Episode Transcript
[00:00:01] Hi, everyone, this is Dawn Klemm, and you are on my podcast, Milkweed and Monarchs.
[00:00:08] I'm going to talk a little bit about how I became a brain tumor navigator.
[00:00:15] It was the last role that I did in nursing, in my career in nursing, I should say.
[00:00:24] But it was probably the thing that impacted me the most.
[00:00:30] And I believe that being a brain tumor navigator actually changed me.
[00:00:37] And I was not a young nurse, I was an old nurse.
[00:00:43] And so you always hear that saying, you can't teach an old dog new tricks, but I would say that is inaccurate, and I firmly believe that. After taking on the role of brain tumor navigator, I started the job as a brain tumor navigator in October of 2017.
[00:01:15] I had been working with other oncology navigators in a consolidated office, and my role when I first got hired there was as a prostate nurse navigator.
[00:01:33] You can imagine that they probably needed a male in that role because some of the questions the men would ask me after treatment were a little bit dicey. And although I'm a healthcare professional, I think it definitely was better suited that a man be in that position.
[00:01:54] Nonetheless, I took on that role.
[00:01:56] And I'll never forget going into an interview with the staff, I had been a nursing director for seven years.
[00:02:08] I was the director of clinical staff development, and I had actually worked in a union hospital, something I had never worked in before in my life. So I started that job in my 50s. So that was a big change for me.
[00:02:29] I didn't really like to be in leadership roles. I'm definitely a nurse that belongs with patients.
[00:02:39] But I found many times throughout my career I would be asked to move into a leadership role.
[00:02:49] I did not regret working as a clinical staff development director for seven years. That was a great job for me and I learned a lot there.
[00:03:04] But it was time for me to get back to the patients.
[00:03:08] So my husband had gotten a different job in a different city, and we were going to be relocating, and I went to one of the largest hospitals in western Michigan and applied for a navigator job.
[00:03:27] The other navigators that were already working there, such as a breast care navigator, lung cancer navigator, colorectal navigator, interviewed me along with the director of the program.
[00:03:43] And I'll never forget it, because the navigator said to me, do you understand that this job is like two levels down from what you've been doing?
[00:03:58] And I said, yes, I do.
[00:04:00] And they said, why would you go from a director level position back down to working with the patients?
[00:04:09] And I said, because that's why I became a nurse, to work with patients.
[00:04:15] And that's all it took for the answer. And they basically hired me almost on the spot.
[00:04:25] So I had worked there for a year, but I was feeling kind of restless, and I was thinking about making a change.
[00:04:35] And I knew that there had been brain tumor. Nurse navigator. They did not sit with us in our clinic. They sat with the neurosurgeons in another building that was interconnected with our building.
[00:04:55] And I was talking to my youngest daughter at the time, and I'm like, what? I think I'm gonna make a change. I don't know.
[00:05:07] I've been here and I'm making a difference, but there's so many days where I just don't feel like I'm doing as much as I could be doing for the patients.
[00:05:17] I really think they need a man in this position.
[00:05:20] And I saw that they have an opening for a brain tumor. Nurse navigator, what do you think about it? She's like, oh, mom, that sounds so interesting.
[00:05:32] I think you would embrace that job. I really believe that you should apply for that job.
[00:05:39] And so I did. I thought about it, and I applied for the job.
[00:05:46] I went to the interview. I got an interview pretty quickly, I would say. And I went to the interview, and it was myself, the assistant manager, the PA in the clinic, the neuro oncologist, and the head neurosurgeon.
[00:06:09] And so I had sent over my resume, and part of my resume is the work that I had done with end of life care when I was living in Maine.
[00:06:23] And I remember the neurosurgeon read that part and asked me about the study. And I told him all about the study and what I had done and how I had correlated everything and that an article was actually published afterwards.
[00:06:42] And he looked up from my resume and he said, I'd like to start the study here tomorrow.
[00:06:49] I remember thinking, wow.
