July 10, 2009

Reflections on Marriage and Cancer

Posted by ONS on July 10, 2009

This is a guest post by: Dennis Pyritz, RN, BA, BSN, practiced oncology nursing from 1987–2004 and was active in local, national, and international ONS projects during that time. In 2001 he was diagnosed with a rare cancer—t-cell prolymphocytic leukemia (T-PLL), relapsed in 2004, achieved remission again with alemtuzumab and consolidated with an allogenic peripheral blood stem cell transplant. He is currently building an active cancer blogging community at his blog, www.beingcancer.net. The blog was recently featured in Top 50 Cancer Sites & Resources.

Scan0001This morning I woke up and realized that today was another of those special days by which we mark the miracle of our continued survival from cancer - the 38th anniversary of the marriage of myself and my lovely wife, Tish. More importantly is the fact this is the seventh time that we have been able to celebrate this day since my diagnosis. That I would be writing about this or even being alive to celebrate it in 2009 was not even something that I would have considered or believed during anytime from 2002 to maybe 2006.

So my first thought upon realizing that fact - actually my second thought, my first being a husband's relief at remembering that the day was his anniversary - was a natural one for any blogger - here is reflective fodder for an essay.

The diagnosis and experience of cancer can profoundly impact that primary relationship of cancer victim and spouse. A number of cancer victims have written me and alluded to less than supportive relationships in their cancer struggle. And several have referred to the fact that their marriage did not survive the cancer even though the patient did.

I remember many years ago, working as a nurse on the oncology unit, what seemed then a startling revelation, that daily family life went on despite the medical crisis. I remember a lymphoma patient who had spent a long time in the hospital and had gone through some really tough times. His wife was in the room, the two young children eating ice cream at the nurses station. The hushed sounds of a somewhat heated discussion emanated from his isolation room. Problems with the kids, the frustration and weariness of the wife in dealing with a myriad of domestic crises alone and feeling unsupported. Expectations of my patient that were perhaps unrealistic and yet keenly, uncontrollably felt by his wife.

I have witnessed the bone-tired weariness of spouses. I have seen in a hundred faces the fear that cancer will overtake the spouse, leaving the other alone, unprepared for a future that may extend for decades. This is not what they signed up for ... and yet it is - "for better or for worse, in sickness and in health", words we all recited but, on that joyful day, did not, could not imagine. In the image above a caption "Leukemia victim and caregiver" simply does not fit with the emotional message. But illness can bring out the best and, per some of my email, the worst in us. Illness challenges our notions of the steadiness and the more enduring comforts and grace of marriage, those tender mercies of a loving relationship.

In the joyful photo above of Tish and I, you can easily imagine what we are thinking, and not thinking, in that moment. We are thinking "how lucky I am", "I have never been this happy before", and "we have our whole lives before us". We are thinking about our honeymoon on the beaches of Florida, we are thinking about sexual bliss, we may even be imagining what kind of kids we might have, their sex, what they will look like, what they will become. We may even have stored somewhere the vague image of two older people, sitting in rocking chairs with little grandchildren playing at out feet. We may be wondering what kind of people we may become, what kinds of success we may achieve, what impact we may have together on the world (we are children on the sixties, idealistic baby boomers after all).

But images that do not flow through our minds on that wedding day - sitting at the hospital bedside of the other, listening to wet, struggling breath sounds, holding a hand on fire with fever. We do not imagine crying together with our young adult children. We do not imagine sitting in the quiet clinical sterility of a doctor's exam room, fearfully awaiting news of a biopsy. No, on this magic wedding day, these images are galaxies away.

So here I sit in my study, thirty-seven years later on a warm rainy morning, sharing these thoughts with a community of colleagues and fellow-travelers whom I have never met. When I first read about my disease on a cloudy cold afternoon in December 2001, when I read the words "aggressive and invariably fatal with a median survival of 7.5 months", my life changed forever in an instant, in the millisecond that it took to process the import of those words.

