I spoke with Mikaela Trites, Jessica Bennett, and Sarah Green, who work for the Nova Scotia Health Authority, about their work as oncology nurses, and their approach to patient care. This is an edited transcript.
Jessica Bennett
I've been a nurse for almost 19 years, currently at the cancer center and been in cancer care specifically for about eight years and otherwise have a background in medicine and palliative care nursing.
Mikaela Trites
I'm Mikaela, I am a newer nurse. I've been a nurse for about one and a half years. And I've been in oncology for about one year and had some student placements as well and oncology that first got me interested in oncology nursing.
Sarah Green
I've been nursing for over 25 years, 15 years in oncology and just varied experiences before that medicine, nephrology, different experiences. So yeah, I've been around a long time.
Golda Arthur
When you talk about how a patient heals from cancer one way or the other, what do you hold in the forefront of your mind as an approach to this?
Mikaela Trites
Well, I think that depends on the definition of health as well for the patient. Because for each person that might look a little bit different, it might look like them being able to keep up with their normal hobbies and see their friends and family or it might look like more of a pathological disease-free stance. So it really depends on the patient and the family as well. So I think we all try to keep that perspective in mind, in meeting the patient's needs, depending on what they're looking for, to kind of keep the patient at the center of the care and just have their best interests in mind.
Jessica Bennett
I would just add too in terms of healing in cancer in general, I feel like in most recent years, cancer can maybe be looked at more of a chronic illness and condition and opposed to an acute thing that's happening. So healing in terms of living with cancer, and for lots of people, I find it also includes meeting certain milestones in terms of timeframes or events that they're looking forward to.
Sarah Green
And I think for me, particularly in cancer care, as both Jessica and Mikayla have said, it is a chronic disease now, that's the way we look at it. And I think there's sort of no endpoint for me with healing. I think there's a lot of healing, but I also also think there's steps forward and steps backwards with cancer care. So I think we do a lot of healing, but then we're also doing some mending and then some healing again. So I think, you know, they come in for an appointment, for example, and they get a really good report that day, and then, we see them back in three months, and maybe we're taking a step backwards. So we're doing a whole different sort of healing and mending at that point. It's a continuum. And I think we take steps backwards and forwards all the time. So that's sort of how I look at that.
Golda Arthur
So - a marathon instead of a race.
Sarah Green
Yeah, it really is, I think. And, because it is a chronic disease, we do see a lot of sort of, like I say, step forwards and steps step backwards, and we sort of handle it wherever we are in that process, we sort of deal with it at that point.
Golda Arthur
What would you say from your point of view is the toughest thing to deal with with ovarian cancer among the many tough things that you can think of?
Jessica Bennett
I think sometimes it can start as very unpleasant physical symptoms, is in the top of my mind, that then essentially force somebody to feel very well most of their life and then all of a sudden, they can't do the normal things they do. Because they're physically not feeling great, that can trickle down to you know, impact and affect their whole lives in terms of how they interact with others or emotions or mental health. So of course, having said that, trying to optimize how they feel physically, and then hopefully, all those other things will fall into place and kind of kind of improve.
Mikaela Trites
I think another difficult aspect would also be for patients with ovarian cancer and their families to kind of cope and understand the reality of the situation and what that means and of course, everybody's in a different place and a different stage. But it could also be very difficult with their family and friends to kind of grasp and understand and help the patient feel seen and known among their friends. Because it does change things. And there is a new normal physically as well. So that's another aspect that can be difficult for the patients themselves.
Sarah Green
I think for me, it starts right at diagnosis. And I think I would be a rich woman, if I could say how many times I've met patients that have said that they knew something was wrong for a long time. And just that difficulty in getting that initial diagnosis, it would be wonderful if there was some sort of a regular screening for ovarian cancer. And we could pick these things up much earlier, because as Jessica said, we do often see women present with some of the symptoms of ovarian cancer that can be quite nasty to deal with. And we see them after they've had multiple visits to the emergency department or to family doctors, and it just sort of gets chalked up to be something else. So I find that really difficult to deal with. The other part, is when you go back to talking about a chronic illness. Well, that's, that's wonderful that women are living a long time with ovarian cancer, it's also hard, because they're sort of my feeling is that they often go from a good scan, and then they have this feeling of elation, and everything is good. And they tell me that it sort of starts the cycle all over where they're feeling really good, right after a good scan. And then you know, within a few days, they're sort of getting ready to prepare themselves for the next scan, or the next interaction, when is the next time going to be the time that I'm told it's back. And so they're often dealing with that anxiety, of sort of knowing the cancer is still there, you know, feeling really good, because it's sort of being kept at bay, but also the worry in the back of their mind that it is going to come back and when will it come back? So like I say, well, while being a chronic illness is a good thing, it can also be a very difficult thing to live with, as well.
