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.
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”