[00:06:51] I. Maybe I actually made an impression on him. I didn't know. I felt really uncomfortable in that interview.
[00:07:00] I know the neuro oncologist said to me, have you ever worked with brain tumor patients? And I said, I did work with a couple of them.
[00:07:12] One in particular was a young woman with an astrocytoma. The minute I said astrocytoma, she said, okay, so you do know what you're talking about.
[00:07:23] I'm sure they were just so skeptical.
[00:07:28] But no one else had applied for that job.
[00:07:32] No one.
[00:07:33] And so I didn't. I left there thinking, well, am I going to get it or not? I had no real understanding.
[00:07:42] I remember I went home and my daughter was really excited how did it go, Mom? How did it go? I said, I really don't know. You know, I gave them my resume. They asked me a bunch of questions. They did. The PA did give me a tour of the workspace and where I would be working.
[00:08:01] And I remember she brought me down an open hallway where everyone sat, and I thought to myself, well, this is so different from what I'm used to.
[00:08:11] But working conditions don't really faze me because I'm really there for the patient. So I didn't think too much of that.
[00:08:20] I went home after the interview, and I just kept continuing to do my prostate navigator job for the next month.
[00:08:32] All of a sudden, I get a phone call out of the clear blue from the manager of the neuro clinic. She had not been in the interview, and she called to say, well, were you interested in that job or not?
[00:08:47] Like, yes, I'm interested in the job, which is why I applied for the job.
[00:08:54] And she said, well, we haven't heard back from you. And I said, actually, I was waiting to hear from you.
[00:09:00] At that moment, I thought, is this. What is this going to be like now? I just wondered how organized they were. I had my doubts.
[00:09:11] She said, well, we'd like to hire you. And I said, really? And she said, yes, we definitely want to hire you to this job.
[00:09:21] So I said, okay, that sounds great.
[00:09:27] I need to give at least a couple weeks notice, I think, for a transfer.
[00:09:31] And she said, yeah, we'd like you to start on October 30th. And I think it was like somewhere around the 10th or the 11th when I was talking to her.
[00:09:43] So I said, okay, I'll let my director here know.
[00:09:47] So the next day, I sent an email to my current director, and I let her know that I was going to be transferring to a new position.
[00:09:59] And she came right up to the clinic and asked to meet with me out in the hall. I'm like, whoa.
[00:10:05] She said, we don't want to lose you. It's only been a year that you've been here.
[00:10:10] You've made a difference, and we would really love to keep you here.
[00:10:15] And I said, I appreciate that, but I'm at the end of my nursing career, and I want to do something that I feel is going to be more meaningful. I want to make a difference with my patients, and they offered me the position, and I'm going to start on October 30th.
[00:10:35] So I think she was unhappy, but, you know, that's the way it goes. You have to do what's going to Be right for you.
[00:10:46] So in two weeks, I went to the clinic to start, but in the meantime, I was emailing the manager over there, asking her who is going to be orienting me to the clinic.
[00:11:01] And she said, oh, the PA is going to. You can ask the PA anything you want.
[00:11:06] You know, it's going to be fine, no worries kind of thing. So I was like, okay, yeah. I mean, I've been a nurse for a long time. I think I can handle it.
[00:11:16] So I just remember coming to the clinic.
[00:11:20] Now you have to remember I met with those four or five, four people for an interview.
[00:11:30] She took me around the clinic, but no one at any time had said to me, there's seven neurosurgeons that you will be supporting.
[00:11:43] And we have clinic four out of five days a week, and it's extremely busy.
[00:11:51] So when I walked into the clinic on the first day day, I remember sitting in my chair where they told me I was going to be sitting.
[00:12:00] And one of the neurosurgeons walked up to me and said, oh, so you're going to be the new navigator to support us. I go, no, I'm just here to support.
[00:12:09] And I named the doctor that had interviewed me, and the PA was behind me, and she's like, oh, no, you support. There's seven neurosurgeons here. I go, what?
[00:12:22] Seven?
