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Despite her training and years of experience as an oncology and hospice nurse, Brown finds it difficult to navigate the medical maze from the other side of the bed. Why is she so often left in the dark about procedures and treatments? Why is she expected to research her own best treatment options? Why is there so much red tape? At times she’s mad at herself for not speaking up and asking for what she needs but knows that being a “difficult” patient could mean she gets worse care.
Of the almost four million women in this country living with breast cancer, many have had, like Brown, a treatable form of the disease. Both unnerving and extremely relatable, her experience shows us how our for-profit health care industry “cures” us but at the same time leaves so many of us feeling alienated and uncared for. As she did so brilliantly in her New York Times bestseller, The Shift, Brown relays the unforgettable details of her daily life—the needles, the chemo drugs, the rubber gloves, the bureaucratic frustrations—but this time from her new perch as a patient, looking back at some of her own cases and considering what she didn’t know then about the warping effects of fear and the healing virtues of compassion. “People failed me when I was a patient and I failed patients when working as a nurse. I see that now,” she writes.
Healing is must-read for all of us who have tried to find healing through our health-care system.
Who Am I?
My first day as a nurse, no one seemed to be expecting me. My preceptor—the nurse teaching me the job—showed up late. We had been told in our student clinicals that arriving late to the hospital was an unforgivable sin, but my preceptor didn’t seem to care, or realize I was coming that day, and it took a while for her to get organized. They’d given her an extra, fifth, patient, plus me, and she grumbled about the combination. An older Black woman, she had a generous smile and was deliberative in almost everything she did. She also moved unhurriedly. Quick of step, and impatient to get on with learning the job, I muttered to myself about her slowness.
A few months later, as I began to really understand how to do the job, I realized my preceptor was one of the best nurses I ever worked with, but I couldn’t see it right then. Time was of the essence, I thought. Speed mattered. I was good at moving fast, at juggling, making quick decisions about which problem to solve first. This was the training of motherhood in addition to nursing. I had baby twins and a toddler in my early thirties. When the twins turned one, I noted: “One year down and no missing limbs.”
From Carrie P.—that was my preceptor’s name—I learned that sometimes in nursing it takes time to notice what is really going on. “You look whicky-whacky,” she would say to a patient askew in a bed. We would help the patient sit up, straighten the blankets, fluff the pillows, and a human being would emerge from the pile of linen. Then we could fully see that person.
A blinking call light outside a patient’s room always drew Carrie P. That’s how it’s supposed to be, but often not how it is. Once it was a man having trouble peeing. He needed help standing upright—he couldn’t urinate sitting down. He was weak, though, and even when he stood up, it took time for him to get all his urine out. Carrie P. and I braced him, one of us on each side, holding him up. She also held the plastic urinal and talked with him, giving encouragement and making small talk as if we were all meeting over coffee. In my head the minutes ticked by, but Carrie P. showed me how considered, hands-on care gives patients respect. She never finished her shifts on time and always strove for the ideal, even though it took me awhile to recognize that.
Carrie P. had a last name, of course, but she was always just “Carrie P.” There must have been another Carrie at some point and the “P” became her differentiator. It stuck. There was no other nurse like her on the floor: so careful with patients’ humanity, so clinically knowledgeable. We got along well, but one chaotic day we drew blood to prep a patient for a test and I used the wrong color tubes. She came so close to losing her patience: “I specifically told you to draw a blue and a yellow.” I felt ashamed and stupid. The next shift I apologized for the mix-up. “Things like that happen,” she said, neutral, focused on our work for the coming day. In that moment I saw that Carrie P. cared about the job more than anything else, more than hurrying, more than scolding a new nurse, and I felt grateful to have her as my preceptor.
But Carrie P. usually worked nights, and my manager wanted me to train during daylight exclusively because day shift was much busier than night shift and I would learn more. I was assigned another preceptor, M, who came from white, working-class Pittsburgh. M asked me about my PhD in English, whether I had kids, and why I chose to work with cancer patients. She seemed to dislike all three of my answers and we never clicked. My manager had worked as a nurse on the floor before her promotion and a group of nurses, including my new preceptor, were still close with her. I didn’t understand that navigating the cliques on the floor would be central to succeeding there and I misjudged how powerful the bonds in those cliques were. I also had no idea how mean nurses could be to other nurses, that there was a tradition of nurses “eating their young.”
