March 2017 VOL 8, NO 3

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Nurse Navigation

A Story of Friendship: A Case Presentation

Penny Widmaier, RN, MSN 

A Story of Friendship: A Case PresentationIn the fall of 2015, I received a phone call from a woman who identified herself as “a friend of someone in trouble.” That was an understatement. Both the trouble and the friendship turned out to be memorable.

Let’s name the caller Mary. The caller’s friend (we’ll call her Sam) apparently had been ignoring a breast mass that had started eroding through the skin on her breast. Mary gave me the contact information for Sam and asked that I call her. Like many patients, Sam seemed to be paralyzed with fear and had indeed ignored this breast problem for many years. Sam was especially nervous about how to pay for healthcare, as she was uninsured and unemployed.

When I spoke to Sam for the first time, I could hear the fear and embarrassment in her voice. I could also hear her smoking a cigarette. She admitted to not enrolling in insurance through the Affordable Care Act because she couldn’t afford any plan. She chose to pay the penalty because it was minimal the first year. Sam described her financial situation as fragile. She was over 50 years old and had lost her long-term job with an airline company following the 9/11 World Trade Center attacks. I did not have an appreciation for how long and far-reaching the attacks were. I immediately put Sam in contact with one of my colleagues, a financial navigator, to begin the insurance enrollment process. Sam ended up with a Medicaid Health Maintenance Organization–style plan that severely restricted her provider options and carried with it a massive deductible. She was assigned to a primary care physician who was unknown to me. I promptly secured Sam an appointment. From there, she was referred to a general surgeon who partnered in the same clinic with her assigned primary care physician.

Unfortunately, the visit with the surgeon was terrifying for Mary and Sam. Sam was basically told to get her affairs in order and to seek hospice care. She was told that she “probably only had a few months left.” Sam’s dear friend, Mary, contacted me again asking for help. I reached out to one of my known surgery practices as well as a medical oncologist on our campus and asked for urgent appointments for Sam. Although the surgeon was officially “out of network,” he agreed to accept whatever fees would be allowed by Sam’s insurer.

Sam’s medical and surgical journeys have been long and difficult. She has endured chemotherapy and multiple hospital admissions over the past months. Her mastectomy was extremely difficult and involved plastic surgery and an open chest wall area for weeks, requiring her to remain hospitalized. Following that extended surgical stay, Sam required inpatient rehabilitation to gain enough strength to go home. Sadly, Sam’s cancer has metastasized. She has much treatment ahead but remains hopeful, something she has not been for years.

For me, Sam’s story has been challenging but has demonstrated what true friendship really looks like. Sam’s friend Mary has been at her side for every appointment and every surgery. Mary keeps meticulous records of Sam’s care and makes sure she never misses any treatment. Mary has been a true inspiration to our entire care team. She has caused us to reflect on the value of friendship and the importance of a caring partner during illness and recovery. We were all surprised to learn that Mary, who we assumed was not employed, was actually a full-time teacher. That explained her extreme organization!

In October 2016, both Sam and Mary were interviewed by a local newspaper seeking a story for Breast Cancer Awareness Month. Mary agreed to the interview but refused to be included in the photo, telling the paper that “Sam is the hero, I just tag along.” Sam agreed to the photo and told the reporter that she wanted to encourage others to reach out for help when they needed it. She further told the reporter that without Mary’s friendship she would have given up. Happily, Sam enjoyed Thanksgiving 2016 with hope and improved health.

I truly consider it a privilege to have helped Sam and Mary navigate the healthcare system. My partnerships with the financial navigator, the oncology social worker, our local Gilda’s Club, the American Cancer Society, our institution’s charitable funds department, and the many healthcare partners allowed me to get Sam into the best hands for her necessary treatment. My nurse navigation approach emphasizes that patients are at the center of care and considers the patient’s physical, social, and spiritual well-being. I believe that if you listen carefully to patients, they will tell you exactly what they need. Nurturing partnerships in practice allows me the luxury of asking for help from the team when a patient needs such, as in Sam’s situation. I also enjoy practicing in an institution where I have the time as well as the resources needed to best help my patients.

Many lessons were learned from these 2 special ladies. Although we could not offer a cure for Sam, we were able to offer treatment and hope. Personally, I took pause to consider my friendships and consider how I could be a better friend. It also made me think of families and marriages and what the “in sickness and in health” promise might really mean for so many couples. Sam is very fortunate to have a friend like Mary, but Mary would be the first to tell you that she feels lucky to have as dear a friend as Sam.

Do you have an inspiring case study you’re compelled to share?
Please consider sending your stories for our Navigator’s Notebook column to

Penny Widmaier, RN, MSN, is an oncology nurse navigator for Beaumont Health, Farmington Hills Cancer Center in Farmington Hills, MI.

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