There is something disconcerting about doctors’ waiting rooms. Threadbare carpets greet heavy footsteps and clinical colour palettes dull the mood. Even the obligatory portraits of country houses and bowls of fruit offer little comfort for what’s ahead. For those anticipating the worst, these become liminal spaces of uncertainty that breed fear and anxiety. When the news is bad, having a hand to hold between these customary visits to a physician’s office can make a world of difference.
Life-threatening illnesses such as breast cancer are on the rise and the need for support systems that help patients cope with the equally devastating psychosocial effects of the disease, is also growing. Much has been written on the surgeons, oncologists, and researchers who treat the medical symptoms of breast cancer. These are the stories of three women who treat the people behind the disease…
Breast care nurses
Jo Beven is not a keen flier; but for her job, hoisting herself into the metal belly of a twin turbo propeller plane is a necessary travel inconvenience. Recalling a particularly harrowing journey home in the middle winter, her flight was forced into a dizzying circle above a darkened airbase for more than twenty minutes. “No one had turned the lights on for the runway and we had to wait for someone to get out there to flip the switch so we could land,” Jo says. “So yeah, I’m not a big fan of flying.”
Jo works as a breast care nurse with the Royal Flying Doctor Service (RFDS) in Broken Hill, New South Wales. Since starting her position nearly six years ago, she has made frequent trips across the plains of Ivanhoe, Tibooburra, and Yunta to provide care and counselling for breast cancer patients who live in remote country towns. On clinic days, Jo flies out of Broken Hill Airport at 7:30 in the morning to visit “her ladies,” dropping off a doctor in town on the way. When she arrives, advice on symptom management and treatment options is given over cups of coffee and good food. “It’s rather nice seeing the women in these places because we’ll often go to the local café and have lunch together,” says Jo. “They don’t have to feel hurried to get out of there because I’ve generally only got them to see and I’ve got as much time as they’ve got.”
It’s a welcome change from her usual office inside the airplane hangar of the RFDS base, where the soundtrack to her day often involves the cacophony of technicians fussing over plane engines. While in town, Jo performs home visits and will often go up to the oncology department to sit with the women who are undergoing chemotherapy. In the process of helping patients navigate their cancer diagnosis, Jo likes to keep her relationships professional, but admits at times it becomes hard not to be personally affected by their stories. “You go into people’s lives and you share their lives with them and in return they want to know about your life,” says Jo. “You have to give a little bit of yourself to them in order to personalise it a bit better, but you just have to be careful to protect yourself.”
Speaking about “a very special lady” who had been living with secondary breast cancer for twenty-four years, Jo described the profound life moments patients can still have when faced with devastating illnesses. “At first she was extremely pragmatic and unemotional about it. Then her daughter gave her a grandchild and she got a completely new lease on life and decided she was going to live to see this child grow up.” While her patient did pass away last year, Jo says she never lost her newfound outlook. “She told me not to cry over her because she would be sitting up on a cloud watching all of us and she would know if we cried.”
Despite the losses, Jo says she has loved being a cancer nurse from day one. “My job isn’t very busy and it can be pretty frustrating sometimes. But there are some days where you see a handful of women and when you leave them, you think ‘I’ve actually helped them today,’ whether it’s mopping up tears or organising their travel.”
Jo’s next flight out is a trip to Tibooburra at the end the month to visit a patient whose hair has begun to fall out. “I’m going to take her up a selection of wigs and we’ll play hairdressers and she can select one she likes.”
Kylie Campbell spends a lot of her workdays on the road. As a clinical manager working between the Mount Barker and Murray Bridge community health centres just outside Adelaide, Kylie often drives over two hours to meet her patients who live out of town. At times, she acts as a chauffeur for women who don’t have easy access to transport, driving them to support groups and community meetings. It was during one of those drives that she began to bond with a breast cancer patient who was struggling with her diagnosis.
“I spent quite a bit of time with her because once she got her diagnosis, she just tended to stay home all the time,” recalls Kylie. “She lost all her connections, got quite depressed and didn’t do anything.” To counsel her through the treatment process, Kylie would make repeated trips to her home and drive her to support meetings and knitting groups. During those quiet moments in the car, Kylie took the time to talk through the woman’s emotional concerns and encouraged her to reconnect with her community. Eventually, she would feel well enough to walk to her closest meetings and began to appreciate the supports systems around her. “That was quite rewarding because you could see her, accepting not only her cancer diagnosis but also her general well being improving as well,” she says.
The rapport they built lasted until the woman’s death. Her family contacted Kylie about the funeral date and expressed their appreciation of the care that she received. It was one of the few patient funerals Kylie’s been to.
For Kylie, the support breast care nurses provide is holistic and extends well beyond the medical. “Sometimes it’s just a matter of listening and being there for them, helping them make sense of what just happened.” Those subtle gestures of empathy become even more substantial for breast cancer patients on end of life care.
Kylie frequently works with a palliative care team to help patients work through familial or financial concerns and form a plan to alleviate any strains on their quality of life. Yet, end of life services are not somber resignations for patients with terminal prognoses. “Palliative care doesn’t just come in when they are about to die,” Kylie says. “We come in early so we can get to know the people, build up a rapport, and know what their wishes are before everything gets stressful.”
More often than not, Kylie sees a sense of hope in her palliative care patients. “Mostly they’re good and certainly with more care, they do deal better with things.”
In many ways, Pip Bell is the consummate multi-tasker. Her role as a telephone support nurse for the McGrath Foundation requires her to cover for any of the organisation’s 110 breast care nurses situated across Australia.
Pip’s day begins much like an exam revision. After reading a steady stream of patient reports from nurses away on leave, she proactively contacts patients who need follow-up calls, ensuring she is well versed in each of their medical histories to offer constructive support. Each call lasts a minimum of twenty-five minutes, with conversations often transitioning from the medical to the personal and ends with Pip transcribing their tête-à-têtes into updated reports for returning nurses.
At the same time, Pip also fields calls from the general public looking for breast care advice and education. From speaking to people in hospital to those with drains or special dressings at home, she views her job as a way to tailor care based on the patients’ needs.
Pip may not have face-to-face contact with the patients she supports, but the emotional load of their stories invariably resonates with her. “It’s people who seem to have everything against them and you just think what else could go wrong in this person’s life,” she says. “And these people just seem to pull it together with inner strength and they crash through, come out the other side, and from that day on they get stronger.”
Whilst they can’t provide a permanent cure for the disease, there is little doubt in Pip’s mind about the indispensable role breast care nurses play in their patients’ lives. “You have to maintain their hope and give them a lot of information. Hope is about preserving morale and maximising courage. We want to get them well enough to look forward to the next thing they want to achieve.”
What you can do support the work of breast care nurses
Donate or volunteer at the McGrath Foundation, a charity that pays the salaries of breast care nurses around Australia.
Support breast cancer research and find local support groups at the Breast Cancer Network Australia.
Donate, volunteer and support cancer research at the Cancer Council NSW.