Defining Moments: A Nurse’s Touch

ABSTRACT

In most cultures, touch is the sense we most strongly associate with healing. In this essay, I describe the different ways touch was incorporated into my cancer treatment as well as wonder how touch in the clinical setting might remain changed as the result of COVID-19. More specifically, I narrate my clinical relationship with my oncology nurses and the role of instrumental and empathic touch over the course of six months of treatment and two years of follow-up. Touch in the nurse–patient relationship is necessary, multi-faceted, complicated, and, in the face of a pandemic, amended.

Acknowledgments

The author would like to thank Lynn Harter, Elissa Foster, and Lynn Nalbone for helpful feedback in the preparation of this essay. And thanks to oncology nurses everywhere for the crucial role you play in healing.

Disclosure of potential conflict of interest

I have no conflict of interest to disclose.

Notes

1. All names, including the name of the facility, have been altered.

2. Williams (2001) also provides an important study about perceptions of intimacy including the hesitancy some nurses have about the use of the word “intimacy” as an element of their profession. While patients employ “intimate” – somewhat unconsciously, I imagine – to refer to medical conditions involving the genitals, breasts, and anus (including the prostate and intestines) – nurses, in an effort to maintain professionalism, see the use of the word as implying something relationally-directed and, even when employing touch and demonstrating empathy – as a group – prefer to perform objectivity and distance (a variation, I suspect, of detached concern).

3. EPOCH stands for five other drugs which make up the treatment: Etoposide Phosphate, Prednisone, Oncovin (Vincristine Sulfate), Cyclophosphamide, and Hydroxydaunorubicin (Doxorubicin Hydrochloride).

4. Chemo brain (also known as chemo fog) is a well-recognized side effect among cancer patients who receive chemotherapy. It can marked by a generalized fogginess, forgetfulness (i.e. words, names, schedules) difficulty in focus, and, in my case, a difficulty in tracking conversations involving more than two participants. For a thorough description of the phenomenon, see Staat and Segatore (2005).

5. Because of the position of the catheter in my vena cava, at times there were challenges in drawing blood. There was no question this was frustrating for both nurse and patient. Each nurse had her own way of triumphing but each technique required physical manipulation of some kind. Turning my head, or producing a deep cough, or pulling my knees up represent a few of these variations but all were accomplished in close proximity and necessitated a degree of humility and vulnerability.

6. After the third cycle, I had a CT scan that showed – for all intents and purposes – that the first three cycles had all but eradicated my lymphoma. A frequent concern these nurses put up with from me was my questioning of the need for three more cycles (and especially the sixth and last cycle). While they listened patiently, however, their collective response was that six cycles was the “protocol” and that “Dr. Kay wants to make sure when it’s gone it stays gone.” Until that CT scan after the third cycle, I had no idea whether I would survive despite the odds, as indicated by Dr. Kay, that I had a fairly high likelihood of survival. I have been asked about the label “survivor” and, because of the five-year follow-up, my response has been “I know I survived chemo!”

7. At some point I realized these nurses were of similar age to most of my graduate students, and yet, to my graduate students, I am not young.