Andrew Becker: A quick note before we start. The content in this episode should not be considered to be medical advice and no physician-patient relationship is implied.
Speaker 2: Have your attention please. All clear on the Code Red. I repeat, all clear on the Code Red. Thank you.
Diana Kott: Hey Janet. We have an add on today for Dr. Kutikov. It's a left nephrectomy.
Janet Kollman: Oh, really? So we're going to be doing that laterally. Is he doing it-
Andrew Becker: That's Janet Kollman, an OR nurse at Fox Chase Cancer Center.
Diana Kott: Well, the patient's in DRU right now, so he's…
Andrew Becker: Although Janet's been a nurse here since the early 90s, her work is anything but old school.
Janet Kollman: Obviously I specialized in oncology, but I do all kinds of surgeries. I guess my heart belongs to robotic surgery, probably.
Janet Kollman: I would suspect there's a bleeding issue, so we better call the blood bank and get some units of blood ... Type and screen, type and cross match. All right, we'll take it from there. Let me go find the DaVinci.
Janet Kollman: Robots are being used for a lot of things. It started out as a urologic tool, and now we use it for gynecologic surgeries, general surgeries, head and neck surgeries, and thoracic surgeries. It can do a lot more than the human hand. Where the regular wrist has limited motion, this has a motion that a human wrist could never do, and the instruments are interchangeable. There are little tiny instruments that can squeeze into very small incisions and get into places that we previously could not have gotten to ... With ease, anyway.
Andrew Becker: While her interests are in technology, it's the human connections that keep her coming back.
Andrew Becker: Everyday, our waiting rooms, laboratories, and clinics fill up with people searching for something ... To take care of others, to find the next big breakthrough, maybe just to feel like themselves again. This is Connected by Cancer, the podcast of Fox Chase Cancer Center, that's all about that search.
Andrew Becker: I'm Andrew Becker and each episode we explore these connections together. Today, we'll talk with a few of Fox Chase's 791 nurses to learn what it's like to spend a career caring for cancer patients. We'll hear how patients have shaped the way some nurses do their work, how they handle the inevitable tough moments, and how patients sometimes influence their lives outside the hospital. For Janet Kollman, it began with finding the right fit.
Janet Kollman: I've been here for 28 years, and a nurse for 30. I actually worked in a big trauma center in the city, and loved it, but the hours were a lot tougher. Then I went to a community hospital and I was bored. Then I came here and I thought, wow, I get the big cases, small cases, a nice diverse type of surgeries. And then I learned, probably, the thing that has kept me here for so long, and that's oncology. At first, I thought that oncology patients, that it would be a very sad atmosphere, and I found that it's the exact opposite. There's no better patient than an oncology patient for me, because they want as many tomorrows as possible and so they're the most compliant. Just the best patients to deal with. No two surgeries are ever the same and it's always exciting, it's always fun.
Janet Kollman: We get people when they're, I believe, at their most vulnerable. I try and figure out, according to somebody's age ... If they're joking, I try and take them individually. Sometimes it's with humor, I might talk sports with them if I see an Eagles tattoo or something like that. That's probably one of the best parts of my job, because I like that challenge and they need us intensely and we're there for them. We're their eyes, we're their ears, we're everything for them while they're asleep. We will get them through this.
Andrew Becker: While Janet loves the fast pace of the operating room and the challenge of creating quick but meaningful connections to our patients, Nurse Educator, Diana Kott recalls a bond she built over time with a patient who helped shape her as a caregiver.
Diana Kott: I had a patient - This was when I was a new nurse. I was maybe a nurse for six months. He had told me ... I had had him for a couple of nights in a row, so I had a lot of continuity of care. I was really with him. I knew him, I felt, in a nice way and he told me ... It was right before Thanksgiving. He told me he had no family to celebrate it with. He was a DNR, so that means "Do Not Resuscitate". Not that he was impending death, but he had cancer. He was no longer getting treatment for it. He just said, "I have no one to celebrate with." Maybe he made some bad decisions in his life and he was just kind of confiding in me. I remember, we got him washed up before going to bed, I gave him a little bit of pain medicine, and he was so comfortable. I went and I took care of other patients.