My new preceptor had an aunt who had died of cancer. It gave her a personal connection to the disease and she revealed it with what seemed to me a trace of sanctimony. Sometimes I think about my response to M’s third question: why did I choose oncology? I had been matter-of-fact. I said the science was really interesting and that there was a lot of cancer in my mother’s family. I’m not sure why I was so curt and analytical—I could have easily revealed more, since my family history of cancer is extensive. My maternal grandmother had four cancers: breast, uterine, colon, and skin. Three maternal aunts had breast cancer, and one died from the disease when it spread to her brain. A maternal uncle died of colon cancer. I could have bonded with M over our shared family grief, but I didn’t. My mother’s siblings were not close and her mother died when I was very young. I didn’t feel sad about their deaths from cancer. I feared the volume of cases among my relatives.
At that time, I told myself that I was fascinated by cancer, while being scared of it. A malignancy is impressively aggressive, biologically speaking. Cancer survives through stealth, taking nutrients and blood away from normal tissue, crowding healthy organs as it grows, invading other sites in the body. It presents as a relentless perversion of social Darwinism: cancer is not “fit,” but it will survive, even if that means consuming the body that gives it life. We might call cancer cells an apex of evolution in that they adapt, often quickly, to stay alive, sometimes even becoming invulnerable to chemotherapy. That is why chemo regimens may include first-, second-, and third-line treatments. The higher a patient goes up the list, the more successfully that person’s cancer has resisted the drugs.
I could not have articulated all that to M, and it probably wouldn’t have helped if I had. Nursing education is a complicated story. I had a college degree in nursing and M’s degree was from a community college. And I had a PhD—in English, not nursing, but still. For some nurses, the difference between a two-year associate’s degree from a community college and a four-year bachelor’s degree feels huge and can create insecurity. Suggest to a group of nurses that all RNs should have bachelor’s degrees and the hackles among nurses who attended community college understandably rise at the implication that some nurses are “better” than others by virtue of being “more educated.” My PhD likely only made me seem educationally farther away from M, and my intellectual interest in cancer might have seemed odd and unwelcome.
M, I think, looked at nursing as something she was personally committed to, and with which she had a personal connection. My explanation of myself to myself then, when I began working as an oncology nurse, was not personal in that way. Though of course it was. The full truth—and why I chose to work specifically with liquid tumor patients, those ill with leukemias and lymphomas—was something I had carefully hidden away, but here it is: My mother is a survivor of hairy-cell leukemia. It’s a rare cancer, and usually people die with it, not of it, but she had it for almost a decade until an effective chemotherapy treatment came along and cured her. It was a long time ago, before I got married, had kids, and became a nurse.
I had packed that story away in bubble wrap. Then I placed the bubble wrap, with the memory protected inside it, in a plain cardboard box. I had taped the box closed and moved it to that place in the human brain where memories go to hide. Three years after I became a nurse, when I was also a nurse-writer and on my way to speak at Yale University, I thought about why I had become an oncology nurse. I knew they would ask me that question at the lecture, and I wanted to have a good answer. As I looked out the window of the plane, taking in a wide view of clear blue sky, my carefully packed mental box opened all by itself. Of course, I thought. My work as a cancer nurse, taking care of leukemia patients, suddenly made sense. Everything suddenly made sense.
My mother had leukemia. If I had talked about my mom’s cancer, the nurses on the floor might have identified with my struggle instead of minding about my education. Oncology nurses feel bad for family members of cancer patients, and in general, people hearing my mother’s diagnosis would breathe in sharply, step back. The nurses on my floor would know that hairy cell leukemia is not the same disease as acute leukemia, but I think they would have had empathy for me anyway. It is terrible when anyone’s mother has cancer.
There was no way I could have said any of that to M, my preceptor, because I didn’t know it myself. I wonder, sometimes, if I had known that, and told M, our working relationship would have been easier. I wonder. I wonder if I had better understood nursing, and myself, whether I could have toughed it out in that first job, whether that in-group of nurse bullies would not have judged me as someone who didn’t belong. It’s impossible to say. Arguably, bullies are always looking for their next victim. That explains why no one welcomed me when I got there, why they overloaded Carrie P. on my first day, and why even Carrie P., who was so dedicated to others, kept aloof from the spite of the other nurses. Only later did I learn that the unit was notorious for treating new nurses, and the medical interns and residents, badly.
