From Oncology Nurse to Therapist: What Cancer Patients Taught Me

After I graduated from undergrad, I floundered.  For a while.  My closest college friends were off to law school and medical school or had engineering jobs at the ready.  But, I had a liberal arts degree and little idea what to do with it.   I worked with kids with developmental delays and cognitive disabilities, but the career path felt short and I was hungry to learn and do more.  I applied to PhD programs with the thinnest of real life experience or passionate drive.  It just seemed like the next thing I should do.  I didn’t get into any of the handful of programs I applied to, though one school offered me a compromise of entry to their master’s level program.  I paid the deposit and made loose plans to go, though I still felt unsure of what was the point of going was.  I called the department chair and asked about mentorship and she openly laughed at my question, naming that faculty could not possibly have time for that sort of thing.

I was disturbed by this dismissal but partially relieved, I was off the hook for accepting the compromise that lit no fire for me.  So, back to the drawing board for what to do for work, as a career, as an adult.  The prestige of a PhD still had its sparkle and could serve as proof positive that I am a capital ‘A’ adult. But, it felt like I needed more experience to fuel the drive and clarify the goals for a program like that, my denied applications suggested as much.  The university I just graduated from had a well regarded nursing school and I had an acquaintance in a similar position to me, but a few steps ahead.  She joined their accelerated program to get another bachelors degree, not a master’s, in nursing.  This was in the early 2000s and the country was in the midst of a national nursing shortage.  I considered this acquaintance, and if I took the same path, I was assured to have an interesting and rigorous job in a helping profession. This carried its own meaning and could pad my experience for the future, all while being paid a decent salary.  More than a pilot light, this lit the fire for a real future.

Nursing school was hard.  Hard because it was crammed with coursework.  Hard because I was poor.  Hard because I was lonely.  Hard because I was in a very exciting city that I had little capacity to enjoy.  But, it served its purpose and  just before graduation I secured a job at arguably the best children’s hospital in the country.  The fire was giving off real heat now and I was truly excited for the opportunity ahead and had great expectations for nursing as a career in its own right, not just to be experience for something greater later.

On a frigid day in February, I joined the inpatient pediatric oncology and bone marrow transplant service.  After a brief general hospital orientation, I landed on the unit.  My first patients were two teenagers, each newly diagnosed with leukemia.  Beautiful, full of energy and potential, but their lives and those of their families was utterly turned upside-down.  I was feeling the upside-down right along side them and learning what it was like to give and be in cancer care.  The devastation of diagnosis, the exhausting length of treatment protocols, the anxiety and drag of side effects, and the terror of the possibilities of the unknown.  The amount of information I was presented with each shift was dizzying.  Most days things moved so fast that I wished I had roller skates to get from patient to patient.  Everything appeared critical and making a mistake was potentially fatal for a patient.  Nursing school offers a general education and even oncology is a massive specialty that impacts people across the lifespan.  Yet, physicians and researchers can spend their entire careers on a rare malignancy limited to a certain organ in a particular time of life, or specific gene expression, or checkpoint inhibitor.  So here I was getting into the weeds of the specialty straight away; each patient room was its own laboratory of measurements, calculations, assessments, and results.  I was learning both the vastness and the nuance of care with each blood draw, infusion, and linen change.  The rigor was exciting, was this some kind of of experiential graduate work?

And here, dear reader, is where I found the backdoor to medical school.  It wasn’t a secret from these specialists and certainly not intel from literal medical students or oncology fellows.  But, I realized that while I had willingly and intentionally worked toward a better understanding of acute and chronic illness in a hospital setting, my patients and their families had not.  In this teaching hospital, I witnessed children and their families coerced into enrollment in the most intensive, unavoidable, crash course medical schooling out there.  Being diagnosed with a life threatening illness like cancer is the easiest way into a medical education.  While I learned right along side my newly diagnosed patients, the kids and families who were deep into treatment or recurrence ran circles around my knowledge base.  Their grasp of symptoms, treatments, test results, and emerging research was awe-inspiring.   They learned these things because they were being asked to make choices about care. And those choices required an amount of understanding that no ordinary civilian casually comes across.  They took the schooling seriously, their lives depended on it.

Over time, my experience started to catch up with those medically educated families. And my early feelings of awe, mixed with a little bit of intimidation, in the depth of their understanding of cancer soon turned into sadness. These patients and families did not want a medical education like this.  The learning curve is dreadfully steep and the stakes couldn’t be higher.  It is very challenging to learn under duress and these folks found a way to do it.  Some could express their overwhelm.  These patients and families reminded some of us nurses and doctors that they were being asked to suddenly grapple with information that many of us spent years learning in formal settings.  They, however, had been asked to learn and make decisions about a life threatening disease in a matter of minutes or days.  “I’m not an oncologist…I don’t know what is going on or what to do here” stood out to me more and more.  The places that pride themselves on patient centered care often assume a kind of medical literacy that is rarely organic and always hard won, even with diligent patient education.  Is it really informed care if you haven’t been able to digest the information?

For patients and their families, admission to this medical school while involuntary and the specialty predetermined, there is something choiceful to be found.  Ordinary medical students have to demonstrate competence in wide ranging tasks, memorize an enormous number of facts, and have a strict chain of command.  There is a rigidity and hierarchy that dominates how to be in relationship to information and to others.  But, as a patient, you get to set the priorities for your care.  You get to deep dive in any aspect of treatment or research that helps you feel connected to your care.  You get to ask for options, second opinions, and for more collaborators to help hold and navigate all of the information.  There is life force in this advocacy, you are the expert of your experience. And there is community to be found too, with other patients and families, pooling resources and knowledge that can ease the overwhelm of how to move ahead.

It’s in the community of care that the sense of being thrust into med school really dissipates.  Being with others who have walked the same halls and can help you not just read a lab result, but also bring you back in touch with your humanity is key.  To be affirmed that you are indeed more than the details in a medical textbook or the next cycle of chemotherapy.  And that we can do more than treatment, but really care for one another.  And then maybe, one day, your hard won knowledge may be the touchstone of relief for the next unwilling med student/patient, or family member, or brand new nurse.

Kerynne O'Malley, RN, AMFT is a former oncology RN and a dedicated therapist passionate about helping those dealing with a serious illness. You can read more about her here and reach her at Kerynne@biglifechangetherapy.com.

Summation:

Cancer patients undergo an involuntary medical education, learning complex oncology information under extreme duress that medical professionals spend years studying. As a former pediatric oncology nurse turned therapist, I witnessed how cancer diagnosis forces patients and families into an intensive crash course in medicine—understanding treatments, test results, side effects, and research to make life-or-death decisions. This hard-won medical expertise often goes unrecognized in patient-centered care, creating a gap between assumed medical literacy and actual capacity to process overwhelming information. Therapy for cancer patients must honor this unwanted medical degree while recognizing that patients are experts of their own experience. Effective psycho-oncology support helps patients navigate not just the medical facts, but the emotional weight of being thrust into expertise they never chose, finding community and reclaiming humanity beyond diagnosis and treatment protocols.