A Unique Privilege: Social Work in a Cancer Institute – Part One
An interview with Elizabeth Agnello, MSW student
by Pat Shelly
Elizabeth (Lizzie) Agnello is now in her last semester and will receive her M.S.W. degree in May 2014. Before coming to UB, she obtained a M.A. in Japanese Literature, has studied in London, and taught English in Japan. She also speaks Mandarin, Italian and Spanish. Since September, her three-days-and-15-hours-per-week field placement has been at Buffalo’s Roswell Park Cancer Institute (hereafter referred to as “Roswell”), a national leader in cancer care while conducting Phase I cancer research studies.
Lizzie is in the Psychosocial Oncology unit at Roswell, which addresses the social, environmental and emotional impact of cancer. Her internship includes collaboration among social workers, medical oncologists, palliative care physicians, nurses and physical therapists. Her patients range in age from 18 to 85 years old, and with all, Lizzie works to increase the quality of life of these terminal or chronically ill cancer patients. She meets with an average of four patients and families per day to conduct psychosocial assessments and links patients and caregivers with local resources after determining their primary needs and concerns.
This interview was conducted in February 2014.
What was it like when you first started interning at Roswell?
As a comprehensive cancer institute, the hospital and research center which comprise Roswell make for a large setting. I was lost in this huge complex of buildings for the first week, and would ask a different staff member each day to point me in the direction of the Psychosocial Oncology wing, where the social work offices are located. The nature of the work is intense and staff work with great focus and at a fast pace. There is rarely a moment when we are not busy attending to the needs of a patient.
Why did you choose this placement?
I chose this placement for two reasons. I have been working for a local non-profit organization for five years, one which strives to improve the quality of life for critically and chronically ill children, many with cancer. Also, my father passed during my first year in the MSW program from pancreatic cancer, a very deadly cancer for which there is no early detection testing and no cure at present. The day of his diagnosis and many of the days that followed that were the worst moments of my father’s life; it was an extremely trying and uncertain time for our whole family. With little support, we struggled to cope and find any hope or find anyone who was willing to offer hope.
I also wanted to be at Roswell because of a moment that happened during that difficult time:
I was sitting by myself, quite hopeless and lost when I was approached by a medical social worker at the Rochester, NY hospital where my father was being treated. She was incredibly open and gracious with her time. She was also compassionate and wise, which helped me in my lowest moment.
I wanted the chance to develop professionally into that kind of worker for another daughter, or family member coping with a deadly cancer diagnosis. As oncology social workers, we have the unique privilege of meeting and engaging with patients who are receiving cancer therapies, undergoing surgery, receiving care for chronic symptoms from cancer and treatment, and those who are dying.
How has this internship developed your skills?
There is no placement I can imagine that would offer a broader and deeper experience in social work than a medical oncology setting. The waves of emotion that patients and their families endure, and the journey that we are allowed to take with them, is almost unimaginable and it is one that touches upon so many aspects of what we are meant to be doing as social workers. Each patient/family has very unique needs that we must approach delicately and to the best of our ability. I have also had opportunity to focus on family caregivers and loved ones to help them cope and meet other needs they might have.
What was most difficult initially?
It was very challenging in the first weeks to guard against experiences which triggered re-traumatization regarding my father’s death, and so I felt a bit emotionally drained many evenings after working three days a week at my internship. I realized that, in being triggered easily and often without warning, I was exhibiting a form of empathy that worked against me and took away any chance I had of seeing what would truly serve my patients.
I would sit with a dying person who is going through a tremendously difficult experience and then I started to freak out inside. That’s not where we want to go. I found these moments to be particularly noticeable with a patient or family member whose words or circumstances directly recalled my father’s illness trajectory. All I could do in those moments was to listen as actively as possible and stay present.
A feeling of growth came unexpectedly one day when I walked out of a patient’s room and realized I had overcome the hurdle and had completely set my own needs or worries aside.
This was a moment when I began to separate self from other. This enabled me to take myself out of it and thus be totally present for the patient and his family. It was only then that I could see what would truly serve my patients.
How does Roswell incorporate trauma-informed care (TIC) with its patients?
I’ve noticed that Roswell staff in general are very good about considering the TIC question, “what has this person experienced?,” as opposed to “what’s wrong with this person?” Roswell’s psychosocial assessments are a central part of being able to identify trauma histories.
The conversations which begin with patients from this part of the assessment enable us to delve deeper into these histories, which may be making their treatment process feel even more stressful and uncertain than it might otherwise be. Thus we can begin to better help our patients based on what has happened to them prior to the cancer diagnosis and during the course of treatment.
This is the end of Part One of this interview. Look for the publication of Part Two in April 2014.
Do you have any comments or questions? If you have worked with individuals with cancer and their families, do you have any advice for those entering that specialty?
