the grace it takes to stay in this field. But what I am most proud of are the patients who have allowed me to be a part of their profound human experience. For without this, there is no purpose in nursing, there is only medicine.