At the end of August, a patient, Ms. Z, was admitted to 6-3 with metastatic disease of unknown origin to the ED with complaints of acute back pain. During the summer, she had a fall, which led to chronic pain and complaints of bilateral hand neuropathy. She was seen by multiple services: ortho, neuro, and rheumatology, and could not get a proper diagnosis. She told Abby she felt unseen and unheard.

The pain had progressed to her whole body. An MRI was ordered, which showed bone lesions all over her spine and sacrum consistent with metastatic disease. She was diagnosed with diffuse large B-cell lymphoma during this admission. The patient was also discovered to have bilateral saddle pulmonary embolisms and a right lower extremity DVT. She also had mild heart strain. The morning Abby was assigned to Ms. Z, the patient was going to go down for a thrombectomy in IR, and the plan was to start chemotherapy immediately as the cancer had been progressing rapidly.

Without either of these immediate interventions, per the oncology care team, the patient was going to die. The thrombectomy procedure was unsuccessful, and the patient came back up very anxious and with increasing O2 requirements on high flow nasal cannula. The patient was becoming acutely ill requiring multiple interventions and it was decided that she would be transferred to the ICU for higher level of care. Abby accompanied the patient to the ICU and worked in tandem with the ICU nurses assigned to the patient. She was started on a precedex drip to calm the strain on her heart and respiratory system, a heparin drip for the PEs and DVT, and the first part of the chemotherapy regimen, Rituxan, was initiated. The patient received the second part, CHOP, the next day.

Abby collaborated with the ICU team and provided the education needed to work together to stabilize this patient over two days. She educated the ICU nurses about the risk factors that this patient had against her: Respiratory distress due to the bilateral pulmonary embolisms, hypercoagulability seen in patients with cancer with the right lower DVT and PEs, risk for tumor lysis syndrome after chemotherapy administration, risk for infusion-related reactions from the Rituxan that could compromise her cardiac and respiratory systems, and severe pain due to bone mets all over her spine and a confirmed L2 fracture. Throughout all of this, Abby remained calm and helped the patient and family get through this crisis. She explained everything that she was doing, listened to Ms. Z and her concerns, and answered all of the questions the patient and family had for her.

When the patient started to panic and cry because of all of the things that were happening at once, Abby sat next to her at the bedside and held her hand, telling her to deep breathe, letting her know that she is not alone and that she (Abby) would be at her side. Ms. Z stated she was afraid of dying and leaving her family. Abby was so patient, kind, and understanding. The patient told her that she felt like Abby was her angel on earth, helping guide her. At one point, while Abby was administering the Rituxan and titrating it up, the patient calmed down enough to tell funny stories about her family. The patient raised five boys who are now adults, and Abby shared that she has three boys. They connected on another level as both shared stories about motherhood and the crazy things sons do. This is a fine example of caring in action.

The outcome of this acute situation was successful and is a testament to how two nursing teams can work together for a patient. The patient was stabilized and transferred back to 6-3 after a few days and discharged home with a plan in place for her cancer treatments, pain control, and management of her PEs and DVT. Per the oncology care team, the patient had a chance for a cure for her cancer. Oncology nursing is not for the faint of heart. It requires a special type of nurse who is competent in her skill set, displays professionalism, compassion, and empathy to the patient and family needs, and collaborates with the interdisciplinary care team.

Abby displays all of the qualities of an exceptional oncology nurse, and I am in awe of her dedication to all of her patients. Abby is the epitome of how a Silver Cross nurse should be.