Thanks for the memories

Thanks for the memories – A Clinician’s View

Amy J. Crownover

My five-year recertification as a family nurse practitioner is due in June 2003. I had planned to write a column contrasting how I function and feel today after five years of practice compared to in 1998–when I was a “new” FNP. But some things cannot be planned. Almost certainly I will have died from inoperable metastatic pancreatic adenocarcinoma before June.

At this writing, the diagnosis is less than two weeks old, but I have already had it confirmed, had a venous access device implanted, and have been placed in hospice care. Pancreatic cancer is just as deadly now as it was when I studied it for nursing school in the 1970s. With virtually no symptoms before metastasis, it has an effective 100% mortality rate. Chemotherapy or radiation cannot extend one’s life span by as much as a month–although in some cases, they are used palliatively for symptom control.

I do not choose to use them. Just as some of us are given to know certain things, I have been aware that something was dreadfully wrong with me for months. My energy level dropped and dropped, my pain level increased and increased. My last day at work was November 4, 2002. My diagnosis was confirmed November 8.

The most difficult battle I have faced so far began after my insistence that I be placed in hospice immediately, not “down the road when it becomes necessary,” the way so many patients are. Some of them never get into hospice before they die, and virtually all of them start hospice care weeks or months later than needed.

It was a “yes, but” battle. That is, I would repeat, “I want hospice now,” and my oncologist (nurse, radiologist, surgeon) would say, “Yes, but we need to discuss chemotherapy [radiation, have a biopsy, etc] first.” I would repeat my priority–they would counter with their priorities. And throughout the (exhausting) process, two thoughts kept surfacing: What happens to patients who aren’t as assertive and knowledgeable as I am? No wonder hospice is so grossly underused!

Do not misunderstand me: I have the greatest respect for my medical team and believe they were trying to do their level best for me. They were kind, patient, pleasant, and unyielding.

However, this was one battle I was going to win. I could not choose the time or method of my death, but I could and did choose the circumstances. If we accept that death is a part of life, we must accept that people have the right to die the way they have lived. I had a fixed purpose and there was no possible way to pressure me into agreeing to hospice “down the road.” When he understood this, my oncologist gave in with relatively good grace–he just made sure I knew he was “giving in.”

My days as a nurse practitioner are over. My days as an active member of my nursing organization are over. I am spending the short time I have left with my family and friends. I wish more than any single thing that I could have lived to finish raising my 14-year-old daughter, surely the most special of all the special children to walk this earth. But she will be okay. I wanted more time with my family and friends. But they will be okay. So I want to take this time to thank the people who made me a nurse practitioner: my patients.

Thanks for trusting me with your illness and your health, your children, spouses, and parents. Thanks for telling me that I made a difference in your lives. Thanks for the snapshots of kids growing up strong and straight, healthy and true, partly because I was there. To all of you I hold most dear: Thanks for the memories.

Amy J. Crownover worked in private practice and was a preceptor for family NP students in Tennessee prior to her illness.

Amy J. Crownover +

+ Amy J. Crownover succumbed to her illness on the morning of December 21, 2002, at her home, where she was under hospice care. She leaves behind her husband, George Steven Henry, her daughter, Laura Stephanie Crownover Henry, and her cat, Rainbow

Contributions in Ms. Crownover’s name may be sent to the Honor Society of Nursing Foundation, Sigma Theta Tau, 550 W North St, Indianapolis, IN 46202, and designated to one of the following chapters: Chapter 379 (Omicron Pi) at Belmont University or Chapter 402 (Pi Upsilon) at Tennessee State University Ms. Crownover was a founding member of both chapters.

COPYRIGHT 2003 Clinicians Publishing Group

COPYRIGHT 2003 Gale Group