This may well be the longest I have been away from my blog – 26 days!  When I started my new job working as a nurse in the Bone Marrow Transplant Clinic, I did not know to what extent it might affect my blogging activity.  Now I have a better idea although things should improve.  I am working three ten hour days a week during orientation.  There are many things I need to learn: new drugs, new equipment, relearning old skills, remembering many of the facts and procedures I have forgotten, new computer software systems, operations and systems specific to the IU Health in general and the BMT Clinic specifically.

These things can only be learned on day shift since I will be working solo when I switch to my evening hours.  The pace has been a physical, mental, and emotional strain.  I am going from being “disabled” to working ten hours shifts, spending most of the time on my feet.  I am used to getting 9-10 hours of sleep and getting up around nine in the morning.  Now I am at work by 7:30.  And because of the parking situation – 22,000 university students and staff competing with 10,000 health system employees – I have to park a ways from the hospital, leaving home early to take a shuttle from the outlying parking lot.

Of course, this was all complicated by being in the hospital for five days.  We just received the $30,000 bill yesterday.  My body always takes a while to recover.  But I felt like a needed to get back to my orientation quickly.  So I probably pushed myself.  I received extra doses of corticosteroids during hospitalization.  I was discharged with transient hypertension which persisted for three days.  Over the first two weeks I had several more periods of high blood pressure while at work.  My hands started trembling, my heart seemed to flutter and I felt lightheaded.  I went to my doctor, for the second time since discharge, and got started on a “beta blocker” to straighten out the pressure problem.  Only now my pressure was getting too low and I began to feel faint.  So we are still fine-tuning the dose.

Eleven hours makes for a long day.  I get home around 7, retire to the recliner, remote in hand.  I try to arrange my schedule so that I only work every other day – Monday, Wednesday, and Fridays.  I usually feel wasted each day following a work day.  Hopefully I will get strong and build my endurance.

One is tempted to think that returning to nursing would be like riding a bicycle – everything would just come back somehow.  I have discovered that returning to nursing is more like riding a unicycle while juggling six balls, balancing a spinning plate on your nose, and knowing how the repair the bike when things go wrong.  Working as a nurse automatically means multi-tasking.  People on disability don’t do a lot of multi-tasking.

So here I am, back at the keyboard.  I have Father’s Day in front of me.  It’s too rainy to work in the garden.  I plan to publish this post.  Then I want to troll the cancer blogging community for more examples of excellent writing about our collective cancer experience.  I go to my evening shift in two weeks.  Then I will have more time and hopefully more energy to devote to the network.

Take care, Dennis

I guess it’s one of life’s little jokes, its persistent sense of irony.  Since I was declared no longer disabled by my insurance company in January, I have been struggling to put together a new sense of identity. I needed to begin seeing myself as more fully enabled.  Given my restrictions it was more difficult than I thought it would be to find a suitable job.  This despite or maybe because of my rich career history in nursing.

I did some seasonal work grading statewide elementary school tests, scoring the same seventh-grade essay question and then the same fifth-grade math question thousands of times over.  There was a kind of enlightened tedium to the work and, at the same time, a sort of nobility.  Many of my co-workers were between real jobs or otherwise struggling with the economy.

When I was called in for an interview for a part-time position at the university bone marrow transplant clinic, it seemed an ideal opportunity.  Less than five hours a day, evening hours to leave my days free to care for my granddaughters and mother, minimal exposure to infectious patients and the large masses of people that populate the medical campus during the day.  And most of all the chance to return to what I knew – both as a professional and as a patient – that hard-won experience.  This was a chance to share my knowledge and the lessons of my suffering.

The first week of general hospital and nursing orientation was full and exciting for me, especially after my seven-year sabbatical.  Two major health care system had recently completed their merger.  Each day we parked at one hospital, then rode the overhead monorail system to the new training center.  Continuing on the route takes you to the medical campus with its various hospitals, outpatient clinics, research centers, and schools of nursing, medicine, and dentistry.