[00:12:23] No one told me that. And she said, well, there are. There's seven neurosurgeons here, and we're one neuro oncologist. And those are all the people that you're going to be supporting while you work here. All seven of the neurosurgeons operate on patients that have brain tumors.
[00:12:42] And the neuro oncologist is the one that prescribes all the medications.
[00:12:49] And you'll be working with her closely to. To get their treatment plan in place.
[00:12:56] The whole time I was in the interview, the neurosurgeon is the one that asked me the most questions. So I was completely convinced that he was going to be my boss.
[00:13:11] And I don't know why I thought that. And when I look back, I think. Why would I think that? I'm an oncology nurse. Of course I'm going to work with the neuro oncologist. But he seemed more interested than she did. So I didn't know how this whole thing was going to pan out because I found out not only was I supporting seven neurosurgeons, but she was actually the director over me.
[00:13:36] So I'm like, oh, boy, I totally misread that. Whole interview, believe me.
[00:13:44] So it didn't take me long to realize that no one was going to orient me.
[00:13:51] There was a LPN in a position that she answered patient telephone calls and she helped the physicians with their office clinic.
[00:14:06] And I think she was kind of not happy that they had hired another navigator.
[00:14:12] But on the other hand, the phone calls that she was getting as an LPN were not something that she could necessarily manage.
[00:14:21] It needed to be someone with a higher education level.
[00:14:25] And I think I was there the very first week and she left on Friday, the PA left on Friday and there I was all by myself.
[00:14:35] And she's like, go ahead and answer the phone. I'm like, oh good lord.
[00:14:41] So I quickly realized I'm, I'm gonna have to figure this out on my own.
[00:14:47] So they're not going to help me. I'm going to have to make this fit into how I practice as a nurse.
[00:15:00] So I decided to do a retrospective analysis for the last three months of patient visits in the clinic.
[00:15:11] If you can even imagine that. I mean, nobody was even there to tell me that there were four grades of brain tumors. I had no understanding of that.
[00:15:23] So basically I self taught myself and I reviewed every single patient chart. I thought I had a. I read all of the progress notes and all, all the while clinic was going on, I sat there and did that retrospective analysis.
[00:15:44] And I remember going up to the neuro oncologist and saying to her, okay, I think I finally got the four grades of brain tumors and types of brain tumors and let me just review it with you and then you can tell me. And so she was like, okay. So I went over what I thought and I did have one out of place, so flop that around. And, and then we had monthly meetings for the brain tumor program.
[00:16:16] And I went into the meeting, she said, you need to come into the meeting. So I come into the meeting and she says to me in front of everybody, so there's like the pa, some of the other surgeons are in there, the neuro oncologist is in there, the medical assistants are in there, they're all in there. And then there's me. And they're beginning to wonder if I'm ever going to work in the clinic. I can just feel, feel the animosity dripping out of them, right?
[00:16:45] I'm thinking to myself, hey, three weeks to self orient myself is not too bad.
[00:16:51] So the neuro oncologist says to me, dawn, why don't you tell everybody in the room what you've been doing? I think they're curious.
[00:17:01] So I told them the whole story. I told them how I had, you know, done this retrospective analysis, how I had figured out who the patients were that we were currently seeing, that I've made a grid for the patients and how I was going to be following them in clinic.
[00:17:19] And I remember the neurosurgeon was like, you got to be kidding me. Like, first of all, they probably hadn't seen somebody that organized before, but I need to get a grip. If I'm going to be going in there, I want to know what I'm doing.
[00:17:36] And I think at that moment, they thought, okay, maybe this is going to work. Because for the last three weeks, she's just sat at that desk, and she hasn't done a darn thing.
[00:17:46] And when I look back on it, I'm sure I would have felt the same exact way.
[00:17:53] So they said, are you going to be ready to start on Monday? I said, yeah, I'm going to be ready. I'm all set. I'm good to go now. And they're like, oh, thank God. Right?
