“I have cancer and I’m wondering if you’ll need somebody to do a case study on, a hospice patient,” was the voice mail message left at the nursing school at Holyoke Community College. The caller was Martha Keochareon, 59, a 1993 graduate of the program who had become a nurse at 40 after working on a factory floor.
As told in the story by Abby Goodnough in the New York Times, the message was received by Kelly Keane, a counselor at the college. Keane saw a unique opportunity for students to participate in an intimate way with a reality of nursing that students typically learn about only through simulation and limited exposure to acutely ill patients at hospitals.
“Sit on my bed and talk to me,” said Keochareon to two first-year nursing students, Cindy Santiago, 26, and Michelle Elliot, 52, when they arrived at her tiny house in South Hadley, Mass. They hesitated, saying they had been taught not to do so in order to prevent transmission of germs. But, as they would discover over the next few weeks, caring for the terminally ill requires sensibilities that don’t always translate neatly from the classroom.
Keochareon had suffered from pancreatic cancer for six years–an unusually long time for a disease that usually kills within months of diagnosis. She spent her time watching Animal Planet, reading a book about heaven, and calling friends. But the disease, which had gone undiagnosed for several years, had formed tumors in her bones and around her throat; by early December the pain was unbearable.
“In school they always teach us that pain management is the biggest thing — like, you know, we have to treat the pain,” Santiago said. “With her it’s like, how do you treat it? Like, you’ve tried everything. What else is there to try?”
As Keochareon’s condition deteriorated, Keane urged the students to practice “therapeutic communication.”
“The way we’ve learned in school, and haven’t applied enough, is just saying, ‘I’m glad to be with you; you must be frustrated; you look uncomfortable,’” Keane said. “And let the patient just talk and talk and talk, and see where they’re at.”
Keochareon died on Dec. 29. On Santiago’s last visit, Keochareon had said, “I’m sorry I went downhill so fast. I thought I could teach more.”
Pam Malloy, director of the American Association of Colleges of Nursing’s End of Life Nursing Education Consortium, believes that end-of-life care deserves more attention. “We live in a death-denying society, and that includes nursing,” she said. “People have begun to understand it’s important, but we’re nowhere where we need to be at this point.”