The re-establishment of quality-of-life in the wake of a cancer diagnosis is not just physical, but demands attention to the aspects of healing that have to do with mastery of the trauma itself. Here, nurses can play a pivotal role.
With a cancer diagnosis comes feelings of disempowerment, disconnection, and extreme vulnerability. These hallmarks of trauma have a powerful impact. Disempowerment brings a sense of helplessness or hopelessness, a loss of the "perception of control." Disconnection is found in feelings of loneliness and isolation, in the experience of a kind of existential aloneness that leaves a person feeling lost and unable to relate even to loved ones and close friends. And the vulnerability after a cancer diagnosis is not just the realization that the body won't always function normally, but a piercing loss of the unconscious sense of invincibility that like the perception of control, can otherwise be so protective in our daily lives.
Illness and the treatment experience can shake a person's confidence in themselves and the world. A cancer diagnosis can shatter the perception of control completely and the treatment process often adds to a feeling of helplessness. Nurses who listen, who answer questions, and who help patients to anticipate what will happen in their treatment process are a powerful healing force in their patients' lives. The work of educating, not just by talking, but through active listening and clear response, becomes a cornerstone of support as the patient works to master feelings of uncertainty and anxiety.
Mastery of trauma also requires communal recognition. The existential aloneness that comes with facing one's mortality is rendered more bearable when it is framed by deeply felt connections in the world. Often, during the course of an illness, medical professionals, particularly the nurses who have the most frequent contact with patients, become the "community" that is best equipped to recognize and acknowledge the trauma and a patient's experiences of it.
There are chemo centers where patients, having completed their last infusion, are invited to ring a bell as a nurse announces their new status as a post-treatment survivor. In other centers, nurses give patients certificates of completion at their last infusion. There are so many ways to mark major milestones in the treatment process and when nurses do this with their patients, that sense of disconnection, the feeling of being so profoundly separate from the community can be ameliorated.
The very presence and consistency of the nursing staff becomes another important piece of the healing puzzle. The reassurance that a patient will not be abandoned by her nurse(s) allows her to begin trusting again. Despite the shock of the diagnosis or bad news along the way, her connection with her nurse becomes an antidote to the feelings of vulnerability that can so often threaten to overwhelm.
As I work with patients and their families, I am struck over and over again by the notion that cancer is not just about disease, fighting, or even a cure, but in a fundamental way, it's about trauma and healing. I am struck by the power of nursing in a healing relationship that goes far beyond the physical.