Five years into my nursing career I felt like I had truly hit rock bottom. It was like the harder I worked, the more I felt like a failure. The expectations of nurses continued to grow, becoming unrealistic, nearly impossible. Because these expectations couldn’t be reached even over the course of a 12-hour shift, I left each shift feeling defeated. Over time the defeat led to burnout.

Today, I continue to wonder when nurses will be able to stop feeling like failures, after giving everything they have during their long 12-hour shifts. I wonder why the system fails us over and over. I wonder why repeated headlines about healthcare workers committing suicide due to the stress and guilt of the job, doesn’t spark a change in the system.

Over the last few years especially, we’ve been watching every hospital hemorrhage their staff. I worry how the rapidly declining supply of nurses will support the increasing demand for patient beds. The list of comorbidities that patients come in with is growing, increasing the acuity and complexity of patient care, yet the nurse-patient ratios continue to demand nurses take on more and more patients. As nurses, we work extra hard to try and make up for this, because it isn’t right for patients to be at the expense. Where does this leave nurses? Overworked and unsatisfied. It’s become more and more challenging to offer hope to our patients when we’re feeling so hopeless ourselves, and when it comes to oncology nursing, hope is what our patients need.

I’m sure you’re asking yourself now, why don’t I quit? Why not go find another job?

I believe that nurses help preserve the art of nursing. I’ve heard too many times that patients report feeling like a science experiment. Especially within the oncology patient population, tests and procedures are waiting around every corner. I believe that when patients feel that science has completely taken over their care, it’s their nurses who step in and remind them that they are still human. We offer an ear to listen, a hand to hold, a warm hug, or a friendly smile. We ask about their friends and families, their traditions, and their dreams. We don’t ever for a second forget that who’s lying in the bed in front of our eyes, is just like you and I, 100% human.

Even on the toughest days my heart tells me to keep fighting at the bedside so that I can continue to be a source of hope for all the patients that choose to fight for just one more day. Unless you’ve been there at the bedside, you’ll never understand what a special place it can be.

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Bone Marrow Transplant (BMT) nursing is a whole different world of nursing.

In the world of BMT nursing, patients report feeling imprisoned. As a BMT nurse, I understand where they’re coming from. When a patient comes in for their BMT they receive myeloablative chemotherapy. This destroys the patient’s bone marrow, making room for their transplant, or their new and healthy bone marrow. Bone marrow is the factory that produces the body’s white blood cells, red blood cells, and platelets. As a result of the destroyed bone marrow, the patient loses their white blood cells, red blood cells, and platelets. About a week after receiving the chemotherapy, all these counts drop down to nearly zero, also known as the nadir. Although this is expected after myeloablative chemotherapy, it comes with risks. During the nadir period, patients are at an extremely high risk for infection and bleeding. An infection that may be self-limiting in the average, healthy individual, can be fatal in the BMT patient population. For this reason, there are lots of rules in place.

Once the BMT patient enters their hospital room, they are prohibited from leaving the room until their counts fully recover. This can take weeks.  Anything they bring with them for their hospital stay must be screened by their nurse and wiped down properly. Their street clothes are removed and replaced with a hospital gown, and two sets of socks are put on. Once crossing the threshold of their door, the outside pair of socks are removed so that a clean pair remains. Food and snacks are allowed, but everything must be cooked thoroughly and individually wrapped/packaged. No takeout is allowed. Water must be filtered. No ice cubes from the unit’s kitchen is allowed. If a patient would like ice, we pour filtered water into medicine cups and freeze them in their individual freezer. Showering/washing up daily is enforced. Activity within the room is encouraged, but restrictions are placed. Physical therapy introduces exercises safe for BMT patients to perform at the start of their admission given their inevitable drop in blood cell counts. The toothbrushes in the hospital are not soft bristled, so we provide mouth swabs to our BMT patients to brush their teeth with. We prohibit alcohol-based mouth washes as these are too hard on the mouth, and provide a special fluoride toothpaste, in addition to mouth rinses that will help prevent dry mouth. Visitors are allowed, but there are visitor restrictions in place as well. No children under twelve, no one who’s been feeling unwell, or who has had sick contacts. We welcome gifts, but do not allow fresh flowers or plants of any kind. Unfortunately, we have to kindly ask for family and friends to leave them outside the unit if they arrive with them in hand.

We encourage our BMT patients to try and maintain some sort of routine from home, but with vital signs every four hours (at least), medications due just about every hour or two, blood and platelet transfusions, electrolyte replacements, education, daily showering, mouth rinses after every meal, there is little time for them to squeeze in any of their home routines. The fatigue that sets in following their chemotherapy, even prior to the BMT, makes even the act of getting out of bed to ambulate to the bathroom a daunting task. During their nadir, fatigue is often accompanied by lack of appetite, and nausea/vomiting, which leads to dizziness and headaches. If their symptoms put them at a high risk for falls, we then must place them on bed alarm to ensure their safety. If someone is on bed alarm, this means the patient must call before getting out of bed and must be escorted to the bathroom. In the BMT patient population, preventing a fall can be the difference between life and death.

As you can see, BMT patients are completely isolated. They are stripped of the things that mean the most to them. They have to put their roles as parents, grandparents, aunts, uncles etc. aside, take a leave of absence from their jobs, leave the comfort of their homes, and ask someone else to assume responsibility of their loved ones. All the normal daily errands like grocery shopping, cleaning around the house, laundry, and cooking must be put on someone else. Control is completely out of their hands. The milestones that they’ve been looking forward to for years must be missed, and less fortunate events like wakes and funerals, must be missed too. They watch these events through their phone screens because they can’t attend in person. They say goodnight to their kids via Facetime, wishing they could wrap their arms around them.

We call it protection, but when asked to describe their experience, many compare it to imprisonment. While our intentions are to cure and treat cancer, are we forgetting that the person lying in the bed, right in front of our eyes, is in fact human too? They have likes and dislikes, fears and goals, just like the rest of us. While we enter their room every day and ask them if they’re experiencing an extensive list of symptoms (pain, fevers, nausea, vomiting, diarrhea, etc.) do we stop and acknowledge their true feelings-the fear of the unknown, the fear of their transplant not engrafting, the fear of death. After receiving their BMT, these patients sit within the same four walls, for weeks, waiting for their blood counts to recover. I cannot imagine what kind of thoughts haunt their mind.  

As a BMT nurse, I really get to know my patients because they’re admitted for several weeks. While obtaining vital signs or administering medications, I try to learn about my patient. I ask them questions about their home life-their job, their hobbies, and their passions. I try hard to remember details, so that I can bring up things that are important to them when they’re having a bad day. I try to attend rounds with the care team so that I can make sure the patient isn’t being talked at, but with. I make sure if the patient wanted to ask a question, but is too afraid to speak up, I ask it. I remind my patients that how they feel and what they’re feeling matters. I strive to make them feel heard. I remind them they have a purpose by reminding them why they’re fighting. I do what I can to make sure above all, they feel human. As the world continues to make tremendous advancements in medicine, we must not forget the patient lying in bed in front of our eyes is 100% human, just like you and I.