That day was an end of dreams. How many more Christmases, birthdays ... anniversaries might I be granted? For years I would not make plans that extended further than six or so months in the future. My life might end at any time. But, as playwright Sherwood Anderson had proclaimed, my relationships with my children, my mother, my family, my wife would "continue on, seeking their own resolution."

So this day, this June 18th in 2009, is yet one of those myriad days when I take time to count my blessings. I awoke this day almost having forgotten that the years since my diagnosis qualify as nothing less than a miracle. This wedding anniversary of ours is a stellar reminder.

So many special moments. In the year after my first remission we were able to take advantage of a speaking engagement in Norway to wander the ancestral lands of Tish's forebearers, Sweden - a trip that I thought might slip away with the rest of my life's dreams. We have been able to enjoy the promise of two beautiful grandchildren. We have gone on vacations together and witnessed hand-in-hand the weddings of our children (suddenly I have the alternate image of Tish standing alone in formal wedding outfit, clutching flowers, or telling tiny children what their grandfather was like).

We downsized our home, our income, but not our dreams. I have had to redefine myself ... as a relapsed cancer patient, as a nurse struggling to reclaim the ability to practice, as a transplant survivor, then as a half-blind disabled provider ... and with each definition, subtly redefining aspects of the marriage.

But the solidity of that relationship holds fast, like an anchor in a rocking violent sea. It could have floundered. I made mistakes, so did Tish, so do we all. And cancer can put a crushing weight on marriage already challenged by the day-to-day struggles of modern life. So in a way being able to celebrate this 38th anniversary is my second miracle. And being able to write this post solves the perennial dilemma of what to give a wife on this special day.

So darling Tisha, this is my gift to you ... and to you as well, my dear readers.

By Dennis Pyritz, RN, BA, BSN

Should We Be "Facebook Friends?"

Posted by Kari Wujcik on July 10, 2009

I wanted to touch on the article Misuse of Social Networking May Have Ethical Implications for Nurses by Deborah McBride and Eric Cohen in the latest edition of ONS Connect. I remember when Facebook first started out many years ago. I was a sophomore in college at UT Knoxville and I thought the whole concept was quite ridiculous. What was the point to be Facebook friends? Well, then I joined and became addicted to "Facebooking," much like the rest of my friends. After all, you were not officially in a relationship until it was confirmed on Facebook. Now, years later Facebook is among one of the top social networking avenues for people of all ages to stay connected.

The problem with Facebook and probably many other social utilities is that people disclose way too much information about themselves to sometimes unintended audiences. Another problem is that patients are asking nurses and other health care professional to "be friends" on Facebook. I have dealt with this situation first hand and it canbecome very akward if you do not take a stand on this matter and be consistent. A sweet little 8 year leukemia patient befriended me on Facebook. At first I thought, how sweet, she wants to be my friend. But after analyzing the situation, I thought that I did not want patients and their families knowingwhat I am doing or who I am talking to outside of the work environment. If anything, it felt like a lack of privacy. I think it would have been incredibly inappropriate to be friends with patients or family members on Facebook.

Another problem I have seen with the users of Facebook is that so many people use the status update feature of facebook to vent about their boss or work in general. This is completely inappropriate and can cause major problems if certain people, like your boss see this information. I think the main point I have is to be professional. Remember that our personal lives and professional lives should always remain respectful. Facebook is not the place to vent about work or the patients you care for. Facebook is meant to be a social utility to connect people.


What are your thoughts about social networks like Facebook and Twitter? Are you "facebook friends" with your patients?

July 03, 2009

What's Next? 'Post-Treatment Letdown'

Posted by Erin Elphee on July 3, 2009

On a regular basis, I try to read the New York Times Health and Wellness section. Earlier this week, Dana Jennings, a reporter for the newspaper and cancer survivor wrote a column that caused me to have an aha! moment. In my clinical practice with lymphoma and leukemia patients, one of the best days for me is on the 10th day post their final cycle of chemotherapy when they come to see me for their final assessment and nadir blood work. I feel deeply satisfied being able to tell patients that their chemotherapy treatment is over, they have responded as we hoped and we will arrange some follow up scans in the upcoming weeks/months and see them back in the clinic to review the results. For me it has always felt like the last day of school sending the kids away for summer vacation with the knowledge that what lies ahead will far exceed anything they've gone through in the past year. The patients however always look at me with great disbelief and say "You mean that's it?" As if I would joke with them about something so important. I don't think I ever really understood what this experience must be like for a patient. Dana Jenning's column has given me much needed insight into this transitional time for patients. Although his diagnosis and treatment differs from those in my practice this is one instance when we can make comparisons between cancer patient populations.

