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Pediatric Oncology

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Pediatric Oncology Nurse: Chrissy Fletcher

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Growing up, Chrissy Fletcher wanted to be like her dad, an engineer. She learned computer-assisted design (CAD) in high school and was hired by an engineering firm as an intern during summer vacations for several years. “I taught all the male engineers how to use CAD,” says Fletcher. She went on to study engineering at the University of Maryland and was on her way to a career in aerospace. But Fletcher started to question her path when, increasingly, the biomedical class that followed her physics class began to interest her more. “I was fascinated and drawn to medicine more and more. I realized that I wanted to work with people, not alone behind a desk. I couldn’t shake wanting to be a nurse. I was called to it.” Overnight, she made the decision to follow her mother’s footsteps, a spinal rehabilitation nurse, and transferred to Villa Julie, now Stevenson University.

After graduation from the nursing program in 2004, she already knew she wanted to work with children. “As a student, I enjoyed working in the pediatric intensive care unit, the fast pace and acute care. When I called to see if they had any openings, there were two: one in the PICU, and the other, which I was offered, in pediatric oncology. ‘I could do that,’ I thought, ‘like Patch Adams.’ But I knew nothing about cancer or kids with cancer, and the first nine months were rough emotionally. It was taxing. I had a 2-year-old at home, and the nursing was an emotional weight. But I did well, and I liked my co-workers and the patients. Gradually it got easier to leave work at work.”

Fletcher says the pediatric oncology team is unique: As nurses, they have great autonomy and much respect from the doctors. The attending doctors and fellows understand the special role they play. “We work well together. They teach us why certain things are prescribed, and we are not just expected to follow orders. We always ask: ‘Why? What are the long-term effects?’ We have the whole picture to look at.” Fletcher believes that a chronic condition affects every aspect of life, and that the nurses must evaluate every part of it from their point of proximity: “We have an invested interest in that whole picture, not just the medical: nutrition, the emotional and social pieces.” 

Fletcher is part of a working group that addresses the psychosocial needs of patients. She finds that she is often called to be counselor, advocate and friend, to provide more than just medical care. Fletcher, in turn, is drawn to patients with complicated social and emotional scenarios. She thinks of a teenage girl, a patient with a difficult relationship with her parents. “Her parents couldn’t be there for her, for emotional and practical reasons. In these cases, there is no judgment: We need to be the advocate for both the child and the family. With this teenager, I became the mom: I would bead with her, we shared hobbies. She made a blanket for me when I was pregnant with my third baby. I was an integral part of her journey, and I helped her cope with the trauma her family was going through.” 

It takes a certain kind of person to do this work. Fletcher says for her, it is important to compartmentalize to function effectively. She needs to find that place that allows her to move seamlessly from the room of the patient at the end of life to that of a patient struggling to come to terms with a new diagnosis. “It’s not about what we are feeling. But the kids are in your heart. Sometimes, if I am feeling sad at home, I remind myself that I’m not at work right now and I must let it go. I have learned not inquire about work when I’m not at work, as I can’t make that personal connection outside the unit. I have to draw the line. You become family to the patient, but we have our own families.” 

Fletcher is a mother of five and knows that being a mom allows for different types of conversation. “Sometimes I am asked: ‘What if it was your child?’ I don’t know the answer to that question.” She answers it, perhaps, in the thousand little things that she and her colleagues do, above and beyond the medical care they give. “We wash the children’s stuffed animals when they get dirty; we find the just right sippy cup from another unit.” She and her co-workers are here for the kids, and they support each other. 

“Fifty-two women could be a recipe for disaster,” Fletcher laughs. “But incidents are few and far between, a testament to how much we care for each other. Someone is always there to lend a shoulder. We are very forgiving, a cohesive group. We do spend time together outside of work — we have no choice but to bond, as we may be the only ones who understand what a co-worker is going through.” Fletcher says it starts at the top. Nurse manager Lisa Fratino is, by all accounts, a very compassionate person, intimately involved in the lives of the nurses. She has encouraged a culture of caring. “It translates into how we precept new oncology nurses, how we work in a collegial, not competitive, way. It’s a caring preface for everything we do and say—- even snarky comments are accepted in that spirit!”

As the daughter of a nurse, Fletcher grew up talking about her mother’s work, hearing her stories about patients, even going to their funerals on occasion. “I was always comfortable with death, but it did bring on some anxiety. I don’t share my stories in the same way with my kids, not least because I don’t want them to associate cancer with death. They are beginning to ask questions about my work as they get older, and I emphasize the many positives.” But Fletcher is a verbal processor, and she and her mom have continued to talk about their shared work. “I talk to her on my way home from work for the 45-minute drive. It helps me to decompress. My family knows not to call me then!”

Fletcher the engineer continues to use that skill set too. “I am the fixer!” She is often called upon by other nurses to look at and fix machines. She heads the technology group, always with an eye on how her former interest can help her current passion.