A Pair of Shoes

 

A few years ago my son talked me into buying him a pair of Reeboks. It’s not that they were all that expensive, but they were purple and orange and, well, sorta ugly. I caved and bought him the shoes after he promised he would “wear them every day.” He wore them for a while, but then they just ended up in the back of his closet. I mean, how long can you wear purple and orange shoes? His feet grew, as boys’ feet do, and I took the shoes (still with plenty of wear left) to Goodwill.

I saw those shoes today. I was volunteering at a free cancer screening clinic when a man walked in with those ugly purple and orange shoes. He was there with many issues: he had untreated high blood pressure, he had not been to a dentist in years, he was unable to use one of his hands (he just woke up that way one day), and he had blisters on his feet because the shoes were 2 sizes too small. He really wasn’t all that interested in the cancer screening. Most important for him was finding some Lysol for the shoes. He wanted to disinfect them. It was obvious within the first few minutes that he had some serious issues. He was a recovering addict, and it was apparent that he had lost use of some gray matter during his addiction, but those shoes made me connect with him. It was that simple…for me. He, on the other hand, could not understand why I was trying to solve all of his problems, when all he really wanted was some Lysol.

That happens to me a lot as a caregiver. I see a young patient wearing the same kind of T-shirt that my own son has, and I become overly involved. I meet a patient with a German accent (like my mother’s), and instantly I am ready to jump over the boundaries that would keep me more professional. Sometimes you meet a patient and you find that you share the same interests in books, movies, etc, and you know that if you met outside of this clinical world you would be besties.

And therein lies the rub. We are in the clinical world, and these are our patients, not our children, parents, or even friends. It is hard to maintain professional boundaries when you are with people who are going through such a difficult time and who need so much. I once heard another oncology nurse say that with our patients, “You go in, you go in deep, and then you’re out.” We create a true therapeutic relationship, in which we allow ourselves to be whatever that particular patient needs at that time. Sometimes it’s a cheerleader and encourager, sometimes it’s a confidant for secrets and/or fears, other times it’s the stern maternal figure that helps rein in some acting out, but most of the time we are ears and shoulders. Listening and compassion are what most patients need, but providing these can be difficult and draining for the caregiver. All this investment of care and emotional support, and then it’s over, either for the best or the inevitable.

So how do we avoid becoming an emotional wreck? Sometimes it is impossible. Most oncology nurses, NPs, and PAs I know have a big box of tissues in their car, and that drive home can be very cathartic. I have had people ask me at stop signs if I am OK, and on rare occasions I have had to pull over for the safety of all—the wipers are, after all, on the outside of the windshield.

Having your own strong support system is also a necessity. Good friends are an absolute must, especially those that can bear your venting—again, and always have a cold pinot grigio for you. A good dog that likes to go on hikes is priceless, especially since you can’t violate HIPAA with him. Family too can be a great balm; nothing beats a good hug from someone you love when you get home after a long day.

Even in oncology, laughter can be the best medicine, and as in any specialty we have our own twisted sense of humor. For instance, I never shave a young man’s head without showing him what he could look like in 30 years, sometimes even including a comb-over. Sometimes for (the patient’s) kicks, I make visiting friends gown up, complete with ugly shower caps, before they enter the patient’s room. Looking for laughter in the little things seems almost normal, even if the little things are anything but normal for these patients. I once had a patient tell me about a time when she reached up for a can of peaches in a grocery store, and her prosthetic breast fell out. We had tears in our eyes when we discussed the benefit of it being a prosthetic breast for a woman over 50 years rather than for a younger woman—less bounce, easier to catch.

Sometimes we can make a tangible target in the personification of cancer because then we can beat it, kick its butt, tell it that it sucks—and that helps. Cancer becomes beatable; we can fight; we can wear our ribbons of many different colors, boasting of our intended defeat of a particular cancer. Making cancer a target can motivate us to raise money, run races, and find other ways to beat it once and for all. We feel stronger and empowered, and we need that because otherwise cancer is something that we can’t really get our mind around—this insidious disease that can walk into anyone’s life at any time, quietly, stealthily, and ugly, sort of like a pair of purple and orange Reeboks that you thought, hoped, you would never see again.