Except for the stress of getting up early each day (like most normal people) and spending eight hours a day at something (again like normal people), it was an invigorating experience.  I was beginning to feel empowered again.  That I had to spend a few more hours each day getting the house and garden ready for the baby shower probably took its toll.  My immune system seems sensitive to stress.

By Saturday after that first week I had developed a strep infection.  This turned to scarlet fever and then to sepsis, followed by acute renal failure and hypokalemia.  I haven’t been sick enough to be hospitalized in over a year.  But this turned out to have been sicker than I have been in a long time.  I rarely end up in critical care.

Life turns so quickly.  One day I was feeling empowered, restored.  Then overnight I found myself debilitated and in danger.  Things stabilized quickly enough but it is a long slough.  My new manager was great but it was embarrassing to have to call in sick on my first day.

This is maybe two steps forward and only one back.  My new nursing scrubs are still packed in bags, sitting on the dresser.  Later today we will work on rescheduling my orientation at the clinic.  I did take the opportunity as I lay on carts and beds transitioning through the various levels of a modern health care system to reflect on what was happening to me, to observe how my new institution’s mission and values were interpreted and practiced from my own ceiling-focused vantage point.

We humans have always been able to find the good in the bad.  I will use this experience to further inform what I bring to my own practice of caring.  Along the way I will write about it here.  Thanks for all the good wishes.

Take care, Dennis

On Monday I start orientation to my new job working evenings in the Bone Marrow Transplant Clinic at Indiana University.  I am looking forward to everything but getting up at 6 in the morning.

As part of my job search, I had subscribed to a number of nursing sites and discussion groups.  Just after you offered me this job, I saw an announcement on the site NurseTogether.com for an essay contest.  The prize was a $250 gift certificate at Tafford Uniforms.
I put together some of my thoughts about returning to nursing after my illness-imposed sabbatical.  I am proud to say that I was informed last week that my essay “Resurrection” has been selected as the contest winner.  The essay is featured on their homepage.

When I left nursing, first in 2001 and then again in 2004, I thought that I might die.  As this spring season ebbs, I find myself returning to nursing, and to the place of my re-birth.
Just before Christmas, almost ten years ago, I was diagnosed with a rare type of cancer – T-cell prolymphocytic leukemia, described in the literature as “aggressive” and “invariably fatal.”  I had been an oncology nurse for fifteen years, ironically caring for inpatients fighting some kind of leukemia or lymphoma. I guess I had forgotten to sign up for the dispensation.

I responded to a new biotherapy and achieved remission, only to relapse, as promised by the same literature, twenty-six months later.  More biotherapy and then on to what may have been a curative treatment for an incurable disease – an allogeneic peripheral blood stem cell transplant.  My immune system transplant, a literal re-birth, took place at the university hospital.

Seven years later I find myself returning to the same hospital, to the same transplant center – this time as a clinic nurse.  An appropriate symmetry.
I had always said that I was a better human being as a nurse.
While I was fighting active disease and then enduring my prolonged recovery, I morphed into a different kind of person.  My journey turned increasingly inward, familiar, and safe.  My contacts with the world faded and become less immediate.  For me there has been nothing quite like nursing for prodding my natural tendency toward introversion into an outward direction.
During my recent interview with the manager of the bone marrow clinic, I found that our conversation was punctuated by stories from my professional past, stories of patients and their families, stories of hope and fear, of tears and laughter.
I worked plenty of overtime over the years and was heavily involved professionally so my life was always dominated somewhat by cancer.  That, of course, was nothing compared to the immersion into the world of cancer that has been my experience for the past ten years.
Throughout the trajectory of my illness and treatment, I have spoken about my experiences, both in person and in print.  I have made my illness narrative inordinately public.  If you google the name of my disease, you will find me in the first three entries – usually below the Wikipedia reference but just above that seminal article that predicts “invariably fatal” results.  Consequently many people have contacted me over the years, patients or their families, about my leukemia and transplant.
I maintain two websites that I share with cancer survivors.  One site has had over 108,000 visits.  So I keep in touch.  I thought I had my hand on the pulse of cancer.  But that contact, though rewarding, has been mostly virtual.
Many of my fellow survivors refer to cancer as the “Beast.”  Returning to nursing, this time as a survivor, is like returning to the belly of the beast.  In working at the transplant clinic, I feel as though I am venturing into its heart.
I have been on disability for a long time.  I will be working only about half-time, four or so hours five evenings week.  I think that I saw this job opportunity as a gradual reintroduction to my nursing career.  But in the days after my interview I realized that there was no such thing as returning to nursing halfway.  If I want to be truly effective, I feel that I must be able to present myself wholly and authentically.
My return to clinical nursing may be marked by contradiction.  I will need to formulate a healing identity that draws upon the best lessons of both worlds, that of professional care provider and that of cancer survivor.  I was reminded just this morning that I am bound in each of those spheres.
I was awakened by a telephone call from a nurse at the occupational health center at the university hospital.Yesterday I went for my pre-employment physical.  Blood was drawn since I will be giving chemotherapy in my new role.  The nurse called to alert me that my blood count values were “off,” not diagnostically low but certainly on the far side of the bell-shaped curve of normalcy.  An immunocompromised nurse working in the land of the immunosuppressed.
I have long said that I was at my best as a human being on this earth in my work as a nurse.  With the experience of having faced the ultimate uncertainty in life, my approach to treating people with cancer will surely be “evidence-based.”
I have faced the “Beast”.  I have won my battles.  And now I am back.  I am a nurse once more.

