It was sometime last year when I was contacted by a woman who had just been diagnosed with breast cancer. Her name was Barb. She lived in a small mountain town in Pennsylvania. She contacted me on the recommendation and encouragement of her daughter, who had done some research on the breast navigator role at the University of Pennsylvania (UPENN). That happens to be my role at the Abramson Cancer Center at UPENN. Barb and her daughter knew they wanted to come to the city after this diagnosis. That initial phone call and contact took great courage. As Barb has shared with me, she was scared. We know it is human instinct to fear for your survival.
My career has been dedicated to the patients. They are the center of what I do and believe. They are the reason for what I do. I often ponder if nurse navigation is sometimes out of touch with the patient’s journey. So many emotions come with that cancer diagnosis. It is true that navigation breaks down barriers, thereby impacting a patient’s outcome. Sometimes our interaction with the patients is mostly by phone. Barb brought me back to my belief as an oncology nurse.
When I answered Barb’s call, we connected immediately. She wanted to hit the “go” button and get this breast cancer taken care of as soon as possible. She told me her story about how the diagnosis was made based on a mammogram. A radiologist called to tell her she had cancer. The “brakes were hit,” and Barb said she froze with the information and diagnosis. We talked for a while and then built her treatment timeline. I was able to look at the appointment she was given to see one of our oncologic breast surgeons. I thought the appointment could be moved up to an earlier date. I asked Barb to give me some time so I could discuss the scheduling with the staff. Sure enough, the team agreed with me, and an earlier appointment was made. I verbally prepared Barb for the appointment. We discussed where she should go, who should be present with her, and what questions to ask. Barb also wanted me there. We decided to meet a few minutes before the appointment.
It was a pleasure meeting Barb. She came with her lovely daughter, who was the reason Barb contacted me initially. It was that face-to-face meeting that made the connection real for both of us. Barb was given the green light to move forward. Her consultation with the surgeon yielded favorable results; Barb was consented for a lumpectomy and sentinel node excision. She was a warrior now and ready to keep the timeline going. She contacted me frequently, and together we did just that, kept the appointments going. She stated she would not let fear win. It was important for her to move it forward, no going back. I was able to schedule Barb with a breast radiation oncologist and a breast medical oncologist based on her surgery date. There was much relief with a plan in place.
Barb did well with her surgery. She wanted to meet with me after her first post-op visit. It was at this visit that Barb wanted my advice about a radiation oncologist near her home. She was so grateful for the city and her experience at the Abramson Cancer Center; however, coming into the city daily from her mountain town would be tough. There tend to be severe snowstorms where Barb lives, so transportation could be a challenge because it would be winter when the radiation would be administered. Barb also planned to work full time during her treatment. We talked and once again evaluated her personal timeline as a team.
We settled on Barb having a meeting with the medical oncologist, an appointment I coordinated to be on the same day as her post-op visit. If her medical oncologist did not recommend chemotherapy, we decided it would be best for Barb to get her radiation treatments closer to home. It would be safer for her and also keep her moving forward. She stated she did not want to miss treatments because of the weather. It was a relief for us both when we found out her breast cancer was slow growing and estrogen receptor–positive. It was recommended that Barb receive radiation followed by hormone therapy. We made some scheduling changes to her timeline. She would meet with a local radiation oncologist. For the moment, we said our goodbyes. Barb went home to get on with her life and treatments. She planned on working right through the radiation treatments, and so she did.
Barb is on maintenance therapy now. She calls me when she is in town to visit her medical oncologist. We have developed a tremendous amount of trust and respect for each other. Recently I asked Barb to reflect on the experience and provide us with some input from a patient’s perspective. Barb stated it was moving it forward that kept her going. She also wanted to surround herself with a positive, trusting team. It was important to have those taking care of her be friendly and smile. She believes this was a big part of her positive outcome. She also needed to have a navigator to keep moving it forward, and she did. Compared with those who find comfort in groups and wristbands and identify themselves as breast cancer patients, Barb had a different perspective. She said she was not going to surrender any more of her identity to her breast cancer than it already had taken from her.
It is with gratitude to her team, and admiration for those who have gone through this before her, that she agreed to let me tell her story.