[00:18:04] So the next day. So we had our brain tumor meetings on Wednesday mornings. So the next day was Thursday, and the LPN was sitting behind me, and she got a phone call from one of the patient's husbands.
[00:18:21] And the patient was definitely winding down, not really talking much anymore, kind of staring off.
[00:18:30] And the husband was calling every day because he was just so sad.
[00:18:36] He was so sad about everything.
[00:18:39] So I'm sitting in that clinic, and I know he's going to be calling.
[00:18:45] So I said, you know what? I'm going to call so and so right now, everybody in the hallway just turned and looked at me like, what?
[00:18:54] I said, yeah, I'm going to call him right now before he calls us.
[00:18:58] I'm going to reach out to him.
[00:19:01] So I picked up the phone. I had the phone number. I called him up. He answered the phone. I said, I'm. This is dawn, and I'm going to be the new brain tumor navigator of the clinic. I know you've really been struggling with your wife, and I just wanted to check in with you this morning to see how you're doing.
[00:19:24] Well, he started crying. He started crying right away.
[00:19:28] And I was like, I completely understand how you must be feeling.
[00:19:35] I know you are completely overwhelmed right now.
[00:19:39] I know you know, you're losing your wife, and I am so sorry. I'm so, so sorry.
[00:19:47] I want you to know that you can call me anytime you feel like you just need to talk to somebody. I would be more than happy to take your phone call.
[00:20:01] And with that, we ended up. We ended the conversation.
[00:20:07] I can't tell you.
[00:20:10] The neurosurgeons at that moment were like, what in the heck just happened?
[00:20:18] What in the heck just happened? They go, oh, my God. We've got somebody in the clinic that actually understands and end of life care.
[00:20:29] We've got somebody in the clinic that actually has empathy, Somebody that's going to try to support our patients and their families.
[00:20:40] And so that was the start of me going forward in that clinic.
[00:20:48] The very next day, the PA said to me, do you think you're ready to do patient education? I go, sure, I'm ready. Bring it on.
[00:20:57] So we went in to see a patient together.
[00:21:00] She would always order all the labs, the X rays, and I would do all of the patient education.
[00:21:11] But we tag teamed it together.
[00:21:14] So if there was something that maybe I was not familiar with, the PA was always there with me, and we were kind of a comedy act, too. The PA had a great sense of humor.
[00:21:26] So, you know, and you need humor when you're going through this. Of course, you have to know when it's appropriate to use humor. But she was spot on with humor, and I fit right into her little act.
[00:21:44] And it really relaxed the patience.
[00:21:48] You could start to see that everybody had been taking or just holding their breath, wondering if I was ever gonna work. And all of a sudden they're like, oh, my God, this is gonna be amazing.
[00:22:03] And that's really how I started working in that clinic.
[00:22:10] I'm gonna be talking about the patients that have impacted me from my time spent as a brain tumor navigator.
[00:22:21] I have many stories to share with you, and I just wanted to give you a little bit of an overview or insight into how I became a brain tumor navigator.
[00:22:35] I know I said at the beginning of this that it was probably the most meaningful job I've ever had.
[00:22:44] And I will tell you that the patients taught me more about life and living than I had been aware of in all of my years.
[00:22:57] Before I started this job, I picked out three patients that really impacted me.
[00:23:09] And those three patients, you will definitely hear their stories.
[00:23:15] But I said, when these three patients come to the end of their treatment cycle and pass on, that is when I'm going to finish working altogether and I'm going to retire.
[00:23:35] So those three patients will be mixed in with the other patients that I tell you about.
[00:23:44] And I hope that you get as much out of these experiences with these patients that as I did.
[00:23:54] And I think you're going to understand from listening to these stories what a profound, profound experience it really was for me.
[00:24:07] It actually changed me. It definitely did.
[00:24:15] So thank you for listening to my podcast today.
[00:24:20] I appreciate you taking the time, and I hope you end up enjoying the stories about my patients as much as I enjoy telling their life story.
[00:24:40] Until the next time.
