May 2, 2014

My Intro into the World of Oncology Nursing (Memoirs of a Cancer Nurse)

When Garrett and I first moved to Texas after getting married, I got busy looking for my dream job as a Labor and Delivery nurse.  Those jobs are hard to find, even in Houston, Texas where the Houston Medical Center (the largest medical center in the world) is so large with its 21 hospitals and 54 medical-related institutions that it has its own skyline.  I did manage to find a night shift position in a small hospital in a very run-down suburb of Houston.  I was told that my average patient would be a teenage, single mother with a myriad of health problems and often very little family support.  I noted the multiple security guards to that wing of the hospital and later learned of their necessity to keep angry and violent baby-daddies at bay.  Um, yikes!  Not really the dream L&D job I had in I kept searching for jobs and putting in applications.  

One day I received a phone call from a HR representative from MD Anderson Cancer Center saying that there was an opening for a nurse's position on P-12, the hospital's clinical trial floor.  This hospital is so large that most of its 12 floors (I believe they recently added 2 more floors to the top) are reserved for a specific type of cancer patient.  There is the breast cancer floor, the sarcoma floor, the bone marrow transplant floor, the leukemia floor, etc.  P-12 was the floor reserved for patients undergoing clinical trials--chemotherapies and treatments that were not yet mainstream and still being tested for effectiveness.  During my job interview I was told that I would likely give chemotherapies that had never been given before and see things and cancers that few people ever see.  It sounded challenging and not necessarily like my dream job, but it was
MD Anderson--the world's #1 cancer hospital--how could I turn down such an amazing work opportunity?!
I started right away. 

I went through a week or two of orientation, learning how to administer chemotherapies carefully while wearing a gown, double gloves, and safety goggles.  Chemotherapy, after all, is a poison and great care has to be taken to not be exposed to it unless you are the one supposed to be receiving it.  It know.....give you cancer.  And no, the irony is not lost on me.  After orientation, I began my first day of orientation on the floor.  I was lucky and got a gem of a preceptor nurse to teach me the ropes (Brandi, you'll always be my mama ;))
As we got our assignment that first morning I noted our patients' diagnoses and reasons for admission to the hospital: 
~ stage 4 colorectal cancer with mets. to the liver, admitted for intrahepatic chemo 
~ osteosarcoma of the femur, admitted with FUO (fever of unknown origin)
~ multiple myeloma, admitted with neutropenic fever
~ stage 4 colorectal cancer with liver mets, admitted for intrahepatic chemo

I quickly discovered that I would be treating A LOT of stage 4 colon cancer patients (with secondary tumors in the liver) and administering a lot of intrahepatic chemotherapy.  This clinical trial treatment entails the patient going to the OR and having a catheter placed in their groin and threaded to the hepatic (liver) artery in order to deliver chemotherapy directly to the blood supplying a tumor in the liver (colon cancer often spreads to the liver, and these secondary tumors in the liver are hard to treat and get rid of).  The patient then spends the next day or two flat on his/her back receiving chemotherapy through this catheter, remains in the hospital for a few more days for observation before going home, and then returns several weeks later to have the same process repeated.  I would quickly discover that these patients who were admitted for treatments at least once a month would become as familiar and as close of friends as my co-workers, which made it all the more hard when they eventually became too sick for treatments, stopped coming, and we later would receive word that they had passed away......  

At the end of my first day on the floor, my preceptor and I admitted another patient who would be receiving her first round of intrahepatic chemotherapy.  She had flown across the country to come get this new treatment.  We got her settled into her room and into bed for the evening when we began asking her all the usual questions to get her admitted to the floor.  She began to tell us her story: she had been having odd hip pain for about a year that her doctors had been treating with steroid (anti-inflammatory) shots and pain meds.  Finally she asked her doctors to look a little deeper for a cause of pain and asked to have a CT scan.  They obliged her and a CT scan revealed masses in her hip that had spread from an initial tumor in her colon.  A PET scan showed another large mass in her liver.  She had stage 4 colon cancer.  Initial treatments showed no decrease in the size of the tumor in her liver, so she was referred to MD Anderson to begin the intrahepatic chemotherapy.  At this point in her story, she grabbed my preceptor's hand and with tears in her eyes, pleaded, "Please help me.  I have an 18 year old daughter and a 10 year old son waiting for me at home.  I cannot die.  Please, I just can't die yet."  
My world was rocked. 

That was my first exposure to the overwhelming world of being an oncology nurse on a clinical trial floor.  
 My eyes had been opened to a world where college students, healthy young mothers and fathers, high school teachers, busy lawyers, FBI agents, and young grandparents were all battling cancer that was so progressed and unresponsive to the traditional and gold standard treatments that their only option left was to come here and try out the new clinical trial drugs that MD Anderson had to offer.  Many of them were so young and had so much to live for that they were willing to drive for hours, fly across the nation, or even fly across oceans in order to come to see if a clinical trial therapy could cure them or even give them a little extra time.  
 It wasn't long before my psyche was convinced that everyone had cancer or was going to get cancer, and it wasn't long before I understood why the staff on our floor had easy access to a therapist who would come to our floor and counsel with us if needed.
Oncology nursing can really kick you in the emotional and psychological rear!  
When I was hired, I thought that this job should be easy-peasy in comparison to the ICU job I had just left.
I was wrong. 
It takes a tough-as-nails yet sweet-and-gentle person to be a cancer nurse, and I had a lot to learn and a lot of praying to do in order to hope to become that kind of nurse.

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