After six months, I left that job. The rule was, you had to remain in a position for a year before you could transfer, but I refused to take no for an answer and insisted on switching jobs earlier. It worked. I moved to another medical oncology unit. There were cliques and strong personalities on the new ward, too, which was separated by an elevator bay from the old one, but not to the same corrosive degree. No one was looking for a target.
Afterwards, one of the nurses’ aides from the old floor asked me why I left. Then he answered his own question: “Too many bitches, right?” It was a gratifying answer, but likely untrue. Too many nurses unhappy, threatened, insecure, along with a manager who did nothing to make the problem go away. What does any of this have to do with cancer? Nothing, right? There are mean people everywhere. But maybe it’s not that simple. Maybe some amalgam of suffering, sorrow, uncertainty, and, possibly, powerlessness in the face of all that, brought out the mean especially well among that set of nurses. We cured patients, but many also died, and sometimes the cures didn’t stick, which was heartbreaking. Not all the nurses were able to accept, with grace, the ongoing tragedy of our work. And powerlessness was part of the problem, too, the kind of powerlessness that led a nurse, after a patient had died unexpectedly, to kick a chair across the nurses’ station. She was the meanest nurse on the floor and, at that moment, hurting.
I became an oncology nurse without knowing why, then figured it out. Ideally, nursing is a sacred duty. It can be just a job, a steady paycheck, but the best nurses dedicate themselves to the work, for all kinds of different reasons.
The road of life can fork in such a way that we’re unsure which path we’re on, or why, but we keep going. That’s survival. Cancer casts a long shadow, but I’ve been living in it my entire life. That’s survival, too.
The patient was nineteen. That’s young to be on an adult hospital floor, young to have his particular cancer. He’d grown up in rural Pennsylvania, and being stuck in a hospital room kept him at a low simmer. It wasn’t his first hospital stay, and it would not be his last.
That shift, on the new floor, where we did bone-marrow transplants, it was my job, as his nurse, to send him home after his blood transfusion finished.
His mother was also there. She was also a nurse, but mostly a mother when I met her in her son’s hospital room. Her full, straight bangs and bleached blond hair that stopped just at her shoulders made an impression of curated control. But waiting for her son’s hospital discharge had put her at a low simmer, too. I could tell from her compressed lips, the way she sat forward in her chair and watched everything I did. Neither of them said much to me, but every time I walked into the room, I felt their anger. I felt it so much that I dreaded going into his room, but I had to. I needed to get him ready to go home.
When the transfusion finished, another nurse came into the room with me to do a required double-check. Our hospital floor was testing a new kind of needleless connector, called a cap, that went on the ends of the intravenous catheters that had been surgically implanted into, and protruded out of, our patients’ chests. The caps were flimsy and broke apart easily.
I knew the transfusion had ended because the bag of blood hanging from the IV pole, connected to the patient via special filtered tubing, was empty. I disconnected the blood tubing from the “permanent” IV line attached to the patient and threw the empty bag of blood away. Then I used alcohol to clean the end of the permanent line, and injected 10 mL of saline into it to clear the line of any blood left over from the transfusion. I twisted the now-empty saline syringe off the end of the patient’s implanted IV line, and as I did that, the IV cap came apart. Its interior piece of hard blue plastic, about one inch long, fell onto the floor.
The cap was a barrier against infection and had to be replaced right away. I took a new cap out of my pocket and screwed it onto the end of the patient’s attached IV catheter. Meanwhile, the nurse who had come into the room with me verified on the computer that the right unit of blood had been transfused into the right patient. She finished, I finished, and the patient, who had been sitting on the bed, his torso tensed like a spring in a jack-in-the-box, stood up, putting his whole weight on the piece of blue plastic that had fallen to the floor.
He was barefoot—ouch—and he swore elaborately. He accused me of not knowing how to do my job. “This one thing,” he kept saying, meaning the cap. If I couldn’t get this one thing right, if I couldn’t pick things up from the floor when it mattered, how could I get anything right?
