This interview is of Heather Rice, my daughter, who has worked in both organ transplant and oncology settings. After the interview, I plan to post a series by her on suffering.
Heather, you are an oncology nurse. You and I have talked a number of times about your career and how you deal with it. I appreciate your willingness to talk about some of our discussion topics in an interview.
Over the years, as real-life, heavy-duty situations have confronted you with ethical questions and difficult life issues, you’ve gone to God’s Word for direction and then planned practical applications of what it says. This has shaped your approach to patients, co-workers, and medical practice, especially in regard to patients who are suffering and dying. For example, you’ve told me that one of the most frequently asked questions you receive when someone learns what you do is, “How do you do it?” meaning, how do you daily try to help people who are in pain and often dying without growing depressed or quitting? That is a question that you were asking yourself even before others did. Your use of God’s Word has also confronted you with the question of how to minister comfort and not just medication. How does the Bible get fleshed out in scrubs and gloves, in how you speak and even how you touch a patient? So to begin…
Where have you worked and what do you do where you are now?
I have been a nurse in oncology for about five and a half years. I worked oncology in a hospital first for over a year. Now I am doing outpatient care in an infusion center. A major part of my job is to prepare the prescribed chemo and administer it to my patients.
The words “oncology” and “chemotherapy” drive another word straight to the surface of my mind–“cancer.” For many people, “cancer” is a frightening word.
Quite true. For most people, those words are like one big monster. But, because this is the world I work in I have a different perspective. With the advent of many of the modern treatments and medications for side effects, the older image of unrelievable misery is no longer true. Cure rates have risen greatly for many cancers since chemotherapy was first invented. I don’t want to sugarcoat the picture. Chemo is no picnic and we still lose over half of our patients. But the oncology world is very different than it was 30 years ago.
So when you say “medications for side effects,” you mean that unbearable side effects that I remember hearing about in the past are no longer the norm. Is that right?
Yes. We have medications that effectively alleviate many side effects.
Toward cancer, is there a difference between doctors and nurses in mental attitude?
Many, not all, oncology doctors take a bit of a warrior mentality toward cancer. They don’t like to lose patients to the enemy. Nurses want cures, too, but by virtue of working for hours with each patient they tend to develop relationships and be more nurturing. Doctors simply can’t spend all that time relating. They tend to have a physio-medical perspective, a problem-solution perspective.
Doctors might not like to hear that. They might disagree with you.
(Smiling) Doctors don’t agree with nurses on everything; sometimes we have to help them a little to see the light.
Remember that oncology doctors already have a strike against them. With other doctors, the patient comes in feeling badly and the doctor makes them feel better. With oncology doctors, patients usually come feeling well and the doctor makes them feel miserable.
I highly respect the drive and hard work that oncology doctors have to assert and the skill they have to attain. Think about the history of cancer treatment. Because cancer is so vicious doctors have had to go to extremes to find cures. So they tend to take a disease-cure, problem-solution approach and do whatever it takes to lengthen a life or achieve a cure. In the past, to battle against cancer it was as if it didn’t matter what side effects someone had as long as you don’t die. That is how we’ve made progress against cancer.
Think about it this way. You have a choice between two doctors. One is all business, brusque, even blunt in telling patients the bad news, doesn’t return phone calls, isn’t very pleasant, is highly knowledgeable, innovative, and very aggressive toward cancer. The other is acceptably knowledgeable, wants to fight cancer, goes by the book, is more responsive and pleasant with patients and makes them feel cared for. One is on the warpath; one is definitely in the fight but more as a regular soldier. The warrior is very advantageous for a patient fighting a beast like cancer.
Meanwhile, nurses see what patients go through with the treatment that the doctor prescribes. They can step in and create balance with other aspects of care like calming fears, minimizing side effects, and alleviating discomfort.
So in the final analysis, it is the doctor-nurse team that can provide the most well-rounded care.
You see a lot of suffering and must experience your own sense of loss when one of your patients dies. In your career, the scenario is repeated over and over. How do you do it? How do you face the suffering and death daily? How do you fight so many battles that you know you won’t win, and yet maintain your sanity?