Gateway to a future...

Job News:

Just about seven  years ago I was reborn at Indiana University Hospital.  With my brother as my donor I underwent an allogeneic peripheral blood stem cell transplant.  My twenty-two days there remain hazy, a vague kind of dream from which I awoke with a new life.  Part of the time I was fighting the predictable infections that accompany the procedure – that period when my immune system in defenseless while engraftment is taking place deep in my bone marrow.

I remember well the night I got up to go the bathroom.  Yes, the nurses said to put on the call light first.  But I was an adult.  I was a nurse so I was capable of assessing my ability to walk unaided.  Then the room began to spin.  I whirled and crashed in to glass-fronted cabinet, bumping my head on the corner.

Dejected and embarrassed, I sat down on the bed and put on my call light.  Two nurses rushed into my room, examined the small cut on my forehead and scolded me gently.  My wife came in at 3:30 in the morning.  I went downstairs for a CT scan.  I remember being bald at the time but for the rest I would have to consult my Caringbridge entries.

Today I accepted a position working part-time evenings in the Bone Marrow Transplant Clinic at the same hospital, just down the hall from my original room.  This will be an ideal job.  I will be the only person in the clinic after six.  My patients will not be there for active infections.  The rooms are Hepa-filtered. And I only work 4.5 hours a day.  So my exposure risk (my immune system is still immature at six years old) and working hours are minimized.

I will still have days free to care for my granddaughters and my mother.  But the biggest excitement is   being able to share with my patients the kind of additional legitimacy conferred by our shared experience, in addition to my twenty-five year background in oncology.  So in returning to IU there is an appropriate kind of symmetry.

We will have to see how this new schedule affects my ability to keep up with the blog.  On the other hand, having the opportunity to work so closely again with people struggling with cancer will certainly give me more to write about.

Book News:

Sheryl Crow – Rockstar.  Singer-songwriter.  Record producer.  Actress.
Cancer survivor.  Activist.  Mother.  And now Cookbook author has written a new book  – IF IT MAKES YOU HEALTHY–written with Chef Chuck White–is filled with over 125 seasonal, locally grown and delicious recipes as well as notes from Sheryl about life on the road, home, and stories of her childhood & path to stardom.

Ashley Murphy, fellow blogger (Ashley’s Art Closet) and liver cancer survivor, announces publication of her book Daddy’s Briefcase.

Check it out at http://ashleysartcloset.blogspot.com/2011/03/daddys-briefcase.html

Drug News:

Pharmaceutical Research and Manufacturers of America (PhRMA) is offering  a new report that details 887 new medicines in clinical trials or under FDA review for Cancer. Go to Cancer | PhRMA and download the 92 page PDF file at the bottom of the page.  Drugs in development are divided according to kind of cancer.