Compassion Fatigue

Back on September 28th, when I saw the "Tara" license plate as we set out on the last mile of the Boston Marathon Jimmy Fund Walk route, I remember my first split-second thought.

That is not for me. 

It was a strange instinctive response to such a coincidence, and I did not think it through at the time. I have, however, thought about it since. In fact, I have been waiting for the right moment to write about it. That moment is tonight.

After I crossed the finish line, joyfully shocked by the crowd gathered there, I spent a few minutes with my family and friends who had come into Boston to join the fun. One of those people was my amazing friend, Amy K.

I have used the term, "superpowers" before when describing my mother, so that should provide some sense of how much I mean by the term. Well, Amy K has super powers of her own. I would describe those powers as a true gift for giving. She gives so much to so many people that I would need a full book, never mind a blog, to scratch the surface of her goodness. Most amazingly, she does all of those things for all of the right reasons. She simply loves to help other people.

I will never forget talking to Amy that Sunday morning in Copley Square. She told me that her friend had a daughter with brain cancer. I remember it so vividly. Mostly because Amy once again centered me as to the real purpose of those miles and those dollars.

Amy went on to tell me that she needed another Team Tara shirt to give to her friend's daughter. Then she told me the daughter's name. Yep. It was Tara.

I felt the hair on the back of my neck stand up when Amy told me this. I don't even know how I responded or if I said anything. But in my head, I was back in the moment less than an hour prior when I saw that license plate.

That's not for me. 

It wasn't. I think it was for her.

*   *   * 

I met Tara W for the first time after work last night at a Boston hospital across the street from where I have been working on a long-term assignment. Amy, who had already visited Tara in the hospital the week prior, had arranged for the two of us to visit her again. See what I mean?! Superpowers.

Tara W was diagnosed with brain cancer in April 2012. At the time, she still lived in Oklahoma where she was born just 28 years prior. After experiencing headaches and a spell of severe disorientation just months before she was set to graduate from nursing school, Tara's doctors discovered a glioblastoma in her brain. Excuse my French, but I swear when I get really upset. And I know now that a glioblastoma is a fucking brutal type of cancer. Fucking brutal.

As one would expect, the news flipped Tara's world upsidedown. All of her plans were derailed. As she explains it, it was as if she became a different person. A sick person. A person with brain cancer.

Tara underwent brain surgery to remove the tumor. She then began proton therapy, which is similar to radiation therapy although it is more targeted so as to try not to damage surrounding brain tissue.

After chemotherapy and proton therapy were complete, Tara was feeling confident that she had beat cancer. After all, she felt well and she had managed to graduate from nursing school and earn herself the job she had always wanted. Everything was in place.

A few months after her therapy ended, Tara went in for an MRI of her brain. Her father accompanied her to that appointment. When the results were ready, Tara told him he could wait outside while she finished up. She expected good news. She got the very opposite.

*   *   *

Amy, Tara, Tara's mother (Joie), and I had a lovely hour together last night while the cold rain pounded the city. 

When it was time for us to catch our train, I wasn't ready to leave. I had discovered that Tara wanted to share her story but since that was not easy for her to do (her second brain surgery left her blind in her right eye and her medications make it difficult to type), I asked her if I could help. She enthusiastically said yes. I was honored. 

So we decided that I would come back to visit the next day (today) during my lunch break. 

This afternoon, I made my way back up to Tara's room. I was excited to see her and to help tell a precious sliver of her story.  

In the first 10 minutes I was there, a Dana-Farber fellow and a nurse paid a visit. Tara made only one request between the two of them. She asked the nurse for some water and some ginger ale. 

*   *   *

I am not sure that Tara would agree, but I felt an immediate connection with her. We talked about fun stuff, like her passion for running, and we talked about dark stuff, like the sheer terror we both feel when we see a friend relapse.

Tara told me about the day that her doctor in Oklahoma reported to her that her cancer had returned. Obviously, she was crushed. As she explained it, her positivity waned as she tried to comprehend the statistics of her disease. As she tried to process the fact that, according to clinical data, she would most likely be dead in a few years. Surprisingly, I didn't cry when she told me this. I think that is because I honestly could not (and cannot) comprehend such injustice.   

I am working on a draft piece about Tara that we will share once she has had the chance to review and revise it. This is not that piece. This is merely an introduction to this brave and lovely person. And it's something else. Join me as I take an abrupt left turn. 

