Mother Nature is wreaking havoc on our world. In the past year, we have experienced massive snowstorms, mudslides, hurricanes, and floods. Dealing with weather emergencies is difficult even in normal circumstances. When a person has cancer, the difficulties are multiplied.

I am an oncology nurse navigator in Philadelphia, Pennsylvania. Last year I was faced with the challenge of trying to navigate oncology patients from the southern United States whose lives were disrupted by the 2 hurricanes that devastated both Florida and Texas. Harvey and Maria are names I will never forget.

One memorable case involved a woman I will call BB. She was 66 years old. She lived in southern Florida and had multiple myeloma. BB was in the middle of treatment with cyclophosphamide (Cytoxan), bortezomib (Velcade), and prednisone. She called to ask what I could do to help her get treatment, because she was being evacuated and coming north to stay with friends. She was driving up alone. She had no family, and her usual support system, her network of friends in Florida, would also be evacuating.

I did an assessment over the phone and tried to get as much information as possible. Her doctor had given her copies of her records to take wherever she went, because he did not know whether her hospital or cancer center would still be standing after the storm went through. He wished her good luck and said he hoped he would see her again. BB told me how scared she was. She would be in the Philadelphia area by the time of her next treatment, which was a week away.

I registered her in our system and vetted her insurance. I asked where she would be staying, as we have a large network of satellite facilities that I could use if needed. I wanted to make this transition as smooth as possible. We agreed to talk again the next day.

“I am in your hands,” she told me. “I trust you to help me get through this.”

I felt a deep burden of responsibility to help BB overcome her challenges and access her treatment. My next step was to reach out to local providers. This was another hurdle, as we did not have records at the time and were basing her appointment on my assessment. My idea was to have her seen in one of the satellite facilities nearby so she would not have to drive in to the city. This would be best for her, especially if she needed to be here long term for continued treatments.

After a lot of juggling, I was able to get an appointment with one of our medical oncologists, as well as an infusion chair for treatment so she could stay on track. I spoke with BB daily to keep her updated on her new plan of care and made sure to keep her provider in the loop in case there were any glitches in her travels north.

BB arrived safely, tired but relieved to have that part of her journey over. She stayed in our area for several treatments, and then went back to Florida when it was safe for her to return. BB was one of the lucky ones whose home survived with minimal damage. Many of her friends were not as lucky. BB was most appreciative of having a navigator to guide her and told me she would have been lost without my help. She keeps in touch with me and is doing well and happy to be home.

I got several other calls from oncology patients in the South who needed help in trying to continue care. It was devastating for them to have to face the fact that their lives might never be the same, and home and comfort as they knew it might no longer exist. While working to accommodate these patients, I wore many hats—that of nurse, counselor, educator, and travel agent, to name a few. I followed the same game plan for each call and was able to successfully get everyone in who needed treatment. All my patients were able to be scheduled, and it felt good to know I could help them during that difficult time.

Being a nurse navigator is challenging, and no 2 days are ever the same. We constantly use our critical thinking skills and think outside the box to help our patients through the disease trajectory, no matter when or where it happens. They face challenges each and every day while battling their cancer.

Meeting these incredible people through this journey showed me how strong they are. They are survivors and fighters and prove that where there is a will, there is a way.

PRO TIPS FOR PREPARING TO HELP DISASTER VICTIMS

If you are expecting patients relocating temporarily due to weather disasters, here’s how you can prepare to help them continue care without disruption:

Do an assessment before they arrive to try to get as much information as possible in advance

Register the prospective patient and vet insurance

Be mindful of logistics; if they arrive without their own transportation, try to schedule treatment close to their temporary residence

Peg Rummell is an oncology nurse navigator at the Abramson Cancer Center, Penn Medicine, in Philadelphia, Pennsylvania.

Articles

One versatile nurse used creative ways to ensure that displaced patients received their treatments on time.

A Navigator Helps Patients Weather the Storms

My journey started 2 years ago when I lost my beloved dog Darla. She was 16 years old and pretty robust for an old girl until her last few months when old age reared its ugly head, and she died on her own terms when I was away. I think she knew how difficult her loss would be for me and did not want me there when she died.

Needless to say, I was devastated. I knew I wanted to provide a forever home for a new dog. It was just a matter of finding the right dog, and it had to be a rescue dog. I was looking for a specific breed and gender (female Border collie or Border collie mix), and my goal was to train her to be a certified therapy dog. I knew how much comfort and love my dogs have brought to me throughout my life, and I wanted to pay it forward by having her visit the cancer center where I work as a nurse navigator.

It was not long after Darla died that I was set to adopt a new dog. I was so excited that I found a new addition to the family, only to be rejected 3 days before I was to pick up my new dog, Sally.

I believe in karma and 3 days later I found an email concerning a dog I had inquired about. I was doing an adoption via the internet, and after careful screening and a lot of discussion specifically related to being a therapy dog, the adoption was approved. My new dog was rescued from a kill shelter in Georgia and was being fostered by a wonderful woman close to the shelter. She came north on the canine transport bus with several other dogs who were traveling to their new forever homes. She was named Darla by the rescue. Talk about coincidence! I think this match was made in heaven.

Darla and I trained for more than a year. We did basic obedience classes and certified therapy dog training. We spent a lot of time practicing to ensure we got it right. She was trained amid noise, with people, with other dogs, and with what she would be in contact with in a medical setting. She did great and passed her test on the first try. I knew I had a smart girl!

I had spoken with my director and our integrative navigator many times throughout our training about starting a therapy program for patients and staff. As oncology providers, we deal with a lot of stress and are so giving to others that we often forget to care for ourselves.

The administration approved our program: “De-stress with Darla Days.” Now, she comes to work with me once or twice a week to provide therapy to anyone who needs some extra love. When she has her ID and red bandana on, she is in her work mode, brightening everyone’s day and providing lots of laughs.

The changes she brings about in people are amazing. When she arrives in the morning, she goes to every staff member’s office to check on all her "herd." One of my colleagues found out she had a death in her family while at work one day. Darla sensed her loss and immediately went into see her and just sat with her.

Our administrator was not a huge fan of dogs at the start of the program but has been charmed by Darla. The two are now best friends. Darla visits her several times a day, and she has taken multiple selfies with her. She constantly asks when she is coming to work because Darla helps her unwind.

One of our big events occurred when our clinics were doubling in size. Need- less to say, moving clinic space, patients, and providers all at the same time to new locations was a massive task. We held a "De-stress With Darla" week, where she was available for staff and patients to decompress and spend some time away from all the craziness. We had giveaways, food, and just a quiet space where people could unwind. Darla was the main attraction, and the feedback we received from the staff and patients told us having her as part of the team helped everyone feel better during the change. 

Darla makes clinic rounds to see patients in the waiting areas to provide support and love, helping patients to share their feelings and cope with a stressful time. Many of our patients live far away and have to leave their pets behind, so Darla reminds them of home. She also has provided bereavement therapy to several patients who recently lost a pet. Darla is a very good listener. Nurses never know where an idea will end up, so don’t be afraid to think outside the box. That is what we do best as oncology nurse navigators.

 Do you have a navigation story to share with your colleagues? Email 

A navigator's simple idea to bring her therapy dog to the cancer clinic reaped enormous benefits for patients and her colleagues.

Peg Rummel, RN, MHA, OCN, NE-BC

Articles

A Navigator Helps Patients Weather the Storms

De-stress With Darla