Gaining God’s perspective of suffering and death was the biggest help and has sustained me throughout my career as an oncology nurse. For me, the eleventh chapter of John is very precious because God used it to teach me His perspective.
That’s the chapter that relates the death and resurrection of Jesus’ dear friend, Lazarus. What do you mean by God’s perspective of suffering and death?
Well first, that chapter explains why there is cancer, suffering and death. One of the disturbing things about cancer is that it can seem so random. A patient once asked me, “Why did I get cancer? I never smoked. I ate all the right things. Why?” God gives the reason: sin. The resurrection of Lazarus anticipates Jesus’ own resurrection. From what was He resurrected? Death. Why did He die? Because of sin. The penalty of sin is death and so sin is the ultimate cause of sickness and death.
Let me hurry to say that I do not mean that every cancer can be traced to specific sins committed by the person. Obviously we can help cancer along by lifestyle, but for most cases cancer cannot be traced to a single cause. So what I mean is that the ultimate cause behind all death and disease, including cancer, is sin. In Eden, before sin, there was no cancer and no death. But, through Adam “sin entered the world, and death through sin, and so death spread to all men” (Romans 5:12). We tend to see disease and death as separate entities, but from God’s perspective disease, suffering, cancer—they are all just stages in a long process culminating in death.
Second, it teaches me to hate sin and be amazed at what Jesus did. It is easy to think lightly of sin. What harm could a little white lie do? But think about it: if one bite from a fruit in Eden could result in something as horrible as suffering and death, sin must be very bad indeed! An eternity in hell cannot satisfy the debt incurred by your and my sin. In fact, sin is so bad that only Christ’s innocent blood can provide remedy for its penalty. What this means, then, for the person asking “why,” who is also usually angry over having cancer, is that if I have cancer and I want something to be angry at, I can be angry at sin since because of it, my Lord was killed. We all need to deal with the sin issue before we die.
Third, it gives me hope. In John 11, Jesus was not helpless before death: one word and Lazarus was alive! The best a doctor can do is postpone death; Jesus can cure it.
Jesus could have healed Lazarus. Instead, He deliberately waited for Lazarus to die. That’s because He had a purpose. Lazarus’ death paved the way for Jesus to demonstrate that He has power over death, power to give life. He even took the time to stop and talk to Martha before raising Lazarus. He was in complete control. I think the reason Jesus discussed resurrection with Martha before raising her brother was to help her focus not on a temporary restoration of life, but on Jesus as the source of eternal life.
Some people become obsessed with living longer by beating their cancer. When living becomes the only hope of a terminal patient, a desperate, bitter despair tends to develop. Of course, I too want them to beat cancer and live, but assurance of peace and life with God and His forever favor is far better than a few more years on earth. Having this answer–that they can have eternal life in Christ by repenting from sin and trusting Him for salvation–is like being able to carry a lantern of hope into the clouds of gloom. No matter what happens, Jesus can be their resurrection and life, “he who believes in [Jesus] will live even if he dies” (John 11:25). This is a hope that is stronger than death.
How do you avoid getting calloused to suffering when you see so much of it?
John 11 shows me how to respond and not be hardened. Thinking about this chapter, I have often been struck at Jesus’ behavior at the tomb. He had an easy solution. He could have waltzed up to the tomb, said a few words and raised the guy. Instead, it says that when Jesus saw everybody crying, “he was deeply moved in spirit and was troubled” and then he began crying too (John 11:33, 35). Think about it: even though he knew he was about to raise Lazarus in a few more minutes, Jesus took the time to cry. He empathized with our deepest grief.
If the Creator was moved by the suffering of his creatures, then it is appropriate for me to be moved. Of course, we should never be controlled or so overwhelmed with emotion that we sin or act inappropriately. But our experience of inner turmoil in response to suffering and death is legitimized by Jesus’ own inner turmoil.
So, in grappling with how to maintain sanity when you daily deal with suffering and dying people, it isn’t a matter of settling for grit and sanity. It is a matter of going other direction by seeing God’s perspective and how Christ relates to each case. Preparing your own heart then works out in how you deal with others. The continuation of the interview will move in that direction.