I apologized, and I meant it, but it made no difference. So, I stood there, taking it. From my point of view, he was entitled. To have cancer at such a young age, and to have his nurse, the professional meant to look out for him, cause him pain . . . I waited, saying nothing, until he stopped. Then I squatted down and picked the piece of blue plastic off the floor. It had a surprisingly sharp edge. It would hurt to step on it. I cradled it in the palm of my hand, and the other nurse and I left the room.
“You handled that just the right way,” she said once we were outside the room. “Not to say anything, not to defend yourself.” She waved one hand in the air, swatting away useless explanations.
“Hey, thanks,” I said. What she told me, including the hand gestures—it helped.
I threw the piece of blue plastic away. Damn those cheap caps. Damn. And I still had to go back in the room to officially discharge him. And his IV line dressing—the bandage that covered where the implanted intravenous line entered his chest—needed to be changed before he left.
His discharge paperwork took longer to prepare than it should have, which is typical, but frustrating. Finally I had it and I went into the room. I felt the patient’s and his mother’s anger again, stronger, sharp now. I went through his instructions, reading off medications, outlining his follow-up care, trying not to hurry while wanting to hurry. His mother’s lips, pressed tautly together, maybe held back the abuse she wanted to inflict on me, on us, her son’s caregivers, to equalize the pain that cancer inflicted on him, and her. It wasn’t personal—I knew that—but then again, I was the person in the room with them.
Just as they were getting ready to leave, I remembered that the bandage over the patient’s intravenous line needed to be replaced. Every seven days, each patient gets a new dressing, and it’s a bit of a rigmarole because the procedure has to be sterile. The patient and his mother, however, were packed and standing up, ready to go. His mother, a nurse, had changed the dressing herself at home when needed, so I gave them a choice: I could change the dressing right then, delaying them slightly, or she could change it when they got home. She shrugged. Then without looking at me she said, “I’ll do it.” And they left.
A few days later my manager called me into her office. The patient had come to an outpatient appointment at the cancer center across the street with the old dressing—the one I should have changed—still in place. Nothing bad happened as a result, but I had broken a rule and someone had reported me.
I said that the patient’s mother had offered to change the dressing herself, that they were in an incredible hurry to get out of the hospital. My manager understood, but told me I should have written a note detailing the patient’s choice.
I wondered why the patient’s mother didn’t change the dressing. Maybe once she got home she was too busy, or too tired, or both. Maybe they had run out of in-home supplies and she thought I wouldn’t give her more because that’s what the rules say, even though nurses, including me, gave out extra supplies all the time. Maybe she wanted to be her son’s mom and not his nurse during their brief time at home. It doesn’t matter—there were no negative sequelae—but of course I should have made a note in the chart specifying that the patient’s mother planned to change the dressing at home. Truth is, I never thought of it. After they left, I only wanted to be done with them. I had looked his anger right in the face, and then, as soon as I could, I looked away.
When I received my own diagnosis from the radiologist, who never said cancer, only “a mass,” even the firm, enveloping hug from the ultrasound tech and her assurance that “they can cure this” couldn’t stop my crying.
I got parked in a hallway to wait for an additional mammogram. Now that the ultrasound had revealed a problem, they wanted to rescan part of my breast using mammography. Other women waiting for their own mammograms were seated near me as I quietly cried. It was the same hallway where I had waited before, and I felt exposed, but mostly I felt guilty. I figured that every woman there knew why I was crying and would prefer not to be reminded that her day, like mine, might include being diagnosed with breast cancer.
The mammography tech (not the comforting ultrasound tech) called me for the new mammogram and I kept crying. Slow tears, one after another, slid down my face while the tech squeezed and flattened my right breast between clear plastic plates. I held my breath and let it out; the tech asked me to step back and reposition, and squeezed and flattened my right breast with the plates again. The tears never stopped falling, so patiently, one right after another. When the mammogram was over, before she sent me back to the hallway, the tech said, “I hope everything turns out OK.” I looked at her, then walked out.