Diana Kott: I came back 30 minutes later, and he had passed away in his sleep. Now as a brand new nurse, I thought, "Oh my God, that five milligrams of pain medicine killed him, that tablet." I was so upset and everyone said, "No, no, of course it didn't." That made me sad initially, and then I had someone sit down with me and say, "You made him so comfortable. You let him talk about all of those things that were sitting on his heart." After he passed and we called his next of kin, ten people from his family came to sit with him. I just thought, I hope that he is looking down at this and realizing he did have somebody there. He did have people that cared. I mean, they were crying, they were sad that he had passed. It was the night before Thanksgiving. It was really ... It was a beautiful thing because I think that it makes you realize people have this sense of themself, that maybe they're not good enough or not worthy enough of something. He had all of that.
Diana Kott: At least at the end, maybe he didn't realize that before he passed, but he was able to get that out to somebody. Even just this brand new nurse sitting there with him. I just let him talk about it. That was a really nice moment for me and it made me start to reevaluate the way I took care of people because I was a brand new nurse and I thought, Oh my gosh, I was so worked up about it. And then after some days of thinking about it and sitting with the thoughts of it all, it made me feel a lot better. When you're in nursing school, you have this idea, I think, in your head of what you're going to be doing and then you get out there and you're like, "Oh my goodness, this is so different."
Diana Kott: It really made me look at everyone in the world very different. I'm in the grocery store and I think, "This person's being so rude", and I'm like, "But if you were my patient, I wouldn't care. I'd take such good care of you." I think about those things all of the time, so I try to be more patient in that way. I think nursing has made me a very patient person because you have to be. And as I'm saying it, I'm thinking "patience" and "patients", but it really is a very stressful job. You are constantly running around. I give any nurse out there in the world major props because it's a very difficult job to be compassionate and work that 12 hour shift and keep that same straight face and be happy. This is the scariest moment of somebody's life and this is just your every day.
Andrew Becker: [inaudible 00:07:09] grew up in a family of nurses.
Kara Itoss: Overall, I would say probably a total of 12 nurses in my family, including aunts and uncles and my mom and my sister, as well. It runs deep, I guess I would say. Yes, yeah.
Andrew Becker: She started on her path to nursing before she even started high school. Now, five years into her career, she has no doubt that caring for people is her calling.
Kara Itoss: I'm a Preadmission Testing Nurse for the peri-operative suite. Primarily, we are the first stop for patients coming in for surgery prior to admission. It's really nice for me to be able to talk to patients at a point where they're getting ready for a procedure. There's a lot of hope that their quality of life will go up or what they're going through right now might be changed via this surgical procedure.
Kara Itoss: Growing up in a family that was in a lot of service professions, from teaching to mostly nursing, to not have the ability or capacity to help people made me feel helpless, in a sense. To be able to help people and also connect with people is really, really important for me. I've been working in hospitals and volunteering since I was 13, so it's essentially just been a build up of, a matriculation of, experiences that led up to now. I think it's just always what I've anticipated to be. People coming in are very vulnerable. I think overall, it's just reverting back to what I said in regards to meeting people where they're at. It might be just maybe ... Were they traffic today? Was it just a stressful day in general? Literacy level? There is a lot of different factors playing in, but you just get a feel of where everyone's at and just look at the best way that you can help that person at that time, at that moment.
Andrew Becker: Janet White recently celebrated her 43rd anniversary as a nurse at Fox Chase. Naturally, she's mastered many facets of nursing, but she's also learned that some lessons don't come easy.
Janet White: I tell you, there was a time when I was working in ICU that there was a patient who had six children. The day he passed away in the ICU, he was by himself. I can remember I went aside and started crying, which I'd never done that before, but I just thought it was so sad that he came from a large family, he had all these children, and yet, he was by himself when he died. It was during the day, maybe that was part of it. People are probably in their own lives at that time. But you know, it just struck me that even though we all have different types of circumstances, you come into this world alone and you leave alone, and that's really true.
Janet White: I think experience gives you the compassion. I think that's probably the hardest thing to learn, because when you're young, you don't understand a lot of the things that people have gone through. It's like, you have to walk a mile in my shoes to understand. As you age, you've experienced some of these things yourself and now you have developed the compassion for a lot of the issues that people go through.
