Negative Margins

May 2, 2017
Lindy J. Jones MSN, CRNP-BC
Lindy J. Jones MSN, CRNP-BC

Lindy J. Jones is a Board Certified Acute Care Adult Gerontology Nurse Practitioner with over ten years of experience in the nursing field. She received her Bachelor of Science degree in Nursing from Immaculata University, then went on to earn her Master of Science degree in Nursing from University of Pennsylvania. Prior to joining St. Mary Comprehensive Urologic Specialists - Langhorne, she has worked as both a House Nurse Practitioner in the Emergency Department and also as a Critical Care Staff Nurse at St. Mary Medical Center.

Dealing with the ambiguity of life and cancer, inspired by Bob Dylan.

My favorite kind of pathology reports are probably the same as yours. Obviously "Benign" is our top choice, but let's be honest, sometimes you know that’s not an option and the runners-up tend to be also quite reassuring: "Negative margins," "Non-Invasive," "Low Grade," "no lymph node involvement," "encapsulated," etc. And then, there’s all the other reports: "invasive," "metastasized," "lymph node involvement," "vascular involvement," etc. Pathology reports, like most of life's big events, sometimes offer a definitive answer and sometimes just offer up more questions.

Personally, I find ambiguity to be the biggest challenge. Waiting is hard. Waiting is harder when you don’t know what will happen next. It’s the gray areas of life that are the most difficult. Whether it is a pathology report you are waiting on, news of a job, a pregnancy test, a loan approval, an annual bonus, a phone call, or to finally graduate — the list is endless. We are all moving forward whether we want to or not. Never back. Sometimes we have help, and at other times we feel quite alone.

My husband and I were recently listening to Tracy Chapman sing Dylan’s, “The times they are a changin”, which I would highly recommend. Take for example the first verse:

Come gather around peopleWherever you roamAnd admit that the watersAround you have grownAnd accept it that soonYou'll be drenched to the boneAnd if your breath to you is worth savingThen you better start swimming or you'll sink like a stoneFor the times they are a-changing.

The whole point of this song and I suppose this post is this, things are changing in all of our lives. Whether we want to move from here and now or not, change comes anyway and we have to figure how to swim or face the alternative. Later in the song, we hear “Your old road is rapidly aging”. None of us remain stagnant and in the same place, sometimes despite our best efforts. I suppose the good news is that even the worst points in our life will also be part of this change and we can move past them.

And there in front of us, people in the middle of all our own personal changes, sit our patients in the middle of their own changes, and we find ourselves assuming the role of caregiver. How do we help them and ourselves learn to “start swimming”? Perhaps the most unambiguous part of my life as a nurse is to help somebody else navigate through a tough time. Sometimes a patient just needs to spend some time expressing frustration, doubts, or anger even. We listen to them. We answer their questions, offer advise, create a plan, deal with the pathology report whatever it ends up saying.

We have this gift we can give, relief and help. We get to help somebody else learn to swim in this particular part of their lives, and illness, just as many others have helped us to swim in ours.