He calls this feeling 'post-treatment letdown' and I think it is an accurate description. We are all creatures of habit and after a cancer diagnosis disrupts the natural rhythm of life we search to find a new normal. For those on treatment, a new normal involves the rules and routines of treatment. He describes the process of coming for treatment as his 'job', a place where he knows everyone's name and has come to learn the idiosyncracies of the environment and cultures from the insider's view. The act of engaging in treatment is 'doing something' rather than the alternative of the uncertainty and the waiting. The end of treatment signals an important transition period for patients and their families. This column has reminded me that as a primary nurse I must pay more attention at ths time to help patients adapt to this new time in their lives.

You can check out Dana Jenning's blog at http://www.nytimes.com/2009/06/30/health/30case.html?_r=1

Nurses as helpers, white cap wearers..........I think not!

Posted by Jeanine Gordon on July 3, 2009

http://well.blogs.nytimes.com/2009/07/01/nurses-helpers-angels-or-something-more/

A colleague sent me the above link to read and it infuriated me so I wanted to get some other opinions on it.  Personally I'm getting annoyed with all the negative stereotypes about our profession in the media lately with the addition of the new nurse shows (if they're worthy of being called that).  It's interesting what people think of us until they're in that hospital bed pushing the call button praying that we appear to assist them with any nursing or non-nursing need that they might have.  

What stereotype about nursing bothers you the most?

June 29, 2009

TV vs. Nursing

Posted by Kimberly George on June 29, 2009

Erin previously posted about Nurse Jackie, and I must say "I agree!"  I have not seen the show as I do not subscribe to that channel, BUT, I don't think I would enjoy it after reading the description.

Several non-nurse friends of mine are divided on the topic as well.  Some say that nursing is a highly-respected profession and that TV shows like this leave a bad impression of real nursing.  Another friend said we shouldn't take it personally; that people know it is fiction and is intended only to pull-in viewers. 

I have spent many years of my nursing career explaining what exactly a nurse is.  This has been especially true since becoming a CNS.  It takes years to earn the respect of our co-workers, physicians, administrators, and, most importantly, out patients.  So does a TV show like this one damage nursings reputation?  Do you take it personally?

Another new TV show focuses on nursing as well.  Have you seen HawthoRNe?  Like Erin, I think highly of the actress playing the lead nursing character, Jada Pinkett-Smith.  My question for those of you who have seen this show:  Have you ever seen a CNO do these things?  No offense to CNOs, but no CNO can be in so many places at one time, performing tasks meant for other disciplines all the while knowing every detail of all of the staff members personal lives. Hmmmmm.  Lesser of 2 evils.  At least she is a patient advocate and not a druggie who hides her next fix in the ER nurses prosthetic leg.

But I digress.........

June 25, 2009

From Orientation to Resourcing

Posted by Kari Wujcik on June 25, 2009

I recently have completed part of my orientation process and have begun resourcing. In the PICU, resourcing is where I have my very own patient assignment but I have a "back-up" RN who sits at the medical receptionists desk area and is there to answer any questions I have or help me if I am too overwhelmed. Everyone that I had talked to said that the Charge Nurses were really great about easing the new orientees into our role as the official RN of the patient. So, I guess I had this idea that my first couple of nights on my own would be easy. Well boy was I wrong! My very first night on my own, I had a two patient assignment and one of my patients coded! My first thought was that I had 15 weeks of orientation to experience a code situation with a preceptor right beside me. Of course it didn't work out like that though. I was so scared, my adrenaline was through the roof and I remember saying to one of my friends, "I don't want to go in that room." My friend, a fellow RN, told me that I had to go in the room and said that she would get the emergency drugs and that I had to go be the nurse. At that moment, I was thinking "ok, ok I can do this." Even though I was scared out of my mind, I was not alone, which was incredibly comforting.