*   *   *

Tara is confined to her hospital bed until she has a seizure. She has been having terrible and mysterious seizure-like episodes for a while now and the doctors are observing her around the clock to figure out why. Tara's thick, dark hair is parted this way and that to make way for the wires taped to her scalp. The wires feed into a screen next to her bed that tracks her brain activity. 

During my lunch break, I sat in a chair at the foot of her bed (padded on the bed rails in case she has a seizure). Actually, for the first few minutes of our conversation, I sat to Tara's right side, where the chair had been placed, until I remembered that she could not see me out of her right eye. When I moved to face her more directly, I could tell she was relieved. I felt terrible that I had not thought about that immediately upon sitting down. 

As we talked and I typed some notes, I noticed that Tara was squinting uncomfortably. The shades to the room were closed but a few beams of sunlight were streaming in through the holes where the strings stretched through. I got up to try to fix the problem.  

"No, no, it's okay. It does this every day but it doesn't last long," Tara explained. 

"But it must be really annoying to have the sunlight right in your eye," I said. 

"Yes, it is, but it's okay." 

"No, it's not," I insisted stubbornly, as I searched around for something to block out the sun. I found some paper and we moved it around on the window until we found the holes that were causing the problem. 

"I just need to get some tape," I explained, as I headed out to the nurses station. 

When I approached a nurse, she looked at me as if I was terribly intrusive. I could see that she was examining my badge, which I forgot I had on. (It is a Harvard Medical School Consultant badge so I can see partly why she would have been confused.) I explained that I did not work at the hospital, that I was just visiting a friend. But that did not ease the tension in our conversation. 

I went back into Tara's room without any tape. 

A few minutes later, the nurse who had visited earlier -- the one from whom Tara had requested the water and the ginger ale -- came back in. She was no doubt agitated by my request for the tape. 

"Why are you putting tape on the windows?" she asked, full of judgment. 

I explained. The sun was behind a cloud at the time, and I wished it would come out so she could see it shining in Tara's eyes.  The nurse looked at me blankly. 

I explained some more. I showed her that if we just blocked out a small part then it wouldn't be in Tara's eyes. But it was clear -- the nurse had no interest in helping. 

Before she left, the nurse eked out an explanation that we could move the bed to avoid the sunlight if it got bad again. She said something about the camera that was focused on the bed so they couldn't move it too much. But she didn't care and it was painfully obvious. It was even more painfully obvious that Tara was far too selfless to call the nurse back into the room the next time the sun came out. 

When the nurse left, I unloaded. I was pissed, and told Tara why, and she smiled. I tried not to get distracted for too long and a few minutes later, we continued with our prior conversation. It's cliche, but true -- we laughed and we cried together for the next half hour or so. And I dropped several f-bombs along the way. Because seriously ... cancer is so fucking awful. 

When Joie arrived a while later, I couldn't help but unleash my wrath about the nurse and the sunlight and the complete lack of compassion. Tara doesn't ask for much and this lady can't even help tape a piece of paper to the window?!? Joie agreed, while entertained by my passionate venting. 

I left the hospital full of emotion. Admittedly, that emotion was somehow funneling itself into one issue -- the nurse and her complete lack of compassion. 

When I got back to my office, I had a bit of panic when I realized something. The nurse had never brought her water or her ginger ale. 

I texted Tara to ask if the nurse had brought it yet. 

She didn't lol, was all she texted back.  

*   *   *

I truly believe that nurses have incredibly difficult jobs. They take care of fragile people, and I have already written about how complex fragile people (including myself) can be. Everyone knows that nurses often work long shifts and that some are overloaded with patients. I get all that, not by first hand experience, I admit, but by careful observation over the last few years. 

In a text later tonight, Tara explained that she thinks many nurses have "compassion fatigue." I couldn't agree more. And I don't think nurses are the only ones who suffer from that. I saw it in teaching, I see it in lawyers, and I see it out in public (like on the train, for instance). It's hard to be compassionate all the time. It's hard to care constantly about another person's needs. But that's no excuse. Tara's nurse should have given me the f-ing tape and if her compassion is too fatigued for that, she should find another job. Period. 

I know I have high standards and I know I have my mom to thank (nope, not blame) for that. But we have to do better for those who are fragile. We have to. We have to tell them that we care enough that we do not want them to have to squint uncomfortably even just for ten minutes every day if we can do something to avoid it. We have to find the tape and hand it over with a smile. A young woman with brain cancer deserves that. 

*   *   *

The news that Tara's nurse had not, two hours later, brought her the water and ginger ale boiled my blood, and I sent Tara several repeated emoticons to express that. 

