Nurses have a unique role to play in the lives of patients diagnosed with cancer. In the November/December 2012 issue of Registered Nurse Journal, the flagship publication of the Registered Nurses’ Association of Ontario (RNAO), Melissa Di Costanzo looks at the experiences and views of several nurses from different vantage points. This excerpt looks at two of those nurses. Morgan Lincoln is advocating for environmental policies that will have widespread consequences for all Ontarians. Grace Bradish works directly with patients in palliative care. They are among the thousands of RNs who are doing amazing things to help those dealing with this pervasive chronic disease.
Morgan Lincoln knows the devastating effects cancer can have on a family. Her aunt passed away from leukemia at the age of five. Her grandfather died of a brain tumour when she was 10. And in 2009,
Lincoln’s mother learned she had breast cancer. After her mother’s diagnosis, Lincoln began her nursing degree at the University of Toronto. She had an interest in environmental health and noticed cancer prevention programs focused on maintaining a healthy, smoke-free lifestyle. Early screening was also offered as a pre-emptive tool. While these messages are important, they “generally eclipse environmental factors, such as air pollution, or toxins in consumer products,” says the Toronto native and president-elect of RNAO’s Ontario Nurses for the Environment Interest Group (ONEIG).
According to the Canadian Cancer Society, harmful – or potentially harmful – substances include: non-stick cookware, arsenic in drinking water, pesticides and radon. Environmental risks include: radio frequency fields and medical radiation. Lincoln believes stronger regulations around carcinogens need to be created and enforced at the federal, provincial and municipal levels. Nurses, with their holistic view of health, are in a strong position to advocate for cancer prevention politically, she says. In fact, ongoing political activity by RNs will keep these environmental risks top-of-mind for policy makers, she adds.
The majority of work ONEIG is currently focused on aims to do just that. Three ONEIG resolutions – all linked to cancer prevention – were passed at RNAO’s 2012 annual general meeting. The group has urged RNAO to support policy that will: reduce vehicle idling, including drive-through emissions; ban the mining, processing, use and export of all forms of asbestos; and reduce the risk of exposure to carbon monoxide and nitrogen dioxide due to emissions from ice resurfacers in arenas. ONEIG is pushing for these changes so Canadians can breathe easier, but its work is not limited to these resolutions. In the fall, the group organized a Greening Health Care event, where sustainability initiatives in place at Toronto’s University Health Network were discussed. RNAO and the Canadian Nurses Association have also passed ONEIG resolutions related to the amount of lead children are exposed to.
Lincoln says few people realize how closely their health and the environment are linked, which is what drives her involvement with ONEIG. “They’re inextricable,” she says, suggesting peoples’ lack of understanding may relate to the lapse in time between exposure and the onset of disease. Breathing air polluted by diesel exhaust, which has been labeled a carcinogen by the International Agency for Research on Cancer, is exposure, but some people may not be diagnosed with cancer until years later, she explains. “We can touch a stove and see a blister or burn right away. This is like constantly touching a hot stove, or being in a toxic soup, but not seeing the effects until way down the line.”
In the fall of 2011, Lincoln was completing a placement in oncology at Toronto’s Princess Margaret Hospital. One day, she learned two people on the unit had been diagnosed with mesothelioma – a rare cancer primarily caused by asbestos exposure. She was surprised to hear that two patients were living with the same uncommon cancer. When it comes to cancer prevention, this is “a warning for what’s potentially to come if we don’t get serious (about protecting our environment).”
Grace Bradish has provided care for hundreds of patients over her 35-year nursing career. Few have had the impact on her that Rob Fazakerley and his wife, Jen, have. “I tell my patients on a daily basis: my job is to help you find joy in living today, because I can’t tell you what’s coming tomorrow,” she says. “Jen and Rob really lived that (philosophy).”
Bradish was the home-visiting nurse practitioner at London’s South West Community Care Access Centre assigned to Rob’s care when he was diagnosed with terminal pancreatic cancer in August 2009. He was only 46. She’s also the co-author of a new book called Just Stay, a novel about Rob and Jen’s last months together.
After his diagnosis, Bradish met numerous times with Rob, his wife, and spiritual care specialist Helen Butlin-Battler to discuss Rob’s care. When the London NP was not available to meet in person, or if Jen had an urgent question, she exchanged emails with the couple. Often criticized as an impersonal way to communicate, Bradish says emailing is a fast, effective method that can be used to supplement in-person client care. Jen asked Bradish for clinical advice – many times via email – right up until Rob’s passing in September 2010. “She would email me with a question: ‘Is this normal?’ ‘What should I do?’” recalls Bradish. “I could respond almost instantly…and she could choose when to open (the message).” Bradish even learned of Rob’s death via email because she was out of town at the time. The message, she admits, was tough to comprehend. “I warn families about this: that regardless of how much they’re anticipating…that final breath, that absence of pulse carries an element of shock and surprise that one can never anticipate,” she says. “(When Rob died) I felt that.”
A few months later, Bradish gathered together 300+ emails she had exchanged with the couple and Butlin-Battler. She sent them to Jen, and talked to her about the wealth of her experience. It could be beneficial to other patients, families and health providers, she said. Discussions ensued, and the idea for Just Stay was born. For two years after Rob’s death, Bradish, Butlin-Battler and Jen collaborated on the book. All three were first-time authors, and the writing experience, Bradish says, was very powerful.
The book, which, in part, is a reflection of Bradish’s approach as a palliative care nurse, was released in September 2012. Bradish hopes it gives readers “confidence that, despite a (loved one’s) departure…there will remain a significant presence with those whom they loved.” For health-care providers, her wish is that the book “releases them from the awkwardness that we all experience in having these very difficult conversations with people. We are so afraid to use the “d” word, and yet, death is what makes life so terribly precious.”