Andrew Becker: We'll be right back.
Speaker 7: Cancer advice from someone who knows.
Barry Taitelman: I'm Barry Taitelman, kidney cancer survivor. I had stage four kidney cancer. The statistics weren't good for me, but I underwent a very specific combination of surgery, chemotherapy, and cutting edge immunotherapy, which saved my life. I was in a position to survive because I was at Fox Chase. They're on the forefront of what's going on in cancer treatment.
Speaker 7: Where you start matters. Fox Chase Cancer Center, 888-369-2427.
Tracy Tusown: "Hi, may I speak with Ms. Martin? It's Tracy, at Dr. Borghaei's office."
Andrew Becker: Nursing is a multisensory proposition, but at the Fox Chase Phone Triage Unit, nurses are limited to just one sense ... Listening.
Tracy Tusown: "You're just having a bad day?"
Tracy Tusown: I don't even have to say my name half the time. They know it's me when I call.
Andrew Becker: Nurse Tracy Tusown spends her days assessing patients by phone and determining each person's next step. She has learned that careful active listening is a powerful tool to help patients.
Tracy Tusown: I worked in the clinic for a long time and my boss was trying to expand our phone triage center. I actually developed a latex allergy and could not work in the clinic anymore, so I kind of slipped into this spot and I've enjoyed it. I've been here probably 14 or 15 years now. I really enjoy it. It's a different side of nursing, but I think the relationships we build with patients on the phone are really strong and the patients really look forward to having that nurse there, especially when they know it's you. It's the same person each time. You build a relationship with them and their families. I think it's beneficial for both.
Tracy Tusown: It is quite a different way to deal with patients. It's learning to assess people without your eyes. You're learning to hear things that you might not normally hear or noticing if someone you talk to daily that there's a difference in their voice today ... They may be more short of breath you can hear pain in someone's voice that you know. It's different little things that you have to be a little more attentive to because you aren't in front of the patient. I guess you have an idea of what a nurse is going to be from TV and things you hear, and I don't find nursing to be that. I find it to be ... It's very ... There's a lot of different aspects that you might not expect. Things that, and I think on TV, you'll see the technical part of things. You don't see the more emotional side or the relationship side of things, that these bonds that you build with people and you take with you through the rest of your life.
Tracy Tusown: There's always someone who's gonna stick with you. The person I'm thinking of was very young and had a young family when they were diagnosed. I think I was around the same age starting my family. It was a younger gentleman who was married, had two children, small children. His parents were there every single day. His brothers were there every single day and you get to know the family as well as the patient. They kind of look at you as part of their family at some point, if someone's there for an extended period of time. I happened to be pregnant with my child when I was taking care of this patient. Sometimes, I think about him, this patient, at times when I am really experiencing something joyful with my child. I think, this is why I want to make sure I remember these moments.
Andrew Becker: Debbie Baldessari had a very similar interaction with a patient.
Debbie B.: If they walked into the room together, I would pick them out in a heartbeat.
Andrew Becker: And just like Tracy and so many other young nurses, she said the experience changed her forever. For Debbie, the lesson might be you can never have too much family.
Debbie B.: One patient that has changed my life was a young person who was diagnosed with cancer, and came in every day just living that day to the fullest. Not looking back, had small children, had a wife, he always had his kids sit in the bed with him. They were three little children, like toddlers, so they always sat with him in bed. He wasn't one that would push them away. All three daughters had the long hair and they always came in prim and proper and nice and neat ... But by the time they left, because they're wrestling with daddy in bed, they were all disheveled looking, and you remember that. Whatever nurse was caring for him was always included. They would bring in coloring books and activities for the girls to do. One of them always inadvertently accidentally hit the call bell. If you walk in, you see a nurse in there coloring with the girls.
Debbie B.: He was very much including their children. They were young, they didn't really know what was happening, they just wanted daddy to get better. We never had conversations with just him. His wife was always there. He always included her. He spent as much time as he possibly could with his kids, with his wife. It was definitely his support system. He had parents, she had parents, but at the time, he just wanted his daughters and his wife. They were our family. We always said, we had a work family and we had our own family. The two never met, but it was very special bonding that we've all had with our oncology patients.