In response, Tara sent me a photo to make me feel better. Joie had found tape in the room and had taken matters into her own hands. 

*   *   *

In trying to decide how to wrap up this lengthy post, I was reminded of the card I brought Tara last night. I usually think greeting card messages are inadequate but this one was perfect. The outside had a cartoon of a big dark cloud and a person on a ladder trying to wipe the cloud away. The front said something like, "If I could, I would take away the dark clouds..." The inside had a bright sun and said something like, "And give you a sky full of sunlight." I wish I could do that for Tara and for countless others. But I can't. None of us can. 

Nevertheless, we must try. We must not excuse compassion fatigue. Sure, this high standard sounds difficult to meet and sometimes, it is. But in my experience, it's usually pretty darn easy to find the tape and cover up the little holes, or bring a glass of water and a ginger ale when your patient kindly requests it. I mean seriously ... brain cancer is naturally complicated. But compassion doesn't have to be. 

FRAGILE: HANDLE WITH CARE (Part Two)

About a month ago, Brian reminded me that the lease on his pick-up truck was up. We had no idea what to do about it, but we both agreed on two things—we wanted a safe and reliable car, and we did not have a lot of money to spend.

In my experience, buying a car is painfully painful and no amount of Herb Chambers quotes on the expressway is ever going to change that. So I knew this wasn’t going to be fun. I just never anticipated the hardest part about it.

When Teddy got wind that we would be trading in “daddy’s twuck,” he immediately began to bawl his eyes out. “I don’t want to give away daddy’s twuck!” he wailed. My heart kind of hurt inside.

I asked him why he was so sad about the truck.

“Because I don’t wike when fings change,” he cried.

I was completely taken aback. Mostly by the fact that my son could articulate such a profound thought. It took me years to figure out that change was the source of so much of my angst. I had a bittersweet tinge of pride (and guilt) that my six-year-old had already discovered this.

I tried to calm him down by telling him that things change all the time and that change can be fun. He insisted that he didn’t like change. That he wanted daddy to keep his twuck. I repeated to him (and to myself) that it was only a car.

Last night, Brian and the kids traded in his truck for a used Toyota Camry. I was not with them for the final change-up, but Brian said it was a bit of scene—Teddy weeping pathetically (and Annabel copying), “Bye bye daddy’s caw.” They can be so dramatic sometimes.

Personally, I love the Camry. My grandma had a Camry (not a great selling point for my 34 year old husband, I do realize). But Camrys are solid, safe cars and I like the way they drive.

In fact, Brian ended up calming Teddy down at bedtime a few nights ago with the crazy realization that if we take good care of the Camry, it may be Teddy’s first car one day. Teddy liked the thought of driving in ten years, although I was completely overwhelmed by it. Not because time flies or because my kids seem to be growing up so fast. But rather, because sometimes, thinking any further beyond today can seem like far more than I am able to handle.

Fragile.

* * *

Yesterday at my lunch-time appointment with my oncologist's PA, Danielle suggested that I check the lump in my neck just once a day. That seemed like a brilliant idea and I decided that I would feel my neck one time every day—when I get off the train after work. For many reasons, I decided that would be the easiest time to face the nightmare.

As I climbed over the catwalk at the train station tonight, I felt my neck. For some reason, however, I chose not to press down enough to get a really good read on it. 

Still, I'm pretty sure it was there. 

I kept climbing.

I tried to push out the darkness. Tragic stories of diagnosis and death. The pain endured by good people I know or had heard about—healthy-looking cancer patients—with the fucking disease in their blood or lungs, brain or pelvis, liver or bones. The sheer terror of metastatic disease. The injustice of it all.

Handle with care. 

*   *   *

While on the way to pick up the new car last night, Brian and the kids called me. Teddy was upset and Brian was telling him about how it was only a car and how mommy and daddy weren’t going anywhere. 

For a split second, I wished he hadn’t said that.

* * *

When I arrived at Dana-Farber yesterday at 12:28 for my 12:30 appointment, I found a large crowd of people waiting in the elevator bank. One elevator was broken and I had never seen that space so busy. 

As I waited, surrounded by people in masks and wheelchairs, I became agitated. Where were the f-ing elevators? It was as if only one of the six was working and when it came by, there were so many people who looked sicker than me that I obviously let them go ahead. But as the minutes ticked away, I got more and more frustrated. I was late for my appointment. I debated walking up nine flights of stairs. Finally, over ten minutes later, I made it up to the breast oncology floor. Fragile and flustered. 

By the time the nurse took my vitals, I was shaking.  

