Pediatric Oncology Nurse: Pamela Frankenfield
Pam Frankenfield hadn’t been touched by cancer and knew very little about it when she considered nursing as a career. “I didn’t know anyone with the disease, and we had, maybe, a one-hour lecture on oncology at nursing school.” Then, on a rotation as a nursing student in pediatric oncology, she met a young boy with a brain tumor and hemorrhagic chicken pox: It would change her course. She had met so many bad-tempered and curmudgeonly adult patients with this complaint or that, but this child, feeling so sick and with such a serious illness, was, Frankenfield says, “zestful!” In her senior year, she was an intern on the infant floor and met another child with cancer, neuroblastoma. His eye was bulging as the tumor pressed against it, and yet “he was the cutest boy.” On graduation, as luck would have it, she became his nurse: Caring for him confirmed her decision to specialize in pediatric oncology.
Frankenfield began as an inpatient nurse and transitioned to the Outpatient Clinic over 25 years ago. “I enjoy seeing my patients go home at the end of their appointment. I have seen the arc of their lives over these years.” She remembers, with intermingled tears of joy and sadness, a 19-year-old patient with leiomyosarcoma in her liver and lungs. She enjoyed a short remission, then relapsed, but, in the time Frankenfield knew her, she graduated from college, traveled to Italy and Africa, and married her true love. She lived life to the fullest. Frankenfield feels that she was a part of making that possible. “Those are the rewards, seeing our patients meet life’s milestones.”
Over the decades, nursing patients with cancer has changed. When Frankenfield started, there were no gowns and gloves to protect children from infections and no nurses from chemotherapy, even as they prepared it themselves long before the advent of a dedicated pharmacy. She knew the protocols by heart; now, there are as many protocols as there are patients. Frankenfield says it keeps her on her toes, and it can be stressful. “Giving a child chemotherapy — that’s on you.” The nurses in clinic are highly experienced and work with a good deal of autonomy. “We have the skills to assess our patients, to triage and to deal with emergencies. We are highly organized, too, and need to finish the job. In clinic, nobody is taking over your shift at the end of the day.”
Nurses are often the patient’s advocate: “We use a lot of common sense,” says Frankenfield. “We are often the first port of call; patients and families will feel things out with us” before mentioning something to a doctor or other member of the care team. If transport is unavailable, for example, the nurse will put in a call to the patient’s social worker. At other times, it’s about changing the treatment plan in a small way: Knowing that a toddler cannot swallow a large pill, the nurse will suggest changing the medication to a liquid.
The nurse is there for those big questions too. At a research hospital like Johns Hopkins, the doctors, at the forefront of their fields, often know or have heard of an option to try when standard treatments have been exhausted. Frankenfield says: “It is our responsibility, sometimes, to get the team to regroup, acknowledge that it is time to stop treatment. We know the patients better. The attending doctors and fellows come up with the plan, and we carry it out. But we put in our piece, improving the experience for our patients, supporting them and their families, participating in team care meetings, helping the patient and family through hospice care if it comes to that, and attending our patients’ funerals.”
When asked what she does after a bad or sad day: “I play tennis. I put the name of a diagnosis on a tennis ball and whack it over the net.” Frankenfield is funny, with a positive outlook, and very upbeat. She is a great believer in the power of humor to help her remain resilient and to heal her patients too. “You can have fun doing this work, and should aspire to doing so.” She invents games to help overcome a patient’s fear of having his port accessed, makes sure she has a child’s favorite toy on hand or has the parent tickle the child to create a happy association with that procedure. Not to mention Race for Remission, her oncology version of Candy Land that entertains her patients while educating them too. An animal lover, Frankenfield helped instigate pet therapy at Johns Hopkins. She has a patient who had become introverted during treatment, and she would barely speak. “One day, I went to find her to check on her infusion. She was with one of the pet therapy dogs, chatting away to this creature as I had never seen before. The dog was just such a wonderful distraction.”
People outside her world wonder if Frankenfield’s work is depressing. Her answer is a categorical “no.” “When my patients finish treatment, they are away from me, and from here, out in the world. But we remain a part of their lives, of who they become, of what they go on to achieve!”