We’ll publish your replies as an addendum to Part Two of A Unique Privilege: Social Work in a Cancer Institute”
I am amazed by the insight provided in this interview. I commend Ms. Agnello on her ability and desire to work with patients and families enduring tremendous trauma, especially with her past experience. I was relieved to read that Ms. Agnello admitted to encountering internal struggles when working with these patients. For myself, I know that working in the field can bring up internal difficulties which we must work through. I also have the experience of a father who was diagnosed with cancer, thankfully he is recovering better than anyone expected. I admire Ms. Agnello on her ability to confront her trauma head-on and give back to others who have similar experiences. I have no doubt that the families and patients working with Ms. Agnello are experiencing less than the utmost respect and care. I am looking forward to part II of this interview!
Confronting trauma head-on – I like that description! Thanks for the comment, Emily.
This interview was quite a joy to read. It seems as though Ms. Agnello has had a great eperience at Roswell, which is actually my first choice for my advanced year placement. Her story is compelling, and I was amazed at how open she was regarding her struggles. A cancer institute undoubtidly brought up an array of emotions for her, but her experience in the field and her education through this program seemed to really help her perceiver as a soial worker. I too had a parent (my mother) diagnosed with cancer, but I have had the fortunate experience that she has fully recovered from it, and this year finally reached her five year remission date. I aspire to be as comfortable and as head strong as Ms. Angello when it comes to facing difficult situations in regards to her past traumatic experiences. This interview touched very close to my heard, and I really thank Ms. Agnello for being so honest about her experience.
I, too, found Lizzie very forthright in sharing her experiences, which makes this interview such a good resource for future/current social work students or anyone who would like to know what working in the area of oncology may entail. Best wishes for your mother’s continued good health, and for your own growth when facing life’s challenges.
Thank you for sharing Lizzie’s experiences and her perspective on increasing the quality of life for her patients. Anyways, I also came across this other article that may further motivate future medical social workers: http://www.gradschools.com/search-programs/social-work-msw/social-worker-salary
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I enjoyed reading this interview very much. As a first year MSW student I am always interested in discussing with others about their field placements and their options for next year. During the field fair Rosewell Park was one of the tables I spent some time at and greatly considered for my second year placement. I commend Ms. Agnello for sharing her experience and her insight on the internal struggles she encountered during her time at Rosewell Park. I, too, have had a number of family members who have/had cancer, and can only imagine how challenging it must have been for Ms. Agnello and I admire her strength. I think it is good for MSW students to read about Ms. Agnello’s experience, because as social workers we will probably all face and have to handle different struggles throughout our careers.
Elizabeth, you have a great perspective. It is great to hear about the work you are doing and have done. Your post is a great example of use of self in social work. It reads that you have found a balance with your use of self and the work with peoples in the hospital. It is tough to be self-aware enough to consciously use self in practice. It takes a level of self-awareness in which we challenge ourselves much in a similar way we would peoples coming to us in practice. Use of self is important as our feelings and experience can be useful to others if used consciously, effectively, with purpose and planning for the benefit of others. Shulman talks a great deal about use of self along with sharing the worker’s feelings. You describe a great process of a personal tuning in before responding or being with a person (Shulman, 2009; Heydt & Sherman, 2005).
What a great way to build engagement and a positive relationship with peoples whom you are working with. You have two key concepts that facilitate this: (a) self-awareness and master of your feelings/experiences/thoughts and (b) an understanding of how the person may see/understand you in this context (Heydt & Sherman, 2005; Shulman, 2009). The formula is one that encompasses trauma informed principles to create a trusting, safe, and mutually respectful space for anyone who is working with you (Harris & Fallot, 2001; Shulman, 2009). What is most striking is the described ability you have at even recognizing your unconscious mannerisms. How we act and are physically with someone does matter. You make effort to pay attention to this aspect of the relationship, which I am sure is helpful for you in your work. I am very glad to read about your work and wish you the best of luck!
Heydt, M. J., & Sherman, N. E. (2005). Conscious Use of Self: Tuning the Instrument of Social
Work Practice with Cultural Competence. Journal of Baccalaureate Social Work, 10 (2), 25-40. Retrieved from http://mcnellie.com/525/readings/heydtsherman.pdf
Harris, M., & Fallot, R. D. (2001). Using Trauma Theory to Design Service Systems. San Francisco, CA: John Wiley & Sons.
Shulman, L. (2009). The skills of helping individuals, families, groups, and communities (7th ed.). Retrieved from http://www.coursesmart.com/9781111521257/firstsection#X2ludGVybmFsX0J2ZGVwRmxhc2hSZWFkZXI/eG1saWQ9OTc4MTExMTUyMTI1Ny9paQ==