My blood pressure was normal but when my temperature registered at 95.9 degrees, I had a rush of panic. The nurse asked me if I had had a cold drink. I hadn't. This is it, I thought to myself. My body is failing me. 

The nurse never said anything else about the low temperature and I was too terrified to ask any questions. So I took my seat back in the waiting room and did the only thing I could do to feel better. 

I wrote. Fragile. Handle with care. Part One.

*   *   *

Now it's Part Two, and time that I make an actual point. 

I know that telephone systems go down and that elevators break and that nurses know way more than I do about when it is necessary to panic. I know all of that when I'm being rational. When I'm not cracked and on the verge of breaking. 

But when I'm fragile, everything changes. A missed call is disasterous. A downed telephone system is utter abandonment. A ten-minute elevator back up feels like five torturous hours. A temperature just a few degrees off is the beginning of the end. 

I realize, if only in part, how hard it must be for people to work with those of us who turn up in such a fragile state. I realize the energy it must take to say the right thing, to handle us so that that we don't break even though we may feel broken. It can't be easy. Indeed, empathy can be hard work. 

*   *   *

At first, I did not understand why Teddy cared about the truck. "It's just a truck," I told Brian carelessly. 

"It's more than that to him," Brian explained. "It's how he knows I'm home. It's what makes him feel comfortable." Well shit. Good point. 

So I'm trying to be better—more understanding. 

It's just a truck. A short delay in a phone call. A back up at the elevator. A few unexplained degrees. 

Something that, if handled with care, could be absorbed.

Or something that, if handled roughly, could make all the fragile little pieces fall apart. 

FRAGILE: HANDLE WITH CARE (Part One)

Sometimes I think we would all be better off if we could emit a signal when necessary as follows:

FRAGILE: HANDLE WITH CARE.

I needed that signal this morning. I needed everyone who came into contact with me to know it. That I was fragile. To handle me with care.

It started before 7am when I became terrified of a lump in my neck.

I had felt the lump for weeks but since I had been nursing a sore throat, I figured it was just a swollen gland. I didn’t worry too much about it, which is to say that I worried about it often but in a way that was not completely debilitating.

I hadn’t assessed the lump in a few days and because I had expected it to be gone, when I found it still there, I freaked out. I rushed to Brian who was heading out the door to school. "Do you feel it?" I asked him.

He did. He told me I should call the doctor this morning. My legs felt weak and my stomach felt nauseous. It had been a while, but I had a keen memory for that feeling.

Dr. Bunnell’s office opens at 7:30am so just after that, I dialed the number. The answering service picked up, one I had not heard before, and I left a message. I tried to compose myself to say hi to my dear friend and Annabel's morning babysitter (Kendra) and to say goodbye to my little girl. I didn’t last five minutes before I fell into a heap of tears on Kendra’s shoulder.

On the commute into work, I called Dr. Bunnell’s office again. Just in case the answering service did not work properly. I left another message and made sure my phone ringer was on its highest setting.

When I got to my office and set my phone on my desk, I noticed that I had missed a called from “Unknown” (Dana-Farber). How could that be? How did I not hear it ring? I may have cursed out loud because I know that missing that call meant I would need to place another call and wait for someone to respond. It would be at least another hour.

Soonafter, I heard the ding of a voicemail and I listened to it. The nurse said that should would call me back in five to ten minutes. I was so relieved.

I checked my phone ringer again. It was on and at the highest setting. Just to be sure, I tapped into the little grey Settings button to make sure that the phone would ring through to me. Everything indicated that it would.

With my phone by my side, I did my work. Fifteen minutes later, when I had not heard back from the nurse, I checked the screen. Another missed call and voicemail from Unknown. My heart sank. How could this happen? Why did it not ring through?!? I wanted to cry. I listened to the second voicemail. The nurse explained that she had one appointment open but I had to answer unless I would not be able to be seen today. I almost lost it.

I tried calling the main number for breast oncology again but it rang through to the outside answering service. I told the man that I had just missed a nurse’s call and that I needed to get in touch with her immediately. He said that they were having technical difficulties and that he was not able to get a message through to the doctor. I asked him how that could be. “How am I supposed to reach them? I need to reach them.”

He was silent. “Um. I don’t know what to tell you. There is nothing I can do. We are having technical difficulties.”

I am not often rude, but I had no ability to edit. “Well that is something they really need to fix!” I asserted before hanging up on him.

I tried the main number again. Answering service. 

I tried again. Answering service. 

I was in full-blown tears by now.

