I could tell straightaway that Annie had all the qualities of a great nurse - caring, gentle, warm and able to talk very easily and comfortably with anyone and everyone. Of course, she was a bit modest like anyone would be when presented by a question ‘Why are you so amazing?’ She went onto say ‘I really don’t know, I just do my job that I love so dearly. Velindre allows time that we are able to give our patients which is so important and I think from a specialist nurse point of view and on behalf of my other co-workers, it is a privilege to meet the patients and their families. I feel so humbled by their stories and journey, I have nothing but admiration for the families I see every day. One of Velindre’s core values is that nothing is too much trouble and I try to embody that every day with every patient. Doesn’t matter what job you do in Velindre, there is always someone who can help the patients.’
Annie looks after patients who have upper gastrointestinal cancers. These involve oesophagus, stomach, pancreas, liver and gall bladder. She explained that these cancers can be very difficult to detect, diagnose and treat because of the nature of where these cancers are. Unfortunately this means that some patients, at diagnosis, are too ill to receive treatment.
So what is a typical day like for a specialist nurse at Velindre? As I thought about how vastly different it must be to my day-to-day. Annie started off saying she has clinics every day. In a new patient clinic we see the patients for the first time after they have been through a long and difficult diagnostic pathway. Understandably this can be quite an anxious and distressing time. Pre chemotherapy clinics are where patients are reviewed who are undergoing treatment. CT scans are performed to monitor how effective the chemo is so quite often CT results are given.
‘It is so hard delivering scan results’. Annie mentioned a patient that morning who had her scan results where despite the chemotherapy, the cancer continued to grow. The discussion then is around trying a different type of chemotherapy, or, does the patient consider best supportive care. This means that they will not receive any active anti-cancer treatment because we know that their cancer cannot be cured, but have the help and support from the palliative care team in the community. I started to think the challenges I face in my job were absolutely minuscule to the harrowing real life scenarios that Annie goes through. A lump starts to form in my throat when I ask her a bit more about the difficult times.
‘I have seen patients who were only diagnosed with cancer a week or so before we see them following an acute admission to hospital. Sadly, all too often in these cases their cancer is so far advanced and they are so unwell, we are unable to offer any treatment and the conversation then turns to discussing what support is there for them all as a family and what, if any, wishes they may have for end of life care. These consultations, as I am sure you can imagine are very distressing and emotional”.
I started to think how in the world do you deliver that type of tragic news to someone? It’s bad news. The cancer has spread. The cancer has come back. Annie went on to say ‘It is usually a knee jerk reaction from the patient when they ask how long have I got left’ She explained that some of the patients actually don’t want to know but ask the question. So she explores this with them a little further and usually it is agreed that they will re-visit that question when the patient is more prepared to hear the answer…if they can be. She says that this is the type of conversation she has all too often with family members and friends of patients. "There is sometimes nothing that I can do to make it better. She says, “I always feel so helpless and the thought of them leaving Velindre after being given that news…………… how do they put one foot in front of the other then drive home and tell the family!! It’s a really small gesture on the grand scheme of things, but I can’t bear to see them leaving the hospital so I walk with them to their car."
Annie says there is a huge driving force which gets her up in the morning and motivates her to go to work every day. ‘One of the best things about the job and what inspires me are the patients’. Surprisingly she says that some of her patients tell her things that they have never told anyone else before and she goes on to say that she feels privileged to be that person who is needed to be that shoulder to cry on or that ear to listen.
This lady is incredible. The type of emotion and sorrow she has to witness and then will still manage to smile at the end of the day. I start to think she isn’t just a nurse and the more we kept speaking, I felt if you worked in Velindre you are also somewhat a counsellor and friend as well. We spoke about how being a nurse is having more than the skills you learn in university and that she always felt her destiny was to be a nurse. ‘I’m quite happy that I’m not necessarily moving up the career ladder but focusing on my vocation which is solely caring and giving time for my patients’.
I asked Annie if there were any stories in particular, from the many she deals with each day, was there one that she struggled to separate her emotions with her home life. She nodded quickly and started telling me about a young lad she got to know well during his treatment. It was during the Six Nations and it was just one line that he said which stuck with her - ‘Annie, I’m going to make the most of these games as I won’t be here next year to see them. He was lying in bed, watching on his iPad and for whatever reason that resonated with me deeply'. She says she does a lot of reflecting on her drive home and has cried many times, especially when a particular song comes on the radio and feels that music is so powerful.