It Comes In Waves

One of the realities I am learning about oncology nursing is that our relationships with patients feel like emotional tidal waves.

Many of our patients come and go in cohorts – some have one or two relatively minor complications for which they are hospitalized, they recover, they go into remission and we don’t see them for months or years, or maybe never again. Some are cancer survivors multiple times over – I’ve met folks who have histories of separate diagnoses dating back decades. There are many who testify that they “shouldn’t be here today” – that the odds were never in their favor and yet they overcame those odds. This terrible disease has changed their lives but they’re still living. The waves may have been violent, but the tides have receded. We celebrate with them.

And then there are the patients who return to us again and again. Each time we see them, they are doing a little bit worse. Each time we see them, we know it is usually a bad sign. Either they’re struggling with chemo and need to be hospitalized to manage the side effects or protect their fragile immune systems. Or they’re suffering one complication after another – either the treatment is killing them or the disease is progressing beyond our ability to control it. And each time we admit them, we wonder if this will be the last time. We see the telltale signs begin to appear. We wait for the inevitable conclusion, both praying that we won’t be working because it will be too painful to lose them and hoping that we are working because we want the chance to say goodbye.

Many time these losses occur in clusters. Suddenly our “regulars” start getting sicker, and then we seem to lose them all at once. It feels like the end of an era.

I think back to my dad’s own series of hospitalizations near the end of his life. Intractable nausea, vomiting, pain. Worsening labs. Increasing doses of opiate medications. I think about those beloved nurses who saw us come back again and again and I wonder if they knew. I know they knew.

As nurses, we dread these times because we know when they are starting. The readmissions begin to pile up and we see the treatment goals change. We see chemo get cancelled. And then we see the “Refer to hospice” orders. The DNR bracelets are placed. Patients and families tearfully tell us that they’ve had “the talk” with the doctors – there’s nothing more to do. No more options.

This is when our work becomes even more important. Each shift becomes a delicate dance of waiting, of wondering if this will be the last time we will see them. Of offering physical, emotional, spiritual comfort. Of wanting to find the right words, but not wanting to be morbid. Of wanting to spend moments with those wonderful people, but wanting to give their families peace and space – placing “Do Not Disturb” signs on doors, and aiming for continuity in their caregivers. Becoming protective of their time because we know how precious it is.

And then we go home. We come back the next week and they’re gone – discharged to hospice or passed while we were away. We Google obituaries and talk about them as if they were family, because in a way they were. We hold private memorials by honoring their what they meant to us. We grieve privately and sometimes not-so-privately.

The tide gradually passes and another generation of patients arrive. We hope they will be the survivors. We know many of them won’t. We know the next wave is coming.

Oncology nursing is the most gratifying and devastating work I will ever do. Easing the way for others, wherever the waves may take them. What an incredible gift.

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