Afterwards the ultrasound tech who had been so comforting when I burst into tears led me into a darkened room. The walls were covered with outsize computer screens glowing in black and white. “We live in the dark,” explained the radiologist, seated in front of a large monitor. She showed me the mass in my right breast. It was small and irregular, pointy like a star. Except it wasn’t a star. It was, possibly, the beginning of the end of my life. The diagnosis was not 100 percent at this point. Only a sample of tissue, from a biopsy, would reveal whether I definitely had cancer.
Still, I cried steadily. When the tears hit my chin, I wiped them away with the back of my hand. “I can’t stop crying,” I said.
“It’s the ones who don’t react that I worry about,” the radiologist said, still looking at the mass—my mass—on the screen. “I worry that they haven’t heard what I’ve said.”
I returned to the dressing room and the kind ultrasound tech gave me a psalm she had written down, a message about heavenly protection. I thanked her. I hugged her. “They can cure this,” she reminded me, and then told me that she likely had something incurable herself; a final test result would soon confirm her diagnosis. I didn’t know what to say. I couldn’t take it in. But hearing it reminded me there’s all kinds of pain in the world, and I stopped crying.
In the dressing room I took off the wrap-around pink cotton gown I’d put on a few hours before and put back on my shirt and sweater. My outfit—a long sweater and black leggings I’d worn that morning to make me look tough and strong—no longer communicated anything other than these are my clothes. My book, Bad Feminist, seemed the work of an alien. I picked up my purse and put my pink gown in the bin for dirty laundry.
After leaving the dressing room, I sat down at the registration desk inside the waiting area. The radiologist had assured me that I wouldn’t leave the hospital without an appointment for a biopsy.
I perched in the chair, shoulders hunched forward, aware of the tear lines streaking my face. There was a computer on the desk and an empty chair behind it, but no one came to schedule my biopsy, which I needed to confirm the diagnosis. Finally, one of the receptionists spoke up. “She leaves at three,” she said, gesturing towards the chair, “You just missed her.”
I looked at my watch. It said three o’clock on the dot.
You just missed her.
Just missed her.
You just missed her.
No “Sorry” or “Call tomorrow morning after eight a.m.” or “Let me see if she’s actually gone.”
Had no one told the scheduler that a patient needing a biopsy would be coming to the desk? Or did she know and leave anyway?
You just missed her.
Just. Missed. Her.
I wanted to slam the receptionist into the wall.
I wanted to punch her in the stomach and as she doubled over, gasping for breath, smash my fist into the bridge of her nose. I wanted to hear bone crack. I wanted to see blood, have her say NO, beg for mercy.
But, of course, none of that happened.
The next morning, early, I called the scheduler. The first biopsy appointment she gave me was two weeks away. “No,” I said. Just no. And then I added, “The radiologist is ‘very concerned.’ This is the best you can do?”
Turns out they were short a radiologist due to a family emergency. She had spent all of the previous day “rearranging everyone else’s schedule.” Ah. That likely explained why she shut up shop at 2:59 p.m.
“That has nothing to do with me,” I told her.
“Well, I know it doesn’t,” she said, with a slightly, only slightly, chastening tone. It was a Friday and she found me an appointment for the next Wednesday. It didn’t even take that long. I thanked her sincerely, but this is what I did not say: Thank you thank you for doing your job today, when yesterday you had to straighten out everyone’s schedule, while I, well, I just had this small problem of being diagnosed with breast cancer.
You just missed her.
We’re short a radiologist. Short, short, short a radiologist.
You just missed her.
The experience grated. It stuck.
Like a small, sharp piece of blue plastic cutting into the tender skin of my sole.
Bob & Wendy
They were Bob and Wendy. She had fashionably cut short brown hair with bangs that curled just above her eyes. He had not much hair and was very tall.
He was the patient and she, the wife. He had a new diagnosis of acute leukemia. Usually when someone comes in as a “new leuk,” they seem panic-stricken, and their partner (if they have one) seems lost, too. Not Bob and Wendy. Going into his room felt like being welcomed to a small, intimate party. Middle-aged and financially comfortable, he was the relaxed host who was always happy to see you, while she pumped energy into the room with her nonstop questions and quick smile that crinkled the skin around her eyes.