Debbie B.: I often reference him in many education programs that I give because of his outlook. He was so thankful for everything. I do, I see myself being more aware of my surroundings, the people in my life. I thank them for it because I wouldn't be where I am today without every patient interaction that I've had. I think I matured as a nurse and a person because he kind of opened my eyes to, yes I have cancer, but there's so much more in life going on that I really need to pay attention to it.
Anne Jadwin: I think intelligence, compassion, moral integrity, a strong sense of ethics, a sense of humor. I think those are some of the main things that we look for. It's interesting because we can teach smart people to do the technical aspects of the job. What's harder to teach is compassion. A lot of what we're looking for when we try to hire people is somebody that has that intrinsic quality that they really want to care for others and that they're members of a team.
Andrew Becker: So it says Anne Jadwin, Vice President of Nursing and Chief Nursing Officer at Fox Chase. As the approach to cancer care has evolved in recent decades to focus more on the patient experience, nurses have been key players in those changes.
Anne Jadwin: We've done a lot of work to really ensure that our patients have a good experience. I'd say years ago, there was more focus on what was convenient for the clinician, and now it's really about a patient and family centered approach to care.
Andrew Becker: As you know, Fox Chase is an NCI designated comprehensive cancer center. I'm wondering what role nurses bring to bear in that designation.
Anne Jadwin: I think patients, when they seek care at an NCI cancer center, expect that they're going to have top physicians, but they also should expect the highest quality of nursing care. Paying attention to outcomes of care, reducing the risk of infection, making sure that patients have a safe experience and that nurses are very well grounded in customer service are important. I also think that nurses at NCI cancer centers also need to be visible in the larger, either regional, national or international, cancer scene because just as our medical staff colleagues would be expected to do that kind of outreach, we have the expectation of our nursing staff to to do that as well.
Andrew Becker: Let's talk about Magnet for a minute. Just explain what Magnet is and why it's important and why it's important to us as an institution, but then also to patients who seek care here.
Anne Jadwin: The Magnet designation actually started in the late eighties. They were noticing that there was a nursing shortage nationally, and so a group of nurse researchers wanted to understand why some hospitals seem to be thriving during this time and had no trouble recruiting staff and other hospitals were really struggling. They did some interesting study to look at some of the characteristics, and they were looking at things like a flattened management structure, staff empowerment, exemplary practice. They looked at leadership characteristics of staff and they found that these hospitals seem to have the type of work environment that really promoted exemplary nursing practice, and one in which nurses really thrived as professionals. They came up with this set of criteria and the first Magnet hospitals were actually accredited in the early nineties. Fox Chase was actually a early Magnet hospital. We were the first NCI cancer center to get Magnet designation, the first specialty hospital in the country, and the 19th Magnet hospital to receive accreditation nationally. That was in 2000.
Andrew Becker: I just want to wrap up by asking what advice would you give to somebody who was trying to start a career in oncology nursing?
Anne Jadwin: I think that's a good question. I think that because you become so closely involved with the patients and their families, that it's important to not lose sight. That even if the outcome is not a good one, that you can still feel a sense of personal satisfaction and reward from being there on that journey. There's some discussion in the literature about compassion fatigue or cumulative grief and I think people that are in oncology for the long haul have to figure out emotionally how they can still be very connected with patients and their families, but yet have that sense of self that you can still feel resilient and positive in sometimes a disease in which the outcomes are not what we would like.
Andrew Becker: Thank you very much.
Anne Jadwin: Thank you.
Andrew Becker: Connected by Cancer is the podcast at Fox Chase Cancer Center and it's produced and edited by Joel Patterson and me with help from Jonathan Pfeffer. Thanks to nurses Debbie Baldessari, Kara Itoss, Janet Kollman, Diana Kott, Tracy Tusown, Janet White and Anne Jadwin for sharing their stories with us. Thanks also to Blue Dot Sessions, who provided us with music, and to Rocket Summer Productions.
Andrew Becker: Subscribe to Connected by Cancer in Apple podcasts, on Foxchase.org, or wherever you listen. And remember, the content of this episode should not be considered to be medical advice, and no physician patient relationship is implied.
Andrew Becker: I'm Andrew Becker, let's stay connected.