I tried the number once again. Someone answered, and by her introduction, I could tell that I had not been switched into the outside answering system.

I tried to compose myself enough to tell her that I was trying to get in touch with a nurse. The woman referenced the nurse’s last name so I knew I had made progress. She said she would call me back. I gave her my cell (again) as well as my office phone number. I explained that I was having issues with my cell phone so please try the second number if the first did not work.

I sat, my office door closed, crying and waiting for the nurse to call back. Less than a minute later I glanced at the phone screen to see a message: “Missed Call – Unknown” It seemed like a cruel joke. The phone never rang.

Thank goodness, the nurse had tried the second number and I picked it up before the first ring even ended.

I explained what I was feeling in my neck. The nurse seemed sure it was a swollen gland. She said I could come in if I wanted to have it seen. I did. Better yet, I so deeply didn’t, but so definitely did at the same time. I took the 12:30 appointment. And so I sit and wait.

Wanting to warn everyone around me...

Fragile. Handle with care.

*   *   *

I wrote the post above while seated in the waiting room at Dana-Farber this afternoon. I re-read it in the exam room and published it a few minutes before Danielle came in to see me. 

When Danielle felt my neck, I could not contain my sheer terror. I cried. I knew that I would so I hadn't even bothered with eye makeup this morning. 

Danielle felt the lump and explained it felt like an enlarged lymph node. She asked me when I first felt it. I cried more. 

Danielle explained that it is normal for a lymph node to swell when the body is fighting an infection. I explained that I had not been sick for a few weeks. "Why would it still be swollen?" I asked. Danielle explained that it could take that long for a node to return to normal size. That my body may still be fighting the infection even after I feel better. 

Ultimately, Danielle suggested that we wait a week. She scheduled an appointment for me next Wednesday although she expects that the lymph node will decrease to normal size by then. If it is still enlarged, she will order additional testing. 

Sometimes it seems like the Intruder is stuck in my basement and will never go away.

My Ship

I have a ship. Not a literal one (way too much money and work), but a figurative one. Usually I’m uncreative and call my ship, “My Ship.” But sometimes I call it, “My Life Boat." (And that's only slightly witty.)

Here’s the deal with My Ship...

First, I get to pick who travels on it with me. No one else’s opinion matters. I decide. Just me. After all, it is my ship.

Before I sound rude, let me assure you that you have a ship, too, even if you don’t know it. Yes, you have your very own Life Boat! You can fill that boat with whomever you want, you can paint it any color, and you can name it something completely ridiculous if that makes you happy. After all, it is your ship.

You may ask, “What exactly does this ship do?” It's a good question, and the answer depends on whose ship it is. Because different ships travel to different ports and set sail in countless different seas.

Another thing about My Ship is that I am the captain of it (and you are the captain of yours). Better yet, let me back up. 

As babies and as kids, we are not ready to captain our ship yet. So others steer it for us. Sometimes they teach us exactly how to steer for when it's our turn. Sometimes we learn from their mistakes.

As adults, however, we take over at the helm. Sometimes we need to call in relief because everyone needs to rest. But still, as the captain, we choose who will steer when we are too tired or to sick to steer ourselves.

The best part about being the captain of our own ship is that we pick our co-captains, our crew, and all of our guests. Sometimes we allow someone onto the ship and later realize that he/she is far too much like a pirate. He/she would be better off on someone else’s ship, or maybe floating in the ocean alone. If we’re brave, we kick them off our ship...with a life jacket, of course, but there is no room for pirates where we are going.

I came up with this ship idea when I got cancer. I have no idea what made me think of it, but over the last two years, I have thought about who I would want on My Ship. Who is a disguised pirate? Who would just drag the boat down, or slowly poke a hole in its bottom? Better yet, who would I ask to help me navigate? Who would make my trip more joyful? More purposeful? More…full? I have lists in my head.

Here's another thing -- some people care a lot about what their boat looks like. In some ways, I do, too. I want my boat to be clean and strong, safe and comfortable. But I don’t want a yacht. I can see why people like yachts, but still, I’m not the yacht type.

I love to think about My Ship. I make decisions about how to spend my time based on My Ship. My Ship has brought me clarity and comfort.

My Ship, like all ships that leave port, has sailed through rough seas and, oftentimes almost simultaneously, has sailed alongside spectacular sunrises. It has cracks and patches and parts that creak. As I said, that happens to any ship that heads out into the open sea. And that is why we better load our boat with the right people, the right maps, and the right motivations. Because we only get one boat. And one awesome journey into the sunset.