I was Bob’s nurse on one of his first days in the hospital. Before leaving to go home, his night-shift nurse told me she had done her best to teach both of them about Bob’s disease and treatment. “Lots and lots of patient education,” she said. It’s what she thought they needed.
“A stunning book that helped me understand how to survive a serious illness and how to understand hospitals in general. Theresa Brown is also a hell of a good writer.”
“Revealing and heart-wrenching . . . Alternating the narrative between her time as a nurse and as a patient, she passionately shares the range of emotions she felt and offers advice for both patients and nurses who are facing breast cancer . . . By sharing her story, Brown delivers much-needed advocacy for those who are often ignored or misunderstood. An essential read for all members of the medical community.”
—Kirkus Reviews (starred review)
“An unflinching look by a former nurse at the lack of compassion in our health-care system and the harms that patients suffer because of it…Brown writes with a winning combination of passion, humor and medical knowledge.”
“An extraordinary writer, Theresa Brown brings the reader into all of her worlds, showing how cancer affected her as a patient, nurse, mother, daughter, wife, and friend. This is more than a good read. Oops, I am crying again.”
—Claire M. Fagin, PhD, RN, Professor Emerita and Dean Emerita, School of Nursing, University of Pennsylvania
“This is the book I want to give to all my colleagues and patients—a smart, moving, clear-eyed, yet ultimately hopeful jewel of a read on health and care from one of the most thoughtful healthcare writers I know.”
—Pauline W. Chen, MD, New York Times contributor and bestselling author of Final Exam: A Surgeon’s Reflections on Mortality
“A deeply moving story of an oncology nurse forced to navigate our imperfect health care system after an ultrasound exam upends her life. Brown offers important lessons for patients and health care providers alike.”
—Damon Tweedy, New York Times bestselling author of Black Man in a White Coat: A Doctor’s Reflections on Race and Medicine
“Timely . . . Brown’s clear-eyed and eloquent examination of illness—from the inside and from the outside—is illuminating… moving and enlightening.”
“Healing should be read by everyone, not just those facing cancer. Brown experiences both grief and revelation, and the beauty of her book is that we learn so much about hope and fear and coping, about living and dying and everything in between.”
—Bobbie Berkowitz, PhD, RN, FAAN, Emeritus Dean, Columbia University School of Nursing
“By relating her own intimate experiences with cancer, Brown provides a candid critique of a system that sometimes fails people when they are most vulnerable. A brave and rare book that advocates for greater compassion in healthcare.”
—Pamela F. Cipriano, PhD, RN, FAAN, Dean, University of Virginia School of Nursing
“Riveting and wrenching, Theresa Brown’s memoir takes us into the heart of what it means to be mortal. Examining illness from the inside and the outside, Brown’s sure hand provides a clear-eyed narrative that’s both intimate and harrowing.”
—Danielle Ofri, MD, PhD, editor of Bellevue Literary Review and author of When We Do Harm: A Doctor Confronts Medical Error
“A compelling and beautiful book. Brown’s personal depth in her narrative and remarkable tie-ins across many facets of history and literature draw the reader in and make it clear how much work we have to do in healthcare to get to reliable, humane practices.”
—Terry Fulmer, PhD, President, John A. Hartford Foundation, former Dean, NYU College of Nursing
“In her wide-ranging examination of fear, illness, and life in what she calls ‘cancer’s shadow,’ Brown never fails to reveal her own humanity. Healing is a book not only for breast cancer patients and their loved ones, but for anyone else who cares about caring. Most importantly, Brown shows us the importance of perspective: how the value of compassion becomes infinitely greater when it becomes your own life that needs saving.”
—Chicago Review of Books
Praise for The Shift:
“An engrossing human drama . . . The Shift is one nurse's story, but it contains elements of every nurse's experience." –The Wall Street Journal
“The Shift . . . should be required reading for all incoming medical and nursing students--or anyone who is a patient or visitor in a hospital . . . Her story is riveting in the exacting way she recounts the way her day unfolds.” –Pittsburgh Post-Gazette
“Brown does an excellent job of taking us moment by moment through her day . . . keeping the narrative flowing. The reader feels her affection and deep sense of responsibility for her patients." –Minneapolis Star-Tribune
- On Sale
- Apr 12, 2022
- Page Count
- 272 pages
- Algonquin Books