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Is that what you were expecting to hear?
“Why did you become a nurse?" my husband asked me. “To help people get better” was my immediate, no nonsense, honest and standard reply. He raised an eyebrow as only a husband can. In a, this is me not an interview raise, adding “you are a cancer nurse, do many get better?”
Nice isn't it when the man you love, have married and had children with can still surprise you. Nudge that dusty corner of your identity that is just so ingrained you don’t question it. Why did I become a nurse, at seventeen all those decades ago, getting people better was the reason.
Why am I still a nurse is probably a better question now I am aged and wise. It has evolved as is right. I am not seventeen, I have different life experiences and skills. Some are better than the seventeen year old student nurse, some are not.
Over the years of work I have met people who inspired me from patients, to nurses and doctors.
One doctor piqued my interest in cancer, the nature of it, occasional hopelessness balanced with his necessary optimism. Another nurse invested in me and I hauled myself through a degree in nursing. No more money or promotion for the five years of part time study, money was never why you became a nurse. What I learned about cancer cells, treatment side effects and communication is essential.
Our children were born and I looked with an altered heart at patients, those leaving children, I could not fix that. New doctors. I had been around awhile now. White coats were going and first names coming in. I met a colleague who became a dear friend and an inspiration. That is joy in any walk of life, in this role a lifesaver.
You have a dark sense of humour working in a cancer department. Please do not judge us. We are not laughing at our patients we laugh with them a lot of the time which is surreal and necessary. When you spend hours in a room watching people be shredded by the information we give them, you need to laugh. Soaking up peoples pain, loss, anger, anguish, fear, terror, hopes, dreams, reality and agony, sometimes you need to laugh.
That is when I realised that what I liked was giving people information. Information became knowledge. Then hopefully, understanding and control. Communication is the skill I see some doctors now excel at. It is an art, as medicine is. I see them tailor their knowledge and present it with care for each family I see come into our rooms. Rooms with their bare walls and hard chairs. To watch thoughtful communication in clinical practice is powerful.
It will go wrong on occasion and that is because we are all individual human beings. Not being dimmed by the errors is necessary, learn from each time. Conversations are wisps of us, most are full of cliches and underpinned by self preservation.
A writer I admire Atul Gawande has written a book and I am too scared to read it. I think it is an important book. It is called “Being Mortal” and is about talking with people about their illness and what is important to them as they come towards death. Honest, hard conversations, emotionally draining and giving of oneself to help people with momentous decisions. Is more chemotherapy worth the side effects and time it will take to give? I have listened to him interviewed. I recognise in him, the work I have seen some doctors put into their relationships with patients and their families and how vital it is.
One question I ask patients after their consultation is, "Is that what you were expecting to hear?" It was a way of instantly assessing where they were after seeing the oncologist and where to start my information from. We need to start asking patients more questions.
What I think is important now is a national conversation on death. Death is normal and needs to be talked about. This is not to do with asking dying people about euthanasia or filling in paperwork. It is about a change in society. Recognising medicine has not stopped death. We need to discuss with each other as families and health-care professionals not how do you want to die but what do you want to do with the rest of your life.