Looking back on that night, I learned a really valuable lesson. I learned that I should never for one second think that I will have an easy night. I need to be on my game every time I step in that hospital, because even though I will not be caring for the most critical patients right out of orientation, a patient at any time during their stay in the hospital can take a turn for the worst, and if I as the patient's nurse am not always on my game, I could potentially harm the patient. In the end, the patient survived. We had to intubate the patient and do compressions for about 10 seconds, but the patient survived. Throughout nursing school and starting my job, I have practiced mock code situations countless times. But I think until you truly experience a real life code situation, you are never really prepared. That was one of the scariest situations I have experienced so far in my career and I am sure there will be many more situations like that. However, I feel like I will be better prepared from here on out and I know I will not be alone.

June 23, 2009

How do you measure nursing workload in your practice?

Posted by Jeanine Gordon on June 23, 2009

Every quarter I send an e-mail to my staff informing them that we will be conducting 2 weeks of "Intenstiy Study".  At my institution the term Intensity Study is used to describe the period of time that the chemo nurses collect data on the various types of care provided to the patients and calculate the actual nursing time spent with them.  Every chemotherapy drug, regimine, supportive medication, injection, blood draw, and follow-up phone call is assigned an Intensity Level of 1-5 based on the nursing time required by the nurse to provide the care required for the treatment/intervention to the patient. The process of collecting the data is quite labor intensive and it's probably one of the least favorite tasks for the nurses, however the information that the Intensity Study provides once the data is collected is very important.  Results from the Intensity Study compare the amount of "actual" nurses to the "proposed" amount of nurses that are actually need to care for the patient load based on the intensity levels collected.  We use this tool to monitor the "real" intensity of the workload as opposed to using the nurses anecdotal feedback of "we're so busy".  The results justify the need for new postions and help us to plan appropriately for future staffing needs. 

How do you measure nursing workload in your own practice? 

June 17, 2009

Portrayal of Nurses on TV

Posted by Erin Elphee on June 17, 2009

I was recently alerted about a new television show premiering this month on ShowTime with a nurse as the lead character. I'm usually 'in-the-know' about new shows especially medical ones but with the arrival of summer I have to admit that this one took me by surprise. By the time the snow melts, I've usually had enough of being a winter couch potato and am ready to engage in hobbies that include more than the mind-numbing tedium that winter on the prairies brings with it.

So I googled "Nurse Jackie" and learned that it is a new medical comedy starring Edie Falco. This intrigued me more. She is a respected and skilled actor, just the person to accurately show the world just how great it is to be a nurse. My opinion of this show in no way is a criticism of the actress. In fact, I haven't even seen it yet. Nurse Jackie is described as "a wife, mother, and highly competent ER nurse who knows more than the doctors. She talks tough, is quiet and mean but when no one is looking she's good with kids and the elderly. She's a rule breaker." Sounds good doesn't it? BUT she's also a highly functioning drug addict who gets her supply from her lover, a co-worker, a pharmacist in the hospital. Ugh! You just lost me. Maybe to non-nurses this sounds great but why oh why can't being an ER nurse, mother, and wife be enough of a storyline? We does the image of nursing have to be tarnished? I don't know about you but none of my friends and coworkers are addicted to drugs or having affairs with co-workers. Granted you hear rumors of 'hospital hookups' but they are the exception not the rule. TV portrayal of nurses and health care professionals sways the general public. If you think it doesn't then you are being naive. My best friend thinks thaT I work at "Grey's Anatomy" despite ongoing reassurance that I actually get my work done without a quickie in the clean supply closet!

Nurses are viewed as sex objects, or cold and heartless. Nursing may not be that glamorous, that is, sex, infidelity and drugs but most days I can go home and tell my boyfriend a good story or two about an interesting case, making a difference and helping someone or a ridiculous mishap that had us in stitches (pun intended). If the people who decide what to put on TV can put 10 'famous for simply being pretty celebrities' on a desert island for the summer so we can watch them do nothing, why can't Nurse Jackie just be Nurse Jackie? I know nurses and I'd tune in. What do you think?

