Nursing Children with Cancer

I don't think this will be my only post about this subject but I just wanted to do an introduction to my career first and this one speciality in nursing has played a huge part in my career.

I have worked with children with cancer on three separate occasions . This was my first....

Paediatric Oncology. From emergency nursing to this. It was a huge learning curve.I was 22 and had just become engaged. I was excited about my life. I loved my job and I loved my career. I don't really know where to start with this part of my nursing journey. I'll just try the beginning.

The ward was newly furnished and shiny! It had single rooms, a four bedded bay and was attached to a Teenage Cancer Unit. We had 14 beds in total and often had 'outliers'. We had a very busy outpatient department.

I was predominately employed in the children's end but would spend shifts looking after the teenagers and was ' Named Nurse' to some of them as they progressed from child to teenager. We were busy. We were often short staffed. We experienced bed pressure. We experienced heartbreak and sadness but also great happiness.We were a great team .We supported each other. I think in these highly stressful,emotional environments a good team is totally vital.

When I started I was lucky enough to be working with two of my closest friends-we trained together and we ended up working on the same ward. It was vital,I think,to my survival at that time. Another of our nursing students joined us later on and we made a great team.I was there initially for a total of almost 3 years. The ward Sister(or Nurse Unit Manager in Australia) was a bubbly,intuitive,mature manager.She knew us all well and was able to recognise our strengths and weaknesses. She taught me the skill of 'leaving your work at work'. She reminded us all that we had lives outside of nursing and to be good nurses and family members we would not take our work home with us.The hospital foyer had a huge 'crest' painted on the floor and she advised us to leave our work behind us as we crossed the crest. Of course it is easier said than done but it is a good skill to learn. Now I like to have the car or train journey home to reflect on the day and then move on with my day once the journey is over. There are obviously some times when I do 'take it home with me' but I have learnt how to deal with this too. I know sometimes I'm not a robot and I am heartbroken.These situations take a little time to resolve and I have stopped beating myself up over my  occasional inability to 'leave my work at work'.

 I learnt quickly that no-one wants to talk about children who have cancer. No-one wants to think of little kids dying. Early on in my career I would find it so frustrating to hear people talking about old people who had died and how sad it was. I raged internally at the injustice of children dying and found it difficult to feel sorrow when an elderly person died,after living a full life. Of course this sounds harsh and to those loosing a cherished loved one, grief shows no mercy. I know that now but then I struggled.

We had lots of wins. Cancer treatment is an ever evolving field and treatment improves all the time. We were involved in alot of cancer trials and in new and exciting treatments.Children with leukaemia were getting better. They weren't relapsing as often. They had a good prognosis. Bone Marrow Transplants were improving life expectancy. I remember one beautiful girl with AML having no family match for her BMT. The family were tested and were devastated to learn no-one was a match. They thought it was the end of the line for their beautiful Sophie. The BMT donor list was searched. A match was found and she survived.

My first patient that I was a 'named nurse' to was a baby of 12 weeks. Thomas had stage IV Neuroblastoma. The prognosis was poor. The treatment was harsh. His mum and I became very close. We were of a similar age and she had 2 other children. Her family lived a few hours drive away and so they went home during the week and visited at weekends. Her lovely hubby found the situation impossible to deal with and so often closed off from everyone and carried on his life in a fairly mechanical nature. He did what he had to do but had nothing extra to give. He cared for the children at home and went to work.There is no judgement here. I have seen families cope in all different manners and unless we have walked a day in their shoes we cannot possibly know how it feels to be told your baby is dying again and again.

 Thomas was with us in the hospital for over a year. Many,many times we were told he would die. Many times he was so sick,he was 'specialed'( had one to one nursing). I was very often nursing him. Every shift I would go into work thinking he may have died. He had a triple lumen C.V.C and an N.G  tube. At one point he needed twice daily platelet infusions and daily blood transfusions. He had a BMT and had GVHD. He had multiple surgeries.We celebrated his first birthday with little party and a cake he couldn't eat.His family came to visit.His siblings didn't really know him.He survived against all the odds.

I saw him again at the age of 10(I had left oncology and then returned by then). His parents had got married and all three kids had been there. His mum told me when she first went home her little girl(who was 2 at the time) refused to have anything to do with her.It took a long time to rebuild that relationship.He was slightly small in stature but was well and in remission and most definitely alive!

One of my most difficult memories was of another little baby. He had leukaemia but didn't do so well. He got an infection and unfortunately died just after his first birthday. He died in PICU and his mum was too distraught to come up to the ward and empty his room. I helped his aunt empty his room. I emptied his wardrobe and pulled out clothes with the labels still attached. First Birthday presents he had never been able to wear. My heart was breaking.

I held the hand of a 13 year old when he was told he had relapsed and there was little hope of survival.'Am I going to die?' he asked. I couldn't answer. I watched a young man marry his girl friend weeks before he died. The same young man had a frank discussion with me about sperm donation before treatment commenced and how could he ensure his girlfriend had access if she wanted to. One solution- to get married at 18. I blocked my ears(literally) when I couldn't bear to hear a three year old scream in pain any longer. It had gone on for days and no amount of pain killers seemed to help.I sat with a young family from Japan when they were told their little boy had cancer -'shall I tell my family to come' his mother said.

I was 24 and in all honesty I look back at this period in my nursing career and see it as 'dark'. I don't regret it at all and I feel immensely privileged to have been able to work with some of those amazing families. I left after 3 years and stepped away from nursing completely. I was worn out. Even at that young age I was fatigued.

It was over 5 years before I would return to hospital nursing. In that time I would have two children,get married,travel and work in a couple of varied roles. I tried to forget nursing but I could not.