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Canadian OnCOlOgy nursing JOurnal • VOlume 26, issue 4, Fall 2016 reVue Canadienne de sOins inFirmiers en OnCOlOgie
FEA TUR ES /R U bR iq UE S
PersONAl reFlectiONs
Behind Enemy Lines: A Personal Perspective
by Tracey Moffatt
T
he doctor nods to me, as he excuses himself from the pastel-coloured examining room and pulls the door tight behind him with a piercing dou- ble-click of the latch. It is a mystical door that changes lives in an instant;a door you step through as an individ- ual seeking consultation, and one you exit as a person living with cancer. I sit in silence and wait, as Jane, a single middle-aged woman, struggles with an accumulation of unspoken thoughts and emotions. I hesitate slightly, and roll my stool closer to her in an effort to fill an emptiness. I am acutely aware of Jane’s trepidation, as my fingers fid- get with the ballpoint pen secured to my lanyard. I know she needs to hear she is not alone. Jane looks to me with fear welling in her eyes, and desperation fill- ing her voice, “What would you do?” she whispers.
When I first began working in the melanoma department, as a research nurse in clinical trials, I joked with my colleagues that I was the poster child for melanoma: red hair, blue eyes, fair skin, multiple moles, and vulnerability to sunburn easily. As a young healthy woman, the thought of having skin can- cer had never crossed my mind; that is until the freezing from my biopsy started to wear off. For as long as I could remember, I had a dark mole in the cen- tre of my chest, just under my bra line.
After being introduced to the mela- noma department and learning I was at an increased risk for melanoma myself,
I decided to have it biopsied. “I would rather have a biopsy scar,” I said, “than have melanoma.”
Unfortunately, I ended up with both.
“I’m so sorry, it’s melanoma” stopped me in my tracks. My thoughts scram- bled, “How can I tell my dad I have mel- anoma? Mom died nine years ago today from breast cancer!” as I spiraled into a sobbing mess.
My melanoma experience was a whirlwind that left me with little time to process my thoughts. Less than a week later I was on a friend’s couch with a fresh railroad of stitches stretching across my chest; the anesthesia gently wore off as I struggled to pretend I was dressed for Halloween.
The days after surgery felt like an eternity, as I awaited my pathology results. The news finally arrived only a few days later: the cancer was caught early. I was lucky. Even so, the diag- nosis left me trapped inside my head, having difficulties focusing on any- thing else. I saw myself mirroring my mother’s fate. Diagnosed with can- cer at a young age, dying a few years later; I believed her destiny would soon become my own.
I promptly became fearful that can- cer was not finished with me and had further moles removed. To this day, I continue to find it difficult to appreci- ate how a piece of me could have been cancerous. It had been a part of me for as long as I could remember, yet this mole penetrated my defense system. It betrayed my body like a spy infiltrating enemy lines. It was especially devious because my dermatologist’s well-trained eye had not been the least bit persuaded the mole was suspicious.
Going back to work was horrible. I would see my patients’ biopsy reports and ruminate over comparisons with my own. Around every corner I would glimpse reminders of my own mortality.
Four years later I remain can- cer-free and have come to terms with my diagnosis. Returning to melanoma clinical trials, with a new perspective and first-hand experience allows me to advocate for my patients’ best inter- ests. It offers me a powerful motiva- tion to ensure they receive the care they deserve, as I know what care I might want in the future. I find inspi- ration in knowing the tables can be so easily turned.
“Jane, I understand that you are scared and would do almost anything to fight this cancer, you need to ask your- self what is right for you.” I explained that, “Melanoma is a very deadly skin cancer, which, until recently, did not have many treatments and results were almost always poor. But now there are options, with improved outcomes,” I reassure her.
“Jane, I’m sorry I don’t have the answers you are looking for,” I say, as I place my hand softly on hers, “I wish I did.” I counsel Jane to decide what risks she is willing to take and strongly rec- ommend she consider her own personal situation.
My key message is simple and I press it further, “Jane, even though I’m sitting here with you, please don’t feel obligated to accept treatment because we’ve presented a few options. It’s important for you to choose because it’s the right thing for YOU to do.” Our soci- ety focuses on fighting and conquering cancer, but it is rare for patients to hear that it is okay to step back to focus on their priorities.
I may never reveal the true intimacy when asked, “What would you do?” but I will support Jane’s decision-making process; ensuring she has the informa- tion to make a well-informed medical decision.
ABOut tHe AutHOr
Tracey Moffatt, RN, BScN, MHSc(C), CCRP, Princess Margaret Cancer Centre, University Health Network, 610 University Avenue, Toronto, ON, M5G 2M9 416-946-2000 [email protected]