June 16, 2009

Lessons from a Nurse Living with Cancer

Posted by Joni Watson on June 16, 2009

The June issue of ONS Connect is cover-to-cover with survivorship. It's so exciting to see this topic come into its own and develop into a new area of study and knowledge. With nearly 12 million and 28 million survivors alive today in the US and around the world, respectively, it's about time (National Cancer Institute, 2008; Lance Armstrong Foundation, 2009). As I reflected over all the cancer survivors in my own life, I didn't have to look very far - just right across the hallway - to a nurse colleague. Mary (not her real name) is a thyroid and melanoma cancer survivor. Her husband has been living with "terminal" lung cancer for the past four years. That's right - "terminal" and "four years" - it's a recurring theme in cancer survivorship thanks to advances in knowledge and medicine.

She went in for a routine exam, her doctor palpated a thyroid nodule, the biopsy was negative, but they decided to remove it anyway. The postsurgical pathology report showed the nodule was malignant. When Mary found out she had cancer and it was removed, she thought nonchalantly, "So, I have cancer." She credits her attitude to her own cancer to living through her husband's diagnosis when he was told he had three to six months to live; they subsequently made some "stupid mistakes," selling their home and waiting. Waiting. Waiting. Until they "threw out the book with the statistics" and started living their lives.

Mary continues to watch her husband live with cancer and she knew she could live with it, too. "Cancer is not synonymous with death. Life is synonymous with death," she chirps. Six months after her thyroid cancer excision, Mary found a questionable spot on her ear - melanoma. She had it removed on an outpatient basis, and says the hardest part of having cancer was telling her children. Neither her nor her husband have a family history of cancer, but "now my children do."

It's no different as stage I or stage IV, Mary says her life has changed greatly as a cancer survivor - physically, emotionally, and mentally. She confidently says it's better because cancer made her straighten her priorities. She now does yoga, prioritizes concerns, does "everything within reason to give [herself] the best shot [at health], and enjoys the day. Boy, does she. I love working and being around her. She and her husband also now have a "bucket list," and they are whittling it down - buying their dream home last fall and taking a first-class, week-long cruise with college friends this summer. I took away a great lesson from her - start living today. "Don't wait until you have cancer." Wait. What? Me? Cancer? Oh, yeah...As I start to see statistics in my mind my bucket list is forming and growing.

As survivorship continuous to grow into its own unique area, I'm curious to learn from other nurses living with cancer. There were several nurse cancer survivors that spoke at ONS Congress. If you attended any of their sessions, what did you learn? How are nurse cancer survivors impacting survivorship in your own practice and lives?

June 07, 2009

Finding a Balance

Posted by Kari Wujcik on June 7, 2009

I wanted to comment on Joni Watson's previous blog about balancing work and life. I too have struggled with balancing my work life and even having a personal life. For the last couple of years, my entire focus has been on getting through school and now my focus is still career related where I am trying to figure out how to be a PICU nurse. Sometimes I feel as if my nursing friends are the only ones who understand me and what I go through on a daily basis. My non-nursing friends simply don't understand what I see and have to go through on a daily basis. A lot of times they are grossed out by the things I deal with at work and don't really want to hear about it. The nursing profession is set up very different than most other careers. It's not the 9 am to 5 pm, Monday through Friday job. It is very long hours, working holidays and it is working when the rest of the world is sleeping. 

I've had to make myself really work at making more of an effort to see my friends and family. That has been incredibly hard to do since starting night shift because I never quite seem to catch up on my sleep. I hope that I will soon find a balance between everything. Commenting on Joni's post, I tend not to make too many commitments, because I never know just how tired I am going to be. Which, I don't think that is working out in my favor because then I feel like I am missing out on life. I know that my career is not what completes me. It is the friends and family and all sorts of relationships that are there for you in the end. At the end of the day, its not very fun to be successful if you have no one to share it with.