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Pediatric Oncology

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Pediatric Oncology Nurse: Anna Walbert

In high school, Anna Walbert had no clue what she wanted to do. Her mom was a pediatric intensive care nurse, and her dad suggested nursing would be a good career. She agreed and went to Howard County Community College for an associate’s degree in nursing. As graduation drew near, her dad, again, suggested that she contact The Johns Hopkins Hospital, a good name to have on your résumé. As luck would have it, there were two positions open: an adult nursing job and one in pediatric oncology. “I knew adult nursing was not for me,” says Walbert. “I find it too sad.” As soon as she started nursing pediatric oncology patients, she knew she was in the right place. “It just hooks you; I love it, love the kids.” 

Walbert enjoys the many different aspects of nursing pediatric oncology patients and their families: from teaching the newly diagnosed about the disease and their treatment to supporting those who now need hospice care. These “bookends” of the care she gives have provided some of the most rewarding moments of her career. “When a child is newly diagnosed, I help to teach the parents to trust their guts. I ask: ‘How did you get here?’” Walbert says that the story usually starts with ‘I took her to the doctor; I knew something wasn’t quite right.’ The parents followed their intuition, their deep understanding and knowledge of their child, and continued the quest for answers. She encourages them to continue doing that throughout treatment. “If you’re awake and worried, call. You know your child best and very often sense when all is not well.”

Walbert teaches parents and co-workers about additional concerns for children who are neutropenic, meaning blood has a low number of infection-fighting white blood cells, usually because of chemotherapy or radiation treatment. “A mom called about her child because she had a fever. They lived on the Eastern Shore and were coming into the Emergency Department. By the time she reached the Bay Bridge, the fever had gone, so they turned around and went home. The child was neutropenic and, because she was not seen and treated for the bacteria causing the fever, she developed a severe infection, called a sepsis, which threatened her life.” 

For many years, Walbert has coordinated special, educational parent lunches, teaching everything from care of the central line to options for palliative care and hospice. “I remember one mom. Her son was not doing well, and there were no other treatment options available to him. It was time for hospice.” But the mother wasn’t ready to make that decision; she wanted to continue to fight. At the lunch, Walbert asked the parents what they understood by “hospice.” “I remember this mom saying: ‘It’s giving up all hope.’ In my experience, over 30 years, it is not about giving up hope. It is about making the many choices for your child’s path to the inevitable. When a parent — and the patient, too — accepts that, it is as if they see a light.” This patient and his mom chose a peaceful death on the unit. Walbert asked the mother: “What was your experience?” She described with great love and warmth: “It was 6 a.m., and the sun was rising. I put the shades up and he died, peacefully. It was a good experience.

There are times when it takes a great deal of behind-the-scenes coordination to translate the choices a patient and her parents make for the end of life. If a patient or her family want the child to be moved home or to a hospital close to home, many arrangement need to be made. “I remember, long before we had a nurse coordinator to handle many of these intricate details, working for hours to make sure a patient and her family got their particularly complex wishes. It was the most rewarding experience of my career, but I couldn’t have done my part if the patient or parent wasn’t ready to talk to me about end of life. When that does happen, I feel blessed to be a party to it.”

Over the years, Walbert has noticed that, for pediatric oncology nurses, “there is a two-year mark at which you question if this specialty is right for you.” For Walbert, she has found the support and respect of colleagues to be a key part of why nurses chose this field. “You and your peers are here because we want to be. We have a common goal: what’s best for the patients.” She also likes that the physicians are always available to both the nurses and the parents if there are concerns or a patient needs assessment. There is great camaraderie amongst the nurses and the care team as a whole. “I don’t go home and unload on my family or at dinner parties — that’d be a conversation stopper.” 

It helps that Walbert’s husband and family are supportive. She has worked throughout her kids’ childhood but enjoyed hours that enabled her to be at parent association meetings and on carpool duty. “I worked from 3 to 11 p.m. when my children were little. It meant that my kids got the chance for a great relationship with their dad.”  

As a parent, Walbert recognizes that maintaining normal expectations of behavior and discipline can be challenging for both parents and children during time spent in the hospital for treatment — challenging, but essential. She has seen how important it is for children to feel that they have some control over what is happening to their bodies and how hard this can be to achieve when a child is very sick. Where she can, she offers realistic and age appropriate choices: “For my part, I try to be honest with the children and their parents. If something is going to hurt, I will tell you; if there are real choices — do you want to sit up or lie down while your port is accessed — I will present them honestly. I will try and offer control to the child where there can be control, and teach the patient and family tips and tricks I have learned from other patients when there cannot.” And this pays off: One little boy always asks for Walbert when there is a difficult or “scary” procedure coming up. His mom says: “My son always asks for Anna when he has to have a nasogastric tube put in. He knows, even if he cannot articulate it, that Anna will be straightforward, is highly skilled and always compassionate.” 

Walbert is a member of the Education Committee both on the pediatric oncology unit and for the Children’s Center as a whole. She helps to evaluate and update procedures and ensure consistency to the highest standards. Surprisingly, Walbert says, “I used to wonder why I haven’t furthered my own education, particularly as I saw my co-workers advance.” Walbert is a registered nurse, a nurse clinician II expert, who happens to love bedside nursing, is a highly respected colleague, and is teacher of co-workers and patients. 

When asked how she manages to remain resilient as she spins so many plates, Walbert says she exercises, sews, and refinishes and sells old furniture with a friend. Her 45-minute commute helps too. It gives her time to decompress and leave work at work, and home at home.