Golda Arthur
And this is a, this is a tough question to ask, and I'm sure it's a tough question to answer. So I apologize for asking, but I don't know how you guys do what you do. Talking about patients being resilient, it seems like the resilience you must have to pull from from somewhere, is also pretty massive. What would you say is the hardest thing about your job?
Mikaela Trites
I mean, for me, I'm a bit newer, but I find it really tough to have other patients my own age, and you just get to know them so well, that you care about them, like they feel like my friends in certain ways. So it's tough to see them go through a tough diagnosis and prognosis. I have a lot of compassion and empathy for it, but I wish I could have more control over what happens to them. So it's a lack of control, for sure. And just offering the support that we can within our boundaries. And it is tough, because you really do get to know and care about these people. For sure.
Jessica Bennett
I would say, you know, end of life care and have no treatment option care, you're still definitely connected to those patients. And like Mikayla said, that kind of lack of control and nothing else to offer, physically. But again, we touch base, and keep in contact, I think really well as a group for sure, with those patients and help their transition, whether it be to palliative care or whatever, whatever be the case, we still play a role in that.
Sarah Green
I guess just to sort of echo what both Jessica and Michaela have said, I guess the really the hard part is when patients do sort of come to the end of treatment options, and you know that their disease has progressed and losing patients, I can still remember the very first patient I ever looked after, you know, when I started nursing over 25 years ago, and you don't forget people, particularly like I say, we're with cancer care, you're attached to patients and families for such a long time that you feel like you sort of become a part of their family. So that is really difficult. The other thing that I find difficult, I guess with if I may say, just healthcare in general, sometimes it's the lack of support. And I mean that from some of the constraints within the healthcare system, particularly in Canada, sometimes, that's frustrating, because we can only do so much and we would love to be able to do more, but sometimes there are just constraints within the system itself that prevent us from being able to is able to do that. But yeah, I think it really is just the loss of patients, a disease that is very, very difficult for me to deal with.
Golda Arthur
And so let me ask a follow up to that. Despite these challenges, which are considerable, you guys are still doing what you're doing. So why do you do what you do?
Jessica Bennett
I think at this point for me, as odd as it sounds, it just kind of seems natural at this point. I can't imagine doing anything else. I don't know. Maybe all the experience and an experience of this whole journey has taught me it just seems like second nature. I guess it's part of my identity at this point.
Golda Arthur
So what has it taught you?
Jessica Bennett
To be flexible, to be very fluid, be in tune with other people's needs and adjust my own reflections and thoughts. Taking what I'm getting from each individual patient.
Mikaela Trites
My story might be a bit similar to yours actually. But my mom as well went through cancer diagnosis, chemo, surgery, radiation and recurrent the whole process, and I was a bit younger when that happened just in high school. So it's really neat to be able to be on this side of things now and know what it feels like to be sitting on the other side of the chair. And just to know what the families feel like, and especially people with kids to be able to relate to what their kids might feel, or their partners, just seeing my whole family go through it. So it definitely feels rewarding for me, and also brings understanding to things I didn't fully understand before. And makes me appreciate the staff as well, and just the whole process that we have now. So that's a big reason I find it very rewarding. And, there's something special about the patients in oncology as well, I appreciate their outlook and positivity despite tough circumstances. So you actually get to know kind of, like Jess was saying, you learn a lot from the patients and you, you really appreciate how their outlook is and what they teach you as well, because you really do learn a lot being on this side of things.
Sarah Green
For me, I couldn't imagine being anywhere else, at this point. In my career, I've done a lot of different areas of nursing. And for me cancer care has by far for me been the most rewarding experience that I've ever had. I love patients, I love getting to know them. I love just sitting and being able to chat with them. And we always try to start our appointments with things other than their cancer, you know, like what is going on in your life? How are your children, you know, visits with grandchildren, I always try to start my conversations with something that's just not cancer related. And often we get off on tangents. And we realize that, you know, we have five minutes left to do the actual clinic part. But it's just been the most rewarding experience for me in my entire career. I also think the other part is that we have, I think, nurses that are in cancer care - we're just so well supported by each other. So and particularly, I can talk about gynie oncology, because we are a pretty close knit group. And we can always bounce things off each other. If one of us is having a bad day, we can sort of be there to support each other. We have a very good team. So I think that is sort of one of the other reasons that I've stayed as long as I have.
Jessica Bennett
I would just add, specifically to ovarian cancer patients from personal experience and being here, as a general rule, those patients are so resilient. They know, in the back of their mind, even if they feel fantastic, and they're living their best life, you know, chances are at some point, this is going to come back and to see, the same patient come back and be disease free or feel really well for so long. And then all of a sudden, you know, on their regular checkup, they’re told their disease is back and they need treatment, they just take it with such grace and dignity, they’re a really unique bunch of patients.